measured using the 4-item Perceived Stress Scale. Blood levels of the carotenoids lutein and zeaxanthin were measured at baseline. Covariates included demographics, education, health conditions, and health behaviours. The effect of stress, carotenoids and their interaction on cognitive function was analysed using mixed-effects regression.

**Results:** Stress was negatively associated with global and memory scores. There was a positive main effect of zeaxanthin on memory (b=-1.12, p<0.05, 95% CI: -2.24, -0.006). There was also a significant effect of the interaction between zeaxanthin and stress on memory scores such that, among individuals with higher stress, those with higher levels of zeaxanthin showed better memory than those with lower zeaxanthin (b=0.32, p<0.01, 95% CI: 0.08, 0.55). There was no significant effect of the interaction on the other cognitive domains.

**Conclusions:** There is limited evidence that antioxidant compounds such as lutein and zeaxanthin may have a protective role in stress-related cognitive dysfunction. More detailed study is warranted.

## O-081

### The effect of a cognitive stimulation program on institutionalized elderly: a randomized controlled trial

V. Parola¹, A. Coelho¹, H. Neves¹, A. Mouro², M. Almeida³, S. Duarte³, A. Cavaleiro³, D. Cardoso¹, J. Apóstolo¹. ¹Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal; Centre for Evidence-Based Practice: a Joanna Briggs Institute Centre of Excellence, Portugal; ²Santo Antonio Nursing Home, Portugal; ³Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal

**Introduction:** Cognitive stimulation therapy (CST) offers a range of activities, which provide general stimulation for thinking, concentration, and memory, commonly in a social setting. This paper describes the effectiveness of CST on cognition and depressive symptoms in older adults in nursing homes (NHs).

**Methods:** A randomized controlled trial, carried out in 2016, included 100 residents from five NHs, 75 women and 25 men (randomized into experimental (n=49) and control groups (n=51)). Six participants dropped out (intention to treat (ITT) analysis and per protocol (PP) analysis were performed). During 7 weeks, participants of the experimental group underwent 14 CST sessions, and participants of the control group received usual care. The Mini-Mental State Examination, the Geriatric Depression Scale-15, were administered at baseline and postintervention.

**Results:** Inferential statistics revealed that CST increased cognition in the experimental group (p<0.01; R2 (%) =58.82), although evidence of differences between groups in depressive symptoms was not found (p>0.05; R2 (%) =43.4). However, from a clinical point of view, in the experimental group there was evidence of depressive symptoms reduction (p<0.05), while there was no evidence reduction in the control group (p>0.05).

**Conclusions:** CST had significantly improved cognition, with a moderate significant correlation, but there was no statistical evidence of its effectiveness on depressive symptoms. These results support the implementation of CST in NHs. Additionally CST may also have an important economic impact by reducing the costs of the impact of elders' cognitive frailty.

## O-082

### Optimization of antipsychotic drug's prescription through an efficient personalized awareness campaign towards nursing home residents suffering from dementia

A.S. Philippe¹, D. Braunstein¹, S. Tessier², B. Roch³, J. Micallef¹, S. Bonin-Guillaume¹. ¹Assistance Publique Hôpitaux de Marseille, Aix Marseille Université; ²EHPAD La Bastide des Oliviers, ORPEA, Vitrolles; ³COS Saint Maur, Marseille

**Introduction:** Antipsychotics drugs (AP) are commonly used to

treat behavioral and psychological symptoms in dementia (BPSD) although their non-negligible adverse effects. Despite several warnings, the prevalence of AP use remains high, particularly in nursing homes (NH).

**Aim:** Optimizing the AP's prescription of NH residents suffering from dementia, with a personalized awareness campaign to the resident's general practitioner (GP) by the NH practitioner. Study design: Observational prospective multicentric study.

**Methods:** All permanent NH residents suffering from dementia or cognitive impairment that are treated with AP were included in the study. Each related NH's practitioners were asked to fill up a questionnaire for every resident, based on her/his medical record. Then, the practitioner asked the resident's general practitioner (GP) to reevaluate the need of the AP's prescription after giving information about the benefice/risk of AP in these indications and reminding national warnings about AP's prescriptions in NH.

**Results:** 30 NH volunteered to participate for a total of 2344 residents. Out of those residents, 24% were under AP regimen, 15% were diagnosed demented and had AP's prescriptions. 317 residents' file were retained; 80,1% of which had an atypical AP's prescription. Most of the residents had a psychotropic drugs coprescription (anxiolytic Benzodiazépines and BZD-like: 43.2%; Antidepressants: 33.1%; Hypnotics: 16.1%). Only 187 files (60%) were completed by the GPs. After the campaign, 44.8% of the AP's prescriptions were modified by the GP (15.5% withdrawal, 19.3% dose modification).

**Conclusion:** The number of AP's prescription is high in NH residents with dementia and is often associated to other psychotropic drugs prescription. Personalized awareness campaign showed an improvement in optimizing AP's prescription in this population. This has to be confirmed with the follow up of this cohort.

## Area: Acute care

### O-083

#### Acute heart failure management and treatment in the elderly: adherence to current guidelines in the real world. Data from the ATHENA Registry

A. Pratesi¹, F. Orso², A.C. Baroncini², A. Lo Forte², C. Ghiara², S. Parlapiano³, A. Herbst³, G. Biagioni³, F. Fedeli³, M.L. Di Meo², E. Currassi³, N. Marchionni⁴, M. Di Bari², L. Gabbani⁵, A. Ungar², S. Baldasseroni². ¹Geriatric Intensive Care Unit, Careggi University Hospital, Florence; University of Florence, Florence, Italy; ²Geriatric Intensive Care Unit, Careggi University Hospital, Florence, Italy; ³University of Florence, Florence, Italy; ⁴Division of General Cardiology, Careggi University Hospital, Florence, Italy; ⁵Department of Medicine and Geriatrics, Florence, Italy

**Introduction:** Heart failure (HF) has a high prevalence in the elderly. Aim of our study was to compare adherence to current clinical guidelines in the management of elderly patients hospitalised for acute HF in the settings of care of most frequent management: cardiology, internal medicine and geriatrics.

**Methods:** Data derived from the ATHENA retrospective observational study which included elderly patients (≥65 years) admitted for acute HF to the emergency department of a tertiary University teaching-hospital and transferred to the above described settings of care in the period 01.12.2014-12.01.2015.

**Results:** 342 patients composed the study population; 17.8% were hospitalised in cardiology, 17.3% in geriatrics and 64.9% in internal medicine. Mean age was 83.7 years, females were 54.1%. 28.1% of the patients had not performed any echocardiographic evaluation during hospitalization. In 44% of patients, no information regarding body weight measurement was collected during hospitalisation. In patients with HF with reduced ejection fraction prescription rates
for beta-blockers, ACE-inhibitors/angiotensin receptor blockers and mineralocorticoid receptor antagonists were 77.3%, 58.6% and 49.3% respectively, without significant differences across the considered settings of care. A clinical FU at the discharge was scheduled only in 16.0% of the total study population, 70.0% in cardiology, 7.0% in geriatrics and 5.0% in internal medicine; p=0.001).

**Conclusions:** In elderly patients hospitalised for acute HF a low adherence to current international guidelines recommendations regarding HF management could be observed. This was particularly evident for non-pharmacological strategies that are known to reduce the risk of rehospitalisation.

### O-084

#### Screening for frailty in the Emergency Department: The utility of The SHARE-FI in predicting outcomes in a cohort of older patients

A. Fallon, L. Kilbane, R. Briggs, T. Coughlan, R. Collins, D. O'Neill, S. Kennelly. Department of Age-Related Healthcare, Tallaght Hospital, Dublin 24

**Introduction:** Greater numbers of older patients are accessing hospital services. Specialist geriatric input at presentation may improve outcomes for high risk patients. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) was developed for use in the community but has been shown to be useful in the emergency department (ED). To measure frailty, review its prevalence in older patients presenting to ED and compare characteristics and outcomes of frail patients with their non-frail counterparts.

**Methods:** Prospective cohort study was carried out with pre-specified convenience sampling of those aged ≥70 years presenting to ED on a 24/7 basis, from January-August 2014. Patient characteristics were recorded using symphony® electronic data systems; SHARE-FI assessed frailty. Cognition, delirium and six and twelve month outcomes were reviewed.

**Results:** Older patients were more likely to die (OR2.34, 95% CI1.30–4.21, p=0.004) and less likely to be alive and at home at twelve months (OR=0.49, 95% CI: 0.23–0.83, p=0.009). Patients with dementia (OR=0.24, p=0.005) and on ≥5 medications (OR=0.37, 95% CI: 0.16–0.87, p=0.022) had a lower likelihood of being alive and at home at twelve months. Frailty was not associated with a significant difference in mortality rates (OR=0.89, 95% CI:0.58–1.38, p=0.614) or being alive and at home at twelve months (OR=1.07, 95% CI: 0.72–1.57, p=0.745).

**Conclusions:** This study suggests SHARE-FI was an inappropriate screening instrument in ED. It may be more useful to treat all older patients as being at risk of adverse outcomes. New screening tools to assess older patients presenting to hospital are required.

### Area: Longevity and prevention

### O-085

#### The obesity paradox: A result of mismeasurement?

K. Bowman¹, D. Melzer². ¹University of Exeter; ²University of Exeter & University of Connecticut Health Center

**Introduction:** In middle aged cohorts, being overweight (BMI 25–29.9) or moderately obese (BMI 30–34.9) is clearly associated with increased mortality, but in later life reduced mortality has been reported. This opposing mortality risk is termed the obesity paradox in older people. We aimed to examine this paradox by assessing the impact of smoking, conditions associated with weight loss, and measurement errors associated with BMI, in very large cohorts.

**Methods:** We used electronic medical records (from Clinical Practice Research Datalink) for nearly 1 million primary care patients aged ≥60 years, with 14.9 years of follow-up. We also used UK Biobank data, including 500,000 volunteers aged 40 to 69 years, with 8 years of follow-up.

**Results:** Mean BMI declines progressively for 14 years before death, potentially biasing risk estimates. Mortality is increased for moderately obese patients aged ≥60 years after properly accounting for smoking and conditions associated with weight loss. The risk paradox is explained further by central adiposity not being measured by BMI. Measures combining BMI and waist-to-hip ratio classified patients more accurately: there were major excess risks for mortality and incident cardiovascular disease in overweight or moderately obese but otherwise healthy 60 to 69 year olds.

**Conclusions:** In later life, people within BMI defined overweight or obesity are at substantially increased risk for mortality and incident cardiovascular disease after accounting for confounding conditions. Calls to amend policies for obesity prevention and to promote healthy ageing are unwarranted.

### Area: Metabolism and nutrition

### O-086

#### Associations between dietary intake and resistance exercise with change in body composition and physical function among elderly

O.G. Geirsdottir¹, A. Ramel¹, M. Chang², K. Briem³, P.V. Jonsson⁴, I. Thorsdottir¹. ¹Unit for Nutrition Research, The National University Hospital of Iceland & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; The Icelandic Gerontological Research Institute; ²The Icelandic Gerontological Research Institute; ³Department of Physical Therapy, University of Iceland; ⁴School of Medicine, University of Iceland, Reykjavík, Iceland; The Icelandic Gerontological Research Institute

**Background:** Age related changes in body composition and physical function are important factors in healthy aging. Dietary intake and physical resistance exercise (RE) can affect these changes. The aim of this study was to investigate the associations between dietary intake and resistance exercise with change in body composition and physical function (PF) among elderly Icelanders.

**Method:** Intervention study with RE for 12 weeks. Participants were community dwelling, aged 65 years and older (60% females). Body composition was measured using DXA. Quadriceps- and grip strength was measured. PF was measured as timed up and go test (TUG) and the 6 minute walk for distance (6MWD). Three day weighed food records were analysed.

**Results:** On average, all outcome parameters improved significantly after the RE intervention. However, 19% lost lean mass (LM) after the intervention. Where those who lost LM had lower protein intake compared with those who gained LM (80±25 vs. 69±21 g/day, P=0.012 or 0.98±0.27 vs. 0.84±0.24 g/kg body weight, P=0.001), no difference in age, gender, medication or physical activity was found between those who gained LM or lost LM. Participants who did not improved PF had lower energy intake (1656±502 vs. 1870±515 kcal/day, P=0.060)

**Conclusion:** A many studies have demonstrated the beneficial effect of progressive RE on LM, strength and PF among older adults. However, few studies have looked at association with dietary intake among non-respondents participants. Our study underlines the importance of sufficient energy and protein intake in the maintenance of LM, strength and PF in elderly.
## Area: Acute care

### O-087

#### Which are the main precipitating causes of heart failure in elderly patients? Real world evidence from the ATHENA registry

A.C. Baroncini¹, F. Orso¹, A. Pratesi¹, S. Parlapiano², A. Herbst², A. Lo Forte¹, C. Ghiara¹, E. Carrassi², G. Biagioni², M.L. Di Meo¹, N. Marchionni¹, L. Gabbani¹, M. Di Bari¹, A. Ungar¹, S. Baldasseroni¹. ¹Geriatric Intensive Care Unit, Careggi University Hospital, Florence; ²University of Florence

**Introduction:** Whilst clinical trials and cardiological clinical registries identify cardiovascular pathologies as the main precipitating cause leading to hospitalisations for Acute Heart Failure (AHF), "real world" administrative data suggest that precipitating causes may be mainly non-cardiovascular. Our purpose was to compare precipitating causes of Heart Failure (HF) in elderly patients hospitalised for AHF in three different, common care settings: cardiology, internal medicine and geriatrics.

**Methods:** Data derived from ATHENA retrospective observational study which included elderly patients (≥65 years) presenting with a diagnosis of AHF to the emergency department of a tertiary University teaching-hospital and subsequently transferred to the cardiology, internal medicine and geriatric wards in the period 01.12.2014–01.12.2015.

**Results:** Study population was formed by 342 patients; 17.8% of them were hospitalised on the cardiology ward, 17.3% on the geriatrics ward and 64.9% on internal medicine. Mean age was 83.7 years old, females were 54.1%. Pneumonia was found in 39.7% of the cases and was more prevalent on geriatrics (52.1%) and internal medicine (42.6%) settings compared to the cardiology one (20.0%), P=0.001. Sepsis also had a greater focus in geriatrics (4.2%) and internal medicine (8.1%) than in cardiology (no cases), P=0.001. Acute Coronary Syndrome (ACS) caused hospitalization in 6.2% of individuals, reaching a significantly higher prevalence in cardiology (21.7%) compared to geriatrics (2.1%) and in internal medicine (2.5%), P=0.001.

**Conclusions:** Precipitating causes of HF in the elderly population hospitalised for AHF are mainly non-cardiovascular, as pneumonia and sepsis, and they seem to be criteria for admission onto different care setting.

## Area: Metabolism and nutrition

### O-088

#### Tailored nutritional guidance has positive effect on energy and protein intake of geriatric patients after discharge: a randomized controlled trial

J. Verho, T. Puranen, M. Suominen. Department of General Practice and Primary Health Care, University of Helsinki, Finland

**Introduction:** Malnutrition is common among hospitalized older adults and nutritional status may deteriorate during hospital stay. Recovering from acute disease requires good nutritional status and adequate energy and protein intake.

**Methods:** 24-week randomized, controlled trial was used to investigate effectiveness of tailored nutritional guidance on nutrient intake after discharge among independently living older adults with normal cognition. MNA was used to assess nutritional status and three-day food diaries collected after discharge to assess nutrient intake. Nutritional guidance included at least one home visit

with registered dietitian, personalized nutritional care plan, written material and ONSs when needed.

**Results:** 41 (73% women) older adults, age 76 y (SD 6) were recruited. 61% of all participants were at risk for malnutrition and only 17% reached the recommended protein intake of 1.2g/kg. Mean energy intake increased in the intervention group (I) from 1210 kcal (SD 359) to 1655 kcal (SD 468) and decreased in the control group (C) from 1532 kcal (SD 477) to 1425 kcal (SD 412) (P<0.05). Mean protein intake increased from 57 g (SD 19) to 76 g (SD 20) in I and decreased from 75 g (SD 25) to 65 g (SD 22) in C (P<0.001).

**Conclusions:** The risk of malnutrition, poor energy and protein intake are common among geriatric patients after discharge. Tailored nutritional guidance and use of ONSs improve energy and protein intake which are essential when recovering from acute disease.

### O-089

#### Agreement between ESPEN criteria and MNA in the diagnosis of malnutrition in elderly patients with hip fracture

L. Del Rosario Evangelista Cabrera¹, L. Fernández Arana¹, V. Garay Airaghi¹, E. Lueje Alonso¹, P. Matía Martín², F. Cuesta Triana¹.

¹Department of Geriatrics, Hospital Clínico San Carlos, Madrid, Spain;

²Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Madrid, Spain

**Introduction:** Recently, new malnutrition diagnosis criteria have been proposed by ESPEN (European Society of Clinical Nutrition and Metabolism) in patients with positive nutritional screening. Validation is still advocated. The objective of this study was to describe the agreement of two methods of nutritional assessment: Mini Nutritional Assessment (MNA) and the new ESPEN criteria.

**Methods:** Patients admitted to the Orthogeriatric Unit above 65 years. During the first 48 hours from admission, a nutritional assessment was carried out: MNA-SF as a screening tool, and when positive, complete version of the MNA and the ESPEN criteria method were applied. A monofrequency Akern® bioimpedance was used to measure the fat free mass index (FFMI). The agreement was determined by Kappa index.

**Results:** 213 patients were evaluated. 42.7% (91) were at risk of malnutrition. The complete version of the MNA in this subsample showed a malnutrition prevalence of 14.3% – n=13 – (score <17) and 84.6% – n=77 – (when a score <24 was considered). The prevalence of malnutrition with ESPEN criteria was 30.8% – n=28; 14 patients with lost values of FFMI and those from the estimation of weight loss 3 months earlier. Considering a MNA score <17, the kappa index for malnutrition diagnose was 0.207 (p=0.038). When a MNA score <24 was used, the kappa index for malnutrition diagnose was 0.043 (p=0.498).

**Conclusions:** The two methods evaluating the nutritional status show a poor or very poor agreement in elderly hip fracture patients. To test the value of each method it is mandatory to assess their relationship with disability and clinical events (mortality, length of stay and complications).

## Area: Acute care

### O-090

#### HFmrEF in elderly patients: the pathogenetic role of ischemia. Real world data from the ATHENA registry

A. Lo Forte¹, F. Orso¹, A. Pratesi¹, C. Ghiara¹, A. Baroncini¹, M.L. Di Meo¹, L. Gabbani², M. Di Bari¹, A. Ungar¹, S. Baldasseroni¹, N. Marchionni³, S. Parlapiano⁴, A. Herbst⁴, G. Biagioni⁴, F. Fedeli⁴.

¹Geriatric Intensive Care Unit, Careggi, University Hospital, Florence;

²Department of medicine and geriatrics, Careggi, Florence; ³Division of
General Cardiology, Careggi, University Hospital, Florence; ⁴University of Florence

**Introduction:** Recently, the ESC has recognized the presence of an "area" of patients with ejection fraction between 40 and 49% defined as "mid-range" Heart Failure (HFmrEF).

**Methods:** Data derived from ATHENA retrospective observational study (patients ≥65 years) admitted with diagnosis of AHF (worsening or de novo) to the Emergency department in the period 01.12.2014–01.12.2015.

**Results:** 246 patients were included: (HFmrEF 19.5%, HFrEF 30.5%, HFpEF 50.0%). HFmrEF and HFpEF shared similar characteristics: mean age 83.8–84.5 versus 79.9 in HFrEF, p<0.001, prevalence of females 41.7%, 67.5% versus 32.0%, p<0.001. History of coronary disease was more frequent in HFmrEF (41.7%) and HFrEF (36.0%) than HFpEF (19.5%), p=0.004, as well as the prevalence of previous PCI (27.1%, 25.3% and 11.5% respectively, p=0.014). Ischemic aetiology was prevalent in HFmrEF (47.9%) and HFrEF (40.0%), while in HFpEF was only 28.5%, p=0.038. Acute coronary syndromes represented (in HFmrEF, was the most frequent precipitating cause (11.6%) and coronary angiography was the procedure most frequently performed in elderly with HFmrEF (12.5%) and in those with HFrEF (22.7%), higher than those reported for patients with HFpEF (6.5%), p=0.004.

**Conclusions:** These data suggest that ischemia plays a role in the pathogenesis of HFmrEF. Patients with HFmrEF could be a group consisting of a subgroup of patients with HFpEF that have experienced a reduction of ejection fraction and a subgroup of patients with HFrEF that improved part of the LVEF: (HFrecEF, Recovered Ejection Fraction).

# Area: Comorbidity and multimorbidity

## O-091

### Pre-stroke mobility associated with worse outcomes in dementia patients with stroke - data from the Swedish Dementia (SveDem) and Stroke registries

M. Eriksdotter¹, B. Contreras Escamez², E. Zupanic³, D. Religa⁴,
L. von Koch⁵, K. Johnell⁶, M. von Euler⁷, I. Kåreholt⁸,
S. Garcia-Ptacek⁹. ¹Karolinska Institutet, Department of Neurobiology,
Care Sciences and Society, Center for Alzheimer Research, Division of
Clinical Geriatrics, Huddinge; Karolinska University Hospital,
Department of Geriatric Medicine, Stockholm, Sweden; ²Karolinska
Institutet, Department of Neurobiology, Care Sciences and Society,
Center for Alzheimer Research, Division of Clinical Geriatrics,
Huddinge; Department of Geriatrics, Hospital Universitario de Getafe,
Getafe Madrid, Spain; ³Karolinska Institutet, Department of
Neurobiology, Care Sciences and Society, Center for Alzheimer
Research, Division of Neurogeriatrics, Huddinge; Department of
Neurology, University Medical Centre, Ljubljana, Slovenia; ⁴Karolinska
Institutet, Department of Neurobiology, Care Sciences and Society,
Center for Alzheimer Research, Division of Neurogeriatrics, Huddinge;
Karolinska University Hospital, Department of Geriatric Medicine,
Stockholm, Sweden; ⁵Karolinska Institutet, Department of
Neurobiology, Care Sciences and Society, Division of Occupational
Therapy, Huddinge, Sweden; ⁶Karolinska Institutet and Stockholm
University, Aging Research Center (ARC), Stockholm, Sweden;
⁷Karolinska Institutet, Department of Clinical Science and Education,
Södersjukhuset and Department of Medicine, Solna, Stockholm;
Karolinska University Hospital, Department of Clinical Pharmacology,
Stockholm, Sweden; ⁸Karolinska Institutet and Stockholm University,
Aging Research Center (ARC), Stockholm; Jönköping University,
Institute of Gerontology, School of Health and Welfare, Aging Research
network - Jönköping (ARN-J), Jönköping, Sweden; ⁹Karolinska

Institutet, Department of Neurobiology, Care Sciences and Society,
Center for Alzheimer research, Division of Clinical Geriatrics,
Huddinge; Södersjukhuset, Department of Internal Medicine. Section
for Neurology, Stockholm, Sweden

Stroke is a common cause of morbidity and mortality in patients with dementia. Pre-stroke dementia is associated with worse outcomes, including a higher rate of disability and mortality. Baseline mobility is an important predictor of functioning and mortality after stroke.

