Older adults represent a rapidly expanding subgroup of patients with inflammatory bowel disease, yet they remain markedly under-represented in pivotal clinical trials, limiting age-specific estimates of drug benefit and harm. This review synthesises the available evidence on the influence of ageing on the pharmacology, efficacy and safety of orally administered targeted inflammatory bowel disease therapies, focusing on registered Janus kinase inhibitors (tofacitinib, upadacitinib, filgotinib) and sphingosine-1-phosphate receptor modulators (ozanimod, etrasimod). Because the available age-stratified evidence is sparse and heterogeneous, a narrative review methodology was chosen to map the literature and identify knowledge gaps. We pragmatically report age-related findings using the age cut-offs applied in original studies and map outcomes including clinical and endoscopic response/remission, corticosteroid sparing and adverse drug events of special interest (serious/opportunistic infections, cardiovascular and thromboembolic events, malignancies and treatment discontinuation). Across the limited age-stratified datasets, efficacy appears largely maintained in older patients, but the evidence base is heterogeneous and frequently lacks dedicated analyses. Ageing-related physiological changes, comorbidity, frailty and polypharmacy are expected to modulate pharmacokinetic and pharmacodynamic variability and to amplify the clinical relevance of class-specific safety concerns, particularly infections, major adverse cardiovascular events and malignancy signals with Janus kinase inhibition and initiation-related cardiovascular/conduction considerations with sphingosine-1-phosphate modulation. There is, however, no clear consensus on how ageing-related vulnerability, including frailty and comorbidity burden, should be defined, measured, and reported across studies, which complicates the interpretation and comparison of outcomes. In the absence of robust outcome data for older adults with inflammatory bowel disease, treatment selection should be guided by biological vulnerability (frailty, organ function, comorbidity burden) and structured risk-mitigation strategies, while future research should prioritise age- and frailty-enriched prospective studies with geriatric-relevant outcomes and long-term pharmacovigilance.
The effectiveness of first-line nucleot(s)side analogs (NAs) for managing chronic hepatitis B (CHB) depends heavily on treatment adherence; however, evidence on longitudinal adherence patterns is limited, especially in older adults. This study examined longitudinal adherence trajectories of NAs among older adults with CHB. This retrospective cohort study involved continuously enrolled Medicare beneficiaries aged ≥ 65 years with CHB from 2014–2019. Monthly adherence was evaluated using proportion of days covered for incident NAs users, specifically entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF). Longitudinal adherence patterns were analyzed using group-based trajectory modeling (GBTM) over a 12-month follow-up. The variation in adherence trajectories across first-line NAs was examined using a multinomial logistic regression model, adjusted for baseline covariates. The study cohort comprised 3,317 older adults with CHB, with a mean age of 72.6 years, and 57.85
Urinary retention in older women is a clinically significant and often underdiagnosed condition with complex and multifactorial etiology. Age-related changes in bladder contractile function and bladder sensation, combined with common comorbidities such as neurologic disease, diabetic bladder dysfunction, and pelvic organ prolapse, substantially increase the risk of retention in this population. Medications commonly prescribed to older adults, including anticholinergics and antidepressants, are an often overlooked cause of urinary retention. Evaluation includes a thorough history, physical exam, medication reconciliation, and post-void residual volume, especially because symptoms of retention that are common in men are often non-specific in women. Management should be risk stratified, with acute retention requiring prompt bladder drainage and chronic urinary retention requiring assessment of symptom burden and risk of upper tract deterioration. Pharmacologic treatment options, such as alpha-blockers, have limited evidence in women and broader therapeutic options remain poorly studied in older female populations. Sacral neuromodulation can be effective for non-obstructive urinary retention in older women. This review highlights the critical need for sex-specific and age-specific trials to guide evidence-based patient-centered management of urinary retention in older women.
