Optimizing Treatment for Older Adults: How Frailty Affects Intervention Outcomes

We reviewed dozens of randomized controlled trials to understand how different treatments work for older adults with varying levels of frailty. Here's what we found:

Pharmacological Interventions: Most drug treatments, including flu vaccines, worked similarly across different frailty levels. However, some drugs (e.g., edoxaban, prasugrel, chemotherapy for multiple myeloma) were more effective or safer in less frail (robust) patients, while sacubitril/valsartan was more beneficial for frail patients.

Non-Pharmacological Interventions: Intensive lifestyle changes and exercise programs benefited frail older adults as much as, or even more than, their non-frail counterparts.

Multicomponent Interventions: The success of complex interventions varied.

Implications for Clinical Practice:

• Understanding how frailty affects treatment outcomes can help healthcare providers tailor interventions to maximize benefits and minimize risks.

• Frailty does not always mean decreased treatment efficacy; therefore, frail patients should not be under-treated.

• Proper frailty assessment tools are essential to apply these findings in practice. The Clinical Frailty Scale is a quick and validated tool suitable for various clinical settings.

Recommendations for Future Research:

• More older adults with frailty should be included in future RCTs to better understand treatment effects.

• Future RCTs are needed to test for heterogeneity of treatment effects by the spectrum of frailty.

Reference:

Yao A, Gao L, Zhang J, Cheng JM, Kim DH. Frailty as an Effect Modifier in Randomized Controlled Trials: A Systematic Review. Journal of General Internal Medicine. 2024 Apr 9:1-22.