Association between frailty and inappropriate prescribing in elderly patients admitted to an Acute Care of the Elderly Unit

Objectives

The aim of this study is to analyze the association between the degree of frailty and inappropriate prescribing patterns at admission to an Acute Care of the Elderly Unit (ACE Unit).

Methods

Prospective observational study conducted in the ACE Unit of an acute hospital in Barcelona city between June and August 2021. Epidemiological and demographic data were collected during hospitalization. Comprehensive geriatric assessment was performed on admitted patients. We recorded frailty (FRAIL scale), extreme polypharmacy (10 or more drugs), central nervous system potentially inappropriate medications-PIMs (STOPP-CNS or group D), cardiovascular potential prescribing omissions-PPOs (START-CV or group A), and anticholinergic burden using the drug burden index (DBI).

Results

Ninety-three patients were included, of whom 48 (51.6%) were male, with a mean age of 82.83 (SD 7.53) years. The main diagnosis upon admission was heart failure in 34 patients (36.6%). Frail patients were older, with more dependence of activities of daily living and more comorbidity than non-frail patients. Additionally, frail patients demonstrated more omissions according to the START-A criteria. No statistically significant differences were observed in term of extreme polypharmacy, PIMs, or anticholinergic burden.

Conclusions

In the current study we found an association between frailty and inappropriate prescribing, specifically with regard to omissions using the START criteria for the cardiovascular system (group A). Notably, frail patients exhibited more omissions compared to their non-frail counterparts, and this difference was statistically significant.