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This policy brief outlines several strategies that may be considered to combat ageism in medication use and its widespread negative consequences. The strategies are the following: 1) Establish a global action plan (designate an international organization to take a leading and coordinating role; involve all stakeholders; take a multidisciplinary, intersectoral, and systems approach; ensure affordability, accessibility, and availability of care and medications; address the needs of older adults facing multiple forms of discrimination; tailor strategies to the local contexts; designate coordinators at the national and organizational levels); 2) Enhance integration and coordination between health and social care and across different levels of health care (deliver team-based, multidisciplinary, integrated, and coordinated care; ensure interoperability of electronic health records); 3) Implement a quality and safety perspective (integrate and implement patient safety in all policies and programmes; establish a safety culture; establish open reporting culture; take an active and proactive approach; use international indicators); 4) Empower and engage older patients (involve patients in shared decision-making; provide health and medication-related information; provide decision aids and question prompt lists; launch campaigns to raise awareness about ageism in medication use and medication safety, and to promote a life-course perspective, a healthy lifestyle, and the benefits of non-pharmacological strategies); and 5) Improve education and training of care professionals (develop comprehensive curricula; implement interprofessional and intergenerational education and training; develop and revise clinical guidelines to meet older persons' needs and preferences; translate clinical guidelines into computerized clinical decision support systems, prescribing algorithms and alerts). By tackling ageism in medication use, policies, strategies, and actions can enhance the lives of older people and, in turn, their contribution to society.\" } { \"@context\": \"http://schema.org\", \"@type\": \"BreadcrumbList\", \"itemListElement\": [ { \"@type\": \"ListItem\", \"position\": \"1\", \"item\": { \"@id\": \"https://f1000research.com/\", \"name\": \"Home\" } }, { \"@type\": \"ListItem\", \"position\": \"2\", \"item\": { \"@id\": \"https://f1000research.com/browse/articles\", \"name\": \"Browse\" } }, { \"@type\": \"ListItem\", \"position\": \"3\", \"item\": { \"@id\": \"https://f1000research.com/articles/11-1025/v1\", \"name\": \"Ageism in medication use: a policy brief\" } } ] } Home Browse Ageism in medication use: a policy brief ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Brkic J and Fialova D. Ageism in medication use: a policy brief [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1025 ( https://doi.org/10.12688/f1000research.121495.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Policy Brief Ageism in medication use: a policy brief [version 1; peer review: 1 approved with reservations] Jovana Brkic https://orcid.org/0000-0002-8971-8400 1 , Daniela Fialova 1,2 Jovana Brkic https://orcid.org/0000-0002-8971-8400 1 , Daniela Fialova 1,2 PUBLISHED 09 Sep 2022 Author details Author details 1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, 500 05, Czech Republic 2 Department of Geriatrics and Gerontology, First Faculty of Medicine, Charles University, Prague, 121 08, Czech Republic Jovana Brkic Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Daniela Fialova Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Ageism in medication use decreases older persons' well-being and quality of life and increases health care utilization and costs. This policy brief outlines several strategies that may be considered to combat ageism in medication use and its widespread negative consequences. The strategies are the following: 1) Establish a global action plan (designate an international organization to take a leading and coordinating role; involve all stakeholders; take a multidisciplinary, intersectoral, and systems approach; ensure affordability, accessibility, and availability of care and medications; address the needs of older adults facing multiple forms of discrimination; tailor strategies to the local contexts; designate coordinators at the national and organizational levels); 2) Enhance integration and coordination between health and social care and across different levels of health care (deliver team-based, multidisciplinary, integrated, and coordinated care; ensure interoperability of electronic health records); 3) Implement a quality and safety perspective (integrate and implement patient safety in all policies and programmes; establish a safety culture; establish open reporting culture; take an active and proactive approach; use international indicators); 4) Empower and engage older patients (involve patients in shared decision-making; provide health and medication-related information; provide decision aids and question prompt lists; launch campaigns to raise awareness about ageism in medication use and medication safety, and to promote a life-course perspective, a healthy lifestyle, and the benefits of non-pharmacological