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Results: 67 HCPs took part in this survey. Of these 19% (13) were
Consultant Physicians,18% (12) were Pharmacists and the rest 63% (42)
were trainees in Medicine. 37% (25) routinely ask patients about HM
use. The commonest reasons for not asking were “don’ t remember to
ask (33%;21) and lack of knowledge about herbal medicines (20%, 13).
The commonest herbal medicines that HCPs had come across were
Ginseng (54%,36), Gingko Biloba (49%, 33) and garlic (48%, 32). 40%
(27) were aware that Gingko improves memory whilst 64% (43) felt
that St John’ s Wort can cause transplant rejection in patients on
cyclosporine. Only a fifth of HCPs recognised the potential drug
interaction between Gingko biloba and clopidogrel whilst 48%(32)
recognised that garlic and 25%(17) recognised that Gingko Biloba had
antiplatelet activity. Only 3% (2) of responders rated their knowledge
as very good and good.
Conclusion: Our findings suggest that HCPs knowledge about HM
is poor. We need to ensure that education about common herbal
medicines is provided as part of multidisciplinary teaching pro-
grammes and that we improve HCPs awareness of where to access
relevant information about HM.
P-788
Development of lidocaine patch guidelines for short term use
A. Mackett, R. Berry. Cambridge Universities Hospitals NHS Trust, United
Kingdom
Introduction: Local consensus supports lidocaine patch use in older
patients as adjunctive therapy for fractures and acute back pain. Local
primary care guidelines restrict use based on insufficient evidence
for neuropathic pain.
Methods: Literature review For fractures and back pain there is a
paucity of quality evidence. In non-randomised, open-label trials there
is a 50% reduction in back pain [1,2]. In rib fractures a randomised-
controlled trial demonstrated significant and persistent reductions in
pain after 5 days [3]. Audit 71 patients were prescribed lidocaine
patches in 7 months (40 “geriatrics”, 31 “other”). Indications: 45%
fractures, 25% back pain, 30% other. 61 patients previously failed trials
of other analgesics due to side effects (SE) (26%) or inefficacy (75%).
Overall 55% had documented improvement in pain with lidocaine
patches – 59% were fracture and 56% back pain patients. 23% of
patients experienced significant improvement in mobility and
engagement with the therapists.
Conclusion: Lidocaine patches are relatively expensive in comparison
to other analgesia [4] but may improve management of localised
musculoskeletal pain especially in groups at risk of SE from other
agents e.g. elderly patients and those at risk of falls [5]. Patch use may
facilitate early mobilisation and potentially reduce length of stay thus
offsetting the cost of the patches. Guidelines to support short term use
in hospital and community have been developed. Recommendations
Trial patch for 10 days. 24 hour removal. If pain returns repeat once.
If pain returns again refer back to initiating team.
References
1. Galer BS, Gammaitoni AR, Oleka N, Jensen MP, Argoff CE: Use of
the lidocaine patch 5% in reducing intensity of various pain qualities
reported by patients with low-back pain. Curr Med Res Opin 2004,
20(Suppl 2): S5– S12.
2. Argoff CE, Galer BS, Jensen MP, Oleka N, Gammaitoni AR:
Effectiveness of the lidocaine patch 5% on pain qualities in three
chronic pain states: assessment with the Neuropathic Pain Scale.
Curr Med Res Opin 2004, 20(Suppl 2): S21–S28.
3. Cheng Y-J: Lidocaine skin patch (Lidopat ® 5%) is effective in the
treatment of traumatic rib fractures: a prospective double-blinded
and vehicle-controlled study. Med Princ Pract 2016, 25: 36–39.
4. HSCB letter Northern Ireland Lidocaine Plaster (Versatis®) –
Recommendations for Primary and Secondary Care in Non-
Specialist settings. November 2013.
5. Pirmohamed M, James S, Meakin S et al. Adverse drug reactions
as cause of admission to hospital: prospective analysis of 18 820
patients. British Medical Journal 2004; 329(7456): 15–19.
