S222 Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234

would provide prevention/treatment against STDs. Majority of

FGD participants believed in TM efficacy than orthodox-medicine.

Hence, Magun could detect/prevent diseases. FGD participants

opined that TM for-instance: Ale or Erii-in; Ajidewe and Agunmu

are for erection; Ale is for ejaculation and sperm-production, Aseje

and Afaatoo enhance multiple sexual-rounds, Agbo or Ogbolo and

Tude boost sexual-performance.

Most elderly in Nigeria used TM to enhance sexual performance.

However, these products are yet to undergo clinical evaluation for

sexual medicine. There is need to support its clinical investigation

especially the claims in the improvement of sexual health.

P446

Usage of potentially inappropriate medications among the

hospitalized elderly fallers

K. Mamun

Singapore General Hospital, Singapore, Singapore

Introduction: Potentially inappropriate medications (PIMs) are

being prescribed for the elderly patients worldwide at an

alarming rate. These medications may lead to falls and subsequent

hospitalizations. A study was planned to assess the prevalence of

PIMs use in the elderly who have been hospitalized due to falls in

Singapore.

Methods: A single-centre, retrospective cohort study was

conducted at an acute care hospital in Singapore over three months

to assess the prevalence of PIMs use before a fall of community

dwelling elderly (age >65) based on 3 explicit criteria; Beers’

List 2003 & 2012, and STOPP 2008 criteria. Data extracted from

hospital electronic database for all patients with ICD-9 diagnosis of

‘hospitalizations due to falls’ and admitted during the study period

were analysed for PIMs based on above criteria.

Results: Our study included 577 patients, 73.1% of whom were

females. The mean age was 79.3 (±0.3) years, average length

of stay was 10.9 (±0.5) days and the hospitalization cost was

SGD$3011.67 (±155.1) (USD2400). At least one PIMs was prescribed

in 43.3% of our study cohort. Prevalence of PIMs were 32.9%,

41.2% and 12.1% as per Beers 2003, Beers 2012 and STOPP criteria

respectively.

Conclusions: Use of PIMs is high among the community dwelling

elderly in Singapore who were hospitalized after a fall. More

awareness among prescribers about potential side effects of

commonly prescribed medications for the elderly may help reduce

the number of falls in this elderly population.

P447

Efficacy of geriatric intervention on polypharmacy

consumption. Experience in an outpatient geriatric service

J.D. Castro-Alvirena, C. Verdejo-Bravo, P. Gil Gregorio,

A.M. Lebreault Polanco

Hospital Clınico San Carlos, Madrid, Spain

Introduction: The aim of this study was to analyze the relationship

between comorbidity and the number of drugs used among patients

treated (first visit and follow up-visits) in an outpatient clinic of a

geriatric department.

Methods: A cross-sectional, observational study was conducted in

an outpatient geriatric service during June and July 2012. Sample:

consecutively referred patients were included in two groups: First

visit, new patients (group A) and follow up (group B) by random.

Comorbidity (Charlson index), number of medications currently

taken, pharmacological groups, and demographic variables were

analysed. Data was obtained through a personal interview, and

answering a questionnaire.

Statistical analysis was done with STATA 12.

Results: Sample: 108 patients. Group A: 62 patients (57.4%),

women: 48. Mean age: 82.9, drug number (percentile 50th): 8.

Charlson index (percentile 50th): 2. Patients using more than

5 drugs: 52 (83.9%). Most commonly pharmacologic groups used:

PPI: 43 (69%), antihypertensive: 37 (60%), diuretics: 29 (47%),

Antiplatelet: 25 (40%), lipid-lowering drugs: 24 (39%).

Group B: 46 patients (42.6%), women: 34. Mean age: 84.6, drug

number percentile 50th: 6. Charlson index (percentile 50th): 2.

Patients using more than 5 drugs: 25 (54.4%). Most

commonly pharmacologic groups used: antihypertensive: 31 (67%),

PPI: 25 (54%), lipid-lowering drug: 20 (43%), Diuretics: 19 (41%),

NSAID: 17 (37%).

Conclusions: (1) Patients seen as first visit consumed significantly

more drugs in comparison with patients treated as follow up. They

didn’t demonstrate differences in comorbidity.

