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

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Results: The study included 667 subjects (63.1% female, mean age:
77.6 ± 6.3 years). Mean drug number was 6.1 ± 3.4. PIM prevalence
detected by STOPP version 2 was higher than that of the Beers
2012 criteria (39.1% vs 33.3%, respectively; p < 0.001; Z = −3.5) with
moderate aggreement in between (kappa = 0.44). Antipsychotics,
over the counter vitamin/supplements, aspirin, selective-serotonin-
reuptake-inhibitors and anticholinergics were the leading drug classes
for PIM. Extend of polypharmacy [p < 0.001, odds ratio (OR) = 1.29, 95%
confidence interval (CI) = 1.20–1.38] was the most important variable
related to PIM, along with multiple comorbidities (p = 0.005, OR = 1.16,
95% CI = 1.05 –1.30), and functional dependency (p = 0.009, OR = 0.90,
95% CI = 0.83–0.97).
Conclusions: Inappropriate prescription prevalence of ∼40% by STOPP
version 2 was similar to the global worldwide prevalence -yet at the
upper end. STOPP version 2 was more succesfull than Beers 2012 to
detect PIM. Patients with multiple drug use, multiple comorbidities,
and more dependency were more likely to have PIM requiring special
attention during prescription.
P-757
Psychotropic drug exposure and hip fractures
M.S. Bakken 1,2, A. Engeland1,3, L.B. Engesæter4,5, S. Hunskaar1,6,
A.H. Ranhoff 2,7, S. Ruths1,8, J. Schjøtt7,9,10. 1Department of Global Public
Health and Primary Care, University of Bergen, 2Kavli Research Centre for
Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen,
3Department of Pharmacoepidemiology, Norwegian Institute of Public
Health, Oslo, 4Department of Clinical Medicine (K1), Faculty of Medicine
and Dentistry, University of Bergen, 5Norwegian Arthroplasty Registry,
Department of Orthopaedics, Haukeland University Hospital, Bergen,
6National Centre for Emergency Primary Health Care, Uni Research
Health, Bergen, 7Department of Clinical Science (K2), Faculty of Medicine
and Dentistry, University of Bergen, 8Research Unit for General Practice,
Uni Research Health Bergen, 9Section of Clinical Pharmacology,
Laboratory of Clinical Biochemistry, Haukeland University Hospital,
Bergen, 10Regional Medicines Information and Pharmacovigilance Centre
(RELIS Vest), Haukeland University Hospital, Bergen, Norway.
Corresponding author: Marit Stordal Bakken, Haraldsplass Deaconess
Hospital, PB 6165, N-5892 Bergen. e-mail Phone
+47 93612620
Introduction: Hip fractures are highly prevalent in older persons, with
great implications for morbidity andmortality. We aimed at examining
associations between psychotropic drug exposure and the risk of hip
fracture, and to estimate the attributable risk.
Methods: A nationwide prospective cohort study based on merged
data from three registries (the Norwegian Prescription Database, the
Norwegian Hip Fracture Registry and the Central Population Registry)
was conducted. The study population included all 906,422 individuals
born prior to 1945 and living in Norway on study start, January 1, 2005.
The study period ended on December 31, 2010.
Results: Exposure to any psychotropic drug was associated with an
excess risk of hip fracture as compared to non-exposure. The excess
risk was two-fold for any antipsychotic drug. Selective serotonin
reuptake inhibitors (SSRIs) and other drugs with high/intermediate
serotonergic properties were the antidepressants associated with the
greatest excess risk, almost two-fold. We found no evidence that short-
acting benzodiazepines (SABs) were safer than long-acting benzo-
diazepines. People exposed to z-hypnotics were at greatest excess risk
at night. The attributable risks were estimated at about 1% (anti-
psychotics), 5% (antidepressants) and 3% (anxiolytics and hypnotics),
respectively.
Key conclusions: In people aged 60 and older in Norway, an excess risk
of hip fracture was found with all psychotropic drugs. Our findings
suggest that the recommended second generation antipsychotics
(SGAs), SSRIs, SABs and z-hypnotics offer no advantages with regard
to hip fracture as compared to the traditional alternatives. Clinical
studies examining mechanisms or causality of the observed associa-
tions are needed.
