3111 Evaluation of prescribing patterns in severely frail older adults in an acute geriatric ward according to the STOPPFrail criteria

Abstract Introduction Polypharmacy, multimorbidity, and frailty are closely interlinked. The STOPPFrail (Screening Tool of Older Person’s Prescriptions) criteria offer a structured approach to identifying potentially inappropriate medications (PIMs in very frail older adults with limited life expectancy. This study evaluates the application of these criteria before and after admission to a specialist geriatric ward in a tertiary care hospital. Method Medications were assessed against the STOPPFrail (Version 2) criteria before and after admission. Patients aged ≥65 years were included if they met all three STOPPFrail criteria: dependency in activities of daily living and/or severe chronic disease or terminal illness, severe irreversible frailty, and a clinical expectation of survival of less than 12 months. Data, including demographics, Clinical Frailty Scale (CFS) scores, medical history, and medication lists, were collected prospectively over three months. Results Of 120 patients admitted, 30 met the STOPPFrail criteria (57% female, median age 89.5 years, median CFS 6, median Charlson Comorbidity Index 7). All patients were prescribed one or more PIMsbefore admission, and 96.7% remained on at least one PIM after admission. Lipid-lowering medications decreased from 36.7% to 16.7%, while antihypertensives were fully discontinued (23.3% to 0%). Vitamin D and calcium supplements decreased from 60% to 43.3%, antipsychotic use increased slightly (10% to 13.3%), and proton pump inhibitor (PPI) use remained unchanged at 30%. Despite deprescribing efforts, the median number of medications increased from 8.5 to 9.5. Conclusion PIMsare prevalent in frail older adults. While deprescribing was focused on lipid-lowering and antihypertensive medications, gaps remain for PPIs and antipsychotics. Structured medication reviews, clinician education, improved documentation, and greater pharmacy involvement are essential to optimise prescribing. Identifying very frail older adults for whom STOPPFrail criteria are appropriate is vital to ensure a person-centred approach to medication management, enhancing safety and appropriateness for this vulnerable population.