Aims: Geriatric in the Home (GITH) Program provides short-term care for elderly patients in their home. This study aimed to quantify and describe the potentially inappropriate medications (PIMs) identified by pharmacists in the GITH Program.
Methods: We identified all older adults aged ≥65 years admitted to the GITH Program between 7/2/2024 and 11/6/2024. Medication reconciliation was conducted by pharmacist and PIM was assessed using the Beer’s Criteria and STOPP/START tool in conjunction with the pharmacist’s and geriatrician’s clinical judgement, forming part of the comprehensive geriatric medication review for all admitted patients. Relevant recommendations (e.g., dose reduction, medication cessation) made by pharmacists for each PIM identified were recorded.
Results: The study included 104 older adults (63% female; mean age=84 years). The most common reason for admission was due to falls (45%), followed by delirium (11%). A total of 240 PIMs were identified by pharmacists on admission, with an average of 2.3 PIMs per patient. Nearly all (n=233; 97%) the recommendations made by pharmacists on PIMs were accepted by geriatricians. The top three classes of PIMs were vitamin/minerals (n=42/240; 18%), antihypertensives (n=35; 15%), lipid-modifying agents (n=29; 12%) and analgesics (n=29; 12%). Over one-third of patients (n=38/104; 37%) would benefit from further follow-up by pharmacist post-discharge (e.g., to review blood pressure/blood test results).
Conclusions: With delirium and falls contributing to over half of admissions in this group of geriatric patients, reduction in PIMs may help reduce hospital readmission rates. These findings demonstrate the pivotal role of pharmacists as core members within GITH services.