strategies); and 5) Improve education and training of care professionals (develop comprehensive curricula; implement interprofessional and intergenerational education and training; develop and revise clinical guidelines to meet older persons' needs and preferences; translate clinical guidelines into computerized clinical decision support systems, prescribing algorithms and alerts). By tackling ageism in medication use, policies, strategies, and actions can enhance the lives of older people and, in turn, their contribution to society. READ ALL READ LESS Keywords ageism, older adults, polypharmacy, inappropriate prescribing, medication non-adherence Corresponding Author(s) Jovana Brkic ( [email protected] ) Close Corresponding author: Jovana Brkic Competing interests: No competing interests were disclosed. Grant information: This work was supported by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement number [764632]; Brkic Jovana and Daniela Fialova are members of the research group \"Ageing, Polypharmacy and Changes in the Therapeutic value of Drugs in the AgeD\" at the Charles University, Faculty of Pharmacy in Hradec Kralove, Czech Republic and work of this group is supported by the following grants: Ministry of Education, Youth and Sports of the Czech Republic, Czech Operational Programme Research, Development and Education, Pre-application research into innovative medicines and medical technologies (InoMed) project, grant number CZ.02.1.01/0.0/0.0/18_069/0010046; Charles University project, grant number: SVV 260 551; Charles University project, grant number: Cooperatis Q42; Ministry of Education, Youth and Sports of the Czech Republic, Czech Operational Programme Research, Development and Education, START Programme, grant number: CZ.02.2.69/0.0/0.0/19_073/0016935; European Union's Horizon 2020 research and innovation programme I-CARE4OLD project, grant number 965341. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2022 Brkic J and Fialova D. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Brkic J and Fialova D. Ageism in medication use: a policy brief [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1025 ( https://doi.org/10.12688/f1000research.121495.1 ) First published: 09 Sep 2022, 11 :1025 ( https://doi.org/10.12688/f1000research.121495.1 ) Latest published: 09 Sep 2022, 11 :1025 ( https://doi.org/10.12688/f1000research.121495.1 ) Introduction To improve the health and well-being of people of all ages and thus achieve Sustainable Development Goal (SDG) 3, “Ensure healthy lives and promote well-being for all at all ages”, 1 the World Health Organization (WHO) identified improving medication safety of central importance and launched its third ‘Global Patient Safety Challenge: Medication Without Harm’ in 2017, 2 recognizing polypharmacy as one of the three priority areas and issuing a technical report ‘Medication safety in polypharmacy’. 3 Furthermore, the United Nations (UNs) Decade of Healthy Ageing (2021-2030 ) 4 and the WHOs Global Campaign to Combat Ageism 5 present an excellent opportunity for accelerating the efforts and actions to improve the quality of life of persons of all ages around the globe. All the above-mentioned actions of the UN and the WHO create the right momentum to address a double burden of ageism towards older people and inappropriate medication use in this population, which are strongly interlinked. Ageism refers to stereotypes (the way we think), prejudice (the way we feel), and discrimination (the way we act) towards others or oneself based on age; it can be positive or negative; it can operate consciously (explicitly) or unconsciously (implicitly); it can be manifested on the individual level (micro-level), in social groups and networks (meso-level) and on an institutional and cultural level (macro-level). 6 It is widespread around the globe and more prevalent than sexism and racism 7 ; about one in two people are ageist towards older people. 8 Ageism against older people contributes to poorer physical and mental health, increased social isolation and loneliness, decreased quality of life, and earlier death. 9 The cost of ageism to society is enormous – billions of dollars. 5 Older people with poorer health status and greater care dependence are more likely to be the targets of ageism. 10 – 12 Ageism in medication use in older adults is prominent at all levels macro- (health policy and drug regulatory area), meso- (health care organizations and healthcare services), and micro- (providers of care, informal carers, and patients themselves). It contributes to the prevalent issues of polypharmacy, inappropriate prescribing, and medication non-adherence in older adults and the widespread negative consequences of these phenomena. 5 Older adults tend to have more conditions and diseases and thus are more likely to take multiple medications but are less able to tolerate drugs’ side effects because of age-related and sometimes also disease-related changes in the body. 13 The prescribing of several medications is defined as polypharmacy, and it can be appropriate (as in certain conditions and for certain patients prescribing multiple medications can be beneficial) or inappropriate. 