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The elderly with hip fracture register a common

prescription habit of 8 medicines, with possible adverse reactions

inadequate polypharmacy.


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.


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


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.


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.


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


The Beers criteria, the Screening Tool of Older People


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.


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



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.


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.


Polypharmacy in elderly patients

application of Beers Criteria in a

Medical Service

A. Pissarra


, C. Rodrigues


, M. Malheiro


, D. Cardoso


, M. Miguens



D. Alberca


, A. Placido


, A. Martins


, L. Campos




Hospital Sao Francisco


Centro Hospitalar Lisboa Ocidental


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.


To assess the prevalence and factors associated with

potentially inappropriate polypharmacy in the elderly treated in the

infirmary and ambulatory settings.


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




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.


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.


Age and comorbidity as predictors of inadequate proton pump


L. Ramos dos Santos


, S. Nóbrega


, D. Santos


, M. Lélis


, M. Luz Brazão




Internal Medicine Department, Funchal Central Hospital, Funchal,



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.


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.


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


years OR 4.83 (1.99



This study shows that elderly patients are at an increase

risk for PPI initiation during hospitalization as well as at the time of


Poster presentations / European Geriatric Medicine 7S1 (2016) S29