Deprescribing in Frailty (DiF) project; Phase 1 – Scoping the issue

Introduction

Deprescribing in older people living with frailty is an evidence-based, structured, patient-centred process aimed at reducing or stopping medications where potential harms outweigh benefits. Evidence suggests that deprescribing is safe and feasible, reduces number of potentially inappropriate medications (PIMs) in older people, without increasing adverse outcomes and leads to modest clinically meaningful benefits. Identifying PIMs is a critical step in deprescribing and Phase1 of this project aims to proactively identify and understand the size of inappropriate polypharmacy in patients living with frailty on older persons’ wards.

Method

A random retrospective snapshot review of medicines from discharge summaries (November 2025) was conducted using STOPP-START 3 and STOPPFRAIL 2 criteria to identify PIMs.

Results

20 patients were included.  Mean age 84.0 years (71–95), 9 males, 11 females. Mean Clinical Frailty Score (CFS) was 6 (5–7). 11 patients were deemed to have short life expectancy as defined by STOPPFRAIL2 criteria.  Mean number of co-morbidities was 14.55(8–20). Of 190 medicines prescribed; mean 9.5 (4–18), 63 PIMs (33%) and 6 potential omissions were identified.

STOPP-START3: 41 PIMs identified, with falls risk increasing drugs being the most common criteria (38%). The most common PIMs were proton pump inhibitors (PPIs), alpha-blockers, opioids, and antidepressants. 6 medicines were identified as potentially omitted. At discharge,15 PIMs were already appropriately stopped including antiplatelets, diuretics and haematinics, and 11 appropriately initiated including antidepressants.

STOPPFRAIL2: (Applied to 11 patients deemed to have short life expectancy) 22 PIMs identified including calcium + vitamin D, statins, PPIs and antidiabetics. At discharge, 10 PIMs had been appropriately stopped including antihypertensives and laxatives.

Conclusion

This review identifies scope to proactively improve deprescribing and prescribing practice on inpatient wards using a structured evidence-based approach. Phase 2 will incorporate proactive structured deprescribing prior to discharge as part of routine care on the wards.