Precision oncology can guide treatment selection and treatment omission in older adults, but molecular actionability alone does not establish an acceptable individual benefit–burden balance. This focused narrative review examines tumor biology, host vulnerability, and implementation barriers, prioritizing randomized trials, prospective cohorts, and guidance published during 2019–2025. Clonal hematopoiesis complicates plasma variant interpretation, and genomic risk must be distinguished from prediction of treatment benefit. The GAP70+ and GAIN trials demonstrate that geriatric assessment linked to management reduces serious treatment toxicity in general oncology; their results do not directly validate geriatric integration into molecular tumor boards. Older-adult studies including RESPECT, EORTC 75111-10114, Alliance A171601, and ASTER 70s inform specific biomarker-selected treatment decisions while exposing limitations in evidence for frail patients. Targeted treatment may complement chemotherapy as maintenance, and de-escalation requires indication-specific evidence. Genomic assays in early breast cancer should be requested when the result can change a realistic treatment choice, rather than offered or withheld solely according to age. Existing American Society of Clinical Oncology (ASCO), Food and Drug Administration (FDA), and European Organisation for Research and Treatment of Cancer (EORTC) responses to underrepresentation provide a foundation for more inclusive research. A proposed clinical framework combines validated molecular evidence, geriatric assessment, medication review, and shared decisions, with reassessment of function and goals. Prospective evaluation should establish whether this integration improves treatment delivery, function, quality of life, and goal concordance.
In Japan, polypharmacy has become a major clinical issue as the population continues to age. Although anticholinergic drugs and potentially inappropriate medications (PIMs) have been associated with adverse outcomes, the utility of and differences among medication-related indicators, including the Japanese Anticholinergic Risk Scale, remain unclear. This study aimed to compare the associations between different medication-related indicators and major clinical outcomes. Using a large-scale administrative claims database, we conducted a population-based matched case–control study to evaluate the associations between medication-related indicators, including the number of anticholinergic drugs, total anticholinergic burden, number of potentially inappropriate medications, and total number of medications, and specific clinical outcomes, as well as their associations across predefined categories. The number of anticholinergic drugs and total anticholinergic burden were significantly associated with hip fracture and dementia. In contrast, for constipation and urinary retention, the total number of medications showed associations comparable to those of anticholinergic exposure. Overall, the strengths of the associations for the number of anticholinergic drugs and total anticholinergic burden were broadly similar. Comparisons of the number of anticholinergic drugs, total number of potentially inappropriate medications, and total number of medications revealed stronger associations of anticholinergic drugs and PIMs with hip fracture and dementia, whereas all three indexes showed comparable associations with constipation and urinary retention. These findings suggest that comprehensive exposure assessments that account for disease characteristics and temporal factors are crucial for appropriately evaluating medication-related risks.
Evidence supporting antihypertensive treatment in older adults is derived largely from populations that differ from long-term care residents, in whom frailty, dementia, multimorbidity, polypharmacy, and competing clinical priorities may alter the balance between preventive benefit and treatment burden. The aim was to synthesize randomized evidence on planned antihypertensive deprescribing in institutional long-term care and determine whether clinically and methodologically comparable effects support a common treatment-effect estimate. Randomized or cluster-randomized studies of planned antihypertensive deprescribing in long-term care were systematically reviewed. MEDLINE/PubMed, Embase, CENTRAL, CINAHL Complete, Web of Science Core Collection, trial registries, and PROSPERO were searched from inception and updated to 20 August 2026. Meta-analysis was reserved for outcomes with at least two clinically and methodologically compatible estimates of a common, interpretable effect; otherwise, structured study-level synthesis was used. Result-specific risk of bias was assessed with the revised Cochrane risk-of-bias tool (RoB 2), and certainty with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Three randomized long-term care studies involving 1548 residents were included. Their populations, deprescribing strategies, monitoring, restart criteria, and follow-up differed substantially, and no outcome was considered sufficiently clinically and methodologically comparable for meta-analysis. RETREAT-FRAIL reported an adjusted hazard ratio (HR) for all-cause mortality of 1.02 (95
Cancer pain in older adults presents unique management challenges because of age-related pharmacokinetic and pharmacodynamic changes. Data on age-stratified opioid prescribing within acute palliative care units remain scarce. We aimed to evaluate the influence of age on opioid dosing, drug selection, and breakthrough pain management in patients with advanced cancer admitted to an acute palliative care unit. We conducted a secondary analysis of a prospective observational study conducted over 5 months. Patients were stratified into three cohorts: adults (A, aged <65 years), young-old (O, aged 65–75 years), and old-old (OO, aged >75 years). Opioid doses, expressed as oral morphine equivalents (mg/24 h), drug choice, and route of administration were recorded at admission, at each opioid prescription change, and at discharge. Kruskal–Wallis tests with pairwise post hoc comparisons using Holm correction and Friedman tests were used for between- and within-group analyses, respectively. One-hundred and thirteen patients were analyzed (A: n = 46, O: n = 43, OO: n = 24). No significant differences in oral morphine equivalents were observed at admission (p = 0.177). Significant between-group differences emerged from the first opioid prescription (p = 0.007), persisted at the second prescription (p = 0.026), and were most pronounced at discharge (p < 0.001). Pairwise post hoc comparisons consistently showed higher oral morphine equivalent doses in adults than in both geriatric age groups, whereas no significant differences were observed between the young-old and oldest-old groups. Methadone was used predominantly in adults. At the first breakthrough pain prescription, adults also received significantly higher rescue oral morphine equivalent doses than the two older groups (p < 0.05). Pain intensity significantly improved from admission to discharge in all three age groups, with no significant between-group differences observed either at admission or at discharge. Age was associated with clinically significant differences in opioid prescribing within the acute palliative care unit. Compared with patients aged ≥65 years, adults aged <65 years received higher opioid doses and more complex opioid regimens, whereas prescribing patterns were similar in the two geriatric age groups. Despite age-related differences in opioid prescribing, comparable pain control was achieved across all age groups (see Table 1 and Results), supporting individualized age-tailored opioid titration in specialist palliative care.
Benzodiazepines (BZDs) remain among the most frequently prescribed psychotropic drugs in older adults, despite well-documented risks and guideline recommendations for short-term use. This study analyzed BZD prescribing trends among individuals aged ≥ 65 years in Catalonia, Spain, between 2018 and 2022. A retrospective drug utilization study was conducted using anonymized electronic health records from the SIDIAP (Information System for Research in Primary Care) database, covering approximately 80
