Geriatricians have long been aware of the risks of harm with polypharmacy, and of the potential benefits of deprescribing. Emerging understanding of the physiological changes of ageing and frailty can help us understand and predict pharmacological changes in old age. Pharmacokinetics and pharmacodynamics in older patients are affected by ageing physiology, chronic conditions that increase with age and the medications used to manage these. Bringing together innovations in geriatric medicine, clinical pharmacology and biogerontology can inform optimal use of medicines in older patients.
Key controversies in geriatric pharmacology arise because of the lack of direct data in old age in all stages of drug development, regulation and use. Controversies range from ‘What is an appropriate translatable pre-clinical model for geriatric medicine patients?, to ‘How can clinical trials provide relevant data for geriatric medicine patients’; ‘What is the ideal framework for drug regulation to meet the needs of frail older people?’; and ‘How can we practice informed shared decision making on prescribing and deprescribing during comprehensive geriatric assessment?’. This talk will discuss some of the current challenges and emerging transdisciplinary strategies to address them.