P-758
Co-prescriptions of psychotropic drugs to elderly patients in a
general hospital
J.-B. Beuscart1,2, G. Ficheur2,3, M. Miqueu3, M. Luyckx4, R. Perichon2,
F. Puisieux1, R. Beuscart2,3, E. Chazard2,3 , L. Ferret2. 1CHU Lille,
Department of Geriatrics, , 2Univ. Lille, EA 2694 – Santé publique:
épidémiologie et qualité des soins, 3CHU Lille, Department of Medical
Information and Archives, F-59000 Lille, 4Denain General Hospital,
Department of pharmacy, F-59220 Denain, France
Introduction: The prescription of psychotropic drugs to elderly
patients in a hospital setting has not been extensively characterized.
The objective was to describe the inappropriate co-prescriptions of
psychotropic drugs in hospitalized patients aged 75 and over.
Methods: By analysing the medical database from 222-bed general
hospital in France, we reviewed a total of 11,929 stays of at least 3 days
by patients aged 75 and over. Prescriptions and co-prescriptions of
psychotropic drugs were identified automatically. Anticholinergic
drugs with sedative effects were considered as psychotropic drugs.
An expert review was performed for stays with the co-prescription
of three or more psychotropic drugs to identify inappropriate
co-prescriptions.
Results: Administration of a psychotropic drug was identified in
5503 stays (46.1% of the total number of stays), of which 1688 (14.2% of
the total) featured at least one co-prescription. Co-prescriptions of
three or more psychotropic drugs for at least 3 days were identified in
389 stays (3.3% of the total). Most of these co-prescriptions (n = 346;
88.9%) were considered inappropriate because of the combination of
at least two drugs from the same psychotropic class (n = 278), the
absence of a clear indication for a psychotropic drug (n = 177) and a
history of falls (n = 87). However, these 389 co-prescriptions were
maintained after hospital discharge in 78% of cases.
Conclusion: The co-prescriptions of psychotropic drugs should be
re-evaluated in elderly hospitalized patients.
P-759
Inappropriate anticholinergic drugs prescriptions in hospitalised
elderly patients
L. Ferret1, G. Ficheur1,3, E. Delaviez1, M. Luyckx 4, S. Quenton1,
E. Boulanger2, R. Beuscart1,3, E. Chazard1,3, J.B. Beuscart1,2. 1EA 2694 –
Department of Health Informatics, Univ. Lille, 2CHU Lille, Department of
Geriatrics, 3CHU Lille, Department of Medical Information and Archives,
F-59000 Lille, 4Denain General Hospital, Department of Pharmacy,
F-59220 Denain, France
Introduction: The prescription of inappropriate anticholinergic drugs
in hospitalized, elderly patients has not been well characterized. The
main objectives of the present study were to describe the frequency of
anticholinergic drug prescription in several at-risk situations and to
quantify gastrointestinal adverse drug reactions (ADR) in hospitalized,
elderly patients.
Methods: Using a database from a French general hospital, we
extracted information on 14,090 hospital stays between 2009 and
2013 by patients aged 75 and over. We detected and analyzed
anticholinergic drug prescriptions in three situations at high risk of
an adverse drug reaction: frequent falls, dementia and benign
prostate hypertrophy. We also screened for cases of constipation that
may have been causally related to the administration of anticholiner-
gic drugs.
Results: Administration of an anticholinergic drug was detected in
1412 (10.0%) of the hospital stays by elderly patients. 36.5% of these
stays corresponded to one or more at-risk situations: 142 (10.1%) for
falls, 253 (17.9%) for dementia and 120 (8.5%) for benign prostatic
hypertrophy. About a quarter of the latter stays combined two or
three at-risk situations. Gastrointestinal ADR induced by anticholin-
ergic drug administration were identified in 197 (14%) patients by
using the Kramer algorithm (90 evaluated as “possible” ADR and 107
evaluated as “probable” ADR).
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S229