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P8: Risk of Delirium According to Demintia and the Use of Psychotropics
- Ana Sofia Pozo Vico, Debora Moral Cuesta, Maria Belen Gonzalez Glaria, Francesca Soler Parets, Beatriz Echarte Archanco, Karmele Garaioa Aranburu, Angela Zulema Hernandez Amador, Marina Sanchez Latorre, Chenhui Chen, Rodrigo Molero De Avila Garcia, Marta Lorente Escudero
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 233-234
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Introduction:
Psychotropics are often used among dementia in order to reduce behavior problems. In patients with dementia, hospital admission is a stressful event, for hospitalization cause as well as for environment change. Consequently, delirium risk is high and this is proportional to dementia stage. In addition, it ́s known psychotropics promote delirium.
Objectives:To evaluate if the patients admitted to an acute geriatric unit develop more delirium depending on dementia diagnosis and dementia stage and depending on the use of psychotropics. To analize if dementia and psychotropics are two independent risk factors for the development of delirium.
Material and Methods:We selected all the patients admitted in the Acute Geriatric Unit of HUN during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as the onset of delirium: delirium signs on admission (DSA) and delirium diagnosis on discharge (DDD) and psychotropics use. A descriptive study was carried out to analyze the relationship between dementia and its stage (GDS), psychotropics use and delirium.
Results:658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities, the most frequent ones were arterial hypertension(81%), Osteoarthritis(55%) and heart failure(51%). The main delirium predisposing factors were: age more than 80(93.5%), polypharmacy(87.5%), and neurological disease(47%). Comparing: -Dementia and non-dementia-patients: DSA(55.7%vs23.7;p0,000), DDD (43.7%vs17.5%;p0.000) -GDS 4-5 and GDS 6-7: DSA(52.7%vs57.2;p0.435), DDD (50.4%vs37.9%;p0.031). -Psychotropics-users and non-psychotropics-users: DSA(42.3%vs27.4%), DDD(31.6%vs22,5%). Night psychotropics DSA(41.8%vs31%), DDD(31.7%vs24%); neuroleptics DSA(53.1%vs33.6), DDD(45.2%vs24.3%); anticholinesterase DSA(51%vs36.9%), DDD(45.1%vs27.7%). All of them p<0.05.
Concusions:Dementia and psychotropics are predisposing factors for delirium. Its effect is additive. Neuroleptics have the clearest relationship with delirium. We observed, as dementia was more severe, the risk of delirium was greater but the use of neuroleptics decreased. This could be due to the presence of more hypoactive phases in final stages.
P7: Institutionalization and Psychotropics
- Ana Sofia Pozo Vico, Debora Moral Cuesta, Maria Belen Gonzalez Glaria, Francesca Soler Parets, Beatriz Echarte Archanco, Karmele Garaioa Aranburu, Angela Zulema Hernandez Amador, Marina Sanchez Latorre, Chenhui Chen, Rodrigo Molero De Avila Garcia, Marta Lorente Escudero
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 232-233
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- Article
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- You have access Access
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Introduction:
Psychobehavioral symptoms are one of the main causes of institutionalization. After the first months of institutionalization, it could be a good opportunity to consider deprescribing psychotropics, at the same time person-centered non-pharmacological measures should be implemented. Also, if dementia stage is moderate or advanced, acetylcholinesterase- olyph-inhibitor (AchEI) should be deprescribed.
Objectives:To evaluate the difference between the number of psychotropic drugs in institutionalized patients and those who are at home.
Materials and Methods:We selected all the patients admitted in the Acute Geriatric Unit of “Hospital Universitario de Navarra” during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as delirium predisposing factors, drugs on admission and discharge and Drug-Burden-Index (DBI). A descriptive study was carried out and our hypothesis was analyzed.
Results:658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia and 22% were Institutionalized. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities: arterial hypertension (81%), Osteoarthritis (55%), heart failure (51%), dislipemia (47%), chronic kidney disease (42%), auricular fibrillation (39%), osteoporosis (33%) and diabetes (31%). Regarding geriatric syndromes: polypharmacy (87,5%), sleep disturbances (48%), hearing loss (43%), chronic pain (41,5%), visual loss and constipation (38%) and depression (33%). The main delirium predisposing factors were: age more than 80 (93.5%), olypharmacy, neurological disease (47%), altered senses, chronic pain and depression. Comparing psychotropic use between institutionalized and non institutionalized: psychotropics (78%vs69%), night psichotropics (72%vs63%), neuroleptics (37%vs18,5%), AchEI (13%vs6,5%), antiepileptics (21%14%). All of them p<0.05. However, there were no statistically significant differences in the use of benzodiazepines, antidepressant or antiparkinsonian.
Conclusion:Nowadays, institutionalized patients have more phsychotropic drugs than non-institutionalized ones, especially neuroleptics. Moreover, they are more frequent in patients with severe dementia. Maybe, the explanation is DEPRESCRIPTION AVOIDANCE due to an acute fear of a behavioral decompensation. We recommend educating in non-pharmacological measures and insisting on an adequacy of pharmacological prescriptions periodically.
Spatiotemporal pattern analysis of schistosomiasis based on village level in the transmission control stage in lake and marshland areas in China
- Yanyan Chen, Jianbing Liu, Ying Xiao, Chenhui Zhong, Fenghua Wei, Si Liu
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- Parasitology / Volume 147 / Issue 2 / February 2020
- Published online by Cambridge University Press:
- 08 November 2019, pp. 199-212
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Hubei Province is one of the endemic regions with severe schistosomiasis in China. To eliminate schistosomiasis in lake and marshland regions, this study detected hotspots of schistosomiasis cases both spatially and spatiotemporally on the basis of spatial autocorrelation; clustering and outlier, purely spatial and spatiotemporal cluster analyses at the village level from 2013 to 2017 in Hubei Province. The number of cases confirmed positive by an immunodiagnostic test and etiological diagnosis and advanced schistosomiasis cases dramatically declined during the study period. Significant global spatial autocorrelation of schistosomiasis patients was found at the village level in the whole province in 5 years. Clustering and outlier analysis showed that most HH villages were mainly concentrated along the Yangtze River, especially in Jianghan Plain. Spatial and spatiotemporal cluster analyses showed that significant clusters of the schistosomiasis cases were detected at the village level. In general, space and spatiotemporal clustering of schistosomiasis cases at the village level demonstrated a downward trend from 2013 from 2017 in Hubei Province. High-risk regions included Jianghan Plain along the middle reach of Yangtze River and Yangxin County in the lower reaches of the Yangtze River in Hubei Province. To eliminate schistosomiasis, precise control and management of schistosomiasis cases should be strictly implemented. Moreover, comprehensive prevention and control measures should be continuously strengthened in these regions.