Susceptibility to Side Effects of Medication: A Frailty Syndrome

SUSCEPTIBILITY TO SIDE EFFECTS OF MEDICATION
A FRAILTY SYNDROME
Introduction
The World Health Organisation reports that the elderly populace is steadily increasing due to,
among other factors, enhanced health care services, healthier living standards and people
becoming more conversant on healthful living (WHO, Newsroom, 2018). The increase in the
population of the elderly presents difficulties in managing the effects associated with ageing
(Gowan and Roller, 2018).
Many long-term conditions prevalent in an older person may require different types of drugs as
part of ongoing treatment, posing a high risk of susceptibility to side effects due to the
physiological changes that occur mostly with the ageing process. In most cases, medication is
necessary to address illness. However, prescribing many drugs to, perhaps, treat the effects of
another drug, may lead to complications, including death.
Statistically, those over the age of 65 are highly likely to be on prescription medication at home,
hospitals or care homes or rely on over-the-counter medicines and supplements in dealing with
comorbidities.
Therefore, health care professionals have an enormous obligation in safeguarding the frail
elderly by prescribing appropriate medication to safely manage comorbidities that may exist as a
result of frailty.
This case study will aim to critically analyse the management of side effects to medication using
the Comprehensive Geriatric Assessment (CGA) concerning polypharmacy:
● Define Frailty, Long Term Conditions and Polypharmacy

● List the causes of polypharmacy
● Prevalence and Demographics concerning ageing and multimorbidity influencing the need for
medication
● Describe adverse reactions of medication/consequences of polypharmacy concerning the
complexity of frailty and other frailty syndromes, and
● Explore the role of health professionals in dealing with unacceptable polypharmacy and
the advantages of deprescribing
● Review learning and highlight areas of development
● conclusion
Frailty
In the absence of a collectively agreed meaning of frailty, Rahman S., (2018), defines it as “a
complex and multidimensional state linked to other concepts including multimorbidity,
disability, dependency and personal resilience" in agreement with Clegg et al. (2013) who
regards it as a clinical condition. According to Clegg, most body systems deteriorate with age
and makes it difficult for an older person to withstand health and wellbeing attacks, like a slight
strain to the body or illness. People living with frailty face a significant increase in the
probability of needing prolonged care and end of life (Ricci and Cunha, 2020). However, not
every older adult is frail, but even among the frail, the condition varies from low to extreme
cases requiring appropriate support. Accordingly, NHS England advises giving full and kind
assistance to people living with frailty unreservedly. (NHS Document 2014). The British
Geriatric Society advises frailty is preventable (Fit for Frailty, 2014). Frailty is linked with but
can happen without several lasting illnesses or conditions.

Furthermore, frailty and fragility are different. The former includes an increase in the risks of
adverse effects observed by clinical events such as recurrent falls, injuries, frequent
hospitalisation, or progressive disability suggesting to clinicians the presence of frailty in the
person. General observation shows frailty recognised more in older than younger persons
because of growth but is not a disease. Since frailty syndromes share many characteristics with
chronic diseases, it is crucial to perform a Comprehensive Geriatric Assessment (CGA). The
evaluation establishes the clinical condition in general health and wellbeing (Walston, 2017). It
creates a strategy to curb the issues known by a multidisciplinary team and implements
interventions to support the plan, combined with ongoing scheduled reviews to ascertain the
effectiveness of the care plans and efficiency of the system. It is, therefore, essential to note that
not everyone elderly will be living with frailty, nor is it sure to happen. Good health habits go
further to promote the desired quality of life.
There are different types of frailty tools from which health of an older people can be
assessed. The gait speed, grip strength, clinical frailty scale, etc. The gait speed tool is an simple
indicator which used to identify conditions and status of patients. This tool also measure the
capacity and function of patient. The advantage of this tool is that it is a quick and inexpensive
method so that major health outcome can be develop. This tool has high risk of inaccuracy from
which deterioration within health of patient can be occur. The grip strength tool is an inexpensive
screening tool which is used to overcome the limitation of gait speed tool. The advantage of this
tool is that it help in avoiding requirements of imaging measures. The disadvantages of it is that
it does not provide accuracy of measures (Martin, 2017). The clinical frailty scale is an easy and
simple tool which is normally based on visualization. The advantages of this model is that health
of more number of patients can be assess. While the disadvantage of it is that this measure is
taken by visual description which does not appropriate stated about health of older people.
The benefit of using this tool is that it can collaborate with comprehensive geriatric
assessment which helps in identify various risk among those who are highly risk of frailty. They
reduces the risk of frailty along with reduction in various falls and other symptoms. This tool is
help in diagnosed of frailty by Walking speed as it reduces to those who has low frailty. This has
been used in clinical trials but its difficult to manage on a large scale.

Long Term Conditions
NHS Wales defines a long-term condition as a disorder without an established e controlled by
but managed through medicines and therapies (Bwrdd Lechyd Prifysgol et al. p e-3). As complex
health needs grow primarily in the frail elderly, so is the need for additional medication
prescribed to manage chronic diseases which in turn initiates side effects. The vicious circle
ushers in more medication to counter the subsequent side effects, and so on, leading to
polypharmacy.
Polypharmacy
Elderly persons living with several prolonged conditions receive much medication and are
associated with poor health outcomes. Polypharmacy often results in prescribing cascades, where
an adverse effect of one medication requires treatment with another medication with a risk to
spiralling out of control (Junius-Walker, 2018).
It would be fair reasoning that the availability of medications to many older people averts severe
dangers to their health, including premature deaths. However, too many medicines may be
clinically unsafe and just like in chemical reactions, combinations of drugs could be fatal without
proper support or usage. The very medicines we run to for safety could be the very same factors
leading to unnecessary harm.
Nevertheless, polypharmacy is more complicated than barely the quantity of various pills or
medicines taken by an individual, whether prescribed or over the counter.
Causes of polypharmacy may include;
● Medication errors (taking the wrong medicines by self or given by a health practitioner,
overdosage or wrongly dispensed)