**Objectives:** To assess the role of mobility and dementia as predictors of level of residential assistance, dependency for mobility and mortality in older patients with stroke. Methods: This is a longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Rikssroke, the Swedish Stroke Registry. 1689 patients >65 years old with dementia registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 non-dementia controls with stroke.

**Results:** Pre-stroke dependency in activities of daily living and mobility was worse in dementia patients than non-dementia controls. Patients with dementia were more likely to be discharged to nursing homes after a stroke than non-dementia controls (51 vs 20% p<0.001). After the stroke, mortality at three months was higher in dementia patients (31 vs 23% p<0.001) and fewer were living at home without help (21 vs 55%; p<0.001). Patients who moved independently before stroke were more often discharged home (60% vs 28%) and had lower mortality. In adjusted analyses, pre-stroke mobility limitations was associated with higher odds for poorer mobility, needing more residential assistance, and death.

**Conclusion:** Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations.

## O-092

### Risks of longer term proton pump inhibitor exposure in 228,752 older adults

J. Zirk-Sadowski ¹,², J. A. Masoli ¹,³, J. Delgado ¹, W.D. Strain ³,⁴,
W. Hamilton ⁶, W. Henley ⁵, D. Melzer ¹, A. Ble ¹. ¹Epidemiology and
Public Health, University of Exeter Medical School, Barrack Road
Exeter, EX2 5DW, UK; ²Medicines Policy Research Unit, Centre for Big
Data Research in Health, University of New South Wales, Sydney, NSW
2052, AU; ³Department of Healthcare for Older People, Royal Devon
and Exeter National Health Service Foundation Trust, Barrack Rd,
Exeter, EX2 5DW, UK; ⁴Department of Diabetes and Vascular Medicine,
University of Exeter Medical School, Exeter, Barrack Road, EX2 5AX, UK;
⁵Health Statistics Group, University of Exeter Medical School, St Luke's
Campus, Exeter, EX1 2LU, UK; ⁶Primary Care Diagnostics, University of
Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK

**Introduction:** Proton Pump Inhibitors (PPIs) are commonly prescribed and often continued in older adults, with limited understanding of longer term risks. We aimed to estimate the risk of fragility fractures (FFs), late community acquired pneumonia (CAP), and cardiovascular disease (CVD) in older adults exposed to PPIs for ≥1 year.

**Methods:** We conducted retrospective cohort analyses in adults over 60 years old using primary care records (CPRD) linked to hospital records (HES). We analysed: i) 86469 patients to estimate the 4-year FF risk; ii) 150100 to estimate the second-year CAP incidence after PPI start; iii) 228752 clopidogrel-free patients to estimate the 4-year CVD (myocardial infarction [MI] and ischaemic stroke [stroke]) risk; and relevant 1:1 age- and gender-matched controls. We used a statistical difference-in-difference methodology (the "Prior Event Rate Ratio" [PERR]) to adjust for measured and unmeasured confounding, as well as traditional propensity-score-adjusted Cox's models.
**Results:** PPI patients were at greater longer-term risk of: i) Fragility fracture (PERR-adjusted Hazard Ratio [HR]: 1.27, 95% CI: 1.16 to 1.34); ii) Community Acquired Pneumonia (HR=1.82, 1.27 to 2.54); iii) MI (HR=2.11, 1.79 to 2.54) and stroke in aspirin treated patients (HR=1.43, 1.12 to 1.94), with no increased stroke risk without aspirin exposure (HR=1.01, 0.83 to 1.17). Several sensitivity analyses conducted in relevant sub-groups and/or using alternative statistical methods provided consistent results.

**Conclusions:** These results raise questions about the safety of current widespread prescribing practices of PPIs in older patients.

# Area: Organisation of care and gerotechnology

## O-093

### Benchmarking European Community care delivery on costs and quality of care, a novel approach

H. van der Roest¹, L. van Lier¹, L. van Eenoo², A. Declercq²,
G. Onder³, V. Garms-Homolová⁴, H. Finne-Soveri⁵, P.V. Jónsson⁶,
J. Smit⁷, J. Bosmans⁸, H. van Hout¹. ¹VU University medical center;
²KU Leuven; ³Università Cattolica del Sacro Cuore; ⁴Hochschule für
Technik und Wirtschaft; ⁵National Institute for Health and Welfare;
⁶Landspitali National University; ⁷GGZ inGeest; ⁸VU University

To deliver adequate care in the future to the rapidly ageing population and avoid excessive costs, reform of healthcare systems is necessary. Evidence-based restructuring of systems should build on reliable benchmarks of quality and costs of care, which are lacking. A novel benchmark method on organizational efficiency in community care was developed with the IBenC project. Longitudinal data collection was performed among 2884 community care clients (six countries, 38 organizations) by means of the comprehensive geriatric assessment instrument interRAI-HC. Baseline and six month follow-up assessments were used. The 11-point Independence Quality scale (IQS) and Clinical Balance Quality scale (CBQS) expressed quality, respectively reflecting quality of care aimed at functional independence and engagement, and at functional improvement. Higher scores indicate better quality. Six month cost of care were estimated by valuing resource utilization with Dutch standard costs. Case-mix adjustments were applied. Organizational quality varied between poor to good: IQS scores varied between 2 and 7, CBQS between 4 and 8. Mean adjusted costs were €21.004 (range €14,300–€24,209). Quality and cost outcomes were integrated in the IQS-index and CBQS-index. Index values of 1 indicate average quality against average costs, higher values reflect better organizational efficiency. IQs-index ranged between 0.49 to 1.74 and CBQS-index between 1.00 and 1.66. The indexes had high face-validity compared to the plotted costs and quality and discriminated organizations based on their efficiency. The indexes permit for a novel benchmark approach, opening up possibilities for unexplored areas of research and knowledge in organizational performance and restructuring care systems.

## O-094

### City4Age: unobtrusive detection of mild cognitive impairment and frailty by harnessing sensor technology and big data sets in smart-cities

G. Ricevuti¹, S. Copelli², L. Venturini¹, F. Guerriero³, F. Mercalli².
¹University of Pavia, Italy, CITY4AGE Project; ²MultiMed Engineers SRLS, Parma, Italy, CITY4AGE Project; ³ASP S.Margherita Hospital, Pavia, Italy

City4Age aims to demonstrate the potential of large datasets obtained from sensing technologies in smart-cities' contexts, to adopt preventing actions for older people [1]. In particular, the challenge is

to demonstrate that such datasets can be harnessed to early detect the onset of Mild Cognitive Impairment (MCI) and frailty - ideally before signs and symptoms become evident - and to consequently enact more effective interventions [2]. A fundamental assumption is that current technology allows "unobtrusive" detection, without the need to place significant burden on the monitored person or on her carers [3]. To achieve this goal, City4Age is applying the following approach:- review of established scales, commonly used in geriatrics to measure MCI and frailty onset (e.g. such as the Lawton IADL scale or the Fried Frailty Index) [4] - identification of relevant behaviours implied in such scales (e.g. communication, shopping, use of transportation, cultural/social activities, engagement in physical activities, gait/mobility progression, etc.) - review and classification of data types that can be collected through sensors and from smart-cities' datasets, and used to reconstruct the above behaviours and to discover relevant changes that may have predictive value in relation to the inception of MCI/frailty. Currently, the Project has successfully completed the above actions and defined a risk model that is, at the same time, easy to understand by geriatricians and technically feasible. Since April 2017 such model is under testing at 6 different Pilot cities (Athens, Birmingham, Lecce, Madrid, Montpellier and Singapore), involving 200 elderly participants, monitored for 6-12 months.

**Acknowledgement:** The City4Age project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 689731.

## References:

[1] Paolini P et al, City4Age: Smart Cities for Health Prevention, IEEE Second International Smart Cities Conference, Trento, September 2016.

[2] Lathia N et al, Smartphones for Large-Scale Behavior Change Interventions, IEEE Pervasive Computing, July 2013.

[3] Rantz MJ et al, Using Sensor Networks to Detect Urinary Tract Infections in Older Adults, IEEE 13th International Conference on e-Health Networking, Applications and Services, June 2011.

[4] Memory Training e Ginnastica Mentale per l'anziano, Monica Bacci, CESI, Roma, 2000.

## O-095

### Functional status and social support network as risk factors for hospital readmission in Heart Failure

S. Duarte, R. Amaral, J.J. Eira, P. Vaz Marques. Centro Hospitalar de Trás os Montes e Alto Douro - Hospital de Vila Real, Internal Medicina Department

**Introduction:** Hospital readmission in chronic heart failure (CHF) is widely recognized as a quality indicator of health care. Sociodemographic factors that supplant the power of medical action, are sometimes neglected in assessing the risk of readmission. The set of social disadvantages surrounding the patient have important implications and should be considered at hospital discharge.

**Aim:** The aim is to examine the impact of demographic characteristics, functional status and social support network on hospital readmissions for CHF.

**Methods:** Retrospective study of total admissions at an Internal Medicine Department of a Portuguese hospital, with the main diagnosis of CHF. Data was obtained through the SClinico system and processed by SPSS 24.0® software. The demographic characterization was according to gender and age; functional status according to Katz Scale; social and hospital support network by type of residence, type of support (family/institutional/none) and destination after discharge (with or without referral for external consultation). For hospital readmission were considered hospitalizations with the same diagnosis in the following 12 months.

**Results:** During one year, 336 admissions with the main diagnosis of CHF were reported, 9.3% of the total hospitalizations.
The readmission rate within 12 months was 49.7%. Among the patients 61.3% were female, with a mean age of 79.9±10 years. The functional status was associated with hospital readmission (X2 (4) =32.3, p≤0.05), unlike gender, age and the social support network. Contrary to expectations, the referral for external consultation was associated with more readmissions (OR=2.47, [1.55–3.94], IC 95%).

**Conclusion:** Functional status appears to be a major risk factor for hospital readmission in CHF. The recognition of patients' sociodemographic disadvantages allows better continuity of care after discharge. Future research is needed to define sociodemographic indicators and to measure their role on readmission risk.

### O-096

#### Comparing the quality of discharge documentation between specialist elderly care wards and acute medical or surgical wards

A. Howe, S. Akbar, H. Ashrafi, W. Chmiel, H. Choonara, L. Kent, K. Yip, O. Gaillemin, A. Vilches-Moraga. *Salford Royal NHS Foundation Trust, Salford, UK*

**Objectives:** We wanted to identify if there were differences in the quality of documentation if a patient was discharged from specialist ageing and complex medicine (ACM) wards in comparison to acute medical or surgical wards (non-ACM).

**Methods:** Using established national and local guidance, we reviewed the discharge documentation of three ACM wards and three non-ACM wards; a medical admissions unit, a general surgical ward and an orthopaedic ward. Patients aged ≥74 years were included.

**Results:** 321 records were reviewed. Regarding authorship, 95% of records were written by a team member involved in a patient's care when from an ACM ward in comparison to 84% from general wards. ACM wards performed more highly in documenting the key elements of an inpatient stay; visit summary (98% ACM wards vs. 93% non-ACM wards), investigations (96% vs. 93%), clear list of new diagnoses (69% vs. 57%) and an up-to-date past medical history (65% vs. 38%). If a patient was from a care facility this was documented in 82% of ACM ward summaries compared to 47% of summaries from non-ACM wards. In contrast, discharge documents from non-ACM wards recorded changes to medication regimes with greater accuracy (84%) than those from ACM wards (79%).

**Conclusions:** Across most domains, discharge summaries from ACM wards were of higher quality when compared to those from non-ACM wards. Standardising the approach to discharge documentation across a variety of inpatient wards will improve continuity of care for our elderly population.

### O-097

#### Robots in care for older people: Opinions of potential end-users

S. Tobis¹, C. Salatino², A. Tapus³, A. Suwalska¹. ¹Poznan University of Medical Sciences, Poland; ²Fondazione Don Carlo Gnocchi, Italy; ³Robotics and Computer Vision Lab, France

**Introduction:** The ENRICHME project - Enabling Robot and assisted living environment for Independent Care and Health Monitoring of the Elderly (Horizon 2020 Programme, No: 643691C), uses a mobile social robot for long-term interaction and monitoring of an older person with MCI, with the aim to optimise their independence. We used focus group discussions to collect opinions about the robot-related requirements of older people, as well as their formal and informal caregivers.

**Methods:** Six focus groups discussions were analysed: one organised in Italy (composed of older subjects attending a day centre, and health workers of a day centre), four in Poland (two with older volunteers, one with professional, and one with informal caregivers), one in Greece (with older participants); all participants were willing to discuss the issues related to the introduction of a robot.

**Results:** Six areas of interest were identified:

* overall attitudes towards the robot,

* ethical issues,

* the scope of the robot's functions,

* safety issues,

* doubts about the preparedness of older persons for the robot,

* issues related to the introduction of robots into the lives of the elderly.

In general, the expectations towards the introduction of a social robot were positive.

**Conclusions:** The use of robots by community-dwelling older persons is generally accepted by all participating groups, especially if the robots' introduction is preceded by efficient pre-training. Ethical and practical issues should be taken into account.

### O-098

#### Predicting hospitalisations and emergence visits: Comparing nine risk scores in care dependent elderly from 6 countries: IBenC Study

H. Finne-Soveri¹, G. Onder², V. Garms-Homolová³, A. Declercq⁴, P. Jónsson⁵, J. Bosmans⁶, S. Draisma⁷, K. Joling⁸, ¹National Institute For Health and Welfare Finland (THL); ²Department of Geriatric Medicine UCS Roma; ³University of Applied Sciences Berlin (HTW); ⁴Lucas Institute, University of Leuven; ⁵National University Hospital of Iceland; ⁶VU University Amsterdam, Health Technology Section; ⁷GGZInGeest, Mental Health Organisation; ⁸VU University Medical Center Amsterdam

**Introduction:** We compared the accuracy of nine existing risk scores to predict hospitalisations or emergency department visits among older care dependent home dwelling adults.

**Methods:** We assessed 2884 persons aged 65 or older, who received professional homecare in six different countries in Europe. Main outcome was the occurrence of hospitalisations or Emergency Department visits within 6 months. Nine existing index risk scores were computed using baseline data: (1) The Changes in Health, End-stage Disease, Signs, and Symptoms Scale (CHESS); (2) Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT); (3) Method of Assigning Priority Levels (MAPLe); (4) Identification Seniors At Risk Primary Care (ISAR PC); (5) Emergency admission risk likelihood index (EARLI); (6) Sherbrooke Postal Questionnaire (SPQ); (7) the Elders Risk Assessment (ERA), (8) Community Assessment Risk Screen (CARS), (9) Rockwood's Frailty Index. Their accuracy to predict was expressed in the area under the ROC curve (AUC).

**Results:** 194 older adults were admitted at the ED and/or hospital ward during the six-month study period. The highest AUC value was found for the DIVERT (AUC=0.70) and CARS (AUC=0.69), followed by EARLI (AUC=0.60), CHESS (AUC=0.58), ERA (AUC=0.63), Frailty Index (AUC=0.54), MAPLE (AUC=0.52), ISAR-PC (AUC=0.49) and SPQ (AUC=0.46). Significantly better AUC values were found in persons without a recent admission at baseline for DIVERT, EARLI and CARS risk scores.

**Conclusion:** DIVERT and CARS were the most promising risk scores: These may help to target preventive interventions in high-risk groups.
# Area: Longevity and prevention

## O-099

### Long-term effects of the LUCAS health promotion and preventive care intervention (RCT) for senior citizens in the community (LUCAS IV/MINDMAP: HORIZON 2020, research and innovation action 667661)

U. Dapp, L. Neumann, W. von Renteln-Kruse. *Albertinen-Haus, Centre of Geriatrics and Gerontology, Scientific Department at the University of Hamburg, Germany*

**Introduction:** A health-promotion and preventive-care RCT was performed in initially community-dwelling older people without need of nursing-care between 2001-2002 as part of the Longitudinal Urban Cohort Ageing Study (LUCAS). The Intervention-group (IG) participants had the opportunity to choose between the programmes "small-group-session" at a geriatric centre performed by an interdisciplinary geriatric team giving information on healthy ageing, physical activity, healthy nutrition and social participation [1]; "preventive home visit (PHV)" performed by a nurse trained in geriatrics [2] or no programme. The 1-year (y) follow-up (FU) results showed significantly higher use of preventive-services and better health-behaviour in the IG (n=878) than the control-group (CG; n=1,702). After completion of the 1-y FU, the CG had the opportunity to participate in the small-group-session, too.

**Methods:** Long-term survival-analyses were performed 12y after 1-y FU. ITT-analyses and in addition, for the subgroup of small-group-session participants On-Treatment-analyses were performed.

**Results:** ITT-Analysis: In the 1y RCT 503 (62.5%) participants of the IG chose small-group-session, 77 (9.6%) persons chose PHV and 224 (27.9%) persons did not choose any. Mean observation-time accounted 10.3y. 313/878 (35.7%) IG-participants and 674/1,702 (39.6%) of the CG died; HR=0.89 [3]. On-Treatment-Analysis: 768 (IG: 503; CG: 265) small-group-session participants were analysed against 1,335 (IG: 224; CG: 1,111) non-participants. Mean observation-time was 10.9y. 194/768 (25.3%) small-group-session participants and 531/1,335 (39.8%) non-participants died; HR<0.001. The results were confirmed after adjustments.

**Conclusions:** The small-group-session addresses ROBUST older persons (ca.18.4% of the European population >65y), to strengthen functional competence and reserves to proactively prevent/postpone frailty and/or need of nursing-care.

## References:

[1] Dapp et al. J Public Health 2005;13:122-7.

[2] von Renteln-Kruse et al. Z Gerontol Geriatr 2003;36:378-91.

[3] Neumann et al. J Nutr Health Ageing 2017; imprint.

## O-100

### Reducing physical restraints in a care home company

D. Curto¹, P. Cano¹, C. García¹, J.F. Tomas². ¹Sanitas Mayores Sanitas ELA-Bupa; ²Sanitas ELA-Bupa

**Introduction:** Half of Spanish Alzheimer patients have suffered, at some point, the use of physical restraints, especially with people with behavioral symptoms and cognitive impairment, especially those that have symptoms of dementia. Prevalence of restraints for elderly residents with dementia has been reported between 21.5 and 41.2% in different Spanish regionsThe main issue of the study was to demonstrate that the use of physical restraints provides no benefits in the care of people with dementia.

**Methods:** In 2011 Sanitas Mayores started an ambitious program to reduce physical restraints in all of its 41 care homes. After implementing an All Staff training programme and analyzing a sample of more of 7,657 subjects from care homes showed that the

frequency of residents having at least one restraint was reduced from 18.1% to 1.0%.

**Results:** Beside the use of benzodiacepines was reduced, with no significant changes in mortality. The rate of total falls increased from 13.1% to 16.1% with no significant increase in injurious falls. The group of residents most restrained before the program were people with dementia (29%). There was no significant difference in use of bed rails at both study waves when the total samples were compared (43.5% vs. 41.7%). A global decrease in psychotropic medication prescription was recorded in people who had dementia.

**Conclusions:** It is safe to reduce physical restraints after a training programme delivered to all staff. The reductions of physical restraints was not accompanied by an increase of psychotropic medications prescription

## O-101

### Predictors of attrition in a large, long-term exercise randomized controlled trial – The Generation 100 study

H. Viken¹, J. Nauman¹, N. Zisko¹, N.P. Aspvik², J.E. Ingebrigtsen², U. Wisloff¹, D. Stensvold¹. ¹K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology Trondheim (NTNU), Norway; ²Department of Sociology and Political Science, Faculty of Social and Educational Sciences, NTNU, Norway

**Introduction:** Dropout from exercise programs both in the real world and in research is a challenge, but few have examined predictors of attrition in exercise randomized controlled trials (RCTs) conducted in the real world, in the general population and over a longer time period – among older adults. The aim of the present study was to examine attrition prevalence rates and predictors, from baseline to 3-years, in a long-term exercise RCT with older adults.

**Methods:** Generation 100 is the world's largest RCT (n=1567) in a general older population, examining the effect of exercise on mortality in older adults (70-77 years at baseline). All study participants were randomized to either exercise- or control group for 5 years. Self-reported demographics (e.g. education), general health, specific health conditions (e.g. heart disease, memory loss, psychological distress), smoking and physical activity (PA) were examined at baseline. Cardiorespiratory fitness (CRF) and grip strength were directly measured. Multivariate logistic regression analysis was used to identify predictors of attrition.

**Results:** The total attrition rate was 14.4% (n=225) after 3-years. Significant predictors of attrition in the exercise group were CRF, level of education (p<0.01), memory status and PA level (p<0.05), and in the control group CRF (p<0.01) and memory status (p<0.05).

**Conclusions:** This is the largest study of predictors of attrition in a long-term exercise RCT on older adults. Our findings provide new and important knowledge about older adults potentially at risk of attrition in long-term exercise RCTs.

## O-102

### Dietary consumption and self-reported health status in older adults. A cross-sectional study

K. Shibasaki¹, S. Yamada², S. Ogawa¹, M. Akishita¹. ¹Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo; ²Komagane Kogen Ladies Clinic

**Introduction:** Little is known about the association between dietary consumption and health status in older adults. We investigated the relationship between them.

**Methods:** We recruited 1394 community-dwelling older adults in Nagano (highest life expectancy in Japan). Food frequency questionnaire and self-reported health condition (physical condition and depressive mood) were asked all participants. Dietary data covered
13 major food groups: fish, meat, eggs, milk, soybeans products, vegetables, seaweeds, potatoes, fruits, fat or oil, snakes, salty foods, and alcohol. Physical condition contains 5 questionnaires, fall, walking distance, one-leg stand, usage of cane and decline of walking speed. Depressive mood also contains 5 questionnaires such as fulfilment in your daily life, a lack of joy, difficulty in doing what you could do easily before, and tiredness. Chi-square tests and regression analysis were done to investigate the relationship between dietary consumption and health status.

