Smart Pharmacies in Geriatric Care: An IoT Framework for Medication Adherence and Polypharmacy Management

Older adults visit community pharmacies more regularly than virtually any other part of the healthcare system, which places these settings in a natural position to support polypharmacy management. The Internet of Things (IoT) opens a realistic path to turning pharmacies into active, data-generating nodes within geriatric care networks, yet no integrated framework has so far mapped what this would look like in practice. Based on a systematic literature search covering 74 peer-reviewed studies (January 2020-January 2026; PubMed, Scopus, Web of Science; 30 countries), supplemented by a targeted search on IoT frameworks and geriatric care, this narrative review proposes a four-layer conceptual framework for IoT-based geriatric medication management. The framework covers sensing and capture, local clinical decision support, network integration, and patient engagement; applied to older adults, it supports polypharmacy reconciliation, opportunistic point-of-care screening, and chronic disease adherence monitoring. Three barriers persist: interoperability gaps, limited digital literacy among pharmacists and patients, and unequal access to digital infrastructure. Realising the pharmacy’s potential as an IoT-enabled care node requires enforced interoperability standards, sustained investment in pharmacist digital training, and deployment strategies that explicitly protect those most at risk of digital exclusion.