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Background and importance Depression affects about 14–26% of the elderly population. It is a frequent affective disorder and one of the main reasons for medical consultation. Elderly patients usually have several comorbidities that make polypharmacy a common issue. In the light of the above information, it is especially important that their antidepressant medication is adequate. Aim and objectives To assess the adequacy of antidepressant treatment and the medication related factors associated with poor quality prescriptions in elderly patients diagnosed with depression. Material and methods Elderly patients, defined as those aged ≥70 years, diagnosed with depression in three primary care centres, from March 2018 to May 2018, were included. Demographic data (age and gender) and the treatment prescribed at the time of the study were collected from the electronic clinical history. Patients with antidepressant therapy and those without were analysed. Also, the adequacy of the prescriptions, consulting different psychogeriatric guides and taking into account the criteria repeated in two or more guides, and the reasons for poor quality prescriptions were studied. Results The study included 170 patients, mean age 77.3 (71–92) years and 81.2% were women. A total of 130 (76.5%) patients were treated and 150 antidepressant prescriptions were analysed: 27 (20.8%) patients were inappropriately treated and 27 (18.0%) prescriptions were inadequate. Forty (23.5%) patients were not treated and 16 (40.0%) should have been treated with antidepressant therapy. In total, 43 (25.3%) patients were not being adequately treated. The main reasons for the inadequate prescriptions were: 3 (7.0%) overdosing, 1 (2.3%) underdosing, 6 (14.0%) incorrect duration, 17 (39.5%) incorrect indication, including lack of treatment, and 16 (37.2%) adverse effects. Conclusion and relevance About 25% of elderly patients with depression had inadequate prescriptions so it is important to choose an adequate treatment in order to reduce adverse effects and improve efficacy, especially in the treatment of a prevalent disease in a fragile population. Clinical pharmacists have an important role in the detection of inadequate medication in this group of patients. References and/or acknowledgements No conflict of interest.

Background and importance Hospital discharge has been described as the care transition in which a major number of incorrect prescriptions occur. Discharge medication reconciliation aims to prevent discrepancies when comparing the inhospital with the discharge electronic prescription. Aim and objectives To assess the incidence of unjustified discrepancies during a medication reconciliation programme by pharmacists in complex chronic patients (CCP) at hospital discharge. Material and methods This was a cross sectional study where we assessed unjustified discrepancies between the inhospital prescriptions (which are summarised in the discharge report) and the electronic prescriptions for all CCP from April 2019 to May 2019. Data were obtained from the discharge report prescriptions and the electronic prescriptions. Unjustified discrepancies were assessed according to the medical records. CCP were defined as patients with chronic diseases and comorbidities due to socioeconomic, cultural and environmental situations interfering with the decision and the need to implement specific plans. Discrepancies were classified according to: (i) incomplete prescription, (ii) omission, (iii) incorrect dose, (iv) incorrect drug selection, (v) duplicity, (vi) incorrect timing and (vii) incorrect administration route. Results We analysed the discharge prescriptions of 97 patients. Mean age was 81.7±9.7 years and 50 (51.6%) were women. Seventy-seven (79.4%) patients were admitted to medical wards and 20 (20.6%) to surgical wards. A total of 272 discrepancies were found in 77 (79.4%) patients with a mean of 2.8±2.8 discrepancies per patient: 114 (41.9%) discrepancies were related to incomplete prescription, 70 (25.7%) to omission, 67 (24.6%) to incorrect dose, 10 (3.7%) to incorrect drug selection, 7 (2.6%) to duplicities, 3 (1.1%) to incorrect timing and 1 (0.4%) to incorrect administration route. Conclusion and relevance We found that about 80% of patients presented at least one unjustified discrepancy. Medication reconciliation is a major component of safe patient care in any environment. Therefore, education of healthcare professionals and implementation of tools such as electronic reconciliation software could be useful to improve safety. References and/or acknowledgements No conflict of interest.

