Evaluation of drug prescriptions on hospital admission in older trauma patients using the Fit fOR The Aged (FORTA) rules.

Abstract

Background: Orthogeriatric comanagement of older patients with hip fractures has been proven to provide significant benefits concerning functional status, readmissions, nursing home placement, in-hospital complications and mortality. Medication management in older individuals is a cornerstone in orthogeriatric comanagement. The aim of the study was to analyze the extent of overprescription and undertreatment in older trauma patients.

Methods: Personal and medical data of consecutively admitted older trauma patients were analyzed. Evaluation of medication was conducted according to the Fit fOR The Aged (FORTA) criteria. Data were retrieved from an ongoing observational study on the incidence of delirium in surgical patients.

Results: A total of 492 patients were enrolled. There were 374 cases of overprescription and 575 cases of undertreatment. Only 78 (16%) patients had neither overprescription nor undertreatment on admission. Overprescription and undertreatment were most prevalent in cardiovascular disease. Undertreatment was most prevalent concerning osteoporosis. The number of prescribed drugs correlated with the Charlson Comorbidity Index (r = 0.478, p < 0.001), age (r = 0.122; p < 0.01), anticholinergic burden (r = 0.528, p < 0.001), FORTA score (r = 0.352, p < 0.001), and overtreatment (r = 0.492, p < 0.001), but not with undertreatment. Undertreatment also correlated with age (r = 0.172, p < 0.001) and overtreatment (r = 0.364, p < 0.01). The FORTA score correlated significantly with age (r = 0.159, p < 0.001), anticholinergic burden (ACB) score (r = 0.496, p < 0.001), Katz index (r = -0.119, p < 0.01), IADL score (r = -0.243, p < 0.001), and clinical frailty scale (CFS, r = 0.23, p < 0.001).

Conclusion: The high numbers of overprescription and undertreatment in older trauma patients underlines the need for orthogeriatric comanagement. Besides the evaluation of multimorbidity and geriatric problems, drug management is a core topic. Future studies should investigate the impact of medication management on outcome parameters such as quality of life, functional status, and mortality. A benefit can be expected.