Abstract
Aim
STOPPFrail criteria identify potentially inappropriate medications (PIMs) in frail older adults with poor predicted one year survival. This study aimed to determine the proportion of older adults in which STOPPFrail criteria are applicable; measure the prevalence of STOPPFrail PIMs and identify potential medication cost savings.
Methods
We prospectively reviewed patients who received Comprehensive Geriatric Assessment following an attendance at the Emergency Department (ED) at a large regional hospital. We recorded Charlson Comorbidity Index, Medications, Rockwood Frailty Status and applied STOPPFrail in patients who fulfilled STOPPFrail criteria after a geriatrician led multidisciplinary assessment. Medication costs were identified using the Medoptimise medication review software.
Results
279 patients were prospectively assessed over a 12 week period between June- August 2022. 47 patients met STOPPFrail eligibility criteria (16.8%) ( mean age 87.7 yrs IQR 82-93; 34% male; CFS 7.2; CCI 6.7). Those STOPPFrail eligible were prescribed 397 medications (mean of 8 medications IQR 6-10.5) of which 104 were PIMs. At least one PIM was identified in 42 eligible patients (89.3%). The mean number of PIMs per person was 2.2. Most common PIMS were i) Antihypertensives in patients with a systolic blood pressure lower than 130mmHg (23 patients;22% of identified PIMs) ii) statins in 21 patients ( 20% of PIMs) and Calcium and Vitamin D supplementation 11 (10.5%) and 15 (14.4%) PIMs respectively. £12,589.39 of medication cost savings were identified by the use of the STOPPFrail criteria.
Conclusion
16.8% of screened patients were STOPPFrail eligible; with PIMS identified in 89.3%. This study has shown the efficacy of the STOPPFrail criteria to identify potentially inappropriate prescriptions and medication cost savings, however the ability of the criteria to prevent adverse events for patients is unknown. STOPPFrail has been incorporated into the routine structured medication review process within our local service.