Improving prescribing for older patients - 'Yes S-I-R-E!'

Area of Science:

• Geriatric Medicine
• Pharmacology
• Clinical Pharmacy

Background:

• Polypharmacy and inappropriate prescribing negatively impact elderly health outcomes.
• Existing prescribing tools lack patient-centeredness and clinical judgment flexibility.
• Assessing medication appropriateness in the elderly is crucial for improving care.

Purpose of the Study:

• To evaluate the prevalence of inappropriate prescribing in hospitalized elderly patients.
• To introduce and assess the utility of the 'S-I-R-E' mnemonic for medication appropriateness.
• To identify common reasons for inappropriate medication use in this population.

Main Methods:

• A cross-sectional observational study of 243 elderly patients in a Singapore tertiary hospital.
• Utilized the implicit 'S-I-R-E' mnemonic (Symptoms, Indication, Risks, End of life) for medication assessment.
• Data collected on patient demographics, medications, and prescribing appropriateness.

Main Results:

• Inappropriate prescribing affected 27.6% of patients.
• Lack of valid indication (62.2%) was the primary reason for inappropriateness.
• Polypharmacy (93%) was significantly associated with inappropriate prescribing (p=0.047).

Conclusions:

• Inappropriate prescribing and polypharmacy are highly prevalent in hospitalized elderly individuals.
• The 'S-I-R-E' mnemonic offers a practical framework for guiding appropriate prescribing.
• This tool can aid clinicians in optimizing medication management for older adults.