265 Polypharmacy and potentially inappropriate medication prescriptions in older Nursing Home Residents presenting to the Emergency Department

Abstract Background Nursing Home Residents (NHR) have high rates of polypharmacy and Potentially Inappropriate Medication (PIM) prescriptions. Emergency Departments (ED) are an access point to acute hospitals for unwell NHRs. Attendance is associated with adverse outcomes. This project aims to identify polypharmacy and PIMsin older NHRs presenting to ED and associations with adverse outcomes. Methods A prospective cohort study including all NHR aged≥50 years presenting to ED over one year (01/10/2019–30/09/2020). Data collected included demographics, medications at attendance, Charlson Comorbidity Index (CCI), Clinical Frailty Score (CFS), modified Barthel Index (BI), continence, falls history, ED presentation details, ED Length of Stay (LoS), hospital LoS and 6-and 12-month mortality. Polypharmacy was defined as ≥5medications. The Screening Tool of Older Persons’ Prescriptions version2 (STOPP), STOPPFrail and Beers’ Criteria were used to identify PIMs Results There were 516 attendances by 343 individual NHRs. Mean age was 78.6 years (50–103; ±10.9). Prescriptions were available for 93.0% (480/516). A mean of 12.4 (0–31,±5.24) medications were prescribed per patient, with polypharmacy present in 96.0% (461/480). Mean age of the polypharmacy group was lower (76.2 vs 83.7; p < 0.001). There were no significant differences in CCI, CFS or modified BI scores. STOPP identified 99% (n = 475) as having ≥1 PIM(mean 7.47[0–19; ± 3.67] per patient). All had ≥1PIM according to STOPPFrail(mean 8.59[0–26; ±3.90] per patient). Beers’ classified 97.5% (n = 468) as having ≥1PIM (mean 4.32[0–13,±2.41] per patient). STOPPFrail identified continence (71.9% vs 65.8%) and intellectual disability (76.7% vs 67.5%) as significantly associated with a higher proportion of PIMsp < 0.001). Beers’ identified delirium and hospital admission as associated with a lower proportion of PIMs31.7% vs 36.8%, 33.2% vs 38.1% respectively; p < 0.001). All tools showed NHRs who died at 6-and 12-months had a lower proportion of PIMs Conclusion Polypharmacy and PIMsare common in NHRs attending ED and should be considered at presentation. NH liaison services may facilitate medication review and deprescribing.