Assessing the impact of a specialist frailty ward on deprescribing rates in older adults

Introduction

Deprescribing is central to frailty care. We evaluated whether a Frailty Enhanced Specialist Service (FESS) was associated with higher deprescribing rates.

Method

Single-centre retrospective observational study using routinely collected data from inpatients admitted from care homes before the existence of FESS (January; n=78) and, post-implementation, to FESS or non-FESS wards in June (FESS n=54; non-FESS n=37) and December (FESS n=32; non-FESS n=49). We recorded total regular medicines and Anticholinergic Cognitive Burden (ACB) scores at admission and discharge, plus age, sex, Clinical Frailty Scale (CFS) and Charlson Comorbidity Index. Overall, mean age was 81.6 years; female 56.8% (142/250); mean CFS 6.8; mean Charlson 6.1. Median age and frailty scores were broadly similar between groups (range 82-84.5; 6-7). Within-group changes were analysed using Wilcoxon signed-rank tests. Between-group differences in net change were assessed using Mann–Whitney U. Proportions of patients with any deprescribing or reduction in ACB were compared using χ² tests.

Results

Pre-FESS, there was no significant within-patient change in total medicines between admission and discharge (median 7→7; Wilcoxon p=0.28). The FESS ward showed significant deprescribing in June (median 8→7; p=0.0005), with a larger reduction by December (median 7→5; p=0.00019). Non-FESS wards showed no significant change at either time point. In December, deprescribing was greater on the FESS ward than in both pre-FESS and non-FESS cohorts (median −2 vs 0 medicines; Mann–Whitney p=0.00048 and p=0.00028). In December, deprescribing occurred in 72% (23/32) of FESS patients versus 20% (10/49) on non-FESS wards (χ²(1)=21.2, p<0.001; OR=9.96), and ACB fell in 41% (13/32) versus 6% (3/49) respectively (χ²(1)=14.5, p<0.001; OR=10.5).

Conclusions

Only the FESS ward demonstrated consistent, statistically significant reductions in total medication count. By December, it was associated with substantially greater ACB reduction than non-FESS care. This supports the role of dedicated frailty services in reducing polypharmacy in hospital inpatients.