14 Nevertheless, polypharmacy increases the likelihood of drug interactions, adverse drug reactions, drug-related morbidity and mortality, and prescribing cascades (prescribing medications to treat drugs’ side effects that were misinterpreted as a new medical condition). 15 , 16 Also, polypharmacy increases the risk of inappropriate prescribing – prescribing medications with higher risks than benefits, where there is no clinical indication, at the wrong dose, frequency, or duration of treatment, as well as not prescribing potentially beneficial medications. 16 , 17 Furthermore, taking more medications increases the complexity of a treatment regimen and thus the likelihood of medication non-adherence – when a person is not following the agreed recommendations from a health care provider, leading to a suboptimal response to treatment and recurrence of the illness. 18 All these problems – polypharmacy, inappropriate prescribing, and medication non-adherence – increase the prevalence of morbidity and mortality in older patients, reduce their quality of life, and increase health care utilization and costs. 15 – 18 The avoidable costs of suboptimal use of medications, including polypharmacy, inappropriate prescribing, and medication non-adherence, are about 500 billion USD per year globally or about 8% of total health expenditure. 19 Polypharmacy, inappropriate prescribing, and non-adherence are prevalent global issues. However, their actual magnitudes are unknown because of the differences across studies in operational definitions, measurement tools, populations studied, and data collection systems. The Organisation for Economic Co-operation and Development (OECD) report showed that the prevalence of polypharmacy in older adults aged 75 and over from selected countries with broader data coverage was around 50%. 20 The reviews of literature estimated that the prevalence of inappropriate prescribing in older adults was about 20% in community-dwellers 21 and much higher in long-term care residents, around 40%, 22 due to higher frailty, disability, and more complex needs in this population. The WHO report estimated that the prevalence of medication non-adherence to long-term therapies in the general population was around 50% in developed countries and much higher in developing countries. 18 Certain populations are more vulnerable to the harmful effects of ageism in medication use because ageism interacts and intersects with other ‘isms’, such as ableism, racism and sexism, mutually reinforcing each other. 5 The most prevalent ‘isms’, ageism and sexism, make older women – who represent the majority of the older population due to the longer life expectancy – particularly vulnerable to the double burden of disadvantage. 7 , 23 Inequities in older age between men and women result from cumulative disadvantages over the life course. Women are less often employed, work in lower-paid jobs, for lower salaries, for fewer years due to caring duties and lower statutory retirement age in certain countries and are less able to access pensions or have lower pensions. 24 These disparities in economic status make older women less able to pay for the healthcare services and necessary medications, although they are more likely to be in poorer health and require long-term care. 24 , 25 Furthermore, women more often consult a doctor and use medical services, but according to some studies, men have better access to preventive care and treatment, and the care provided to them tends to be of higher quality. 5 , 25 Policy outcomes and implications Ageism in medication use in older adults, which encompasses prevalent problems of polypharmacy, inappropriate prescribing, and medication non-adherence, has serious negative impacts on individuals and society. Therefore, combating this complex issue presents a public health priority that this policy brief aims to address. Many changes need to be made at all system levels around the globe, and we propose several strategies that could be considered with the overall goal of improving older adults’ health and quality of life and increasing their contribution to society. The strategies are the following: 1) Establish a global action plan; 2) Enhance integration and coordination of care; 3) Implement a quality and safety perspective; 4) Empower and engage older patients; and 5) Improve education and training of care professionals. Actionable recommendations 1. Establish a global action plan An international organization, ideally WHO, should take the role of leader and coordinator of policies and strategies in order to help countries tackle the issue of ageism in medication use by creating and disseminating guidance, tools, targets, and international indicators. The organization should identify, bring together, engage, and coordinate all key stakeholders to formulate the global action plan, foster international collaboration, avoid duplication of efforts, share best practices, and encourage mutual learning. Also, experts from different fields and sectors should be involved in tackling this multifaceted problem by taking a multidisciplinary and intersectoral approach and avoiding working in silos. Furthermore, to combat this complex issue, we need a systems approach that takes a holistic view of the problem and considers all system