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People with frailty may benefit from more lenient therapeutic targets for some conditions, according to prescribing guidance from the British Geriatrics Society (BGS).
The National Institute for Health and Care Research-funded guidance, published on 11 November 2025, offers advice on balancing the risk and benefits of medicines for a range of conditions often association with frailty, including hypertension and osteoporosis.
Patients with hypertension and moderate frailty may benefit from a more lenient average systemic blood pressure target of between 140–160 mmHg, according to the guidance.
It also said that patients with severe frailty should not be set a blood pressure target — as the harms are likely to exceed benefits — so deprescribing is advised.
For patients with moderate frailty and osteoporosis who are taking bisphosphonate, the guidance suggests that if the drug has been taken for more than three years, then there is little evidence that taking it for a further three years would be helpful.
The patient and healthcare professional should then discuss stopping the medication, it said.
In addition, for people with severe frailty, medication is unlikely to be beneficial if the patient is immobile or in the last year of their life, the guidance said.
In guidance published in February 2025, the BGS described frailty as a long-term health condition, which reflects vulnerability to adverse health outcomes. More than one in ten people aged over 65 years live with frailty in the community, which rises to over half of adults in hospital or care home settings, it revealed.
Other conditions covered in the BGS guidance include heart failure with reduced ejection fraction, type 2 diabetes mellitus, high cholesterol and cognitive impairment.
The tool is intended to help support shared decision-making conversations between patients and clinicians.
Commenting on the guidance, Lelly Oboh, consultant pharmacist in the care of older people at Guy’s and St Thomas’ NHS Trust Community Health Services, said: “This publication provides a valuable and pragmatic guide to supporting prescribing (and deprescribing) decisions in people living with moderate to severe frailty.
“In this population, the balance of risks and benefits of medicines often shifts and can be unpredictable due to factors, such as polypharmacy, increased vulnerability to adverse drug effects, multimorbidity, differing therapeutic goals (palliative vs. preventive), the time required to realise medication benefits, limited research evidence in frailty cohorts and the need to honour individual patient values and priorities.”
She added: “This new guidance offers a practical and credible framework to support clinicians in delivering such personalised, evidence-informed prescribing, deprescribing, and medication reviews across common conditions affecting those with moderate-to-severe frailty.
“It represents an important and welcome first step, and we look forward to its future expansion to additional conditions, high-risk medicines and clinical situations.”
Caroline Abrahams, charity director at Age UK, said: “Older people, particularly those living with frailty, are much more likely to be on multiple medicines, some of which are critical to staying well and maintaining wellbeing.
“However, these medicines are often not optimised, leaving older people taking things that are delivering little to no benefit or even actively harming them. Knowledge of the harms and impact of inappropriate polypharmacy is all too often absent in those making prescribing decisions, and we welcome this guidance from the BGS to help to fill those gaps.
“Community pharmacists are well placed to encourage older people to request a structured medication review and to help them think through some questions to get the most out of a review.”
Read more: ‘Frailty and the patient journey’ and ‘Case-based learning: frailty’
