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

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Introduction: In the UK, two billion pounds is spent annually
on the direct healthcare costs of hip fractures alone. To reduce
further morbidity, mortality and cost, early mobilisation of the
orthogeriatric population is essential, for which there is often a role
for strong/ weak opiates. This patient cohort is particularly at risk
of opiate toxicity and side-effects. Appropriate, anticipatory prescrib-
ing is essential.
Methods: Drug charts of 50 inpatients were assessed against 2
standards: 1. Regular laxative, PRN anti-emetic and PRN naloxonewith
every opiate prescription. 2. Maximum of one regular and one PRN
opiate prescribed. Two interventions were commenced. Firstly, the
ward round proforma was edited to include an “opiate” box so the
clinician was prompted to assess this prescription. Secondly, an
educational awareness campaign was initiated on the ward. Four
months later, 50 drug charts were re-audited against the same
standards.
Results: The number of correctly prescribed anti-emetics increased
from 80% to 96%; laxatives from 76% to 90%; and naloxone from 16% to
80%. Inappropriate, simultaneous opiate prescriptions were elimi-
nated with the number of 2+ regular opiates down from 2% to 0% and
number of 3+ PRN opiates reduced from 36% to 0%.
Key conclusions: Simple measures at a local level can have a signi-
ficant impact on safe opiate prescribing practices in this population. A
ward round proforma with targeted prompts is an effective way to
increase clinician adherence to prescribing standards.
P-776
Primary care hypnotic and anxiolytic prescription – reviewing
prescribing practice over eight years
L.D. Hughes, K. Erskine. East Practice Medical Centre, Arbroath
Introduction: Over the last few years, hypnotic and anxiolytic medi-
cations have had their clinical efficacy questioned in the context of
concerns regarding dependence, tolerance alongside other adverse
effects.
Material and methods: Anxiolytic and hypnotic medications were
defined in accordance with British National Formulary classes. All
patients receiving a drug within this class in 2007, 2011 or 2015 were
collated and anonymised using primary care prescribing data. Patients
age, gender, name of the prescribed drug(s), and total number of
prescriptions in this class over the year were extracted.
Results: There were 130 patients prescribed hypnotic/anxiolytic
medications in 2007, 173 patients in 2011 and 267 in 2015, which
was an increase from 3.1% of the practice population in 2007 to 4.1%
and 6.3% in 2011 and 2015 respectively [p-value = 0.368]. The
proportion of patients prescribed a benzodiazepine medication
decreased between 2007 and 2015: 83.8% (n = 109) in 2007, 70.5%
(n = 122) in 2011 and 51.7% (n = 138) in 2015 [p-value = 0.006]. The
proportion of these patients prescribed a nonbenzodiazepine drug
increased between 2007 and 2015: 30% (n = 39) in 2007, 46.2% (n = 80)
in 2011 and 52.4% (n = 140) in 2015 [p-value = 0.001]. Patients over 65
were more likely to be prescribed a benzodiazepine than those under
65 [68.5% compared to 60.4%].
Discussion: This study reports a reduction in benzodiazepine
prescriptions in primary care alongside increases in nonbenzo-
diazepine prescribing. Changes in this prescribing practice may
reflect local changes in prescribing practice and alongside national
recommendations.
P-777
How many pills are too much?
R. Ivo1, M. Teles1, M. Fonseca1, R. Conde1, S. Augusto1, P. Santos1, R. Reis1,
I. Madruga 1, A. Mello e Silva1. 1Hospital Egas Moniz- CHLO, Lisbon,
Portugal
Introduction: The most problematic expression of an ageing popu-
lation is the clinical condition of frailty. Polypharmacy is common
among the elderly and frail and is a strong predictor of potentially
inappropriate medication.
Objectives: Evaluate the prevalence of polimedication (PM) in an
Internal Medicine (IM) ward and its association with age and frailty.