Polypharmacy is a significant health concern associated with adverse outcomes in older adults. To mitigate these risks, Korea’s National Health Insurance Service implemented a hospital-based, pilot polypharmacy management program. We aimed to evaluate the clinical and economic effectiveness of the polypharmacy management program in beneficiaries aged ≥ 65 years. This retrospective cohort study evaluated the polypharmacy management program implemented across 34 hospitals (2020–21). The program targeted hospitalized patients with at least one chronic condition receiving either ten or more medications or five or more medications plus an additional high-risk factor. To address the lack of randomization, an external historical control group was established by linking pilot data with the nationwide National Health Insurance Service claims database. Propensity score matching was performed on the entire cohort with subsequent analyses restricted to those aged ≥ 65 years. The primary outcome was 90-day readmission, analyzed using Cox proportional hazards regression. A cost–benefit analysis was performed from payer and societal perspectives. The final analysis included 1135 intervention and 1125 control patients. Polypharmacy management program participants showed a lower risk of readmission compared with controls (adjusted hazard ratio = 0.85; 95
Polypharmacy is a known risk factor for adverse outcomes during stroke rehabilitation; however, evidence is limited on whether nutritional status modifies this association. This study investigated whether the association between polypharmacy and functional recovery in patients after stroke differed according to body mass index (BMI), an anthropometric indicator related to nutritional status. This retrospective cohort study included patients with stroke admitted to a convalescent rehabilitation ward in Japan between January 2015 and December 2024. Patients with cerebral infarction, intracerebral hemorrhage, or subarachnoid hemorrhage were eligible. Polypharmacy was defined as the prescription of five or more medications at admission. Patients were classified by BMI according to the criteria of the Japan Society for the Study of Obesity: underweight (< 18.5 kg/m2), normal weight (18.5 to < 25.0 kg/m2), and obese (≥ 25.0 kg/m2). The primary outcome was the functional independence measure (FIM)-motor score at discharge, and secondary outcomes were the FIM-cognitive score at discharge and home discharge. Multivariable regression analyses were used to evaluate whether BMI category modified the association between polypharmacy and each outcome. Among 1245 patients (median age, 75 years; 54.3
Population ageing increases multimorbidity, which in turn contributes to polypharmacy, elevating fall risk through drug interactions and adverse effects on cognition or balance. Although polypharmacy is recognised as a risk factor, specific fall-risk-increasing drugs (FRIDs) may pose greater hazards. This study aimed to examine the associations of polypharmacy, diuretic and antipsychotic use with injurious falls among older adults. Data from 952 participants (590 men and 362 women) aged ≥ 65 years in the Geelong Osteoporosis Study were linked with the Victorian Emergency Minimum Dataset. The outcome variable was time to first fall-related emergency presentation or injurious falls, with polypharmacy, diuretics and antipsychotics as exposure variables. The associations were examined using competing risk regression, with results presented as adjusted subdistribution hazard ratios (aSHR) and 95
Bronchiectasis is increasingly recognized as a chronic inflammatory airway disease involving persistent immune dysregulation, recurrent infection, and progressive lung tissue damage. Older adults bear a particularly high burden of bronchiectasis, as age-related changes such as immunosenescence, multimorbidity, and polypharmacy complicate disease management in this population. Anti-inflammatory therapies are emerging as a central component of treatment strategies, reflecting the growing understanding of inflammation as a key driver of disease progression. However, applying these therapies to older populations requires considering altered pharmacokinetics and pharmacodynamics, increased susceptibility to adverse effects, and comorbid conditions. This review examines current and emerging anti-inflammatory treatments for bronchiectasis, focusing on their relevance, safety, and limitations in older patients. Attention is given to the roles of neutrophilic and type 2 inflammatory pathways, as well as the challenges of implementing precision medicine approaches for older people.
Non-cystic fibrosis bronchiectasis is increasingly recognized as a major cause of chronic respiratory morbidity, particularly among older adults. Its rising prevalence is largely attributable to improved diagnostic imaging and heightened clinical awareness, with epidemiological data consistently demonstrating a marked age-related increase in disease burden. Older patients represent the majority of contemporary cases and exhibit a distinct clinical phenotype characterized by multimorbidity, frailty, and worse outcomes. Pathophysiologically, bronchiectasis is driven by a 'vicious vortex’ of airway inflammation, impaired mucociliary clearance, chronic infection, and structural lung damage. In older individuals, this process is amplified by immunosenescence, inflammaging, and age-related structural and functional lung changes, which together promote persistent infection and progressive airway injury. Additional contributors, such as microaspiration, cumulative environmental exposures, and coexisting conditions, including chronic obstructive pulmonary disease and gastroesophageal reflux disease, further exacerbate disease progression. Diagnosis in older adults with bronchiectasis is frequently delayed due to atypical presentations and clinical overlap with other chronic conditions, resulting in more advanced disease at the time of recognition. Microbiologically, older patients show a shift toward more virulent and resistant pathogens, particularly Pseudomonas aeruginosa and Enterobacteriaceae, with important implications for management. Prognosis is poorer in this population, with higher mortality, increased healthcare utilization, and reduced quality of life, largely driven by frailty and comorbidities rather than by disease severity alone. These findings highlight the need for a comprehensive, geriatric-informed approach integrating respiratory care with systematic assessment of functional status, comorbidities, and patient-centered outcomes to optimize management in older patients with bronchiectasis.
