Scenario Analysis: This scenario presents a common challenge in geriatric pharmacy practice: ensuring effective communication with an elderly patient who may have sensory impairments or cognitive changes that affect their ability to understand medication instructions. The pharmacist must balance the need for clear, accurate information with the patient’s dignity and autonomy, while also adhering to professional standards for patient counseling. The risk lies in miscommunication leading to medication non-adherence, adverse drug events, or patient dissatisfaction. Correct Approach Analysis: The best professional practice involves a multi-faceted approach that directly addresses potential communication barriers. This includes actively assessing the patient’s sensory capabilities (hearing, vision) and cognitive status at the outset of the interaction. If impairments are identified, the pharmacist should adapt their communication style accordingly. This might involve speaking clearly and at an appropriate volume, using visual aids, simplifying language, and confirming understanding through open-ended questions and teach-back methods. This approach aligns with the ethical principles of beneficence (acting in the patient’s best interest) and autonomy (respecting the patient’s right to make informed decisions), and implicitly supports the pharmacist’s professional responsibility to provide adequate patient counseling as mandated by general pharmacy practice standards, which emphasize patient understanding and safety. Incorrect Approaches Analysis: One incorrect approach involves proceeding with standard verbal counseling without first assessing for any sensory or cognitive deficits. This fails to acknowledge the potential for misinterpretation and can lead to the patient not fully grasping critical medication information, thereby increasing the risk of non-adherence or adverse events. This overlooks the professional obligation to ensure patient comprehension. Another incorrect approach is to rely solely on written instructions, assuming the patient can read and understand them, without verbal reinforcement or confirmation. This disregards potential visual impairments or difficulties with literacy, and bypasses the opportunity for interactive clarification, which is crucial for effective patient education, especially in a geriatric population. A third incorrect approach is to delegate the entire counseling process to a caregiver without directly engaging the patient. While involving caregivers is often beneficial, the primary responsibility for patient counseling rests with the pharmacist. Failing to directly communicate with the patient undermines their autonomy and the pharmacist’s professional duty to ensure the patient themselves understands their treatment. Professional Reasoning: Professionals should adopt a patient-centered approach that prioritizes understanding. This involves a systematic assessment of the patient’s needs, followed by tailored communication strategies. When interacting with elderly patients, it is prudent to anticipate potential challenges and proactively implement adaptive techniques. The pharmacist should always aim for two-way communication, actively listening to the patient’s concerns and confirming their understanding through methods like teach-back. This ensures that the information provided is not only accurate but also comprehensible and actionable for the patient.

This scenario is professionally challenging because it requires a pharmacist to balance the immediate need for effective pain management in an elderly patient with the significant physiological changes associated with aging that impact drug excretion. Overlooking these changes can lead to adverse drug events, reduced efficacy, and compromised patient safety, all of which are critical concerns within geriatric pharmacotherapy. Careful judgment is required to select an appropriate analgesic and dosage regimen that accounts for potential renal and hepatic impairment, common in this population. The best professional approach involves a comprehensive risk assessment that prioritizes understanding the patient’s current renal and hepatic function before initiating or adjusting analgesic therapy. This includes reviewing recent laboratory values (e.g., serum creatinine, eGFR, liver function tests) and considering the patient’s overall health status, including comorbidities and concurrent medications. Based on this assessment, the pharmacist should select an analgesic with a pharmacokinetic profile that is less susceptible to accumulation in impaired renal or hepatic function, or if such a drug is necessary, initiate it at a reduced dose with close monitoring for efficacy and toxicity. This approach aligns with the core principles of geriatric pharmacotherapy, emphasizing individualized treatment plans and proactive risk mitigation to ensure patient safety and optimal outcomes, as advocated by professional bodies like the American Society of Consultant Pharmacists (ASCP) and reflected in general pharmaceutical practice standards that mandate patient-specific care. An incorrect approach would be to simply prescribe a standard dose of a commonly used analgesic without assessing the patient’s excretory function. This fails to acknowledge the profound impact of aging on drug metabolism and elimination, potentially leading to supratherapeutic drug levels and increased risk of adverse effects, such as central nervous system depression or gastrointestinal bleeding. Ethically, this constitutes a failure to provide appropriate care and a breach of the duty to protect the patient from harm. Another incorrect approach would be to immediately switch to a more potent analgesic without a thorough assessment of the underlying cause of inadequate pain relief. This overlooks the possibility that the current analgesic may be ineffective due to altered pharmacokinetics or pharmacodynamics related to aging, or that the pain itself has changed. It also bypasses the crucial step of evaluating renal and hepatic function, which is paramount when considering changes in drug excretion. This approach prioritizes symptom management over a holistic understanding of the patient’s physiological state and drug response, which is contrary to best practices in geriatric care. Finally, an incorrect approach would be to rely solely on the patient’s subjective report of pain without objective assessment of their physiological status. While patient reporting is vital, it must be integrated with objective data, particularly in the elderly where physiological changes can significantly alter drug responses. Failing to consider excretory function when adjusting pain medication in an elderly patient is a significant oversight that can lead to suboptimal or harmful outcomes. Professionals should employ a systematic decision-making framework that begins with a thorough patient assessment, including a review of their medical history, current medications, and relevant laboratory data. This should be followed by an evaluation of the specific pharmacological properties of potential treatments, considering how age-related physiological changes might impact their efficacy and safety. Finally, a plan for ongoing monitoring and reassessment should be established to ensure the treatment remains appropriate and effective.

