Introduction

Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves. A person living with frailty is vulnerable to significant, often sudden, changes in health and functional ability in response to what would usually be a minor stressor event or change such as a simple infection or an alteration in medication. They are more likely to experience side-effects of medication and their shorter life expectancy limits time to gain therapeutic benefit compared to adults without frailty. Therefore it is important to reduce medication induced harm in this group of adults. As Frailty varies from mild to severe, so that person centred decisions on medications is essential. The assessment of frailty, and level of frailty can therefore help guide decision making when starting new medication or reviewing current medication. This 90-minute workshop is a collaboration between two of IFICs SIGs: Polypharmacy and Adherence and Ageing & Frailty.

Objectives and target audience

The interactive workshop will be of interest to prescribers, patients, carers, advocated, policy makers, researchers, and professionals who plan, commission, fund, provide or regulate care for older people across the globe. Participation by a wide range of professionals and experts by experience from different countries will offer diverse insights on current challenges and integrated approaches to optimising adherence to medicines, reducing harm and personalising treatment. The session will outline updated guidance that will support prescribers and other members of the multidisciplinary team involve patients and carers in shared decision making about their medication.

Format

Background and introduction to the workshop (25 minutes)

Two short presentations will highlight the updated guidance including key tools for assessing level of frailty, making shared decisions about prescribing and optimising medications to reduce harm and improve outcomes from drug treatments in older people with frailty.

Group discussion (40 minutes)

Two case studies will be presented using role play techniques to illustrate the complex interactions and dialogue between prescriber, patient and carer, and other members of the multidisciplinary team when adjusting medication. Participants will be allocated to discussion groups of 6-8 people. Each group will reflect on the scenarios presented and, using the updated polypharmacy guidance, identify touchpoints for specific interventions that could optimise polypharmacy in each case. The group will consider the interpersonal interaction they have observed and, using appreciative inquiry, offer a critique on the communication style and approach to shared decision making.

Summary of key points from the groups (15 minutes)

Facilitators from each group will summarise practical actions that different members of the multidisciplinary team can take to optimise polypharmacy and reduce harm at key touchpoints. They will also identify strategies to enhance communication and shared decision making around medication, particularly for people with communication, cognitive or sensory impairment.

Take home messages (10 minutes)

The final plenary will agree actions that can be taken by participants and SIG members to raise awareness of the new guidance and tools and promote their adoption in practice.