Biology of frailty: Implications for clinical pharmacology and drug therapy in frail older people

Hilmer, Sarah N.; Wu, Harry; Zhang, Meggie

doi:10.1016/j.mad.2019.111119

Cited by 35 publications

(24 citation statements)

References 73 publications

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“…Adverse effects associated with such drugs may therefore be potentiated. Changes in pharmacokinetics and pharmacodynamics may be amplified in older adults with frailty, making them particularly vulnerable to adverse drug events [22,23]. Whilst beyond the scope of this paper, a recent review has considered medication use in frailty in more detail [24].…”

Section: Age-related Prescribing Considerationsmentioning

confidence: 99%

An Update on Medication Use in Older Adults: a Narrative Review

Barry

Hughes

2021

Curr Epidemiol Rep

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Purpose of Review The global phenomenon of population aging is impacting the health and care needs of society. The use of medications by older adults is acknowledged to be the most common form of medical intervention for many acute and chronic conditions and prescribing in this population continues to increase. In this narrative review, we summarise the age-related factors that should be considered when prescribing for older adults, address some of the perennial challenges related to medicine use in older people, and highlight important emerging research in this area. Recent Findings A range of age-related factors should be considered when prescribing for older adults. However, the evidence base still lacks data pertaining to older adults due to their continued under-representation in clinical trials. Multimorbidity, polypharmacy, and inappropriate prescribing continue to remain prevalent among older adults, although recent research has been focused on the development and evaluation of complex interventions to address these challenges. Summary Further high-quality studies of interventions to improve and support medication use in older adults are needed, ensuring that older adults are well represented in such trials and consideration is given to the measurement of patient- and provider-focused outcomes.

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Section: Age-related Prescribing Considerationsmentioning

confidence: 99%

An Update on Medication Use in Older Adults: a Narrative Review

Barry

Hughes

2021

Curr Epidemiol Rep

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“…Population-based studies have demonstrated that polypharmacy is independently associated with increased risks of adverse geriatric outcomes such as delirium, falls, frailty, cognitive impairment and hospitalization. [2][3][4][5] With increasing burdens of geriatric syndromes and age-related diseases, [6][7][8] there is significant public interest in reducing medication-related harms in older people. 9 Reduction of inappropriate polypharmacy is a major public health goal identified by the World Health Organization Third Global Patient Safety Challenge: Medication Without Harm.…”

Section: Introductionmentioning

confidence: 99%

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Wu¹,

O’Donnell²,

Fujita³

et al. 2021

IJGM

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Polypharmacy is a major challenge in healthcare for older people, and is associated with increased risks of adverse outcomes, such as delirium, falls, frailty, cognitive impairment and hospitalization. There is significant public and professional interest in the role of deprescribing in reducing medication-related harms in older people. We aim to provide a narrative review of 1) the safety and efficacy of deprescribing interventions, 2) the challenges and solutions of deprescribing research and implementation in clinical practice, and 3) the benefits of using Computerized Clinical Decision Support Systems (CCDSS) and Quality Indicators (QIs) in deprescribing research and practice. Deprescribing is an established management strategy to minimize polypharmacy and potentially inappropriate medications. There is limited clinical evidence for its efficacy on global and geriatric outcomes. Various challenges at patient, healthcare professional and healthcare system levels may impact on the success of deprescribing interventions in research and practice. Management strategies that target all levels of the healthcare system are required to overcome these challenges. Future studies may consider large multicenter prospective designs to establish the effects and sustainability of deprescribing interventions on clinical outcomes.

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“…Frailty, defined as a state of vulnerability that carries an increased risk of poor outcomes in older adults, is common ( 1 ). Frailty is a complex process that involves multiple system impairments and has been shown to cause altered responses to some medical therapies ( 2 ). Aging and frailty are associated with many physiological changes that can alter drug absorption, distribution, metabolism, and excretion ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…Frailty is a complex process that involves multiple system impairments and has been shown to cause altered responses to some medical therapies ( 2 ). Aging and frailty are associated with many physiological changes that can alter drug absorption, distribution, metabolism, and excretion ( 2 , 3 ). Experimental studies have shown that compared with the nonfrail, frail older people have increased body fat, reduced lean body mass, and lower levels of serum albumin ( 1 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…Experimental studies have shown that compared with the nonfrail, frail older people have increased body fat, reduced lean body mass, and lower levels of serum albumin ( 1 , 3 ). In addition, decreased liver metabolism and reduced renal clearance have also been observed in the frail ( 2 ). Some studies showed that responses to therapies were altered in frail people, such as influenza and pneumococcal vaccines ( 4 – 6 ) and antithrombotic medications ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Frailty on the Effectiveness and Safety of Intensive Glucose Control and Blood Pressure–Lowering Therapy for People With Type 2 Diabetes: Results From the ADVANCE Trial

et al. 2021

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To develop a frailty index (FI) and explore the relationship of frailty to subsequent adverse outcomes on the effectiveness and safety of more intensive control of both blood glucose and blood pressure (BP), among participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESEARCH DESIGN AND METHODSCox proportional hazard models were used to estimate the effectiveness and safety of intensive glucose control and BP intervention according to frailty (defined as FI >0.21) status. The primary outcomes were macro-and microvascular events. The secondary outcomes were all-cause mortality, cardiovascular mortality, severe hypoglycemia, and discontinuation of BP treatment due to hypotension/dizziness. RESULTSThere were 11,140 participants (mean age, 65.8 years; 42.5% women, 25.7% frail). Frailty was an independent predictor of all primary outcomes and secondary outcomes. The effect of intensive glucose treatment on primary outcomes showed some evidence of attenuation in the frail: hazard ratios for combined major macro-and microvascular events 1.03 (95% CI 0.90-1.19) in the frail versus 0.84 (95% CI 0.74-0.94) in the nonfrail (P = 0.02). A similar trend was observed with BP intervention. Severe hypoglycemia rates (per 1,000 person-years) were higher in the frail

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Biology of frailty: Implications for clinical pharmacology and drug therapy in frail older people

Cited by 35 publications

References 73 publications

An Update on Medication Use in Older Adults: a Narrative Review

An Update on Medication Use in Older Adults: a Narrative Review

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

The Impact of Frailty on the Effectiveness and Safety of Intensive Glucose Control and Blood Pressure–Lowering Therapy for People With Type 2 Diabetes: Results From the ADVANCE Trial

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