years, 8.6% in 75-84 years and 21.9% in 85 years and older). The prevalence of having low gait speed is 41.0%, low grip strength 57.0%, low calf circumference 6.1%. The prevalence having both low gait speed and low grip strength 14.3%. Increase in age (OR 1.084, p=0.007), physical inactivity (OR=3.924, p=0.017), BMI (OR=29.118, p<0.001) and having malnutrition risk or malnutrition (OR=7.950, p<0.001) increases sarcopenia risk.

In conclusion prevalence of sarcopenia is quite high in this population. Increase in age, physical inactivity, low BMI, having malnutrition risk or malnutrition are risk factors for having sarcopenia.

P-239

Prevalence of sarcopenia in a Danish geriatric out-patient population

M.G. Christensen¹, K.S. Piper², R. Dreier¹,³, C. Suetta³,
H.E. Andersen¹. ¹Department of Internal Medicine, Geriatric section,
Glostrup, University Hospital Amager, Hvidovre, Denmark;
²Department of Occupational Therapy and Physiotherapy,
Rigshospitalet - Glostrup, Denmark; ³Department of Clinical
Physiology, Nuclear Medicine & PET, University of Copenhagen,
Denmark

**Introduction:** Using the European Working Group on Sarcopenia (EWGSOP) criterias on a geriatric outpatient-population the aim was to assess the prevalence of sarcopenia and to describe the association between sarcopenia and age, gender, body-mass index (BMI).

**Methods:** Patients referred to a geriatric outpatient-clinic were assessed and classified accordingly EWGSOPs recommendations. Assessment included Dual Energy X-ray absorptiometry (appendicular skeletal muscle mass (ASM)), Hand-grip strength (HGS), 10-meter Walk (GS). Cutoff points: Skeletal Muscle Mass Index (SMI) ASM/height2 (kg/m²). Cutoff men <7.23 kg/m², women <5.67 kg/m². HGS men <30 kg, women <20 kg, GS <0.8 m/s. Patients were classified: No sarcopenia (normal SMI), presarcopenia (reduced SMI, normal HGS and GS), sarcopenia (reduced SMI and reduced HGS or GS) or severe sarcopenia (reduced SMI, HGS and GS).

**Results:** 189 patients were screened for inclusion; 80 were included. 12 (15%) had severe sarcopenia, 9 (11%) had sarcopenia, 8 (10%) had presarcopenia and 51 (62%) did not have sarcopenia. Comparing the groups mean age was significantly higher in the sarcopenic group (sarcopenia and severe sarcopenia) than in the non sarcopenic group (presarcopenia and no sarcopenia), (p:000.9). The nutritional status was significantly poorer in the sarcopenic group (p: <0001). No difference was found in gender distribution (p: 0.729).

**Conclusions:** Prevalence of sarcopenia was 26% in our study highligthing that this condition in common in a geriatric outpatient population. Assessment using the EWGSOP diagnostic method was feasible and is suggested to be part of the standard clinical comprehensive geriatric assessment.

P-240

Prevalence of sarcopenia in very old patients hospitalized in a geriatric ward

P. Fdez-Montalbán, J. Albéniz, L. Hernández, E. Sánchez, B. Montero, A. Merello, A.J. Cruz-Jentoft. Hospital Universitario Ramón y Cajal, Madrid, España

**Introduction:** Few studies have described the prevalence of sarcopenia in hospitalized patients. The aim of this study was to measure the prevalence of sarcopenia in very old patients admitted to a geriatric acute care ward.

**Methods:** Prospective, observational study of all patients admit-

ted to a single Geriatric Acute Unit in a three months period. Sarcopenia was diagnosed by the presence of low muscle mass (measured with bioimpedanciometry using Janssen's equation) plus low muscle strength (measured with a Jamar dynamometer). Sociodemographic, functional, anthropometric and clinical variables were recorded. The sarcopenic group was compared to the non-sarcopenic group.

**Results:** 81 patients were included (60% women, mean age 93±4 years). Mean length of stay 7±5 days. In-hospital mortality 7%. The prevalence of sarcopenia prevalence on admission was 67%. There were more women in the sarcopenic group (74% vs 26%, p<0.01), we found no difference in any other characteristic. Some 30% of those with sarcopenia were institutionalized, 41% lived at home with a caregiver. 31% were unable to walk, 69% were dependent for at least one BADL and 52% were malnourished (MNA≤7) but almost half had a BMI>28. 54% had dementia, most frequent cause of admission was an infection (72%).

**Conclusions:** The prevalence in sarcopenia in acute geriatric care was 67%, with a higher prevalence in women. Sarcopenic patients did not significantly differ from non-sarcopenic patients in other characteristics.

P-241

Relation of CT-scan muscle mass to iliopsoas hematoma in patients treated with anticoagulant? Preliminary results

A. Gioanni. 1. Unit of Peri-Operative Geriatric care, geriatric department, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France

**Introduction:** Iliopsoas hematomas (IPH) represent a classic and life threatening anticoagulation-related complication in elderly patients. Despite its localization, muscle assessment is not considered in haemorragic risk assessment. We hypothesized that muscular mass was inversely associated with IPH.

**Methods:** Retrospective study from 2000 to 2017 in 4 geriatrics acute wards. Data were obtained from medical charts. Inclusion criteria: patients treated with anticoagulant and anticoagulation-related spontaneous IPH confirmed by CT-scan. Controls without anticoagulation-related spontaneous IPH were matched for age and anticoagulant, and explored by CT-scan. Main criteria was iliopsoas muscle surface (IPMS) measured by CT-scan on contralateral psoas. Secondary criteria included fat involution of psoas.

**Results:** There are preliminary results, including 22 cases with anticoagulation-related spontaneous IPH (age 85±6 y/o, sex.ratio 1:1, anticoagulant 100%, transfusion 89%, albumin 29±5 g/L). History was dementia (33%), hypertension (50%), atrial fibrillation (67%), coronary artery disease (33%), and treatments VKA (60%), DOA (5%), heparin (60%) and antiplatelet therapy (29%). CT-scan analysis showed an IPH hematoma size of 2005±1010 mm³. The mean IPMS of cases vs controls was respectively 938±244 vs 914±308 mm³, (p=0.55). Other parameters are being analysed and will be available for the EUGMS congress.

**Conclusion:** The CT-scan muscle mass assessment is a feasible tool to evaluate muscle mass in patients treated with anticoagulant. From our preliminary results, IPMS is not associated with risk of IPH, and the role of muscle assessment to evaluate haemorrhagic risk in elderly patients treated with anticoagulant is questionable. Further analysis must be provided to confirm our hypothesis.

P-242

Relationship between hearing impairment and frailty in older patients with diabetes mellitus

S. Sable-Morita¹, S. Sugiura², Y. Uchida², T. Tanikawa³, H. Tokuda³, H. Arai⁴. ¹Nursing Department, National Center for Geriatrics and Gerontology, Obu, Japan; ²Department of Otorhinolaryngology,
National Center for Geriatrics and Gerontology, Obu, Japan;
³Department of Endocrinology, Metabolism and Diabetes, National Center for Geriatrics and Gerontology, Obu, Japan; ⁴Deputy Director, National Center for Geriatrics and Gerontology, Obu, Japan

**Objective:** Hearing impairment, diabetes, and frailty are three conditions that are increasingly prevalent in older people. Recently, the assessment of frailty has been recommended for older patients with diabetes mellitus. However, the relation between hearing impairment and frailty is still unclear in patients with diabetes. The purpose of this study was to clarify the relationship between hearing impairment and frailty among older diabetes patients.

**Research design and methods:** We used a finger friction test as a simple auditory screening for the assessment of hearing impairment and the Kihon Checklist (KCL) for the assessment of frailty. Cognitive function was assessed using the Mini Mental State Examination (MMSE). Logistic regression analysis was used to investigate cross-sectional associations between frailty and patient characteristics.

**Results:** The study participants were 283 diabetes patients with an average age of 75.3 years; the prevalence of frailty using the KCL was 30%. Hearing impairment was present in 32.8% of those without frailty and 57.6% of those with frailty (p<0.01). In multivariable analysis, frailty in diabetes patients was associated with the prevalence of hearing impairment (odds ratio: 1.96, 95% confidence interval: 1.07–5.59).

**Conclusions:** These data suggest that hearing impairment as determined using a finger friction test could be an important factor contributing to frailty among diabetes patients.

P-243

**Reliability of the sarcopenia screening test (SARC-F) in elderly patients**

A. Doventas¹, D.C. Ercelebi¹, H. Yavuzer¹, M. Cengiz², S. Avci¹, F. Demirdag¹, Z. Kara¹, S. Yavuzer², M. Yuruyen³, D.S. Erdinler¹.
¹Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics/University of Istanbul, Istanbul, Turkey;
²Cerrahpasa School of Medicine, Department of Internal Medicine/University of Istanbul, Istanbul, Turkey; ³Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Internal Medicine, Division of Palliative Care/Republic of Turkey, Ministry of Health, University of Health Sciences, Istanbul, Turkey

**Aim:** The aim of this study was to investigate the presence of sarcopenia in the hospitalised geriatric patients and the role of following measurements for diagnosis: antropometric measurements, bioimpedance analyses, handgrip strength, 6 meter walk test, Barthel index and SARC-F scale.

**Method:** 116 hospitalised elderly patients in the internal medicine, cardiology, pulmonology and infectious disease clinics were followed. The patients were grouped according to the diagnostic criteria for EWGSOP. Age, gender, medical history, drugs, length of hospitalization, Barthel index, SARC-F scale were questioned and the anthropometric parameters were measured.

**Results:** 85 of 116 patients were mobile, whereas the other 31 patients were immobile. Sarcopenic patients were older than normal patients with statistical significance (p=0,001). Weight, BMI, circumference of hip, waist, upper-middle arm and calf were lower in sarcopenic patients. The handgrip strength of normal group was stronger (18.2±12 kg) than sarcopenic patients (13±9.1 kg) with statistical significance (p=0.018). Number of comorbidities and drugs were higher in normal group (p=0.034; p=0.024, respectively). SARC-F was positively correlated with age, length of hospitalisation, number of comorbidities and drugs, nutritional support, Barthel index and calf circumference and negatively correlated with walking speed, handgrip strength and fat free body mass. SARC-F scale

results were 5.1±3.3 in normal group and 5.8±2.8 in sarcopenic group (p=0.24).

**Discussion:** SARC-F scale was not efficient for evaluation of sarcopenia in the hospitalised geriatric patients; but Barthel index, BIA, hand grip strength and walking speed were relevant with it.

P-244

**Sarcopenia and sarcopenic obesity in Japanese geriatric ward**

A. Sampei, S. Harada, K. Shibasaki, Y. Yoshioka, M. Yakabe, A. Yonenaga, K. Toyoshima, T. Kojima, M. Ishii, Y. Kameyama, Y. Yamaguchi, T. Urano, S. Ogawa, M. Akishita. Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

**Introduction:** Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. It is correlated with physical disability, poor quality of life. We evaluated the characteristics of sarcopenic elderly patients.

**Methods:** We analysed 117 patients discharged from the geriatric ward in the University of Tokyo Hospital, from April 2016 to March 2017. We divided them first into two categories; sarcopenia or non-sarcopenia. Secondly we also looked at the sarcopenic obese, sarcopenic non-obese, non-sarcopenic obese and non-sarcopenic non-obese group. In those groups, we assessed various characteristics such as age, sex, duration of hospitalization and comorbidities (hypertension, diabetes mellitus, dyslipidemia, cerebrovascular diseases, and cardiovascular diseases).

**Results:** After exclusions, we collected 117 patients (47 men and 70 women), aged 81 on average. Out of them, 72 sarcopenic (10 sarcopenic obese, 62 sarcopenic non-obese) and 45 non-sarcopenic (20 non-sarcopenic obese and 25 non-sarcopenic non-obese) patients were identified. No statistically significant differences were found between sarcopenic and non-sarcopenic patients as for age and sex. However, in sarcopenic patients, we detected longer hospitalization by approximately one week, and lower complication rates with diabetes mellitus or with cerebrovascular diseases compared to non-sarcopenic patients. Especially sarcopenic non-obese patients showed lower complication rates with diabetes mellitus.

**Conclusions:** In sarcopenic patients, we observed longer hospitalization and lower prevalence of diabetes or cerebrovascular diseases. We assume that sarcopenia itself can be the influential factor for longer hospitalization. And we suspect obesity has stronger relations with diabetes mellitus or cerebrovascular diseases than sarcopenia.

P-245

**Self-assessed kyphosis and chewing disorders predict disability and mortality in community-dwelling older adults**

M. Okura¹, M. Ogita², M. Yamamoto³, T. Nakai³, T. Numata³, H. Arai⁴. ¹Kyoto University Graduate School of Medicine; ²Shiga University of Medical Science; ³Kami-cho Municipal Office; ⁴National Center for Geriatrics and Gerontology

**Background:** Degenerative changes affecting the spine accumulate and contribute to an overall trend of kyphosis with increased age. Since there is no widely accepted definition of hyper-kyphosis, current estimates of the prevalence of this condition range between 20 to 40 percent among community-dwelling older people. Particularly, hyper-kyphosis is associated with several adverse health conditions including thoracic pain, decreased pulmonary function, limited physical functioning, increased fall risk, increased health-related quality-of-life, increased fractures, and increased mortality. There was no significant difference between depressive mood and kyphosis. However, it should be noted that these are studies of hyper-kyphosis and not of general kyphosis. Research questions: Our research questions focused on chewing power in common
health-related issues of older people caused by frailty. However, it is not a simple mechanism through which aging affects chewing power, unlike any other part of the human body. If tooth loss is not considered as an attribute of physiological aging, then aging per se may not be a risk factor for masticatory dysfunction. Chewing power, which is closely related to quality of life, is essential for maintenance of the activities of daily living in the elderly.

**Research significance:** Both these health issues (the presence of kyphosis or chewing disorders) are widely observed in aging people. These two adverse health outcomes are easily noticed even by older people themselves and by the others. Furthermore, these health issues are preventable through continued everyday health activities starting in late middle age.

**Research objectives:** Therefore, our study objectives were to clarify the following three research questions: (1) Is the existence of kyphosis or the decrease in chewing ability related to frailty without being affected by age or sex? (2) How much influence does the presence of kyphosis or chewing disorders have on the need for new coverage under long-term care insurance (LTCI) service requirement? (3) How much influence does the presence of kyphosis or chewing disorders have on predicting mortality?

**Methods and design:** A prospective cohort study.

**Setting and participants:** We analyzed the cohort data for older adults (65 years or older) from a prospective study in Kami town. The response rate was 94.3%, and we followed 5,094 older individuals for three years. Thus, we analyzed 5,083 older adults using Multiple imputation to manage missing data.

**Outcome:** The outcomes were mortality or new certifications for LTCI services in a 3-year period.

**Measurements:** We developed three groups by asking two self-reported questions on both “no kyphosis” and “good chewing ability”. The groups were no kyphosis and good chewing ability (GG), kyphosis and poor chewing ability (BB), and kyphosis and good chewing ability or no kyphosis and poor chewing ability (GB/BG).<Results> The prevalence of BB, BG/GB, and GG were 8.9%, 40.3%, and 50.8%, respectively in our survey. During the 3-year follow-up period, 5.2% (n=262) died and 13.9% (n=708) individuals were newly certified as needing LTCI services. We confirmed that these results were consistent with the whole data analysis including missing data. Similar results were obtained for each frailty domain. First, those participants who agreed with the statement, “I don’t think I have kyphosis” had significantly lower odds for having frailty (OR 0.41, 95% CI: 0.36–0.46). Similarly, those who had good chewing ability showed lower odds for frailty (OR 0.38, 95% CI: 0.32–0.44). When the two were analyzed at the same time, the GB/BG group (OR 0.40, 95% CI: 0.32–0.50) and the GG group (OR 0.16, 95% CI: 0.13–0.20) were less likely to be frail than the BB group. Second, as determined by multivariate analyses, BG/GB older adults (adjusted hazard ratio (HR) 1.33, 95% CI: 1.13–1.57) and BB older adults (adjusted HR 1.94, 95% CI: 1.54–2.44) had a significantly higher risk of needing LTCI services than GG older adults. Similarly, BG/GB older adults (adjusted HR 1.48, 95% CI: 1.12–1.96) and BB older adults (adjusted HR 2.27, 95% CI: 1.53–3.29) had a significantly higher risk of mortality than GG older adults did. The ORs and HRs were adjusted for age and sex.

**Discussion:** As our first of objective, we confirmed that prevalence of kyphosis and chewing disorders was relatively common among community-dwelling older Japanese adults. However, the prevalence of frailty in our study was slightly higher than other surveys. In previous studies, kyphosis or chewing disorders were known as a risk factor for frailty. However, we found that these two health issues were not only detrimental to health on their own, but had a more negative effect on frailty when combined. As second of objective, multivariate analyses demonstrated that kyphosis and chewing disorders were independently associated with mortality and new certifications for LTCI services. It is meaningful that these health

issues are particularly easy to recognize by both oneself and others, and to use in self-reported questionnaires for community-dwelling older adults. Because these two health issues are easy to recognize by both oneself and others, these could be used as a marker in the high-risk approach and could be prevented by the population approach targeting the middle age.

**Limitations:** First, there is a possibility of underestimation or overestimation compared to the present situation, under the influence of individual personality characteristics, because this examination was self-reported. In this survey, we could not obtain the following: the degree of kyphosis, the presence or degree of pain in the back, the degree of chewing power, the difference of chewing power based on the type of food, and so on. Second, we were not able to identify whether related kyphosis or poor chewing power was the cause of mortality or new certifications for LTCI services. One of the aspects that future research should examine is how much effect kyphosis or chewing power had on mortality or new certifications for LTCI services.

**Conclusion:** The presence of kyphosis or poor chewing ability was related to mortality and new certifications for LTCI services, and we found an additive effect of these two factors related to frailty.

**Acknowledgements:** We are extremely grateful to all the study participants and to all the staff of the Kami Town Hall who were involved in this study. Conflicts of interest: The authors declare no conflicts of interest.

**Funding source:** This work received financial support from Health, Labour and Welfare Sciences Research Grants (Comprehensive Research on Aging and Health, grant number H24-Choju-Ippan-001), Research Funding for Longevity Sciences from Japan Agency for Medical Research and Development (grant number 16dk0110019h0001) and Research Funding for Longevity Sciences from the National Center for Geriatrics and Gerontology (grant number 27-1), Japan. No support was received from industry. The funding source played no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

## P-246

### Socioeconomic differences in frailty and frailty components among 26,014 Dutch citizens aged 55 years and older

C.B. Franse¹, A. van Grieken¹, L. Qin²,³, R.J.F. Melis³,
J.A.C. Rietjens¹, H. Raat¹. ¹Erasmus University Medical Center,
department of Public Health, Rotterdam, The Netherlands;
²Quantitative Solutions, A Certara Company, The Netherlands;
³Department of Geriatric Medicine, Radboud University Medical
Center, Nijmegen, The Netherlands

**Introduction:** Older persons with a low socioeconomic status (SES) are frail and become frail over time. Little is known about the association of SES with the frailty index (FI) and with its different components. Our aim was to examine socioeconomic differences in frailty and FI components and assess whether socioeconomic differences in number of morbidities can explain socioeconomic differences in other FI components.

**Methods:** This was a cross-sectional study of pooled data of 26,014 independently living persons in the Netherlands aged 55 years and older. Frailty was measured with a previously validated FI that consisted of 45 items. We selected six FI components based on previous literature: morbidities, activities of daily living (ADL), instrumental ADL (IADL), health-related quality of life (HRQoL), psychosocial health and self-rated health (SRH). SES was measured by education level and neighbourhood deprivation level. Multilevel linear regression models were fitted to assess the association of SES with frailty and with FI components.

**Results:** We found educational differences and to a lesser extent differences in neighbourhood deprivation level in frailty and
all FI components except ADL limitations, stronger associations were observed in younger ages. After adjusting for the number of morbidities, significant socioeconomic differences in the other FI components; IADL limitations, HRQoL, psychosocial health and SRH, reduced or disappeared.

**Conclusions:** There are significant socioeconomic differences in frailty and in FI components. Morbidities appear to play an important role in explaining socioeconomic differences in frailty at older age and should not be overlooked in prevention efforts.

## P-247

### Systematic review of non-pharmacological interventions to treat well-defined sarcopenia and physical frailty

I. Lozano-Montoya¹, A. Correa-Pérez¹, I. Abraha², R.L. Soiza³, A. Cherubini², D. O'Mahony⁴. ¹Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS). Madrid. Spain; ²Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging. Ancona. Italy; ³Department of Medicine for the Elderly, NHS Grampian. Aberdeen. UK; ⁴Dept. of Medicine (Geriatrics), University College Cork, Ireland

**Introduction:** Although exercise and nutritional interventions are recommended as first-line treatment to prevent or treat frailty and sarcopenia, most systematic reviews (SR) do not use standard definitions of the populations included in clinical trials. Following the ONTOP methodology, we did a review of SR, including primary studies of non-pharmacological interventions in older patients with physical frailty (defined by Fried's frailty phenotype) and sarcopenia (EWGSOP definition).

**Methods:** Pubmed, Cochrane, EMBASE, and CINHAL databases were searched looking for SR. All primary studies from those SRs evaluating any non-pharmacological intervention for physical frailty or sarcopenia in any setting were included. Quality assessment was made using Cochrane and GRADE criteria. A meta-analysis could not be performed due to the heterogeneity of the studies.

**Results:** Only 5 primary studies from 10 SR fulfilled the inclusion criteria. The most frequent interventions were physical exercise and nutritional supplementation. Muscle strength (except one study in frail subjects) and physical performance (except another study in frail people) improved with exercise and supplementation with amino acids in frail and sarcopenic older adults. The effects of these interventions on falls and ADLs were evaluated in two studies with opposite results. The overall quality of the evidence was low.

