Abstract
Frailty is a geriatric condition associated with increased vulnerability to adverse
drug events and medication-related harm. Existing clinical practice guidelines rarely
provide medication management recommendations specific to frail older people. This
report presents international consensus principles, generated by the Optimizing Geriatric
Pharmacotherapy through Pharmacoepidemiology Network, related to medication management
in frail older people. This consensus comprises 7 principles for clinical practice,
6 principles for research, and 4 principles for education. Principles for clinical
practice include (1) perform medication reconciliation and maintain an up-to-date
medication list; (2) assess and plan based on individual's capacity to self-manage
medications; (3) ensure appropriate prescribing and deprescribing; (4) simplify medication
regimens when appropriate to reduce unnecessary burden; (5) be alert to the contribution
of medications to geriatric syndromes; (6) regularly review medication regimens to
align with changing goals of care; and (7) facilitate multidisciplinary communication
among patients, caregivers, and healthcare teams. Principles for research include
(1) include frail older people in randomized controlled trials; (2) consider frailty
status as an effect modifier; (3) ensure collection and reporting of outcome measures
important in frailty; (4) assess impact of frailty on pharmacokinetics and pharmacodynamics;
(5) encourage frailty research in under-researched settings; and (6) utilize routinely
collected linked health data. Principles for education include (1) provide undergraduate
and postgraduate education on frailty; (2) minimize low-value care related to medication
management; (3) improve health and medication literacy; and (4) incorporate evidence
in relation to frailty into clinical practice guidelines. These principles for clinical
practice, research and education highlight different considerations for optimizing
medication management in frail older people. These principles can be used in conjunction
with existing best practice guidelines to help achieve optimal health outcomes for
this vulnerable population. Implementation of the principles will require multidisciplinary
collaboration between healthcare professionals, researchers, educators, organizational
leaders, and policymakers.
Keywords
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Article info
Publication history
Published online: July 12, 2020
Footnotes
The consensus principles have been endorsed by the International Conference on Frailty and Sarcopenia Research (ICFSR), the European Geriatric Medicine Society (EuGMS), and the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR).
SJL was supported by a postgraduate research scholarship funded by the Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, and the Australian Government Research Training Program Scholarship. SJL and RV were supported by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing. JKS was supported by a NHMRC Early Career Fellowship. AH was supported by a grant from the Pro Humanitate Foundation. ECKT was supported by NHMRC-ARC Dementia Research Development Fellowship. JSB was supported by a NHMRC Boosting Dementia Research Leadership Fellowship.
MC received honorarium from Nestlé for presentations at scientific meetings and held membership on the scientific advisory board. MC also received honorarium from Nutricia for presentations at scientific meetings. SH received a lecture fee from Astellas. RV was on the Clinical Governance Committee of Resthaven Inc. RV undertook consultancy for Nestlé. RV also received honoraria, travel, and accommodation support from Nestlé, Abbott and Nutricia over the past 3 years. JSB received grant income paid to his employer from NHMRC, Australian Government Department of Health, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, GlaxoSmithKline and several aged care provider organizations. There are no other conflicts of interest to declare.
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