In older adults, bipolar disorder (BD) frequently presents atypically, with manic symptoms manifesting as irritability or confusion rather than euphoria. Cognitive impairments, including mild cognitive impairment and dementia, can obscure or mimic bipolar symptoms, complicating accurate diagnosis. Depressive episodes tend to be more frequent and prolonged, increasing misdiagnosis risk as unipolar depression. Pharmacological management requires careful consideration of age-related pharmacokinetic and pharmacodynamic alterations. Mood stabilizers including lithium, valproate, and lamotrigine are commonly employed but necessitate vigilant monitoring for adverse effects and drug interactions. Atypical antipsychotics such as quetiapine and aripiprazole are generally preferred for their tolerability profiles, though comorbidity burden and polypharmacy substantially elevate risks of adverse drug reactions and interactions. Late-onset and early onset bipolar disorder in older adults (LOBD and EOBD) represent clinically relevant subgroups with differing diagnostic considerations. However, current evidence does not clearly support major differences in pharmacologic management. The purpose of this narrative review is to address this gap by comprehensively exploring the clinical presentations and diagnostic challenges in older-age BD (OABD) as well as the pharmacological treatment patterns worldwide. We also outlined clinically focused synthesis of special considerations and tailored approaches, and finally critically appraise the literature to determine future directions and research needs. Addressing the multifaceted diagnostic and pharmacotherapeutic challenges of OABD through dedicated age-specific clinical trials, comparative effectiveness studies, systematic evaluation of deprescribing strategies, and enhanced clinician awareness will be fundamental to improve outcomes for this understudied and expanding population.
Data on age-specific outcomes in patients with atrial fibrillation (AF) treated with edoxaban in real-world settings are limited; this prespecified analysis of the ETAF-TR study aimed to investigate the influence of age on prespecified clinical outcomes, including overt bleeding, major bleeding, ischemic stroke, all-cause mortality, major adverse cardiovascular events (MACE), and net clinical benefit. The ETAF-TR study is a prospective, multicenter, observational registry conducted at 50 cardiology clinics across Türkiye. Patients with AF receiving edoxaban (60 mg standard dose or 30 mg reduced dose) were categorized into three age groups: < 65 years (n = 265), 65–74 years (n = 397), and ≥ 75 years (n = 391). Time-to-event outcomes were analyzed using the Kaplan–Meier method and unadjusted Cox proportional hazards models, with the < 65-year age group as the reference. Of 1053 enrolled patients, 25.1
Gout is the most prevalent inflammatory arthritis worldwide and disproportionately affects older adults, who frequently have comorbid conditions such as chronic kidney disease and cardiovascular disease that lead to polypharmacy and complicate both urate-lowering therapy (ULT) and management of acute flares. Although treat-to-target ULT (lowering and maintaining serum uric acid levels below 6 mg/dL) remains the cornerstone of gout care, a subset of patients fail to achieve serum urate goals owing to intolerance, contraindications, or inadequate response with available agents. This narrative review summarizes current and emerging pharmacologic therapies for gout with a focus on ULT in clinical development and their relevance to aging populations. In addition to ongoing studies of novel xanthine oxidase inhibitors (XOI), the development of highly selective urate transporter 1 (URAT1) inhibitors underscores a renewed interest in uricosuric therapy. Agents such as dotinurad have demonstrated effective urate lowering with favorable renal and hepatic safety profiles in older individuals, including patients with chronic kidney disease, suggesting potential advantages in this higher-risk population. Likewise, novel uricase-based strategies, including immune-tolerizing platforms such as nanoencapsulated sirolimus plus pegadricase (NASP), aim to overcome immunogenicity and treatment burden associated with pegloticase. Novel agents targeting the NLRP3 inflammasome and IL-1β appear to have promise for anti-inflammatory prophylaxis and flare treatment that are integral to effective ULT. Currently, with several next-generation agents in late-phase trials, efforts will be needed to enhance the generalizability of these studies to older patients with comorbidity that are common to real-world gout care.