**Conclusions:** The only interventions studied for physical frailty and sarcopenia are exercise with or without nutritional supplements. Most of the studies in previous SR include non-frail or sarcopenic individuals. Interventions improve muscle strength and physical performance; there are no solid data on its effects on other health outcomes.

## P-248

### Targeting muscle to improve independence, quality of life and lower health care costs

D. Mijnarends¹, Y. Luiking², S. Verlaan³, M. Wallace², J. Schols¹. ¹Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; ²Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands; ³Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam, The Netherlands

**Introduction:** Insight in muscle parameters that contribute most to negative health and economic outcomes could help clinicians with screening and targeted intervention.

**Aim:** To assess the association between muscle parameters and activities of daily living (ADL), quality of life (QoL) and health care costs.

**Methods:** The cross-sectional Maastricht Sarcopenia Study (MaSS) included community-dwelling adults ≥65 years (n=227). Muscle parameters were assessed by bio-electrical impedance, JAMAR hand-held dynamometer and the Short Physical Performance Battery. The Groningen Activity Restriction Scale (disability in ADL) and the EQ-5D-5L (QoL) were used to assess health outcomes. Data on health care use in the past three months were collected.

**Results:** Muscle strength and muscle function showed strong correlations with ADL function, QoL, and health care costs; no significant correlations were observed for muscle mass. Regression analyses showed that slower gait speed (OR 0.06, 95% CI: 0.01-0.55), slower chair stand (OR 1.23, 95% CI: 1.08-1.42), and more comorbidities (OR 1.48, 95% CI: 1.15-1.92) were explanatory factors for disability in ADL. Explanatory factors for QoL and health care costs were disability in ADL (OR 1.26, 95% CI: 1.12-1.41 for QoL; B =0.09, P<0.01 for costs) and comorbidities (OR 1.44, 95% CI: 1.14-1.82 for QoL; B=0.35, P<0.01 for costs).

**Conclusions:** Muscle function and comorbidities were associated with disability in ADL. Disability in ADL and comorbidities were associated with QoL and costs. This suggests that muscle function and ADL may be important targets for research and intervention in order to improve health and economic outcomes.

## P-249

### The assessment of the frailty in a geriatric rehabilitation institute: A comparison between various tests

G. Ricevuti¹, E. Mattiuzzo¹, G. Cuzzoni¹, N. Schifino¹, M. Rollone¹, C. Alfano¹, L. Venturini¹, S. Geniere Nigra², F. Guerriero¹.

¹Department of Internal Medicine and Therapeutics, Section of Geriatrics, University of Pavia, Italy; ²Azienda Servizi alla Persona, S. Margherita Institute, Pavia, Italy; ³Department of Internal Medicine and Therapeutics, Section of Geriatrics, University of Pavia

Italy, like most of Western societies is characterised by a progressive increase of average life expectancy. According to ISTAT's annual, there are 13.4 million individuals over 65 years of age, i.e. 22% of the total population. Following an increase in life expectancy, age-related diseases also increase. There is good scientific evidence showing that the multiple co-morbidities among elderly people are part of a broader entity called "elderly fragility". Such nosological entity is still being defined, as there are two schools of thought: the first one considers fragility as a syndrome, the second one as a state. During the course of the last years there have been numerous tests aiming to define the boundaries of this entity by assessing each of its different facets. Considered individually, such tests prove useful as diagnostic/prognostic tools. However, they are even more useful when combined, as they describe patients' clinical condition in a more ample and complete way. In fact, fragility leads elderly people to the likelihood of developing numerous conditions with a short-term prognosis. This Study aims to assess a sample of geriatric patients at the moment of admission into a rehabilitation centre. The purpose was that of identifying fragile patients, and classify them through a multi-faceted assessment., as well as through a comprehensive individual rehabilitation programme. This was carried out through a series of 7 tests, plus a DXA exam for the sarcopenia. The data collected was analysed individually, and later integrated into a radar graphic visualising frail patient's clinical characteristics in various areas. Through this study it was possible to compare tests that are normally used in the typical CGA of geriatric clinical practice. A concordance was noticed between EFS, GFI, FI, SPPB, PASE, CF in Fragility evaluation. It has been seen that SHARE-FI and sarcopenia do not agree with the other tests, this is most likely due to the small number of enrolled patients (n=47) or to the effect of rhehabilitation. An insufficient number of patients does not allow to have a representative population group and therefore to be able to perform a valid and repeatable statistical analysis.
P-250

**The BMD change after Ibandronate (Bonviva®) treatment In osteopenic elderly women**

K. Choi. Dongguk University International Hospital

**Background:** Ibandronat (Bonviva®) is effective in the treatment of postmenopausal women with osteoporosis. But, there were few datas about Ibandronat (Bonviva®) treatment. We evaluated the effect of Ibandronat (Bonviva®) therapy on bone mass and compared the effectivity on bone mineral densit (BMD) in 1-year treatment group.

**Objective:** The aim of the study is to assess the effect of 1-year treatment with Ibandronat (Bonviva®) on bone mineral density (BMD) in postmenopausal women with osteopenia or osteoporosis.

**Methods:** The BMD was assessed in 118 postmenopausal women with osteopenia or osteoporosis from March 2007 to January 2011, 42 patents who treated with 2.5 mg per day of Ibandronat (Bonviva®) were enrolled to study. BMD of lumbar spine (L2-L4) and femur was assessed by dual energy absorbiometry at baseline, 12 months after treatment.

**Results:** The annual BMD of the lumbar spine showed a 9.11% increase, while also positive changes were noted in the proximal femur as a 1.89% increase. The BMD changes were 11% (L: Lumbar spine) and 1.1% (F: Femur) for the T-scores <-4.0, 6.3% (L) and 0.9% (F) for the T-scores -3.0 to -4.0, and 3.8% (L) and 0.5% (F) for the T-scores >-3.0 respectively.

**Conclusion:** This study suggests that Ibandronat (Bonviva®) treatment in postmenopausal women with osteopenia or osteoporosis is effective in terms of improving BMD.

P-251

**The relationship between frailty and osteosarcopenia in geriatric patients**

S. Kaya, O. Deniz, H.D. Varan, M.C. Kızılsarlanoğlu, B. Göker. Gazi University School of Medicine, Department of Geriatrics

**Introduction:** Osteosarcopenia, defined as the presence of both sarcopenia and osteoporosis in elderly patients, has been shown to be related with worse clinical outcomes. However, limited data are available in the literature about its association with frailty. We aimed to investigate the association between frailty and osteosarcopenia in the elderly patients.

**Material and methods:** One hundred elderly patients, who had bone mineral densitometry (BMD) performed on a routine basis within last one year, were enrolled in the study. All patients were evaluated by comprehensive geriatric assessment. Diagnosis of sarcopenia was done according to the criteria of the European Working Group on Sarcopenia in Older People. Osteosarcopenia was considered when both sarcopenia and osteoporosis were present. Frailty status of the patients were evaluated according to the Fried's Frailty Index including five domains weight loss, weakness, exhaustion, low activity and slow walking speed. The patients with three or more deficits over five components were considered as "frail", those with 1 or 2 deficits as "pre-frail" and no deficits as "robust".

**Results:** The median age of the one hundred patients (11 sarcopenic/non-osteoporotic, 12 osteosarcopenic and 77 non-sarcopenic) were 75 years (min-max: 65-90) and 51.0% were male. Frailty status of the patients was as follows: 21% frail, 44% pre-frail and 35% robust. Frailty was more common among osteosarcopenic patients compared to sarcopenic/non-osteoporotic and non-sarcopenic groups (66.7%, 27.3% and 13.0%, respectively) (p<0.001). Osteosarcopenia was found to be associated with frailty in univariate analysis (OR: 11.5, p<0.001). Low handgrip strength and calf circumferences, higher age, slow walking speed, lower body mass index (BMI), frailty, decreased scores of basic and instrumental activities of daily living (ADL), clock drawing test, mini-mental state examination and

mini-nutritional assessment-short from (MNA-SF) were shown to be associated with osteosarcopenia (all parameters had p<0.05). In multivariate analysis, age (OR: 1.395, p=0.023), instrumental ADL (OR: 0.550, p=0.042), female gender (OR: 43.203, p=0.012) and BMI (OR: 0.507, p=0.004) were detected to be independently associated factors with osteosarcopenia.

**Conclusion:** Our results suggest that frailty rate in osteosarcopenic patients may be higher than sarcopenic/non-osteoporotic and non-sarcopenic patients. Further studies with larger number of patients are needed to elucidate its pathogenetic mechanisms.

P-252

**Transitions between frailty states over three years in the MAPT study**

M. Herr¹, M. Cesari², J. Ankri¹, B. Vellas², S. Andrieu². ¹UMR 1168, INSERM and University of Versailles St-Quentin-en-Yvelines, France; ²UMR 1027, INSERM and University of Toulouse, France

**Introduction:** The epidemiology of frailty (prevalence and associated factors) has mostly been described in cross-sectional studies. However, there is increasing evidence that frailty is a dynamic state that can worsen but also improve. Using repeated measures of frailty, this work aimed to describe transitions between frailty states during the three years of follow-up.

**Methods:** This study is nested in the MAPT trial (randomized trial to assess the effect of omega 3 supplementation and multidomain intervention on cognitive decline in people aged 70 and over). The study population included the 842 participants included in the control and omega 3 arms. Frailty was assessed using the Fried criteria (including measures of grip strength and walking speed) at baseline and at 6, 12, 24, and 36 months.

**Results:** The study population included 548 women and 294 men, of mean age 75.4±4.5 years. At baseline, 430 (53.3%) participants were robust, 349 (43.2%) pre-frail, and 28 (3.5%) frail. A total of 2271 transitions were observed during the 3 years of follow-up. In most cases, people remained in a robust (36.6% of the transitions) or pre-frail state (30.5%). The third most observed transition was from the robust to the pre-frail state (14.8%). Of note, direct transitions from robust to frail or from frail to robust were very rare and frail people were more likely to recover than to stay frail.

**Conclusions:** This study confirms the dynamic nature of frailty and shows that recovery is possible. Factors associated with the transitions will be investigated.

P-253

**Untargeted metabolomics reveals pre-frailty sub-phenotypes in elderly**

E. Pujos-Guillot¹, M. Pétéra¹, D. Centeno¹, B. Lyan¹, B. Pietruszka², A. Santoro³, A. Brzozowska², C. Franceschi³, B. Comte⁴. ¹Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, France; ²Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, CRNH Auvergne, F-63000 Clermont-Ferrand, France; ³WULS-SGGW, Department of Human Nutrition, Warsaw, Poland; ⁴Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, France

**Introduction:** Human ageing is a dynamic process depending on intrinsic and extrinsic factors and its evolution is a continuum of transitions, involving multifaceted processes at multiple levels. It is recognized that frailty and sarcopenia are shared by the major age-related diseases, thus contributing to elderly morbidity and mortality. They are major health issues in elderly populations, given their high prevalence and association with several adverse outcomes. Due to their complex phenotypes and underlying patho-
physiology, the need for robust and multidimensional biomarkers is now essential to move towards a more personalized care and prevention.

**Methods:** The NU-AGE project [1] regroups 1250 free-living elderly people (65-79 y.o., men and women), free of major diseases, recruited within 5 European centres. Twenty percent of the subjects were pre-frail as defined by the criteria proposed by Fried et al.[2]. Six hundred twenty five volunteers were randomly assigned to an intervention group (1-year Mediterranean diet). A sub-cohort consisting in first, 120 subjects, half pre-frail randomly selected from the Italian and Polish centres, and secondly, 92 subjects shifting their frailty status were included for untargeted serum metabolomics at T0 (recruitment) and T1 (after diet intervention).

**Results:** Metabolomics enables to discriminate sub-phenotypes of pre-frailty both at the gender level and depending on the pre-frailty progression and reversibility. Additionally, early and/or predictive markers of pre-frailty were identified in both populations.

**Conclusion:** These results open the door, through multivariate strategies, to a possibility of monitoring the disease progression over time and/or in response to interventions at a very early stage.

## References:

[1] Santoro A, Pini E, Scurti M, Palmas G, Berendsen A, Brzozowska A, Pietruszka B, Szczecinska A, Cano N, Meunier N, de Groot CP, Feskens E, Fairweather-Tait S, Salvioli S, Capri M, Brigidi P, Franceschi C. NU-AGE Consortium. Mech Ageing Dev. 2014 Mar-Apr;136:137-3-13.

[2] Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence for a phenotype. J. Gerontol. A: Biol. Sci. Med. Sci. 2001 56 (3) M146-M156.

## P-254

### Urinary incontinence and sarcopenia: a new insight

T. Erdoğan¹, G. Bahat¹, C. Kılıç¹, P. Cucukdagli¹, O. Yilmaz¹, Y. Topcu¹, İ. Bay², M.A. Karan¹. ¹Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul, Turkey; ²Erzurum Atatürk University, Medical School, department of Internal Medicine, Erzurum, Turkey

**Purpose:** Urinary incontinence (UI) is a common cause of morbidity in the elderly. Identification of factors associated with urinary incontinence is necessary to identify risky individuals and to take preventive measures. We suggest that sarcopenia may facilitate urinary incontinence by decrease in muscle mass/strength. In this study, we aimed to investigate the relationship between urinary incontinence and sarcopenia.

**Methods:** Elderly people between the ages of 60-99 were included in study. Demographic data, clinical data, UI and its types were obtained. Body mass index (BMI), hand grip strength and walking speed were assessed by using physical examination. Muscle mass was measured by bioimpedance analysis (TANITA-BC532). Low muscle mass thresholds were assessed according to national data (Muscle mass adjusted by height for women <7.4 kg/m², for men <9.2 kg/m²; muscle mass adjusted by weight for women <33.6%, for men <37.4%; muscle mass adjusted by BMI for women <0.82 kg/BMI, for men <1.05 kg/BMI, another threshold for muscle mass adjusted by BMI for women <0.68 kg/BMI, men <1.02 kg/BMI, for men <1.02kg/BMI).

**Results:** The prevalence of UI was 46.2 (601/1302). Associated factors with UI were gender, age, drug-number, BMI, fecal incontinence, constipation, falls, sleep disorders, frailty, activities of daily-living, instrumental activities of daily-living, grip strength, walking speed, bia muscle, skeletal muscle mass, muscle mass adjusted by weight and BMI. Independent factors related with UI in regression analysis models; Fecal-incontinence, drug-number, frailty and instrumental activities of daily-living. While hand-grip

strength was not associated with UI, muscle mass adjusted by weight and body mass index were found to be related to urinary incontinence.

**Conclusion:** The results of our study show that UI is independently associated with sarcopenia. Treatment of sarcopenia may have a positive effect on UI.

## P-255

### Validation of the Korean version of the SARC-F to assess sarcopenia: KFACS

S. Kim¹, C.W. Won², M. Kim³. ¹Department of Medicine, Graduate school, Kyung Hee University, Seoul, Korea; ²Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea; ³College of Medicine/East-West Medical Research Institute, Kyung Hee University, Seoul, Korea

**Introduction:** Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls (SARC-F) scale is a simple screening tool for sarcopenia using a simple 5 item questionnaire. The aim of this study was to validate the Korean version of SARC-F (K-SARC-F) in Korean community dwelling older adults.

**Methods:** Using data from the Korean Frailty and Aging Cohort Study (KFACS), and 1,548 participants who aged over 70 years were included. Questionnaire items were translated into Korean, and 5 questions were used to calculate the score. Classification using the K-SARC-F score (≥4: sarcopenia group) was compared using consensus panel criteria from international, European, and Asian sarcopenia working groups. The association of K-SARC-F with other scales or tests was analyzed Measurements, including appendicular muscle mass, were taken using dual-energy X-ray, grip strength using a dynamometer, 4-m gait speed, and time taken for repeated chair stand.

**Results:** The participants' mean age was 76.2 years old, and 726 (46.8%) were males. Using K-SARC-F tool, the overall prevalence of sarcopenia was 10.8% (8% with European, 12.7% with International, 9.7% with Asian working group, male: 4.7%, female: 16.3%). The SARC-F has excellent specificity (over 90%) but poor sensitivity for sarcopenia classification. The scale was also correlated to other measures related to sarcopenia (such as age, gait speed, grip strength, SPPB, balance, SMI, and frailty).

**Conclusion:** The K-SARC-F scale is correlated with the sarcopenia index and is a simple tool to rule out for sarcopenia in a clinical setting.

## P-256

### Validation of the Turkish version of the Clinical Frailty Scale

C. Özsürekci¹, C. Balcı¹, C. Kızılslanoğlu², H. Çalışkan¹, R.T. Doğrul¹, G. Ayçiçek¹, F. Sümer¹, E. Karabulut³, B.B. Yavuz¹, M. Cankurtaran¹, M. Halil¹. ¹Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Geriatrics, Ankara, Turkey; ²M.D. Gazi University Faculty of Medicine Department of Internal Medicine Division of Geriatrics, Ankara, Turkey; ³Hacettepe University Faculty of Medicine Department of Biostatistics, Ankara, Turkey

**Background:** Frailty is a geriatric syndrome which develop as a result of cumulative decline in many physiological systems and resulting in an increased vulnerability and risk of adverse outcomes. The clinical frailty scale (CFS) was validated as a predictor of adverse outcomes in community-dwelling older people and mixes items such as comorbidity, cognitive impairment and disability.

**Aim:** We aimed to study the concurrent validity and inter-rater reliability of the 9 point CFS in Turkish Population. Design: Cross-sectional observational study in a large tertiary, Hacettepe University hospital in Ankara, Turkey.

**Methods:** Between March 2017 and May 2017, total, 82 patients
aged ≥65 years admitted to a geriatric outpatient clinic were included. Construct validity of CFS was assessed with Fried Frailty phenotype and FIND questionnaire–Turkish version.

**Results:** Total 82 patients' mean age was 75,6 years (SD:6,09 years) and %61 were females. %64.6 patients used ≥4 drugs. CFS inter-rater reliability and re-test reliability was very strong (kappa 0.811, p<0.001 and 0.899, p<0.001 respectively). When frailty was examined within 3 groups (normal, prefrail and frail group); concordance of CFS and Fried Frailty phenotype was moderately (Cohen's kappa 0.514 p<0.001). When frailty was examined within 2 groups (normal and frail group); concordance of CFS and Fried Frailty phenotype was good (Cohen's kappa 0.715, p<0.001). The concordance of CFS and FIND questionnaire–Turkish version was low (Cohen's kappa 0.34, p:0.001).

**Conclusions:** CFS appears to be a quick, reliable, and valid frailty screening instrument for Turkish community dwelling elderly.

P-257

**What are the best 1-year predictors of falls and mortality among nursing home residents? Results of the SENIOR cohort**

F. Buckinx¹, J.-L. Croisier², J.-Y. Reginster¹, T. Brunois¹, C. Lenaerts¹, X. Rygaert¹, J. Petermans³, O. Bruyère¹. ¹Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium; ²Department of Sports Sciences and Rehabilitation, University of Liège, Belgium; ³Department of Geriatrics, CHU of Liège, Belgium

**Introduction:** The present study aimed to find clinical predictors of falls and deaths among nursing home residents.

**Methods:** We studied 662 subjects from the SENIOR cohort (Sample of Elderly Nursing home Individuals: an Observational Research) aged 83.2±8.99 years, including 484 (72.5%) women, and living in nursing homes. Among this cohort, respectively 584 and 565 subjects were monitored during 12 months, for mortality assessment and for occurrence of falls (i.e. via their medical records). A large number of clinical characteristics were also collected at baseline, during a face-to-face examination with each patient. Stepwise regressions analyses were carried out to predict mortality and falls.

**Results:** When comparing clinical characteristics of deceased and still alive subjects, being a man (OR: 1.89, 95% CI: 1.19–3.01, p=0.002) and being diagnosed with sarcopenia (OR=1.7, 95%CI: 1.1–2.92, p=0.03) were independent factors associated with the 1-year mortality. Other independent factors that were significantly associated, this time with the one-year occurrence of falls were: the result obtain at the Tinetti test (OR =0.93, 95%CI: 0.87–0.98, p=0.04), at the grip strength test (OR=0.95, 95%CI: 0.90–0.98, p=0.03) and at the isometric strength test of the elbow extensors (OR=0.93, 95%CI: 0.87–0.97, p=0.04).

**Conclusion:** Globally, the frequency of undesirable health outcomes (i.e. falls and mortality) seems to be higher among subjects with lower muscle strength and mobility. These findings, strategically exploited, could potentially, but significantly, reduce falls and even deaths.

P-258

**What characterises hip fracture cases in AGES-Reykjavik study?**

S.S. Skuladottir¹,², I. Hjaltadottir³, L. Launer⁴, T. Harris⁵, P. Caserotti⁶, M.F. Cotch⁷, T. Lang⁸, G. Eiríksdóttir⁹, K. Siggeirsdóttir⁹, V. Guðnason⁹, G. Sigurdsson⁹, L. Steingrimsdóttir¹, I. Halldorsson Thorhallur¹. ¹Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; ²The Icelandic Gerontological Research Institute, Reykjavik, Iceland; ³National University Hospital of Iceland, Reykjavik, Iceland; ⁴National Institute on Aging, Bethesda, Maryland, USA; ⁵National Eye Institute, Bethesda, Maryland, USA; ⁶National Institute on Aging, Bethesda

Maryland, USA; ⁷National Eye Institute, Bethesda Maryland, USA; ⁸Faculty of Medicine, University of California, San Francisco, California, USA; ⁹Icelandic Heart Association, Kopavogur, Iceland

**Introduction:** Elderly people are at increased risk of hip fracture. Apart from poor bone health, hip fracture cases tend to be older, have lower BMI and are less active. Other factors that may contribute to the risk of fracture are not well characterised.

