Interventions to optimize medication management in elderly: An umbrella review of systematic reviews

Abstract Objectives This umbrella review aimed to synthesize evidence on various interventions targeting these issues to inform strategies for optimizing medication use in the elderly population. Methods A search was conducted on PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL until 2024 to find relevant systematic reviews of interventions to improve medication management among elderly aged ≥60 years. Eligible reviews focused on pharmacist-led reviews, deprescribing protocols, educational programs, clinical decision support systems (CDSS), and community-based initiatives. Data were extracted, and the methodological quality was evaluated. The outcomes were: medication-related process, physical and functional, health care utilization and cost, and acceptability of the intervention among physicians and patients. Descriptive statistics was used. The credibility of the evidence was determined. Results Seventy-one systematic reviews with >1.5 million participants were included. Pharmacist-led reviews and deprescribing interventions indicated significant improvement in medication appropriateness. Multidisciplinary approaches and CDSS could improve adherence and prescribing practices. Improvements in clinical outcomes, such as quality of life, cognitive function, and mortality, were inconsistent. Economic evaluations showed mixed results. Implementation challenges were scalability and resource allocation. Evidence was convincing in reducing the number of medications, inappropriate prescribing, and falls. Conclusions Although interventions, such as deprescribing and pharmacist-led reviews can be effective in improving medication outcomes, their impact on broader clinical and economic metrics is variable. There is a need for targeted, context-specific strategies, and rigorous implementation research. Future studies should concentrate on scalable, patient-centered interventions with measurable improvements in clinical and system-level outcomes. Key messages • This umbrella review demonstrated that pharmacist-led reviews and deprescribing interventions could lead to a significant improvement in medication appropriateness in the elderly population. • Multidisciplinary approaches and clinical decision support systems could improve adherence and prescribing practices.