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

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systematic reviews, published in the last 10 years, in English or
Portuguese. It was also carried out research in textbooks and
guidelines.
Results: Atypical antipsychotics are a good therapeutic option to
control behavioral and psychological symptoms in dementia.
However, they should be used with caution, optimizing the dose and
duration treatment. Common target dose ranges in dementia are
0.25–1 mg of risperidone, 2.5–7.5 mg of olanzapine, 12.5–150 mg of
quetiapine, 5–10 mg of aripiprazole. Treatment should be short-term
(6–12 months) and discontinued with a 3–6 months’ history of
behavioral stability. Beers Criteria recognize the increased risk of
stroke and mortality associated to antipsychotics treatment in people
with dementia, and that they should be avoided unless patient is threat
to self or others.
Key conclusions: Behavioral disorders and psychopathological symp-
toms associated with dementia decrease patient’ s quality of life
and cause physical and psychological stress of caregiver. Antipsychotic
agents have an important role in controlling these symptoms.
Therefore, medical community must have an adequate knowledge of
efficacy, risks and correct use of these drugs.
P-799
Polypharmacy in elderly patients admitted to Acute Medical
Wards, Hospital Sungai Buloh, Malaysia
S.M. Mohd Shariff1, B.S. Teoh, T. Marimutu 2, J. Supayah2, W.M. Wan
Hashim 2, M.L. Saimon3, M. Francise 3, N. Nordin2. 1Department of
Pharmacy, Hospital Sungai Buloh, 2Geriatric Unit, Medical Department,
Hospital Sungai Buloh, 3Department of Rehabilitation, Hospital Sungai
Buloh
Introduction: Several studies show that over-prescribing in elderly is
frequently associated with unwanted side effects and medicine
interactions. This study aims to observe the demographics of elderly
patients admitted to our acute medical wards and the prevalence of
polypharmacy among the elderly.
Method: Elderly patients admitted were interviewed for medication
histories. Data on demographics, patient ’s medication lists and
discharge outcome were gathered. STOPP Criteria along with Beers ’
were used to decide for potential medicine that could be stopped. Data
were prospectively collected over a 12-week period, and analysed via
SPSS version 20.0.
Results: Out of the 209 paients, only 61.7% (129) patient data
were analyzed after exclusions. 14% of the population were above
80 years old and 46.6% were male, (64). 31/64 of the males were in
the age group of 71 –80 years (p ≤ 0.26). Malays dominated, 57.4%
(74) and 79.8% had multiple admission. 50/129 (38.8%) presented
with polypharmacy on admission and significantly associated
with PIP according to STOPP and Beers (p ≤ 0.000). Polypharmacy
was also associated with ADR, for which 4/6 patients with ADR
experienced polypharmacy (p ≤ 0.15). Polypharmacy on admis-
sion was not associated to age group, ethnicity and education
level. On discharge, 43.4% (56) were on polypharmacy. 33/50
patients on polypharmacy during admission remained to be on
polypharmacy on discharge (p ≤ 0.000). Among those with poly-
pharmacy on discharge, 55.3% (31) has potential. On discharge,
nearly half (55.3% (31)) still had at least one potential medicine that
can be stopped.
Conclusion: There was high prevalence of polypharmacy and PIP use
in older adults both pre admission and on discharge. Interventions
should be done to minimize this occurrence via the STOPP and Beers
criteria. Abbreviation: ADR: Adverse Drug Reactions PIP: Potentially
Inappropriate Prescription
P-800
Acute kidney failure due to anti-inflammatory drugs and
antihypertensive drugs in elderly inpatients
D. Oliveira1, S. Silva1, P. Dias1, J. Feio1. 1Centro Hospitalar e Universitário
de Coimbra, Coimbra, Portugal
Introduction: The “triple whammy” refers to the combination of
diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), ACE
inhibitors (ACEI) and/or angiotensin receptor antagonists (ARA) that
may impair the kidney function (KF).
Objectives: To identify the risk of the triple whammy in hospitalized
elderly patients prescribed with NSAIDs and antihypertensive drugs
(AHTd) simultaneously.
Methods: We selected elderly inpatients (≥65 years old) from all
inpatients prescribed with NSAIDs and AHTd simultaneously, during
the first half year/2015. For patients medicated with NSAIDs plus ACEI/
ARA plus diuretics, we evaluated change in serum creatinine and
estimated glomerular filtration rate (eGFR) – MDRD calculator. Data
was analysed using Excel2007® .
Results: 396 of 662 inpatients medicated with NSAIDs and AHTd
simultaneously were elderly. 156 elderly inpatients (39%) were
prescribed with NSAIDs plus ACEI/ARA plus diuretic (mean age: 76
years old); most (28%) were prescribed in the orthopedic ward. 40%
were using 1 NSAID plus 1 ACEI plus 1 diuretic. The most common
NSAID was cetorolac (31%) while losartan (39%), enalapril (39%) and
furosemide (67%) were the most used ARA, ACEI and diuretic,
respectively. 32% of them saw a decline of their KF, 30% were not
monitored and 38% remained stable. Among patients with worsened
KF the average increase of serum creatinine was of 0.72+/−0.69 mg/dL
and eGFR decrease was of 27.5+/− 20.22 mL/min.
Conclusion: The prevalence of elderly inpatients medicated with
NSAIDs plus ACEI/ARA plus diuretics is considerably high given that
they’ re a susceptible population to suffer from “triple whammy”, a
potentially serious preventable adverse effect.
P-801
Serotonin syndrome and polypharmacy
R. Ortés-Gómez, G. Lozano-Pino, E. Villalba-Lancho. Geriatrics Unit,
Virgen del Puerto Hospital, Plasencia (Cáceres), Spain
Introduction:The serotonin syndrome is a potentially life-threatening
adverse drug reaction that can be caused by the use of drugs that
increase the availability of serotonin. Elderly people are at risk of
serotonin syndrome because of comorbidity and polypharmacy. We
describe a case of serotonin syndrome in an 84-year-old woman.
Methods: Mrs. M., an 84-year-old woman with a history of
depression and osteoarthritis, was admitted to hospital with a
3-days history of hypervigilance, insomnia, tremor and difficulty
with speech articulation. She was polymedicated and she had been
taken paroxetine 30 mg daily, quetiapine 25 mg daily and fentanyl
25 mcg every three days. On exam, Mrs. M. was dehydrated and
afebrile and she had agitation, tachycardia, shivering, stiffness,
diaphoresis, mydriasis, horizontal ocular clonus and inducible clonus
in the lower extremities.
Results: We though about the possibility of serotonin syndrome
and we started treatment with parenteral fluids and benzodiazepines
after stopping oral treatment and fentanyl. Instead treatment,
Mrs. M. started with hyperthermia, autonomic instability, rhabdo-
myolysis and renal failure and we added parenteral chlorpromazine.
After this we could control agitation, diaphoresis, shivering and
stiffness with persistence of hyperthermia and tachycardia. Lastly,
Mrs. M. died after sudden cardiorespiratory arrest.
Key conclusions: Serotonin syndrome is a predictable consequence
of excess serotoninergic agonism on serotoninergic receptors and it
is a potentially life-threatening adverse drug reaction. Elderly people
are at risk of serotonin syndrome because of comorbidity and
polypharmacy.
P-802
Orthogeriatrics unit: an opportunity to medication reconciliation
in the elderly with hip fracture
R. Pérez López, M.M. Luis, C. Pablos Hernández, A. González Ramírez,
J.M. Julián Enríquez, J.F. Blanco Blanco. Universitary Hospital of
Salamanca
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S240