Quality use of medicines and medicine safety is important for the well-being of older people. Older people with multiple chronic conditions have potential to benefit from quality use of medicines but are at high risk of experiencing medicines-related harm if prescribing is suboptimal. Effective medicines management is critical to manage these multiple conditions and symptoms to reduce the risk of acute events, functional decline and premature mortality. Potentially suboptimal prescribing is increasingly considered a risk factor for poor clinical outcomes in older adults with high disease burden and complex medicine regimens.
Suboptimal prescribing can include under-prescribing, over-prescribing and high risk prescribing. Under-prescribing is the absence of an indicated medicines, in the absence of a contra-indication, preventing beneficial clinical effects being realised. Further, there is a risk that an undertreated condition such as pain can manifest in other symptoms. Overprescribing potentially contributes to polypharmacy (five or more regular medicines prescribed concurrently). High risk prescribing, such as prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines (PIMs), usually identified through a consensus list such as the Beers criteria, can also cause harm in older people. Prescribing cascades are a form of suboptimal prescribing where a new medicines is prescribed to manage the side effects of another medicines, for example where an agonist is coadministered alongside an antagonist.
This research topic aims to explore potential strategies to optimise prescribing in older people irrespective of setting. Research is welcomed on interventions that reports outcomes or evaluates implementation of strategies. Additionally, we welcome research that furthers the understanding of issues that contribute to suboptimal prescribing and its effects.
Epidemiology of suboptimal prescribing in older people
Strategies to optimize prescribing in older people
Medication related harm in older people
Effect of medication regimens in older people
Quality use of medicines and medicine safety is important for the well-being of older people. Older people with multiple chronic conditions have potential to benefit from quality use of medicines but are at high risk of experiencing medicines-related harm if prescribing is suboptimal. Effective medicines management is critical to manage these multiple conditions and symptoms to reduce the risk of acute events, functional decline and premature mortality. Potentially suboptimal prescribing is increasingly considered a risk factor for poor clinical outcomes in older adults with high disease burden and complex medicine regimens.
Suboptimal prescribing can include under-prescribing, over-prescribing and high risk prescribing. Under-prescribing is the absence of an indicated medicines, in the absence of a contra-indication, preventing beneficial clinical effects being realised. Further, there is a risk that an undertreated condition such as pain can manifest in other symptoms. Overprescribing potentially contributes to polypharmacy (five or more regular medicines prescribed concurrently). High risk prescribing, such as prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines (PIMs), usually identified through a consensus list such as the Beers criteria, can also cause harm in older people. Prescribing cascades are a form of suboptimal prescribing where a new medicines is prescribed to manage the side effects of another medicines, for example where an agonist is coadministered alongside an antagonist.
This research topic aims to explore potential strategies to optimise prescribing in older people irrespective of setting. Research is welcomed on interventions that reports outcomes or evaluates implementation of strategies. Additionally, we welcome research that furthers the understanding of issues that contribute to suboptimal prescribing and its effects.
Epidemiology of suboptimal prescribing in older people
Strategies to optimize prescribing in older people
Medication related harm in older people
Effect of medication regimens in older people