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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S139
P-399
Determinants of prescription of vitamin D supplementations in
nursing homes: an online survey among general practitioners
F. Buckinx
1
, J.-Y. Reginster
1
, E. Cavalier
1
, J. Petermans
1
, C. Ricour
1
,
C. Dardenne
2
, O. Bruy `ere
1
1
University of Li`ege, Li`ege, Belgium;
2
Medical Center Oxyg`ene, Li`ege,
Belgium
Background:
The aim of this study was to assess the prescription
profile of vitamin D supplementation in nursing homes and its
potential determinants.
Methods:
A link to an ongoing online survey was sent to general
practitioners (GPs) having at least one patient in a nursing home
in Li `ege, Belgium.
Results:
Out of the 120 GPs contacted so far, 50 (41.6%) participated
in the survey. Among them, 27 (54%) systematically prescribe
vitamin D to their institutionalized patients and the 23 (46%)
others prescribe only sometimes. The main reasons for prescribing
vitamin D cited by GPs who do so systematically are as follows:
because they believe nursing home residents are mostly deficient
in vitamin D status (92.6%), because they believe vitamin D
supplementation prevents osteoporotic fractures (81.5%), and
because vitamin D supplementation is recommended by various
scientific societies (44.4%). GPs who do not prescribe systematically
vitamin D supplementation supplement some patients mainly on
the basis of results of a blood test (86.4%), following a diagnosis
of osteoporosis (86.4%) or in case of prevalent fractures (45.5%).
Interestingly, 47% of GPs always prescribe the same dose of
vitamin D. For the remaining 53%, the dose prescribed mainly
depends on the results of the blood test (96.2%). At last, 54.2% of
GPs always prescribe calcium in combination with vitamin D.
Conclusion:
More than half of GPs systematically prescribe
vitamin D to their patients living in nursing homes. The other GPs
usually prescribe vitamin D following a blood test or a diagnosis of
osteoporosis.
P-400
The Multidimensional Prognostic Index (MPI) predicts central
nervous system-related adverse drug events (CNS-ADRs)
in older patients admitted to hospital: a prospective 3-year
observational study
J. Daragjati
1
, A. Pilotto
2
1
Geriatrics Unit S. Antonio Hospital, Azienda ULSS 16, Padua, Italy;
2
Italy
Objective:
To evaluate the risk factors for CNS-ADRs in a cohort of
elderly hospitalized with ADR.
Methods:
Patients aged ≥65 years hospitalized to a Geriatrics
Unit for an ADR according to the World Health Organization
Adverse Reaction Terminology during a study period of 3 years. The
causality and avoidability of ADRs were assessed using Naranjo and
Hallas criteria. Multidimensional Prognostic Index (MPI), a validated
tool to predict mortality based on a standardized comprehensive
geriatric assessment (CGA) including eight domains, i.e. functional
(ADL, IADL), cognitive (SPMSQ), nutritional (MNA), risk of pressure
sores (Exton-Smith Scale), comorbidity (CIRS), drug use and co-
habitation social status was performed at baseline in all patients.
Results:
The prevalence of ADRs was 7.3% (274 ADRs of 3,745
patients admitted to hospital in the study period, mean age
84.7
±
6.8 years). 36 cases (13.1% of all ADRs) were CNS-related ADRs,
i.e. stupor state (n = 20, 55.5%), delirium (n = 8, 22.2%), syncope
(n = 4, 11.1%), tremor (n = 3, 8.2%), headache (n = 1). 89% of the
CNS-ADRs occurred in patients with severe grade MPI-3 (high
mortality risk). 92% of cases were considered to be avoidable
ADRs. Multivariate analysis demonstrated that severe cognitive
impairment (SPMSQ, OR = 1.34, 95% CI 1.17–1.56) and MPI value
(OR = 1.74, 95% CI 1.32–2.30) were the two only risk factors
significantly associated with the presence of CNS-ADR. Moreover,
the use of CNS drugs was associated with ADR in older patients
with a severe grade of MPI (OR = 1.44, 95% CI 1.15–1.78).
Conclusion:
A proper stratification of the frail older subjects
admitted to hospital by using MPI may identify patients at high-risk
for CNS-ADRs.
P-401
Use of intravenous haloperidol in hospitalized older adults
Y.R. Davila Barboza
1
, E.H. Azana Fernandez
1
1
Hospital San Juan de Dios, Le´on, Spain
Introduction:
Haloperidol is often used in symptomatic
management of delirium episodes. Although it is approved for
intravenous (IV) use in many countries, numerous cases of QT
prolongation (QTP), Torsades de Pointes (TdP), and sudden death
have been associated with IV haloperidol.
Objectives:
Evaluate the use of haloperidol in hospitalized older
adults.
Method:
We retrospectively studied patients hospitalised at
Geriatric Department during October to November 2014 who
received at least one dose of IV haloperidol. Diagnoses and pre-
admission medication were recorded.
Results:
31 patients (100 patients admitted in this period) received
at least one dose of IV haloperidol, all of them had delirium.
Mean patient age was 86.31
±
4.5 years. 70.96% were female. Mean
Charlson’s index: 1.76. Mean number of prescription medicines: 7.4.
Polypharmacy (≥5 drugs): 74.19%.
The median dose of haloperidol given was 4.11mg, and 64.5%
received 5mg for their first dose. 41% received a second dose.
83% had an ECG performed within 7 days before their first dose of
haloperidol.
QTc was not calculated prior to haloperidol administration (avoid
IV haloperidol for baseline QTc of 500ms or greater).
Conclusion:
Although the proarrhythmic potential of haloperidol
has been well established in the literature, IV haloperidol has been
used without care concordant with expert recommendations.
P-402
Advanced age and medication prescription
F. Mammarella
1
, A. Marengoni
2
, P. Russo
3
, L. Degli Esposti
4
,
S. Pecorelli
3
, R. Bernabei
5
, G. Onder
5
1
Catholic University of the Sacred Heart, Department of Geriatrics,
Rome, Italy;
2
Department of Clinical and Experimental Sciences,
University of Brescia, Brescia, Italy;
3
Agenzia Italiana del Farmaco
(AIFA), Rome, Italy;
4
CliCon Srl Health, Economics and Outcomes
Research, Ravenna, Italy;
5
Catholic University of the Sacred Heart,
Rome, Italy
Objectives:
To describe in a large, national representative, sample
how prescription of medications varies across age groups, with
specific focus on the oldest old.
Methods:
This is a cross-sectional study using 2013 data from
the OsMed Health-Database, which comprises all prescribed
medications reimbursed by the Italian National Healthcare System
in community setting. The study population amounts to 15,931,642
individuals (26.8% of the overall Italian population). Individuals
aged ≥65 years or older are 3,378,725 (21.2% of the study sample).
The main outcomes assessed were mean number of medicines
and Defined Daily Doses (DDD) prescribed in 2013 and the use of
individual medications.
Results:
The mean number of prescribed medications progressively
raised from 1.9 in the age group
<
65 years to 7.4 in the group 80–84
years and then declines, with a more marked reduction in the group
aged 95 or older, which receives a mean number of 2.8 medications.
A similar pattern was observed for the mean number of DDD.
Among participants aged 65 or older, proton pump inhibitors were
the most commonly prescribed medication (40.9% of individuals 65
or older), followed by platelet aggregation inhibitors (32.8%) and