recognition of acidic drugs (pka < 6) with albumin binding over 90%.
Determination of serum albumin (reference value of 3.2
Average age 83.7 years, 63% males, average Cumulative Illness
Rating Scale Geriatrics 11.2, average Barthel score 62.6. Prevalence of
hypoalbuminemia 47.4% (min 1.8 mg/dL); average number of drugs
per patient 7.07 ± 3.12. 70% of patients were prescribed at least one
acidic drug. Prevalence of prescription of acidic drugs 16.8% (117/696).
Acidic drugs more prescribed were furosemide (n = 42), acetylsalicylic
acid (n = 24), warfarin (n = 5), rivaroxaban (n = 3), diazepam (n = 1),
lorazepam (n = 14), levothyroxine (n = 7), nifedipine (n = 5), pantopra-
zol (n = 17). Patients who were prescribed acidic drugs showed a
slightly higher serum albumin but still under reference value (average
albumin 3.16 ± 0.66).
Acidic drugs were commonly prescribed despite hypoal-
buminemia, which can precipitate dangerous side effects such as
hemorrhagic complications related to acetylsalicylic acid and warfarin
prescription and hydroelectrolytic imbalances related to furosemide.
Hypoalbuminemia results in increase in free drug concentration in
serum which can enhance potential drug interactions. Therefore,
patients with hypoalbuminemia should be offered alternative non
Anticholinergic burden of drug therapy of older patients admitted
in an Internal Medicine ward
, M. Maia
, S. Duque
, M.J. Serpa
, A. Watts Soares
, S. Velho
, F. Araújo
, J. Pimenta da Graça
Internal Medicine Department, Loures,
Centro Hospitalar de
Hospital São Francisco Xavier
Unidade Universitária de Geriatria
Universidade de Lisboa, Lisboa,
Hospital Beatriz Ângelo
Nutrition and Dietetics Department, Loures, Portugal
Drugs with anticholinergic properties are commonly
used in the geriatric population, including not only
holinergics, but also other pharmacological groups with intrinsic
anticholinergic properties. Anticholinergic properties may precipitate
or exacerbate cognitive decline and increase risk of Delirium. Our
objective was to evaluate the anticholinergic burden of drug therapy
(AntiCB) and to assess the association to cognitive and functional
Retrospective study of 100 hospitalized patients
Sociodemographic and clinical characterization, including functional
(Barthel score (BS)) and cognitive status. AntiCB was assessed by the
Anticholinergic Cognitive Burden Scale (ACBSc).
Average age 83.7 years, 63% males, average Cumulative Illness
Rating Scale Geriatrics 11.2, average Barthel score 62.6, 70% malnour-
ished, 31% cognitively impaired. Patients were categorized into three
risk categories according ACBSc: LR- low risk (0 points) 26%, MR-
medium risk (1
2 points) 43%, HR- high risk (3 or more points) 31%.
Average ACBSc 1.86 ± 1.85 revealing averagemedium risk. Therewas no
association between ACBSc and cognition. Low risk patients showed
better functional status (LR: BS 72.7 ± 31.4, MR + HR: BS 60.6 + 36.2).
The ACBSc revealed that elderly admitted in an Internal
Medicine ward presented only medium risk of anticholinergic side
effects (ACSE). However, the real risk of ACSEmight be underestimated,
as the risk of ACSE in geriatric population should depend not only
on the drug profile but also on previous cognitive, nutritional and
functional status. Possibly, new tools to assess the risk of ACSE in the
elderly might include other parameters related to physiologic and
Number of discharge medications as a risk factor for early
readmission of elderly patients: a retrospective study
J. Fonseca, F. Costa, J.E. Mateus, A.R. Nogueira, D. Ferreira,
M.T. Veríssimo, A. Carvalho.
Internal Medicine Department A
Hospital and University Center
Early unplanned readmission of elderly patients to the
hospital is a common occurrence, but difficult to predict. The main
purpose of the study was to analyze if the number of discharge
medications leads to early readmission within 30 days of discharge
from the hospital.
A retrospective study was carried out by reviewing the
hospital records of 1619 patients, 65 years of age and older, who were
admitted to Internal Medicine ward of a tertiary care hospital in
Portugal, from January 1 to June 30, 2014. 212 were excluded. Day
0 was defined as the day of discharge and day 1 was defined as the
day-after admission to the hospital.
The final cohort had 1407 patients, with a mean age of
81.73 ± 7,60 years, 828 (58.85%%) were women. Were readmitted
within 30 days 236 patients (16.77%). Polypharmacy (
occurred in 1137 patients (80.81%), and
drugs) in 270 (19.19%). The number of discharge medications was
significantly greater for patients having a thirty-day readmission
compared to those without a thirty-day readmission: 7.37 ± 3.42
versus 8.32 ± 3.43 medications (p < 0.001). Those with
8 drugs had
a significant higher rate of readmission: 20.48% versus 13.46% (<8
drugs), respectively (OR 1.66; 95% CI 1.25
2.20; p = 0.0005). There was
no association between the number of medications and thirty-day
In our study the number of discharge medications was
associated with thirty-day hospital readmission.
The PharE STUDY: an Italian pharmacovigilance study in elderly
home care patients affected with dementia
, A. Castagna
, M. Staglianò
, A. Corsonello
, G.B. De Sarro
ASP Catanzaro, Geriatrician
Ambulatory for Cognitive
Disorders Catanzaro Lido and Soverato-Chiaravalle,
Chair of Pharmacology, Department of Health Sciences, Faculty of
Medicine, University Magna Graecia of Catanzaro, Italy
The PharE Study (Pharmacovigilance in the Elderly) is
an ongoing study in the ASP Catanzaro, Italy, on elderly home care
patients affected with dementia. The aim of the present study is:to
assess the use of inappropriate drugs;to study the possible drug-drug
interactions;to perform the possible strategies for avoiding the
potential harmful prescriptions, by using the STOPP and STARTcriteria.
Data were obtained from 461 home patients, 185 men, 276
women, mean age 81.1 ± 6.8 years old. Overall patients with Alzheimer
dementia were 39%, vascular and mixed dementia 52%, other
dementias 9%. A classification of potential inappropriate drugs was
made according to the Beers criteria. Data were collected through an
appropriate software able to gather the main information on patients.
In selected cases Naranjo Scalewas applied. The study of possible drug-
drug interactions was made by Micromedex 2.0. All analyses were
performed using the SPSS program version 21.0 for Windows.
Patients were functionally and moderately to severely cogni-
tively impaired.71.8% of patients used 5
9 drugs and 10.6% more than
10 drugs. Kidney function was shown to be related to the number of
drugs used (p = 0.0001). Overall anticholinergic drugs were 13.2%,
tricyclics antidepressants 2.8% and ticlopidine 2.1%. Long half-life
benzodiazepines were used in 4.3% of patients, antipsychotics in 20%
of the cases. Proton pump inhibitors were used in 86.6% of the cases.
Some interesting case reports were recorded too.
These data show the need for an accurate choice of drugs
in elderly people. We expect further details through the application of
STOPP and START criteria.
How can opiate prescribing be optimised in orthogeriatrics? An
audit in a district general hospital setting
, A. Kannan
, J. Moss
Oxford University Hospitals NHS
Oxford University Hospitals NHS Foundation Trust,
Poster presentations / European Geriatric Medicine 7S1 (2016) S29