New principles to help frail patients

dementia-friendly communities: older hand held by younger hands

Monash researchers have played a leading role in an international collaboration on medicines management for vulnerable people

Researchers from Monash University’s Centre for Medicine Use and Safety and the National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing have led an international collaboration in the development of consensus principles for medication management in frail older people.

CMUS teamed up with clinicians and researchers from countries with ageing populations, including Finland, France, Italy, Norway and Sweden, to identify a gap in existing frameworks designed to protect at-risk members of the community, particularly from medication-related harm due to complex regimes or polypharmacy (multiple medicine use).

Frailty refers to low physiological reserve linked to declines across multiple organ systems, they say.

They note that frail older people often experience challenges managing medicines, exacerbated by polypharmacy and complex medicine regimens. In addition, frail older people often have dementia, poor eyesight or limited dexterity, which have been linked to increased risk of harm from medication errors.

Pharmacist and PhD candidate with CMUS and the CRE, Shin Liau, said: “These principles represent a positive step towards improving medicines management among our most vulnerable members of society.”

The principles relate to clinical practice (seven principles), research (six principles) and education (four principles).

The principles include ensuring appropriate prescribing and deprescribing, including more frail older people in clinical trials, improving health and medication literacy, and facilitating better communication among patients, carers and healthcare teams.

CMUS Director and Chief Investigator with the CRE Professor Simon Bell said frail older people may have a different risk-to-benefit ratio from their medicines than those who are robust.

“Frail older people are often excluded from participating in clinical trials, and so the evidence-base for prescribing in this population is limited,” Professor Bell said.

As Australia’s ageing population continues to grow, the number of frail elderly persons is also increasing every year, the researchers note. Medicine safety recently became Australia’s newest national health priority, with health ministers recognising the urgent need to ensure medicines improve the health of older Australians, not place them at risk.

The principles have been endorsed by the European Geriatric Medicine Society (EuGMS), International Conference on Frailty and Sarcopenia Research (ICFSR) and Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR).

The consensus principles are published in the Journal of the American Medical Directors Association.

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