patient and his unformal caregiver living with him at home. After information and consent, patients and caregivers were evaluated every six months according a standardized assessment including medical, psychological, behavioral, economic, environmental and formal aids. Statistical analyses included correlations analysis, univariate and multivariate logistic regressions.

**Results:** At one year, 22 patients (22,7%) were institutionalized. In univariate, characteristics significantly correlated with institutionalization were: (i) patient-related: age, severity of cognitive impairment (MMSE score), taking antipsychotic treatment, functional disability (IADL) and (ii) caregiver-related: moderate to high burden (Zarit). In multivariate, patient's age and antipsychotic treatment were the only significant independent predictors of institutionalization (respectively p=0,007 and p=0,010). A model with patient's characteristics only could classify correctly 81,6% of the institutionalizations. Adding caregiver's characteristics did not improve the model.

**Conclusions:** Risk factors for institutionalization of patients living at home with a family caregiver are mainly patient-related. Taking an antipsychotic treatment is a strong predictive factor of institution.

## P-051

### Prevalence of cognitive impairment in patients with type 2 diabetes: a systematic review and meta-analysis

Y. Kwon¹, Y.-J. Kwon¹, H.J. Kim¹, Y.-K. Roh², Y.-G. Park³,
K.-H. Cho¹. ¹Korea University College of Medicine, Seoul, Republic of Korea; ²Hallym University College of Medicine, Chuncheon, Republic of Korea; ³The Catholic University of Korea, Seoul, Republic of Korea

**Introduction:** Mild cognitive impairment (MCI) and dementia are common in patients with type 2 diabetes (T2DM), but published results vary and lack precision. We performed a systematic review and meta-analysis to provide a precise MCI and dementia prevalence estimates in patients with T2DM and clarify the heterogeneity in reported results.

**Methods:** The MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials were searched for studies using a list of keywords. Articles were included if they (1) reported patients with T2DM as a primary study group, (2) reported MCI or dementia using a validated instrument, (3) reported MCI or dementia prevalence in patients with T2DM, and (4) were performed prospectively in a population-based setting. Data were pooled using a random-effects model, and heterogeneity was explored using stratification and random-effects meta-regression.

**Results:** Of the 596 potentially relevant studies, 32 were included in the meta-analysis. The overall pooled MCI and dementia prevalence in patients with T2DM were 25% (95% CI, 12–39; I2 =90.2%) and 4% (95% CI, 3–5; I2 =88.2%), respectively. Studies with older patients and longer T2DM durations reported significantly higher prevalence estimates, whereas glucose control, insulin usage, disease subtype, and diagnosis method did not significantly influence the pooled prevalence.

**Conclusions:** The MCI and dementia prevalence in patients with T2DM are high, and older patients with longer diabetes duration have a greater burden of MCI and dementia. MCI and dementia prevalence estimates for patients with T2DM can guide both clinical decisions and public health policy.

## P-052

### Preventive medicine: physical activity and cognitive disorders

J. Duhautois¹, L. Bonnel¹, D. Huvent², H. Idiri¹, F. Puisieux²,
F. Pasquier². ¹CHI Wasquehal, Wasquehal, France; ²CHRU Lille, Lille, France

**Introduction:** Various dementia-related pathologies currently represent a major public health issue and it's considered as a significant medical activity especially related to the population's aging. The practice of regular physical activity already represents a protective factor known and recognized in several fields such as cardiovascular diseases, cancer, diabetes or even osteoporosis. The current recommendations yield merely a few prevention and drug treatments that only allow for partial control of the disease. As a matter of fact, as physical inactivity prevails in industrialized countries, it has become a public health issue. A part from the prevention of cardiovascular risk factors, no preventive link has so far been established between the practice of regular physical activity and the advent of cognitive impairment later on. However, some assumptions seem to highlight the possibility that a protective factor link might exist. Faced with an increasing prevalence, approaching these pathologies on the preventive level could be a new element in the context of a preventive activity in primary care.

**Method:** The present study establishes a global description of the characteristics of a population who consult a memory consulting center for a memory troubles, and compares the different physical activity groups with each other in order to observe the possible influence of physical activity on the dementia process.

**Results and Conclusion:** This is to provide an additional argument in favor of the practice of regular physical activity so as to establish an early preventive management of dementia pathologies in primary care.

## P-053

### Prognostic impact of "syncopal-like falls" in elderly patients with dementia: Preliminary results of the follow-up of the "Syncope and Dementia" Study

F. Tesi¹, A. Ceccofiglio¹, M. Rafanelli¹, G. Rivasi¹, C. Mussi²,
G. Bellelli³, F. Nicosia⁴, M. Bo⁵, D. Riccio⁶, A.M. Martone⁷,
A. Langellotto⁸, E. Tonon⁹, G. Noro¹⁰, A. Ungar¹. ¹Syncope Unit,
Department of Medicine and Geriatrics, Azienda Ospedaliero-
Universitaria Careggi and University of Florence, Florence, Italy;
²Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics,
University of Modena and Reggio Emilia, Modena, Italy; ³Department
of Health Sciences, University of Milano Bicocca and Acute Geriatric
Unit, San Gerardo Hospital, Monza, Italy; ⁴Medicine and Geriatric Unit
- Spedali Civili of Brescia, Brescia, Italy; ⁵SCDU Geriatria e Malattie
Metaboliche dell'Osso, Azienda Ospedaliero-Universitaria Città della
Salute e della Scienza di Torino, Torino, Italy; ⁶Geriatric Department,
SS. Trinity Hospital, Cagliari, Italy; ⁷Department of Geriatrics,
Neurosciences and Orthopedics, Catholic University of the Sacred
Heart, Rome, Italy; ⁸S. Maria di Ca' Foncello Hospital, Treviso, Italy; ⁹S.
Jacopo Hospital, Azienda USL 3, Pistoia, Italy; ¹⁰Geriatric Unit, Santa
Chiara Hospital, Trento, Italy

**Objectives:** Syncope and falls are one of the main causes of hospitalization in elderly patients with dementia. Aim of the observational, multicenter "Syncope and Dementia" (SYD) study was to investigate the etiology of transient loss of consciousness suspected for syncope and unexplained falls in elderly adults with dementia. The present follow-up study was aimed at identifying predictors of mortality.

**Methods:** Of 532 patients enrolled in the SYD study (mean [SD] age 83.5±6.2 years) from February 2012 to December 2016, preliminary follow-up data were available in 355 patients (66.7%). Mortality were investigated during a mean follow up of 197.4±128.5days. Unexplained fall with a final diagnosis of syncope was defined "syncopal fall", unexplained fall was considered "non-syncopal fall" when a syncopal origin was excluded.

**Results:** 87 patients died (24.5%) during the follow-up. In this subgroup, pathological electrocardiographic findings were more common (p=0.042), particularly persistent or permanent atrial fibrillation (p=0.041), they had a higher heart rate (p<0.001) and a
longer QT interval (p=0.002). A higher mortality rate was observed in patients with non-syncopal falls compared with patients with syncopal falls or confirmed syncope (36.9% vs 24.7% and 16.9%, p<0.002). At logistic regression, a diagnosis of non-syncopal falls (OR 2.753 [1.595, 4.750], p=0.001), male gender (OR 1.448 [1.226, 1.889], p=0.001) and functional status (OR 1.135 [1.001, 1.287], p=0.048) were predictors of mortality.

**Conclusion:** Non-syncopal falls are predictive of short-term mortality in elderly patients with dementia. It is necessary to pay attention to patients with non-syncopal fall that required greater supervision and should be followed over time.

## P-054

### Ranking barriers, motivators and facilitators to promote physical activity participation in dementia patients: an explorative study

F.H. de Klijn¹, E.G.A. Karssemeijer², W.J. Bossers¹, M.G.M. Olde Rikkert², M.J.G. van Huuvelen¹. ¹Center for Human Movement Sciences, University Medical Center Groningen, Groningen, The Netherlands; ²Radboud University Medical Center, Radboudumc Alzheimer Center, PO 9101 (hp 925), Nijmegen, The Netherlands

**Introduction:** Community-dwelling dementia patients are inactive most of the day. The purpose of this study was to explore which barriers, motivators and facilitators play a role in promoting physical activity (PA) participation in dementia patients. Results can be used to design effective interventions to promote dementia patients to be physically active.

**Methods:** Twenty community-dwelling dementia patients (79±5.3 years, 25% female, X̄ MMSE = 23±3.5), their (family) caregivers (70±11.5 years, 85% female) and an expert group of physiotherapists (n=15, 41±12.3 years, 73% female) ranked preselected barriers, motivators and facilitators for PA participation in dementia patients. Fifty-five statements were included and ranked by family caregivers and experts on a continuum from - (not important) to +5 (very important). Dementia patients used a ranking method with series of two-choice questions ranging from 0 to 1. Statements were classified by the socio-ecological model, including the intrapersonal level, interpersonal level and community level.

**Results:** In both caregivers and dementia patients, the motivator "beneficial health effects" scored highest (X̄=3.00±1.41 and X̄=0.91 ±0.19) for engagement in physical activity. Physiotherapists scored highest on the barrier "loss of initiative" (X̄=3.15±1.56). Intrapersonal level factors scores highest compared to factors from interpersonal level and community level.

**Conclusions:** Experts focus strongly on barriers to engage in physical activity participation, whereas caregivers and dementia patients focus more on motivators and facilitators. The current study suggests that intrapersonal factors are most important to promote PA in dementia patients, for example by communicating the benefits of PA.

## P-055

### Relationship between white matter hypointensities and daily life activity tests in Alzheimer's patients

E.A. Karakulak¹, E. Bulut², B.V. Salanci³, K.K. Oğuz², B. Erbaş³, E.L. Ergun³, B.B. Yavuz¹, M. Cankurtaran¹, M. Halil¹. ¹Hacettepe University Faculty of Medicine Department of Geriatric, Ankara, Turkey; ²Hacettepe University Faculty of Medicine Department of Radiology, Ankara, Turkey; ³Hacettepe University Faculty of Medicine Department of Nuclear Medicine, Ankara, Turkey

**Objective:** Cerebral white matter hyperintensity is frequently seen in patients with Alzheimer Diseases (AD) and evaluated by using hypointensity in T1 imaging sequence and fazekas scaling in T2 imaging sequence. The aim of this study is to demonstrate the relationship between fazekas scale, T1 hypointensity and instrumental and basic daily living activities in AD patients.

**Methods:** Thirty-seven patients with AD were included. T1 hypointensity and fazekas scale of patients were performed by two radiologists using FLAIR sequence images on the transverse plane and by visual analysis. Daily life activities were assessed by questionnaire.

**Results:** Fazekas scale was found to be significantly correlated with instrumental (r=0.553, p=0.001) and baseline daily life activity score (r=0.378, p=0.021). The cortical white matter T1 hypointensity was found to be significantly and negatively correlated with instrumental (r=-0.628, p=0.009) and baseline daily life activity score (r=-0.488, p=0.050).

**Conclusion:** Control of vascular risk factors provides an increase in daily living activities in alzheimer patients and reducing the workload of caregivers. Fazekas scale and T1 hypointensity are useful tool to assess and monitor vascular risk factor in alzheimer disease.

## P-056

### Renal Function and Cognitive Decline in the frail elderly. The ReFiCi (Chronic Renal Failure in Cognitive Impairment) study

A. Castagna¹, G. Coppolino², C. Ruberto¹, G. Ruotolo³, P. Gareri¹. ¹Azienda Sanitaria Provinciale di Catanzaro (ITALY); ²AO Pugliese Ciaccio di Catanzaro; ³SOC di Geriatria, AO Pugliese Ciaccio di Catanzaro (ITALY)

**Introduction:** Frailty is associated both with an increased risk of cognitive decline, and the development of Chronic Kidney disease. In primary care units Frailty Ambulatory is dedicated to elderly people and is an example of health innovation. The aim of the present study was to investigate the relationship between renal and cognitive functions in the frail elderly.

**Methods:** Frailty Ambulatories have to facilitate the "art" of caring complex elderly patients' needs through geriatricians and out-of-hospital network services. We analyzed data from 271 consecutive patients visited in our ambulatories. The starting point is caring patients and their needs. The first step is represented by over-65 year-old patients' selection according to prefrailty and frailty Fried's criteria. We performed multidimensional assessment and kidney function assessment in all the patients.

**Results:** Of 271 patients, 109 (40,22%) were men, mean age 82,74±6,77 years old; BMI was 22,65±2,21 kg/m²; CKD-EPI eGFR was 64,25±25,04 ml/min/1,73 m². After performing multidimensional assessment we found the following scores: MMSE 12,18±3,65; ADL 0,90±2,02; IADL 0,04±0,189. In the 271 patients analyzed we detected a positive correlation between cognitive function and the estimated glomerular filtration rates (eGFR). After multivariate analysis the relationship was confirmed (beta=0,474; p=0,000).

**Conclusions:** Experimental activity in Frailty Ambulatories could offer a tool able to recognize conditions of prefrailty/frailty. Frailty, assessed through Renal function and cognitive functions are significance related in the frail elderly.

## P-057

### Sensory gating in the elderly with subjective memory complaints: An MEG study

C.-H. Cheng¹, P.-N. Wang². ¹Department of Occupational Therapy, Chang Gung University, Taiwan; ²Department of Neurology, Taipei Veterans General Hospital, Taiwan

**Introduction:** Subjective memory complaint (SMC) has been associated with an increased risk of dementia. Although SMC can hardly to be determined by neuropsychological assessments, functional neuroimaging offers an alternative method to probe this symptom. Sensory gating (SG), an attenuation of the neural response to the
second identical stimulus, is considered as an automatic process of the brain to inhibit redundant sensory inputs. Accumulating evidence showed that patients with Alzheimer's disease demonstrated a deficit in SG function. However, there has been no study of SG in the elderly with SMC. Thus, we aimed to use a whole-head magnetoencephalography (MEG) to address this issue.

**Methods:** We recruited 15 healthy older adults and 15 elderly seeking help for their SMC at an out-patient memory clinic. Participants were cognitively normal as evaluated by Cognitive Ability Screening Instrument (CASI), with no between-group differences. An auditory paired-stimulus (S1-S2) paradigm was delivered to each subject during MEG recordings. SG ratio was calculated as S2/S1, and a lower value indicates a better function.

**Results:** SG ratio was obtained from superior and middle temporal gyrus (STG, MTG), inferior frontal gyrus (IFG) and orbitofrontal cortex (OFC) of each hemisphere. Compared to the controls, elderly with SMC exhibited significantly decreased S2/S1 ratios in the left STG and MTG, suggesting an enhanced SG ability in SMC.

**Conclusions:** This is the first study to show that increased SG function is present in elderly with SMC. Our data also suggest that self-reported SMC is a reflection of objective alterations in brain function.

## P-058
Stop Walking While Talking test: Is it related to cognitive function?

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

**Objective:** To assess the relationship between cognitive function and the Stop Walking While Talking (SWWT) test.

**Patients and method:** A prospective, observational and cross-sectional study conducted on 108 patients (62% women), with a mean age of 80.5±8.4 years. Twenty-three (21.3%) of them were living at home, 24 (22.2%) in a nursing home and 61 (56.5%) in an intermediate care unit. The SWWT test was performed on all the patients. All patients were able to walk (with or without walking aids). Based on the results of the SWWT test, patients were divided in two groups: "stoppers" and "non-stoppers". Mini-Mental State Examination of Folstein (MMSE) was performed. The cognitive status was categorized in absence of impairment (MMSE: 21-30 points) and moderate cognitive impairment (MMSE: 15-20). Patients with severe cognitive impairment (MMSE <15 points) and those with significant auditory or visual deficit were excluded.

**Results:** The stoppers group of patients had a mean of MMSE 21.6±5.1 and the non-stoppers 24.4±4.0, (p=0.004). Of the 50 non-stoppers patients, 9 (18%) had cognitive impairment and 41 (82%) had not. Of the 58 stoppers patients, 27 (46.5%) had cognitive impairment and 31 (53.5%) had not, (p=0.002).

**Conclusions:** The stoppers patients had greater cognitive impairment, suggesting a relationship between the presence of cognitive impairment and less ability to perform double tasks.

## P-059
The test of the watch drawing as a method of evaluation of cognitive deterioration

M.I. Porras¹, M.N. González², T. Porras³, J.C. Verdejo⁴. ¹Geriatra Complejo Asistencial Universitario de León; ²Geriatría Complejo Asistencial Universitario de León; ³Profesora bilingüe. IES Tomás Bretón Villamayor Salamanca; ⁴Geriatra Hospital Clínico San Carlos Madrid. España

The clock drawing test is widely used in clinical practice because it is a fast and reliable method for assessing cognitive impairments.

**Objective:** To assess and compare the cognitive status of two groups

of patients attending the hospital day care center.

**Material and methods:** Observational, longitudinal, descriptive study. The clock drawing test was carried out to assess the cognitive status of two groups of patients attending the day care center during the months of November and December 2014. One group had functional recovery and the second had cognitive stimulation. Variables: sex, age, domicile, pathological antecedents, reason to go to day care center and in the second group, the prescribed treatment for cognitive impairment. SPSS v.15 statistical treatment.

**Results:** n=30 36.7% males. 63.3% females. Group 1 (functional recovery) 43.3%. Group 2 (cognitive stimulation) 56.4%. Average age: 81.2 years. Domicile: alone 24.5%, with marriage 47.1%, with family 28.4%. Average pathology: 5.6. Hypertension, dyslipidemia, depressive disorder and diabetes more frequent pathologies. Group 1: derived to Day center by: hip fracture 69%, vertebral fracture 7.7%, stroke 7.7%, discopathy 7.7%, fall syndrome 7.7%. Group 2: derived by: Degenerative dementia: 64.7%, mixed dementia: 23.5%, vascular Parkinsonism 5.9%, stroke sequels 5.9%. Test of the clock: 65.4% pathological. Group 1: pathological 50%; Group 2: 17.6% pathological.

**Conclusions:** Increased cognitive impairment in women and in the functional recovery group. Worst functionality worst result of the clock drawing test. It is the pluripatology a protective factor for dementia or, pluripathological patients are less concerned about their memory?

## P-060
The Cafe-multimedia: a promising psychosocial intervention for frail older adults

S. Damnee¹, L. Djabelkhir², C. Ware², J. Benovici², Y.-H. Wu², H. Kerherve², A.-S. Rigaud². ¹Hopital Broca, AP-HP, Paris, France & EA4468, Faculty of medicine, University Paris Descartes, Paris, France; ²Hôpital Broca, AP-HP, Paris, France & Equipe d'accueil 4468, Faculté de médecine, Université Paris Descartes, Paris, France

**Objective:** Psychosocial interventions using technologies could promote social ties in frail older adults at risk of isolation. The objective of this pilot study was to evaluate the effects of a psychosocial intervention using ICT on social links and technology acceptance parameters in frail older adults.

**Methods:** Participants (n=13) in group with mean age 75.9 (± 8.8) were trained to use Tablets and Smartphones by two psychologists. The course encompassed two-hour sessions per week for three months. Measures at baseline and after intervention included assessment of the Montreal cognitive assessment (MoCA), Mini Geriatric Depression Scale (GDS), loneliness scale (UCLA), perceived social support (QSSP), and questionnaires of feeling of competency in ICT and of acceptance of ICT. Opinions and perceptions of participants about the psychosocial intervention were collected at the end of the program by mean of a focus group and interviews.

**Results:** There was a significant increase in the scores of acceptance of ICT and feeling of competency in ICT, but no changes in MoCA, GDS, UCLA and QSSP between baseline and the end of intervention. Results showed that the intervention provided 1) cognitive stimulation and positive engagement with the outside world, 2) positive social contacts with other participants but frustration for making real friendship, 3) engagement in technology learning and use provided that technology is easy to use and services can facilitate every day activities. This type of intervention can be an effective tool in supporting older people at risk of isolation and helping to increase technology adoption.
## P-061

**The effect of a cognitive stimulation program, with initial, maintenance program and follow-up, on institutionalized elderly: a randomized controlled trial (a research protocol)**

V. Parola¹, A. Coelho¹, H. Neves¹, M. Almeida², S. Duarte²,
A. Cavaleiro², D. Cardoso¹, J. Apóstolo¹. ¹Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal; Centre for Evidence-Based Practice: a Joanna Briggs Institute Centre of Excellence, Portugal; ²Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal

**Introduction:** Cognitive stimulation therapy (CST) offers a range of activities, which provide general stimulation. Evidence suggests that cognitive stimulation (CS) has a positive effect on cognition and depressive symptomatology (DS). This research aims to analyse the effectiveness of CST, on cognition and depressive symptoms in older adults in nursing homes (NHs) in different periods of time.

**Methods:** A randomized controlled trial will be developed in residents from five NHS. If required, "intention to treat" analysis and per protocol analysis will be performed. During 7 weeks, participants of the experimental group will participate in 14 CST sessions, and participants of the control group received usual care. Then during another seven weeks, participants of the experimental group will participate in 16 CST sessions (maintenance program), and participants of the control group still received usual care. The Mini-Mental State Examination, the Geriatric Depression Scale-15, will be administered at baseline, postintervention of the initial program, postintervention of the maintenance program and 3 months after the end of the program.

**Results:** The present study will provide information on how effective the CST is over time.

**Conclusions:** This study will bring evidence about CST's relevance in elders in NHs, guiding recommendation of CST in this context.

## P-062

**The effect of cognitive stimulation in the elderly**

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

**Introduction:** Evidence suggests that cognitive stimulation (CS) has a positive effect on cognition and depressive symptomatology (DS). This study aims to demonstrate that the implementation of the CS program "Making a Difference" (MD) improves cognition and depressive symptoms in elders in nursing homes (NHs).

**Methods:** This was a multicentre quasi-experimental study of 76 elders (59 women and 17 men), with a mean age of 84.28, from 5 nursing homes, in rural, semi-rural and urban environments in Portugal. Participants attended 14 sessions twice a week over seven weeks. The Mini-Mental State Exam and the Geriatric Depression Scale-15 were administered at baseline and postintervention.

