(P22) What’s for Dinner? A Case of Polypharmacy Induced Weight loss

Introduction: The complications arising from polypharmacy in the elderly have been well described in literature. Increasing numbers of prescriptions have led to poor health outcomes, including; increasing frailty, loss of independence and worsening nutritional status. While historically polypharmacy implies multiple prescribers and pharmacies, here we present a case of a patient from a long-term care facility, whose single-prescriber prescription cascade over the course of two years resulted in 30 active prescriptions and a subsequent unintentional weight loss of 50 pounds over the course of a single year.

Case Description: An 83 year old female presented with recurrent nausea, poor oral intake, abdominal pain and an unintentional weight loss of 50 pounds over the preceding year. She was previously evaluated for these complaints through three acute hospitalizations with no etiology identified following extensive work-up and specialist evaluation. Physical exam revealed an ill-appearing female with temporal wasting, dry mucus membranes, tachycardic rhythm, soft but tender to palpation abdomen in the upper quadrants and minimal pitting edema to the ankles of the lower extremities bilaterally. Imaging, lab work and endoscopy throughout all acute hospitalizations, were significant only for poor nutritional status, mild gastritis and a single gastric polyp that was resected and shown to be benign on histology. Through exclusion of all other potential etiologies, the patient’s weight loss was attributed to her high pill burden. The patient's medications fell into multiple drug classes which included anti-epileptics, mild opioids, antidepressants, stimulant laxatives, antimuscarinics, anticholinergics and antihypertensives among others. Many of her medications were deprescribed after reviewing the indication and treatment length for each, with the patient noting a gradual return of appetite and plateauing of weightloss on follow-up.

Discussion: Hormonal changes, decreased basal metabolic rate, changes in sense of taste and smell as well as functional limitations have all been shown to play a role in decreasing oral intake with age. Prescribers must also be cognizant of iatrogenic causes, such as that of polypharmacy arising from a provider initiated prescription cascade. In the long-term care setting, a patient’s medications are mostly prescribed by a single prescriber. When complications arise, these are frequently addressed with the addition of newer prescriptions, with little review of current therapies and indications or implications in current presentation. It is important that long-term care patients regularly have their medications audited for necessity and medications deprescribed when able as to not result in the emergence of geriatric syndromes as a direct result from polypharmacy. This case highlights one such presentation of iatrogenic induced failure to thrive, frailty and nutritional deficits.