Key Message
The inaccuracy of clinical evidence on therapeutic interventions for extreme longevity (nonagenarians and centenarians) could lead to biased decision-making, influenced by age-related beliefs or misperceptions about their therapeutic needs: polypharmacy and therapeutic inertia. To date, documents on polypharmacy in nonagenarians and centenarians account for less than 0.35% of the overall available evidence on polypharmacy. Furthermore, evidence regarding therapeutic inertia is non-existent. This letter discusses polypharmacy and therapeutic inertia as potential clinical ageism scenarios resulting from the clinical evidence gaps in extreme longevity.