DISTINGUISHING BETWEEN THE FIT AND FRAIL ELDERLY, AND OPTIMIZING PHARMACOTHERAPY

Frail older patients are at risk for adverse consequences from medicat ions or other external stresses. No single marker, such as age or phys ical disability, or laboratory test can identify this group of patient s. As a result, screening questionnaires have been developed and succe ssfully used by nurses to help identify frail older patients upon admi ssion to a hospital. A very short, 7-item screen with questions concer ning cognitive ability, physical mobility, nutrition, number of medica tions used and hospitalisation within the previous month, was able to identify those patients who were more likely to be discharged to a nur sing home, die, or incur a large hospitalisation cost for the institut ion. While the number of medications used was not an independent predi ctor of the outcome measures studied (e.g. discharge to a nursing home ), data from the literature show that the number of medications prescr ibed is related to iatrogenic complications in older patients, and spe cific impairments in mobility and cognition. The proper choice and pre scribed dose of a medication is extremely important in frail older pat ients who, for instance, are at increased risk from hip fracture with some benzodiazepines, and who have markedly diminished clearance of so me drugs. A systematic approach is suggested for the prescription of m edications in frail older persons which will help achieve optimal phar macotherapy by using a limited number of medications, thoughtfully sel ecting medications which will not impair function, and prescribing an appropriate dose based on pharmacodynamic and pharmacokinetic changes that occur with age.