**Results:** T test for related samples revealed that, there is evidence of improvement in cognition (p<0.001), and in depressive symptoms (p<0.01) in the post-test scores compared with baseline. From the clinical point of view, 42 elders (55.3%) improved cognition and 25 elders (32.9%) maintained. Regarding depressive symptoms, 36 elders (47.4%) reduced while 21 elders (27.6%) maintained.

**Conclusions:** Our results showed improvement in elders' cognition and depressive symptoms after a seven weeks intervention. Therefore we recommend its implementation as a component of health promotion care plan for the elderly in nursing homes context. Further studies should include larger samples as well as maintenance

program and follow-up in order to strengthen and clarify these results.

## P-063

**The effect of continuous positive airway pressure (CPAP) therapy on cognitive functions in patients over 60 years old with moderate to severe obstructive sleep apnea**

A. Tufan¹, G. Bahat², D. Büyükgök³, Z. Bingo¹, E. Kıyan⁴, R. İliaz⁵,
M.A. Karan². ¹Marmara University Hospital, Dept. of Internal Medicine, Division of Geriatrics; ²Istanbul University Istanbul Medical School, Dept. of Internal Medicine, Division of Geriatrics; ³Istanbul University Istanbul Medical School, Dept. of Psychiatry; ⁴Istanbul University Istanbul Medical School, Dept. of Pulmonary Medicine; ⁵Istanbul University Istanbul Medical School, Dept. of Internal Medicine

**Introduction:** Obstructive sleep apnea (OSA) characterizes apneas and hypopneas during sleep. Daytime sleepiness and cognitive dysfunction were reported in untreated OSA patients. However, the effect of Continuous Positive Airway Pressure (CPAP) treatment on cognitive functions, daily life activities, depression, anxiety and quality of life in elderly is unknown. The aim of our study was to investigate the effect of CPAP treatment on the parameters of the OSA patients over 60 years of age.

**Method:** ESS (Epworth Sleepiness Score), AHI (apnea-hypopnea index), ODI (oxygen desaturation index), sleeping SpO2 <90% of patients >60 years old with moderate to severe OSA who applied to the pulmonary diseases outpatient clinic between May 2014-January 2015 were recorded. At least 5 days/week-at least 4 hours/day using CPAP, was accepted as compatible to treatment. Neuropsychological assessment was performed before CPAP treatment and after 3-months of CPAP. Digit span forward-backward, semantic-phonemic verbal fluency, trail test, stroop test, visuospatial perception, instant-delayed story memory, instant memory and learning score were determined. Functionality was evaluated using Katz activities of daily living and Lawton instrumental activities of daily living scores, depression by geriatric depression scale, anxiety by STAI anxiety scale, and quality of life by EQ5 test. Baseline values were compared with values after 3 months of effective CPAP use.

**Results:** Thirty patients included to the study. Analysis was completed on 16 patients due to device incompatibility and follow-up drop (Poster table 1). After 3-month CPAP result in significant improvements in clock drawing test, recognition, instant memory and learning scores (Poster table 2).

**Conclusion:** In our study, 3-month CPAP treatment improved executive functions (attention and planning) in patients. The results of our study suggest that CPAP therapy is effective in preventing cognitive impairments in older OSA patients.

## P-064

**The effect of implementation a program the physical activity in the functionality and well-being in old people**

L. Pedro¹, J. Pais Ribeiro², J.P. Pinheiro³. ¹Instituto Politecnico de Lisboa - Escola Superio de Tecnologia da Saúde de Lisboa; ²Universidade do Porto - FPCE; ³Universidade de Coimbra - FM

**Introduction:** The increasing number of old people with chronic illness to live in the community, allows the involvement of public health, management of chronic disease, promoting well-being and functionality of these people. The Promoting physical activity in old people has an important role for public health. The aim of this study is implementation of a program of physical activity to improve the functionality and well being in old people.

**Methods:** This is a prospective study. The study includes 17 people, aged between 66 and 83 years old, 75% female, 65% married, were all retired and all had functional independence. The data collection
was performed on senior's universities in Lisbon - Portugal. It was applied in the program of self-regulation the promotion of physical activity (IPPA), 90 minutes for a week, lasting seven weeks. We used one question "Please classify your functionality?" with an answer in numerical scale between "0" and "11" and the Personal Wellbeing Scale (PWS) before implementing the program (time A) and end implementing the program (time B).

**Results:** The correlations between the functionality perception and well-being, before application of IPPA (r=0.42, p<0.01), and the end of the implementation of IPPA (r=0.68, p<0.01). The results show that the IPPA improves the correlation between functionality and well-being.

**Conclusions:** We think this program promotion and awareness of the importance of physical activity, using the conceptual model of self-regulation, can be very beneficial for Functionality and well-being in old people.

## P-065

### The effects of cognitive impairment on health-related quality of life in geriatric oncology patients

D. Matelot¹, A. Martin¹, B. de Wazieres², V. Antoine¹. ¹CHU Nîmes, France; ²CHU Nîmes FRance

**Background:** Cancer incidence increases with age. Quality of life (QOL) has become a major factor when considering treatment approach and medical care in geriatric oncology. Various QOL measures have been recognized to help treatment decisions, prognostic and survival assessment. The presence of cognitive disorders is a potential practical problem with QOL measurement. The objective of this study is to describe determinants and level of QOL in elderly cancer patients with cognitive decline.

**Methods:** More than 100 consenting patients ≥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. Determinants of their QOL were collected by open-ended questions and the validated QOL questionnaire EORTC QLQ-C30 (version 3.0). 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. Cognitive function was measured by Montreal Cognitive Assessment (MoCA). We compared the determinants and level of QOL in older cancer patients with or without cognitive impairment.

**Results:** We present socio-demographical, medical and QOL data associated with the presence of cognitive decline in an elderly and frail geriatric oncology population.

**Conclusion:** QOL and cognitive function should be integrated into geriatric oncology evaluation in order to make the best treatment decision.

## P-066

### The MINDMAP Consortium – Survey on mental health promotion and mental disorder prevention for older people in cities (HORIZON 2020, research and innovation action 667661)

U. Dapp¹, L. Neumann¹, W. Jacobsen¹, F. van Lenthe², W. von Renteln-Kruse¹. ¹Albertinen-Haus Centre of Geriatrics and Gerontology, Scientific Department at the University of Hamburg, Hamburg, Germany; ²Erasmus University, Department of Public Health, Rotterdam, The Netherlands

**Introduction:** The MINDMAP consortium (2016–2019) aims to identify opportunities offered by the urban environment for the promotion of mental wellbeing and functioning of older individuals in Europe, by bringing together 10 European cities with

urban longitudinal aging studies: GLOBE, HAPPIE (3 cities), HUNT, LASA, LUCAS, RECORD, Rotterdam study, Turin study. A survey on mental health-care planning policies, strategies and programmes addressing the heterogeneous group of older people covering health promotion to need of nursing care was performed for profound data interpretation.

**Methods:** First, the MINDMAP partners identified experts in their cities, who had an overview of the current mental health sector. Then, a structured telephone interview (1–2 h) with the expert was performed always by the same person from the Albertinen-Haus. All interviews were transcribed and analysed using an analysis pattern based on the WHO Public-Health Framework for Healthy Aging including the geriatric functioning continuum [1].

**Results:** Almost every city has developed specific mental health-care planning policies and strategies with corresponding intervention programmes. However, it appears that the focus on older citizens should be strengthened. Examples of good practices were based on national guidelines and local strategies to strengthen both physical and mental health. Promising intervention programmes for older people made use of a target group identification based on the bio-psycho-social approach.

**Conclusions:** The findings will contribute to future-proof preventive strategies in urban settings favouring functional ability seen as a combination of assessing physical and mental capacities.

### References:

[1] WHO. World Report On Ageing & Health. Geneve, 2015.

## P-067

### Towards a graduated detection and diagnosis strategy of neuro-cognitive disorders in Europe

N. Vanacore¹, G. Selbaek², K. Rejdak³, T. Latchezar⁴, A. Politis⁵, A. Leperre-Desplanques⁶. ¹National Center for Disease Prevention and Health Promotion, Institute of Health, Rome, Italy; ²Norwegian National Advisory Unit on Ageing and Health, Norway; ³Medical University of Lublin, Poland; ⁴Clinic of Neurology, Medical University, Sofia, Bulgaria; ⁵Athens University, Greece; ⁶Claude Bernard University (UCBL), Institute for the Elderly, University Hospital (HCL), Lyon, France

In Europe, between 40% and 50% of demented persons are undiagnosed. When the etiological diagnosis is performed, it is mostly done lately at a stage of advanced autonomy loss or behavioural disorders. One of the reasons of poor diagnosis relies on a lack of cognitive detection in primary care. Under the authority of the European Commission, the new Joint Action "Act on dementia" proposes a workpackage dedicated to "Diagnosis and post-diagnosis supports" to enhance rates and quality of neurocognitive disorder diagnosis. As the detection and diagnosis procedures are not always clear for primary care professionals, the workpackage group proposes a consensual strategy to better understand the steps of graduated detection and diagnosis supports, as well as the links between care pathways and research dynamics. With that aim, a consensus has been adopted and discloses: 1 – a neurocognitive disorder detection step in primary care, 2 – a first step of etiological diagnosis dynamics of major neurocognitive disorders, 3 – a second step of etiological diagnosis that may be proposed for complex cases, 4 – a specific pathway dedicated to patients with a minor neurocognitive disorder, and patients who want to access to research. At each step, post-diagnosis supports, including research dynamics, are tailored to the patient-caregiver dyad profile and wills. This consensual European diagnosis strategy will help professionals to better explain to patients and caregivers the content of clinical, neuropsychological, biological and neuro-imaging supports that may be proposed and adapted to the patient.
## P-068

### Trajectories of cognition among older patients from hospitalization to three months post-discharge

L. Reichardt¹, R. van Seben¹, J. Aarden², M. van der Schaaf¹,
R. Engelbert², J. Bosch³, B. Buurman¹. ¹Academic Medical Center;
²Amsterdam University of Applied Sciences; ³University of Amsterdam

Acute hospitalization often initiates events leading to changes in cognitive functioning. The majority of studies that investigated cognitive trajectories over time focused on specific patient-populations such as patients who suffered a hip fracture, stroke, or delirium. Moreover, previous studies have had only long-term follow ups. Trajectories of cognitive changes within the short critical three months post-discharge are hence unknown. Therefore, the aim of this study was to identify distinct trajectories of cognitive functioning from acute hospitalization up to three months post-discharge and to study the incidence of functional decline and mortality. We conducted a multicenter prospective cohort study, the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, including 400 acutely hospitalized patients of 70 years and older, who had a minimal MMSE-score of 15 at admission. Data were collected in six hospitals in the Netherlands. We identified three cognitive trajectories: 1) consistently high level of cognitive functioning (69%), 2) moderate cognitive functioning and improvement (22%), and 3) consistently minimal cognitive functioning (9%). In the group with a consistently high level of cognitive functioning, 14% had functional decline and the mortality rate was 11% at three months post-discharge. Of the participants with moderate cognitive functioning and improvement, 24% experienced functional decline and the mortality rate was 6.5%. Finally, of the participants with consistently low cognitive functioning, 41% had functional decline and 14% died within three months post-discharge. These distinct trajectory groups of cognitive functioning provide information about the possible prognosis of cognition and functional recovery after an acute hospitalization.

## P-069

### Validation of the 7-point scoring system of the clock-drawing test for the screening of cognitive disorders in elderly patients: A pilot study

E. Thomas-Hermet¹, C. Leissing-Desprez², L. Segaux³,
A. Broussier¹, F. Canouï-Poitrine⁴, J.P. David². ¹AP-HP, Hôpital Henri-Mondor/Emile-Roux, Department of Geriatrics, Créteil, France;
²AP-HP, Hôpital Henri-Mondor/Emile-Roux, Department of Geriatrics; Université Paris Est (UPEC), IMRB, A-TV B DHU, CepiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; ³AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France;
⁴Université Paris Est (UPEC), IMRB, A-TV B DHU, CepiA EA 7376 (Clinical Epidemiology and Ageing Unit); Université Paris Est (UPEC), Faculté de Médecine, Département Master; AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France

**Goal:** The main objective was to assess diagnosis performances of the 7-point Clock-Drawing Test (CDT) using a pre-drawn circle for screening of cognitive disorders in elderly patients and the interest to integrate an additional task of copy.

**Methods:** The CDT was administered to 103 elderly patients divided in 3 groups according to their score at the Clinical Dementia Rating (CDR): 0: no cognitive impairment; 0.5: very mild cognitive impairment; CDR1, 2, 3: mild, moderate and severe dementia. The CDT and its copy were scored in 7 points according to the system of Solomon [1]. All the patients had an initial cognitive assessment using traditional screening tests.

**Results:** Patients with CDR0 were significantly younger and of a higher education level. The comparison of the CDT scores between the three groups showed a significant difference (p<0.0001). The

cut-off score ≤6 gave a specificity of 71.4% and a sensitivity of 70.8% for CDR0.5, 93% for CDR≥1. In addition, 41.2% of patients with CDR0.5 didn't normalize their score in copy. The post-hoc subgroup analysis showed a decrease of the sensitivity (55%) for the youngest patients CDR0.5 (less than 82 years).

**Conclusions:** The study showed that the 7-point scoring system of the CDT allows early identification of cognitive decline, despite a decrease of the sensitivity for the youngest subjects. Furthermore, the additional copy task showed that a large proportion of the patients with very mild cognitive impairment present cognitive disorders potentially associated with dysfunction in the parietal region of the brain.

**References:**

[1] Solomon PR, Hirschoff A, Kelly B, Relin M, Brush M, DeVeaux RD, Pendlebury WW. A 7 minute neurocognitive screening battery highly sensitive to Alzheimer's disease. Arch Neurol. 1998 Mar;55(3):349–55.

## P-070

### Visual [18F]Flutemetamol PET read and CSFs measures in routine geriatric assessment of dementia

E. Fantoni. GE Healthcare, Life Sciences, Amersham, UK

**Introduction:** Amyloid PET imaging and CSF beta-amyloid (Aβ42) measurement are two valid alternatives for determining the presence of pathological amyloid load. The accuracy of measurement by the two diagnostic modalities was previously found by Palmqvist et al., 2015 to be comparable. However, the CSF Aβ42 threshold required to establish a "positive"diagnosis of beta-amyloid plaque accumulation is somewhat arbitrary and varies between sites. This 60-patient cohort from routine clinical assessment compared matched pairs of CSF Aβ42 with [18F]flutemetamol PET read results to assess the concordance between PET and CSF measures. T and P-tau measures were also collected.

**Methods:** During the course of 18 months, 60 patients referred by their general practitioner to the Oslo University Memory Clinic with cognitive complaint (mean age 69; range 49 to 81) underwent lumbar CSF fluid sampling and PET scanning following the intravenous injection of approximately 185 MBq [18F]flutemetamol. Aβ42, T-tau, and P-tau concentrations were determined in the Norwegian Central CSF Laboratory in Akerhus University Hospital, Oslo using INNOTEST enzyme-linked immunosorbent assays (Fujirebio, Ghent, Belgium). PET [18F]flutemetamol images were read and classified by readers trained per the manufacturers instructions as either positive or negative.

**Results:** [18F]Flutemetamol PET scanning resulted in 38 subjects being amyloid-positive and 22 negative. 17/22 negative amyloid scan had Aβ42 measures above 770 pg/mL.15 cases below 550 pg/mL had a positive PET read. The remainder of the 28 cases had Aβ42 measures between 560–760 pg/ml with 23/28 reading amyloid positive in the PET read and only 5/28 reading negative.

**Conclusion:** Results indicate that a threshold of over 720 pg/mL captures approximately 78% of PET negatives (18/23), whilst below 720 pg/mL leads to a PET positivity rate of 89% (33/37 cases). This cutoff is higher than regularly accepted in routine practise (550 pg/mL). 17 cases out of 60 (28%) lie in the range 650–770 pg/mL an area where there is not a consistent pattern of either positive or negative PET scan reads. This data is compared with clinical diagnosis.

**References:**

[1] Palmquist S, et al. Detailed comparison of amyloid PET and CSF biomarkers for identifying early Alzheimers Disease. Neurology (2015) 85: 1–10.
## P-071
### Visual scan-path study of social cognition tasks in neurodegenerative diseases: A link between behavior disorders and atypical gaze strategy in social situations

K. Polet, S. Hesse, B. Kullmann, A. Morisot, S. Louchart de la Chapelle, A. Pesce. *Centre Hospitalier Princesse Grace, Monaco*

**Introduction:** Empathy, Theory of Mind (ToM) and facial emotion recognition impairments are associated with social behavior disorders. This kind of disorders is observed in Fronto-Temporal Dementia (FTD), Dementia of the Alzheimer's Type (DTA) and Parkinson's Disease (PD). Our hypothesis is that patients apply inappropriate visual exploration strategies to decode emotions and intentions of others, explaining misinterpretation of others' intentions, and then inappropriate social behaviors.

**Methods:** This study, conducted in the Rainier III Gerontologic Center (Monaco), compares eyes movements in social cognition tasks in patients with FTD (n=5), DTA (n=13), PD (n=10) and normal elderly people (n=12). We studied empathy using standardised observation of an artwork, ToM using the "Reading mind in the eyes" test, and recognition of facial emotions using pictures from the Ekman faces library. Behavior was assessed with the Neuropsychiatric Inventory. Finally, eyes movements were recorded with the EyeBrain Tracker® T2.

**Results:** We highlighted a link between social cognition impairment, behavior disorder and atypical gaze strategy for decoding facial emotions, with a specific profile for each pathology.

**Conclusions:** These results open new perspectives for differential diagnosis of dementia especially for an individualized rehabilitation of facial emotion recognition using explicit technics engaging patients to attend to the eye region of faces. This kind of rehabilitation could be a way to prevent or delay behavioral disorders.

## Area: Comorbidity and multimorbidity

## P-072
### A forgotten cause of falls; onychogryphosis

M. Atef. *Russells Hall Hospital, Dudley, UK*

An 89 years old lady presented with recurrent falls. She complained of feet pain and no other symptoms. Examination was unremarkable apart from thickened curved hooked discoloured toenails. FBC, kidney and liver functions, TSH and Calcium were all unremarkable. The falls and feet's pain were attributed to onychogryphosis. Onychogryphosis is hypertrophy of the nails resulting in long, curved and thickened nails. It is common in older people; however patients are often reluctant to seek professional advice. It is more common in toenails than in fingernails. Onychogryphosis is most commonly caused by neglect or failure to cut the nails for long periods. It may be also caused by injury or trauma to the toenails by ill-fitting shoes, peripheral vascular disease or diabetes. Damage to the ulnar or median nerves can cause Onychogryphosis of the fingernails. Congenital onychogryphosis of all toenails and fingernails is rare however congenital onychogryphosis of the fifth toe is not uncommon. Clinically, the nails may be so thickened and curved that they look like a ram's horn. The thickened curved nails are difficult to cut especially if left for long periods. Pressure on an affected toenail may cause severe pain and it may predispose to falls. Onychogryphosis can be mistaken for fungal nail infection, because of the yellowish brown discolouration, and treated inappropriately. Affected nails can have infection due to growth of the nails into the skin. The best treatment is prevention by regular trimming of the nails. Once onychogryphosis is established, treatment is by surgical removal of the nail and destruction of the nail bed. Foot and toenail

pathology can predispose to falls. Onychogryphosis is an overlooked and under diagnosed contributing factor for falls. Feet inspection should be a routine in assessment of older people especially those with falls.

## P-073
### Acute functional decline or Guillain-Barre Syndrome?

A. Grevy, P. Gibert, G. Gavazzi. *CHU Grenoble Alpes*

**Introduction:** A 75-year-old woman was hospitalized due to a hypovolemic shock caused by diarrhoea. She had a medical history of hypertension, rheumatoid polyarthritis, thyroid hypofuntion and chronic renal failure. Her prescribed treatment included Léflunomide 20mg, Prednisone 5mg, Bisoprolol 10mg, Levothyroxine 75µg. Activities of daily living at home was about 6/6.

**Methods:** Acute renal failure (161 µmol/L), hyperkaliemia (6,2mmol/L) were reported. Based on favourable evolution of hypovolemic shock, etiology of diarrhea was not identified (negative CMV, EBV, VIH, Campylobacter Jéuni). After hospitalization, she had a thirteen days period of functional decline that led to a geriatric rehabilitation. His assessment at admission was ADL: 2,5/6. After 2 days, extreme fatigue and a poor participation were reported.

**Results:** Clinical examination of lower limbs showed a loss of strength rating at 3/5, hyporeflexia. Upper limbs, pair of cranial nerves were preserved. Saturation value was 98%. We suspected a polyradiculoneuritis that led us to considering an electromyography which concluded a Guillain-Barre Syndrome (GBS). She died 10 days after a septic shock on intestinal perforation.

**Conclusions:** Acute functional decline is a typical geriatric syndrome based on post acute care complications. Nevertheless, we have to think about others etiology and carry out a rigorous medical examination. GBS's prevalence increases with age and the mortality rate ranges from 5 to 10%. Agent identification was negative but she was immunocompromised due to Léflunomide and Prednisone. Physiopathological pathway is not clearly established but immune reactions could be involved in the process. We made a declaration to the pharmaco-vigilance department.

## P-074
### Adherence to treatment of patients with chronic pain and osteoarthritis

I. Sierra-Martinez¹, L. Sierra-Martínez², R. Martinez-Fuerte², L.A. Diez-Suarez¹, ¹Traumatology Department, Hospital of Medina de Campo (Valladolid), Spain; ²Valladolid Este Primary Assistance Center, Valladolid, Spain

**Objective:** To know the Adherence to the Therapy of Patients with Osteoarthritis and Chronic Pain (CPO), in order to promote improvement interventions.

