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Review
. 2021 Jun;12(3):453-462.
doi: 10.1007/s41999-021-00471-x. Epub 2021 Mar 11.

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

F Lombardi  1 , L Paoletti  2 , B Carrieri  1 , G Dell'Aquila  1 , M Fedecostante  1 , M Di Muzio  2 , A Corsonello  3 , F Lattanzio  4 , A Cherubini  5
Affiliations
Review

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

F Lombardi et al. Eur Geriatr Med. 2021 Jun.

Abstract

Purpose: Under-prescription is defined as the omission of a medication that is indicated for the treatment of a condition or a disease, without any valid reason for not prescribing it. The aim of this review is to provide an updated overview of under-prescription, summarizing the available evidence concerning its prevalence, causes, consequences and potential interventions to reduce it.

Methods: A PubMed search was performed, using the following keywords: under-prescription; under-treatment; prescribing omission; older adults; polypharmacy; cardiovascular drugs; osteoporosis; anticoagulant. The list of articles was evaluated by two authors who selected the most relevant of them. The reference lists of retrieved articles were screened for additional pertinent studies.

Results: Although several pharmacological therapies are safe and effective in older patients, under-prescription remains widespread in the older population, with a prevalence ranging from 22 to 70%. Several drugs are underused, including cardiovascular, oral anticoagulant and anti-osteoporotic drugs. Many factors are associated with under-prescription, e.g. multi-morbidity, polypharmacy, dementia, frailty, risk of adverse drug events, absence of specific clinical trials in older patients and economic factors. Under-prescription is associated with negative consequences, such as higher risk of cardiovascular events, worsening disability, hospitalization and death. The implementation of explicit criteria for under-prescription, the use of the comprehensive geriatric assessment by geriatricians, and the involvement of a clinical pharmacist seem to be promising options to reduce under-prescription.

Conclusion: Under-prescription remains widespread in the older population. Further studies should be performed, to provide a better comprehension of this phenomenon and to confirm the efficacy of corrective interventions.

Keywords: Clinical pharmacist; Comprehensive geriatric assessments; Explicit criteria; Older adult; Polypharmacy; Under-prescription.

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