Patient-Centricity: A Much-Needed Strategy to Enhance the Quality Use of Medicines in Older Patients

The older patient population represents the largest and ever-increasing medication consumer group worldwide. The number of medications concomitantly used by older patients in the community is also high, with studies reporting a nearly fivefold
increase in the prevalence of polypharmacy (≥5 concomitant medications) over the last 20-30 years [1]. Concerningly, however, older patients are rarely included in clinical trials. When they are, the generalizability of the results of these studies is significantly curtailed as the typically stringent inclusion and exclusion criteria of trials allow the participation of a nonrepresentative subgroup of healthier subjects, with minimal co-morbidity, polypharmacy, and frailty burden [2]. Therefore,
professional guidelines tend to extrapolate the evidence regarding the efficacy and safety of medications from trials conducted
in younger patients to routine geriatric care. This approach is sub-optimal and potentially dangerous as several commonly prescribed drugs and drug classes have been shown to exert acute and chronic detrimental effects in the older patient population
[3-7]. Furthermore, the combination of high, often off-label medication use, and the significant pharmacokinetic and pharmacodynamic alterations associated with advancing age inevitably increases the risk of clinically relevant drug-drug and drugdisease interactions [8-11]. As a result of the toxicity associated with the use of these medications, and overall inappropriate
polypharmacy, there is an intense research focus on investigating the benefits of targeted and untargeted deprescribing interventions in older age [12-14].