health resort of Balaruc-les-Bains, the most frequently visited Spa in France (over 46,000 medicalised persons welcomed per year). A fall in the previous years was observed in 33% of the curists (29% in men and 34% in women) and at least two falls in the previous fall in 20% of them (16% in men and 22% in women). A timed-up and go test over 12 seconds was observed in 34% of men and 39% of women and a one-leg stand test under 5 seconds in 42% of men and 46% of women. 16% of men and 24% of women were unable to stand in tandem position for 10 sec and 63% of men and 76% of women had a 4-m walking speed <1 m/s. The 5 sit-to-stand test was not possible in less than 12 sec in 73% of men and 76% of women and the fear of falling was not reduced during the stay. Performance in all the above functional tests was significantly lower in fallers than in non-fallers. Taken together, the above results suggest that a systematic screening of curists at risk of falling should be implemented in spas and that, in subjects screened at risk of falling, a specific program should be initiated during the stay in order to prevent falls and fractures.

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## Profile of results of a comprehensive geriatric FLS in the follow-up of fragility hip fracture patients (FONDA protocol)

D. Moral-Cuesta<fnref n="1" />, P. Matovelle<fnref n="1" />, T. Alarcón 1,2, R. Velasco <fnref n="1" />,
R. Menéndez-Colino 1,2, R. Queipo 2,3, J.I. González-Montalvo 1,2.

**Introduction:** Hip Fracture (HF) patients suffer an important decrease in their function and health status. Many patients die and others do not recover after the HF. The objective was to assess the results of an intervention program in the recovery of physical function, bone health, nutrition and anemia since admission to 1-year of follow up.

**Methods:** HF patients admitted during one year in a university Hospital were studied. An intervention (FONDA Protocol) based on physical function (Barthel Index -BI-, Short Physical Performance Battery -SPPB- and handgrip strength), bone health (vitamin D), nutrition (serum protein, albumin levels and muscle mass index -MMI-) and anemia (hemoglobin level), was applied. In those who could come to the outpatient clinic an assessment of the efficacy of the protocol result was made. Data were collected at admission and at 3, 6 and 12 months.

**Results:** 134 HF patients were included. The assessment results at admission, 3, 6, and 12 months were respectively: MMI (kg/m<fnref n="2" />): 8.6 (±2.2), 8 (±1.6), 8 (±1.7), 8 (±1.4); handgrip strength (Kg): 16.1 (±7.3), 19.3 (±6.8), 20 (±8), 21.2 (±8.2); hemoglobin (g/dL): 12.9 (±1.6), 13.3 (±1.3), 13.7 (±1.3), 13.6 (±1.4); total serum protein (g/dL): 6.8 (±0.8), 6.8 (±0.5), 6.9 (±0.5), 6.9 (±0.4); albumin (g/dL): 3.2 (±0.4), 4 (±0.4), 4.1 (±0.4), 4.1 (±0.3); vitamin D (ng/mL): 16.2 (±8), 56.4 (±37), 41.6 (±19.8), 35.4 (±14.1). The results at 3, 6, and 12 months were for BI: 87.2 (±15.4), 89.2 (±13.2), 90.1 (±17.2) and for SPPB: 6.4 (±2.8), 7.2 (±2.9), 7.75 (±2.9).

**Conclusions:** An individualized protocol aimed to solving the specific needs of each HF patient reach the overall health status recovery, which improvement in the functional, nutritional, vitamin D and hemoglobin status.

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## Profile of re-hospitalization in Prevent Senior, a private health provider that caters exclusively geriatric patients, in 2016

S.A.D. Silveira Jr, P.B. Batista Jr, A.L.A. Nascimento, E.F. Parrilo.
Prevent Senior Brazil

**Objective:** To evaluate the profile of readmissions in a particu-

lar health care provider that caters exclusively geriatric patients (Prevent Senior) in Brazil during the year 2016.

**Method:** We conducted a prospective study between January 01 to December 31, 2016, where evaluated all readmissions that occurred during that period.

**Results:** Were analyzed in 3147 (8.44%) readmissions, of a total population of 37.249 admissions. 40.0% of these re-admitted in up to seven days post discharge; 43.0% readmitted for the same reason discharge. 59% of readmissions were due to infectious aetiology, 15.4% from cardiovascular causes, 11.3% for palliative care, 7.8% for renal insufiencia and 6.5% by other causes. The overall hospital mortality was 7.50%, and the average length of stay was 4.3 days.

**Conclusion:** The results presented show a low rate of re-hospitalization, low death rate and low time of permanency for the population studied. The main reason for the readmission of this population were the infectious causes, with pneumonia being the most responsible. Such results show indirectly an efficient in-hospital management mechanism of the different conditions that affected the population studied.

P-147

## RCT Intervention with robust older people measuring functional competence, risk of falling and gait modification outcomes (LASTIMO)

U. Dapp<fnref n="1" />, L. Neumann<fnref n="1" />, C. Rohn<fnref n="1" />, R. Hoee<fnref n="1" />, V. Nagel<fnref n="2" />, W. von Renteln-Kruse<fnref n="1" />, A. Daubmann<fnref n="3" />, A. Zech⁴. ¹Albertinen-Haus Centre of Geriatrics and Gerontology, Scientific Department at the University of Hamburg, Hamburg, Germany; ²Institute of Human Movement Science, University of Hamburg, Hamburg, Germany; ³Department of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf, Hamburg, Germany; ⁴Department of Exercise Physiology, Institute of Sports Science, Friedrich Schiller University of Jena, Jena, Germany

**Introduction:** Older persons may be at increased risk of falling due to functional decline and decreased muscle strength. Therefore, adequate shoes providing stability are recommended although evidence is lacking. However, such shoes may have negative impact on the feet muscles and sensitivity, and thereby, may impair movement and posture control. The aim of LASTIMO is to study whether habitual patterns of gait, and mobility will be modified by physical training under conditions that are comparable to barefoot.

**Methods:** RCT with robust (measured with LUCAS-Functional-Ability-Index, FI [Dapp et al. BMCGeriatrics2014]) older people (70+ years). Intervention group (IG): Comprehensive training focused on balance and coordination 2x/week over 6 months with minimalistic shoe use (similar to unshod). Control group (CG): Identical training with familiar shoes. Measurement: CGA (2h) incl. gait parameters (Gaitrite®) and functional competence (i.e. LUCAS FI, fall risk, SPPB).

**Results:** The randomisation (1:1) was successful: 56 persons were part of the IG and 56 part of the CG. Proportion of women was: IG 55.4%, KG 57.1%. Mean age (SD) accounted in the IG 75.6 (±3.4) and in the CG 75.6 (±4.5) years. First pre-post-analyses (LUCAS FI, SPPB, fall risk) showed no significant differences. In-depths analyses concerning foot and gait stability and variability (Gaitrite®) are currently under way.

**Conclusions:** Findings and effects concerning functional competence, fall risk and gait modifications will be integrated in the "Pact for Prevention Hamburg – staying healthy in old age!" which is the regional stakeholder framework according to the mandatory German prevention policy and regulations.

<footnote n="1">¹Geriatrics Department, Hospital Universitario La Paz, Madrid, Spain;</footnote>

<footnote n="2">²Instituto de Investigación del Hospital La Paz IdiPAZ, Madrid, Spain;</footnote>

<footnote n="3">³Preventive Medicine Department, Universidad Autónoma, Madrid,
Spain</footnote>
P-148

Restless leg syndrome and associated factors

S. Bovatekin, G. Bahat, B. İlhan, A. Tufan, Y. Topcu, O. Yilmaz, T. Öbekli, P. Küçukdağlı, C. Kılıç, M.A. Karan. Department of Internal Medicine, Division of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

**Objective:** Sleep disorders are prevelant but an underestimated problem in the elderly. RLS is associated cardiometabolic and norocognitive comorbidities. Especially restless leg syndrome (RLS) is common among sleep disorders. Studies regarding prevalence and associated factors of RLS and are limited. We aimed to assess RLS prevelance and its associated factors.

**Methods:** We included the elders 60-99 years of age admitted to Istanbul Medical School Geriatrics outpatient clinic in 2013-2016 years period. International RLS diagnosis criteria was used for RLS diagnosis and Cardiovascular Health Study group criterias were used for frailty. Activities of daily livin (ADL) and Instrumental activities of daily livin (IADL) were defined by Katz/Lawton index. Handgrip strength was measured with jamar hydrolic dynamometer. Statistical methods were chi-square analysis, independent-T-test, logistic regression model analysis.

**Results:** 405 were male (%32), 854 (%68) were female from 1259 subjects. Mean age was 74,65±7 years. RLS prevelance was %28,4. Mean handgrip strength measurement was 26±8.5. Mean ADL and IADL were 17.2±1,39, 20,76±4,6 respectively. Median frailty score was 1±1,192 (minimum score was=0 maximum score=5). After regression analysis, RLS was associated with IADL, frailty and lower handgrip strength (p<0,001, p<0,001, p=0.13 respectively). But it was not associated with ADL (p=0,9).

**Conclusion:** RLS is associated with geriatric syndromes as like cardiometabolic diseases. RLS is associated with frailty, lower handgrip strength, and functional dependence. Frailty should be considered in patients with RLS because of increased sensivity to every kind of systemic disease. New studies are needed to light its pathophysiological mechanism.

P-149

Screening of oropharyngeal dysphagia in a community old population suffering from dementia

A. Michel¹, F. Roca¹, M. Bordage¹, L. Druesne¹, E. Vérin²,
P. Chassagne³. ¹Centre Hospitalier Universitaire de Rouen, Rouen,
France; ²Centre Régional de Médecine Physique et de Réadaptation Les
Herbiers, Bois Guillaume, France; ³Centre Hospitalier Universitaire
Vaudois, Lausanne, Suiss

**Introduction:** Oropharyngeal dysphagia (OD) is a common geriatric syndrome associated with negative outcomes (malnutrition or aspiration pneumonia). In community-dwelling old populations, the 3-Oz test (3-ounce water swallow test) has been previously validated as an effective screening tool for OD. Recently, the V-VST (Volume-Viscosity Swallow Test) has been suggested as a relevant screening method. We aimed to assess in an ambulatory setting the relevance of V-VST comparing to the 3-Oz test in a population of old demented patients.

**Methods:** This prospective, monocentric study was conducted with a population recruited from our geriatric outpatients clinic. Patients aged 70 years or older with a diagnosis of dementia (NINCDS-ADRDA criteria) with an effective cough and attention capacities preserved for testing. Each patient was evaluated by applying consecutively the 3-Oz test and the V-VST in order to compare the prevalence of OD diagnosed by the two tests. Feasibility of V-VST was defined by measuring the mean time necessary to realize the test and the rate of patients capable of successfully completing it.

**Results:** 117 patients were included (77 women, mean age =84.5±5.1 years). The prevalence of OD was significantly higher (p=0.04) when

applying the V-VST (86.6%) in comparison to the 3-Oz test (15%). The mean time necessary to apply V-VST was 8 minutes which has been successfully achieved in 96% of studied patients.

**Conclusions:** The V-VST is a screening test, easily applied and well tolerated in the elderly population suffering from dementia that should be preferred to the 3-Oz test in this population.

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Sensitivity to change of Berg Balance Scale, Timed Up and Go test, Four Square Step Test for older adults

K. Cekok¹, T. Kahraman², B.O. Ugut², P. Keskinoglu³, A. Genc⁴.
¹Department of Physical Therapy and Rehabilitation, Medical Park Hospital, Izmir, Turkey; ²Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey; ³Department of Biostatistics and Medical Informatics, Dokuz Eylül University, Izmir, Turkey; ⁴School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey

**Objectives:** Balance is an integral component of physical function and a fundamental area of assessment and intervention in geriatric rehabilitation. Clinicians and researchers in this field regularly use standard balance measures to diagnose balance deficits, measure the risk of falls, and monitor changes in balance over time. Although several balance measures are available, there is lack of evidence regarding the most appropriate measure to assess change in older adults. The aim was to investigate the sensitivity to change of Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and Four Step Square Test (FSST) for older adults.

**Methods:** This cohort study is comprised of participants aged older than 50 years. The BBS, TUG test. and FSST were performed baseline and after one year. Sensitivity to change was assessed using effect size (ES) and standardized response mean (SRM).

**Results:** There were 94 participants in the baseline assessment. After one year, 35 of them were re-assessed. There was a significant balance deterioration assessed with all measures compared to one year ago (p<0.01). ES values were small for all the measures (BBS: -0.44, TUG: 0.28, and FSST: 0.26), whereas SRM values were moderate for BBS and TUG (-0.75 and 0.67, respectively). SRM value was large for FSST (1.31).

**Conclusions:** Although BBS, TUG, and FSST have similar responsiveness abilities, the FSST seems much better to sensitively measure balance deterioration with age in older adults. Since a notable balance deterioration was observed after one year, regular balance assessment and appropriate rehabilitation are important.

P-151

Social deprivation and primary care access among elderly patients – A cohort study on patients hospitalized in a geriatric unit

D. Nghiem, W. Jarzebowski, C. Lafuente, J. Belmin. Hopital Charles-Foix, Ivry-Sur-Seine, France

**Context:** There are little publications on primary care access for the poor elderly population, although they are among the frailest.

**Objectives:** To assess a potential association between poverty among the elderly and their access to primary care in France.

**Design:** Cohort study, based on a self-assessment questionnaire completed by 80 patients hospitalized in two geriatric units of the Charles-Foix Hospital, between March and September 2016. The data collected included the deprivation score EPICES, frailty indicators (Charlson, Rockwood and FiND scores), as well as the number of times they consulted their primary care physician the year before their hospitalization.

**Results:** In this population, most patients were women (n=49, 61%), with a mean age of 85 years. They were frail, with a median Rockwood score of 5/7 and also highly comorbid, with a mean Charlson
index of 6.8. Most (n=61, 76%) were considered deprived according to the EPICES score. Mean number of primary care consultations was 7 per year. By assessing a distribution by quintiles, the EPICES score was significantly associated with the number of consultations by a complex relationship, in which the lowest and the highest quintiles had a greater number of primary care consultations per year (p<0.05).

**Conclusion:** Primary care access seems to be associated in a non linear link with social deprivation among the elderly in France. More studies are needed to assess whether the EPICES score could be a good instrument to detect social frailty among geriatric patients.

P-152

Socio-demographical and medical characteristics associated with quality of life in very old and frail geriatric oncology patients

V. Antoine, D. Matelot, A. Martin, B. de Wazieres. CHU Nîmes, France

**Background:** Quality of life (QOL) has become a major factor when considering treatment approach and medical care in geriatric oncology. QOL measures have been recognized to help treatment decisions, prognostic and survival assessment. The objective of this study is to describe the level of QOL in very old and frail geriatric oncology patients and factors associated with a low QOL level.

**Methods:** Over 100 consenting subjects ≥74 years of age, with a progressive cancer (solid tumors or hemopathy, treated or not) were included from a geriatric oncology clinic in a French university hospital. The validated QOL questionnaire EORTC QLQ-C30 (version 3.0) was administrated to patients. Socio-demographics (age, sex, lifestyle), cancer (type of cancer, metastatic or not, curative treatment or not), comorbidities, G8 score and geriatric characteristics (cognitive and sensorial functions, depression, nutrition, walking speed and perimeter, grip strength), pain, hemoglobin, creatinine clearance, autonomy for activities of daily living (ADL/IADL) were also collected.

**Results:** We present socio-demographical and medical data associated with QOL level in a frail and elderly population (mean age 84, OMS performance status >2: 43%).

**Conclusion:** Geriatric assessment is important to optimize QOL evaluation in geriatric oncology.

P-153

Telemedicine as a successful tool for improving territorial care to elderly people

M. Ammendola¹, A. Castagna², L. Manfredi², P. Gareri³, M. Rocca³.

¹ASP di CAtanzaro, ITALY; ²ASP di Catanzaro; ³ASP di Catanzaro, Italy

**Background:** Telemedicine offers a number of services addressed to chronic diseases able to improve the quality of care by applying technology to clinical practice. Elderly people need a highly personalized diagnostic approach aimed to the improvement in the quality of life and the delay in disease progression.

**Aim:** The aim of the present work was to compare a sample of 11 patients who underwent telemonitoring of health conditions (group A) with a sample of 11 patients (group B) following the routine geriatric check-up.

**Methods:** People were from Catanzaro Lido or Chiaravalle Districts, age 65 year old or older; they had to be affected with hypertension, diabetes, respiratory insufficiency/COPD. Telemedicine tools included Phebo platform, with a software able to receive signals from peripheral devices in real time. Devices were directly provided to patients. All of them were linked to a smartphone with evodroid system, able to communicate to the central platform through the internet. Patients were administered a questionnaire for assessing the compliance in the two groups: 1) self monitoring of parameters, adherence to 2) pharmacological prescriptions and 3) to diet,

4) adherence to parameter monitoring and self-care and 5) the perception of patient's care.

**Results:** Telemonitored patients globally presented a better adherence to monitor the examined parameters (blood pressure, oxygen saturation, glycemia and body weight). The adherence to drug treatment was higher in group A (82% vs 73%). Unlike group B, patients of group A declared they never changed drug regimen autonomously. The adherence to diet was overall low in both groups. The level of perceived quality of assistance was high in both groups (55% in group A vs 45% in group B).

**Conclusions:** Telemonitored patients presented a high compliance to clinical monitoring and drug treatment and low adherence to diet regimens. Clinical monitoring was much higher compared with non-telemonitored patients. In conclusion, compliance improved as much as perceived care got better and the tools provided by telemedicine offered a valid help for improving parameters monitoring.

P-154

The European study of older subjects with atrial fibrillation (EUROSAF). Aim and study design

A. Pilotto¹, S. Maggi², M.C. Polidori³, E. Canepa¹, N. Veronese¹, A. Ferri¹, on behalf of EUROSAF Investigators. ¹Department of Geriatric Care, OrthoGeriatrics& Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy; ²EUGMS European Union Geriatric Medicine Society, Europe; ³Ageing Clinical Research, Dpt. Medicine II, University Hospital of Cologne, Germany

**Introduction:** The EURopean Study of Older Subjects with Atrial Fibrillatio (EUROSAF), NCT 02973984, is a cross-national, prospective, observational study performed in subjects aged ≥65 years with Atrial Fibrillatio (AF) admitted to European Centers with the aim to evaluate in a "real word" population of multimorbid frail older patients with AF the clinical benefit/risk ratio of the anticoagulant treatment according to the different individual risk profile, as determined by the Multidimensional Prognostic Inde (MPI).

**Methods:** All patients at baseline underwent a standardized Comprehensive Geriatric Assessment (CGA), i.e. information on functional (ADL, IADL), cognitive (SPMSQ), nutrition (MNA-SF), risk of pressure core (Exton-Smith Scale), comorbidity (CIRS), polypharmacy and co-habitation status in order to calculate the MPI. in order to calculate the MPI. Patients were divided in three MPI-risk groups: MPI-1-low-risk, MPI-2-moderate-risk, MPI-3-severe-risk of mortality. Systemic thromboembolic risk (according to CHA2DS2-VASC score), and bleeding risk (according to HAS-BLED score) were also calculated. During the 12 months follow-up period, information will be collected on survival/mortality, hospital re-admissions, thromboembolic events, haemorrhagic events and compliance to oral anticoagulant treatments.

**Results:** The recruitment period started on November 2016 in three centers. 156 elderly patients were included (updated 30th april 2017), i.e. 80 males and 76 females, mean age 84.6±5.9 years, range 66–96 years. 36 patients were included in MPI-1 group, 72 to MPI-2 and 48 to MPI-3 group.

**Conclusion:** EUROSAF study is a multicenter cross-national prospective study to evaluate the clinical benefit/risk ratio of anticoagulant treatment in frail older subjects with multimorbidity and polypharmacy.

P-155

The experience of formal caregivers in a Portuguese nursing home care: a case report

C. Laranjeira, Z. Azeredo. RECI - Higher School of Health Sciences Viseu (Piaget Institute)

**Introduction:** The need for assistance with personal care or house-
hold activities is a hallmark of aging. With the increasing of disability comes the need for more assistance and more formal caregiving services.

**Methods:** This study aims to verify the type of care provided by formal caregivers of institutionalized elderly, know the difficulties experienced by formal caregivers and find out what their sources of satisfaction. We conducted a qualitative study with transversal approach, whose data collection instrument was the interview, conducted on a sample of seven formal caregivers of a Nursing Home Care in Viseu (Portugal).

**Results:** The results show that the sample is female, aged from 32 to 53 years, most of which has the basic education, with a professional exercise time between 8 and 16 years, corresponding to the time in the profession in the current institution they work. There are cases of lack of training on caring for the elderly, and those that have been in institutional contexts (care for the elderly, health, geriatrics and first aid), expressing the desire to invest more in their education (geriatrics, long-term care, palliative care and elderly psychology). The type of care/activities that caregivers provide were hygiene, food, positioning, live with the elderly, leisure activities, ensure their welfare and home cleaning. The activities that give more pleasure to the caregivers perform were living with the elderly and throw to them. In contrast, the activities in which they feel the most difficult positions are deal with the elderly patient and control the dementia crisis.

**Conclusions:** Formal caregivers contribute to many activities. The difficulties experienced are varied (efforts, initial insecurity in relation to the elderly, more autonomous elderly, food, unable to control the old crises, hygiene and degradation of the elderly). Most caregivers think that their prospect of future change. The most complicated moment with that interviewed faced was the death of the elderly. Mostly, the interviewees reveal professional satisfaction and personal benefits, which is very positive experience in terms of personal growth.

P-156

**The language validation study of the Sarc-F Turkish version**

G. Bahat¹, O. Yilmaz¹, P. Cukucdagli¹, M. Oren², M.A. Karan¹.

¹Department of Internal Medicine Division of Geriatrics; ²Department of Public Health, Istanbul University Istanbul Medical School

**Objective:** The SARC-F scale is a recently developed practical tool to screen for sarcopenia and the score ≥4 is defined as positive. We aimed to perform its Turkish language validation.

