Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women’s Health (ALSWH)



Frailty is an essential consideration with potentially inappropriate medications (PIMs), especially among older women.


This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs.


This prospective longitudinal study included 9355 participants aged 77–82 years at baseline (2003). Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness and loss of weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs.


Among participants who were frail and non-frail at baseline, the majority used ≥ 3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥ 3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and non-steroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI 1.01, 1.03).


Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77–96 years who are frail.

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The authors thank Dominic Cavenagh and Peta Forder (Priority Research Centre for Generational Health and Ageing, University of Newcastle), and Natasha Weaver (School of Medicine and Public Health, University of Newcastle) for their statistical input. This research is based on a study conducted as part of the Australian Longitudinal Study on Women’s Health by the University of Queensland and the University of Newcastle. The authors are grateful to the Australian Government Department of Health for funding and to all women who provided the survey data. The authors also acknowledge the Departments of Health and Veterans’ Affairs, and Medicare Australia, for the provision of the PBS data, and the Australian Institute of Health and Welfare (AIHW) as the integrating authority.


This work was supported by the Australian Government Department of Health.

Author information




KT contributed to the design and conceptualisation of the study, performed formal analysis, and wrote the first draft and made final corrections. JB contributed to the conceptualisation of the study, reviewed and made final corrections to the manuscript. SSH contributed to the conceptualisation of the study, and reviewed and made final corrections to the manuscript. NE contributed to formal analysis, reviewed and edited the manuscript. TK contributed to the conceptualisation of the study, and reviewed and edited the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Kaeshaelya Thiruchelvam.

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Conflicts of Interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethics approval

The ALSWH has ongoing ethical approval from the University of Queensland (UQ) (reference 2004000224) and the University of Newcastle (UoN) (reference H-076–0795) Human Research Ethics Committees (HREC), and also for the health record linkage (UQ: reference 2012000132 and UoN: reference H-2011–0371). Our study was approved by the ALSWH Data Access Committee. Access to national data collections was approved by the Australian Institute of Health and Welfare HREC (reference EC2012/1/12).

Human and animal rights

For the linked data (PBS), ALSWH participants who decline health record linkage are excluded from linked data requests. Over 80 percent of all ALSWH participants have explicitly consented to record linkage. Since 2005, the responsible Human Research Ethics Committees have approved opt-out consent; in addition, a waiver applies to unconsented participants who were deceased or lost to follow up before 2005.

Informed consent

For the ALSWH survey data, all participants consented to joining the study and are free to withdraw or suspend their participation at any time with no need to provide a reason.

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Thiruchelvam, K., Byles, J., Hasan, S.S. et al. Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women’s Health (ALSWH). Aging Clin Exp Res (2021).

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  • Frailty
  • Older women
  • Oldest old
  • Potentially inappropriate medications