63IS THERE A DIFFERENCE OF ASSESSMENT OF POLYPHARMACY BY GERIATRICIANS AND NON-GERIATRICIANS IN PATIENTS PRESENTING WITH FALL?

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Abstract

Introduction: Polypharmacy is a major problem in patients presenting with falls. Assessment of polypharmacy is of vital importance in these patients. It is an important part of NICE guidelines on falls. We assess the difference of assessments of polypharmacy in falls patients presenting to medical admission unit run by non-geriatrician and emergency frailty unit run by geriatrician in University Hospitals of Leicester.

Method: It is a retrospective study. Case notes were reviewed. We included patients who were on four or more drugs. A total of 80 patients are included in the study. Forty were reviewed by non-geriatric consultants (acute physicians, gastroenterologist, endocrinologist and infectious disease consultants) in medical admission unit and 40 were reviewed by geriatrician in emergency frailty unit. We reviewed the case notes to see if there is documented evidence of drug review.

Results: Average age of the patients was 83 in the medical admission group and 85 in the emergency frailty unit group. Forty-five percent of patients were on psychotropic medication and 87% were on antihypertensives. Sixty-five percent of patients have documented evidence of drug review by geriatrician. On the other hand 40% of patients have documented evidence of drugs review by non-geriatrician consultant grade. This was a statistically significant difference (P-value 0.043 calculated by Fisher's exact test).

Conclusion: Geriatricians are more likely to address polypharmacy issue as part of comprehensive geriatric assessment in patients presenting with falls. However, there is still room for improvement. There is a need for increasing awareness to review medications in patients presenting with fall to minimise the risk of future falls and to avoid repeated hospital admissions. A vast number of patients are on potentially harmful medications which contribute enormously in fall especially in frail elderly patients.

Reference:

1. Ziere G, Dieleman JP, Hofman A. Br J Clin Pharmacol 2006; 61: 218–23

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