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

Aim To provide an updated overview of studies on under-prescription in older subjects, describing its prevalence, causes, consequences as well as potential interventions to reduce it. Findings Under-prescription is common in older patients and associated with negative clinical outcomes, such as higher risk of cardiovascular events, worsening disability, hospitalization and death. Promising interventions to correct it include the implementation of explicit under-prescription criteria, the use of comprehensive geriatric assessment by geriatricians, and the involvement of a clinical pharmacist. Message Further studies should be performed to provide a better understanding of under-prescription and to confirm the efficacy of corrective interventions. 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. 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. 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. 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.