Elderly patients are the main users of drugs and they difer from younger patients. They are a heterogeneous population that cannot be defned only by age but should rather be stratifed based on their frailty. The elderly have distinctive pharmacokinetic and pharmacodynamic characteristics, are frequently polymorbid, and are therefore treated with multiple drugs.
They may experience adverse reactions that are difcult to recognize, since some of them present non-specifc symptoms easily mistaken for geriatric conditions. Paradoxically, the elderly are underrepresented in clinical trials, especially the frail individuals whose pharmacological response and expected treatment outcome can be diferent from those of non-frail patients. This means that the beneft–risk balance of drugs used in frail elderly patients is frequently unknown.
We present some proposals to overcome the barriers preventing the enrollment of frail elderly patients in clinical trials, and strategies for monitoring their therapy to minimize the risk of adverse reactions. Automated alerts for drug and drug–disease interactions could help appropriate prescribing but should fag only clinically relevant interactions.
Pharmaceutical forms should be designed to allow easy dose adjustment and, together with packaging and labeling, should account for the physical and cognitive limitations of frail elderly patients. Aggregate pharmacovigilance reports should summarize the safety profle in the elderly, but rather than presenting the results by age they should focus on patients’ frailty, perhaps using the number of comorbidities as a proxy when information on frailty is not available