Determination of drug-related problems in geriatric intensive care patients

The aim of the study was to determine the prevalence, classification, and causes of inappropriate drug use in geriatric patients hospitalized in the intensive care unit using the STOPP-START criteria The study was conducted retrospectively using the data of patients hospitalised in the intensive care unit (ICU) of Istanbul University Cerrahpaşa Cardiology Institute between January and November 2024. This study was ethically approved by the local ethics committee with decision number 2023/187. Geriatric patients who were hospitalised in the ICU for at least 48 hours between January 1st 2017 and December 31st 2022 were included in the study. Sociodemographic characteristics, comorbidities, prescribed medications, and routine laboratory data were obtained by detailed patient file review. The appropriateness of the prescribed medication was investigated according to STOPP/START criteria and drug-drug interaction (DDI) was detected with Lexicomp® drug interaction programme. The mean age of 496 geriatric patients was 73.31±6.89 years and the mean duration of hospitalisation was 6.38±5.13 days. The mean number of drugs used per patient was 20.52±13.22, the mean number of DDI(drug-drug interaction) was 8.92±5.28, and the mean number of level DDIs per patient was 0.52±0.79. According to STOPP-START criteria, at least one PIM(Potentially Inappropriate Medication) was detected in 473 (94.6%) patients and the total number of PIMs in 496 patients was 1212. The total number of STOPP-START criteria non-conformities was 1162. Of these, 758 (65.29%) were related to START criteria. The number of PIMs detected per patient was 2.38±1.23. According to START criteria, 89.84% of PIMs were associated with cardiovascular diseases (Category B). According to the STOPP criterion, 47.63% belonged to category B. Considering the complexity of the geriatric patient and the challenging environment of the ICU unit, PIMs may increase. Clinical pharmacists can detect, classify and prevent potential inappropriate medication use. Keywords: Geriatrics, Clinical Pharmacy, START-STOPP Criteria, Cardiology, Intensive Care Unit, Potentially Inappropriate Medication