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Prevalence of potentially inappropriate medications in a cohort of hospitalized elderly: Results from the REPOSI study
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9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S7–S19
education, functional capacity and depressive mood. Spatial abilities (B = 0.490, P = 0.012) and processing speed (B = 0.116, P = 0.030) remained significantly associated with LSI-A three years later after adjustment. Conclusion.–Fluid intelligence, expressed by spatial abilities and processing speed predicts LS in the oldest-old. http://dx.doi.org/10.1016/j.eurger.2013.07.017 O 010
Prevalence of potentially inappropriate medications in a cohort of hospitalized elderly: Results from the REPOSI study D. Mari a,b,c,d,e,f , L. Pasina a,b,c,d,e,f , C.D. Djade a,b,c,d,e,f , A. Nobili a,b,c,d,e,f , M. Tettamanti a,b,c,d,e,f , C. Franchi a,b,c,d,e,f , F. Salerno a,b,c,d,e,f , S. Corrao a,b,c,d,e,f , A. Marengoni a,b,c,d,e,f , A. Iorio a,b,c,d,e,f , M. Marcucci a,b,c,d,e,f , P.M. Mannucci a,b,c,d,e,f , on behalf of REPOSI Investigators a Geriatrics, IRCCS Cà Granda and DISCCO, University of Milan, Milan, Italy b IRCCS Mario Negri, Milan, Italy c Internal Medicine I, IRCCS San Donato, University of Milan, Milan, Italy d Dip. Biomedico di Medicina Interna e Specialistica, University of Palermo, Italy e Geriatric Unit, Spedali Civili,Dip. of Medical and Surgery Sciences, University of Brescia, Brescia, Italy f Dip. of Internal Medicine,University of Perugia, Perugia, Italy Introduction.– Inappropriate prescribing is highly prevalent in older people and has become a global healthcare concern because of its association with negative health outcomes, including adverse drug events, hospitalization and resource utilization. Beers criteria are widely utilized as a tool for evaluating appropriateness of medications and an update version has recently been published. Aim of our study is to assess the prevalence of PIMs comparing the 2003 and 2012 versions of Beers criteria in a cohort of hospitalized elderly patients. Methods.– This cross-sectional, prospective study was held in 66 Italian internal medicine and geriatric wards, participating in the REPOSI study during 2010. The sample included 1380 in-patients aged 65 years or older. Prescription of PIM was evaluated at hospital discharge. Results.– Prevalence of patients receiving almost one PIM according to the Beers criteria were 20.1% and 23.5% with the 2003 and 2012 version, respectively. The 2012 version of Beers criteria identify a higher number of patients with almost one PIMs than criteria published in 2003, although 72.2% of those patients are also identified by the criteria updated in 2003. Prescription of benzodiazepines; chronic use (> 90 days) of nonbenzodiazepine hypnotics; antipsychotics in people with dementia and iron at dosage higher than 325 mg/day represent the main differences in the prevalence of PIMs according to Beers criteria. Key conclusions.– There were a slightly higher prevalence of patients with almost a PIM using the 2012 version of Beers criteria. However, we observed a high overlap of patients identified by both version of criteria. http://dx.doi.org/10.1016/j.eurger.2013.07.018 O 011
Fall prevention in the general practitioners setting: A cluster randomized controlled study- PreFall (NCT01032252)
E. Freiberger , S. Monika Institute for Biomedicine of Aging (FAU University), Centre for Prevention and Sportmedicine TU München, Nuernberg, Germany Background.– Prevention of falls and injurious falls in older people is a public health target. The challenge remains to deliver most effective intervention to the right target group of older persons. We conducted a multicenter cluster randomized controlled study in the general practitioner [GP] setting. Objective.– To determine effects of a 16-week complex exercise intervention on falls as primary outcome, and on fall-related injuries, physiological and psychological as secondary outcomes in the GP setting. Methods.– Inclusion criteria for community-dwelling older patients through the general practitioners were a positive fall history, decreased muscle strength and balance, limited function and fear of falling. Patients were tested three times over 12 months by their GPs. Falls were also obtained with daily calendar over 12 months. Results.– In total, 33 GPs recruited 378 participants (75.4% females). The mean age of the participants was 78.1 years (SD 5.9 years). The primary outcome – falls per person – was significantly reduced over 12 months in the IG compared to the CG (95% CI 0.35–0.84, P = 0.007). Injurious falls as secondary outcomes were also significantly reduced at 12 months ((95% CI 0.42–0.94, P = 0.033). Physiological and psychological outcomes were significantly reduced after the intervention phase and difference between IG and CG was maintained over 12 months. Conclusion.– A complex intervention reduced falls, injurious falls and fall risks in functional limited older community-dwelling persons at high risk of falls in the GP setting and was effective. http://dx.doi.org/10.1016/j.eurger.2013.07.019 O 012
