The study, published in BMC Geriatrics by a team of hospital pharmacists and pharmacoepidemiologists affiliated with Assistance Publique–Hôpitaux de Paris and Paris-Saclay University, set out to measure how often DOAC prescriptions in hospitalized older adults deviated from European Society of Cardiology (ESC) guidelines, and whether the situation had improved since a comparable assessment in 2018. The answer, in short, is that it had not.

Between November 2022 and May 2023, the researchers consecutively enrolled older adults who were already taking a DOAC before admission and who stayed in one of three French university hospitals for more than 24 hours. The participating departments spanned cardiology, internal medicine, post-emergency care, and acute geriatrics, giving a broad picture of real-world prescribing across the acute care pathway. In total, 536 patients were eligible, with a mean age of 84.1 years and a slight majority of women; 421 patients formed the primary analysis cohort.

The pharmacological profile of the cohort reflected current practice. Apixaban dominated, accounting for 70.1 percent of prescriptions, and atrial fibrillation was the indication in 83.6 percent of cases. This matters because apixaban, like all DOACs, has a narrow therapeutic window whose appropriateness hinges on patient-specific factors: renal function, age, body weight, and the indication being treated. Unlike warfarin, which is monitored with routine blood tests, DOAC dosing is fixed at prescription time, so an error at the moment of prescribing persists silently until harm occurs.

Using ESC guidelines as the benchmark, the team classified prescriptions as appropriate or inappropriate at two critical moments: hospital admission and hospital discharge. On admission, 32.0 percent of prescriptions were judged inappropriate. By discharge, the figure had fallen to 24.9 percent, a statistically significant improvement (p = 0.004), suggesting that the hospital stay does correct some errors, but leaves a substantial fraction of patients heading home with potentially unsafe anticoagulation.

The consequences of such errors are not abstract. An excessive dose in a frail 85-year-old with declining kidney function increases the risk of major bleeding, including intracranial hemorrhage. An insufficient dose, conversely, can mean therapeutic failure, allowing a stroke or systemic embolism to occur despite the patient dutifully taking their medication. In older patients with polypharmacy, where DOACs interact with other drugs and renal clearance is often reduced, the margin for error shrinks further, which is why inappropriate prescribing is considered a major patient safety concern in geriatric care.

To understand who was most at risk, the researchers used logistic regression to identify predictive factors for inappropriate prescribing. Two variables stood out at admission: age over 80 years nearly doubled the odds of an inappropriate prescription (odds ratio 1.80, 95 percent confidence interval 1.20–2.72), and elevated serum creatinine above 133 µmol/L, a marker of impaired kidney function, similarly raised the odds (OR 1.84, 95 percent CI 1.13–2.98). At discharge, age over 80 remained a strong risk factor (OR 2.71, 95 percent CI 1.63–4.61), while a body weight below 60 kilograms was unexpectedly protective (OR 0.42, 95 percent CI 0.25–0.69), possibly because clinicians scrutinize low-weight patients more carefully when selecting doses.

The renal connection deserves particular emphasis. DOACs are cleared substantially by the kidneys, and estimates of glomerular filtration rate in older adults vary depending on the formula used, whether Cockcroft–Gault, MDRD, or CKD-EPI. The study’s authors assessed prescriptions against the Summary of Product Characteristics for each molecule, which specify dose reductions based on renal function, age, and weight. When kidney function is overestimated, or when a hospitalization changes a patient’s renal status without the prescription being adjusted, the fixed daily dose can quickly become dangerous. Advanced age and impaired renal function, the two risk factors identified here, are precisely the conditions that make this pharmacokinetic tightrope hardest to walk.

Perhaps the most sobering finding is the comparison with 2018. Using chi-squared tests, the team compared their results with data collected five years earlier and found no significant changes. Despite growing awareness of DOAC dosing pitfalls, updated guidelines, and the expansion of clinical pharmacy services in French hospitals, the rate of inappropriate prescribing in this vulnerable population has remained essentially flat. The authors conclude that further efforts to optimize DOAC prescribing are warranted, and they point toward concrete interventions: pharmacist-led medication reviews at admission and discharge, and integrated prescribing tools embedded in electronic medical records that would automatically flag doses inconsistent with renal function, age, and weight.

