79.67% 44.51% 23.08% 8.79% 1.67% ≥5 MEDS 5 -9 MEDS 10 -14 MEDS 15 -19 MEDS ≥20 MEDS Polypharmacy 37.36% 6.59% 1 ACH ≥1 ACH PIMs (anticholinergics): Anticholinergic Effect on Cognition Scale. Photo: www.carepathways.com/ 29.67% 7.69% 1 ACH ≥1 ACH PIMs (anticholinergics): Anticholinergic Burden Scale Introduction Ø The older patient is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and being under the care of several specialists. Ø Medications are not commonly reviewed for continued indications, altered physiology, adverse events and reactions. Ø Anticholinergic medications confer added risks of cognitive impairment, delirium, hospitalisation and death. Aim Ø To estimate the prevalence of polypharmacy and Potentially Inappropriate Medications (e.g anticholinergics) in patients referred to the Cognitive Impairment and Dementia Service, Elm Lodge (Ealing West), West London NHS Trust. Methods Ø All referrals between 01/10/20 and 30/11/20 were screened for medications currently prescribed. Ø 182 of 193 referrals were included in the study. 11 excluded due to incomplete or unavailable medication records. Ø The Anticholinergic Effect on Cognition Scale, South London & Maudsley’s (SLAM, UK) tool was used to identify anticholinergic medications, and compared with the Anticholinergic Burden Scale (US). Results Ø 79.67% prescribed ≥ 5 medications Ø 44.51% prescribed ≥ 5-9 medications Ø 23.08% prescribed ≥ 10 -14 medications Ø 8.79% prescribed ≥ 15 -19 medications Ø 1.67% prescribed ≥ 20 medications Ø 37.36% prescribed an anticholinergic (AEC tool) Ø 29.67% prescribed an anticholinergic (ABS tool) Ø 6.59% prescribed > 1 anticholinergic (AEC Tool) Ø 7.69% prescribed > 1 anticholinergic (ABS Tool) Ø Anticholinergic exposure was broadly similar between the Anticholinergic Effect on Cognition tool and the Anticholinergic Burden Scale. Conclusions Ø Polypharmacy and potentially inappropriate prescribing remain widespread in the older adult population. Anticholinergics are also commonly prescribed, sometimes in combination. Ø Other classes of Potentially Inappropriate Medications prescribed (including medications no longer needed, and OTCs) also ought to be identified and reviewed. Ø Polypharmacy and PIMs adversely impact on morbidity and increase mortality rates. Ø Reduction in anticholinergic burden may improve cognition and quality of life. Ø Pharmacovigilance and regular training are needed across services caring for the older adult.. References • Bishara, et al. The anticholinergic effect on cognition (AEC) scale: Associations with mortality, hospitalisation and cognitive decline following dementia diagnosis. Alzheimer's Dement., 16: e039357. • Corsonello, et al. Polypharmacy in elderly patients at discharge from the acute care hospital. Ther Clin Risk Manag. 2007;3(1):197-203. • Maher, et al. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. doi:10.1517/14740338.2013.827660 Polypharmacy and Potentially Inappropriate Medications (PIMs) in older adults referred to a Memory Clinic. Dr Anietie Akpan 1 , Cornelia Termure 1 , Issadevi Nellaya 1 , Dr Bruno De Blaquiere 1 , Dr Sujoy Mukherjee 1 1 Older Persons Mental Health, West London NHS Trust (correspondence: [email protected] ) Acknowledgements: Channessa Wright (admin support).