Frailty: A key indicator to minimize inappropriate medication in older people

Abstract

Older populations are more likely to have multiple co-morbid diseases that require multiple treatments, which make them a large consumer of medications. As a person grows older, their ability to tolerate medications becomes less due to age-related changes in pharmacokinetics and pharmacodynamics often heading along a paththat leads to frailty. Frail older persons often have multiple co-morbidities with signs of impairment in activities of daily living. Prescribing drugs for these vulnerable individuals is difficult and is a potentially unsafe activity. Inappropriate prescribing in older population can be detected using explicit (criterion-based) or implicit (judgment-based) criteria. Unfortunately, most current therapeuticguidelines are applicable only to healthy older adults and cannot be generalized tofrail patients. These discrepancies should be addressed either by developing new criteria or by refining the existing tools for frail older people. The first andforemost step is to identify the frail patient in clinical practice by applying clinically validated tools. Once the frail patient has been identified, there is a needfor specific measures or criteria to assess appropriateness of therapy that consider such factors as quality of life, functional status and remaining life expectancy and thus modified goals of care. © The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.