Poster Presentation 6th Annual Scientific Meeting of the Australian and New Zealand Society for Sarcopenia and Frailty Research 2024

Medication Challenges in Geriatric Frailty: Assessing Polypharmacy and Inappropriate Prescribing Patterns (#6)

Annie MC Yu 1 2 , Sue Kurrle 2 3 , Ian Cameron 2 4 , Keri Anne Lockwood 2 3
  1. Pharmacy, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
  2. Rehabilitation and Aged Care, Northern Sydney Local Health District, Sydney, NSW, Australia
  3. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  4. John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia

Background:

Frailty, prevalent among geriatric population, necessitates meticulous management of multiple co-morbidities, often resulting in complex medication regimens. Polypharmacy, defined as the use of five or more medications, compounded by age-related changes in drug metabolism, increases the risk of potential inappropriate prescribing (PIP) in this demographic.

Objective:

This study is the subset study of the FORTRESS study1 (Frailty in Older people: Rehabilitation Treatment Research Examining Separate Settings) and sought to elucidate the prevalence of polypharmacy and assess instances of PIP using the STOPP/START2 criteria version 2 within a cohort of frail patients. Additionally, the investigation aimed to delineate the key factors associated with the most prevalent potentially inappropriate medications.

Methods:

Patients aged 75 years and older, admitted to acute Hospital, underwent thorough frailty screening utilizing the Frailty Scale3. Those scoring 3 or higher were enrolled in the study cohort. A detailed medication reconciliation process was conducted by a clinical pharmacist upon admission, followed by comprehensive medication reviews throughout hospitalization. The STOPP/START criteria version 2 was utilized to methodically identify potential inappropriate medications (PIMs) and potential prescribing omissions (PPOs).

Results:

A subset of 50 patients from the FORTRESS study have been reviewed. The average age was 85 years, with 40% representing the male demographic. Notably, 88% of patients were subjected to polypharmacy, with an average of 9.8 medications per patient. Significantly, 52% of patients exhibited at least one instance of PIP, with 34% experiencing PIMs and 22% encountering PPOs. For the prevalence of PIMs, 55.6% were “Medication prescribed without evidence-based indication” and 27.8% were “Medication that adversely increasing fall risk”. Proton Pump Inhibitors (44.4%) and benzodiazepines (16.7%) appeared as the medications with the highest incidence of PIMs. 17 deprescribing recommendations were made. For the dominance of PPOs, a notable 22% were “the prescription of vitamin D supplements with documented osteoporosis” in frail patients.

Conclusion:

This investigation illuminates the frequent occurrence of inappropriate prescribing and polypharmacy within the vulnerable cohort of frailty patients. The importance of thorough medication assessments, customized for deprescribing and dosage adjustments, is highlighted. The implementation of pharmacist-led structured medication reviews is recommended to address the complexities of inappropriate medication use in this vulnerable population.

  1. The FORTRESS Study (Frailty in Older People: Rehabilitation Treatment Research Examining Separate Settings) https://sites.flinders.edu.au/residential-aged-care/fortress/
  2. O’Mahony D et al, STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2, Age Ageing 2014; 44: 213–218
  3. Morley J et al, A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans, J Nutr Health Aging 2012 Jul; 16(7): 601–608