[Discrepancies in reported medication use in elderly psychiatric outpatients]. / Discrepanties in gerapporteerd medicatiegebruik bij ouderen in ambulante psychiatrische behandeling.

BACKGROUND: Different fields of study have revealed discrepancies between the reported medication use presented by patients and medical records held by their doctor or apothecary. These also appear to have clinically relevant consequences. At present only two studies have explored medication discrepancies in psychiatry.
AIM: To investigate the occurrence of discrepancies in the reported medication use of a psychiatric elderly out-patient population.
METHOD: Comparing 40 medication records of patients to their respective general practitioner and pharmacy records. Information on their social situation, Mini-Mental State Examination score and diagnosis was collected.
RESULTS: One or more discrepancies were present in 80 percent of cases. Patients living alone had a higher percentage of discrepancies. Patients with cognitive problems or a low score on the Mini-Mental State Examination had less discrepancies.
CONCLUSION: Medication discrepancies are also common in a psychiatric elderly outpatient population.

Mortality and incident vertebral fractures after 3 years of follow-up among geriatric patients.

UNLABELLED: In a prospective cohort study of 395 geriatric outpatients, mortality after 3 years was associated with prevalent vertebral fractures at baseline. The mortality risk was independently associated with the presence of three or more vertebral fractures at baseline. In the surviving patients, the risk of incident fractures was noteworthy, occurring in 26 % of these patients. INTRODUCTION: The purpose of this study is to determine mortality rate and the incidence of vertebral fractures in a geriatric outpatient group, during a 3-year follow-up period, in a teaching hospital in Amsterdam, The Netherlands. METHODS: This study includes a prospective cohort study of 395 geriatric patients who had their baseline visit at a diagnostic day hospital in 2007 and 2008. They were invited for follow-up 3 years later. Lateral X-rays of the lumbar spine and chest were performed at baseline and after 3 years; vertebral fractures were scored in all patients according to the semi-quantitative method of Genant. RESULTS: After 3 years, mortality was 46 % and associated with prevalent vertebral fractures at baseline (odds ratio (OR), 1.83; 95 % CI, 1.23-2.74). The presence of three or more vertebral fractures at baseline was an independent risk factor for mortality (OR, 3.32; 95 % CI, 1.56-7.07). Other independently associated risk factors were greater age, higher co-morbidity score, and having more prescriptions. Higher cognitive capacity protected against mortality after 3 years. In 72 patients, radiography was repeated. Nineteen patients (26 %) had an incident radiographic vertebral fracture: 16 in those with a prevalent fracture, and 3 in those without a prevalent vertebral fracture at baseline. CONCLUSIONS: In geriatric outpatients, mortality after 3 years was associated with prevalent vertebral fractures at baseline, and the mortality risk was independently associated with 3 or more vertebral fractures at baseline. In survivors, the risk of incident fractures was noteworthy, since these occurred in 26 % of the patients, particularly in those with a prevalent vertebral fracture.

Elderly patients with an atypical presentation of illness in the emergency department.

BACKGROUND: Very little information is available on the prevalence and clinical outcome of elderly patients with atypical presentations of illness in the emergency department. The objective was to determine the prevalence and clinical outcome of elderly patients seen in the emergency department with an atypical presentation. METHODS: A monocentric retrospective observational study on 355 elderly patients presenting to the emergency department. Patients of 80 years and older were included. Data were extracted from the electronic medical file. RESULTS: A total of 355 patients were included, with a mean age of 86 years; 53% of these elderly patients had an atypical presentation of illness. Mostly this was due to a fall (71%). A total of 15% of the patients with an atypical presentation reported no specific symptoms of the underlying disease. Patients with atypical presentation were more likely to have a longer stay in hospital (p < 0.001), to be discharged to a care institution (p = 0.000), and to have a higher delirium observation score (p < 0.001). There was no significant difference in one-year survival (p = 0.056). CONCLUSION: Atypical presentation of illness in elderly patients is highly prevalent in the emergency department. Falling accidents are the most important reason for this. Patients with an atypical presentation have a worse clinical outcome. Accurate training of emergency staff is necessary to recognise this group of patients to ensure proper clinical monitoring and timely treatment.

Diagnosis of vertebral fractures on lateral chest X-ray: intraobserver agreement of semi-quantitative vertebral fracture assessment.

BACKGROUND: In clinical practice lateral images of the chest are performed for various reasons. As these lateral chest X rays show the vertebrae of the thoracic and thoraco-lumbar region, we wondered if these X-rays can be used for evaluation of vertebral fractures instead of separate thoracic spine X-rays. METHODS: To evaluate the agreement and intraobserver reliability of the semi-quantitative method for vertebral fractures on the lateral chest X-ray (X-chest) in comparison to the lateral thoracic spine X-ray (X-Tspine), two observers scored vertebral fractures on X-Tspine and twice on X-chest, separately,blinded and in different time periods. Agreement and Cohens' kappa were calculated for a diagnosis of any fracture on patient level and on vertebral body level. The study was done in patients visiting an outpatient geriatric day clinic, with a high prevalence of vertebral fractures. RESULTS: 109 patients were included. The intraobserver agreement for X-chest versus X-Tspine was 95-98%for the two levels of fracturing, with a Cohen's kappa of 0.88-0.91. The intraobserver agreement and reliability of the re-test on the X-chest showed an agreement between 91 and 98% with a Cohen's kappa of 0.81-0.93. More vertebrae were visible on the X-chest, mean 10.2, SD 0.66 versus mean 9.8, SD 0.73 on the X-Tspine (p < 0.001). CONCLUSION: The results show good agreement and intraobserver reliability on the X-chest compared to the X-Tspine for visualizing vertebral fractures. The results of this study emphasizes that the routinely performed X-chest is reliable in order to diagnose vertebral fractures.