Factors Influencing Medication Overuse and Underuse in Older Adults

Maintaining geriatric medication appropriateness is a cornerstone of safe clinical practice for the rapidly aging global population. Recent data from the German National Cohort (NAKO) reveals that nearly 26% of older adults encounter potentially inappropriate medication (PIM). Furthermore, medication underuse and overuse remain strikingly common, affecting 19.1% and 23.6% of participants, respectively. These findings underscore the urgent need for systematic medication reviews to mitigate preventable drug-related harms and optimize therapeutic outcomes.

Clinical Factors Impacting Geriatric Medication Appropriateness

The NAKO study identifies several chronic conditions as strong predictors of inappropriate prescribing. Specifically, Parkinson's disease showed a 16.2-fold increase in the odds of PIM use. Additionally, arterial hypertension and epilepsy significantly raised the risk of inappropriate therapy. Consequently, clinicians should prioritize patients with these complex comorbidities for comprehensive pharmacological assessments. For instance, physicians must regularly evaluate whether the benefits of a prescribed drug still outweigh the risks in the context of changing aging physiology.

Addressing the Global Challenge of Polypharmacy

Besides PIM use, the study highlighted significant gaps in preventive care, such as low vaccination rates for pneumococcal and influenza viruses. This trend is also evident in the Indian healthcare landscape, where polypharmacy rates often exceed 70% in tertiary care settings. Therefore, implementing standardized screening tools like the Fit fOR The Aged (FORTA) or Beers Criteria is essential for every practice. Because multimorbidity often leads to fragmented care, a multidisciplinary approach involving geriatricians and pharmacists is vital for ensuring medication safety. Moreover, identifying people with specific characteristics helps clinicians prioritize those who would benefit the most from intensive medication reviews.

FAQs on Geriatric Medication Management

Which conditions show the strongest link to medication underuse?

According to recent cohort data, osteoporosis, atrial fibrillation, and Parkinson\'s disease are particularly associated with underuse. Therefore, clinicians must ensure that these high-risk patients receive evidence-based treatments to prevent secondary complications like fractures and strokes.

How can physicians improve geriatric medication appropriateness in daily practice?

Regular medication reviews remain the most effective tool for identifying PIMs and overuse. Consequently, physicians should use validated screening lists to prune unnecessary drugs and address untreated conditions during every scheduled follow-up visit.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice or a professional relationship. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Degen M et al. Factors associated with potentially inappropriate medication use, medication underuse and overuse in older adults in the German National Cohort. J Intern Med. 2026 Apr 11. doi: 10.1111/joim.70097. PMID: 41964402.


2. Anand P et al. Characterization of potentially inappropriate medications use in Indian elderly population and their impact on quality of life using Beers criteria. Aging Med (Mainz). 2022;5(1):45-52. doi: 10.1002/agm2.12197.


3. Fathima Sana VM et al. Geriatric Medication Safety in India: A Review of Potentially Inappropriate Medications Using the Beers Criteria. Journal of Pharmaceutical Research International. 2026;38(4):112-120.