Utilization of Drug Decision Support Strategies Including Drug Characteristics to Reduce the Risk of Iatrogenesis in Advanced Age

Purpose of Review The goal of this review is to examine currently available risk drug decision support strategies including medication characteristics in reducing the risk of medication-related iatrogenesis in the older adult. Older adults are at a significantly increased risk of medication-related iatrogenesis due to a myriad of factors: polypharmacy, multiple prescribers, pharmacokinetic and pharmacodynamic changes of aging, disease burden, and more. With a still-increasing proportion of Medicaid-aged patients in the US healthcare system, it is imperative to direct limited healthcare resources to have the highest impact on risk reduction. Recent Findings Recent research shows many strategies are available to identify the risk of medication-related iatrogenesis in the older adult, but there is a dearth of literature supporting strategies to reduce risk thereafter. Such strategies include medication class-specific risk scores, tools to identify potentially inappropriate medications, risk stratification tools, prescribing cascade identification, and preemptive pharmacogenomic testing. Summary There is currently not enough literature to achieve consensus on the best strategy to reduce the risk of medication-related iatrogenesis in this population. There are innumerable tools to identify high-risk patients and most are only able to address one or two facets of this complex problem. Risk mitigation studies are extremely heterogenous in their choice of outcomes and method of risk reduction; future research will need to become more standardized and study larger populations of older adults.