**Aim:** To examine characteristics of people who develop hip fracture compared to non-hip fractures.

**Methods:** Longitudinal study of 5764 participants (mean age 77y at baseline) from the Age, Gene/Environment Susceptibility-Reykjavik study (AGES-Reykjavik) 2002–2006. Extensive clinical measurements including CT-scans, functional and leaning tests and history of past and present health was recorded.

**Results:** During follow-up of 7.2y, were 486 hip-fractures (144 occurred in men). Men and women who developed hip fractures were significantly (p<0.001) older (80 vs. 77y) and had reduced bone mineral density of the femoral neck (213 vs 252 mg/cm³), lower serum 25(OHD) (48 vs 54 mmol/L), and longer timed up and go test (14 vs 12 sec) (p<0.001) poorer leaning test (7.1 vs 8.3cm). Comparable results were observed for both sexes. In addition, muscle strength of leg in knee extension was 17 and 10 kg among male and females who did not devlop hip fractures compared to 14 and 9 kg for males and females who devloped hip fracture (p<0.001 for both sexes). Similar pattern was observed for muscle area in thigh. All differences remained significant after adjustment for age.

**Conclusions:** Elderly men and women who develop hip fractures already manifest significantly less muscle strength, mobility and balance compared to peers of comparable age.

**Area: Geriatric education**

P-259

**A serious game concerning delirium care as educational tool: effect on skills, attitude and learning motivation**

K.R. Spanjers, H.H.M. Hegge, S.E.J.A. de Rooij. Department Internal Medicine and Geriatrics; University Medical Centre Groningen the Netherlands

**Introduction:** Yearly 100,000 patients in Dutch hospitals experience delirium, with very adverse consequences. Good diagnosis followed by adjusted care are crucial for treatment. Delirium is often detected late and treated inadequately. The Delirium Experience (DE), a simulation-based serious game, is developed to educate healthcare professionals in caring for delirious patients.

**Methods:** A randomised controlled trial was conducted in third year medical students, to study whether the DE influences skills and attitude regarding care for delirious patients, and learning motivation. Participants received a lecture on delirium, the control (c. video on healthy ageing) or one of the intervention conditions (i1. video concerning delirium and a patient's experience or i2. serious game DE), and were demonstrated an interview of a delirious patient. Skills were measured by assignments on the interview, attitude with the Delirium Attitude Scale, and learning motivation with the Motivation and Evaluation questionnaire. Data were analyzed with the use of a one-way ANOVA, and pairwise post hoc comparisons.

**Results:** In total 156 students participated, 31% had experience with delirious patients. Attitude was more positive in the i1 group, compared to the control group (p=0.007). Learning motivation and skills were higher in the i2 group compared to both other groups (p=0.000).

**Conclusion:** The serious game DE demonstrated its capacity to train students' skills and increase learning motivations but not attitude.
P-260

Adult children of persons with dementia and their experience: Thoughts about mental health services

V. Giannouli, N. Syrmos. School of Medicine, Aristotle University of Thessaloniki, Greece

Adult children of persons with dementia and their experience: Thoughts about mental health servicesVaitsa Giannouli & Nikolaos SyrmosSchool of Medicine, Aristotle University of Thessaloniki, Greece Introduction: The aim of this research study is to distinguish the main factors that influence the attitudes of adult children of persons with dementia and reveal their real needs that mental health experts should focus on.

**Methods:** Ten adult children of patients with severe dementia (6 women, mean age =42.5 years, mean education years =16 years, and mean age of formal diagnosis for the patient 8.5 years) from Greece participated in the study. The method that was used were semi-structured interviews based on grounded theory that aimed at unveiling (without imposing false categories) the main categories that shape their everyday emotions and thoughts.

**Results:** Results indicated that initially 102 categories existed, which were later diminished at 4. The categories can be described as: 1) the patients' interaction with others, 2) the social life of the family, 3) the general support network, and 4) the thoughts for the future of the dementia patient. All the above categories were linked with and causally created from the poor existing health care system according to the interviewees' words.

**Conclusions:** Mental health experts in Greece should try to understand that in many cases there exists an imperative need for the design of support programs or/and therapeutic programs for relatives of patients with dementia.

P-261

Are medical students ageist? Explicit and implicit survey

J. Prud'homme¹, S. Adam², A. Gentric³, D. Somme¹, P. Missotten²,
A. Corvol⁴. ¹CHU Rennes, Université Rennes 1; ²UPsySen, Université
de Liège; ³CHU Brest, Université de Bretagne Occidentale; ⁴CHU
Rennes, CRAPE

**Introduction:** Negative stereotypes concerning elderly persons are widespread in general population. If health care professionals adopt such stereotypes, their behavior may result in a decrease the quality of care for elderly, or even in an induce disability. That's why medical curriculum should take the question of ageism in consideration. Though, little is known about ageism among medical students and its determinants.

**Methods:** We conducted a study on Rennes and Brest University (France) medical students (year 2 to year 6) using online questionnaires. Explicit preferences have been studied with validated tools, such as Fraboni Scale of Ageism, and innovating ones, such as verbal fluency task about aging and youth. To underplay the social desirability bias, we then used implicit association test (IAT) to evaluate the strength of implicit stereotypes. Results have been analyzed according to age, gender, year of study, and geriatric training.

**Results:** Concerning explicit questionnaire, response rate was above 90%, leading to 814 replies. Negative stereotypes seemed lower in female students, and in those who have regular contact with elderly persons, especially if these contacts are good, with no effect of geriatric training. Implicit survey is in course with already 570 replies.

**Conclusion:** Ageism is widespread in medical students and should be addressed in geriatric training.

P-262

Associations of total and different types of physical activities with quality of life in Korean elderly population

J. Han¹, J.A. Lee². ¹Daehang hospital, Seoul, Korea; ²Asan Medical Center, Seoul, Korea

Physical activity is a well-known determinant of Quality of Life (QoL) in older adults. However, the association between the specific type of physical activity and QoL has not been evaluated in older adults and little is known about whether physical activity improves QoL in retired individuals. This cross-sectional study was conducted using the latest data from the Korea National Health and Nutrition Examination Survey, 2015. In this nationally representative study, 1811 participants aged over 60 years were analyzed. We investigated the association between demographic characteristics and health related QoL assessed by the EQ-5D index. To evaluate health-related QoL of participants regarding total and the specific types of physical activities, multivariate logistic regression analysis was performed after adjusting the age, sex, household income, occupational status, and the number of co-morbidity. In multiple logistic regression analysis, moderate to vigorous total physical activity compared to low physical activity showed lower odds of problem of mobility (OR=0.61, 95% CI: 0.47-0.79), problem of self-care (OR=0.67, 95% CI: 0.45-0.99) and problem of usual activity (OR=0.49, 95% CI: 0.34-0.72). Moderate-high commuting physical activity had inverse association with risk of problem of mobility (OR=0.64, 95% CI: 0.48-0.85), problem of usual activity (OR=0.47, 95% CI: 0.31-0.72) and problem of anxiety (OR=0.63, 95% CI: 0.43-0.95). Moderate-high leisure-time physical activity showed decrease in problem of mobility (OR=0.49, 95% CI: 0.30-0.79). Moderate-High total, commuting, and leisure-time physical activity lowered the problem of mobility in QoL. However, occupational physical activity neither increased nor decreased all subtypes of QoL in the Korean elderly population.

P-263

Defining the curriculum for medical care in nursing homes

D. Fitzpatrick¹, O. Samuelsson², I. Holmerová³, F. Martin⁴,
D. O'Neill⁵, on behalf of EUGMS Long Term Care Special Interest
Group⁵. ¹ARHC, Tallaght Hospital, Tallaght, Dublin, Ireland;
²Landspitali University Hospital, Reykjavik, Iceland; ³Faculty of
Humanities, Charles University, Prague, Czech Republic; ⁴Department
of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust,
London, United Kingdom; ²Centre for Ageing, Neuroscience and the
Humanities, Trinity College, Dublin, Ireland

**Introduction:** The definition of standards of medical care and curricula for training of medical officers in nursing homes has been neglected until very recently. The EUGMS has taken a lead on this topic, examining both current national policies [1] and establishing the first set of standards of medical care in the biomedical literature [2]. A topic worthy of research is to define a core curriculum for competence in medical nursing home care.

**Methods:** Itemizing and comparison of curricular items in a range of national and international sources, including the IAGG Handbook, Irish, Dutch and Australian curricula, and the AMDA competencies curriculum. These will then be prioritized by a Delphi process involving members of national societies in the EUGMS.

**Results:** Items common to all five sources included: delirium and dementia, mobility and falls, polypharmacy and medication review, palliative and end of life care and incontinence. Mood disorders, skin care, infection and management of chronic diseases were featured in four out of five sources.

**Conclusions:** This preliminary work lays the foundation for the development of an agreed common trunk to an EUGMS curriculum for training of doctors working in nursing homes with older
people. It will also allow for the development of audit and quality indicators

**References:**

[1] Briggs R, et al. European Geriatric Medicine 2012;3(6):365–7.

[2] Briggs R, et al. European Geriatric Medicine 2015;6(4):401–403.

P-264

Design of a geriatric program in United Arab Emirates

F.J. Soria Perdomo¹, C. González Navajas². ¹Geriatrician Quironsalud Medical Group, Madrid, Spain; ²Chief Psychiatry Hospital La Luz Quironsalud Medical Group, Madrid, Spain

**Aims:** We created a three days geriatric program for Primary Care Physicians belonging to United Arab Emirates Health and Prevention Ministry (MOH) sponsored by Quironsalud Medical Group of Madrid Spain.

**Methods:** Different interactive activities were prepared related to essential features of geriatric work: Comprehensive Geriatric Assessment, Geriatric syndromes. Special emphasis was placed on information exchange.

**Results:** Between April 14th and 16th 2017 a team of two doctors visited the MOH Training and Development Center in Sharjah doing different activities with a gropu of 30 doctors from different emirates. The program included comprehensive geriatric assessment, geriatric syndromes, nutrition in the elderly patient, dementia and cognitive impairment, behavioral symptoms, Perioperative care, Urinary tract infections and medical cares at the end of life.

**Conclusions:** During the three days the geriatric team had the opportunity to exchange information with primary care physicians. Primary care physicians showed a high level of interest in geriatric subjects. The course received very good reviews and help to establish relation between primary care physicians in the Arab world and our geriatric team.

P-265

Determination of attitudes of participants in an advanced age symposium related to age discrimination

S. Şahutoğlu¹, H. Şimşek², E. Tenli³, S. Şahin⁴. ¹Ege University Hospital, department of Internal Medicine, Division of Geriatrics, İzmir, Turkey; ²Dokuz Eylül University School of Medicine, department of Public Health, İzmir, Turkey; ³Ege University, Faculty of Nursing, İzmir, Turkey; ⁴Ege University Hospital, department of Internal Medicine, Division of Geriatrics, İzmir, Turkey

**Aim:** To detect the perspective of those from different occupations who are in touch with the world of the elders and attending 1st International Izmir 10th Advanced Age Symposium (22–23th March 2017).

**Method:** Ageism Attitude Scale was used. Independent variables were age, gender, education, visiting nursing home, marital status, occupation, family type, place where they live, living with the elderly person.

**Results:** 202 people have been reached. Mean age was 35.8±16.5, %79.9 were women, %8.4 (n=17) 65 years and over. The average score is 89.2±7.4 (65–107) and this score is statistically significant for 65 years and below (p=0.008). Participants are asked what comes first to their mind when said “old” and %51.9 of the replies are determined as negative stereotype, %32.3 are positive stereotype. Restricting life of elderly score is 36.3±3.1 (26–44), Positive ageism score is 31.8±4.3 (16–40) and Negative ageism score is 21.1±3.4 (6–30). For the married average score of the negative ageism is statistically significant (p=0.002). Positive ageism for the unmarried (p=0.001), for those living in extended family (p=0.029) and those who have not worked in a unit that serves elderly (p=0.038) is statistically significant.

**Conclusion:** It was determined that there was a positive attitude

towards the elderly in the study. In sub-dimensional analysis, it is found that old age is restrictive and there is a positive ageism. The more positive attitude is detected for those who have less contact with the elderly, unmarried and living with extended family.

P-266

Does geriatric interprofessional education increase student's confidence in core geriatric presentations?

C. Hallsworth¹, S. Thompson², J. Riley¹, G. Alg⁴, Z. Etheridge¹, K. Boncey¹, J. Bowen¹, A. Montagu¹, G. Hadley¹, E. Puffet³, C. Hardy³, C. Forde-Johnston³, K. Sherrington³, N. Lovett¹, J. Lafferty¹, Z. Hussein¹, C. Pedlar³, D. Goyal¹, S. Wheeler³, F. Los¹, K. Shah¹, J. Beale³. ¹Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; ²University of Oxford Medical Sciences Division, Oxford, United Kingdom; ³Oxford Brookes University, Oxford, United Kingdom; ⁴Royal Berkshire NHS Foundation Trust, Reading, United Kingdom

**Objective:** To assess the efficacy of a case-based interprofessional education (IPE) programme covering core geriatric topics relevant across specialties.

**Background:** The Shape of Training Report 2013 recognises increasing disease burden in our ageing population. “Geriatric giants” present across specialties, and are often medically or ethically challenging, requiring involvement of multiple professionals. Population changes outpace curricula changes and these are often sparsely taught. Oxford Medical School and Brookes University continue to deliver geriatric IPE addressing such issues.

**Methodology:** Anonymous self-assessment in perceived confidence in adopting inter-professional approach in dealing with geriatric medical problems was collected before and after IPE sessions. Confidence was measured by using a 5-point Likert scale. Nursing and medical students worked in small groups on four chosen common geriatric problems before the arrival of senior nurse and doctor who facilitated the discussion from the inter-professional team's perspective.

**Results:** 73 nursing and 85 medical students provided feedback (5 excluded as incomplete). Using the paired T test, 63% nursing students had improved confidence post intervention, (mean score increase 0.77), while 84% of medical students had improved confidence, (mean score increase 1.21) post-intervention.

**Conclusion:** There was a statistically significant improvement in students' confidence following intervention, slightly greater for medical students, likely due to relative inexperience compared to nursing students, who already had 3 years clinical experience. Future sessions could potentially be improved by better matching of student's level of clinical experience and the involvement of other health care professionals. This form of geriatric IPE statistically significantly increases student's confidence.

P-267

Educational initiative to promote knowledge of cognitive dysfunction in minority older communities, their caregivers and clinicians

K. Alexander¹,², R. Manna¹, N. Gangai¹, R.C. Muniz¹, B. Korc-Grodzicki ¹,². ¹Memorial Sloan Kettering Cancer Center, New York City, USA; ²Weill Cornell Medical Center, New York City, USA

**Introduction:** In addition to the ageing of the population, the United States faces a significant sociodemographic challenge: the growth in the number of minorities. Minorities and older adults are particularly vulnerable to receiving suboptimal healthcare.

**Methods:** In collaboration with community organizations and a Federal government grant through the Health Resources and Services Administration (HRSA), the Geriatric Resource Interprofessional Program (GRIP) was set up at Memorial Sloan Kettering
Cancer Center (MSKCC). It spearheaded an educational initiative on cognitive dysfunction targeting minority communities in Queens County. Four sessions were conducted at community centers. An additional session was conducted to address the needs of caregivers of older adults with dementias. Consecutive interpretation of the lectures was performed to the predominant language of the group. Two sessions discussing the assessment and management of cognitive syndromes in older cancer patients were delivered to clinical staff at regional locations of MSKCC.

**Results:** A total of 171 people who spoke 15 different primary languages attended the community sessions. Their median age was 66 (28–99 years) and 65% were women. 53% were born in Bangladesh, the rest in 16 other countries. 34 providers- nurses, case managers, social workers and oncologists attended the two clinical sessions. Their median age was 57.5 (31–73 years). 90% were female (N=31) and 82% identified as white (N=28).

**Conclusions:** Challenges to the initiative included differences in literacy, multiple cultures and languages. Successes and barriers faced in implementing the educational initiative, as well as pre and post-test results will be presented.

P-268

End the silence: Developing an educational curricula for health
care professionals on elder abuse

S. Sarfraz. Brown University, Providence, RI 02906

**Background:** Elder abuse (EA) is an under-recognized problem which increases morbidity and mortality among those affected. EA is defined as a single or repeated act, or lack of action, occurring within any trust relationship, which causes harm or risk of harm to an older person. Only 40% of the countries have laws to prevent EA. In US, physicians report 1% of all EA cases. Lack of education is often cited as a primary cause of failure to identify and report EA.

**Methodology:** An educational curriculum based on the adult model of learning was developed and piloted at the Durham Veterans Affairs Medical Center. The curriculum was developed as a 60 minute, multimedia case based interactive lecture for health care providers (HCP) routinely caring for older adults. Components include EA definition, types, risks factors, symptoms, and the reporting processes. Pre, post, and post-post surveys were done testing knowledge, clinical skills and attitude on EA.

**Results:** 86 participants included social workers, physical and occupational therapist, nurses, geriatricians, and learners. There was noted improvement post and post-post test after the educational intervention. Most significantly, recognition all types to abuse (7/86 to 20/86) and ability to identify sexual abuse as a type of EA (15/86 to 27/86). Focus group analysis suggests that the curriculum was effective at increasing awareness, ability to identify and report EA.

**Conclusion:** Our 1-hour curriculum on EA for HCP has since been reproduced in CD format and interactive webinar and has the potential to improve knowledge and recognition of EA.

P-269

Fibromyalgia and health education

I. Sierra-Martinez¹, L. Sierra-Martínez², R. Martinez-Fuerte²,
L.A. Diez-Suarez¹, N. Sanz-González³. ¹Traumatology Department,
Hospital of Medina de Campo (Valladolid), Spain; ²Valladolid Este
Primary Assistance Gerency, Valladolid, Spain; ³Parquesol Senior
Center, JCyL Social Services Gerency, Valladolid, Spain

**Introduction:** Fibromyalgia is a chronic disease with generalised
pain and psychosocial problems which could benefit from multidis-
ciplinary intervention.

**Objectives:** To create a group of people diagnosed with fibromyalgia to train them to improve their quality of life. And quantify the improvement of chronic pain, after a group didactic intervention.

**Methodology:** Urban primary care center of 15387 patients as-
signed, where 3% suffers from fibromyalgia. A multidisciplinary
group was created by a nurse, a social worker, traumatologist and
a primary care physician. Group open to the entire population
assigned to the Primary Care Center (PCC) affected by fibromyalgia.
The intervention was a year of one-hour weekly sessions, with
professionals performing health education in hygienic and postural
care and evaluating the improvement in the impact on activities of
daily living.

**Results:** We started the group with 18 people, who at the end of the experience had tripled. A descriptive analysis of the participants was performed: 100% women, mean age 61.5±10.2, 90% married, 95% did not work. Improvement in self-perception was assessed in 58.9% of patients. The mean score on the visual analogue scale of pain intensity (range 0 to 10) decreased from 4.5±1.9 SD to 3.9±2.4 SD (p=0.02). The satisfaction level was 9 out of 10.

**Discussion:** Patients improved their attitude about the disease as well as their emotional state. They have created an association for their benefit and establishing themselves as an autonomous group. We are planning to organise eight structured sessions with reduced groups.

P-270

Mutual respect – how should doctors, nurses & patients address
each other

J. Narendran, S. Marsh, Z. Subhan, B. Creswell, A. Johansen. *Trauma Unit, UHW, Cardiff, UK*

**Background:** A successful consultation depends upon the initial rapport built between healthcare professionals and patients. Older patients will be used to having been addressed more formally than is common nowadays, but limited published data is available questioning whether such patients would prefer to be addressed by their first or surname.

**Objective:** We set out to question patients' perspective – asking how they would prefer to be addressed, and seeking their views in how healthcare professionals should introduce themselves.

**Method:** We approached 66 consecutive in-patients on trauma and orthogeriatric wards. Our hypothesis was that oldest patients might prefer a more formal form of address than was actually being used on the ward, so individual patients were questioned by someone who had not previously introduced them self, and who not involved in the patient's clinical care. Questioning was open, without the presumption of informality sometimes evident in nurses approach to the admissions process. We asked each patient how they would prefer to be addressed by the staff, how they were actually being addressed, and how hospital staff introduced themselves.

**Results:** Nine patients (14%) were unable to answer the questions due to cognitive impairment. Of the remaining 57 patients the mean age was 80 years (range 27 to 101 years), and 63% were female. 54 (95%) stated that they preferred to be called by their first or nickname, one patient wished to be called by their surname, and two patients stated no preference. 48 (84%) of them stated that doctors tended to introduce themselves by their title and full name. On discussion the majority of patients preferred this. 47 (82%) said that nurses introduced themselves by their first name and most patients preferred this. "A doctor's title should be used, I want to know who I am speaking to." There was no apparent difference in attitudes between younger and older patients.

**Conclusion:** Even the oldest patients in hospital are now com-
fortable with informal forms of address. Traditional attitudes are
still evident in a preference for respecting a doctor's title and sur-
name. When approaching patients we should introduce ourselves
formally, but ask them what they would like to be called.
P-271

**New educational technologies in gerontology**

A. Ilnitski, Belarusian Republican Gerontological Public Association

The aim of study is to implement the best educational practices among younger's in gerontology to achieve clear understanding of healthy aging and improve knowledge's in communication with seniors.

**Material and methods:** Few educational technologies were implemented: interactive games with using of simulators of geriatric syndromes; education in physical training by using of special exercises for cognitive support (intelligent gym); education in field of local folk and language traditions which can be used in supporting of physical and cognitive functions. The average age of younger's group was 21,2+1,5 years, participants were students of different senior schools, total number of participants of educational programs was 346. For estimation of effects of training programs special original questionnaires were used.

**Results:** During educational programs the level of knowledge in preventive and healthy behavior increased on 35,5%, the number of healthy habits on 15,5%, understanding of healthy aging on 52,0%, understanding of health and social problems of elders on 70,0%, the level of ageism decreased on 30,0%. 70,0% of participants of education trainers noticed the increased level of understanding of problems of their old relatives and neighbours, 82,5% expressed interest in training because all topics were in fashion in the society.