**Results:** Participants' mean age was 76.3±5.5 years, female were 778 (55.8%). Women consumed meat, soy beans products, potatoes, fruits and snakes frequently compared with men. On the other hand, male consumed salty food and drink alcohol frequently. In men, higher meat consumption was related to long walking distance and less depressive mood. In women, higher soybeans products and vegetable consumption were related to long walking distance and less depressive mood. Logistic regression analysis revealed vegetable consumption was significantly connected to favorable effect on both physical conditions and depressive mood.

**Conclusion:** In older adults, health status might be improved by daily dietary intake such as meat, soy beans products and vegetables.

## O-103

### Variation in falling and fall risk among community-dwelling older citizens in 12 European countries

C. Franse¹, J. Rietjens¹, A. Burdorf¹, A. van Grieken¹, I. Korfage¹, A. van der Heide¹, F. Mattace-Raso², E. van Beeck¹, H. Raat¹.

¹Erasmus MC, department of Public Health; ²Erasmus MC, section of Geriatric Medicine, department of Internal Medicine

**Introduction:** The rate of falling among older citizens appears to vary across different countries, but the underlying aspects causing this variation are unexplained. We aim to describe between-country variation in falling and explore whether intrinsic fall risk factors can explain possible variation.

**Methods:** This was a prospective study of Survey of Health, Ageing and Retirement in Europe (SHARE) data in twelve European countries among community-dwelling persons aged ≥65 years (N=18,596). Socio-demographic factors (age, gender, education level and living situation) and intrinsic fall risk factors (less than good self-rated health (SRH), mobility limitations, limitations with activities of daily living (ADL), dizziness, impaired vision, depression and impaired cognition) were assessed in a baseline interview. Falling was assessed 2-years later by asking whether the participant had fallen within the 6 months prior to the follow-up interview.

**Results:** There was between-country variation in the rate of falling. The prevalence of intrinsic fall risk factors varied 2–4 fold between countries. Associations between factors age ≥80 years, less than good SRH, mobility limitations, ADI limitations, dizziness and depression, and falling were different between countries (p<0.05). Between-country differences in falling largely persisted after adjusting for socio-demographic differences but strongly attenuated after adjusting for differences in intrinsic fall risk factors.

**Conclusion:** There is considerable variation in the rate of falling between European countries, which can largely be explained by between-country variation in the prevalence of intrinsic fall risk factors. These findings emphasize the importance of addressing intrinsic fall risk in (inter)national fall-prevention strategies, while highlighting country-specific priorities.

## Area: Oral and dental health

### O-104

#### Oral pain and discomfort in community-dwelling older people – a randomised 2-year intervention study

K. Komulainen, A. Nihtilä, I. Nykänen, S. Hartikainen. University of Eastern Finland, Finland

**Introduction:** Oral pain or discomfort can cause problems in eating, speaking and swallowing affecting the quality of everyday life. The aim of this study was to examine the effect of oral health intervention on the self-reported oral pain or discomfort among community-dwelling people aged 75 years or older over a 2-year period.

**Methods:** The study was based on subpopulation in Geriatric Multidisciplinary Strategy for Good Care of Elderly People (GeMS) study (2004–2007). In this 2-year randomised intervention study, 279 community-dwelling old people completed the study, 145 person in the intervention group and 134 in the control group. Oral health intervention included individually tailored instructions for oral and/or denture hygiene and healthy oral habits. Oral pain and discomfort were asked by the dentist at the baseline and after one year and two years. Both groups also had the possibility to get basic dental treatment during the study.

**Results:** In the intervention group, at the baseline 31% (n=45) and at the end 21% (n=30) reported oral pain or discomfort. In the control group, the corresponding figures were 22% (n=30) and 18% (n=24). In the intervention group the main reasons at the beginning of the study were problems with removable dentures (n=16), teeth (n=13) or mucosa/tongue (n=13) and after two years problems with teeth (n=11), removable dentures (n=9) or mucosa (n=5).

**Conclusions:** Despite the preventive intervention and dental treatment, every fifth of the participants had oral pain or discomfort. The management of oral pain in old people is challenging, a multifactorial treatment approach is often needed.

## Area: Infectious diseases and vaccines

### O-105

#### Procalcitonin to individualize antibiotic therapy duration in hospitalized pneumonia in very old population

B. de Wazieres¹, M. Paccalin², M. Debray³, R. Gonthier⁴, M. Bonnefoy⁵, S. Drevet⁶. ¹University Hospital of Nimes; ²University Hospital of Poitiers; ³Hospital of Annecy; ⁴University Hospital of Saint Etienne; ⁵University Hospital of Lyon; ⁶University Hospital of Grenoble-Alpes

**Background:** Procalcitonin (PCT) may help Physician to reduce duration of antibiotic therapy (ATBt) in pneumonia in adult. However, there was no specific study older population. We performed a Randomized Clinical Trial assessing if PCT serial measurements reduces antibiotic duration in pneumonia (community or nosocomial) in older patients.

**Methods:** Inclusion criteria were: >80 years old, ATbt <3 days for pneumonia, and had a PCT measurement. After inclusion, PCT was measured every 2 days in both groups (from Day 2 to the end of treatment or discharge). In the PCT group, physician could use PCT levels to stop ATbt according a PCT algorithm, (stop ATbt if PCT <0.25 ng/l and pursues if PCT >0.25 ng/l). Demographic, clinical and geriatric characteristics, and, severity of pneumonia (pneumonia severity index (PSI), CURB 65) at baseline and every 2 days were collected. Diagnosis was confirmed by reviewed Chest
X ray or/and CT Scan. ATBt duration without outcome differences (Day 45) was the first end point.

**Results:** Final analysis includes 107 pneumonia (57 in control group, 50 in PCT group). All characteristics of patients and severity of pneumonia weren't significantly different; In control group, 86% had a CURB 65 of 2 or 3 and 84% had PSI class IV or V; in PCT group 86% had a CURB 65 of 2 or 3 and 78% had PSI was class IV or V; PCT levels were not significantly different in between both group; Antibiotic duration was significantly shorter in PCT group (8. 4 days ±3.1) than in control group (10.7 days ±3.6) (p<0.001). with a good outcome in both groups (>85%). Algorithm was followed for only 52% of PCT group.

**Conclusion:** PCT algorithm is useful to individualize the duration of ATBt for pneumonia in very old without any impact on outcome and leads to decrease ATBt duration. Further studies need to measure the impact of the limitation of antibiotic use at individual and collective level in this special population.

## Area: Pre and post operative care

### O-106

**Baseline characteristics and clinical outcomes of older surgical persons admitted to a tertiary hospital. Proactive care of older people admitted to General surgery-Salford General Surgery (POPS-GS)**

A. Vilches-Moraga, J. Fox, A. Gomez-Quintanilla, M. Tan, A. Paracha, M. Moatari, L. Miguel-Alhambra, M. Rowles, A. Price. Ageing and Complex Medicine Directorate, Salford Royal NHS Foundation Trust

**Introduction:** We describe the characteristics of older people admitted to general surgical wards reviewed by an elderly care in-reach service.

**Methods:** Prospective non-randomised study of consecutive patients >74 years of age requiring admission to general surgery.

**Results:** Between 08/09/2014 and 28/02/2017 we reviewed 719 consecutive patients, age 81.4±4.6, 55.2% females, 577 emergency (Em) and 142 elective (El). 36% underwent surgery (Em 135- 23.3% El 124- 87.3%), 15.4% non-surgical procedure (Em 102- 17.7% El 9- 6.3%) and 48.5% medical management (Em 340- 58.9% El 9- 6.3%). Most common diagnoses: biliary disease in emergency (22.4%) and cancer in elective admissions (70.4%). There were differences in emergency vs elective regarding independence for basic (78.6% vs 98.6%) and instrumental (52.8% vs 88%) ADLs, mobility with no aids/cane (69.2% vs 92.3%), absence of cognitive impairment (81.3% vs 95.8%), ASA I-II (35.7% vs 51.4%), average medications (8.4 vs 6.2) and comorbidities (5.5 vs 4.6). No differences in individual comorbidities except in emergency patients who suffered more ischemic heart disease (30.2 vs 19), stroke (15.9 vs 7.7) and dementia (12 vs 0.7). Median length of stay was 9 days (8 Em, 10 El); in hospital mortality 5.9% 43/719 (2.1% Em, 6.9% El), 30-day mortality from admission 7.3% 53/719 (Em 8.8%, El 1.4) and 30-day readmission rate 8.8% 60/676 (Em 9.9%, 4.3% El).

**Conclusions:** Older persons admitted to surgery are multimorbid and take multiple medications. Biliary disease and cancer are the commonest diagnoses. 50% are managed non-invasively. Individuals admitted electively are significantly less complex and experience significantly better clinical outcomes.

## Area: Infectious diseases and vaccines

### O-107

**Elderly patients (>75yo) with infective endocarditis: geriatric, therapeutic and prognostic characteristics before, through and 3 months after the infection course. (Elderl-IE)**

C. Roubaud-Baudron¹, E. Forestier², G. Gavazzi³, C. Schambach⁴, J. Zirnhelt⁵, C. Patry⁶, E. Averyt⁷, T. Basileu⁸, M. Chuzeville⁹, M.-C. Laurain¹⁰, J.L. Novella¹¹, R. Guiard¹², M. Paccalin¹³, G. Sost¹⁴, J. Naturel¹⁵, B. Chokry¹⁶, C. Ernst¹⁶, F. Alla¹⁷, M.-L. Erpelding¹⁸, W. Ngueyon Sime¹⁸, C. Selton Suly¹⁹. ¹Geriatrics Department, Bordeaux University Hospital, Bordeaux, France; ²Infectious Disease Dot, Ch Metropole Savoie, Chambéry, France; ³Geriatrics Department, Grenoble University Hospital, Grenoble, France; ⁴CH Alès, Alès, France; ⁵CH Annecy, Annecy, France; ⁶Geriatrics Department, Bichat-Claude Bernard University Hospital, Paris, France; ⁷Geriatrics Department, CH Métropole Savoie, Chambéry, France; ⁸Geriatrics Department, Pointe à Pitre University Hospital, Guadeloupe, France; ⁹Geriatrics Department, Lyon University Hospital, Lyon, France; ¹⁰Geriatrics Department, Nancy University Hospital, Nancy, France; ¹¹Geriatrics Department, Reims University Hospital, Reims France; ¹²Geriatrics Department, Polyclinique Les Bleuets, Reims, France; ¹³Geriatrics Department, Poitiers University Hospital, Poitiers, France; ¹⁴Geriatrics Department, Rennes University Hospital, Rennes, France; ¹⁵CH Villeneuve Saint Georges, Villeneuve Saint Georges, France; ¹⁶Geriatrics Department, Montpellier University Hospital, Montpellier, France; ¹⁷Nancy University Hospital, Nancy, France; ¹⁸Public Health Department, Nancy University Hospital, Nancy, France; ¹⁹Cardiology Department, Nancy University Hospital, Nancy, France

**Introduction:** 1/3 patient with infective endocarditis (IE) is >75 yo in Western countries with specific features and prognosis, but geriatric characteristics are poorly known. Our aim was to describe geriatric assessment through the infective endocarditis (IE) course and its impact on 3-month prognosis.

**Methods:** Comprehensive geriatric assessment was performed during the first week after diagnosis of IE (D0) and at 3 months follow-up (M3) over one year in 14 French hospitals.

**Results:** Prior IE, among the 111 pts (83.1±5.1 yrs, 53% men) included, most patients lived at home (88%) with a low CIRS-G score (14.1±6.9) and subnormal ADLs (5.1±1.7). At diagnosis (D0), functional status decreased (ADLs 3.2±2.1) with a cognitive (MMSE 20.2±7.2) and nutritional (MNA<17 in 40%) impairment. Intracardiac devices were frequent (valvular prosthesis 31%, PM 22%). Digestive bacteria and Staphylococcus aureus were the most prevalent pathogens. Surgery was indicated in 36 patients (32%) but performed only in 18. Operated patients were more fit: CIRS-G 9.2±4.3 vs 15.2±7, p<0.001 and MNA 20.9±4.8 vs 17.4±5.9, p=0.03 than others. At M3, 29 patients were dead (27%) and 27 did not attend the visit (24%). The 55 assessed patients recovered and autonomy was almost back at the initial level (ADLs 4.7±1.8), 80% were back at home. Low ADLs (HR 0.7 (0.5–0.9), p=0.002) and MNA score (HR 0.9 (0.8–1.0), p=0.006) at D0 were associated with a poorer prognosis.

**Conclusions:** Nutritional and functional impairment are frequent at admission in elderly patients with IE. They are associated with a less aggressive management and a poorer prognosis.

### O-108

**Management of elderly patients with Clostridium difficile infections: Observational data of the French survey CLOdi**

A. Caupenne¹, I. Ingrand², M. Lauda¹, M. Priner¹, P. Ingrand², G. Gavazzi³, M. Paccalin¹. ¹Pôle de gériatrie, CHU de Poitiers, 2 rue de
la Milétrie, Poitiers, France; ²Epidémiologie et biostatistique, Pôle
Biologie, Pharmacie et Santé Publique, Centre Hospitalier Universitaire
de Poitiers, Université de Poitiers, Poitiers, France; ³Pôle
Pluridisciplinaire de Médecine et de Gérontologie Clinique, CHU de
Grenoble Alpes, Avenue Maquis du Grésivaudan, La Tronche, France

**Introduction:** Incidence of Clostridium difficile infections (CDI) is high in hospitalized elderly patients, estimated at 2.28 cases/10,000 day-patients. Risk of recurrence is reported between 10 and 30% at 3 months, and CDI-related mortality varies from 5 to 40%. The main objective of the French survey CLOdi, is to assess prognosis of elderly patients with CDI. We report observational data collected during hospitalization and therapeutic regimen regarding to the European recommendations, published in 2013.

**Methods:** Prospective observational multicentric study, supported by the French Societies of Geriatrics and Infectious Diseases. From march 2016 to march 2017, patients aged ≥75 presenting with CDI were included in 31 french hospital centers. An online survey focused on clinical criteria of severity, and CDI therapeutic support. A systematic follow-up was performed to report recurrences.

**Results:** One hundred and eighty-two patients were included with 74% of CDI cases that were nosocomial. Overall 144 (79%) patients presented with at least one severity criteria. CDI episods were treated with metronidazole, vancomycin and fidaxomicin, respectively in 55%, 30% and 15% of patients. Less than half of the patients were treated with the appropriate regimen according to the European recommendations. Thirty-one patients (17%) died during the acute infectious episode and the rate of CDI recurrence was up to 11%.

**Discussion:** This is the first national survey focusing on CDI in very elderly patients. Rate of recurrence and mortality are close to literature data. Still our results highlight the lacks of knowledge or of adequacy of therapeutic regimen to the guidelines.

## O-109
### Pertussis incidence in older individuals: Results from the French EPICOQSEN study

G. Gavazzi¹, D. Pinquier², J. Gaillat³, J.-L. Gallais⁴, N. Guiso⁵.

¹University of Grenoble-Alpes; ²CHU de Rouen; ³CH Annecy Genevois;

⁴Société française de médecine générale; ⁵Institut Pasteur de Paris,

Paris, France

**Introduction:** In France, vaccination against Bordetella pertussis is recommended in children and young adult (cocooning strategy) but not for people aged 50 years and over (50+). As the duration of protection is limited following vaccination, the 50+ may be infected and participate in the spread of the disease. The aim of this survey was to assess the incidence of B. pertussis (whooping cough) in 50+ in France.

**Methods:** Between June 2013 and August 2014, participating general practitioners (GPs) using management software Axisanté® were to include all volunteer 50+ patients suffering from a cough lasting 7 to 21 days. Final diagnosis of whooping cough was based on polymerase chain reaction (PCR) (nasopharyngeal samples) or on clinical or epidemiological definition. Crude incidence rates were calculated and then extrapolated to France.

**Results:** 42 GPs included 129 patients (large towns: 38; medium-sized towns; 57, rural areas: 34); 106 samples were collected for analysis. Overall, 30 pertussis cases were diagnosed; 10 were confirmed by PCR and 20 based on clinical and/or epidemiological definitions. Crude incidence rate was 103.6 [95% confidence interval (CI): 69.9–147.9]/100'000 patients (50+) and extrapolated incidence rate was 187.1 [126.2–267.1]; the lowest incidences (77.1 and 131.1, respectively) were observed in large towns.

**Conclusions:** According to these results, older individuals (50+) may play a role in B. pertussis circulation in France. As whooping

cough may be severe in the older population, booster dose of vaccine in 50+ should be discussed. Similar studies are required to elaborate adapted vaccine programs in adult.

## O-110
### Antibiotic resistance of Escherichia coli in 312 non-hospitalised nursing home acquired urinary tract infection

G. Gavazzi¹, F. Guerber², J. Chouteau³, B. Boussat⁴, D. Dye³.

¹University clinic of Geriatric Medicine University Grenoble Alpes/GREPI, EA 7408, Grenoble, France; ²Groupe Oriade-Noviale, Grenoble France; ³Groupe Oriade-Noviale, Grenoble, France; ⁴Public Health Department, University of Grenoble-Alpes

**Introduction:** Urinary tract infection is one the major infection in Nursing home (NH) leading to overuse of antibiotic. The risk of emerging resistance leads to use inappropriate empirical therapy in a high-risk population. E coli is the main bacteria responsible for UTI and bacteraemia and takes part of Intestinal flora in older population. Yet we believe that antibiotic susceptibility of E coli may represent an overview of ATBic susceptibility in NH. The aim of this study was then to analyse ATBic resistance of Escherichia coli in urine culture collected in 14 NH of the same French area.

**Methods:** Between 2014 and 2015, we retrospectively selected from a community private laboratory all positive urine cultures for E. coli performed in 14 NH because of UTI suspicion. All usual antibiotics were tested.

**Results:** 312 Positive urines cultures were analysed. Antibiotic resistances were as follow: amoxicillin 52%, amoxicillin+ clavulanate 34%, ciprofloxacin 18%, ceftriaxone 11,8%, cefexime 14,1% and below 5% for penems, gentmamycin, Furan and fosfomycin; there was no difference in between NH.

**Discussion and conclusion:** Regarding the high level of resistance Amoxicillin, coamoxiclav can no longer be used as empirical treatment; of concern, resistance to 3rd cephalosporin generation, becoming higher than at the university Hospital of the area. This suggests that NH may act as a reservoir of multidrug resistance bacteria; Yet, the surveillance of the resistance is critical in NH to better guide the empirical therapy.

## Area: Pre and post operative care

## O-111
### Total transfusion requirements in hip fracture patients from emergency department to geriatrics: retrospective validation of a restrictive regimen. The UPOG-TRF1 study

L. Dourthe¹, J. Cohen-Bittan¹, L. Zerah¹, H. Vallet¹, A. Gioanni¹, C. Villain¹, R. Haddad¹, M. Verny¹, M. Raux¹, A. Mézière², B. Riou¹, F. Khiami¹, J. Boddaert¹. ¹Pitié Salpêtrière, Paris, France; ²Charles Foix, Paris, France

**Introduction:** In the elderly, management of anaemia and blood transfusion is still a matter of debate in hip fracture (HF). According to the FOCUS study (2011), we evaluated the association between restrictive transfusion strategy and cardiovascular complications during hospitalizations for hip fracture in a dedicated unit of perioperative geriatric care (UPOG).

**Material and methods:** All patients >70 years old admitted for HF to our emergency department were included in our time series analysis study. Patients with multiple, metastatic or periprosthetic fractures were excluded. We used a liberal strategy (LS) (Goal: hb level ≥10 g.dL-1) from July 2009 (the opening of UPOG) until December 2011 and a restrictive strategy (RS) (Goal Hb level ≥8 g.dL-1 or transfusions according to symptoms) from January 2012 until June 2016. The primary endpoint was in-hospital acute cardio-
vascular complications (acute heart failure (AHF), acute coronary syndrome (ACS), acute atrial fibrillation (AF) or stroke). Secondary endpoints were in-hospital 6-month mortality rate, transfusions and infections.

**Results:** 667 patients were included: 193 in the LS group, 474 in the RS group. The change of transfusion regimen for a RS was associated with a reduction in acute cardiovascular complications (21 vs 34%, p<0.01), including AHF (10 vs 19%, p<0.01) and ACS (8 vs 17%, p<0.01), and a UPOG transfusion reduction (31 vs 50%, p<0.01).

**Conclusion:** In elderly patients with consecutive hip fracture, a change to restrictive strategy of transfusion is associated with fewer cardiovascular complications and transfusion with no effect on in-hospital and long-term mortality

# Area: Geriatrics in organ disease

## O-112
Analysis of a national dataset: Single kidney transplant outcomes in recipients over 65

I. Chappelow¹, A. Arshad¹, J. Hodson², J. Nath², A. Sharif².

¹University of Birmingham, Birmingham, United Kingdom; ²Queen Elizabeth Hospital, Birmingham, United Kingdom

**Introduction and aims:** It is well established that patients with end-stage kidney failure that receive kidney transplants have huge improvements in life expectancy compared with the alternative treatment of dialysis. However, the risks versus benefits of kidney transplantation become less clear with increasing age. With our aging population and many patients in their 70's and 80's are receiving transplants yet they are often excluded from clinical research trials. Therefore, I intend to look at the current practice of transplantation in elderly patients in the UK and determine how recipient age affects clinical outcomes in the contemporary era of transplantation practise. Results from this study will hopefully aid decision making into the optimal allocation of these precious resources.

**Method:** This nationwide population cohort analysis used the NHS Blood and Transplant Registry dataset for all deceased donor single kidney transplants to adults aged 18 and over performed in the UK between 2003 to 2015. We originally stratified cases into recipients aged 18–40, 41–59, and 60 and older and then undertook further subgroup analysis focusing on patients over 60, using the following age bands (1≤59, 2=60–65, 3=66–70, 4=71–75, 5=76>). Patient and graft survival outcomes were assessed using Kaplan Meier curves and Cox regression models, while delayed graft function (DGF) was assessed using binary logistic regression.