**Methods:** This study is a part of SARC-F Validation Study of sarcopenia special interest group of EUGMS. Firstly a bilingual expert translated SARC-F in Turkish and the other 2 bilingual expert and a forward translator reviewed the translation and decided on the final draft version. After the consensus, a bilingual translator performed the back-translation. The expert panel reviewed the all versions and reached a consensus in the translations. Turkish translated version was applied as pretest to 10 participants. It was validated with the same 20 participants (10 men and 10 women) in order to assess inter-intra rater reliability.

**Results:** There was no problem in the translation and pretest process. There were 5 men and 5 women (mean age of 71.5±10.4 years) in the pretest step. Inter-intra rater reliability participants' mean age was 71.4±8.1 years. Inter-rater reliability was performed with an ICC of 0.78 CI 95% (0,60–0,89). Result was considered to show adequate internal consistency. The intra rater reliability was performed with an ICC of 0.78, 95% CI: (0.61–0.90) two weeks later and this was also satisfactory.

**Conclusions:** Turkish version of SARC-F proved to be easy to complete, valid, reliable, and reproducible sarcopenia questionnaire. This standard form can be used in clinical practice and research studies.

P-157

**The Older Person's Assessment and Liason (OPAL) team in Emergency Department: impact of embedding specialty staff in ED**

R. Barratt, R. Keelan. University Hospital of South Manchester, Manchester, UK

**Background:** Elderly patients attending the emergency department (ED) have a high rate of hospital admission. The Older Persons Assessment and Liaison (OPAL) team aim to address the difficulties encountered with the management of frailty syndromes and provide safe alternatives to admission. It currently operates a five-day week multidisciplinary service within the ED, led by consultant geriatricians. This permits timely and comprehensive review of individuals who can be better managed in the community.

**Method:** A questionnaire comprising 11 questions was given to staff members in ED to assess the effectiveness of, and satisfaction with, the OPAL team. There were 25 respondents who were asked to provide their role but were otherwise anonymous. Questions assessed qualities ascertaining to leadership: approachability, communication, time to response, effectiveness in facilitating discharge, education, influence on practice.

**Results:** The OPAL team in ED are felt to increase thresholds for admission and facilitate safe discharge. Their accessibility, availability and approachability are valued as is their role as advisors and team players. OPAL referral criteria are generally well understood and the wider influence on the practice of other clinicians is appreciated, with reported increased confidence and awareness of managing frail elderly in ED.

**Conclusions:**

* Specialist teams embedded in ED facilitates better patient care and augments knowledge in non-specialists.

* OPAL team in the ED inspires others and influences positive change.

* OPAL team in ED ensures fast and effective assessment of the frail elderly patient.

* Integral to facilitating safe discharge of frail elderly with establishment of support in the community.

P-158

**Use of physical restraints in italian hospitals and nursing homes: Data from the 2015 “Delirium Day” initiative**

P. Mazzola¹, G. Annoni¹, S. Di Santo², A. Mazzone³, A. Ferrari⁴, N. Ferrara⁵, M. Trabucchi⁶, M. Alessandro⁷, E. Mossello⁸, A. Cherubini⁹, G. Bellelli¹⁰. ¹University of Milano-Bicocca, School of Medicine and Surgery, Monza (MB), Italy; ²Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Roma, Italy; ³Redaelli Geriatric Institute, Milan, Italy; ⁴Geriatric Unit, Department of Neuromotor Physiology, ASMN Hospital, Reggio Emilia, Italy; Italian Society of Hospital and Community Geriatrics (SIGOT), Roma, Italy; ⁵Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy; Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese, Telese Terme (BN), Italy; Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy; ⁶Tor Vergata, Rome University, Rome, Italy; Italian Psychogeriatric Association (AIP), Brescia, Italy; ⁷Department of Rehabilitation and Aged Care “Fondazione Camplani” Hospital, Cremona, Italy; ⁸Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy; ⁹Geriatrics and Geriatric Emergency Care. IRCCS-INRCA, Ancona, Italy; ¹⁰University of Milano-Bicocca, School of Medicine and Surgery, Monza (MB), Italy; NeuroMI – Milan Center for Neuroscience, Clinical Neurosciences research area, Milano (MI), Italy

**Introduction:** Physical restraints, originally intended to prevent
falls and injuries, did not show any advantage in terms of fall prevention. Despite their potential of causing delirium and agitation, restraints are largely used.

**Methods:** Data from the 2015 "Delirium Day" initiative, a point prevalence observational study that accounted for 3534 patients enrolled in a single day. Subjects with complete data included 1867 who were admitted to acute care or rehabilitation wards, and 1439 who were nursing home (NH) residents. Patients of both settings were also divided according to the use of restraints: no restraints, bedrails, restraints attached to the body.

**Results:** NH patients were older than those in acute wards (84.4 vs. 82.0 years, p<0.001). In the latter group, patients who used bedrails or restraints were older than those without restraints (84.6, 86.0, and 80.4 years respectively). Patients in acute wards were more comorbid, more malnourished, and less functionally dependent than NH patients, but the latter were more affected by dementia, took more drugs, and experienced more delirium according to the Delirium-o-meter scale (maximum prevalence among the restraints users in both settings). Multivariate logistic regressions showed that age, female gender, number of drugs, low BADL score, bladder catheterization and dementia were independently associated with the use of bedrails. Only low BADL, dementia, and delirium were independently associated with the use of restraints attached to the body.

**Conclusions:** The use of bedrails and of restraints attached to the body are associated with different risk factors, thus they should be considered as different strategies.

P-159

Usefulness of the multidimensional prognostic index (MPI) to identify older patients who will return home after discharge from a post-acute care unit

A. Cella, F. Tricerri, N. Vello, M. Pomata, D. Torriglia, A. Delrio, R. Boi, S. Morelli, A. Pilotto. Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Genoa, Italy

**Introduction:** The ultimate goal of post-acute care units is to enable patients to return home once their independence has improved. This study aimed to evaluate the usefulness of the Multidimensional Prognostic Index (MPI), a Comprehensive Geriatric Assessment (CGA)-based prognostic tool, in identifying patients able to return home after hospitalization.

**Methods:** On admission and on discharge, 325 consecutive older patients admitted to our post-acute care unit (males 150, females 175, mean age 82.0±7.1 years) underwent a standardized CGA to calculate their MPI by means of Activities of Daily Living-ADL, Barthel-Index, Instrumental ADL, Short Portable Mental Status Questionnaire, Mini Nutritional Assessment, Exton-Smith Scale, Comorbidity Illness Rating Scale, drug use and co-habitation status.

**Results:** Nineteen patients (5.8%) died; 165 (50.8%) returned home; 130 (40.0%) were admitted to nursing homes; 11 (3.4%) required re-admission to acute-care wards due to relapsing diseases. The MPI of subjects who returned home was significantly lower than that of all other patients, both on admission (0.70 vs 0.78, p<0.001) and on discharge (0.59 vs 0.70, p<0.001). The most significant predictors of returning home were MPI on admission (binary logistic regression: OR 0.017, CI95% 0.001–0.225; p=0.002) and Barthel-Index on discharge (OR 1.019; CI95% 1.009–1.028; p<0.001).

**Conclusions:** In post-acute care geriatric facilities, MPI can help clinicians to identify frail patients able to return home after discharge; improving MPI values can indicate improved functional status and increase the probability of returning home.

Area: Delirium

P-160

Anticholinergic burden and delirium in unplanned admissions with Parkinson's disease: Prevalence, associations and outcomes

E. Parkinson¹, A. Thomson². ¹The University of Manchester, UK;

²Salford Royal Hospital, UK

**Introduction:** Patients with idiopathic Parkinson's disease (iPD) are often exposed to a variety of drugs with anticholinergic effects. These agents may cause a variety of unwanted antimuscarinic side-effects which can exacerbate non-motor symptoms, including effects on cognition. Delirium is associated with poor prognosis and may be more prevalent in PD patients. This study aimed to examine the influence anticholinergic drugs may have on unplanned iPD admissions and delirium.

**Methods:** A retrospective case note review of unplanned admissions in patients with iPD to the medical unit of a University teaching hospital was undertaken. An anticholinergic burden (ACB) score was calculated for each admission and the relationships between ACB score and delirium, with various clinical and non-clinical parameters, were investigated and adjusted for comorbidities.

**Results:** 89 patients (52 male, mean age 76.8 years) accounted for 133 admissions. A positive ACB score was identified in 70.7% of admissions with an overall average of 2.008. The ACB score was found to be significantly decreased in patients with dementia (p=0.009) but not associated with delirium alone (p=0.198) or adverse outcomes requiring further care (p=0.533). Investigation of delirium alone demonstrated significant associations with dementia (p=0.019), adverse outcomes (p=0.005), infectious pathology (p=0.011) and increased length of stay (p=0.030).

**Conclusions:** Although adverse cognitive effects of anticholinergic medications are well-recognised, there was no correlation with delirium in this cognitively vulnerable group. This absence of association in Parkinson's disease patients seems counterintuitive, and the reasons for this warrant further investigation.

P-161

Assessment of risk of delirium in geriatric patients using the Neecham Confusion Scale

S. Blandfort, M. Gregersen, K. Rahbek, E.M. Damsgaard. Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark

**Objectives:** Delirium frequently occurs among elderly hospitalized patients. Currently more than 40 delirium screening instruments exist. Confusion Assessment Method (CAM) is the most commonly used. However, CAM does not predict whether patients are at risk of developing delirium during hospital stay or assess the severity of the condition. The Neecham Confusion Scale (NEECHAM) is developed for that purpose. Our aim was to validate NEECHAM (translated from Swedish) in Danish patients in a geriatric ward.

**Methods:** A pilot study included 60 patients (aged ≥75 years), acutely admitted to a geriatric ward at Aarhus University Hospital from 15 September to 14 October 2016 for both medical and surgical reasons. Delirium was assessed morning and evening using CAM, which is part of the usual procedure. NEECHAM was measured within 24 hours after admission to the ward. Tests for concurrent and predictive validity were used to compare NEECHAM with CAM as the golden standard. The total score ranges from 0 (confusion) to 30 (normal function). A value of 25 or more was considered to be normal.

**Results:** The mean age of the patients was 86 years (± 5.5). Sixty-six percent were women. The incidence of delirium was 16.7%. The sensitivity of NEECHAM was 50% and the specificity was 35.2%. The
positive and the negative predictive values were 7.89% and 86.4%, respectively.

**Conclusion:** NEECHAM does not seem to be suitable for predicting delirium in older geriatric patients acutely admitted to hospital due to the low positive predictive value.

## P-162

### Delirium as a predictor of mortality and institutionalization in nonagenarian patients admitted to an intermediate care unit

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

**Aim:** To assess whether delirium in nonagenarian patients is a predictor of mortality and institutionalization at discharge of an intermediate care unit.

**Patients and method:** Prospective study of nonagenarian patients admitted to an intermediate care unit. Demographic variables (age, sex) and main medical diagnoses (fracture-injury, neurological, cardiopulmonary, vascular and others) were recorded. The presence of delirium was evaluated during admission using the Confusion Assessment Method (CAM). Patients who died during admission and were discharged to nursing home were registered. The patients who came from a nursing home prior to admission, died and were transferred to the acute care hospital were excluded.

**Results:** Two hundred and twelve patients (75.90% female) were recorded. Ninety (42.45%) had delirium, 18 (8.50%) died and 54 (32.53%) were institutionalized at discharge. The main medical diagnoses were: 124 (58.50%) fracture-injury; 30 (14.15%) neurological; 20 (9.43%) cardiopulmonary, 7 (3.30%) vascular and 31 (14.62%) others. Of the 18 patients who died, 12 (66.67%) had delirium and 6 (33.33%) had not. Of the remaining 194, 78 (40.21%) had delirium and 116 (59.79%) had not (p=0.030). Of the 54 patients who were institutionalized, 30 (55.56%) had delirium and 24 (44.44%) had not. Of the remaining 112, 34 (30.36%) had delirium and 78 (69.64%) had not, (p=0.002).

**Conclusions:** The prevalence of delirium in nonagenarian patients hospitalized in an intermediate care unit was high. The delirium could be a predictive factor of mortality and institutionalization at discharge in nonagenarian patients admitted to an intermediate care unit.

## P-163

### Delirium in a geriatric population suffering from dementia: Complication or picture at the onset?

M.J. Ceravolo, C. Alfano, S. Geniere Nigra, G. Cuzzoni, L. Venturini, G. Ricevuti. *Department of Internal Medicine and Therapeutics, University of Pavia*

Delirium is a serious syndrome related to an increase of the length of hospitalization, the risk of instituzionalization, the morbidity and the mortality. Delirium can be found in any medical condition and is common in hospitalised elderly patients in his hyperactive, hyperactive and mixed form. This syndrome occurs in 20% of subjects affected by dementia.

**Study design:** The aim of the current experimental study is to determine factors associated with the incidence of delirium in a hospitalized geriatric population with dementia.

**Materials and methods:** Over the course of 15 months, 167 patients aged 65 years and older, with cognitive decline, were enrolled in the Alzheimer Unit of the S. Margherita Hospital of Pavia. The patients came from the home or from acute wards. The diagnosis of delirium has been provided by applying the criteria of the DSM-V supported by the use of CAM.

**Results:** Delirium had been recorded in 10,18% of the patients, in almost all cases in its hypoactive form. On admission it was

strongly associated with several conditions: cognitive decline, vascular dementia and Alzheimer disease, adverse drugs effects, severe cardiovascular and pulmonary diseases, neuropsychiatric disorders, hospitalization, urinary/kidney tract infection, liver disease, alcohol withdrawal, neoplasms. The data obtained from this work are in agreement with the international literature on the acute mental confusion. We can identify three potential pathophysiological mechanisms underlying the clinical condition: a state of systemic inflammation, poor nutritional/metabolic conditions, a state of dehydration.

**Conclusion:** Our results confirm the presence of an association between delirium and advanced age, reduced autonomy and multicomorability. Our study also confirms the association between delirium and systemic inflammatory markers, malnutrition and dehydration.

## P-164

### Delirium in elderly patients with hip fracture

S. Jiménez Mola¹, J. Idoate Gil¹, M. López Viñas², P. Sáez López³, E. Martín Pérez⁴, K. López López⁵. ¹Complejo Asistencial Universitario de León, León. Spain; ²Centro de Mayores de Armunia, León. Spain; ³Complejo Asistencial de Avila, Avila. Spain; ⁴Hospital San Juan de Dios, León. Spain; ⁵Hospital San Juan de Dios, Burgos. Spain

**Introduction:** One of the most common postoperative complications after hip fracture repair is delirium. The aim of the present study was to evaluate the occurrence of delirium in patients admitted to hospital for femur fracture and to identify individuals at high risk of delirium.

**Methods:** We enrolled 534 patients with hip fracture, aged 75 years or older in an Orthogeriatric Unit between December 2013 and November 2014. Underwent comprehensive geriatric assessment that evaluates comorbidities, medication use, ability to perform basic activities of daily living, place of residence, anesthesia risk as measured by the ASA score, type of fracture, type of surgery and anesthesia, in-hospital mortality, and healthcare variables (pre-operative and overall stay). Delirium was evaluated by the Confusion Assessment Method (CAM).

**Results:** Among the 534 participants, 499 (93%) underwent surgery. The mean age 86.1±7.3 years (75–105 years) and 75.4% were women. Only 132 (25%) had a previous diagnosis of dementia. Forty-three patients (36,7%) developed delirium. The incidence of delirium was lower in the group without dementia (26%) than in the group with probable dementia (56%) and with Mild Cognitive Impairment (49%), (p<0.001). In comparison to patients without delirium, those who developed delirium were not significantly older, more limited in outdoor mobility and basic activities of daily living (p>0.5). Patients who developed delirium presented a longer length of stay (median 13.09 versus 11.30; p<0.001).

**Conclusions:** Clinicians treating people with a hip fracture should be vigilant towards peri-operative delirium if their patients have pre-existing cognitive impairment.

## P-165

### Delirium in hospitalized older patients – An educational project to raise awareness and minimize risks

A. Hofmann¹, E. Kaufmann², M. Gosch¹. ¹Geriatric department, Klinikum Nürnberg, Paracelsus Medical University, Prof. Ernst-Nathan Str.1; ²Center for Medicine of Ageing, Klinikum Nürnberg, Paracelsus Medical University, Prof. Ernst-Nathan Str.1

**Introduction:** Delirium affects more than 50% of hospitalized older persons and is often followed by serious and even life threatening complications. Furthermore delirium is associated with a high burden not only for the patient but also for caregivers. Still delirium in clinical practice often remains unrecognized.
**Methods:** We established a hospital-wide case-based interprofessional training program on delirium including preventive, screening and non-pharmacological treatment methods. The program was built up on a structured management pathway. Incidence and duration of delirium as well as rate of diagnosed delirium according to DRG-system were assessed before and after the intervention. Care giver burden before and after the intervention was assessed by semistructured interviews. The program also included information of relatives, the results so far are not completely assessed.

**Results:** After implementation of the training program a significant increase in the diagnosis of delirium was mentioned and duration of delirium was shortened, whereas no changes were recorded regarding the incidence of delirium. In semi-structured interviews care-giver knowledge on key aspects in the management of delirium was associated with diminished burden.

**Conclusions:** Structured, case based training programs can be implemented in a broad setting and have a positive effect on awareness and duration of delirium.

## P-166

### Delirium recognition in clinical practice according to severity and motor subtype: Data from the "Delirium Day 2016" national survey

E. Mossello¹, A. Morandi², A. Mazzone³, S.G. Di Santo⁴,
A. Cherubini⁵, A. Marengoni⁶, M. Bo⁷, A. Zambon⁸, F.L. Fimognari⁹,
M. Campanini¹⁰, M. Montorsi¹¹, I. Penco¹², F. Perticone¹³,
N. Ferrara¹⁴, M. Trabucchi¹⁵, G. Bellelli¹⁶. ¹Research Unit of Medicine
of Ageing, Department of Experimental and Clinical Medicine,
University of Florence and Azienda Ospedaliero-Universitaria Careggi,
Firenze, Italy; ²Department of Rehabilitation and Aged Care
"Fondazione Camplani" Hospital, Cremona, Italy; ³Redaelli Geriatric
Institute, Milano, Italy; ⁴Department of Clinical and Behavioral
Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia,
Roma, Italy; ⁵Geriatrics and Geriatric Emergency Care, IRCCS-INRCA,
Ancona, Italy; ⁶Department of Clinical and Experimental Sciences,
University of Brescia, Italy; ⁷Division of Geriatrics, Città della Salute e
della Scienza - Molinette, Torino, Italy; ⁸School of Medicine and
Surgery, University of Milano-Bicocca; ⁹Italian Society of Hospital's
and Community Geriatrics (SIGOT); ¹⁰Federazione Italiana delle
Associazioni Dirigenti Ospedalieri Internisti (FADOI); ¹¹Italian Society
of Surgery; ¹²Italian Society of Palliative Care; ¹³Italian Society of
Internal Medicine (SIMI); ¹⁴Italian Society of Gerontology and
Geriatrics (SIGG); ¹⁵Italian Psychogeriatric Association (AIP); ¹⁶School
of Medicine and Surgery, University of Milano-Bicocca, and Division of
Geriatrics, San Gerardo University Hospital, Monza, Italy

**Introduction:** Delirium is often not recognized and recorded in clinical practice. The present large multicenter study aimed (1) to assess the ability of nurses to identify delirium features in comparison with a standardized clinical assessment; (2) to identify the effect of delirium severity and motor subtype on delirium recognition.

**Methods:** 2877 Italian inpatients aged 65+ were included in "Delirium Day 2016", a national delirium point prevalence study. The nurse on duty was asked to report the presence of three delirium features (acute change, fluctuations and impaired arousal) for each subject, who was formally assessed using 4AT afterwards, with scores >4 indicating delirium. Delirium severity was defined according to 4AT score (4-7 mild; 8+ severe) and motor subtype according to Delirium Motor Subtype Scale-4. Vital status one month after the assessment was recorded.

**Results:** Prevalence of delirium was 22% (n=634). Nurse identification of at least one delirium feature had an 86% [83, 89] sensitivity and an 81% [79, 82] specificity for delirium diagnosis. Sensitivity was 80% for mild cases and 93% for severe ones. Sensitivity was lowest for delirium without motor features (59%) and highest

for mixed (hypo/hyperkinetic) one (97%). Delirium defined either with 4-AT or according to nurse observation showed a similarly increased mortality risk, with severe cases being associated with greater mortality (13%) compared with mild ones (5%).

**Conclusions:** Systematic record of nurse observation in routine practice might be an efficient method to detect delirium, especially of severe cases with a greater impact on survival.

## P-167

### Developing family-centered delirium care: A participatory action research study

L. Van Humbeeck, L. Dillen, R. Piers, N. Van Den Noortgate. Ghent University Hospital, Ghent, Belgium

**Introduction:** Delirium is probably the most common symptom of disease at old age. Healthcare professionals (HCPs) at acute geriatric wards are well-trained in delirium management. Yet delirium often leaves a significant impression on family caregivers, who are pivotal partners during and after admission. Although HCPs are aware of this impact, family's concerns are often overlooked. This study aimed at supporting HCPs in developing family-centered delirium care (FCdC).

**Methods:** The study was conducted at the delirium room, a four-bed unit at the acute geriatric ward of Ghent University Hospital with round-the-clock nursing care for agitated geriatric patients. A working group of HCPs developed a tailored FCdC trajectory based on participatory action research (PAR). Two 0.5 FTE researchers enabled co-creation between HCPs, patients and family and monitored the action cycles.

**Results:** First, shadowing and benchmarking of FCdC occurred. In a second phase the working group was composed and started to develop FCdC goals. Based on discussing care situations it was decided to develop and unroll a new welcome policy for family. An action plan was made up and tested. Finally, the project was evaluated by interviewing all stakeholders.

**Conclusion:** Delirium in acute geriatric wards asks for a multifactorial, interdisciplinary, and individualized care approach: all aspects in which HCPs are well trained. Yet delirium also asks for a FCdC approach, an aspect that often challenges HCPs. PAR, a relatively new approach, allowed to develop a tailored FCdC approach. It offers a flexible trajectory that uses local knowledge and takes into account possible hindrances.

