Hospitalisation as an Opportunity to Optimise Quality Use of Medicines in Older Adults: A Systematic Review

BACKGROUND: Hospitalisation represents an opportunity to optimise medication therapy in patients at high risk of medication-related harm. Quality Use of Medicines (QUM) activities are typically incorporated into routine care, yet their impact as part of usual inpatient practice has not been comprehensively synthesised. OBJECTIVE: The aims of this systematic review were to determine the extent to which hospitalisation serves as an opportunity for improving QUM in older adults receiving usual inpatient care, explore barriers and facilitators influencing the implementation and sustainability of QUM activities during hospitalisation, and identify which components of usual care most effectively improve medication appropriateness and safety. METHODS: We conducted a systematic review of observational studies, identified using Medline, Embase, and International Pharmaceutical Abstracts, from January 2010 to May 2025. Eligible studies included older adults (≥ 65 years) admitted to hospital for at least 24 hours, where healthcare professionals delivered QUM-related activities as part of usual care during hospitalisation. Measurable changes in medications between admission and discharge using QUM indicators were reported. Methodological quality was assessed using the Joanna Briggs Institute (JBI) cohort checklist and findings were synthesised narratively. RESULTS: Twenty-one studies met the inclusion criteria. Nineteen were rated as high quality and two as moderate quality. All studies evaluated changes in prescribing, most commonly using explicit tools such as the Beers criteria, Screening Tool to Alert to Right Treatment and guideline-based assessments of therapy. Ten studies showed usual care led to improvements in QUM indicators, including reduction in potentially inappropriate medicines (PIM) in settings with strong multidisciplinary involvement and structured medication reviews. However, 11 studies reported that QUM did not improve, with persistent or increased PIM use and polypharmacy at discharge. Factors contributing to ongoing QUM problems included limited clinician awareness, fragmented communication, inadequate documentation, constrained resources, poor integration of pharmacists, and variable use of QUM tools. CONCLUSION: Hospitalisation represents an important but inconsistently realised opportunity to optimise QUM in older adults. Inappropriate prescribing and polypharmacy frequently persist at discharge, indicating missed opportunities within usual care. System-level strategies embedding structured medication reviews, pharmacist involvement, explicit QUM tools, and robust documentation into routine practice may enhance medication safety.