**Conclusion:** Achievement of long and healthy lifespan by paying attention to the health status, behavior, habits of younger generation is possible by using of untraditional interactive forms of education of younger's in sphere of healthy ageing.

P-272

**Prevalence of carotid sinus syndrome in older versus younger patients presenting with unexplained syncope, falls and dizziness**

S. Banu, Z.M. Lwin, S. Mansour, K. Shahpar, T. Masud, M.H. Poon.

Nottingham University Hospital NHS Trust

**Introduction:** Carotid sinus syndrome (CSS) is a known cause of unexplained syncope, falls or dizziness, although it is often under-recognised in clinical practice. CSS can be cardio-inhibitory (CI-CSS), vasodepressor (VD-CSS) or mixed. The aim of this study was to assess the prevalence of CSS in this population.

**Methods:** We reviewed data from consecutive patients with unexplained syncope, falls or dizziness referred for carotid sinus massage (CSM). CSM was performed in a standardised manner for 10 seconds bilaterally in supine and upright positions (tilt table) with electrocardiography and digital plethysmography measuring beat-to-beat blood pressure (BP). The diagnostic criterion for CI-CSS was 3 second pause and for VD-CSS was 50mm Hg systolic BP drop (or 30mmm with symptoms).

**Results:** 272 patients (mean age=53.6±22.6; range=18–93; 106=men) were studied. The overall prevalence (95%CI) of CSS was 8.4% (5.1–11.7). Prevalence of CI-CSS and VD-CSS were 1.8% and 6.9% respectively. The CSS prevalence in older (≥65 years) was four-fold higher than in younger (<65 years) patients [16.3% (9.2–23.4) vs 4.1% (1.3–6.9); p<0.05]. The CSS prevalence in men tended to be twice that in women [12.3% (6.0–18.6) vs 6.0% (2.4–9.6)]. The prevalence in older (≥65 years) men and women were 23.2% (10.6–35.8) and 11.4% (3.4–19.4) respectively. No adverse events occurred.

**Conclusion:** Approximately a quarter of men and one tenth of women aged over 65 years with unexplained syncope, falls or dizziness were diagnosed with CSS which allowed appropriate intervention to be performed. This included general advice for VD-CSS and dual-chamber pacemakers for CI-CSS. CSM procedure was safe.

P-273

**Quality improvement project to improve the knowledge and prescribing practices by trainee doctors inpatients with Parkinson's disease**

R. Matthews, A.L.T. Yong, A.M. Thomson. Salford Royal NHS

Foundation Trust, United Kingdom

**Introduction:** Medication management in patients with idiopathic Parkinson's disease (iPD) is challenging for trainee doctors. Education in prescribing practice is limited by the time constraints of rotas and busy clinical jobs. Using Quality Improvement methodology, this project aimed to identify what learning technique would be most acceptable to doctors in training.

**Methods:** Trainee doctors working in the Emergency Assessment Unit (EAU) of a University teaching hospital were surveyed to assess their baseline knowledge in prescribing Parkinson's medications. A 2-week educational approach was then implemented, including email messages and a short presentation at twice-daily handover. A post-intervention survey was used to determine the trainee's preferred learning techniques.

**Results:** 30 trainees completed the pre-intervention survey. This confirmed knowledge-gaps including route of delivery, contraindicated medications and management of nil-by-mouth status. 32 trainees completed the post-intervention survey. 23/32 (71.9%) felt the project had improved their prescribing practice in this area. 29/32 (90.6%) agreed they understood the adverse effects of missed doses, and 26/32 (81.2%) how to manage nil-by-mouth status. Given a choice of a single educational approach, the cohort expressed a preference for seminar-based teaching (33.3%) or an on-line learning module (33.3%), over a daily EAU handover (26.7%) or email at the beginning of the placement (6.7%).

**Conclusions:** Although it was not surprising that trainees felt their knowledge had improved following the intervention, what is more important is the learning style they wish to adopt. We are now in the process of developing an on-line education module in this important area of prescribing.

P-274

**Relation between falls and consequences in institutionalized elders, before and after a removal intervention of physical and pharmacological restraints**

P. Alcala Manchado, E. Aulló Chavez, S. Bercial Velez, D. Curto i

Prieto, C.M. Garcia Alonso, M. Saez Pomares. Spain

**Introduction:** Being falls one of the geriatric syndromes with a highest impact in institutionalized people in nursing homes; this study tries to assess if with a physical and chemical restraints reduction programme is possible to achieve a reduction in the number of falls and its consequences.

**Methodology:** An intervention in Alcorcón's nursing home shows that after training their staff, physical restraints were phased out compared to last year, where 60% of the residents had a physical restraint prescription. The main variables studies were: falls and psychotropic medication prescriptions.

**Results:** It is proven that removing physical restraints do not cause an increase in the number of falls, also showing a positive improvement in its consequences. Likewise, it is shown that is has not been necessary to increase the prescription of psychotropic medication.

**Conclusion:** It is verified that the elimination of physical restraints has not a negative impact in falls, improving certain aspects of welfare and behavioral changes. It is evident that this program should be complemented with a removal of pharmacological restraints.
P-275

Solving an age-old problem, how do our trainees learn about geriatric medicine

J. Lee¹, C. Lisk², ¹North London Hospice, London, United Kingdom;
²Barnet Hospital, London, United Kingdom

**Introduction:** The UK population is ageing and it is critical that effective Geriatric Medicine teaching programmes are established to train the Physician workforce to effectively care for an ageing population. We sought to establish how Core Medical Trainees CMT within North central and North east London learnt about Geriatric Medicine.

**Methods:** A questionnaire adapted from a survey of training in Geriatric Medicine in UK medical schools was sent as a web based survey to all 197 CMTs in March 2016.

**Results:** 94 trainees responded (response rate 46%). 59.57% (56) had Geriatric Medicine as part of their 2 year CMT rotation. Workplace based learning WBL were the predominant source of teaching and learning in core Geriatric Medicine; delirium 75.9%, dementia 74.7%, falls 72.29%, mental capacity 68.75%, polypharmacy 65%, advanced directives 62.5%, assessment scales 69%, stroke/TIA 59.4%, Parkinson's disease 57.83%, principles of medical ethics 56.2% and osteoporosis 49.4%. Trainees learning about Pressure ulcers, Incontinence, Cancer in the elderly, Cellular aspects of aging, Physiological aspects of ageing, Elder abuse, Population ageing, Social ageing and models of community based care were poor in local and regional teaching programmes. E learning was used commonly in Principles of medical ethics 17.5%, Mental capacity 17.5%, Elder abuse 18.75% and advanced directives 10%.

**Conclusion:** This study emphasises that teaching and learning experiences for CMTs occur in the workplace through day to day work experiences. It is important to include topics with low WBL into formal teaching sessions to ensure adequate exposure to all aspects of Geriatric Medicine.

P-276

The use of the aging simulator in nursing students: A scoping review

A. Coelho¹, V. Parola¹, M. Almeida², S. Duarte², D. Cardoso¹,
H. Neves¹, J. Apóstolo¹. ¹Health Sciences Research Unit: Nursing,
Nursing School of Coimbra; Centre for Evidence-Based Practice: a
Joanna Briggs Institute Centre of Excellence, Portugal; ²Health Sciences
Research Unit: Nursing, Nursing School of Coimbra, Portugal

**Introduction:** The use of Simulation as a teaching/learning strategy in the training of nurses has increased in the last decades and provided the acquisition and development of several competences. However, data regarding the specific use of the Aging Simulator are scattered in the literature. The purpose of this Scoping Review is to analyse and map interventions with the Aging Simulator, implemented in nursing students.

**Methods:** Scoping Review conducted according to the methodology proposed by the Joanna Briggs Institute (1,2). This review considered qualitative and quantitative studies, focused on nursing students, who used the Aging Simulator. Studies were considered without limitation of year of publication, in English, Spanish and Portuguese.

**Results:** Of 195 studies found, two studies were included in the review. The use of the simulator oscillated between one and three hours, between the use of the complete simulation suit and only some constrictors. Empathy evaluation and learning effectiveness tools were implemented. Both studies were implemented in students of the 2nd year of the Degree.

**Conclusions:** The characteristics of the intervention, duration and evaluation instruments differ between studies, so a systematic review of the effect of the Aging Simulator is necessary to deter-

mine the best available evidence and guide the training of nursing students. Further studies should be performed to determine the effect/findings of the implementation of the Aging Simulator in the acquisition and development of competences in a pre and post clinical context.

References:

[1] Peters M, Godfrey C, McInerney P, Baldini Soares C, Khalil H, Parker D. Methodology for JBI scoping reviews. The Joanna Briggs Institute Reviewers' Manual 2015. Adelaide (Australia): The Joanna Briggs Institute; 2015. p. 1–24.

[2] Peters M, Godfrey C, Khalil H, McInerney P, Parker D, Soares C. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015 Sep;13(3):141–6.

P-277

Toward physician mediated quality measure for nursing home care

C.M.P.M. Hertogh. VU University Medical Center

**Background:** Most quality measures for nursing home care emphasize facility-level processes and structure and are not designed to evaluate the role of the physician in this setting. AMDA, the Society for Post Acute and Long Term Care Medicine (AMDA) engaged providers in Europe and the US to identify physician competencies for nursing home care; however, these competencies have not been linked to specific measures that reflect the steps of care under the control of these providers.

**Methods:** Starting in January 2017 and supported by RAND, a research team that included content experts in nursing home care from the US, Canada, the Netherlands and EUGMS SIG long term care identified existing quality measures that map to AMDA's Attending Physician Competencies. Quality Indicators considered included ACOVE Quality Indicators for community dwelling elders, the ACOVE NH Quality Indicator set, published guidelines, recommendations from "Choosing Wisely" and items in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) suite of surveys. The team updated and adapted measures to create candidate measures that are appropriate for US, Canadian and European facilities and that reflect the achievement of AMDA competencies. As a next step, an international expert meeting was held in June 2017 that used the RAND modified Delphi process to identify a final set of measures, considering validity and feasibility.

**Findings:** The presentation will go into the key findings of the consensus meeting and present the resulting quality measures. Special attention will be given to feasibility of these measures in different health care systems across Europe.

P-278

Training to adopt National Early Warning Score (NEWS) in community hospitals: Improvement after training in recognising unwell patients using the NEWS

S. Hyne, B. Lakkappa, K. Kodavali, M. Suppiah. Community Hospitals, Northamptonshire Healthcare NHS Foundation Trust (NHFT), United Kingdom (UK)

**Introduction:** NEWS was implemented in the UK to standardise the assessment of acute-illness, severity of all hospital inpatients and also to track their clinical condition, alerting the clinical teams to any clinical deterioration and triggering a timely clinical response. The NEWS was adopted in our community hospitals, on three wards for 69 patients in 2015. Lack of timely clinical response for a patient; led to the review of practice and the implementation of NEWS training for all community hospital staff.

**Methods:** In 2015, NEWS charts of 30 inpatients were reviewed and the results showed patient monitoring and clinical response were not satisfactory. Following the completion of NEWS training to all
staff, NEWS charts of all inpatients (69 in total) were reviewed on one day in 2016. The two audits were assessed against Trust and Royal College of Physicians (RCP) guidelines and compared.

Results There was significant improvement seen in every area assessed when compared between 2015 and post-teaching in 2016. NEWS Assessment on consecutive days improved from 53% to 70%, time documented 53% to 70%, scoring 70% to 81%, scoring correctly 77% to 93%, monitoring based on guidance 13% to 78%, Documentation on electronic medical records from 0% to 53% and documentation on NEWS paper charts for action 90% to 100%.

**Conclusions:** The findings show clear improvement in patient monitoring and timely clinical response after teaching sessions, with room for more improvement. Teaching sessions should be incorporated, for any local adaptation and implementation of national guidelines to improve staff competency and clinical practice.

# Area: Metabolism and nutrition

## P-279

### A prospective cross-sectional study of hyponatremia among elderly patients in the Department of Geriatrics at Kaunas Clinical Hospital (Lithuania)

J. Knasiene¹, R. Zilinskiene², A. Abramaviciute². ¹Lithuanian University of Health Sciences, Academy of Medicine, Department of Geriatrics, Kaunas, Lithuania; ²Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania

**Introduction:** HN is frequent electrolyte imbalance in clinical practice. Aging, chronic diseases, use of medications can cause HN. HN is associated with multiple poor clinical outcomes: increased mortality, longer hospital stay, higher institutionalization risk.

**Methods:** In a prospective cross-sectional study we used interview, clinical examination, medical data (n=144, age 83,34±6,78 years). Patients with HN were defined as serum Na+<135 mmol/L. Variables were evaluated using Chi-square, Spearman test. Data were considered statistically significant if value p<0.05.

**Results:** Prevalence of HN among elderly patients was 28.5% with mean Na+value of 127.85±5.47 mmol/l. This group consisted of 46.3% mild, 29.3% moderate and 24.4% severe HN. The duration of HN was evaluted as chronic (n=41; 100%). All of patients complained about weakness, fatigue, 78% felt thirst, 61%-vertigo, 56%-headache, 43.9%-nausea. 36.6% of elderly patients had moving disorders, 39.0% swelling legs, 36.6% consciousness, 31.7% irritability, 29.7% irregular heartbeat, 19.5% fever, vomiting, lethargy. Heart diseases was most common among comorbidity: hypertension (90.2%), coronary artery disease (78%), 65.9% elderly patients presented chronic kidney diseases, 56.1% anorexia, 61% had anemia, 70.7% infections, 87.7% were taking diuretics. The study had weak positive correlation between HN and heart diseases (r=0.245), HN and kidney diseases (r=0.375), HN and use of diuretics (r=0.341) (p<0.05).

**Conclusions:** 1/3 of elderly patients had chronic HN and even half of them - moderate or severe HN. Elderly patients with mild HN felt weakness, fatigue, in moderate cases - nausea, headache, in severe cases - vomiting, lethargy. Elderly patients with HN statistically significant had heart and kidney diseases and were using diuretics

## P-280

### Analysis of survival in patients >75 years with gastrostomy according to the cause of indication

E. García Tercero¹, M. Araujo Ordoñez¹, T. Martínez Maroto¹, V. Landaluce Pelligra¹, C. Pedro Monfort¹, R.M. García Tercero², C. Lanciego¹. ¹Hospital Virgen del Valle, Toledo, Spain; ²Hospital General Universitario Alicante, Alicante, Spain

**Introduction:** Gastrostomy is performed more and more frequently in elderly patients. A retrospective 5-year study evaluating the survival of the placement of gastrostomies according to the cause of the indication, whether it's for stroke or dementia, is proposed.

**Method:** We performed a data reconnaissance chart on patients with gastrostomy performed between 2011 and 2015, collecting different variables: patient age, gender, associated comorbidities, cause of gastrostomy indication, type of nutrition used, The Months that are alive after the implant or not and the cause of death. In this poster we'll focus on the analysis of survival according to the cause of indication of gastrostomy. On the one hand we have the ACVS and on the other hand the dementia (GDS3-7).

**Results:** n=177, ACVs: 33% (59) and Dementia: 66% (118) of the total sample. Within the ACVS group, mortality was 44.1% and in the dementia group 48.3%. The median survival in the stroke group was 17 months and that of dementias was 22 months.

**Discussion:** The group of patients in whom ACV gastrostomy was indicated had no significant differences (p: 0.86) in the group with indication of dementia, questionnaires in relation to the small number of cases.

**Conclusions:** The reason why gastrostomy is placed does not influence the survival of the same so it should not be a limiting factor at the time of application. It's necessary to carry out studies with a more sample to achieve a statistical significance.

## P-281

### Coffee consumption and fracture risk in older men and women: the Health, Aging, and Body Composition Study

M.R. Olthof¹, L.A. Schaap¹, E.S. Strotmeyer², T.B. Harris³, J.A. Cauley⁴, P.M. Cawthon⁵, S.M. Rubin⁶, M. Visser¹. ¹Department of Health Sciences, Faculty of Earth and Life Sciences, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; ²Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Ave., 5th Floor, Pittsburgh, PA 15213, United States; ³Intramural Research Program, Laboratory of Epidemiology, and Population Sciences, National Institute on Aging, National Institutes of Health, Laboratory of Epidemiology, Demography, and Biometry, Gateway Building, 3C309, 7201 Wisconsin Avenue, Bethesda, MD 20892, United States; ⁴Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Desoto Street, A510 Crabtree Hall, Pittsburgh, PA 15261, United States; ⁵California Pacific Medical Center Research Institute, San Francisco, California, United States; ⁶Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States

**Introduction:** Several studies suggest an association between consumption of coffee and risk of osteoporotic fractures. However, the results are inconclusive. In this study, we investigated the association between coffee consumption and risk of osteoporotic fractures in older men and women.

**Methods:** Data on 2542 well-functioning Black and White men and women aged 70-79 years at baseline were used. The median follow-up was 10.4 years. Coffee consumption was assessed with interviewer-assessed food frequency questionnaires, and categorized as less than 1 cup, 1 cup, 2-3 cups and 4 or more cups per day. Fractures were assessed every six months and verified with radiology reports. Multivariate-adjusted hazard ratios (HR) of fractures with 95% confidence intervals (CI) were estimated for men and women separately by Cox proportional hazard models.

**Results:** During follow-up, 392 participants (127 men and 265 women) experienced an osteoporotic fracture at any site. After multivariate adjustment for demographics, health and lifestyle factors, consumption of 4 or more cups of coffee per day, compared to less than 1 cup of coffee per day, was significantly associated with 1.63 times higher risk of osteoporotic fractures in women (HR: 1.63; 95%
CI: 1.04–2.57). No significant association was observed in men (HR: 1.54; 0.84–2.83).

**Conclusions:** Consumption of coffee was associated with increased risk of osteoporotic fractures in older women, but not in older men.

P-282

**Comparison of the nutritional risk in the elderly over 75 years in home vs health care units**

I. Figueiredo¹, R. Alves¹, M. Saldanha², F. Lourenço¹, M. Antunes¹, H. Gruner¹, A. Panarra¹. ¹S. Medicina7.2 Hospital de Curry Cabral, Centro Hospitalar Lisboa Central; ²U Nutrição e Dietetica, Hospital de Curry Cabral Centro Hospitalar Lisboa Central

**Introduction:** According to WHO, elderly people are especially vulnerable due to malnutrition, being related to many different factors. Our aim was to evaluate if patients from different cohabitation status had the same risk of undernutrition and evaluate contributing factors.

**Methods:** Retrospective descriptive study of all patients with >75 years old, admitted to the medical ward of a tertiary hospital during a one year period with a nutritional evaluation either by MUST or NRS. Patients were grouped according to habitation status home (H) vs health care unit (HCU) and compared per gender, age, autonomy (KATZ score), primary diagnosis, median length of stay and mortality.

**Results:** A total of 89 patients fulfilled the inclusion criteria with a median age of 83,7 years (37 with >85 years), 60 were female, 44 patients with nutritional risk, median length of stay of 9,89 days and mortality of 32,4%. Concerning the 2 groups: there were H 15 patients and HCU 74, the patients living in HCU were slightly older (83,9 VS 83,7 years), with a male prevalence (53% VS 28%), lesser autonomy with a KATZ <3 (73% VS 55,4%) and higher mortality of 86% VS 14%. The risk ratio for nutritional risk in patients living in health care facilities patients was 2,06, but the risk ratio for mortality in patients with nutritional risk living at Home was 2,53

**Discussion:** Half of the population above 75 years old is at nutritional risk, that risk is even greater considering the population living in health care facilities. This study pretends to raise awareness on this subject, considering malnutrition is frequently related to poor outcomes. In our study the influence of malnutrition in mortality was more important in patients living at Home.

P-283

**Developing a clinical diagnostic tool for the identification of older adults with hypovitaminosis D**

C. Annweiler¹, G. Duval¹, G. Chevallereau¹, O. Beauchet²,
B. Fantino¹, A. Kabeshova¹. ¹Angers University Hospital, France;
²McGill University, Canada

**Introduction:** Hypovitaminosis D is highly prevalent among older adults and associated with adverse health events. To rationalize vitamin D assays and save health costs, our objectives were to develop and test a clinical diagnostic tool for the identification of older community-dwellers with hypovitaminosis D.

**Methods:** 1924 community-dwelling volunteers ≥65 years without vitamin D supplements were recruited in this cross-sectional study. A set of clinical variables (age, gender, living alone, individual deprivation, body mass index, undernutrition, polymorbidity, number of drugs used daily, psychoactive drugs, biphosphonates, strontium, calcium supplements, falls, fear of falling, vertebral fractures, Timed Up & Go test, walking aids, lower-limb proprioception, handgrip strength, visual acuity, wearing glasses, cognitive disorders, sad mood) was recorded from standardized questionnaires and medical examination at the time of serum 25-hydroxyvitamin D (25OHD) measurement. Hypovitaminosis D was defined as serum 25OHD ≤75 nmol/L, ≤50 nmol/L or ≤25 nmol/L. The whole sample was

separated into training and testing subsets to design, validate and test an artificial neural network (multilayer perceptron, MLP).

**Results:** 1729 participants (89.9%) had 25OHD ≤75 nmol/L, 1288 (66.9%) had 25OHD ≤50 nmol/L, and 525 (27.2%) had 25OHD ≤25 nmol/L. MLP using 16 clinical variables was able to diagnose hypovitaminosis D ≤75 nmol/L with accuracy = 96.3%, area under curv (AUC) = 0.938, and κ=79.3 indicating almost perfect agreement. It was also able to diagnose hypovitaminosis D ≤50 nmol/L with accuracy = 81.5, AUC=0.867 and κ=57.8 (moderate agreement); and hypovitaminosis D ≤25 nmol/L with accuracy = 82.5, AUC=0.835 and κ=55.0 (moderate agreement).