## P-168

### Development and validation of the delirium risk assessment score (DRAS)

R. Vreeswijk¹, I. Kalisvaart², A. Maier³, C.J. Kalisvaart¹. ¹Spaarne Gasthuis, Haarlem (NL); ²IGZ, Utrecht (NL); ³VU Amsterdam (NL)

**Objectives:** Development and validation of a simple clinical prediction rule for identifying patients at risk for delirium during their hospitalstay. Using evidence based predisposing risk factors for delirium and easily assessed at hospital admission without the additional testing or labresults.

**Design:** A prediction model was developed in a mixed patient cohort (N=842). Al risk factors were weighed to establish their relation with delirium. Validated in 2 orthopedic patientcohorts (N=408, N=365) and in N=365 cohort the DRAS was compared calculating AUC, sensitivity and specificity with 3 other prediction rules: the Inouye, Kalisvaart and Dutch VMS rules which require a more extensive data collection.

**Results:** Nine risk factors were analyzed, 8 were significantly predictive and after -2log likelihood calculation for weighing the factors, the final DRAS is obtained by given 3 points to acute admission, alcoholabuse >4 units/day, cognition problems, 2 point to ADL problems, 1 point to age (>75), hearing/vision problems, polyphar-
macy (>5), previous delirium. Comorbidities>2 was excluded. The delirium incidence 31.8%, the AUC 0.76 (95% CI: 0.72-0.79), sensitivity 0.77, specificity 0.60. At >5 points the delirium risk is considered positive. DRAS AUC in the validation studies was 0.75 (95 %CI: 0.96-0.81), and 0.76 (95% CI: 0.70-0.83), Kalisvaart AUC 0.74 (95% CI: 0.67-0.81), Inouye AUC 0.70 (95% CI: 0.62-0.78) and VMS AUC 0.70 (95% CI: 0.62-0.77). DRAS sensitivity ranges from 0.65 to 0.77, specificity 0.60 to 0.72.

**Conclusion:** The DRAS is an easily established delirium risk score based on the admission interview using predisposing delirium risk factors. The simplicity of the DRAS means that the data collection required is feasible in busy wards without the extra testing or labvalues. The DRAS performs well in comparison to more elaborate scores.

P-169

Drug prescription and delirium in older persons. Results from
the Italian Delirium Day 2016

G. Aloisi¹, A. Marengoni², A. Cherubini³, E. Mossello⁴, S. Di Santo⁵,
A. Mazzone⁶, M. Bo⁷, P. Porrino⁷, F. Fimognari⁸, M. Campanini⁹,
M. Montorsi¹⁰, I. Penco¹¹, N. Ferrara¹², F. Perticone¹³,
M. Trabucchi¹⁴, A. Morandi¹⁵, G. Bellelli¹⁶. ¹Post-graduate School in
Geriatrics, University of Brescia, Brescia, Italy; ²Department of Clinical
and Experimental Sciences, University of Brescia, Brescia, Italy;

³Geriatrics and Geriatrics Emergency Care, IRCCS-INRCA; Ancona,

Italy; ⁴Department of Experimental and Clinical Medicine, University
of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence,
Italy; ⁵Department of Clinical and Behavioral Neurology,

Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Roma, Italy;

⁶Department of Rehabilitation, Redaelli Geriatric Institute, Milan, Italy;

⁷SCDU Geriatria e Malattie Metaboliche dell'Osso, Citta' della Salute e della Scienza Molinette-Torino;

⁸Italian Society of Hospital's and community Geriatrics (SIGOT); ⁹Federazione Italiana delle Associazioni Dirigenti Ospedalieri Internisti (FADOI); ¹⁰Società italiana di Chirurgia;

¹¹Società italiana di Cure Palliative; ¹²Department of Translational Medical Sciences, University of Naples “Federico II” and Italian Society of Gerontology and Geriatrics, Italy; ¹³Italian Society of Internal Medicine, Rome, Italy;

¹⁴Department of Systems Medicine, University of Rome “Tor Vergata” and Geriatric Research Group, Brescia (Italy);

¹⁵Department of Rehabilitation and Aged Care "Fondazione Camplani"
Hospital, Cremona, Italy; ¹⁶School of Medicine and Surgery, University
of Milano-Bicocca

**Objective:** The aim of this study was to evaluate the association between number of prescribed drug categories and delirium in older persons.

**Methods:** Data were collected during the "Delirium Day", a point prevalence study including 4810 patients (65+ year-old) across acute and long-term wards in Italy. Delirium was assessed on the same day according to 4AT Score. Prescriptions were classified by main drug categories. Analyses were carried out in patients admitted to acute clinical and surgical units (n=2517).

**Results:** 573 out of 2517 participants had delirium (22.8%). The mean number of drug categories after the exclusion of psychotropics, i.e. neuroleptics, trazodone and benzodiazepines, was similar in patients with or without delirium (5.2 vs. 5.1, p=0.330). When we analysed separately patients admitted to clinical (n=2261) and surgical units (n=256), we found that patients admitted to surgical units and diagnosed with delirium were prescribed with a higher number of drugs than those without delirium (6.5 vs. 4.7, p<0.001). This association was still significant after adjustment for age, sex, education, dementia and the Charlson Index (OR=1.3;95% CI: 1.1–1.5). No prescription of psychotropic medications was inversely correlated with delirium in the whole sample (adjusted OR=0.54;95% CI: 0.43–0.68) and in the two hospital settings.

**Conclusions:** The association between number of drugs and delir-

ium varies by hospital setting being significant only in surgical units and rising the issue of medication reconciliation in those units. The inverse association between no prescription of psychotropics and delirium could be a proxy of the absence or a lower severity of mental diseases.

P-170

Factors associated with delirium superimposed on dementia: The results of the “Italian Delirium Day 2016” study

A. Morandi¹, A. Zambon², A. Mazzone³, S. Di Santo⁴,

A. Cherubini⁵, E. Mossello⁶, A. Marengoni⁷, S. Gentile¹, M. Bo⁸,

F. Fimognari⁹, M. Campanini¹⁰, M. Montorsi¹¹, I. Penco¹²,

F. Perticone¹³, N. Ferrara¹⁴, M. Trabucchi¹⁵, G. Bellelli².

¹Department of Rehabilitation and Aged Care "Fondazione Camplani"
Hospital, Cremona, Italy; ²School of Medicine and Surgery, University
of Milano-Bicocca; ³Redaelli Geriatric Institute, Milan, Italy;

⁴Department of Clinical and Behavioral Neurology, Neuropsychiatry

Laboratory, IRCCS Foundation S Lucia, Roma, Italy; ⁵Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy; ⁶Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-

Universitaria Careggi, Firenze, Italy; ⁷Department of Clinical and Experimental Sciences, University of Brescia, Italy; ⁸Section of Geriatrics, Città della Salute e della Scienza - Molinette, Torino, Italy;

⁹Italian Society of Hospital's and community Geriatrics (SIGOT);

¹⁰Federazione Italiana delle Associazioni Dirigenti Ospedalieri

Internisti (FADOI); ¹¹Società italiana di Chirurgia; ¹²Società italiana di Cure Palliative; ¹³Italian Society of Internal Medicine, Rome, Italy;

¹⁴Italian Society of Gerontology and Geriatrics (SIGG; ¹⁵Italian

Psychogeriatric Association (AIP)

**Objective:** Few studies have investigated delirium superimposed on dementia (DSD) showing an association with mortality and functional declined. However, no studies have studied factors specifically associated with DSD. To fill the current gap we have designed the current investigation to evaluate factors associated with DSD in patients admitted to acute hospital and rehabilitation settings.

**Methods:** This was part of the "2016 Delirium Day", an Italian multicenter study to evaluate the delirium point prevalence among a large number of older patients (65 years and older) admitted to acute medical and surgical hospital wards and long-term care facilities. Dementia was defined through clinical records. Delirium was determined with the 4-AT. A multivariable logistic regression was used to determine factors associated with DSD, defined a priori.

**Results:** A total of 908 patients with dementia were included and 424 (47%) had delirium. The mean age was 85±6 years. A total of 577 (64%) were evaluated in acute hospitals and 331 (36%) in re-habilitations. Factors associated with DSD were severe malnutrition (Odds Ratio: 2.1, 95% Confidence Intervals: 1.27-3.16), prescription of antibiotics (OR 1.6, 95% CI: 1.16-2.26), typical and atypical neu roleptics (OR 1.71, CI: 1.16-2.5; OR 1.6, CI: 1.6-2.3), presence of intravenous lines (OR 1.56, CI: 1.14, 2.14), urinary catheter (OR 1.8, CI: 1.31-2.58), and wrist bends (OR 13.5, CI: 1.7-104).

**Conclusions:** The current study reports specific factors associated with DSD in patients admitted to acute hospital and rehabilitation setting, suggesting possible areas of interventions to reduce the burden of DSD related outcomes.

P-171

How to fight the delirium of ages: A position paper from an
Italian interdisciplinary experience

C. Paolillo¹, G. Bellelli², M. Trabucchi³, F. Perticone⁴,

M.P. Ruggieri⁵, N. Ferrara⁶, C. Tommasino⁷, A. Ferrari⁸, P. Gnerre⁹,

G. Ricevuti¹⁰. ¹Emergency Department, Udine Healthcare and
University Integrated Trust; ²Università degli Studi di Milano-Bicocca, SCC Geriatria, AO San Gerardo, Monza, Italia; ³Università di Roma "Tor Vergata", Roma, Italia, PRESIDENTE AIP; ⁴Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Italy, PRESIDENTE SIMI; ⁵Medicina d'Urgenza e Accettazione, Ospedale San Giovanni Addolorata, Roma, Italia, PRESIDENTE SIMEU; ⁶Medicina Interna e Geriatria, Università degli Studi di Napoli "Federico II", Napoli, Italia, Presidente SIGG - Società Italiana di Gerontologia e Geriatria; ⁷Dipartimento di Scienze Biomediche, Chirurgiche ed Odontostomatologiche, Università di Milano, ASST Santi Paolo e Carlo Polo Universitario, Milano, Italia, SIAARTI; ⁸UOC di Geriatria, ASMN-Azienda Ospedaliera di Reggio Emilia, Italia, PRESIDENTE SIGOT; ⁹Medicina, Ospedale San Paolo di Savona, Italia, FADOI; ¹⁰Azienda Servizi alla Persona, S. Margherita Institute, Pavia, Italy, Department of Internal Medicine and Therapeutics, Section of Geriatrics, University of Pavia, Italy

Over the age of 80 years, more than one third of those in hospital will experience Delirium. Despite its high prevalence, delirium often goes undetected and undetected delirium is associated with the highest mortality. Delirium prevalence is not bound by specialty and crosses over to both hospital and community settings. Given its ubiquity and its heterogeneous presentation, delirium diagnosis and management is the responsibility of all clinicians. To help address the need of develop a cultural movement that stressed early identification and the immediate removal of predisposing factors that can made an old patient more susceptible to delirium, in February 2017 an interdisciplinary group of clinicians and researcher belonging to fifteen Italian Scientific Societies (geriatricians, emergency physicians, internal physicians, anesthesiologists, surgeons, psychiatrists and toxicologists) shared ideas on advancing the best care practices in this field. After a review of international guidelines a writing group composed a draft and turned around by email, than after picking up suggestions and modifications the final document was produced. In summary, the document focused on the need of diagnosing delirium and the opportunity of a comprehensive patient-care program that prevents delirium. A little attention was given to pharmacological therapy, last beach only when the patient is in danger. To make the document as widely know as possible, it will be published in the Official Journal of the Societies in the coming months. We believe that only by involving all team members within the hospital we can fight that so common syndrome.

P-172

**Impaired cognition is highly prevalent and independently associated with adverse outcomes in older patients presenting to the emergency department; the APOP study**

J. Lucke¹, J. de Gelder², C. Heringhaus¹, J. Fogteloo³, S. Anten⁴, G.J. Blauw², B. de Groot¹, S. Moojaart⁵. ¹Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands; ²Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands; ³Department of Internal Medicine, section of Acute Care, Leiden University Medical Center, Leiden, The Netherlands; ⁴Department of Internal Medicine, section acute care, Alrijne Hospital, the Netherlands; ⁵Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands/Institute for Evidence-based Medicine in Old Age (IEMO), Leiden, The Netherlands

**Introduction:** We investigated whether impaired cognition is associated with adverse outcomes in older emergency department (ED) patients, because this association could have large implications for ED management and follow-up after disposition.

**Methods:** A prospective multi-center cohort study was performed in all acutely presenting older patients visiting the ED (APOP study).

Demographic data, disease severity and geriatric characteristics were collected during the first hour of the ED visit. Cognition was measured using the 6 Item Cognitive Impairment Test (6CIT). Cognitive impairment was defined as a 6CIT ≥11, self-reported dementia or the inability to perform the cognition test. Adverse outcome after three and twelve months was defined as a 1 point decrease in Katz-ADL, new institutionalization or mortality. Multivariable regression analysis was used to assess whether impaired cognition independently associates with adverse outcome.

**Results:** Of the 2131 included patients 588 (27.6%) had cognitive impairment. A total of 375 (24.5%) patients with normal cognition suffered from adverse outcomes after three months, compared to 280 (47.8%) patients with impaired cognition. The association remained after correction for baseline functional status, disease severity and comorbidities (OR 1.71, 95% CI: 1.36–2.15). After twelve months 332 (27.9%) patients with normal cognition suffered from adverse outcome, compared to 240 (54.5%) patients with impaired cognition (adjusted OR 1.89, 95% CI: 1.46–2.46).

**Conclusions:** Cognitive impairment is highly prevalent in older ED patients and is associated with adverse outcome after three and twelve months, independent of baseline functional status, disease severity and comorbidities. This emphasizes the importance for ED physicians to assess cognition and possibly intervene.

P-173

**Improving behaviour documentation in the acute hospital setting**

K. Spensley, O. Wilks, L. Tsam. West Middlesex University Hospital, London, England

**Introduction:** Behaviour charts are used in hospitals to assist clinical staff in providing best care for dementia patients with challenging behaviour (BPSD), and also to assist discharge planning. Staff are poorly compliant with current charts resulting in sub-optimal care with increased falls risk, discharge delays and readmissions. A new behaviour chart was thus needed to address these issues and aid staff compliance in chart completion.

**Methods:** Our population consisted of patients over 65 admitted to an acute medical ward with BPSD. No staff had specialist training for dementia care. A new chart was introduced which consisted primarily of tick boxes. Using questionnaires, we gathered subjective data about staff perceptions towards the old compared to the new charts, namely ease of completion and clinical relevance. We also compared objective data regarding chart completion, length of patient stay and patient fall frequency on both charts.

**Results:** Our preliminary results showed that accurate behaviour documentation increased from 38.0% to 73.3% (p<0.05) following new chart implementation. Useful differentiation between aggressive and calm behaviours were identified in 90% of new charts compared with 12.5% of the old (p<0.05), and identification of BPSD-triggers doubled. Additionally, staff satisfaction with the new charts increased from 17.54% to 100% (p<0.05). A preliminary correlation was noted between new chart use and reduced length of stay, although further results are awaited.

**Conclusion:** The new behaviour chart was well received by staff, which has improved engagement and positive outcomes for patients.

P-174

**Multifactorial pathogenesis and multicomponents treatment of delirium: A case report in Geriatric Intensive Care Unit (ICU)**

S. Venturini, F.M. Nigro, C. Ghiara, M. Torrini, E. Mossello. Geriatric Intensive Care Unit (UTIG), AOU Careggi, University Study of Florence, Florence, Italy

**Background:** In elderly, delirium is associated with increase of
mortality, extension of hospitalization, loss of functional autonomy. It's indicated to adopt preventive measures, identify the causes, consider the psychoactive therapy in case of persistent agitated behavior.

**Case:** Man, 77 years old, affected by hypertension, diabetes, chronic kidney failure, who was hospitalized in Geriatric ICU because of myocardial infarction undergoing PTCA and stenting. The hospitalization was complicated by haemopericardium, anemia, acute exacerbation of chronic kidney failure undergoing CVVHDF, nosocomial pneumonia treated with fluoroquinoloni. Fourty-eight hours from hospitalization, developed hyperkinetic delirium with persecutory ravings. In his medical history it's not present cognitive impairment; at the admission in the hospital, it was suspended triazolam, taken to sleep.

**Results:** The patient, initially sedated under continuous infusion with midazolam, in order to safety make CVVHDF, even if he was moved in an ordinary medical division, delirium has not been solved. He has been moved again in ICU where, once deep sedation i.v. has been carried on, he has started treatment with antibiotic, has been hydrated and feed with N.G. tube.

**Conclusion:** As well as myocardial infarction, infective state, renal failure, other reasons are the recovery in ICU, the suspension of chronic therapy with benzodiazepine and the choose of fluoroquinoli. The administration of antipsychotic and the transfer in ordinary medical division were not been sufficient. The solution is obtained through intensive therapy, via deep sedation that makes possible therapies of vital support, nutrition and hydration, to follow second line of antibiotic therapy and to treat a possible abstinence from benzodiazepine.

P-175

Precipitating factors for delirium in community-dwelling elderly individuals: a prospective case series

H. Lepetitcorps¹, M. Pociumban², Z. Bouksani-Kacher², E. Pautas², J. Belmin², S. Bastuji-Garin³, C. Lafuente-Lafuente². ¹Service de Gériatrie aiguë, Hôpitaux universitaires Pitie-Salpêtrière-Charles Foix, APHP, DHU FAST, Sorbonne Universités, UPMC Univ Paris 06, F-75013, Paris, France; ²Hôpitaux universitaires Pitie-Salpêtrière-Charles Foix, APHP, DHU FAST, Sorbonne Universités, UPMC Univ Paris 06, F-75013, Paris, France; ³Clinical Epidemiology and Ageing team (CEPIA), Service de Santé Publique, CHU Henri Mondor, F-94010, Créteil, France

Factors associated with delirium among community-dwelling old patients have not been extensively studied. Our aim was to investigate them. Consecutive patients admitted from home to three geriatric acute care units with a confirmed initial diagnosis of delirium were included. An independent investigator recorded using a predefined form any acute organic medical condition considered to be a precipitating factor, at the first patient assessment and at the end of his stay in acute care unit. The main objective was to describe the frequency of predisposing and precipitating factors for delirium in these patients. A secondary objective was to know if all precipitating factors were correctly recognized at patients' first assessment at hospital. A total of 208 patients were included, of whom 74.0% had a pre-existing cognitive disorder and 24.0% a history of neurological disease. The most frequent precipitating factors found were: 1) infections (49.0% of all patients), especially respiratory (22.1%) and urinary tract infections (15.4%); 2) dehydration and electrolytic disturbances (45.7%); and 3) drugs (30.8%). Acute neurological conditions were found only in 38 patients (18.3%). Fewer precipitating factors were found at first than at final assessment (1.4 per patient ±0.9 versus 1.9±1.02 respectively, p<0.001). This difference was significant for all categories of precipitating factors. Infections, hydro-electrolytic disorders and drugs seem to be the most frequent precipitating factors for delirium in community-dwelling elderly individuals. In all categories, a

significant number of precipitating factors are missed at the first evaluation of patients.

P-176

Prevalence and outcomes of delirium in older persons: The results of the "Italian Delirium Day 2016" study

G. Bellelli¹, A. Zambon¹, A. Morandi², A. Mazzone³, S. Di Santo⁴, A. Cherubini⁵, E. Mossello⁶, A. Marengoni⁷, M. Bo⁸, F. Fimognari⁹, M. Campanini¹⁰, M. Montorsi¹¹, I. Penco¹², F. Perticone¹³, N. Ferrara¹⁴, M. Trabucchi¹⁵. ¹University of Milano-Bicocca, Milan, Italy; ²Fondazione Camplani Hospital, Cremona, Italy; ³Redaelli Geriatric Institute, Milan, Italy; ⁴IRCCS Foundation S Lucia, Roma, Italy; ⁵Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy; ⁶University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy; ⁷University of Brescia, Italy; ⁸Città della Salute e della Scienza - Molinette, Torino, Italy; ⁹Italian Society of Hospital's and community Geriatrics (SIGOT), Roma, Italy; ¹⁰Federazione Italiana delle Associazioni Dirigenti Ospedalieri Internisti (FADOI), Roma, Italy; ¹¹Società italiana di Chirurgia, Roma, Italy; ¹²Società Italiana di Cure Palliative, Milano, Italy; ¹³Italian Society of Internal Medicine, Rome, Italy; ¹⁴Italian Society of Gerontology and Geriatrics (SIGG), Firenze, Italy; ¹⁵Italian Psychogeriatric Association (AIP), Brescia, Italy

**Objective:** To evaluate the prevalence of delirium and the 1-month mortality associated with in older hospitalized persons.

**Methods:** The "2016 Delirium Day" is an Italian multicenter study to evaluate the delirium point prevalence among older patients (65+ yo) admitted to acute medical and surgical hospital wards and long-term care facilities. Delirium was assessed on an index day (Sept 27th, 2016) according to 4AT score. One-month mortality was evaluated at follow-up. Analyses for the present study were carried out only in patients with 1-month follow-up after admission to acute clinical and surgical units (n=2480), post-acute care (n=540) and hospice (n=47).

**Results:** Overall, 527 (21.3%) in acute hospitals had delirium, while 74 (13.7%) in post-acute care and 20 (42.6%) in hospices. Among hospital wards, delirium prevalence was 25.7% in Geriatrics, 9.3% in Cardiology, 8.0% in General Surgery, 18.0% in in-hospital rehabilitation, 13.3% in Infectious diseases, 19.1% in Internal Medicine, 5.9% in Neurosurgery, 26.9% in Neurology and 15.9% in Orthopedics. At 1-month follow-up, the rate of mortality was 10.0% in patients with delirium vs 3.3% in those without. In a multivariate analysis, adjusted for age, education, setting, Charlson Comorbidity index, dementia and Activities of Daily Living score, delirium was independently associated with the 1-month mortality (Odds Ratio: 1.81, 95% Confidence Intervals: 1.18-2.77, p-value =0.006).

**Conclusions:** The data confirm the findings of the "2015 Delirium Day" edition, i.e., that >1/5 patients had delirium in acute hospitals and also suggest that delirium is an independent predictor of short-term mortality in older hospitalized patients.

