21 Prevalence of Potentially Inappropriate Medications (PIMs) in Older Palliative Patients, Defined by STOPPFrail Criteria

Abstract Background Polypharmacy is common in older persons with multi-morbid illness, increasing the risk of adverse drug events. Drug pharmacokinetics and pharmacodynamics are often altered in this group increasing the risk of adverse drug events and many prescribed drugs take considerable time to benefit. STOPPFrail criteria are designed to help prescribers to identify potentially inappropriate medications in older sicker patients with short life expectancy. The aim of this pilot study was to estimate the prevalence of STOPPFrail defined potentially inappropriate medications (PIMs in older patients with terminal illness at the point of admission to specialist hospice care. Methods We conducted a prospective analysis of inpatient case records and drug kardexes at a university teaching hospice over a period of one month. We recorded patients’ demographic details, principal symptoms, co-morbidities, medications at admission and at day 3-7. STOPPFrail criteria were applied to patients’ medications lists at both time points. Results Of 22 patients studied, 13 were female with a mean (+/- SD) age of 80 years (+/- 6). Eighteen patients were transferred directly from an acute hospital, 4 patients from the community. Common symptoms were pain (72%) and severe lethargy (68%). Twenty out of 22 patients had cancer as the life-limiting condition. There was a significant reduction in the mean (+/- SD) number of medications from admission (11 ± 4.1) to post palliative review (8 ± 4.7; p=0.002). 90% of patients had polypharmacy i.e. ≥ 6 daily medications, 87% had ≥ 1 STOPPFrail PIM on admission. The median number of STOPPFrail PIMs per patient was 1 (1-2, IQR), most commonly high dose proton pump inhibitors, multivitamin supplements, calcium supplements and lipid lowering therapies. Conclusion In this small study, STOPPFrail-defined PIMs were highly prevalent in older terminally ill patients. Prescribers should carefully review the medication lists of terminally ill older patients in order to minimize inappropriate polypharmacy.