Aims: To assess an intervention targeting FRIDs in older hip fracture patients, and barriers to and factors associated with deprescription.
Methods: Prospective chart-based study, extracting data from clinical registry complemented by eMR review. Jul-Oct 2024. All patients ≥65 years with hip fracture underwent medication review assisted by Kick.amc.nl/falls/decision-tree to facilitate FRID deprescription.
Results: Amongst 109 participants, mean age was 80.3 years (SD10.2), 65.2% were female, 16.7% from residential facilities,40.74% were moderate-severely frail, mean Charlson Comorbidity index (CCI) 5.16 (SD 2.06). Median number of admission FRIDs was 2 (IQR 1-3); at discharge median was 3 (IQR 2- 4), most commonly opioids (76/90), antihypertensives (11/90). Overall,15.5% had 1+ FRID deprescribed; mean number deprescribed 0.53 (SD=0.78). Deprescribing barriers were identified in 91.7% (77/84), hypertension (56/77) and depression (12/77) frequent reasons for continuation.
On simple comparative tests, comparing those with or without any FRID deprescribed, age (82.6 versus 78.9,p=0.08), gender (39.44% female V 34.21% male, p=0.59) and frailty (56.90% versus 43.10% frail, p=0.21) were all similar. Those with any FRID deprescribed had higher CCI score (mean 5.90 versus 4.71,p=0.002). Univariate analysis outcomes were similar. On multivariable modelling, adjusting for age, CCI independently associated with likelihood of any FRID being deprescribed (aOR 1.32, 95% CI 1.04-1.66, p=0.021).
Conclusions: FRID deprescription was common in patients with hip fracture; this was commoner with higher comorbidity. Deprescribing barriers were common. Further work may explore how patient preferences and values might be better aligned with FRID prescription, and whether risk/benefit support deprescribing over continuation of medications in this population.