**Results:** There were 18,769 transplants in our study cohort, with the median age for recipients 48, and age groups were as follows; 40 and under (n=4712), 41–59 (n=8968), and 60 and over (n=5055). In unadjusted analyses, graft survival differed significantly across the age groups (p<0.001). Cox regression analysis showed graft survival was significantly better for the age group 41–59 years (Hazard Ratio [HR]: 0.793, p<0.001) compared with the over 60's group. However, there was no significant difference between graft survival of the over 60's compared to the under 40's [HR=0.984, p=0.755]. Patient survival between the three groups confirmed reduced patient survival with HR 0.143 (p<0.001) and HR 0.353 (p<0.001) for the ages under 40's and 41–59 respectively. Delayed graft function varied significantly between the age groups (40 and under, 23.4%; 41–59, 28.1%; 60 and over, 33.1%, p<0.001). Mean creatinine among surviving kidneys was higher in the 60 and over groups (142 mmol/l) versus the 41–59 group (139 mmol/l) and 40 and under (138 mmol/l) (p<0.001). Further stratification of age groups 60–65 (n=2396), 66–70 (n=1496), 71–75 (n=679), and

> 75 (n=148) showed worse outcomes for creatinine, delayed graft function, graft and patient survival for the over 75 groups compared to other "older" adults.

**Conclusion:** Even in the contemporary era, increasing recipient age remains a predictor of inferior clinical outcomes graft survival, adding a layer of complexity into the decision of how best to allocate such scarce resources. In the literature, there is much heterogeneity in defining at the elderly and therefore we lack clear guidelines on risk of kidney transplantation stratified by recipient age. In our analysis, we highlight this difficulty by showing the gradual stepwise decrease in graft survival and the unusual pattern of delayed graft function amongst the 60 and over group. Therefore, we recommend further research into clinical outcomes among the 60 and over group and consideration should be given for targeted research for age-adapted immunosuppression to optimise outcomes for older kidney transplant recipients.

## O-113
IGF-1 pathway in the regulation of Nox4 ROS production in chondrocytes: Osteoarthritis physiopathology

S. Drevet, G. Gavazzi, B. Lardy. Grenoble University Hospital

**Introduction:** Osteoarthritis (OA) is characterized by a cartilage dysregulation, a degenerescence of the chondrocytes with oxidative stress (OS) involvement. Nox 4 isoform dependent reactive oxygen species (ROS) production is one of the triggers for the matrix metalloproteases (MMPs) synthesis and extracellular matrix (ECM) degradation. IL-1β could induce OA conditions. Insulin-like Growth Factor-1 (IGF-1) is another key regulator in human articular chondrocytes. The main objective of the study was to assess IGF-1 stimulation on MMPs synthesis in chondrocytes immortalized cell line C-20/A4.

**Methods:** We used human C-20/A4 chondrocyte cell line. Nox4 overexpression was performed with retrovirus (RV) Nox4. Rv Nox4 C-20/A4 stimulation was performed using IL1-b 20ng/ml or IGF-1 200ng/ml. Quantitative RT-PCR was used to assess MMP 1, 9, 13, Nox 4 expression level.

**Results:** Human IL-1β stimulation induced MMP-1 -13 and -9 mRNA rate elevation. IGF-1 cell stimulation induced MMP-9 peak at 4 hours and an increase of MMP-13 mRNA level sevenfold at 24 hours. The effect seemed to be Nox4 dependent.

**Conclusions:** We showed for the first time that IL-1β induced MMP-9 by a Nox 4 dependent pathway. High concentrations IGF-1 induced MMP-9 and MMP-13 mRNA synthesis, trigger of catabolism. IGF-1 pathway is interesting since Klotho anti-ageing protein has at least two ways to participate in OA pathway. Klotho is known to inhibit Insulin/IGF-1 pathway and to enhance cellular protection against OS by inducing transcription of anti oxidant enzyme as Mn Superoxide dismutase. Klotho could be a protein of interest for future OA treatment.

## O-114
Analyzing kidney impairment in the elderly

V. Guerrero, R. Quílez, R. Sander, A. Narvión, A. Sanjoaquín, J. Galindo. *H. Sagrado Corazón Jesús, Huesca, Spain*

**Introduction:** Chronic Kidney Disease (CKD) is a disease with a high prevalence in people over 65 years old. It's 23.6% in Spain, 35.7% in Canada, 35.8% in Finland and 23.4% in the USA [1,2]. The most widely accepted method for measuring renal function is glomerular filtration (GFR), for which different formulas have been developed (MDRW, CKD-EPI, Cockroft Gault (C-G), BIS1), although none have been validated in a population older than 70 years or overestimate the true glomerular filtration rate in subjects over 65 years. In 2011 was created a new formula, called HUGE formula (hematocrit, urea and gender). It will help to assure if the GFR is reduced below 60
ml/min, is due to a physiological process associated with aging or
due true CKD [3].

**Objectives:** To evaluate the sensitivity (S) and specificity (E) of the different formulas (MDRW, CKD-EPI, CG, BIS1) to diagnose CKD. Evaluate if the HUGE formula has predictive value in people over 90 years.

**Methods:** Prospective longitudinal cohort study. Study the characteristics of patients over 90 years seen in the out patient clinic between 2015 and 2016 in Huesca. Also Socio-demographic data, comorbidity, analytical results and drugs were recorded. All collected data was analyzed with Statistical analysis SPSS 23.

**Results:** A total: 288 patients with age: 94.5±2.4 years, 69.8% were female, survival in first year of 81.3%. Comorbidities: HTA 78.5%, DM 29.2%, dyslipidemia 45%, anemia 35.7%. We evaluated (S) and (E) of each formula twice during the study: At the beginning of the study, comparing all the formulas against the CKD-EPI obtaining: MDRW4: S: 77.3% and E: 100%. C- G: S: 100% and E: 10.7%. BIS1: S: 100% and E: 20.4%. Throughout the follow-up year, comparing all the formulas against the CKD-EPI from the beginning of the study obtaining; MDRW4: S: 82.9% and E: 93.5% and CKD-EPI: S: 95.9% and E: 74.2%. According to the HUGE formula of patients with GF below <60 ml/min (48.6%) had a physiological deterioration associated with aging. CKD identified by HUGE formula was associated with higher mortality at one year (p=0.003).

**Conclusions:** It is confirmed that despite different and new formulas for estimating glomerular filtration rate, CKD-EPI continues to be the most sensitive and specific even in older patients. Current available formulas can overestimate the diagnosis of CKD, so it is advisable to apply the HUGE formula in a complementary way, which also gives us prognostic value.

**References:**

[1] Otero A, Francisco ALM De, Gayoso P, García F, Study E. Prevalence of chronic renal disease in Spain: Results of the EPIRCE study. Rev Soc Española Nefrol. 2010;30(1):78-86.

[2] Martín De Francisco A., Piñera C, Gago M, Ruiz J, Robledo C, Arias M. Epidemiología de la enfermedad renal crónica en pacientes no nefrológicos. SEN. 2009;29:101-5.

[3] Heras M, Fernández-Reyesa M. Nuevas herramientas para abordar la función renal en ancianos: la ecuación Berlin Initiative Study y la fórmula hematocrito, urea y género. Med Clin (Barc). SEGO; 2016;146(10):450-4.

O-116

Low diastolic blood pressure increases risk of cardiovascular
events in the vascular frail

L. Wijsman¹, A. De Craen¹, W. Jukema¹, R. Westendorp²,
S. Mooijaart¹. ¹Leiden University Medical Center; ²University of
Copenhagen

**Background:** In older age, a low diastolic blood pressure (DBP) has been associated with increased risk of cardiovascular events, especially in frail older people. A potential mechanism might be that low DBP leads to inadequate perfusion of vital organs due to a 'frail' vascular system. Here, we tested the hypothesis that low DBP is associated with a high risk of cardiovascular events in people with a previous history of cardiovascular disease, as a proxy of vascular frailty.

**Methods:** 5,804 participants (mean age 75 years) from the PROspec- tive Study of Pravastatin in the Elderly at Risk (PROSPER) who as part of the trial were intensively monitored for an average period of 3.2 years. Baseline DBP was categorized in low (<70 mmHg), nor- mal (70-90 mmHg) or high (>90 mmHg). Cox proportional hazards analyses were used to estimate hazard ratio (HR) with 95% confi- dence intervals (CI) for the association of DBP with cardiovascular events. Analyses were stratified for cardiovascular history.

**Results:** Participants with low DBP had an 1.24-fold (1.04; 1.49)

increased risk of cardiovascular events compared to those with normal DBP. After further adjusting for cardiovascular factors, this association attenuated to 1.05 (0.86; 1.28). A previous history of cardiovascular disease significantly modified the relation between DBP and risk of cardiovascular events (p-interaction = 0.042). In participants without a history of cardiovascular disease, DBP was marginally significant associated with an increased event risk (HR (95%) per 10 mmHg increase in DBP 1.08 (0.99; 1.18), p-value = 0.07), whereas in participants with a history of cardiovascular disease higher DBP was associated with a decreased risk of cardiovascular events (HR (95%) per 10 mmHg increase in DBP 0.92 (0.85; 0.99, p-value = 0.018). These risk estimates were independent of potential confounders, including classical cardiovascular risk factors.

**Conclusion:** The association of DBP with cardiovascular events in older people varies upon their previous history, showing that in participants who are vascular frail (pre-existing cardiovascular diseases) lower DBP associates with an increased risk of future cardiovascular events.

Area: Urology and continence management

O-117

Recurrent urinary retention: 6 months follow-up of elderly
patients who benefited an alternative treatment to the
indwelling catheter after a multidisciplinary team board

C. Rambaud¹, M. Durand², S. Gonfrier¹, C. Arlaud¹, M. Sanchez¹,
J. Fallot³, G. Sacco¹, O. Guérin⁴. ¹Geriatrics Department, University
Hospital of Nice, France; ²Department of Urology, University Hospital
of Nice, INSERM, U1189, ONCO-THAI, Lille, France; ³Department of
Urology, University Hospital of Nice, France; ⁴Geriatrics Department,
IRCAN - University of Nice - Sophia-Antipolis INSERM U1081 - CNRS
UMR 7284

**Introduction:** The indwelling urinary catheter (IUC) is over used on the elderly. The aim is to analyze the success rate of alternative treatments (AT) to the IUC at 6 months follow up.

**Methods:** A standardized multidisciplinary team board was es-
tablished to screen patients, over 70y, who can benefit from an
alternative treatment option to IUC, using comprehensive geriatric
assessment. We evaluated success of AT (defined by the lack of
urinary retention at 7 days, 1, 3 and 6 months) and overall death
rates.

**Results:** Sixty-one patients were enrolled with a mean age of 87y (women: 42.6%). Alternative technics were offered to 62% (n=38), including 23 catheter withdrawals, 7 thermo-expandable intra-prostatic stents, 8 prostatic photovaporizations. Overall, the success rate was 92.1% at 7 days and raised up to 100% at 1, 3 and 6-month follow-up. The IUC group patients were significantly older (89.3 vs 85.3y, p=0.021), very dependent (ADL <2, 78.3% vs 39.5%, p=0.03) and with neurologic comorbidities (78.3% vs 52.6%, p=0.045). The global rate of death of the cohort were at 1, 3 and 6 months: 6.6% (n=4), 21.3% (n=13), 36% (n=22). At 6 months, the rate of death in the IUC group was higher (65% vs 18.4%, p=0.01). In univariate analyzes, predictive factors of a 6-months death were neurologic comorbidities (HR: 4.3 [1.2-14.9], p=0.023), a dependence (ADL<2) (HR: 4.9 [1.5-16]) and the IUC (HR: 5.5 [1.8-17], p=0.003). In multivariate analyzes, the factors were a dependence (ADL<2) (HR: 3.9 [1.1-13.4], p=0.034) and the IUC (HR: 4.4 [1.4-14.5], p=0.014).

**Conclusion:** The multidisciplinary analysis may offer a better chance to deal with IUC in elderly people with a steady global success rate of 62% catheter withdrawals at 6 months. The elevated rate of death in IUC group highlight the frailty of dependent patients and data is needed to report the relation with IUC.
Late Breaking Abstracts – Oral presentations

**LB-001**
**Genetic variants associated with physical performance and anthropometry in old age: a genome-wide association study in the iLSIRENTE cohort**

E. Marzetti¹, D. Heckerman², B.J. Traynor³, A. Picca¹, R. Calvani¹, D. Hernandez⁴, M. Nalls⁵, S. Arepali⁴, L. Ferrucci⁶, F. Landi¹, R. Bernabei¹. ¹Center for Geriatric Medicine (CEMI), Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of Sacred Heart, Rome, Italy; ²Microsoft Research, Los Angeles, California, USA; ³Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, 35 Convent Drive, Room 1A-1000, Bethesda, MD, USA; ⁴Genomics Technology Group, Laboratory of Neurogenetics, National Institute on Aging, 35 Convent Drive, Room 1A-1000, Bethesda, MD, USA; ⁵Molecular Genetics Unit, Laboratory of Neurogenetics, National Institute on Aging, 35 Convent Drive, Room 1A-1000, Bethesda, MD, USA; ⁶Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, 251 Bayview Blvd., Room BRC/04C225, Baltimore, MD, USA

**Background:** Unraveling the complexity of aging is crucial for understanding its mechanisms and why aging is the risk factor for most chronic conditions. The advancements marked by genome-wide association studies (GWASs) have sparked interest in gene cataloguing in the context of aging and age-related conditions. Here, we used GWAS to explore whether single nucleotide polymorphisms (SNPs) were associated with functional and anthropometric parameters in a cohort of old community-dwellers enrolled in the *iLSIRENTE* aging study.

**Methods:** Analyses were carried out in men and women aged 80+ years enrolled in the *iLSIRENTE* Study (n=286) and replicated in the *in CHIANTI* Study (n=1055). Genotyping was accomplished on Infinium Human610-QUAD version 1.

**Results:** In the *iLSIRENTE* population, genetic variants in ZNF295 and C2CD2 (rs928874 and rs1788355) on chromosome 21q22.3, were significantly associated with the 4-meter gait speed (rs928874, p=5.61×10⁻⁸; rs1788355, p=5.73×10⁻⁸). This association was not replicated in the *in CHIANTI* population.

**Conclusions:** Our findings suggest that specific SNPs may be associated with a key measure of physical performance in older adults. GWASs using larger samples are needed to confirm these preliminary results to enhance our comprehension of complex age-associated phenomena.

**LB-002**
**MtDNA content and MtDNA deletion mutation abundance in skeletal muscle of sedentary high- and low-functioning elderly individuals**

A. Picca¹, A. Gordillo Villegas², R. Mankowski², A.M.S. Lezza³, R. Calvani¹, E. Marzetti¹, C. Leeuwenburgh², R. Bernabei⁴.

¹Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Teaching Hospital "Agostino Gemelli", Rome, Italy; ²Department of Aging and Geriatric Research, Institute on Aging, Division of Biology of Aging, University of Florida, Gainesville, FL, USA; ³Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, Bari, Italy; ⁴Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy

**Introduction:** Mitochondrial dysfunction in skeletal myocytes has been proposed as a major factor contributing to the development and progression of sarcopenia. Hence, the quantitation of mitochondrial DNA (mtDNA) abundance and mtDNA deletion mutation

load may help clarify the role of mtDNA instability in muscle aging.

**Methods:** We applied real-time PCR-based approaches to total DNA purified in muscle samples obtained from young adults, sedentary older adults, classified as high- and low-functioning based on the Short Physical Performance Battery (SPPB), in order to examine the effect of aging on key quantitative alterations of mtDNA and how this relates to physical performance.

**Results:** Muscle volume, as quantified via 3D-NMR, was decreased by 38% and 30% in low- (LFE) and high-functioning elderly (LFE) participants, respectively when compared to young and high-functioning elderly participants, respectively, and positively correlated with physical performance. The content of mtDNA was found to be significantly reduced in both groups of elderly participants, regardless of the SPPB score, relative to their younger counterparts. The age-associated decrease in mtDNA abundance was paralleled by an increase in the mtDNA deletion in HFE and LFE participants, with no differences between the two groups. Further investigations will probe alterations in mtDNA encoding genes: NADH dehydrogenase 1 (ND1/Complex 1), Cytochrome b (Complex III), and cytochrome c oxidase (COI/Complex IV).

**Conclusion:** This study shows altered mitochondrial homeostasis in muscles of aged human. The decline in myocyte mitochondrial mass and the accumulation of mtDNA deletions may therefore represent critical steps to muscle aging and possible targets for interventions against sarcopenia.

**LB-003**
**A study of executive function (EF) and prospective fall risk in community-dwelling older adults**

C. Smith 1,2,4, C. Bula 1,2, H. Krief 2, L. Seematter-Bagnoud 3,
B. Santos-Eggimann 3. ¹University of Lausanne, Lausanne, Vaud,
Switzerland; ²University of Lausanne Medical Center, Lausanne, Vaud,
Switzerland; ³JUMSP, Lausanne, Vaud, Switzerland; ⁴Rehabilitation
Clinic Bois-Bougy

**Background:** Recent findings suggest that older people with executive function (EF) impairment have an increased fall risk. Prospective evidence with prolonged follow-up is however lacking.

**Objective:** To examine 1) whether EF impairment at baseline predicts falls at 6-year follow-up; and 2) whether a dose-response relationship exists between EF impairment and falls at 6-year follow-up.

**Methods:** Community-dwelling older adults (N=906, mean age 69±1.4, women 59.8%) were followed between 2005 and 2011. Measures of EF at baseline: clock drawing test (CDT), verbal fluency (VF), TMT-A, -B, and ratio (TMT B-A/A). Falls were collected prospectively in 2011 using monthly calendars.

**Results:** At baseline, 5.5% were cognitively impaired (MMSE≤24), 17.9% had abnormal CDT (score≤7). In 2011, 13% fell one time without injury and an additional 20.2% had multiple or injurious falls. Baseline cognitive profiles of non-fallers and multiple/injurious fallers were similar. In multivariable analysis, poor EF at baseline was significantly associated with reporting one non-injurious fall (RR_worst quintile TMTB = 0.38, 95% CI: 0.19–0.77, p=0.007; RR_worst quintile ratio TMT B-A/A = 0.33, 95% CI: 0.16–0.67, p=0.002). There was no significant association between poor EF and multiple/injurious falls, showing no dose-response relationship. In subgroup analysis among fallers, poor EF was associated with recurrent or injurious falls (OR_worst quintile of TMT B = 1.86, 95% CI: 0.98–3.53, p=0.059; (OR_worst quintile ratio TMT B-A/A = 1.84, 95% CI: 0.98–3.43, p=0.057).

**Conclusions:** Among fallers, EF impairment at baseline predicted recurrent or injurious falls. Further investigations will examine whether decline in EF increases fall risk during follow-up.
LB-004

Incidence and cost of medication-related harm in older adults
following hospital discharge in the UK: Results from the PRIME
study

N. Parekh¹, K. Ali¹, J.M. Stevenson², J.G. Davies², R. Schiff³,
J. Harchowal⁴, J. Raftery⁵, C. Rajkumar¹, on behalf of the PRIME
Study Group. ¹Department of Elderly Medicine, Brighton And Sussex
Medical School, Brighton UK; ²Institute of Pharmaceutical Science,
King's College London, London UK; ³Department of Ageing And Health,
Guy's and St. Thomas' NHS Foundation Trust, London UK;
⁴Department of Pharmacy, The Royal Marsden NHS Foundation Trust,
London UK; ⁵Department of Medicine, University of Southampton,
Southampton, UK

**Introduction:** Medication-related harm (MRH) is the most com-
mon adverse event following hospital discharge [1]. We sought to
determine the incidence of MRH post-discharge in a population
of older adults in the UK and associated cost of National Health
Service (NHS) utilisation.

**Methods:** The study methods have been published [2]. Patients 65 years and above were recruited at the point of discharge following an acute admission from 5 teaching hospitals in South-England between September 2013 and November 2015. Patients were followed-up by research pharmacists for 8 weeks to determine whether they experienced MRH through 3 sources; hospital read-mission, patient/carer telephone interview and GP records. MRH was defined as harm from adverse drug reactions or non-adherence. National Health Service (NHS) utilisation associated with MRH was recorded and costed using national NHS tariffs, and extrapolated using national hospital admissions data.

**Results:** Data from 1116 patients were analysed, median age 81.9 years (IQR, 75.5–86.9), and 58.4% female. The median discharge medicines per patient was 9 (IQR, 7–12). Four hundred and thirteen (37.0%) patients experienced MRH in the 8-weeks follow-up period, of which 51.9% was potentially avoidable. The most common MRH events were gastrointestinal (25.4%), neurological (17.9%), cardiovascular (11.0%) and musculoskeletal (10.5%). Four patients experienced fatal MRH (0.4%). Medicine classes associated with the highest risk of MRH (adverse events per 1000 discharge prescriptions) were opiates (399), antibiotics (189), benzodiazepines (180) and diuretics (153). Of 413 patients that experienced MRH, 328 (79.4%) sought NHS care. The incidence of MRH-associated patient readmission was 78 per 1000 discharges. We estimate post-discharge MRH in older adults to cost the NHS £ 395.5 million annually, of which £ 243.4 million is potentially avoidable.

**Conclusions:** MRH is common in older adults following hospital discharge, and results in substantial use of NHS resources. Interventions to prevent avoidable MRH could lead to considerable savings for NHS.

References:

[1] Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 2003;138:161-7.

[2] Stevenson J, Parekh N, Ali K, Timeyin J, Bremner S, Van Der Cammen T, et al. Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study). BMC Geriatr 2016;16:22. doi:10.1186/s12877-016-0191-8.

LB-005

Caregivers' tailored nutritional counseling increases protein intake among male caregivers and patients receiving care at home

S. Kunvik 1,2, R. Valve 2, M. Salonoja 1, M.H. Suominen 3. ¹The Social Services and Healthcare Centre of Pori, Finland; ²Department of Food and Environmental Sciences, University of Helsinki, Finland; ³Unit of Primary Health Care, Helsinki University Central Hospital, Finland

**Introduction:** Older caregivers (CG) and care recipients (CR) are vulnerable to nutritional problems. Low intake of protein is common and can affect to their nutrition and health. Tailored nutrition counseling is needed to improve caregivers' and care recipients' nutrition.

**Methods:** In this RCT, we investigated the effectiveness of tailored nutrition counseling on nutrient intake among CG aged ≥65 years with normal cognition and CR aged ≥50 years. Nutrient intake was assessed with three-day food diary. Six-month intervention included tailored nutritional counseling with home visits, group meetings and written material in intervention group (I). Written material was offered to control group (C). Main outcome measure was change in protein intake (g/kg bodyweight (BW)/d) and it was analyzed among participants with protein intake under 1.2 g/kgBW/d (intervention target) at baseline.

**Results:** Total of 55 CG (n=28 I, n=27 C) and 40 CR (n=25 I, n=15 C), who had protein intake under 1.2 g/kgBW/d at baseline (79.7% CG and 88.8% CR), completed the study. Mean protein intake was 0.86 g/kgBW/d in the CG and 0.90 g/kgBW/d in the CR. Protein intake increased in CG male intervention group (n=12) 0.11 g/kgBW/d and decreased in male control group (n=13) -0.07 g/kgBW/d), p=0.007. Among CR intervention group protein intake increased 0.07 g/kgBW/d, p=0.033, but did not change in controls. There were no significant differences between other groups.

