Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/130351
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Type: Journal article
Title: Medication management in frail older people: Consensus principles for clinical practice, research, and education
Author: Liau, S.J.
Lalic, S.
Sluggett, J.K.
Cesari, M.
Onder, G.
Vetrano, D.L.
Morin, L.
Hartikainen, S.
Hamina, A.
Johnell, K.
Tan, E.C.K.
Visvanathan, R.
Bell, J.S.
Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network (OPPEN)
Citation: Journal of the American Medical Directors Association (JAMDA): long-term care: management, applied research and clinical issues, 2021; 22(1):43-49
Publisher: Elsevier
Issue Date: 2021
ISSN: 1525-8610
1538-9375
Statement of
Responsibility: 
Shin J. Liau, Samanta Lalic, Janet K. Sluggett, Matteo Cesari, Graziano Onder, Davide L. Vetrano, Lucas Morin, Sirpa Hartikainen, Aleksi Hamina, Kristina Johnell, Edwin C.K. Tan, Renuka Visvanathan, J. Simon Bell, on behalf of the Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network (OPPEN)
Abstract: Frailty is a geriatric condition associated with increased vulnerability to adverse drug events and medication-related harm. Existing clinical practice guidelines rarely provide medication management recommendations specific to frail older people. This report presents international consensus principles, generated by the Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network, related to medication management in frail older people. This consensus comprises 7 principles for clinical practice, 6 principles for research, and 4 principles for education. Principles for clinical practice include (1) perform medication reconciliation and maintain an up-to-date medication list; (2) assess and plan based on individual's capacity to self-manage medications; (3) ensure appropriate prescribing and deprescribing; (4) simplify medication regimens when appropriate to reduce unnecessary burden; (5) be alert to the contribution of medications to geriatric syndromes; (6) regularly review medication regimens to align with changing goals of care; and (7) facilitate multidisciplinary communication among patients, caregivers, and healthcare teams. Principles for research include (1) include frail older people in randomized controlled trials; (2) consider frailty status as an effect modifier; (3) ensure collection and reporting of outcome measures important in frailty; (4) assess impact of frailty on pharmacokinetics and pharmacodynamics; (5) encourage frailty research in under-researched settings; and (6) utilize routinely collected linked health data. Principles for education include (1) provide undergraduate and postgraduate education on frailty; (2) minimize low-value care related to medication management; (3) improve health and medication literacy; and (4) incorporate evidence in relation to frailty into clinical practice guidelines. These principles for clinical practice, research and education highlight different considerations for optimizing medication management in frail older people. These principles can be used in conjunction with existing best practice guidelines to help achieve optimal health outcomes for this vulnerable population. Implementation of the principles will require multidisciplinary collaboration between healthcare professionals, researchers, educators, organizational leaders, and policymakers.
Keywords: Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network (OPPEN)
Frailty; medication therapy management; aged; inappropriate prescribing; polypharmacy; multimorbidity
Rights: © 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
DOI: 10.1016/j.jamda.2020.05.004
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