Team-Based Medication Reviews Could Slash Risky Prescriptions for Hospitalized Older Adults

For millions of older adults, a stay in a tertiary care hospital can be a double-edged sword. The very medications meant to heal them can, when poorly managed, become a source of harm. Now, a comprehensive scoping review published in BMC Geriatrics suggests that a team-based approach to reviewing prescriptions could dramatically reduce the number of potentially inappropriate medications given to hospitalized older adults.

The review, led by Aravinda Kumar Balan of the Pondicherry Institute of Medical Sciences and colleagues from institutions across India, including the Indian Council of Medical Research, analyzed 38 studies conducted in diverse healthcare settings. The researchers set out to map how collaborative medication review programs operate in tertiary care hospitals and what outcomes they achieve for older adult patients. Their findings, published on 14 October 2026, offer a technical roadmap for hospitals hoping to optimize medication use in an aging population.

The problem the review addresses is both technical and deeply human. As people age, they tend to accumulate chronic conditions—diabetes, hypertension, heart failure, arthritis—each managed with its own set of drugs. This phenomenon, known as multimorbidity, often leads to polypharmacy, the concurrent use of multiple medications. While polypharmacy is sometimes clinically necessary, it raises the risk of potentially inappropriate medications: drugs whose risks outweigh their benefits for a particular patient, or which interact dangerously with other prescriptions. In hospitals, where medications are frequently added, adjusted, or discontinued, the risk of inappropriate prescribing climbs even higher.

The scoping review followed the Joanna Briggs Institute methodology and adhered to the PRISMA-ScR reporting guidelines, ensuring a rigorous and transparent synthesis of the available evidence. The researchers performed a comprehensive search across multiple databases, identifying relevant studies published between 2010 and 2024. They extracted data on team composition, review processes, assessment tools, and outcomes, then synthesized the findings narratively.

What emerged from the analysis was a consistent technical pattern. Successful collaborative medication review programs typically involved an interdisciplinary team of pharmacists, physicians, nurses, and other specialists working together. Rather than relying on a single clinician to spot inappropriate prescriptions, these programs distributed the task across multiple professional perspectives. Pharmacists, with their deep knowledge of drug interactions and pharmacokinetics, could flag medications that physicians might overlook. Nurses, who observe patients closely during hospitalization, could identify adverse drug events or functional decline that might signal a problematic prescription. This distributed model of medication oversight proved far more effective than solo review.

The review also identified standardized protocols as a key component of successful programs. Medication reconciliation—the technical process of verifying that a patient’s medication list is accurate and complete at transitions of care—formed a foundational step. Geriatric assessments, which evaluate older adults’ functional status, cognition, and overall health, helped teams tailor medication decisions to each patient’s specific circumstances. Deprescribing interventions, the systematic process of tapering or stopping medications whose harms exceed their benefits, rounded out the review process. Together, these standardized components created a repeatable technical framework that hospitals could implement consistently.

Validated assessment tools played a central role in determining medication appropriateness. The STOPP/START criteria—Screening Tool of Older Persons’ Prescriptions and Screening Tool to Alert to Right Treatment—provided a structured checklist of prescriptions to avoid and treatments to ensure older adults receive. The Medication Appropriateness Index offered a complementary approach, rating each medication on dimensions such as indication, effectiveness, dosage, and interactions. These clinical decision support tools transformed medication review from a subjective judgment call into a standardized, evidence-based evaluation.

The outcomes reported across the 38 studies were significant. Collaborative medication review interventions demonstrated meaningful reductions in potentially inappropriate medications, adverse drug events, and healthcare utilization. Patients also experienced improvements in quality of life and satisfaction with their care. These findings suggest that when hospitals invest in structured, team-based medication oversight, the benefits extend beyond prescription lists to measurable improvements in patient wellbeing and system efficiency.

The review’s authors conclude that collaborative, interdisciplinary medication review programs are effective in optimizing medication use and improving outcomes for hospitalized older adult patients. However, they caution that successful implementation requires dedicated resources, standardized processes, and strong organizational support. Further research is needed to explore the scalability and long-term sustainability of these interventions across diverse healthcare settings, particularly in India, where the older adult population is growing rapidly due to improved healthcare, advances in medical technology, and enhanced living conditions. As life expectancy increases and multimorbidity becomes more prevalent, the findings offer a timely technical blueprint for tertiary care hospitals worldwide seeking to make medication use safer for their oldest patients.

The demographic backdrop against which this review was conducted helps explain its urgency. India’s older adult population has been expanding steadily, a shift driven by better access to healthcare, progress in medical technology, and improved living conditions that together extend life expectancy. Longer lives, however, bring a longer cumulative exposure to chronic disease and to the prescriptions used to manage it. An older adult admitted to a tertiary care hospital may arrive with a medication regimen assembled over years by multiple prescribers, often with little coordination among them, and the hospital admission itself becomes another point at which the list can grow more complex rather than less.

