European Psychiatry - Volume 33 - March 2016

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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.
EW300
Delirium related distress in family:
A non-systematic review
S. Martins ∗, L. Fernandes
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.
EW301
Dementia severity among
institutionalized elderly: Are there
more unmet needs?
A.R. Ferreira ∗, S. Martins , C.C. Dias , L. Fernandes
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.