Bastiaan Sallevelt

20 CHAPTER 1 Objectives of this thesis The general aim of this thesis is to investigate strategies for medication optimisation in hospitalised older people with polypharmacy and multimorbidity. This aim was divided into the following objectives: 1. To evaluate the applicability of medication optimisation tools recommended by clinical practice guidelines; 2. To develop a process for in-hospital medication review using implicit and explicit medication optimisation tools; 3. To investigate the effect of an in-hospital medication review in older people with multimorbidity and polypharmacy on clinical outcomes; 4. To evaluate the process of the in-hospital medication review to formulate recommendations for future refinement of the medication review process.