EMERALD, elderly medicine early review and liaison for discharge O. Kelly , A. Flynn , E. Coleman , C. O’keeffe , M. Connolly , D. Reddy , E. Ahern , C. Cotter , R. Mcgovern St Luke’s Gh, Kilkenny, Ireland Introduction.– Hospitalised, older patients are at high risk of functional decline. Functional level at admission can predict survival and early comprehensive geriatric assessment has been shown to provide better outcomes. We aimed to assess the impact of prospectively identifying high risk elderly in-patients using a validated scoring system (VIP), and providing early comprehensive geriatric assessment (CGA) in this group. Methods.– Patients > 85 years were screened by the EMERALD team using the VIP. A non-interventional pilot cohort was observed. A subsequent intervention cohort with early CGA for those screening positive was undertaken. Length of stay (LOS), mortality and 30 day readmission rates are reported, and comparison undertaken between the 2 cohorts. Results.– Data were collected prospectively over 6 months. 371 patients were assessed; 50 in the observation cohort, 328 in the intervention cohort. Mean age was 89.4 (3.32) years for the intervention cohort; and 82.3 (4.87) years for the observation group. VIP screen was positive in 211 (64.3%) of the intervention cohort and 27 (54%) of the observation cohort. 30-day readmission rate was significantly higher in the observational cohort than in the intervention cohort (18.4% vs 7.0%; p < 0.0001). LOS was not significantly different in intervention compared to observation cohort (10.3 vs 9.58 days; p = 0.64). Mortality did not differ significantly between the groups although it tended to be higher in the older intervention group (9.74% vs 2%; Chi sq= 2.35, p = 0.13). In a multivariate model, screening positive with VIP was the only predictor of LOS. Conclusion.– VIP screening in older people identifies those at risk of prolonged length of stay and readmission. Early targeted inter-
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S7–S19
education, functional capacity and depressive mood. Spatial abilities (B = 0.490, P = 0.012) and processing speed (B = 0.116, P = 0.030) remained significantly associated with LSI-A three years later after adjustment. Conclusion.–Fluid intelligence, expressed by spatial abilities and processing speed predicts LS in the oldest-old. http://dx.doi.org/10.1016/j.eurger.2013.07.017 O 010
Prevalence of potentially inappropriate medications in a cohort of hospitalized elderly: Results from the REPOSI study D. Mari a,b,c,d,e,f , L. Pasina a,b,c,d,e,f , C.D. Djade a,b,c,d,e,f , A. Nobili a,b,c,d,e,f , M. Tettamanti a,b,c,d,e,f , C. Franchi a,b,c,d,e,f , F. Salerno a,b,c,d,e,f , S. Corrao a,b,c,d,e,f , A. Marengoni a,b,c,d,e,f , A. Iorio a,b,c,d,e,f , M. Marcucci a,b,c,d,e,f , P.M. Mannucci a,b,c,d,e,f , on behalf of REPOSI Investigators a Geriatrics, IRCCS Cà Granda and DISCCO, University of Milan, Milan, Italy b IRCCS Mario Negri, Milan, Italy c Internal Medicine I, IRCCS San Donato, University of Milan, Milan, Italy d Dip. Biomedico di Medicina Interna e Specialistica, University of Palermo, Italy e Geriatric Unit, Spedali Civili,Dip. of Medical and Surgery Sciences, University of Brescia, Brescia, Italy f Dip. of Internal Medicine,University of Perugia, Perugia, Italy Introduction.– Inappropriate prescribing is highly prevalent in older people and has become a global healthcare concern because of its association with negative health outcomes, including adverse drug events, hospitalization and resource utilization. Beers criteria are widely utilized as a tool for evaluating appropriateness of medications and an update version has recently been published. Aim of our study is to assess the prevalence of PIMs comparing the 2003 and 2012 versions of Beers criteria in a cohort of hospitalized elderly patients. Methods.– This cross-sectional, prospective study was held in 66 Italian internal medicine and geriatric wards, participating in the REPOSI study during 2010. The sample included 1380 in-patients aged 65 years or older. Prescription of PIM was evaluated at hospital discharge. Results.