British Geriatric Society, Royal College of General Practitioners, Age UK. Fit for frailty. Part 1. Consensus best practice guidance for the care of older people living in community and outpatient settings. 2014. (accessed 19 July 2021)

Canadian study of health and aging: study methods and prevalence of dementia. CMAJ.. 1994; 150:(6)899-913

Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet.. 2013; 381:(9868)752-762

De Lepeleire J, Iliffe S, Mann E, Degryse JM. Frailty: an emerging concept for general practice. Br J Gen Pract.. 2009; 59:(562)e177-182

Department of Health and Social Care. Prevention in better than cure. Our vision to help you live well for longer. 2018. (accessed 19 July 2021)

Effective Public Health Practice Project. Quality assessment tool for quantitative studies. 2020. (accessed 19 July 2021)

Faber SJ, Scherpbier ND, Peters HJG, Uijen AA. Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication - an observational study in general practice. BMC Nephrol.. 2019; 20:(1)

Fried LP, Tangen CM, Walston J Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci.. 2001; 56:(3)M146-M157

The Health Literacy Place. Teach back. (accessed 19 July 2021)

Hurmuz MZM, Janus SIM, van Manen JG. Changes in medicine prescription following a medication review in older high-risk patients with polypharmacy. Int J Clin Pharm.. 2018; 40:(2)480-487

The King's Fund. Making our heath and care systems fit for an ageing population. 2014. (accessed 19 July 2021)

Kojima G, Liljas A, Iliffe S. Frailty syndrome: implications and challenges for health care policy. Risk Manag Healthc Policy.. 2019; 12:23-30

Polypharmacy management by 2030: a patient safety challenge. 2017. (accessed 19 July 2021)

Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. Scientific World Journal.. 2001; 1:323-336

National Institute for Health Research. Comprehensive care—older people living with frailty in hospital. 2017. (accessed 19 July 2021)

National Institute for Health and Care Excellence. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcome. NICE guideline NG5. 2015. (accessed 19 July 2021)

Office for National Statistics. Past and projected periods and cohort life tables, 2018-based. UK 1981-2068. 2019. (accessed 19 July 2021)

Rhalimi M, Rauss A, Housieaux E. Drug-related problems identified during geriatric medication review in the community pharmacy. Int J Clin Pharm.. 2018; 40:(1)109-118

Schmidt-Mende K, Andersen M, Wettermark B, Hasselström J. Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines. A pragmatic open-label cluster-randomized controlled trial in primary care. Pharmacoepidemiol Drug Saf.. 2017; 26:(11)1347-1356

Schmidt-Mende K, Hasselström J, Wettermark B, Andersen M, Bastholm-Rahmner P. General practitioners' and nurses' views on medication reviews and potentially inappropriate medicines in elderly patients—a qualitative study of reports by educating pharmacists. Scand J Prim Health Care.. 2018; 36:(3)329-341

Scottish Government. The 2018 general medical services contract in Scotland. 2017a. (accessed 19 July 2021)

Scottish Government. Realising realistic medicine: Chief Medical Officer for Scotland annual report 2015-2016. 2017b. (accessed 19 July 2021)

Scottish Government Polypharmacy Model of Care Group. Polypharmacy guidance. Realistic prescribing. 2018. (accessed 19 July 2021)

Simon C, Everitt H, van Dorp F, Burkes M. Oxford handbook of General Practice, 4th edn. Oxford: Oxford University Press; 2014

Willeboordse F, Schellevis FG, Chau SH, Hugtenburg JG, Elders PJM. The effectiveness of optimised clinical medication reviews for geriatric patients: Opti-Med a cluster randomised controlled trial. Fam Pract.. 2017; 34:(4)437-445

World Health Organization. World report on ageing and health. 2015.

World Health Organization. Global strategy and action plan on ageing and health. 2017a. (accessed 19 July 2021)

World Health Organization. 10 facts on ageing and health. (accessed 19 July 2021)

World Health Organization. Medication without harm. WHO global patient safety challenge. 2017c. (accessed 19 July 2021)

Exploring the benefits of structured medication reviews for frail older patients in advanced clinical practice

12 August 2021
12 min read
Volume 30 · Issue 15


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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