The interplay between dementia, frailty, and medications among older adults across settings

Abstract

Background Older adults, facing multimorbidity and using numerous medications, are recognised as a high-risk group. Dementia, common in this demographic, often coexists with frailty, leading to increased vulnerability to inappropriate prescribing. This thesis aims to determine frailty prevalence among individuals with dementia and examine medication use accordingly.

Method A systematic review identified several knowledge gaps, followed by three studies. The first, a retrospective cohort study, explored frailty prevalence in individuals with dementia in Long-Term Care Facilities (LTCFs) and its impact on medication use. The second, a multi-centre hospital-based study, examined frailty prevalence among inpatients with dementia and explored medication use. The third study investigated deprescribing patterns among inpatients across different hospital specialities.

Results The systematic review of 16 international studies found frailty prevalence ranging from 50.8% to 91.8% among inpatients with dementia and 24.3% to 98.9% among community-dwelling older. No studies on LTCFs were identified, and none addressed differences in medication use based on frailty. In the LTCF retrospective cohort study, frailty prevalence was 80.0%, with higher inappropriate prescribing among frail residents. The second cohort study in hospitals revealed a frailty prevalence of 78.5%, with increased inappropriate prescribing with frailty. The third study indicated that 50.0% of frail inpatients with dementia underwent deprescribing, compared to 37.7% of non-frail inpatients, with cardiology showing the highest frequency of deprescribing.

Conclusion. High frailty prevalence among older individuals with dementia emphasises the importance of systematic frailty screening in optimising patient-centred care by identifying those who would benefit from tailored interventions, including medication reviews for safe prescribing and deprescribing.