title: [Interventions to optimize pharmacologic treatment in hospitalized older adults: a systematic review].
abstract: OBJECTIVE
  To summarise the evidence on interventions aimed at optimising the drug treatment of hospitalised elderly patients.
  
  
  METHODS
  We conducted a search in the main medical literature databases, selecting prospective studies of hospitalised patients older than 65 years who underwent interventions aimed at optimising drug treatment, decreasing polypharmacy and improving the medication appropriateness, health outcomes and exploitation of the healthcare system.
  
  
  RESULTS
  We selected 18 studies whose interventions consisted of medication reviews, detection of predefined drugs as potentially inappropriate for the elderly, counselling from a specialised geriatric team, the use of a computer support system for prescriptions and specific training for the nursing team. Up to 14 studies assessed the medication appropriateness, 13 of which showed an improvement in one or more of the parameters. Seven studies measured the impact of the intervention on polypharmacy, but only one improved the outcomes compared with the control. Seven other studies analysed mortality, but none of them showed a reduction in that rate. Only 1 of 6 studies showed a reduction in the number of hospital readmissions, and 1 of 4 studies showed a reduction in the number of emergency department visits.
  
  
  CONCLUSIONS
  Despite the heterogeneity of the analysed interventions and variables, we obtained better results in the process variables (especially in medication appropriateness) than in those that measured health outcomes, which had greater variability.
authors.affiliation: Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, España; IdiSNa, Navarra Institute for Health Research, Pamplona, España. Electronic address: marta.guva@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Gutiérrez Valencia
authors.affiliation: Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, España; IdiSNa, Navarra Institute for Health Research, Pamplona, España; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Pamplona, España.
authors.forename: N
authors.initials: N
authors.lastname: Martínez Velilla
authors.affiliation: Servicio de Farmacia, Complejo Hospitalario de Navarra, Pamplona, España.
authors.forename: E
authors.initials: E
authors.lastname: Lacalle Fabo
authors.affiliation: Servicio de Farmacia, Fundación Matia, San Sebastián, España.
authors.forename: I
authors.initials: I
authors.lastname: Beobide Telleria
authors.affiliation: Servicio de Farmacia, Complejo Hospitalario de Navarra, Pamplona, España.
authors.forename: B
authors.initials: B
authors.lastname: Larrayoz Sola
authors.affiliation: Centro Medicina Dell'Invecchiamento, Università Cattolica Sacro Cuore, Policlinico A. Gemelli, Roma, Italia.
authors.forename: M
authors.initials: M
authors.lastname: Tosato
keywords: Anciano; Elderly; Hospitalizados; Hospitalized; Inappropriate prescribing; Polifarmacia; Polypharmacy; Prescripción inadecuada; Revisión de tratamientos; Treatment review