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Introduction:
The elderly with hip fracture register a common
prescription habit of 8 medicines, with possible adverse reactions
–
inadequate polypharmacy.
Objective:
Therapeutic Adjustements (TA) in patients with hip fracture
admitted in an Orthogeriatric Unit were performed. Its registration
and follow up were pursued.
Material and methods:
Epidemiologic, observational, descriptive
study performed during 30th April 2015
–
8th June 2015. Population:
elderly patients with admission diagnosis in an Orthogeriatrics Unit of
hip fracture in this period of time. Pharmacological treatment
information sources: MedoraR, JimenaR, FarmatoolsR, anamnesis.
Bibliographic sources: STOPP-STARTR criteria. Database and its
analysis: File MakerR.
Results:
189 TA were registered in 58 patients (42 women, 16 men).
Mean age 86 (+/
−
8) year-old. 3,7 TAwere registered per patient and 6,2
per workday. The most frequent TA implied were: 46 medicines were
switched because of absence in hospital pharmacological guide
(mainly ARA II and statins). Posology adjustment to admission
’
s
clinical situation was performed in 16 of 20 TA: antihypertensives in 9
AT and oral antidiabetics in 7. More adequate medicines in the frail
patient were the option in 10 of the 12 TA, 8 of which being
psychotropic agents.
Conclusion:
The elderly admission in an Orthogeriatric Unit due to hip
fracture may be a golden opportunity to review and adjust pharma-
cological treatment in inadequate polypharmacy. Antihypertensive
drugs, statins, oral antidiabetics and psychotropic agents were the
most often adjusted medicines.
P-803
Drug prescription in the elderly: are we doing it right?
A.S. Pessoa, J. Barros, R. Nogueira, N. Cardoso, A. Duarte.
Serviço de
Medicina I, Centro Hospitalar Médio Ave, Vila Nova de Famalicão, Portugal
Objectives:
The Beers criteria, the Screening Tool of Older People
’
s
Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment
(START) criteria have been devised to help with drug prescription in
our increasingly ageing population. This work aims to revise the
prescription charts of admitted elderly patients, to conclude on the
appropriateness of our practice and on what needs to be changed.
Methods:
We performed an observational cross-sectional study,
including patients over 64 years admitted to an internal medicine
ward. The data analyzed was patient age, sex, current pathologies,
creatinine level for calculation of glomerular filtration rate and drugs
prescribed.
Results:
A total of 44 patients were included, 52.3% males and 47.7%
females, with an average of 80 years. About 9 drugs per patient
were prescribed (4
–
17 drugs). In light of Beers criteria, 63.6% of the
admitted patients had at least one potentially inappropriate pre-
scribed drug. Using STOPP criteria, this number decreased to 43.2%.
The most frequent potentially inappropriate drugs/drug classes were
benzodiazepines, amiodarone, hydroxyzine, atypical antipsychotics,
non-steroid anti-inflammatory drugs and tricyclic antidepressants.
Analyzing patients
’
prescriptions regarding the START criteria, 40.9%
had a potentially omitted drug, and the most frequent drugs were
cholinergic agents for the treatment of dementia, angiotensin-
converting enzyme inhibitors, antiplatelet agents and statins.
Conslusion:
A lot needs to be done in this area, and knowing what
drugs are most frequently culprits will help fine tune drug prescrip-
tion, decreasing polypharmacy and adverse reactions. However, these
criteria shouldn
’
t be applied blindly, and clinical judgement is called to
action when considering these tools.
P-804
Polypharmacy in elderly patients
–
application of Beers Criteria in a
Medical Service
A. Pissarra
1
, C. Rodrigues
1
, M. Malheiro
1
, D. Cardoso
1
, M. Miguens
1
,
D. Alberca
1
, A. Placido
1
, A. Martins
1
, L. Campos
1
.
