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

Pharmacie des Hopitaux de l'Est Lemanique

Status: Begins enrollment this month

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

Treatments: Other: Pharmaceutical analysis based on the Electronic Patient Record

Study type: Observational

Funder types: Other

Identifiers

NCT07282379

DISARMED2026

Details and patient eligibility

About

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.

Enrollment: 300 estimated patients

Sex: All

Ages: 75+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 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 .

Exclusion criteria

• 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.

Trial design

300 participants in 1 patient group

Elderly patients in the ED

Description:

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

Treatment:

Other: Pharmaceutical analysis based on the Electronic Patient Record