Polypharmacy in Acute Frailty Admissions : An Audit on Deprescribing

Introduction

East Sussex is an area of the UK with a comparatively higher proportion of the older population and high prevalence of frailty. Polypharmacy is becoming increasingly common in the older population and may contribute to hospital admissions through adverse drug effects. We aimed to identify the most common potentially inappropriate medications on admission and evaluate whether appropriate medications review and deprescribing occurred. 

Method

A retrospective study was conducted with 310 patients aged ≥65 years admitted to our acute frailty ward over a 3-month period. Admissions and discharge data were collected by a team of resident doctors from our hospital records systems. This included demographics, medications on admission and discharge, and observed changes. After data collection, python code was used to analyse and quantify the data. 

Results

We found that patients tended to leave hospital with more medications than at admission (M=5.73 to M=6.10), however the classes of medications changed drastically. There was a significant reduction in overall statin (-41.7% total reduction) and antihypertensive prescriptions (M=0.89 to M=0.60 per patient, %patients taking ≥1 antihypertensive 59.3% to 44.2%). 

The most commonly stopped medications were atorvastatin, amlodipine and ramipril. The most commonly started medications were paracetamol, colecalciferol and macrogol powder. Mean anticholinergic burden increased (M=1.63 to M=2.28), which is accounted for by anticipatory medications in end-of-life care preparations. 

Conclusion

Though patients tended to leave hospital with more medications the composition had changed, demonstrating active review and deprescribing behaviour. There is an observed shift from preventative and prophylactic medications towards analgesics, vitamin supplementation and laxatives. Statins were by far the most commonly stopped medication – due to poor prognostic benefit in older patients with frailty. 

Appropriate deprescribing occurs in the acute hospital setting; further benefit may be gained from regular structured reviews in the primary care setting to reduce polypharmacy prior to admission.