Background Antipsychotics have been associated with aspiration pneumonia in older people. However, epidemiologic evidence of the association between antipsychotic drug use and pneumonia is limited. Purpose To investigate the association between antipsychotic exposure and aspiration pneumonia during hospitalisation in a large older population. Material and methods Retrospective cross-sectional study. We included all hospitalisations between January 2013 and December 2017 of patients aged from 65 to 85 years. Aspiration pneumonia was defined according to the discharge diagnosis codes of the International Classification of Diseases 9 and 10 and antipsychotic use as any pharmacy charge for an antipsychotic medication. Results Our cohort included 1 06 552 hospitalisations of patients from 65 to 85 years (medium age 74.86±10.61 years; 58% female). Aspiration pneumonia occurred in 1291 (1.2%) hospitalisations. Antipsychotics were used in 4484 (4.2%) hospitalisations. The incidence of aspiration pneumonia was 0.6% (612 patients) in patients not taking antipsychotics and 0.9% (41 patients) in those taking antipsychotics (OR=1.5, 95% CI 1.0 to 2.1). The magnitude of the association was only a little bit higher for typical (OR=1.6, 95% CI: 0.94 to 2.2) rather than atypical (OR=1.4, 95% CI: 1.0 to 2.0) antipsychotics. Conclusion The use of either typical or atypical antipsychotics in older people is modestly associated with increased risk for aspiration pneumonia. Clinicians who prescribe antipsychotics should closely monitor patients for pneumonia, should consider the lowest possible dose of the antipsychotic for the shortest possible time and it should be stopped when the patient stabilises or symptoms cease. References and/or acknowledgements No conflict of interest.

Background The standard treatment for rectal cancer stage II-–III is neoadjuvant chemoradiotherapy based on oral capecitabine (CPC) or continuous 5-fluorouracil (5-FU) infusion. While efficacy has been demonstrated to be equivalent between the two treatments, there is a discrepancy over safety. Purpose To assess the incidence of adverse events (AE) between CPC and 5-FU in neoadjuvant chemoradiotherapy for rectal cancer to compare the safety profiles of both treatments. Material and methods This was an observational, retrospective study on patients treated with CPC (1650 mg/m2/day) or 5-FU (225 mg/m2/day) from 2012 to 2018. Data was obtained from medical records and the oncology software Oncofarm. AE (reported as Grade 1–2 or ≥3), dose reductions, treatment interruptions and administration-related AE were assessed. Results Seventy-six patients were included, 32 treated with CPC and 44 with 5-FU. Mean age was 63.1 (10.1)a in the CPC group and 62.3 (11.8)a in the 5-FU group. Sex: 24 (75.0%) in the CPC group and 34 (77.3%) in the 5-FU group were men. Adverse events: 36 AE G1–2 and 2 AE G≥3 were reported in the CPC group; and 61 AE G1–2 and one AE G≥3 were reported in the 5-FU group. Two patients in the CPC group reduced doses for diarrhoea and palmar–plantar erythrodysesthaesia (PPE) and three patients discontinued the treatment for diarrhoea, PPE and fatigue with anorexia; and one patient in the 5-FU group reduced doses for PPE. avalues are mean (SD). Conclusion While the CPC group had a lower incidence of AE except for PPE, they had more dose reduction and treatment interruption. A posterior analysis showed that dose reduction and treatment interruption in the CPC group happened in the last week of treatment. In disagreement with previous studies, 5-FU patients had a higher incidence of diarrhoea. References and/or acknowledgements No conflict of interest.

Background Nowadays, 12 different therapies are available as immune-mediated therapies (IMT) for multiple sclerosis (MS) drugs. Guidelines classify these treatments as first- and second-line. This variety allows treatment discontinuations (TD) under situations different from those initially planned. Apart from high disease activity or poor drug tolerance, patient comfort or lack of adherence are becoming important reasons for TD. Treatment changing reasons in the usual practice can help better understand this reality and in future decision making. Purpose Assessing reasons for TD in relapsing-remitting MS for IMT. Assessing TD causes for each kind of IMT. Material and methods In this retrospective, observational study, TD for any cause with IMT for MS from August 2014 to August 2017 was studied in our centre. Treatments with no available discontinuation conditions were excluded. To achieve the objectives, IMT was divided according to: interferon-like, glatiramer acetate, teriflunomide, dimethyl-fumarate, fingolimod and natalizumab. Reasons for TD were listed according to: high disease activity, isolated radiological disease activity, complete interruption of IMT, administration patient preferences (oral drugs or pegylated interferon),drug hypersensitivity reactions, injection-site reactions, lymphopenias, JC virus detection, and other adverse reactions (specified) or situations. Results During the study period, 65 TD were performed: 60 (92.3%) due to treatment switch, three (4.61%) led to IMT complete interruption and two (3.97%) were not correctly evaluated due to patient transfer. Conclusion Probably, the 27 cases reported as patient preferences are related to the most prominent INF adverse effects (injection-site reactions and flu-like symptoms) although it has not been documented. During the study period, IMT extension variety had permitted individualised treatment adjustment according to disease clinical form, each subject progression, and patient preferences and tolerance. No conflict of interest

