IntroductionA significant proportion of acutely ill hospitalised elderly patients have impaired consciousness and this has been associated with increased mortality. It remains unclear which factors underlie this relation. Identification of mortality predictors in this population is important to improve care.ObjectivesDetermine if advanced age, cognitive impairment, high burden of comorbidities and poor functional status are predictors of increased mortality during hospitalisation in acutely-ill medical hospitalised elderly patients with altered state of consciousness.MethodsAll male patients (> 65 years) admitted to a medical ward (> 48 h) between 01/03/2015 to 31/08/2015 with delirium or RASS lower than–2 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or medical condition precluding the evaluation. Baseline evaluation included socio-demographic variables, RASS, CAM, IQCODE-SF, DSM-IV-TR criteria for dementia, Charlson Comorbidity Index and Barthel Index. The variables were entered in a logistic regression model (significance level < 0.05).ResultsThe final sample consisted of 75 male subjects with altered state of consciousness, 14 of them died during hospitalisation. Dementia and Barthel Index were significantly associated with mortality during hospitalisation (P = 0.01 and P < 0.01, respectively). On the other hand, age and Charlson Co-morbidity Index were not associated significantly with mortality during hospitalisation (P = 0.22 and P = 0.1, respectively).ConclusionsAcutely ill elderly patients with altered state of consciousness at admission have higher risk of death during hospitalisation if they have prior dementia or poor functional status. Health care should be improved to provide better response to this type of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionDementia is one of the leading causes of disability and burden in Western countries. In Portugal, there is a lack of data regarding dementia prevalence in hospitalized elderly patients and factors associated with in-hospital adverse outcomes of these patients.ObjectivesDetermine dementia prevalence in acutely-ill medical hospitalized elderly patients and its impact in health outcomes.MethodsAll male patients (> 65 years) admitted to a medical ward (> 48 h) between 1.03.2015 to 31.08.2015 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or severity of the acute medical condition. Baseline evaluation included socio-demographic variables, RASS, NPI, Barthel Index and Confusion Assessment Method.ResultsThe final sample consisted of 270 male subjects with a mean age of 80.9 years, 116 (43%) having prior dementia. Dementia patients were significantly older (83.5 vs 78.9; P < 0.001) and had lower values of Barthel Index (dementia: 34.8 vs non-dementia: 85.8; P < 0.001). Mortality rate (9,3%) and length of hospitalization (11.2 days) were similar between groups (12.1 vs 7.1; P = 0.204 and 11.9 vs 10.6; P = 0.218, respectively). Patients with dementia had higher rates of all neuropsychiatric symptoms except depression, anxiety and mood elation. The level of consciousness (measured by RASS) was impaired in 50% of patients with dementia, which was significantly higher than in non-demented subjects (12.3%; P < 0.001). Delirium rates were 29.5% in dementia compared with 7.1% in controls (P < 0.001).ConclusionsThere is a high prevalence of dementia and an appreciable rate of delirium among these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Hyperprolactinemia is a common adverse effect of typical and some atypical antipsychotics and can induce side effects associated with decreased quality of life and poor adherence to treatment. Management options are limited and can lead to decompensation of the patient. Aripiprazole is a recent antipsychotic with partial agonist activity over the dopamine D2 receptors which can be effective in reducing hyperprolactinemia in patients treated with antipsychotics. Review the existing literature about the effect of adjunctive treatment with low doses of aripiprazole on antipsychotic-induced hyperprolactinemia. Search for literature about the topic in PubMed and Goocle Scholar databases using "hyperprolactinemia" and "aripiprazole" as keywords. We found 6 case reports with 8 patients treated with risperidone, paliperidone, zuclopenthixol and fluphenazine that, with 2,5-10mg of aripiprazole, showed a decrease in serum levels of prolactin. 4 open label studies, with a total of 69 patients, all treated with risperidone, also showed a decrease in prolactin levels for adjunctive treatment with 3-10mg of aripiprazole. Two double-blind and two single-blind RCT vs placebo was found, with a sample of 297 patients treated with risperidone or sulpiride and 5-10mg of aripiprazole, and showed decrease in serum levels of prolactin. In all studies treatment with aripiprazole was not significantly associated with an increase in adverse effects or worsening of clinical symptoms. The antipsychotic-induced hyperprolactinemia could be partially or totally reversed after adding low doses of aripiprazole to current treatment. It seems to be an effective, safe and well tolerated option.