Drug Related Problems in Geriatric Critical Care: Challenges, Clinical Implications and Future

Drug Related Problems (DRP) represent a significant and often under-recognised challenge in the care of elderly patients admitted to Intensive Care Units (ICU). Epidemiological data reveal a high prevalence of DRP among geriatric ICU patients, with trends dominated by polypharmacy, inappropriate medication use, drug-drug interactions, and adverse drug reactions. Patient-related factors such as multimorbidity, organ dysfunction, and the complexity of critical care regimens contribute to the development of DRP. Furthermore, high-risk drug classes-including sedatives, analgesics, antibiotics, anticoagulants, and cardiovascular agents-pose significant risks. Communication gaps, inadequate medication reconciliation, limited geriatric-focused therapy, and the rapid pace of ICU decision-making further complicate DRP management. DRP in elderly ICU patients are strongly associated with increased morbidity, prolonged hospitalisation, higher healthcare costs, and mortality. Evidence-based strategies, including medication review, clinical decision support systems, deprescribing, therapeutic drug monitoring, and multidisciplinary care models, have demonstrated effectiveness in reducing DRP. Pharmacists can play a crucial role by assisting with medication reconciliation, identifying risks, optimising therapy, and supporting clinicians through real-time interventions. This review highlights the importance of standardised DRP monitoring tools, enhanced pharmacist involvement, and future research focused on predictive analytics and personalised pharmacotherapy in geriatric critical care settings. Based on this aim, we collected and evaluated nearly 70 articles from various databases (using specific keywords) that were included in this review.