– Prevalence of patients receiving almost one PIM according to the Beers criteria were 20.1% and 23.5% with the 2003 and 2012 version, respectively. The 2012 version of Beers criteria identify a higher number of patients with almost one PIMs than criteria published in 2003, although 72.2% of those patients are also identified by the criteria updated in 2003. Prescription of benzodiazepines; chronic use (> 90 days) of nonbenzodiazepine hypnotics; antipsychotics in people with dementia and iron at dosage higher than 325 mg/day represent the main differences in the prevalence of PIMs according to Beers criteria. Key conclusions.– There were a slightly higher prevalence of patients with almost a PIM using the 2012 version of Beers criteria. However, we observed a high overlap of patients identified by both version of criteria. http://dx.doi.org/10.1016/j.eurger.2013.07.018 O 011
Fall prevention in the general practitioners setting: A cluster randomized controlled study- PreFall (NCT01032252)
E. Freiberger , S. Monika Institute for Biomedicine of Aging (FAU University), Centre for Prevention and Sportmedicine TU München, Nuernberg, Germany Background.– Prevention of falls and injurious falls in older people is a public health target. The challenge remains to deliver most effective intervention to the right target group of older persons. We conducted a multicenter cluster randomized controlled study in the general practitioner [GP] setting. Objective.– To determine effects of a 16-week complex exercise intervention on falls as primary outcome, and on fall-related injuries, physiological and psychological as secondary outcomes in the GP setting. Methods.– Inclusion criteria for community-dwelling older patients through the general practitioners were a positive fall history, decreased muscle strength and balance, limited function and fear of falling. Patients were tested three times over 12 months by their GPs. Falls were also obtained with daily calendar over 12 months. Results.– In total, 33 GPs recruited 378 participants (75.4% females). The mean age of the participants was 78.1 years (SD 5.9 years). The primary outcome – falls per person – was significantly reduced over 12 months in the IG compared to the CG (95% CI 0.35–0.84, P = 0.007). Injurious falls as secondary outcomes were also significantly reduced at 12 months ((95% CI 0.42–0.94, P = 0.033). Physiological and psychological outcomes were significantly reduced after the intervention phase and difference between IG and CG was maintained over 12 months. Conclusion.– A complex intervention reduced falls, injurious falls and fall risks in functional limited older community-dwelling persons at high risk of falls in the GP setting and was effective. http://dx.doi.org/10.1016/j.eurger.2013.07.019 O 012
EMERALD, elderly medicine early review and liaison for discharge O. Kelly , A. Flynn , E. Coleman , C. O’keeffe , M. Connolly , D. Reddy , E. Ahern , C. Cotter , R. Mcgovern St Luke’s Gh, Kilkenny, Ireland Introduction.– Hospitalised, older patients are at high risk of functional decline. Functional level at admission can predict survival and early comprehensive geriatric assessment has been shown to provide better outcomes. We aimed to assess the impact of prospectively identifying high risk elderly in-patients using a validated scoring system (VIP), and providing early comprehensive geriatric assessment (CGA) in this group. Methods.– Patients > 85 years were screened by the EMERALD team using the VIP. A non-interventional pilot cohort was observed. A subsequent intervention cohort with early CGA for those screening positive was undertaken. Length of stay (LOS), mortality and 30 day readmission rates are reported, and comparison undertaken between the 2 cohorts. Results.– Data were collected prospectively over 6 months. 371 patients were assessed; 50 in the observation cohort, 328 in the intervention cohort. Mean age was 89.4 (3.32) years for the intervention cohort; and 82.3 (4.87) years for the observation group. VIP screen was positive in 211 (64.3%) of the intervention cohort and 27 (54%) of the observation cohort. 30-day readmission rate was significantly higher in the observational cohort than in the intervention cohort (18.4% vs 7.0%; p < 0.0001). LOS was not significantly different in intervention compared to observation cohort (10.3 vs 9.58 days; p = 0.64). Mortality did not differ significantly between the groups although it tended to be higher in the older intervention group (9.74% vs 2%; Chi sq= 2.35, p = 0.13). In a multivariate model, screening positive with VIP was the only predictor of LOS. Conclusion.– VIP screening in older people identifies those at risk of prolonged length of stay and readmission. Early targeted inter-