This scenario is professionally challenging because it requires the pharmacist to balance the patient’s immediate need for pain relief with the potential for adverse drug events due to age-related metabolic changes. The pharmacist must proactively assess risk rather than reactively manage problems. Careful judgment is required to identify subtle changes in drug pharmacokinetics and pharmacodynamics that can significantly alter drug response and toxicity in older adults. The best approach involves a comprehensive risk assessment that integrates knowledge of geriatric pharmacotherapy principles with the patient’s specific clinical profile. This includes evaluating the patient’s renal and hepatic function, considering potential drug-drug interactions, and understanding how reduced body water and lean muscle mass, along with altered protein binding, can impact drug distribution and clearance. This proactive, individualized assessment aligns with ethical obligations to provide patient-centered care and regulatory expectations for safe and effective medication management, particularly for vulnerable populations like geriatric patients. It prioritizes prevention of harm through informed decision-making. An incorrect approach would be to simply prescribe the standard adult dosage without considering the patient’s age and potential for altered metabolism. This fails to acknowledge the physiological changes associated with aging that can lead to increased drug accumulation and toxicity, violating the principle of providing individualized care and potentially contravening guidelines that emphasize dose adjustments in geriatric patients. Another incorrect approach would be to rely solely on the patient’s reported tolerance of the medication in the past. While patient history is important, it does not account for potential recent changes in health status or the cumulative effects of other medications that could now impact metabolism and increase risk. This approach is reactive and overlooks the need for a current, comprehensive risk evaluation. A further incorrect approach would be to defer all decision-making to the prescribing physician without offering any pharmacist-led risk assessment or recommendations. While collaboration is essential, the pharmacist has a distinct professional responsibility to utilize their expertise in medication therapy management, including identifying and mitigating risks associated with age-related metabolic changes, before a prescription is finalized or administered. Professionals should employ a systematic approach to geriatric medication management. This involves a thorough medication review, assessment of functional status, consideration of age-related physiological changes, and evaluation of potential drug interactions. When prescribing or dispensing medications for geriatric patients, especially those with known metabolic impacts, a risk assessment should be a standard part of the process, leading to appropriate dose adjustments, selection of safer alternatives, or enhanced monitoring.

