Table of Contents Table of Contents
Previous Page  251 / 290 Next Page
Show Menu
Previous Page 251 / 290 Next Page
Page Background

myelogram and infectious diseases investigation were negative. From

the chest/abdominal CTs the only finding was an effusion located in

the left thigh. During investigation she received 3 RBCs units. In the

absence of diagnosis we reevaluated the imaging studies during the

past three months and the femoral effusion was present with

unchanged size. Rivaroxaban discontinued for 2 days; subsequently

the patient received enoxaparin and was discharged. One month later

the Hct remained stable and the femoral effusion was absent.


Chronic blood loss due to hematoma must be considered

in the differential diagnosis of anemia especially in patients that

underwent invasive procedures and consecutively continue to receive



The effectiveness of geriatric integrated outpatient service in a

tertiary teaching hospital in southern Taiwan

Y.-C. Wang.

Center for Geriatrics and Gerontology, Kaohsiung Veterans

General Hospital


To evaluate the effectiveness of geriatric integrated

outpatient service in a tertiary teaching hospital.


This prospective study enrolled the subjects aged 65 years

and over who visited the geriatric outpatient service for study. Those

who visited our hospital for 4 times andmore in the past one year were

recruited and those who didn

t visit our hospital 9 months later were

excluded. The clinical pharmacists would interview every patient and

reported the results to geriatricians. The number of drugs, the visiting

times and the expenditure of drugs one year before and after the first

visit to the geriatric integrated clinics were recorded from the

computer system of our hospital for comparison.


From Jan 2008 to Dec 2012, 999 older people were enrolled

(mean age = 83.3, SD = 6.93, 69.5% male). By comparing previous one

year to intervention year, the total visiting times for all outpatient

services decreased for 21.3% (from 12.7 to 10.0 times per person), total

cost of drugs decreased for 12.3% (from 412 to 357 in Euros per person)

and total numbers of drug per person per year decreased for 15.5%

(average 5.6

4.7 tablets per person).


Through geriatric integrated outpatient service with

cooperation with clinical pharmacists, the number of drugs, the times

of visiting for outpatient services and the expenditure of drugs could

decrease significantly. Further outcome study is needed to conclude

the benefits of geriatric integrated outpatient service.


EURO-FORTA: a study to promote the usage of the FORTA (Fit fOR

The Aged) List internationally

F. Pazan, M. Wehling.

Institute for Experimental and Clinical

Pharmacology and Toxicology, Medical Faculty Mannheim, Ruprecht-

Karls-University Heidelberg


The elderly are the main recipients of medications in

many regions of the world. Numerous trials have revealed that a large

section of the elderly is subject to inadequate drug treatment. The

reason is that for most of the drugs there is hardly any evidence

regarding efficacy and safety in the aged. Furthermore, the presence of

multimorbidity and as a result polypharmacy aggravates this problem.

In order to effectively address this issue and to ameliorate the

appropriateness and quality of drug treatment in the elderly, our group

has developed a clinical aid called the FORTA List. FORTAwas originally

created byWehling, and the FORTA List was validated by 20 experts in a

Delphi consensus procedure. Furthermore, we evaluated FORTA


utility in a pilot clinical trial and in a randomized prospective trial.

These two studies showed that FORTA significantly (p < 0.001)

improves the quality of drug treatment.


Based on these results, we conducted a consensus validation

of country-specific FORTA Lists in the UK, France, Poland, Italy, Spain,

the Nordic countries and the Netherlands. In this study, we used a self-

developed algorithm to choose experts in the field of geriatrics with

high experience in pharmacotherapy.


46 experts agreed to participate in our study. In a preliminary

analysis of the data from 4 participating countries each mean

consensus coefficient was higher than 0.9.


The overall consensus among experts is very high. The

outcomes of this project will be used to develop country-specific

FORTA Lists and a European FORTA List.


A crucial update of the FORTA (

Fit fOR The Aged

) List: a clinical

tool for the optimization of drug treatment in the elderly

F. Pazan, M. Wehling.

Institute for Experimental and Clinical

Pharmacology and Toxicology, Medical Faculty Mannheim, Ruprecht-

Karls-University Heidelberg


Numerous trials have revealed that the aged are often

subjects to inappropriate and unsafe drug treatment. The main reason

for this problem is that for most of the drugs there is no evidence

regarding efficacy and safety in the aged. This problem is worsened by

the high prevalence of multimorbidity and therefore polypharmacy in

this population. To raise the appropriateness of pharmacotherapy in

the aged, we have developed a clinical aid called the FORTA List. FORTA

was originally invented by Wehling and validated and expanded by

twenty experts in a Delphi consensus procedure. Subsequently, we

evaluated FORTA

s usefulness in a pilot clinical trial as well as in a

controlled prospective trial. These trials showed that FORTA signifi-

cantly increases the quality of pharmacotherapy and reduces the

frequency of adverse drug reactions.


As an evidence-based document the FORTA List needs

regular updates as the field of geriatric pharmacology progresses

rapidly. Thus, we performed a newDelphi survey to update this helpful

clinical tool. This Delphi consensus procedure involved over 20 experts

who evaluated the proposal of 4 initiators.


The new FORTA List now contains nearly 50 additional items

as compared to its first version and 3 new indications (nausea and

vomiting, hypothyroidism, obstipation) were added to the list

resulting in almost 30 indications in total. The overall mean consensus

coefficient which reflects the degree of agreement among raters

increased from 92.2% to 93.8%.


All in all, the updated list now incorporates more illnesses

and contains more drugs used to treat the elderly.


Pharmaceutical care in geriatrics in Poland

A. Neumann-Podczaska, E. Grzeskowiak, K. Wieczorowska-Tobis.

Poznan University of Medical Sciences, Poznan, Poland


In Poland, in spite of the alarming data regarding the

potential inappropriateness of pharmacological treatment among

elderly, there is no system of pharmaceutical care. The aim of the

research was to create a practical model for pharmaceutical care in

geriatrics which will be based on the set of Criteria Defining

Potentially Inappropriate Pharmacotherapy in Geriatrics developed

within the project.


The study was done among 300 elderly patients (195 female

[F], 105 men [M]; mean age: 74.9 ± 7.3] within 10 public pharmacies.

The including criteria was patient age (65 years+) and the number

of drugs (prescribed [Rp] and over the counter [OTC]) taken regularly

(10+) Pharmacists involved within the projects organized meetings

with the patients to assess the appropriateness of pharmacological

treatment and in case of incorrect treatment they undertook the

pharmaceutical interventions.


The mean number of Rp and OTC drugs before and after the

pharmaceutical intervention was relatively: 11.8 ± 2.9 (F:11.8 ± 2.8;

M:11.9 ± 3.3) and 11.5 ± 2.9 (F:11.5 ± 2.7; M:11.6 ± 3.3). The mean

number of consulting physicians was 3.6 ± 0.9 (87% of studied subjects

were seen by general practitioners and 73% by cardiologists). The

major inappropriateness of treatment involved: concomitant usage of

NSAIDs (ibuprofen, diclofenac, naproxen) and ACE-I (enalapril,

perindopril) in subjects with hypertension, consumption of NSAIDs

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