P-789
Prevalence of preventive cardiovascular medication use in nursing
home residents with short life expectancy. The SHELTER Study
A. Malek Makan1,2, H. van Hout1, G. Onder3, R. van Marum1,3. 1VU
University Medical Centre, Amsterdam, 2Amaris Zorggroep, Hilversum,
The Netherlands; 3Universita Cattolica del Sacro Cuoro, Rome, Italy;
4Department of Geriatric Medicine, Jeroen Bosch Hospital,
’s-Hertogenbosch, The Netherlands
Introduction: In nursing home (NH) residents with a very short life
expectancy, the benefits of preventive cardiovascular medication
maintenance are questionable.
Objective: To assess the prevalence of four classes of preventive
cardiovascular medication (PCM) in nursing home residents.
Methods: A 12 months prospective cohort study was conducted in 57
NH in 8 countries (Czech Republic, England, Finland, France, Germany,
Italy, The Netherlands, Israel). We assessed the prevalence at first
measurement of 4 classes of PCM: oral anticoagulants (OAC), platelet
aggregation inhibitor (PAI), antihypertensive (AHT), and lipid modi-
fying agent (LMA), in older (60+) residents with valid medication
assessments. The PCM prevalence was compared across the length of
stay (short < 60 days, mid, long >12 months), mortality risk as defined
by CHESS > 3 (Changes in Health, End-Stage Disease, Signs, and
Symptoms Scale), and cognitive impairment by CPS > 2 (cognitive
performance scale).
Results: Of the 3759 eligible residents, 2175 (57.9%) used at least 1 or
more PCMs. The prevalence of the four groups of PCM: OAC, PAI, AHT
and LMAwas 5.6%, 34.9%, 35.7%, and 10.4% respectively. PCM use was
lower in long stay residents versus mid stay: 56.0% vs. 62.7%, in
cognitively impaired residents (47.1% vs 67%), and in residents with a
high mortality risk (47.4% vs 58.6%).
Conclusion: Although the prevalence of PCM use was lower in long
stay, cognitively impaired residents, and persons with a high mortality
risk, there seems to be room for deprescribing.
Keywords: Keywords: Cardiovascular disease; medication; Cognitive
impairment; Nursing home resident; Shelter study.
P-790
Metformin-associated lactic acidosis in the very old: reflexions
about a case report
L. Marques. Unidade Universitária de Geriatria, Faculdade de Medicina
da Universidade de Lisboa, Hospital Beatriz Ângelo
Introduction: Metformin is first line therapy for type2 diabetes.
Metformin-associated lactic acidosis (MALA) is rare, but has 50%
mortality rate. MALA risk factors are renal impairment and a
secondary event like cirrhosis, sepsis or hypoperfusion. Metformin
contraindications include moderate to severe renal dysfunction,
hepatic insufficiency and circulatory dysfunction. Very elderly patients
are a risk group for metformin treatment. Case Report A 96 year old
male, autonomous, was admitted to an emergency department in
shock. He had medical history of type2 diabetes, essential hyper-
tension and mild cognitive impairment. He was medicated with
metformin, furosemide and ramipril. On admission he was unrespon-
sive, had immensurable arterial blood pressure, respiratory rate was
29 per minute and had ventricular escape rhythm. Atropine was
administered with response. Objective analysis revealed severe lactic
acidosis with pH 7,01 and lactate >130 mg/dL, acute renal failure and
no elevated inflammatory parameters. Patient was started on
antibiotics and resuscitation with crystalloid fluids with clinical
benefit. MALA was admitted. He was putted under renal dialysis
with progressive correction of lactic acidosis and renal function
recovery. After 5 dialysis sessions the patient recovered from renal
insufficiency and was discharged 14 days after hospital admission.
Metformin and furosemide were removed from his prescription. The
patient remains alive and autonomous a month after hospital
discharge.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S237