Table 1. Characteristics and comparison between new patients

(Group A), and follow up patients (Group B) treated in an outpatient

clinic of a geriatric department (total 108 patients)

Group A

(New

patients)

Group B

(Follow up

patients)

Number per group 62 (57.4%) 46 (42.6%)

Age (years) 82.9 84.6

Female, N (%) 48 (77.4%) 34 (73.9%)

Charlson Index, P 50th 2 2

Number of drugs being taken at home, P 50th 8 6

Patients taking more than 5 drugs 53 (83.9%) 25 (54.4%)

Figure 1. Most common pharmacologic groups used in new patients and in follow up

patients.

P448

Potentially inappropriate medications detected by explicit

criteria; are they really inappropriate?

I. Lozano-Montoya, M. Velez-Dıaz-Pallares, E. Delgado-Silveira,

B. Montero Errasquın, A.J. Cruz-Jentoft

Hospital Ramon y Cajal, Spain

Introduction: Explicit criteria to detect potentially inappropri-

ate (PI) drugs in older patients are not always followed by the

attending physician and some may be appropriate for a particular

patient. Our aim was to analyse the appropriateness of the

STOPP-START criteria in older inpatients using a multidisciplinary

comprehensive assessment as gold standard.

Methods: Patients admitted to an acute geriatric unit during 18

months were included. STOPP-START criteria were applied to pre-

admission treatments. A multidisciplinary geriatric team (including

a clinical pharmacist) assessed drug use and decided what drugs

were recommended after discharge. Two researches independently

reviewed when STOPP-START recommendations were not followed

and why.

Results: 388 patients were included (88.8±6.0 years, 68.3% female),

42 of them died in hospital (data excluded from analysis). In those

discharged alive, 284 PI prescriptions were identified (0.8/patient),

of which 247 (87.0%) were followed at discharge. In 37 (13%) cases

Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234 S223

the suggestion of removing the drug was not accepted because of

other therapeutic priorities (n = 35; lorazepam n=12, risperidone

n=5, other n =18), palliative care (n = 1) and severe disability

(n = 1).

397 prescribing omissions were identified according to START

criteria (1.1/patient). 133 (33.5%) of them were followed at

discharge. The most important reasons for not prescribing

potentially appropriate medications were: advanced physical

disability (n = 90), use of an effective alternative treatment (n = 38)

and high risk of severe adverse effects (n = 32).

Conclusions: PI medications detected with explicit criteriaare

usually discontinued. Establishing different therapeutic priorities

was the main reason for not stopping drugs, mainly

benzodiazepines. Two thirds of the START recommendations not

followed, mainly based on sound clinical reasons.

P449

Oral anticoagulants in geriatric patients and dementia

A.Z. Zamora, Z.A. Zamora

Hospital de Barbastro, Spain

Introduction: Work done to study the characteristics of patients

over one year of treatment with oral anticoagulants.

Methods: A prospective descriptive study.

Results: N=121; 34.7% men, 65.3% women. Average age:

82.26±5.84. Average stay anticoagulated: 16.4 days. Average

hospital stay: 14 days, men 17.07, women 16.05. Average previous

Barthel 55. Average present Barthel 30. Pfeiffer <3 40%. Pfeif-

fer >3 60% from which MM <24 15%. GDS Distribution: 43.8% GDS1,

0% GDS2, 5.8% GDS3, 13.2% GDS4, 12.4% GDS5, 9.1% GDS6,

15.7% GDS7. Falls in previous year 50 (41.3%). Mean albumin: 3.3.

Average cholesterol 149. Main caregivers: 21% none, 30% spouse,

36% sons, nurse home 22%, another 11%. Atrial fibrillation in 93

cases (77%). Drug Media: 8±2.7. In 50% 7 or more drugs.

Conclusions: High percentage of dementia in advanced stages

with anticoagulation and high polypharmacy. High dependency in

anticoagulated patients. Increased frequency of female caregivers,

institutionalized and living alone.

P450

Inappropriate prescribing in older patients admitted to

psychiatric hospital: a cross-sectional cohort study

S.E. Rongen1, A.I.A. Ahmed1, T.B. Feuth2

1Vincent van Gogh, Venray, The Netherlands; 2Epidemiology,

Biostatistics and Health Technology Assessment, Radboudumc,

Nijmegen, The Netherlands

Aims: This study aimed to determine the prevalence of

inappropriate prescribing among older patients admitted to a

psychiatric hospital.

