Medical licensing for older people

Abstract

Older people are the largest users of medications. Prescribing in later life differs significantly from younger adults. However, older people are under-represented in drug trials and geriatric medicine input is lacking in regulation and prescribing guidelines. We investigated geriatric medicine input in European Union and European Economic Area medicine licensing agencies. A questionnaire concerning geriatric medical input to medication licensure, including comparative questions on prescribing to children, was mailed to 31 national EU and EEA medication licensing agencies in 2009. Two further email reminders followed: 21/31 (68%) responded. While 6/21 (29%) national agencies have specific committees for review of medications relating to children, only 2/21 (10%) have committees for older people. Eleven agencies out of 21 (52%) have specific policies relating to licensing of medications to children while 2/21 (10%) have policies for older people. Six agencies out of 21 (29%) have geriatricians sitting on medical advisory boards. Ten agencies out of 21 (48%) have access to geriatricians to advise medical advisory boards. Five national agencies out of 21 (24%) have policies relating to exclusion of potential patients by age in studies presented to them regarding licensing medications for adults. Fourteen agencies out of 21 (67%) felt input from geriatric medicine would be useful and 7/21 (33%) helpful in evaluating drugs. Expertise in geriatric medicine is under-represented in national prescribing agencies of European countries, with 90% having neither committees nor policies relating to prescribing to older people. It is encouraging that over 67% acknowledge that geriatric medicine input would be beneficial: geriatricians, advocacy groups, national agencies and the European Medicines Agency need to work together to ensure that drug licensing policies in Europe reflect the more diverse needs of older people.