Underprescription of medications in older adults: causes, consequences and solutions—a narrative review

Interventions to improve medicines optimisation in frail older patients in secondary and acute care settings: a systematic review of randomised controlled trials and non-randomised studies

“…Schmader et al addressed the impact of medicines optimisation interventions on all aspects of PIP, including underprescribing [ 41 ], with the other two studies focusing on reducing the number of prescribed medications without addressing underuse [ 42 , 43 ]. This is consistent with the findings of the Cochrane review of interventions to improve the appropriate use of polypharmacy in older people in any healthcare setting, which highlighted a dearth of evidence that assesses underprescribing [ 50 ] despite the prevalence of underprescribing among older populations [ 17 , 19 , 20 , 69 ]and its association with negative health outcomes including increased morbidity, disability, healthcare utilisation, costs, and mortality [ 18 ].…”

“…Polypharmacy (the concurrent use of multiple medications) and potentially inappropriate prescribing (PIP) are highly prevalent among frail older patients who are at greater risk of experiencing more severe and frequent drugrelated negative outcomes than robust older adults [10][11][12][13][14]. PIP incorporates 'overprescribing' (the use of drugs without a valid indication), 'misprescribing' (the utilisation of incorrect drug, dose or route of administration) [15,16] and 'underprescribing' (the omission of a potentially beneficial medication clinically indicated for the prevention of disease) [17][18][19][20], and refers to the prescribing of potentially inappropriate medications (PIMs), defined as medications with questionable efficacy that may cause significant risk of adverse drug reactions, excess morbidity and mortality [15,21,22].…”

Mastering the complexity: drug therapy optimization in geriatric patients

“…Cherubini et al address the causes and consequences of underprescription of medications in older adults. They show that despite the fact that polypharmacy is widespread, there are multiple studies illustrating that many older subjects are not treated with drugs appropriate for their disease, a condition known as underprescription [8]. Among the medicines most commonly underprescribed, there are cardiovascular drugs, e.g., ace inhibitors and statins, anticoagulants and anti-osteoporosis drugs.…”

The association between polypharmacy and malnutrition(risk) in older people: A systematic review

“…Patients are exposed to treatment harms, and waste of resources is inevitable on a grand scale [47]. Undertreatment is associated with negative clinical outcomes, such as higher risk of cardiovascular events, worsening disability, hospitalization and death [48]. A crosssectional study based on 3807 Clinical Medication Reviews (CMR) in older patients with polypharmacy demonstrated that overtreatment (25.5%) and undertreatment (15.9%) were the most common drug related problems [46].…”