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were polymedicated, versus 14.72% (n = 44). The mean number of

diagnostics were 8 and 9 per patient, respectively.


Polypharmacy is a reality among elderly patients, with

hospitalization currently not being an opportunity to reduce medicine

numbers, even when its use can be questionable. Can not medicating

sometimes be the best approach?


A point prevalence study of psychoactive drugs and the elderly

patient in the hospital setting

A. Rola, J. Monteiro.



Over-prescription of psychoactive drugs is a major issue

in hospitalized patients. Using psychotropics in the elderly is

challenging given changes in pharmacokinetics, pharmacodynamics,

polypharmacy potential, and increasing possible adverse effects.


The aim of this study was to establish the prevalence of

psychotropic medication use in the hospitalized elderly patient. A

randomized sample of 299 elderly patients from a 1231 universe

admitted on the first semester of 2015 in all Internal Medicinewards at

a tertiary Portuguese hospital was analyzed. Data were taken

consulting clinical electronic records. Patients who died during

hospital admission were excluded.


On admission 188 (62.9%) of patients were on psychotropics,

with 113 (37.8%) taking benzodiazepines; 99 (33.1%) antidepressants;

35 (11.7%) neuroleptics, 20 (6.7%) anti-parkinsonians and 19 (6.4%)

anti-epileptic drugs.195 (65.2%) patients went home on psychotropics,

with a similar drug class profile. On discharge, 17 patients (9%) ceased

psychoactive drugs, while 24


patients (21.6%) began psycho-

tropic therapy. Patients were identified with having cognitive

impairment (34.4%), chronic pain (9.4%), active psychiatric disorder

(10.7%), withdrawal syndromes (0.7%), and seizure history (5.4%). Of

the 99 patients already having antidepressants, only 56 had identified

chronic pain or active psychiatric disorder (56.6%). On admission, 8.7%

of patients were on psychotropics and totally dependent, versus 9.6%

on discharge.


Almost two-thirds of patients admitted were on

psychoactive drugs, with this numbers remaining unchanged on

discharge. Prescription of such therapy in the elderly should be done

carefully, restricted to when there is a clear benefit for quality of life.


Benzodiazepines: potentially dangerous, highly used

M. Teles, R. Ivo, M. Fonseca, R. Conde, P. Santos, R. Reis, I. Madruga,

A. Mello-e-Silva.

Hosp. Egas Moniz, Centro Hosp. Lisboa Ocidental


Despite its proved risks, long-term use of benzodiaze-

pines (BZD) is still a concerning reality. The elderly, especially

susceptible to its deleterious effects are among their most frequent



To evaluate and characterize the prevalence of BZD

prescription in a population of patients admitted to an Internal

Medicine (IM) ward.


cross-sectional study. Data collected from patients admitted

during 2015 in an IMward. Measured the prevalence of BZD prescribed

previously to admission and described the main characteristics of the

patients with BZD prescription. The Clinical Frailty Score of Rockwood

(CFS) was used as a measure of frailty. Chi-square tests were used

considering a statistically significant p of less than 0.05.


N = 374 patients, median age of 81 years. The overall

prevalence of BZD prescription was 26%. It was higher among those

aged 65 or above (29% vs 6%, p < 0.01) and throughout increasing levels

of frailty (p < 0.01), being similar among patients with or without

dementia (p = 0.43). When present, the majority of the BZD were

prescribed for more than 4 weeks.


We found a high prevalence of BZD prescription,

especially among those more prone to their potential risks: the old,

frail and patients with dementia. Considering the known dangers of

long term BZD use (greater risk of falls, cognitive and motor decline,

dependency, agitation, confusion and even mortality), its start should

be continuously discouraged and, when present, its tapered discon-

tinuation should always be considered.


Chronic diarrhea? Think about olmesartan

A. Mendes


, S. Vieira




USF Tílias,


USF do Parque, Lisbon, Portugal


Olmesartan, is a selective angiotensin II receptor

blocker (ARB) indicated in hypertension

s treatment. Since 2012,

several cases of chronic diarrhea and weight loss due to severe sprue-

like enteropathy associated to Olmesartan have been reported, yet this

is not known by many physicians.

Clinical Case:

Female, 74-year-old, with a history of diabetes mellitus

type II, hypertension, hypothyroidism treated with levothyroxine,

amlodipine and olmesartan, metformin and sitagliptin. On May 2015,

she presented at her family physician

s office with non-bloody

diarrhea and vomiting that had started three days before. She denied

fever and abdominal pain. Physical examination was normal. She was

diagnosed with viral gastroenteritis and treated with loperamide and

strengthening hydro intake. Two weeks later for worsening she was

admitted at internal medicine department. Physical examination was

normal except for mucocutaneous dehydration. Blood chemistry

revealed hyponatremia and metabolic acidosis. A month later, for

persistent diarrhea and weight loss measured in 5kg, her family

physician ordered an abdominal CT-scan, a colonoscopy and a

esophagogastroduodenoscopy, to rule out a cancer or an inflammatory

bowel disease. All the exams she performed were negative. On July, she

was admitted again at internal medicine department. Chart review

revealed daily use of olmesartan. Given the patient extensive negative

workup, a diagnosis of olmesartan-induced enteropathy was made.

After discontinuing the medication, her symptoms gradually

improved, with complete resolution in weeks.


This case provides further evidence for olmesartan-

induced sprue-like enteropathy, and emphasises the importance of its

awareness, especially in elders due to dehydration risk and among

physicians alike.


Selective serotonin-reuptake inhibitors (SSRI) and hyponatremia

in the elderly: a case report

S. Vieira


, A. Mendes




USF do Parque,


USF Tílias, Lisbon, Portugal


Higly used in the treatment of depressive and anxious

disorders, selective serotonin-reuptake inhibitors (SSRI) are associated

with hyponatremia and/or syndrome of inappropriate secretion of

antidiuretic hormone (SIADH) as a side effect. Many studies demon-

strate that this adverse drug reaction is more common in older patients


65 years) and in those using diuretics and should be used with


Clinical case:

85-year-old female, with diagnosis of hypertension,

atrial fibrillation, heart failure (grade II/IV NYHA), mechanical aortic

valve, treated with olmesartan/hydrochlorothiazide, furosemide,

digoxin and warfarin. In a psychiatric evaluation she was diagnosed

with depressive syndrome and started sertraline for its treatment. The

reappraisal consult with the psychiatrist was scheduled for six weeks

later. Three days after beginning SSRI she developed muscleweakness,

lethargy and dizziness and her relatives took her to the family

physician. Physical examination was normal except for the cognitive

changes, therefore the physician requested lab exams to screen for

possible infections or other causes of this kind of symptoms in the

elderly. An hyponatremia of 122 mEq/L was identify and associated

with the begin of the sertraline treatment which was titrated and

sodium levels was corrected. After a few days, patient condition



With this case we want to emphasize the importance of a

careful monitoring of the elderly patients when any treatment with

SSRIs is started, especially in those treated with diuretics as well. This

kind of side effect occurs very quickly and could be life-threatening.

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