Why assess frailty when prescribing?

Considering frailty can be helpful when making decisions regarding appropriateness of treatment. Those with frailty are more susceptible to adverse effects of medication and have a reduced life expectancy to gain benefit from medication compared to adults without frailty. The assessment of frailty, and level of frailty can therefore help guide decision-making when starting new medication or reviewing current medication. The principles of Realistic Medicine with a person-centred approach should be considered with a focus on reducing harm, personalising the treatment, and wherever possible, involving the individual in decision-making. This can be achieved by following the 7-Steps process when making decisions about medication. The table below sets out the recommendations on reviewing the evidence, and a considered judgment process (see Methods for deriving evidence-based guidance for methodology).

Recommendations on when to screen for frailty when undertaking 10 or more multiple medications or have two or more long-term conditions

1 - Conditional recommendation

Healthcare professionals may want to consider screening for frailty in the following groups of people:

Older adults (over 65 years)
Anyone with reported change in mobility, presence of falls, and noticeable decrease in Activities of Daily Living after discharge from a hospital
Anyone with continual fatigue
People with multimorbidity

2 - Conditional recommendation

Healthcare professionals should look for the following indicators of frailty:

Falls, incontinence, immobility and/or confusion
Any underlying medical problems that might cause frailty
Polypharmacy and adverse effects of medications.
Acute illness presenting as functional deterioration e.g. mobility, difficulty with self-care and toileting
Reduced cognition and delirium
Slowness, weakness, low physical activity, exhaustion, and shrinking

3 - Conditional recommendation

Assessment can take place in the following settings:

Ambulatory setting
Primary care
Hospital outpatient
Community care

4 - Conditional recommendation

Assessment might be appropriate at the following points in time:

At baseline and then at least annually
As part of Comprehensive Geriatric Assessment (CGA) to determine a person’s medical, psychosocial, and functional capabilities