**Conclusions:** We developed an algorithm able to identify, from 16 clinical variables, older community-dwellers with hypovitaminosis D. Such inexpensive tool should help clinicians in decisions to supplement their patients without resorting to blood tests.

P-284

**Development and validation of a short food questionnaire to assess low protein intake in community-dwelling older adults**

H. Wijnhoven¹, R. de Vet², L. Elstgeest¹, M. Visser ¹,². ¹Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; ²VU University Medical Center, Amsterdam, the Netherlands

**Introduction:** In old age, sufficient protein intake is important to preserve muscle mass and function. We developed and validated a short food questionnaire to assess low protein intake in community-dwelling older adults.

**Methods:** We used data of 1392 older adults (>55 years) of the Longitudinal Aging Study Amsterdam. Protein intake was measured using a 220-item semi-quantitative food frequency questionnaire (FFQ). A restricted multivariate prediction model was built to predict protein intake >1.0 g/kg adjusted body weight, including original FFQ questions on frequency and amount of specific foods as independent variables.

**Results:** The final multivariate model included 13 questions (frequency and/or amount) on intake of bread, dairy dessert, milk, eggs, pasta, fish, meat, and cheese. The area-under-the-curve (AUC) was 0.861 (good discriminative ability).

**Conclusion:** The developed short food questionnaire can be used to validly assess low protein intake in community-dwelling older adults in the Netherlands. External validation in other countries is needed.

P-285

**Dietary fat quality is associated with cognition, mobility and nutrient intakes in older populations**

S. Jyväkorpi, K. Pitkälä, T. Strandberg, M. Björkman, T. Puranen, H. Soini, M. Suominen. University of Helsinki

**Background:** For the prevention of coronary heart disease, a diet with high polyunsaturated fatty acids to saturated fatty acids (PUFA:SFA) ratio has been recommended. We analyzed fat quality, defined as higher PUFA:SFA ratio and its associations with mobility, nutrition and cognition in heterogeneous groups of older people.

**Methods:** The cross-sectional study combined five nutritional studies including home-dwelling (n=526) and institutionalized (n=374) older people. Nutritional status was assessed, using Mini Nutritional Assessment (MNA) and nutrient intakes retrieved from 1–3-day food records. The participants were divided into quartiles corresponding to PUFA:SFA ratios. Background characteristics, mobility, cognition, energy, nutrient, and fiber intakes were classified according to the PUFA:SFA ratios.

**Results:** Higher PUFA:SFA ratios were linearly associated with mobility, cognition, education level and BMI. Protein, fiber and micronutrient intakes were positively, whereas total carbohydrate and sugar intakes were inversely associated with PUFA:SFA ratios.
Of the institutionalized participants, 80% were classified to the lowest PUFA:SFA ratio quartiles. MNA scores were linearly associated with higher PUFA:SFA ratios in institutionalized participants, but inversely associated with home-dwelling participants. In home-dwelling participants, cognition and age was linearly associated with higher PUFA:SFA ratios.

**Conclusion:** Higher PUFA:SFA ratios were associated with several positive characteristics of older people, including better mobility, education, cognition, nutrient intake and diet quality. The institutionalized participants had lower fat quality and nutrient density than the home-dwelling participants. Interestingly, in home-dwelling older people both cognition and age were associated with higher PUFA:SFA ratios although age is usually a determinant of cognitive decline.

## P-286

### Does diabetes still imply disability in the elderly?

D. Concu¹, M.A. Spanu¹, A. Gentilini², A. Fancellu¹, A. Errigo³,
G. Pes⁴. ¹Azienda Sanitaria Locale Sassari, Italy; ²Azienda Sanitaria
Locale, Sassari, Italy; ³Azienda Ospedaliera Universitaria, Sassari, Italy;
⁴Dipartimento di Medicina Clinica e Sperimentale, Università di
Sassari, Italy

**Introduction:** The impact of diabetes on the quality of life of older people (≥75 years) is not completely understood. It is commonly believed that, owing to the occurrence of severe long-term complications, the disease tends to accelerate the progression of functional deterioration. A case-control study on elderly diabetics from Sardinia aged 75 is currently underway in order to investigate the relationship between diabetes and functional disability.

**Methods:** Currently, 27 outpatient diabetics with known disease duration have been recruited, as well as 27 controls aged ≥75 years. In both groups, a Comprehensive Geriatric assessment was performed, including ADL, IADL, Barthel, MMSE, GDS and MNA scales. Differences between the two subgroups were tested statistically.

**Results:** In diabetics, average disease duration was 15.7±10.5 years. Mean values of disability indexes in diabetics and controls were respectively: Barthel 91.7±10.7 and 93.1±10.3; ADL 5.5±0.6 in both groups; IADL: 6.2±1.9 and 6.42±1.8. The mean MMSE values were 25.7±2.5 and 26.3±2.5 respectively, while GDS values were 6.2±1.9 and 3.1±3.1. MNA score was 24.3±3.0 in diabetics and 25.2±3.6 in controls. None of differences were significant.

**Conclusions:** These preliminary results suggest that diabetes does not necessarily have a significant impact on functional autonomy of the elderly, even in the case of long-term illness. The current study aims to analyze a final case of 200 subjects in order to strengthen the results obtained.

## P-287

### Energy need and energy intake according to the body mass index among patients hospitalized in an acute geriatric unit

S. Allepaerts¹, G. Doupagne¹, J. Weber¹, F. Buckinx², O. Bruyère³,
N. Paquot¹. ¹CHU de Liège; ²Université de Liège; ³université de Liège

**Background:** The aim of this study was to measure the energy need and the energy intake among patients hospitalized in an acute geriatric unit regarding to their Body mass index (BMI).

**Methods:** Energy need or total energy expenditure (TEE) is the energy used by the human body for daily function, is a combination of rest energy expenditure (REE), energy used during substrate metabolism and energy used in physical activity. REE was measured by indirect calorimetry. Energy intake (EI) was measured over a 3-day period. Cut off of BMI was defined according the European society of enteral and parenteral nutrition (ESPEN) and the World Health organization (WHO).

**Results:** Seventy-nine patients hospitalized in acute geriatric unit

were evaluated (77% of women, 82.4±16.3 years on average). Prevalence of malnutrition was 34%. REE and TEE were significantly and conversely correlate with the BMI. The lower was the BMI and the higher were the REE and the TEE (REE was 21±3.4 Kcal/kg/j in BMI <18.5 kg/m² vs 14.4±1.7 Kcal/kg/j in BMI >30 kg/m²) (p=00001 vs p=0.009). The EI were also significantly and conversely correlate with the BMI (EI was 37.3±11 Kcal/kg/j in BMI <18.5 Kcal/kg/j and 26.3±5.35 Kcal/kg/j in BMI >30 Kcal/kg/j) (p=0.0004).

**Conclusion:** In patients hospitalized in an acute geriatric unit, the energy need is correlated to the BMI, which suggests that the energy requirements to maintain body weight are higher with the decrease in BMI. Energy intake are correlated with the energy need and increase with the increase of BMI.

## P-288

### Energy need and energy intake among patients hospitalized in an acute geriatric unit

G. Doupagne¹, J. Weber¹, F. Buckinx², O. Bruyère², N. Paquot¹,
J. Petermans¹. ¹CHU de Liège; ²université de Liège

**Background:** The aim of this study was to compare the energy need and the energy intake among patients hospitalized in an acute geriatric unit.

**Methods:** Energy need or total energy expenditure (TEE) is the energy used by the human body for daily function, and a combination of rest energy expenditure (REE), energy used during substrate metabolism and energy used in physical activity. REE was measured by indirect calorimetry. Energy Intake (EI) was measured over a 3-days period. Three groups of population were defined: sarcopenic, undernourished and frail (moderate and severe). Sarcopenia was diagnosed according to the criteria of European working group of sarcopenia in older people (EWGSOP), undernutrition by the criteria of European society of parenteral and enteral nutrition (ESPEN), and frailty by the Edmonton scale.

**Results:** Twenty-nine patients hospitalized in acute geriatric unit were evaluated (77% of women, 82.4±16.3 years on average). Prevalence of malnutrition was 34%, sarcopenia was 32%, moderate frailty was 35% and of severe frailty was 57%. TEE was significantly lower than energy intake among all population, malnourished, well-nourished, sarcopenic, moderately and severely frail patients.

**Conclusion:** In patients hospitalized in an acute geriatric unit, the energy intake seemed to be sufficient to cover TEE, regardless their nutritional status. Therefore, food rations can be adapted according to the geriatric profile.

## P-289

### Evaluation of quality indicators for obesity in patients under 17 years in primary care

L. Sierra-Martínez¹, R. Martínez-Fuerte¹, N. Sanz-González².
¹Valladolid Este Primary Assistance Gerency, Valladolid; ²JCyL Social Services Gerency, Valladolid

**Background and aim:** Study on the quality of clinical care provided to patients under 17 years with Obesity assigned to a medical practice (during the period 2015).

**Method/Design:** Longitudinal evaluation: Palmer's Quality Cycle. Setting: An urban health care center. Population and sample: Patients (total according to inclusion criteria, year 2014) with obesity (year 2015) (n=120). Interventions: Internal evaluation, dimensions: scientific-technica, quality, adequacy, accessibility, continuity of care; data related to the care process and intermediate results; explicit, evidence-based procedural criteria. Subjects: Analysis of coverage. Analysis on the evolution of treatment compliance. The Z statistical test for comparing proportions, alpha 0,05.

**Results:** Compliance criteria (year 2015): Population ≤17 years: 2276. Obesity prevalence: 5,27% (120 patients). Overweight preva-
lence: 3,73% (85 patients). Patients with Obesity with two BMIs recorded in 2015: 24 patients. Patients with Obesity with two BMIs registered and have reduced two measures in 2015: 11 (9,17%).

**Conclusions:** Establish a plan of intervention activities to improve results: diagnosis and control of Obesity to avoid complications.

## P-290

### Factors associated with vitamin D deficiency in the elderly: the Korean National Health and Nutrition Examination Survey 2010-2012

J.E. Oh¹, S.H. Kim¹, H.S. Shin¹, Y.J. Cho¹, Y.G. Lee², C.Y. Cho³.

¹Department of Family Medicine, Soonchunhyang University Hospital, Soonchunhyang University, Cheonan-City, Korea; ²Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Soonchunhyang University, Seoul, Korea; ³Department of Family Medicine, Soonchunhyang University Hospital, Soonchunhyang University, Seoul, Korea

**Introduction:** The aim of this study was to evaluate risk factors associated with vitamin D deficiency and its prevalence in Korean non-institutionalized adults aged 65 or older.

**Methods:** The study subjects (n=2,687) were individuals who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) in 2010–2012. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D concentration <20 ng/mL. The logistic regression analysis was done to determine the association between vitamin D deficiency and sex, smoking status, physical activity, alcohol consumption, sleep duration, chewing difficulty, energy intake, calcium intake, skipping meal, and metabolic syndrome.

**Results:** The prevalence of vitamin D deficiency was 56.7%. Multiple logistic regression analysis showed that independent predictors of vitamin D deficiency were female, BMI (≥25kg/m²), current smoker, low energy intake (male <2,000 kcal/day, female <1,600 kcal/day), skipping breakfast, low intensity physical activity, moderate intensity physical activity, sleep duration (<7 hours/day), and metabolic syndrome (P<0.05).

**Conclusions:** In Korean older adults, vitamin D deficiency is very common and is at increased risk for health risk factors related with lifestyle. These results suggest that unhealthy lifestyle in the elderly may be associated with vitamin D deficiency.

## P-291

### Fluid prescription in the elderly

S.D. Brincat¹, C. Cassar¹, M.J. Grech², A. Vella³. ¹Mater Dei Hospital, Msida, Malta; ²St Vincent De Paul Residence, Luqa, Malta; ³Karin Grech Hospital, Pieta, Malta

**Introduction:** A critical aspect in the care of elderly patients is fluid administration; an integral part of patient's treatment to prevent and restore abnormal body fluid and electrolyte loss. Elderly patients are particularly vulnerable to complications of fluid administration.[1,2] The aim of the audit is to assess for appropriate documentation of fluid prescription of the geriatric population at St Vincent De Paul long term facility (SVP) and to assess the compliance of prescribers with the standard guidelines.

**Methods:** The geriatric population at SVP under the care of all geriatric firms, who were prescribed fluids during the preceding 24hours in a 5-day period in May 2016 was selected. Data from medical and nursing notes, fluid balance charts, observation charts and computerised results system on iSoft®. Results were compared to international studies.[3] The standard used was the National Institute of Health and Care Excellence (NICE) guidelines – “Intravenous fluid therapy in adults in hospital” published in 2013.[4].

**Results:** Thirty patients were being administered fluid therapy; all prescribed as part of the medical notes with no documentation regarding stop or review date. Physicians documented limited intake in 23% (n=7) patients, abnormal losses in 3% (n=1) and requested parameters charting in 43% (n=13) patients. A request for catheterisation was documented in 47% patients (n=14). In none of the patients, initial or daily weight was requested.

**Conclusion:** This clinical audit has shown that prescribing, administering and monitoring of fluid administration can be improved. A local fluid prescribing guideline and prescription fluid chart were developed for rational, standardised and accurate documentation of the administration of fluid.

### References:

[1] Gao X, Huang KP, Wu HY, Sun PP, Yan JJ, Chen J et al. Inappropriate prescribing of intravenous fluid in adult inpatients – a literature review of current practice an research. Journal of clinical pharmacy and therapeutics 2015;40:489–495

[2] Sansom LT, Duggleby L. Intravenous fluid prescribing: improving practices and documentation in line with NICE CG174 guidance. BMJ quality improvement reports 2014; 3–8

[3] Ferenczi E, Datta SS, Chopada A. Intravenous fluid administration in elderly patients at a London hospital: a two-part audit encompassing ward-based fluid monitoring and prescribing practice by doctors. Int J Surg 2007;5:408–12

[4] National institute for health and care excellence. [Internet] Intravenous fluid therapy in adults in hospital [published 2013 Dec 10; cited 2017 Apr 4]. Available from: https://www.nice.org.uk/guidance/cg174/resources/intravenous-fluid-therapy-in-over-16s-in-hospital-35109752233669

## P-292

### Handgrip strength among Thai elderly

J. Horpibulsuk¹, P. Jongjol². ¹School of Internal Medicine, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand; ²School of Industrial Engineering, Institute of Engineering, Suranaree University of Technology, Nakhon Ratchasima Thailand

**Introduction:** The physical of elderly had changed, which included muscle power and muscle mass. The muscle strength was measured from hand grip strength (HGS). This research studied HGS and nutritional status of Thai elderly (aged 60 years or older), who lived in Nakhon Ratchasima province.

**Design:** A cross-sectional analytic study Methods: Assessment of HGS of the dominant hand followed standardized testing procedures as per the American Society of Hand Therapists [1] using the Jamar handheld dynamometer. Measured body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. The subjects were classified as: underweight (BMI <18.5); normal (18.5 < BMI <22.9) and overweight (BMI >23) [2].

**Results:** A total of 491 elderly were studied and the mean (+SD) age was 69.15+6.86 (from 60 to 90) years. When comparing between elderly males and females, it was found that an elderly male group had higher height, higher weight, and higher HGS than an elderly female group (p-value =0.00). When considering HGS of overall elderly, which divided according to BMI, it was found that the elderly with normal weight and overweight had higher HGS than those who were in a group of underweight (p-value =0.00).

**Conclusion:** The mean value of the dominant HGS in the elderly was significantly higher in elderly males when compared to elderly females. Furthermore, elderly with underweight is associated with poorer HGS than elderly with normal weight or overweight.

### References:

[1] Fess E. Grip strength. In: Casanova J, ed. Clinical Assessment Recommendations. Chicago: American Society of Hand Therapists, 1992; 41–5.

[2] WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363: 157–63.
P-293

Human albumin prescription among the elderly

S. Costa¹, C. Canha², M.T. Veríssimo³, A. Simão³, A. Carvalho³.
¹Internal Medicine A, Centro Hospitalar e Universitário de Coimbra,
Portugal; ²CIMAGO; ³Faculty of Medicine, Universidade de Coimbra

**Introduction:** The most important nutritional disorder in the elderly is malnutrition, which is associated with increased mortality and reduced quality of life. Serum albumin levels allow the identification of patients at high risk for malnutrition.

**Materials and methods:** This is a descriptive retrospective study, aiming to characterize the prescribing policy for human albumin in the population over 64 years of age, admitted in the Internal Medicine ward, within January 1st and December 31st, 2016. Patients were identified through data obtained from pharmacy services. The data collection was performed through consultation of clinical processes and analyzed using Excel.

**Results:** One hundred and ninety-seven admissions were analyzed, of which 134 were included, corresponding to 99 patients, with a mean age of 81.2±6.7 years, mainly men (79%). In 81% of the prescriptions, patients had a Charlson index above 6 and a Katz index of 6 in 25% of patients and 0 in 24%. In 57% of the cases albumin prescription, patients died during hospitalization or during the first 30 days after discharge. The average duration of albumin prescription was 3.7 days, with an average dose of 21.5g per patient. The most frequent reason for prescribing human albumin was the correction of hypoalbuminemia (49%).

**Conclusion:** Human albumin was prescribed to patients with high comorbidities and hypoalbuminemia, both associated with malnutrition. The mortality was high, which was expectable due to the high rate of comorbidities. It is important to correct all the factors that contribute to malnutrition, more than correcting hypoalbuminemia itself.

P-294

Identification of fatty acid biomarkers in human longevity

C. Manca¹, A. Errigo², E. Murru¹, G. Carta¹, S. Banni¹,
A. Demurtas¹, L. Muredda¹, F. Tolu², M. Palermo², M.P. Dore³,
G. Pes³. ¹Dipartimento di Scienze Biomediche, Università degli Studi
di Cagliari, Italy; ²Azienda Ospedaliero-Universitaria di Sassari, Italy;
³Dipartimento di Medicina Clinica e Sperimentale, Università degli
Studi di Sassari, Italy

**Introduction:** Human longevity is a multifactorial condition with genetic, environmental and behavioral contributions. Fatty acid metabolism may play a role in maintaining lifelong tissue homeostasis by modulating the formation of fatty acid-derived molecules such as endocannabinoids, eicosanoids and recently discovered lipokines such as palmitoleic acid (cis-9-hexadecenoic acid, POA), which influence inflammatory response, insulin resistance, proliferative stimuli and neuroinflammation, all factors involved in major age-related chronic disorders such as atherosclerosis, cancer, diabetes and neurodegenerative diseases.

**Methods:** In the present study, we aimed to evaluate the fatty acid metabolism, namely plasma levels of eicosanoids, endocannabinoids and lipokines in a cohort of apparently healthy Sardinian subjects of different age groups (range 50–90) living in areas within the island characterised by relatively higher and lower longevity levels. All subjects were substantially healthy, had normal cognitive capacity, were functionally independent and well nourished.

**Results:** Plasma fatty acid profile revealed a peculiar pattern in the elderly of the high-longevity areas with respect to either age-paired individuals or younger from other areas. Specifically, POA levels, POA/palmitate ratio, and the levels of some endocannabinoids were significantly increased, especially in oldest subjects. Dietary records strongly suggested that this peculiar fatty acid profile was not

related to dietary fatty acid intake, but rather to activation of specific metabolic pathways, which in turn may determine a more favorable tissue homeostatic control.

**Conclusions:** Our results suggest that well-defined fatty acid metabolic changes could help to trigger an adequate physiological response against adverse stimuli that may potentially lead to age-related disorders.

P-295

Impact of nutritional status in elderly patients with acute myocardial infarction

K. Komici¹, A. Mancini¹, S. Provenzano¹, M. Conte¹,
L. Bencivenga¹, C. Morisco¹, B. Trimarco¹, G. Corbi², N. Ferrara³,
G. Rengo³. ¹Federico II University of Naples; ²University of Molise;
³University of Naples

**Background:** Malnutrition is a common condition in the elderly population and is associated with reduced physical performance, prolonged hospitalization and increased mortality. However, the prevalence and impact of malnutrition among elderly patients with acute myocardial infarction (AMI) is still poorly studied.

**Methods and results:** We prospectively enrolled 167 consecutive elderly patients (age≥65 yrs; mean age=73,7±6,6 yrs) admitted at Intensive Coronary Care Unit (ICCU) for AMI (51,4% STEMI). Demographic, clinical, laboratoristic and echocardiography data were collected at the time of ICCU admission, together with questioners included in the geriatric multidimensional evaluation (i.e. Mini nutritional assessment [MNA], ADL, IADL, SPMSQ, Exton-Smith, CIRS). According to MNA score, 73 patients (51,4%) presented a good nutritional status (MNA≥24) while 14 (9,9%) presented malnutrition (MNA<17) and 55 (38,7%) were at risk for malnutrition. Dichotomizing our study population in two groups, malnutrition plus at risk for malnutrition (69 patients, 48,6%) and good nutritional status (73 patients, 51,4%), we found that these two groups were homogeneous for demographic characteristics and clinical, laboratoristic and instrumental data, but were different for the majority of the geriatric scales measured (Table). Importantly, poor nutritional status was associated with higher 6-month mortality rate (26,1% vs 5,5%; p<0,001). At multivariate cox regression analysis, among 13 variables tested MNA emerged as independent predictor of short-term mortality, together with GRACE score, LVEF and type of AMI (Table). Kaplan-Mayer Survival analysis confirmed that the group with good nutritional status had a significant better survival compared to the group with malnutrition or at risk for malnutrition (longrank p<0,001).

**Conclusions:** Nutritional status is an independent predictor of short-term mortality among elderly patients with AMI. Measurement of MNA score in elderly patients with AMI may help prognostic stratification and identification of patients with/at risk of malnutrition in order to apply interventions to improve nutritional status.

P-296

Innovative food products for oral nutrition supplements: opportunities for food companies?

