Frailty and treatments for benign prostatic hyperplasia

Frailty is “a state of increased vulnerability to poor resolution of homeostasis following a stress, which increases the risk of adverse outcomes including falls, delirium and disability.”1 Depending on how this is measured, the prevalence of frailty among men over 64 years old has been estimated at 4–19 per cent, with rates doubling after age 80–85 years.2,3 Fit for Frailty, published by the British Geriatrics Society, the Royal College of General Practitioners and Age UK, set out best practice for caring for older people living with frailty.4 Frailty is not necessarily associated with older age, disability or ill health but it should be suspected when a person presents with a frailty syndrome (see Table 1). Of these, the adverse effects of medication are a particular concern. Polypharmacy is recognised as a risk factor for frailty.4 It is more prevalent with increasing age: one in six people in their 70s and almost one in four of those aged over 80 years may be prescribed 10 or more medicines.5 The risk of adverse effects leading to hospital admission and drug interactions increases with the number of medicines prescribed.5-7 Benign prostatic hyperplasia and frailty Benign prostatic hyperplasia (BPH), as indicated by lower urinary tract symptoms (LUTS) not likely to have an alternative cause, is increasingly common with age and, in one 2005 UK study, was reported by more than 30 per cent of men aged over 80 years (see Figure 1).8 Having LUTS increases the risk of frailty. Compared with men with mild symptoms, having moderate symptoms increased the risk of a fall by 11 per cent and of two falls by 21 per cent; the increased risks for severe symptoms were 33 and 63 per cent respectively.9 The symptoms most strongly predicting falls were urinary urgency, difficulty initiating urination and nocturia, which is at least partially consistent with the hypothesis that the increased risk may be linked with hasty visits to the toilet at night.