Clinical Pharmacist Interventions and Management of Potentially Inappropriate Medications in Older Adults: A Narrative Review

Older adults frequently experience multimorbidity and complex medication regimens, increasing the risk of polypharmacy, potentially inappropriate medication (PIM) use, adverse drug reactions, drug–drug interactions, non-adherence and medication-related harm. Clinical pharmacists can contribute to medication optimisation through comprehensive medication review, medication reconciliation, identification of PIMs, assessment of drug–disease interactions, deprescribing recommendations, patient and caregiver education, monitoring and communication with prescribers. This narrative review synthesises recent evidence on the role and effectiveness of clinical pharmacist interventions in reducing PIM use among older adults. The evidence indicates that pharmacist-led and multidisciplinary medication reviews can reduce medication burden, PIM exposure and medication-related problems, although effects on hospitalisation, mortality, falls and quality of life are less consistent. The 2023 American Geriatrics Society Beers Criteria and the third version of STOPP/START provide complementary frameworks for identifying potentially inappropriate prescribing and prescribing omissions, while tools such as the Medication Appropriateness Index and STOPPFrail support patient-centred assessment. Effective interventions generally combine structured medication review with clinical assessment, communication with prescribers, shared decision-making, follow-up and monitoring rather than relying on a medication-count threshold alone. Barriers include limited pharmacist integration, short follow-up, incomplete medication histories, prescriber acceptance and heterogeneity of intervention design. Future studies should use standardised outcomes, longer follow-up and context-specific models that evaluate both prescribing quality and patient-centred outcomes. Clinical pharmacists therefore represent an important component of multidisciplinary strategies for safer and more appropriate medication use in older adults.