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

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P-814
Diseases linked to polypharmacy and consequences of multiple
drug use in consecutively admitted elderly patients at the time of
admission
P. Voukelatou, I. Vrettos, A. Bitsikokou, E. Rapti, E. Sfendouraki,
A. Ragkou, S. Fokas, A. Kalliakmanis. 2nd Department of Internal
Medicine, General Oncological Hospital of Kifissia “The Agioi Anargyroi”,
Athens
Introduction: Several factors contribute to polypharmacy (use of ≥5
drugs) in the elderly, a phenomenon with negative consequences.
Objective was to assess the diseases linked to polypharmacy and the
consequences of polypharmacy in patients aged ≥65 years.
Methods: In 276 patients, mean age 80.39 ± 8.020 Μ± 1SD, (50.4%
women) demographic characteristics, medical history, medications
and cause of admission were recorded. Adverse drug reactions (ADR)
assessed using Amended-Hallas criteria. Chi-square test was used to
compare the data. Statistically significant variables were processed
with multivariate analysis.
Results: 53.6% of patients belonged topolypharmacygroup. In 15.9% an
ADR was the main cause of admission. 16.3% had a lower significance
ADR.18.4%had anADR and 6.6%was hospitalized foranADR in the past.
The probability of an ADR as a main cause of admission (χ2 = 11.772,
p = 0.001) orof anADRof lower significance (χ2 = 10.400, p = 0.002)was
significantly higher in polypharmacy group. Patients receiving ≥5
medications were more likely to have either an ADR ( χ2 = 12.278,
p = 0.000) or an ADR-induced hospitalization ( χ2 = 6.895, p = 0.012) in
the past. In multivariate analysis polypharmacy patients were more
likely to suffer from arterial hypertension (p = 0.024, OR = 2.224, 95%CI
1.113– 4.443), coronary artery disease (p = 0.000, OR = 7.015, 95%CI
2.676–18.393), heart failure (p = 0.034, OR = 4.395, 95%CI 1.117–17.297),
atrial fibrillation (p = 0.006, OR = 3.453, 95%CI 1.435 –8.313), diabetes
mellitus (p = 0.007, OR = 2.593, 95%CI 1.295 –5.192), dementia (p =
0.001, OR = 4.371, 95%CI 1.794–10.649) and COPD (p = 0.013, OR = 4.651,
95%CI 1.383–15.638).
Conclusions: Polypharmacy mainly was linked to cardiovascular
diseases. If deprescribing is not feasible, physicians must oversee
those patients in order to recognise early, possible drug reactions.
P-815
Inappropriate proton pump inhibitors (PPIs) use in consecutively
admitted elderly patients at the time of admission: prevalence and
determinants
P. Voukelatou, I. Vrettos, A. Bitsikokou, E. Rapti, E. Sfendouraki,
A. Ragkou, A. Kalliakmanis. 2nd Department of Internal Medicine,
General Oncological Hospital of Kifissia “The Agioi Anargyroi”, Athens,
Greece
Introduction: PPI’ s high efficacy, good tolerance, safety profile, and
acceptable cost are the main reasons, contributing to their frequently
off label use. The objective of this study was to assess the prevalence
and risk factors for inappropriate PPI’ s use (according to NICE
guidelines) in consecutively admitted elderly patients.
Methods: In 236 patients, mean age 80,50 ± 7,88 Μ ± 1SD, (49,6%
women) demographic characteristics, medical history, medications,
Katz-index, Charlson-Comorbidity-Score and reason of admission
were recorded. Chi-square test was used to compare categorical data.
Student’s t-test and Man-Whitney U test were used to compare
continuous data. Only variables being statistically significant were
processed with multivariate analysis.
Results: The mean number of diseases and medications were
3.08 ± 1.60 and 5.10 ± 2.92 Μ ± 1SD respectively. 46.6% received anti-
platelet/anticoagulant agents. 8.9% were admitted due to an upper
gastrointestinal bleeding. 50 patients (21.2%) received PPI’s without an
indication. Mean number of both diseases (t(234) = −3.543, p = 0,000)
and medications (U = 2.193, p = 0,000) were significantly higher for
patients receiving PPI’ s inappropriately. Furthermore those were more
likely to receive blood thinners (χ2 = 9.585, p = 0,002). In multivariate
analysis number of diseases was the only independent predictor of
inappropriate PPI use (p = 0,000, OR = 1.446, 95%CI 1.209–1.729).When
we compared patients receiving PPI’s without indication with those
who didn’ t receive, no statistical significant differencewas found in the
occurrence of upper GIT bleeding.