**Methods:** Cross-sectional study of a selection of patients (n=104, 52 males and 52 females (F)) selected by non-probabilistic sampling treated in our clinic. With chronic pain and osteoarthritis. The Morisky-Green-Levine trial was also included to assess adherence to treatment. 1 – Have you ever forgotten to take the medication? Yes/No. 2 – Do you take medications at the right time? Yes/No. 3 – If you feel well. Stop taking the medicines? Yes/No. 4 – If you ever feel bad. Stop taking the medicine? No Yes. The data is collected in an Excel spreadsheet and analyzed with SPSS 9.0 for Windows.

**Results:** Therapeutic Adherence to Chronic Arthritic Pain: Therapeutic compliance, if adequately answered in order: No, Yes, No, No, Therapeutic noncompliance, if the answer is incorrect. Male patients: Therapeutic compliance: 83, 33%. Therapeutic noncompliance: 16.67%. Female patients: Therapeutic compliance: 41, 66%. Therapeutic noncompliance: 58.34%.

**Conclusions:** Adherence was greater in males 83.33% than in females 41.66%. Taking into account these results, we propose accord-
ingly Interventions designed to improve adherence: 1 – Measures to simplify treatment. 2 – Information and educational interventions in primary care consultations and specialized consultations and in dynamic groups of health education. 3 – Family and social support measures. 4 – Behavioral reinforcement interventions. 5 – Combination of Interventions.

P-075

Assessment of independency in activities of daily living of older patients in nursing departments

J. Macijauskiene, A. Jakavonyte-Akstiniene. Lithuanian University of Health Sciences, Department of Geriatrics, Kaunas, Lithuania

**Introduction:** Ageing of the population is one of the most urgent health care concern. Long life doesn't necessarily mean healthy life, older patients more frequently experience vulnerability, morbidity, disability, and mortality.

**Methods:** The study is part of the bigger project which was carried out in 2015 from January to December in one of nursing hospitals in Vilnius with the aim to assess older patients' cognitive functions and variables affecting them. Barthel Index (BI) scale [Mahoney & Barthel, 1965] was used to evaluate basic activities of daily living (ADL). The sumscore from 0 to 20 means total dependence, 21–60 – severe dependence, 61–90 – moderate dependence, 91–99 – mild dependence, 100 – independence. The authors received a permission from Vilnius Regional Biomedical Research Ethics Committee.

**Results:** The study included 177 patients, 106 women (59.9%) and 71 men (40.1%). The youngest patient was 61 and the oldest 97 years old (mean age – 78.9±8.9). The mean sumscore of BI was 33.31±24.53. No significant statistical differences were found between BI and age groups (p=0.241) and sex (p=0.538). Statistically significant difference was found between BI sumscore and mortality during first month in the hospital (p=0.004): four fifths of the patients who died during the first month were totally dependent on admission.

**Conclusions:** BI low sumscore is important prognostic factor for negative outcomes in the nursing department.

P-076

Association between dipstick proteinuria and all-cause mortality: a nationwide population-based study in Korea

Y. Kwon¹, K. Han², Y.H. Kim¹, Y.-K. Roh³, Y.-G. Park², K.-H. Cho¹.

¹Korea University College of Medicine, Seoul, Republic of Korea; ²The Catholic University of Korea, Seoul, Republic of Korea; ³Hallym University College of Medicine, Chuncheon, Republic of Korea

**Introduction:** Proteinuria has been shown to be associated with mortality in various settings, and dipstick urinalysis is used as an initial screening tool to assess proteinuria. We investigated the association between dipstick proteinuria and all-cause mortality in a general population.

**Methods:** The study population included 17,342,956 adults who underwent health examinations between 2005 and 2008 under the National Health Insurance System. Proteinuria was determined using a single dipstick semi-quantitative urinalysis, and the primary outcome of this study was all-cause mortality. The prognostic impact of proteinuria was assessed by constructing a multivariable Cox model.

**Results:** The mean age of the study population (53.24% male) was 46.06 years; 724,681 deaths from all causes occurred over a median follow-up period of 9.34 years, and the maximum follow-up was 12.12 years. After full adjustment for covariates, a higher level of dipstick proteinuria indicated a higher risk of all-cause death, and various subgroup analyses, including using age groups divided by 65 years, did not affect the main outcome for the total population. Among older adults ≥65 years old, ≥1+ proteinuria in the group

without metabolic diseases (hypertension, diabetes, dyslipidemia, or obesity) resulted in higher hazard ratios than those in the group with metabolic diseases and negative or trace proteinuria.

**Conclusions:** Our study showed a strong association between dipstick proteinuria and all-cause mortality in this nationwide population-based cohort in South Korea. Dipstick proteinuria is more effective for stratifying mortality in the older adult population than metabolic diseases known to be cardiovascular risk factors.

P-077

Cardiometabolic risk modeling using a typical high risk adult population of sub-Saharan settings

K. Leshabari¹,², B. Mphumuhila³, N. Mavura⁴, R. Bushiri⁵,
R. Kalikawe⁶, ¹Medical Director-Alshifa Polyclinics & Dialysis Centre,
Dares Salaam, Tanzania; ²Clinical Research Unit of H; ³Institute, Dares
Salaam, Tanzania; ⁴Te meke Municipal hospital, Dares Salaam,
Tanzania; ⁵Mwananya Mala Hospital, Dares Salaam Tanzania;
⁶Amana Municipal Hospital, Dares Salaam Tanzania; ⁶Muhimbili
National Hospital, Dares Salaam, Tanzania

**Introduction:** Cardiometabolic risk syndrome is now an acceptable prevalent condition in Africa. There are potential evidence to suggest differences in therapeutic as well as pathogenesis in Africans compared to other human races. Little is known of additional benefits of screening in African environment. The aim of the study was to develop a simple, non-invasive cardiometabolic risk tool for identification of adults at risk of diabetes mellitus in sub-Saharan Africa.

**Method:** A community based opportunistic screening was conducted among pre-defined high risk population of Dar es Salaam, Tanzania. Data were collected using a locally pre-validated questionnaire provided by Tanzania Diabetes Association after fasting blood glucose measurements. Analysis was done using SAS version 9.2 by fitting linear models. A verbal informed consent was sought to each participant before screening.

**Results:** We screened a total of 502 residents. A slight maleponderance was noted (male: female =1.8:1). A validated logistic regression model (Adj. R2=0.714) revealed participant's age >65 years (OR=1.6, 95% CI: 1.2–1.87), family history of diabetes (OR=2.0, 95% CI: 1.87–3.1), systolic BP (OR=1.01, 95% CI: 0.97–1.24) and BMI (OR=1.33, 95% CI: 1.00–4.1) to be useful in prediction of diabetes risk. Statistical association was evident between family history of diabetes and diabetes screening results (γ =0.7, p=0.002) No statistical significant effect was found between gender and positive diabetes screening (χ²=1.66, df=1).

**Conclusion:** Age of participants, family history of both diabetes and hypertension, BMI as well as systolic measures of BP were predictive of diabetes in this study population.

P-078

Characteristics of gastrointestinal symptoms in older adults with diabetes mellitus

G.I. Prada¹, R.M. Nacu¹, I.D. Alexa², A.G. Prada³, A. Kozma⁴,
A.M. Herghelegiu¹. ¹N.I.G.G. "Ana Aslan" and U.M.F. "Carol Davila",
Bucharest, Romania; ²U.M.F. "Gr. T. Popa", Iassi, Romania; ³U.M.F.
"Carol Davila", Bucharest, Romania; ⁴Institute of Anthropology,
Bucharest, Romania

**Introduction:** Diabetes mellitus (DM), a frequent condition in elderly, has significant and multiple consequences. Study objective was to identify characteristics of gastrointestinal symptoms in elderly with diabetes mellitus.

**Material and methods:** A total of 731 subjects, age-range 50–91 years, were included. They were divided into two groups, both presenting DM: 359 adults (50–64 years) and 372 elderly (75–91 years).

**Results:** There was no significant difference between the 2 groups
regarding obesity (p>0.05), but arterial hypertension and dyslipidemia were more prevalent in elderly (p<0.01). In elderly diabetes mellitus was diagnosed more than 20 years before inclusion into the study. In elderly diabetes was poorly controlled (higher HbA1c). DM complications were more frequently encountered in elderly, cardiovascular involvement and neuropathy having a leading position, followed by stroke. Gastrointestinal symptoms were: most frequently abdominal pain, followed by heartburn, constipation, appetite loss, early satiety, bloating and nausea. Elderly had more concomitant symptoms than adults had (p<0.01), 5 and 6 symptoms, adults presenting mostly 3 symptoms in the same time. Gastrointestinal symptoms increased in poorly controlled DM (increased HbA1c). Number of symptoms increased more significantly in elderly with longstanding DM, as compared to adults (p<0.01). Presence of gastrointestinal symptoms was correlated with presence of neuropathy (r=0.79). In elderly these symptoms were more evenly distributed amongst the 2 genders, except for constipation and loss of appetite that were more prevalent in women.

**Conclusions:** Gastrointestinal symptoms in older diabetics pose special problems regarding differential diagnosis, including with cardiovascular diseases, this being complicated by silent presentation.

P-079

**Chronic pain and post-traumatic stress disorder in elderly**

N. Delrue, A. Plagnol. Université Paris 8/Laboratoire de Psychopathologie et Neuropsychologie, Saint Denis, France

**Introduction:** Recent studies have highlighted the frequent co-occurrence of somatic complaints in Post-Traumatic Stress Disorders (PTSD). Moreover, PTSD symptoms are more severe during associated chronic pain. However, the data about the elderly are very scarce. This study investigates the hypothesis that chronic pains presented by elderly patients in nursing home may be a PTSD manifestation. We argue that the two entities would tend to maintain each other but that a simultaneous treatment could be efficient.

**Method:** We present five clinical cases of female patients (84, 88, 91, 92 and 97 years). Each patient has recently entered a nursing home (less than one year) and was complaining about a chronic pain that was unexplained by a medical factor. In each case, the pain was measured on Algoplus scale, a detailed physical check-up was negative and a PTSD was diagnosed using a clinical interview and the Clinician Administered PTSD Scale. After diagnosis, a short treatment protocol was proposed to decrease pain and PTSD symptoms. The Algoplus scale and the Clinician Administered PTSD Scale were filled again after treatment and after 6 months of follow-up.

**Results:** For each patient the reactivation of a trauma has been evidenced. The trauma was related to a war situation (several decades before) or to a recent bereavement in the family. A five to thirteen weeks of specific treatment by cognitive-behavioural therapy (CBT) was efficient with a complete disappearance of pain and PTSD symptoms for more than 6 month.

**Conclusion:** Our data highlight some mechanisms involved in the pain maintenance in relation with a PTSD, in particular the hypervigilance and the avoidance, and indicate a non medical efficient treatment for PTSD and pain.

P-080

**Comorbidity in an elderly cancer population; a cross-sectional study**

M. Ørum¹, M. Gregersen¹, K. Jensen², P. Meldgaard²,
E.M. Damsgaard¹. ¹Department of Geriatrics, Aarhus University
Hospital, Denmark; ²Department of Oncology, Aarhus University
Hospital, Denmark

**Introduction:** Comorbidity is prevalent in elderly patients. Han-

dling comorbidity is of paramount importance when treating elderly cancer patients as it may complicate treatment of the cancer disease. Assessment of comorbidity is part of a Comprehensive Geriatric Assessment (CGA). Our aim is to quantify and classify comorbidity in a cohort of elderly cancer patients.

**Methods:** We performed CGA in 70+-year-old patients with lung cancer (LC), cancer of the head and neck (HNC), colo-rectal cancer (CRC) or upper gastro-intestinal cancer (UGIC) who had been referred to the Oncology Department, Aarhus University Hospital, Denmark for evaluation for cancer treatment. We registered comorbidity and its severity from the patient interview using the Cumulative Indexed Rating Scale- Geriatrics (CIRS-G).

**Results:** From 8 January 2015 to 31 December 2015, we assessed 217 patients. The distribution of cancers was: 7% HNC, 43% LC, 15% UGIC and 35% CRC. Median age was 75 yrs. (interquartile range (IQR)) 72–80). Median number of comorbidities was 5 (IQR 3–6).46% had vascular-hematopoietic (including anemia) comorbidity, 42% had hypertension, 36% suffered from endocrine-metabolic comorbidity, 26% had a history of cardiac disease, 12% had another cancer disease besides the index disease. 57% of patients had one or more grade-3 comorbidity and 9% had any grade-4 comorbidity. Further details on the distribution of comorbidity will be presented.

**Conclusions:** Comorbidity is prevalent in elderly cancer patients. Comorbidity in elderly affects a number of organ systems. More than half of patients had severe or extremely severe comorbidity

P-081

**Comorbidity in nursing home residents with cognitive impairment**

J.M. Fernández Ibáñez¹, M. del Carmen Morales Ballesteros¹,
O. Redondo González². ¹Section of Geriatrics, General Hospital La
Mancha Centro, Alcázar de San Juan, Spain; ²Support Unit Research
General Hospital La Mancha Centro, Alcázar de San Juan, Spain

**Introduction:** In elderly patients with dementia there is a high level of multiple pathology associated. The objective was to assess whether there are differences in comorbidity among nursing home residents with and without cognitive impairment (CI).

**Methods:** A retrospective cohort study of 277 residents over 65 years. The sociodemographic characteristics, Charlson index and type of CI were collected. We compared the degree of comorbidity between residents with and without CI by applying the chi2 test using bivariate analysis.

**Results:** 75% (204) of the residents had CI. We did not find significant differences regarding age and sex between residents with and without CI. CI residents had a higher degree of comorbidity than those without CI (Charlson 3.1 and 2.3 respectively, p=0.005). The most frequent dementias were: Alzheimer's disease (44.4%), mixed dementia (19.3%) and vascular dementia (13.5%). We found differences between the residents with and without CI in the prevalence of cerebrovascular disease (CVD) (52% and 32.4% respectively, p=0.005), osteoarticular disease (40.2% and 54.4%, p=0.041) and respiratory failure (20.1% and 36.8%, p=0.005). The CVD was more common in the mixed and vascular dementia (p<0.001). We found no significant differences in the prevalence of Parkinson's disease, epilepsy, depression, heart disease, renal failure and diabetes mellitus.

**Conclusions:** Nursing home residents with CI have high comorbidity. CVD is more common in residents with mixed and vascular dementia. Osteoarticular disease and respiratory failure are more common in the residents without CI.
## P-082

### Comparison of different tools to detect frailty in nursing homes: Feasability and interrelationship with disability and multimorbidity

N. Martinez-Velilla¹, A.C. Herrero¹, M. Lopez Sáez De Asteasu², F. Zambon Ferraresi², M. Gutiérrez-Valencia¹, A. Sola Mateos³, A.C. Zubillaga⁴, F.A. Amu Ruiz², M. Izquierdo². ¹Department Of Geriatrics, Pamplona, Spain; ²Universidad Publica De Navarra, Pamplona, Spain; ³Residencia El Vergel, Pamplona, Spain; ⁴Residencia La Vaguada, Pamplona, Spain

**Introduction:** Little is known about frailty among nursing homes, and the evidence is scarce as only a limited number of studies have focused on this topic. Few articles have analyzed the relationship between the concept of different measures of frailty, disability and multimorbidity.

**Methods:** This is a cross-sectional analysis of basal data of a concurrent cohort study in subjects older than 65 years, residents in two nursing homes. We used 4 Frailty measures: The Fried frailty criteria, the Frailty Index (FI) de Rockwood, the FRAIL-NH, and an innovative approach trying to approach the limitations of the Fried criteria: The Imputed Fried frailty criteria, usando la técnica denominada MICE (multivariable imputation by chained equation).

**Results:** One hundred and ten individuals were included in the study analyzed. Mean age: 86.3 (SD 7.3), 71.8% women. Most of the residents had high rates of functional and cognitive impairment, multimorbidity and malnutrition. According to the different frailty scales, the prevalence was: Rockwood's FI: 71.8%, Frail-NH: 42.7%, Fried with MICE imputation 36.4%. There is an important heterogeneity between the interrelationship of the frailty scales and the concepts of disability and multimorability

**Conclusion:** There is a significant heterogeneity in the prevalence of frailty in nursing homes depending on the definition of frailty used which significantly affects the interrelationship with the concepts of disability and multi-morbidity. This work is the first to analyze four different scales and to make an innovative approach to the use of the Fried index.

## P-083

### Comprehensive geriatric assessment in the older cancer patient: A multidisciplinary approach to optimize management of comorbidities - a pilot study

C. Choukroun, G. Leguelinel-Blache, J.-M. Kinowski, H. Richard, V. Antoine. *CHU Nimes*

**Introduction:** Older patients with cancer have increased risk for multimorbidity, polypharmacy, inappropriate prescribing and adverse drug reaction (ADR). The objective of this study is to assess the value of a clinical pharmacist-geriatrician teamwork on medication review (MR) to optimize management of comorbidities during comprehensive geriatric assessment (CGA).

**Methods:** A prospective, monocentric and observational study was conducted among older patients (≥75 years old) with cancer (all types), during 11 months in a French university hospital. We integrated a pharmacist consultation into CGA process in an acute geriatric care. The pharmacist records medication story, risk of ADR with Trivalle score and identifies potentially inappropriate medication (PIM) using STOPP/START (V2) and Laroche criteria. The multidisciplinary teamwork then submits its proposals for prescription modification to general practitioners (GP).

**Results:** We recruited 51 consenting patients. We present their socio-demographical and medical characteristics: age, sex, lifestyle, G8 score and geriatric rating scales (cognitive, depression, nutrition, autonomy), cancer types and stages, comorbidities, number of drugs, adherence, PIM and proposals for GP. We assessed the value of MR on number of drugs, Trivalle score and PIM reduction.

**Conclusion:** Multidisciplinary team seems to have a positive impact on iatrogeny and prevalence of PIM and underuse. The clinical pharmacist can find his place into CGA process to optimize management of comorbidities. This pilot study will lead to a larger research project that will assess efficiency of this process, in a wider town-hospital network.

## P-084

### Diabetes mellitus is associated with sleep disturbance in the oldest old

C. Balcı¹, M. Esme², B.B. Yavuz¹, F. Sümer¹, R.T. Dogrul¹, G.S. Aycicek¹, C. Özsurekci¹, H. Çalışkan¹, M. Halil¹, M. Cankurtaran¹. ¹Hacettepe University Faculty of Medicine Department of Internal Medicine Division Of Geriatrics, Ankara, Turkey; ²Hacettepe University Faculty of Medicine Department Of Internal Medicine, Ankara, Turkey

**Introduction:** Sleep is an essential biological process and sleep disturbance is a common health problem that has substantial consequences like cognitive impairment, low quality of life and increased mortality in older people. The prevalence of sleep problems increase with age and there are well known risk factors for sleep disorders in older adults.

**Methods:** The aim of this study is to investigate whether the presence of diabetes mellitus increases the sleep problems in oldest old patients. A retrospective cohort analysis was performed using health records of patients admitted to outpatient clinic of the Division of Geriatric Medicine, Department of Internal Medicine, at Hacettepe University Hospital. Demographic characteristics, comorbid conditions and presence of well known risk factors for sleep disturbance were recorded.

**Results:** Ninety-nine patients over 85 years of age were included in the study. Mean age was 88.45±4 and 44.4% (n=44) was female. Twenty one percent of the patients had diabetes mellitus. Percentage of the patients that declared they had sleeping problem was 35.4% (n=35). 34% of the patients experiencing sleep disturbance had diabetes mellitus while 14% of those not experiencing (p=0.02). Also nocturia was higher among patients with sleep problem (p=0.02). There was no statistical significant correlation between sleep disturbance and gender (p=0.8), history of dementia (p=0.8), depression (p=0.06), hypertension (p=0.2), heart failure (p=0.27), chronic obstructive pulmonary disease (p=0.8) and Parkinson disease (p=0.55). The Odds Ratio (OR) of the significant risk factors in the logistic regression were: diabetes mellitus (OR [95% CI] = 3,4 [1,2–9,7]), depression (OR [95% CI] = 3,3 [1,3–8,5]) and nocturia (OR [95% CI] = 3,4 [1,2–20,4]).

**Conclusion:** In addition to well known risk factors our findings highlight the importance of diabetes mellitus in the development of the sleep disturbance in the oldest old.

## P-085

### Evaluation of quality indicators for patients with dyslipidemia in Primary Care

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

**Background and aim:** Study on the quality of clinical care in patients with dyslipidemia assigned to a family doctor.

**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 Dyslipidemia (n=406). Interventions:-Internal evaluation, dimensions: scientific-technica, quality, adequacy, accessibility, continuity of care; data related to the care process and intermediate results; explicit, evidence-based procedural criteria. Subjects: analysis of
coverage. Analysis on the evolution of treatment compliance. The Z statistical test for comparing proportions, alpha 0,05.

**Results:** Compliance criteria (year 2015): Results Indicators in patients with dyslipidemia associated with a Family Doctor (FD), in the Health Center (HC) and in the Health Area (HA). Patients diagnosed with dyslipidemia 14 years of age or older: FD 406 patients (30.27%), HC 3403 patients (22.39%), HA 56,355 patients (23.88%), Patients with dyslipidemia with registered cardiovascular risk: (CVR): FD 204 patients (50.25%), HC 1687 patients (49.57%), HA 25590 patients (45.43%), Patients with dyslipidemia with a registered CVR between 14 and 65 years: FD 88 (42%), HC 855 patients (45.50%), HA 13432 patients (44.52%), Patients with dyslipidemia with CVR registered over 65 years: FD 116 (56.86%), HC 832 patients (44.37,45%), HA 12168 patients (47.54%).

**Conclusions:** The analysis of the records of care process indicators for patients with Dyslipidemia 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 Dyslipidemia and the quality. The analysis of the records of care process indicators for patients with Dyslipidemia 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 Dyslipidemia and the quality of the records of CVR of the care process.

