Proceedings of the Canadian Frailty Network Summit: Medication Optimization for Frail Older Canadians, Toronto, Monday April 24, 2017

Abstract

Appropriate and optimal use of medication and polypharmacy are especially relevant to the care of older Canadians living with frailty, often impacting their health outcomes and quality of life. A majority (two thirds) of older adults (65 or older) are prescribed five or more drug classes and over one-quarter are prescribed 10 or more drugs. The risk of adverse drug-induced events is even greater for those aged 85 or older where 40% are estimated to take drugs from 10 or more drug classes. The Canadian Frailty Network (CFN), a pan-Canadian non-for-profit organization funded by the Government of Canada through the Networks of Centres of Excellence Program (NCE), is dedicated to improving the care of older Canadian living with frailty and, as part of its mandate, convened a meeting of stakeholders from across Canada to seek their perspectives on appropriate medication prescription. The CFN Medication Optimization Summit identified priorities to help inform the design of future research and knowledge mobilization efforts to facilitate optimal medication prescribing in older adults living with frailty. The priorities were developed and selected through a modified Delphi process commencing before and concluding during the summit. Herein we describe the overall approach/process to the summit, a summary of all the presentations and discussions, and the top ten priorities selected by the participants.

Appropriateness of Medications in Older Adults Living With Frailty: Impact of a Pharmacist-Led Structured Medication Review Process in Primary Care

“…51 Possible strategies include detailed documentation and justification for prescribing (eg, duration, reassessment guidance) by all prescribers; better use of shared health records and enhanced prescribing systems; education about PIMs and pharmacokinetics/dynamics in the elderly and; systematic medication reviews in at-risk groups. 52 The small sample size is a limitation of the study. The academic clinic setting, where physicians may demonstrate potentially different prescribing behaviors, may affect generalizability of results.…”

Frailty Is Associated With Decreased Time Spent at Home After Critical Illness: A Population-Based Study

“…32 Similarly, guidelines suggest that frail patients benefit from deprescribing of commonly used medications and careful discussions to ensure that the intended effects of various therapies align with patient goals. [33][34][35][36][37] Strengths of our study include its long follow-up period compared with other critical care studies and the very large number of patients assessed, using a comprehensive and reliable data source for patient characteristics (used to determine frailty level and other covariates) and outcome information. We chose to use not only mortality but also DAH after index hospitalization, as this is a patient-centered outcome that is of value to many older patients.…”

Reducing Potentially Inappropriate Medications in Older Adults: A Way Forward

“…(1) augmented efforts towards developing innovations focused on facilitating prescribing of appropriate medications, and/or de-prescribing in older adults living with frailty; (2) facilitating research for developing or improving models that facilitate pharmacists to be actively involved in the process of monitoring and assessing use of PIMs; and (3) encouraging further research into the values and preferences held by older adults living with frailty with respect to medication use (Muscedere et al, 2017).…”