Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Clinical decision support systems (CDSS) are becoming more prevalent to improve medication safety in geriatric and long-term care (LTC) settings, where polypharmacy and multimorbidity pose particular risk of adverse drug events. This narrative review synthesizes evidence from a structured literature search using thematic analysis to evaluate the effectiveness of CDSS on prescribing quality, medication-related risks, and clinical outcomes in geriatric and LTC populations. CDSS consistently improves the appropriateness of prescribing across multiple studies with statistically significant reductions in potentially inappropriate medications both at initiation (up to 18% reduction) as well as system level prevalence (87.7% vs. 74.4%). These led to significant improvements in adherence to guidelines and medication appropriateness indices, as well as better identification of medication-related risks, including drug–drug interactions, therapeutic duplications and omissions regarding appropriate prescribing. CDSS also improved medication safety procedures, with discrepancies detected in up to 98% of patients and adverse drug events identified with high precision. Although these process-level improvements are encouraging, changes in clinical outcomes such as hospitalizations, mortality, and readmissions were modest or inconsistent. Alert quality and prescriber engagement, as well as system usability and integration into clinical workflows, were among the strongest determinants of effectiveness, with alert fatigue and implementation barriers reported most often. Overall, CDSS can serve as a valuable tool to improve medication use in geriatric and LTC settings, particularly relating to prescription quality and risk detection. However, translation to consistent outcomes at the patient level is lacking. Optimal impact requires a multidisciplinary care environment and robustly designed, context-appropriate systems.