Exploring the benefits of structured medication reviews for frail older patients in advanced clinical practice
Frailty in old age has become synonymous with medication use. As people age, the risk of disease burden increases. Older age is often linked with complex healthcare needs, with a rise in the number of comorbidities. This often results in the need to use multiple medications. Frailty is a global concern and requires early interventions to help people maintain their health as they age. Advanced clinical practitioners have an important role in supporting frail people living in the community. This article will review the literature and explore strategies that advanced practitioners can implement to optimise wellbeing and reduce medicines-related harm for this vulnerable population.
Frailty is a global concern as populations age. The World Health Organization (WHO) describes frailty as one of the ‘geriatric syndromes’, which also include urinary incontinence, delirium and falls (WHO, 2017a). The prevention of frailty in older age requires early interventions to help people maintain good health as they age (WHO, 2017a).
It is estimated that by 2050, one in five people will be over 60 years of age, accounting for 2 billion people globally (WHO, 2017a). Moreover, by 2068, the number of people living to 100 years of age in the UK is expected to have nearly doubled (Office for National Statistics, 2019). Older age often leads to complex healthcare needs and comorbidities requiring medication (Kojima et al, 2019).
Frailty and polypharmacy are interlinked, with structured medication reviews (SMRs) deemed central to optimising medication use (National Institute for Health and Care Excellence (NICE), 2015; Scottish Government Polypharmacy Model of Care Group, 2018). Today's medical practices tend to address single disease systems, which is not conducive to current demographics, because a majority of the ageing population will have co-existing morbidities and will not present with one simple diseased system or problem (WHO, 2015). Early intervention treatments that focus on health prevention are in line with today's healthcare directives (Department of Health and Social Care, 2018). As people age they are at greater risk of medication-related harm, with the SIMPATHY project (Mair et al, 2017) advocating the need to look at more innovative means to help address medication management in older populations. Strengthening this, the Scottish Government Polypharmacy Model of Care Group (2018) has demonstrated that the frailer population are at greater risk of polypharmacy and it is this group that the NHS needs to target with preventive medicine. The transformations taking place within general practice are to support more robust means of addressing the increased complexity of care needs through collaborative working and quality improvement programmes (Scottish Government, 2017a). Quality improvement and innovations are essential in meeting public expectations and pivotal to the future care needs of the elderly population. This can help build resilience into the NHS and create a culture of creativity, by exploring new ways of working to enable a reduction in the pressures on acute hospital services, assist in lowering the economic burdens and help keep frail older people in community settings (British Geriatric Society, 2014; The King's Fund, 2014).
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