Background and importance Oral iron is prescribed to elderly patients as the treatment for episodes of iron deficiency anaemia. Inadequate follow-up and chronic prescription in patients who no longer benefit from it is common.
Aim and objectives To identify potentially inappropriate prescriptions (PIP) for oral iron (OI) in institutionalised elderly patients, as well as describing the deprescribing process in consensus with the centre’s medical team.
Material and methods Demographic (age, sex), clinical (pathologies), analytical (haemoglobin, ferritin and serum iron) and pharmacological variables (dosage, possible adverse reactions) were collected from all patients undergoing oral iron treatment at the centre under our care. The Selene medical record and the Mira electronic prescription were used for data collection.
Chronically prescribed treatments without evidence of iron deficiency anaemia and non-iron deficiency analytical profile in elderly patients (Hb >12 g/dL, ferritin >100 ng/mL) were ruled as cut-off points for PIP. Data weres collected prior to and 3 months after the intervention.
Results Out of the 129 institutionalised patients, a total of 27 patients (21%) followed a chronic treatment with different presentations of OI (10 iron lactate, 17 sulfate). With a median age of 88 years, the majority (74%) were women. 56% of the patients in treatment had chronic constipation, possibly exacerbated by OI.
Of the 27 patients with OI, 16 PIPs (59%) were found. 12 patients (75%) had high iron reserve values (ferritin and haemoglobin) and 4 patients followed a chronic prescription without adequate analytical testing.
We proposed to the medical team to study the possibility of suspending OI treatment in those 12 patients with high iron reserve values, as well as assessing those 4 patients without previous blood tests, and to reevaluate after 3 months. The pharmaceutical deprescribing recommendation was accepted in 10 patients (63%).
Three months after the withdrawal, 4 patients had normal values of iron reserve tests, 3 were deceased, 2 had no analytical data, and 1 patient restarted a 3-month course of OI treatment.
Conclusion and relevance Oral iron treatments are prone to inadequate chronic prescription; these drugs commonly cause gastrointestinal adverse effects. Deprescribing efforts by pharmacists in a nursing home as part of a multidisciplinary team is a effective way of optimising treatment in polymedicated, elderly patients.
Conflict of interest No conflict of interest
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