levels: macro, meso, and micro. Also, these policies should ensure equitable access to medications and care that should be of the highest attainable quality, available, and affordable to everyone. Finally, the needs of older adults facing multiple and intersecting forms of discrimination, such as older women, should be taken into account when formulating policies, strategies, and plans. These policies and tools should be adapted to national contexts due to differences in health system design and funding, available resources and infrastructure, culture and traditions. If countries have strategies or plans related to the issue of ageism in medication use, they should review and align them with the global action plan. Also, it is necessary to designate national coordinators to oversee and coordinate the implementation of the global action plan at the national levels, as well as a coordinators responsible for each care facility. 2. Enhance integration and coordination between health and social care and across different levels of health care Fragmented silos-based care, where each specialist treats a specific organ without holistically considering all patient needs and without communicating with other professionals involved in patient care, can lead to serious negative consequences. 26 For example, professionals usually do not know all patient conditions and medications, which leads to drugs being duplicated and reintroduced after being discontinued due to lack of efficacy or adverse drug reactions. The causes of this multifaceted issue are complex and dependent on the context: limited resources, workforce shortages and maldistribution, high workloads, lack of time, increasingly specialized care (increasing number of specializations and sub-specializations), and lack of electronic health care systems/interoperability of electronic health care systems. 27 Also, the skills of certain professionals are underused, such as pharmacists who are knowledgeable about medication therapy. Care professionals from multiple disciplines should work collaboratively and make complementary contributions to team-based, multidisciplinary care. Their team roles and responsibilities should be clearly defined in national legislations. The teams should be coordinated and integrated by one primary care professional – a registered nurse, general practitioner or, in the case of older adults, a geriatrician. Also, pharmacists’ knowledge and skills could be used more efficiently by involving them in healthcare teams at all levels of healthcare. Furthermore, to enable teamwork and the flow of information among care professionals and their patients, electronic health records should be implemented or adapted to make them interoperable across health systems. Electronic health records should also be user friendly and secure to protect patient privacy. All these changes require restructuring healthcare systems and organizations, changing legislations and regulations, redesigning workflows, redistributing tasks and responsibilities, ensuring the educational foundations, tailoring activities to the local contexts, developing health information technologies, and allocating resources. Thus, all activities and interventions should be carefully planned, developed, implemented and monitored to avoid increasing the workload of the already overburdened workforce and unnecessary expenses. 3. Implement a quality and safety perspective The issue of ageism in medication use should also be addressed from a health care quality and safety perspective that aim to prevent avoidable medical errors, including medication errors. Patient safety should be integrated and implemented in all health and social policies and programmes, which requires establishing a safety culture and having committed and devoted political and organizational leadership to promote it. Furthermore, it is important to develop an open, transparent, and blame-free incident and near-miss reporting culture and to learn from reported mistakes and investigate their root causes. However, it is required not to take only a reactive but also a proactive approach to prevent medical errors. Also, the focus should be on preventing system and organizational failures rather than errors of individuals because “to err is human”. To measure the quality of care provided and to monitor progress, indicators that are suitable for international comparison should be used. In order to enable comparability between countries, it is necessary to use uniformly defined indicators, the same sources of information, methods of data collection, age- and sex-disaggregated data expressed in standard units (e.g., Defined Daily Dose per 1,000 inhabitants per day). The OECD has developed several health care quality indicators that encompass the most relevant problems in prescribing for older adults. 28 These indicators could be used and/or adapted to enable broader international comparisons. Also, several other validated and cross-nationally comparable indicators could be developed. Three OECD indicators that are examples of ageism in medication use are antipsychotics, long-term benzodiazepines/related drugs, and long-acting benzodiazepines/related drugs. 