P-177

Private rooms and prevention of delirium

A. Gade Holdensen, L. Madsen Fredholm. *Hospital Lillebælt, Kolding, Denmark*

**Introduction:** In October 2016 the Geriatric Ward at Hospital Lillebælt Kolding moved into new buildings. The old ward consisted of three four-bed rooms and three two-bed rooms, to a summary of 18 beds. The new ward consists of fourteen one-bed rooms and one two-bed room, to a summary of 16 beds. In the old ward constant interruptions were a part of day and night, and many patients had trouble sleeping. In the new ward there is a much calmer environment due to the private rooms and therefore we suspect that fewer patients develop delirium.

**Methods:** To investigate the suspected decrease in delirium we
assessed the use of haloperidol, as it is our first choice drug in the treatment of delirium. We assessed the daily dosages (DDD) of haloperidol per admitted patient in November 2015–March 2016 in the old ward and in November 2016–March 2017 in the new ward.

**Results:** The average use of haloperidol was 0.111 DDD per admitted patient in the old ward and 0.056 DDD per admitted patient in the new ward.

**Conclusions:** The use of haloperidol has decreased by 50% after moving into the new ward. We have had the same staff, the same assessment methods for delirium, and our clinical guideline hasn't changed between the two periods. The only difference is the structure of the ward. It is well known that facilitating a calm environment and securing sleep are major factors in preventing delirium. This study supports that knowledge.

P-178

Renal function is predictive of delirium in the orthogeriatric setting: the role of cystatin C

G. Rivasi¹, V. Tortù¹, A. Ceccofiglio¹, I. Iacomelli², M. Rafanelli¹, A. Cartei³, C. Rostagno³, A. Ungar¹. ¹Dept. of Geriatrics, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; ²Dept. of Internal Medicine, Santa Maria alla Gruccia Hospital, Montevarchi (AR) Italy; ³Dept. of Cardiology, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

**Background:** The occurrence of delirium is common in older hospitalized patients, particularly after surgery. There are no studies reffering to the association between delirium and renal function in the orthogeriatric-setting. Aim: To evaluate the predictive value of renal function in determining the risk of delirium in the orthogeriatric-setting.

**Methods:** Patients aged ≥65 consecutively referred to the orthogeriatric department for traumatic bone fractures were enrolled. Six equations were used to estimate glomerular filtration rate (eGFR) based on serum creatinine and/or cystatinC values obtained within 24hours of admission: Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on creatinine (CKD-EPIcr) and/or cystatin C (CKD-EPIcys, CKD-EPIcr-cys) and Berlin Initiative Study equations (BIS1 and 2). During hospitalization, delirium was assessed using the Cognitive Assessment Method algorithm. The predictive value of renal function was tested on the basis of creatinine and cystatinC levels and creatinine- and cystatinC-based eGFRs.

**Results:** 571 patients were enrolled (76.7% female; mean age 82.7±8.2 years). 73% of patients had serum creatinine≤1mg/dL. 192 patients (33.6%) had delirium: they had higher cystatinC levels (p<0.001) and a lower eGFR, regardless of the equation used. At multivariate analysis, a low CKD-EPIcys eGFR was predictive of delirium (OR 0.957; CI 0.918–0.998 p=0.042), with a 4% increased risk for each mL/min of decreasing eGFR. Equations using creatinine or creatinine-cystatinC together did not predict the development of delirium.

**Conclusions:** CKD-EPIcys eGFR is a predictor of delirium in orthogeriatric patients with sarcopenia and low creatinine levels. CystatinC-based eGFR may help improving patient management during hospitalization.

P-179

Suspicious minds

S. Ponnambath¹, R. Hinton¹, M. Devlin¹, J. Tam², K. Franks², A. Miller¹, F. Rickard¹, P. Toh¹. ¹University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; ²Queen Elizabeth Hospital, Gateshead, United Kingdom

**Case report:** A 91 year old lady presented to hospital with poor mobility, with concern from her residential home that she was

engaging less with staff and fellow residents. On initial assessment she appeared very suspicious and had particularly negative thoughts towards the staff at her residence. She hadn't been eating, believing that she was being poisoned and even felt that her family were conspiring against her. Examination revealed mild dysarthria and unsteady gait. Routine blood tests were unremarkable and CT brain revealed an old right occipital infarct and small vessel disease. After taking a careful collateral history it appeared that her suspicious thoughts began following an episode diagnosed as a TIA four months prior to her presentation. This behaviour persisted across a number of different environments and was having a hugely negative impact on her life and family relationships. She was reviewed by the psychiatrist and was given the diagnosis of organic psychosis secondary to TIA. She was started on low dose antipsychotics and made a dramatic improvement within a week.

**Conclusion:** This case demonstrates that TIA and stroke may result in atypical neuropsychiatric presentations, which are likely to present to psychiatry. This emphasises the importance of thorough investigation and highlights the valuable role antipsychotics can play in the elderly despite the risks attached to such therapies.

Area: Ethics and end of life care

P-180

Allow natural death: Do words matter

E. Kamp, J. Wright, R. Saad, E. Mucci. East Sussex Healthcare Trust

**Introduction:** There has been numerous anecdotal reports from doctors at East Sussex Healthcare Trust about the difficulties in discussing resuscitation with patients. The wording of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) is negative and detrimental to these discussions. The Gold Standard Framework and GMC recognise an alternative wording: Allow Natural Death. Our project looks to change the wording to Allow Natural Death (Do Not Attempt Cardiopulmonary Resuscitation).

**Method:** An online survey was emailed to all doctors at ESHT over a four week period. We received 132 responses from FY1 to consultant.

**Results:** There were many reasons why doctors felt patients disagreed with DNACPR decisions. 43% felt the wording of DNACPR forms contributed. Other factors included: poor understanding of CPR prognosis (82%), poor understanding of their prognosis (67%) and family member influence (55%). On a scale of 0 (very negative) - 5 (very positive) the wording of DNACPR scored 2.55 compared to 3.74 for AND (48% improvement). 66% felt substitution of DNACPR with AND (DNACPR) would help counteract poor patient response. Perceived barriers to this change included: difficulty changing established protocol (34%) and confusion for medical staff (44%).

**Conclusion:** Numerous factors contribute to patient resistance to resuscitation decisions and the wording of DNACPR forms was one these. Doctors felt that re-wording these forms to AND (DNACPR) would help discussions. In the coming months there will be educational events promoting this form in conjunction with good discussion technique. The proposal will be submitted to the resuscitation and end of life committees.

P-181

Association between education and status of receiving care among community dwelling older adults in Iceland

M. Chang¹, O.G. Geirsdottir², A. Ramel³, I. Kåreholt⁴, S.H. Sigurdarsdottir⁵. ¹The Icelandic Gerontological Research Center, National University Hospital of Iceland & Faculty of Medicine, Reykjavik, Iceland/School of Science and Engineering, Reykjavik
University, Reykjavik, Iceland; ²The Icelandic Gerontological Research National University Hospital of Iceland & Faculty of Medicine, Reykjavik, Iceland/Unit for Nutrition Research, National University Hospital of Iceland & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; ³Unit for Nutrition Research, National University Hospital of Iceland & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; ⁴Aging Research Center, Karolinska Institute, Stockholm, Sweden/Institute of Gerontology and Aging Research Network, School of Health and Welfare, Jönköping University, Sweden; ⁵School of Social Science, University of Iceland, Reykjavik, Iceland

**Background:** Older adults in Iceland have a good access to the health care and social services that support elderly to maintain independent living. Receiving informal care is common among older adults living in Iceland. The aim of this study is to analyze whether education is associated with the use of formal and informal care among older adults in Iceland.

**Methods:** The survey of Icelandic older people was conducted in 2008. The study population was a national sample of 721 persons aged 65 years and older living in Iceland. Older adults living in nursing homes were excluded from the survey. A telephone survey included questions on socioeconomic status (education and occupation), social network, health status, activities of daily living, and the status of received help either from the community elderly care system and/or from close family members and friends.

**Results:** Among the total sample, 372 (52%) people reported to receive either type of care. Among those who received care, 197 (53%) people reported receiving informal care only. The status of receiving informal care had shown that people with higher education had a significantly lower risk to receive informal care compared with people with lower education (odds ratio (OR) 0.67, 95% CI, 0.47–0.97, p=0.031), however formal care was not significantly associated with education level.

**Conclusions:** Informal care which is provided from the social network and family members are an important source for the elderly care system in Iceland. The contribution of informal care/help should be recognized when preparing the care of older people.

## P-182
### Caregiver burden in older patients with cancer or dementia

J. Massias¹, N. Oubaya²,³, E. Audureau²,³, S. Herbaud¹, E. Alonso¹, M.-A. Cariot¹, F. Canouï-Poitrine²,³, E. Paillaud ¹,²,* M. Laurent ¹,²,*
¹AP-HP, Hôpitaux universitaires Henri Mondor, Département de médecine interne et gériatrie, France; ²UPEC, DHU A-TVB, IMRB, EA 7376 CEPiA (Clinical Epidemiology And Ageing Unit); ³AP-HP, Hôpitaux universitaires Henri Mondor, Service de santé publique
*These authors contribute equally to this work

**Introduction:** The caregiver burden must be taken into account in chronic disease such as dementia or cancer in older patients. Level of the caregiver burden and factors associated with this burden are little known.

**Objectives:** To assess caregiver burden measured with Zarit Burden Interview (ZBI) in older patients with cancer or dementia, and to identify clinical factors associated with this burden.

**Methods:** This was an observational, cross sectional study of ambulatory individuals aged 70 and older. Patients were referred to geriatric clinic in French teaching hospital between 01/11/2013 and 01/06/2016. 52 cancer patients (group 1) were age- and gender-matched with 100 patients with dementia (group 2). We used linear regression and multi-level model to assess factors associated with ZBI increase.

**Results:** 152 patients with a median age (81.9 years group 1/82.2 years group 2) presented similar sociodemographic characteristics. The median ZBI score was lower in group 1 (14 IQR [7–25]) than in

group 2 (26 [16–43]), (p<0.00001)). Factors independently associated with caregiver burden were the degree of illness – metastatic disease in group 1 (p=0.06 and Mini Mental State Examination <10 in group 2 (p=0.006), and functional impairment (Activities of Daily Living score <6- p=0.06 for group 1 and 0.04 for group 2).

**Conclusion:** Although the caregiver burden is higher in patients with dementia than in cancer patients, associated factors are similar in both groups. The follow-up of caregiver burden and its predictive factors is required to identify most vulnerable caregivers who are most likely to need specific support.

## P-183
### Clinical audit: quality of end-of-life care in Long term care facilities in Western France in 2015

J. Prud'homme¹, K. Hammas², A. Corvol¹, D. Somme¹. ¹Rennes University Hospital, Geriatric Department; ²Rennes University Hospital, Public Health Department

101 long-term care (LTC) facilities are spread over Western France out of 572 in all country. In 2006, French Court of Audit considers that information systems do not give any information on the end-of-life in LTC facilities. This tranversal study is evaluating the quality of palliative care in LTC facilities between October 2015, the 15th and November 2015, the 15th in Western France. The outcome measure used was the Family Perception of Care Scale, translated in French. 70 LTC facilities were contacted. 12 participated. 37 deceased patients were identified. Over 20 family answers, 17 filled the questionnaire. Families' satisfaction total mean (± SD) was very high 145 (±25.1) as well as the sub-scales means (±SD): 63 (± 13.4) for residents care, 33.6 (± 6) for family support, 36.8 (± 5.8) for communication, and 11.6 (± 2.3) for rooming. The 3 priority items for providing quality end-of-life care were "My family member's pain was eased by to the greatest extent possible", "The staff were sensitive to the needs of my family member", and "The staff informed me when they thought that death was at hand". Those results are opposite to difficulties reported by half of the LTC practitioners, especially about lack of time, lack of human and financial resources and trainings. Ceiling effect and polarized answers seem to limit the data analysis. Other larger quantitative and qualitative studies appear to be led as end-of-life care in LTC departments belong to usual practice and is under-assessed.

## P-184
### Evaluation of quality indicators for patients with palliative or end-of-life care in primary health care

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

**Background and aim:** Study on the quality of clinical care for patients Palliative or End-of-Life Care assigned in a Primary Care Health Center (HC) and to compare them with patients in the Health Area (HA) and the autonomous community of Castile and León (CyL), Spain. (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 2015) with Palliative or End-of-Life Care (n=23). 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 0,05.3.

**Results:** Compliance criteria (year 2015): – Number of patients with the Palliative or End of Life guide, active at least one day in the
period 2015: HC 23 patients, HA 499 patients, CyL 2026 patients.
- How many have recorded the Visual Analog Pain Scale (VAS) in the period 2015?: HC 1 patients (4,35%), HA 80 patients (16,03%), CyL 498 patients (24,98%). - How many have registered skin and mucous care in the period 2015?: HC 0 patients (0%), HA 96 patients (19,4%), CyL 473 patients (23,35%).

**Conclusions:** The analysis of the records of care process indicators for patients with patients Palliative or End-of-Life Care makes us aware of the importance of patient control. Registration allows us to evidence improvements in the care process. To make a good registry of the controls, to adapt the interventions with the patient, adapting them to each case. After our analysis we say that we must improve the uptake of patients with patients Palliative or End-of-Life Care and the quality of the records of the care process.

P-185

**Gastrostomy's implantation in the geriatric patient: survival analysis**

T. Martínez Maroto, V. Landaluce Pelligra, E. García Tercero,
M. Araujo Ordóñez. *Hospital Virgen del Valle, Toledo, Spain*

**Introduction:** Gastrostomy's implantation in the elderly patient supposes in many times an ethical issue, especially in relation to the effectiveness of them extending the life of our patients. The decision to place the gastrostomy involves, among others, the assessment of the cause of dysphagia.

**Study design:** Retrospective study in patients older than 75 years who underwent gastrostomy's implants due to different causes. Sample: Patients older than 75 years, hospitalized in the Geriatrics, Internal Medicine and Neurology departments of Toledo Hospital Complex, in the period from 2011 to 2016, who underwent gastrostomy's implants during admission.

**Material and methods:** For our study, we used a collection notebook with different variables including dysphagia, patient comorbidity, cognitive and functional status, age, place of residence, type of enteral nutrition, post-implant survival and cause of death If it had happened.

**Results:** Sample of 197 patients, 53.3% women. Regarding the cause of dysphagia, in 29.9% of patients it was cerebrovascular accident, in 60.7% the cause was cognitive impairment in different stages and in the remaining 9.4% it was motivated by other reasons. The service that most requested the placement of gastrostomy was Geriatrics department. In 50.3% of the cases, the diet used was normoproteic and normocaloric. Regarding the survival after gastrostomy, the median was 16 months (95% CI: 8.78-23.21). In subgroup analysis, survival after stroke was 22 months (95% CI: 4.15-39.8) and in 17-month (moderate-severe) dementia (95% CI: 5.77-28.22) Without appreciating significant differences between them (p: 0.984).

**Conclusions:** After the analysis, we conclude that the underlying pathology or the cognitive status should not be an impediment to the initiation of enteral nutrition, since we did not appreciate significant differences in mean survival after implantation.

P-186

**How do the doctors live mourning in their wards?**

R. Fernandes, F. Leal-Seabra, A.R. Ramos, P. Monteiro, P. Caiano-Gil,
R. Veríssimo, V. Paixão-Dias, A. Oliveira. *Internal Medicine Service,
Centro Hospitalar de Vila Nova de Gaia-Espinho, Oporto, Portugal*

The recognition of human finitude is essential to the knowledge of all health professionals, since death will be part sooner or later of their daily lives. Observational, Cross-sectional study, convenience sampling. Included all the physicians who worked at the Internal Medicine/Geriatrics wards. An anonymous online questionnaire was created with Googleforms®, with 47 multiple choice questions evaluating sociodemographic issues, professional experience and

training skills in Clinical Communication (CC), Palliative (PC) and Mourning Care (MC). The response rate was 32% (56/175). Therefore 75% were female, 71.4% residents, with 25-30 years old (53.6%). Most of them (43%) were working less than 1 year. Negative answers for training skills in PC (57.1%), CC (71.5%) and MC (58.9%). It is agreed the universal need of MC training (94,6%), because 47,9% are incapable of answering the patients' needs. Death is a natural process (100%), 12.5% of these professionals had advanced directives of will (ADW) and about 10% are in mourning. When a patient dies 87.5% can give bad notices by telephone and 97.4% personally, but 46% with difficulty. The majority (80.4%) feel that death isn't a clinical failure, 85,7% include the patient/caregivers in decision-making and 71.5% talk about the patients' ADW. Then 62.5% can recognize non-adaptive mourning. After the patient's death, 5.4% make telephonic contact and around 10% schedule meetings. Only 5.4% participated in the funeral celebrations. Universal training skills in this area is required, both at the pre-graduate and post-graduate levels since most of these professionals are very young and with lack of experience.

P-187

**Improvement in DNACPR discussion and form completion in elderly oncology patients**

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

**Introduction:** The General Medical Council and Resuscitation Council UK guidance advises a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) discussion and form should be considered in patients with advanced disease, irreversible disease or those approaching end of life. The project aim was to improve forward planning with early DNACPR decisions in elderly oncology patients.

**Methods:** We identified 30 patients over 65 years with end stage cancer who were audited for DNACPR discussion and form completion. The 1st round interventions included audit result feedback, and teaching. 2nd round interventions included prompting senior Doctors, increasing DNACPR form availability and addition of a DNACPR status on the ward list. Re-audits post intervention was performed to assess improvement.

**Results:** A n initial audit showed 12 (40%) patients had a DNACPR discussion and form documented. Following 1st round interventions there was an improvement to 20 (67%) patients, and post 2nd round interventions a further improvement to 26 (87%) of 30 patients, with a DNACPR discussion and form documented.

**Conclusions:** The project showed that audit feedback, teaching, prompting Senior Doctors, increased form availability and a DNACPR section on the Oncology patient list, encouraged good practice. In turn this improved early and timely DNACPR discussion and form completion to 87% in elderly end stage oncology patients.

P-188

**Inhospital mortality risk model in very old patients admitted with descompensated congestive heart failure. A view from palliative care**

J. Marttini Abarca, L. Fernandez Arana, E. Lueje Alonso, F.J. Martin Sánchez, P. Gil Gregorio. *Clinico San Carlos Hospital, Madrid, Spain*

**Introduction:** Objective: design a risk model which help identify patients with descompensated congestive heart failure (DCHF) at high risk for in-hospital mortality who might benefit from palliative care in a Geriatric department.

**Methods:** Retrospective cohort study. Includes patients ≥80 years old admitted to a Geriatric Acute Care Unit with DCHF. January 2012 - December 2014. Variables included: Age, sex, cardiovascular risk factors, comorbidity, NYHA class, functional status, geriatric syndromes, treatment, left ventricular ejection function and laboratory
variables, previous treatment and cause of exacerbation. In-hospital mortality was the primary outcome. A multivariate logistic regression analysis was performed. Discrimination was examined with ROC curves and an internal validation and a score were carried out. Statistical analysis: SPSS version 23.0.

**Results:** 629 patients, age: 90 (SD5), female: 470 (73.1%). Severe comorbidity (Charlson Index ≥3): 559 (89%). Died during hospitalization: 86 (13.7%). Multivariate analysis: NYHA class III and IV (OR: 2.03; 95% CI: 1.13–3.66), Katz index <2 (OR: 1.77; 95%CI: 0.98–3.19), infection as cause of exacerbation of HF (OR: 2.06; 95% CI: 1.09–3.87), polypharmacy (OR: 1.87; 95% CI: 1.05–3.33), albutamin <3 mg/dl (OR: 1.85; 95% CI: 1.03–3.31), glomerular filtration rate <60 ml/min (OR: 2.21; 95% CI: 1.12–4.37), hyperkalemia >5.5 mEq/L (OR: 2.60; 95% CI: 1.01–6.69) and RDW >17% (OR: 3.33; CI: 1.84–6.03). The area under ROC curve was 0.78 (CI: 0.73–0.84, p=0.029). Internal validation 0.77 (95% CI: 0.71–0.82, p=0.03).

**Conclusion:** This model allows to detect that older patient with advanced organ disease that would benefit from palliative care, using easily obtainable clinical variables and analytical parameters in addition to the cardiovascular factors.

## P-189

### Knowledge about advance directives and attitudes towards discussing end-of-life care in older people attending primary care clinics

M. Carpena-Ruiz¹, M. Puerto del Antonio², S. González-Rodríguez¹, M.V. Valverde-Moyar¹, A.J. Cruz-Jentoft³, C. Verdejo-Bravo⁴.
¹Centro de Salud Valdelasfuentes, Alcobendas, Spain; ²CS Colmenar Viejo Norte, Colmenar Viejo, Spain; ³Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain; ⁴Hospital Clínico San Carlos, Madrid, Spain

**Introduction:** Advanced directives on end-of-life care preferences were regulated by Law in Spain in 2002. However, little is known about a, information received and use of living wills by older people in our country.

**Method:** Descriptive study of an opportunistic sample of subjects 65+ years old attending two primary care practices. A structured interview was used to assess knowledge on advance directives and availability of a living will, where information was obtained, and attitudes about discussing end-of-life issues.

**Results:** 243 subjects (88.9% living in the community, 11.1% in care homes), mean age 78.1 years (65–100), 39.5% males. Education: 23% secondary or higher, 69% primary studies, 7% illiterate. Only 16.9% knew what advance directives are (most of them through social media, few from family or physicians) and only 2 (0.8%) had a living will. 57.2% of the subjects they were reluctant to discuss end-of-life issues. Should they start a discussion, 70% would do it with members of their family, 16% with health care providers, 9% with friends; 5% would never accept discussing this topic.

**Conclusions:** Roughly 17% older subjects in our country have any information about advance directives, 15 years after the Law was passed. They mostly receive information through social media, with a marginal role for doctors. Less than 1% has a living will. A large majority are reluctant to discuss this topic and would start such discussion with family members. New approaches should be explored to improve the use of advance directives in our country.

## P-190

### Living with advanced chronic heart failure: a phenomenological study

I. Renaud¹, P. Ponce-Leão², C. Sampaio¹. ¹Universidade Católica Portuguesa - Instituto de Bioética; ²CECH/Universidade de Coimbra

**Introduction:** Chronic Heart Failure (CHF) is increasing in prevalence and will continue to do so with an ageing population. Few

studies describe the experiences of elderly people who are very ill and living with advanced CHF from a lifeworld perspective and how meaning is created about personal dignity in daily life.