1
Hospital Sao Francisco
Xavier
–
Centro Hospitalar Lisboa Ocidental
Introduction:
Alongside with the aging of the population, the
prevalence of diagnosed chronic diseases increases, which ultimately,
leads to polypharmacy in the elderly. This presents a public health
issue with potential serious complications. Therefore the optimization
of drug therapy is essential. Beers et al published criteria for
determining the extent of excessive and inappropriate consumption
of drugs in the elderly.
Objectives:
To assess the prevalence and factors associated with
potentially inappropriate polypharmacy in the elderly treated in the
infirmary and ambulatory settings.
Methods:
Cross-sectional observational study in a Medical Unit.
Inpatients (hospitalized) and outpatients (ambulatory setting), 65
years old or older were evaluated in regards to the prescribed medical
therapy. The inappropriate medication (IM) factors based on Beers
Criteria 2012 were registered and the statistical analysis was carried
out in Excel
®
.
Results:
We enrolled 45 patients: 55% female and with an average age
of 80 years. Maximum number of drugs was of 17 in the outpatients
(ambulatory setting) and 19 in the inpatients (hospitalized) with an
average of 8 drugs in outpatients and 11 in inpatients. Of the 489 drugs
11.7% were IM. About 78% of the population had one or more IM of
which 53.3% had only one IM prescribed. The greater the number of
drugs, the greater the likelihood of IM: 91% of patients with 11 or more
drugs had at least 1 IM. Also, patients with dementia had more
prescribed IM (45.5%): antipsychotics and benzodiazepines. The most
prescribed IM were metoclopramide (18%), amiodarone (12%), hydro-
xyzine (12%) and quetiapine (10%). The most inappropriate prescribed
drug classes were antipsychotics (19.3%), prokinetics (17.5%) and anti-
arrhythmics (14%). Eleven cases of IM-related pathology were found.
Conclusions:
Polypharmacy and the usage of potentially inappropri-
ate drugs are common among the elderly. Nonetheless, we cannot
disregard that Beers et al state that these criteria should not override
clinical judgment. Therefore, studies, evaluating the pattern of usage
of drugs and adverse outcomes, are imperative, as well as developing
strategies to improve the quality of clinical prescription in the elderly.
P-805
Age and comorbidity as predictors of inadequate proton pump
inhibition
L. Ramos dos Santos
1
, S. Nóbrega
1
, D. Santos
1
, M. Lélis
1
, M. Luz Brazão
1
.
1
Internal Medicine Department, Funchal Central Hospital, Funchal,
Portugal
Objectives:
Proton Pump Inhibitors (PPIs) are widely used for
treatment of gastrointestinal (GI) pathology and prevention of upper
GI bleed. This is frequently done inadequately in hospitalized medical
patients as well as at discharge with possible consequences for the
elderly population namely iatrogenic and polypharmacy. Purpose of
this study was to identify predictors of inadequate PPI prescription.
Methods:
Prospective observational study of 3 months with consecu-
tively admitted patients at an Internal Medicine ward, aged 18 years
and over. Demographic and prescription data were recorded and
clinical files reviewed for verification of PPI need. A set of criteria for
appropriate indications was developed for guidance. Chi-square tests
were used with 95% confidence interval.
Results:
585 patients were included. Mean age was 75 years ( ± 14.6)
and 55% of patients had
≥
4 comorbidities. 373 patients were medi-
cated with a PPI on admission; 83% of these inadequately. Predictors of
inadequate PPI initiation during hospitalization were: female sex odds
ratio (OR) 1.49 (1.02
–
2.17), age
≥
75 years-old OR 2.02 (1.24
–
3.30) and
PPI before admission OR 3.41 (2.03
–
5.76).163 patients were medicated
with a PPI prior to admission, 52% of which without clear indication.
212 received a PPI at discharge, 57% inadequately as well. Predictors of
inadequate PPI prescription at dischargewere: 4
–
6 comorbid states OR
1.89 (1.15
–
3.10), 7
–
9 comorbid states OR 4.51 (1.85
–
10.99) and age
≥
75
years OR 4.83 (1.99
–
11.73).
Conclusion:
This study shows that elderly patients are at an increase
risk for PPI initiation during hospitalization as well as at the time of
discharge.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S241