New principles a ‘positive step’ for frail older people

Matt Woodley

15/07/2020 3:40:25 PM

Australian researchers have led an international effort to develop medication management principles for what is a vulnerable patient cohort.

Old person's hand resting on chair
Older people with frailty often experience challenges managing medicines, exacerbated by polypharmacy and complex regimens.

The team from Monash University worked with clinicians and researchers from other countries with ageing populations to identify any existing gaps in frameworks that are designed to protect at-risk members of the community.
The group, which included researchers from Finland, France, Italy, Norway and Sweden, was particularly concerned with protecting against medication-related harm related to complex regimens or polypharmacy.
These principles represent a positive step towards improving medicines management among our most vulnerable members of society,’ Monash PhD candidate Shin Liau said.

The principles, related to clinical practice (seven principles), research (six principles) and education (four principles), include:

  • ensuring appropriate prescribing and de-prescribing
  • including greater numbers of frail older people in clinical trials
  • improving health and medication literacy
  • facilitating better communication among patients, carers and healthcare teams.
Frailty, which was last year declared a medical condition, refers to low physiological reserve linked to declines across multiple organ systems.
According to the researchers, frail older people often experience challenges managing medicines, which is exacerbated by polypharmacy and complex medicine regimens. In addition, frail older people often have dementia, poor eyesight or limited dexterity, all of which have been linked to increased risk of harm from medication errors.

Professor Simon Bell, Director of Monash’s Centre for Medicine Use and Safety, said frail older people may have a different risk-to-benefit ratio from their medicines than those who are more robust.

‘Frail older people are often excluded from participating in clinical trials, and so the evidence base for prescribing in this population is limited,’ Professor Bell said.

The principles have been endorsed by the European Geriatric Medicine Society (EuGMS), International Conference on Frailty and Sarcopenia Research (ICFSR) and Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR).

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