The frequency of medication errors is high in patients with polypharmacy in primary care. Development of strategies (e.g. external medication review) is required to counteract medication errors.

The current Austrian list of potentially inappropriate medications may be a helpful tool for clinicians to increase the quality of prescribing in older patients. Like all explicit lists previously published, its validity needs to be proven in validation studies.

Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.

Background: The consumption of certain drugs can cause urinary incontinence. The aim of this study is to determine the frequency of consumption of drugs that can favour incontinence, the incidence of polypharmacy and the incidence of potentially dangerous drug-drug interactions in female patients suffering from overactive bladder (OAB) who presented to a urogynaecological outpatient department. Methods: We undertook a retrospective case series study. The data from 100 female patients who attended the urogynaecological outpatient department of the Vienna General Hospital [VGH; Allgemeinen Krankenhauses Wien (AKH)] in the period from 20.?07.?2010 to 30.?08.?2011 were evaluated. The patients suffered either from an OAB or mixed incontinence with predominantly urge components. Among other factors, we were interested in the drugs taken for longer periods of time as well as the general and the urogynaecological case histories. 15 parameters were recorded: age, BMI, menopausal status, parity, pelvic organ prolapse, DIAPPERS criteria (delirium, infection (urinary), atrophic urethritis and vaginitis, pharmaceuticals, psychological disorders (especially depression), excessive urine output, restricted mobility, stool impaction), drug side effects and drug-drug interactions. A descriptive statistical analysis was performed. The drugs were checked with the help of a drug information system (Intranet-KH [V 6.0]). Of particular interest was the consumption of drugs that could favour urinary incontinence as an adverse side effect. In addition the frequency of polypharmacy and the frequency of potentially health-threatening drug combinations were registered. Results: 57?% of the patients consumed at least one drug that could reinforce urinary incontinence. The frequency of polypharmacy was 38?%. In 45?% of the patients the possibility for health-damaging interactions existed as a result of the consumed drugs. Conclusion: The frequencies of consumption of drugs that can favour urinary incontinence and of polypharmacy are high among the patients who attend a specialist outpatient department for urinary incontinence. This emphasises the importance of a complete drug history in the diagnostic work-up for urinary incontinence.

This article presents a list of potentially delirogenic properties of drugs that are currently of relevance to drug therapy in Europe, which was created through a Delphi process including experts from professions relevant to diagnosis and treatment of delirium. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) defines delirium as a disturbance in attention, awareness and cognition that develops over a short period of time and fluctuates. Possible causes of delirium are manifold: usually delirium is considered to develop in a multifactorial way, caused by inalterable parameters, such as advanced age and pre-existing cognitive impairment and precipitated by modifiable parameters, such as the use of certain drugs or substance withdrawal. Delirium is a serious condition with a pronounced impact on morbidity, mortality and costs to the healthcare system. Circumstances and drugs that might precipitate or worsen delirium should therefore be avoided whenever possible. A list of drugs that might have a detrimental influence on the emergence and duration of delirium has been created using the terms "delirogenity" and "delirogenic" to describe the potential of a drug or withdrawal to cause or worsen delirium. The results are novel and noteworthy, as their focus is on substances relevant to European pharmacotherapy. Furthermore, they represent a methodical consensus from a group of experts of a wide variety of professions relevant to the prevention, diagnosis and treatment of delirium, such as nursing, pharmacy, pharmacology, surgical and internal medicine, neurology, psychiatry, intensive care and medicine, with working, teaching and scientific experience in several European countries practicing both in primary and secondary care.

PurposeInappropriate use of diagnostic and therapeutic medical procedures is common and potentially harmful for older patients. The Austrian Society of Geriatrics and Gerontology defined a consensus of five recommendations to avoid overuse of medical interventions and to improve care of geriatric patients.MethodsFrom an initial pool of 147 reliable recommendations, 20 were chosen by a structured selection process for inclusion in a Delphi process to define a list of five top recommendations for geriatric medicine. 12 experts in the field of geriatric medicine scored the recommendations in two Delphi rounds.ResultsThe final five recommendations are concerning urinary catheters in elderly patients, percutaneous feeding tubes in patients with advanced dementia, antipsychotics as the first choice to treat behavioral and psychological symptoms of dementia, and screening for breast, colorectal, prostate, or lung cancer, and the use of antimicrobials to treat asymptomatic bacteriuria.ConclusionsThe selected recommendations have the potential to improve medical care for older patients, to reduce side effects caused by unnecessary medical procedures, and to save costs in the health care system.

Delirium, the acute deterioration of cognitive function and attention, is the most frequent mental disorder in elderly. Its correct diagnosis and adequate management are of crucial importance for the patient's health and functional outcome. First of all, one has to be aware of the possibilities of preventing this complex, potentially life-threatening problem, which means recognizing the patient at risk, avoiding environmental stress and causal factors (i.e., anticholinergic medication) in cognitively impaired patients, and timely reaction to prodromal symptoms. Causal therapy (i.e., treatment of the causal condition and/or eliminating the precipitating situation) is imperative. It must be accompanied by nursing and environmental measures and, if necessary, by antipsychotic and/or sedating symptomatic treatment.

Diese Fortbildungseinheit steht Ihnen in der Springer Medizin e.Akademie zur Verfügung. Online teilnehmen unter springermedizin.de/kurse-cme Die CME-Teilnahme ist mit dem Zeitschriftenabonnement und mit e.Med möglich. e.Med 30 Tage kostenlos testen: springermedizin.de/eMed Dieser Beitrag erschien ursprünglich in Z Gerontol Geriatr 2014, 47(5):425-438; DOI 10.1007/s00391-014-0613-1. Die Teilnahme an der zertifi zierten Fortbildung ist nur einmal möglich. ZusammenfassungDas Delir, eine akute Verschlechterung kognitiver Funktionen und der Aufmerksamkeitsfähigkeit, ist die häufi gste psychische Störung bei älteren Menschen. Die richtige Diagnose und ein adäquates Management sind für die weitere Gesundheit und Selbstständigkeit der Betroff enen entscheidend. Die Primärprävention dieses komplexen, potenziell lebensgefährlichen Problems umfasst das Erkennen der Risikopatienten, Vermeiden von Umgebungsstress und kausalen Faktoren, wie z. B. anticholinerge Medikamente, insbesondere bei kognitiv bereits kompromittierten Patienten, sowie ein rechtzeitiges Reagieren auf Prodromalsymptome. Eine kausale Therapie, d. h. die Behandlung der auslösenden Erkrankung und Beseitigung der mitverursachenden Situation, ist unumgänglich. Sie wird begleitet durch pfl egerische und milieutherapeutische Maßnahmen sowie bei Bedarf durch eine antipsychotische und/oder sedierende symptomatische Therapie. SchlüsselwörterDelir -Kognitive Störung -Ätiologie -Geriatrisches Assessment -Präventivmaßnahmen