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Hemorrhage and vitamin K antagonist in elderly with atrial fibrillation. Assessment one year after hospitalization in a geriatric center
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
Methods.– Data collection and analysis of the pharmacotherapeutic profile according to the “Operationalization to Portugal Beers Criteria of Inappropriate Medication use in the elderly” and the STOPP (Screening Tool of Older Person’s Prescriptions)/START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) Criteria. Duration of Data Collection: One year. Results.– In the pharmacotherapeutic profile analysis, 28 (40%) out of 70 patients (age average 79.8, 47 women) were taking 38 PIM. Nine of these patients were taking two PIM. Twelve patients were taking long half-life benzodiazepines (32% of the total PPI), four fluoxetine and one glibenclamide. Hence, five prescription duplications were found. Conclusions.– Given the previous results, one can conclude that PIM’s screening is extremely important. Long half-life benzodiazepines were the most frequently potentially inappropriate medication prescribed to these patients. Consequently, this medication prescription’s procedure can lead to cognitive impairments, prolonged sedation and falls. Thus, pharmacists can play a crucial role on elderly’s prescription analysis and PIM identification. Acknowledging this fact helps to increase therapeutic’s safety and to reduce ADE risks. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.312 P312
Hemorrhage and vitamin K antagonist in elderly with atrial fibrillation. Assessment one year after hospitalization in a geriatric center O. Trinh a,∗ , S. Estivin b , M. Andro b , E. Nowak c , A. Gentric c Service de médecine gériatrique, centre hospitalier des Pays-de-Morlaix, Morlaix, France b Service de médecine interne gériatrique, CHU de Brest, Brest, France c Centre d’investigation clinique, CHU de Brest, Brest, France
a
Introduction.– Atrial fibrillation has an impact on morbi-mortality by thrombo-embolic risk and stroke. According to recommendations, the majority of elderly should receive a treatment of vitamin K agonist. However, only 60% are treated in this manner due to fear of intra-cranial hemorrhaging. Purpose.– To analyze the number of hemorrhages and to study the associated circumstances. Methods and results.– The prospective observational study took place between 2009 and 2011 including 151 patients ≥ 75 years old who suffered from atrial fibrillation. Patients’ demographic and clinical data were collected, and a follow-up was conducted one year after by telephone with GP. The population was divided into two groups: 35 in Group 1(new to VKA), and 115 in Group 2(receiving VKA for thromboprophylaxis before hospitalization). The median age was 84 years.72% of elders lived at home. Ninety-seven percent received therapeutic education. The median Charlson’s score was 2.17 in Group 1 and 2.93 in Group 2.The median CHADS’ score was 2.42 and the median CHA2DS2-VASc’s score was 4.5. The median HAS-BLED score was 4.5.76% of elders were at risk to fall, and 29% were demented. At one year, 16 patients were no longer contactable (six in Group 1, ten in Group 2). VKA was delivered by a nurse in 77% of cases and 97% of patients were still using the VKA treatment. Three major hemorrhages occurred (one in Group 1, two in Group 2), all from digestive tract and INR was greater than 3. Conclusion.– In our study, incidence of hemorraghae was very low among very frail and old patients treated by VKA for AF. This low occurrence is possibly linked to a therapeutic education, which was successful in 97% of patients. Disclosure.–No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.313
S127
P313
65 years and older patient who hospitalized in Ege university hospital with pressure ulcers H. Eskiizmirli a , E. Sozen b , S. Sahin c,∗ , B. Baydal a , F. Senuzun b , F. Akcicek c a Department Of Internal Medicine, Ege University, Izmir, Turkey b Department Of Nursing, Ege University Izmir Ataturk School of Health, Izmir, Turkey c Departmant Of Internal Medicine Division Of Geriatric Medicine, Ege University Hospital, Izmir, Turkey Introduction.– Pressure sores are one of the complications among the geriatrics syndrome, which can cause significant mortality and morbidity but which are preventable if appropriate and essential precautions are taken. This research was conducted as a retrospective study to determine the pressure wound and risk for pressure wound development in patients admitted to internal medicine departments of Ege University Hospital. Text.