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P.5.e.002 Polypharmacy in elderly hospitalised patients suffering from delirium in dementia
S632
P.5.e Dementia and neurological disorders - Other (clinical)
Dementia and Mild Cognitive Impairment Study (GDEMCIS). Metabolic syndrome was determined according to the National Cholesterol Education Program Adult Treatment Panel-III. Participants fulfilling three or more of the following five criteria were defined as having metabolic syndrome: high blood pressure (~ 130/85mmHg), elevated fasting blood glucose (~ 110 mg/dl), hypertriglyceridaemia (~ 150 mg/dl), low HDL-cholesterol (men, < 40mg/dl; women, <50mg/dl), and abdominal obesity by waist circumference (men, > 90 em; women, >80 em). Men and women with waist circumference values of ~90 and 80 em, respectively, were considered to have abdominal obesity, according to the WHO Western Pacific Region on Asians. And nutritional risk was evaluated using the Nutrition Screening Initiative (NSI) checklist. Differences between groups with and without metabolic syndrome were analyzed using unpaired t-tests. We used a one-way analysis of variance (ANOYA) to assess NSI score according to number of metabolic components. When found to be significant, we used a post-hoc (Scheffe method) multiple comparison to establish differences between groups. The odds ratio (OR) of metabolic disorders in the subjects at moderate or high nutritional risk compared to the good nutritional risk was calculated for 2 x 2 cross-tables and is expressed with the 95% confidence interval (Cl), We used multiple logistic regression analysis to examine the factors associated with metabolic syndrome. P-values < 0.05 were considered statistically significant. Results: Among 2,284 elderly subjects, 1,219 (53.4%) had metabolic syndrome. NSI score was higher in subjects with metabolic syndrome than in those without metabolic syndrome (2.5±1.9 vs. 2.2±1.9, P < 0.05). The risks of abdominal obesity, elevated blood pressure, elevated glucose, and metabolic syndrome were higher in subjects with moderate or high nutritional risk compared to subjects in a good nutritional state. Nutritional risk was independently associated with metabolic syndrome for subjects in their 60s, but not in their 70s or 80s and above. Conclusions: High nutritional risk is associated with increased risk of metabolic syndrome in the elderly. Measurement of nutritional status in the elderly may serve as a marker for metabolic syndrome, and the identification and adjustment of nutritional risk can be beneficial for the prevention of metabolic syndrome, especially for those in their 60s.
Iatrogenically induced cognitive deficits are common with pharmacological therapy. Methods: All patients of 65 years and older suffering from delirium in dementia admitted to a gerontopsychiatric ward of a general hospital were included The number and type of medications taken at the time of hospital admission were recorded. Each person taking six or more medications per day was considered to be a patient with polypharmacy. The pre-admission medication of the patients was analyzed with respect to appropriateness by physicians trained in psychiatry, neurology and geriatric medicine. The medication was evaluated for the occurrence of adverse drug events. Results: A total of 333 patients were analyzed (median age 81.5 years; 65.7% female). However the mean number of drugs taken was 7.8+/-3.2. Overall, 69.7% of the patients fulfilled the given criteria for polypharmacy (>6 drugs). Risk factors for polypharmacy and adverse drug events were polymorbidity and inappropriate prescribing. Unnecessary drugs were found prescribed in 32.7% and possible drug-drug interactions in 48.6% of all patients. Adverse drug events were identified in 15.2% of the patients suffering from delirium in dementia. Conclusion: The study confirmed a high prevalence of polypharmacy in elderly patients suffering from delirium in dementia. Also inappropriate prescribing and adverse drug events were highly prevalent in elderly patients suffering from delirium in dementia. Polypharmacy and higher age are the main risk factors for potentially inappropriate drug use in the elderly. Successful treatment in the elderly requires appropriate multidimensional assessment of the patient, knowledge of possible multiple comorbidities, and awareness of the complexities of polypharmacy, age-dependent changes in pharmacokinetics and pharmacodynamics, and drug-drug interactions in this age group. The elderly, who have multiple co-morbidities, complex chronic conditions and are usually receiving polypharmacy, are at increased risk for adverse drug events. These adverse events are often linked to problems that could be preventable delirium. The increasing numbers of medications in inpatients indicate the need for the careful reevaluation of pharmacotherapy during the stay in hospital.