**Conclusions:** Tailored nutritional counseling improve protein intake among elderly male caregivers. Offering nutritional counseling to caregivers can affect to care recipient's nutrition at the same time.
<figure><img src="image_8.png" /></figure>

<figure><img src="image_9.png" /></figure>

# Poster presentations

## Area: Biogerontology and genetics

### P-001

#### Accelerated attrition early in life can explain short telomeres in patients with atherosclerotic cardio-vascular disease

A. Benetos¹, S. Toupance², S. Gautier³, C. Labat², M. Kimura⁴, P.M. Rossi⁵, N. Settembre⁶, J. Hubert⁷, L. Frimat⁸, B. Bertrand⁹, M. Boufi¹⁰, X. Flecher¹¹, N. Sadoul¹², P. Eschwege⁷, M. Kessler⁸, J.D. Kark¹³, S. Malikov⁶, S. Verhulst¹⁴, A. Aviv⁴. ¹INSERM UMRS 1116, Université de Lorraine, Nancy, France; Department of Geriatric Medicine, CHRU de Nancy, Université de Lorraine, Nancy, France; ²INSERM UMRS 1116, Université de Lorraine, Nancy, France; ³Department of Geriatric Medicine, CHRU de Nancy, Université de Lorraine, Nancy, France; ⁴Center of Human Development and Aging, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA; ⁵Department of Vascular Surgery, North hospital, APHM, Marseille of Internal Medicine, North hospital, APHM, Marseille, France; ⁶Department of Vascular Surgery, CHRU de Nancy, Université de Lorraine, Nancy, France; ⁷Department of Urology, CHRU de Nancy, Université de Lorraine, Nancy, France; ⁸Department of Nephrology, CHRU de Nancy, Université de Lorraine, Nancy, France; ⁹Department of Plastic Surgery, Conception Hospital, APHM and UMR-S1076, Aix-Marseille University, France; ¹⁰Department of Vascular Surgery, North hospital, APHM, Marseille, France; ¹¹Department of Orthopedic Surgery, North hospital, APHM, France; ¹²Department of Cardiology, CHRU de Nancy, Université de Lorraine, Nancy, France; ¹³Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem 29107, Israel; ¹⁴Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, the Netherlands

Short telomere length (TL) in leukocytes is associated with atherosclerotic cardiovascular disease (ACVD). It is unknown whether this relationship stems from having inherently short leukocyte TL (LTL) at birth, a faster LTL attrition thereafter, before or during the clinical manifestation of ACVD, or both. To understand the temporal relation of LTL with ACVD, we built on the following findings: TL attrition during extra-uterine life varies in proportion to the replicative activities of tissues. Consequently, skeletal muscle (M), a minimally proliferative tissue, displays a longer TL than LTL, which represents the highly proliferative hematopoietic system. We applied this blood-and-muscle to study the relation between TL and ACVD. We studied 259 individuals (82 women) aged 63±1 years (mean±SEM), undergoing surgery with (n=131) or without (n=128) clinical manifestation of ACVD. TL in leukocytes and in muscle biopsies was measured by Southern blots. In all subjects, MTLA (MTL adjusted for muscle biopsy site) was longer than LTL and LTL-MTLA difference became wider with age similarly in ACVD patients and controls. Age- and sex-adjusted LTL,

but not MTLA, was shorter in patients with ACVD than controls (6.52±0.06 vs 6.80±0.06, P=0.005). LTL-MTLA was wider in ACVD than in controls (-2.01±0.05 vs -.74±0.05 respectively, P=0.0003). This first study, applying the "blood-and-muscle" TL model, shows more pronounced LTL attrition in ACVD patients than controls. The difference in attrition rates was not modified by age during adulthood indicating that accelerated attrition in early life is likely to be a major explanation of the shorter LTL in ACVD patients.

### P-002

#### Activation of SKN-1 response in Caenorhabditis elegans by dietary protein-bound Nε-carboxymethyllysine

R. Litke, T. Leycuras, I. Bin-Saïd, E. Boulanger, C. Fradin. LIRIC-UMR995

**Introduction:** Caenorhabditis elegans is one of the major model organisms for studying aging. We investigated the impact of dietary protein bound Nε-carboxymethyllysine (CML) on C. elegans lifespan. We also studied the influence of CML on activation of three transcription factors controlling C. elegans longevity: DAF-16, SKN-1 and PHA-4 which are orthologs of human FOXO, NRF1/2 and FOXA, respectively.

**Methods:** Bovine serum albumin (BSA) was incubated with glyoxylic acid to produce CML-modified BSA (CML-BSA). Non-modified BSA (Ctrl-BSA) was used as control. C. elegans lifespan was measured in presence of CML-BSA and Ctrl-BSA. Activation of DAF-16, SKN-1 and PHA-4 transcription factors was monitored by using strains which express GFP fusion protein. Nuclear translocation of GFP fusion transcription factors was visualized by fluorescence microscopy. Expression of SKN-1 target genes (HSP-4, ATF-5 and GST-14) was analysed by RT-qPCR.

**Results:** CML-BSA had a transient but significant effect on C. elegans median lifespan. This effect was dependent on the concentration of CML. Activation of DAF-16 and PHA-4 was not controlled by CML-BSA. Nuclear translocation of SKN-1 was observed in proximal intestinal cells of worms incubated with CML-BSA. Time-course expression of SKN-1 target genes is in progress to confirm SKN-1 response induced by CML-BSA.

**Conclusions:** Our preliminary data show that dietary BSA-bound CML transiently influences C. elegans lifespan. SKN-1 activation, which typically results in recovery of homeostatic functions, could be responsible for CML detoxification, then worms' recovery. Additional analysis will be necessary to uncover mechanisms and molecules involved in SKN-1 activation by CML.

### P-003

#### Assessing the role of APOE polymorphism on the executive dysfunctions in Alzheimer's disease

G. D'Onofrio, D. Sancarlo, F. Panza, A. Mangiacotti, P. Bisceglia, C. Gravina, M. Urbano, M. Lauriola, M. D'Agostino, L. Cascavilla,
D. Seripa, A. Greco. *Complex Structure of Geriatrics*, Department of
Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni
Rotondo, Foggia, Italy

**Introduction:** To determine the role of the apolipoprotein E (APOE) ε4 allele on executive dysfunctions in Alzheimer's disease (AD) patients.

**Methods:** A total of 182 AD patients attending Alzheimer's Evaluation Unit of Geriatrics, IRCCS "Casa Sollievo della Sofferenza" were included in the study. Of these patients, 132 were with executive dysfunctions (AD-ED) and 50 were without executive dysfunctions (AD-noED). All patients underwent APOE genotyping, Comprehensive Geriatric Assessment (CGA), Mini Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Clock Drawing Test (CDT), and Frontal Assessment Battery (FAB).

**Results:** Percentage of females with AD-ED were significantly higher (p=0.044). AD-ED showed significantly higher cognitive impairment in MMSE (p<0.0001) and CDT (p=0.002), a more severe stage of dementia (CDR, p=0.008), and a worsening in several CGA domains (ADL, p=0.048; IADL, p=0.015; ESS, p=0.035). A higher frequency of APOE ε4/ε4, ε3/ε4 and ε2/ε4 genotypes was observed in patients with AD-ED (82.4%, 97.6%, and 66.7% respectively; p<0.0001). Conversely, a lower frequency of APOE ε3/ε3 and ε2/ε2 genotypes was observed in patients with AD-ED (45.1% and 28.6% respectively; p<0.0001).

**Conclusions:** If confirmed in wider samples of subjects, the observed differences suggested that the presence of ED in AD might identify two clinically and diagnostically distinct groups of patients. The observed results may have important clinical implications regarding mechanisms underlying these symptoms that may implicate a different treatment of these patients.

P-004
Association of mitochondrial DNA copy number and self-rated health status: A cross-sectional study

J. Cerhan, J. Olson, S. Thibodeau, M. Cicek, B. Welkie, S. McDonnell, J. Evans, E. Ryu. *Mayo Clinic, Rochester, MN*

**Introduction:** Mitochondria DNA (mtDNA) has received attention in aging and human health. We evaluated the association of mtDNA copy number with self-rated health status, independent of age.

**Methods:** This is a cross-sectional study of patients enrolled within the Mayo Clinic Biobank. We used 956 MCB patients with a completed health questionnaire and whole genome sequencing. The primary outcome was mtDNA copy number. The primary predictor was self-rated health status with 3 collapsed categories (excellent/very good, good, and fair/poor). A quantile regression model was used to test the association between self-rated health status and mtDNA copy number, adjusting for age and sex.

**Results:** The median age at enrollment was 61 years (range: 20 to 96), and 63% reported excellent or very good health with 31% good; and 6% with fair/poor health. The median mtDNA copy number was 89.3 (25th – 75th: 77.6–101.3). Higher copy number was observed with younger age (median of 96.0 for those ≤30 years vs 84.8 for subjects >65), and excellent or very good self-rated health status (median of 91.1, compared to 86.1 for good health and 83.0 for fair/poor health status). The association of self-rated health status with mtDNA copy number remained significant, even after adjusting for age and sex (2.2 [95% CI: 0.4–4.2] greater median mtDNA copies for those reporting excellent or very good health, compared to those with “good” health).

**Conclusions:** We found higher mtDNA copy number is associated with better self-rated health status independent of age and sex.

P-005
BMP-2 and BMP-4 plays a positive role in articular cartilage maintaining in mice

J. Li¹, A. Zhu¹, H. Zheng¹, D. Chen². ¹Liaoning Traditional Chinese Medicine University; ²Rush University Medical Center

BMPs, specifically BMP-2 and -4, have been shown to play a major role in mesenchymal cell differentiation and chondrocyte hypertrophy. The graded genetic expressions of BMP-2 and -4 within the four major growth plate zones represent an important molecular component of long bone formation after birth. However, the role of BMP-2 and -4 in mature articular cartilage remains limited. In this study, we investigate the significance of the BMP2While BMP signaling plays an important role in chondrocyte metabolism, and BMP2 and BM and BMP 4 gene in articular cartilage maintaining at postnatal stage in mice vivo.

**Objective:** To observe the phenotype of deleting BMP-2 and BMP-4 gene in chondrocytes in the development and maintaining of articular cartilage in mice. Try to demonstrate the molecular mechanism of articular cartilage development and degradation through BMP 2 and BMP 4 gene related signaling.

**Material and method:** Bmp-2, Bmp-4 conditional knockout mice, (Bmp-2 Bmp-4)Col 2 ER mice were generated by breeding (Bmp-2,Bmp-4)fx/fx mice with Col2-CreER transgenic mice. Knee joints were harvested from 3 months and 6 months old mice for histology to compare the difference in morphology of AC. Immunohistochemical were performed to analyze the OA-related proteins expression, which involves mmp13, adams 4, and adams 5.

**Results:** 1. The silence of BMP2 and BMP4 induced articular cartilage degradation phenotype, such as narrowed AC area, shortened AC depth, and massive subchondral bone, and the osteometric data of calculated AC area is consistent to the dramatically morphology changes in both 3- and 6- month old mice. (P<0.05) 2. The protein expression of MMP 13, Adamts4 and Adamts5 in superfacial zone of articular cartilage tissue is significant increased in (BMP2, BMP4)Col 2 ER Group in 3-month old mice. (P<0.05) While in the 6-month old mice there showed the same tendency but the data is not statistical

**Conclusion:** Bmp2 and Bmp4 are not only involved in the formation of articular cartilage but also the mature cartilage metabolism and play a positive role in cartilage maintaining.

P-006
Mechanism of secretion of ribosomal protein S3 (rpS3) from cancer cells: a potential serological marker for cancer

Y. Kwon¹, Y. Kim², K.-H. Cho¹, J. Kim². ¹Korea University College of Medicine, Seoul, Republic of Korea; ²Laboratory of Biochemistry, Korea University, Seoul, Republic of Korea

**Introduction:** Our previous study reported the secretion of ribosomal protein S3 (rpS3) into the extracellular space in conjunction with tumor malignancy. However, the secretion pathway and mechanism have not been fully elucidated.

**Methods:** Human fibrosarcoma (HT1080) cells were cultured in Dulbecco's modified Eagle's media. To confirm whether the secretion of rpS3 was regulated by an endoplasmic reticulum (ER) to Golgi or Golgi to ER pathway, HT1080 cells were treated with brefeldin A or monensin. To determine whether glycosylation was necessary for the secretion of rpS3, HT1080 cells were treated with tunicamycin, and an immunoblot assay and ELISA were performed. The presence of glycans in rpS3 was determined using peptide-N-glycosidase F (PNGase F) and concanavalin A. To identify the sites of glycosylation in rpS3, liquid chromatography-tandem mass spectrometry was performed.

**Results:** Secretion of rpS3 was inhibited by brefeldin A and tunicamycin. RpS3 bound to concanavalin A, whereas the band
for the secreted rpS3 shifted to lower-molecular-weight after the treatment with PNGase F, indicating that the secreted rpS3 was N-glycosylated. Mass spectrometry analysis showed that rpS3 is glycosylated at the Asn165 residue.

**Conclusions:** N-linked glycosylation is needed for rpS3 to be secreted into culture media, in which ER-Golgi-dependent pathway is involved. Moreover, we proved that the Asn165 residue of rpS3 had an important role for N-linked glycosylation. Additional studies are needed to define the role of the N-linked glycosylation of rpS3 in cancer pathophysiology and to assess its potential as a new target of cancer therapy.

## P-007

### Ribosomal protein S3 (rpS3) is secreted by various cancer cell lines: a potential biomarker for cancer

Y. Kwon¹, Y. Kim², S. Park¹, K.-H. Cho¹, J. Kim². ¹Korea University College of Medicine, Seoul, Republic of Korea; ²Laboratory of Biochemistry, Korea University, Seoul, Republic of Korea

**Introduction:** Ribosomal protein S3 (rpS3) is known to be secreted only by cancer cell lines and cells from cancer patients. We compared the secretion level of rpS3 among various cancer cell lines, cells from healthy adults, and normal cell lines. We then evaluated its possibility as a novel general biomarker for cancer.

**Methods:** HT1080 and MPC-11 (mouse plasmacytoma) cells were cultured in serum-depleted media for 24 h. Thereafter, the culture media were collected and precipitated to assess rpS3 protein secretion into the cell culture media. To clarify whether the secretion of rpS3 is associated with tumor malignancy, we used a series of tumor cell lines derived from a single immortalized human normal bronchial epithelial cell line (BEAS-2B). Their malignancy is classified as follows: non-transformed (1799), transformed but non-tumorigenic (1198), and tumorigenic (1170-1). A doxorubicin-resistant MPC-11 cell line was generated to examine the relationship between secreted rpS3 and tumor malignancy.

**Results:** The rpS3 protein was only detected in the culture media of HT1080 and MPC-11 cells. The secretion of rpS3 was dramatically higher in 1170-1 cells compared to that in other cells. Additionally, 1198 and 1799 cells showed a moderately higher secretion of rpS3 compared to BEAS-2B. The level of rpS3 secreted by doxorubicin-resistant MPC-11 cells was significantly higher than that secreted by the MPC-11 parental cells.

**Conclusions:** We demonstrated that malignant cells release rpS3 protein. Based on our findings, secreted rpS3 can be a useful cancer biomarker, and the rpS3 level might indicate the aggressiveness of tumor cells.

## P-008

### Role of epigenetics as a novel therapeutic approach to Parkinson's disease

A. Shueb. Glan Clwyd Hospital (BCU- North Wales)

Parkinson's disease (PD) is a complex multifactorial disease with an elusive aetiology, in which genetic and environmental factors are intricately associated. In recent years, epigenetic mechanisms such as DNA methylation, histone modifications and non-coding RNAs have been recognised as potential mediators in the pathogenesis of PD. Epigenetics refers to the heritable changes in gene expression that do not involve changes to the underlying DNA sequence. These modifications exist throughout our lifetime, commencing in the prenatal phase, and are influenced by the summation of one's genome and the environmental factors we are subjected to, rendering epigenetics as the missing link between the risk factors for PD and its development. Current pharmacological agents only provide symptomatic relief, of which levodopa still remains the gold standard. However, drugs that halt or delay progression of PD

are still lacking. The increasing amount of papers aimed at understanding the epigenetics of PD has led to a better understanding of the molecular pathways involved in dopaminergic neuron degeneration, and several researchers are now working to understand the therapeutic potentials of epigenetic molecules to counteract age-related neurodegenerative diseases. Research revealed that DNA methylation, histone modification, and alterations in non-coding RNA profiles often precede disease pathology, which might prove useful as early disease biomarkers. Over the past few years, there has been a substantial progression in the development of epigenetic drugs, particularly the histone deacetylase (HDAC) inhibitors and DNA methyltransferase (DNMT) inhibitors, as a novel therapeutic modality in the management of PD. Cell replacement therapy is a promising avenue for the treatment of PD with scientific research making great progress in the development of induced pluripotent stem cells (iPSCs) to produce midbrain dopamine phenotypes. With direct access to the neurons that are affected in PD, the pace of discovery should speed up and the cure for PD should become an attainable goal. This comprehensive critical appraisal will shed light on the emerging role of epigenetics in the pathogenesis and therapeutic modulation of PD.

## Area: Cognition and dementia

### P-009

#### A project improving identification and assessment of elderly oncology patients with suspected dementia

N. Rajcoomar, Z. Ali, S. Holikova, S. Tahir. Broomfield Hospital Mid Essex Hospitals NHS Trust, Chelmsford, UK

**Introduction:** In the UK 1 in 14 people aged over 65 have Dementia and over 600,000 live with Dementia. On average 48% of these have no formal diagnosis, nor have access to specialist services [1]. Oncology patients with suspected Dementia have a poorer prognosis and are more likely to be unsuitable candidates for surgical management [2]. Our project aim was to improve practice identifying and assessing elderly oncology inpatients suspected of Dementia.

**Methods:** 30 oncology patients over 65 years with Abbreviated Mental Test Score of 8 or less were audited. In line with NICE guidance we reviewed appropriate history, examination, and investigations, as well as a discharge recommendation for memory clinic. Interventions implemented include feeding back audit results, teaching and printed summary NICE Dementia guidance as an aide memoire. A re-audit was performed to assess improvement.

**Results:** A n initial audit showed that 15 (50%) patients had appropriate investigations, and 20 (66%) patients had recommendations for memory clinic. Post intervention an audit showed improved compliance with NICE recommended investigations to 26 (87%) patients and memory clinic recommendations in 28 (93%) patients.

**Discussion:** Following simple intervention our project showed that current practice of identifying and assessing elderly oncology patients with suspected cognitive impairment, improved from 50–66% to 87–93% compliance in line with NICE Dementia Guidance. Future recommendations include teaching, signposting Doctors and making summary NICE guidance widely available; with re-audit in 1 year to ensure continued compliance.

### References:

[1] National Institute for Health and Clinical Excellence (NICE) (2016) Dementia: supporting people with dementia and their carers in health and social careAvailable at: https://www.nice.org.uk/guidance/cg42?unlid=725106828201715152953 [Last accessed 29/01/2017]
[2] Solomons et al. Dementia and Cancer. Ageing Health. 2013;9 (3):307–319

P-010
A randomized controlled trial on the effect of physical and combined physical and cognitive dual-task training on frailty in early stage dementia patients

E.G.A. Karssemeijer, M.G.M. Olde Rikkert. Department of Geriatric Medicine, Radboud university medical center, Nijmegen, The Netherlands

**Background:** Reducing frailty could have large positive effects on health status and reduce future healthcare costs, specifically in frail older adults suffering from dementia. This study aims to assess the efficacy of an aerobic training with and without a cognitive dual-task on the level of frailty in older adults with mild dementia.

**Methods:** A three-arm randomized controlled trial compared single aerobic training, combined cognitive-aerobic training, and an active control group (i.e. stretching and toning). Frailty was measured by the Evaluative Frailty Index for Physical activity (EFIP), a questionnaire that assesses patient-related outcomes on multiple domains (e.g. physical, psychological and social). Older adults with mild dementia (N=56, age = 79.4±5.2 years) were randomized and individually trained three times a week during 12 weeks.

**Results:** This abstract concerns preliminary results. At baseline, the mean frailty index was 0.25 (95% CI: 0.22–0.28) and after 12 weeks the index declined significantly to 0.21 (0.18–0.25) in the total study population. Post intervention group means for single training, combined training and active control were 0.20 (0.14–0.26), 0.21 (0.15–0.28) and 0.23 (0.17–0.29) respectively. These between group differences were not significant (ANCOVA p=0.535).

**Conclusions:** A 12-week training successfully reduces the level of frailty in older adults with mild dementia. Since a significant contrast between the intervention groups was not found, the effectiveness of the different components of the intervention could not be identified. This may be due to a lack of power at this interim stage of the trial and should be re-examined following future inclusions.

P-011
Administering continuous palliative sedation to patients with dementia and extreme neuropsychiatric symptoms

R.T.C.M. Koopmans<fnref n="1" />, A.E. Veldwijk-Rouwenhorst<fnref n="1" />, D.L. Gerritsen<fnref n="1" />, S.A.J. Hanssen<fnref n="1" />, M. Smalbrugge<fnref n="2" />, H. Bor<fnref n="1" />, S.U. Zuidema³.

**Introduction:** Less than one percent of the patients with dementia living in nursing homes exhibit very severe neuropsychiatric symptoms (NPS). Within this group, there are patients with so-called "refractory" NPS. In these patients the treating physician sometimes decides to administer continuous palliative sedation (CPS).

**Methods:** To explore the process of decision-making leading to CPS, this study retrospectively describes 3 cases where CPS was administered because of refractory NPS. We performed in-depth interviews of involved physicians, nurses and relatives. All interviews were transcribed ad verbatim and qualitative analyzed using Atlas.ti.

**Results:** Preliminary results show a range of themes relevant in the process leading to the decision to administer CPS. The NPS are extremely burdensome and considered refractory after a long period of trying various interventions; stakeholders mention to have tried everything, but with no effect. At a certain moment,

they seem to lose hope, leading to a point dictated by feelings of powerlessness. These feelings appear especially when the resident explicitly suffers, showing an intensive internal struggle and sometimes verbally expressing a death wish. At that point, the physicians face the dilemma whether or not to make the decision to administer CPS, knowing that the Dutch guideline only permits CPS when life expectancy is less than two weeks.