Methods: Prospective observational study. Data collected from all
patients admitted during 2015 in an IMward. Measured the number of
medications (NM) before admission, PM (more than 5 medications)
and the Clinical Frailty Score of Rockwood (CFS). Used t-test, qui-
square and spearman correlation when appropriate, considering a
statistically significant p of less than 0.05.
Results: N = 374 patients, median age of 81 years. Between those
below or above 65 years therewas a difference on the average NM (3 vs
6, p < 0.01) and on the prevalence of PM(61% vs 20%, p < 0.01), also seen
between those with a CFS below or above 4 (4 vs 7 and 8% vs 47%,
p < 0.01). There was a low to weak positive correlation between frailty
and the NM after adjustment for age (ro = 0.274, p < 0.01).
Conclusion: We found a high prevalence of PM, especially among the
elderly and frail. Frailty score and NM had a weak positive correlation.
A higher strength of correlation was expected, according to the
literature and our daily practice. We postulate this might be the result
of an indiscriminate prescribing practice, which should be revised
especially in the frailer population.
P-778
Effects of cholinergic burden decrease on behavioral disorders
among elderly demented subjects
Y. Jaïdi1, J.L. Novella1,2, Y. Duval1, R. Mahmoudi1,2. 1Department of
Geriatrics and Internal Medicine, Reims University Hospitals, 2University
of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, Reims,
France
Objectives: Drugs with elevated cholinergic burden (CB) are fre-
quently prescribed for elderly subjects with behavioral and psycho-
logical symptoms of dementia (BPSD). The aim of this study was to
assess the evolution of frequency, severity and caregiver distress of
BPSD according to the variation of the CB of 20%.
Methods: A prospective and monocentric study performed in an acute
care Alzheimer unit. The CB was assessed by the Anticholinergic
Cognitive Burden (ACB) scale. BPSD were assessed by the Neuro-
Psychiatric Inventory (NPI) nursing home version. Multivariate
analysis was performed using logistic regression (dependent vari-
ables: the reduction of frequency X severity and caregiver distress;
explanatory variables: the reduction of CB of 20%).
Results: 60 patients were included (average age: 84.5 ± 6.0 years).
Twenty two patients (36.6%) had possible Alzheimer disease,
12 (20.0%) had mixed dementia, 6 (10.0%) vascular dementia, and 2
(3.3%) Lewy body dementia. Fifty (83.3%) patients were exposed to
drugs with elevated CB. Among them, 15 (30%) had a drug with a CB
score ≥1. The decrease of frequency X severity score was significantly
associated with the reduction of 20% of CB (OR 3.0; IC 95% 1.1– 8.7;
p = 0.01). The decrease of caregiver distress score was significantly
associated with the reduction of 20% of CB (OR 15.3; IC 95% 3.1– 77.5 ;
p = 0.001).
Conclusion: The reduction of CB allows the decrease of frequency,
severity and caregiver distress of BPSD. The management of BPSD
must associate non pharmacological therapies to the optimization of
drug prescription.
P-779
Investigation of prescriptions delivered to the elderly in
community pharmacies
N. Janus1, F. Cavagna2, F. Beauvais1, M. Garenaux3, D. Livet4,
J.-F. Bergmann5, S. Pol 6, J. Sicard 7, F. Véron 8, B. DiMaria9,
F. Monchecourt10, N. Dallery10, V. Launay-Vacher1, G. Deray, P. Lechat11,
O. Hanon12. 1GH Pitié-Salpêtrière, Paris, 2Pharmacie Cavagna, Belley,1GH
Pitié-Salpêtrière, 3Pharmacie Garenaux-Jouan, Pluméliau, 4Pharmacie
Livet, 5Hôpital Lariboisière, 6Hôpital Cochin, Paris, 7Pharmacie Sicard,
Châlons-en-Champagne, 8Pharmacie Véron, Le Rouret, 9Pharmacie
Clairaz-Mahiou, Chatenay-Malabry, 10Teva France, Puteaux, 11Hôpital
Saint-Louis, 12Hôpital Broca, Paris, France
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S234