28 These medications are still prevalently prescribed despite their serious negative consequences on older peoples’ lives. 20 Antipsychotic use in people with dementia increases mortality and rate of cognitive decline. 29 Despite this, antipsychotics are often used as chemical restraints in nursing homes. This malpractice can be considered abuse, inhuman, and degrading treatment 30 and must be ceased, primarily by providing legal protection to people with dementia. Furthermore, benzodiazepines are often prescribed to older adults for sleep disorders despite their risks – falls, fractures, cognitive decline, delirium, and road accidents. 29 In both cases, instead of medications – antipsychotics in people with dementia and benzodiazepines for sleep disorders – non-pharmacological alternatives, such as behavioural interventions, are preferred for most older adults. 29 , 31 4. Empower and engage older patients Healthcare professionals less often involve older patients in treatment decisions than younger ones. 32 Moreover, some older persons are less likely to ask physicians questions and challenge their authority than younger adults. 33 However, professionals should never make assumptions about a patient’s desired level of involvement but try to elicit it. Care provided should be person-centred and individualized, and older patients should be empowered and encouraged to take an active role in their care and decision making. Care professionals should respect all patients, irrespective of their age, gender, race and other characteristics, as experts and partners with whom they share power and responsibility. Professionals should also respect that patients might have different needs and priorities, which can change over time. They should provide reliable information about disease, medications, and risks and benefits of different options of treatment to enable patients to make informed decisions; elicit patient’s beliefs, preferences, values and priorities; encourage and help patients to decide on the therapy approach that would be in line with their needs and agree on next steps. Decision aids that provide information about the possible treatment strategies should be developed/adapted for common medical conditions and made available across clinical settings. Also, question prompt lists that can help patients actively discuss their health problems and medications with clinicians should be developed/adapted and made available. Campaigns should be launched to raise awareness about ageism and inappropriate medication use. These campaigns should also aim to reduce self-ageism and ageism towards others by promoting that people of all ages have equal rights to the best available healthcare. The campaigns should also promote a life course perspective, i.e., that we all, if lucky, will be older one day, so that younger and older persons should take appropriate self-care and lead a healthy lifestyle to age as healthy as possible. Also, this ideation about our future selves could encourage care professionals to provide the best possible care to everyone and treat older persons with dignity and respect. Furthermore, these campaigns should promote a healthy lifestyle and the benefits and effectiveness of non-pharmacological strategies that should be used instead of drug therapies in certain cases. Finally, the campaigns should raise awareness that some medicines can harm older adults and educate the public about the most severe and prevalent medication problems and where to find reliable health- and medication-related information. The campaigns should use different channels to reach the diverse older population with different health and digital literacy levels, preferences and access options: social media, the internet, and traditional media (television, radio, billboards, newspapers, posters, and leaflets in healthcare institutions). 5. Improve education and training of care professionals Comprehensive curricula for all care professionals should be developed to include diverse but interrelated topics: ageism and other ‘isms’, ageing, older age, geriatric medicine, geriatric pharmacotherapy, health literacy, medication adherence, and patient safety. All these topics should be part of undergraduate, postgraduate, and continuing education courses, board certifications, and renewal of licenses. Especially important is the knowledge about older age and ageing because people who have greater knowledge in these areas tend to have more positive attitudes towards older adults. 34 This knowledge would decrease clinicians’ ageistic practices such as treating only symptoms, often inappropriately attributed to ageing, instead of establishing a proper diagnosis. 35 Also, care professionals should develop communication skills to avoid patronizing and disrespectful communication and elderspeak, i.e., speaking more slowly, more loudly, or using simpler vocabulary when talking to older adults. 36 Elderspeak is the consequence of wrong generalizations that all older adults have lower cognitive capacity and hearing problems. 