**Conclusions:** CPS for NPS in residents with dementia is an undiscovered area. These preliminary results offer highly important insights into the process of stakeholders surrounding a resident with dementia and extreme NPS in their search for providing the best care that they possibly can.

P-012
Age differences in reaction time during an inhibitory choice stepping task challenged by a proprioceptive perturbation

G. Berrut<fnref n="1" />, C. Couturier<fnref n="2" />, C. Cornu³, T. Deschamps³. ¹Lab "Movement, Interactions, Performance" (E.A. 4334) (University of Nantes, France), Clinical Centre of Gerontology Department (Nantes University Hospital, France); ²Clinical Centre of Gerontology Department (Nantes University Hospital, France); ³Lab "Movement, Interactions, Performance" (E.A. 4334) (University of Nantes, France)

**Introduction:** We aimed to explore the effects of a proprioceptive perturbation from Achilles' tendon vibrations on an inhibitory stepping reaction time (RT) in young and older adults.

**Methods:** Twenty-six older adults (65–77 years, Mini-Mental State Examination >26, non-fallers) and twenty-six young adults (20–30 years) performed quiet standing trials with and without vibrations to record postural sway. Then, they executed an inhibitory stepping RT task, with and without Achilles tendon vibration. They had to step as quickly as possible in response to the direction of visual arrows that manipulated specific inhibition processes (congruent "no inhibition" vs. incongruent "inhibitory" trials).

**Results:** During quiet standing, postural instability was higher in young adults as compared with older adults while challenging the vibratory perturbation. Concerning the stepping performance, older adults had higher RTs than younger adults (p<0.01, +30%). Incongruent trials had larger effects on performances than congruence (p<0.01, +16%). Interestingly, only the young adults showed an increase in RTs in presence of vibrations (p<0.05, +8%).

**Conclusions:** The vibrations did not affect the stepping RT performance in older adults, unlike young adults. The attentional cost associated with the postural regulation might be already high enough to be affected by vibrations and/or their well-known age-affected sensory system may have not been perceived the vibratory perturbation. Current investigations are conducted to know whether this composite assessment of inhibition and reactive stepping can strongly discriminate fallers from non-fallers.

P-013
Ageism and dementia stigma among healthcare professionals

S. Schroyen<fnref n="1" />, S. Adam<fnref n="2" />, P. Missotten<fnref n="2" />. ¹University of Bordeaux, Bordeaux, France; ²University of Liège, Liège, Belgium

**Introduction:** Attitudes of staff working in nursing homes (NH) are of great importance when it comes to the quality of life of residents. The purpose of this research is to determine which parameters are associated to more aging and dementia stigmas among different types of professionals working in NH.

**Methods:** Our sample was constituted of 1276 professionals (M age =39.21 years old), recruited from 32 NH belonging to the FIH ASBL (Belgium). They were classified in nine groups: administrative (N=48); cooking staff (N=56); cleaning staff (N=150); activities (N=37); ergotherapists (N=39); assistant nurses (N=546); nurses (N=258); physiotherapists (N=76); and managers (N=64). Ageism

<footnote n="1">¹Department of Primary and Community Care, Radboudumc Alzheimer Centre, Radboud University Medical Center, Nijmegen;</footnote>

<footnote n="2">²Department of General Practice and Elderly Care Medicine/EMGO+ Institute, VU University medical center, Amsterdam; ³Department of General Practice and elderly care medicine, University of Groningen, University Medical Center, Groningen</footnote>
was evaluated by using the French version of the FSA-R [1] and the attitudes towards dementia were assessed by the DAS [2].

**Results:** Regression analyses show that the more people have experience, the more they have aging stigmas (p=0.001). Differences are also observed according to their profession: assistant nurses, cooking and cleaning staff have a more negative aging view than nurses (all p<0.001). Concerning dementia stigmas, being a man, a lower study level, working at partial time (vs full time) is associated with more negative attitudes toward dementia (respectively, p=0.24, 0.002 and 0.005). Moreover, cooking, cleaning and administrative staff have more stigmas toward dementia in comparison to nurses (all p<0.001).

**Conclusion:** Experience and profession seems to influence aging stigma. Concerning dementia stigmas, they are associated with profession, gender, level of education and working time.

## P-014

### Alzheimer and Helicobacter pylori infection: inflammation from stomach to brain? Preliminary results

G. Albaret¹, E. Sifré¹, P. Floch¹, S. Layé², A. Aubert², N. Salles³, F. Mégraud¹, P. Lehours¹, C. Roubaud-Baudron¹. ¹INSERM 1053; ²INRA 1286; ³Pôle gérontologie CHU Bordeaux

Alzheimer's disease (AD) is the leading cause of dementia worldwide. Its neuropahtology is well described; still its origin is unknown. Besides amyloid hypothesis, the role of infections has emerged. Recent studies concluded that Helicobacter pylori (Hp) infection increased AD incidence in humans and amyloïd plaques in the brain of AD-predisposed mice [1]. We hypothesized that Hp-induced gastritis was associated with an increased systemic and cerebral inflammation worsening AD lesions. C57BL6 mouse were infected with H. pylori (Hp, n=15) or H. felis (Hf, n=13) or left uninfected (NI, n=9). Stomach, brain and serum were collected after 18 months. Gastritis was scored after H&E staining. Brain specimens were processed to detect astroglial cells (immunochemistry anti-GFAP). Systemic and cerebral cytokines (IL1β, TNFα, IL-6, INFγ, IL17a, IL-4, IL-10) were evaluated by ELISA and semi quantitative protein array test, respectively. After 18 months, infection induced a severe gastric inflammation (Hf>Hp) and an increase of astroglial cell area (8.0±2.2% (Hf), 6.0±1.2% (Hp) versus 5.6±2.4% (NI), p=0.02). Inflammatory cytokines were enhanced in the brain of infected mice (Hf>Hp) compared to NI mice. Systemic cytokines measurements are pending.

These preliminary results showed that long lasting gastritis induced by Helicobacter is associated with an increased neuroinflammation. To document the stomach-brain axis, systemic inflammation will be investigated soon.

### References:

[1] Roubaud Baudron C, Letenneur L, Langlais A, Buissonnière A, Mégraud F, Dartigues J-F, et al. Does Helicobacter pylori infection increase incidence of dementia? The Personnes Agées QUID Study. J Am Geriatr Soc. 2013 Jan;61(1):74-8.

## P-015

### Are we aware of dementia?

O. Yilmaz¹, S. Gurkas², G. Bahat¹, M.A. Karan¹. ¹Istanbul University Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics; ²Istanbul University Istanbul Medical School

**Objective:** Dementia is increasingly prevalent in our community, but its awareness is relatively less. We aimed to reveal the knowledge, attitudes and opinions of our country about dementia.

**Method:** Anyone ≥18 years who agreed to complete the online questionnaire were included. There were 36 general questions about the characteristics of dementia, factors associated with dementia, the dementia courses and attitudes about dementia. Further ques-

tions were asked to subgroups (doctors, medical students, nurses, physiotherapists, dietitians, relatives of patients with dementia) about attitudes and disease knowledge.

**Results:** 2808 subjects ≥18 years were enrolled in to the study so far (male 895, female 1908). 2277 subjects were in the age range 18-44. The vast majority of participants were at least college graduates. Participants thought that dementia is a natural aging process (n=2088, %75), dementia isn't a killing disease (n=1406, %50), early diagnosis is important (n=1745, %62), patients with dementia are not living dead (n=1106, %39) and it is an unashamed illness (n=1906, %67).

**Conclusion:** According to the results that the early recognition of dementia is important, but the participants do not have enough information about the dementia. And on the other hand attitudes regarding patients with dementia is quite humane. We aim to be completed the survey by 10,000 people and the trial is ongoing now. The data at the end of the study would give the opportunity to have an opinion on the general disease perspective of our community. So it can be a guide to what can be done for awareness.

## P-016

### Associations between plasmatic poly-unsaturated fatty acids concentrations and cognitive status and decline in Alzheimer's disease

M. Haution-Bitker, T. Gilbert, A. Vignoles, C. Lecardonnel, S. Watelet, C. Falandry, M. Bonnefoy. Service de Gériatrie du Pr Bonnefoy, Centre hospitalier Lyon Sud, France

**Introduction:** Despite an indisputably role of Omega-3 poly-unsaturated fatty acids (n3-PUFA) in neuronal protection and prevention of dementia, the associations between PUFA blood concentrations and both cognitive status and decline, remain to be tested. In addition, the impact of nutrition seems more significant on erythrocytes linked PUFA than circulating plasma PUFA.

**Methods:** A prospective cohort was performed in Lyon Sud memory center, France, in order to correlate PUFA biomarkers and Cognitive function in a longitudinal way: Mini Mental Status Examination (MMSE) was assessed at baseline and every 6 months. Concentration of n-3 PUFA (linoleic: AAL, eicosapentaenoic: EPA and docosahexaenoic: DHA) and n-6 PUFA (arachidonic: AA), were measured at baseline in plasma and erythrocytes membranes by gas chromatography-mass spectrometry extraction. Statistical analysis included Student's t-test and linear regression.

**Results:** From March 2010 and February 2014, 140 patients aged over 65 years were included. Compared to participants with mild or normal cognition (MMS ≥24), participants with advanced dementia had lower plasmatic concentrations of EPA and DHA (p<0.05). Cognitive decline (defined as ≥2 points loss on MMSE/year) was not associated with PUFA plasma concentrations but with DHA and AA levels in erythrocytes fractions (p<0.05).

**Conclusions:** Our study confirms n-3 PUFA concentrations (mainly EPA and DHA) are associated with cognitive status in the elderly. Moreover, in this exploratory study, lower erythrocyte PUFA concentrations (AA and DHA) were associated with accelerated decline and could be proposed as a surrogate marker for prediction of cognitive decline.

## P-017

### Attitude of General Practitioners face to Alzheimer's diseases's drugs prescriptions

O. Maigre¹, A. Corvol². ¹CHU Rennes; ²Gériatrie CHU Rennes

The goal of this study is to describe the attitude of General Practitioners (GP) in front of drugs which are initiated by a consultant, here the Alzheimer's disease (AD) drugs, and to analyze the consequences on the relationship between GP and consultants. The
method used a survey sentby email to the GP of the region Brittany between december 2016 and february 2017.

**Results:** 233 completes replies out of 1380 respondents. 13% had a cessation attitude without delay, 50% temporize with an prospective attitude of cessation and 36% continue these treatments. The evaluation of the benefit-risks ratio was negative regardless of the attitude.

**Discussion:** The relational determinants were predominating in the medical decision process, with attitude frequently paternalistic. The prescription of AD drugs can create a mistrust felling to the "memory consulting" or feeling sick among those who continue treatments despite of a negative evaluation.

**Conclusion:** Because of divergences between GP and consultants, the first prescription of ADdrugs reserved for consultants seems to cause destructuring consequences on accompanying patients.

## P-018

### Can the principle of Occam's Razor be applied to the elderly?

L.L.B. Wong, S.E. Ng, R.A. Merchant. *National University Hospital*

An 87-year-old woman with Alzheimer's dementia presented with a two-day history of lethargy, altered mental status and fever of 38.6°C. She had deteriorated from being able to walk with assistance to being bedridden within two days. Her family also reported significant weight loss of eight kilograms over one year but declined further investigations. On admission she was delirious, clinically dehydrated and uncooperative with neurological examination. Investigations revealed haemoglobin of 8.6 g/dL (11.4–14.7g/L) with normocytic hypochromic picture, total white blood cell of 9.4 × 10⁹/L (3.84–10.01 × 10⁹/L) and c-reactive protein within the normal range. Urine microscopy was unremarkable although urine culture grew Escherichia coli and Klebsiella pneumonia. A non-contrasted CT brain showed lobulated hypodensities with hyperdense rims in the right occipital lobe, associated with perilesional oedema which was initially attributed to malignancy but MRI confirmed it to be a brain abscess with a diameter of 40mm. Her family declined biopsy and patient was commenced on six weeks of intravenous ceftriaxone and metronidazole. Transthoracic echocardiogram revealed an aortic valve vegetation. Three sets of blood cultures were negative for bacterial growth. CT thorax abdomen pelvis was unremarkable. She was discharged to community hospital for rehabilitation and improved significantly back to baseline. Functional decline, delirium and atypical presentations (which may cause a delay in diagnosis) are not uncommon in patients with dementia. Our patient had normal inflammatory markers. There is no substitute for a good history, physical examination and constant revision of diagnosis. Occam's Razor does not apply to elderly.

## P-019

### Co-conception of a robot-assisted intervention for the management of care-induced pain in major neurocognitive disorders

M. Demange¹,², M. Pino¹,², H. Kerhervé¹,², A.-S. Rigaud¹,², I. Cantegreil-Kallen¹,². ¹Department of Geriatrics, Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Paris, France; ²Unit EA 4468. Alzheimer's disease: risk factors, treatment and support for patients and their families, Paris Descartes University, Paris, France

**Introduction:** Health care professionals lack tools to deal with acute pain in patients with moderate to severe dementia during daily nursing situations. The present study determined a framework and examined the feasibility of an innovative intervention using the Paro robot for the management of nursing-induced pain in dementia.

**Methods:** A mixed-method research design combining qualitative (4 focus groups) and quantitative (questionnaire survey) approaches was used to defined the intervention framework. We recruited 51

health care professionals from various medical and paramedical specialties (e.g., nursing auxiliaries, nurses, physicians, psychologists) and with expertise in gerontology.

**Results:** Four main issues regarding the intervention framework were addressed: (1) identification of a core group of situations associated with nursing-induced pain (washing, dressing/change, transfer/mobilization), currently considered as inefficiently managed, (2) the selection of an appropriate assessment methodology including criteria and tools for pain evaluation, (3) the definition of professionals training needs and organizational requirements for its implementation and, (4) the perceived usefulness of a robot-assisted intervention for the management of pain in dementia.

**Conclusion:** A consensual and feasible intervention framework for the management of nursing-induced pain in dementia using the Paro robot was defined. Understanding of professionals' needs, opinions and perceived obstacles regarding the intervention was necessary to implement effectively the assessment of the intervention clinical effects.

## P-020

### Cognitive decline and functional status in elderly cancer survivors from non Hodgkin lymphoma

D. La Carpia¹, B. Di Capua², R. Liperoti², M. Guglielmo³, G. Colloca², D. Fusco², M.C. Cipriani², P. Matteucci³, L. Farina³, L. Devizzi³, P. Di Pede³, C.I. Ripamonti³, R. Bernabei². ¹Università Cattolica Del Sacro Cuore (Roma, Italy), Fondazione IRCCS Istituto Nazionale dei Tumori (Milano, Italy); ²Università Cattolica Del Sacro Cuore (Roma, Italy), Fondazione Policlinico Agostino Gemelli (Roma, Italy); ³Fondazione IRCCS Istituto Nazionale dei Tumori (Milano, Italy)

**Introduction:** Cancer and oncological treatments have been shown to cause cognitive impairment in cancer survivors. Data on elderly haematological patients are laking.

**Methods:** This is a multicentric observational study. Long-term outpatient survivors from Non Hodgkin Lymphoma aged 65 or more (N: 52) and a corresponding group of non-cancer controls (N: 51) have been enrolled since November 15th 2016 at Istituto Nazionale dei Tumori (Milano, IT) and Policlinico Agostino Gemelli (Rome, IT). Enrollement will end in July 2017. All study subjects have been assessed with a battery of neuropsychological tests; ADL, IADL and Karnofsky Performance Status scales were used for functional status. Data are presented using descriptive statistics and compared using T-test for unpaired samples with unequal variance for continuous variables and Chi squared test for categorical variables.

**Results:** Mean age was 74 years in both groups. Survivors scored lower in IADLs (6.9±2.5 vs 7.8±0.9) while no difference was observed in ADLs. As for cognition, survivors showed poorer performances in all tests for executive functions (Stroop Time 23.4" vs 15.6"; Trail Making Test A 34.3" vs 36.9", part B 84.1" vs 71.1", part B-A 48.7 vs 36.0) as well as in attention and visuospatial tasks (Multiple Features Target Cancellations time 48.3" vs 39.2"). No significant difference was observed in verbal learning and immediate recall.

**Conclusions:** Similarly to previous evidence, we observed a frontal subcortical profile with a relative sparing for episodic memory. The impairment in IADL is remarkable because it can be of critical importance for functional autonomy in elderly patients.

## P-021

### Cognitive profile of nonagenarian patients hospitalized in an intermediate care unit

N. Leiva, C. Roqueta, S. Ubero, M.I. Martínez-Fernández, R. Miralles, O. Vázquez. Geriatric Medicine Department, Centre Fòrum, Parc de Salut Mar, Barcelona, Spain

**Aim:** To assess the cognitive status of nonagenarian patients in an intermediate care unit.
**Patients and method:** Prospective study of nonagenarian patients admitted to an intermediate care unit. The following demographic variables (age, sex) and the presence of previous cognitive impairment were recorded (through anamnesis and review of clinical documentation). The cognitive status at admission was evaluated by Mini-mental Examination of Folstein (MMSE) and the presence of delirium by the Confusion Assessment Method (CAM) during admission. MMSE scores were categorized as: Normal (MMSE: 21–30), moderate cognitive impairment (MMSE: 15–20), and severe cognitive impairment (MMSE <15).

**Results:** Two-hundred and twelve patients (75.9% women) were registered. Eighty (37.73%) had cognitive impairment prior to admission. The mean of MMSE at admission was 15±9.82 points. At admission, 71 (34.80%) patients had not cognitive impairment (MMSE ≥21 points), 55 (26.96%) had moderate cognitive impairment (MMSE: 15–20 points) and 78 (38.24%) severe cognitive impairment (MMSE <15 points). The test was not applied to 8 patients because of aphasia, severe cognitive deterioration or deterioration of the state of consciousness. Ninety (42.45%) presented delirium during admission and 75 (35.37%) met dementia criteria.

**Conclusions:** The prevalence of cognitive impairment in the sample of patients evaluated was high. More than one-third of the nonagenarians had cognitive impairment prior to admission and had delirium during admission.

P-022

Course of neuropsychiatric symptoms in institutionalized patients with young onset dementia

R.T.C.M. Koopmans¹, R. Bauhuis¹, A. Mulders². ¹Department of Primary and Community Care, Radboudumc Alzheimer Centre, Radboud University Medical Center, Nijmegen; ²Archipel Care Group, Landrijt, Centre for Specialized Care, Eindhoven, The Netherlands

**Introduction:** Young onset dementia (YOD) often comes with neuropsychiatric symptoms (NPS) that are burdening for patients and caregivers and are predictors for institutionalization. The course of NPS in institutionalized patients with YOD is unknown. This study aims to fill this gap.

**Methods:** This study is part of the BEYOND-study, a descriptive cohort study of patients in Dutch YOD special care units. Eighty-nine patients were included in a two-year follow-up study, of which 50 patients completed follow up. NPS were assessed using the Neuropsychiatric Inventory Nursing Home version. Prevalence, incidence, resolution and persistence of NPS were calculated from all patients alive at the moment of a given assessment. Cumulative prevalence was calculated in patients with complete follow up.

**Results:** 82–94% of the residents had at least one NPS at any of the five assessments. Over the two year course 94% of the patients developed at least one new symptom of which 58% developed irritability, 52% agitation, 44% disinhibition, 44% eating change, and 42% apathy or aberrant motor behaviour. Apathy had the highest overall prevalence rate and was the most persistent symptom over the two-year course, followed by eating changes and aberrant motor behaviour. Most symptoms had a variable course with no clear patterns of increase or decrease.

**Conclusions:** NPS in institutionalized YOD patients vary during the course of the disease. More research into the course and predictors of NPS in institutionalized YOD patients is necessary in order to develop interventions tailored to the specific needs of these patients.

P-023

Depression in the elderly: the impact of comorbidities and sociodemographic factors

S. Hammami¹, I. Chabéne¹, A. Mhalla², L. Gaha². ¹CHU F Bourguiba, Department of Internal Medicine Faculty of Medicine, University of Monastir, Tunisia; ²CHU F Bourguiba, Department of Psychiatry Faculty of Medicine, University of Monastir, Tunisia

**Introduction:** The depression in the elderly is the most common psychiatric disorder. In current practice, it represents a diagnostic and therapeutic challenge because of the atypical forms, screening difficulties and the presence of potentially serious forms.

**Objective:** The aim of our work is to determine the impact of co morbidities and the socio-demographic factors on the depression in elderly.

**Methodology:** This was a retrospective, descriptive study, interest- ing patients aged 65 years and more, who where consulting, in both Geriatric and psychiatric unit in the Fattouma Bourguiba Hospital in Monastir, from 1 January to 31 December 2015, for a major depressive disorder.

**Results:** In all. we collected 38 cases. Our population was predom- inantly female (sex-ratio=0,72). The mean age was 71 years. 68,4% of our patients were not married, 60,5% were illiterate and 60% were unemployed. Over three-quarters of our patients (86,8%) had a personal history of somatic disease dominated by the cardio- vascular one. A major depressive disorder, type of single episode was diagnosed in 25 patients (65,8%) and recurrent one in 31 cases (34,2%). The SSRI antidepressants were the most frequently prescribed drugs (81,5%) followed by the benzodiazepines (31,5%) and the tricyclic ones (18,5%). The Factors which was correlated with a severe disorder are: the social status, a high stress factors score and co morbidities. An academic instruction was considered as a protective one.

**Conclusion:** According to this study, the high frequency of somatic co morbidities and the low level of education were predictive of a severe and atypical forms of depressive disorders in the elderly population

P-024

Description of a cognitive-behavioral unit: management of behavior disorders in dementia

C. Marinho, R. Razou, V. D'Ouince, O. Saint Jean. Hôpital Corentin Celton - Hôpitaux Universitaire Paris Ouest

Behavior disorders found in dementia are a source of caregiver fatigue and hospitalization. The Cognitive Behavioral Units (UCC) for the management of its symptoms was created within the framework of measure 17 of the Alzheimer plan in 2008/2012. The objective of this study is to characterize the patients hospi- talized in our CCU as well as to evaluate the pharmacological vs. non-pharmacological therapeutic practices implemented to reduce behavioral symptoms.

**Results:** 145 patients were enrolled in the study with an average age of 80.35 years (±8.0). An improvement in behavioral disorders was obtained in 65% (n=95) of patients. Symptoms of aggressive- ness, anxiety and hallucination were the most frequent reasons for admission. Patients had severe deterioration (mean MMS at 14). The duration of hospitalization was 56.57 days. A decrease in the number of psychotropic drugs is confirmed by non-drug therapies.