– This study was conducted on 209 patients aged 65 and over between 1 April 2011–1 October 2011.The patient files and clinic on a regular basis to collect data for each patient from admission to the clinic weekly filled Braden pressure ulcer tool. Pressure ulcer location, and degree of recovery score (PUSH) are recorded weekly. Localization, number and clinical stage according to the depth of pressure ulcers were recorded. Results.– The mean age of the patients was 73 (65–93) years. Most of the patients are diagnosed malignancy and diabetes. Of the total patient, 16.6% is a chronic disease patients, 15.8% of the total patients had 2 and 11.7% of the total patients also had three chronic diseases. With pressure, ulcer at the time of hospitalization was 2.7% patients. Interior treatment of diseases of the service within 1.6% consists of pressure ulcer patients. Pressure ulcers due to bed in the service of a new 1.1% rates of hip and coccyx areas, 0.8% ratio sacrum and 0.3% are formed by the bones of rowing. At this clinic, hospital patients, 1, 2, and 3 weeks, the average pressure ulcer risk score 19 (9–24), while receiving the therapy, depending on the score of 4 17% per week, 8 decreased to 15% in a week. Conclusion.– We believe that medical staff working in intensive care units should be educated for prevention strategies and the early management of pressure sores. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.314 P314
Early recognition of drug-related problems in homecare. development and validation of the home observation of medication related problems by homecare employees (HOME) instrument C. Sino a,∗ , M. Bouvy b , I. Schop c , P.A.F. Jansen d , M. Schuurmans e Research Centre For Innovation In Healthcare, University of applied sciences Utrecht, Utrecht, Netherlands b Division Of Pharmacoepidemiology And Clinical Pharmacology, Utrecht University, Utrecht, Netherlands c Department Of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands d Expertise Centre Pharmacotherapy In Old Persons (ephor), UMC Utrecht, Utrecht, Netherlands e Nursing Research, University Medical Center Utrecht, Utrecht, Netherlands
a
Introduction.– Home healthcare employees are particularly well positioned to act in a preventive way to recognize symptoms of potential Drug Related Problems (DRPs). The Home Observation of Medication-related problems by homecare Employees (HOME) instrument is an early recognition tool, based on observations and divided in the categories: Process, Pill and Patient.
Methods.– Data collection and analysis of the pharmacotherapeutic profile according to the “Operationalization to Portugal Beers Criteria of Inappropriate Medication use in the elderly” and the STOPP (Screening Tool of Older Person’s Prescriptions)/START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) Criteria. Duration of Data Collection: One year. Results.– In the pharmacotherapeutic profile analysis, 28 (40%) out of 70 patients (age average 79.8, 47 women) were taking 38 PIM. Nine of these patients were taking two PIM. Twelve patients were taking long half-life benzodiazepines (32% of the total PPI), four fluoxetine and one glibenclamide. Hence, five prescription duplications were found. Conclusions.– Given the previous results, one can conclude that PIM’s screening is extremely important. Long half-life benzodiazepines were the most frequently potentially inappropriate medication prescribed to these patients. Consequently, this medication prescription’s procedure can lead to cognitive impairments, prolonged sedation and falls. Thus, pharmacists can play a crucial role on elderly’s prescription analysis and PIM identification. Acknowledging this fact helps to increase therapeutic’s safety and to reduce ADE risks. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.312 P312
Hemorrhage and vitamin K antagonist in elderly with atrial fibrillation. Assessment one year after hospitalization in a geriatric center O. Trinh a,∗ , S. Estivin b , M. Andro b , E. Nowak c , A. Gentric c Service de médecine gériatrique, centre hospitalier des Pays-de-Morlaix, Morlaix, France b Service de médecine interne gériatrique, CHU de Brest, Brest, France c Centre d’investigation clinique, CHU de Brest, Brest, France
a