Scenario Analysis: This scenario is professionally challenging because it requires a pharmacist to balance the immediate need for medication with the potential long-term risks associated with altered drug distribution in geriatric patients. Changes in body composition, organ function, and protein binding in older adults can significantly impact how a drug is absorbed, distributed, metabolized, and excreted. Failing to account for these changes can lead to suboptimal therapeutic outcomes, increased adverse drug events, and potentially serious health consequences. Careful judgment is required to assess the individual patient’s risk factors and determine the most appropriate course of action. Correct Approach Analysis: The best professional practice involves a comprehensive risk assessment that prioritizes patient safety and adherence to evidence-based geriatric pharmacotherapy principles. This approach involves evaluating the patient’s current clinical status, including renal and hepatic function, hydration status, nutritional status, and any co-existing conditions that might affect drug distribution. It also necessitates reviewing the specific medication’s pharmacokinetic profile and its known effects in the elderly population. Based on this holistic assessment, the pharmacist should then collaborate with the prescriber to adjust the dosage, formulation, or even consider alternative medications if necessary, ensuring the patient receives the most appropriate and safest therapy. This aligns with the ethical obligation to provide patient-centered care and the professional responsibility to ensure medication safety, particularly for vulnerable populations like geriatric patients. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the prescribed dosage without any modification, assuming standard dosing is always appropriate. This fails to acknowledge the significant physiological changes that occur with aging, which can lead to altered drug distribution and potentially toxic drug levels or reduced efficacy. This approach disregards the fundamental principles of geriatric pharmacotherapy and the pharmacist’s role in mitigating drug-related risks. Another incorrect approach is to immediately discontinue the medication without consulting the prescriber. While caution is warranted, abrupt discontinuation of certain medications can lead to withdrawal symptoms or a relapse of the condition being treated. This bypasses the collaborative nature of patient care and can negatively impact the patient’s health outcomes. A third incorrect approach is to only consider the patient’s reported symptoms without objectively assessing objective clinical parameters like renal function or albumin levels. Symptoms alone may not fully reveal the extent of altered drug distribution, and a thorough clinical assessment is crucial for making informed decisions about medication management in geriatric patients. Professional Reasoning: Professionals should employ a systematic approach to medication management in geriatric patients. This involves: 1) Recognizing the unique physiological changes associated with aging and their impact on pharmacokinetics and pharmacodynamics. 2) Conducting a thorough patient assessment, including a review of current medications, comorbidities, renal and hepatic function, nutritional status, and functional status. 3) Utilizing evidence-based guidelines and resources specific to geriatric pharmacotherapy. 4) Collaborating effectively with prescribers to optimize medication regimens, considering dose adjustments, alternative formulations, or different therapeutic agents when indicated. 5) Educating patients and caregivers about potential risks and benefits, and monitoring for therapeutic response and adverse effects.

Scenario Analysis: This scenario is professionally challenging because it involves a complex interplay between pharmacodynamics, the aging process, and the potential for adverse drug events. The monitoring system has flagged a potential issue, but the underlying cause is not immediately obvious. Differentiating between a true pharmacodynamic shift due to aging, a drug-drug interaction, or an underlying disease exacerbation requires careful clinical assessment and a systematic approach to risk management. The pharmacist must balance the need for effective treatment with the heightened vulnerability of geriatric patients to side effects and altered drug responses. Correct Approach Analysis: The best professional practice involves a comprehensive assessment of the patient’s current medication regimen, including dosage, timing, and indication for each drug, in conjunction with a review of their recent clinical status, including vital signs, laboratory results, and any reported symptoms. This approach is correct because it directly addresses the core principles of geriatric pharmacotherapy, which emphasize individualized care, polypharmacy management, and the recognition of age-related physiological changes that can alter drug responses. Specifically, understanding how aging affects drug absorption, distribution, metabolism, and excretion (pharmacokinetics) and how drugs interact with altered physiological systems (pharmacodynamics) is paramount. This systematic review allows for the identification of potential contributing factors to the observed change, such as altered receptor sensitivity, reduced organ function, or cumulative pharmacodynamic effects. This aligns with ethical obligations to provide safe and effective patient care and regulatory expectations for pharmacists to actively monitor and manage drug therapy. Incorrect Approaches Analysis: One incorrect approach would be to immediately adjust the dosage of the flagged medication without further investigation. This is professionally unacceptable because it fails to identify the root cause of the observed change. The flagged response might not be solely due to the targeted medication’s pharmacodynamics in the elderly; it could be a consequence of a drug-drug interaction, a new or worsening comorbidity, or even a non-pharmacological factor. Such an adjustment risks either undertreating the original condition or introducing new adverse effects without addressing the actual problem, violating the principle of providing evidence-based and patient-centered care. Another incorrect approach would be to dismiss the monitoring system’s alert as a false positive without any clinical correlation. This is professionally unacceptable as it disregards a valuable tool designed to enhance patient safety. Geriatric patients are particularly susceptible to subtle changes in drug response, and a monitoring system can be crucial in detecting these early. Ignoring such alerts can lead to delayed intervention, potentially resulting in significant harm to the patient and a failure to meet professional standards of care and vigilance. A further incorrect approach would be to focus solely on the pharmacokinetics of the flagged medication without considering its pharmacodynamic implications in the context of the patient’s overall health status. While pharmacokinetic changes are important in the elderly, pharmacodynamic alterations, such as changes in receptor sensitivity or downstream signaling pathways, are equally critical and can manifest even with seemingly appropriate pharmacokinetic profiles. Neglecting this aspect means missing a crucial piece of the puzzle in understanding why a drug’s effect might be different or more pronounced in an older adult. Professional Reasoning: Professionals should employ a systematic approach to medication review and patient assessment. This involves: 1) Acknowledging and investigating alerts from monitoring systems. 2) Conducting a thorough medication reconciliation, considering all prescribed and over-the-counter agents. 3) Evaluating the patient’s current clinical status, including symptoms, vital signs, and relevant laboratory data. 4) Considering age-related physiological changes and their impact on both pharmacokinetics and pharmacodynamics. 5) Identifying potential drug-drug and drug-disease interactions. 6) Formulating a differential diagnosis for the observed change. 7) Developing and implementing a patient-specific management plan, which may include dose adjustments, drug discontinuation, or initiation of new therapy, always with ongoing monitoring.

