Association Between Geriatric Frailty and Medication Related Problems in the Emergency Department to Help Clinical Pharmacists Prioritise Patients

NCT07282379 | Not Yet Recruiting DMC

• 1 other identifier: DISARMED2026
• Study Type: observational
• Target: 300
• Locations: 1 country
• Sites: 1

Brief Summary

The healthcare systems are under increasing pressure due to a rise in emergency consultations, staff shortages, an ageing population and rising costs. Emergency departments are seeing more vulnerable patients, including elderly people, who are often on multiple medications and at risk of medication errors. To improve safety, the integration of pharmacists specialising in emergency medicine has proven beneficial: their presence in the team improves the detection of medication-related problems, speeds up and optimises treatment, reduces rehospitalisations and lowers healthcare costs. However, in most countries, these pharmacists are still rarely found in emergency departments, mainly due to a lack of resources and clinical prioritisation criteria tailored for them and adapted to this environment. Frailty screening tools and scores, such as ISAR, can be used to identify the elderly patients most at risk, predict adverse events such as fall or mortality, and thus adapt their care in the emergency department. Indeed, elderly frail patients often take many medications and consequently are at risk of medication errors, adverse events, inappropriate prescriptions or serious drug interactions. These patients may therefore require a specialised review on their medication by clinical pharmacists when they are admitted to the emergency department, but their high number make it impossible to care for all of them. We aim thus to evaluate the association between frailty (according to the ISAR score) and medication-related problems among elderly patients admitted to the emergency department. Researchers will examine whether this score can predict the presence of inappropriate prescribing and high-risk drug interactions. If so, pharmacists would then have a quick and easy tool to prioritise patients who would benefit most from a specialised review of their medications when they visit the emergency department. There will not be any intervention and this study will not influence patients care. Once patients agree to participate, researchers will prospectively collect medical data from elderly patients admitted to the emergency department and analyse their medical history, home medication, reason for admission, frailty score using ISAR, and perform a pharmaceutical analysis based on these data.

Conditions

Drug Drug Interaction; Inappropriate Drug Use; Frailty; Emergency Department Visit; Elderly

Keywords

emergency department; clinical pharmacists; elderly; frailty; ISAR; inappropriate prescription; Drug interaction; drug-related problems

Outcome Measures

Primary Outcomes (2)

• The rate of inappropriate prescription (PIP) as a function of their ISAR score.

  The rate of inappropriate prescription (PIP) will be compared as a function of their ISAR score, using Poisson regression analysis. PIPs will be defined according to the STOPP/START online tool version 3, developed for geriatric patients.

  At the time of their admission to the emergency department

• The rate of high-risk drug-drug interactions (DDIs) as a function of their ISAR score.

  The rate of high-risk drug-drug interactions (DDIs) will be compared as a function of their ISAR score, using Poisson regression analysis. High-risk DDIs will be detected with the Lexicomp™ Interact online tool and only categories D ("Consider therapy modification") and X ("Avoid combination") will be considered.

  At the time of their admission to the emergency department

Secondary Outcomes (1)

• The predictive performance of the ISAR score for the detection of PIPs and high-risk DDIs.

  At the time of their admission to the emergency department.

Other Outcomes (2)

• The number of drug-related problems (DRPs) in function to the ISAR score.

  At the time of their admission to the emergency department.

• The likelihood of a medication-related emergency visit in function to the ISAR score.

  At the time of their admission to the emergency department.

Study Arms (1)

Elderly patients in the ED

Patients aged of 75 or more who are admitted to the emergency department

Other: Pharmaceutical analysis based on the Electronic Patient Record

Interventions

Pharmaceutical analysis based on the Electronic Patient Record OTHER

After inclusion, each patient's data will be collected and analysed by the investigator in the following 5 days. The said data will be: * Independent variables (demographic data, laboratory results, comorbidities, home medication treatment, reason for admission) * The ISAR score, using the electronic patients record * The number of inappropriate prescriptions, using STOPP/START version 3 online tool. * The number of high-risk drug interactions (categories D "Consider therapy modification" and X "Avoid combination"), using Lexicomp™ Interact online tool. * The number of drug-related problems, using the PCNE classification version 9.1, including usual home patient's treatment as well as treatment received in the ED. * The likelihood of a medication-related emergency consultation, using AT-HARM 10 score.