**Methods:** Data were collected through in-depth interviews with twelve Portuguese older people with advanced CHF. The transcribed texts from the interviews¹ were analysed using phenomenological hermeneutical method.

**Findings:** The results demonstrate two main themes: the perspective of oneself as vulnerable and as a significant person. From the elderly people's stories it is clear that in order to keep a sense of dignity people need to be seen and respected for who they are. This study adduces ethical questions about a person's basic rights to be cared for with dignity, also providing the elements required for realizing and maintaining respect in the care of older people in home settings and the factors connected to it.

**Conclusions:** Findings demonstrate the need for health care professionals to find an approach that ensures both good quality medical care and, at the same time, acknowledges the uniqueness of each subject.

## P-191

### Palliative care and symptom control at the end of life in very old patients admitted with advanced dementia

J. Marttini Abarca¹, P. Carrillo Garcia¹, M. Oviedo Briones², B. Perdomo Ramirez³. ¹Clinico San Carlos Hospital, Madrid Spain; ²La Paz Hospital, Mdrid, Spain; ³La Cruz Roja Hospital, Madrid, Spain

**Introduction:** The objective was to analyze the medical management and symptom control at the end of life of patients with advanced dementia admitted to an acute geriatric unit (AGU).

**Methods:** Descriptive study in patients aged 75 and older, with a history of severe dementia admitted at the AGU (died from any cause). January 2014 to December 2015. Variables: demographic data, medical history, type of dementia, comorbidity (Charlson index), functional status (Barthel index), polypharmacy, reason for admission and cause of death, advance directives and adequacy of therapeutic effort. In the last 48 hours we evaluated: symptom control, treatment, complementary tests. Statistical analysis: SPSS version 23.0.

**Results:** 50 patients, age 88.8 (SD: 5.9), female 50%. institutionalized 28%. Number of drugs: 7 (IQR 4–9), median hospital stay: 6 (IQR 3–12.25), primary caregiver - family:66%. Type of dementia (Alzheimer:44%, vascular:6%, mixed:14%, not studied:28%, others:8%). Charlson index: 2 (IQR 1–3). Pluripathology:80%, Barthel index <20: 90%, dysphagia:52%. Cause of admission (respiratory tract:36%, urinary tract:18%, neurological:14%, infected pressure ulcers:12%) Cause of death (respiratory tract:42%, urinary tract:20%, infected pressure ulcers:10%, neurological:8%) Not control symptoms: pain:14%, dyspnea:48%, psychomotor agitation:24%, nausea:2%, respiratory secretions:60%. Drugs used for symptom control: sedatives:54%, opioids:82%, neuroleptics:14%, anticholinergics:50%, analgesics:74%, Oxygen:78%. Complementary tests: blood test:40%, X-ray:28%. Remained Intravenous hydration:24%, remained active treatment with antibiotics:24%. DNR order:94%. Active treatment (suspended:66%, not initiated:16%), adequacy of therapeutic effort:84%, information to the family:96%. None of the patients had advance directives.

**Conclusion:** There was an adequate clinical recognition of patients at the end of life. Even though a few remained with active treatment perhaps due to a rapidly progressive deterioration.
P-192

**The geriatric dilemma: is less aggressive management a trap of ageism or letting nature take its course?**

A. Micallef¹, M. Grech², A. Vella³. ¹Mater Dei Hospital; ²St. Vincent de Paul Residence, Malta; ³Karin Grech Rehabilitation Hospital, Malta

We report a case of a ninety-five year old male who is a known case of vascular dementia and a resident at St. Vincent de Paul Residence. His general condition deteriorated owing to episodes of shortness of breath secondary to recurrent pleural effusions and lung collapse. He was managed with repeated thoracentesis and chest drain insertion. Appropriate management led to a dramatic improvement. Even though the patient in question was ninety-five years of age with co-morbidities, great symptomatic improvement was achieved. This case highlights how appropriate intervention has led to an improvement in the quality of life of the patient in spite of his age and his co-morbidities. Thus, the clinician should not be caught in the trap of ageism and withhold treatment at a relatively early point in the management of elderly patients in distress.

P-193

**The Gold standard Framework in Acute Hospital- Priorities for care of the dying person**

A. Tong, S. Shafiq, N. Ruff, C. Hooper, C. Mcgrath, H. Costelloe, T. Morton, C. Agogbua, K. Niranjan. *Queen's Hospital*

**Introduction:** The Gold Standard Framework (GSF) is a programme designed to identify patients that are progressing towards the end stages of their lives and empowering these patients by involving them in the management plan allowing them to make decisions regarding their end of life care such as preferred place of care. GSF also provide appropriate support for patients in community requiring palliative input also improve communication between community and hospital teams.

**Methods:** A retrospective analysis of total 623 patients were registered for GSF and on the palliative registry from 2013 to 2017. Patients were identified suitable for GSF by clinical judgement during their admission in hospital. The question posed in identifying these patients was suitable for GSF discussion with the patient and family. Patients were then stratified into colour coding depending on their prognosis or life expectancy.

**Results:** Median Age of the population group was 85, 483 (77%) patients had passed away since they had been added to the registry, 397 (64%) had decided on a preferred place of care. 175 (28%) patients had chosen their preferred place to be their own home. Clear escalation plan communicated with patient and family members and 72% alert recorded in central computer database.

**Conclusion:** GSF Allows sufficient time for physicians to engage in the topic of end of life and for patients to reflect on their end of life plans also empowers patients and relatives to make decisions regarding their end of life and minimise traumatic experiences for patients in their end of life care.

P-194

**Validation of the Supportive and Palliative Care Indicators Tool (SPICT) in a geriatric population**

R. De Bock¹, N. Van Den Noortgate², R. Piers². ¹Ghent University, Faculty of Medicine and Health Science, Ghent, Belgium; ²Department of Geriatrics, Ghent University Hospital, Ghent, Belgium

**Introduction:** Timely identification of patients in need of palliative care is especially challenging in a geriatric population because of prognostic uncertainty. The Supportive and Palliative Care Indicators Tool (SPICT) aims at facilitating this identification, yet hasn't been validated in a geriatric population admitted to the hospital.

**Methods:** All patients admitted to the acute geriatric ward of a Belgian university hospital between January 1st and June 30th 2014 were included. Data considering demographics, functional status, comorbidities, Do-Not-Resuscitate (DNR) codes and one-year mortality were collected. SPICT was measured retrospectively by an independent assessor.

**Results:** Out of 435 included patients, 54.7% had a positive SPICT, using a cut-off value of two for the general indicators and a cut-off value of one for the clinical questions. SPICT-positive patients were older (P=0.003), more frequently male (P=0.028) and had more comorbidities (P=0.015) than SPICT-negative patients. The overall one-year mortality was 32.2%, 48.7% in SPICT-positive patients and 11.5% in SPICT-negative patients (P<0.001). SPICT predicted the one-year mortality with a sensitivity of 0.841 and a specificity of 0.579. The area under the curve of the general indicators (0.758) and the clinical indicators of SPICT (0.748) did not differ (P=0.64). In 71.4% of SPICT-positive cases, a DNR-code was present versus 26.9% in SPICT-negative cases (P<0.001).

**Conclusions:** SPICT is a valuable tool for identifying geriatric patients in need of palliative care as it is significantly associated with one-year mortality and with clinical predictive survival by experienced geriatricians, as reflected by DNR-codes given.

P-195

**What leads care managers to engage in end-of-life discussions with older clients in Japan? An examination on the effect of clients' use of home-visiting medical care services**

C. Shimada, R. Hirayama, T. Wakui, M. Ito. *Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan*

**Introduction:** Using national long-term care insurance, Japanese older adults are supposed to consult with care managers about how to arrange public care services to negotiate age-related functional decline. Given the influence that care managers exert on older adults' lives, they have the potential to encourage their clients to become prepared for their end-of-life. Our aim in this study was to explore whether and how care managers' engagement in end-of-life discussions with their clients was influenced by clients' use of medical care services in home.

**Methods:** We conducted a mail survey of care managers from certified home care support offices in both urban and rural Japan (N=3,320). Data were analyzed to identify whether and how the number of clients who received home-visiting medical care was associated with (a) the proportion of clients with whom participants talked about end-of-life preferences and (b) that of clients they asked about type(s) of medical treatment wished for in their end-of-life.

**Results:** Having had more clients who received home-visiting medical care made it more likely for participants to talk with their clients about both general end-of-life preferences and wished-for type(s) of medical treatment. These results were obtained while controlling for participants' job-related backgrounds.

**Conclusions:** Results suggest that Japanese care managers are urged to engage in end-of-life discussions in the process of arranging in-home medical care services for their clients. Future research should investigate what leads them to engage in such discussions before their clients become so seriously ill as to require substantial medical care.
# Area: Frailty and sarcopenia

## P-196
1-Year change in quality of life, assessed with the specific questionnaire SarQoL®, is associated with 1-year change in physical performance

C. Beaudart, M. Locquet, L. Delandsheere, J.-Y. Reginster, O. Bruyère. Research Unit in Public Health, Epidemiology and Health Economics (URSAPES), University of Liège, Liège, Belgium

**Background:** Recently, the SarQoL®, a quality of life questionnaire specific for sarcopenia has been developed. Our aim was to assess the relationship between 1-year change in quality of life (QoL) and 1-year change in musculoskeletal health.

**Methods:** The SarQoL®, the specific QoL questionnaire, as well as the EQ-5D and the EQVAS, two generic QoL questionnaires were completed by 301 subjects from the SarcoPhAge study (Sarcopenia and Physical impairments with advancing Age, a cohort developed in Belgium). Muscle mass (ALM/h², assessed with DXA), grip strength (assessed with hydraulic dynamometer) and gait speed were evaluated. Sarcopenia was diagnosed according to the EWGSOP algorithm.

**Results:** After one year of follow-up, the QoL of the general population (75.0±5.97 years, 59% women) decreased (p<0.001 with the SarQoL®, p=0.03 with the EQVAS, p<0.001 with the EQ-5D). The ALM/h² was not significantly modified but a decrease in muscle strength and gait speed was observed (p<0.001 for both). A significant correlation was found between 1-year decrease in gait speed and 1-year decrease in QoL only when using the specific questionnaire SarQoL®, but not when using the generic EQ-5D or EQVAS tools. Results indicated a correlation of r=0.21 (p<0.001) for the whole cohort population and r=0.41 (p=0.013) for the sarcopenic elders (n=38). These associations were not observed for muscle mass (p=0.65) or muscle strength (p=0.06). Using a multivariate regression the association between decreased gait speed and decreased QoL, assessed with the SarQoL®, was significant, independently of age, sex, number of comorbidities and number of drugs (p<0.001 for both whole cohort and sarcopenic subjects).

**Conclusion:** Our findings suggest that a decrease in physical performance (gait speed) is associated with a decrease in QoL, specific of muscle impairments, in elders and more specifically in those suffering from sarcopenia. The specific SarQoL® seems better adapted than generic tools to identify decrease in QoL related to muscle function.

## P-197
A simple, pragmatic frailty detection tool can predict adverse outcomes when used in the Emergency Department

S. Lewis, L. Evans, T. Rainer, J. Hewitt. Cardiff University, Cardiff, United Kingdom

**Introduction:** Older people commonly experience adverse outcomes after urgent care use; early identification of frailty is key to allow targeted interventions.

**Methods:** Casenote review of consecutive emergency department (ED) attendances in patients aged 75+ for the British Geriatrics Society's Frailsafe screening questions [1] and demographics. Electronic record review for admission outcomes, mortality, re-attendance at 30, 120, 180 days and institutionalisation at 180 days.

**Results:** 468 patients were included. Frailsafe was completed in 356 patients. Mean (Standard deviation (SD)) age was 85.8 (5.8) for frail and 82.2 (5.4) for non-frail patients (p<0.001). More frail than non-frail patients had died (35/190 (18.4%) vs 15/152 (9.9%), p=0.026) or been institutionalised (22/190 (11.6%) vs 2/152 (1.3%), p<0.001) at

180 days. Admitted frail patients had greater median (interquartile range) lengths of stay (LOS) (7 (2–32) vs 4 (2–10), p=0.037), inpatient mortality (12/116 (10.3%) vs 3/81 (3.7%), p=0.043), and 30-day re-attendance (33/112 (29.5%) vs 11/75 (14.7%), p=0.009). Discharged patients had similar re-attendance rates. Frailsafe independently predicted LOS >28 days (adjusted odds ratio (AOR) 3.42 (95% CI: 1.41–8.31, p=0.007), 30-day post-admission re-attendance (OR 2.73 (1.27–5.88, p=0.010), combined admission-related adverse outcome (LOS>28 days/inpatient mortality/institutionalisation/30-day re-attendance) (OR 2.67 (1.42–4.99)), 180 day mortality (AOR 3.23 (1.45–7.19)) and institutionalisation (AOR 8.95 (2.01–39.83)) and combined long-term adverse outcome (death/institutionalisation at 180 days, AOR 3.55 (1.64–7.67)). Frailsafe did not predict ED re-attendance.

**Conclusions:** Frailsafe independently predicts adverse outcomes amongst older ED attendees, suggesting a role for routine use.

## References:

[1] British Geriatrics Society. Frailsafe. [Accessed Nov 28 2016].
Available from: http://www.frailsafe.org.uk

## P-198
Agreement and predictive validity of the EWGSOP and FNIH sarcopenia definitions. The Glisten study

S. Volpato¹, L. Bianchi¹, E. Maietti¹, F. Landi², GLISTEN Study Group, Italy. ¹University of Ferrara, Italy; ²Università Cattolica del Sacro Cuore, Roma, Italy

**Background:** Sarcopenia may contribute to disability and mortality. Multiple research groups, including the European Working Group on Sarcopenia in Older People (EWGSOP) and the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project, proposed criteria for sarcopenia diagnosis. Although measures of muscle mass and muscle strength overlap, the operational definitions differ. We assessed agreement of EWGSOP and FNIH definitions and prediction of prevalent disability and mortality risk in a sample of older hospitalized Italian patients.

**Methods:** Cross sectional and longitudinal analysis of 611 participants enrolled in a multicenter observational study of older adults admitted to 12 hospitals. Weakness was determined according to handgrip strength using a hand dynamometer, appendicular lean mass using bioimpedance analysis, and walking speed according to 4-m usual walking speed. For both definitions two categories of intermediate and severe sarcopenia were created according to the presence of two or three criteria, respectively. Analyses were performed using Cohen's kappa, logistic regression and Cox models.

**Results:** Prevalence of intermediate sarcopenia was 24% and 36% using the FNIH and EWGSOP criteria, respectively, whereas prevalence of severe sarcopenia was 18% and 20%. Agreement between EWGSOP and FNIH classifications was low using both definitions (Kappa Statistic: 0.12 and 0.26, respectively). Intermediate and severe FNIH sarcopenia was statistically associated with prevalent ADL disability, but only severe EWGSOP definition was. In multivariable analyses, both FNIH definitions predict one-year mortality whereas EWGSOP definitions were not significantly associated.

**Conclusions:** Agreement between EWGSOP and FNIH sarcopenia definitions is low. FNIH classification better predicts important clinical endpoints.

## P-199
Anemia and frailty in the elderly hospitalized in an acute unit: Preliminary results

X. Sui Seng, N. Kadri, J. Doucet, E. Andres. CHU Rouen

**Introduction:** Anemia is a frequent reason for hospitalization in acute geriatric units. The elderly are particularly susceptible and can condition the prognosis in cases of poor tolerance. Our goal is to
determine if anemia is a geriatric frailty factor. The main objective is to research the link between anemia and weakness according to FRIED. The secondary objectives are on the one hand looking for a link between anemia and weakness according to SEGA, and on the other hand, the research for a link between anemia and ADL, IADL, and MMS.

**Method:** This is a prospective, observational study, conducted in an acute geriatric unit at Rouen, from May 1 to August 31, 2016. All patients older than 65 years were included; only palliative patients were excluded.

**Results:** 120 patients were included, 62 anemic (51.7%). 77 women (64.2%). The average age of 86.8 years. 7% of subjects aged <75 years; 26% of subjects aged between 75 and 85 years; 68% of subjects aged ≥85 years. In the anemia group: the average age is 87.4 years; with a female predominance (42 patients). 55 patients have cardiovascular antecedents, of whom 13 have a documented heart failure. The Charlson average is 7.88. On the clinical side, 16 patients had mucocutaneous pallor and 21 had dyspnea. The hemoglobin average count is 9.7 g/dl (6 to 11.9), with an average MCV to 91.83fl, thrombocytopenia associated with 2 cases, lymphopenia associated with 18 cases and high PNN for 8 cases. On the side of autonomy and frailty: ADL average is 1.8; IADL average is 0.52; MMS average is 16.6; Fried average is 3.8 and SEGA average is 17.8. We found 7 deaths in the service. In the group of non-anemic patients: average age 86.1, with a female predominance (35 cases); history of cardiovascular disease in 49 patients, including 12 with documented heart failure. The average Charlson score is 7. The average hemoglobin is 13.48g/dl, albumin at a rate of 29.7g/l; ADL average at 3.7, IADL average at 1.9, MMS average at 18.6, SEGA average at 12.6 and Fried average at 2.26. In bivariate analysis, anemic patients are more fragile as evidenced by the Fried's score (3.87 IC [3.62; 4.12] vs. non-anemic subjects: 2.26 IC [1.89; 2.63], p<0.0001), but also SEGA score (17.87 IC [16.99, 18.75] vs. non-anemic subjects: 12.62 [11.33, 13.91], p<0.0001) and less autonomous (ADL: 1.81 IC [1.51; 2.11] vs. non-anemic subjects IC 3.69 [3.27; 4.11], p<0.0001; IADL 0.53 IC [0.32; 0.75] VS non-anemic subjects 1.88 [1.58; 2.18], p<0.0001). In multivariate analysis, we can say that on average, anemic subjects have a FRIED score increase of 1.64 compared to non-anemic (of the sample). The increasing of FRIED score in anemics should be between 1.21 and 2.08. If we adjust on albumin, age, sex, and heart failure, the result is almost unchanged. This means that albumin, gender, age, and heart failure equal, a subject that has anemia will have on average a FRIED larger of 1.64 point compared to a non-anemic subject (95: 1,19; 2.09). These results are significant (p<0.0001). Multivariate analysis wasn't done for the MMS because some data is missing.

**Conclusion:** In all cases, anemia is a frailty marker independent from albumin, age, sex, heart failure. The clinical contribution of anemia in evaluating frailty is not obvious. If FRIED was made for a patient, does the information of anemia bring something? To answer the question, we should analyze the relationship of the adjusted anemia on the FRIED in models explaining an outcome such as rehospitalization, falls, or death.

## P-200
### Association between fall in the previous year with some comprehensive geriatric assessment components

C. Kılıç¹, R. Demir², G. Bahat¹, M.A. Karan¹. ¹Department of Internal Medicine, Division of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; ²Cardiology Institute, Istanbul University, Istanbul, Turkey

**Introduction:** In this study, we aimed to analyse the association between fall in the previous year with some comprehensive geriatric assessment components.

**Methods:** The subjects were composed of older adults (>65 y)

admitted to geriatric outpatient polyclinic of a university hospital in Istanbul, Turkia between October 2016 and April 2017. We retrieved data on fall in the previous year, postural instability, short physical performance battery, functional reach, BIA detected fat %, ADL, IADL, urinary incontinence, constipation, SARC-F sarcopenia screening test. The correlation between fall number in previous 1 year and the aforementioned parameters were investigated.

**Results:** A total of n=186 participants (125 female, 61 male) were included. There were 82 participants with at least 1 fall in last year (58 female, 24 male). Mean age was 76±7.4 years. There was a moderate and significant association between the fall no, urinary incontinence (r=0.54, p<0.0001) and SARC-F sarcopenia score (r=0.38, p=0.004).

**Conclusions:** In predicting falls, urinary incontinence and sarcopenia detected by SARC-F score may aid the clinicians.

## P-201
### Association between frailty and phase angle derived from bioelectrical impedance analysis among elderly patients

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

**Introduction:** Phase angle derived from bioelectrical impedance analysis is a parameter that has been shown to be associated with sarcopenia and malnutrition in the elderly population. However, its relationship with frailty has not been adequately studied. Here, we aimed to investigate association between phase angle and frailty in elderly.

**Material and methods:** One hundred and eighty-eight elderly patients (age over 65) were included in the study. All patients underwent comprehensive geriatric assessment. The frailty status of the patients were evaluated by Fried's Frailty Index which has five components including weight loss, weakness, exhaustion, low activity and slow speed walking. Those who had three or more positive results in this scale were considered "frail", 1–2 points were considered "pre-frail" and those who satisfied none of these criteria were considered "robust". All patients were evaluated by using bioelectrical analysis device to determine phase angles.

**Results:** The median age of the patients were 74 years (min-max: 65–91) and 41.5% were female. The most common co-morbidities were hypertension (75.5%) and diabetes mellitus (41.0%). Mean ± SD phase angle was lower in frail group compared to pre-frail and robust groups (4.12±0.79 vs. 4.60±0.63 vs. 5.20±0.80, respectively) (p<0.001). The parameters which were significantly different (p<0.2) in univariate analysis were included in multivariate analysis and phase angle (OR: 0.360, p=0.018), age (OR: 1.132, p=0.020), mini-mental state examination (OR: 0.777, p<0.001) and Yesavage geriatric depression scale (OR: 1.307, p=0.002) were found to be independently associated with frailty. Receiver operating characteristic (ROC) analysis suggested that optimum cut-off point of phase angle for frailty was ≤4.00 with 54.8% sensitivity, 91.0% specificity, 54.8% positive predictive value and 91.1% negative predictive value (AUC: 0.751, p<0.001).

**Conclusion:** Our results suggest that phase angle may be an independently associated factor for frailty. Further prospective studies are needed to investigate casual relationships between these entities.

