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S218

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S116–S348

EW299

Anticholinergic burden in inpatient

psychogeriatric population – Do we

care?

M. Lee

, A. Warren , B. Zolotarev , J. Henderson , M. George

West Moreton Mental Health, Older Person, Ipswich, Australia

Corresponding author.

Background

Although recent studies have found that there

is significant association between anticholinergic and cognitive

impairment, especially in the elderly population, there seems to

be minimal emphasis on anticholinergic burden (ACB) when pre-

scribing medications to the inpatient psychogeriatric population.

Aim

To evaluate the prescribing patterns in Older Person Mental

Health Inpatient Unit (OPMHU), whether the ACB Score on admis-

sion has been reviewed for lowest possible ACB while maintaining

therapeutic effects. A protocol will be developed to ensure that ACB

is reviewed for future admissions and discharges.

Methodology

Fifty patients admitted and discharged from

OPMHU are recruited retrospectively from 30th September 2015,

excluding outliers and deceased patients. For those who had multi-

ple admissions during that period, only the most recent admission

would be included for evaluation. Individual ACB score is calculated

on admission and discharge based on pharmacist final medication

summary. Their mental health records are also audited for any doc-

umented ACB review by the treating team, while making note for

any pre-existing cognitive impairment.

Result

ACB has not been taken into consideration in all patients

by the treating teamon admission aswell aswhen prescribingmed-

ications on discharge. Hence, it is unsurprising that the ACB score

showed an increment of 30% on discharge (3.25) when compared

to the admission score (2.5).

Conclusion

The study found that although ACB poses signifi-

cant risks on cognitive impairment, this knowledge has not been

employed pragmatically. A protocol should be developed to ensure

that ACB is evaluated and managed accordingly.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.417

EW300

Delirium related distress in family:

A non-systematic review

S. Martins

1 ,

, L. Fernandes

2

1

Center for Health Technology and Services Research/CINTESIS,

Faculty of Medicine of University of Porto, Porto, Portugal

2

Center for Health Technology and Services Research/CINTESIS,

Faculty of Medicine of University of Porto, Psychiatry Service, CHSJ

Porto, Porto, Portugal

Corresponding author.

Introduction

Delirium is a common neuropsychiatric syndrome,

particularly in elderly hospitalized patients, and is associated with

an increase in morbidity and mortality. Although these negative

consequences are well documented, only a few studies describe

the experience of delirium from the families’ perspective.

Aims

To analyze studies regarding the experience and distress

caused by delirium in the families/caregivers of adult/elderly hos-

pitalized patients.

Methods

A non-systematic review of published articles until

October 2015 in the database PubMed was carried out. The key-

word “Delirium” was combined with: “experience”, “distress”,

“anxiety” and “family”, “carer” and “relatives”. Inclusion criteria

were: standardized diagnosis of delirium, systematic/prospective

assessment of distress level. Clinical cases were excluded.

Results

Sixteen studies met the inclusion criteria for analysis.

In most of them, family members (mostly younger) showed high

levels of distress, even higher than health care professionals and

patients. Several predictors of family distress were found, including

poor functional status, psychomotor agitation, delusions, emo-

tional lability, incoherent speech, inattention and disorientation.

Higher distress was associated with long-term consequences (e.g.

generalized anxiety). In the qualitative research, family members

interpreted delirium as a sign of approaching death, result of

pain/discomfort or an effect of medication. In addition, distress

was associated with rapid and unexpected changes or unable to

recognize the loved ones.

Conclusions

Delirium in patients was associated with significant

distress in family members. These findings underline the impor-

tance of providing information and the development of appropriate

supportive and psychoeducational interventions in order to help

families throughout this process and reduce the associated distress.

This work is supported by FCT (SFRH/BPD/103306/2014).

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.418

EW301

Dementia severity among

institutionalized elderly: Are there

more unmet needs?

A.R. Ferreira

1 ,

, S. Martins

2

, C.C. Dias

3

, L. Fernandes

4

1

PhD Program in Clinical and Health Services Research/PDICSS,

Health Information and Decision Sciences Department, Faculty of

Medicine of University of Porto, Porto, Portugal

2

Center for Health Technology and Services Research/CINTESIS,

Faculty of Medicine of University of Porto, Porto, Portugal

3

Health Information and Decision Sciences Department. Center for

Health Technology and Services Research/CINTESIS, Faculty of

Medicine of University of Porto, Porto, Portugal

4

Center for Health Technology and Services Research/CINTESIS,

Faculty of Medicine of University of Porto. Psychiatry Service- CHSJ

Porto, Porto, Portugal

Corresponding author.

Introduction

The ageing population and the resulting increase in

chronic diseases, including dementia, make the evaluation of their

emergent needs a crucial step in psychogeriatric care. Unmet needs

are found to be important clinical targets that should be followed by

active management in order to improve health status and survival.

Objectives

To analyze the relation between unmet needs and

cognition, and explore the nature of these needs across dementia

severity stages.

Methods

A cross-sectional study was conducted in three nursing

homes. Residents were excluded if they were terminally ill, unre-

sponsive or presented delirium. All participants were assessed by

Mini-Mental State Examination/MMSE (cognition) andCamberwell

Assessment of Need for the Elderly/CANE (needs). Additionally,

cognitive decline was staged as: absent (MMSE = 30), questionable

(26–29), mild (21–25), moderate (11–20) and severe (

10).

Results

The study included 175 elderly with a mean age of 80.6

(SD = 10.1) years, of which 58.7% presented cognitive decline. For

these, the mean number of unmet needs was greater than for

those without (4 vs 3,

P

< 0.001), and they differed significantly in

the domains of daytime activities (

P

< 0.001), memory (

P

< 0.001)

and psychotic symptoms (

P

= 0.005). A significant negative cor-

relation was found between MMSE and number of unmet needs

(rs =

0.369,

P

< 0.001). Considering the severity stages, unmet

needs also differed: more needs in early stages in daytime activi-

ties (73.3%), and in advanced ones inmemory (63.9%) and psychotic

symptoms (23%).

Conclusions

Greater cognitive decline was related with more

unmet needs, which agree with previous studies. The different

nature of needs across severity stages also suggests that interven-

tions should be tailored comprising this specificity and complexity,

when effective care is planned.