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Drug treatment is central in the management of most chronic conditions, leading to extensive drug use in older people. The risk of medication-related problems (MRPs), including under-prescribing, is pronounced in older people, especially among those with cognitive impairment.

The aim of the thesis was to describe cardiovascular drug treatment and to develop an intervention to improve drug treatment among older people.

Paper I and II had similar overall aims to describe cardiovascular drug use and associated factors among older people. Paper I was based on the AC2007 (n=2494) and AC2013 (n=1654) data collections comprising people 65 years and older living in nursing homes. In paper II, the study population consisted of 2186 persons from the Umeå 85+/GERDA database. The four data collections, conducted in 2000-2002, 2005-2007, 2010-2012 and 2015-2017, included very old people regardless of living conditions. The results showed increased use of guidelines-recommended drug classes for cardiovascular diseases over time. Nevertheless, older age and cognitive impairment were associated with lower use of guidelines-recommended treatment of heart failure and atrial fibrillation, indicating under-prescribing linked to these factors.

Paper III described a randomized controlled trial (RCT), where a clinical pharmacist-led follow-up programme was developed with the purpose to reduce medication-related hospital readmission among people 75 years and older in transitions of care. Among the 194 participants, for which data collection was complete, approximately 60% received all components of the follow-up programme, with a minimum deliverance of 78% of an isolated component. The mean number of identified MRPs (0.88) and discrepancies (0.42) per person were lower compared to similar studies, likely due to prior medication reviews during hospitalisation. 

In paper IV, where semi-structured interviews were conducted with nine participants from the RCT, the experiences were diverse in some respects. A few participants appreciated the help they had received and thought their treatment had improved, while others did not recall the intervention and saw limited benefit of it. Telephone follow-up was well-accepted by the majority participants, and the clinical pharmacists were considered knowledgeable with good communication skills. However, the role of the clinical pharmacist seemed unclear. 

In conclusion, the findings indicate improved adherence to treatment guidelines for cardiovascular diseases over time and increased awareness among prescribers of previously reported under-prescribing to older people. The results also suggest that clinical pharmacists could play a more active role in optimising medication treatment during transitions of care. This thesis highlights the importance of tailoring medication therapy and information to each individual.