Potentially inappropriate medication in palliative care patients according to STOPP-Frail criteria

Background: Potentially inappropriate medications (PIMs) are common in palliative care patients, but no specific tools have been used to determine these PIMs.

Objective: To evaluate the prevalence of PIMs according to specific tool 'STOPP-Frail', related factors with its existence and clinical consequences.

Methods: This is a post hoc analysis from a 10-month prospective cross-sectional study. Upon hospital admission in an acute geriatric unit (AGU), demographic and pharmacological data were collected to determine related associated factors. The main outcome was prevalence and type of PIMs (by STOPP-Frail criteria). Measured clinical outcomes were adverse drug events, length of stay, location upon discharge, in-hospital mortality and 1-year survival.

Results: Two hundred thirty-five patients (mean age 86.80; 65.50% women) were recruited. Overall, 67.2% of patients had ≥ 1 criterion (mainly 'drugs without clinical indication' due to alimentary tract and metabolism drugs). Related factors associated with PIMs according to STOPP-Frail criteria were moderate polypharmacy (OR 7.16 CI 95% 2.27-22.52) and excessive polypharmacy (OR 7.30 CI 95% 2.34-22.73), but not advanced age (OR 0.26 CI 95% 0.12-0.53) or previous hospitalisations (OR 0.61 CI 95% 0.48-0.79). There were no differences in clinical outcomes.

Conclusion: PIMs according to STOPP-Frail are often used in palliative care patients. PIMs were associated with polypharmacy, but no related morbidity or mortality effects have been observed.