Frailty Status and Cognitive Function Should Guide Prescribing in Long-term Care Facilities

Area of Science:

• Gerontology
• Geriatric Pharmacology
• Clinical Pharmacy Practice

Background:

• Long-term care facilities (LTCFs) house residents with high prevalence of frailty, dementia, and complex multimorbidity.
• Current prescribing practices often rely on guidelines developed for younger, healthier populations, potentially misaligning with LTCF residents' needs.
• Frailty and cognitive impairment can significantly alter medication efficacy and safety profiles.

Purpose of the Study:

• To highlight the challenges in medication management for LTCF residents with frailty and dementia.
• To advocate for individualized prescribing strategies that consider resident-specific factors.
• To emphasize the need for evidence tailored to this population, complementing existing clinical guidelines.

Main Methods:

• Review of existing literature on medication benefits and risks in frail, cognitively impaired individuals.
• Discussion of the potential for both over-prescribing (deprescribing rationale) and under-prescribing of medications.
• Exploration of how observational studies using routinely collected health data can inform practice.

Main Results:

• Frail residents with dementia are susceptible to adverse drug events (ADEs) and may not benefit from preventative medications.
• Conventional guidelines may not be suitable, leading to potential undertreatment or overtreatment.
• Individualized assessment considering frailty, cognition, goals of care, and time-to-benefit is essential.

Conclusions:

• A shift from rigid guideline application to individualized medication assessment is necessary for LTCF residents.
• Integrating frailty screening into medication reviews can better align treatments with evolving care goals.
• Holistic evaluation balancing over- and under-prescribing is key to optimizing care for vulnerable LTCF residents.