**Discussion:** The use of UCCs appears to be fundamental to manage behavioral disorders; nevertheless there is still room for im- provement in the management of non-drug therapies. This study demonstrates that UCC fulfills the specifications of the UCCs.
P-025

**Diagnosis of neurodegenerative diseases: interest of a second**
**FDG-PET**

A. Pesce¹, C. Vincent¹, S. Louchart de la Chapelle¹, B. Paulmier²,
A. Morisot¹, S. Hesse¹, K. Polet¹, B. Kullmann¹. ¹Rainier III
*Gerontologic Center - Princess Grace Hospital;* ²*Nuclear Medicine*
*Department - Princess Grace Hospital*

**Introduction:** The diagnosis of cognitive disorders requires clinical, neuropsychological/orthophonic examination, brain MRI, functional imaging, proteomic study, amyloid-PET. However, the evolution of these disorders often conducts to correction of prior hypothesis. Lack of investigation on this topic, conducted us to evaluate the interest of a second 18F-flurodeoxyglucose positon emission tomography (FDG-PET).

**Methods:** Retrospective study of patients followed in our primary clinic. 66 patients were enrolled: 27 men (41%), 39 women (59%); mean age 74.7 (44–87); mean MMS-E at first assessment 24 (12–29); mean time between first and second FDG-PET was 18 months (6.4–56.5). Primary diagnosis were compared with a second clinical and neuropsychological assessment, and all cases were discussed to determine final diagnosis and usefulness of second FDG-PET.

**Results:** Among second FDG-PET, 46 (69.7%) were considered as useful. In 22 (48%) patients from this group, second FDG-PET led to correct previous diagnosis, in 12 (26%) conducted to eliminate a second hypothesis, in 12 (26%) confirmed the first hypothesis. Secondary FDG-PET is more useful when performed after 12 months. Furthermore, in patients presenting initially with a psychiatric profile, second FDG-PET was useful in 85.7% of cases.

**Conclusions:** A second FDG-PET performed at least 12 months after first complete assessment is of high interest to define diagnosis of neurodegenerative diseases, and can correct initial diagnosis, especially in patients with initial psychiatric presentation.

P-026

**Differential association between BP level and cognitive function**
**in the elderly and very elderly treated hypertensive subjects**

N. Sharashkina¹, V. Ostapenko¹, O. Tkacheva¹, N. Runikhina¹,
Y. Kotovskaya², E. Mkhitaryan¹. ¹Pirogov Russian National Research
Medical University of the Ministry of Health of the Russian Federation,
Russian Gerontology Clinical Research Center, Moscow; ²RUDN-
University, Moscow

**Aim:** To evaluate relationship between blood pressure and the severity of cognitive impairment in elderly and very elderly patients was studied.

**Material and methods:** The study included 356 patients, the mean age was 74.9±6.1 years, 80.4% were women All patients underwent clinical-neurological examination. Cognitive functions were assessed by Mini Mental State Examination (MMSE). All statistical analyses were performed using "IBM SPSS Statistics version 20" and "Microsoft Excel 2010". Univariate analysis and regression analysis using Pearson's product-moment and Spearman's rank correlation coefficients were undertaken to evaluate data.

**Results:** Average BP level among 65–79 y.o. patients with 28–30 points on the MMSE reveal 141,7±22,93/80,7±9,12 mmHg; among 65–79 y.o. patients with less than 27 points on the MMSE reveal 152,0±23,94/91,0±8,21 mmHg. However the results of BP level among ≥80 y.o. was 144,1±22,44/78,5±8,55 and 145,7±27,04/ 77,9±8,23. In the group of patients under the age of 80, a significant inverse relationship between the total score of MMSE and the level of blood pressure found: for systolic blood pressure (r=-0.22, p=0.0003), for diastolic blood pressure (r=-0.13, p=0.03). That is, in patients with higher blood pressure, low scores on the cognitive status assessment scale were obtained from the Spearman correlation analysis. In those aged 80 years and, correlations were insignificant,

for systolic blood pressure (r=-0.05, P=0.64), for diastolic blood pressure (r=-0.13, p=0.25).

**Conclusion:** The results suggest differential association between BP and cognitive function in the elderly and very elderly patients. Diminishing of inverse correlation between SBP and MMSE may be found in the very elderly treated hypertensive subjects

P-027

**Distinguishing Alzheimer disease and other forms of dementia:**
**the role of amyloid positron emission tomography imaging**

G. Ricevuti¹, G. Trifiro², C. Vellani², I. Bossert², G. Cuzzoni¹,
L. Venturini¹, C. Alfano³, F. Guerriero¹. ¹Dept. of Internal Medicine
and Therapeutics, Section of Geriatrics, University of Pavia, Italy;
Azienda Servizi alla Persona, S. Margherita Institute, Pavia; ²Nuclear
Medicine Unit, ICS Maugeri, Pavia; ³Dept. of Internal Medicine and
Therapeutics, Section of Geriatrics, University of Pavia, Italy

**Background:** Diagnosing Alzheimer Disease (AD) is complex. With no single test currently available, diagnosis is based on an individual's history, physical examination, and cognitive testing. One of the main features of AD is the presence of amyloid beta deposits, which accumulate in the brain years before the onset of symptoms. Positron emission tomography (PET) imaging assessing amyloid burden represents a potential advance in the assessment of neurocognitive disorders. PET scanning has been reported to play a pivotal role in helping the clinician distinguishing between AD and other dementia disorders.

**Aim:** This study aimed at exploring the ability and efficacy of Amyloid PET-CT to diagnose AD in patients with a suspicion of AD.

**Methods:** 66 subjects (mean age 75.2 y, SD ±5.2 y) suffering from cognitive impairment suspicious for AD underwent amyloid PET. Laboratory and neuropsychological assessment and brain CT/MRI scan were also performed for differential diagnosis. AD diagnosis was made according to 2011 Alzheimer Association/National Institute of Aging (AA/NIA) diagnostic criteria and guidelines for AD.

**Results:** Concordance with AD diagnosis – according to AA/NIA criteria – and PET-CT visual reads was estimated at 96.9% in our study population. Statistical analysis has demonstrated that amyloid PET-CT has a 98.4% sensitivity and 91.9% specificity to distinguish AD from other forms of dementia.

**Conclusion:** Amyloid PET has improved the non-invasive assessment of the pathological hallmarks of AD. It should be used as an additional diagnostic tool when evaluating individuals who may have AD, in conjunction with cognitive tests and patient history gathering.

P-028

**Economic impact of the intervention of geriatric specialized**
**teams (EAR) in the assessment of patients with dementia in**
**nursing homes in two catalan counties (Vallès Occidental and**
**Vallès Oriental)**

J. Mandujano Valencia. EAR (Nursing home care team) - Mutuam

**Introduction:** There is worldwide concern about healthcare economic impact of population aging and the exponential increase of prevalence of elderly people with dementia. Until 2016, 98,800 people were diagnosed with Alzheimer's disease in Spain, assuming an annual pharmacological cost of €23,354 and a direct medical cost of €10,291 per person in a year. Dementia directed treatment (DDT) cost is €1,000 per patient/year while hospital specialised assessment cost is 200€ per visit. Every patient is usually assessed twice a year at the hospital. In 2016, EAR teams began monitoring patients with dementia in Vallès Occidental (VOC) and Vallès Oriental (VOR) nursing homes.

**Method:** Prospective and descriptive study of assessment, performed on dementia patients admitted in VOC and VOR nursing homes.
**Objective:** EAR teams are cost-effective in monitoring patients on dementia directed treatment in VOC and VOR nursing homes.

**Results:** 105 patients (81 women and 24 men) were assessed by EAR at their nursing home. Mean age was 85 years old and 42% had severe dependence (Barthel index below 20). Only 20 patients were identified as MACA (chronic advanced disease); 7 out of 20 had severe cognitive impairment as assessed with a Global Deterioration Scale (GDS) of 7. 40 were not identified neither MACA nor PCC (chronic complex patient); 22 out of 40 had a GDS of 7. After EAR assessment DDT was withdrawn in 53 patients, renewed in 37 patients, started in 1 patient and partially renewed in another.

**Conclusion:** EAR intervention had a reduction of direct costs to healthcare system of 101,500€ in 2016. For this reason, we conclude that speacilized geriatric provided at the nursing home is probably the most suitable and efficient device to assess and monitor resident nursing home patients with dementia.

## P-029

### Effects of multisensory stimulation in a snoezelen room on the behavior of elderly people with dementia

D. Curto¹, P. Cano¹, C. Garcia¹, J.F. Tomas², C. Resano¹. ¹Sanitas Mayores Sanitas ELA-Bupa; ²Sanitas ELA-Bupa

**Introduction:** Snoezelen rooms (multisensory stimulation) are available in day centers and care homes, but there is little research on the impact of these on the behavior of people with dementia. The main objective of this study is to investigate the benefits of multisensory stimulation on the affective-behavioral level in elderly people with mild, moderate or severe dementia.

**Method:** Mixed methodology: quantitative and qualitative data. Design: Quasi experimental, pre and post test with control group. Subjects: 18 people with dementia. Instruments: Standard tests combined with video footage are combined. Tests applied: Blessed (dementia); Cornell (depression). Hamilton (Anxiety) Cohen (agitation). Record of relaxation. Procedure: Participants were randomly assigned to the snoezelen room or reminiscence sessions (control group). They have participated in two weekly sessions of 30 minutes for 3 weeks in a group of three people. The tests and videotaped sessions 1, 3 and 6. The therapist of the multisensory classroom has completed two questionnaires designed ad hoc for each participant: a) Register of the different materials that have used. b) Perception of the professional about the general condition of the patient.

**Results:** Presented for each study group as well as comparative between groups. Regarding the behavior in general there are no significant differences between the pre and post test, but it is noteworthy that regarding relaxation there are remarkable changes. The group with mild dementia presents notable improvements in participation.

**Conclusions:** Multisensory therapy favors relaxation and inter-personal relationships in the individuals studied. Implications for clinical practice of snoezelen rooms are discussed.

## P-030

### Evidence of RedOx homeostasis disruption on red blood cells of patients with dementia

A. Zarrouk¹, S. Hammami², M. Dabbabi¹, M. Frih³, G. Lizard⁴, M. Hammami¹. ¹University of Monastir, Faculty of Medicine, Department of Biochemistry -UR "Nutrition Humaine et Désordre Métabolique", Monastir, Tunisie; ²CHU F Bourguiba, Department of Internal Medicine, University of Monastir, Faculty of Medicine, UR "Nutrition Humaine et Désordre Métabolique", Monastir, Tunisie; ³CHU F Bourguiba, Department of Neurology, University of Monastir, Tunisie; ⁴(EA 7270)/University of Bourgogne/INSERM, Dijon, France

**Introduction:** The pivotal role of oxidative stress in brain degeneration is widely accepted, and its increase may cause adverse effects

in the cell membranes. The present study realized on 64 demented patients vs 79 healthy non-demented controls was undertaken to precise the relationships between the different types and stages of dementia and oxidative stress.

**Methods:** All the participants (age>60) were classified according to the DSM-IV diagnostic criteria for dementia. Demented patients were stratified into 3 groups; Alzheimer disease (AD), vascular dementia (VD) and others dementia group (OD). We measured malondialdehyde (MDA) and conjugated dienes (CD) levels, super-oxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities and reduced glutathione (GSH) in RBCs from all participants.

**Results:** A significant increase in catalase and SOD activity was revealed in all demented patients compared with controls. Besides, a significant decrease of the GPx activity was revealed associated with a significant increase of GSH level compared to controls. Highly significant differences were observed with GPx activity of each group comparatively to controls. An increase in catalase activity was also observed in the different groups of patients. Furthermore, mean values of MDA increase in AD, VD and OD. Also, raised levels of CD were observed in demented patients. In conclusion, on the population of demented patients considered, our investigation suggests that the occurrence of oxidative stress at the peripheric level is not counteracted by enhanced activities of anti-oxidative defenses.

## P-031

### Factors associated with adherence to multidomain lifestyle interventions for the prevention of dementia: data from the MAPT and FINGER trials

N. Coley¹, T. Ngandu², C. Cantet³, J. Lehtisalo², B. Vellas³, M. Kivipelto⁴, S. Andrieu⁵. ¹INSERM UMR1027/CHU Toulouse, Toulouse, France; ²Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; ³INSERM-Toulouse University UMR1027/CHU Toulouse, Toulouse, France; ⁴Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden; Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland; Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; ⁵INSERM-University of Toulouse UMR1027/CHU Toulouse, Toulouse, France

**Introduction:** Multidomain lifestyle interventions have been advocated for dementia prevention, but can be burdensome. The content, intensity and method of delivery of interventions could affect adherence, which in turn could affect efficacy. Our aim was to study factors associated with adherence in two multidomain trials aiming to prevent cognitive decline.

**Methods:** The 2-year FINGER trial included 1260 Finnish individuals aged 60-77 years with an increased dementia risk score, and the 3-year MAPT trial included 1680 French individuals aged ≥70 with a subjective memory complaint, IADL limitation and/or slow walking speed. The FINGER intervention involved separate group and individual sessions of computer-based cognitive training, physical exercise, nutritional counselling and cardiovascular monitoring. The MAPT multidomain intervention involved group sessions simultaneously covering pen and paper-based cognitive training, and advice/education on physical activity and diet. We examined factors associated with adherence to the MAPT group sessions, and simultaneous adherence to all components of the FINGER intervention.

**Results:** In unadjusted analyses, only poor physical status and low income were significantly associated with poorer adherence in both trials. In addition, in FINGER, older age, lower education, lack of physical exercise and being single were associated with poorer adherence, while in MAPT, lower cognition and cardiovascular risk
factors (BMI, diabetes, high blood pressure) were associated with poorer adherence. Multivariate analyses will be presented.

**Conclusions:** Dementia risk factors were associated with poorer adherence to multidomain lifestyle interventions, although results varied across trials, probably due in particular to differences in study populations, and intervention design.

P-032

Factors associated with caregiver burden in caregivers of patients with dementia admitted to psychiatric hospitals for behavioral and psychological symptoms of dementia in Japan

T. Ishii¹, K. Fuchino², H. Okamura³. ¹Medical Corporation Tijinkai, Maple Hill Hospital, Otake, Japan; ²Medical Corporation Fuchinokai, Green-Hill Health Hospital, Oita, Japan; ³Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan

**Background:** We have reported that caregiver burden may impede early discharge of patients with dementia admitted to psychiatric hospitals for the management of the behavioral and psychological symptoms of dementia (BPSD) in Japan. We analyzed the data of a nationwide prospective cohort study to identify factors associated with caregiver burden.

**Methods:** A total of 138 psychiatric hospitals with dementia units (31.5% of such hospitals in Japan) participated in the cohort study. The subjects were patients with dementia admitted to psychiatric hospitals for BPSD and their caregivers and their data at admission were analyzed. Caregiver burden was assessed using the Zarit Caregiver Burden scale (ZCB). Measures of patients included Barthel index (activities of daily living), cognitive function (Mini Mental State Examination), agitation (Cohen-Mansfield Agitation Inventory), BPSD severity and burden (Neuropsychiatric Inventory-Questionnaire). The association with caregiver burden was assessed using multiple linear regression.

**Results:** Of 361 caregivers included in the analysis, the mean of ZCB was 43.8 with standard deviation of 20.4. In multiple linear regression analysis, patient's marital status, experience of caregivers quitting or changing their job for caregiving, time for caregiving more than 8 hours per day, caregiver's self-rated health, BPSD severity were associated with caregiver burden.

**Conclusion:** Multiple factors may contribute to caregiver burden. Our results may enable medical staff to identify caregivers at high risk for caregiver burden, which would be a prime target for the intervention to alleviate caregiver burden.

P-033

Frailty indicates study dropouts in a randomized drug trial among mild to moderate Alzheimer's disease patients

A.M.M. Santoso, G.J. van Spijker, M.G.M. Olde Rikkert. Donders Institute for Brain, Cognition and Behavior; Radboud Alzheimer Centre; Department of Geriatric Medicine; Radboud University Medical Center, Nijmegen, The Netherlands

**Introduction:** While frailty has been widely reported in observational studies as an important predictor for adverse health outcomes, its contribution to dropouts and adverse events in trials has not been reported. We examined whether frailty is linked with these relevant events in a drug trial among patients with mild to moderate Alzheimer's Disease (AD).

**Methods:** 469 participants (73±8 years, female 61.6%) were included in the NILVAD-frailty substudy [1]. A Frailty Index (FI) with a range of 0 (fittest) to 1 (frailest) was derived based on a previously defined approach [2] from 26 deficits across seven domains (i.e. daily functioning, cognition, morbidity, physical performance, social network, polypharmacy, and body mass index) assessed at baseline and at 78±1 week follow up. Using Mann-Whitney test, differences of baseline FI were examined among participants who dropped

out versus those who adhered to the study. Spearman's correlation coefficient was examined between baseline FI and number of recorded adverse events.

**Results:** 408 participants had available FI at both time points, with positive-skewed distribution at baseline (median=0.18), which became significantly higher (p<0.001) and normalized at follow up (median=0.29). Median baseline FI was 0.06 higher (p<0.05) for participants who dropped out than for those who adhered to study. We did not find an association between baseline FI and number of recorded adverse events (Spearman's r=0.55).

**Conclusions:** Our findings suggest that the frailty status of participants in AD drug trials will significantly increase over 1.5 year study period, and it may assist researchers to anticipate dropouts among these patients.

References:

[1] Meulenbroek, O., et al., European multicentre double-blind placebo-controlled trial of Nilvadipine in mild-to-moderate Alzheimer's disease - the substudy protocols: NILVAD frailty; NILVAD blood and genetic biomarkers; NILVAD cerebrospinal fluid biomarkers; NILVAD cerebral blood flow. BMJ Open, 2016. 6(7).

[2] Searle, S.D., et al., A standard procedure for creating a frailty index. BMC Geriatrics, 2008. 8(1): p. 24.

P-034

How to support people with dementia to take part in activities

R. Granbo. Boulton,L (UK), Saltvedt, I. (Norway), Helbostad, J.L. (Norway), Taraldsen, K. (Norway)

**Introduction:** Participation in activities outside home can be a challenge for people with dementia. In this qualitative study we wanted to explore the experiences and perspectives of caregivers related to participation in physical activities, in order to understand barriers and facilitators to participating in activities for older adults with dementia. The study represents a first step in describing challenges, in order to be able to design new activities adapted to this particular group of older adults.

**Methods:** We recruited eight caregivers of home-dwelling people with a dementia diagnosis from a local centre for people with dementia and their families in a Norwegian municipality. We performed two focus groups, and qualitative data were analysed by Systematic Text Condensation method.

**Results:** The findings indicate that current health care services for people with dementia do not meet the needs of either the people with dementia or their caregivers. The services offered are characterised by passivity and lack of individual and personalised care. Rather than focus on the dementia diagnosis, caregivers suggest that services consider individual resources, interests, and physical function.

**Conclusions:** To improve the health care services for people with dementia participation and involvement from both people with dementia and their caregivers is necessary. Design and organisation of services for people with dementia should take their total situation into account, in order to provide activities that people with dementia can use, and also to support and decrease caregivers' burden.

P-035

Hypertension and cognitive function in the elderly: preliminary results of a screening study

G. Rivasi, M. Bulgaresi, L. Menozzi, F. Sgrilli, A. Giordano, L. Martella, C. Lorenzi, A. Ungar. Department of Geriatrics, Careggi Hospital and University of Florence, Florence, Italy

**Introduction:** Hypertension is a risk factor for cognitive decline, therefore cognitive evaluation should be included in the clinical
assessment of elder hypertensive patients. Nonetheless, there is
still controversy over which screening test is more appropriate. Our
study evaluates the Mini-Cog test as first-line screening, to assess
cognitive function in old hypertensive patients without a previous
diagnosis of cognitive impairment.

**Methods:** Patients aged ≥65 years consecutively referred to our Centre were enrolled. All patients underwent a first-line evaluation with the Mini-Cog test (three-item repetition and recall and clock drawing). If the Mini-Cog result was abnormal, the Mini Mental State Examination (MMSE) was administered. In case of a MMSE score ≤27, a Neuropsychological Evaluation (NPE) was performed.

**Results:** 80 patients were enrolled; the mean age was 75.7±5.5 years, 27.5% of patients was octogenarian. All patients had both clinic and out-of-office blood pressure (BP) values in the target range; mean BP values were similar in patients with normal and abnormal Mini-Cog Test results. A Mini-Cog Test suggestive for cognitive impairment was observed in 16 patients (20%); of these, 5 had a MMSE score ≤27. At the NPE, a diagnosis of cognitive decline was confirmed in 2 patients (2.5% of our population). Clock Drawing Test was incorrect in 39.1% of patients with a normal Mini-Cog test; the 51.3% of the overall population had a deficit in clock drawing.

**Conclusions:** The Mini-Cog test cannot be suggested as a screening test for the evaluation of cognitive function in old hypertensive patients.

P-036

Improvement of behavioral and psychological symptoms of
dementia (BPSD) by teaching basic comprehensive standardized
care methodology to family caregivers

M. Honda, C. Shimada. National Hospital Organization Tokyo Medical Center

In Japan, the population with dementia is estimated over 7 million
in 2025. Although it is recommended to support person with de-
mentia to live in familiar community as long as possible, it can cause
caregivers' burden. Especially BPSD brings enormous care burden
and interferes the health of family caregivers, which results to
hasten timing of long-term care institutionalization. A multimodal
comprehensive French care methodology; Humanitude, focuses on
their perception, emotion and verbal-nonverbal communication
between vulnerable elderlies and their caregivers. The effectiveness
of this methodology has been reported in professional caregivers,
however, no study was conducted among family caregivers. The
objective of this study is to evaluate reduction of BPSD by teaching
Humanitude to family caregivers. This pilot study was designed as
pre-post comparison of teaching the care methodology to family
caregivers. It conducted in two regions in Japan, and 9 caregivers
participated. Family caregivers learned this methodology, and used
the techniques at home. The BPSD of the care-receivers was evalu-
ated by Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD)
before the training, at month 1 and month 3 after the training.
The average age of caregivers was 65.1 (±12.7) and care-receivers
was 81.5 (±8.0). The score of BEHAVE-AD at baseline was 9.0 and
decreased to 6.4 at month 1 (t-test, p=0.088), 5.9 at months 3 (t-test,
n.s.). There was no difference in Burden score. A comprehensive
multimodal care methodology for family caregivers was effective
for improvement BPSD of people with dementia at home.