Background Antipsychotics (APs) are commonly used to manage neuropsychiatric symptoms (NPS) in the elderly with dementia (approximately 48% of the elderly with dementia are treated with APs), even though several large studies have demonstrated an association between AP treatment and increased morbidity and mortality in people with dementia. Purpose The aim of this study was to review the scientific literature of the use of AP in the elderly with dementia and to propose an algorithm to assist in decision-making regarding the withdrawal of APs. Material and methods A computerised literature search (MEDLINE: 1966 to July 2017, EMBASE: 1982 to July 2017) was used to locate relevant literature. The following terms were used in the MESH database and EMTREE thesaurus: aged, antipsychotic agents, behavioural symptoms and dementia. The information and recommendations of full references were extracted to perform an algorithm represented on paper in a flow-chart form. In the algorithm we define non-pharmacological interventions, NPS and signs and symptoms of AP withdrawal. We use the Neuropsychiatric Inventory Questionnaire (NPI-Q) to score the severity of the NPS. Results Earlier studies of APs used in the elderly with dementia suggest that, in most elderly demented patients, APs can be withdrawn with no effect on behaviour. These patients are likely to benefit from the algorithm we propose to assist clinicians with in the withdrawal of APs (Algorithm 1). Although prolonged treatment in specific circumstances may be advisable in clinical practice, the general advice is to discontinue APs after 12 weeks in cases of agitation or psychosis associated with dementia based on weak and conflicting evidence regarding long-term efficacy. A gradual tapering strategy is to reduce dosage by 25% to 50% every 2 weeks and to end treatment 2 weeks after administering the lowest dose. Conclusion Information gathered in this review raises the need to establish safe and effective pharmacological approaches to AP prescription for the demented elderly with NPS. We have described an algorithm consisting of three main steps presented in the form of a flowchart that draws on AP withdrawal approaches recommended in both dementia and care guidelines, and which can assist clinicians in the withdrawal of APs. No conflict of interest

BACKGROUND: The prevalence of dysphagia in patients with dementia ranges from 13% to 84%. The high prevalence is likely the result of the presence of age-related lesions in the diffuse area of the brain in addition to those produced by the neuropathology. Moreover, antipsychotics (APs), which are extensively used to treat dementia patients, have also been associated with impaired swallow. PURPOSE: The objective of this study is to characterise the patophysiology of oropharyngeal dysphagia (OD) using videofluoroscopy (VFS) in patients with dementia and those with dementia and taking APs. MATERIAL AND METHODS: An observational cross-sectional study was performed on dementia patients (DP) discharged from the hospital with a diagnosis of dementia and a VFS study. Demographical, clinical factors and swallowing parameters measured by VFS were compared between no dementia patients (NDP). NDP were elderly patients with dysphagia but without a diagnosis of dementia or other neurological or cerebrovascular diseases. Moreover, DP taking APs (DPA) were also compared with DP not taking APs (DPWA). Receiver operating characteristic (ROC) curves were drawn for laryngeal vestibule closure (LVC) time for DPA, DPWA and NDP, which predicts unsafe swallow. RESULTS: We included 129 consecutive DP (82.2±7.8 years, 56.3% females) studied by VFS. 85.2% presented impaired efficacy and 66.4% impaired safety of swallow, penetration aspiration scale (PAS)=3.81±1.94. Time to glossopalatal junction opening (GPJO) and upper esophagal sphincter opening (UESO) was significally delayed in DP in comparison with NDP (p