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Maturitas. 2019 Aug;126:1-10. doi: 10.1016/j.maturitas.2019.04.212. Epub 2019 Apr 20.

Reducing inappropriate prescribing for older adults with advanced frailty: A review based on a survey of practice in four countries.

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Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork City, Ireland; Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland. Electronic address:
School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork Ireland, Ireland.
Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork City, Ireland.
APC Microbiome Ireland, University College Cork, Ireland.
UZIK Consulting Inc., 86 Gerrard St E, Unit 12D, Toronto, ON, M5B 2J1 Canada.
School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork City, Ireland.


The management of medications in persons with frailty presents challenges. There is evidence of inappropriate prescribing and a lack of consensus among healthcare professionals on the judicious use of medications, particularly for patients with more severe frailty. This study reviews the evidence on the use of commonly prescribed pharmacological treatments in advanced frailty based on a questionnaire of prescribing practices and attitudes of healthcare professionals at different stages in their careers, in different countries. A convenience sample of those attending hospital grand rounds in Ireland, Canada and Australia/New Zealand (ANZ) were surveyed on the management of 18 medications in advanced frailty using a clinical vignette (man with severe dementia, Clinical Frailty Scale 7/9). Choices were to continue or discontinue (stop now or later) medications. In total, 298 respondents from Ireland (n = 124), Canada (n = 110), and ANZ (n = 64) completed the questionnaire, response rate 97%, including 81 consultants, 40 non-consultant hospital doctors, 134 general practitioners and 43 others (nurses, pharmacists, and medical students). Most felt that statins (88%), bisphosphonates (77%) and cholinesterase inhibitors (76%) should be discontinued. Thyroid replacement (88%), laxatives (83%) and paracetamol (81%) were most often continued. Respondents with experience in geriatric, palliative and dementia care were significantly more likely to discontinue medications. Age, gender and experience working in nursing homes did not contribute to the decision. Reflecting the current literature, there was no clear consensus on inappropriate prescribing, although respondents preferentially discontinued medications for secondary prevention. Experience significantly predicted the number and type discontinued, suggesting that education is important in reducing inappropriate prescribing for people in advanced states of frailty.


Deprescribing; Frailty; Inappropriate prescribing; Multi-morbidity; Polypharmacy; Systematic review

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