P-037

Improving personalised care for inpatients with dementia in
Wales: quality improvement initiative using the “This is me”
booklet

S. Wright, L. Linley-Adams, N. Moss, O. Daly, G. Jones, L. Rozier. *Care of the Elderly Department, Royal Glamorgan Hospital, Cwm Taf University Health Board, Wales*

**Introduction:** Personalised care can alleviate psychological distress for inpatients with dementia. The “This is Me” booklet contains questions which patients and families can fill in together: these questions explore important life events, preferences and causes for anxiety. The UK National Audit for Dementia aims for all inpatients to have access to a “This is Me” or alternative care booklet.

**Methods:** We are undertaking a quality improvement initiative within the Royal Glamorgan Hospital (RGH) to ensure that “This is me” booklets are completed for all inpatients with dementia. We have undertaken a primary audit of their use, followed by focused interviews and questionnaires for relatives (n=16) and clinical staff (n=36) to assess the perception of the quality of personalised care delivered on the wards.

**Results:** 18% of patients with dementia had a "This is me" or alternative personal care booklet completed (n=32). Focused interviews highlighted concerns that staff didn't know their relatives preferred name, food/drink preferences or communication requirements. 37% of family members felt that staff were aware of what makes their relative anxious.

**Conclusions:** RGH is currently providing inadequate personalised care to patients with dementia. We have therefore provided ward based multi-disciplinary education sessions, emphasising the benefits of providing personalised care. We have also created dementia packs for relatives, which include "This is me" booklets in addition to information about dementia/delerium. Improvements in staff and patient satisfaction have already been noted following this intervention and will be re-audited throughout Summer 2017.

P-038

Leisure activity, social interactions and the risk of cognitive
decline in old people

H. Hansdóttir¹, G. Eiríksdóttir², M.K. Jónsdóttir¹, D. Fisher²,
P.V. Jónsson¹, V. Guðnason². ¹Landspitali University Hospital;
²Icelandic Heart Association

**Introduction:** Participation in leisure activities as well as extensive social networks have been associated with a lower risk of incident dementia. While cognitive activity, such as solving puzzles, reading or playing board games have been shown to reduce the likelihood of incident dementia, the role of group, social, creative or physical activity is less clear.

**Methods:** We examined the relationship between leisure activities and social relations and the risk of MCI (mild cognitive impairment) and dementia in a cohort of 4409 elderly individuals who participated in the Ages-Reykjavik Study. The cohort was cognitively intact at baseline and was followed for 5 years. Logistic regression analysis was used to evaluate the risk of cognitive decline with adjustment for age, sex, education, occupation, physical function, health and vascular risk factors.

**Results:** There were 351 (8%) individuals who were cognitively impaired at AGES II follow up, 243 were diagnosed with MCI and 108 with dementia. Frequent engaging in solitary or group cognitive or creative activity, was associated with reduced risk of cognitive decline Odds Ratio (OR): 0.49 (95% conficence interval (CI):0,38–0,64), OR: 0,50 (95% CI:(0,30–0,82) and OR:0,53 (95% CI:0,35–0,83) respectively. Frequency of interaction with friends and relatives was associated with reduced risk of cognitive decline (OR:0,49 (95% CI:0,31–0,75). The associations were generally stronger for women, except for the frequency of interactions with friends or relatives.

**Conclusion:** Cognitive, either solitary or group, and creative leisure activities and frequent social interactions was associated with reduced risk of cognitive decline by half over 5 years of follow-up
P-039

**Refusal and acceptance of Paro-based therapy: a pilot study in patients with major neurocognitive disorders**

M. Demange¹,², H. Lenoir¹,², M. Pino¹,², I. Cantegreil-Kallen¹,², A.-S. Rigaud¹,², V. Cristancho-Lacroix¹,², ¹Department of Geriatrics, Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Paris, France; ²Unit EA 4468. Alzheimer's disease: risk factors, treatment and support for patients and their families, Paris Descartes University, Paris, France

**Introduction:** Social robot therapy is a promising psychosocial intervention for patients displaying behavioral and psychological symptoms of dementia (BPSD). While the acceptability of robot-based interventions plays a crucial role in the therapeutic observance, studies on refusal causes and the influence of acceptability on intervention's efficacy remains little explored.

**Methods:** A pilot study was conducted among 17 patients with BPSD in order to measure the impact of an exposition to PARO robot without simultaneous human presence. Intervention consisted of four 15-minutes individual sessions. Participants were assessed on their perceived emotional well-being and the acceptability of the intervention.

**Results:** Of the 24 pre-selected patients for the study, seven refused to participate (29,2%). Reasons for refusals were classified into three categories: (1) "no interest in robots" (57,2%), (2) "It is childlike" (28,6%), and (3) "refuse consent to any care" (14,3%). However, included participants reported good robot acceptability. No statistical differences were found between patients who accepted and refused the intervention regarding socio-demographic characteristics, cognitive status or BPSD profile. Higher acceptability level was positively associated with positive affects improvement in the well-being scale (r = 0.56; p < 0.05).

**Conclusion:** In spite of Paro's impact in patients' with BPSD, its use would be limited by the preconceptions, which seems change after real experiences. Thus, producing strategies to democratize the use of social robots in these populations seems warranted.

P-040

**Motor performance of older subjects with mild cognitive impairment and early Alzheimer's disease: Is dual task test really useful?**

M. Mengoni¹, M. Baccini², L. Vicarelli¹, E. Latini¹, M. Betti¹, G. Rubbieri¹, M. Paoli¹, L. Sati¹, A.M. Mello², D. Simoni¹, C. Baroncini¹, M.C. Cavallini¹, M. Di Bari¹, E. Mossello¹.

¹Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy; ²Azienda USL Toscana Centro, Florence, Italy

**Introduction:** Motor impairment has been observed in Alzheimer's disease (AD), since early stages, and Mild Cognitive Impairment (MCI), with dual task (DT) measures being considered as specific correlates of cognitive decline. The purpose of this study is to compare motor performance (including DT performance) of older subjects with and without cognitive impairment.

**Methods:** Subject 65+ with mild AD or MCI (D+) and peers without cognitive impairment (D-) underwent Short Physical Performance Battery (SPPB) and quantitative gait analysis with GAITRite, both as single task (ST) and as dual task (DT, with concurrent verbal fluency test). DT cost was calculated as percentage change of motor performance in DT compared with ST.

**Results:** 32 D- and 35 D+ were enrolled. In comparison with D-, D+ had a similar age (78) but greater cognitive (Mini Mental State Examination 25.0 vs. 28.6) and functional impairment, comorbidity and polypharmacy. D+ showed a poorer motor performance than D-, both as SPPB score (10 vs. 11, p=0.02) and as walking speed (1.10 vs. 1.24 m/sec, p=0.02) and cadence. DT cost was similar between the two groups. These differences were lost after adjustment for

comorbidity and polypharmacy. In the whole sample, both MMSE score and polypharmacy independently predicted SPPB score.

**Conclusion:** Older subjects with MCI and mild AD showed a worse motor performance compared to cognitively intact peers, but this difference was at least partly explained by greater comorbidity/polypharmacy. Contrary to previous literature, dual task cost was not associated with cognitive impairment.

P-041

**My life story**

E. Borizovski¹, M. Sambuchi², C. Farjon¹, J. Dodart², A. De Chassey Parzy¹. ¹EHPAD Frédéric Mistral, CH Vaison la Romaine, France; ²EHPAD Albert Artilland, Bedoin, France

**Introduction:** "My Life Story" is a concept which involves making a book of one's life, which allows seniors in nursing homes to inappropriate and revisit their history and memories. This booklet contains the life course of resident and has for the purpose a long-term study of behavioral and moods disorders, in the practical application of non-drug treatments.

**Methods:** Each book is created during a weekly session. The resident himself or one of his relatives, (if the resident presents demential disabilities or psychiatric disorders), evoke his life based on specific events illustrated by personal photos that he has preselected. This booklet is established two months after arrival in nursing home while residents get their benchmarks. This study analyses three groups of residents: – "Placebo", – "Demented" – "Psychiatric"; Under three different conditions: – With booklet and an hour a week personal accompaniment, – With booklet and without accompaniment, – Without booklet and without accompaniment.

**Results:** The qualitative results, verbalized or observed data, will allow working on the resident's representations and interpretations on some aspects of their lives, but also how they lived them. The quantitative results, which study the decrease in medical prescriptions, as well as mood and behavioral disorders will demonstrate the positive effect or not of this booklet.

**Conclusions:** Improvements will be made in multidisciplinary group such as recording interviews by video to investigate objectively the exchange time and the different expressions between the resident and his family or nursing team.

P-042

**Negative perceptions of Alzheimer disease and memory problems: factor to beginning a diagnosis process?**

A. Besozzi¹, C. Perret-Guillaume¹, E. Spitz², P. Balassa². ¹CHRU Nancy; ²Equipe APEMAC - Université de Lorraine

Illness perceptions are well known to influence how people live with chronic disease and deal with bad news such as diagnosis disclosure. Assessment of illness perceptions is used for preventive approach too. In this study, the Common Sense Model of Leventhal helps us to assess memory problems perceptions of people with memory complaints. These people were split in two groups: 54 persons with help seeking behavior recruited at a memory center and 46 persons without help seeking behavior met in their homes. The aim of the study was to identify: the main causes of memory problems reported by people with memory complaints, perceptions and factors of help seeking. For that purpose, we developed a French version of Illness Perceptions Questionnaire-Memory.

**Results:** Memory problems are embarrassing for the majority of respondents in the two groups. Nevertheless, memory problems are considered controllable with external support. Besides aging, the main causes of memory problems reported are lack of attention and lack of brain stimulation. Memory problems perceptions are linked to quality of life and are more predictive of help seeking behavior than aging or effective cognitive decline.
**Conclusion:** Assessment of memory problems perceptions could be interesting when memory complaints appear to determine the degree of global understanding and the need for medical care. In the diagnosis process and after the diagnosis disclosure, memory problems perceptions could help health professionals to adjust their care.

P-043

Neuropsychiatric symptoms in people with Korsakoff syndrome and other alcohol-related cognitive disorders living in specialist long-term care facilities: the prevalence, severity and associated caregiver distress

I. Gerridzen 1,2, C. Hertogh 1, M. Depla 1, R. Veenhuizen 1,
E. Verschuur 2,3, K. Joling 1. ¹Department of General Practice and
Elderly Care Medicine, Amsterdam Public Health research institute, VU
University Medical Center, Amsterdam, the Netherlands; ²Nursing
Home Markenhof, Atlant, Beekbergen, the Netherlands; ³HAN
University of Applied Sciences, Nijmegen, the Netherlands

**Introduction:** Caring for people with Korsakoff syndrome (KS) residing in specialist long-term care facilities (LTCFs) can be distressing due to challenging neuropsychiatric symptoms (NPS) and may lead to inappropriate prescription of psychotropic drugs. However, good quality studies on NPS in this under-researched population are lacking. This study examined the prevalence and severity of NPS in residents with KS living in specialist LTCFs and the associated distress on care staff.

**Methods:** A cross-sectional, observational study was conducted among 281 residents with KS living in nine specialist LTCFs in the Netherlands. Data were obtained using structured interviews with care staff, elderly care physicians, and residents. The prevalence and severity of NPS were measured with the Neuropsychiatric Inventory-Questionnaire (NPI-Q). The associated caregiver distress was assessed with the NPI Distress Scale (NPI-D) according to the nurse or nursing assistant.

**Results:** Almost all residents (96.4%) showed at least one NPS and 45.8% showed five or more symptoms. Irritability/lability (68.3%), agitation/aggression (58.7%) and disinhibition (52.7%) were most prevalent. While NPS scored overall low on severity, half of the residents (49.1%) had at least one severe NPS. Care staff experienced low levels of distress associated with NPS.

**Conclusions:** This study demonstrates that NPS are highly prevalent in residents with KS, but manageable for care staff. Acquiring more insight in NPS and its associations among residents with KS is important to better understand and reduce these symptoms. This may improve the quality of care of these residents.

P-044

NEVIP, a new test assessing visual perception in elderly

C. Sagot 1, B. Dieudonné 2, S. Greffard 2, L. Mora 3, M. Daeschner 2,
J.-L. Golmard 4, V. de La Sayette 5, M.J. Firbank 6, M. Verny 2. ¹Service
de gériatrie et médecine polyvalente, Centre hospitalier Sud Francilien,
Corbeil, France; ²Sorbonne Universités, UPMC Univ Paris 06 (DHU
FAST), Groupe Hospitalier Pitié Salpêtrière - Charles Foix (AP-HP),
Centre de Gériatrie, Paris, France; ³Service de médecine gériatrique,
Centre Hospitalier Charles Foix, Ivry-sur-Seine, France; ⁴Département
de Biostatistiques, Groupe Hospitalier Pitié Salpêtrière - Charles Foix
(AP-HP), Paris, France; ⁵Service de Neurologie, Centre Hospitalier
Universitaire, Université Caen-Normandie, Caen, France; ⁶Institute of
Neuroscience, Campus for Ageing and Vitality, Newcastle University,
Newcastle, United Kingdom

**Objective:** Visuoperceptual deficits are common in neurodegenerative diseases, especially in dementia with Lewy Body, with high impact on diagnosis and prognosis. In the geriatric population, testing visuoperception is rare because of decline in other cognitive

domains and motor difficulties. The NEVIP is a new, easy to use, and quick computer based battery, which evaluates visuoperceptual deficits. We aimed to study, in routine care, the feasibility of the NEVIP, and its performance compared to paper-and-pencil tests, in the geriatric population.

**Methods:** We conducted a prospective study in a French geriatric medical center. During 3 months, we recruited patients with memory complaint, MMSE ≥18 and without significant visual impairment. Visuoperception was examined with usual tests (Benton Judgment of line orientation, Incomplete Letters of VOSP, PEGV's overlapping figures and Rey-Osterrieth figure complex copy) and NEVIP, which was composed of 4 subtests (angle, color, form and motion perceptions). Memory and executive functions were also evaluated and compared with NEVIP.

**Results:** Thirty patients were included with an average age of 81.9±5.3 and an average MMSE of 24.8±2.8. Global NEVIP score and angle perception score were correlated with visuoperception score even after controlling for executive functions. Motion perception score was specifically correlated with both visuoperception and executive scores. Color perception score was only correlated with executive score.

**Conclusions:** We highlighted multiple correlations between NEVIP and standard paper-and-pencil tests assessing visuoperception. Our finding suggests that the NEVIP battery could be a quick and easy alternative to explore visuoperception deficits, including in the geriatric population.

P-045

Optimising falls risk assessment in memory services: sharing best practice across geriatric and psychiatric services in England

A.K. Buttery¹, A. Hopper², C. Ballard³, M. Kinirons², J. Sauer⁴,
R.M. Lawrence⁵, A.B. Saiz⁶, F.C. Martin². ¹Faculty of Life Sciences
and Medicine, King's College London, UK; ²Guy's and St Thomas' NHS
Foundation Trust, London, UK; ³University of Exeter Medical School,
Exeter, UK; ⁴South London and Maudsley NHS Foundation Trust,
London, UK; ⁵South West London and St George's Mental Health NHS
Trust, London, UK; ⁶Oxleas NHS Foundation Trust, London, UK

**Background:** In the UK, a variety of medical specialists are involved in delivering memory services and diagnosing dementia. As people with dementia have an increased risk of falling, understanding variation in falls risk assessment in memory services will clarify the implementation approach needed to improve effective assessments.

**Methods:** Comparative case study design of four large regional National Health Service (NHS) memory services in England involving geriatricians or psychiatrists.

**Methods:** Included: i) document analysis of local falls policies including assessment and referral arrangements for those at risk; ii) observation of falls risk assessment procedures in memory services (total=17.5 hours); iii) semi-structured qualitative interviews (n=30) with multi-disciplinary memory and falls service providers. Interviews were audio-recorded, transcribed and analysed using thematic analysis and NVivo software.

**Results:** Three key themes emerged: i) identifying people at risk of falling is regarded as a high priority among memory services, ii) memory service providers varied in confidence and knowledge in performing falls risk assessment and, iii) standardised assessments and electronic prompts for assessment and referral to falls prevention services are underutilised. Falls risk assessment was conducted by all memory services, but assessment methods varied. Most used patient self-report, asking recommended questions about the frequency of falls in the previous 12 months, problems with mobility, gait and balance and occasionally fear of falling. Brief observation of gait was performed, but objective measures (e.g. Timed Up and Go test) were not routinely performed.

**Conclusions:** Improving case finding of people at risk of falling in
memory services requires embedded standardised assessments and simplified care pathways.

P-046

**Physical activity, physical function, and gait in persons with dementia**

K. Taraldsen¹, P. Thingstad¹, J.L. Helbostad¹, S. Bergh², G. Selbæk³,
C. Becker⁴, I. Saltvedt¹. ¹NTNU, Norway; ²IHT, Norway; ³Ageing and
Health, Norway; ⁴RBK, Germany

**Introduction:** For persons with dementia, PA may influence phys-
ical function and ability to perform activities of daily living. The
aim was to investigate differences in PA, physical function, and
gait function between older adults with normal cognition/mild
cognitive impairment (MCI), mild, and moderate/severe dementia.

**Methods:** This cross-sectional study included 100 home-dwelling older adults from an outpatient geriatric clinic. Cognitive impairment was categorised by using clinical dementia rating scale (CDR), CDR 0 was normal, CDR 0.5 was MCI, CDR 1 mild, CDR 2 moderate and CDR 3 severe dementia. We used accelerometers to measure PA, the Short Physical Performance Battery (SPPB) and gait speed to measure physical function, and an electronic gait mat to evaluate gait characteristics. Statistical analyses included one-way ANOVA.

**Results:** Participants (mean age 78.9 years, SD 6.7, 57% women) average upright time was 301 min/day and gait speed was 0.93 m/sec. Upright time, SPPB, gait speed, step length, and walk ratio differed between groups. Post hoc tests revealed significant differences between CDR 0/0.5 and CDR 1 for upright time (345.7 vs. 265.7 min/day, p=0.011), SPPB (10.4 vs. 8.3 points, p=0.001), and step length (0.6 vs. 0.5 metres, p=0.003), and CDR 0/0.5 and CDR 2/3 for SPPB (10.4 vs. 8.1 points, p=0.004), gait speed (1.1 vs. 0.8 m/sec, p=0.001), and step length (0.6 vs. 0.5 metres, p=0.002).

**Conclusions:** Results indicate that PA, physical function, and gait differ depending on the severity of cognitive impairment and highlight the need for including such measures in the evaluation of geriatric patients.

P-048

**Physical fitness in older people recently diagnosed with cognitive impairment compared to older people recently discharged from hospital**

K. Hesseberg¹, A. Bergland², E. Rydwik³, T. Brovold².

¹Diakonhjemmet Hospital, Norway; ²HIOA, Norway; ³KI, Sweden

**Introduction:** There is evidence of an association between cogni-
tive function and physical fitness. The aim of this study was to
compare physical fitness in patients with cognitive impairment
with a group of older people recently discharged from hospital.
By comparing two groups of older persons with different health
problems, we wanted to highlight how affected physical fitness
can be in older people with cognitive impairment. Early detection
is essential in order to prevent further decline through physical
activity interventions and rehabilitation strategies.

**Methods:** The sample includes baseline data from two study settings and has a cross-sectional design. 98 patients recently diagnosed with cognitive impairment and 115 patients recently discharged from hospital participated. Associations between the study group variable and different components in the Senior fitness test were examined, controlling for demographic factors and comorbidity.

**Results:** The main findings showed that the group recently diag-
nosed with cognitive impairment indicated poorer results on three
of six physical fitness Components, Chair sit and reach-test, Up&go
test and 6-min walk (p<0.05) compared to older people recently
discharged from hospital.

**Conclusion:** This study shows that the level of physical fitness was

low among older adults with cognitive impairments compared to
older people discharged from hospital. Thus, this study supports
that public health initiatives should be designed to reduce passive
sedentary behavior in older adults with cognitive impairment.
Older adults with cognitive impairment are in need of individually
tailored physical activity programs to increase the level of physical
fitness.

P-049

**Predictors of functional decline among Portuguese hospitalized older adults**

J. Tavares, J. Grácio, L. Veiga Nunes. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

**Introduction:** Functional decline (FD) represents the most frequent adverse event among hospitalized older adults, about 30–60%. This decline during hospitalization is associated with poor outcomes including death both during and following hospitalization. This study aim to estimate the incidence of FD and to examine the predictors of FD in hospitalized older adults.

**Methods:** A Cohort study was perfomed. Funcional status was mea-
sured at three moments: two weeks before admission (baseline),
discharge and three months after discharge. A demographic and
clinical survey was conduct at admission moment and Katz scale
administered in three moments. Logistic regression analyses were
employed to examine the predictive fators. SPSS software, version
20, was used for the statistical analysis.

**Results:** Of the 117 older patients, 55% experienced FD at discharge and 35.5% at three months after discharge. Of the 117 older patients, 55% experienced FD at discharge and 35.5% at three months after discharge. Logistic regression revealed delirium, not having a partner, prior social support, previous hospitalization, cognitive decline and restraint use were significant predictors of FD between baseline and discharge. The advance age, delirium and risk assessment of FD at baseline were significant predictors of FD three months after discharge.

**Conclusions:** The higher prevalence of DF highlights the impor-
tance of prevention in Portuguese hospitals. Some of predictors
occur in the health-disease process, but others may be associated
with hospital practice. Thus, implementing interventions directed
at some of these predictors, such as restraint and delirium, may
contribute to preventing the decline.

P-050

**Predictors of institutionalization for Alzheimer's patient living at home with a family caregiver**

C. Lecardonnel¹, B. Fantino², F. Fantino¹, M. Rabilloud³,
C. Falandry¹, M. Valero¹, E. Nahornyj⁴, M. Haution-Bitker¹,
M. Bonnefoy¹. ¹Geriatric Unit, Lyon Sud University Hospital, Hospices
Civils de Lyon, Pierre-Bénite, France; ²Department of Neuroscience,
Division of Geriatric Medicine, Angers University Hospital, Angers,
France; ³Department of Biostatitics, Hospices Civils de Lyon, Lyon,
France; ⁴Geriatric Unit, Pierre Garraud Hospital, Hospices Civils de
Lyon, Lyon, France

**Introduction:** Determining the predictive factors for institution-
alization of Alzheimer's disease patients is a priority to prevent
care pathway breakdowns. If the role of patient's related covariates
is well described, few studies evaluated the impact of caregivers'
characteristics.

**Purpose:** To identify predictors of institutionalization at one year by a simultaneous evaluation of the patient-caregiver dyad. The primary endpoint of this prospective study was the institutionalization of the Alzheimer disease patient at 1 year follow-up.

**Methods:** Between mars 2012 and December 2013, 97 dyads were
recruited through a Memory Resources & Research Centre: the