## P-202
### Association between results on four clinimetric tests at hospital discharge and falls after hospitalisation in older patients

I.P.B. Tournoij, H. Nijboer, C.M.J. van der Linden. Catharina Hospital Eindhoven, Eindhoven, The Netherlands

**Introduction:** Thirty percent of community dwelling people aged 65 and over fall at least once a year. Emergency room visits have
increased up to 137% in the last 20 years [1]. Many clinimetric tests are available to analyse and predict the risk of falling. However, little is known about the risk of falling after hospitalisation and how to evaluate this risk. The main objective of this study is to assess the association between the results on four clinimetric tests at hospital discharge and falls after this hospital stay.

**Methods:** We performed an observational study including patients of 65 years or older admitted to internal medicine, pulmonary and gastroenterology wards of the Catharina Hospital in Eindhoven, the Netherlands. Participants performed four clinimetric tests at discharge: timed up and go, chairstand, handgrip strength and legstrength. After discharge, participants used a fall calendar and we contacted participants by phone every two weeks for 18 weeks. We compared outcomes on clinimetric tests of fallers with those of non-fallers using Students T-test.

**Results:** We included 129 participants, of which 41% were female and mean age was 75 years. Thirty-four participants reported a fall after hospitalisation. Pair wise comparisons found no difference in results on clinimetric tests between fallers and non-fallers.

**Conclusions:** There is no association between results on four clinimetric tests at discharge and falls in four months after discharge. For predicting fall risk after hospitalisation using clinimetric tests further research is necessary.

**References:**

[1] Hartholt KA, et al. Trends in fall-related hospital admissions in older persons in the Netherlands. Arch Intern Med. 2010 May 24;170(10):905–11.

P-203

Association of physical frailty with cognitive function and mood
in patients without dementia and depression

R.T. Doğrul, C. Kızılsarslanoğlu, H.D. Varan, M.K. Kılıç, F. Sümer, G. Arık, Ö. Kara, B. Can, G.Ş. Ayçiçek, G. Güner, B.B. Yavuz, M. Halil, M. Cankurtaran. *Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Geriatrics*

**Aim and background:** Frailtyis mostly defined as a geriatric syndrome consists of medical problems and functional loss increasing the risk of hospitalization and may result in mortality. It is thought that physical frailty is related to cognitive functions and social status. In this study, we evaluated the associationof physical frailty with cognitive function and mood in patients without dementia and depression.

**Material and methods:** In this study, we evaluated 612 patients aged 65 years and over admitted to our outpatient clinic. For evaluation of physical frailty we used Fried criteria. According to Fried criteria, the patients having 3 or more points were reported as frail, having 1 or 2 points as pre-frail and 0 point as robust. We also performed detailed comprehensive geriatric assessment. Depression status of the patients was screened with Yesavage Geriatric Depression scale. Cognitive functions were screened with MMSE and clock drawing test. Patients with dementia and depression were excluded.

**Results:** Mean age of the patients was 72 and 58% was female. Diabetes mellitus and hypertension were the most common comorbidities (35,6% and 67,2% respectively). Forty five percent of patients were robust, 48.4% were prefrail and 6.5% were frail. When grouped according to frailty, clock drawing test (p<0.001), MiniMental State Examination test (p<0.001), Yesavage Geriatric Depression scal (p:0.01) weresignificantly different between groups. Age (p: 0.009), educational level, being university graduat (p:0.031), three words recall tes (p: 0.014), Activities of Daily Livingscore (p: 0.006), Instrumental Activities of Daily Livingscore (p<0.001), Mini Nutritional Assessment (p: 0.001) were determined to be independent factors related to frailty.

**Conclusion:** In this study, we have demonstrated that cognitive

function and mood are associated with physical frailty in patients without dementia and depression. Further studies are needed to elucidate the causal relationship between these entities.

P-204

Audit: Implementation of vitamin D guidelines in hip fracture
care pathway to improve management of vitamin D deficiency

H. Shah, A. Jacob, A. Brown. Arrowe Park Hospital, Wirral, UK

A growing cohort of evidence suggests Vitamin D supplementation in patients with fracture neck of femur is associated with reduced readmission rates, improved physical performance and reduced risk of further fractures. Prior to February 2015, there were no recommendations on the local Hip Fracture pathway regarding Vitamin D testing or management. 0% of patients had vitamin D levels checked. In February 2015, National Osteoporosis Society guidelines were incorporated into a Hip Fracture Care pathway. The following audit assessed if incorporation of these guidelines in the Hip Fracture Care Pathway improved vitamin D deficiency management in fracture neck of femur patients. A cohort of patients admitted with fracture neck of femur were analysed from February 2016 - Information obtained via patient e-records. 49 patients were studied. 41 patients had vitamin D levels checked on admission (84%). Of these 41 patients, 16 were vitamin D deficient – 8 patients were given a loading regime of colecalciferol (50%), 5 received the maintenance dose of Adcal (31%) and 3 received no intervention (19%). Where colecalciferol was prescribed, information regarding monitoring was provided on the discharge letter to primary care in 100% of cases. Patients with vitamin D level >25nmol/L, 92% of patients received Adcal D3. Incorporation of Vitamin D guidelines within a hip fracture protocol has significantly improved identification and management of Vitamin D deficiency. To further improve compliance, we aim to develop a flagged note on e-prescribing systems when prescribing colecalciferol, advising what to prescribe, and include Vitamin D tests in A&E Triage.

P-205

Cathepsin K activity controls cardiotoxin-induced skeletal
muscle repair in mice

S. Ogasawara, X.W. Cheng, A. Inoue, M. Kuzuya. *Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of medicine*

**Introduction:** Cathepsin K (CatK) is a widely expressed cysteinyl protease that has gained attention due to its enzymatic function and nonenzymatic function as signaling. Here, we hypothesized that CatK-deficient (CatK-/-) would mitigate injury-related skeletal muscle remodeling and fibrosis in mice, with a special focus on inflammation and cell apoptosis.

**Methods:** Cardiotoxin was injected into the left gastrocnoleus muscle of male wild-type (CatK+/-) and CatK-/- mice, and then the mice were processed for morphological and biochemical studies.

**Results:** On post-injection day 14, CatK deletion ameliorated the muscle interstitial fibrosis and remodeling and performance. At an early time point (day 3), CatK-/- educed the lesion macrophage and leukocyte contents and cell apoptosis, the mRNA levels of monocyte chemoattractant protein-1, toll-like receptor-2, and toll-like eceptor-4, and the gelatinolytic activity related to matrix metalloproteinase-2/-9. CatK silencing also restored the changes in the protein levels of caspase-3 and cleaved aspase-8 and the ratio of the BAX to the BCL-2. Moreover, CatK deficiency protected muscle fiber laminin and desmin disorder in response to CTX injury. These muscle eneficial effects were mimicked by CatK-specific inhibitor treatment. In vitro experiments demonstrated that pharmacological CatK inhibition reduced C2C12 mouse myoblasts' apoptosis and the levels of BAX and caspase-3 proteins induced byCTX.
**Conclusions:** These results demonstrate an essential role of CatK in skeletal muscle loss and fibrosis in response to CTX injury, possibly via the reduction of inflammation and cell apoptosis, suggesting a novel therapeutic strategy for the control of skeletal muscle diseases by regulating CatK activity.

## P-206
### Cellular senescence and falls in elderly patients with sarcopenia

J. Sulicka-Grodzicka¹, K. Piotrowicz², K. Bukowska-Strakova³, M. Strach², T. Grodzicki², A. Skalska². ¹Department of Rheumatology and Balneology Jagiellonian University Medical College, Krakow, Poland; ²Department of Internal Medicine and Gerontology Jagiellonian University Medical College, Krakow, Poland; ³Department of Clinical Immunology and Transplantology, Children's University Hospital, Krakow, Poland

**Background:** Immunosenescence involves changes in the immune system which result in chronic, low-grade inflammation, higher prevalence of infections and other age-related diseases. Inflammation contributes to age-associated loss of muscle mass, sarcopenia and elevated risk of falls. The aim of the study was to examine adaptive immune system and the presence of persistent infection in the context of functional impairments in elderly patients with sarcopenia.

**Methods:** Flow cytometry studies were performed in patients 70 years and older with performance score 3–9 points in short physical performance battery (SPPB) and sarcopenia diagnosed using SARC-F questionnaire and DXA measurements. Lymphocytes T and B subsets, including cells representing “immune risk profile”: CD19, terminally differentiated CD8+CD45RA+CCR7-CD27-CD28- (TEMRA), CD4+/CD8+ ratio were evaluated, as well as cytomegalovirus (CMV) IgG seropositivity.

**Results:** Mean age of 38 patients (84% women) was 77.9±5.9 years. The prevalence of CMV serology was 84%. The percentage of CD8+TEMRA lymphocytes was negatively associated with BMI-adjusted appendicular lean mass (r=-0.35; p<0.05). Over half of study participants (52%) reported having experienced a fall within past year. Patients with falls had higher SARC-F score (3.3±1.4 vs. 1.8±1.5; p=0.003). We found increased prevalence of CD8+TEMRA lymphocytes in patients with history of falls compared with non-fallers (2.0 [1.0–3.3]% vs. 0.6 [0.3–1.6]%; p=0.01).

**Conclusion:** Our findings indicate that persistent viral infection leading to accumulation of senescent, pro-inflammatory, highly differentiated CD8+ T cells may be related with loss of muscle mass and may contribute to elevated risk of falls in elderly, sarcopenic patients.

## P-207
### Challenges with a new tool in screening of frailty

S.M. Aurelian¹, R. Dascalescu², A. Zamfirescu¹, V. Elian¹, A. Capisizu. ¹University of Medicine and Pharmacy “Carol Davila”; ²University of Medicine and Pharmacy “Carol Davila”

**Introduction:** Frailty represents an important issue in geriatric assessment. Atherosclerosis is one of the most frequent pathology and an important risk factor for cardiovascular disease at the elderly [1]. We aimed to create a new index for an easier screening tool of frailty at elderly with diabetes or cardiovascular pathology.

**Methods:** This is an observational six months study (June-December 2016) included 143 participants; 81.2% female and 18.8% males; mean age was 72.28±10.098 years, with or without diabetes. Frail assessment was made by Fried's five criteria established. We included arterial stiffness (Aortic pulse wave velocity-PWV) in the new index. This was measured using an oscillometric device (Arteriograph)[2] in addition to a medical history, physical examination, and laboratory tests.

**Results:** Outcomes shows statistically significant correlation between frailty and arterial stiffness on diabetic than non-diabetic groups (Chi square test, p=0.010). Women are more frail (Chi square test, p=0.039) and in particular elderly living alone (Chi square test, p<0.001) in urban areas. PWV aortic shows a frailty better classification: frail group (19.57%) became pre-frail (14.68%) and robust (4.89%) in new classification.

**Conclusions:** Vascular assessment is useful in clinical evaluation of frailty, alongside of Fried's phenotype. A pre-frail old people can become a robust one with a personalized cardiovascular treatment.

**References:**

[1] Capisizu A, Aurelian SM, Badiu C, Zamfirescu A. Multifactorial hemodynamic entities of hypertension at the elderly. Acta Medica Mediterranea 2015; 31(4):847–850.

[2] Ring M, Eriksson M, Zierath JR, Caidahl K. Arterial stiffness estimation in healthy subjects: a validation of oscillometric (Arteriograph) and tonometric (SphygmoCor) techniques. Hypertension Research (2014) 37, 999–1007.

## P-208
### Changes in skeletal muscle mass assessed with BIA during acute hospital admission

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

**Introduction:** Bio-impedance analysis (BIA) is a simple portable method to assess skeletal muscle mass in older patients that can be used at bedside during hospital admission. However, dehydration and fluid overload, frequent in acute care, may limit its value in this setting. We are studying changes in BIA skeletal muscle mass (SM) during hospital admission, we report here a preliminary analysis of the first subjects included.

**Methods:** Prospective, observational study of all patients admitted to a geriatric acute care unit. Muscle mass was estimated by BIA (Janssen's equation) on admission and at discharge.

**Results:** 81 patients have been included in the study at this time (60% women, mean age 93±4 years, mean length of stay 7±5 days, mortality 7%). All data were available in 61 patients. When comparing SM at admission and discharge, 58% had a loss of SM, 4% had a stable SM and 38% had an increased SM at discharge. Average change during admission was 1±1kg (Range: 0.02–14.6kg). Those who lost SM were more often males (53% vs 22%, p=0.01) and had more anemia (31% vs 4%, p<0.05). We found no differences in age, comorbidities, ADLs, use of drugs or social status with those that did not lose SM. We found no differences according main diagnosis, or length of stay. Mean CPR was higher in those with loss of SM (118 vs 52, p=0,007).

**Conclusions:** Skeletal muscle mass can be estimated with BIA in acute geriatric patients, and changes along hospital admission. Whether this changes are due to changes in hydration or with a real loss of muscle mass remains to be determined.

## P-209
### Characteristics of elderly fallers with hip fractures in Singapore

K. Mamun, M.H. Nguyen, L.L. Chen, W.C. Foo. Singapore General Hospital

**Introduction:** Falls leads to an estimated 95% of hip fractures incidence in elderly population resulting in hospitalization, disability, and loss of independence. One-year mortality rates after this injury range from 20–30%. Approximately half of patients who used to live independently became reliant on their caregivers or required institutionalization. This study aims to characterize the elderly fallers with hip fracture in Singapore.

**Methods:** This is a retrospective cross-sectional analysis of patients
aged ≥65 years via review of medical records, hospitalized from May-August 2016, due to hip fractures caused by a falls. Elderly with osteoporotic fracture and low velocity trauma were included.

**Results:** A total of 104 patient, 81.3±7.5 years old with Barthel score, 91.7±19.4 were hospitalized for falls-related hip fracture during the study period. Majority were female (70.2%), Chinese (86.5%) and with 6 or less years of education (72.1%). Most were able to ambulate independently (65.4%) and 43.3% have no caregivers before the falls. The population was generally healthy with low score on Charlson Comorbidity Index (CCI), median 1 (IQR: 0–2) and 60.6% have no history of recurrent falls. The Vitamin D level was low in the population, 20.7±6.6 ng/ml. After hospitalized for 19±13 days, patients were discharged to home (51%), community hospitals (44.2%) for rehabilitation and nursing home (5%).

**Conclusions:** Falls leading to hip fractures is devastating, causing significant impact in morbidity and mortality outcomes. Given these serious consequences, it is vital to adopt a multifactorial approach, involving education, medication review, exercises and home modification to prevent falls in the community dwelling elderly population.

## P-210

### Clinical characteristics and outcomes of frail old patients with anticoagulant therapy for atrial fibrillation

Y. Yamada¹, T. Kojima², S. Ogawa², M. Eto², M. Akishita².

¹Department of Cardiology, Kitasato University Kitasato Institute Hospital; ²Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo

**Purpose:** Preventing embolic cerebral infarction is important since it decreases activity of daily living and quality of life in old people. However, appropriate use of anticoagulants is difficult in frail old people because of increasing risk of bleeding events. Thus the present study examined the predictive factor for practical management of anticoagulants in older patients.

**Methods:** 783 patients aged ≥65 who were admitted to the geriatric ward of the University of Tokyo Hospital between 2013 and 2015 were enrolled. 90 patients (men 47%, mean age 85 years) had atrial fibrillation. We followed the patients for 1 to 3 years after baseline. Major gastrointestinal bleeding, stroke and all cause mortality were investigated for outcome.

**Results:** Among them, 52% were taking anticoagulant therapy. Factors affecting the decision about administration of anticoagulants for physician were risks for fall, history of bleeding, levels of cognition function. There was no significant difference between with or without anticoagulant therapy in all three outcomes.

**Conclusions:** Age, risks for fall, cognition function and levels of ADL might be the predictor factors for practical management of anticoagulants in frail old people with atrial fibrillation.

## P-211

### Correlation between the Clinical Frailty Scale and the frailty phenotype in community dwelling elderly with multimorbidity

A.L. Mazya¹,², A.-M. Boström²,³,⁴, A.W. Ekdahl¹,⁵. ¹Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; ²Geriatric Department of Danderyd Hospital, Stockholm, Sweden; ³Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden; ⁴Department of Nursing, Western Norway University of Applied Sciences, Haugesund, Norway; ⁵Institution of Clinical Research, Helsingborg hospital, Lund University, Helsingborg, Sweden

**Introduction:** The identification of frail elderly is a necessary prerequisite for preventive measures and tailored interventions. The Fried frailty phenotype (FP) is a validated, albeit resource intensive,

instrument to assess frailty. The Clinical Frailty Scale (CFS) by Rockwood et al, is based on clinical judgement and is easy to use. The aim of this study was to test the agreement of the CFS with the FP in identifying frailty in community dwelling elderly with multimorbidity.

**Methods:** A cross-sectional study on data from 24 month follow-up of the Ambulatory Geriatric Assessment - a Frailty Intervention Trial (Participants were community dwelling elderly people with multimorbidity (n=382). Inclusion criteria: age ≥75 years, ≥3 diagnoses per ICD-10, and ≥3 inpatient admissions during the last 12 months. Frailty was assessed by FP (robust, pre-frail, frail) and the CFS (range 1–7, frail = CSF ≥5). Concurrent validity of the CFS against the FP was evaluated by Spearman Rho correlation coefficient.

**Results:** 211 participants were analyzed. The FP identified more participants as frail, 44% (n=92), than the CFS, 30% (n=63). The CFS moderately correlated with severity in FP (r=0.523, p=0.01). Six frail participants were phenotypically frail but classified as CSF 2 (well). Seven phenotypically robust participants were categorized as mildly frail (n=1) and apparently vulnerable (CFS 4–5) (n=6).

**Conclusions:** In this study the FP identified more frail older persons than the CFS and there was a moderate agreement between the methods of frailty assessment.

## P-212

### Correlation between vastus lateralis muscle ultrasound parameters and appendicular lean mass in older patients with physical frailty

A. Ticinesi¹, M. Narici², F. Lauretani¹, A. Nouvenne¹, E. Colizzi¹, M. Mantovani¹, M. Pedrazzoni¹, T. Meschi¹, M. Maggio¹.

¹Department of Medicine and Surgery, University of Parma, Parma, Italy; ²MRC-ARUK Centre of Excellence for Musculoskeletal Aging Research at University of Nottingham, Derby, United Kingdom

**Background:** Muscle ultrasound (MUS) has not been studied in the context of sarcopenia assessment of older people. The aim of this cross-sectional study was to verify the correlation between right vastus lateralis (RVL) MUS measures and dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass (ALM) in a group of older patients.

**Methods:** We enrolled 45 older (age 79±5) community-dwellers (28 F) with physical frailty, defined as Short Physical Performance Battery (SPPB) score ≥3 and ≤9. DXA scans were performed using a Hologic™ QDR 4500 A densitometer (Hologic, US). We also performed RVL MUS using a MyLab Gamma™ system (Esaote, Italy) equipped with a 5MHz linear probe, acquiring longitudinal and transversal scans with real-time and extended-field-of-view (EFOV) techniques at the 65% of muscle length. Muscle thickness (MT), fascicle length (FL), pennation angle (PA) and EFOV-derived cross-sectional area (CSA) were measured using the NIH-ImageJ software. The age-adjusted Pearson correlation coefficients between crude ALM and MUS parameters were calculated stratifying by sex.

**Results:** Mean values of ALM, MT, FL, PA and CSA were 16.1±2.6 kg, 1.7±0.4 cm, 10.6±2.6 cm, 9.3±5.0° and 10.9±4.8 cm² in females, and 21.7±3.2 kg, 1.8±0.4 cm, 12.9±3.1 cm, 9.1±3.0° and 12.8±3.1 cm² in males, respectively. ALM was significantly correlated with CSA in both genders (r=0.70, p<0.001, in females; r=0.46, p=0.04, in males) and MT only in females (r=0.58, p=0.001), but not with FL and PA.

**Conclusions:** In older patients with physical frailty, RVL MUS-derived CSA exhibited a good correlation with crude ALM, particularly in females.
P-213

Diagnosing sarcopenia using a formula derived walking speed from the Timed Up And Go Test

V. Hood¹, M. Azad¹, R. Moorchilot¹, M.H. Poon¹, T. Masud¹, C. Hørlyck². ¹Nottingham University Hospitals NHS Trust, United Kingdom; ²Aarhus University, Denmark

**Introduction:** The European Working Group on Sarcopenia in Old People (EWGSOP) defines sarcopenia as both low muscle mass and either slow walking speed (WS) or weak grip strength (GS). Previous researchers have derived the WS (DWS) using a formula adjustment of Timed-Up-and-Go-Test (TUG). The aim of this study was to assess how the DWS performed compared to WS in diagnosing sarcopenia in a falls clinic.

**Methods:** Consecutive attenders at a secondary care falls clinic were recruited. Muscle mass was measured by bio-impedance to estimate skeletal muscle index (SMI). Handgrip strength was measured. WS (10m) and TUG (3m) were ascertained. TUG was converted to DWS by using the formula 6/TUG\*1.62 [1]. We used the EWGSOP cut-off values for WS (0.8 m/s), GS (30 kg men, 20 kg women) and SMI (8.87 kg/m² women, 6.42 kg/m² men) to diagnose sarcopenia.

**Results:** Fifty patients (mean age = 80.3±5.9 years; 26 women) were recruited. Mean SMI was 7.9 kg/m² for men and 6.8 kg/m² for women. Mean WS and DWS were 0.63±0.22 m/s and 0.40±0.21 m/s, respectively. Pearsons Correlation coefficient between WS and DWS was 0.66 (p<0.001). The formula derived TUG equivalent to a WS of 0.8 m/s was 12.2 seconds. The sensitivity, specificity, false positive rate and false negative rate for diagnosing sarcopenia using the DWS method were 100%, 92.9%, 96.0% and 100% respectively.

**Discussion:** We propose that the TUG can be used to estimate the WS with sufficient accuracy to diagnose sarcopenia.

**Reference:**

[1] "Skeletal Muscle Function Deficit" in A Nationally Representative British Birth Cohort in Early Old Age, Rachel Cooper et al, Journals of Gerontology: Medical Sciences, 2015, 604-607

P-214

Does cognitive decline play a role in the operational definition of frailty? A systematic review

R. Vella-Azzopardi ¹,², I. Beyer ¹,², S. Vermeiren ¹, M. Petrovic ³,
N. Van Den Noortgate ³, I. Bautmans ¹,², E. Gorus ¹,². ¹Gerontology
department and Frailty in Ageing (FRIA) Research department, Vrije
Universiteit Brussel (VUB), Brussels, Belgium; ²Department of
Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels,
Belgium; ³Department of Geriatrics, Ghent University Hospital (UZ
Gent), Ghent, Belgium

**Introduction:** A dvancing age is associated both with frailty and cognitive decline. The quest for a unifying approach has led to a new and evolving concept, namely cognitive frailty. This systematic review aims to elaborate the trend of assessing the cognitive domain within the existing frailty instruments.

