Precision oncology can guide treatment selection and treatment omission in older adults, but molecular actionability alone does not establish an acceptable individual benefit-burden balance. This focused narrative review examines tumor biology, host vulnerability, and implementation barriers, prioritizing randomized trials, prospective cohorts, and guidance published during 2019-2025. Clonal hematopoiesis complicates plasma variant interpretation, and genomic risk must be distinguished from prediction of treatment benefit. The GAP70+ and GAIN trials demonstrate that geriatric assessment linked to management reduces serious treatment toxicity in general oncology; their results do not directly validate geriatric integration into molecular tumor boards. Older-adult studies including RESPECT, EORTC 75111-10114, Alliance A171601, and ASTER 70s inform specific biomarker-selected treatment decisions while exposing limitations in evidence for frail patients. Targeted treatment may complement chemotherapy as maintenance, and de-escalation requires indication-specific evidence. Genomic assays in early breast cancer should be requested when the result can change a realistic treatment choice, rather than offered or withheld solely according to age. Existing American Society of Clinical Oncology (ASCO), Food and Drug Administration (FDA), and European Organisation for Research and Treatment of Cancer (EORTC) responses to underrepresentation provide a foundation for more inclusive research. A proposed clinical framework combines validated molecular evidence, geriatric assessment, medication review, and shared decisions, with reassessment of function and goals. Prospective evaluation should establish whether this integration improves treatment delivery, function, quality of life, and goal concordance.

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.