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

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P-764
Physicians ’ approach of prescribing drugs for older patients – a
qualitative study
L.D. Christensen 1,2, J. Petersen1, O. Andersen1, S. Kaae3. 1Optimized
Senior Patient Program (Optimed), Clinical Research Centre, Amager-
Hvidovre Hospital, University of Copenhagen, 2The Capital Region
Pharmacy, Amager-Hvidovre Hospital, University of Copenhagen, 3Section
for Social and Clinical Pharmacy, Department of Pharmacy, University of
Copenhagen, Denmark
Objectives: Multimorbidity and polypharmacy are common in older
patients. Hence, they are more prone to experiencing adverse drug
events and hospitalizations. However, little work has been done to
investigate physicians ’ perspectives on prescribing drugs for older
patients using a qualitative approach; therefore the aim of this study
was to explore the physicians’ approach of prescribing drugs for older
patients.
Methods: Semi-structured interviews were carried out with medical
specialists with 23 different specialties relevant for older patients
nationwide in Denmark. Content analysis was conducted to identify
relevant themes. Fifty physicians were interviewed.
Results: The most frequent risk drugs which physicians considered to
cause hospitalization were: vitamin K antagonists, opioids, diuretics,
nonsteroidal anti-inflammatory drugs, anxiolytics, and immune-
suppressants. Independent of their medical or surgical background,
or how often they managed prescriptive drugs in their daily work, all
physicians expressed a cautious attitude when prescribing risk drugs
for older patients. The most frequently used terms were “cautious”,
“contemplate”, “attentive ”. Despite their common cautiousness,
the physicians had different strategies when prescribing drugs for
the older patients. The following strategies were identified: (1) “Start
low, go slow” (2) “Trial and error” (3) “Dose reduction” (4) “Never
prescribe”. Moreover, the physicians used different prescribing
strategies for the same drugs.
Conclusions: The physicians expressed a cautious approach when
prescribing drugs to older patients. The physicians had different
prescription strategies when prescribing drugs for this particular
group. However, there was no practice consensus about how to be
cautious with drugs for older patients.
P-765
Benzodiazepine use in the elderly in the secondary hospital
I. Santos1, G. Girithari1, M. Sousa1, S. Martins1, A. Sanches1,
M. Carvalho 1, F. Pimenta1, M. Melo1. 1Centro Hospitalar Médio Tejo,
Abrantes, Portugal
Introduction: Portugal has the highest levels of benzodiazepine use at
European level and it ’s very relevant to analyze this aspect in the
elderly, since their pathophysiological changes and multiple patholo-
gies, make them more susceptible to adverse events.
Objectives: to determine the prevalence and incidence of use of
benzodiazepines and to investigate the association between the use
of benzodiazepines and mortality in the patients admitted in our
department.
Methods: 1-month cross-sectional epidemiological study was con-
ducted. The study comprises all patients older than 65 years admitted
in the first month of 2015 in secondary hospital. The datawas collected
from the discharge data.
Results: Patients’ (n = 363) mean age was 82.3 years (range 65–100),
58.7% (n = 213) were female and 27.82% (n = 101) were benzodiazepine
users. Benzodiazepine users were more likely to be female (35.68%,
n = 76) and have polypharmacy (6 or more medications;81.18%, n = 82)
compared to non-users (58.78%). Benzodiazepine users took on
average 8.57 (CI 95% 7.89–9.25) medicines, compared to non-users
(n = 6.42; CI 95% 6.06 –6.78). The mortality rate was 25.74% (n = 26) in
benzodiazepine users group (vs 20.61% in non-users). No significant
differences in mean age and average stay were observed. Higher
prevalence in antidepressants and antipsychotics use was observed in
benzodiazepines users. The most prevalent benzodiazepines were
intermediate-acting (n = 60, 59.4%).
Conclusion: A high prevalence of benzodiazepine consumption was
demonstrated in our study, especially among women. In this group of
patients, the data suggests a negative effect in the death rate, since the
mortality is higher among these patients.
P-766
Pill Box – are they all necessary? (PB-ATAN)
R.L. Costa1, G.C. Neves1, C. Dias 1, H. Santos1, M.E. Pereira1, S.B. Costa1,
T.F. Ferreira1. 1USF Castelo, Sesimbra, Portugal
Introduction: Advances in medicine and consequent improvement of
health care have increased life expectancy and prescription of drugs as
well. Polypharmacy occurs when taking ≥5 drugs simultaneously.
Although there isn’t a specific age, it is largely associated with the
elderly condition, especiallyamong the veryelderly (people aged≥75).
The goals of this study are: to quantify the prescription of chronic
medication (≥3 months) in the very elderly of our Primary Care Unit,
classifying the consumption (total number, class and amount of drugs
without chronic indication in polymedicated patients).
Methods: Cross-sectional descriptive study. Population: patients aged
≥75 of a Primary Care Unit, excluding medical contact absences in
2015 and the deaths occurred during the study. Data collection and
analysis: MedicineOne® and Excel®. Variables: gender, age, number
and class of drugs and number of chronically incorrect drugs.
Results: From 1461 patients, 242 were excluded, leaving a sample of
1219 patients, with 60.21% polymedicated. Most of them take 6 drugs,
23.84% of these are properly indicated and the majority of patients
incorrectly consumes 1 drug. From the 16 chronically prescribed drug
classes without indication, proton pump inhibitors lead, followed by
vitamin/supplement and anxiolytic/sedative/hypnotics.
Key conclusions: As bias of this study, we refer: different observers in
collecting data, absence of an agreed list of scientific chronically
incorrect pharmacological classes and the not confrontation of chronic
medications with individual pathologies. Annual therapeutic reviews
are crucial, as is to stimulate medical education with the ultimate goal
of a safe and effective prescription.
P-767
The association of antidepressive medication with physical activity
in older adults: the ActiFE study
D. Dallmeier1,*, I. Fischer1, *, U. Braisch1,2, D. Rothenbacher2, J. Klenk2,
M. Gahr3, C. Schönfeldt-Lecuona3, M. Denkinger1. 1AGAPLESION
Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Ulm University,
2Institute of Epidemiology and Medical Biometry, Ulm University,
3Department of Psychiatry and Psychoterapy III, Ulm University, Germany
*equally contributed
Objectives: The prescription of antidepressants has increased in
recent years. Physical activity (PA) is an important prerequisite for
autonomy, quality of life, and is related with healthy ageing. However,
it is unclear whether antidepressants modulate PA. We aimed to
analyze this association among older adults.
Methods: In a cohort study (Activity and Function in the Elderly in Ulm
(ActiFE Ulm)) including 1506 community-dwelling adults ≥ 65 years
PA was objectively measured over seven days by an uniaxial
accelerometer (ActivPal®). We used linear regression to evaluate the
association of antidepressants with PA adjusted for identified
confounders including pain and anxiety. Due to the presence of
effect modification by symptoms of depression (Hospital Anxiety and
Depression Scale (HADS-D) ≥ 8) we present stratified analyses.
Results: In our study sample (n = 1082, mean age 75.6, 56.3% male)
only 120 participants (11.1%) had a HADS-D ≥ 8, showing a mean PA of
91.6 min/day compared to 106.4 min/day among those without
symptoms of depression (HADS-D < 8). Age- and sex-adjusted analyses
showed that among subjects with symptoms of depression anti-
depressant use was associated with an increment of PA by 4.1 min/day
[95% CI −17.7, 26.0], in contrast to a reduction of PA by 22.6 min/day
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S231