152 / 210
S144
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
Methods:
All residents (N = 3404) in nursing homes and
assisted living facilities were assessed in 2011 for demographics,
functioning, diagnoses, use of drugs and well-being. Their mortality
was retrieved from central registers in 2015. All mortality analyses
are adjusted for age, gender, and comorbidities.
Results:
Mean age of participants was 84.2 y, 75.6% were females,
and 43.5% were bed-bound. 25.5% were malnourished according
to MNA, 71.9% suffered from dementia, and mean Charlson
comorbidity index 2.4. The mean number of regular drugs was
8.0 among both men and women, and 91.4% were administered
psychotropic drugs. Of residents, 37.5% received opioids either
regularly or as-needed, and 28.2% atypical antipsychotics,
47.5% DAPs and 38.1% PPIs. Opioid use was associated with
increased mortality (HR 1.33, 95% CI 1.22–1.45). The finding was
the same when only those without cancer were included (HR 1.34,
95% CI 1.23–1.47). Use of atypical antipsychotics was associated with
decreased mortality (HR 0.90, 95% CI 0.81–0.99), and the finding
was the same when only dementia patients were included. Use
of more than two DAPs increased mortality (HR 1.35, 95% CI 1.02–
1.79). PPIs did not affect mortality.
Conclusions:
The benefits and harms of various potentially
inappropriate drugs should be balanced among institutionalized
residents.
P-418
A botulinum jigsaw
S. Ponnambath
1
, H. Reed
2
, E.-K. Reed
2
1
Royal United Hospital, NHS, Bath, United Kingdom;
2
Bristol Royal
Infirmary, Bristol, United Kingdom
Case report:
83-year-old man presented with dysarthria and
dysphagia four days post botulinum toxin (BT) injection and
dialatation for oesophageal dysmotility. This was his third BT
injection to lower oesophagus. He has had no complications
previously. Past medical history includes achalasia and depression.
On examination he had ptosis, squint right eye and slurred
speech. The initial working diagnosis was symptoms secondary to
BT injection or pseudobulbar palsy secondary to cerebrovascular
disease. CT head showed chronic small vessel disease and old
right sided infarct. MRI scan did not show any acute changes.
Stroke team was not convinced this was acute stroke. Speech and
language therapist felt he had an unusual dysarthria and severe
dysphagia and advised to be kept nil by mouth and commence
nasogastric tube feeding. Neurology review found slightly weak
neck flexion and noted that he was unable to whistle. He felt whilst
the temporal association with BT is clear the spatial distribution of
his problems do not clearly replicate the BT and alternate diagnosis
of myasthenia should be excluded and advised blood test including
full blood count, plasma viscosity, acetylcholine receptor and anti
musk antibodies, ACE and CK which were all normal and nerve
conduction study which showed locally disseminated NMJ blockade
due to BT which can have remote effects from the injection site.
Conclusion:
As botulinum toxin is used widely across various
specialties these days including aesthetic medicine for various
medical conditions, one should be aware of the rare side effects
associated with it.
P-419
Changes in drug prescribing during a care episode in a geriatric
clinic
M. Reimers
1
, J. Fastbom
2
1
Brommageriatriken, Bromma, Sweden;
2
Aging Research Center,
Stockholm, Sweden
Aim:
The aim was to study how an episode of care in a geriatric
clinic influences the drug prescribing and which factors are
associated with changes in prescribing.
Method:
Medical records for patients with the main diagnosis
pneumonia, during 2005 and 2010, were studied with respect to
drug prescribing at the beginning and end of the care episode. We
studied the extent and quality of prescribing with respect to length
of care episode, comorbidity, age and sex. The results from 2005
and 2010 were compared with each other and with the opinions of
the specialist physicians at the clinic.
Result:
Polypharmacy was very common during both years, and
the number of drugs was two units higher 2010 compared to 2005.
The drugs that increased the most were antithrombotic agents,
loop diuretics, beta blocking agents, analgesics, and proton pump
inhibitors. The quality of drug prescribing, according to Swedish
national indicators, was largely better in 2010 compared to 2005.
The care episode led to a marginal decrease in the number of
prescribed drugs, but to an increase in quality of drug use in 2010.
The changes in drug prescriptions were more extensive for patients
with long episodes of care, high comorbidity and high age.
Conclusion:
The geriatric care contributed to a higher quality in
drug prescribing in 2010 and led to a decrease of the number of
drugs used during both years, however the contribution was small
compared to the general increase in drug prescribing to these
patients between 2005 and 2010.
P-420
Influence of a geriatrician in the benzodiazepine prescription
in a hospital unit: comparison between two cohorts
C. Roqueta Guill ´en
1
, H. Manj ´on Navarro
1
, A. Garc´ıa Bazt ´an
2
,
M. Mart´ın Montagut
1
, M.I. Mart´ınez-Fern ´andez
1
, C. Udina Argilaga
3
,
R. Miralles
3
1
Parc de Salut Mar. Centre F`orum, Barcelona, Spain;
2
Complejo
Hospitalario de Navarra, Pamplona, Spain;
3
Parc de Salut Mar
–
Centre Forum, Barcelona, Spain
Aim:
Compare prevalence of benzodiazepine prescription between
two cohorts of elderly patients with a hip fracture admitted to an
intermediate care unit (ICU) in two different periods of time. To
evaluate the influence of a geriatrician on this prescription.
Patients and Methods:
Retrospective study of two cohorts of
patients: cohort A (n = 129) were from an Orthopedic Surgery
and Traumatology Unit (OSTU) (no geriatrician) and cohort B
(n = 128) from an Orthogeriatrics Unit (OU) (integrated geriatrician
in team). A comprehensive geriatric assessment was performed.
Characteristics of both cohorts, prevalence of benzodiazepines
prescription at admission in ICU (at discharge of acute hospital)
and new prescriptions were compared.
Results:
In comparison between both cohorts were found
differences between age:cohort A:81.0
±
9.2 versus cohort
B:83.4
±
8.1 (p = 0.02)) and functional status at admission (Barthel
index (BI):30.8
±
25.1 versus 16.1
±
13.7, respectively (p = 0.002)); no
differences in sex or in functional and cognitive previous status and
at discharge of ICU. Prevalence of benzodiazepine prescription at
discharge of acute hospital was 71 (55.0%) in cohort A and 25 (19.5%)
in the B (p
<
0.0001); previous admitted to the hospital (home) was
37 (28.7%) and 36 (28.1%), respectively (p = 0.9211). Proportion of
the new prescriptions at discharge from acute hospital was 40
(56.3%) in cohort A and 4 (16.0%) in B (p
<
0.005).
Conclusion:
Prevalence of benzodiazepine prescription at discharge
of the OU was lower than at OSTU. Prevalence of new prescription
was higher in the OSTU. Presence of a geriatrician influences in non
prescription drugs considered inappropriate in elderly patients
P-421
Antalgic efficacy of transdermal fentanyl in the elderly
N. Marie
1
, I. Simonenko
2
, N. Shpak-Deschamps
3
1
Psychiatric Hospital, Rennes Cedex 7, France;
2
University Rennes 1
Pharmacy Faculty, Rennes Cedex, France;
3
Psychiatric hospital, Rennes
cedex7, France
Objectives:
To analyze the efficacy in the management of non-
cancerous pain by transdermal fentanyl in elderly patients.