37 Finally, it is important to promote specialization in gerontology, geriatrics and geriatric pharmacy, which remain unpopular despite population ageing. Education and training should be interprofessional to practice teamwork. Teamwork could be further enhanced by conducting peer discussions and clinical peer reviews. Furthermore, education and training should be intergenerational to expose care professionals to the whole spectrum of older adults. It would help professionals understand that older adults are not a homogenous group of vulnerable and frail people and enhance intergenerational solidarity. Care professionals commonly see a more vulnerable older population and therefore, sometimes, they tend to be more ageistic than the general population. 33 Clinical guidelines are usually single disease-focused, not addressing the needs of multimorbid or frail or older patients. 38 Consequently, complying with guidelines can lead to polypharmacy, drug-drug interactions, and patient harm. 39 Also, guidelines are usually based on clinical trials that mainly included younger adults. Even when older adults were included in clinical trials, they tended to be healthier and thus not representative of this diverse population. 40 Prescribers are often forced to follow these guidelines that do not consider individual patient needs and preferences, especially in pay-per-performance payment models. 38 Therefore, existing treatment guidelines should be revised, or new ones should be developed considering older people’s needs and preferences and disseminated to all clinical practices. Furthermore, digital technology provides an excellent opportunity to translate these clinical guidelines into computerized clinical decision support systems, prescribing algorithms and alerts, which professionals can use on computers, mobile phones, and tablets. However, clinicians should be constantly reminded that clinical judgment about individual patients’ needs and preferences is always required. Conclusions Appropriate policy solutions can mitigate the negative effects of ageism in medication use for today’s older population and prevent harm for future generations. In order to achieve the desired change, the following is required: strong, continued political commitment and leadership, participation of all relevant stakeholders and their regular education and training, clear strategies and action plans, progress measurement, and dedicated financial and human resources. Potential barriers to addressing this complex problem encompass competing priorities, short political time horizons related to elections, limited resources (financial, human, time), reluctance to change, and well-established hierarchical structures in health systems. On the other hand, potential facilitators are the right momentum created by the UN and WHO initiatives and increased levels of ageism towards older people during the COVID-19 pandemic. Therefore, it is essential not to miss this critical window of opportunity and act promptly to improve today’s and tomorrow’s older population’s quality of life and survival. Data availability No data are associated with this article. References 1. United Nations: THE 17 GOALS|Sustainable Development. Reference Source 2. World Health Organization: Medication Without Harm.2017. Reference Source 3. World Health Organization: Medication safety in polypharmacy: technical report.2019. Reference Source 4. World Health Organization: Decade of Healthy Ageing (2021-2030). Reference Source 5. World Health Organization: Global report on ageism.2021. Reference Source 6. Iversen TN, Larsen L, Solem PE: A conceptual analysis of ageism. Nord. Psychol. 2009; 61 : 4–22. Publisher Full Text 7. Ayalon L: Perceived Age, Gender, and Racial/Ethnic Discrimination in Europe: Results from the European Social Survey. Educ. Gerontol. 2014; 40 : 499–517. Publisher Full Text 8. 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PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 09 Sep 2022 ADD YOUR COMMENT Comment Author details Author details 1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, 500 05, Czech Republic 2 Department of Geriatrics and Gerontology, First Faculty of Medicine, Charles University, Prague, 121 08, Czech Republic Jovana Brkic Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Daniela Fialova Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This work was supported by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement number [764632]; Brkic Jovana and Daniela Fialova are members of the research group \"Ageing, Polypharmacy and Changes in the Therapeutic value of Drugs in the AgeD\" at the Charles University, Faculty of Pharmacy in Hradec Kralove, Czech Republic and work of this group is supported by the following grants: Ministry of Education, Youth and Sports of the Czech Republic, Czech Operational Programme Research, Development and Education, Pre-application research into innovative medicines and medical technologies (InoMed) project, grant number CZ.02.1.01/0.0/0.0/18_069/0010046; Charles University project, grant number: SVV 260 551; Charles University project, grant number: Cooperatis Q42; Ministry of Education, Youth and Sports of the Czech Republic, Czech Operational Programme Research, Development and Education, START Programme, grant number: CZ.02.2.69/0.0/0.0/19_073/0016935; European Union's Horizon 2020 research and innovation programme I-CARE4OLD project, grant number 965341. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 09 Sep 2022, 11:1025 https://doi.org/10.12688/f1000research.121495.1 Copyright © 2022 Brkic J and Fialova D. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Brkic J and Fialova D. Ageism in medication use: a policy brief [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1025 ( https://doi.org/10.12688/f1000research.121495.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 09 Sep 2022 Views 0 Cite How to cite this report: Silcock J. Reviewer Report For: Ageism in medication use: a policy brief [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1025 ( https://doi.org/10.5256/f1000research.133359.r190901 ) The direct URL for this report is: https://f1000research.com/articles/11-1025/v1#referee-response-190901 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 09 Aug 2023 Jonathan Silcock , School of Pharmacy and Medical Sciences, University of Bradford, Bradford, England, UK Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.133359.r190901 This is a comprehensive review of an important policy area, especially as populations age in developed countries and long-term multi-morbidity increases in prevalence. However, I'm not sure about the logical connection between ageism and polypharmacy. It seems more likely that ... Continue reading READ ALL This is a comprehensive review of an important policy area, especially as populations age in developed countries and long-term multi-morbidity increases in prevalence. However, I'm not sure about the logical connection between ageism and polypharmacy. It seems more likely that ageism would lead to under- rather than over-treatment with pharmaceuticals. Unless the authors are arguing that overprescribing reflects an inability to address the real issues underlying poor health in an ageing population? When the authors say that ageism is contributing to or creating pharmaceutical care issues, I think that the (proposed) mechanism requires more careful description. The context and the outcomes are beyond doubt. The policy prescriptions are sensible but far-reaching - especially given the other burdens faced by global economies. So, I also think that the (potential) barriers to change at least need to be mentioned. Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Yes Is the discussion on the implications clearly and accurately presented and does it cite the current literature? Partly Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Yes Competing Interests: I conduct research about medicines use by older people and supporting healthcare services. Reviewer Expertise: Use of medicines and evaluation of pharmacy services. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Silcock J. Reviewer Report For: Ageism in medication use: a policy brief [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1025 ( https://doi.org/10.5256/f1000research.133359.r190901 ) The direct URL for this report is: https://f1000research.com/articles/11-1025/v1#referee-response-190901 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 09 Sep 2022 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 09 Sep 22 read Jonathan Silcock , University of Bradford, Bradford, UK Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 Silcock J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 09 Aug 2023 | for Version 1 Jonathan Silcock , School of Pharmacy and Medical Sciences, University of Bradford, Bradford, England, UK 0 Views copyright © 2023 Silcock J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a comprehensive review of an important policy area, especially as populations age in developed countries and long-term multi-morbidity increases in prevalence. However, I'm not sure about the logical connection between ageism and polypharmacy. It seems more likely that ageism would lead to under- rather than over-treatment with pharmaceuticals. Unless the authors are arguing that overprescribing reflects an inability to address the real issues underlying poor health in an ageing population? When the authors say that ageism is contributing to or creating pharmaceutical care issues, I think that the (proposed) mechanism requires more careful description. The context and the outcomes are beyond doubt. The policy prescriptions are sensible but far-reaching - especially given the other burdens faced by global economies. So, I also think that the (potential) barriers to change at least need to be mentioned. Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Yes Is the discussion on the implications clearly and accurately presented and does it cite the current literature? Partly Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Yes Competing Interests I conduct research about medicines use by older people and supporting healthcare services. Reviewer Expertise Use of medicines and evaluation of pharmacy services. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Silcock J. Peer Review Report For: Ageism in medication use: a policy brief [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :1025 ( https://doi.org/10.5256/f1000research.133359.r190901) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-1025/v1#referee-response-190901 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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