## P-086

### Evaluation of quality indicators for patients with gender violence in Primary Care

L. Sierra-Martínez¹, R. Martínez-Fuerte¹, N. Sanz-González².

¹Valladolid Este Primary Assistance Gerency, Valladolid; ²JCyL Social Services Gerency, Valladolid

**Background and aim:** Study of the quality of the registry of screening of gender violence patients assigned to a Primary Care Physician (PCP) and to compare them with patients with gender violence at the Health Center (HC), with the Health Area (HA) and with the patients of the Autonomous Community of Castilla and León (CyL) (during the period 2015).

**Method/Design:** Longitudinal evaluation: Palmer's Quality Cycle-Setting: An urban health care center. Population and Sample: Female patients ≥14 years: 753 (year 2015) (n=753). Interventions: Internal evaluation, dimensions: scientific-technica, quality, adequacy, accessibility, continuity of care; data related to the care process and intermediate results; explicit, evidence-based procedural criteria. Subjects: analysis of coverage. Analysis on the evolution of treatment compliance. The Z statistical test for comparing proportions, alpha 0,05.

**Results:** Compliance criteria (year 2015): Population of women ≥14 years: PCP 754, HC 8.039, HA 121.649, CyL 1.088.855. Of the aforementioned, how many have been screened for gender violence in the last four years: PCP 44, HC 907, HA 23,697, CyL 152,246. Screening Rate: PCP 5.84%, HC 11.28%, HA 19.48%, CyL 13.98%.

**Conclusions:** The analysis of the records of the screening indicators for patients with gender violence 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 recruitment of patients with gender violence and the quality of the records of the care process.

## P-087

### Evaluation of quality indicators for patients with heart failure in Primary Care

L. Sierra-Martínez¹, R. Martínez-Fuerte¹, N. Sanz-González².

¹Valladolid Este Primary Assistance Gerency, Valladolid, Spain; ²JCyL Social Services Gerency, Valladolid, Spain

**Background and aim:** Study of the quality of the registry of screening of Heart Failure (HF) patients assigned to a Health Center (HC) and to compare them with HF patients with the Health Area (HA) and with the patients of the Autonomous Community of Castilla and León (CyL) (during the period 2015).

**Method/Design:** Longitudinal evaluation: Palmer's Quality Cycle-Setting: An urban health care center. Population and Sample: HF patients ≥14 years: 116 (year 2015) (n=116). Interventions: Internal evaluation, dimensions: scientific-technica, quality, adequacy, accessibility, continuity of care; data related to the care process and intermediate results; explicit, evidence-based procedural criteria. Subjects: analysis of coverage. Analysis on the evolution of treatment compliance. The Z statistical test for comparing proportions, alpha 0,05.

**Results:** Compliance criteria (year 2015): Population ≥14 years: HC 17,122, HA 2,482, CyL 2,398,647. Number of patients with open HF in the period: HC 116, HA 2,482, CyL 28,038. With the clinical data Fraction of Ejection (Fe) of the left ventricle (LV) recorded in Electronic Clinical History: HC 0, HA 4, CyL 48. Prevalence IC: HC 0.68%, HA 0.94%, CyL 1.17%. Percentage of patients with HF who have LV, recorded in Electronic Clinical History: HC 0%, HA 0.16%, CyL 0.17%. Patients with at least one prescription of ACE inhibitors or ARAs in the period: HC 68, HA 1.663, CyL 16,928. Percentage of patients with at least one prescription of ACE inhibitors or ARAs in the period: HC 58.62%, HA 67%, CyL 60.38%.

**Conclusions:** The analysis of the records of the screening indicators for patients with HF 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 recruitment of patients with HF and the quality of the records of the care process.

## P-088

### Evaluation of quality indicators of physician follow-up after hospital discharge in Primary Health Care

L. Sierra-Martínez¹, R. Martínez-Fuerte¹, N. Sanz-González².

¹Valladolid Este Primary Assistance Gerency, Valladolid, Spain; ²JCyL Social Services Gerency, Valladolid, Spain

**Background and aim:** Evaluation of the Quality Indicators of the Medical Follow-up after the discharge in Primary Health Care from patients assigned to a Primary Care Physician (PCP) and compare them with patients from the Health Center (HC), the Health Area (HA) and the Autonomous Community of Castilla y 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) Medical Follow-up after the discharge in Primary Health Care (n=119). Interventions: Internal evaluation, dimensions: scientific-technica, quality, adequacy, accessibility, continuity of care; data related to the care process and intermediate results; explicit, evidence-based procedural criteria. Subjects: analysis of coverage. Analysis on the evolution of treatment compliance. The Z statistical test for comparing proportions, alpha 0,05.

**Results:** Compliance criteria (year 2015): - Number of notifications of Medical Follow-up after the discharge in Primary Health Care in the period 2015: PCP 119, HC 1477, HA 26688, CyL 309573. - How
many notifications of Medical Follow-up after the discharge, do you have an accompanying hospital discharge report?: PCP 64 (53,78%), HC 803 (54,37%), HA 16426 (61,55%), CyL 222483 (71,87%). – How many notifications of Medical Follow-up after discharge have an appointment, a note on the electronic medical record, or medical follow-up after discharge within 48 hours of the discharge date?: PCP 71 (59,66%), HC 811 (54,91%), HA 17286 (64,77%), CyL 216574 (69,96%).

**Conclusions:** The analysis of the records of care process indicators for patients with notifications of Medical Follow-up after the discharge 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 notifications of Medical Follow-up after the discharge and the quality of the records of the care process.

## P-089

### Frequency and impact of medical complications in the patients undergoing hip fracture

M.E. Baeza-Monedero, C. González-Villaumbrosía, C. Oñoro-Algar, J. Martínez-Peromingo, V. Sendín-Martín, I. Navas-Clemente, I. Robles-Barrena, R. Barba-Martín. *Hospital Rey Juan Carlos, Madrid, Spain*

**Objective:** To study the incident of medical complications in patients undergoing hip fracture and the impact on mortality, hospital stay, and functional deterioration.

**Methods:** Prospective and observational study, which includes all patients admitted for hip fracture since 1st January 2016 to 15th February 2017 in a secondary hospital in Madrid. We assessed the presence of anaemia with transfusion requirement, acute renal failure, cardiovascular complications, stroke, thromboembolic, nosocomial infection, ulcers by pressure, delirium, malnutrition, constipation with enema requirement and vitamin D deficiency. We did a descriptive analysis of the population characteristics, and a linear correlation (Pearson test) between the number of complications and hospital stay and functional impairment (Barthel). We also did an univariate analysis between each complication and mortality (χ² test), and we studied the association between each complication and hospital stay, functional impairment and mortality (T for independent samples).

**Results:** n:163 patients. The average number of complications was 3.39 (range 1–7). The most frequent was vitamin D deficiency (64.4%), malnutrition (60.7%), anaemi (59.5%), constipation (48.5%), renal failure (30.7%), nosocomial infection (17.8%), cardiovascular complications (17.2%), ulcer (6.7%), strok (1.2%), and thromboembolis (0.6%). The number of complications was statistically significant with the stay (Pearson0.18, p=0.02) and functional decline (Pearson 0.16,p=0.04). The average of complications was significantly higher among the deceased patients against the living patient (5.5Vs3.39, p=0.045). Complications associated significantly with a higher mortality were nosocomial infection (20.7Vs1.5%, p<0.001), cerebrovascular (100%Vs3.7%, p<0.001) and ulcer (27.3Vs3.3%, p=0.01) and those related to a higher functional impairment were anaemi (loss of 21 points in BarthelVs15, p=0.025)and cardiovascular complications (25Vs17, p=0.018).

**Conclusion:** The coexistence of medical complications is a common problem in the patients undergoing hip fracture correlating their number with increased mortality. Some complications are associated with higher mortality and functional impairment.

## P-090

### Geriatrician input into the care home significantly reduces anticholinergic burden (preliminary report)

S.-J. Bailey¹, T.J. Welsh¹,²,³. ¹Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; ²RICE (Research Institute for the Care of Older People), Bath, UK; ³University of Bristol, Bristol, UK

**Introduction:** Many commonly used medications have mild anticholinergic effects of which practicing clinicians may not be routinely aware. The cumulative effect of multiple such medications, known as anticholinergic burden, has been associated with adverse outcomes. Interventions that reduce anticholinergic burden may therefore be beneficial. Review of care home residents' medications is an intervention used by community geriatricians. This quality improvement project aimed to evaluate the impact of a community geriatrician on care home residents by using change in anticholinergic burden as a proxy measure.

**Methods:** A joint review of care home residents' medication was carried out by a geriatrician in conjunction with the patient's general practitioner and care home manager. Medication pre and post review was documented. The anticholinergic cognitive burden scale was retrospectively used to quantify and compare anticholinergic burden before and after review.

**Results:** At the time of submission data was available from 25 residents: 76% female, mean age of 84 (8), taking a mean of 7.9 (3.8) medications at baseline. 22 (11%) out of a total of 198 medications were stopped or reduced following review. Both the median anticholinergic burden (1 (0–3) to 0 (0–1) P=0.02) and the mean number of medications (7.9 (3.8) to 7.2 (3.2) P=0.008) were significantly reduced.

**Conclusions:** Geriatrician input into the care home reduces anticholinergic burden and total medications. If the results were to be replicated over a larger population this could have a potentially important impact on health through a reduction in anticholinergic burden and on cost through a reduction in medication expense.

## P-091

### GP-led locality hub for older people living with frailty in North West Surrey

R. Lisk¹, P. Wilkinson², N. Selby³, J. Wagstaff³, L. Lawn⁴. ¹Elderly Care Department, Ashford & St. Peter's NHS Foundation Trust, Chertsey, UK; ²Cardiology Department, Ashford & St. Peter's NHS Foundation Trust, Chertsey, UK; ³North West Surrey CCG, Weybridge, UK; ⁴Medical Director, Bedser Locality Hub, Woking, UK

**Introduction:** At North West Surrey, (NWS) we faced a number of challenges including an ageing population, people living with chronic conditions, overreliance on hospitals and disconnect between social and medicalised care. Our mission was to find a way to manage the challenges we face from a growing older population within an integrated GP-led community service and in a manner that promotes independence, reduce social isolation, improve patient experience and safely delivers appropriate acute care in the community.

**Methods:** The model delivers standardised, multidisciplinary care to patients focused on tasks and activities that maximise health, maintain independence and functioning, based on individual need. These interventions are delivered in a co-located setting by a single integrated team including carers and volunteers and we provide transport to enable attendance. The 1st hub in Woking was opened on 20th Dec 2015 and 2 other locality hubs are due to open towards the end of 2017.

**Results:** From Dec 15–Sept 16, there has been a 3.6% reduction in non-elective admissions across acute providers in NWS in the over 75s for Woking, compared with an increase in activity in the other localities. Friends & Family feedback (88 patients) showed
98.9% were likely/extremely likely to recommend service with 89% extremely likely.

**Conclusions:** The locality hub has had an impact on admissions. It is important that initiatives such as this, which focus on partnership working, are adopted more widely to enable older patients to be treated in the most appropriate environment for their social and medical needs.

P-092

Hypotension in nursing home residents on antihypertensive
treatment: risk of mortality and hospitalization

G. Bahat¹, B. İlhan¹, A. Tufan², S. Bovatekin¹, H. Özkaya³,
H. Doğan³, C. Kılıç¹, M.A. Karan¹. ¹Istanbul University, Istanbul
Medical School, Division of Geriatrics, Istanbul, Turkey; ²Marmara
University, Department of Internal Medicine, Division of Geriatrics,
Istanbul, Turkey; ³Istanbul Kayışdağı Nursing Home, Istanbul, Turkey

**Objective:** Prevalence of hypertensio (HT) and use of antihypertensive medications increase by-aging. Antihypertensive-medication is a potential risk-factor for hypotension for morbidity/mortality in elders. We aimed to assess prevalence of hypotension and orthostatic hypotension (OHT) and their relationship between subsequent one-year hospitalization and mortality in nursing home (NH) residents receiving antihypertensive-medications.

**Methods:** A group of NH resident >60 years of age receiving antihypertensive medications accepted to involved. Blood pressures (BPs) were measured sitting and 3–5 min after standing to assess OHT. BPs were measured supine and 3–5 min after sitting to assess OHT in bedridden residents. Also BP measures recorded in the last year at NH have been studied retrospectively. Residents were evaluated for both recorded and current BPs and comprehensive geriatric assessment thoroughly.

**Results:** 175 were male (%66) and 89 were female (%34) from 264 subjects. Mean age was 75.7±8.7 years. Most of residents were ambulate (n=191, 72%). At one year, ratio of hospitalization from any cause was 50.8% (n=134), mortality rate was 21.6% (n=57). 88 residents had mean SBP ≤110 mmhg (34.8%). 170 residents had mean DBP≤70 mmhg (67,2%). 54 residents had OHT (21.6%). Lower SBP (≤110 mmhg) was statistically significant predictor of mortality (p=0,047) in cox regression analysis after adjusting for age, sex, number of comorbidities and medications, and MNA-sf. Mortality was significantly higher in residents with mean DBP ≤70 mmhg (p=0,031) in chi-square analysis. Hospitalization was higher in only group with DBP≤65 mmhg with borderline statistical significance (p=0,05) in regression analysis. OHT was not seen associated with mortality nor hospitalization.

**Conclusion:** Both supine hypotension and OHT are significantly prevalent in “hypertensive” NH residents on antihypertensive-treatment. Either lower SBP≤110 mmhg is independently associated with mortality in NH residents. Lower DBP ≤65 mmhg is also associated with increased hospitalization in NH residents.

P-093

Hypoxic-ischemic brain injury related to dual disorder

C. García-Alonso¹, D. Curto-Prieto¹, B. Gonzalvo Cirac². ¹Grupo
Residencial Valdeluz, Madrid, Spain; ²CAS Benito Menni, CASM. Sant
Boi LLobregat (Barcelona), Spain

**Objective:** Observational and descriptive study of the N=21 out-
patients in an addiction treatment center. There are cognitive and
functional impairment (clinically detected and through The Mon-
treal Cognitive Assessment – MoCA) that hinder the therapeutic
program of deshabituation.

**Purpose of study:** Show the reality (increasing) of outpatient addiction treatment centers and the difficulties of treatment of these patients.

**Material and methods:** Data are collected from N=21 patients, who are being treated at a outpatient drug addiction center (CAS). All of them have mild cognitive and functional impairments.

**Results:** 89% of outpatients had alterations in neuroimaging evaluation (NMR). Two of them are women. Mean age were 61 ages (44–72 years old). 61% had Dual Disorder (addiction and other mental illness). 83% had Alcohol Use Disorder. 72% had hypoxic-ischemic brain injury throughout life. MoCA were less than 24 in all of outpatients.

**Conclusions:** Chronic substances abuse and cognitive and func-
tional impairments, should not be problem to the neurological
assessment and rehabilitation of affected outpatients. Dysfunction
of patients makes it extremely difficult to follow the specific
therapies to recover from the addiction. Comprehensive cognitive/
neurological rehabilitation treatments and substance use disorders
would have to be started.

References:

[1] Fernández-Serrano MJ, Pérez-García M, Verdejo-García A. What are the specific vs. generalized effects of drugs of abuse on neuropsychological performance? Neurosci Biobehav Rev 2011; 35: 377-406.

[2] Verdejo-García A, Chong T-J, Stout J, Yücel M, London ED. Stages of dysfunctional decisión-making in addiction. Pharmacology, Biochemistry and Behavior. In press (2017).

P-094

Improving the management of osteoporosis in older men

R. Litke, E. Boulanger, F. Puisieux. Lille University Hospital, Lille,
France

Osteoporosis in older men is common and causes significant mor-
tality and morbidity [Walsh et al. Nature Rev Endoc 2013]. Some
data suggest that osteoporosis is underidentified and undertreated
in men. Additionally, 50% of the causes of osteoporosis are sec-
ondary in men [Gielen et al. Best Pract. Res Clin Endoc Metab 2011].
The 2012 Endocrine Society recommend additional laboratory in-
vestigations in men with osteoporosis so as to treat them more
efficiently [Watts et al. JCEM 2012]. Our aim was to determine
whether men managed in our geriatrics centre, diagnosed with
osteoporosis, underwent investigations to determine the aetiology
of osteoporosis and what the secondary causes were. We conducted
a monocentric, retrospective study including all men seen at the
geriatric consult in 2016 diagnosed with osteoporosis. For each
patient, we evaluated our clinical practice, whether common sec-
ondary causes were sought-after and what these aetiologies were.
Among the 121 men with a diagnosis of osteoporosis seen at the
geriatric consult at the Lille University Hospital in 2016 only 55
had undergone further investigations. Among the 3 major identified
secondary causes: 16% glucocorticoid induced, 12% hyperparathy-
roidism, 12% treatment induced hypogonadism. The investigations
conducted in elderly men to seek a secondary cause to osteoporosis
are insufficient. The 2012 Endocrine Society guideline and Rheuma-
tology societies provide a framework for evaluation and treatment
of osteoporosis in men. We should aim to more widely research
secondary causes for osteoporosis in our patients so as to better
adapt the management.

P-095

Intervention program for caregivers of multimorbid patients

R. López-Liria¹, F.A. Vega-Ramírez², P. Rocamora-Pérez¹,
M.I. Segura-Luján³. ¹Department of Nursing Science, Physiotherapy
and Medicine, University of Almería, Almería, Spain; ²Torrecárdenas
Hospital, Almería. Spain; ³Physiotherapist, Almería. Spain

**Objective:** To develop a practical guide for caregivers of multimorbid patients, which should be useful, providing information that
suits the demands and needs of both the patients and caregivers themselves.

**Methods:** A cross-sectional descriptive study was carried out in Almería Health District to describe the home care provided by Mobile Rehabilitation and Physiotherapy Teams, the characteristics of its implementation, and its results on patients' functional independence and on their caregivers' overload.

**Results:** Family and caregivers receive training to promote patient's functional independence, and are also given information about the intervention on the patient and its objectives, helping them incorporate these activities into their daily routine. Additionally, they receive information on health and community resources, in order to help them look after their own physical and mental welfare. Furthermore, they are encouraged to participate in support groups for stress management, among other activities. There is supporting evidence showing how the support from family, friends and both public and private services and resources can diminish the overload experienced by caregivers.

**Conclusions:** Access to information and the various domiciliary resources available, both health and social, offer caregivers more possibilities to provide their dependent patients with a more adequate intervention that will have an impact on their quality of life. Caregivers themselves reach better physical and emotional welfare, so as to face the problems and difficulties of their daily lives. Research Project PI 0354/2014 issued by the Ministry of Health of the Government of Andalusia.

## P-096

### Invasive versus non invasive management of acute myocardial infarction in patients with dementia: Data from SveDem, the Swedish Dementia Registry

D. Religa, P. Cermakova, K. Szummer, K. Johnell, J. Fastbom, B. Winblad, M. Eriksdotter. Karolinska Institutet, Stockholm, Sweden

**Background:** Acute myocardial infarction (AMI) is one of the leading cause of death and is particularly prevalent and deadly after 80 years of age. We aimed to study factors that determine the use of invasive procedures in the management of AMI in patients with dementia and determine whether the use of invasive procedures was associated with better survival.

**Methods:** The study was based on data from Swedish Dementia Registry (SveDem), 2007–2012. We included 29 630 newly diagnosed dementia patients from specialist memory units (60) and primary care units in Sweden (ca 880). During median follow-up time 228 days 525 dementia patients got AMI (mean age 89 years, 54% women).

**Results:** 110 patients (21%) with dementia received invasive treatment for AMI. After multivariate adjustment, lower age and higher global cognitive status were associated with the use of invasive procedures. The invasively managed patients survived longer (P=0.001). Invasive treatment was associated with a lower risk of all-cause mortality, adjusting for type of AMI and dementia disorder, age, gender, registration unit, history of AMI and comorbidity score (HR 0.35, 95% CI: 0.21–0.59), or total number of drugs (HR 0.34, 95% CI: 0.20–0.58).

**Conclusions:** Age and cognitive status determine the use of invasive procedures in patients with dementia. This study suggests that the invasive management of AMI has a benefit for survival of patients with dementia.

## P-097

### Is multimorbidity a “Domino” phenomenon? The results of the PolSenior study

A. Skalska¹, K. Piotrowicz¹, A. Pac², T. Grodzicki¹. ¹Department of Internal Medicine and Gerontology, Jagiellonian University Medical

College, Kraków, Poland; ²Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland

**Introduction:** Multimorbidity is a complex problem of the current geriatric medicine. Patients with multimorbidity require more clinical concern, use healthcare resources more often, and experience significantly worse short- and long-term outcomes. The aim of the analysis was to determine the prevalence figures and conditional counts for the most frequent chronic diseases and multimorbidity in the Polish elderly.

**Methods:** Medical questionnaire, history taking and physical examination, and blood and urine collection were employed in order to gather data on 17 chronic diseases in participant of nationwide PolSenior Project. Multimorbidity was defined as a co-occurrence of 2 and more chronic diseases. All data was weighted with regard to age and sex.

**Results:** Multimorbidity was diagnosed more often with advanced age, in 88.4% of those 65–79, and in almost 94% of those aged 80 and older. Hypertension, metabolic diseases and obesity were the most common chronic condition, however it was changing with advanced age and in octogenarians and older hypertension, eye disorders and cognitive impairment were the most frequent medical problems. The highest risk for multimorbidity was found in the respondents aged 65–79 with stroke, and in the oldest olds who had suffered from stroke or heart failure. Hypertension was most often diagnosed as a single disease, in 4.1% of those aged 65–79 and in 2% of those aged 80 years and more.

**Conclusions:** We showed that in the elderly chronic diseases were usually diagnosed as multimorbidity patterns that might influence the way how we diagnosed and treat the older patients.

