Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland.
Department of Medicine, University College Cork, Cork, Ireland.
Drugs Aging. 2022 Aug;39(8):597-606. doi: 10.1007/s40266-022-00952-z. Epub 2022 Jun 29.
Frail older adults commonly experience multiple co-morbid illnesses and other risk factors for potentially inappropriate prescribing. However, determination of frailty varies depending on the frailty instrument used. Older people's degree of frailty often influences their care and treatment priorities. Research investigating the association between frailty and potentially inappropriate prescribing is hindered by a wide variety of frailty definitions and measurement tools. We undertook a narrative review of selected articles of PubMed and Google Scholar databases. Articles were selected on the basis of relevance to the core themes of frailty and potentially inappropriate prescribing. We identified observational studies that clearly link potentially inappropriate prescribing, potential prescribing omissions, and adverse drug reactions with frailty in older adults. Equally, the literature illustrates that measured frailty in older adults predisposes to inappropriate polypharmacy and associated adverse drug reactions and events. In essence, there is a bi-directional relationship between frailty and potentially inappropriate prescribing, the underlying substrates being multimorbidity and inappropriate polypharmacy. We conclude that there is a need for consensus on rapid and accurate identification of frailty in older people using appropriate and user-friendly methods for routine clinical practice as a means of identifying older multimorbid patients at risk of potentially inappropriate prescribing. Detection of frailty should, we contend, lead to structured screening for inappropriate prescribing in this high-risk population. Of equal importance, detection of potentially inappropriate prescribing in older people should trigger screening for frailty. All clinicians undertaking a medication review of multimorbid patients with associated polypharmacy should take account of the important interaction between frailty and potentially inappropriate prescribing in the interest of minimizing patient harm.
体弱的老年人通常患有多种合并疾病和其他潜在不适当处方的风险因素。然而，衰弱的确定因使用的衰弱工具而异。老年人的衰弱程度通常会影响他们的护理和治疗重点。研究衰弱与潜在不适当处方之间的关联受到各种衰弱定义和测量工具的阻碍。我们对 PubMed 和 Google Scholar 数据库的选定文章进行了叙述性综述。根据与衰弱和潜在不适当处方的核心主题的相关性选择了文章。我们确定了观察性研究，这些研究明确将潜在不适当的处方、潜在的处方遗漏和药物不良反应与老年人的衰弱联系起来。同样，文献表明，老年人测量的衰弱易导致不适当的多药并用以及相关的药物不良反应和事件。从本质上讲，衰弱和潜在不适当处方之间存在双向关系，潜在的基础是多种合并疾病和不适当的多药并用。我们得出结论，需要就使用适当且用户友好的方法快速准确地识别老年人的衰弱达成共识，这是常规临床实践的一种手段，用于识别有潜在不适当处方风险的老年多病患者。我们认为，检测到衰弱应该会导致对高危人群进行不适当处方的结构化筛查。同样重要的是，在老年人中检测到潜在不适当的处方应该会引发对衰弱的筛查。所有对合并多药并用的多病患者进行药物审查的临床医生都应该考虑到衰弱和潜在不适当处方之间的重要相互作用，以尽量减少患者的伤害。
