Abstract
Introduction
Inappropriate polypharmacy in complex, multimorbid, and frail older adults increases risks of adverse events, hospital admissions, and nonadherence. Polypharmacy review is an important part of Comprehensive Geriatric Assessment (CGA) with national guidance emphasising the goal being harm reduction rather than deprescribing. This audit evaluated the impact of polypharmacy review within the Dundee Enhanced Care at Home Team (DECAHT) geriatrician caseload.
Method
A retrospective audit of the 25 most recent patient discharges under DECAHT-geriatrician care (July–August 2024) was performed. Admission, inpatient, and discharge prescriptions were reviewed. Data included total medication count, any medication changes, anticholinergic burden (ACB) score, and high-risk medication use (anticoagulants, antihypertensives, diuretics, antidepressants, antipsychotics, opiates, benzodiazepines, insulin, and gabapentinoids). Data was collected and analysed using Microsoft Excel.
Results
Mean age was 79.6 years (female 78.8; male 81.1), and 64% were female. Mean medication number on admission was 9.64 (range 4–21) versus 9.44 at discharge. Mean ACB score decreased from 2.76 (range 0–11) on admission to 2.16 (range 0–8) at discharge. 9 patients (36%) had a high-risk ACB score of ≥3 on admission, following polypharmacy review 3(33%) dropped below to the high-risk threshold.
85 medication changes occurred across 22 patients (88%): 32 starts (commonly laxatives 28.1%, and analgesics 31.2%), 37 stops (antihypertensives 29.7%, analgesics 21.6%), and 16 dose/frequency adjustments. 17 patients (68%) had ≥1 medication stopped, with reductions seen in prescription of antihypertensives (–30%), antidepressants (–11%), opiates (–25%), and gabapentinoids (–50%).
Conclusion(s)
Though 88% of patients had prescription changes made, and medications were stopped in 68%, there was minimal change in total medication count. Meaningful reductions were seen in anticholinergic burden and high-risk drug prescribing. These findings highlight the importance of targeted metrics—rather than medication number alone—to evaluate safe prescribing practices in frail, older populations.