Interventions to Optimize Medication Management in Older Adults: An Umbrella Review of Systematic Reviews.

OBJECTIVE

Medication management in older adults with multimorbidity and polypharmacy is inherently challenging. This umbrella review consolidates evidence on interventions aimed at mitigating these challenges to promote safe and effective medication use.

METHODS

This was an umbrella review. A systematic search was conducted on PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL until 2024 to find relevant systematic reviews of interventions to improve medication management among older adults aged ≥ 60 years (PROSPERO ID: CRD42024607956). Eligible systematic reviews focused on pharmacist-led reviews, deprescribing protocols, educational programs, clinical decision support systems (CDSS), and community-based initiatives. Data were extracted, and methodological quality was evaluated using the AMSTAR-2 tool. Descriptive statistics were applied, and the credibility of the evidence was determined. Outcomes included medication optimization, clinical, healthcare utilization and cost, and acceptability of the intervention among physicians and patients.

RESULTS

Seventy-one systematic reviews with > 1.5 million cumulative participants were included. According to the AMSTAR-2 assessment, the included systematic reviews demonstrated variable methodological quality, with many rated as moderate to high risk of bias. Pharmacist-led reviews and deprescribing interventions both indicated significant improvement in medication appropriateness. Multidisciplinary approaches and CDSS could improve adherence and prescribing practices. Improvements in clinical outcomes, such as quality of life, cognitive function, and mortality, were inconsistent. Economic evaluations showed mixed results. Implementation challenges were identified, including scalability and resource allocation. Evidence was convincing in reducing the number of medications, inappropriate prescribing, and falls.

CONCLUSIONS

Pharmacist-led and multidisciplinary medication reviews showed the most consistent benefits, improving medication appropriateness and reducing falls and unplanned healthcare use. Interventions like education, policy and guideline measures, and community-based strategies demonstrated mixed or modest effects, often limited to adherence or prescribing quality. Overall evidence strength was limited by methodological heterogeneity. Future high-quality, context-specific research with standardized outcomes is needed in this regard.