How should I approach the management of frailty in a patient with multiple comorbidities?

Management of frailty in a patient with multiple comorbidities requires a personalised, holistic approach that integrates comprehensive assessment, shared decision-making, and coordination of care to optimise quality of life and reduce treatment burden. Begin with a careful assessment of frailty using appropriate tools such as informal gait speed assessment, self-reported health status, or validated questionnaires like PRISMA-7, avoiding physical performance tests if the patient is acutely unwell ¹.

Following frailty identification, conduct a comprehensive review of all comorbid conditions and treatments, considering how these interact and impact the patient's overall health and quality of life. This includes evaluating the risks and benefits of each treatment in the context of frailty and multimorbidity, with particular attention to polypharmacy and potential adverse drug events ¹.

Engage the patient in shared decision-making to establish their personal goals, values, and priorities, which should guide the development of an individualised management plan. This plan may involve starting, stopping, or modifying medications and non-pharmacological interventions, prioritising healthcare appointments, and anticipating changes in health status ¹,².

Coordination of care is essential, assigning responsibility for care coordination and ensuring communication among healthcare professionals, the patient, and carers. Promote self-management where appropriate, supporting the patient’s ability to manage their conditions and treatments effectively ¹,².

Non-pharmacological strategies such as tailored exercise programs, nutritional support, and social interventions should be integrated to address frailty and improve functional status, alongside careful monitoring for delirium or acute deterioration, which may complicate frailty management ¹,³,⁴.

Recent literature highlights the complexity of managing frailty in patients with inflammatory rheumatic diseases and other multimorbidities, underscoring the need for multidisciplinary collaboration and flexible treatment plans that adapt to fluctuating health states and patient preferences (van Onna and Boonen, 2022).