This scenario presents a professional challenge because it requires balancing the patient’s immediate comfort and perceived needs with the pharmacist’s ethical and professional responsibility to ensure safe and effective medication use, especially in a vulnerable geriatric population where pharmacokinetic changes are significant. The pharmacist must navigate potential patient or caregiver pressure against established clinical guidelines and the principles of geriatric pharmacotherapy. Careful judgment is required to avoid oversimplification or a purely reactive approach to symptom management. The best professional approach involves a comprehensive assessment of the patient’s current medication regimen and their pharmacokinetic profile in the context of their age-related physiological changes. This includes evaluating potential drug-drug interactions, altered drug metabolism and excretion, and the impact of comorbidities on drug efficacy and safety. This approach is correct because it directly addresses the core issue of altered pharmacokinetics in the elderly, which can lead to increased risk of adverse drug events and reduced therapeutic outcomes. It aligns with the ethical imperative to provide patient-centered care that is evidence-based and prioritizes patient safety, as mandated by professional practice standards for geriatric pharmacotherapy. This proactive and analytical method ensures that any medication adjustments are made with a thorough understanding of the underlying physiological mechanisms and potential consequences. An incorrect approach would be to simply increase the dosage of the prescribed medication to alleviate the patient’s reported symptoms without further investigation. This fails to acknowledge the altered pharmacokinetics in the elderly, where reduced clearance or increased sensitivity can lead to toxicity at standard doses. Ethically, this bypasses the pharmacist’s duty to critically evaluate medication appropriateness and safety. Another incorrect approach would be to dismiss the patient’s reported symptoms as a normal part of aging without exploring potential medication-related causes. This demonstrates a failure to recognize the significant impact of pharmacokinetics on drug response in older adults and neglects the pharmacist’s responsibility to advocate for the patient’s well-being and investigate all possible contributors to their condition. A further incorrect approach would be to immediately discontinue the medication based solely on the patient’s subjective report of discomfort, without considering the therapeutic benefits or potential withdrawal effects. This reactive measure ignores the need for a systematic evaluation of the drug’s pharmacokinetic profile and its role in the patient’s overall treatment plan, potentially jeopardizing the management of their underlying condition. Professionals should employ a systematic decision-making framework that begins with a thorough patient assessment, including a review of their medication history, comorbidities, and physiological status. This should be followed by an analysis of the patient’s pharmacokinetic profile in relation to their age and any observed symptoms. Consultation with the prescribing physician for potential medication adjustments or alternative therapies, based on this comprehensive evaluation, is a crucial step. The ultimate goal is to optimize therapy for safety and efficacy, respecting the unique physiological characteristics of the geriatric patient.

