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

94 / 290

P-225
Development and validation of a standardised method to identify
drug-related hospital admissions in older people
S. Thevelin 1, A. Spinewine1,2, B. Boland3, J.B. Beuscart1, S. Marien1,
F. Vaillant 4, S. Cullinan5, J. Donzé6, C. Floriani6, C. Schneider6,
A. Vondeling7, I. Wilting8, P. Jansen7, D. O’Mahony9, N. Rodondi6,10,
O. Dalleur 1,4. 1LDRI, UCL, Brussels, 2Pharmacy Department, CHU UCL
Namur, Yvoir, 3Geriatric Medicine, CUSL, 4Pharmacy Department, CUSL,
Brussels, Belgium; 5School of Pharmacy, UCC, Cork, Ireland; 6Internal
Medicine, BUH, Bern, Switzerland; 7Geriatric Medicine & Ephor, UMCU,
Utrecht, 8Pharmacy Department, UMCU, the Netherlands; 9Geriatric
Medicine, UCC, Cork, Ireland; 10BIHAM, UBERN, Switzerland
Introduction: Drug-related admissions (DRAs) are hospitalisations
resulting from adverse drug events (ADEs) and contribute to up to 30%
of all admissions in older people. The OPERAM multicentre rando-
mised controlled trial aims to assess the impact of pharmacotherapy
optimisation on DRAs. Currently, no validated DRA identification
method exists. We aimed to develop and validate a standardised
method to screen for and adjudicate DRAs caused by adverse drug
reactions, overuse, underuse and misuse of medications.
Methods: The DRA identification method was developed in 4 steps;
(1) Literature review on existing approaches of ADE/DRA identification
and on common causes of DRA in older people, (2) content validation
of a trigger tool using a 2-round modified Delphi survey with 15
experts from 8 countries, (3) evaluation of feasibility of use during a
pilot test on 15 cases by a physician and a pharmacist (adjudication
pair), (4) evaluation of inter-rater reliability for 16 cases between
adjudication pairs from 4 countries.
Results: The DRA identification method consists of a comprehensive
medical record review with the aid of a trigger tool. The method
includes standardised data abstraction, screening for potential ADEs
and adjudication of ADE causality, contribution to admission and
preventability. Experts reached consensus on 26 triggers. Inter-rater
reliability was moderate for DRA identification (71% agreement,
kappa = 0.41). Disagreements arose mainly from cases with potential
underuse.
Conclusion: A DRA identification method was successfully elaborated
and validated for content. Specific measures, including in-depth
training, will be implemented to maximise reliability across study
centres during the trial.
P-226
Prevalence of hyperuricemia among very elderly Russian patients
and its association with cardiovascular diseases
S. Topolyanskaya1, O. Vakulenko2, L. Kupina2, N. Strizhova1. 1First
Moscow State Medical University named after I.M.Sechenov, 2War
Veterans Hospital N3, Moscow, Russia
Introduction: There are few data available on the prevalence of
hyperuricemia and its possible association with cardiovascular
diseases (CVD) among the very elderly population.
Methods: Cross sectional data from 300 very elderly hospitalized
patients (aged 86.36 + 5.02 years; females – 78.15%, males – 21.85%)
with coronary artery disease (CAD) and arterial hypertension (AH)
were analysed. Patients with gout were excluded from analysis.
Hyperuricemia was defined as serum uric acid (SUA) more than
340 μmol/L in women and 420 μmol/L – in men.
Results: The prevalence of hyperuricemia in this study was 35.2%.
Mean SUA in the study population was 337 μmol/L (in hyperuricemia
group – 446 + 86, in normal uricemia – 278 + 62 μmol/L). Mean SUA
was higher in women than in men (p = 0.02). Hyperuricemia
was associated with heart failure (OR = 3.88 (95% CI = 1.99 –7.57);
p < 0.0001), and stroke in history (OR = 2.18; p = 0.02). Hyperuricemia
remained significant risk factor of heart failure in the multiple
regression analysis (p = 0.00005). Prevalence of atrial fibrillation in
patients with hyperuricemia was higher than in subjects without
it (OR = 2.1, p = 0.005). The left atrium diameter was significantly
correlated with SUA level (r = 0.23, p = 0.0001). Also, elevated SUAwas
associated with increased serum creatinine (r = 0.49, p < 0.0001).
There was no correlation between hyperuricemia and myocardial
infarction (p = 0.87) along with diabetes mellitus (p = 0.54), as well as
between SUA and plasma glucose level (p = 0.8).
Conclusions: The study results demonstrated high prevalence of
hyperuricemia in very elderly patients with CAD and AH as well as
its association with various CVDs. Higher SUA is strongly correlated
with larger left atrium size.
P-227
Association of cardiovascular and neuro-psychiatric
multimorbidity with mobility limitation and disability in the
elderly: a population-based study
D.L. Vetrano1,2, D. Rizzuto 1, A. Calderón-Larrañaga1,3, G. Onder 2,
A.-K. Welmer1, R. Bernabei2, A. Marengoni 4, L. Fratiglioni1. 1Aging
Research Center, NVS, Karolinska Institutet and Stockholm University,
Sweden; 2Dept of Geriatrics, Neurosciences and Orthopedics, Catholic
University of the Sacred Heart, Italy; 3EpiChron Research Group, Aragon
Health Sciences Institute, Spain; 4Department of Clinical and
Experimental Sciences, University of Brescia, Italy
Introduction: Cardiovascular (CV) and neuro-psychiatric (NP) dis-
eases are highly prevalent in older adults and are associated with
adverse outcomes such as disability. The aim of this study was to
examine to what extent CV and NP multimorbidity, individually and in
combination, are associated with mobility limitation and disability.
Methods: In a population-based cohort of 3,353 people aged 60+ years
CV and NP multimorbidity were defined as the co-occurrence of 2 or
more CV and NP chronic diseases. Mobility limitation was defined as
slow waking speed (≤ 0.8 m/s) or difficulty/inability to walk 300– 400
meters, and disability as need of assistance or inability to perform at
least 1 Katz’s activity of daily living. Stratified and sensitivity analyses
were also performed.
Results: Among the study participants (mean age 75 years; 65%
females), NP multimorbidity was positively associated with slow
walking speed (OR 3.78; 95% CI 2.47–5.77), difficulty/inability to
walk 300–400 meters (OR 2.60; 95% CI 1.72–3.94), and disability (OR
3.57; 95% CI 2.24–5.68) as compared with participants free from CV
or NP multimorbidity. CV multimorbidity was associated only with
slow walking speed (OR 1.70; 95% CI 1.20–2.42) as compared with
participants free from CV or NP multimorbidity. The combination of
CV and NP multimorbidity showed an additive effect on the positive
association with the three outcomes.
Conclusions: Cardiovascular and neuro-psychiatric multimorbidity
affect differently the functional ability of older adults. When co-
occurring, they have an additive effect on poor function.
Area: Comprehensive geriatric assessment
P-228
Community study of the elderly in the Middle East using the
InterRAI-CHA instrument
A. Abyad. Chairman Middle East Academy Medicine of Ageing, Abyad
Medical Center
Background: Middle eastern countries have certain cultural, social
and economic characteristics in common with similar aspiration.
The percentage of elderly in the Middle East is expected to increase
with improvement of the health care delivery in the area. The region,
like other developing countries, needs to define the policies and
programs that will reduce the burden of aging populations on the
society and its economy. There is a need to ensure the availability
of health and social services for older persons and promote
their continuing participation in a socially and economically pro-
ductive life. The morbidity burden of the geriatric population can
quickly overwhelm fragile and under financed health infrastructures
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S88