249 / 290
were polymedicated, versus 14.72% (n = 44). The mean number of
diagnostics were 8 and 9 per patient, respectively.
Conclusions:
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?
P-810
A point prevalence study of psychoactive drugs and the elderly
patient in the hospital setting
A. Rola, J. Monteiro.
C.H.P.
Introduction:
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.
Methods:
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.
Results:
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
“
virgin
”
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.
Conclusion:
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.
P-811
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
Introduction:
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
users.
Objectives:
To evaluate and characterize the prevalence of BZD
prescription in a population of patients admitted to an Internal
Medicine (IM) ward.
Methods:
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.
Results:
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.
Conclusion:
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.
P-812
Chronic diarrhea? Think about olmesartan
A. Mendes
1
, S. Vieira
2
.
1
USF Tílias,
2
USF do Parque, Lisbon, Portugal
Introduction:
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.
Conclusions:
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.
P-813
Selective serotonin-reuptake inhibitors (SSRI) and hyponatremia
in the elderly: a case report
S. Vieira
1
, A. Mendes
2
.
1
USF do Parque,
2
USF Tílias, Lisbon, Portugal
Introduction:
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
caution.
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
improved.
Conclusion:
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
–
S259
S243