**Methods:** The keywords aged; frail elderly; aged, 80 and over; frailty; diagnosis; risk management and classification were used to search for articles related to frailty instruments and published until December 2016 in the electronic databases PubMed, Web of Knowledge and PsycINFO.

**Results:** Out of the identified 2,863 articles, 116 described original frailty instruments. Thirty-seven were duplicates and 79 were finally included in this systematic review, describing ninety-four original or modified frailty instruments. Two instruments were excluded as their items were not sufficiently specified. Out of the remaining 92 frailty instruments, 46% included a cognitive component. Importantly, 85% of the frailty instruments inclusive of a cognitive component were published in 2011 or later. The

correlation between inclusion of cognitive domain in frailty operationalisation and study publication date was significant, $\chi^2=8.45$, p<0.05. This review identified 7 sub-groups of cognitive assessment – dementia as co-morbidity, objective cognitive screening instruments (e.g. MMSE), self-reported cognitive screening assessments, signs and symptoms, delirium/clouding of consciousness, non-specified and mixed assessments.

**Conclusion:** Although cognitive assessment has been increasingly integrated in recently published frailty instruments, this has been operationalised in a heterogeneous way. Therefore, the next step is to identify the cognitive domain/s affected in cognitive frailty followed by the standardisation of its operationalisation. This, obviously, will be the groundwork for the development of preventive interventional strategies.

P-215

Dynamic approach of the frailty status in nursing homes:
the SENIOR Cohort

F. Buckinx¹, T. Brunois¹, C. Lenaerts¹, J.-Y. Reginster¹,
J. Petermans², O. Bruyère¹. ¹Department of Public Health,
Epidemiology and health Economics, University of Liège, Belgium;
²Geriatrics Department, CHU of Liège, Belgium

**Background:** This study aimed to assess frailty transitions over 1-year of follow-up among nursing home residents.

**Methods:** This is an analysis of the 1-year follow-up of the SENIOR cohort (Sample of Elderly Nursing home Individuals: an Observational Research). All participants included in this cohort were classified into frail, pre-frail or robust according to the Fried's criteria (i.e. weight loss, weakness, exhaustion, slow gait, low physical activity level) at baseline (T0) and after a 12-month follow-up period (T12). Frailty transitions from T0 to T12 were assessed.

**Results:** Among the 662 residents included in the SENIOR cohort (83.2±8.99 years, 73.1% of women), 359 were included in the present analysis (i.e. 90 residents died, 2 nursing homes refused to continue the study (58 residents), 91 residents refused to be assessed at T12, 20 moved away from the nursing home, 41 were physically or cognitively unable to perform the various assessments at T12 and 3 have incomplete data). Among people with complete evaluations, respectively 75 (20.9%), 225 (62.6%) and 59 (16.4%) residents were classified frail, pre-frail and robust at baseline. At T12, these categories counted respectively 121 (33.7%; +12.8% from T0), 184 (51.2%; -11.4%) and 54 (15.1%; -1.3%) residents. Between T0 and T12, 69 (19.2%) became frail and 45 (12.5%) became pre-frail. More surprisingly, 31 (8.5%) subjects became robust although they were frail or pre-frail at baseline.

**Conclusion:** Frailty is a dynamic process with transitions in both directions, worsening and improvement, even within such a short period and among nursing home residents.

P-216

Factors affecting the subjective well-being of Japanese
community-dwelling elderly at one-year follow-up:
A preliminary study

T. Arai. Mejiro University, Saitama, Japan

**Introduction:** Subjective Well-Being (SWB) is thought to be one of the primary outcome in the health promotion for the community-dwelling elderly. As health promotion specialists, we should consider how to improve or maintain their SWB. The purpose of this preliminary investigation was to examine the factors which affected SWB at one-year follow-up.

**Methods:** Overall, 65 community-dwelling elderly individuals participated in the study (13 men, 52 women, mean age = 75.6 years, range = 66–85). The dependent variable was SWB (five-grade evaluation; 1 = very poor, 5 = very good). The independent variables
included basic characteristics such as age, body mass index, phys-
ical functions (walking ability, Timed Up and Go test, one-legged
standing time, handgrip strength), and Frailty Check List (FCL),
which consisted of 25 questions. We investigated these variables
at baseline and one-year follow-up. The associations between SWB
at one-year follow-up and other variables at the baseline were
evaluated by Spearman rank correlation.

**Results and conclusions:** Overall, 45 subjects participated in the one-year follow-up investigation. Significant associations were detected between SWB and walking ability, total FCL score, and sub-items of FCL (locomotive and depressive symptoms). The results suggested that it is important to improve or maintain the walking ability and mental health to ensure a higher SWB in the community-dwelling elderly; therefore, we should develop intervention strategies for this population.

P-217

Fear of falling and low-grade inflammation in sarcopenic obese older women

E. Freiberger, R. Kob, W. Kemmler, C. Sieber, N. Rohleder. FAU Erlangen-Nürnberg

**Introduction:** Falls and fear of falling (FoF) are both independent risk factors for losing mobility or independency in an aging population. To date, there is no data if FoF activates stress systems and stimulates inflammation fostering further health declines. Therefore, our goal was to test whether FoF was related with inflammation.

**Method and results:** In the FORMOSA study, community-dwelling women 70 years and older were recruited for an intervention to counteract sarcopenic obesity (SO) [1,2]. Forty-nine of those provided valid blood samples for measuring IL-6 at baseline. In those, we investigated the relationship between FoF as measured with FES-I, and low-grade inflammation via plasma interleukin (IL)-6.61.2 percent (n=30) of our participants experienced a fall in the past. FoF and IL-6 did not differ between those who had fallen and those who had not (FoF: F=0.11; p=0.92; IL-6: F=1.6; p=0.21). However, IL-6 was higher in women reporting more severe injuries after a fall (bone fractures or muscle injuries vs. bruises or abrasions; F=3.86; p=0.017), and FoF was significantly associated with IL-6 (r=0.40; p=0.044). No relationships were found in the whole group or in those without falls.

**Conclusion:** Our results in this very specific but small population demonstrate first trends for a possible impact of FoF on the pathophysiology of sarcopenia. In older women who had experienced a fall in the past, more severe falls, and higher fear of falling was associated with higher IL-6, providing first evidence that psychological stress resulting from previous falls was affecting inflammation, thereby potentially contributing to further health declines.

References:

[1] Kemmler, W., et al., Prevalence of sarcopenia in Germany and the corresponding effect of osteoarthritis in females 70 years and older living in the community: results of the FORMOSA study. Clin Interv Aging, 2015. 10: p. 1565-73.

[2] Kemmler, W., et al., Prevalence of sarcopenic obesity in Germany using established definitions: Baseline data of the FORMOAS study. Osteoporos Int, 2016. 27(1): p. 275-81.

P-218

Frailty and chronic kidney disease in elderly population: A prospective cohort study

S.M. Badr¹, L.A. Bertholon¹, V. Nonnonhou¹, A. Wolak-Thierry²,
J.-L. Novella³, R. Mahmoudi³. ¹Department of Geriatrics and Internal
Medicine, Reims University Hospital, Maison Blanche Hospital, Reims,
F-51092, France; ²Department of Research and Public health, Reims

University Hospitals, Robert Debré Hospital, Reims, F-51092, France;
³Department of Geriatrics and Internal Medicine, Reims University
Hospital, Maison Blanche Hospital, Reims, F-51092, France; Faculty of
Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims,
F-51092, France

**Objectives:** Chronic kidney disease (CKD) is associated with physiologial changes that may predispose to frailty. The principal aim of this study was to determine the prevalence and characteristics of frailty among patients with CKD. We also tried to determine if CKD is associated with frailty.

**Methods:** A prospective study was performed in an acute geriatric unit from February 2015 to June 2016. The frailty syndrome was assessed using Fried criteria and Modified Short Emergency Geriatric Assessment (SEGAm) score. The CKD status was defined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for a glomerular filtration rate lower than 60 ml/min/1.73m². Association between CKD and frailty was performed using logistic regression.

**Results:** Two hundred and fifty patients were included in this study (mean age =84.6±6.8 years) and 62.5% were women. Of these 250 patients, 34.3% presented a CKD. The prevalence of frailty participants with CKD was 60.2% and 81.3% according to Fried criteria and SEGAm score respectively. Moreover subjects with CKD presented a higher burden of comorbidities (p<0.0001) and a higher prevalence of weakness according to Fried criteria (p=0.025) compared to subjects without CKD. Finally, CKD was associated with frailty according to SEGAm score (OR 1.772, 95% CI: 1.121-2.801, p=0.014).

**Conclusion:** Frailty syndrome is prevalent among elderly subjects with CKD. This study may suggest an association between frailty and CKD according to the SEGAm score.

P-219

Frailty and chronic pain: A novel association

P. Kucukdagli, G.B. Ozturk, C. Kılıç, T.O. Erdoğan, O. Yilmaz, Y. Topcu, B. İlhan, S. Muratlı, M.A. Karan. *Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul, Turkey*

**Objective:** Frailty is most often defined as a syndrome of physiological decline in late life, characterized by marked vulnerability to adverse health outcomes. Frail older adults are less able to adapt to stressors such as acute illness or trauma than younger or non-frail older adults. We aimed to assess prevalence of frailty in elder people and its relationship with other conditions in this study.

**Methods:** 1107 individuals ≥60 years of age admitted to Istanbul-Medical-School Geriatrics-outpatient clinic for the first time the period between 2013–2016 were enrolled to study. We used The International Association of Nutrition and Aging’s FRAIL scale contains 5 simple questions to define frailty. Frail person was accepted as who gets ≥3 points in scale. Patients were asked about their fallings, urinary incontinence, chronic pain, sleep disorders, activities of daily living (ADL), instrumental activities of daily livin (IADL), cognitive status, number of illness and medication, postural instability and assessed about their nutritional status by Mini Nutritional Assessment (MNA).

**Results:** 1107 patients were analyzed with a geriatric assessment. The sample was composed of wome (66.8%) and me (33.2%) with mean age of 78.5±5.7 years. Prevalence of frailty was 16% (n=179). Frailty was found independently assosiated with ag (p=0.041), chronic pain (p=0.021), usual walking spee (p<0.01), malnutrition (p<0.01), IADL (p=0.024) respectively.

**Conclusion:** Frailty carries an increased risk for poor health outcomes, including fall, incident disability, hospitalization and mortality. Elucidating its etiology and natural history is therefore critical for identifying high-risk subsets and new arenas for frailty
prevention and treatment. An important strength of our study is assessment of chronic pain which is a new area of research in frailty concept. Our findings provide data on the significance of chronic pain and its association with frailty.

P-220

Frailty and muscle correlates in older people with diabetes:
An MRI explorative study

M. Danet-Lamasou¹, S. Regueme¹, G. Catheline², E. Barse²,
J. Girard³, T. Pickles⁴, L. Rodriguez-Mañas⁵, A.J. Sinclair⁶, K. Hood⁴,
I. Bourdel-Marchasson¹,³. ¹Pole gérontologie clinique, CHU Bordeaux,
Bordeaux, France; ²UMR 5287 Institut de Neurosciences Cognitives et
Intégratives d'Aquitaine (INCIA), CNRS/Université de Bordeaux,
Bordeaux, France; ³UMR 5536 Résonance Magnétique des systèmes
Biologiques, CNRS/Université de Bordeaux, Bordeaux, France; ⁴Centre
for Trials Research, College of Biomedical & Life Sciences, Cardiff
University, Cardiff, UK; ⁵Department of Geriatrics at Hospital
Universitario de Getafe, Madrid, Spain; ⁶Foundation for Diabetes
Research in Older People at Diabetes Frail Ltd, Worcestershire, UK

**Introduction:** Although diabetes is known as a frailty inducing disease the characteristics of sarcopenia within this group has not been extensively explored.

**Method:** Among participants of MID-Frail, one recruiting center volunteers underwent both brain and muscle MRI and functional assessments. Muscle areas and muscle magnetization transfer (MTR) were calculated in thigh and particularly in rectus femoris (RF). Grey matter volumes and muscle assessments relationships were described using positive and negative regressions (SPM software).

**Results:** Twenty-six subjects (7 female, mean age 78.2 y, SD 5.0), were explored in this sub-study. Among them 6 were frail and the others were prefrail. Total SPPB was positively related with maximal rectus femoris area. The sub-scores for walking and rising chair test were related to RF strength but not to RF area or MTR. Higher walking time was negatively associated with thalamus volume and higher score in chair rising test was positively associated with caudate nucleus area. MNA score was related to grey matter volume.

**Conclusions:** Frailty in older people is multifactorial and brain and muscle MRI correlates may improve our understanding of its different physical components.

P-221

Frailty-guided management model for severely frail older adults
in an acute hospital setting

N.A. Malik, W.K. Panagoda, F.Y.H. Tan, W.Y. Pang. Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore

**Introduction:** Frailty underpins every aspect of the care of an older person, from the goals of care to risk-benefits of interventions to function, discharge and mortality. We explore the use of a checklist of interventions to augment the medical management of older acute hospital patients with advanced frailty.

**Methods:** The Geriatric Frailty Unit (GFU) in our hospital was established to pilot care models for older patients with advanced frailty, as defined by a score of 7 or 8 on the Clinical Frailty Scale (CFS). We applied a package of 5 core interventions – Listening Clinic, Care Needs Assessment, Medication Review, Diet Review and Future Care Planning – on top of usual management of the medical conditions they had been admitted for.

**Results:** Data had been collected on 60 patients at time of writing, 85% of patients or surrogates attended the Listening Clinic, where a Preferred Plan of Care (PPC) discussion was offered to 52% and taken up by 32%. 41% of patients had their medication list reduced, 17% had their dietary restrictions liberalised and 19%

had their follow-up appointments reduced. Qualitative feedback showed almost universal caregiver and staff satisfaction.

**Conclusion:** A package of interventions applied as an overlay to usual medical management of older patients with advanced frailty had meaningful effects on streamlining their care and reducing burdensome treatments that were no longer beneficial at this stage of their life journey. We look forward to further refining the interventions and extending this model to patients admitted under other departments. We also anticipate designing such overlays tailored to the needs of patients at other stages of the frailty spectrum, such as the robust and pre-frail, to complement usual medical care.

P-222

French version of the SARC-F questionnaire: translation and language validation

C. Beaudart¹, M. Locquet¹, S. Schneider², S. Bornheim³,
J.-Y. Reginster¹, O. Bruyère¹, ¹Research Unit in Public Health,
Epidemiology and Health Economics (URSAPES), University of Liège,
Liège, Belgium; ²Centre Hospitalier Universitaire de Nice, Pôle Digestif,
Université de Nice Sophia-Antipolis, Faculté de Médecine, Nice, France;
³Unité de Kinésithérapie générale, CHU Liège, Liège

**Objectives:** To obtain a valid translation of the SARC-F questionnaire (giving a predictive symptom score for sarcopenic subjects).

**Methods:** A global methodology developed by the EUGMS sarcopenia interest group (SIG) regarding the translations of the SARC-F questionnaire has been followed. The English original version of the SARC-F has first been translated in French by a bilingual expert and then, back translated by another bilingual expert. An expert panel has been established in order to identify and resolve any issues during the process of translation. The translated version has been pre-tested on 10 sarcopenic subjects and validated (inter-rater reliability and test-retest reliability) on 20 other sarcopenic subjects. Sarcopenic subjects have been identified from the SarcoPhAge study (Belgium) and diagnosed according to the EWGSOP diagnosis criteria.

**Results:** The translation from English to French has been performed without any difficulties. No amendment has been made to the questionnaire following the pre-test (10 sarcopenic subjects, 5 men and 5 women, mean age of 72.5±4.79 years). The French version of the SARC-F demonstrated an excellent inter-rater reliability with an ICC of 0.90, CI 95% (0.76–0.96) (20 sarcopenic subjects, 9 women, 11 men, mean age of 75.2±5.02 years) as well as an excellent test-retest reliability after a two-week interval with an ICC of 0.86, 95% CI: (0.66–0.94) (20 sarcopenic subjects, 15 women, 5 men, mean age of 77.0±6.57 years).

**Conclusions:** The French version of the SARC-F questionnaire is now available. The clinical validation of this translated tool (sensitivity, specificity, VPN, VPP in order to predict sarcopenia) is currently in process. The language validation studies are in progress in 13 other European languages.

P-223

Handgrip strength as a predictor of functional recovery in elderly patients with hip fracture

L. Del Rosario Evangelista Cabrera, E. Lueje Alonso, V. Garay Airaghi, L. Fernández Arana, J. Mora Fernández. *Hospital Clínico San Carlos, Madrid, Spain*

**Introduction:** Functional recovery is one of the main purposes on hip fracture patients. The objective of this study was to describe the role of grip strength in predicting the short-term functional recovery after hip fracture.

**Methods:** Prospective six-month follow up study. Patients aged >65 with hip fracture (September 2015-August 2016). Variables: Functional assessment (Barthel index-BI-, Functional ambulation
NPT, implementation enablers identified included motivated ward champions, managerial support, engagement strategies, and staff shared-commitment. High turnover of staff and champions, lack of managerial buy-in and staff commitment were the main barriers to successful implementation. Both staff and patients found the grip strength test easy and potentially beneficial. The total cost was < £ 3800.

**Conclusions:** It was feasible, cheap and acceptable to train 155 staff to routinely measure grip strength. Most patients had low grip strength and were at high risk of sarcopenia and poor healthcare outcomes.

P-227

Improving and maintaining the assessment and documentation of the Clinical Frailty Scale score in an acute hospital setting. A multiple cycle quality improvement project

R. Haider, N. Rajcoomar, C. Mukherjee, M. Sweeting. *Mid Essex Hospital Services NHS Trust, Chelmsford, UK*

**Introduction:** The prevalence of frailty in the UK is increasing. Clinical frailty is associated with increasing morbidity, mortality and length of hospitalisation. The Rockwood Clinical Frailty Scale (CFS) score is a validated tool used to identify clinical frailty, enabling risk stratification and advanced care planning. Broomfield Hospital, Essex, UK, started using the CFS score after initial audits revealed poor documentation of clinical frailty. The CFS score was subsequently introduced on Electronic Discharge Letters (EDLs) to highlight frail patients to GPs. Consecutive Quality Improvement Project cycles incorporated interventions aimed at improving this communication.

**Methods:** A retrospective review of randomly selected EDLs (n=369) for patients aged >75 conducted between June 2015–March 2017 assessed documentation of CFS scores. Cycle 1 introduced a frailty tab (a computerised Rockwood CFS) on the EDL. Cycle 2 focused on departmental and face-to-face education of medical staff and a desktop and paper simplified CFS score poster.

**Results:** Prior to intervention 0% (n=60) of EDLs had documented CFS scores (June 2015). Introducing the frailty tab improved documentation to 74% (n=60) (October 2015). 12 months after Cycle 1, CFS documentation was maintained at 75% (n=64) without further intervention. Following staff education and introduction of the poster, CFS documentation improved to 94% (n=185).

**Conclusion:** A simple electronic frailty tab in the EDL dramatically improved coding for clinical frailty in the hospital setting. However, departmental education further improved compliance to 94%. When implementing a system-wide change (such as the frailty tab), tailored educational programs should be used alongside such changes to ensure the best results.

P-228

Level of physical activity evaluated by accelerometry in older subjects from the SarcoPhAge study with or without muscle impairment

M. Locquet¹, C. Beaudart¹, L. Delandsheere¹, J. Petermans²,
G. Appelboom³, J.-Y. Reginster¹, O. Bruyère¹. ¹University of Liège;
²CHU of Liège; ³Stanford University Medical Center

**Introduction:** Our objective was to assess the relationship between
muscle impairment and daily steps.

**Methods:** We investigated elders from the SarcoPhAge (Sarcopenia and Physical Impairment with Advancing Age) study. Three measurements were performed: muscle mass (using DEXA), muscle strength (using a dynamometer) and physical performance (with the Short Physical Performance Battery test). Using the cut-off limits proposed by the EWGSOP, women were classified in the "low muscle mass group" when their muscle mass value was <5.50kg/m², in

the "low muscle strength group" when their strength was <20kg and in the "low physical performance group" when their SPPB ≤8 points. Respectively, the thresholds used for men were <7.26kg/m², <30kg and ≤8 points. The number of daily steps was evaluated, over a 7-day period, by a validated accelerometer.

**Results:** During one week, 174 subjects (74.7±5.7 years, 54.6% women) wore the accelerometer. In women, a correlation was found between daily steps and physical performance (r=0.24, p<0.05). However, no significant difference in the number of daily steps was reported in women with low muscle mass, low muscle strength, or poor physical performance compared to women with a better muscle status. In men, the number of daily steps was significantly correlated with physical performance and muscle strength (r=0.44 and r=0.26, p<0.05). Men with low strength and poor physical performance walked significantly less than men with good muscle function (4565 steps versus 6672 steps, p=0.004; 4198 steps versus 6554 steps, p=0.005). However, these relationships were no longer evident when adjusted for confounders (i.e., age, sex, number of comorbidities and number of drugs).

**Conclusions:** The muscle health status of older individuals does not seem to strongly influence their number of daily steps.

P-229

Long-term home-based physiotherapy for older people with signs of frailty - RCT (NCT02305433)

K. Kukkonen-Harjula¹, P. Kärmeniemi¹, S. Suikkanen¹, S. Kääriä²,
S. Sipilä³, K. Pitkälä⁴, M. Hupli¹. ¹Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland; ²Hyvis-ICT, Kotka, Finland; ³Gerontology Research Ctr, Unit of Health Sciences, University of Jyväskylä, Finland; ⁴Dept. General Practice, University of Helsinki; Unit of Primary Health Care, Helsinki University Hospital, Finland

**Introduction:** There is increasing need for new rehabilitation models to postpone disabilities and institutional care in older persons with signs of frailty. One alternative is home-based rehabilitation. We applied home-based physiotherapy with emphasis on functional exercises for 12 months with 12 months' registry follow-up.