1P.5.e.0031 Effects of physical, mental, social activity and health concern on cognition in the elderly
Ip.5.e.0021 Polypharmacy in elderly hospitalised patients suffering from delirium in dementia
T. Kratz 1 '. 1Konigin Elisabeth Krankenhaus, Department of Psychiatry/Gerontopsychiatry, Berlin, Germany Objective: The aims of the present study were to analyse the prevalence of polypharmacy in a group of older patients suffering from delirium in dementia and to evaluate the influence of delirium in dementia on the number of drugs taken. The study was carried out in the Department ofPsychiatry / Gerontopsychiatry of a non-university general hospital. Delirium is a common syndrome in hospitalized medical and surgical patients. It is particularly common in the demented elderly patients. To prevent it, for example by avoiding polypharmacy in the elderly, is important. Precipitating factors that may provoke delirium are: infection, fever, dehydration, serum electrolyte imbalance, polypharmacy, and the use of psychotropic medication, particularly anticholinergic drugs. Elderly people are more likely than younger patients to develop cognitive impairment as a result of taking medications.
K.Y. Lim 1 " Y.K. Chung 1, H.C. Kim 1 , C.H. Hong 1 . 1Ajou University School ofMedicine, Psychiatry, Suwon, South-Korea Background: Generally, concern for one's own health increases as one grows older and with the increase in longevity of life. But, having concern does not necessarily lead to engagement in activities that enhance one's health, especially one's cognitive functions. In recent years, there have been prospective studies confirming the association between physical, mental, social activities and decrease in cognitive function [1]. There is evidence that physical, mental, social activities are preventing factors against cognitive decline and dementia [2,3]. Regular physical activity and leisure physical activity have been shown to be an important protective factor for cognitive decline in the elderly persons. Purpose: The authors hypothesize that having only concern for health without putting thoughts into action is not enough to preserve cognitive function in the elderly. Methods: The study sample consists of 3157 elderly from Gwangju Dementia and Mild Cognitive Impairment Study (GDEMCIS), a large prospective cohort study carried out in
P.5.e Dementia and neurological disorders - Other (clinical)
Dementia and Mild Cognitive Impairment Study (GDEMCIS). Metabolic syndrome was determined according to the National Cholesterol Education Program Adult Treatment Panel-III. Participants fulfilling three or more of the following five criteria were defined as having metabolic syndrome: high blood pressure (~ 130/85mmHg), elevated fasting blood glucose (~ 110 mg/dl), hypertriglyceridaemia (~ 150 mg/dl), low HDL-cholesterol (men, < 40mg/dl; women, <50mg/dl), and abdominal obesity by waist circumference (men, > 90 em; women, >80 em). Men and women with waist circumference values of ~90 and 80 em, respectively, were considered to have abdominal obesity, according to the WHO Western Pacific Region on Asians. And nutritional risk was evaluated using the Nutrition Screening Initiative (NSI) checklist. Differences between groups with and without metabolic syndrome were analyzed using unpaired t-tests. We used a one-way analysis of variance (ANOYA) to assess NSI score according to number of metabolic components. When found to be significant, we used a post-hoc (Scheffe method) multiple comparison to establish differences between groups. The odds ratio (OR) of metabolic disorders in the subjects at moderate or high nutritional risk compared to the good nutritional risk was calculated for 2 x 2 cross-tables and is expressed with the 95% confidence interval (Cl), We used multiple logistic regression analysis to examine the factors associated with metabolic syndrome. P-values < 0.05 were considered statistically significant. Results: Among 2,284 elderly subjects, 1,219 (53.4%) had metabolic syndrome. NSI score was higher in subjects with metabolic syndrome than in those without metabolic syndrome (2.5±1.9 vs. 2.2±1.9, P < 0.05). The risks of abdominal obesity, elevated blood pressure, elevated glucose, and metabolic syndrome were higher in subjects with moderate or high nutritional risk compared to subjects in a good nutritional state. Nutritional risk was independently associated with metabolic syndrome for subjects in their 60s, but not in their 70s or 80s and above. Conclusions: High nutritional risk is associated with increased risk of metabolic syndrome in the elderly. Measurement of nutritional status in the elderly may serve as a marker for metabolic syndrome, and the identification and adjustment of nutritional risk can be beneficial for the prevention of metabolic syndrome, especially for those in their 60s.
