166 INAPPROPRIATE PRESCRIBING IN COMMUNITY-DWELLING OLDER ADULTS: A CROSS SECTIONAL REVIEW USING THE STOPP/START CRITERIA

Abstract

Abstract Background Older adults are a heterogenous cohort of patients, often with multiple comorbidities and prescribed numerous drugs. Polypharmacy, defined as use of five or more medications, and inappropriate prescribing are risk factors for adverse outcomes. STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) are criteria that facilitate medication review in older people to aid better prescribing and health outcomes. This review aims to identify inappropriate prescribing in the community-dwelling older adult attending Integrated Care Programme for Older Persons (ICPOP). Methods We performed a cross-sectional review of patients attending the ICPOP Hub between January 2022 and May 2022. Patients’ prescriptions were obtained from pharmacies and/or General Practitioners (GP) and cross checked against the medications brought to their appointment. Patients’ past medical history was obtained from the patient, GP and hospital letters. Their prescriptions were analysed using the STOPP/START criteria. Results This study included 68 patients. The mean age was 83.5 years. Polypharmacy was present in 94%, with an average of 9.5 drugs prescribed. Common medications identified via STOPP criteria were hypnotic z-drugs in patients with falls (13.2%); loop diuretics for pedal oedema without heart failure (11.8%) and benzodiazepines for >4 weeks in patients with falls (10.3%). Common medications identified to commence via START criteria were vitamin D supplement in those with falls (32.4%); bone anti-resorptive therapy in those with osteoporosis (13.2%); laxatives in patients taking opiates (11.8%) and acetylcholinesterase inhibitors in those with memory impairment (8.8%). 48 participants had medications commenced with 46 having medications stopped. Only 9 patients required no change to their medication prescription. Following STOPP/START, there was an overall reduction in prescribed medications by 0.12 (p=0.494). Conclusion Applying STOPP/START criteria lead to a reduction in inappropriate medications prescribed in our multi-morbid older people cohort while identifying appropriate treatments to improve health outcomes.