Description:
SGLT2 inhibitors remain effective and safe in older and frail CKM patients, challenging the common reluctance to prescribe them in these groups. In adults aged 65 years and older, they reduce all-cause mortality, cardiovascular death, heart-failure hospitalization, and major adverse cardiovascular events, with benefits persisting at age 75 and beyond. Importantly, the relative benefit does not diminish with age, and absolute risk reduction may be greater because baseline event rates are higher. Safety data are reassuring: there is no increase in hypoglycaemia, while albuminuria and acute kidney injury are reduced. Frailty does not blunt efficacy across major trials, and empagliflozin has even been associated with improvement in frailty status over follow-up. Although body composition changes and volume status still require attention, the overall balance favors treatment rather than avoidance. The practical message is clear: older age and frailty should prompt careful monitoring and individualized prescribing, not automatic withholding of a therapy that provides meaningful cardiorenal protection.