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Accounting for frailty when treating chronic diseases

Published:March 08, 2018DOI:https://doi.org/10.1016/j.ejim.2018.02.021

      Highlights

      • Chronic diseases are considered to be major determinants of frailty.
      • Frailty may modify the risks and benefits of chronic disease treatments.
      • Clinical guidelines should provide specific recommendations for the treatment of frail people.

      Abstract

      Chronic diseases are considered to be major determinants of frailty and it could be hypothesized that their treatment may counteract the development of frailty. However, the hypothesis that intensive treatment of chronic diseases might reduce the progression of frailty is poorly supported by existing studies. In contrast, some evidence suggests that intensive treatment of chronic diseases may increase negative health outcomes in frail older adults. In particular, if treatment of symptoms related to chronic diseases (i.e. pain in osteoarthritis, dyspnoea in respiratory disease, motor symptoms in Parkinson disease) might potentially reverse frailty, the benefits related to preventive pharmacological treatment of chronic diseases (i.e. antihypertensive treatment) in patients with prevalent frailty is not certain. In particular, several factors might alter the risk/benefit ratio of a given treatment in persons with frailty. These include: exclusion of frail persons from clinical studies, reduced life expectancy in frail persons, increased susceptibility to iatrogenic events, and functional deficits associated with frailty. Therefore, frailty acts as an effect modifier, by modifying the risks and benefits of chronic disease treatments. This hypothesis must be considered and tested in future clinical intervention studies and clinical guidelines should provide specific recommendations for the treatment of frail people, underlining the pros and the cons of pharmacological treatment and possible targets for therapy in this population. Meanwhile, in older patients, the prescribing process should be individualized and flexible.

