- Section 1 Ageing population and policy
- Section 2 Key concepts in care of older adults
- Chapter 14 A life course approach for understanding later life sustainability
- Chapter 15 Ageing, multimorbidity, and daily functioning
- Chapter 16 Comprehensive geriatric assessment: evidence
- Chapter 17 Comprehensive geriatric assessment
- Chapter 18 Engaging older patients in their treatment and care
- Chapter 19 Models of healthcare for older people
- Chapter 20 History taking and physical examination
- Chapter 21 Communication
- Chapter 22 Interprofessional team building and case management
- Chapter 23 Age-friendly environments and their role in supporting Healthy Ageing
- Chapter 24 Principles of medication management
- Chapter 25 Optimizing pharmacotherapy for older patients
- Chapter 26 Limitations in the evidence for safe and effective medications for older people
- Chapter 27 General principles of recovery and rehabilitation
- Chapter 28 The approach of dying and death, and the mourning process of the survivors
- Chapter 29 Legal and ethical issues in care of older adults
- Section 3 Principles and organization of care
- Section 4 Age-related biological changes, altered physiology, and vulnerability to diseases and chronic conditions
- Section 5 Geriatric syndromes in clinical practice
- Section 6 Nutrition and metabolism
- Section 7 Mobility disorders: prevention, impact, and compensation
- Section 8 Infections in older adults: epidemiology, pathophysiology, diagnosis, and management
- Section 9 Cancer: epidemiology, pathophysiology, diagnosis, and management
- Section 10 Vascular diseases: epidemiology, pathophysiology, diagnosis, and management
- Section 11 Neurological disorders: epidemiology, pathophysiology, diagnosis, and management
- Section 12 Cognitive decline and dementia in older adults: epidemiology, pathophysiology, diagnosis, and management
- Section 13 Mental health of older adults
- Section 14 Management of common medical conditions: epidemiology, pathophysiology, diagnosis, and management
- Section 15 Palliative medicine and end-of-life care
- Section 16 Healthy ageing
(p. 189) Limitations in the evidence for safe and effective medications for older people
- Chapter:
- (p. 189) Limitations in the evidence for safe and effective medications for older people
- Author(s):
Antonio Cherubini
and Graziano Onder
- DOI:
- 10.1093/med/9780198701590.003.0026
In the last decades, evidence-based medicine has emerged as the approach to promote the best clinical practice for health problems. It collates the best published evidence, preferentially based on randomized clinical trials, to guide clinical practice. However, the growing older population challenges the evidence underpinning ‘best practice’. Many older patients are characterized by multimorbidity and polypharmacotherapy, present various degrees of functional and cognitive impairment, and are at risk of developing geriatric syndromes. For these reasons they have been almost systematically excluded from clinical trials. In addition, the results of clinical trials are difficult to apply to patients with these characteristics, given the high risk of drug–drug and drug–disease interactions. An effort to promote a greater involvement of older patients in clinical research is needed, using specific measures to facilitate the participation of complex older patients, who are representative of those treated in clinical practice.
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- Section 1 Ageing population and policy
- Section 2 Key concepts in care of older adults
- Chapter 14 A life course approach for understanding later life sustainability
- Chapter 15 Ageing, multimorbidity, and daily functioning
- Chapter 16 Comprehensive geriatric assessment: evidence
- Chapter 17 Comprehensive geriatric assessment
- Chapter 18 Engaging older patients in their treatment and care
- Chapter 19 Models of healthcare for older people
- Chapter 20 History taking and physical examination
- Chapter 21 Communication
- Chapter 22 Interprofessional team building and case management
- Chapter 23 Age-friendly environments and their role in supporting Healthy Ageing
- Chapter 24 Principles of medication management
- Chapter 25 Optimizing pharmacotherapy for older patients
- Chapter 26 Limitations in the evidence for safe and effective medications for older people
- Chapter 27 General principles of recovery and rehabilitation
- Chapter 28 The approach of dying and death, and the mourning process of the survivors
- Chapter 29 Legal and ethical issues in care of older adults
- Section 3 Principles and organization of care
- Section 4 Age-related biological changes, altered physiology, and vulnerability to diseases and chronic conditions
- Section 5 Geriatric syndromes in clinical practice
- Section 6 Nutrition and metabolism
- Section 7 Mobility disorders: prevention, impact, and compensation
- Section 8 Infections in older adults: epidemiology, pathophysiology, diagnosis, and management
- Section 9 Cancer: epidemiology, pathophysiology, diagnosis, and management
- Section 10 Vascular diseases: epidemiology, pathophysiology, diagnosis, and management
- Section 11 Neurological disorders: epidemiology, pathophysiology, diagnosis, and management
- Section 12 Cognitive decline and dementia in older adults: epidemiology, pathophysiology, diagnosis, and management
- Section 13 Mental health of older adults
- Section 14 Management of common medical conditions: epidemiology, pathophysiology, diagnosis, and management
- Section 15 Palliative medicine and end-of-life care
- Section 16 Healthy ageing