Oral presentations / European Geriatric Medicine 5S1 (2014) S45–S81 S61

Figure: The proportion of available and applicable information.

O2.18

The development of the Appropriate Psychotropic drugs use

In Dementia (APID) index

K. van der Spek1, D.L. Gerritsen1, S.U. Zuidema2,

M.H.J.M.G. Nelissen-Vrancke3, R.B. Wetzels1, C.H.W. Smeets1,

M. Smalbrugge4, R.T.C.M. Koopmans1

1Radboudumc, Nijmegen, The Netherlands; 2University Medical Center

Groningen, Groningen, The Netherlands; 3Dutch Institute for Rational

Use of Medicine, Utrecht, The Netherlands; 4VU Medical Center,

Amsterdam, The Netherlands

Introduction: There are many tools to measure appropriate drug

use, but these, including the Medication Appropriateness Index

(MAI), are not specified for psychotropic drug use (PDU) for

neuropsychiatric symptoms (NPS) in dementia. For this purpose,

the MAI needs to be adjusted, by developing an index with relevant

items that weighs drug use against specific guidelines. The aim of

this study is to develop an index derived from the MAI items that

is suited for research in PDU for NPS in dementia and to test its

reliability and validity.

Methods: An expert panel used the MAI items to construct items

for appropriateness in PDU; a second independent expert panel

validated this process, to create the APID index. An inter-rater

reliability study was conducted and an index’ summated score was

developed to enhance the use in clinical studies. Construct validity

was explored using a sample of 560 medical files.

Results: Five existing and one adjusted MAI items were used, the

item ‘evaluation’ was added. The second expert panel concluded

that all items contributed to the construct. All items and the

index’ summated score had moderate to almost perfect inter-

rater reliability. The index’ summated score reflects putative

distribution.

Conclusions: The results of this study show that the APID items

are reliable and valid for measuring appropriateness of PDU in

dementia. The index’ summated score is reliable and valid for use

in clinical studies.

O2.19

Are drugs with sedative properties a risk factor for oral health

habits in community-dwelling older people?

A.T. Tiisanoja1, A.M. Syrjala1, K. Komulainen2, S. Hartikainen2,

H. Taipale2, M. Knuuttila1, P. Ylostalo2

1University of Oulu, Oulu, Finland; 2University of Eastern Finland,

Kuopio, Finland

Introduction: Because of the high consumption of drugs with

sedative properties, it is important to study the effects of these

drugs on oral health habits among older population. The aim was

to study whether sedative load, which measures the cumulative

effect of taking multiple drugs with sedative properties, is related

to oral health habits, such as toothbrushing, using toothpaste, dental

visits and number of teeth with dental plaque, among community-

dwelling older people.

Methods: The study population consisted of 159 (112 women and

47 men, mean age 79.3 years) community-dwelling, dentate, non-

smoking, older people from the Geriatric Multidisciplinary Strategy

for the Good Care of Older People study. The data were collected by

interviews and clinical examinations during 2004–2005. Sedative

load (SL) was calculated using the Sedative Load Model. Logistic and

Poisson regression models were used to estimate odds ratios (OR)/

relative risks (RR) and 95% confidence intervals (CI).

Results: After adjusting for confounding factors, both moderate

(1–2) and high (≥3) sedative load were associated, although not

strongly, with toothbrushing (SL 1–2: OR 1.29, CI 0.38–4.41) and

using toothpaste (SL ≥3: OR 4.52, CI 0.84–24.4) less than twice a day,

irregular dental visits (SL 1–2: OR 1.75, CI 0.69–4.59) and higher

number of teeth with dental plaque (SL ≥3: RR 1.10; CI 0.94–1.29).

Conclusions: Within the limitations of this study, including small

sample size, the results suggest that the use of drugs with sedative

properties is a potential risk factor for poor oral health habits.

O2.20

Effects of clinical pharmaceutical counseling on medication

safety in geriatric patients

A. de Campo1, I. Friedl2, W. Schippinger1

1Geriatic Health Centers, Graz, Austria; 2LKH Graz West, Graz, Austria

Introduction: To warrant the safety of drug therapy is always

challenging, especially so when treating geriatric patients with

frailty or high comorbidity, who often need extensive drug therapy.

The present study aims to evaluate if comprehensive counseling of

prescribing physicians, nursing staff and patients done by a clinical

pharmacist leads to measureable effects in regard to occurrence

and frequency of adverse drug reactions.

Methods: A randomized, controlled, prospective, open, parallel-

group design was chosen for a mono-center pilot study. 100

participants were enrolled.

As clinical parameters we chose laboratory results, ECG and

parameters of the Geriatric Assessment. Non-clinical parameters

were employed to assess the risk for adverse drug reactions. To

assess the appropriateness of medication prescriptions a synopsis

of tools was used: PIM (Potentially Inappropriate Medication) lists, a

dosing tool, product information and drug interactions data bases.

Results: Analysis of the clinical data showed significant differences

in renal parameters (D signifies the change from baseline to end of

study):

DCreatinine: −0.04±0.13 for the intervention group vs. 0.12±0.49

for the control group; p =0.047.

DUrea: −1.5±9.4 for the intervention group vs. 8.3±26.1 for the

control group; p =0.032.

The differences in non-clinical parameters at end of study were

pronounced: intervention group vs. control group number of drugs:

8.1% difference, PIMs 18.4% difference, dosing recommendations:

56.5% difference, drug interactions: 72.7% difference, all in favor of

the intervention group.

Conclusion: Our results suggest that comprehensive counselling

can improve medication safety.