Medication Management in Frail Older People: Consensus Principles for Clinical Practice, Research, and Education

Liau, Shin J.; Lalic, Samanta; Sluggett, Janet K.; Cesari, Matteo; Onder, Graziano; Vetrano, Davide Liborio; Morin, Lucas; Hartikainen, Sirpa; Hamina, Aleksi; Johnell, Kristina; Tan, Edwin C.K.; Visvanathan, Renuka; Bell, John

doi:10.1016/j.jamda.2020.05.004

Cited by 55 publications

(49 citation statements)

References 53 publications

(103 reference statements)

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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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“…Research has shown that low health literacy is associated with frailty ( Hou, 2019 ), and medication literacy is the embodiment of health literacy in the field of medicine ( Raynor, 2009 ). Frailty is associated with an increased susceptibility to adverse drug events and drug-related injuries ( Liau et al, 2021 ). However, there is no direct evidence of a link between medication literacy and frailty.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Medication Literacy and Frailty in Elderly Inpatients With Coronary Heart Disease: A Cross-Sectional Study in China

Zhou

Xue

et al. 2021

Front. Pharmacol.

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Background: Mastering medication literacy may be related to medication safety, and the identification of frailty is very important for the prognosis of coronary heart disease (CHD). Few studies have examined the relationship between medication literacy and frailty in patients with CHD. The aim of this study was to investigate the state of medication literacy and frailty in patients with CHD and to explore the relationship between medication literacy and frailty.Methods: A cross-sectional investigation evaluated 295 inpatients with CHD recruited from hospitals in Yangzhou, China. Demographic and clinical data on participants were collected using a general information questionnaire. The Chinese medication literacy scale was used to evaluate medication literacy. The Fried Frailty Phenotype scale was used to evaluate frailty. Univariate analysis employed chi-square test and Kruskal-Wallis H test to examine the potential factors affecting frailty. Taking frailty status as the outcome variable, the ordered logistic regression model was used to analyze the relationship between the degree of medication literacy and frailty. Spearman’s correlation analysis was used to analyze the correlation between medication literacy and frailty.Results: A total of 280 elderly CHD inpatients were included in the analysis. There were 116 (41.4%) individuals with inadequate medication literacy and 89 (31.8%) frail individuals. Ordered logistic regression analysis showed that the age (p < 0.001, OR = 1.089), Charson Comorbidity Index (p = 0.029, OR = 1.300), number of medications taken (p = 0.012, OR = 1.137), and medication literacy (p < 0.05, OR > 1) were independent predictors of debilitating risk factors. The population with inadequate medication literacy had a 2.759 times greater risk of frailty than adequate medication literacy (p < 0.001, OR = 2.759); The population with marginal medication literacy had a 2.239 times greater risk of frailty than adequate medication literacy (p = 0.010, OR = 2.239). Spearman’s correlation analysis showed that the medication literacy grade was associated with the frailty grade in elderly CHD patients (R = -0.260, p < 0.001).Conclusion: The study showed a significant correlation between medical literacy and frailty in patients with CHD. The results suggested that medication literacy was an important consideration in the development, implementation, and evaluation of frailty.

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“…It is a multinational consensus paper on principles for clinical practice, research, and education around medication management in frail older persons. 62 That article provides a valuable overview of good practice in addressing the issues outlined in this editorial. The authors identify the following principles of clinical practice: up-to-date medication lists, medication reconciliation, accounting for the patient's capacity to self-manage medications, appropriate prescribing and deprescribing, regimen simplification, alertness to complications and adverse effects of medications, tailoring regimens to changing goals of care, and ongoing quality communication within the health care team and with the patient and caregivers.…”

Section: Principles Of Clinical Practice Around Medication Prescribing and Usementioning

confidence: 99%

Medications in Post-Acute and Long-Term Care: Challenges and Controversies

Sloane

Brandt

Cherubini

et al. 2021

Journal of the American Medical Directors Association

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Nursing Homes post-acute care long-term care medications prescribing deprescribing Pharmaceutical agents are a valuable resource to assist in the care of older persons. Their use in post-acute and long-term care settings is particularly notabledfor example, the proportion of nursing home residents taking 9 or more medications increased from 18% in the mid-1990s to 40% less than 15 years later. 1,2 Average drug counts are similarly high around the world, although there is considerable variation in use between settings and countries. 3,4 High medication use occurs despite the fact that persons with advanced age and multimorbidity are particularly susceptible to drug adverse effects due to physiological changes such as declines in hepatic and renal clearance. Further, the probability of deleterious drug interactions rises exponentially as the number of medications increases. 5 Why are so many drugs administered in post-acute and long-term care, and why does the number keep rising? One reason is because new and better agents have been developed for a variety of conditions common in nursing homes, which relieve or prevent morbidity and delay mortality. Many of these newer medications, such as bisphosphonates for fracture prevention, angiotensin-converting enzyme inhibitors for diabetic renal protection, and beta blockers for coronary artery disease, have strong data in the nursing home literature supporting their use. Other reasons for increasing drug lists, however, are less clearly good for patients. In some cases,The authors declare no conflicts of interest.

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Medication Management in Frail Older People: Consensus Principles for Clinical Practice, Research, and Education

Cited by 55 publications

References 53 publications

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

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

Relationship Between Medication Literacy and Frailty in Elderly Inpatients With Coronary Heart Disease: A Cross-Sectional Study in China

Medications in Post-Acute and Long-Term Care: Challenges and Controversies

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