The study has the strengths and limits of its design. As a prospective observational study, it captures real prescribing behavior rather than idealized trial conditions, and its multicenter scope across four department types strengthens generalizability within the French hospital system. But it also reflects a single country’s practice in a single year, and appropriateness was defined by ESC guidelines rather than patient-specific outcomes, so the findings measure guideline concordance rather than directly measured harm. Even so, the message is clear and actionable: the transition points of hospital care, admission and discharge, remain moments where older patients on DOACs are at elevated risk of a prescribing error, and after years of stagnation, systematic medication reconciliation and decision support may be the tools that finally bend the curve.

Subject of Research: Appropriateness of direct oral anticoagulant prescribing in hospitalized older adults

Article Title: Appropriateness prescriptions of direct oral anticoagulants in hospital in 2023 in the older population: a prospective observational multicenter study

Article References: Rodier, T., Gibert, A., Lepors, A., Fernandez, C., Hindlet, P., Savoldelli, V., & Schwab, C. (2026). Appropriateness prescriptions of direct oral anticoagulants in hospital in 2023 in the older population: a prospective observational multicenter study. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08330-9

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08330-9

Keywords: DOACs, anticoagulants, older adults, prescribing appropriateness, medication safety, atrial fibrillation, apixaban, renal function, polypharmacy, hospital discharge, pharmacist-led medication review, geriatrics

Medication management in older adults is a multifaceted issue, intertwining pharmacological, physiological, and social factors. As humans age, their bodies undergo significant changes affecting drug absorption, metabolism, and excretion, thereby altering therapeutic outcomes. The study highlights how these physiological changes necessitate tailored medication management strategies, demanding a high level of expertise from community pharmacists who often serve as the most accessible healthcare professionals.

One of the study’s prominent findings is the pharmacists’ role not merely as dispensers of medication but as critical advisors who navigate polypharmacy risks — a common scenario among older patients who often juggle multiple chronic conditions. Polypharmacy increases the likelihood of adverse drug reactions, drug interactions, and medication non-adherence, complications that pharmacists manage through careful review and patient education.

Through in-depth interviews and observational data, Deniz and Ceylan uncover that Turkish community pharmacists employ a variety of techniques to optimize medication management. These include medication reconciliation, personalized counseling, and collaboration with other healthcare providers. Such approaches are crucial in identifying potentially inappropriate medications and ensuring that prescribing aligns with current clinical guidelines.

The study also illuminates the socio-cultural factors influencing medication practices within the elderly Turkish population. Pharmacists noted cultural beliefs and family dynamics significantly impact medication adherence and perceptions of illness, requiring a highly empathetic and culturally competent approach. This insight underscores how pharmacists must adapt communication styles and educational efforts to effectively serve diverse patient populations.

Importantly, the research emphasizes the systemic barriers faced by pharmacists, such as time constraints, limited access to patient medical records, and lack of formalized protocols for medication management. These obstacles hinder pharmacists’ ability to fully utilize their expertise, suggesting a need for policy reforms and infrastructural investments to empower these healthcare providers.

Another critical angle explored is the integration of technological tools to enhance medication management. Electronic health records, automated alert systems for drug interactions, and telepharmacy services, while not yet ubiquitously implemented in community settings in Turkey, represent promising avenues to support pharmacists in their complex duties.

Furthermore, the study reveals that pharmacists frequently engage in therapeutic monitoring activities, tracking patient responses and side effects to make timely interventions. This active involvement can prevent hospital readmissions and reduce healthcare costs, illustrating the broader societal benefits of optimizing medication management in older adults.

Deniz and Ceylan also discuss educational gaps among pharmacists, especially concerning geriatric pharmacotherapy. As the global population ages, specialized training and continuous professional development become imperative to prepare pharmacists for the unique demands of elderly care.

The research acknowledges the emotional and psychological dimensions of medication management, noting that older adults often experience medication fatigue and anxiety. Pharmacists who establish trustful relationships can alleviate these concerns, improve adherence, and ultimately enhance quality of life.

Interestingly, the study serves as a springboard for broader discussions on interprofessional collaboration. Community pharmacists are well-positioned to act as liaison points between doctors, nurses, patients, and caregivers, fostering a more holistic and coordinated approach to elderly health management.

In conclusion, the insights offered by Ulutas Deniz and Ceylan’s investigation reveal not only the challenges but also the immense potential within community pharmacy practice to transform medication management for older adults. Their findings call for systemic enhancements, including policy support, advanced training, and technological integration, to enable pharmacists worldwide to fulfill pivotal roles in geriatric care.