## P-098

### Life with cancer in nursing homes. Can e-health technologies improve the quality of care?

T. Delespierre¹, P. Clot-Faybesse², A. Letty³, L. Josseran⁴.

¹Paris-Saclay & Institut du Bien Vieillir Korian; ²Korian SA; ³Institut du Bien Vieillir Korian & Korian SA; ⁴Paris-Saclay

**Introduction:** Korian is a private group specialized in medical accommodation for elderly and dependent people. A professional data warehouse set up in 2010 hosts all residents' data, the transmissions' table containing key information about the residents' care fed on a daily basis. As cancerous residents require multiple interventions and hospitalizations, following them in nursing homes (NH) in real time can be really challenging. The objective of this study is then to show what e-health can bring to cancerous residents' quality of care.

**Methods:** Through nursing care narratives extraction, using deep learning we built 26 syndromes including hospitalizations and deaths, afflicting our residents: a first layer shortened the character fields and cleaned up expressions, a second selected the syndromes, and a third involved medical expertise and logical predicates. In this study we chose to extract the life course of residents with at least one recent cancer mention syndrome, staying in two NH where a GP coordinating care was following them, from that transmission until 02/26/2017. A first classification using socio demographic variables and care information, designed as a preliminary work, gave the following results.

**Results:** Splitting the 57 residents between dead and alive, men and women, or by using a first cancer mention delay in days' threshold, shed light on the ever changing residents' health and socio profiles but also on the cancer treatment through time.

**Conclusion:** Including the residents' past syndromic transmissions information, especially cancer features, through textmining and machine learning analyses will give new insight and improve GP's treatments.
## P-099
### Management of chronic insomnia in elderly

S. Hammami¹, I. Chabène¹, A. Mhalla², L. Gaha², ¹CHU F Bourguiba, Department of Internal Medicine, University of Monastir; ²CHU F Bourguiba, Department of Psychiatry University of Monastir, Tunisia

**Introduction:** Insomnia is the most common sleep disorder in the elderly. Its management must take into account the physiological changes related to the age, the higher frequency of co morbidities and the polymedication.

**Objective:** To evaluate the management of chronic insomnia in the elderly patients by general practitioners and to compare them with international recommendations.

**Population and methods:** We conducted a cross-sectional and descriptive study among general practitioners over a period of two months. We proposed to these doctors to participate in our study by sending to them a questionnaire in their emails, which they fill anonymously.

**Results:** A total of 32 doctors responded to the questionnaire. Among them, 62.5% reported that they often or very often receive elderly consulting for insomnia. Before prescribing hypnotic drugs, 65.6% of practitioners reported that they often advise lifestyle and dietary rules. The most prescribed hypnotic classes were: Benzodiazepine (BZD) and antihistamines in 59.37% of cases each one and homeopathic treatments in 56.25% of patients. The treatment period exceed 30 days in 18.75%. As for the prescription of BZD, molecules with long half-life were used in 37.48% of cases, and the posology was identical to adults in 34.4% of cases.

**Conclusion:** The prescription of hypnotic treatment in the elderly must be cautious, taking into account psychiatric and somatic co morbidities. Patients must be educated about environmental factors that affect sleep, such as avoiding caffeine late in the day, having a regular sleep schedule, avoiding napping and the importance of exercise.

## P-100
### Mortality risk factors among long-term care facility residents

A. Kantoch¹, B. Gryglewska¹, T. Grodzicki¹, J. Wojkowska-Mach², P. Heczko², ¹Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University, Medical College, Kraków, Poland; ²Chair of Microbiology, Faculty of Medicine, Jagiellonian University, Medical College, Kraków, Poland

**Objective:** The main aim of the study was to evaluate potential mortality risk factors among long-term care residents during one year of follow-up.

**Material and methods:** The study was performed among 172 elderly residents of three long-term care facilities in Poland. The study population was divided into two groups: people who were alive [Group 1] and people who died [Group 2] during one year follow-up period. Medical documentation, blood pressure (BP) measurements, Body Mass Index (BMI) and selected tests including Abbreviated Mental Test Score (AMTS), physical dependence score, Mini Nutritional Assessment (MNA) and Barthel Index were performed in all study participants at the beginning of the study. Statistical analysis: Results obtained in two analyzed groups were compared using U Mann-Whitney or Chi square tests. Univariate and multivariate logistic regression models were used for investigating the risk factors for mortality.

**Results:** The analyzed sample consisted of 172 long-term care residents. Group 1 (N=148) and group 2 (N=24) revealed similar age, number of diagnosed diseases, number of used treatment, BMI and BP values. However, group 2 showed significantly lower score in ADL (0 [0; 2,5] vs 3 [1; 6]), Barthel Index (5 [0; 37,5] vs 40 [15; 95]), MNA (8 [6;10] vs 12 [9;13]), AMTS (4 [2;7] vs 8 [6;9]) and greater physical dependence score (4 [3;5] vs 3 [1;3]) than group 1.

The statistical analysis showed that the potential risk factors that increased the mortality among residents were: diagnosed diabetes (8,1 OR [95% CI: 3,00–21,86], p<0,001), dementia (3,0 OR [95% CI: 1,25–7,27], p=0,014) and physical dependence (2,13 OR [95% CI: 1,47–3,07], p<0,001). The protection factor was diagnosis of hypertension (0,28 OR [0,10 - 0,74], p=0,010).

**Conclusion:** Lower functional, nutritional, cognitive status, greater dependence and diagnosis of diabetes or dementia were negatively influenced on mortality outcomes. However, occurrence of hypertension may have positive impact on probability of survival among institutionalized individuals.

## P-101
### Non-pulmonary symptoms and comorbidities in older people with chronic obstructive pulmonary disease

G.I. Prada¹, R.M. Nacu¹, O.N. Penes¹, I.D. Alexa², A. Kozma³, A.G. Prada⁴, A.M. Herghelegiu¹, ¹N.I.G.G. "Ana Aslan" and U.M.F. "Carol Davila", Bucharest, Romania; ²U.M.F. "Gr. T. Popa", Iassi, Romania; ³Institute of Anthropology, Bucharest, Romania; ⁴U.M.F. "Carol Davila", Bucharest, Romania

**Introduction:** Chronic Obstructive Pulmonary Disease (COPD) is frequently seen in elderly, with important consequences on morbidity and mortality. We analyzed non-pulmonary symptoms and comorbidities in elderly with COPD.

**Material and methods:** A retrospective study performed on 120 randomly selected patients previously diagnosed with COPD, divided into 2 equal groups: adults (50–64 years), elderly (≥75 years), with equal number of women and men.

**Results:** A most all subjects had no occupational risk. 2/3 of patients resided in urban area; 77.5% were current or previous smokers, mainly males (58%). 16.7% had tachycardia and 2.5% had bradycardia, more often encountered in elderly. Heart failure was more prevalent in elderly (p<0.05), 1 in 7 having ejection fraction ≤40%. Pulmonary hypertension was more prevalent in adult women chi-square test = 4.261 (p<0.05). C-reactive protein more prevalent in elderly (p<0.01). Body Mass Index higher in adults, chi-square test showed no gender difference. High prevalence of diabetes mellitus amongst elderly, no significant difference from adults. Pearson test showed no statistical correlation between COPD severity (GOLD category) and HbA1C levels. Osteoporosis more prevalent in elderly women (chi square = 10.652, p<0.05). Regarding neurocognitive status, only decreased orientation skills in elderly group and anxiety in women in both age-groups. Comorbidities were highly prevalent in both groups (92%), elderly having more than 3 conditions concomitantly. Most prevalent comorbidities in elderly, in order: diabetes mellitus, heart failure, hypertension.

**Conclusions:** Comorbidities and non-pulmonary symptoms in elderly with COPD have a significant impact on severity of disease and survival in this category of patients and need special attention.

## P-102
### Potentially inappropriate medications in hospitalized elderly in a tertiary hospital in Singapore using the STOPP criteria

D. Chia¹, P.S. Ong², L. Chia², C.P. Lee³, M.Q. Wan¹. ¹Dept. of Pharmacy, National University Health System, Singapore; ²Dept. of Pharmacy, National University of Singapore, Singapore; ³Dept. of Pharmacy, National Cancer Centre Singapore, Singapore

**Background:** Potentially inappropriate prescribing (PIP) in elderly is prevalent and is associated with increased risk for adverse drug events, morbidity and healthcare cost (Scott, 2015). Screening tools such as Screening Tool of Older Persons (STOPP) assist to evaluate PIP prescribing among elderly (Hill-Talyor, 2016). However, extent of inappropriate prescribing among Singapore hospitalized elderly is currently unknown.
**Objectives:** This study aims to investigate the prevalence of PIP in elderly patients on hospital admission and at discharge as well as to identify risk factors associated with PIP.

**Methods:** A retrospective cross-sectional study was conducted over a 2-month period in a cardiology ward in National University Hospital, Singapore. Patients 65-years and older who were taking at least one medication were included. STOPP Version 2 criteria was used.

**Results:** A total of 115 patients were included with 52.2% having more than 8 medications on admission. Admission PIP prevalence was 51.3% (59 patients, 105 PIPs) which was decreased to 47.0% (54 patients, 78 PIPs) on discharge. Admission PIM index was reduced from 0.110±0.150 to 0.0698±0.093 on discharge (p=0.007). The two leading classes of PIPs were prescription of Vitamin B supplementation without evidence-based clinical indication and medications that increase the risk of falls including first-generation antihistamine. A significant predictor of PIP on admission identified was taking more than eight prescribed medications [OR 3.79; 95% CI: (1.75, 8.21)].

**Conclusion:** Inappropriate prescribing was common among elderly in Singapore and hospitalization resulted in a decrease in PIPs. The number of medications prescribed was significantly associated with number of PIP.

P-103

Predictors of cardiorenal damage in the elderly

D. Tasic, Z. Dimitrijevic, B. Mitic, K. Tasic. *Serbia*

**Introduction:** It is known that the incidence of heart failure increases with age, and therefore, it is now characterized as a geriatric syndrome. Renal function is valorized as a marker of early or advanced stages of heart disease and is of much greater clinical significance than the value of the ejection fraction. We are analyzing the structural and functional markers of heart and kidney damage (BNP, troponin I, cTnhsT, cystatin C), inflammation markers (CRP, IL-8, PAI-1) and oxidative stress markers (AOPP, MDA, XOD, XO, XD) and determining their importance in different clinical modalities of the cardiorenal syndrome.

**Methods:** The clinical group consisted of 79 patients, 40 of whom were men (50.63%) and 39 of whom were women (49.37%), in the average age of 70.72±9.26 years. Based on the current classification of cardiorenal syndrome, the patients was divided into five subgroups. The main criteria for the inclusion of subjects with associated renal and heart failure in the study were the existence of a "de novo" or previously diagnosed, clinically manifested cardiovascular disease.

**Results:** In the univariate logistic model, the age of the patients (p=0.002) and the elevated concentrations of CRP (p=0.001) were identified as risk factors for the development of chronic cardiorenal syndrome. The multivariate model includes variables with the statistical significance of p<0.010. The age of the patients (p=0.002), the concentration of PAI-1 (p=0.032) and CRP (p<0.001) were identified as significant risk factors.

**Conclusions:** The age of the respondents, as well as the high levels of CRP were identified as independent risk factors for the development of chronic forms of cardiorenal syndrome. In the multivariate model, the ages of respondents, as well as the high plasma levels of CRP and PAI-1 have retained the importance as the risk factors.

P-104

Prevalence and pattern of use of oral antihyperglycemic drugs and insulin in a population of diabetic patients in nursing homes: Results from the SHELTER Study

F. Martini, D. Ronconi, G. Onder, R. Liperoti, R. Bernabei. *Universita' Cattolica del Sacro Cuore*

**Objectives:** Describe prevalence and pattern of use of antidiabetic

drugs in elderly people with diabetes mellitus residing in nursing homes (DMRs), and to identify individual socio-demographic and clinical features associated with these drugs. Design: Cross-sectional analysis of the Services and Health for Elderly in Long TERm care (SHELTER) database. SHELTER is a 12-month prospective cohort study, conducted between 2009 and 2011, to assess Nursing home (NH) residents in 7 European countries and Israel.

**Methods:** The study included 4037 residents in 59 NH during the 3-month enrollment period. The multidimensional InterRAI instrument for Long-Term Care Facilities (InterRAI-LTCF) was used to assess health and functional status. Descriptive statistics and logistic regression models were used to perform the analyses.

**Results:** About 61.3% of DMRs were treated with antidiabetic drugs (33% with oral antihyperglycemic drugs (OAD), 22% with insulin (Ins) and 6% with combined therapy (OAD + Ins)). Among the OAD, Biguanides were the most prescribes drugs (53%). Non treated residents were more likely to be female, older, with a higher BMI and with more severe cognitive decline. DMRs treated with Ins presented more severe functional decline. Ins+OAD was associated with lower prevalence of cognitive impairment, depression, urinary incontinence and pain.

**Conclusion:** Over 60% of DMRs receive pharmacological treatment with antidiabetic drugs. Advanced age is the main barrier to treatment, while severity of cognitive and functional decline may influence the prescribing choice. Further studies are needed to confirm these findings and evaluate the effectiveness of antidiabetic treatment in frail elderly population.

P-105

Prevalence of benign paroxysmal positional vertigo, orthostatic hypotension and polyneuropathy in patients referred to a geriatric falls clinic – a cross-sectional study

L.H. Andersen, E.M. Damsgaard, M. Gregersen. *Dept. of Geriatrics, Aarhus University Hospital, Aarhus, Denmark*

**Introduction:** Falls and vertigo are common in older persons. One third falls at least once a year. The prevalence of vertigo is approximately 30%. Three common causes of vertigo and falling are: benign paroxysmal positional vertigo (BPPV), orthostatic hypotension (OH), and polyneuropathy (PNP). Our aim was to find the prevalence of these diseases in older patients referred to a geriatric falls clinic.

**Methods:** We made a cross-sectional study of all patients affiliated to a falls clinic on March 15th 2017. We calculated the prevalence of BPPV, OH and PNP by chart review. BPPV had been diagnosed by physical therapists using the Dix-Hallpike method. OH had been diagnosed using blood pressure measurements after having the patient stand up for minimum three minutes and was conducted by a geriatric nurse. PNP had been diagnosed on the basis of distal loss of sense, vibration and/or reflexes. This was performed by a geriatric doctor.

**Results:** The number of patients was 97. Mean age was 79.8 years (SD: 6.6), 67% were female. BPPV was found in 10% of the patients, OH in 36%. PNP had been newly diagnosed in 40%. Twenty-six percent of the patients had two diagnoses. Other common diagnoses were other vestibular disorders, polypharmacy and cardiac arrhythmias.

**Conclusions:** BPPV, OH and PNP are common causes of vertigo and falls in a geriatric falls clinic. BPPV, OH and PNP are potentially reversible. Further studies should be made to determine the outcome of intervention of these diseases.
P-106

**Risk factors and complications of arterial hypotension in older people**

G.I. Prada¹, O.N. Penes¹, R.M. Nacu¹, I.D. Alexa², A. Kozma³,
A.G. Prada⁴, A.M. Herghelegiu¹, ¹N.I.G.G. "Ana Aslan" and U.M.F.
"Carol Davila", Bucharest, Romania; ²U.M.F. "Gr.T. Popa", Iassi,
Romania; ³Institute of Anthropology "Fr. I. Rainer", Bucharest,
Romania; ⁴U.M.F. "Carol Davila", Bucharest, Romania

**Introduction:** Arterial hypotension is a major problem in elderly and has significant consequences: syncope, falls, stroke, myocardial infarction, even death. Study objective was to identify risk factors and complication of this condition in elderly.

**Material and methods:** A total of 277 subjects, age-range 44–95 years, were included. They were divided into two groups, both presenting arterial hypotension: 136 adults (44–64 years) 136 and 141 elderly (75–95 years).

**Results:** Three types of arterial hypotension have been identified in elderly: orthostatic hypotension, post-prandial, post-exercise hypotension. In our sample, most cases had orthostatic hypotension, other variants had less than 4% prevalence. Parkinson disease was more often seen in older patients (p<0.05). Type 2 diabetes mellitus and chronic renal disease were also more prevalent in elderly (p<0.05). Smoking was more prevalent in adult males. Three groups of medicines were involved: psychoactive, antiparkinsonian, vasodilator drugs. Age of menopause younger than 46 years was more prevalent in elderly women with arterial hypotension (chi square=9.762, p<0.05). Anemia was significantly more prevalent in elderly (p<0.001). Stroke and myocardial infarction was significantly more prevalent in elderly patients (p<0.01). Vertigo and syncope occurred as complications of arterial hypotension more often in elderly (p<0.01), as well as falls, fractures and ischemic heart disease. Orthostatic hypotension was identified in elderly more than twice in adults. Headache and asthenia occurred more often in elderly (p<0.05).

**Conclusions:** Identifying arterial hypotension, its forms and addressing some of its most important risk factors, could improve standing and prevent falls and other complications in elderly.

P-107

**Severity of vitamin D deficiency predicts mortality in stroke patients**

J. Wajda¹, M. Swiat², A. Owczarek³, A. Brzozowska⁴,
M. Olszanecka-Glinianowicz⁴, J. Chudek⁵. ¹Department of
Nephrology, Regional Specialist Hospital No. 3, Rybnik, Poland;
²Department of Neurology with Stroke Unit, Regional Specialist
Hospital No. 3, Rybnik, Poland; ³Department of Instrumental Analysis,
Faculty of Pharmacy and Laboratory Medicine in Sosnowiec, Medical
University of Silesia, Katowice, Poland; ⁴Health Promotion and Obesity
Management Unit in Department of Pathophysiology, Medical Faculty
in Katowice, Medical University of Silesia, Katowice, Poland;
⁵Pathophysiology Unit in Department of Pathophysiology, Medical
Faculty in Katowice, Medical University of Silesia, Katowice, Poland

**Introduction:** Vitamin D (VD) deficiency is considered as a risk factor for death due to cardiovascular events including stroke. In the present study we assessed the hypothesis that decreased levels of 25-hydroxyvitamin D (25-OH-D) and related calcium-phosphate disturbances are associated with increased risk mortality in patients with ischemic stroke.

**Methods:** Serum 25-OH-D, intact parathyroid hormone (iPTH), intact fibroblast growth factor 23 (iFGF23) levels were assessed in serum samples left after routine tests in a hospital laboratory in 240 consecutive patients with acute ischemic stroke, admitted within the 24 hours after the onset of symptoms to the Stroke Unit. Mortality data were obtained from the local registry office.

**Results:** Only three subjects (1.3%) had optimal 25-OH-D level (30–80 ng/ml), 25 (10.4%) had mildly reduced (insufficient) level, 61 (25.4%) moderate deficiency and 151 (62.9%) a severe VD deficiency. 20% subjects had increased iPTH (>65 pg/mL). Of all patients, 79 (32.9%) died during a follow-up observation (44.9 months). The incidence rates of death (per year) were 4.81 and 1.89 in a group with and without severe VD deficiency, respectively (Incidence Rate Ratio =2.52; 95% CI: 1.44–4.68). In multivariable stepwise backward Cox proportional hazard regression age, 25-OH-D <10 ng/mL and functional status (assessed by the modified Rankin scale) were significant factors increasing the risk of death.

**Conclusions:** Severe VD deficiency is a strong and independent from age and functional status negative predictor for survival in stroke patients. VD supplementation in patients after stroke may be considered even without 25-OH-D assessment.

P-108

**The gouty tophus**

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

**Background and aim:** The incidence and prevalence of gout has increased in recent decades, probably due to changing lifestyles and the aging of the population. The objective of this clinical case is the review of a case of patient with chronic gout and habit of alcohol abuse.

**Method, results and case description:** Patient of 70 years. Personal history: Arterial hypertension, Impaired glucose tolerance, Hyperuricemia, Tendinitis aquilea left, Spondyloarthrosis, Hepatic steatosis (drinker of 6 doses/day of wine), chronic gout. Surgical interventions: left hip prosthesis, right knee tibial osteotomy, right thumb fracture. In study and follow up by Gouty Tophus: – Episodes of gouty tophus for 15 years, with ankle involvement; One or two annual episodes of 8–10 days duration and recently episode in right thumb (where it has previous structural damage) swelling and drainage in the right wrist and 5th interphalangeal right hand. – Tophus in left elbow for 2 years. – Structural damage in the right hand, knees, ankles and 1th metatarsophalangeal joints (MTP joints) (hallux rigidus).

**Conclusions:** This type of patient needs a lot of support and a more continuous follow-up on the part of his family doctor, emphasizing the importance of the dietary advice for the alcoholic abstinence, since its consumption is a risk factor to present acute episodes of Gout more and more Frequent and severe, structurally damaging more joints. In addition, liver damage may increase and therefore difficult to treat with Allopurinol. Remember to establish allopurinol that we must make a check at 15 days and if Urico Acid >6 mg, we increase at the dose of 300 mg/day. It is important to clarify the basis of gouty tophus treatment: colchicine will be used daily and nonsteroidal anti-inflammatory drugs (NSAIDs) in inflammatory outbreaks.

P-109

**The impact of hospitalization on the number of administered medications in consecutively admitted elderly patients**

P. Voukelatou, I. Vrettos, A. Ragkou, A. Bitsikokou, A. Didaskalou, D. Theotoka, A. Katsoras, A. Kalliakmanis. 2nd Department of Internal Medicine, General Oncological Hospital of Kifissia "The AgioiAnargyroi", Athens, Greece

**Introduction:** Previous studies concerning how hospitalization affects the number of medications administered to elderly patients, before hospital admission and after discharge, have yielded mixed
results. The objective of this study was to assess the impact of hospitalization on drug prescriptions in consecutively admitted, elderly patients.

**Methods:** In 262 patients, mean age 80,45±7,95 M±1SD, (53,4% women) demographic characteristics, medical history, medications, Katz-index, Charlson-Comorbidity-Score (CCS) and reason of admission were recorded. The number of medications and CCS were recorded both at admission and discharge. Parametric tests were applied to identify the variables that have significant association with the reduction of medications. The paired Wilcoxon test was applied to analyze both the difference between the number of drugs and CCS at the time of admission and discharge.

