Older people are major users of medicines. In addition to highly prevalent use of multiple medications (polypharmacy), ageing is accompanied by multisystem physiological decline over time with major implications in pharmacodynamics and pharmacokinetics. Accumulating clinical evidence demonstrates that certain commonly prescribed drugs and polypharmacy are associated with adverse geriatric outcomes, such as falls, frailty and cognitive impairment. At present, the molecular basis remains poorly explored. This talk will present recent advances in elucidating the complex molecular landscape of geriatric pharmacology, along with exciting frontiers on integration with pharmacometrics. Emphasis will be placed on the integration of large-scale molecular datasets generated by omics technologies, utilising systems pharmacology approaches to better understand drug effects, as well as the development of novel bioinformatic, and mathematical frameworks aimed at unraveling this multifaceted issue in geriatric pharmacology. By understanding the molecular mechanisms and effects, we can help answer clinical questions such as (i) how does the body adapt/respond to chronic medication use?; (ii) how do these changes consequently lead to medication-related harms in some patients?; (iii) how does deprescribing medications improve health outcomes in some older patients?; and (iv) how can we better classify drugs with adverse geriatric outcomes? Understanding these mechanisms can improve healthcare for older adults through development of biomarkers of medication-related harms to guide personalised medicine.
