Abstract
This service evaluation reviewed the impact of the Perioperative Care of Older People Clinic (POPS) on Anticholinergic Burden (ACB) in older surgical patients and identified areas for improvement. The study assessed 75 patients aged ≥65 years, revealing widespread anticholinergic use. Among patients on anticholinergics, 34% experienced a reduction in ACB post-POPS review. However, maintaining these changes at ≥6 months was challenging, with 50% of patients experiencing a change in their ACB score due to new prescriptions or the re-initiation of old medications. The study identified communication gaps at the POPS-primary care interface affecting de-prescribing efforts, underscoring the need for improved discharge letters, systems to flag high ACB patients and a universal ACB tool.
Introduction
The UK's ageing population is increasingly undergoing surgery, and older adults are at higher surgical risk partly due to anticholinergic use. POPS is a relatively new initiative aimed at reducing ACB in this demographic, but the sustainability of these reductions is not well understood. This service evaluation aims to fill this gap and suggest solutions for maintaining reduced ACB levels.
Methods
Retrospective data from 75 patients from 2022-2023 who met the criteria for ACB evaluation pre- and post-POPS review, with follow-up at ≥6 months, were included. Results Post-POPS, ACB was reduced in 34% of patients, with a median decrease of -2. However, ACB increased again in 50% of patients at ≥6 months, with re-initiation of amitriptyline and furosemide contributing to the rise in 67% of these cases.
Conclusions
CGA effectively reduces ACB in older surgical patients, but sustaining these reductions poses significant challenges. Communication difficulties at the POPS-primary care interface likely contribute to the re-initiation of medications, indicating a need for standardised discharge summaries and a universal system for evaluating and flagging high ACB patients to maintain improvements.
Comments
Interesting!
Really interesting. Thank you for sharing!
Thank you for interacting
Thank you - really interesting. Would love to hear more - does the POPs review occur at the pre-op stage? Do you look at ACB in emergency surgery patients? I am working in periop care and I am really interested to learn about how services are delivered for frail patients on non-elective surgical wards.
Thank you
Thank you for your comment.
Yes the initial review occurs at pre-op stage. We wanted to look at the demographics of these patients and the prevalence of anticholinergic drug use to see how much change POPS interventions had and whether this intervention could be sustained.
We also have looked at emergency surgery patients - this was not reviewed in this QIP, but my colleague has performed it on this subgroup and I can get you in touch if you wish?
That's great to hear you're working in such an important area. Nia Humphry in UHW oversaw this project, and leads the POPS team. She is absolutely the best person to give you some more insight with this. I will put you in touch.