Cluster page — medicines optimisation
Medicines optimisation in frailty and the over-75s
The priority cohort
Why over-75 frailty is the centre of gravity for PCN MO
The over-75 cohort with mild-to-moderate frailty (eFI 0.12–0.36) is where problematic polypharmacy, anticholinergic burden and falls-risk medicines concentrate, and where structured medication review delivers the largest measurable outcome gains: falls reduction, cognitive preservation, reduced unplanned admission and improved quality of life. The PCN DES recognises this by naming the cohort as a priority SMR group.
Frailty-adjusted prescribing is a different clinical discipline from standard adult prescribing: the harm-benefit calculation shifts for primary prevention statins, intensive hypertension control, intensive diabetes control, bisphosphonates and SSRI use. STOPP/START v3, the ACB scale and the Drug Burden Index are the operating tools.
Frailty MO review prompts
What the pharmacist actually checks
- eFI score and recent change (rising eFI prompts deprescribing review)
- STOPP v3 — potentially inappropriate prescriptions in older adults
- START v3 — potentially under-prescribed (e.g. anticoagulant in AF)
- ACB score — anticholinergic burden ≥3 triggers review
- Falls-risk medicines — anticholinergics, sedatives, antihypertensives, hypoglycaemics
- Statin appropriateness in advanced frailty / limited life expectancy
- Bisphosphonate review beyond 5 years
- Blood pressure target adjustment per frailty status (NICE NG136)
Cohort numbers
Over-75 MO in a typical 50k PCN
Frequently asked questions
Frailty & over-75s MO — FAQs
Why is the over-75 cohort the priority for MO?+
Over-75s are the most polypharmacy-exposed cohort, account for the majority of medication-related hospital admissions, and benefit most from structured review. The PCN DES names them as a priority SMR cohort for exactly this reason.
What is STOPP/START?+
Screening Tool of Older Persons' Prescriptions / Screening Tool to Alert to Right Treatment — an evidence-based list of potentially inappropriate prescriptions and potentially under-prescribed medicines in over-65s. Version 3 (2023) is the current standard.
What is anticholinergic burden?+
The cumulative anticholinergic effect of all an individual's prescribed medicines. Quantified via the Anticholinergic Cognitive Burden (ACB) scale; ACB ≥3 is associated with falls, cognitive impairment and mortality in older adults.
How does frailty modify prescribing decisions?+
Advanced frailty changes the harm-benefit calculation for many long-term medicines: statins, intensive blood pressure control, intensive diabetes control, bisphosphonates, and primary prevention generally. Frailty-adjusted prescribing is core to over-75 MO.
Talk to our Service Development team
30-minute discovery call. We'll show you how BCS maps to your PCN's specific priorities.