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Healthy ageing: Structuring change
S112
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
ing resources and updating medical records of every patient. With EGU’s, visits also controlled inappropriate prescribing of drugs. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.263 P263
Healthy ageing: Structuring change T. Robbins a , H. Robbins b,∗ a Brasenose College, Oxford University, Oxford, United Kingdom b Medical School, Bristol University, Bristol, United Kingdom Text.– Introduction.–There has been extensive work delineating individual healthy ageing interventions and their relative benefits. What has not been done, and what is so badly needed, is a structured approach synthesising how to bring about successful change at a population level to make a meaningful impact. Methodology.– This work has reviewed not only the standard medical literature, but also the contributions of organisations working on the ground to produce change. This is combined with detailed case studies analysis (America, India, Malaysia, Norway, UK) and lessons learnt from other public health drives to compile a successful strategy for change. Results.– Healthy ageing can only be implemented at a population level if three key pillars are addressed; why change is needed, what change is needed and how those changes occur. Case studies show none of these stages can be completed by an isolated stakeholder group–collaboration and involvement of the target population is essential. When considering the “what” and “how” we demonstrate that the developing world is as important as the developed world, and success is generated by sharing ideas between these two groups. Developing countries excel in creating innovative solutions and rapidly building experience. Conclusion.– The why, what and how of successful change are united by two common themes; leadership and networking. Health practitioners have a unique opportunity to take leadership responsibility in implementing strategies, and in doing so define the future of their professions. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.264 P264
Trazodone for behavioral and psychological symptoms in patients with dementia R. Faure ∗ , C. Mouchoux , A. Lacour , F. Delphin , G. Martin-Gaujard , P. Krolak Salmon Rhône, hôpital des Charpennes, Villeurbanne, France
Introduction.– Behavioural and Psychological Symptoms (BPS) affect at least 50% of people with Alzheimer’s disease and other dementias. Trazodone is a psychoactive compound with antidepressant, sedative and anxiolytic properties. Previous reviews have reported the use of trazodone in the BPS of dementia but its clinical efficacy remains controversial. Text.– Objective.– To describe the clinical efficacy and safety of trazodone for people with Alzheimer’s disease and other dementias hospitalized in a Cognitive Behavioural Unit (CBU). Methods.– A retrospective study was conducted in the CBU of Charpennes geriatric teaching hospital (France). The clinical efficacy was classified by a multidisciplinary group into two groups according to the trazodone response: “no response” group or “positive response” group. Results.– Twenty patients were included with eleven patients in « positive response » group and nine in “no response” group. No significant difference in the characteristics of patients was detected according to gender, age, diagnosis of dementia, comorbidities. Psychotropic treatments use, in particular antidepressant and anxiolytic drugs, was lower in the “positive response” to treat-
ment group (P = 0.08). Treatment was discontinued in five patients including three for no efficacy and two for sedation. Conclusion.– This study showed no specific profile of patients respond to trazodone. Efficacy could be explained by sedative, anxiolytic, and antidepressant effects of this drug. Future studies involving more subjects are required to determine if trazodone is safe and effective for BPS of dementia, and if specific patients or symptoms are most likely to respond to trazodone. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.265 P265
Anticholinergic load as a modifiable risk factor in sitter use in acute care hospitals L. Mallet a , A. Lessard b,∗ University Of Montréal, Faculty of pharmacy, Montreal, QC/QC, Canada b Pharmacy, McGill University Health Centre, Montreal/QC, Canada
a
Introduction.– Prior research has provided evidence that psychotropic drugs are associated with a higher likelihood of sitter use in acute care hospitals. Objective.– The aims of this study were to describe the prevalence and characteristics of three potentially modifiable pharmacological mechanisms that may account for this association (namely the anticholinergic load, drugs not adjusted for renal function, and drug-drug interactions), and their association with sitter use. Method.– A retrospective case-control study was conducted. All medical patients 65 years and older who received a sitter (cases) were selected from a cohort of 43,212 patients who had been admitted to an academic health centre in Montreal (Canada) in 2007–2008. For each case (n = 143), one control was randomly selected among all medical patients 65 years and older who did not receive a sitter. For each patient, we determined the: – number of psychotropic drugs that were non-adjusted for renal function; – total anticholinergic load; – number of clinically significant drug-drug interactions. Multivariate logistic regression was used to assess the association between sitter use and the three pharmacological mechanisms, while controlling for patient demographic characteristics and comorbidities. Results.– Compared with controls, patients with sitters had a higher overall anticholinergic load and more drug-drug interactions in the period prior to sitter use. In multivariate analysis, every additional drug with an anticholinergic load of 1 increased the likelihood of sitter use by 1.4 (95%CI: 1.1.–1.7). Conclusion.– To decrease sitter use in elderly patients, physicians should prescribe, when possible, drugs with a low anticholinergic load. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.266 P266
What is the anticholinergic load and how to use it in clinical practice? A. Charbonneau-Allard ∗ , L. Mallet University Of Montréal, Faculty of pharmacy, Montreal, QC, Canada
Introduction.– Elderly patients are at high risk of presenting adverse drug reactions. Drugs with anticholinergic properties can contribute to cognitive decline and delirium in these patients. Objective.– This presentation aims to review: – the tools that can be used to quantify anticholinergic burden; – studies that have assessed the association between anticholinergic burden and cognitive decline or delirium in the elderly and;
