Mastering the complexity: drug therapy optimization in geriatric patients.

The management of pharmacological therapy in older patients is challenging in clinical practice. Older subjects experience age-related changes that influence pharmacokinetics and pharmacodynamics of drugs, they also usually have multiple diseases, i.e., multimorbidity, and are often cared for, and hence, prescribed by a number of physicians over a long period of time. Therefore, it is not surprising that polypharmacy, literally the use of multiple drugs, is extremely common in older patients and is increasing over time, at least in developed countries. Appropriate geriatric pharmacotherapy, global assessment of patients’ clinical and functional parameters, and integration of skills from different healthcare professionals are needed to address the medical complexity of older adults. In this special issue, the most relevant aspects of geriatric pharmacotherapy are presented and critically discussed. The optimal management of drugs in older patients is a corner stone of the practice of geriatric medicine and one of the most important contributions to the evolution of health care in the direction of adapting contemporary clinical practice to the specific needs of older patients. However, while the tasks are clear, i.e., tailoring drug therapy according to the personal preferences and characteristics, increase patient safety by reducing adverse drug reactions, achieve the most favorable risk benefit ratio for each patient, periodically reviewing pharmacological therapy including deprescribing, as appropriate, the implementation in practice is often difficult, particularly when health care professionals are not geriatricians or clinical pharmacists.