This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the pharmacist’s professional judgment regarding their capacity to make informed decisions about their medication. The pharmacist must navigate the ethical imperative to respect patient autonomy while also upholding their responsibility to ensure patient safety and well-being, especially in the context of geriatric care where cognitive changes can impact decision-making. Careful judgment is required to balance these competing principles. The best professional approach involves a thorough assessment of the patient’s capacity to understand their treatment options, the risks and benefits involved, and the consequences of their decisions. This includes engaging in a direct conversation with the patient to gauge their comprehension, exploring their reasoning for refusing the medication, and identifying any potential barriers to adherence or understanding. If, after this assessment, the pharmacist reasonably believes the patient lacks the capacity to make an informed decision, the next step is to involve the patient’s designated healthcare proxy or a family member who can act in the patient’s best interest, while continuing to advocate for the patient’s well-being and ensuring their wishes are considered to the extent possible within the bounds of their capacity. This aligns with ethical principles of beneficence, non-maleficence, and respect for autonomy, and is supported by professional guidelines that emphasize patient-centered care and the pharmacist’s role in medication therapy management. An approach that immediately overrides the patient’s wishes and administers the medication without further assessment or consultation with a surrogate decision-maker is ethically problematic. It disrespects the patient’s autonomy and can erode trust. Similarly, an approach that simply accepts the patient’s refusal without exploring the underlying reasons or assessing their capacity fails to uphold the pharmacist’s duty of care and could lead to suboptimal health outcomes. Furthermore, an approach that involves informing the patient’s physician of the refusal but taking no further action to assess capacity or involve other parties neglects the pharmacist’s direct responsibility in ensuring safe and effective medication use. Professionals should employ a decision-making framework that prioritizes patient assessment. This involves first gathering information about the patient and their situation, then identifying the core ethical and professional issues, exploring potential courses of action, evaluating the consequences of each action based on ethical principles and professional standards, and finally, selecting and implementing the most appropriate course of action, followed by reflection and evaluation. In cases of potential diminished capacity, a structured approach to capacity assessment and appropriate escalation to surrogate decision-makers is crucial.

This scenario is professionally challenging because it requires balancing the patient’s immediate needs and preferences with the pharmacist’s responsibility to ensure safe and effective medication management, particularly in a vulnerable geriatric population. The complexity arises from potential cognitive impairment, polypharmacy, and the need for ongoing assessment of treatment efficacy and adverse effects, all within the framework of patient autonomy and professional duty of care. The best professional approach involves a comprehensive, multi-faceted follow-up strategy that prioritizes direct patient engagement and objective data collection. This includes scheduling regular follow-up appointments with the patient and/or their caregiver to assess adherence, identify any emerging side effects or drug interactions, and evaluate the effectiveness of the current medication regimen. Simultaneously, obtaining objective data through laboratory monitoring, as indicated by the specific medications and the patient’s comorbidities, is crucial for detecting sub-therapeutic levels, toxicities, or organ dysfunction. This integrated approach ensures that medication therapy is optimized, risks are mitigated, and the patient’s quality of life is maintained, aligning with the principles of patient-centered care and professional responsibility to monitor therapeutic outcomes. An approach that solely relies on patient self-reporting without objective verification is professionally unacceptable. This fails to account for potential memory deficits, misunderstanding of instructions, or the subtle onset of adverse effects that a patient may not recognize or report. It neglects the pharmacist’s ethical and professional obligation to actively monitor for therapeutic efficacy and safety, potentially leading to undertreatment or serious adverse events. Another professionally unacceptable approach is to focus exclusively on laboratory monitoring without engaging the patient or caregiver. While objective data is vital, it does not provide a complete picture of the patient’s experience. This method overlooks crucial information regarding adherence, functional status, quality of life, and patient-reported symptoms, which are essential for holistic medication management and patient satisfaction. Finally, an approach that delegates all follow-up responsibilities to the prescribing physician without proactive pharmacist involvement is also professionally deficient. While collaboration with physicians is paramount, the pharmacist has a distinct role in medication therapy management, including ongoing monitoring and patient education. Abdicating this responsibility can lead to missed opportunities for early intervention, suboptimal medication outcomes, and a breakdown in the continuity of care. Professionals should employ a systematic decision-making process that begins with a thorough assessment of the patient’s medication regimen, comorbidities, and potential risk factors. This should be followed by the development of a personalized monitoring plan that incorporates patient interviews, caregiver input, objective laboratory data, and regular reassessment of therapeutic goals. Proactive communication and collaboration with the healthcare team are essential throughout the process.

