052Prevalence of Potentially Inappropriate Medications (PIMs) According to STOPPFrail in an Older Frailer Cohort with Limited Life Expectancy

Abstract

Background: STOPPFrail is an explicit tool, developed by Delphi technique, to assist physicians with deprescribing medications in older frailer patients with limited life expectancy. The objective of this research was to identify potentially inappropriate medications (PIMs) according to STOPPFrail in a representative population. Methods: Comprehensive multi-disciplinary applications for nursing home placement, between January and June 2016, were retrospectively reviewed. Each application comprised detailed data regarding diagnosis, medication use, function and cognition. STOPPFrail criteria were applied where appropriate. Results: 464 assessments were analysed. 38 were excluded because of incomplete information. STOPPFrail was applied to 274 (64.3%) patients; 152 patients did not meet STOPPFrail inclusion criteria. The STOPPFrail group were older 84 (SD7) vs 77 (SD13) years, p < 0.001, had 1 more comorbidity (7 (SD2) vs 6 (SD2), p < 0.001, were more dependent Barthel 8 (SD4) vrs 12(SD4), p < 0.001 and more likely to have dementia (73% vs 43%, p < 0.001). There was no difference in the median number of medications between the groups; 8 (IQR5-10.5) vs 7 (IQR5-10), p = 0.490. STOPPFrail identified 894 PIMs in 247 patients (90%); a median of 3 (IQR2-4) per patient. The most common PIMs were medications without indication (66%), nutritional supplements (40%), high dose proton pump inhibitors (32%), lipid-lowering therapies (29%) and neuroleptics (25%). Conclusions: PIMs are commonly prescribed for frailer older patients with limited life expectancy in whom nursing home admission is deemed appropriate. 90% of such patients were prescribed at least one PIM. Application of STOPPFrail criteria to this cohort has the potential to optimise medication use.