As societies globally confront aging populations, such research highlights the indispensable function of community pharmacists and the need for amplified attention to their professional experiences. This study not only enriches academic understanding but also sparks a necessary discourse on optimizing healthcare delivery for one of the most vulnerable yet underserved patient groups.

By spotlighting Turkish community pharmacists, this research transcends national boundaries, illustrating universal themes and solutions applicable to global healthcare systems. It invites healthcare stakeholders to reevaluate and restructure support mechanisms, aiming for safer, more effective, and empathetic medication management for older adults everywhere.

Subject of Research: Medication management for older adults from the perspective of Turkish community pharmacists.

Article Title: Understanding medication management in older adults: experiences of Turkish community pharmacists.

Article References:
Ulutas Deniz, E., Ceylan, C. Understanding medication management in older adults: experiences of Turkish community pharmacists. BMC Geriatr (2026). https://doi.org/10.1186/s12877-026-07802-2

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The premise of the PharMoG study is anchored in the recognition that older adults are disproportionately affected by inappropriate prescriptions, which often involve drugs that pose higher risks due to altered pharmacokinetics and pharmacodynamics resulting from age-related physiological changes. These inappropriate prescriptions can precipitate a cascade of negative clinical outcomes, including falls, cognitive impairment, and severe adverse drug reactions. The intervention tested in the study leverages the unique expertise of a mobile geriatrics team, incorporating a clinical pharmacist, to conduct comprehensive medication reviews and provide tailored recommendations, a strategy designed to address the multifaceted nature of drug therapy in the elderly.

Central to the study’s design is the mobility of the geriatrics team, which enhances accessibility and individualized care in diverse clinical settings. Unlike traditional models confined to fixed locations, the team’s mobility facilitates in-situ evaluations of the patient’s medication regimen, enabling real-time identification of potentially inappropriate medications (PIMs) and swift recommendations for adjustments. This approach is particularly advantageous in complex care environments such as nursing homes or community settings where older adults might not have continuous access to specialized geriatric care.

The inclusion of a pharmacist as a key team member represents a paradigm shift in interdisciplinary collaboration. Pharmacists bring a profound understanding of drug interactions, contraindications, and the latest evidence-based guidelines on safe prescribing in the elderly. Their role in the team involves meticulous review of each patient’s medication list, scrutinizing for PIMs using validated criteria such as the Beers Criteria and STOPP/START tools. This expert pharmacological insight complements the clinical assessments by geriatricians, resulting in a holistic approach that marries clinical judgment with pharmaceutical precision.

The results described in the PharMoG study reveal a significant reduction in potentially inappropriate drug prescriptions following the intervention. This outcome not only underscores the efficacy of the mobile team model but also highlights the critical impact of integrated pharmacist involvement. Specific drug classes frequently flagged for inappropriate use in elderly populations—such as benzodiazepines, anticholinergics, and certain cardiovascular agents—were effectively identified and addressed, leading to safer, more appropriate medication regimens.

Furthermore, the study delves into the transformative effects of the intervention on healthcare utilization patterns. By optimizing pharmacotherapy, the mobile geriatrics team contributed to a decline in adverse drug events, which are major drivers of emergency visits and hospital admissions among older adults. This improvement in medication safety translates into tangible benefits for both patients and healthcare systems, encompassing enhanced patient wellbeing and decreased financial burdens due to preventable complications.

The methodology employed by Dintilhac and colleagues is robust, involving a controlled, prospective design that meticulously tracks prescription modifications and patient outcomes. The study’s strength lies in its ability to capture dynamic changes over time, illustrating not only the immediate impact of the intervention but also its sustainable influence on prescribing practices. Additionally, qualitative analyses gathered from healthcare providers involved in the intervention underscore the value of the mobile team’s consultative role, illustrating a cultural shift towards closer pharmacist-physician collaboration.

One particularly noteworthy element of the study is its attention to the challenges inherent in geriatric pharmacotherapy, such as the balancing act between managing chronic conditions and minimizing medication burden. The interdisciplinary team approach fosters nuanced decision-making, respecting patient individuality and prioritizing deprescribing when appropriate. This personalized approach counters the historically prevalent ‘one-size-fits-all’ prescribing paradigm, aligning treatments with evolving clinical statuses and patient goals.

