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

December 2, 2025 updated by: Pharmacie des Hopitaux de l'Est Lemanique

DETECTION OF ISAR-FLAGGED AT-RISK MEDICATION IN THE EMERGENCY DEPARTMENT (DISARMED)

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Observational

Enrollment (Estimated)

300

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Switzerland
    • Canton of Vaud
      • Rennaz, Canton of Vaud, Switzerland, 1847
        • Hôpital Riviera-Chablais (Vaud-Valais), service des urgences
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Older Adult

Accepts Healthy Volunteers

N/A

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).

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
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

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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The rate of inappropriate prescription (PIP) as a function of their ISAR score.
Time Frame: At the time of their admission to the emergency department
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.
Time Frame: At the time of their admission to the emergency department
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 Outcome Measures

Outcome Measure
Measure Description
Time Frame
The predictive performance of the ISAR score for the detection of PIPs and high-risk DDIs.
Time Frame: At the time of their admission to the emergency department.
Determining optimal ISAR threshold for predicting medication problems further improves its use in clinical settings. If possible, sensitivity, specificity, positive predictive value, negative predictive value, and Youden index will be calculated.
At the time of their admission to the emergency department.

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
The number of drug-related problems (DRPs) in function to the ISAR score.
Time Frame: At the time of their admission to the emergency department.
After pharmaceutical analysis of the electronic patient file, DRPs will be classified according to the Pharmaceutical Care Network Europe Association (PCNE) V9.
At the time of their admission to the emergency department.
The likelihood of a medication-related emergency visit in function to the ISAR score.
Time Frame: At the time of their admission to the emergency department.
The likelihood of a medication-related emergency visit will be measured with the AT-HARM 10 score. This score gives a binary result ("possibly" or "unlikely" medication-related visit) and is a useful tool to exclude patients who are unlikely to be admitted due to a medication issue.
At the time of their admission to the emergency department.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Pharmacie des Hopitaux de l'Est Lemanique

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

March 1, 2026

Primary Completion (Estimated)

August 31, 2026

Study Completion (Estimated)

September 1, 2026

Study Registration Dates

First Submitted

December 2, 2025

First Submitted That Met QC Criteria

December 2, 2025

First Posted (Actual)

December 15, 2025

Study Record Updates

Last Update Posted (Actual)

December 15, 2025

Last Update Submitted That Met QC Criteria

December 2, 2025

Last Verified

December 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • DISARMED2026

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

If patients give their consent for data re-utilisation (consent signature independent from their inclusion in the study), demographic data and all individual outcomes (ISAR score, inappropriate prescriptions, high-risk drug interactions, drug-related problems, AT-HARM10 score) will be shared. All data will be anonymised and shared in a secure format (CSV).

IPD Sharing Time Frame

IPD data will be available 6 months after publication of the first study results and for 10 years

IPD Sharing 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.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Frailty

Clinical Trials on Pharmaceutical analysis based on the Electronic Patient Record

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Togo

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe