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Accounting for frailty when treating chronic diseases
Graziano Onder1, Davide L Vetrano2, Alessandra Marengoni3
1Department of Gerontology, Neuroscience and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy.
European Journal of Internal Medicine
|March 13, 2018
Summary
Treating chronic diseases in older adults may not slow frailty and could pose risks. Individualized, flexible prescribing is crucial for frail patients, considering potential harms and benefits.
Area of Science:
- Gerontology
- Clinical Pharmacology
- Internal Medicine
Background:
- Chronic diseases are key drivers of frailty in older adults.
- The impact of intensive chronic disease treatment on frailty progression is uncertain.
- Evidence suggests intensive treatment may harm frail individuals.
Purpose of the Study:
- To evaluate the hypothesis that intensive chronic disease treatment reduces frailty progression.
- To explore the risk-benefit ratio of pharmacological interventions in frail populations.
- To highlight frailty as an effect modifier in chronic disease management.
Main Methods:
- Review of existing studies on chronic disease treatment and frailty.
- Analysis of factors influencing treatment risk/benefit in frail individuals.
- Consideration of symptom-focused vs. preventive treatments.
Main Results:
- Limited evidence supports intensive treatment reducing frailty progression.
- Preventive treatments (e.g., antihypertensives) have uncertain benefits in frail patients.
- Frail individuals face increased risks (iatrogenic events, functional deficits) and reduced life expectancy.
Conclusions:
- Frailty significantly modifies the risks and benefits of chronic disease treatments.
- Future research should test frailty as an effect modifier.
- Clinical guidelines need specific recommendations for treating frail individuals, detailing pros, cons, and therapeutic targets.
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