polypharmacy!in!stable!elderly!medical!pa5ents!is

Polypharmacy in Stable Elderly Medical Pa5ents is Prevalent but Virtually Unaddressed by Emergency Physicians: No Apparent Link to Six Month Mortality Camilla Strøm, Søren Wis5sen Rasmussen, Thomas Andersen Schmidt Department of Emergency Medicine, Holbaek Sygehus, Copenhagen University Hospital, Denmark Introduc5on & Scope Adversely impac/ng elderly pa/ents, polypharmacy may not be addressed in the Emergency Department se9ng (ED). The SCOPE of the study was to observe whether emergency physicians addressed polypharmacy, and to observe whether there were subsequent diﬀerences in hard endpoints. Polypharmacy is deﬁned as the use ≥ 5 medica5ons per day. Methods Retrospec/ve chart review. Over the dura/on of 1 month consecu/ve stable pa/ents ≥75 years old admiEed to the ED were divided into a polypharmacy group (PGgroup) taking ≥ 5 drugs and a non polypharmacy group (NPW group) taking less than 5 drugs per day. We registered in how many pa/ents, polypharmacy had been addressed by the admi9ng physicians in the pa/ents’ charts. The two groups were compared with regard to • 6Gmonth mortality • length of stay (LOS) • inGhospital mortality • transfer of care • adverse events • number of readmissions Results are reported by number (%), mean (SD) or median (IQR). We used Chi squareGtest, unpaired Student`s tGtest or mul/ple logis/c regression analysis as appropriate. KEY FINDINGS NP n=32 (20%) P n=125 (80%) p Age in years, mean (SD) 83.8 (6.1) 83.0 (6.0) 0.50 Gender female/male, n (%) 16/16 (50/50) 58/67 (46/54) 0.72 Median number of daily medica/ons, n (IQR) 3 (2G5) 9 (7G11) NA Pa%ents where polypharmacy has been addressed in ED 8 (6) 6 month mortality, n (%) 6 (19) 19 (15) 0.83 LOS in days, median (IQR) 5.25 (1.2G7.2) 7.4 (1.9G11.4) 0.10 Pa/ents with one or more adverse events, n (%) 5 (16) 11 (9) 0.41 NP: non polypharmacy. P: polypharmacy. p: pGvalue Adverse events: nosocomial infec/on, medica/on error, deep venous thrombosis, pulmonary embolism, delirium, falls, fractures, decubitus ulcers, GI haemorrhage, cerebral infarc/on. Conclusion • The prevalence of polypharmacy was high (80%) • ED physicians address polypharmacy to a very limited extent (6%). • Polypharmacy did not have an apparent impact on 6Gmonth mortality, LOS, inGhospital mortality, transfer of care, adverse events, or the number of readmissions. • This study is limited due to small sample size and retrospec/ve design • A randomised clinical trial is pending

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Page 1: Polypharmacy!in!Stable!Elderly!Medical!Pa5ents!is

!Polypharmacy!in!Stable!Elderly!Medical!Pa5ents!is!Prevalent!but!Virtually!

Unaddressed!by!Emergency!Physicians:!No!Apparent!Link!to!Six!Month!Mortality!!

Camilla!Strøm,!Søren!Wis5sen!Rasmussen,!Thomas!Andersen!Schmidt!!Department!of!Emergency!Medicine,!Holbaek!Sygehus,!Copenhagen!University!Hospital,!Denmark!

Introduc5on!&!Scope!Adversely!impac/ng!elderly!pa/ents,!polypharmacy!may!not!be!addressed!in!the!Emergency!Department!se9ng!(ED).!The!SCOPE!of!the!study!was!to!observe!whether!emergency!physicians!addressed!polypharmacy,!and!to!observe!whether!there!were!subsequent!differences!in!hard!endpoints.!

Polypharmacy!is!defined!as!the!use!!≥!5!medica5ons!per!day.!

Methods!Retrospec/ve!chart!review.!Over!the!dura/on!of!1!month!consecu/ve!stable!pa/ents!≥75!years!old!admiEed!to!the!ED!were!divided!into!a!polypharmacy!group!(PGgroup)!taking!≥!5!drugs!and!a!non!polypharmacy!group!(NPWgroup)!taking!less!than!5!drugs!per!day.!!We!registered!in!how!many!pa/ents,!polypharmacy!had!been!addressed!by!the!admi9ng!physicians!in!the!pa/ents’!charts.!The!two!groups!were!compared!with!regard!to!•  6Gmonth!mortality!•  length!of!stay!(LOS)!•  inGhospital!mortality!•  transfer!of!care!•  adverse!events!•  number!of!readmissions!Results!are!reported!by!number!(%),!mean!(SD)!or!median!(IQR).!We!used!Chi!squareGtest,!unpaired!Student`s!tGtest!or!mul/ple!logis/c!regression!analysis!as!appropriate.!!

!!!!

KEY!FINDINGS!

NP!n=32!(20%)!

P!n=125!(80%)! !!!!p!

Age!in!years,!mean!(SD)! 83.8!(6.1)! 83.0!(6.0)! 0.50!

Gender!female/male,!n!(%)! 16/16!(50/50)! 58/67!(46/54)! 0.72!

Median!number!of!daily!medica/ons,!n!(IQR)! 3!(2G5)! 9!(7G11)! NA!

Pa%ents!where!polypharmacy!has!been!addressed!in!ED! 8!(6)!

6!month!mortality,!n!(%)! 6!(19)! 19!(15)! 0.83!

LOS!in!days,!median!(IQR)! 5.25!(1.2G7.2)! 7.4!(1.9G11.4)! 0.10!

Pa/ents!with!one!or!more!adverse!events,!n!(%)! 5!(16)! !11!(9)! 0.41!NP:!non!polypharmacy.!P:!polypharmacy.!p:!pGvalue!Adverse!events:!nosocomial!infec/on,!medica/on!error,!deep!venous!thrombosis,!pulmonary!embolism,!delirium,!falls,!fractures,!decubitus!ulcers,!GI!haemorrhage,!cerebral!infarc/on.!

Conclusion!•  The!prevalence!of!polypharmacy!was!high!(80%)!•  ED!physicians!address!polypharmacy!to!a!very!limited!extent!

(6%).!!•  Polypharmacy!did!not!have!an!apparent!impact!on!6Gmonth!

mortality,!LOS,!inGhospital!mortality,!transfer!of!care,!adverse!events,!or!the!number!of!readmissions.!!

•  This!study!is!limited!due!to!small!sample!size!and!retrospec/ve!design!

•  A!randomised!clinical!trial!is!pending!!!

Polypharmacy in the Elderly - hsc.ghs.org · Polypharmacy in the Elderly C. Wayne Weart, Pharm D, BCPS, FASHP, FAPhA Professor Emeritus of Clinical Pharmacy and Outcome Sciences Professor

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