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OBJECTIVES: The aetiology of behavioural and psychological symptoms (BPSD) could be related to inadequate treatment in patients with dementia. The aim of this study was to determine how a multifaceted intervention based on a medication review and multidisciplinary follow-up could improve treatment and minimise risk in these patients. METHODS: A prospective interventional study was undertaken between July 2015 and July 2016 of patients with dementia admitted to control BPSD. Patients with previous psychiatric illness or palliative care were excluded. Prescription information was obtained from Aegerus and the Catalonia clinical record HC3. The intervention was conducted by a multidisciplinary team. The Medication Appropriateness Index (MAI) was used to assess the intervention. RESULTS: 65 patients (60% women, mean age 84.9±6.7 years) with mild-moderate cognitive impairment (mean 4.5±1.8), moderate-severe functional dependence (mean 43.8±23.9) and a high prevalence of geriatric syndromes and comorbidity were included in the study. 87.7% of the patients were taking ≥5 drugs (mean 9.0±3.1) and 38.5% were taking ≥10. Patients presented with BPSD values of 1.9±0.8 at admission. Common symptoms prompting admission were agitation (47.7%) and irritability (43.1%). A total of 175 drug-related problems (DRPs) were detected (2.97 per patient). Significant differences (p

Background Patient safety is the most important concern for healthcare professionals, patients and healthcare systems. Adverse drug events (ADEs) are a common cause of hospitalisation and occur with increasing frequency in hospital as patients age. Purpose Determine the ADEs at admission and during the stay in a psychogeriatric unit. Material and methods One-year prospective cross-sectional study (July 2015–2016), in a psychogeriatric ward (21 beds). Included patients with dementia, admitted presenting neuropsychiatric/behavioural and psychological symptoms in dementia (BPSD). Excluded patients with previous psychiatric illness or palliative conditions. Prescription information: Aegerus and Catalonia clinical record HC3. Variables: demographics, diagnoses, Global Deterioration Scale (GDS-R), functional assessment (Barthel Index), fall risk (Downton JH and Tinetti). Anticholinergic risk level (Drug Burden Index (DBI). ADE assessment: causality by Naranjo algorithm, severity by classification system of the Institute for Healthcare Improvement and preventability by the Schumock–Thornton algorithm. Drugs classification by the Anatomical Therapeutic Chemical Code (ATC). Results Sixty patients (60% females), age: 84.8 years (68–96). Dementia: unidentified (43%), Alzheimer’s (31%), Lewy bodies (8%), vascular (8%), mixed (5%) and others (6%). GDS-R 4.5 (±1.2), moderate cognitive impairment. Barthel Index 43.8 (±23.9), moderate dependence. Patients comorbidities 4.8 (±1.6). Drugs/patient 9.03 (±3.12). DBI high risk in 69% of the patients. High risk of falls, Tinetti (15.5±8) and Downton test (4.5±1.3). Sixty-eight ADEs (53 patients, 81.5%, 22.6% more than one). 73.5% not related to falls. From this 80% were related to the ATC nervous system (46% (23 ADE) psycholeptics). Naranjo algorithm one definite (2%), probable 45 (90%) and possible four (8%). Severity Category E: temporary harm to the patient and required intervention in 34 (68%) and F: temporary harm to the patient and required initial or prolonged hospitalisation in 16 (32%). Schumork–Thornton test 58% (29) of the ADE were preventable, possibly preventable 6% (three) and unavoidable 36% (18). Main ADE drowsiness/somnolence 27.7%, 12.8% weakness and hypoactivity and 10.7% hypotension. DBI significant differences related to fall as ADE result (fall group 1.288±0.79, non-fall group 0.95±0.71 p=0.05). Conclusion The balance between effective treatments and safety is complex in these patients. Mostly ADE are related to the pharmacological treatment of this BPSD. Anticholinergic load is a determinant for a specific ADE and were related to falls, the worst consequence in this patient, clinical and economic impact. References and/or acknowledgements No conflict of interest.

Older people usually present with adverse drug events (ADEs) with nonspecific symptoms such as cognitive decline, recurrent falls, reduced mobility, and/or major deterioration. The aims of this study were to assess the ADEs of patients with dementia and presenting neuropsychiatric/behavioral, and psychological symptoms in dementia (BPSD) and to categorize and identify the principal factors that allow to prevent ADEs, and separately ADEs that result in falls. To that end, a one-year prospective study in a psychogeriatric ward (July 2015 to July 2016) was performed. All patients admitted to this ward were eligible for enrolment. Patients who met any of the following criteria were excluded from the study: Patients without cognitive impairment, a length of stay under 7 days, and palliative or previous psychiatric pathology. We included 65 patients (60% women, 84.9 years &plusmn, 6.7) with mild to moderate cognitive impairment, moderate to severe functional dependence, and a high prevalence of geriatric syndromes and comorbidity. A total of 87.7% were taking five or more drugs (mean 9.0 &plusmn, 3.1). ADEs were identified during the interdisciplinary meeting and the follow up by clinical record. Sixty-eight ADEs (81.5% patients) were identified, of which 73.5% were not related to falls. From these, 80% were related to drugs of the nervous system. The Naranjo algorithm determined that 90% of ADEs were probable. The severity of the ADEs was Category E in 34 patients (68%). The number of preventable ADE according to the Schumork&ndash, Thornton test was 58%. The main ADE was drowsiness/somnolence (27.7%). ADEs related to falls represented a 26.5%. The balance between effective treatment and safety is complex in these patients. A medication review in interdisciplinary teams is an essential component to optimize safety prevention.

Resumen Objetivo Los familiares de los pacientes ingresados en una unidad de cuidados paliativos (UCP) padecen un elevado sufrimiento e impacto emocional. Describir la intervencion realizada con las familias de los pacientes que fallecieron en la UCP del centro sociosanitario Mutuam Guell, analizando las necesidades detectadas y las respuestas del equipo. Material y metodos Estudio descriptivo prospectivo realizado durante un ano (febrero 2009-febrero 2010). Se realizo un contacto telefonico con las familias de pacientes que habian fallecido en la UCP. Un mes despues del fallecimiento, la psicologa realiza una entrevista telefonica semiestructurada con el cuidador principal. Segun las necesidades detectadas se plantea la intervencion psicologica a realizar. Resultados Fallecieron 271 pacientes, se entrevistaron telefonicamente 234 familiares y se realizaron 35 seguimientos. El parentesco, el sexo y la edad media de los familiares atendidos ha sido el de conyuge, mujer, de 78 anos. Los casos mas complejos han sido un intento de autolisis, sintomatologia depresiva grave (9 familiares), dificultades en la resolucion de problemas practicos (5 familiares), desajuste en referencia al tiempo transcurrido (8 familiares) y duelo complicado (3 familiares). Conclusiones El numero de casos que han requerido atencion psicologica especializada ha sido bajo. La intervencion psicologica ha permitido mejorar el afrontamiento y la aceptacion del proceso de duelo. Dicho seguimiento ha sido fundamental para detectar las familias que si han requerido de una intervencion especifica para evitar el duelo complicado.