      Keywords

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      References

        • World Health Organization
        World Report on Ageing and Health.
        World Health Organization, Geneva, Switzerland2015
        • Collard R.M.
        • Boter H.
        • Schoevers R.A.
        • Oude Voshaar R.C.
        Prevalence of frailty in community-dwelling older persons: a systematic review.
        J Am Geriatr Soc. 2012; 60: 1487-1492
        • Santos-Eggimann B.
        • Cuénoud P.
        • Spagnoli J.
        • Junod J.
        Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries.
        J Gerontol A Biol Sci Med Sci. 2009; 64: 675-681
        • Theou O.
        • Tan E.C.
        • Bell J.S.
        • Emery T.
        • Robson L.
        • Morley J.E.
        • et al.
        Frailty levels in residential aged care facilities measured using the frailty index and FRAIL-NH scale.
        J Am Geriatr Soc. 2016 Nov; 64: e207-e212
        • Clegg A.
        • Young J.
        • Iliffe S.
        • Rikkert M.O.
        • Rockwood K.
        Frailty in elderly people.
        Lancet. 2013 Mar 2; 381: 752-762
        • Kusumastuti S.
        • Gerds T.A.
        • Lund R.
        • Mortensen E.L.
        • Westendorp R.G.J.
        Discrimination ability of comorbidity, frailty, and subjective health to predict mortality in community-dwelling older people: population based prospective cohort study.
        Eur J Intern Med. 2017 Jul; 42: 29-38
        • Cesari M.
        • Marzetti E.
        • Thiem U.
        • Pérez-Zepeda M.U.
        • Abellan Van Kan G.
        • Landi F.
        • et al.
        The geriatric management of frailty as paradigm of “The end of the disease era”.
        Eur J Intern Med. 2016 Jun; 31: 11-14
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • Newman A.B.
        • Hirsch C.
        • Gottdiener J.
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-56
        • Rockwood K.
        • Mitnitski A.
        Frailty in relation to the accumulation of deficits.
        J Gerontol A Biol Sci Med Sci. 2007 Jul; 62: 722-727
        • Onder G.
        • Marengoni A.
        Frailty: the pleasure and pain of geriatric medicine.
        Eur J Intern Med. 2016 Jun; 31: 1-2
        • Palmer K.
        • Marengoni A.
        • Russo P.
        • Mammarella F.
        • Onder G.
        Frailty and drug use.
        J Frailty Aging. 2016; 5: 100-103
        • Lohman M.C.
        • Whiteman K.L.
        • Greenberg R.L.
        • Bruce M.L.
        Incorporating persistent pain in phenotypic frailty measurement and prediction of adverse health outcomes.
        J Gerontol A Biol Sci Med Sci. 2017 Feb; 72: 216-222
        • Wade K.F.
        • Marshall A.
        • Vanhoutte B.
        • Wu F.C.
        • O'Neill T.W.
        • Lee D.M.
        Does pain predict frailty in older men and women? Findings from the English Longitudinal Study of Ageing (ELSA).
        J Gerontol A Biol Sci Med Sci. 2017 Mar 1; 72: 403-409
        • Veronese N.
        • Maggi S.
        • Trevisan C.
        • Noale M.
        • De Rui M.
        • Bolzetta F.
        • et al.
        Pain increases the risk of developing frailty in older adults with osteoarthritis.
        Pain Med. 2017 Mar 1; 18: 414-427
        • Ahmed N.N.
        • Sherman S.J.
        • Vanwyck D.
        Frailty in Parkinson's disease and its clinical implications.
        Parkinsonism Relat Disord. 2008; 14: 334-337
        • Roland K.P.
        • Cornett K.M.
        • Theou O.
        • Jakobi J.M.
        • Jones G.R.
        Concurrence of frailty and Parkinson's disease.
        J Frailty Aging. 2012; 1: 123-127
        • Vaz Fragoso C.A.
        • Enright P.L.
        • McAvay G.
        • Van Ness P.H.
        • Gill T.M.
        Frailty and respiratory impairment in older persons.
        Am J Med. 2012 Jan; 125: 79-86
        • van den Bergh J.P.
        • van Geel T.A.
        • Geusens P.P.
        Osteoporosis, frailty and fracture: implications for case finding and therapy.
        Nat Rev Rheumatol. 2012 Jan 17; 8: 163-172
        • Greenspan S.L.
        • Perera S.
        • Ferchak M.A.
        • Nace D.A.
        • Resnick N.M.
        Efficacy and safety of single-dose zoledronic acid for osteoporosis in frail elderly women: a randomized clinical trial.
        JAMA Intern Med. 2015 Jun; 175: 913-921
        • Barzilay J.I.
        • Blaum C.
        • Moore T.
        • Xue Q.L.
        • Hirsch C.H.
        • Walston J.D.
        • et al.
        Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study.
        Arch Intern Med. 2007 Apr 9; 167: 635-641
        • Doba N.
        • Tokuda Y.
        • Goldstein N.E.
        • Kushiro T.
        • Hinohara S.
        A pilot trial to predict frailty syndrome: the Japanese Health Research Volunteer Study.
        Exp Gerontol. 2012 Aug; 47: 638-643
        • Butt D.A.
        • Mamdani M.
        • Austin P.C.
        • Tu K.
        • Gomes T.
        • Glazier R.H.
        The risk of hip fracture after initiating antihypertensive drugs in the elderly.
        Arch Intern Med. 2012 Dec 10; 172: 1739-1744
        • Benetos A.
        • Labat C.
        • Rossignol P.
        • Fay R.
        • Rolland Y.
        • Valbusa F.
        • et al.
        Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: the PARTAGE study.
        JAMA Intern Med. 2015 Jun; 175: 989-995
        • Odden M.C.
        • Peralta C.A.
        • Haan M.N.
        • Covinsky K.E.
        Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty.
        Arch Intern Med. 2012 Aug 13; 172: 1162-1168
        • Williamson J.D.
        • Supiano M.A.
        • Applegate W.B.
        • Berlowitz D.R.
        • Campbell R.C.
        • Chertow G.M.
        • et al.
        Wright JT Jr, Pajewski NM; SPRINT research group. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial.
        JAMA. 2016 Jun 28; 315: 2673-2682
        • Liang Y.
        • Vetrano D.L.
        • Qiu C.
        The role of biological age in the management of hypertension in old age: does SPRINT tell the whole story?.
        Int J Cardiol. 2016 Nov 1; 222: 699-700
        • Van Spall H.G.
        • Toren A.
        • Kiss A.
        • Fowler R.A.
        Eligibility criteria of randomized controlled trials published in high-impact general medical journals: a systematic sampling review.
        JAMA. 2007 Mar 21; 297: 1233-1240
        • Angus D.C.
        Fusing randomized trials with big data: the key to self-learning health care systems?.
        JAMA. 2015 Aug 25; 314: 767-768
        • Cardona-Morrell M.
        • Lewis E.
        • Suman S.
        • Haywood C.
        • Williams M.
        • Brousseau A.A.
        • et al.
        Recognising older frail patients near the end of life: what next?.
        Eur J Intern Med. 2017 Nov; 45: 84-90
        • Romero-Ortuno R.
        • Fouweather T.
        • Jagger C.
        Cross-national disparities in sex differences in life expectancy with and without frailty.
        Age Ageing. 2014 Mar; 43: 222-228
        • Cullinan S.
        • O'Mahony D.
        • O'Sullivan D.
        • Byrne S.
        Use of a frailty index to identify potentially inappropriate prescribing and adverse drug reaction risks in older patients.
        Age Ageing. 2016 Jan; 45: 115-120
        • Kirkman M.S.
        • Briscoe V.J.
        • Clark N.
        • Florez H.
        • Haas L.B.
        • Halter J.B.
        • et al.
        Consensus development conference on diabetes and older adults. Diabetes in older adults: a consensus report.
        J Am Geriatr Soc. 2012 Dec; 60: 2342-2356
        • Gnjidic D.
        • Hilmer S.N.
        • Blyth F.M.
        • Naganathan V.
        • Cumming R.G.
        • Handelsman D.J.
        • et al.
        High-risk prescribing and incidence of frailty among older community-dwelling men.
        Clin Pharmacol Ther. 2012 Mar; 91: 521-528
        • Bennett A.
        • Gnjidic D.
        • Gillett M.
        • Carroll P.
        • Matthews S.
        • Johnell K.
        • et al.
        Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug-drug interactions in robust versus frail hospitalised falls patients: a prospective cohort study.
        Drugs Aging. 2014 Mar; 31: 225-232
        • Elliott R.A.
        • Goeman D.
        • Beanland C.
        • Koch S.
        Ability of older people with dementia or cognitive impairment to manage medicine regimens: a narrative review.
        Curr Clin Pharmacol. 2015; 10: 213-221
        • Chudiak A.
        • Jankowska-Polańska B.
        • Uchmanowicz I.
        Effect of frailty syndrome on treatment compliance in older hypertensive patients.
        Clin Interv Aging. 2017; 12: 805-814
        • Sheppard V.B.
        • Faul L.A.
        • Luta G.
        • Clapp J.D.
        • Yung R.L.
        • Wang J.H.
        • et al.
        Frailty and adherence to adjuvant hormonal therapy in older women with breast cancer: CALGB protocol 369901.
        J Clin Oncol. 2014; 32: 2318-2327