**Results:** The mean CCS before admission and after discharge was 5,50±1.80 M±1SD and 6,00±1,92 M±1SD respectively, while the number of medications was 5,22±3,06 M±1SD and 5,49±2,65 M±1SD respectively. In 191 patients (72.9%) CCS remained stable while in 71 patients (27.1%) increased. The mean number of medications after discharge increased, remained stable or decreased in 106 (40.5%), 104 (39.7%) and 52 (19.8%) respectively. While after hospitalization the mean CCS increased (Z=-2.953, p=0.003)a statistically significant change in the mean number of medications was not elicited (Z=-1.299, p=0.194). The only variable linked with the reduction of medications was the unchanged CCS (p<0.001, χ²=18.859).

**Conclusions:** Hospitalization seems to contribute in medications' reduction. The effort to reduce the number of medications gets more complicated when the CCS is increased.

## P-110

### The usability of the Supportive and Palliative Care Indicator's tool and the surprise question in Dutch nursing homes

L. Oosterbaan, K. Andringa, J. Harmer, P. Sonneveld, M. Smalbrugge, J. van Berkel. *VUmc/Gerion, Amsterdam, The Netherlands*

**Introduction:** There are various tools available for indicating the need for palliative care. However these tools have not been studied for use in nursing homes. The aim of this study is to explore the usability of the Supportive & Palliative Care Indicators Tool (SPICT) and to compare the SPICT with the Surprise Question (SQ) in nursing homes.

**Methods:** Elderly care physicians used the SPICT and the SQ for indicating the need for palliative care in 120 patients living in Dutch nursing homes. This study features a quantitative data set with a cross-sectional design in which the inter-rater agreement of the SPICT and SQ for indicating palliative care was analysed. The usefulness of the tools perceived by the physicians was studied with a qualitative analysis based on a focus group.

**Results:** The SPICT indicated a need for palliative care in 71% of included nursing home patients. The SQ indicated this need in 62,5%. A moderate agreement (kappa = 0,495) of the instruments was found. The elderly care physicians regarded the SPICT unusable for indicating a need for palliative care, but deemed it helpful for the conversation concerning advanced care planning.

**Conclusion:** In indicating the need for palliative care, the SPICT and the SQ are moderately comparable. However, according to elderly care physicians the indicators used in the present form of the SPICT are not appropriate for use in a nursing home.

## P-111

### The value of “p”: Novel risk factors for ischemic stroke?

J.J. Martínez Rivas, O. Duems Noriega. *General Hospital Granollers, Barcelona, Spain*

**Introduction:** The interatrial block (IAB) is a delay in atrial conduction defined as a wide p-wave (WpW) on electrocardiogram (ECG) but has low specificity for supraventricular tachycardia (SVA) and ischemic stroke (IS) prediction. New criteria for IAB appeared

as the biphasic morphology of p wave in the inferior leads, which has increased its predictive value. The objective of this study is to find relationship between new IAB's criteria (NIAB) and IS of undetermined cause (ISUC).

**Method:** Retrospective study of 188 cases admitted to hospital for ISUC (A group) without prior arrhythmias, compared to 180 controls admitted for other causes (B group). NIAB finding on the ECG (biphasic p≥120ms in II, III and AVF) was assessed in both groups. Data analysis was made to find NIAB differences between groups in relation to age (<75; ≥75) and comorbidities.

**Results:** 368 patients (47% women; mean age 72,7±15,2; Barthel index 79,5±24,9) were included. WpW and NIAB findings were significantly more prevalent in A group (p≤0.000), with no other differences observed. Significant differences were found considering age: stronger association WpW-IS vs NIAB-IS in the youngest group (OR 24.1 (12.4–46.7) vs 20.5 (4.8–87.3) in contrast with a stronger association NIAB-IS vs wpw-IS in the oldest group (OR 33.8 (4.3–264.7) vs 7.4 (2.1–26.8)).

**Conclusions:** WpW and NIAB were significantly related to ISUC. Relevant differences were found considering age, being more prevalent the presence of WpW in younger with ISUC and NIAB in elder. Although more studies are needed, these outcomes could justify primary prophylaxis with anticoagulation before SVA appears.

## P-112

### Twenty year blood pressure trajectories in 46,634 older patients

J. Masoli¹,², J. Delgado¹, K. Bowman¹, A. Ble¹, Y. Han³, W. Henley³, S. Welsh⁴, G.A. Kuchel⁴, L. Ferrucci⁵, D. Melzer¹. ¹Epidemiology and Public Health, University of Exeter Medical School; ²Royal Devon and Exeter NHS Foundation Trust 3Health Statistics Research Group, University of Exeter Medical School; ⁴UConn Center on Aging, UConn Health, Farmington; ⁵Longitudinal Studies Section, National institute of Health, Baltimore

**Introduction:** We aimed to estimate trends in blood pressure (BP) for 20 years prior to death and test associations with multimorbidity and cardiovascular diagnoses.

**Methods:** We used Clinical Practice Research Datalink primary and secondary care records. We estimated BP in 46,634 participants aged ≥60 who died 2010–2014 (including 10,957 aged 90+). We investigated associations of comorbidity and cardiovascular diagnoses (hypertension, heart failure, AF, and stroke or TIA) with BP trajectories. We compared BP slopes >2 years (to reduce end of life effect) to 10 years prior to death for 28,241 participants who died, with 46,856 birth-year and gender matched controls surviving >9 years.

**Results:** Peak systolic BPs occurred 14 years before death in ages 60–69 and 18 years in age ≥90 years. BP decline >2 to 10 years prior to death was steeper compared to matched controls surviving >9 years across age-groups with interaction terms <0.001 in all age groups: eg.60 to 69 years cases β coefficient 0.88 (0.82:0.95) controls 0.13 (0.0:0.15), 90+ years cases 1.88 (1.82:1.95) controls 0.37 (0.13:0.62).

Cardiovascular diagnoses increased the slope of SBP decline (interaction term: p-value <0.001 for all conditions). BP declines were modestly larger in higher RFI comorbidity quintiles.

**Conclusions:** In this first long-term individual patient analysis, we showed that BP decline is not limited to the final years of life, but for ≥14 years. Declines were widespread and not simply due to better survival in those without hypertension or multimorbidity. These findings may have implications for BP treatment monitoring in older adults.
# Area: Comprehensive geriatric assessment

## P-113

### A prospective cohort study of 112 elderly patients with bladder cancer: predictive factors of early death after a Comprehensive Geriatric Assessment

C. Rambaud¹, M. Sanchez¹, M. Durand², S. Gonfrier¹,
D. Borchiellini³, R. Boulahssass¹, O. Guérin⁴. ¹Geriatrics
Department, University Hospital of Nice; ²Department of Urology,
University Hospital of Nice, INSERM, U1189, ONCO-THAI, F-59037, Lille,
France; ³Department of Oncology, CAL, Nice; ⁴Geriatrics Department,
IRCAN - University of Nice, Sophia-Antipolis, INSERM U1081 - CNRS
UMR 7284, OncoAge, Nice, France

**Objectives:** The management of bladder cancer (BCa) in the elderly remains controversial. The aim of the study is to analyze predictive factors of early death in a group of patients >70y, with Bca, at 100 days after a geriatric comprehensive assessment (CGA).

**Methods:** 112 patients with Bca were enrolled. This is a multicentric and prospective cohort study approved by an ethics committee. A standardized CGA was done before the decision-making. Geriatric data were collected: MMSE, MNA, BMI, Grip hand grip strength, ADL, IADL, Gait speed, QLQC30, Charlson, G8 and Balducci classification. Within 100 days follow up, events (death), oncologic and geriatric data were collected.

**Results:** A total of 112 patients were enrolled, including 25.9% of women and a mean age of 82y [70-96]. 26.8% (n=30) of patients died within the 100-days follow up. 34.8% (n=39) of patients had metastatic cancers. The most common proposed treatments, by the surgeon or the oncologist, were surgery (radical cystectomy) (44.6%, n=50) and chemotherapy (42, n=47). In 35.7% (n=40) of cases, CGA modified the decision-making, in favor to palliative care in 57.5%. In univariate analyzes, metastatic cancers (HR=2.7 [1.3-5.5], p=0.008), cognitive impairments (MMSE<24) (HR=3.2 [1.5-7], p=0.003), confusion (HR=2.2 [1.1-4.5], p=0.032), under nutrition (MNA<17) (HR=6.9 [2.1-22], p<0.001), gait speed<0.8m/sec (HR=5.6 [2.4-12.9], p<0.001), social isolation (HR=4.5 [2.1-9.6], p<0.001), and dependence for ADL (<5.5) (HR=2.7 [1.1-6.2], p=0.023) and IAD (>0) (HR=2.7 [1.1-6.5], p=0.032) have significantly more risk of dying. Predictive factors of early death, in multivariate analyzes, were metastatic cancers (HR=3.5 [1.6-7.5], p=0.002), gait speed<0.8m/sec (HR=3.1 [1.2-7.7], p=0.015), social isolation (HR=2.6 [1.2-5.9], p=0.02) and dependence (ADL<5.5) (HR=3.3 [1.2-9.2], p=0.022).

**Conclusion:** This study confirms that some geriatric data could be predictive of worse outcomes. These results can help in decision-making and encourage to propose targeted geriatric interventions to improve the patient's prognosis.

## P-114

### Applicability of comprehensive geriatric FLS: treatments of FONDA protocol to recover the overall health status in fragility hip fracture patients

D. Moral-Cuesta¹, P. Matovelle¹, T. Alarcón 1,2, R. Velasco 1,
R. Menéndez-Colino 1,2, A. Otero 2,3, J.I. González-Montalvo 1,2,
¹Geriatrics Department, Hospital Universitario La Paz, Madrid, Spain;
²Instituto de Investigación del Hospital La Paz IdiPAZ, Madrid, Spain;
³Preventive Medicine Department, Universidad Autónoma, Madrid,
Spain

**Introduction:** Many patients die and others do not recover in the follow-up after a Hip Fracture (HF). Orthogeriatric units are considered the best option of treatment. There is not an agreed protocol involving both secondary osteoporotic prophylaxis and

overall health status recovery of patients. The objective was to assess the applicability of an intervention program addressed to accomplish these purposes.

**Methods:** HF patients admitted during one year in a university Hospital were studied. Patients who could come to the outpatient clinic were included. A protocol based on the specific needs of each patient (FONDA Protocol) was designed based on physical exercises, correction of Vitamin D, nutritional assessment and treatment, scheduled analgesic prescription and iron deficiency correction. Data were collected at admission and patients were followed-up at 3, 6 and 12 months.

**Results:** 134 HF patients were included. The patients with treatments prescribed by the FONDA Protocol at admission, discharge, 3, 6, and 12 months were respectively: Ca + Vitamin D: 8%, 81%, 76%, 75%, 71%; Vitamin D: 72%, 91%, 71%, 74%, 82%; Nutritional Supplements: 95%, 70%, 11%, 6%, 4%; Minor Analgesics: 99%, 99%, 50%, 46%, 39%; Opiates: 17%, 12%, 8%, 16%, 11% and Physical Exercises: 49%, 85%, 94%, 96%, 97%. Parenteral Iron was prescribed in 51% during admission. Antiosteoporotic drugs were prescribed in 84%.

**Conclusions:** An individualized protocol addressed to solve the overall specific needs of each HF patient besides to start secondary osteoporosis prophylaxis is viable. Needs are different in the several phases of the process.

## P-115

### Assessment clinic for the elderly at a university hospital in Iceland

A. Björg Jónsdóttir¹, I. Hjaltadóttir², S. Bergmundsdóttir¹.
¹Landspitali University Hospital of Iceland; ²Landspitali University Hospital of Iceland and University of Iceland

**Introduction:** The assessment clinic for the elderly was a product of a workshop at the Department of Geriatric Medicine. The idea was to create a more direct pathway from the ED to the geriatric ambulatorium for those frail older adults that needed a geriatric assessment. The aim of the assessment clinic is to reduce the number of revisits of the 75+ to the ED.

**Methods:** An individual got referred to the assessment clinic from the ED if he/she met one or more of the following criteria: a) a frail elderly, b) multimorbidity, c) had an internal medicine health-problem, d) repeated falls, e) musculo-skeletal problems, f) pain problems. All came to the assessment clinic inside a week after visiting the ED.

**Results:** In 2016 40 individuals got assessed, 28 (70%) were female and 12 (30%) male. Mean age was 84,3 years (median 85,5). 30 days before coming to the assessment clinic those 40 people had been to the ED 51 times, the majority (26) came only once. After they had been to the assessment clinic there were only 7 vistis to the ED, and of those 1 person came three times.

**Conclusions:** The conclusion is that the aim of the assessment clinic to reduce revisits to the ED is met. The frail elderly got assessed to a more appropriate treatment and pathway.

## P-116

### Assessment of vision in people presenting with falls

O. D'Souza, L. Meadows, A. Andrusca, B. Ahmed, H. Ellis,
I. Bargaoanou. *Scarborough Hospital, Scarborough, UK*

**Introduction:** Falls are common in older people. Guidelines recommend that people who fall should undergo multifactorial assessment, including of visual impairment. Often this assessment is neglected mainly due to lack of time and a validated Tool in a clinical setting. The Royal College of Physicians (UK) have devised the 'Look out!' bedside vision check tool for falls prevention. We undertook this project to evaluate the ease of using this new tool.

**Methods:** We evaluated fifty inpatients presenting with falls from
hospital wards, and twenty outpatients in the falls clinic, over 2 months from March – April 2017. An assessment of vision using the vision assessment Tool was performed on each patient. Areas addressed included date of last eye test, use and indication for glasses, ophthalmological conditions and medications, visual acuity, eye movements and visual fields. Subjective data was collected from the doctors using the Tool regarding its ease and practicality.

**Results:** The Assessment tool, was found to be easy to use, by all the doctors who trialled it. It took between 5 and 10 minutes to complete this Tool. In about 10% of patients, the Tool could not be used due to dementia. In 3 patients eye sight was not tested recently. One patient was found to have Progressive supranuclear palsy.

**Conclusions:** This is an easy validated Tool, which can be applied in both outpatient and inpatient settings. Dementia is the only factor we found, which would prevent the full use of this Tool.

P-117

**Attitude and practice patterns of geriatricians towards discussing sexual function with their patients. A literature study**

A.B.M. Elskamp, M.C. Faes. Amphia Hospital Breda

**Introduction:** Discussing patients' sexual function by physicians is fundamental for addressing treatable causes of sexual dysfunction. Aging and the associated morbidity and use of medication have a negative impact on sexual function of older persons. Physicians consider sexuality a difficult topic to discuss. A literature study was performed to explore the attitude and practice patterns of geriatricians in discussing sexual function with their patients, and which problems they might experience discussing this subject.

**Method:** A Pubmed, Medline and Medscape search was performed. The search terms sexual behaviour, sexuality, aged, frail elderly and communication were used. All publications were screened for relevant information in title and abstract. The full text of relevant articles was read.

**Results:** 437 publications were identified, after screening title and abstract, 17 articles were fully read. Only one study explored practice patterns of geriatricians, by using a limited questionnaire. None of 120 geriatricians did routinely take a sexual history, even though 96.7% believed that patients with sexual problems should be managed further. General practitioners do not routinely discuss sexual function because of the stereotype that older patients are asexual. There is a low level of awareness of later life sexuality among health care professionals. It is stated that more education to increase awareness of sexual function of older persons and to improve communication skills is needed.

**Conclusion:** At present there is limited information on practice patterns and attitude of geriatricians towards discussing sexuality with their patients. Such a study is planned among geriatricians in the Netherlands.

P-118

**Audit of the use of 24-72-hour ambulatory ECG's as an investigation tool for older patients presenting with a fall**

E.E. Ladikou, C. Jadawji, A. Mathur. University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

**Introduction:** Syncopal falls in older patients are often investigated with 24-72-hour ambulatory ECG's. However, this investigation is sometimes also requested as "routine", to investigate the cause of falls. The aim of this audit was to assess the appropriateness of ambulatory 24-72-hour ECG requests in patients aged over 65 years who presented with a fall.

**Methods:** 24-72-hour ambulatory ECG's requests for those aged 65 and above in one month were reviewed. 55 requests were identified as planned investigations for falls. An audit data collection tool was

created and used to retrospectively review case-notes to establish if the investigative approach from NICE guidance was followed.

**Results:** In more than two-thirds of the requests, an alternative diagnosis was more plausible than syncope and half of the tests were not an appropriate choice of investigation. 52% of the tests were abnormal when syncope was diagnosed clinically & inpatient investigations deemed necessary. When done as outpatient after discharge, or where there was a more plausible alternative diagnosis with a normal electrocardiogram, about 85% of the tests had no abnormalities.

**Conclusions:** Indiscriminate use of 24-72-hour ambulatory ECG's for older patients presenting with falls, without applying clinical criteria, in the presence of other plausible mechanisms of falls, or when syncopal episodes are infrequent leads to low diagnostic yield. This delays identification of mechanism(s) of falls and adds costs due to inappropriate use of investigations. Our results suggest that clinicians should be more aware of the indications for 24-72-hour ambulatory ECG monitoring in older patients presenting with falls.

P-119

**Centers of gerontology - institute of public health and gerontology centers in Croatia**

S. Tomek-Roksandic, B. Kolaric, I. Popek, Z. Šostar, V. Fortuna, S. Predavec, N. Tomasovic-Mrcela, M. Lukic, S. Mravak, M. Maltaric, D. Sajko. Reference Centre for Health Care of the Elderly of the Ministry of Health of the Republic of Croatia, Center of Health Gerontology, Andrija Štampar Teaching Institute of Public Health

The gerontologic-public health service provided at primary health care level by the Centers of Gerontology of the Public Health Institutes (PHI) in particular Croatian counties, City of Zagreb and Republic of Croatia is based on the established gerontologic-public health parameters of health care needs and functional ability of the elderly in institutional and non-institutional health care. The measures of gerontologic-public health care have been legally defined by the Act on Amendments of the Act on Health Care, referring to the Plan and Program of Health Care Measures on National Health Insurance for Gerontologic-Public Health Service provided by gerontologic-public health care teams. Appropriate preventive gerontologic program of primary prevention for the elderly has also been performed by Gerontology Centers in local community, providing immediate gerontologic non-institutional care for the elderly. A comprehensive approach in health care of the elderly, with family medicine playing the leading role, is ensured by due coordination at the level of primary health care for the elderly as part of the gerontologic-public health service with a catchment population of 30,000 people older than 65. Health care of the elderly cannot be performed, upgraded or evaluated for efficiency and availability unless the respective gerontologic-public health parameters on health care needs and functional ability of the elderly in institutional and non-institutional health care have been established. These very parameters make the basis of the gerontologic-public health service provided at primary health care level by the Centers of Gerontology at Institutes of Public Health in Croatian counties, City of Zagreb and Republic of Croatia. Appropriate programs of health care measures and procedures in health care of the elderly, including primary, secondary and tertiary prevention for the elderly, could only be developed based on monitoring and assessment of the health care needs of the elderly. Such an appropriate preventive gerontologic program of primary prevention for the elderly has also been implemented by Gerontology Centers in local community, by providing immediate gerontologic non-institutional care for the elderly. The aim is to enable the elderly to stay at home, with the family, as long as possible. In these efforts, coordination with primary health care (PHC) professionals, i.e. selected family physicians providing care for geriatric insurees, is necessary. Based on their recommendation
(PHC referral letter; Poster Fig. 1), geriatric insurees would be justi-
fiably relieved of unnecessary and time-consuming waiting in lines
in waiting rooms for examination at PHC offices. This is confirmed
by frequent visits of elderly insurees to the selected PHC office for
some social indication.

P-120

Comprehensive geriatric assessment and intervention proposal
in an outpatient hematology ward

C. Palicio¹, C. Boqué², M. Antonio², M. Bidó¹. ¹Red Cross Central Hospital; ²Oncology Catalan Institute

**Introduction:** 60% of patients with malignant hemopathies are older than 65 years and this proportion will continue to rise.

**Methods:** We evaluated thirty patients attending an outpatient hematology ward, all of them older than 75 years. After the geriatric assessment, treatment changes were proposed. Comorbidities, functional status, mental status, depression, geriatric syndromes and social situation were evaluated.

**Results:** Average age was 80 years old. Average functional scales results: Barthel 84, Performance Status 0.8, Short Physical Performance Battery 7.9. Mental status scales: 36% failed the Pfeiffer test (4.41 average mistakes). 76% had an altered Yesavage test. Charlson Index average result was 2.1. All patients had at least one geriatric syndrome, being 3.6 the average: 66% pain, 60% polypharmacy, 52% sensory disturbances, 42% constipation and 36% hyporexia. 93% had no social assistance. After finding these problems, different interventions were proposed by the geriatrician in 43% of them: 43% needed new painkillers, 23% needed psychotropic drugs to treat insomnia or depression, 23% needed laxatives. 51 other outpatient referrals to other specialists could have been avoided.

**Conclusions:** In order to properly identify modifiable frailty determinants and classify older patients with malignant hemopathies, a multidisciplinary approach and a comprehensive geriatric assessment are mandatory strategies. Old patients should benefit from a consensuated decision to adapt the curative and/or supportive approach, that should take into account the potential reversibility of frailty and geriatric syndromes. Prehabilitation and prevention strategies should be started in this vulnerable population, and potential economic benefits from a geriatric assessment should also be considered.

