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Background <p>Frailty is a multidimensional syndrome associated with increased vulnerability to stressors, chronic disease exacerbations, hospitalizations, and disability. Polypharmacy, often defined as the chronic use of five or more medications, is closely and bidirectionally related to frailty. In this context, medication review is a potential strategy to improve health outcomes and slow down the frailty process by optimizing pharmacological treatments. This study aims to evaluate the impact of a geriatrician-led medication review, integrated within primary care (+ AGIL Barcelona program) on polypharmacy and medication adequacy in older adults.</p> Methods <p>We evaluated the effect of the + AGIL Barcelona program on medication adequacy. The + AGIL is a multidisciplinary and multicomponent intervention aimed at promoting healthy aging, based on a comprehensive geriatric assessment and a 10–week structured exercise program, nutritional counseling, medication review, and healthy lifestyle promotion tailored to the individual's needs. Based on patient’s frailty status, comorbidities, and preferences, geriatricians revised the medications, and the modifications were discussed with the participants’ primary care physician, and in selected cases, with a clinical pharmacist. Baseline and three-month follow-up data were collected, including quantitative polypharmacy prevalence, and potentially inappropriate medications (PIMs), according to the EU(7)-PIM list. Subgroup analyses were based on Clinical Frailty Scale scores.</p> Results <p>The study included 173 community-dwelling older adults (mean age: 81.2&#xa0;years – SD: 5.7; 68.8% women). At baseline, polypharmacy was prevalent (84.4%), with 59.5% of participants receiving at least one PIM. After three months, a slight reduction in the mean number of medications per patient was observed (7.6 to 7.4, <i>p</i> = 0.051). Reduction of number of PIMs was also observed (1.0 to 0.9 per patient, <i>p</i> = 0.011), particularly in those medications affecting the nervous (from 30.1% to 24.3% in the sample, <i>p</i> = 0.025) and genitourinary (from 6.9% to 4.6%, <i>p</i> = 0.046) systems. After stratifying by frailty, a consistent trend was observed overall and especially among non-frail and vulnerable groups.</p> Conclusions <p>While the + AGIL Barcelona program had a limited quantitative impact on polypharmacy, it significantly reduced PIMs’ use, particularly in nervous system-acting medications, which are involved in increased risk of falling and cognitive impairment in older adults. The study highlights the importance of medication review in multidimensional frailty management, although future research with larger samples and standardized medication review protocols is needed.</p>

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The effect of a complex intervention for older adults on medication adequacy: results from the + AGIL Barcelona program

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • Francesco Salis,
  • Ana María de Andrés-Lázaro,
  • María Pamela Burbano,
  • Luis Ignacio Soto-Bagaria,
  • Francisco Díaz-Gallego,
  • Neus Gual-Tarrada,
  • Marco Inzitari,
  • Laura Mónica Pérez-Bazán

摘要

Background

Frailty is a multidimensional syndrome associated with increased vulnerability to stressors, chronic disease exacerbations, hospitalizations, and disability. Polypharmacy, often defined as the chronic use of five or more medications, is closely and bidirectionally related to frailty. In this context, medication review is a potential strategy to improve health outcomes and slow down the frailty process by optimizing pharmacological treatments. This study aims to evaluate the impact of a geriatrician-led medication review, integrated within primary care (+ AGIL Barcelona program) on polypharmacy and medication adequacy in older adults.

Methods

We evaluated the effect of the + AGIL Barcelona program on medication adequacy. The + AGIL is a multidisciplinary and multicomponent intervention aimed at promoting healthy aging, based on a comprehensive geriatric assessment and a 10–week structured exercise program, nutritional counseling, medication review, and healthy lifestyle promotion tailored to the individual's needs. Based on patient’s frailty status, comorbidities, and preferences, geriatricians revised the medications, and the modifications were discussed with the participants’ primary care physician, and in selected cases, with a clinical pharmacist. Baseline and three-month follow-up data were collected, including quantitative polypharmacy prevalence, and potentially inappropriate medications (PIMs), according to the EU(7)-PIM list. Subgroup analyses were based on Clinical Frailty Scale scores.

Results

The study included 173 community-dwelling older adults (mean age: 81.2 years – SD: 5.7; 68.8% women). At baseline, polypharmacy was prevalent (84.4%), with 59.5% of participants receiving at least one PIM. After three months, a slight reduction in the mean number of medications per patient was observed (7.6 to 7.4, p = 0.051). Reduction of number of PIMs was also observed (1.0 to 0.9 per patient, p = 0.011), particularly in those medications affecting the nervous (from 30.1% to 24.3% in the sample, p = 0.025) and genitourinary (from 6.9% to 4.6%, p = 0.046) systems. After stratifying by frailty, a consistent trend was observed overall and especially among non-frail and vulnerable groups.

Conclusions

While the + AGIL Barcelona program had a limited quantitative impact on polypharmacy, it significantly reduced PIMs’ use, particularly in nervous system-acting medications, which are involved in increased risk of falling and cognitive impairment in older adults. The study highlights the importance of medication review in multidimensional frailty management, although future research with larger samples and standardized medication review protocols is needed.