A Narrative Review of Medication Optimisation in Older Adults with Polypharmacy: From Structured Medication Review to AI-Enabled Medication Safety.
5 affiliations
- 1Department for Research Support and Technology Transfer, University of Mons (UMONS), 7000 Mons, Belgium.
- 2Department of Geriatrics, Medical University of Bialystok, Kilinski Str.1, 15-089 Bialystok, Poland.
- 3Unit of Therapeutic Chemistry and Pharmacognosy, Faculty of Medicine, Pharmacy and Biomedical Sciences, University of Mons (UMONS), 7000 Mons, Belgium.
- 4Department of Engineering Innovation Management, Faculty of Engineering, University of Mons, 7000 Mons, Belgium.
- 5Unit of Clinical Pharmacy, Faculty of Medicine, Pharmacy and Biomedical Sciences, University of Mons (UMONS), 7000 Mons, Belgium.
Abstract
Context
Polypharmacy, commonly defined as the concurrent use of five or more medicines, and excessive polypharmacy, often defined as the use of ten or more medicines, are highly prevalent among older adults with multimorbidity. Although appropriate polypharmacy may be necessary, polypharmacy can be associated with adverse drug reactions, drug-drug interactions, falls, hospitalisation, cognitive impairment, non-adherence, treatment burden and (preventable) harm during transitions of care.Methods
This narrative review examines medication optimisation in older adults, tracing its evolution from structured medication review, pharmacist-led interventions, explicit prescribing and deprescribing criteria to digital decision support, artificial intelligence (AI)-enabled pharmacovigilance and personalised medication-risk management. European implementation perspectives, with Belgium and Poland as illustrative examples, are used to examine how professional roles, reimbursement mechanisms, clinical tools and health-data infrastructure shape medication safety.Results
This review integrates geriatric medication optimisation, European implementation experience and AI-enabled pharmacovigilance within a framework linking risk detection, clinical interpretation and treatment optimisation. Current evidence is more consistent for improvements in prescribing quality and medication-related problems than for hard clinical outcomes such as mortality, falls or hospitalisation. AI-supported approaches may improve risk detection and prioritisation, but their clinical value depends on data quality, interoperability, explainability, external validation, human oversight and prospective evidence of patient benefit.Conclusions
Future geriatric medication safety should combine comprehensive geriatric assessment, explicit clinical criteria, patient-centred deprescribing, pharmacist-led multidisciplinary review, interoperable health data and accountable AI-enabled decision support.
Related
- Structured medication reviews for adults with multimorbidity and polypharmacy in primary care: a systematic review
- Structured medication reviews for polypharmacy: evidence and implementation across Europe
- The Effect of Medication Self-Management During Hospitalisation (SelfMED) on Medication Adherence Post-Discharge in Oncology Patients with Polypharmacy: A Prospective, Exploratory, Single-Centre, Non-Randomised Pre-Post Intervention Study with Sequential Control and Intervention Cohorts.
- Telemedicine-Enabled Medication Optimization for Adults with Polypharmacy: A Systematic Review and Implications for Saudi Vision 2030 Healthcare Transformation.
- Inverse care law in polypharmacy and medication review among older adults: a population-based study
BibTeX
@article{aro2026narrative,
title = {{A Narrative Review of Medication Optimisation in Older Adults with Polypharmacy: From Structured Medication Review to AI-Enabled Medication Safety.}},
author = {Rania Aro and Zyta Beata Wojszel and Pierre Duez and Fabian Lecron and Stéphanie Patris},
journal = {Healthcare (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/healthcare14193240},
url = {https://europepmc.org/article/MED/42881678},
note = {CC BY},
}
RIS
TY - JOUR
TI - A Narrative Review of Medication Optimisation in Older Adults with Polypharmacy: From Structured Medication Review to AI-Enabled Medication Safety.
AU - Rania Aro
AU - Zyta Beata Wojszel
AU - Pierre Duez
AU - Fabian Lecron
AU - Stéphanie Patris
PY - 2026
DA - 2026/10/01
JO - Healthcare (Basel, Switzerland)
DO - 10.3390/healthcare14193240
UR - https://europepmc.org/article/MED/42881678
AB - Context Polypharmacy, commonly defined as the concurrent use of five or more medicines, and excessive polypharmacy, often defined as the use of ten or more medicines, are highly prevalent among older adults with multimorbidity. Although appropriate polypharmacy may be necessary, polypharmacy can be associated with adverse drug reactions, drug-drug interactions, falls, hospitalisation, cognitive impairment, non-adherence, treatment burden and (preventable) harm during transitions of care.Methods This narrative review examines medication optimisation in older adults, tracing its evolution from structured medication review, pharmacist-led interventions, explicit prescribing and deprescribing criteria to digital decision support, artificial intelligence (AI)-enabled pharmacovigilance and personalised medication-risk management. European implementation perspectives, with Belgium and Poland as illustrative examples, are used to examine how professional roles, reimbursement mechanisms, clinical tools and health-data infrastructure shape medication safety.Results This review integrates geriatric medication optimisation, European implementation experience and AI-enabled pharmacovigilance within a framework linking risk detection, clinical interpretation and treatment optimisation. Current evidence is more consistent for improvements in prescribing quality and medication-related problems than for hard clinical outcomes such as mortality, falls or hospitalisation. AI-supported approaches may improve risk detection and prioritisation, but their clinical value depends on data quality, interoperability, explainability, external validation, human oversight and prospective evidence of patient benefit.Conclusions Future geriatric medication safety should combine comprehensive geriatric assessment, explicit clinical criteria, patient-centred deprescribing, pharmacist-led multidisciplinary review, interoperable health data and accountable AI-enabled decision support.
SN - 2227-9032
ER -