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
ing resources and updating medical records of every patient. With EGU’s, visits also controlled inappropriate prescribing of drugs. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.263 P263
Healthy ageing: Structuring change T. Robbins a , H. Robbins b,∗ a Brasenose College, Oxford University, Oxford, United Kingdom b Medical School, Bristol University, Bristol, United Kingdom Text.– Introduction.–There has been extensive work delineating individual healthy ageing interventions and their relative benefits. What has not been done, and what is so badly needed, is a structured approach synthesising how to bring about successful change at a population level to make a meaningful impact. Methodology.– This work has reviewed not only the standard medical literature, but also the contributions of organisations working on the ground to produce change. This is combined with detailed case studies analysis (America, India, Malaysia, Norway, UK) and lessons learnt from other public health drives to compile a successful strategy for change. Results.– Healthy ageing can only be implemented at a population level if three key pillars are addressed; why change is needed, what change is needed and how those changes occur. Case studies show none of these stages can be completed by an isolated stakeholder group–collaboration and involvement of the target population is essential. When considering the “what” and “how” we demonstrate that the developing world is as important as the developed world, and success is generated by sharing ideas between these two groups. Developing countries excel in creating innovative solutions and rapidly building experience. Conclusion.– The why, what and how of successful change are united by two common themes; leadership and networking. Health practitioners have a unique opportunity to take leadership responsibility in implementing strategies, and in doing so define the future of their professions. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.264 P264
Trazodone for behavioral and psychological symptoms in patients with dementia R. Faure ∗ , C. Mouchoux , A. Lacour , F. Delphin , G. Martin-Gaujard , P. Krolak Salmon Rhône, hôpital des Charpennes, Villeurbanne, France
Introduction.– Behavioural and Psychological Symptoms (BPS) affect at least 50% of people with Alzheimer’s disease and other dementias. Trazodone is a psychoactive compound with antidepressant, sedative and anxiolytic properties. Previous reviews have reported the use of trazodone in the BPS of dementia but its clinical efficacy remains controversial. Text.– Objective.– To describe the clinical efficacy and safety of trazodone for people with Alzheimer’s disease and other dementias hospitalized in a Cognitive Behavioural Unit (CBU). Methods.– A retrospective study was conducted in the CBU of Charpennes geriatric teaching hospital (France). The clinical efficacy was classified by a multidisciplinary group into two groups according to the trazodone response: “no response” group or “positive response” group. Results.– Twenty patients were included with eleven patients in « positive response » group and nine in “no response” group. No significant difference in the characteristics of patients was detected according to gender, age, diagnosis of dementia, comorbidities. Psychotropic treatments use, in particular antidepressant and anxiolytic drugs, was lower in the “positive response” to treat-
ment group (P = 0.08). Treatment was discontinued in five patients including three for no efficacy and two for sedation. Conclusion.– This study showed no specific profile of patients respond to trazodone. Efficacy could be explained by sedative, anxiolytic, and antidepressant effects of this drug. Future studies involving more subjects are required to determine if trazodone is safe and effective for BPS of dementia, and if specific patients or symptoms are most likely to respond to trazodone. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.265 P265
Anticholinergic load as a modifiable risk factor in sitter use in acute care hospitals L. Mallet a , A. Lessard b,∗ University Of Montréal, Faculty of pharmacy, Montreal, QC/QC, Canada b Pharmacy, McGill University Health Centre, Montreal/QC, Canada
a
Introduction.– Prior research has provided evidence that psychotropic drugs are associated with a higher likelihood of sitter use in acute care hospitals. Objective.– The aims of this study were to describe the prevalence and characteristics of three potentially modifiable pharmacological mechanisms that may account for this association (namely the anticholinergic load, drugs not adjusted for renal function, and drug-drug interactions), and their association with sitter use. Method.– A retrospective case-control study was conducted. All medical patients 65 years and older who received a sitter (cases) were selected from a cohort of 43,212 patients who had been admitted to an academic health centre in Montreal (Canada) in 2007–2008. For each case (n = 143), one control was randomly selected among all medical patients 65 years and older who did not receive a sitter. For each patient, we determined the: – number of psychotropic drugs that were non-adjusted for renal function; – total anticholinergic load; – number of clinically significant drug-drug interactions. Multivariate logistic regression was used to assess the association between sitter use and the three pharmacological mechanisms, while controlling for patient demographic characteristics and comorbidities. Results.– Compared with controls, patients with sitters had a higher overall anticholinergic load and more drug-drug interactions in the period prior to sitter use. In multivariate analysis, every additional drug with an anticholinergic load of 1 increased the likelihood of sitter use by 1.4 (95%CI: 1.1.–1.7). Conclusion.– To decrease sitter use in elderly patients, physicians should prescribe, when possible, drugs with a low anticholinergic load. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.266 P266
What is the anticholinergic load and how to use it in clinical practice? A. Charbonneau-Allard ∗ , L. Mallet University Of Montréal, Faculty of pharmacy, Montreal, QC, Canada
Introduction.– Elderly patients are at high risk of presenting adverse drug reactions. Drugs with anticholinergic properties can contribute to cognitive decline and delirium in these patients. Objective.– This presentation aims to review: – the tools that can be used to quantify anticholinergic burden; – studies that have assessed the association between anticholinergic burden and cognitive decline or delirium in the elderly and;