J.O. Linschooten¹, T. Kanters², P.C. Dagnelie², A.J.C. Roodenburg¹.

¹HAS University of Applied Sciences, Den Bosch, The Netherlands;

²Maastricht University, Maastricht, The Netherlands

**Introduction:** Despite the growing attention in recent years, malnutrition remains a major problem in healthcare and at home for a growing group of elderly people. This study investigated the opportunities and barriers for innovative food products and concepts as alternative to oral nutrition supplements (ONS) in market of malnutrition in The Netherlands.

**Methods:** In a qualitative study, semi-structured interviews were
held with 11 different stakeholders involved in malnutrition: Representatives from two ONS producers, two home care companies, two caterers, dieticians from two hospitals, representatives from a food producer, an insurance company and a nursing home.

**Results:** This study showed that awareness of malnutrition is gradually increasing. ONS products and innovative food products are seen as complementary products, but evidence-based proven effectiveness of these products is required. Main opportunities are: the stepped care treatment of malnutrition, tendency towards patient self-management and increase of knowledge on and treatment of malnutrition in both secondary and primary care. Barriers for innovation are financial limitations, organizational complexity and low awareness of these products and of malnutrition in primary care. Key factors to success are that these products are tasty, offer variation and are proven (cost)-effective.

**Conclusion:** The market of malnutrition is open for large business potential. Healthcare organizations are implementing new food concepts in order to address the problem of malnutrition in their organizations, offering opportunities for industry to collaborate with these organizations and develop new products to combat malnutrition.

## P-297
### Input of multidimensional phenotyping in the metabolic syndrome stratification

E. Pujos-Guillot¹, S. Monnerie², E. Thévenot³, C. Junot⁴, J. Morais⁵, H. Payette⁶, P. Gaudreau⁷, B. Comte². ¹Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, Clermont Ferrand; Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, CRNH Auvergne, Clermont-Ferrand, France; ²Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, Clermont Ferrand, France; ³CEA, LIST, Laboratory for Data Analysis and Systems' Intelligence, MetaboHUB, Gif-sur-Yvette, France; ⁴Laboratoire d'Etude du Métabolisme des Médicaments, DSV/iBiTec-S/SPI, MetaboHUB, CEA-Saclay, Gif-sur-Yvette, France; ⁵Division of Geriatric Medicine, McGill University, Montreal, Canada; ⁶Faculté de médecine et des sciences de la santé Université de Sherbrooke, Sherbrooke, Canada; Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de Sherbrooke, Sherbrooke, Canada; ⁷Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada; Département de médecine, Université de Montréal, Montreal, Canada

**Introduction:** Metabolic syndrome (MetS) is defined by a cluster of cardio-metabolic factors including obesity, hypertension, dysglycemia, and dyslipidemia. It affects a growing number of persons, in particular older adults often suffering from multiple chronic diseases, and its prevalence is now a public health challenge. In the context of personalized medicine/nutrition, new tools are necessary to bring additional knowledge about MetS etiology, better stratify populations and customise strategies for prevention.

**Methods:** A nested case-control study on MetS was designed within the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge). It includes 61 cases and 62 controls of similar age (68-82 y.o.), selected among the 853 men. Both targeted and untargeted metabolomic/lipidomic approaches, available within the MetaboHUB French infrastructure [1], will be performed on serum samples collected at recruitment 2003-2005 (T1) and three years later (T4). Data analysis will be performed using reproducible online Galaxy workflows [2].

**Results:** The metabolomic/lipidomic data will be processed to identify specific signatures of MetS and its components, and study their stability over time. Then, these data will be analysed for evaluation of a molecular reclassification of the MetS phenotype. Finally, they will be integrated with phenotypic and detailed nutritional data available to better characterize sub-phenotypes.

**Conclusion:** The approach developed here will open a door for a more comprehensive understanding of the metabolic phenotype resulting from the complex interplay between intrinsic and extrinsic factors. Thus, this project will allow an improved description of MetS associated characteristics and will offer new tools for better patient stratification in elderly populations.

### References:

[1] http://www.metabohub.fr

[2] http:// workflow4metabolomics.org

## P-298
### Longitudinal associations of nutritional status and body composition with outcomes in the elderly, the effect of dietary advices - preliminary results

S. Savas¹, A. Ozdener², F. Sarac¹, F. Akcicek¹. ¹Geriatrics Section, School of Medicine, Ege University, Izmir, Turkey; ²Internal Medicine Department, School of Medicine, Ege University, Izmir, Turkey

**Introduction:** We aimed to investigate body composition (BC) and nutritional status (NS) of the elderly in the internal medicine outpatient clinic (IMOC), and the relationships between each other, and to follow them after dietary advice.

**Methods:** Patients with ≥65 years of age in the IMOC were included in the study. Mean age, body mass index (BMI), waist-hip circumference, waist/hip ratio, fat-free mass and index, Mini Nutritional Assessment -Short Form score, prealbumin and high-sensitivity CRP levels, calf circumference were measured. Patients who are assessed by the same dietitian and evaluated as at risk of malnutrition were advised protein and energy - rich diets when applicable. Patients will be followed in the first 6 months for NS, BC, gait speed and hand grip strength; after 12 months for activities of daily living (ADL) -Instrumental ADL (IADL) disability, institutionalization, hospitalization, falls-fall related injuries, and mortality. We are presenting the first cross-sectional results.

**Results:** A total of 85 patients with ≥65 years of age were included in the study. All were independent in ADL and IADL. Age of 38 patients (44.7%) were <70 years of age, where 47 (55.3%) were ≥70 years of age. There was no difference in BMI groups classified as normal weight, obese or underweight between age groups > and <70 years of age (P=0.46).

**Conclusions:** Most (98,8%) of the elderly patients consulted by the dietician in a period of time were normal to obese for BMI which is interesting for BC of IMOC elderly patient profile.

## P-299
### Nutritional needs among sarcopenic patients: a study using indirect calorimetry

S. Allepaerts¹, J. Weber¹, G. Doupagne¹, F. Buckinx², O. Bruyère², N. Paquot¹, J. Petermans¹. ¹CHU de Liège; ²Université de Liège

**Background:** The aim of this study is to assess the energy need of patients with sarcopenia.

**Methods:** Rest energy expenditure (REE) is the energy required to maintain the body's basic cellular metabolic activity and organ functions. REE was measured by indirect calorimetry, at rest, at fasting and without physical or psychological stress. Total energy expenditure (TEE) is defined as the amount of energy used by the human body for daily function, it is a combination of REE, energy used during substrate metabolism and energy used in physical activity. Nutritional assessment has been performed by the Mini Nutritional Assessment (MNA). Sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP).

**Results:** Twenty-nine patients (77% of women, 82.4±16.3 years on average) hospitalized in acute geriatric unit were evaluated. The prevalence of sarcopenia was 32%. Sarcopenia was associated
with lower Mini nutritional assessment (MNA) (p=0.003), lower Body mass index (BMI) (p<0.0001). RRE was 978±262 kcal/d in sarcopenic patients, significantly lower than in non sarcopenic patient (1120±167 kcal/d) (p<0.004). TEE was 1564±272 kcal/d in sarcopenic patients significantly lower than in non sarcopenic patients (1706±228 kcal/d) (p<0.02). REE in sarcopenic patient was 17.7±3 kcal/kg/d.

**Conclusion:** TEE was lower in sarcopenic patients than in non sarcopenic patients. REE in sarcopenic patient is similar to the REE observed in elderly hospitalized patients, about 18 kcal/kg/d.

## P-300

### Nutritional risk in the elderly - Living at home vs health care units

I. Figueiredo¹, R. Alves¹, S. Castro¹, M. Antunes¹, M. Saldanha², H. Gruner¹, A. Panarra¹. ¹S. Medicina 7.2 Hospital Curry Cabral, Centro Hospitalar Lisboa Central; ²S. Nutrição e Dietética, Hospital Curry Cabral, Centro Hospitalar Lisboa Central

**Introduction:** According to WHO, elderly people are especially vulnerable due to malnutrition, being related to many different factors. Our aim was to evaluate if patients from different cohabitation status had the same risk of undernutrition and evaluate contributing factors.

**Methods:** Retrospective descriptive study of all patients with >75 years old, admitted to the medical ward of a tertiary hospital during a one year period with a nutritional evaluation either by MUST or NRS. Patients were grouped according to habitation status home (H) vs health care unit (HCU) and compared per gender, age, autonomy (KATZ score), primary diagnosis, median length of stay and mortality.

**Results:** A total of 89 patients fulfilled the inclusion criteria with a median age of 83,7 years (37 with >85 years), 60 were female, 44 patients with nutritional risk, median length of stay of 9,89 days and mortality of 32,4%. Concerning the 2 groups: there were H 15 patients and HCU 74, the patients living in HCU were slightly older (83,9 VS 83,7 years), with a male prevalence (53% VS 28%), lesser autonomy with a KATZ <3 (73% VS 55,4%) and higher mortality of 86% VS 14%. The risk ratio for nutritional risk in patients living in health care facilities patients was 2,06, but the risk ratio for mortality in patients with nutritional risk living at Home was 2,53.

**Discussion:** Half of the population above 75 years old is at nutritional risk, that risk is even greater considering the population living in health care facilities. This study pretends to raise awareness on this subject, considering malnutrition is frequently related to poor outcomes. In our study the influence of malnutrition in mortality was more important in patients living at Home.

## P-301

### Nutritional risk in the elderly in an Internal Medicine ward

I. Figueiredo¹, R. Alves², S. Castro², M. Antunes², M. Saldanha³, F. Lourenço², A. Panarra², H. Gruner². ¹S. Medicina 7.2 Hospital Curry Cabral, Centro Hospitalar Lisboa Central; ²S. Medicina 7.2 Hospital de Curry Cabral, Centro Hospitalar Lisboa Central; ³U.Nutrição e Dietética, Hospital de Curry Cabral, Centro Hospitalar Lisboa Central

**Introduction:** Malnutrition is a determinant of health, associated with a global decline in function and poorer outcomes. It is under diagnosed in the elderly, though nutritional deficiencies are present in 20-65% of hospitalized elders.

**Methods:** Retrospective descriptive study of patients with >65 years, admitted to the medical ward (tertiary hospital) for 1-year, with a nutritional evaluation either by MUST or NRS. The patients were grouped in A (at risk) and N (no risk) and characterised by gender, age, autonomy (Katz Score <4 dependent, or >4 au-

tonomous), primary diagnosis, mean length of stay and mortality. Comparison between groups was done with proportions and the mortality evaluated with risk ratio.

**Results:** 131 patients were included, with a mean age of 79,1years (37 patients >85years), of which 83 female, 67 patients (61.1%) were dependent. Concerning the groups 64 were NR and 67 AR, with no difference by gender (NR:AR - fem 0,9 and masc 1), age (NR:AR - <75 years 0,9, 75-85 years 1,08 and >85 years 0,85) and Katz (NR:AR - autonomous 0,82 and dependent 0,76). In AR group, there was a higher prevalence of respiratory diseases (1.57), renal (2.75), neoplasia (3), but not cardiovascular diseases (0.44). Mean length of stay was higher for AR (11,27) vs NR:9,82. Mortality in AR patients had a RR of 8.93.

**Discussion:** In our small sample, almost half the patients were at risk of malnutrition. Patients with a risk of malnutrition had a longer length of stay, with greater costs and higher mortality.

## P-302

### Nutritional status, functional status and mortality in the Caucasian elderly and oldest-old: Results of the PolSenior study

M. Puzianowska-Kuznicka ¹,², A. Kurylowicz¹, J. Borkowska¹, M. Olszanecka-Glinianowicz³, K. Wieczorowska-Tobis⁴, A. Skalska⁵, A. Szybalska⁶, M. Mossakowska⁶. ¹Mossakowski Medical Research Centre, PAS, Warsaw; ²Centre of Postgraduate Medical Education, Warsaw; ³Medical University of Silesia, Katowice; ⁴Poznan University of Medical Sciences, Poznan; ⁵Jagiellonian University Medical College, Cracow; ⁶International Institute of Molecular and Cell Biology, Warsaw, Poland

**Introduction:** Obesity increases the risk of aging-related diseases, disability and mortality.

**Methods:** Four thousand six hundred twenty-four seniors aged ≥65 years completed a detailed questionnaire and underwent medical examination. Their survival was taken from the Population Register.

**Results:** Approximately 34% of seniors were obese (38.42% women, 25.52% men) and 88.55% had abdominal obesity (89.2% women, 72.61% men). Median BMI, waist (WC) and arm (AC) circumference decreased with age in both genders (all p<0.001). The percentage of obese seniors and these with abdominal obesity also decreased (both p<0.001). Notably, the higher ADL score, the higher were median BMI, WC and AC values (all p<0.001). In multivariate analysis taking age into account, all three body measurements remained independent predictors of physical performance in women (p=0.008, p=0.004 and p<0.001, respectively), while in men only AC (p<0.001). Similarly, the higher MMSE score, the higher were median BMI, WC and AC values (all p<0.001). In multivariate analysis, all three measurements remained significant predictors of cognitive performance in women (p=0.001, p=0.002 and p<0.001, respectively), while in men only AC (p<0.001). There was no association between the number of aging-related diseases and BMI or WC or AC. In individuals aged ≥80 years, overweight and obesity were associated with the highest probability of survival (both genders p<0.001), as were abdominal obesity (women p=0.0011, men p<0.001) and the highest AC (both genders p<0.001).

**Conclusions:** In seniors, overweight and obesity are associated with better physical and cognitive function, and with a higher probability of survival.

## P-303

### Obesity survival paradox in older-cancer patients: results from the Physical Frailty in Elderly Cancer patients (PF-EC) cohort study

F. Pamoukdjian¹, T. Aparicio², B. Duchemann³, V. Levy⁴, P. Wind⁵, N. Ganne⁶, G. Sebbane¹, L. Zelek³, E. Paillaud⁷. ¹APHP, Avicenne Hospital, Geriatric Department, Coordination Unit in Geriatric
Oncology, Bobigny, France; ²APHP, Avicenne Hospital, Department of Gastroenterology, Bobigny, France; ³APHP, Avicenne Hospital, Department of medical oncology, Bobigny, France; ⁴APHP, Avicenne Hospital, Clinical Research Unit and Clinical Research Center, Bobigny, France; ⁵APHP, Avicenne Hospital, Department of Surgery, Bobigny, France; ⁶APHP, Jean Verdier Hospital, Liver Unit, Bondy, France; ⁷APHP, Henri-Mondor Hospital, Geriatric Department, Geriatric Oncology Unit, Créteil, France

**Background:** The obesity survival paradox is an emergent issue in oncology, but its existence remains unclear particularly in older cancer patients.

**Methods:** All consecutive outpatients 65 years and older referred for geriatric oncology assessment (GA) before a therapeutic decision between November 2013 and September 2016 were enrolled in the PF-EC cohort study. A Cox proportional hazard regression model was performed in non-survivors for GA, oncologic variables (cancer site, extension and treatment modalities) and C-reactive protein (CRP). Obesity was defined as a body mass index (BMI) ≥30 kg/m². A stepwise procedure was conducted to assess the specific effect of each predictor. We created three models to adjust BMI categories for sex and geriatric variables (model 1), oncologic variables (model 2) and C-reactive protein (model 3).

**Results:** 433 patients with a mean age of 81.2±6.0 years were included, of whom 51% were women. Eighty-six of these patients (20%) were obese at baseline. Seventy-three patients (17%) died during the 6-month follow-up period. Obesity was negatively and independently (age, sex, Mini-Mental State examination, local status, best supportive care and CRP) associated with overall 6-month mortality after stratification by cancer site. This association was strengthened after adjustment for gait speed. KEY

**Conclusions:** Our study confirms the obesity survival paradox in older cancer patients. This paradox seems closely linked with the metabolic healthy obese phenotype, which exhibits better survival.

## P-304

### Optimized selection process to identify a metabolic syndrome metabolomic/lipidomic signature in older adults of the NuAge cohort

N. Lenuzza¹, E. Thévenot¹, S. Monnerie², J. Morais³, H. Payette⁴, P. Gaudreau⁵, B. Comte², E. Pujos-Guillot⁶. ¹CEA, LIST, Laboratory for Data Analysis and Systems' Intelligence, MetaboHUB, Gif-sur-Yvette, France; ²Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, Clermont Ferrand, France; ³Division of Geriatric Medicine, McGill University, Montreal, Canada; ⁴Faculté de médecine et des sciences de la santé Université de Sherbrooke, Sherbrooke, Canada; ⁵Centre de recherche sur le vieillissement, Centre intégré universitaire de santé et de services sociaux de Sherbrooke, Sherbrooke, Canada; ⁶Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada; ⁷Département de médecine, Université de Montréal, Montreal, Canada; ⁸Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, Clermont Ferrand, France; ⁹Université Clermont Auvergne, INRA, UNH, Plateforme d'Exploration du Métabolisme, MetaboHUB Clermont, CRNH Auvergne, Clermont-Ferrand, France

**Introduction:** Metabolic syndrome (MetS) is characterized by a cluster of risk factors including obesity, metabolic dysregulations such as insulin resistance, hypertension, and dyslipidemia, raising the risk for type 2 diabetes development and its complications. It involves multifaceted processes at multiple levels that are still far from being understood. New tools are therefore necessary to bring new knowledge about MetS, better stratify populations and customise strategies for its prevention and/or reversal.

**Methods:** The Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge) regroups 853 men and 940 women, aged 68-82 at recruitment in 2003-2005 (T1) and followed up annually

for three years (T2-T4). In the present study, a nested case-control study on MetS was designed to identify a metabolomic/lipidomic signature of MetS in older men, reflecting its phenotypic spectrum. An optimized participant selection strategy was developed based on presence and number of MetS criteria, including medication, their stability over 3 years, as well as the identification of outliers.

**Results:** The final selection included 123 men, 61 cases and 62 controls, with similar age and partial overlap of values defining MetS. This design is necessary to precisely detect and estimate the amplitude of metabolic deviations among the massive data sets, at an individual metabolite level as well as for a multivariate description.

**Conclusion:** This selection process, optimized to limit confounding effects, will allow identifying specific metabolomic/lipidomic signatures along with significant features for sample classification. Thus, one complex molecular phenotyping will provide a new approach/tool for a better MetS stratification in elderly.

## P-305

### Predictors of incident malnutrition in older nutritionDay participants in nursing homes - a MaNuEL secondary data analysis

G. Torbahn¹, M. Streicher¹, K. Schindler², M.J. Hiesmayr³, C.C. Sieber¹, D. Volkert¹. ¹Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Nuremberg, Germany; ²Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria; ³Division Cardiac-, Thoracic-, Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria

**Introduction:** Malnutrition in nursing home (NH) residents is associated with poor outcomes. For the prevention of malnutrition, the knowledge of risk factors is crucial. Therefore, we were interested in predictors of incident malnutrition in older NH residents.

**Methods:** NH residents participating in the nutritionDay project (nD) between 2007 and 2014, aged ≥65 years with complete data on malnutrition at enrolment (previous weight loss (WL) >5kg or BMI <20kg/m²) and 26 potential predictors were included. Incident malnutrition was defined as WL ≥10% or BMI <20kg/m² at 6-month follow-up. All variables were separately analysed in univariate generalized estimated equation (GEE) models with NH-unit as cluster variable. Significant (p<0.05) variables were selected for multivariable GEE analyses. Effect estimates are presented as Odds ratios (OR) and their respective 95%-confidence intervals (95%-CI).

**Results:** The incidence of malnutrition was 12.1% (n=701, n total=5,814). Female gender (vs. male: OR 1.33, 95%-CI [1.06; 1.65]), no intake at lunch (OR 2.92 [1.85; 4.60]) or only a quarter (OR 2.38 [1.79; 3.16]) or half (OR 1.60 [1.34; 1.93]) of lunch intake (vs. complete intake), lower BMI (OR 0.935 [0.91; 0.96]) and increasing number of days in hospitals (OR 1.05 [1.03; 1.06]) remained as significant parameters in the final model (aROC 0.66 [0.64; 0.68]).

**Conclusions:** According to nD data, particular attention should be paid to vulnerable groups, such as females, persons with low BMI, poor meal (lunch) intake, and residents with hospital stays to prevent malnutrition in nursing home residents.

**Conflict of interest:** None declared

## P-306

### Prevalence and associated factors of overweight and obesity among older Iranian adults: Findings from a population-based study (Urban HEART-2)

V. Rashedi¹, M. Asadi-Lari¹, M. Foroughan², R. Fadayevatan², A. Delbari². ¹Iran University of Medical Sciences, Tehran, Iran; ²University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

**Introduction:** The elderly obese are at increased risk of mortality
and morbidity of many obesity-related chronic diseases, such as hypertension, diabetes and coronary heart disease. This study examined the prevalence and associated factors of overweight and obesity among older Iranian adults based on the Urban HEART-2 study in Tehran, Iran.

**Methods:** In this large cross-sectional population-based study, data on 15069 persons 60 years and older, the participants of second round of the Urban Health Equity Assessment and Response Tool (Urban HEART-2) which had been selected based on a multi-stage, cluster sampling in Tehran, Iran, in 2011, were analyzed. All the participants were interviewed and the information regarding the self-reported weight and height and socio-demographic variables were gathered. Predictors of overweight (Body Mass Index [BMI]=25.0–29.9 kg/m²) and obesity (BMI>30 kg/m²) relative to normal weight (BMI=20.0–24.9 kg/m²) were examined using logistic regression analyses.

**Results:** The mean age of the participants was 68.93±7.27 years and of the total study population, 54.8% were male. Among older adults, 2.2% was found to be underweight, 40.1% normal weight, 40.8% overweight, and 17% obese. Multivariate logistic regression showed that being female, being married, having low levels of education, being retired, lack of history for smoking and being in early stages of aging are risk factors for overweight and obesity in this population.