Hospital transitions deserve particular attention because they are recognized weak points in medication safety. When a patient moves between home, emergency care, inpatient wards, and discharge, the medication list is repeatedly rewritten, and each rewrite creates an opportunity for omission, duplication, or dosing error. This is why medication reconciliation appeared so consistently in the successful programs the review identified. By verifying the accuracy and completeness of the medication list at each transition, teams establish a reliable baseline before any decisions about deprescribing or substitution are made. Without that foundation, even well-intentioned review efforts can be built on incomplete information.

The emphasis on validated tools in the reviewed studies reflects a broader movement in geriatric pharmacotherapy toward explicit, criteria-based assessment. Implicit judgment by an individual clinician, while valuable, varies widely between reviewers and across institutions. Structured instruments reduce that variability by encoding expert consensus about which drug classes carry elevated risk in older adults, which combinations are problematic, and which commonly omitted treatments should be initiated. The review’s finding that STOPP/START criteria and the Medication Appropriateness Index were the dominant instruments suggests a degree of international convergence on how medication appropriateness should be operationalized, even as the studies themselves came from varied healthcare systems.

Deprescribing, one of the three core process components highlighted by the review, is often the most delicate step in practice. Stopping a medication is not simply the reverse of starting one. Some drugs require gradual tapering to avoid withdrawal effects, others may have been prescribed long ago for an indication that has since resolved, and patients and families can be reluctant to abandon familiar treatments. The review’s inclusion of deprescribing interventions within standardized protocols signals that successful programs treat discontinuation as a planned, monitored clinical activity rather than an incidental byproduct of review.

The interdisciplinary composition of effective teams also carries practical implications for workforce planning. Embedding clinical pharmacists in ward-based teams, enabling nurses to contribute observations from bedside care, and giving physicians final decision-making authority requires institutional structures that many hospitals do not yet have. The authors’ caution that implementation demands dedicated resources and strong organizational support is not a formality; it reflects the reality that collaborative review competes for limited staff time and depends on leadership commitment to sustain. Hospitals in resource-constrained settings may need adapted models that preserve the collaborative principle while fitting available personnel.

The review’s connection to India’s national research infrastructure is noteworthy. The work was carried out as part of a study funded by the Indian Council of Medical Research through its National Task Force on the Safe and Rational Use of Medicines, with coordination and technical advisory support from that body. This institutional anchoring suggests the findings are intended to inform policy and practice within India’s tertiary care network rather than remain an academic exercise, and the authors’ call for research on scalability and long-term sustainability across diverse Indian healthcare settings points toward implementation studies as the logical next step.

Methodologically, a scoping review occupies a specific niche in the evidence hierarchy. Rather than pooling effect estimates statistically, it maps the breadth of existing literature, characterizing how interventions are structured, what tools are used, and what outcomes have been reported. That approach is well suited to a field like collaborative medication review, where program designs vary considerably and a single pooled estimate would obscure important differences in team composition, setting, and process. The trade-off is that the review can describe patterns of effectiveness but cannot precisely quantify them, which the authors acknowledge in directing future research toward rigorous evaluation of these models.

For clinicians and hospital administrators, the practical takeaway is that medication safety in older inpatients is a systems problem, not an individual failing. The evidence assembled here indicates that reductions in potentially inappropriate medications, fewer adverse drug events, lower healthcare utilization, and better patient-reported outcomes are achievable when review is collaborative, protocol-driven, and supported by validated criteria. As populations age worldwide, the challenge for tertiary care hospitals will be translating that blueprint into routine practice, adapting team structures and tools to local constraints while preserving the core elements that made the reviewed programs succeed.

Subject of Research: Collaborative medication review to reduce potentially inappropriate medication use in hospitalized older adults

Article Title: Collaborative medication review to reduce potentially inappropriate medication use in the hospitalised older adult patients in tertiary care hospitals – A scoping review

Article References: Balan, A. K., Konduru, R. K., Rajaram, S., Mani, M., Natarajan, A., Cherian, J. J., Srinivasan, M., Treasa Sabu, S., Bagepally, B. S., Purty, A. J., Iqbal, N., Sekar, D., Sundaramurthi, S., Topno, I., Hanumappa, M. C., Elango, B., Saravanamuthu, R., & Girish, G. (2026). Collaborative medication review to reduce potentially inappropriate medication use in the hospitalised older adult patients in tertiary care hospitals – A scoping review. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08453-z

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08453-z

Keywords: Collaborative, medication, review, reduce, potentially, inappropriate, hospitalised, older, adult, patients, tertiary, care