Introduction.– Atrial fibrillation has an impact on morbi-mortality by thrombo-embolic risk and stroke. According to recommendations, the majority of elderly should receive a treatment of vitamin K agonist. However, only 60% are treated in this manner due to fear of intra-cranial hemorrhaging. Purpose.– To analyze the number of hemorrhages and to study the associated circumstances. Methods and results.– The prospective observational study took place between 2009 and 2011 including 151 patients ≥ 75 years old who suffered from atrial fibrillation. Patients’ demographic and clinical data were collected, and a follow-up was conducted one year after by telephone with GP. The population was divided into two groups: 35 in Group 1(new to VKA), and 115 in Group 2(receiving VKA for thromboprophylaxis before hospitalization). The median age was 84 years.72% of elders lived at home. Ninety-seven percent received therapeutic education. The median Charlson’s score was 2.17 in Group 1 and 2.93 in Group 2.The median CHADS’ score was 2.42 and the median CHA2DS2-VASc’s score was 4.5. The median HAS-BLED score was 4.5.76% of elders were at risk to fall, and 29% were demented. At one year, 16 patients were no longer contactable (six in Group 1, ten in Group 2). VKA was delivered by a nurse in 77% of cases and 97% of patients were still using the VKA treatment. Three major hemorrhages occurred (one in Group 1, two in Group 2), all from digestive tract and INR was greater than 3. Conclusion.– In our study, incidence of hemorraghae was very low among very frail and old patients treated by VKA for AF. This low occurrence is possibly linked to a therapeutic education, which was successful in 97% of patients. Disclosure.–No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.313
S127
P313
65 years and older patient who hospitalized in Ege university hospital with pressure ulcers H. Eskiizmirli a , E. Sozen b , S. Sahin c,∗ , B. Baydal a , F. Senuzun b , F. Akcicek c a Department Of Internal Medicine, Ege University, Izmir, Turkey b Department Of Nursing, Ege University Izmir Ataturk School of Health, Izmir, Turkey c Departmant Of Internal Medicine Division Of Geriatric Medicine, Ege University Hospital, Izmir, Turkey Introduction.– Pressure sores are one of the complications among the geriatrics syndrome, which can cause significant mortality and morbidity but which are preventable if appropriate and essential precautions are taken. This research was conducted as a retrospective study to determine the pressure wound and risk for pressure wound development in patients admitted to internal medicine departments of Ege University Hospital. Text.– This study was conducted on 209 patients aged 65 and over between 1 April 2011–1 October 2011.The patient files and clinic on a regular basis to collect data for each patient from admission to the clinic weekly filled Braden pressure ulcer tool. Pressure ulcer location, and degree of recovery score (PUSH) are recorded weekly. Localization, number and clinical stage according to the depth of pressure ulcers were recorded. Results.– The mean age of the patients was 73 (65–93) years. Most of the patients are diagnosed malignancy and diabetes. Of the total patient, 16.6% is a chronic disease patients, 15.8% of the total patients had 2 and 11.7% of the total patients also had three chronic diseases. With pressure, ulcer at the time of hospitalization was 2.7% patients. Interior treatment of diseases of the service within 1.6% consists of pressure ulcer patients. Pressure ulcers due to bed in the service of a new 1.1% rates of hip and coccyx areas, 0.8% ratio sacrum and 0.3% are formed by the bones of rowing. At this clinic, hospital patients, 1, 2, and 3 weeks, the average pressure ulcer risk score 19 (9–24), while receiving the therapy, depending on the score of 4 17% per week, 8 decreased to 15% in a week. Conclusion.– We believe that medical staff working in intensive care units should be educated for prevention strategies and the early management of pressure sores. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.314 P314
Early recognition of drug-related problems in homecare. development and validation of the home observation of medication related problems by homecare employees (HOME) instrument C. Sino a,∗ , M. Bouvy b , I. Schop c , P.A.F. Jansen d , M. Schuurmans e Research Centre For Innovation In Healthcare, University of applied sciences Utrecht, Utrecht, Netherlands b Division Of Pharmacoepidemiology And Clinical Pharmacology, Utrecht University, Utrecht, Netherlands c Department Of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands d Expertise Centre Pharmacotherapy In Old Persons (ephor), UMC Utrecht, Utrecht, Netherlands e Nursing Research, University Medical Center Utrecht, Utrecht, Netherlands
a
Introduction.– Home healthcare employees are particularly well positioned to act in a preventive way to recognize symptoms of potential Drug Related Problems (DRPs). The Home Observation of Medication-related problems by homecare Employees (HOME) instrument is an early recognition tool, based on observations and divided in the categories: Process, Pill and Patient.