Medication Management in Older Adults
Medication management in older adults is the geriatric-medicine area concerned with how drugs behave, accumulate, interact, and are reviewed in ageing patients. Older people often live with multiple chronic conditions and take many medicines at once, while age-related changes in the body alter how those drugs are handled and tolerated. The area brings together the pharmacology of ageing, the problems of polypharmacy and drug interactions, the recognition of potentially inappropriate prescribing, and the structured withdrawal of unneeded drugs known as deprescribing.
Definition
Medication management in older adults is the body of geriatric pharmacology and prescribing science addressing how ageing alters drug handling and response, how multiple-medication use creates interaction and adverse-event risk, and how prescribing quality is assessed and optimised across the life course of older patients.
Scope
This area orients four topics: age-related pharmacokinetic changes, polypharmacy and drug interactions, potentially inappropriate prescribing, and medication deprescribing. It frames how physiological ageing and high medication burden together raise the risk of adverse drug events, and how explicit criteria and review processes have been developed to make prescribing safer. It is a conceptual and reference overview of the field, not a protocol for managing any individual patient.
Sub-topics
Core questions
- How does ageing change the way drugs are absorbed, distributed, metabolised, and eliminated?
- Why does taking many medicines at once increase the risk of harm in older people?
- How can clinicians and researchers identify medicines that are potentially inappropriate for older adults?
- When and how can medicines be safely reviewed and withdrawn?
Key concepts
- Pharmacokinetics and pharmacodynamics of ageing
- Polypharmacy and medication burden
- Drug-drug and drug-disease interactions
- Adverse drug events and reactions
- Potentially inappropriate medications
- Explicit and implicit prescribing criteria
- Deprescribing
- Prescribing cascade
- Multimorbidity
Mechanisms
Ageing reduces renal and hepatic clearance, changes body composition, and alters target-organ sensitivity, so that a dose well tolerated in younger adults may produce higher exposure or stronger effect in older patients (Mangoni & Jackson, 2003). When several medicines are combined, the chance of drug-drug and drug-disease interactions rises, and adverse drug events become more frequent as the number of medicines grows (Maher, Hanlon, & Hajjar, 2013). Because definitions of polypharmacy vary, the field also works to standardise how medication burden is described (Masnoon et al., 2017). Prescribing-quality tools and deprescribing processes are the responses developed to detect inappropriate medicines and to withdraw them in a structured way (O'Mahony et al., 2014; Scott et al., 2015).
Clinical relevance
Older adults experience a disproportionate share of medication-related harm, and understanding the area helps explain why drug safety is a central concern of geriatric care. This entry describes the concepts and evidence behind safer prescribing for ageing populations; it is educational background on how the field reasons about medication risk and is not guidance for prescribing, adjusting, or stopping any specific medicine.
Epidemiology
Multimorbidity and the resulting use of several concurrent medicines are common in later life, and the prevalence of polypharmacy rises with age and number of chronic conditions; the lack of a single agreed threshold complicates comparison across studies (Masnoon et al., 2017). Polypharmacy is consistently associated with adverse drug events, falls, hospitalisation, and other harms in older populations (Maher, Hanlon, & Hajjar, 2013).
History
Concern with prescribing for older people grew through the late twentieth century as life expectancy and chronic-disease prevalence increased. Work on the pharmacology of ageing clarified why standard doses can behave differently in older bodies (Mangoni & Jackson, 2003), while the recognition of polypharmacy as a measurable risk factor (Maher, Hanlon, & Hajjar, 2013) motivated explicit prescribing-quality criteria such as STOPP/START (O'Mahony et al., 2014). More recently, deprescribing emerged as an organised counterpart to prescribing, framing medication withdrawal as a deliberate, evidence-informed process (Scott et al., 2015).
Key figures
- Arduino Mangoni
- Joseph Hanlon
- Denis O'Mahony
- Ian Scott
- Sarah Hilmer
- Emily Reeve
Related topics
Seminal works
- mangoni-2003
- maher-2013
- omahony-2014
- scott-2015
Frequently asked questions
- Why do older adults need a distinct approach to medication?
- Ageing changes how drugs are handled and how organs respond, and older people often take many medicines at once; together these factors raise the risk of adverse effects and interactions compared with younger adults.
- What does this area cover?
- It orients four topics: how ageing alters pharmacokinetics, the risks of polypharmacy and drug interactions, how potentially inappropriate prescribing is identified, and the structured withdrawal of unnecessary medicines (deprescribing).