Iatrogenically induced cognitive deficits are common with pharmacological therapy. Methods: All patients of 65 years and older suffering from delirium in dementia admitted to a gerontopsychiatric ward of a general hospital were included The number and type of medications taken at the time of hospital admission were recorded. Each person taking six or more medications per day was considered to be a patient with polypharmacy. The pre-admission medication of the patients was analyzed with respect to appropriateness by physicians trained in psychiatry, neurology and geriatric medicine. The medication was evaluated for the occurrence of adverse drug events. Results: A total of 333 patients were analyzed (median age 81.5 years; 65.7% female). However the mean number of drugs taken was 7.8+/-3.2. Overall, 69.7% of the patients fulfilled the given criteria for polypharmacy (>6 drugs). Risk factors for polypharmacy and adverse drug events were polymorbidity and inappropriate prescribing. Unnecessary drugs were found prescribed in 32.7% and possible drug-drug interactions in 48.6% of all patients. Adverse drug events were identified in 15.2% of the patients suffering from delirium in dementia. Conclusion: The study confirmed a high prevalence of polypharmacy in elderly patients suffering from delirium in dementia. Also inappropriate prescribing and adverse drug events were highly prevalent in elderly patients suffering from delirium in dementia. Polypharmacy and higher age are the main risk factors for potentially inappropriate drug use in the elderly. Successful treatment in the elderly requires appropriate multidimensional assessment of the patient, knowledge of possible multiple comorbidities, and awareness of the complexities of polypharmacy, age-dependent changes in pharmacokinetics and pharmacodynamics, and drug-drug interactions in this age group. The elderly, who have multiple co-morbidities, complex chronic conditions and are usually receiving polypharmacy, are at increased risk for adverse drug events. These adverse events are often linked to problems that could be preventable delirium. The increasing numbers of medications in inpatients indicate the need for the careful reevaluation of pharmacotherapy during the stay in hospital.
1P.5.e.0031 Effects of physical, mental, social activity and health concern on cognition in the elderly
Ip.5.e.0021 Polypharmacy in elderly hospitalised patients suffering from delirium in dementia
T. Kratz 1 '. 1Konigin Elisabeth Krankenhaus, Department of Psychiatry/Gerontopsychiatry, Berlin, Germany Objective: The aims of the present study were to analyse the prevalence of polypharmacy in a group of older patients suffering from delirium in dementia and to evaluate the influence of delirium in dementia on the number of drugs taken. The study was carried out in the Department ofPsychiatry / Gerontopsychiatry of a non-university general hospital. Delirium is a common syndrome in hospitalized medical and surgical patients. It is particularly common in the demented elderly patients. To prevent it, for example by avoiding polypharmacy in the elderly, is important. Precipitating factors that may provoke delirium are: infection, fever, dehydration, serum electrolyte imbalance, polypharmacy, and the use of psychotropic medication, particularly anticholinergic drugs. Elderly people are more likely than younger patients to develop cognitive impairment as a result of taking medications.
K.Y. Lim 1 " Y.K. Chung 1, H.C. Kim 1 , C.H. Hong 1 . 1Ajou University School ofMedicine, Psychiatry, Suwon, South-Korea Background: Generally, concern for one's own health increases as one grows older and with the increase in longevity of life. But, having concern does not necessarily lead to engagement in activities that enhance one's health, especially one's cognitive functions. In recent years, there have been prospective studies confirming the association between physical, mental, social activities and decrease in cognitive function [1]. There is evidence that physical, mental, social activities are preventing factors against cognitive decline and dementia [2,3]. Regular physical activity and leisure physical activity have been shown to be an important protective factor for cognitive decline in the elderly persons. Purpose: The authors hypothesize that having only concern for health without putting thoughts into action is not enough to preserve cognitive function in the elderly. Methods: The study sample consists of 3157 elderly from Gwangju Dementia and Mild Cognitive Impairment Study (GDEMCIS), a large prospective cohort study carried out in