Clinical Decision Support Systems (CDSS) for older adults – impact depends on implementation

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Clinical Decision Support Systems (CDSS) for older adults – impact depends on implementation

Science to Practice
Latest highlights on drug safety and efficacy

3.8.2026

Healthcare professional handing medication to an older adult during a medication review consultation.

Older adults are particularly vulnerable to medication-related harm due to multimorbidity and polypharmacy. In a 2025 systematic review of 16 randomised controlled trials (135,108 participants), CDSS interventions reduced initiation of new potentially inappropriate medications (PIMs) by up to 18% and increased deprescribing of pre-existing PIMs (1). In one large hospital trial, 55.4% of patients in the CDSS group had at least one PIM discontinued compared with 29.8% in usual care (1).

Effects on adverse drug events (ADEs) were less consistent, and evidence certainty was low. Importantly, many studies reported suboptimal adherence to recommendations, with implementation rates ranging from 15% to 62% (1).

To move from “CDSS exists” to “CDSS improves outcomes,” the review implies:.

  • Improve signal-to-noise to raise adherence (15% → toward 62%).
  • Integrate deeply into EHR/workflow so recommendations are patient-specific and easy to execute.
  • Use nudges and feedback loops to sustain engagement under time pressure.
  • Pair CDSS with pharmacist-led, structured medication review, where the largest deprescribing gains (~20–30% absolute) are seen.

CDSS can improve medication safety in older adults, but only if clinicians use it. The greatest benefits come from workflow-integrated, high-acceptance implementation.

CDSS works best as part of a team-based, workflow-integrated medication optimisation strategy. For older adults with polypharmacy, one of the greatest impacts comes from high-acceptance implementation within the EHR.

Improving medication safety in older adults is not just about deploying CDSS – it is about designing, integrating, and governing it properly.

Learn more about how Medbase CDS helps healthcare professionals make safer, evidence-based medication decisions directly within clinical workflows.

News produced by Medbase Medical Team

References

  1. Ng Y, Hsu J, Ng N, et al. Evaluating the role of clinical decision support systems in medication safety for older people: a systematic review. Age Ageing. 2025;54(7). doi:10.1093/ageing/afaf206.

 
 

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