**Conclusions:** This study showed a high prevalence of overweight and obesity among older adults living in Tehran. This finding points to the need of educating healthy life style and healthy eating habits to Iranian older adults and also designing and implementing more effective weight-control interventions for overweight older people to have a longer and healthier life.

P-307

Prevalence of poor appetite and associated conditions among community dwelling older adults in Iceland: Age, Gene/Environment Susceptibility-Reykjavik study

M. Chang Gudjonsson¹, O.G. Geirsdottir², G. Eiríksdóttir³,
T.B. Harris⁴, L.J. Launer⁴, V. Guðnason⁵, M. Visser⁶,
I. Gunnarsdottir⁷. ¹The Icelandic Gerontological Research Center,
Landspitali University Hospital & University of Iceland; ²The Icelandic
Gerontological Research Center, Landspitali University Hospital &
University of Iceland, Faculty of Food Science and Nutrition, University
of Iceland; ³Icelandic Heart Association, Kopavogur; ⁴Epidemiology &
Pop Science Lab, National Institute on Aging, National Institute of
Health, Bethesda, MD, USA; ⁵Icelandic Heart Association, Kopavogur,
Faculty of Medicine, University of Iceland; ⁶Vrije Universiteit,
Amsterdam, The Netherlands; ⁷Unit for Nutrition Research, Faculty of
Food Science and Nutrition, University of Iceland & Landspitali
University Hospital

**Background:** Poor appetite is common among hospitalized older adults or nursing home residents which may lead to inadequate dietary intake and weight loss. However, the prevalence of poor appetite among community-dwelling older adults and its contributing risk factors has been little explored. The aim of the study was to investigate the prevalence of having poor appetite among community-dwelling older adults and its associated conditions.

**Methods:** It is a cross-sectional study design. A large community-based population residing in Reykjavik, Iceland participated in the Age, Gene/Environment Susceptibility-Reykjavik Study (n=5764). Appetite and its associated conditions were evaluated by questionnaire. Poor appetite was defined for having conditions or illnesses associated with poor appetite. The questionnaire included poor appetite related list of illnesses and conditions with the additional open question for other reasons of poor appetite.

**Results:** Among 5764 study population, 804 people reported having appetite problem (n=804, 15%). The reported illnesses contributing

to poor appetite were teeth, dysphagia, taste, smell, and indigestion such as pain and bloating in stomach, and diarrhea. Among those reported illnesses associated with appetite, the poor digestive related condition had the highest prevalence (50%).

**Conclusion:** Appetite is a subjective experience which is difficult to measure. Our study explored the prevalence of poor appetite with detailed questions about major illnesses and conditions associated with appetite among community-dwelling older adults. The digestive related problem was the most associated condition for having poor appetite among community-living older adults.

P-308

Ready-meal consumption in older people: associations with nutritional status and dietary intake

G. Soriano¹, P. De Souto Barreto¹, S. Goisser², S. Guyonnet²,
B. Vellas¹, S. Andrieu¹. ¹Inserm UMRI027, Université de Toulouse III
Paul Sabatier, Toulouse, France; ²Gérontopôle, Centre Hospitalier
Universitaire de Toulouse, Toulouse, France

**Introduction:** Difficulties with cooking are prevalent in older persons [1]. One way to simplify meal preparation and thus maintain independence in food intake is the use of convenience food [2]. Ready-meals are often low in protein and rich in energy [3], which could have a negative impact on nutritional status [4]. However, studies investigating associations between ready-meal consumption, nutritional status and dietary intake are lacking, particularly in older adults.

**Objectives:** We examined whether diet quality and malnutrition are associated with ready-meal consumption in older French people.

**Methods:** This is a secondary analysis using data from the Multidomain Alzheimer Preventive Trial (MAPT). Diet quality and ready-meal consumption were assessed in 421 subjects who fulfilled a food frequency questionnaire, using mPNNS-GS. BMI was used to assess malnutrition signed by underweight (BMI <21 kg/m²) or overweight/obesity (BMI >25 kg/m²). Adjusted multiple linear regressions were performed.

**Results:** Older participants, those with a lower education level, with lower physical, cognitive and/or functional status, with more depressive symptoms and declaring more difficulties with cooking consumed significantly more ready meals (p<0.05). In multivariate analysis, weekly ready-meal consumption was associated with a lower diet quality (p=0.037) but not with nutritional status (p=0.603). Moreover, the more ready meals people consumed, the more they judged their dietary quality to be poor.

**Conclusions:** In our population, ready-meal consumption was higher in older people with age-related impairments, lower education levels and more depressive symptoms, but this was not associated with a lower nutritional status or diet quality.

**References:**

[1] M. Ferry, B. Sidobre, A. Lambertin, and P. Barberger-Gateau, The SOLINUT study: analysis of the interaction between nutrition and loneliness in persons aged over 70 years, J. Nutr. Health Aging, vol. 9, no. 4, pp. 261–268, Aug. 2005.

[2] Convenience foods and health in the elderly - Maturitas. [Online]. Available: http://www.maturitas.org/article/S0378-5122(15)00826-9/abstract. [Accessed: 11-May-2017].

[3] J. Remnant and J. Adams, The nutritional content and cost of supermarket ready-meals. Cross-sectional analysis, Appetite, vol. 92, pp. 36–42, Sep. 2015.

[4] K. van der Horst, T.A. Brunner, and M. Siegrist, Ready-meal consumption: associations with weight status and cooking skills, Public Health Nutr., vol. 14, no. 2, pp. 239–245, Feb. 2011.
P-309

**Regression tree analysis and detection of hypovitaminosis D: a cross-sectional hospital-based study**

G. Chevallereau, G. Duval, C. Annweiler. Angers University Hospital, France

**Introduction:** Hypovitaminosis D is common among geriatric patients. The correction of hypovitaminosis D is not recommended without assessing the vitamin D status at first. To reduce costs linked to blood tests, we hypothesized that hypovitaminosis D could be diagnosed using clinical criteria. Our objective was to identify the clinical profiles of geriatric patients with hypovitaminosis D.

**Methods:** 156 participants ≥75years taking no vitamin D supplements and consecutively admitted into the department of geriatric medicine of Angers University Hospital, France, were included in this analysis. Hypovitaminosis D was defined as serum 25-hydroxyvitamin D concentration ≤75 nmol/L. An age-adjusted regression tree (CHAID algorithm) was used to determine the clinical profile of participants with hypovitaminosis D based on risk factors for hypovitaminosis D (age, gender, sun exposure, ethnicity, consumption of fatty fish and eggs, BMI, weight loss, oral mycosis, renal failure, use of anti-epileptics or glucocorticoids, loss of autonomy, institutionalization, isolation) and clinical manifestations of hypovitaminosis D (osteoporosis, falls, bone fractures, asthenia, sadness, cognitive disorders, multimorbidity).

**Results:** 84.6% of patients had hypovitaminosis D. Patients with the profile "Caucasian, non-sad, BMI >21 kg/m²" had the lowest risk of hypovitaminosis D (67.6%). In comparison, the profiles "Caucasian, non-sad, BMI <21kg/m²", "Caucasian, sad, history of vertebral fracture" and "non-Caucasian" were associated with a 1.48-fold higher risk of hypovitaminosis D (100%); and the profile "Caucasian, sad, no history of vertebral fracture" with a 1.30-fold higher risk (87.6%).

**Conclusions:** Three clinical profiles of geriatric patients had 100% hypovitaminosis D. These patients should receive vitamin D supplementation without prior blood test.

P-310

**Relationship between the risk of dysphagia and functional outcomes in older community-dwellers**

S. Tagliaferri, L. Gionti, F. Lauretani, A. Ticinesi, T. Meschi, G.P. Ceda, M. Maggio. Department of Medicine and Surgery, University of Parma, Parma, Italy

**Background:** Oropharyngeal dysphagia (OD) is a swallowing disorder highly prevalent in older community-dwellers, increasing the risk of malnutrition and aspiration pneumonia. However, it is frequently underdiagnosed and its association with functional performance is still unclear.

**Methods:** With a cross-sectional study design, we enrolled 228 older (mean age 81) community-dwellers evaluated at the Frailty-Multimorbidity Lab Geriatric Clinic Unit of Parma University-Hospital. Subjective dysphagia was assessed with 10-item Eating Assessment Tool (EAT-10). Nutritional screening was performed calculating BMI and Mini-Nutritional Assessment-Short Form (MNA-SF) score. Physical and muscle performance was assessed with Short-Physical Performance Battery (SPPB) test and handgrip strength. Cognitive performance was screened with Mini-Mental State Examination (MMSE) test. The relationship between EAT-10 and nutritional, physical, cognitive and motor performance was estimated through univariate analysis in sex- and age-adjusted and multivariate linear regression model. A logistic regression analysis was run to identify the most predictive factor of dysphagia risk.

**Results:** In the univariate models, EAT-10 score was significantly and negatively correlated with SPPB score (β=-0.18±0.04, p<0.0001), handgrip strength (β=-0.35±0.11, p=0.001) and MNA-

SF (β=-0.43±0.07, p<0.0001). In the multivariate model, EAT-10 score confirmed as significantly associated with SPPB (β=-0.29±0.10, p=0.003) and handgrip strength (β=-0.12±0.05, p=0.02), but not with MNA-SF. In logistic regression analysis, SPPB was the only factor significantly associated with EAT-10 score (OR=0.82, 95%IC=0.70–0.96).

**Conclusion:** In older outpatients, the risk of dysphagia was significantly correlated with physical performance and muscle strength. The screening of OD should be implemented in the geriatric setting.

P-311

**Serum leptin levels in very elderly patients with coronary artery disease**

S.V. Topolyanskaya¹, I.A. Gusev², O.N. Vakulenko², T.A. Eliseeva², N.A. Balyasnikova², G.A. Kalinin². ¹First Moscow State Medical University, Department of hospital therapy N2, Moscow, Russia; ²War Veterans Hospital N3, Moscow, Russia

**Introduction:** Very limited data are available on leptin in very elderly patients. Therefore, we evaluated serum leptin levels and their relationship with obesity and other disorders in patients with coronary artery disease (CAD).

**Methods:** Serum leptin levels were measured in 90 hospitalized patients (aged 88.3+4.3 years, females - 65.5%, males - 34.5%) with CAD. Fat mass was assessed by the dual-energy X-ray absorptiometry.

**Results:** Mean leptin concentration in the study group was 17.2 (0.49–100) ng/ml. 60% of patients had increased leptin levels. Serum leptin levels in women were 2.3 times higher than in men; increased concentrations were detected in 67.7% of women and in 45% of men (p=0.03). Decrease of leptin concentration was registered in 14.4% of patients; all but one of these had severe heart failure. Serum leptin levels were strongly correlated with body mass index (p<0.0001). Significant positive correlations between serum leptin and fat mass were revealed: p=0.0001 – for total fat, p=0.002 – for abdominal fat, p=0.004 – for upper extremities, p=0.003 – for lower extremities fat. Leptin levels were positively correlated with total cholesterol and triglycerides (p=0.0002). Higher leptin levels were in patients with diabetes mellitus (21.01 vs 16.26 ng/ml, p=0.06); increased leptin was associated with higher glucose level (p=0.004). There was trend to higher leptin in patients with atrial fibrillation (19.3 vs 14.6 ng/ml, p=0.2).

**Conclusions:** Study results demonstrated high prevalence of leptin abnormalities in very elderly patients with CAD. High leptin levels are associated with increased fat mass. Serum leptin levels are strongly correlated with various disorders.

P-312

**Serum lipid profile in very elderly Russian patients with coronary artery disease**

S.V. Topolyanskaya¹, O.N. Vakulenko², T.A. Eliseeva², N.A. Balyasnikova², G.A. Kalinin², L.M. Kupina². ¹First Moscow State Medical University, Department of hospital therapy N2, Moscow, Russia; ²War Veterans Hospital N3, Moscow, Russia

**Introduction:** There are few data available on serum lipids in very elderly patients with coronary artery disease (CAD); these data are conflicting.

**Methods:** Cross sectional data from 555 hospitalized patients (aged 86.8±5.02 years, females - 74.5%, males - 25.5%) with CAD were analysed. Serum levels of total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), triglycerides (TG), atherogenic index) were determined.

**Results:** Prevalence of high serum total cholesterol and triglycerides was 13.3% and 10.4%, respectively; increase of LDL-C level was observed in 26.3% of patients. Decrease of HDL-C was registered in
10.5% of patients. Significant negative correlation between TC and LDL-C concentrations and patient's age was revealed (p=0.001 for TC). Mean TC level in patients aged 75-80 years was 5.43±1.44, in patients ≥90 years – 4.7±1.08 mmol/L (p=0.001). Females had higher concentrations of all lipids than males (p<0.0001 – for TC). Lower lipids concentrations (mainly TC level) were associated with clinically significant heart failure (p<0.0001) and atrial fibrillation (p<0.0001). Higher TC and triglycerides levels were correlated with higher blood pressure values (both systolic and diastolic) (p=0.001). Significant positive correlations between triglycerides and glucose concentration (p<0.0001) as well as between TG and uric acid level (p=0.001) were revealed. Higher triglycerides and lower HDL-C levels were registered in patients with higher creatinine level (p=0.001 and p=0.0003, respectively). Only 11.4% of patients were treated with low doses of statins.

**Conclusions:** The study results demonstrated some features of lipid profile in very elderly patients with CAD. In this population serum lipids are strongly correlated with various disorders.

## P-313

### Subcutaneous hydration in geriatric patients – what is the evidence? A systematic review

M.B. Danielsen¹, M.G. Jørgensen¹, S. Andersen¹,², ¹Dept. of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark; ²Dept. of Clinical Medicine, Aalborg University, Aalborg, Denmark

**Introduction:** The use of subcutaneous hydration differs between geriatric departments with a trend for underuse. A systematic review of the underlying evidence is missing.

**Method:** We performed a systematic search in Pubmed and Embase for clinical trials on subcutaneous hydration in geriatric patients. We excluded papers on the relevance hydration in palliative patients and papers written in languages other than English or Scandinavian. Each paper was evaluated for risk of bias by two independent authors and outcomes were rated according to GRADE.

**Results:** We included 19 papers. Only five papers compared the use of subcutaneous vs. iv. hydration and found comparable side effects (GRADE-rating ⌒⊕OO). The use of hyaluronidase was evaluated in three papers and these suggested insufficient reason to add hyaluronidase (GRADE-rating ⌒⊕OO). Ten observational studies, four RCT and two case reports reported on the safety of subcutaneous hydration. Pooled data on the use of subcutaneous hydration suggest a low incidence of serious side effects (2.2% of patients; GRADE-rating ⌒⊕OO), and an acceptable number of mild, local side effects (GRADE-rating ⌒OOO). No studies compared different types of fluid, but data suggest that a combination of saline and glucose is safe (GRADE-rating ⌒⊕⊕O). Isotone glucose with potassium is insufficiently studied to support its use (GRADE-rating ⌒OOO).

**Conclusions:** Low quality evidence suggests that subcutaneous hydration is safe in geriatric patients.

## P-314

### Subjective Global Assessment (SGA) is a reliable and valid instrument to assess nutritional status in hospitalized older patients in Turkey

C. Balcı¹, B. Bolayır², F. Sümer¹, R.T. Doğrul¹, G.Ç. Ayçiçek¹, C. Özsürekci¹, H. Çalışkan¹, B.B. Yavuz¹, M. Cankurtaran¹, M. Halil¹. ¹Hacettepe Universitiy Faculty of Medicine Department of Internal Medicine Division of Geriatrics; ²Gazi University Faculty of Medicine Department of Internal Medicine Division of Endocrinology and Metabolism

**Objective:** Malnutrition is a state resulting from lack of intake or uptake of nutrition that leads to altered body composition body cell mass. It is a frequent occurrence despite the fact that it is frequently seen in hospitalized patients, prolonging the hospital

stay, increasing morbidity and mortality. In this study, the validity and reliability of the Turkish version of the Subjective Global Assessment (SGA) test used to assess malnutrition in hospitalized older people was evaluated.

**Methods:** A total of 98 patients 56 women (57.1%) and 42 men (42.9%) with an average age of 73.3±6.6 were included in the study. 50 (51%) and 48 (49%) of the patients were followed at the medical and surgical wards respectively. Two geriatricians experienced in the field of malnutrition who were unaware of the SGA results, interpreted the patients nutritional status after the evaluation of several parameters such as medical history including weight loss, appetite, disease severity, neuropsychological problems, mobility problems, dependency in activities of daily living, anthropometric measurements, biochemical markers, bioimpedance analysis, hand grip strength, geriatric assessment and 3-day dietary records. Based on these groups of data, the patients were divided into "at nutritional risk" and "not at nutritional risk" groups by specialists. Concordance between the two clinicians' clinical assessment was analyzed by kappa statistics and excellent concordance was found (kappa = 0.861), therefore the more experienced specialist's decisions was accepted as gold-standard. A third physician performed SGA within 48 h of admission. At the end of the SGA evaluation patients with a category A were classified as "non-malnourished" and those with categories B and C were classified as "malnourished".

**Results:** In general, SGA was found to be 91% both sensitive and specific compared to the clinician's assessment of malnutrition. The positive predictive value and the negative predictive value were 89% and 91%, respectively.

**Conclusion:** The Turkish version of the SGA test in hospitalized older people is a valid and reliable method for evaluating malnutrition.

## P-315

### The impact of nutritional status on mortality in long-term care facilities residents

A. Parnicka¹, B. Wizner¹, B. Gryglewska¹, J. Wójkowska-Mach².

¹Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland; ²Department of Microbiology, Jagiellonian University Medical College, Kraków, Poland

**Introduction:** The aim was to assess whether nutritional status of residents living in long-term care facilities influence on risk of death.

**Methods:** The observational study has been conducted in one nursing and two residential homes in Cracow. At baseline demographic characteristics, nutritional and health status were analysed. The nutritional status was assessed based on the screening part of the Mini Nutritional Assessment® and BMI. After 12 months of follow-up, the data on general health condition were collected.

**Results:** 122 residents have completed data on nutritional status and BMI. Mean age (±standard deviation) of the residents was 78.89±8.6 (range: 60 to 100 years), 67.2% were women. Malnutrition was identified in 19 (15,6%), at risk of malnutrition was 36 (29,5%) and normal nutritional status was in 67 (54,9%) of the subjects. Residents at risk of malnutrition and malnourished was older than residents with normal nutritional status, respectively: 79.3±8.6 yrs and 82.0±9.6yrs vs 77.6±8.2 yrs. During the follow-up 16 residents have died, among them 12 (75.0%) were women; 12 (75.0%) were at risk of malnutrition or malnourished and 13 (81.3%) were residents of nursing homes. In univariate analysis as well as age-gender-settings adjusted analyses the nutritional status based on MNA screening part was significantly linked with risk of death.

**Conclusions:** The impairment of the nutritional status affected almost 50% of the residents. Risk of death was increased in malnourished only in univariate analysis probably due to small number of deceased.
## P-316

**The Nutritional Risk Screening (NRS2002) tool predicts mortality in elderly people after discharge from a geriatric hospital**

A. Mendes¹, F. Hermann¹, G. Gabriel¹, C. Graf², L. Genton³, G. Gold¹, D. Zekry¹. ¹Geriatrics, Dept. of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva; ²Medical Rehabilitation, Dept. of Rehabilitation and Palliative Medicine, Geneva University Hospitals and University of Geneva, Geneva; ³Clinical Nutrition, Geneva University Hospitals and University of Geneva, Geneva, Switzerland

**Introduction:** The nutritional risk screening (NRS2002) is validated to detect the presence of malnutrition and to estimate the risk of developing it during hospitalisation. We aim to determine whether the NRS2002 predicts mortality after discharge from geriatric acute care.

**Methods:** Cohort of 439 patients selected by randomization at admission in the Geriatric University Hospital in Geneva. Clinical data was collected from medical records retrospectively by the same experienced rater. The NRS2002 comprises a nutritional and a severity of disease scores (0–3 points each) with an additional point attributed if age ≥70y. Cox-regression models were used to assess the association between NRS2002 and 12y all-cause mortality. Kaplan-Meyer survival curves were compared using log rank test.

**Results:** Of 439 patients (mean age 86y; 74% female), 235 (53.5%) had high nutritional risk and 201 (45.8%) enhanced risk. The mean survival was 4.74y (SD=4.08). No survival differences were observed when comparing groups according to NRS2002 classification cut-off for nutritional risk diagnosis (HR 0.834, 95% CI: 0.68–1.022, p=0.081). However, patients at very high global score (NRS2002 ≥5) presented increased mortality risk (HR 1.825, 95% CI: 1.275–2.612, p=0.001). After adjustments for age, sex, albumin and inflammatory status, the association remained statistically significant (HR 1.704, 95% CI: 1.177–2.468, p=0.005). A severity of disease score of 3 points independently predicted mortality (HR 2.82, 95% CI: 1.543–5.155, p=0.001).

**Conclusions:** The NRS2002 predicts mortality after discharge from geriatric acute care. These results may help to develop preventive strategies selecting patients who would benefit the most from geriatric follow-up in the community after discharge.

## P-317

**Trends in the management of type 2 diabetes in a short term geriatric unit in Sherbrooke from 2005 to 2015**

D. Tessier¹, L. Trottier¹, A.-C. Thébeau¹, I. Bourdel-Marchasson².

¹Centre de Recherche sur le Vieillissement, Sherbrooke, Canada;

²Université de Bordeaux, France

**Introduction:** Type 2 diabetes is a growing epidemic and the main considerations in this population are hypoglycaemia and the target glycated hemoglobin (HbA1c) in relation to the frailty status.

**Method:** This quality act retrospective transversal study was realized at the short term geriatric unit in Sherbrooke. Data were collected regarding prescriptions regarding hypoglycemic agents and insulin, HbA1c and rate of hypoglycaemia episodes in patients with type 2 diabetes hospitalized in 2005, 2010 and 2015.