The analysis reveals a scenario that is professionally challenging due to the inherent conflict between a patient’s expressed preferences and the pharmacist’s clinical judgment regarding the appropriateness of a prescribed therapy. This requires careful consideration of patient autonomy, professional responsibility, and adherence to ethical guidelines and professional standards of practice. The pharmacist must navigate the complexities of geriatric pharmacotherapy, where polypharmacy, comorbidities, and altered pharmacokinetics can significantly impact drug efficacy and safety. The best approach involves a comprehensive medication review that prioritizes patient-centered care while upholding professional standards. This includes engaging in a direct, empathetic conversation with the patient to understand their rationale for requesting the medication, their perceived benefits, and any concerns they may have. Simultaneously, the pharmacist must conduct a thorough clinical assessment of the patient’s current health status, existing conditions, and other medications to objectively evaluate the appropriateness of the prescribed therapy. This assessment should be informed by current evidence-based guidelines for geriatric pharmacotherapy and consider potential drug-drug interactions, adverse effects, and the patient’s functional status and goals of care. If the assessment reveals the therapy to be inappropriate or potentially harmful, the pharmacist should then initiate a collaborative discussion with the prescribing physician, presenting their findings and recommending alternative, evidence-based treatment options that align with the patient’s needs and preferences. This collaborative approach respects the roles of all healthcare providers and ensures the patient receives optimal, safe, and appropriate care. An incorrect approach would be to immediately refuse to dispense the medication based solely on the patient’s request without a thorough clinical assessment. This fails to acknowledge the patient’s right to participate in their healthcare decisions and may alienate the patient, potentially leading to non-adherence or seeking care elsewhere without proper oversight. Another incorrect approach would be to dispense the medication without addressing the underlying clinical concerns, thereby potentially exposing the patient to unnecessary risks or suboptimal treatment outcomes. This abdication of professional responsibility to assess and ensure therapeutic appropriateness is ethically and professionally unacceptable. Finally, solely relying on the prescriber’s order without independent clinical review, especially in a geriatric population where complex factors are at play, overlooks the pharmacist’s crucial role in medication safety and optimization. Professionals should employ a decision-making framework that begins with patient-centered communication, followed by objective clinical assessment informed by evidence-based practice and professional guidelines. This framework emphasizes the pharmacist’s role as a medication expert and patient advocate, necessitating collaboration with other healthcare professionals to achieve the best possible patient outcomes.

This scenario presents a common challenge in geriatric pharmacotherapy: managing polypharmacy and potential drug-drug interactions in an elderly patient with multiple comorbidities. The professional challenge lies in balancing the benefits of necessary medications with the risks of adverse events, particularly in a population with altered pharmacokinetics and pharmacodynamics. Careful judgment is required to individualize therapy, considering the patient’s specific clinical status, functional capacity, and potential for drug interactions. The best professional approach involves a comprehensive medication review, prioritizing deprescribing of non-essential medications and optimizing the regimen for efficacy and safety. This includes assessing the indication for each medication, evaluating its effectiveness, identifying potential duplications or interactions, and considering the patient’s goals of care. This systematic process, often guided by established deprescribing guidelines and clinical judgment, aims to reduce the pill burden and minimize the risk of adverse drug events, aligning with the principles of patient-centered care and pharmacoeconomic responsibility. Regulatory frameworks and professional guidelines emphasize the importance of regular medication reconciliation and review, especially in vulnerable populations like the elderly, to ensure appropriate and safe medication use. An incorrect approach would be to simply add a new medication to manage a symptom without re-evaluating the existing regimen. This fails to address the potential contribution of current medications to the patient’s symptoms or the risk of additive side effects and drug interactions. Ethically, this approach neglects the duty to provide comprehensive care and may lead to iatrogenic harm. Another incorrect approach is to discontinue a medication solely based on a single reported side effect without considering its therapeutic necessity or exploring alternative management strategies. This could lead to undertreatment of a serious condition and compromise patient outcomes. Professional responsibility dictates a balanced assessment of risks and benefits before altering established therapy. Finally, relying solely on patient self-report without objective assessment or medication reconciliation is also professionally unacceptable. While patient input is valuable, it must be corroborated with objective clinical data and a thorough review of the medication list to ensure accurate diagnosis and appropriate management. Professionals should employ a decision-making framework that begins with a thorough medication history and reconciliation. This is followed by an assessment of each medication’s indication, efficacy, and safety profile in the context of the patient’s comorbidities and functional status. The framework then involves identifying opportunities for deprescribing, dose optimization, or substitution, always prioritizing patient safety and shared decision-making.