Prescribing decisions when someone is frail

As people become increasingly frail, their life expectancy reduces and the time to accumulate benefit from medication reduces. An individual’s priorities of treatment can often change from prolonging life and reducing major events, to symptom control and reducing harm. There can be additional challenges with administration, and adherence to medication. In this section the key areas where prescribing decisions may be influenced by the level of frailty are considered. It is recognised that this is an area with only limited evidence as few clinical trials focus on frail subgroups.

There is limited evidence regarding prescribing according to different levels of frailty (mild, moderate, severe). Due to this, the strength of recommendations are good practice points based on expert clinical opinion. Prescribers and patients may be helped by the use of NNT charts or Cates plots to help visualise potential magnitude of benefit of medication for this intervention, to support shared decision-making.