Table 9: Medication Effects on Sarcopenia Medications
Impact on Physiology, Strength, and Muscle Mass
Glucocorticoids
● Associated with muscle toxicity
Beta-blockers or nonsteroidal anti-inflammatory drugs (NSAIDS)
● Detrimental metabolic effects ● Mitochondrial dysfunction ● Diminished blood flow ● Electrolyte, hormonal, or acid-base alterations
Antidepressants
● Associated with muscle toxicity
(Prokopokis et al., 2023) Polypharmacy and frailty
2. Exhaustion 3. Slowness 4. Low activity level 5. Weakness
Older adults that suffer with multimorbidity, sarcopenia, and polypharmacy may also experience frailty. Frailty occurs when a patient experiences simultaneous declines in multiple physiological systems, causing weaknesses in functionality that increase vulnerability to stressors, as per Hoogendijk et al. (2019). Frailty is not always symptomatic and may not be visually present at the onset. Unaddressed frailty can result in: ● Impaired quality of life ● Increased fall risk ● Loss of independence ● Increased morbidity and mortality ● Admission to nursing home or other long-term care facility ● Lack of social connection ● Increased loneliness and isolation Frailty is most prevalent in older adults, and its effects are expected to increase as the cohort size increases, especially with the occurrence of polypharmacy. Other risks for frailty also include varied social determinants of health including socioeconomic status, lifestyle, access to healthcare, adherence to treatment plans, genetics, and personal behavior. Treatment plans for chronic disease management should address frailty with the presentation of specific steps for patients to implement as a measure of avoidance. Frailty assessments should become an integral element in the delivery of standard care, especially as it pertains to” avoidance of harm in primary, secondary, and tertiary prevention of disease” as quoted by Hoogendijk et al. (2019). Kurnat-Thoma El et al. (2022) have identified five criteria for frailty as a syndrome: 1. Weight loss Polypharmacy and impact on cancer Throughout the aging process there are changes in the body that make people more vulnerable to stressors such as falls, cognitive decline, delirium, depression, and polypharmacy (Magnuson et al., 2019). These stressors are important to acknowledge in older adults with a cancer diagnosis because they can conceivably impact a clinical presentation that can potentially unveil root causation. Without this insight a physician may not be able to interpret a full picture of an individual’s physiology which can impact potential treatment and response. (See Table 10.) Polypharmacy as a stressor for an oncology patient can blur the path to improved wellness and functionality since many meet the criteria prior to beginning a treatment protocol for their cancer diagnosis (Magnuson et al., 2019). Screening for polypharmacy, as well as other stressors, is an important tool
Physical frailty syndrome is the result of accrued cellular damage throughout a person’s life that causes inflammatory cycles and processes that interfere with normal functioning. The following can precede frailty syndrome: ● Sarcopenia
● Mitochondrial dysregulation ● Decreased insulin sensitivity ● Osteopenia
All of the foregoing may occur simultaneously with other illnesses and conditions which in tandem with frailty can increase the respective risks for hospitalizations, falls, and other disease. It should be noted that for patients with frailty the risk to benefit ratio relative to medication must constantly be evaluated to ensure the intervention is positive and does not cause more harm. According to Cesari et al. (2020), frail patients may not be able to participate in some pharmacological interventions because the potential harms outweigh the benefits, the risks are too high. There is possible integration in all chronic conditions and polypharmacy, but according to Cesari et al. (2020), polypharmacy and frailty are interconnected and share a “bidirectional relationship” that can cause tremendous damage to the older person’s well-being and quality of life. This is an area of geriatric medicine that requires insight and expertise, as well as consultation with a clinical pharmacist. Cesari alludes to the hope that the concept of patient- centered care will allow clinicians to gain deeper insight into each patient’s life to ensure a more personalized, frank approach that can unveil aspects of frailty that can be addressed. for oncologists who are treating older adults with cancer diagnosis. These cancer patients who concurrently address polypharmacy are found to be vulnerable to: ● Adverse drug reactions ● Depression ● Disability ● Increased fall risk ● Frailty ● Abundant healthcare utilization ● Postoperative complications ● Caregiver burden ● Death To prevent these potential outcomes, the oncologist should screen for (Manguson et al., 2019): ● Fall risks specific to older adults with cancer
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