Iron deficiency is common in heart failure (HF) and particularly frequent in older adults, in whom it may contribute to fatigue, exercise intolerance, impaired quality of life and functional decline, even without overt anaemia. In HF, intravenous iron has shown consistent benefits on symptoms, functional capacity and health-related quality of life in selected populations, mainly with reduced ejection fraction, and some studies have suggested a reduction in recurrent HF hospitalisations. However, more recent large trials have shown less consistent effects on hard clinical outcomes and a mortality benefit remains unproven. Importantly, the evidence underpinning current recommendations is derived predominantly from younger and highly selected HF populations, creating a major evidence-to-practice gap for patients who are very old and multimorbid. Although some pivotal trials included meaningful numbers of chronologically older participants, frailty, cognitive impairment, functional dependency, multimorbidity severity and treatment burden remain poorly characterised. Diagnostic criteria used in HF are also more difficult to interpret in older adults because of chronic inflammation, renal dysfunction, malnutrition and other age-related comorbidities that influence ferritin and transferrin saturation. Preliminary evidence in HF with preserved ejection fraction suggests a possible functional benefit, but available data remain insufficient to establish effects on clinical events or applicability to frail older populations. In this structured, clinically oriented review, we examine the pathophysiology, diagnostic challenges and trial evidence for iron deficiency management in older adults with HF, with particular emphasis on the mismatch between available evidence and real-world data on patients who are older and multimorbid. We also propose an illustrative frailty-informed framework integrating conventional biomarker thresholds, expected symptomatic and functional benefit, adverse-effect risk, cognition, treatment burden and patient goals, without using frailty as an automatic exclusion criterion.

Older adults represent a rapidly expanding subgroup of patients with inflammatory bowel disease, yet they remain markedly under-represented in pivotal clinical trials, limiting age-specific estimates of drug benefit and harm. This review synthesises the available evidence on the influence of ageing on the pharmacology, efficacy and safety of orally administered targeted inflammatory bowel disease therapies, focusing on registered Janus kinase inhibitors (tofacitinib, upadacitinib, filgotinib) and sphingosine-1-phosphate receptor modulators (ozanimod, etrasimod). Because the available age-stratified evidence is sparse and heterogeneous, a narrative review methodology was chosen to map the literature and identify knowledge gaps. We pragmatically report age-related findings using the age cut-offs applied in original studies and map outcomes including clinical and endoscopic response/remission, corticosteroid sparing and adverse drug events of special interest (serious/opportunistic infections, cardiovascular and thromboembolic events, malignancies and treatment discontinuation). Across the limited age-stratified datasets, efficacy appears largely maintained in older patients, but the evidence base is heterogeneous and frequently lacks dedicated analyses. Ageing-related physiological changes, comorbidity, frailty and polypharmacy are expected to modulate pharmacokinetic and pharmacodynamic variability and to amplify the clinical relevance of class-specific safety concerns, particularly infections, major adverse cardiovascular events and malignancy signals with Janus kinase inhibition and initiation-related cardiovascular/conduction considerations with sphingosine-1-phosphate modulation. There is, however, no clear consensus on how ageing-related vulnerability, including frailty and comorbidity burden, should be defined, measured, and reported across studies, which complicates the interpretation and comparison of outcomes. In the absence of robust outcome data for older adults with inflammatory bowel disease, treatment selection should be guided by biological vulnerability (frailty, organ function, comorbidity burden) and structured risk-mitigation strategies, while future research should prioritise age- and frailty-enriched prospective studies with geriatric-relevant outcomes and long-term pharmacovigilance.

Urinary retention in older women is a clinically significant and often underdiagnosed condition with complex and multifactorial etiology. Age-related changes in bladder contractile function and bladder sensation, combined with common comorbidities such as neurologic disease, diabetic bladder dysfunction, and pelvic organ prolapse, substantially increase the risk of retention in this population. Medications commonly prescribed to older adults, including anticholinergics and antidepressants, are an often overlooked cause of urinary retention. Evaluation includes a thorough history, physical exam, medication reconciliation, and post-void residual volume, especially because symptoms of retention that are common in men are often non-specific in women. Management should be risk stratified, with acute retention requiring prompt bladder drainage and chronic urinary retention requiring assessment of symptom burden and risk of upper tract deterioration. Pharmacologic treatment options, such as alpha-blockers, have limited evidence in women and broader therapeutic options remain poorly studied in older female populations. Sacral neuromodulation can be effective for non-obstructive urinary retention in older women. This review highlights the critical need for sex-specific and age-specific trials to guide evidence-based patient-centered management of urinary retention in older women.

Pain management in older adults presents unique challenges owing to age-related physiological changes, comorbidities, polypharmacy, and heightened vulnerability to opioid-related adverse effects. This consensus review synthesizes current evidence and expert opinion on the safe and effective use of opioids in older adult patients. A multidisciplinary panel reviewed the literature, addressing the mechanisms of action of opioids, pharmacokinetic characteristics, routes of administration, pharmacology of aging, and distinctions in opioid use for cancer pain versus noncancer pain. Recommendations were developed through iterative consensus. Opioids produce analgesia primarily via μ, κ, δ opioid receptor agonism and nonclassical nociception. The receptor selectivity influences efficacy and side effect profiles. Age-related alterations, such as reduced renal and hepatic clearance, decreased lean body mass, increased body fat, and changes in protein binding, affect absorption, distribution, metabolism, and elimination, requiring dose adjustments and extended dosing intervals. The choice of route of administration (oral, transdermal, parenteral, epidural) should be based on initial needs, adherence to treatment, gastrointestinal function, and skin integrity. In older adult patients, opioid selection should be carefully considered, giving preference to agents with inactive metabolites or predictable clearance, and with conservative initial doses ("start low, go slow"), regular reassessment and proactive management of side effects, such as constipation, cognitive effects, and fall risk, are essential. For cancer pain, prioritizing potent opioids with transdermal administration for fixed-dose medication and ultrarapid acting fentanyl in pro re nata for the control of sudden pain is usually appropriate. Nevertheless, the target is the multimodal pharmacological treatment; for chronic noncancer pain, greater emphasis on therapy directed at the pathophysiology of pain, risk-benefit assessment, and time-limited use of opioids are strategic actions. Individualized opioid prescriptions in older adults, guided by pharmacologic principles, route-specific considerations, and differentiated approaches for cancer pain versus noncancer pain, optimize analgesia while minimizing harm. Further research should target age-specific dosing algorithms and long-term outcomes.