Conclusions: The most important determinant of inappropriate PPI
use was the number of diseases. PPI use without indication had no
additional benefit regarding upper GIT bleeding occurrence.
P-816
Potentially inappropriate medications (PIMs) used by
consecutively admitted elderly patients in a Greek hospital:
prevalence and independent predictors
I. Vrettos, P. Voukelatou, A. Bitsikokou, E. Rapti, E. Sfendouraki,
A. Ragkou, A. Didaskalou, A. Kalliakmanis. 2nd Department of Internal
Medicine, General Oncological Hospital of Kifissia “The Agioi Anargyroi”,
Athens, Greece
Introduction: Despite the extend of information on PIMs, health
professionals continue to prescribe them, leading to increased
morbidity, mortality and health-care cost. Objective was to assess
both prevalence and predictors for PIM use.
Methods: In 178 patients, mean age 79,63 ± 8,289 Μ ± 1SD, (50%
women) demographic characteristics, medical history, medications,
Katz-index and Charlson-Comorbidity-Score were recorded. PIMs
were assessed using updated Beer’s criteria. Chi-square test was
used to compare categorical data. Student’ s t-test and Man-Whitney U
test were used to compare continuous data. Variables being statistic-
ally significant were processed with multivariate analysis.
Results: 26,9% were taking at least one PIM. Among 50 cases of PIMs,
that elderly should avoid, independent of their condition, benzodia-
zepines were the most common drugs (23 cases). Moreover, in 50
other cases of PIMs, that elderly with certain illnesses or syndromes
should avoid, benzodiazepines in patients with history of falls, was the
most frequent combination (13 cases). Statistical difference was found
while comparing the PIM and the non-PIM group according to the
number of diseases (t(175) = −3.906, p = 0,000) and medications, (t
(175) = −3.842, p = 0,000) the presence of atrial fibrillation (AF)
(χ2 = 9.118, p = 0,003), neuropsychiatric disorders (χ2 = 31.924, p =
0,000) and stroke (χ2 = 4.106, p = 0,043). Patients aged above 80 were
more likely to receive at least one PIM (χ2 = 4.807, p = 0.028). In
multivariate analysis the only independent predictors were AF
(p = 0.011, OR = 4.216, 95%CI 1.382– 12.860) and neuropsychiatric
disorders (p = 0.000, OR = 8.329, 95%CI 3.441–20.160).
Conclusions:Almost 30% of patients received at least one PIM. Patients
at risk for PIM prescribing are those who suffer from AF and
neuropsychiatric disorders.
P-817
Chronic femoral haematoma (FH): a hidden cause of anemia in a
66-year old woman
I. Vrettos, P. Voukelatou, E. Rapti, A. Bitsikokou, S. Fokas, E. Sfendouraki,
A. Kalliakmanis. 2nd Department of Internal Medicine, General
Oncological Hospital of Kifissia “The Agioi Anargyroi”, Athens, Greece
Background: Systemic thrombolytic therapy is a widely accepted
indication for patients with PE who present with hemodynamic
instability. FH is the most common vascular access site complication
and can result in decrease in hemoglobin. Many hematomas resolve
within a few weeks as the blood dissipates and is absorbed into the
tissue.
Objective: To describe a patient, who underwent an extended workup
for anemia, before the diagnosis of chronic blood loss due to FH, was
reached. Case presentation: She was admitted for her normochromic
normocytic anemia. She suffered from multiple sclerosis. 2,5 months
later she had amassive pulmonary embolism; she underwent systemic
thrombolytic therapy and, subsequently, received rivaroxaban. During
hospitalization, she received 7 RBCs units. At discharge her Hct was
29,9%. 25 days later she was admitted with Hct 22.0%. B12, folic acid
and ferritin levels were normal. Immunological examinations,
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S244