A Review of the Potentially Inappropriate Prescribing in Frail Patients at The Mill Medical Practice
Authors: Menary C , Ridout K 
Published: March 2021

Abstract

Introduction
Elderly care is becoming increasingly complex due to the increasing age of the population leading to higher disease burden. The British Geriatric Society (BGS), defines frailty as a ‘distinctive health state related to the ageing process in which multiple body systems gradually lose built in reserves’ (1). Patients included in this study were both male and female selected at random. Age included those over the age of 65 with a frailty score over 0.25 to include moderately and severely frail.

Aim
To identify frail patients at The Mill Medical Practice and assess the appropriateness of their prescribed medication using statistically validated medication review tools. This included looking at STOP/START interventions, anti-cholinergic burden and frailty index.

Methods
Moderately and severely frail patients were categorised using the electronic frailty index within the emis system at the GP surgery. 20% of patients from each group were chosen at random to have their medication assessed using the review tools. The tools included: STOPP/START, Anticholinergic burden calculator, PrescQIPP falls risk, NICE guidelines, and adapted RiO scoring tool.

Results
In total, the medications of 113 patients were assessed using the review tools. 38% of patients had a STOPP intervention and 63% had a START intervention. The most commonly inappropriately prescribed medicine was Furosemide for both patient groups. It has an anticholinergic burden score of 1 and moderate falls risk. Overall, 16% of patients had a drop of one in anticholinergic burden score. Also, an increase in 23% of patients having a score of zero.

Conclusion
This study was successful in identifying those patients that could have changes made to their medication to improve quality of care. Anticholinergic burden can have detrimental effects in those frail patients leading to physical and cognitive changes. Decreasing anticholinergic burden in frail patients is clinically important due to the risk of these adverse effects such as confusion, dizziness which could result in injury. Even a small increase in in anticholinergic burden score can have serious effects for these frail patients resulting in a hospital admission (2). By decreasing the medicine burden on frail patient this can reduce issues associated with anticholinergic burden and other medicine related issues in turn improving quality of life. Despite the use of medication review tools which try to prevent inappropriate prescribing, this is still an occurrence within the frail population and primary care. This could be due to: lack of time, limited resources available, patients not wanting to change, prescriber willingness to change medication and availability of healthcare professionals to do medicine reviews. Future work could include looking in depth at the ideas explored in this study such as anticholinergic burden and the long terms effects of this on patients.

References
1. British Geriatrics Society [BGS]. Introduction to Frailty, Fit for Frailty part 1. 2014. URL: https://www.bgs.org.uk/resources/introduction-to-frailty [25 November 2019].
2. Ruxton K, Woodman RJ, Mangoni AA. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis. Br J Clin Pharmacol. 2015;80(2):209–220.