P-121

Comprehensive geriatric assessment in elderly patients with
severe aortic stenosis referred for transcatheter aortic valve
implantation (TAVI)

C. Roqueta¹, N. Leiva¹, M.I. Martínez-Fernández¹, A. Sánchez-Carpintero², B. Vaquerizo², S. Burcet¹, N. Farre², M. Cladellas², R. Miralles¹, O. Vázquez¹. ¹Geriatric Medicine Department, Parc de Salut Mar, Centre Fòrum, Hospital del Mar, Barcelona; ²Department of Cardiology, Parc de Salut Mar, Hospital del Mar, Barcelona

**Aim:** To assess patients with severe symptomatic aortic stenosis with a comprehensive geriatric assessment.

**Patients and methods:** Prospective and descriptive study of patients with symptomatic severe aortic stenosis referred for TAVI, were evaluated by a geriatrician from April 2016 to March 2017. Socio-demographic variables (age, sex, cohabitation), functional status [Barthel index (BI) and Lawton index (LI)], cognitive status [Mini-Mental State Examination of Folstein (MMSE)], emotional situation (GDS Yesavage), nutritional status [Mini-nutritional Assessment abbreviated (MNA)], comorbidity (Charlson index) and geriatric syndromes (immobility, pressure ulcers, dementia, delirium, depression, falls, urinary incontinence, polypharmacy, constipation, sensory impairment, malnutrition, insomnia) were registered.

**Results:** Forty-five patients were evaluated (62.22% women), mean

aged 82.62±6.09 years. Fifteen (33.33%) lived alone and the rest with the family. Mean of the parameters evaluated: LI: 5.02±2.05; BI: 94±10.97; MMSE: 26.06±3.40; GDS Yesavage: 1.84±1.79; corrected Charlson index according to the age: 6.08±1.22. Geriatric Syndromes: 4 (8.89%) dementia, 5 (11.11%) depression, 1 (2.22%) delirium, 10 (22.22%) previous falls, 5 (11.11%) urinary incontinence, 42 (93.33%) polypharmacy, 5 (11.11%) constipation, 24 (53.33%) sensory impairment, 2 (4.44%) malnutrition and 5 (11.11%) insomnia.

**Conclusions:** Patients with severe symptomatic aortic stenosis evaluated by a geriatrician were old and predominantly female patients. One-third of the patients lived alone. The patients had a good functional status of basic activities of daily living, involvement of instrumental activities, good cognitive, emotional and nutritional status and a high comorbidity. Polypharmacy was the most prevalent geriatric syndrome in the sample of patients studied.

P-122

Comprehensive geriatric assessment of elderly patients with
cancer living in nursing home

A.-L. Couderc¹, G. Delalande¹, M. Boucekine², E. Cretel¹, J. Berbis², E. Lechevallier³, L. Greillier⁴, F. Barlesi⁴, P. Villani¹. ¹Division of Internal Medicine, Geriatric and Therapeutic, Sainte Marguerite Hospital, AP-HM, 270 Boulevard Sainte Marguerite 13009 Marseille, France; ²Department of Public Health, EA 3279 Self-perceveid Health Assessment Research Unit, Medical School, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France; ³Division of Urological Surgery and Renal Transplantation, La Conception Hospital, AP-HM, 147 Boulevard Baille 13005 Marseille, France; ⁴Division of Multidisciplinary Oncology and Therapeutic Innovations, Nord Hospital, AP-HM, Chemin des Bourrely 13015 Marseille, France

**Objectives:** To compare elderly population with cancer living in nursing home and those living at home, to identify frailty factors and to adapt oncological treatment.

**Design, setting and participants:** Monocentric, prospective, descriptive and comparative study conducted in Assistance Publique-Hôpitaux de Marseille (AP-HM) Oncogeriatric Day Hospital. About 211 elderly patients with cancer were refered by Oncology Units from September 2015 to October 2016.

**Results:** The mean age was 81.98±6.6 years. 57.8% patients were men and 18/211 patients (8,5%) were nursing home residents. The most common cancers in this population were prostate cancers (47/211 patients; 22.3%), lung cancers (35/211 patients; 16.6%), digestive cancers (23/211 patients; 10.9%) and breast cancers (21/211 patients; 9.9%). 57/211 patients (27%) have presented a metastatic cancer. Nursing home residents have more co-morbidities (p=0,001), cognitive disorders (p<0,001), dependency (p<0,001), nutritional disorders (p=0,026), grip strength reduction (p<0,001) and have been hospitalized at the Emergency Unit during 3 months (p=0,016) compared to those living at home.

**Conclusion:** Elderly patients with cancer living in nursing home have more severe geriatric syndromes and frailties than those living at home. Prevention of functional decline should be a priority for this population. The personalized care plan should be tailored to each patient, oncological treatments should not alter the quality of life and medical staff should be trained to these specific cares. Following this work, a course of personalized care for elderly cancer patients living in nursing home is now offered in Marseille's Hospitals and its name is ONCO-EHPAD.

P-123

Determinants of 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. Various QOL measures have been recognized to help treatment decisions, prognostic and survival assessment. The objective of this study is to describe determinants of QOL in very old and frail geriatric oncology patients.

**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. Determinants of their QOL were collected by 3 open-ended questions: "What is the most important factor for you to have the best QOL?", "What could enhance your QOL?" and "What could reduce your QOL?". 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 the main areas of importance for QOL quoted by an elderly and frail geriatric oncology population and compare the quoted determinants for QOL with areas explored by the reference questionnaire used to measure QOL in elderly cancer patients (QLD ELD 14).

**Conclusion:** Determinants of QOL in elderly cancer patients are personal and multi-factorial.

P-124

Digital technologies in comprehensive geriatric assessment

A. Ilnitski, K. Prashchayeu, E. Korshun. Belarusian Republican
Gerontological Public Association, Minsk, Belarus

Effective introducing and spreading of diagnostic technologies in geriatrics is possible on the base of ICT devices. Aim of the research is to work out and introduce into geriatric practice the ICT based comprehensive geriatric assessment.

**Material and methods:** On web-site www.gerontology.by we submitted the special original program for physicians for performing comprehensive geriatric assessment which can be downloaded into ICT device and allows to estimate automatically the risks of functional decline, problematic geriatric syndromes and targets of personalized coaching in rehabilitation process. In the same time such program gives possibility to perform the eLearning of physicians on better ways of rehabilitation and care of elders on the base of syndromatic approach in geriatrics.

**Results:** 537 physicians experienced work with original computer program. Using ICT for comprehensive geriatric assessment reduced time of diagnostic procedure on 23,5%, increased the number of correct prognosis of geriatric syndromes on 18,5%, decreased the number of mistakes in diagnosis and rehabilitation on 10,0%. Using ICT for consultations and eLearning of physicians was most important factor of positive changes in quality of geriatric care. As a result was observed the positive changes in occurring of acute functional decline, decreasing of functional ability, quality of life was increased (p<0,05).

**Conclusion:** Introducing ICT technologies in comprehensive geriatric assessment improved quality of diagnostic process, geriatric care and health status of elderly patients.

P-125

EASYCare Standard 2010 as an instrument for self-assessment of older people living at home

S. Tobis¹, K. Jaracz¹, D. Talarska¹, S. Kropińska¹, E. Zasadzka¹, M. Pawlaczyk¹, I. Philp², A. Suwalska¹. ¹Poznan University of Medical Sciences; ²Warwick Business School, UK

**Introduction:** EASYCare Standard 2010 is a concise instrument to

identify concerns in health, functional independence, and well-being of an older person. So far it has not been used for self-assessment. Our aim was to determine whether self-assessment (EC1) can give comparable results to an evaluation performed by professionals (EC2), for older people living at home.

**Methods:** The study included 100 older individuals (67 females), living in the community, without dementia (Abbreviated Mental Test Score [AMTS] above 6). Two assessments (self and professional) were performed, including summarising indexes: Independence score [IS], Risk of breakdown in care [RBC], Risk of falls [RF], within a period between 1 and 2 weeks. Additionally, during EC1, gold standard tests of physical and mental function (Barthel Index: 96.3±6.5, Lawton scale: 6.7±2.0, Geriatric Depression Scale: 3.0±2.7, AMTS: 10.2±1.0) were applied to test for concurrent validity.

**Results:** Cohen Kappa values (self-assessment versus professional) across all EASYCare domains were high (0.89–0.95). Results of all summarising indexes derived from self-assessment correlated well with gold standard tests. No differences were found in IS and RBC between EC1 and EC2 (8.6±12.0 vs. 9.0±12.7 and 1.0±1.1 vs. 1.2±1.4). Results of RF were higher in EC2 (1.0±1.1 vs. 1.1±1.4; p=0.005), due to a different response to the item "Do you feel safe outside your home?".

**Conclusions:** Self-assessment with EASYCare Standard 2010 in community-dwelling older people can yield valid results, thus providing an efficient system for the assessment of relatively independent individuals.

P-126

Elderly's medication management ability: What are the predictors?

A.M. Advinha¹, C. Nunes², M.J. Lopes³, S. Oliveira-Martins¹.
¹University of Lisbon, Faculty of Pharmacy; ²Universidade NOVA de Lisboa, National School of Public Health, Public Health Research Centre; ³University of Évora, Nursing School of S. João de Deus

**Introduction:** Medication management functional ability is defined as the cognitive and physical ability to self-administer medications and to follow the prescribed regimen, when it is the patient desire [1]. This study aims to screen the predictors of elderly's medication management ability assessed with Drug Regimen Unassisted Grading Scale (DRUGS-PT) and Self-Medication Assessment Tool (SMAT-PT) – Portuguese versions.

**Methods:** The study was carried out in a purposive sample of 207 Portuguese community-dwelling elders, using DRUGS-PT, SMAT-PT, Medication Regimen Complexity Index (MRCI), Measure Treatment Adherence (MTA), Mini-Mental State Examination (MMSE), Clock-Drawing Test (CDT) and Instrumental Activities of Daily Living scale (IADL). The associations were analysed with Wilcoxon-Mann-Whitney and Kruskal-Wallis. The logistic regression used Forward: LR method. Analysis was conducted using SPSS (v22).

**Results:** Of the 207 participants, 156 (75.4%) were women, and the mean age was 75.5, ±6.6 years. The elderly's ability to manage their medication was assessed with DRUGS-PT (80.7, ±25.7) and SMAT-PT (real regimen scales: medication recall 83.6 (±15.6) and adherence self-report 97.2 (±10.9)). It was obtained significant association with scholarship (p≤0.01), MMSE (p≤0.03) and CDT (p≤0.003). The binary model built according to maximum score demonstrated that MMSE (p=0.002), CDT (p<0.001) and the number of medications (p<0.001) were significant on the probability of the elderly have full ability to manage their medication. The ROC presented an excellent power (89.9%).

**Conclusions:** The predictors of elderly's medication management ability were the cognitive measures and the medication daily consumption. This reflects the importance of early detection of the cognitive impairment and the inclusion of medication management ability assessment in clinical practice.
## References:

[1] Maddigan SL, Farris KB, Keating N, Wiens CA, Johnson JA. Predictors of older adults' capacity for medication management in a self-medication program: a retrospective chart review. J Ageing Health. 2033; 15(2):332-52.

## P-127

### Evaluation of the impact of comprehensive geriatric assessment (CGA) in older patients with kidney cancer

M. Sanchez¹, R. Boulahssass¹, S. Gonfrier², D. Saja¹, C. Rambaud³, J.M. Turpin⁴, F. Leborgne⁵, E. Clais³, E. François¹, O. Guérin¹.
¹UCOG CHU Nice, France; ²USLD CHU Nice, France; ³SSR CHU Nice, France; ⁴CSG CHU Nice, France; ⁵EMG CHU Nice, France

**Introduction:** In the future, life expectancy and incidence of cancer will increase, and also incidence of kidney cancer will increase in patients over 75 years old. The treatment of kidney cancer is surgery. We observe in this population several comorbidities which increase the risk of surgical morbidity and could lead to only best supportive care.

**Objective:** The aim of this work is to determine the impact of CGA in treatment decisions and also in guided geriatric interventions.

**Methods:** This is an observational and prospective cohort study approved by an ethics committee. A complete CGA has been done. Treatments made, final therapeutic decisions and geriatric interventions have been collected during the follow-up.

**Results:** The study included 58 patients, 31 men and 27 women. The mean age was 83y. 39 patients were dependent for ADL. 38 patients were Balducci 3. 25 patients were metastatic. There were 13 patients with clear renal cell carcinoma; half of patients had no histology. The most common predisposing factors were hypertension (n=39), and chronic kidney disease (n=24). 32 patients of the 58 enrolled patients were symptomatic. The geriatric interventions the most often proposed were: the nutritional management (n=48), physiotherapy (n=34) and prevention of delirium (n=23). 25 patients approved the care plan, 22 opinions are not known. 21 patients undergo the standard treatment (33%), 37 patients have a modification of the care plan (67%). CGA influence the modification of the therapeutic decision in over 43% (n=23) of cases, and for the most of them it was best supportive care, active surveillance or ablative therapies. Of 22 operated patients, there were 16 extended radical nephrectomies, 4 partial nephrectomies and 2 radical nephrectomies. 4 arterial embolization and 1 radiofrequency ablation were conducted. 4 patients received inhibitors of VEGF receptors and 2 patients received mTOR inhibitors. The 3 factors influencing the modification treatment are geriatric factors from the CGA: decline of autonomy (p=0.016), a decreased gait speed (p=0.001), and a home confinement (p=0.001).

**Conclusion:** There is a major selection of patients by urologists, explaining why the effect of geriatric assessment is increasingly important in the treatment of elderly patients with kidney cancer. There is still a difference between the recommended standard treatment and those applied after multidisciplinary consultation. Reasons that lead to the modification of treatment were the existence of geriatric syndromes and not the anesthetic evaluation. The French Association of Urology recommends to have an early CGA for patient over 70y.

## P-128

### Feasibility and validity of the InterRAI ED Screener

E.P Grétarsdóttir¹, A. Björg Jónsdóttir¹, G. Tomasson²,
E.E. Guðmundsdóttir², I. Hjaltadóttir¹, I. Sigurþórsdóttir¹, I. Bjork
Jakobsdottir², T. Thorsteinsdottir¹. ¹Landspítali - The National
University Hospital of Iceland, University of Iceland; ²University of
Iceland, Reykjavik, Iceland

**Introduction:** The InterRAI ED Screener (RAI-ED) is a novel risk stratification instrument incorporating functional and social aspects intended to identify older adults at increased risk for adverse health outcomes. We assessed the feasibility of the instrument in an emergency department (ED) and its construct validity with established instruments.

**Methods:** Data from a convenience sample of 67+ patients at the ED were used. The items of the RAI-ED, Triage risk screening tool (TRST) and Identification of Seniors at risk (ISAR) were verbally administered. Correlation coefficients were calculated between RAI-ED with ISAR and TRST respectively. Linear regression was used to determine the scores of the RAI-ED that best corresponded to accepted cut-offs for the TRST and ISAR.

**Results:** Of 237 approached patients, 200 provided full consent for participation. The mean age was 78.5 years (range 67-97 years and sd 7.4) and 44% were male. Majority of the participants (85%) lived at home, 43% lived alone and 53% received home care. RAI-ED and ISAR scores could be obtained for 187 participants (93%) and TRST scores for 163 (81%). The mean scores were 3.19 (1.53), 2.22 (1.43) and 2.16 (1.36) for the RAI-ED, ISAR and TRST respectively. The correlation of RAI-ED with ISAR and TRST was 0.56 and 0.41 respectively. Scores of 3.02 and 3.01 on RAI-ED corresponded to the accepted cut-offs of 2 on the ISAR- and TRST instruments respectively.

**Conclusion:** These data provide initial support for the utility of the RAI-ED instrument in the ED.

## P-129

### Functional and psychological impact of pain in elderly people

P. Carrillo Garcia, J. Marttini Abarca, M. Vigara Garcia, P. Gil
Gregorio. Hospital Clinico San Carlos, Madrid

**Introduction:** The purpose of this study was setting the relationship between pain relief and functional and psychological impact in elderly patient.

**Methods:** Descriptive study. Includes patients ≥75 years old with chronic pain at geriatric clinic in two separate one-month visits. January - June 2016. Variables: demographic data, comorbidity (Charlson index), functional status (Barthel index), Geriatric syndromes: falls, insomnia, cognitive impairment: Mini Mental State Examination (MMSE-30) and depression (Yesavage Test). Pain assessment: Visual analgesic scale (VAS), type, location and analgesic treatment. Follow-up (a month later): Change of analgesic step, VAS, Barthel index, depression and insomnia. Statistical analysis: SPSS version 23.0

**Results:** 126 patients. Age 84,3 (SD:5), female 58.7%. Functional evaluation Barthel Index 73.4 (SD 17.1). Charlson Index: 5 (SD 1.3). Insomnia 48.4%, falls 16%, no cognitive impairment 25.4%, mild cognitive impairment 60.3% and moderate 14.3%. Depression: 31.7%. Type of pain: neuropathic pain 23%, nociceptive 33.3% and mixed 43.7%, location: Lower limbs: 37.3%, dorsolumbar column 35.7%. Baseline VAS 6.7 (SD 1.4). Comparing results after pharmacological intervention about functionality (Barthel Index 80), depression (4%) and insomnia (26.2%) we got significant differences.

**Conclusion:** A correct evaluation of chronic pain, adjustment in treatment and subsequent medical follow-up, leads to an improvement in the pain relief and a positive impact on functional and emotional state. Every geriatric patient should receive a global evaluation of chronic pain as a large geriatric syndrome.
P-130

**Functional status and demand for hospital care services in COPD**
**elderly survivors treated with NIV for acute respiratory failure:**
**one-year evolution**

P. Kamienski. Department of Geriatrics, Duchenne General Hospital, Boulogne sur Mer, France

**Introduction:** Non-invasive ventilation (NIV) has been shown to reduce intubation and mortality in elderly patients with exacerbations of underlying chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure (AHRF). Nevertheless, the effects of this therapeutic approach remains unclear in terms of functional status, autonomy and demand for hospital care services.

**Methods:** Prospective one-year study of 30 survivors of AHRF undergoing NIV at the Pneumology Department, Duchenne General Hospital, Boulogne sur Mer, France.

**Results:** 30 patients, mean age 83,4 years are included: average ADL (activities of daily living) score is 4,3, average IADL (instrumental activities of daily living) score is 2,3. 22 patients are autonomous. The average length of hospital stay is 11,8 days. At one year, morality is 20%. The demand for hospital care services increases after discharge: number of hospital stays, average length of stay, emergency department (ED) consultations. One year after discharge there is a loss of autonomy: average ADL score: 3,6, average IADL score: 2,7. 8 patients have become dependent. Poor functional status, weak degree of mobility, Charlson Comorbidity Index, polypharmacy, anaemia, hypoalbuminemia, length of hospital stay and hospitalisation in the previous year were correlated with readmission and death. These findings are not statistically significant.

**Conclusion:** This is the first study to show impairment of functional status with a risk of loss of autonomy in elderly treated with NIV for AHRF one year after discharge. Comprehensive geriatric assessment should be applied in these patients.

P-131

**How geriatric intervention helped to save a life**

P. Marques, R. Martins, E. Haghighi. Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal

**Introduction:** Only recently has Geriatrics been recognized in Portugal as a competence. Slowly the medical community begins to understand its necessity.

**Methods:** Complex clinical case where a geriatric approach was performed as a life-saving strategy.

**Results:** 79 year old male patient, independent in daily activities, with past history of atrial fibrillation, on anticoagulation, was referred to a Geriatrics Consultation for repeated falls. Before the consultation, he was admitted to the emergency department for confusion and slurred speech. TC scan excluded brain hemorrhage and laboratory results showed hyponatremia and anemia. During the stay at the ward the patient developed multiple complications (immobility syndrome, urinary retentions, convulsion, nosocomial pneumonia and dysphagia). Due to the rapid and apparently irreversible functional and neurological decline a do not intubate order was declared. The patient survived and went home with a urinary catheter and a naso-gastric feeding tube. He then presented at the previously booked consultation with apathy and mutism. The comprehensive geriatric assessment revealed very severe functional dependence and malnutrition. After meticulous medication adjustment, better social support, physical rehabilitation, nutritional advisements and close follow-up in consultations, he showed significant global improvement. His more recent major concern is to get back driving.

**Discussion:** This case allowed to show the major benefits of a comprehensive geriatric assessment, important step in alerting the

medical community to the need to include wards and geriatric consultations in Portugal.

P-132

**Impact of cognitive impairment and nutritional state on**
**mortality and length of hospitalization in acutely ill geriatric**
**patients**

H. Yamamoto¹, K. Ogawa¹, T. Ishitake², N. Kobayashi³. ¹Yamamoto Memorial Hospital, Imari, Japan; ²Kurume University School of Medicine, Kurume, Japan; ³Azuma-Dori Clinic, Fukushima, Japan

**Introduction:** It is well known that cognitive impairment and malnutrition are prevalent conditions in the elderly. In a previous survey, we reported the usefulness of the Revised Simplified Short-Term Memory Recall test (STMT-R) positively correlated with MMS (r=0.65, p<0.001). The Short-Form Mini-Nutritional Assessment (MNA-SF) was also performed on these patients to evaluate their nutritional state. We herein aim to appraise the impact of both cognitive impairment and nutritional state on mortality and length of hospitalization in acutely ill geriatric patients.

**Methods:** Between December 2014 and September 2015, a total of 976 patients ≥ 50yo were admitted in our hospital. STMT-R and MNA-SF were performed for non-critical patients within one week after admission. 770 subjects consented and were enrolled. 130 patients couldn't complete the STMT-R due to delirium, severe dementia, auditory disturbance, etc. ("uncomplete" group). STMT-R ≤ 4 was considered as cognitive dysfunction by Kobayashi's study [1].

**Results:** The mean age was 78.9 and 52.5% were female. Cognitive dysfunction was found in 409 subjects. "Malnourished", "at risk of malnutrition" and "well-nourished" status were found in 398, 310 and 62 patients respectively. Statistically, a significant positive correlation was found between STMT-R and MNA-SF points (r=0.50, p<0.001). The relative risks for mortality in the "uncomplete" and "malnourished" groups were 3.25 (OR: CI95%;1.53-7.23) and 10.30 (OR: CI95%;2.09-186.6) respectively. The length of hospitalization was also significantly longer in the cognitive dysfunction, "uncomplete" and "malnourished" groups (p<0.05).

