[SGLT2 inhibitors, also in frail older adults?] / SGLT2-remmers, ook bij kwetsbare ouderen?

Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) have gained prominence in the treatment of diabetes mellitus type 2, heart failure, and chronic kidney disease. However, concerns arise for frail older adults, given their underrepresentation in trials and heightened susceptibility to adverse drug events. This review summarizes the clinical effects of SGLT2 inhibitors in older adults with frailty. SGLT2 inhibitors seem to exhibit consistent cardiovascular benefits irrespective of age. As such, these drugs can be beneficial for older adults with 'cardiovascular frailty': in other words, cardiovascular multimorbidity. However, in the current data there is a lack of focus on the broader definition of frailty, which also includes functional status and self-dependence. Also, some research suggest that adverse events, such as volume depletion and genitourinary infections, are more common in the frail older population. Therefore, until more data is available, SGLT2 inhibitors should be prescribed with caution in older adults living with frailty.

Towards a "prescribing license" for medical students: development and quality evaluation of an assessment for safe prescribing.

PURPOSE: This report describes the development and validation process of an assessment with national consensus in appropriate and safe pharmacotherapy. METHODS: A question-database on safe prescription based on literature of pharmacotherapy-related harm was developed by an expert group from Dutch medical faculties. Final-year medical students concluded a 2-year education program on appropriate and safe prescription by one of nine assessment variants of 40 multiple-choice questions each. An expert panel of professionals (n = 10) answered all database questions and rated questions on relevance. Questions were selected for revision based on lack of relevance or poor test and item characteristics. RESULTS: A total of 576 final-year medical students of the Radboud University was assessed. There was no significant difference in performance between students and content expert group (p = 0.7), probably due to learning behavior. Out of 165 questions, 59 were selected for revision. CONCLUSION: Joint national effort from a team of experts in prescription and pharmacotherapy is an appropriate way to achieve a valid and reliable last-year student drug prescription assessment.

[Frailty in the elderly]. / 'Frailty' bij ouderen.

Older people differ in their level of multimorbidity, functional dependence and need for assistance. Frailty is a recently constructed syndromatic entity used to characterize vulnerable older people with an increased risk of functional decline, institutionalization and death. This is illustrated by the case history of a 97-year-old woman. In addition to somatic multimorbidity, she suffered from fatigue, weight loss, diminished strength and mood, fear of falling and a decreased gait velocity, without a clear link to a disease. The term 'frailty' is useful in such cases and its application is quickly expanding. Frailty highlights the need to individualize and integrate guidelines for treatment, and to prevent adverse outcomes by choosing health care interventions fit for such frail elderly. However, in practice the frailty syndrome is defined by diverse sets of criteria. As frailty is used to predict different adverse outcomes, a single definition is not possible. Awareness of the advantages and pitfalls of the frailty concept may lead to fruitful clinical application.