Increasing recognition of the burden associated with iatrogenic disease has led to international interest into how best to promote patient safety. Within this field, the subject of adverse drug events (ADEs) has received particular attention, this reflecting the known high frequency with which such events occur, particularly in the elderly.We conducted a narrative review summarizing epidemiological data on medication-related adverse events in elderly people, considering various known causes of such events and suggesting practical ways in which prescribing can be made safer for high-risk populations.There is an increasing recognition that a relatively high proportion of ADEs in the elderly may be preventable. Systems issues have been found to play a particularly powerful role in this context, resulting in several promising approaches to address the problem.Relatively simple system changes have the potential to reduce the burden associated with medication-related adverse events in the elderly.