Geriatric
pharmacotherapy represents one of the biggest achievements of modern medical interventions. However, geriatric
pharmacotherapy is a complex process that encompasses not only
drug prescribing but also age-appropriate
drug development and manufacturing, appropriate
drug testing in clinical trials, rational and safe prescribing, reliable administration and assessment of
drug effects, including adherence measurement and age-appropriate outcomes monitoring. During this complex process, errors can occur at any stage, and intervention strategies to improve geriatric
pharmacotherapy are targeted at improving the regulatory processes of
drug testing, reducing
inappropriate prescribing, preventing beneficial
drug underuse and use of potentially harmful drugs, and preventing adverse drug interactions. The aim of this review is to provide an update on selected recent developments in geriatric
pharmacotherapy, including age discrimination in
drug trials, a new healthcare professional qualification and shared competence in geriatric
drug therapy, the usefulness of information and communication technologies, and pharmacogenetics. We also review optimizing strategies aimed at medication adherence focusing on complex elderly patients. Among the current information technologies, there is sufficient evidence that computerized decision-making support systems are modestly but significantly effective in reducing
inappropriate prescribing and
adverse drug events across healthcare settings. The majority of interventions target physicians, for whom the scientific concept of appropriate prescribing and the acceptability of the alert system used play crucial roles in the intervention's success. For prescribing optimization, results of educational intervention strategies were inconsistent. The more promising strategies involved pharmacists or multidisciplinary teams including geriatric medicine services. However, methodological weaknesses including population and intervention heterogeneity do not allow for comprehensive meta-analyses to determine the clinical value of individual approaches. In relation to drug adherence, a recent meta-analysis of 33 randomized clinical trials in older patients found behavioural interventions had significant effects, and these interventions were more effective than educational interventions. For patients with multiple conditions and
polypharmacy, successful interventions included structured medication review, medication regimen simplification, administration
aids and medication reminders, but no firm conclusion in favour of any particular intervention could be made. Interventions to optimize geriatric
pharmacotherapy focused most commonly on pharmacological outcomes (
drug appropriateness,
adverse drug events, adherence), providing only limited information about clinical outcomes in terms of health status, morbidity, functionality and overall healthcare costs. Little attention was given to psychosocial and behavioural aspects of
pharmacotherapy. There is sufficient potential for improvements in geriatric
pharmacotherapy in terms of
drug safety and effectiveness. However, just as we require evidence-based, age-specific, pharmacological information for efficient clinical decision making, we need solid evidence for strategies that consistently improve the quality of pharmacological treatments at the health system level to shape 'age-attuned' health and
drug policy.