Frailty and Drug Safety at Older Ages

People over the age of 80 years represent the fastest growing sector in the population of most high-income countries. This emerging demographic poses important challenges for drug safety. Older adults are highly exposed to prescription medications, with 40% of older non-institutionalized adults in the USA experiencing polypharmacy with five or more prescription medicines, often for substantial periods of time. Polypharmacy increases with age and is particularly prevalent in care home populations. The evidence base for pharmacological intervention at older ages is weak, as people of advanced ages have less often been included in clinical trials. The frailty concept has proved challenging to operationalise, leading to multiple different definitions and assessment methods. Indeed, it is unclear whether frailty should be considered as representing an objective state of affairs or as a latent trait that can only be evaluated indirectly.