Prescriber interventions for the older adult with frailty receiving care at home to reduce medication-related harm

Seven SRs identified prescriber interventions to reduce medication-related problems (such as falls) in people with frailty;^{55,59,60,61,62,63,64} and five guidelines^{65,66,67,68,69} provided recommendations for the treatment of people with frailty, which included medication interventions. These were of varying quality. A medication review (carried out by a range of different healthcare professionals) can be undertaken to identify and address medicine-related problems. See also the section on falls and medication review.

The table below sets out the recommendations on reviewing the evidence, and a considered judgment process.

Medication review for people with frailty

1a - Good practice point

Medication review to identify medication-related problems in those receiving care at home

Healthcare professionals (HCP) and people over 65 years with frailty may want to discuss the importance of a medication review at least annually (regardless of the level of frailty).

1b - Good practice point

HCPs and people over 65 years with frailty may want to discuss the importance of the investigation of falls in the last 12 months.

2a - Conditional recommendation

Person-centred medication review that recommends stopping inappropriate medication

HCPs and people over 65 years with frailty may want to discuss the 7-Steps process; including reviewing the medication of all older people for the purpose of potentially discontinuing, particularly in those vulnerable to adverse effects.

2b - Good practice point

Prescribers should ensure there is a valid clinical indication for current medication, and consider deprescribing medicines, where appropriate.

2c - Conditional recommendation

Prescribers and older people with frailty should discuss reducing or stopping a medication that is no longer clinically appropriate or has more harms than benefits.

2d - Good practice point

Prescribers should consider discontinuing medication when appropriate, where there is a narrow window of benefit and evidence of potential harms, especially for sedative and antipsychotic medications.

2e - Strong recommendation

Prescribers should follow the 7-Steps process to undertake holistic medication reviews.

3 - Good practice point

Multidimensional interventions

Medication review may identify the need for additional medications. It is important to take a person-centred approach to ensure that medicines that are needed for symptomatic control or prevention are considered where appropriate, with planned monitoring and review.