Propofol is widely used in clinical anesthesia, but its cardiorespiratory depressive effects may limit its safety in older patients. With the growing number of older adults requiring anesthesia, ciprofol has attracted interest because of its higher potency and relatively mild hemodynamic impact. This meta-analysis evaluated the efficacy and safety of ciprofol compared with propofol in older patients undergoing general anesthesia or painless endoscopy. We conducted a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science up to 7 November, 2025, to identify eligible studies. All statistical analyses were performed using RevMan 5.4 and R version 4.5.1. A total of 12 randomized controlled trials involving 2027 older participants were included. For safety outcomes, ciprofol significantly reduced the incidence of hypotension (risk ratio = 0.76, 95
Older adults represent most patients with cancer worldwide, yet they remain substantially underrepresented in randomized clinical trials (RCTs), limiting the evidence available to guide treatment decisions in this growing population. Real-world data (RWD), defined as data routinely collected from clinical practice such as electronic health records, administrative claims, clinical registries, wearable devices, and patient-reported outcomes, offer an opportunity to complement traditional trial evidence. In this narrative review, we aimed to synthesize the potential benefits, limitations, and considerations in leveraging RWD for clinical decision making in geriatric oncology. When analyzed rigorously, RWD can generate real-world evidence (RWE) that reflects the heterogeneity of patients seen in routine care and provides insights into treatment patterns, safety, effectiveness, healthcare utilization, and patient-centered outcomes. In geriatric oncology, these data sources are particularly valuable for capturing multidimensional health profiles that extend beyond chronological age, including comorbidities, functional status, and social determinants of health. RWD can also help characterize healthcare trajectories, identify predictors of treatment tolerance and toxicity, and evaluate outcomes such as quality of life and resource utilization. However, important challenges remain, including issues related to data quality and standardization, confounding and bias inherent to observational analyses, ethical considerations surrounding data sharing, and difficulties integrating RWE into clinical decision making. Advances in artificial intelligence, global data networks, regulatory acceptance of RWE, decentralized clinical trials, and expanded data infrastructure may further enhance the role of RWD in oncology. When used rigorously, RWE can help fill evidence gaps and support more personalized care for older adults with cancer.
Falls are a leading cause of hospitalisation among older adults, with substantial impacts on quality of life and healthcare costs. Fall-risk-increasing drugs represent an important risk factor. This study aimed to evaluate the association between fall-risk-increasing drug use and the risk of fall-related hospitalisation. A nested case-control study was conducted using administrative healthcare data from a sample of Italian community-dwelling older adults. Cases included individuals aged ≥65 years hospitalised for fall-related injuries in 2018, matched 1:1 by sex and age with controls who had no fall-related injuries. Fall-risk-increasing drug exposure was assessed by drug class, duration and recency of use. Adjusted odds ratios (aORs) were estimated using logistic regression, controlling for polypharmacy and comorbidities. Among 16,118 cases and 16,118 controls (68.77
Gabapentinoids, particularly gabapentin and pregabalin, are widely prescribed for neuropathic pain and other chronic conditions, including in populations at risk for cognitive decline. Their long-term cognitive safety and potential association with Alzheimer’s disease and related dementias (ADRD) remain uncertain. We examined whether gabapentinoid use is associated with ADRD risk and assessed between-study heterogeneity and potential study-level modifiers. PubMed, Embase, and the Cochrane Library were searched from inception through November 2025. We included observational studies comparing gabapentinoid users with non-users or non-gabapentinoid comparators and reporting incident ADRD. Risk of bias was assessed using ROBINS-E. A random-effects meta-analysis was performed using odds ratios. Subgroup and meta-regression analyses explored study-level modifiers. Certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). The protocol was registered in PROSPERO (CRD420251240055). Five observational studies (325,245 participants) were included. Gabapentinoid use was associated with modestly higher estimated odds of ADRD (odds ratio, 1.28; 95
