Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia.
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Pharmacy Department, Monash Health, Melbourne, Australia.
J Am Med Dir Assoc. 2021 Jan;22(1):43-49. doi: 10.1016/j.jamda.2020.05.004. Epub 2020 Jul 12.
Frailty is a geriatric condition associated with increased vulnerability to adverse drug events and medication-related harm. Existing clinical practice guidelines rarely provide medication management recommendations specific to frail older people. This report presents international consensus principles, generated by the Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network, related to medication management in frail older people. This consensus comprises 7 principles for clinical practice, 6 principles for research, and 4 principles for education. Principles for clinical practice include (1) perform medication reconciliation and maintain an up-to-date medication list; (2) assess and plan based on individual's capacity to self-manage medications; (3) ensure appropriate prescribing and deprescribing; (4) simplify medication regimens when appropriate to reduce unnecessary burden; (5) be alert to the contribution of medications to geriatric syndromes; (6) regularly review medication regimens to align with changing goals of care; and (7) facilitate multidisciplinary communication among patients, caregivers, and healthcare teams. Principles for research include (1) include frail older people in randomized controlled trials; (2) consider frailty status as an effect modifier; (3) ensure collection and reporting of outcome measures important in frailty; (4) assess impact of frailty on pharmacokinetics and pharmacodynamics; (5) encourage frailty research in under-researched settings; and (6) utilize routinely collected linked health data. Principles for education include (1) provide undergraduate and postgraduate education on frailty; (2) minimize low-value care related to medication management; (3) improve health and medication literacy; and (4) incorporate evidence in relation to frailty into clinical practice guidelines. These principles for clinical practice, research and education highlight different considerations for optimizing medication management in frail older people. These principles can be used in conjunction with existing best practice guidelines to help achieve optimal health outcomes for this vulnerable population. Implementation of the principles will require multidisciplinary collaboration between healthcare professionals, researchers, educators, organizational leaders, and policymakers.
衰弱是一种与老年人相关的疾病状态，其特点是易发生药物不良事件和药物相关伤害。现有的临床实践指南很少针对体弱老年人提供具体的药物管理建议。本报告提出了通过药物流行病学网络优化老年药物治疗学的国际共识原则，这些原则涉及体弱老年人的药物管理。这些共识包括 7 项临床实践原则、6 项研究原则和 4 项教育原则。临床实践原则包括：（1）进行药物重整并保持最新的药物清单；（2）根据个人自我管理药物的能力进行评估和计划；（3）确保适当的处方和撤药；（4）在适当的情况下简化药物方案以减少不必要的负担；（5）警惕药物对老年综合征的贡献；（6）定期审查药物方案，以适应不断变化的治疗目标；（7）促进患者、护理人员和医疗团队之间的多学科沟通。研究原则包括：（1）在随机对照试验中纳入体弱老年人；（2）将衰弱状态视为一个效应修饰因子；（3）确保收集和报告与衰弱相关的重要结局指标；（4）评估衰弱对药代动力学和药效动力学的影响；（5）鼓励在研究较少的环境中进行衰弱研究；（6）利用常规收集的相关健康数据。教育原则包括：（1）提供关于衰弱的本科和研究生教育；（2）尽量减少与药物管理相关的低价值护理；（3）提高健康和药物知识素养；（4）将与衰弱相关的证据纳入临床实践指南。这些临床实践、研究和教育原则突出了优化体弱老年人药物管理的不同考虑因素。这些原则可以与现有的最佳实践指南结合使用，以帮助实现这一脆弱人群的最佳健康结果。这些原则的实施需要医疗保健专业人员、研究人员、教育工作者、组织领导者和政策制定者之间的多学科合作。