**Results:** We looked at 100, 83 and 94 charts for the years 2005, 2010 and 2015, respectively. We noticed an increase in prescriptions of metformin and DPP-4 inhibitors over time (p<0.001) and a decrease in prescriptions of thiazolidinediones and sulfonylureas. Long acting insulin seems to be favoured to intermediate, prandial and premixed insulin in 2015 compared to 2005. The mean glycated haemoglobin value increased from 6.48 in 2005 to 6.72 in 2010 and 7.15 in 2015 (p=0.001). The rate of hypoglycemic event (glucose value <4) and severe hypoglycemic event (glucose value <2.8) were significantly reduced over this period.

**Conclusion:** Our study demonstrates a change in drug prescription tendency for type 2 diabetes between 2005 and 2015. We think that this practice, along with higher target glycated haemoglobin, explains the reduction in hypoglycemic events.

## P-318

**Two components of the new ESPEN diagnostic criteria of malnutrition, body mass index and fat free mass index, are independent predictors of lung function in hospitalized patients with chronic obstructive pulmonary disease (COPD)**

A.R. Ingadottir¹, A.M. Beck², C. Baldwin³, E. Weekes³, O.G. Geirsdottir⁴, A. Ramel⁵, T. Gislason⁶, I. Gunnarsdottir¹. ¹Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland and Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland; ²Department of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen N, Denmark; ³Division of Diabetes and Nutritional Sciences, King's College London, London, UK; ⁴Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland and The Icelandic Gerontological Research Center, Landspitali University Hospital & University of Iceland, Reykjavik, Iceland; ⁵Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; ⁶Faculty of Medicine, University of Iceland, Reykjavik, Iceland and Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland

**Introduction:** Diagnosis criteria of malnutrition were proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) in 2015. The aims of the study were to assess the prevalence of malnutrition in patients with chronic obstructive pulmonary disease (COPD) applying the ESPEN criterion, and to examine the ability of each criteria to predict length of stay (LOS), 6 and 9 months mortality and hospital readmissions within 30 days.

**Methods:** Subjects were COPD patients (n=121) admitted to Landspitali in the period March 2015- March 2016. Patients were screened for nutritional risk using Icelandic screening tool (ISS) and NRS-2202. Body composition was measured with a bioelectrical impedance analyser (BIA). Lung function was measured with spirometry.

**Results:** The prevalence of malnutrition according to the ESPEN criteria was 21%. The association between nutritional assessment (with all methods and different components of the ESPEN criteria) and severity of the disease was highly significant, low FFMI (kg/m²) being the variable associated with the highest risk of being at a severe or very severe stage of the disease (OR 4.77 95% CI: 2.03, 11.20; p<0.001). Furthermore, there was a trend towards higher risk of hospitalization for >7 days in subjects with low FFMI (OR 2.46 95% CI: 0.92, 6.59; p=0.074).

**Conclusion:** Our study is the first to describe the prevalence of malnutrition in hospitalized COPD patients using the ESPEN criteria from 2015. It might be suggested that FFMI should be used as an independent criteria for diagnosis of malnutrition in COPD patients.

## P-319

**Vitamin D status in octogenarians: data from elderly database in Vilnius**

V. Alekna¹, A. Mastaviciute¹, M. Tamulaitiene², J. Kilaite¹. ¹Faculty of Medicine of Vilnius University; Vilnius, Lithuania; ²Faculty of Medicine of Vilnius University; National Osteoporosis Center, Vilnius, Lithuania

**Objective:** The aim of this study was to assess vitamin D concentration in octogenarians.

**Methods:** A cross-sectional study was performed in National Osteo-
porosis Centre based in Vilnius, Lithuania. Persons aged ≥80 years from Vilnius community dwelling elderly people database were included. Vitamin D (25(OH)D) and parathyroid hormone (PTH) concentrations in serum were measured with Cobas E411. Participants were divided into three groups according to their vitamin D concentration: deficient, insufficient, sufficient. One-way ANOVA with post hoc test was used to determine comparisons between groups. Association between vitamin D and PTH concentrations was assessed using Spearman correlation.

**Results:** The study was performed on 81 octogenarians: 45 (55.6%) women and 36 (44.4%) men. The average age of participants was 83.59±2.99 years, average height was 160.82±9.27 cm, and weight – 73.11±13.05 kg. Mean vitamin D concentration was 11.77±8.12 ng/ml and PTH – 68.79±42.11 µg/ml. Seventy (86.4%) octogenarians had vitamin D deficiency, 7 (8.6%) – insufficiency, and only 4 (4.9%) persons were vitamin D sufficient. Of all participants, two persons were taking vitamin D supplements, of which one was in deficient group and other was in insufficient group. Vitamin D groups did not differ in age, height, weight or PTH concentration. No statistically significant correlation was found between PTH and vitamin D concentrations (p=0.18).

**Conclusion:** The Vitamin D deficiency was found in the majority of octogenarians. There was no correlation between vitamin D and PTH concentrations.

## P-320

### Which factors inhibit food intake in newly discharged, malnourished older adults?

E.M. Damsgaard¹, P.U. Pedersen². ¹Department of Geriatrics, Aarhus University Hospital, Denmark; ²Aalborg University, Aalborg, Denmark

**Introduction:** Disease-related malnutrition leads to poor appetite and decreased food intake that affects the convalescence negatively in malnourished older adults after discharge from hospital.

**Objective:** To identify factors associated with decreased food intake.

**Method:** The study sample constitutes two intervention groups from a RCT. Inclusion: Malnourishment or risk of malnutrition, 75+years, home dwelling, and living alone. Exclusion: Terminal illness, cognitive impairment, and nursing home residency. At discharge, all patients received a diet plan covering their individual energy needs. Individualised nutritional counselling was performed one, two, and four weeks after discharge. Information about food intake (was the food intake consistent with the diet plan?) as well as inhibiting factors to food intake were recorded. A logistic regression models was used to estimate Odds Ratios (OR) with 95% confidence intervals.

**Results:** One week after discharge 121 patients were contacted, 111 at two weeks, and 99 at four weeks. The occurrence of fatigue the first 2 weeks after discharge was associated with decreased food intake between weeks 2 and 4 after discharge, OR 0.41, 95% CI: 0.19–0.92; p=0.03. Eating all meals alone was associated with poor food intake, OR 0.34, 95% CI: 0.15–0.73; p=0.006. Gastro-intestinal problems and sadness affected food intake, OR 0.32, 95% CI: 0.08–1.16; p=0.08, and OR 0.37, 95% CI: 0.12–1.84; p=0.09 respectively, but not significantly.

**Conclusion:** Decreased food intake is associated with eating alone and fatigue. This knowledge may help healthcare professionals to provide efficient nutritional support to malnourished older adults and thereby prevent some negative consequences of disease-related malnutrition.

## Area: Organisation of care and gerotechnology

### P-321

#### "Never event" insulin: Audit of insulin administration in a French nursing home

B. Lewden-Bernadac¹, M. Nauleau¹, S. Lafargue², V. Lebreton¹, S. Pergeline³, F. Delamarre-Damier⁴, V. Bricard-Pacaud¹. ¹GCS Pays de Retz, France; ²EHPAD Mer et Pins, Saint-Brévin, France; ³HIPR, Pornic, France; ⁴University hospital Nantes and Saint-Laurent sur Sèvre Montfort nursing home, France

**Introduction:** Insulin administration errors constitute events that should never occur (i.e "never event"). However, the nursing home adverse events annual report has recently described several adverse events concerning insulin. Analysing reasons for such errors is an essential preliminary step to establish an adapted action plan. The objective is to compare gaps between professional practices, (i) official recommendations and (ii) theoretical knowledge. Then, this analysis may help us to choose "preventive measures" adaptable to our local context.

**Methods:** Two different audit grids were developed by the pharmacist in collaboration with the physician, pharmacy technicians and a quality specialist: one for nurses and one for physicians. Questions covered the whole medication circuit. Data were collected through interviews and observations during visits in services by pharmacy technicians.

**Results:** Nine forms were completed by nurses, two by doctors and a pharmacy technician did eight visits. A lack of knowledge about official and local recommendations and discrepancy between knowledge and practical implementation were observed. For example, insulin pencils were identified with the patient name but the expiry date was never notified, dispensing was not nominative, etc.

**Conclusion:** Gaps and dysfunctions highlighted during this audit allowed us to take decisions to improve control on-patient drug care. The main actions consisted in modifying insulin storage and dispensing system, creating a checklist for nurses. An assessment will be performed after one year with a second audit and continued monitoring of insulin adverse events.

### P-322

#### A new way to assess care needs in Germany – New assessment procedure

S. Hindrich. Acaddemic ORPEA Germany

After 20 years the dependancy assessment of care change completely. Changes by the new concept of the need for care:

* The concept of nursing neediness changed not only the evaluation.

* He has an effect on the entire system of professional care.

* Through the three Maintenance strengthening law of transition designed to promote and a performance-related maintenance to a person-centered and comprehensive care, care and relief.

The definition of the need of care in relation to independance has changed: before it was: "What I can do for you" and now "What are you able to do by yourself". This new one involve an assessment of: 1. Subject module 1 – Mobility. 2. Subject module 2 – Cognitive and communicative abilities. 3. Subject module 3 – Behaviors and mental problems. 4. Subject module 4 – Self care. 5. Subject module 5 – Dealing with disease - and therapy-related requirements and burdens. 6. Subject module 6 – Life in social relationships Design of everyday life and social contacts.

**Background of the reform:** Reason 1: More care by demographics: Currently, about 2.7 million people in Germany are reliant. Forecast:
For 2030 assuming care about 3.5 million. Currently, 1.5 million people in Germany are ill with dementia. Forecast: by 2050 the number of dementia patients will be twice as high. Reason 2: Previous care means-tested term formed from too little demential diseases. Consequence: People with dementia get fewer services than handicap people. Reason 3: The long-term care insurance are designed in the long term on a secure financial foundation. This new assement (NBI: Neues Begutachtungsinstrument) starts on january 2017. Our experience since the beginning of the year allow us to notice: Pro: better assessment of dementia, more services for caring, a faster access to get the services, same tool for evry lander in Germany. Contra: no suitable procedure for mobile patients suffering from dementia, at the beginning complicated to understand and assess, need of training, lack of teachers in the nursing school, patients without cognitive problems get less services than before (because the law is focused on dementia).

**Conclusion:** The policy of the government is that every person in need of care should remain as long as possible at home. The benefits for nursing care are higher at home than for nursing home. An evaluation is required; Staffing basis for long-term care, advantages for certain patient groups, more experience is necessary to evaluate these new assessment procedures

P-323

ACANTO: a robotic friendly walker

M. Valdés Aragonés 1,2, P.A. Moreno 2, R. Pérez-Rodríguez 2,
L. Rodríguez-Mañas 1,2. ¹Hospital Universitario de Getafe, Getafe,
Spain; ²Fundación para la Investigación Biomédica del Hospital
Universitario de Getafe, Getafe, Spain

**Introduction:** ACANTO is an European project, funded by EU Hori-
zon 2020 program, aimed at improving physical performance in
elderly people through physical exercises provided by a robotic
friendly walker (FriWalk). To evaluate the FriWalk' s clinical scenar-
ios and user requirements, two focus groups were carried out, one
with physicians and the other with potential elderly users.

**Methods:** The two focus groups were composed of 9 physicians (n=9), and 8 elderly people (n=8) respectively. Initially, the project and the target of the session were explained with the aim at collecting opinions/suggestions, clinical utility, weaknesses and strengths about each clinical scenario: rehabilitation after hip fracture, functional decline and diagnostic tool. After the participants had a general idea of the project, the FriWalk was presented. Moreover, some exercises demonstration took place and some volunteers could use it under supervision.

**Results:** All physicians highlighted that for the whole set of clinical scenarios proposed, the FriWalk is an excellent tool to monitor exercise programs and prescribe treatments. In addition, having available information related to the evolution of the patients is of great clinical interest. The focus group of elderly participants agreed that the Fri-Walk is a positive tool that could help them in their daily life, since they could improve their self-confidence and become more independent.

**Conclusions:** Proposed clinical scenarios were accepted by both groups who agreed that FriWalk helps to improve physical performance. Finally, collected results have determined the clinical framework for ACANTO pilot study.

P-324

Agression and violence against caregivers in nursing home and
long term care units

M. Blanchard¹, A. Corvol². ¹Faculté de médecine, université de Rennes 1, France; ²Service de gériatrie, CHU Pontchaillou, Rennes, CRAPE UMR 6051, France

**Introduction:** Workplace violence (WV) against caregivers is a

frequent phenomenon, particularly in psychiatric, geriatric and
emergency medical units.

**Methods:** The aim of this study was to understand how physical violence affects professional caregivers working in long term care and nursing homes, to evaluate the usefulness of post-incident follow-up through incident reporting (IR), and to enumerate the expectations of caregivers. This study was based on IR data covering the 2013–2015 period from Rennes University Hospital’s nursing home and long term care units and from 20 semi-directed caregiver interviews.

**Results:** Over the 3-year study period, 76 IR claims were filed. These claims covered 108 aggressive incidents broken down as follows: 44.4% blows or slaps, 20.4% aggressive incidents using physical force, 10.2% assaults with objects and 10.2% threatening gestures. More than half of these incidents occurred in the nursing home's Alzheimer's Unit. The interviews show that violence is largely under-reported, with important variations among caregivers. Thirty percent of caregivers file IRs several times a week. IR is hampered by both the trivialization of the violence due to the frequency and repetitive nature of the attacks, as well as by the guilt of the declarant, the fear of colleagues' judgement, and the lack of managerial support. Available WV training courses were not adapted to the specific issues inherent in dealing with dementia patients.

**Conclusion:** Monitoring IR is necessary to avoid trivializing work-
place violence and its repercussions. Incident reporting, especially
of cases with physical or psychological consequences, should be
encouraged by medical institutions.

P-325

Analysis of the oncogeriatric activity of Saint Joseph Hospital
Marseille in 2016: toward a transversal oncogeriatric
organization

S. Tournier Louvel. Saint Joseph Hospital Marseille

**Introduction:** The geriatric activity of Saint Joseph Hospital Mar-
seille has been organized around a mobile team (2012), an
out-patient department, and a day hospital (2016). Our objective
was to analyze the oncogeriatric activity in 2016 to optimize its
organization.

**Material and methods:** This retrospective study analyzed 186 consecutive medical records of patients with cancer evaluated from 01/01 to 31/12/2016 directly in-hospital or in out-patient department. The analysis focused on oncologic geriatric assessments (OGA) versus oncologic multi-disciplinary team meetings (OMDM) and on geriatric recommendations.

**Results:** In 2016, 165 patients (86 women, 79 men) from 70 to 97 (mean age 84.1±5.5) were evaluated through 186 interventions (144 in-hospital and 42 in out-patient department). In 2016, the number of OGA represented only 14.6% of all OMDM (147/1008). OGA were solicited in 46% of sinonasal and throat cancer OMDM, 29% digestive cancer OMDM, 19% of broncho-pulmonary cancer OMDM, and 6% of other cancer OMDM. Only 16.5% of the geriatric recommendations were "compliant" with OMDM whereas 37.9% were "compliant with reserve". On average 4.1±1.4 oncogeriatric recommendations/patient were proposed: acts of nutrition (91.4%); physiotherapy (89.9%), complementary examinations (81.3%), social support (73.4%), pain support (41.7%) and depression support (33.1%).

**Conclusion:** Too few oncologists required OGA in 2016. Therefore OGA brought significant contribution to patient care through complementary recommendations. A strong awareness campaign should be organized toward organ specialists and doctors to systematize oncogeriatric requests. To manage this foreseeable increase, it seems necessary, maintaining the same geriatric team size, to establish a transversal oncogeriatric strategy
## P-326

# Community hospital geriatric ward cover through remote access robotic tele-presence: A pilot study

A. Mathur. University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

**Introduction:** A 4-month pilot study was done to establish the suitability of remote assessment of frail older patients in a community hospital ward by a "robotic tele-presence". This technology allows virtual audio-visual interaction through a remote controlled mobile robot to replicate physical presence, all of which can be controlled from a distant location through an "app" on a smart device.

**Methods:** The parameters assessed through "robotic tele-presence" ward rounds were: a) quality of clinical assessment, b) technical quality, c) patient experience and, d) staff experience. The Consultant Geriatrician was in a different geographic location and controlled the robot through a smart device "app" for these ward rounds.

**Results:** Difficulties were experienced in some aspects of physician-patient interaction, particularly where there was a need for physical examination and interpretation of findings. However, pre-assessment reviews, formulating problem lists and communicating management plans to patients were satisfactory. Technical quality was affected by variable WiFi connectivity, ambient noise and initial problems in steering the robot remotely. Patient experience was largely positive for overall interaction, including engagement with the doctor and clarity of image but mixed for clarity of voice. Staff experience was mixed, largely due to more prolonged ward rounds, often due to variable connectivity and technical issues.

**Conclusion:** This exciting technology using "robotic tele-presence" relies on uniformly good connectivity and may not replace "traditional" ward rounds, but should be tested further as a potentially valuable asset for providing specialist opinion remotely to multidisciplinary teams, carers, families and social workers by bridging distances.

## P-327

# Dependency is associated with age, cognitive impairment and infections: LPZ study in Turkish hospitals

B. Saka¹, C. Kocaturk², I. Tasci³, S. Akin⁴, S. Savas⁵, T. Atli⁶, P. Tosun⁷, M. Halil⁸, D.S. Erdincler⁹, M. Varli¹⁰, A. Curgunlu¹¹, A. Tufan¹², Z.A. Ozturk¹³, G. Sezgin¹⁴, F. Kirbiyik¹⁵, M.A. Karan¹⁶.

¹Istanbul University Istanbul Faculty of Medicine; ²Health Sciences University, Yedikule Chest Diseases Hospital; ³Health Sciences University, Gülhane Faculty of Medicine; ⁴Erciyes University School of Medicine; ⁵Ege University School of Medicine; ⁶Ankara Guven Hospital; ⁷Health Sciences University, Erzurum Teaching Hospital; ⁸Hacettepe University School of Medicine; ⁹Istanbul University, Cerrahpasa Faculty of Medicine; ¹⁰Ankara University School of Medicine; ¹¹Istanbul Bilim University School of Medicine; ¹²Marmara University School of Medicine; ¹³Gaziantep University School of Medicine; ¹⁴Maltepe University School of Medicine; ¹⁵Nutricia Turkey, Istanbul; ¹⁶Istanbul University, Istanbul Faculty of Medicine

LPZ is an annual international multicenter cross-sectional prevalence measurement of care problems on institution, department and patient level. It evaluates, risk, prevalence, prevention and treatment interventions.

**Materials and methods:** Measurement was done on November 2016 in 14 hospitals of Turkey. LPZ tool included 3 forms including questions related with the institutions, departments, care-givers and patients. Patients ≥65 years old were evaluated. This study was supported by Nutricia Turkey.

**Results:** 281 patients were taken into the study (%53 males). According to LPZ tool, 29.5% of the patients were extensively/completely dependent, 14.6% were partially dependent and 55.9% were extensively/completely independent. Median number of care-givers

(nurse, care worker) per ward was 9 in day time, 4 in the evening and 3 in the night shifts. Dependency was related with infectious diseases, mental and behavioural disorders, dementia and stroke. Patients with increased risk for pressure ulcer, malnutrition, falls and polypharmacy also showed increased dependency. Dependency was also found associated with age, BMI (kg/m²), urinary incontinence, dysphagia, falls and pain. According to multivariate analysis, dependency was associated with age, infectious diseases and dementia.

**Conclusion:** This study provided important data about 6 care problems in hospitalised elderly in Turkey. Dependency in elderly was found associated with age, dementia and infections.

## P-328

# Enhancing the continuity of care: Assessing the quality of discharge documentation for our elderly population

A.P. 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:** Good quality documentation is essential to the safe transition of care for elderly patients at the point of discharge. We intended to review the quality of discharge documentation for patients discharged from acute inpatient services.

**Methods:** Utilising the electronic patient record we reviewed summaries for patients aged ≥74 years from acute medical, surgical and ageing and complex medicine wards. The content of summaries was compared against established national and local standards.

**Results:** 321 documents were reviewed. Team members involved in patient care authored 88% of summaries. A succinct summary of the admission with relevant investigations or procedures were adequately documented in 306 (95%) records. However, a clear list of new diagnoses and an up-to-date past medical history were present in only 207 (64%) and 161 (50%) summaries respectively. Episodes of delirium and diagnoses of dementia were appropriately recorded 98% of the time. 273 (85%) patients had an amendment made to their medication regime. When required, this was adequately recorded 83% of the time, with rationale for changes included in 73% of documents. Information for patients, in lay terms, was recorded in 254 (79%) summaries.

**Conclusions:** High quality discharge summaries are authored by team members involved in a patient's care. Though events of admission are recorded well for this cohort; further work is required to improve recording critical elements such as medication amendments and new diagnoses. Relaying information in lay terms for the patient and carers should be viewed as a vital element of this transfer of care document.

## P-329

# Evaluation of Motor Abilities in young and older subjects using HD-sEMG and IMU data

L. Imrani¹, S. Xérès¹, K. Lepetit¹, M.M. Al Harrach¹, S. Boudaoud¹, K. Kinugawa², F. Marin¹. ¹Sorbonne Universités, Université de technologie de Compiègne, UMR CNRS 7338, Compiègne, France;

²Functional Exploration Unit, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France; Sorbonne Universities, University Pierre and Marie Curie (UPMC) Paris 06, UMR CNRS 8256 B2A Institute of longevity, France

**Introduction:** The aim of this study is to characterize the motor abilities of young compared to older subjects by combining a recent electromyography technique, the HD-sEMG (high density surface electromyography), and the Inertial Measurement Unit (IMU) to estimate muscle activation and motion efficiency during the sit-to-stand test (STS).

**Materials and methods:** Twelve subjects participated in the STS