Methods: A cross-sectional, cohort study of 164 older patients

(≥65 years), who have been admitted to a psychiatric hospital in the

Netherlands. Prevalence of inappropriate prescribing was assessed

by using the Beers criteria 2003 and 2012, and STOPP/START

criteria.

Results: The mean age of included patients was 74.9±7.3 years

and 62% were female. The total number of prescribed medications

was 1269 (mean: 7.6; range: 0–19). The Beers’ criteria 2003 and

2012 identified in 48% and 47% of patients, respectively, potential

inappropriate medications (PIMs), while STOPP identified PIMs in

79% of the patients. 71% of all PIMs were related to psychotropic

medication. The number of PIMs identified by STOPP criteria

was significantly higher than Beers’ 2003 and 2012 (p< 0.0001).

There was a significant association between number of prescribed

medications and occurrence of PIM according Beers’ 2003 [OR 1.2

(95%CI 1.1–1.4)], Beers’ 2012 [OR 1.2 (95%CI 1.1–1.3)] and STOPP

[OR 1.5 (95%CI 1.3–1.8)]. 59% of patients had potential prescribing

omissions (PPOs), according to START criteria.

Conclusions: Inappropriate prescribing as identified by Beers’

and STOPP/START criteria was highly prevalent among older

patients in psychiatric hospital. However, the focus on psychotropic

medications without taking into account the benefits of individuals,

may limit the use of Beers’ and STOPP criteria in psychiatric

hospitals. The START criteria seems an appropriate screening tool

for underprescribing in older patients with mental disorders.

P451

The effect of vascular risk factors on GFR in older patients

during lithium use

E.J.M. van Melick1, I. Wilting2, R.M. Kok3, A.C.G. Egberts2

1Reinier de Graaf Gasthuis, Delft, The Netherlands; 2Department

of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht,

The Netherlands; 3Department of Old Age Psychiatry, Parnassia

Psychiatric Institute, The Hague, The Netherlands

Introduction: The effect of lithium on glomerular filtration rate

(GFR) in older patients is still unclear. The aging process itself is

associated with vascular risk factors, vascular disease and declining

GFR. The objective of this study is to ascertain the association

between GFR and duration of lithium use in older patients with

and without vascular risk factors (CVR).

Method: This is a cross-sectional study in elderly outpatients

treated with lithium, who were divided into a group without

and with CVR. CVR consisted of diabetes, hyperlipidemia and

hypertension. A multiple linear regression analysis was conducted

with GFR as dependent variable (subsequently using Cockcroft-

Gault (CG-GFR), Modification of Diet in Renal Disease (MDRD)

and the measured GFR) and duration of lithium use and age as

independent variables in patients with and without CVR. Gender,

smoking, weight and antipsychotic use were evaluated as potential

confounders.

Results: 50 patients with and 61 without CVR were included. There

was not a significant difference between the potential confounders

in the two groups (Table 1). The CG-GFR, the MDRD and the

measured GFR were all significantly associated (p < 0.05) with

duration of lithium use in the group with CVR (Table 2) but not in

the group without CVR.

Table 1. Characteristics of patients using lithium (N=111)

Patients without

vascular

risk factors

(N=50)

Patients with

vascular

risk factors

(N=61)

Age (SD) 74.2 (6.8) 76.0 (6.0)

Gender, women, N (%) 38 (76) 51 (83.6)

Smoking, N (%) 15 (30) 19 (31)

Weight, kg (SD) 71.5 (12.2) 74.4 (16.3)

Duration lithium use, years (SD) 10.2 (9.0) 9.3 (8.1)

Lithium trough level, mmol/L (SD) 0.61 (0.17) 0.60 (0.19)

Antipsychotic use, N (%) 11 (20.2) 13 (21.3)

Antidepressant use, N (%) 26 (52) 41 (67.2)

Table 2.

Dependent variable N B 95% Confidence interval P

CG

patients without CVR 49 −0.21 −0.66; 0.23 0.34

patients with CVR 59 −0.65 −1.21; −0.10 0.02

MDRD

patients without CVR 49 −0.17 −1.88; −0.70 0.51

patients with CVR 60 −0.78 −1.25; −0.32 0.00

Measured GFR

patients without CVR 39 −0.32 −1.08; 0.45 0.40

patients with CVR 47 −0.84 −1.51; −0.17 0.02