**Methods:** Three hundred persons (>65 y) were recruited. Frailty was screened using Morley's FRAIL questionnaire and verified according to modified Fried's criteria. Persons were randomized to a physiotherapy and a usual care arm. The primary outcome is duration of living at home during 24 months. Secondary outcomes include physical functioning (assessed by SPPB, FIM, IADL), health-related quality of life (15D), frailty status, use and costs of health and social services (registry information during 24 months), falls, and mortality. A physiotherapist performs assessments at the participant's home at baseline, 3, 6 and 12 months. MMSE, GDS-15, MNA and SPS are also assessed. Physiotherapy (60 minutes 2 times weekly) is based on Otago method, and includes exercises for strength, muscle endurance, balance and flexibility.

**Results:** Twelve-month assessments will be completed in August 2017. At baseline the mean age was 82 y, 75% were women, and 61% were pre-frail (scored 1–2 points). Mean (SD) SPPB was 6.2 (2.6), FIM 108.8 (10.6), 15D 27.1 (5.1), MMSE 24.4 (3.1), GDS-15 4.8 (2.7), and MNA 23.0 (3.2) points.

**Conclusions:** Our trial will provide new knowledge whether long-term home-based physiotherapy improves physical functioning to postpone institutional care in persons with signs of frailty. - Supported by Social Insurance Institution

P-230

Muscle mass adjusted for body mass index reveals better efficacy in relation of sarcopenia with functional measures

A. Tufan¹, G. Bahat², S. Muratlı², C. Kılıç², M.A. Karan².
¹Department of Internal Medicine, Division of Geriatrics, Marmara
University Hospital; ²Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School

**Objective:** The prevalence of sarcopenia differs according to its adopted definition. Hereby, we aimed to examine which Low Muscle Mass (LMM) adjustment method reveals better efficacy in relation to its functional outcomes.

**Methods:** Community-dwelling older adults 60–99 years of age were included. Body composition was assessed with bioimpedance analysis. LMM was evaluated according to our national data. Muscle strength was assessed by measuring hand grip strength (HGS) with a Jamar hydraulic hand dynamometer. The relation of skeletal muscle mass index (SMMI) with hand grip strength, usual gait speed (UGS), activities of daily living (ADL), instrumental ADL (IADL) and frailty were examined between different adjustment methods.

**Results:** 1307 older adults (421 male, 886 female) were included. The prevalences of LMM were 2.1%, 47.2%, 63.4% and 21% and prevalences of sarcopenia were 1.3%, 23.9%, 35.2% and 13.2% with adjustments by height (H), weight (W), body mass index (BMIa) and BMIB, respectively. HGS was correlated with all SMMIs, most being adjusted with the BMI (H, r=0.286; W, r=0.298; BMI, r=0.548, p<0.001). UGS was not correlated with LMM adjusted by H (p=0.267) but with W (r=0.077, p=0.009) and BMI (r=0.223, p<0.001). ADL was not correlated with LMM adjusted by H (p=0.71) but with W (p=0.008) and BMI (p<0.001). IADL was not correlated with LMM adjusted by H (p=0.49) but with W (p=0.045) and BMI (p=0.026).

**Conclusions:** The prevalences of LMM and sarcopenia change significantly between SMM adjustment methods. Muscle mass adjustment with BMI proves better relation with functional associations of sarcopenia.

## P-231
### Newly suggested definition of cognitive frailty for epidemiologic study

C.W. Won. *Kyung Hee University*

A concept of “cognitive frailty” has recently been proposed by an (I.A.N.A./I.A.G.G.) International Consensus Group. The group suggested that “cognitive frailty” means a clinical condition characterized by the simultaneous presence of both physical frailty and cognitive impairment, occurring in the absence of overt dementia diagnosis. (I.A.N.A./I.A.G.G.) International Consensus Group defined cognitive frailty as follows: 1) presence of physical frailty and cognitive impairment (CDR=0.5); and 2) exclusion of concurrent dementia. By the way, CDR is not frequently available in epidemiologic studies and what can be an alternative to CDR=0.5? How can we exclude the demented in a condition dementia specialists or neuropsychologists are not available in epidemiology studies? According to the International Working Group on MCI, MCI was operationalized as 1.5 standard deviations below that of age appropriate norms in one or more cognitive domains. The revised criteria for AD dementia, which are comparable to widely used criteria for dementia of the Alzheimer type (DAT), stipulate that impairment must be present in two or more cognitive domains and must interfere with the ability to function in usual activities. Putting these things together, we suggest a new alternative definition of cognitive frailty for epidemiologic studies as follows; 1) physical frailty and 2) any cognitive function test <1.5 SD of the age-, gender-, education adjusted norm (for example, verbal learning test, Digit Span, Boston Naming Test, Trail Making Test, and Frontal Assessment Battery) and 3) no dependency in IAD (especially, managing money, telephone use, responsibility for medication, and shopping, etc)

## P-232
### One-year change in weight, muscle strength, walking speed, walking endurance, and physical activity in older adults

T. Kahraman¹, K. Cekok², B.O. Ugut¹, P. Keskinoglu³, A. Genc⁴.
¹Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey; ²Department of Physical Therapy and Rehabilitation, Medical Park Hospital, Izmir, Turkey; ³Department of Biostatistics and Medical Informatics, Dokuz Eylül University, Izmir, Turkey; ⁴School of Physical Therapy and Rehabilitation, Dokuz Eylül University Izmir, Turkey

**Objectives:** The normal course of aging affects musculoskeletal system, and as a result plays an important role in reducing the mobility observed in later life. Frailty is a common clinical syndrome in older adults with increased risk for poor health outcomes including falls, impairment, hospitalization and mortality. In the absence of consensus, the frailty syndrome requires at least three of the following five characteristics: unintentional weight loss, muscle weakness, low walking speed, poor endurance, and low physical activity. Here, we report one-year change in these domains in older adults.

**Methods:** Participants aged older than 50 years were included in this cohort study. The participants were assessed baseline and after one year regarding to weight, muscle strength, walking speed, endurance, and physical activity with appropriate measures including, a hand-held dynamometer, 10-MeterWalk Test, Six-Minute Walk Test, and Rapid Assessment of Physical Activity Questionnaire.

**Results:** Thirty-five 35 of 94 participants assessed in the baseline were re-assessed after one year. There was a significant decrease in walking speed, muscle strength, and physical activity level (p<0.05), whereas there was no significant difference in weight and walking endurance (p>0.05).

**Conclusion:** This study suggests that the relevant physiological variables are changing in favor of frailty syndrome even within a year. It seems that regular assessment of the frailty syndrome is an important issue to plan the appropriate treatment interventions and improve rehabilitation outcomes.

## P-233
### Osteoporotic fractures in geriatrics

A. Brincat¹, S.D. Brincat², J. Calleja-Agius³, *Sir Anthony Mamo*
Oncology Centre, Msida, Malta; ²Mater Dei Hospital, Msida, Malta; ³University of Malta, Msida, Malta

**Aim:** To present an overview of the physiological process and treatment of osteoporosis.

**Method:** A search for the relevant articles was conducted on PubMed and Google Scholar using the terms 'falls', 'osteoporosis', 'fractures' and 'elderly'. A literature review was compiled.

**Results:** Osteoporosis is a systemic progressive disease characterized by a decrease in bone mass per unit volume enhancing susceptibility to fractures on minor trauma [1]. The pathophysiology of osteoporosis is multifactorial involving cytokines in combination with genetic and environmental influences [2,3]. Osteoporotic patients are on the increase as a result of an improved life expectancy and decreased physical activity [4]. Locally, the commonest risk factor is menopause (83%) followed by a sedentary lifestyle (58%) and a family history (30%). Metabolic bone diseases may occur secondary to co-morbidities or pharmacological therapy [5,6]. With increasing age, females lose more bone mass (35-50% trabecular bone; 25-30% cortical bone) compared to males (15-45% trabecular bone; 5-15% cortical bone) resulting in increase in the incidence of fractures [7]. Femoral neck fractures have the most severe repercussion as 20% die within a year, 40% incapable to carry out activities of daily living, 20% bedridden whilst 25% require institutionalisation [4,8]. The commonest treatment prescribed locally is
bisphosphonates and calcium supplements [5]. Novel pharmacological therapies targeting osteoporosis from its molecular levels are developed [4,9]. Assessment of the patient's risk of falls combined with non-pharmacological therapy are crucial adjuncts especially in the elderly population [7].

**Conclusion:** Osteoporosis is a major clinical problem in geriatrics. It increases morbidity and mortality, reduces the patient's quality of life and creates an economic burden.

**References:**

[1] World health organisation, World Health Organ Tech Rep Ser. 1994;843:1–129

[2] Brincat SD, Borg M, Camilleri G et al. Minerva Ginecol. 2014; 66(4):391–407

[3] Salari P, Abdollahi M. Int. J. Pharm. 2011;7(5):552–567

[4] Baqir W, Copeland C. The Pharmaceutical Journal. 2010; 284: 345–346

[5] Fenech J, Galea R, Serracino-Inglott A et al. Journal of Applied Therapeutic Research 2011;8:101–106

[6] Le Templier G, Rodger MA. Curr Opin Pulm Med. 2008;14(5):403–7

[7] Francis RM. Age and Ageing 2001;30:S4:25–28

[8] Mayes SL. Nutr Clin Pract. 2007;22(3):276–2859. Cole Z, Dennison E, Cooper C. Br Med Bull. 2008; 86:129–143

P-234

**Physical activity, frailty and elderly: Prospective and observational study over a period of 3 months. Preliminary results**

H. Habchi¹, M. Drame², N. Kadri³, J. Doucet³. ¹Hospital of Chaumont; ²University Hospital of Reims; ³University Hospital of Rouen

**Background:** In their privileged relationship and repeated contact with the elderly, general practitioners should be the first line of defense for the early identification of frailty. This would allow a reversal of the frail state if appropriate management strategies are in place, including counseling for physical activity adapted to the condition of the elderly.

**Methods:** This is a prospective study conducted in a general practice in Chaumont, France. It took place during the period from 1 February 2016 to 30 April 2016 inclusive. The inclusion criterion was to be age 65 years or more at the primary care office visit.

**Results:** Forty-four patients were included, 26 of whom were female (59.10%); they had a mean age of 75 years, an average Charlson score of 2.8, an average MMS of 25.4, an average IADL of 6.7, and an average ADL of 5.8. Sixteen of the subjects (36.36%) were accompanied during their medical visit to the doctor. For 25% of the patients, the reason for the visit was a single medical consultation; for 57%, the visit was a follow-up. We noted 21 patients (47.73%) who had a manual occupation. Sixteen smoked (36.36%), and 30 said they drink alcohol moderately (68.18%). Arthritic diseases, cardiovascular history (primarily high blood pressure), and lung disease were the conditions most frequently encountered in the patients' medical histories. Malnutrition was found by the BMI for 11 patients (25.00%), by the MNA for six patients (13.64%), and by albumin levels for three patients); the mean albumin level was 38.4 g/l. We noted weakness among the subjects on the SEGA scale for seven patients (15.91%) and according to the Fried scale for 25 patients (56.82%). According to the Ricci-Gagnon scale, 10 patients (22.73%) were considered inactive; the average Ricci-Gagnon score was 22.6. The monopodal support test found pathology in 18 patients; two patients had a Get-Up and-Go Test result of greater than 20 s (4.55%). Anemia was present in one patient (2.33%) (One patient had missing data); whereas a vitamin D deficiency was present in 34 patients (85.00%). Among the subjects, six patients (13.64%) practiced a team sport. We did not find a correlation

between the SEGA fragility score and the Ricci-Gagnon physical activity (p=0.68), but a slight correlation was found between the Fried fragility score and Ricci-Gagnon physical activity (p=0.092); this may be explained by the small sample size. We found a slight correlation between the SEGA fragility score and the monopodal support pathology test result (p=0.083) as well as between the Fried fragility score and the monopodal support pathology test result, close to significance (p=0.06). No correlation was found between the SEGA fragility score and Get-Up-and-Go Test result >20 s (p=0.17) nor between the Fried score and a Get-Up-and-Go Test result >20 s (p=0.2), nor even between the SEGA score and team sport participation (p=0.25) nor between the Fried score and team sport participation (p=0.6). We did not find a correlation between SEGA fragility and malnutrition according to the BMI (p=0.47), whereas we did find a significant link between Fried fragility and malnutrition according to the BMI (p=0.02). We found a significant link between the Fried score and malnutrition according to the MNA (p=0.02), but not between SEGA and malnutrition according to the MNA (p=0.21). We did not find a significant relationship between the SEGA score and malnutrition according to albumin level (p=0.002), but not between the Fried score and malnutrition according to albumin level (p=0.1). No significant associations were found between SEGA and vitamin D (p=0.26), nor for the Fried score with vitamin D (p=0.68). Finally, we found a slightly significant link between the SEGA score and comorbidities according to the Charlson score (p=0.07) and a significant association between the Fried score and comorbidities according to the Charlson score (p=0.05). We studied the physical activity by Ricci-Gagnon score, and we found significant links between inactive character according to the Ricci-Gagnon scale and the monopodal support pathology test (p=0.014), a Get-Up-and-Go Test result above 20 s (p=0.0076), malnutrition according to the MNA (p=0.0057), and the Charlson comorbidity score (p=0.027), as well as a marginally significant correlation with age, this most likely associated with a lack of power (p=0.06). We did not find any significant correlation with the team sport participation item (p=0.15), malnutrition according to BMI (p=0.68), malnutrition according to albumin level (p=0.3), or vitamin D deficiency (p=0.61), and MMS level (p=0.4).

**Discussion:** It is recognized that physical activity helps curb the development of frailty in the elderly. A literature review published in 2013 explored the contribution of physical activity to several parameters associated with frailty in the elderly. In this work, Cadore et al. (1) included 20 randomized controlled trials and cited the beneficial effect of physical activity; decreased fall incidence (based on 7 studies), improved rapid walking (for 6 studies), improved balance (based on 10 studies), and increased muscle strength (based on 10 studies). In our present study, we evaluated physical activity using the Ricci-Gagnon questionnaire. To our knowledge, there have been no previous studies looking for a correlation between the level of physical activity assessed by this score and the presence of frailty according to Fried and SEGAm criteria.

**Conclusion:** Our study could serve as a pilot for other large-scale trials in order to establish a significant correlation between these two parameters, allowing the validation of this simple and rapid questionnaire and its use by the general practitioner to track and monitor the condition Frailty of elderly patients.

P-235

**Postural muscles weakness in older adults with fall history: A neural or a muscular deficit?**

T. Cattagni¹, J. Harnie¹, M. Jubeau¹, C. Cornu¹, C. Couturier², G. Berrut². ¹Laboratory Movement, Interactions, Performance, Faculty of Sport Sciences, University of Nantes, France; ²Department of Geriatric Medicine, Hôpital Bellier, CHU Nantes, France

**Introduction:** The decline in torque production of postural muscles
during aging is considered as a key factor in the risk of falling. Recent works showed that the maximal torque of plantar flexor muscles (PF) was lower in older adults with recent fall history (OF) than in older non-fallers (ONF). The present study aimed to investigate the neural and muscular factors associated with the lower maximal PF torque production in OF.

**Methods:** Fifteen young adults (YA) (22±4 years), 15 OF (84±4 years) and 15 ONF (83±4 years) were included in this study. Torque and electromyographic activity of soleus, gastrocnemii and tibialis anterior (TA coactivation) muscles were recorded during maximal voluntary contractions of the PF. Electrical nerve stimulation was used to assess the voluntary activation level (neural factor) during maximal plantar-flexion and the muscle contractile properties (twitch torque at rest, muscular factor).

**Results:** The maximal PF torque was lower (P<0.05) for OF (51±12 Nm) than ONF (70±15 Nm) and YA (119±40 Nm). The voluntary activation level was lower (P<0.05) for OF (73±18%) than ONF (82±19%) and YA (90±14%). A similar trend was observed for the maximal PF electromyographic activity. No difference in TA coactivation was reported among the three groups. While age affected the contractile properties of ankle muscles (P<0.001), no difference was observed between ONF (13±3 Nm) and OF (12±3 Nm).

**Conclusions:** These results suggest that the alteration of muscle force production observed in OF could be mainly related to a deficit in muscle activation rather than reduced muscle contractile properties.

## P-236

### Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review

F. Pamoukdjian¹, T. Bouillet², V. Levy³, M. Soussan⁴, L. Zelek², E. Paillaud⁵, ¹APHP, Avicenne Hospital, Geriatric department, Coordination Unit in Geriatric Oncology, F-93000, Bobigny, France; ²APHP, Avicenne Hospital, Department of medical oncology, F-93000, Bobigny, France; ³APHP, Avicenne Hospital, Clinical Research Unit/Clinical Research Center, F-93000, Bobigny, France; ⁴APHP, Avicenne Hospital, Department of radiology, F-93000, Bobigny, France; ⁵APHP, Henri-Mondor Hospital, Geriatric department, geriatric oncology unit, F-94000, Créteil, France

**Background:** To assess the prevalence of sarcopenia before cancer treatment and its predictive value during the treatment.

**Methods:** We searched MEDLINE via PubMed for articles published from 2008 to 2016 that reported prospective observational or interventional studies of the prevalence of pre-therapeutic sarcopenia and its consequences in adults with cancer who were 18 years or older. Two independent reviewers selected articles based on titles and/or abstracts before a complete review. Sarcopenia had to be measured before cancer treatment. Methods recommended by consensuses (CT scan, MRI, dual X-ray absorptiometry or bio-impedancemetry) to assess sarcopenia were considered. Characteristics of the studies included the prevalence of pre-therapeutic sarcopenia and the prognostic value for outcomes during the cancer treatment.

**Results:** We selected 35 articles involving 6,894 participants (in/outpatients, clinical trials). The mean age ranged from 53 to 69.6 years. Pre-therapeutic sarcopenia was found in 38.6% of patients [95% CI: 37.4–39.8]. Oesophageal and small-cell lung cancers showed the highest prevalence of pre-therapeutic sarcopenia. Pre-therapeutic sarcopenia was significantly and independently associated with post-operative complications, chemotherapy-induced toxicity and poor survival in cancer patients.

**Conclusions:** Pre-therapeutic sarcopenia is highly prevalent in cancer patients and has severe consequences for outcomes of cancer patients.

## P-237

### Prevalence of frailty in two Finnish cohorts born 10 years apart before and after Second World War

M.M. Koivukangas¹, M.J. Koiranen¹, M.R. Leskinen¹, T.E. Strandberg², R. Peters³, S.M. Keinänen-Kiukaanniemi¹, R.L. Antikainen¹, ¹University of Oulu, Finland; ²University of Helsinki, Helsinki University Hospita, /University of Oulu, Finland; ³Australian National University, Australia

**Introduction:** Frailty is a state of vulnerability as a result of decline in various physiological systems leading to impaired ability to adapt to external stressors and increased risk of adverse outcomes. Little data exist about secular trends of frailty. We aimed to investigate community-dwelling cohorts in relation to frailty. Participants were born in 1935, before World War II, and after it in 1945, and living in Oulu.

**Methods:** Participants born in 1935 (Oulu35, N=593) and in 1945 (Oulu45, N=708) were examined with identical methods at the age of about 70 years. Frailty was measured using modified Fried Frailty phenotype (FF), Morley Frail Scale (FS) and by a 70-item Frailty index (FI). FI-cut point was 0.21. Logistic regressions were made for associations with marital status, economical satisfaction, education and sex.

**Results:** The mean age in Oulu35 was 72 and of Oulu45 69 years. Prevalence of frailty using FI was 30% in Oulu35 and 17.2% in Oulu45, using FS or FF, they varied from 1.3% to 4.5%. Prevalences of prefrailty and frailty combined using FF were was 45.3% in Oulu35 and 32.2% in Oulu45, using FS 38% and 25.9%, respectively. Frailty was associated to with unsatisfying economical status, ORs 2.5 (1.2–5.0) in Oulu35 and 5.9 (2.5–14.1) in Oulu45.

**Conclusions:** Different frailty instruments detect frailty in different ways. Prevalences of frailty were lower in Oulu45 than in Oulu35. Oulu35 participants were older, they lived their childhood in wartime which may have influenced their health. Low economical status was associated with frailty.

## P-238

### Prevalence of sarcopenia and factors related to sarcopenia in the community-dwelling elderly

H. Şimşek¹, R. Meseri², S. Şahin³, A. Kilavuz⁴, D. Hopanci⁵, M. Uyar⁶, E. Sumru Savas³, F. Sarac³, F. Akcicek³, ¹Dokuz Eylul University, Faculty of Medicine, Department of Public Health, Izmir Turkey; ²Ege University, Izmir Ataturk School of Health, Department of Nutrition and Dietetic, Izmir, Turkey; ³Ege University Hospital, Department of Internal Medicine, Division of Geriatric Medicine, Izmir, Turkey; ⁴Ege University Hospital, Department of Internal Medicine, Izmir, Turkey; ⁵Ege University Tulay Aktas Oncology Hospital, Izmir, Turkey; ⁶Ege University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey

**Aim:** The aim of this study is to determine sarcopenia prevalence and affecting factors in Bornova district of Izmir aged 65 years and older people.

**Method:** The population of this cross-sectional study is 28,323 people aged 65 years and older living in centre of Bornova district, Izmir. Minimum sample size was calculated by assuming sarcopenia prevalence is 10% with 2% error and 95% confidence limit. Twenty percent of this minimum sample size was added for nonresponse. 1007 individuals were targeted to reach. The dependent variable is having sarcopenia and diagnosis was made on the basis of EWGSOP algorithm. Independent variables were sociodemographic and economic features, healthy life behaviours, condition. Data were collected by interviewers at home with face-to-face interview, analysed using chi-square and logistic regression analysis.

**Results:** The response rate was 90.3%. Mean age is 72.8±6.2, 60.2% were female. The prevalence of sarcopenia is 5.2% (3.0% in 65–74