Elderly patients in the ED

Eligibility Criteria

• Age: 75 Years+
• Sex: all
• Age Groups: Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study population will consist of all geriatric patients residing in the area of the Riviera-Chablais Hospital (Rennaz, Canton of Vaud, Switzerland). This hospital cares for nearly 200,000 people and its adult emergency department receives 35,000 patients per year (20% of whom are aged 75 and over).

You may qualify if:

• Patients aged ≥ 75 years admitted to the adult emergency department
• Patients able to give informed consent as documented by signature or a therapeutic representative, if applicable .

You may not qualify if:

• Patients initially admitted to the emergency resuscitation room.
• Patients admitted to the minor accidents and emergencies room.
• Patients admitted to the stroke unit, as they just pass through the emergency department to directly proceed to the CT-scanner.
• Missing data for proper file analysis (e.g., missing usual home medication)
• Patient's inability to sign consent and no therapeutic representative available
• Patient's refusal to sign consent
• Emergency physician's refusal to include patient for any reason.

Sponsors & Collaborators

• Pharmacie des Hopitaux de l'Est Lemanique: lead

Study Sites (1)

Hôpital Riviera-Chablais (Vaud-Valais), service des urgences

Rennaz, Canton of Vaud, 1847, Switzerland

Location

Related Publications (6)

• Kempen TGH, Hedstrom M, Olsson H, Johansson A, Ottosson S, Al-Sammak Y, Gillespie U. Assessment tool for hospital admissions related to medications: development and validation in older patients. Int J Clin Pharm. 2019 Feb;41(1):198-206. doi: 10.1007/s11096-018-0768-8. Epub 2018 Dec 26.

  PMID: 30585296 RESULT

• Abuzour AS, Hoad-Reddick G, Shahid M, Steinke DT, Tully MP, Williams SD, Lewis PJ. Patient prioritisation for hospital pharmacy services: current approaches in the UK. Eur J Hosp Pharm. 2021 Nov;28(Suppl 2):e102-e108. doi: 10.1136/ejhpharm-2020-002365. Epub 2020 Dec 1.

  PMID: 33262131 RESULT

• McCusker J, Bellavance F, Cardin S, Trepanier S, Verdon J, Ardman O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc. 1999 Oct;47(10):1229-37. doi: 10.1111/j.1532-5415.1999.tb05204.x.

  PMID: 10522957 RESULT

• Ellis B, Carpenter CR, Lowthian JA, Mooijaart SP, Nickel CH, Melady D. Statement on Minimum Standards for the Care of Older People in Emergency Departments by the Geriatric Emergency Medicine Special Interest Group of the International Federation for Emergency Medicine. CJEM. 2018 May;20(3):368-369. doi: 10.1017/cem.2017.426. Epub 2018 Jan 23. No abstract available.

  PMID: 29357950 RESULT

• Almarsdottir AB, Haq R, Norgaard JDSV. Prioritizing patients for medication review by emergency department pharmacists: a multi-method study. Int J Clin Pharm. 2023 Apr;45(2):387-396. doi: 10.1007/s11096-022-01515-3. Epub 2022 Dec 5.

  PMID: 36469215 RESULT

• Bamps J, Lelubre S, Cauchies AS, Devillez A, Almpanis C, Patris S. Identification of seniors at risk (ISAR) score and potentially inappropriate prescribing: a retrospective cohort study. Int J Clin Pharm. 2024 Dec;46(6):1345-1351. doi: 10.1007/s11096-024-01766-2. Epub 2024 Jul 2.

  PMID: 38954078 RESULT

Related Links

• Web page of the hospital pharmacy conducting the study (PHEL) and describing all current research projects summaries.

MeSH Terms

Conditions

Frailty; Emergencies

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms; Disease Attributes

Central Study Contacts

Ferdinand Le Bloc'h, PharmD

CONTACT

+41774879035; ferdinand.lebloch@unige.ch

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: OTHER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 2, 2025
• First Posted: December 15, 2025
• Study Start: March 1, 2026
• Primary Completion (Estimated): August 31, 2026
• Study Completion (Estimated): September 1, 2026
• Last Updated: December 15, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• Time Frame: IPD data will be available 6 months after publication of the first study results and for 10 years
• Access Criteria: Data will be accessible to external researchers, regulatory bodies, and authorized entities under the following conditions: Formal request submission detailing the project and data usage. Access granted if the request meets ethical, scientific, and confidentiality criteria.

Locations

CH (1)