Evaluation of an initiative to address polypharmacy in hospitalized older adults

Abstract

Background

Polypharmacy contributes to medication-related harm in older adults. Deprescribing interventions are often employed in the outpatient setting, potentially missing patients with limited healthcare access. Hospitalization represents a unique touch point to address polypharmacy in older adults with a multidisciplinary team.

Methods

This retrospective cohort study examined the feasibility and effectiveness of a polypharmacy intervention in hospitalized older adults. The intervention was developed by a multidisciplinary team with a quality improvement framework and implemented by clinical pharmacists on an academic teaching service. Adults aged 65 years and older were included. Pharmacists completed a comprehensive medication review with the identification of medication therapy problems (MTPs), with additional evaluation for polypharmacy (five or more chronic medications) and potentially inappropriate medications (PIMs) using validated tools (Beers and STOPP/START criteria), with recommendations implemented during hospitalization. Descriptive statistics were used to describe the intervention and its outcomes. Reporting followed the SQUIRE statement.

Results

The polypharmacy intervention was provided to 155 patients. Polypharmacy occurred in 98.7% of older adults, whereas 82.6% received at least one PIM (261 total). This demonstrates a significant need for an intervention to address polypharmacy and PIMs during hospitalization. A median of two MTPs was identified per patient (total 287), the most common being adverse drug reaction (present in 52.3% of patients), medication without indication (47.7%), and indication without medication (31%). Opioids were the most common PIM (present in 36.1% of patients), followed by benzodiazepines (10.3%) and skeletal muscle relaxants (8.4%). A total of 40.6% of PIMs were successfully deprescribed at discharge.

Conclusion

Polypharmacy is ubiquitous in hospitalized older adults. A multidisciplinary approach to deprescribing can reduce PIMs during hospitalization.