Importantly, the PharMoG initiative also advances the concept of continuous education and feedback loops within clinical practice. The mobile geriatric team acts as a catalyst for knowledge dissemination, equipping primary care providers and nursing staff with practical insights on medication safety and appropriate prescribing. This educational aspect ensures that improvements extend beyond the immediate intervention, embedding best practices into everyday clinical workflows.

The study’s implications resonate widely in the context of aging populations globally. As life expectancy increases, the prevalence of multimorbidity and polypharmacy is expected to rise, intensifying the need for innovative strategies that safeguard medication safety. The mobile geriatrics team model, highlighted by a central pharmacist’s role, offers a scalable and adaptable framework that can be integrated into various healthcare systems, potentially reshaping geriatric care paradigms on a broader scale.

Moreover, this research underscores the vital importance of integrating technology and data-driven tools in optimizing pharmacological care. Mobile teams equipped with electronic health records, decision-support systems, and telemedicine capabilities can enhance the precision and efficiency of interventions, paving the way for future studies and implementations to further refine and extend the model’s benefits.

The PharMoG study also opens avenues for exploring patient-centered outcomes beyond medication appropriateness, such as impacts on functional status, cognitive performance, and quality of life metrics. By establishing effective medication stewardship, the intervention sets the foundation for holistic improvements in the health trajectories of elderly patients, supporting their autonomy and dignity.

In addressing drug safety in the elderly, the study contributes to the broader discourse on healthcare equity. Older adults, especially those in underserved or rural areas, often face barriers to specialized care. Mobile geriatrics teams serve as a bridge to these communities, democratizing access to expert evaluation and intervention, and therefore reducing disparities in geriatric care quality.

The innovative methodology and compelling results of the PharMoG study invigorate the field with a model that is both practical and profoundly impactful. It exemplifies how interdisciplinary collaboration, mobility, and precise pharmaceutical expertise can coalesce to create meaningful change in complex clinical environments. As healthcare systems grapple with the intricacies of aging populations, such pioneering approaches offer hope and direction.

Future directions following this study include scaling the intervention to diverse healthcare settings, assessing long-term patient and system-level outcomes, and incorporating artificial intelligence-driven analytics to further enhance medication review processes. The integration of patient and caregiver perspectives will also enrich the evolving model, aligning it ever closer to the needs and experiences of the elderly population.

Ultimately, the findings of the PharMoG study resonate as a call to action for healthcare providers, policymakers, and researchers alike. Ensuring medication safety in older adults demands innovative, collaborative, and patient-centered strategies—a challenge that the mobile geriatrics team model meets with marked success. This approach not only improves prescribing practices but also advances the larger goal of enhancing healthspan alongside lifespan for society’s most vulnerable members.

Subject of Research: The impact of a mobile geriatrics team intervention, including a pharmacist, on reducing potentially inappropriate drug prescriptions in elderly patients.

Article Title: The impact of an intervention by a mobile geriatrics team including a pharmacist on potentially inappropriate drug prescription: results of the PharMoG study.

Article References:
Dintilhac, A., Qassemi, S., Roland, C. et al. The impact of an intervention by a mobile geriatrics team including a pharmacist on potentially inappropriate drug prescription: results of the PharMoG study. BMC Geriatr (2026). https://doi.org/10.1186/s12877-026-07366-1

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Sepsis is a life-threatening condition triggered by an infection that leads to systemic inflammation and organ dysfunction. It can progress rapidly, resulting in septic shock, which is characterized by dangerously low blood pressure and multi-organ failure. Traditionally, the management of sepsis involves a multidisciplinary team; however, the role of clinical pharmacists has often been underestimated. This study provides a deeper understanding of how integrating clinical pharmacists into the sepsis treatment protocol could significantly influence patients’ recovery trajectories.

In this non-randomized controlled study, researchers focused on a cohort of critically ill patients diagnosed with sepsis or septic shock. The primary aim was to evaluate the impact of systematic medication reviews conducted by clinical pharmacists on patient outcomes. The study methodology bestowed a unique insight into how medication management can be optimized within the ICU context. Adjusting medications, avoiding potential drug interactions, and ensuring optimal dosing regimens are critical tasks that pharmacists expertly navigate.

