There is a foundational assumption embedded in almost every prescription written in modern medicine.

That the person receiving the drug is physiologically similar to the people in whom the drug was tested.

That their kidneys clear drugs at roughly the same rate. That their liver processes drugs through the same pathways at the same speed. That their brain responds to drug concentrations with the same sensitivity. That their body distributes the drug through the same physiological spaces in the same proportions.

This assumption is reasonable when the prescription is written for a 45-year-old with a single condition and a single medication.

It is physiologically incorrect — and potentially dangerous — when the prescription is written for a 78-year-old with five conditions, eight medications, reduced kidney function, reduced liver mass, lower protein levels, a more sensitive brain, and a body composition that has shifted fundamentally from the younger adults whose data determined the dose on the package insert.

And yet the same dose is frequently written. The same monitoring schedule is applied. The same safety thresholds are used.

Because medicine was built on evidence generated predominantly in middle-aged adults — and the translation of that evidence to the fastest-growing and most medicated demographic in the developed world has been incomplete, inconsistent, and in many cases dangerous.

Adults over 65 consume approximately 36% of all prescription medications in the United States while comprising approximately 16% of the population.

Adults over 65 account for approximately 30% of all adverse drug reaction hospitalisations.

The leading cause of preventable harm in older adults is not surgical error or diagnostic delay.

It is medication.

Not because older adults should not take medication. Many medications are essential, genuinely life-extending, and improve quality of life in older people who take them appropriately.

But because the prescribing of those medications — in doses calibrated for younger physiology, monitored with tools insensitive to older adults' actual drug exposure, and reviewed in 15-minute consultations that cannot encompass the complexity of the ageing pharmacological body — is one of the most consistently underaddressed patient safety challenges in modern medicine.

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