BackgroundInappropriate prescribing in Sri Lankan older adults, contributes to adverse drug events, hospital admissions and increased healthcare expenditure. Although international tools exist to assess prescribing appropriateness in older adults, their direct application in Sri Lanka is limited by differences in clinical practices, resource constraints and variability in medicine availability.ObjectiveWe aimed to develop and validate country-specific prescription appropriateness criteria for Sri Lankan older adults, focusing on prevalent diseases.MethodsA literature review was conducted to develop a preliminary list of criteria, which was scrutinised by three internal reviewers. The criteria were then validated using the RAND/UCLA Appropriateness Method (RAM). A multidisciplinary Sri Lankan panel (medical specialists, hospital pharmacists and pharmacy academics) completed three rounds of ratings involving 15, 11 and 7 panellists, respectively.ResultsThe preliminary list contained 38 criteria; all were rated appropriate in round one, with clarity amendments suggested for seven criteria. Two additional criteria were proposed and accepted, producing a final set of 40 criteria. The criteria most frequently addressed medicines used for cardiovascular disease and diabetes mellitus, with additional focus on pain, musculoskeletal and bone health, asthma and neuropsychiatric disorders. Criteria not commonly included in international tools covered gabapentinoid prescribing for pain with renal dose adjustment, corticosteroid-associated glycaemic monitoring with antihyperglycaemic dose adjustment and blood monitoring requirements for methotrexate therapy.ConclusionsThese criteria provide a context-specific framework to support safer prescribing for older adults in Sri Lanka. Their integration into clinical practice and pharmacist-led medication reviews could reduce medication-related problems and improve outcomes.
Older adults represent a growing proportion of dermatology patients, yet their care is complicated by multimorbidity, cognitive vulnerability, polypharmacy, functional decline, and competing health priorities. The Geriatric 5Ms framework (Mind, Mobility, Medications, Multi-Complexity, and Matters Most) offers a structured, patient-centered approach to address these challenges. This review applies the 5Ms to the management of common dermatoses in older adults, highlighting cognitive–regimen mismatch and preservation of autonomy (Mind), fall-risk and physical limitations affecting treatment feasibility (Mobility), polypharmacy and prescribing cascades (Medications), multimorbidity and caregiver context (Multi-Complexity), and alignment of care with patient goals (Matters Most). Integrating the 5Ms into dermatologic practice can enhance safety, preserve function, and align treatment with individual priorities.
Frailty increases the risk of medication-related harm in older adults, emphasising the importance of early detection of drug-related problems during medication reviews. A new frailty screening tool, using electronic pharmacy data on age, sex, preferential reimbursement of medical expenses, number of chronic medications and medication use, offers a practical solution for community pharmacists to identify this risk group. In this study, we aimed to externally validate this tool. For this external validation, data of community-dwelling participants with available frailty status from the HISLink project were used. This database contains data from the national Health Interview Survey 2018, a cross-sectional population survey conducted by Sciensano, linked to health insurance data (i.e. claims data from the Belgian Compulsory Health Insurance, which includes records on reimbursed healthcare utilisation and medication, and level of reimbursement of medical expenses). The Health Interview Survey 2018 database also contains frailty status assessed using SHARE-FI, which was used to evaluate the frailty screening tool’s model performance and predictive accuracy. Logistic recalibration was applied to account for differences in baseline risk and predictor effects, between the development and validation cohorts. A subgroup sensitivity analysis was conducted. Of the 2191 (mean age 74.4 ± 7.2 years, 53.5
Multi-dose dispensing (MDD) is a medication management system in Sweden that pre-packages regularly used prescription medicines into unit doses. Despite widespread use, there are no recent national estimates of MDD prevalence in Sweden, and little is known about how use evolved through the coronavirus disease 2019 (COVID-19) pandemic or which patient groups account for most MDD utilisation. The purpose of this study was to describe the prevalence of multi-dose dispensing in older adults in Sweden from 2014 to 2023, spanning the COVID-19 pandemic, and describe trends by patient subgroups. We conducted a repeated cross-sectional study of older adults aged ≥ 70 years old in Sweden, 2014–2023. We used nationwide data from the Swedish Prescribed Drug Register linked at the individual level with several other administrative and healthcare registers. The primary outcome was annual period prevalence of MDD, stratified by age, sex, education level, living status, civil status, health status and geography. Prevalence of MDD amongst adults aged 70 years or older increased by 1.5 percentage points between 2014 and 2023, reaching 12.1
