Frailty is a progressive, long-term condition with episodic deteriorations. In frail older people, a minor event can trigger major changes in health status from which they may fail to return to their previous level of health. Some 25 to 50 per cent of people aged over 85 years are frail.

Frail people are at higher risk of hospital admissions, stay longer in hospital and are higher users of health and social care resources. They typically present with falls, immobility, incontinence, delirium and ADEs €“ sometimes referred to as the 'geriatric giants' or 'frailty syndromes'.

An older person who is taking five to nine or 10 or more drugs is one-and-a-half and three times more likely to be frail compared to those on fewer than five drugs.

Frailty poses a challenge to medicines optimisation as it can affect how patients access, adhere to and respond to medicines. Housebound patients, for example, may have reduced muscle strength or poor dexterity, meaning they require help to collect and/or administer medicines. Similarly, cognitive impairment may result in forgetting to take medicines or difficulty mastering and continuing techniques needed for self-administration (e.g. inhalers, blood glucose monitoring devices). Sensory impairments and swallowing difficulties may also be practical barriers to adherence.