Njoku, Maria Chidiamara Augustina, Barnett, Fiona, Valenzuela Arteaga, Trinidad, Fiatarone Singh, Maria, and Inskip, Michael (2024) Multi-faceted Interventions Inclusive of Medication Optimization for Frailty in Aged Care: A Systematic Review. Journal of the American Medical Directors Association. (In Press)

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Abstract

Objectives: Implementation of best practice frailty guidelines in residential aged care are currently suboptimal, and there is a particular paucity of evidence regarding multi- faceted frailty treatments inclusive of medication optimization in these settings, despite the bi-directional relationship between polypharmacy and frailty. This review aimed to retrieve all relevant literature and evaluate the effect of medication optimization delivered in conjunction with exercise and/or nutritional interventions in the best- practice management of frailty in residential aged care.

Design: Systematic review with a qualitative synthesis Settings and Participants: Older adults residing withing residential aged care (otherwise referred to as nursing homes or long-term care)

Methods: The protocol was prospectively registered on PROSPERO (Reg. No.: CRD42022372036) using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Five electronic databases were searched from inception to 23 November 2023 with alerts monitored until 28 March 2024. Quality of studies was assessed using the ROB 2 and ROBIN-1 tools.

Results: A total of 10,955 articles were retrieved; 62 full articles were reviewed with three studies included (2 randomized controlled trials and 1 non-randomized controlled trial) involving 1,030 participants. Included studies did not use specific frailty scores but reported individual components of frailty such as weight loss or number of medications prescribed. No trial combining medication review, exercise and nutrition was identified. Medication review reduced the number of medications prescribed, while the use of nutritional support reduced gastrointestinal medication and maintained weight.

Conclusion and Implications: There is no published research investigating best- practice guidelines for medication optimization used in combination with both exercise and nutrition in aged care to address frailty. This review confirms the need for studies implementing Consensus Guidelines for frailty treatment in this vulnerable cohort.

Item ID:	82809
Item Type:	Article (Research - C1)
ISSN:	1525-8610
Keywords:	frailty; Gerontology; exercise; nutrition; medication optimization; long-term care
Date Deposited:	22 May 2024 03:36
FoR Codes:	42 HEALTH SCIENCES > 4207 Sports science and exercise > 420702 Exercise physiology @ 33% 42 HEALTH SCIENCES > 4203 Health services and systems > 420301 Aged health care @ 34% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3214 Pharmacology and pharmaceutical sciences > 321403 Clinical pharmacy and pharmacy practice @ 33%
SEO Codes:	20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200502 Health related to ageing @ 50% 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 50%
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