Pharmacists bring specialized training in pharmacotherapy, which is invaluable in a fast-paced ICU environment where time and accuracy are crucial. The study included detailed analyses of prescription patterns, adherence to clinical guidelines, and the implications of individualized medication regimens tailored to each patient’s pathology. This level of scrutiny is essential in addressing the complexities of drug therapy in patients suffering from sepsis, where the stakes are alarmingly high.

Furthermore, the research contextualizes the importance of early intervention. The study’s findings reveal that patients who participated in pharmacist-led medication reviews experienced shorter lengths of ICU stays and improved clinical markers compared to those who did not receive such reviews. By meticulously evaluating medication regimens, clinical pharmacists can not only mitigate adverse effects but also enhance therapeutic efficacy, underscoring the critical role they play in sepsis management.

The interaction between clinical pharmacists and other healthcare providers was also a key focus of the study. Collaborative practice models that include pharmacists in the decision-making processes foster a more cohesive care approach. Multidisciplinary rounds, where healthcare providers discuss patient care plans, have shown to enhance communication and ensure that therapeutic decisions are evidence-based and patient-centered.

Moreover, the findings contribute to the larger discourse on healthcare costs. By reducing the duration of ICU admissions and improving patient outcomes, pharmacist-led medication reviews suggest a potential for decreased overall healthcare expenditures associated with sepsis management. As healthcare systems grapple with rising costs and limited resources, the integration of clinical pharmacists into critical care settings may constitute a cost-effective strategy that can ultimately save lives while optimizing resource utilization.

As the research progresses, it becomes increasingly clear that the role of clinical pharmacists should not just be limited to medication dispensing. Evidence gathered through studies such as this supports the notion that pharmacists are invaluable healthcare professionals whose clinical insights can lead to improved patient safety and outcomes. Consequently, healthcare administrators are encouraged to embrace this integration strategy for the betterment of patient care.

While obstacles to implementation persist, including resistance from traditional medical hierarchies, the growing body of evidence advocating for clinical pharmacists’ contributions cannot be ignored. As healthcare professionals collaborate to improve sepsis management, those in leadership positions will need to foster environments that welcome pharmacist-led initiatives. Such measures not only facilitate better patient care but also advance the role of pharmacists within healthcare teams.

The impact of the study extends beyond just immediate clinical implications; it paves the way for future research. There exists a wealth of opportunities for further exploration into how pharmacist involvement can be tailored for other critical conditions or diseases that require intricate medication management. As the landscape of healthcare continuously evolves, identifying specific roles for pharmacists in various specialties can further enhance the quality of care provided.

In conclusion, the insights derived from this study underscore the necessity for adaptive strategies in managing sepsis and septic shock. The findings not only illuminate the critical role of clinical pharmacists in ICUs but also set a precedent for integrating medication management into critical care protocols. As researchers continue to evaluate and advocate for pharmacist-led initiatives, it is clear that their contribution is not just beneficial—it is essential.

This study represents a significant step forward in recognizing the multifaceted role of clinical pharmacists in the ICU setting. It advocates for a broader perspective on healthcare team dynamics and emphasizes the indispensable value that pharmacists can bring to patient management strategies. Continued dialogue and research in this area will undoubtedly further solidify the role of pharmacists as core healthcare providers, essential in the fight against life-threatening conditions like sepsis.

In an era where evidence-based practices are paramount, the data generated from this research should compel healthcare systems to rethink existing care models. The incorporation of clinical pharmacists into critical care teams may very well be a game-changer in the quest for optimized patient outcomes in sepsis. As the medical landscape progresses, the alignment of clinical pharmacy with critical care delivery should not just be an aspiration—it must be an imperative.

Subject of Research: Clinical pharmacist-led medication review in patients with sepsis and septic shock in the intensive care unit.

Article Title: Clinical pharmacist-led medication review in patients with sepsis and septic shock in the intensive care unit: a non-randomized controlled study.

Article References:

Aksoy, M., İlerler, E.E., Karakurt, S. et al. Clinical pharmacist-led medication review in patients with sepsis and septic shock in the intensive care unit: a non-randomized controlled study.
BMC Health Serv Res 25, 1375 (2025). https://doi.org/10.1186/s12913-025-13570-3

Image Credits: AI Generated

DOI: 10.1186/s12913-025-13570-3

Keywords: Sepsis, Septic Shock, Clinical Pharmacist, Intensive Care Unit, Medication Review, Patient Outcomes, Pharmacy Practice, Multidisciplinary Teams, Healthcare Costs, Evidence-Based Practice.