European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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Rehabilitation, Frailty Area, E.O. Galliera Hospital, National Relevance &
High Specialization Hospital, Genoa, Italy
Objectives: Aging is associated with an increased prevalence of
chronic diseases and polypharmacy, with consequent major risks of
potentially inappropriate drug prescriptions (PIPs). Aim of this study
was to evaluate the efficacy of a computer-based tool to reduce PIPs in
hospitalized older patients.
Methods: Subjects aged 65+ years admitted to the Geriatrics Unit of
the Galliera Hospital in Genoa for any acute illness were enrolled.
Therapies at admission and at discharge were collected. Then a
validated computer-based tool was used in order to detect any PIPs
according to the Screening Tool of Older People’s Prescription (STOPP)
criteria and Micromedex ® system was used to detect major drug
interactions. All identified PIPs have been then discussed by the
multidisciplinary geriatric team (MGT) that included geriatricians,
pharmacist and nurses to consider possible modifications of the
potentially inappropriate drug prescriptions. In all patients the
Medication Appropriateness Index (MAI) at admission and at
discharge has been calculated.
Results: 166 patients were enrolled (mean age 87 ± 5.4 years, females
72% and males 28%) with an average number of 6 ± 2.9 drugs at
admission. Between admission and discharge the number of detected
STOPP criteria decreased by 32.7% while the number of drug
interactions decreased by 65.5%. The median value of MAI score
decreased from admission to discharge [2 (IQR 0–4) to 1 (IQR 0–2)
respectively, (p < 0.01)].
Conclusion: Prescriptive appropriateness in older patients could be
improved during hospitalization by using a computerized system that
detects PIPs and the pharmacist ’s involvement in the MGT.
Area: Cognitive disorders
O-036
Psychotropic drug use and mortality in old people with dementia:
a gender-sensitive analysis
J. Brännström 1, G. Boström1, E. Rosendahl2, P. Nordström1,
H. Littbrand 1, H. Lövheim1, Y. Gustafson1. 1Department of Community
Medicine and Rehabilitation, Geriatric Medicine, Umeå University,
2Department of Community Medicine and Rehabilitation, Physiotherapy,
Umeå University, Sweden (ER)
Objectives: Psychotropic drugs are common among old people with
dementia, and have been associatedwith increasedmortality. Previous
studies have not investigated gender differences in this risk. This study
was conducted to analyse associations between the use of anti-
psychotics, antidepressants, and benzodiazepines and 2-year mortal-
ity in old people with dementia, and to investigate gender differences
therein.
Methods: In total,1,037 participants (74% women; mean age, 89 years)
with dementia were included from four cohort studies and followed
for 2 years. Data were collected through home visits and medical
records. Cox proportional hazard regression models were used to
analyse associations between ongoing baseline drug use and mortal-
ity. Multiple possible confounders were evaluated and adjusted for.
Results: In fully adjusted models including data from the whole
population, no association between baseline psychotropic drug use
and increased 2-year mortality was seen. Significant gender differ-
ences were found in mortality associated with antidepressant use,
which was protective in men, but not in women (hazard ratio [HR]
0.61, 95% confidence interval [CI] 0.40–0.92 and HR 1.09, 95% CI 0.87–
1.38, respectively). The interaction term for sex was significant in
analyses of benzodiazepine use, with a higher mortality risk among
men than among women.
Conclusions: Among old peoplewith dementia, ongoing psychotropic
drug use at baseline was not associated with increased mortality in
analyses adjusted for multiple confounders. Gender differences in
mortality risk associated with antidepressant and benzodiazepine use
were seen, highlighting the need for further investigation of the
impact of gender.
O-037
Can we influence hospital readmission for people with dementia?
C. Scampion1, A. Eltilib1, N. Cahill1, R. Robinson1, O.J. Corrado1. 1Leeds
Teaching Hospitals NHS Trust, Leeds, United Kingdom
Introduction: 90% of people with dementia in Leeds have at least one
other significant co-morbid medical problem. As a result they are at
great risk of frequent admission to hospital. We have undertaken an
audit to determine the health and social factors contributing to
readmission in people with dementia to try and identify potential
strategies to prevent avoidable re-admissions.
Methods: We undertook a retrospective case note audit of patients
aged ≥65 years with an ICD code of dementia with 4 or more
emergency admissions to Leeds Teaching Hospitals in the year
following an initial admission in 2013. We devised an audit tool to
identify the factors contributing to each admission.
Results: 72 patients had 4 or more readmissions within a year. 14
patients were omitted due to missing data. The remaining 58 patients
were admitted a total of 264 times. 57% of admissions were to Elderly
Medicine, the mean length of stay was 11 days. The majority of
admissions were attributed to health (73%) rather than social factors.
Only 16% of admissions were from 24 hour care. Involvement of mental
health teams was poor (8% of admissions) and communication with
carers was lacking.
Conclusions: Contrary to our expectations, people with dementia
were readmitted to hospital principally for medical rather than social
reasons. Given the relative paucity of admissions from care homes,
their admissions may be influenced by social factors or “risk”. Many
admissions were for relatively “soft” medical problems potentially
lending themselves to “unplanned admission strategies’ in primary
care.
O-038
Differences in prevalence and treatment of atrial fibrillation in
dementia disorders: data from the Swedish Dementia Registry
R. Dorota, L. Bognandi, P. Cermakova, S. Ptacek, B. Winblad,
M. Eriksdotter. Karolinska Institutet, Polish Academy of Sciences
Introduction:Emerging evidence shows an association between atrial
fibrillation (AF) and dementia. Treatment for AF in patients with
dementia has been suggested to be lower than for patients without
dementia due to a higher risk of bleeding. Studies have not included all
types of dementia disorders. Aims: This study aimed to find the
prevalence of AF in different dementia disorders and to assess
prevalence of warfarin use in dementia disorders.
Material and methods: A register based, cross-sectional study,
combining data from several registries. Patients from the Swedish
Dementia Registry (n = 29,630) within 2007–2012 were included.
Results: In the total study cohort, prevalence of AF was 19%. AF was
more prevalent in mixed dementia (MD) (OR 1.1; 95% CI 1.0–1.3) and
vascular dementia (VD) (OR 1.3; 95% CI 1.1– 1.4) and more associated
with MD and VD than Alzheimer’s disease (AD) even after adjustment
for confounders. Forty percent of individuals with AF got treated with
warfarin. Warfarin use was more associated with MD (OR 1.2; 95% CI
1.0–1.4) and VD (OR 1.3; 95% CI 1.1–1.5) than AD, after controlling for
confounders.
Conclusions: The burden of AF is high in dementia patients. The
burden is highest in patients with MD and VD, disorders possibly
partially caused by AF. Warfarin treatment is more often associated
with MD and VD than other dementia diagnoses, probably due to a
higher risk of stroke.
Oral presentations / European Geriatric Medicine 7S1 (2016) S1–S27 S11