**Conclusion:** Cognitive impairment and nutritional state at admission may influence mortality rates and length of hospitalization in acutely ill geriatric patients.

**References:**

[1] Kobayashi N et al; Development of a simplified Short-Term Memory recall Test (STMT) and its clinical evaluation; Aging Clin Exp Res 2010, Vol. 22, No. 2 157

P-133

**Impact of organizational culture in the elderly living in**
**long-term care by the elderly – A longitudinal study in Central**
**Portugal (a research protocol)**

V. Parola¹, A. Coelho¹, E. Santos¹, J. Tavares², S. Pereira³, M. Almeida², S. Duarte², A. Cavaleiro², M. Cordeiro², I. Gil², J. Apóstolo¹, H. Neves⁴. ¹Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal; Centre for Evidence-Based Practice: a Joanna Briggs Institute Centre of Excellence, Portugal; ²Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal; ³Nursing School of Coimbra, Portugal; ⁴Instituto de Ciências da Saúde - Universidade Católica Portuguesa; Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence-Based Practice: a Joanna Briggs Institute Centre of Excellence, Portugal

**Introduction:** Long-Term Care Facilities (LTCF) provide care to elderly as an alternative when living at home is no longer an option. Long-term effect of institutionalization in the elderly is not yet understood, as cultural and organizational differences even
between regions, may impact in overall outcomes. This leads to the need of development of studies that provide insight of how organizational cultures and strategies impact the elderlies' health in the long-term.

**Methods:** A longitudinal study, will be carried in ten LTCF in Central Portugal. Evaluation of the risk of functional decline (Identifying seniors at Risk Scale), presence of cognitive impairment (Six Item Cognitive Impairment Test), activities of daily-living (Barthel Index), fall risk (Timed Get Up and Go), fear of falling (Falls Efficacy Scale), risk of pressure ulcer (Braden Scale), incidence of pressure ulcer, geriatric depression (GDS-15), social isolation (UCLA-Loneliness Scale), and quality of life (EQ-5D), will be evaluated three and six months after the initial evaluation, and correlated with organizational aspects of the LTCF (ratio of healthcare providers/shift, presence of interventions targeting cognitive impairment and/or functional decline).

**Results:** The development of this study will provide insight of how organizational culture impacts elderly care, and which aspects influence positively and negatively quality of life.

**Conclusions:** Elderly care is a concern of today, but also an emergent need in the future. This study aims to develop knowledge of how to provide the best care. This will allow organizations to achieve higher levels of care thus improving the elderly's quality of life.

## P-134

### Implication of circulating immune complexes in atherosclerosis

G.I. Constantin, S. Opris. *National Institute of Gerontology and Geriatrics "Ana Aslan", Bucharest, Romania*

**Introduction:** The atherogenicity of immune complexes containing modified low-density lipoproteins (LDL-CIC) increases with age. LDL-CIC induce cholesterol accumulation in vascular cells that leads to foam cell formation, cellular proliferation, and extracellular matrix production, therefore can play a significant role in atherogenesis and are involved in the formation of early atherosclerotic lesion.

**Methods:** In the present study, we determined oxidatively modified lipoproteins of the circulating immune complexes in two study groups of elderly patients (aged 72±4 years): a group of patients with atherosclerosis and a control group of patients selected according to the SENIEUR protocol for immunogerontological studies. The LDL content in circulating immune complexes was evaluated by measuring total cholesterol levels in polyethylene glycol (PEG 8000) precipitates (immune cholesterol).

**Results:** Our results showed that the circulating immune complexes containing LDL (LDL-IC) was increased in patients with atherosclerosis compared to the control group (21.34±7.94 vs. 9.41±5.36 µg cholesterol/ml serum).

**Conclusions:** This evidence indicates that the quantification of LDL-containing immune complexes has a predictive value superior of that of traditional risk markers that are currently in use. In conclusion, immune complexes involving low-density lipoprotein induce profound changes on cholesterol metabolism at the cellular level.

## P-135

### Is hip pain affects quality of life in elderly women?

E. Baskan, N. Yağcı. *Pamukkale University School of Physical Therapy and Rehabilitation*

**Introduction:** The incidence of hip joint pathologies increases with age. However the women are more affected than men. The most important symptom of these pathologies is hip pain. The purpose of this study is to determine the effect of hip pain on quality of life in elderly women.

**Method:** A total of 430 volunteer women aged 65–96 years were included in the study. The severity of pain was assessed by the Visual Analogue Scale (VAS). The General Health Level CDC HRQOL-4 questionnaire was used yo evaluate health related quality of life.

**Results:** The average age of participants was 72.65±6.34 years. Hip pain was detected in 36.7% of the participants (VAS mean: 4.86±1.98cm). 44.4% of the participants stated that their general health status was moderate. Positive weak correlations were found between hip pain and physical health (r =0,273, p=0,001), mental health (r =0,218, p=0,006), activity limitation (r =0,246; p=0,002).

**Conclusions:** As a result, it has been observed that hip pain affects all parts of quality of life including physical, emotional and daily life activities in elderly women. Prevention or manage of hip pain would improves all parameters related quality of life.

## P-136

### Low back pain risk among older Turkish adults

N. Yağcı, U. Cavlak, E. Baskan, M. Oztop. *Pamukkale University School of Physical Therapy and Rehabilitation*

**Introduction:** Low back pain is well documented to be an extremely common health problem. The aim of this study was to evaluate the low back pain risk among older Turkish adults.

**Methods:** Five hundred fifty six elderly people (279 females; 277 males; mean age: 71.45±5.99 yr.) included the study. The pain intensity was measured using a Visual Analog Scale (VAS). The risk of low back pain was evaluated with low back pain risk scale.

**Results:** The mean pain intensity was 4.43±1.98 cm. Low back pain rate was found as 60.4% among the participants. While 36% of the sample was found as they have potential risk, the 34.2% of the participants were found as risky.

**Conclusions:** The findings indicate that mostly older Turkish adults are at risk in terms of low back pain. That's why older adults should be evaluated about a chronic low back pain to improve their quality of life.

## P-137

### Multidimensional Prognostic Index (MPI) predicts re-hospitalization in frail older patients admitted to hospital: a multicentre, international, one-year follow-up study.
**The MPI_AGE European Project**

J. Daragjati¹, E. Topinkova², M. Puntoni³, A. Cruz-Jentoft⁴,
M.C. Polidori⁵, M. Paccalin⁶, A. Greco⁷, F. Mattace-Raso⁸,
A.A. Mangoni⁹, C. Musacchio¹⁰, H. Michalkova², T. Brunet⁶,
A. Egberts¹¹, C. Miret⁴, K. Ruxton⁹, A. Mangiacotti⁷,
M. Simonato¹², A. Pilotto¹⁰. ¹Geriatrics Unit, AULSS 6 Padova, S Antonio Hospital; ²Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; ³Clinical Trial Unit, Scientific Directorate, E.O. Galliera Hospital, Genoa, Italy; ⁴Hospital Universitario Ramón y Cajal, Madrid, Spain; ⁵Ageing Clinical Research, Dpt. Medicine II, University Hospital of Cologne, Germany; ⁶Geriatrics Department University Hospital La Milétrie, Poitiers, France; ⁷IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; ⁸Erasmus Universitair Medisch Centrum, Rotterdam, The Netherlands; ⁹Department of Clinical Pharmacology, Flinders University, Adelaide, Australia; ¹⁰Department of Geriatric Care, OrthoGeriatrics & Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy; ¹¹Erasmus UniversitairMedisch Centrum, Rotterdam, The Netherlands; ¹²Geriatrics Unit, AULSS 6 Padova, S Antonio Hospital, Padova, Italy

**Background:** The MPI_AGE is a European Commission co-funded project aimed to identify the most cost-effective health interventions according to the individual prognostic mortality-risk profile by using Multidimensional Prognostic Indices (MPI).

**Aim:** To evaluate the usefulness of the MPI in predicting one-year re-hospitalization in older patients.
**Methods:** Patients admitted to nine Geriatric Units across Europe and Australia underwent at hospital admission a Comprehensive Geriatric Assessment (CGA), i.e. functional (ADL, IADL), cognitive (SPMSQ), nutrition (MNA-SF), risk of pressure sores (Exton-Smith Scale), Comorbidity (CIRS), drugs and cohabitation status to calculate MPI. Patients were divided in MPI-1-low-risk, MPI-2-moderate-risk and MPI-3-high-risk of mortality. Time-to-event (Kaplan-Meier and Cox regression) and logistic analyses were performed adjusting data for age, gender, discharge and hospital center.

**Results:** 1,140 hospitalized patients were included (mean age 84.1±7.4 years, females=60.8%) and classified according to MPI score as MPI-1=169 patients (14.8%), MPI-2=502 patients (44.0%) and MPI-3=469 patients (41.1%). During the one-year follow-up 606/1,140 patients (53.1%) were re-hospitalized. A significant association between one-year re-hospitalization and all-cause mortality was observed (HR=1.79, 95% CI: 1.42–2.36, p<0.001). Multivariate logistic regression analysis confirmed that one-year re-hospitalization was significantly associated with higher MPI grade at baseline (MPI-1, Odds Ratio:1.0 reference; MPI-2, OR: 1.69 95% CI: 1.15–2.48, MPI-3, OR:1.60 95% CI: 1.07–2.38), lower age (OR=0.98, 95% CI: 0.96–0.99), male sex (OR: 1.29, 95% CI: 1.0–1.65) and the centre (OR: 0.91, 95% CI: 0.86–0.96).

**Conclusion:** Re-hospitalization is associated with all-cause mortality in hospitalized older patients. MPI performed at hospital admission identifies frail older patients at high risk of re-hospitalization during the one year follow-up period after hospital discharge.

## P-138
### Oropharyngeal dysphagia in a geriatric outpatient unit

S. Jiménez Mola¹, J. Idoate Gil¹, K. López López², M. López Viñas³, P. Sáez López⁴, E. Martín Pérez⁵. ¹Complejo Asistencial Universitario de León, León. Spain; ²Hospital San Juan de Dios, Burgos. Spain;

³Centro de Mayores de Armunia, León. Spain; ⁴Complejo Asistencial de Ávila, Ávila. Spain; ⁵Hospital San Juan de Dios, León. Spain

**Introduction:** Oropharyngeal dysphagia, or inability to swallow liquids and/or solids, is one of the less well known geriatric syndromes, despite its enormous impact on functional ability, quality of life and health in affected individuals. The complications of oropharyngeal dysphagia are malnutrition, dehydration and aspiration, and can cause high morbidity and mortality. One therapeutic intervention is adaptation of the texture of the solid and the viscosity of the liquid.

**Aim:** The aim of this study was to determine the characteristic pattern and the prevalence in our outpatient unit.

**Methods:** We performed a retrospective and descriptive study of all patients with dysphagia seen in our office from December 2012 to May 2015. Underwent comprehensive geriatric assessment that evaluates age, gender, comorbidities, medication use, ability to perform basic activities of daily living (Barthel Index) and place of residence.

**Results:** We enrolled 276 patients, 69% women. Mean age 87.4 years and 57% were living in a nursing home. 81% had a Barthel Index <20 and only 7% a Barthel Index >60. Dementia was the most common diagnosis (70%) followed by Cerebrovascular Disease (16%) and Parkinson's Disease. The swallowing inability of liquids and or solids was the reason for consultation in 64% of patients, but in the 36% were their complications as aspiration, malnutrition and dehydration.

**Conclusions:** Geriatric assessment may help in dysphagia detection at outpatients units. Patients with neurodegenerative or cerebrovascular diseases and the frail elderly are the most vulnerable. Oropharyngeal dysphagia should be identified early in risk groups.

## P-139
### Polypharmacy based on the data of inpatient assessment for elderly cancer patients in General Hospital

Y.-H. Park¹, D.Y. Jung². ¹Seoul National University, Seoul, South Korea; ²Seoul National University Hospital, Seoul, South Korea

**Introduction:** As old aged cancer patients have been increasing, this study aims to understand the status of polypharmacy among elderly cancer patients who have been in General hospital in order to support the appropriate mediation and management for them.

**Methods:** This research has made retrospective survey research study for 3 months starting from January 1, 2015. The data was collected from 170 senior cancer patients over 65 years old at the cancer ward in S university General Hospital. PI (Potentially Inappropriate Medication) for elderly patient was verified by Beers criteria and risky Drug-Drug interaction medication was referred to the appropriate medication guideline for elders issued by Ministry of Food and Drug Safety.

**Results:** The average age of patient was 72.3 (±5.43) years old among 110 me (64.7%) and 60 wome (35.3%). 87.1% of patients had more than 1 chronic disease and they had average 1.9 (±1.4) types of chronic disease. The most of patients had colorectal cancer with 22.9%, lung cancer with 11.8% and gastric cancer with 11.2% in order. The patients were taking average 5.3 (±3.3) self-medications daily and 55.9% were taking polypharmacy with over 5 and 10.0% were overtaking polypharmacy with more than 10. It was verified by Beers criteria that 30.0% showed PI (Potentially Inappropriate Medication) in 62 cases and 21.2% showed risky Drug-Drug interaction medication in 50 cases among patients.

**Conclusions:** It is necessary to reduce the polypharmacy for elderly cancer patients and build pharmacovigilance system to monitor PIM and risky Drug-Drug interaction medication.

## P-140
### Potential impact of geriatric assessment on surgical treatment decisions in the older cancer patient

K. Alexander ¹,², A. Shahrokni ¹,², S. Sarraf ¹, B. Korc-Grodzicki ¹,².

¹Memorial Sloan Kettering Cancer Center, New York City, USA; ²Weill Cornell Medical Center, New York City, USA

**Introduction:** Older cancer patients are a heterogenous group. The Geriatric Assessment (GA) is an important risk stratification tool in oncogeriatrics. This study aims to assess the impact of GA on the decision to treat the cancer surgically, and the characteristics of patients that underwent surgery as opposed to those in whom the procedure was cancelled.

**Methods:** This is a retrospective analysis of a cohort of 1767 patients ≥75 years with diagnosis of cancer, scheduled for surgery, who presented to the Geriatrics clinic at Memorial Sloan Kettering Cancer Center between 01/2015 and 12/2016 for a pre-operative assessment. Sociodemographic characteristics and GA parameters were collected and analyzed. For continuous and categorical variables, t-test and Chi-square test were applied respectively.

**Results:** Of the 1767 patients (median age 80) who were evaluated with preoperative GA, 114 (6.5%) did not proceed with surgery. Significant differences between the group of patients that did not vs. the group that did proceed to surgery, include: median age (82.5, 80; p<0.05), KPS (70, 85; p<0.05), ADL (9.6, 12.3; p<0.05), iADL (10.4, 13.7; p<0.05), MiniCog (3, 4; p<0.05), distress thermometer (5, 4.2; p<0.05), social activity limitation score (9.7, 8.2; p<0.05). The differences were also significant in their use of assistive devices for ambulation, history of falls in the past year and their performance on Timed Up and Go Test (p<0.05).

**Conclusions:** Preoperative GA helped identify a subset of frail older cancer patients highlighting the need for this assessment. These patients were then offered alternative treatment approaches.
P-141

**Predictors of lower respiratory tract infections (LRTIs) in elderly patients requiring hospitalization**

P. Voukelatou, I. Vrettos, A. Bitsikokou, A. Ragkou, D. Theotoka, A. Katsoras, A. Kalliakmanis. 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece

**Background:** Previous studies concerning risk factors for LRTI's in the elderly have shown conflicting results. Most frequently reported risk factors include age, swallowing difficulties, comorbidities and stroke.

**Objective:** To assess the predictors of LRTI's in elderly patients.

**Methods:** In 310 patients (49,6% women), mean age 80.24 (95% CI: 79.35–81.10) demographic characteristics, medical history, medications, Katz-index (KI), Charlson-Comorbidity-Score (CCS) and reason of admission were recorded. Chi-square test was used to compare categorical data. Student's t-test and Man-Whitney U test were used to compare continuous data. Only variables being statistically significant were processed with multivariate analysis. Age was both analyzed as a categorical and continuous variable.

**Results:** 52 patients (16.8%) mean age 82.52 (95% CI: 80.02–85.08) suffered from LRTIs. Mean age was significantly higher (t(308)= -2.289, p=0,023) for patients with LRTIs. Mean number of diseases, number of medications and CCS were not significantly different between patients with or without LRTIs. Patients aged above 80 years old (χ²=5.783, p=0.016) or with lower KI (χ²=14.355, p=0.026) were more likely to have been admitted due to LRTIs. Sex, use of PPI's or SSRI's, the presence of stroke, dementia, COPD, Parkinson disease and psychiatric disorders were not linked with LRTIs. In multivariate analysis, the only independent predictor was KI (p=0.021, OR=0.867, 95% CI: 0.769–0.979).

**Conclusion:** Elderly unable to function independently in the everyday living activities are more prone to experience an LRTI. Thus, it is of highly importance the education and the awareness of the caregivers to take extra precautions to prevent LRTIs.

P-142

**Prevalence and severity of vitamin B1- and B6 deficiencies in a large cohort study in The Netherlands**

M. Newton-Boerjan, A.-K. Boer, C. van der Linden. Catharina Hospital Eindhoven, The Netherlands

**Introduction:** A though multiple guidelines do not recommend screening for vitamin-B1 deficiency (B1D) and vitamine-B6 deficiency (B6D) in geriatric patients, it is not known how many (severe) B1D and B6D remain undiagnosed. This study aims to answer the following questions: what is the prevalence and severity of B1D and B6D in geriatric patients?

**Methods:** This descriptive study investigates the prevalence of B1D and B6D in a large cohort of patients referred to an inpatient or outpatient geriatric department from February 2012 to May 2016. Furthermore we made a subdivision for patients with malnutrition, alcohol use or dialysis.

**Results:** Data of 4378 subjects were included in analysis. Mean age was 82,2 years and 60,1% was female. B1D in the entire population was 4,1% (3,6% moderate and 0,5% severe). In clinical and ambulant patients B1D was 6,0% (5,0% moderate and 1,0% severe) and 2,6% respectively. In the malnutrition and alcohol use group B1D was 7,7% (6,2% moderate and 1,5% severe) and 3,4% respectively. B6D in the entire population was 5,0% (4,5% moderate and 0,5% severe). In clinical and ambulant patients B6D was 10,4% (9,4% moderate and 1,0% severe) and 2,4% respectively. In the malnutrition and alcohol use group B6D was 8,5% (7,8% moderate and 0,7% severe) and 3,5% respectively.

**Conclusion:** This large study shows that the prevalence of B1D and B6D was twice as high compared with healthy subjects. Since most patients suffer from moderate deficiency, one can defend the policy not to screen the entire geriatric population. However, we do recommend screening for patients in the clinical setting and patients who suffer from malnutrition.

P-143

**Prevalence of abuse and neglect, and associated factors in community dwelling older adults**

B. İlhan, F. Saka, G. Bahat, C. Kılıç, S. Bovatekin, Y. Topçu, O. Yilmaz, P. Küçükdaglı, T. Erdoğan, M.A. Karan. Istanbul University, Istanbul Medical School, Division of Geriatrics, Istanbul, Turkey

**Objective:** Elder abuse and neglect is a critical-health-care-issue that-must-be-brought-to the attention. Each year approximately 10% of adults 65 years and older are abused, and 4% experience moderate to severe abuse.

**Aim:** In this study, we aimed to assess the prevalence of elder abuse and neglect, and associated factors.

**Methods:** Elders ≥60 years-of-age admitted to outpatient-clinic were included. Patients with acute-clinical-conditions, disable-to-cooperate, and absence-of-informed-consent were excluded. Eligible individuals had face-to-face interview by social worker in a room and alone. Components of comprehensive-geriatric-assessment, The Hwalek-Sengstock Elder Abuse Screening Test (HSEAST) scores have been recorded. Also a new-scale has been developed by-our social-worker to assess elder's self-neglect.

**Results:** 226 eligible individuals were included among 481 new admission. 142 were femal (%63) and 84 were mal (%37). Mean age was 74±6.5 years. According to HSEAST-scores 81 (35,8%) respondents met the criteria for elder abuse/neglect risk. This ratio were higher in female-group than male-group (p=0,008; 42% and 25%, respectively). HSEAST-scores were positively-correlated with geriatric-depression-scale scores and EQ5D-self-report quality-of-life questionnaire (p<0,0001 for both). The cut-off threshold for new self-neglect scale was 7 in ROC analysis. Scores ≤7 reflect self-neglect with a ratio of 39.8%. Self-neglect were higher in female-group than male-grou (p=0,0017; 46% and 30%, respectively). The new-self-neglect-scale scores were negatively-correlated with HSEAST-scores, geriatric-depression-scale-scores and EQ5D-scores (p=0,11, p<0,0001, p=0,001 respectively).

**Conclusion:** We observed high rates of abuse/neglect. This study showed females are at more abused risk than males. Abuse and neglect are correlated with lower quality of life and depression. Also our new self-neglect scale was correlated with HSEAST scores, depression, and lower quality of life. This cross-sectional study confirms that elder abuse is a considerable public health problem warranting further longitudinal studies.

P-144

**Prevalence of fallers and of subjects at risk of falling in the most visited French climatic health resort**

N. Raffort¹, L. Soriteau¹, B. Aliaga¹, H. Desfour¹, P. Pech¹, L. Gamon², M. Faunanie², M.-C. Picot², X. de la Tribonnière³, H. Blain⁴. ¹Centre Thermal de Balaruc-Les-Bains; ²Département de l'Information Médicale, Centre d'Investigation Clinique, CHU Montpellier; ³Unité Transversale d'Éducation du Patient (UTEP) CHU Montpellier; ⁴Department of Internal Medicine, University Hospital of Montpellier, Montpellier University, MACVIA France, EUROMOV

Balneotherapy has proven positive effects in various musculoskeletal diseases, conditions potentially associated with an increased risk of falls. We determined the history of fall and the prevalence of risk factors of falling in 1471 subjects aged 65 or older consecutively admitted between June and August 2016 in the climatic