injury due to dehydration. He was commenced on intravenous antibiotics and fluids. Allopurinol was stopped as a suspected culprit drug. Renal ultrasound and CT imaging of kidneys, ureter and bladder were unremarkable. He was reviewed by the Dermatologist same day and skin biopsy was performed. They felt the rash was most likely secondary to drug rash or Sezary syndrome. His CRP and renal functions continued to deteriorate. The skin biopsy results were consistent with a drug reaction.

**Conclusion:** Allopurinol is a widely prescribed gout treatment, and it is known to cause erythroderma. Although typically a well tolerated medication, it may result in severe complications, and higher doses should be used with particular caution in the context of chronic kidney disease.

## P-613

### Drug therapy among the elderly in nursing homes: analysis using the STOPP criteria version 2

I.E. Jondottir¹, P. Gunnarsson¹, O. Samuelsson², H. Hansdottir³, A. Gudmundsson². ¹University of Iceland, Dept. of Pharmacology, Reykjavik, Iceland; ²University Hospital Iceland, Dept. of Geriatrics, Reykjavik, Iceland; ³Mörk Nursing Home, Reykjavik, Iceland

**Introduction:** The aim of this study was to use the STOPP criteria version 2 to analyse potentially inappropriate medicine use in two selected Icelandic nursing homes.

**Methods:** The study was a cross sectional study. Total number of residents included from the two care homes was 216. Data was collected over 8 weeks. Data collected were; age, sex, treatment goals, length of stay, number, type and lenght ot use of medications, diagnoses reported in medical records, blood test results and functional parameters according to selected RAI instrument scores (ADL, CHESS and CPS scores).

**Results:** The results showed that 95,4% of the residents were prescribed potentially inappropriate medications. The most common reasons were no registered indication, medications prescribed for too long or medications that were potentially inappropriate for this population (for example antipsychotics, benzodiazepines and z-sleeping medicines). Inadequate documentation of diagnoses was common.

**Conclusions:** The STOPP criteria might be helpful to detect Potentially inappropriate medicinations in Icelandic nursing homes. Improved documentation of indications would make the STOPP criteria more specific and their use might be helpful to optimize quality of drug prescribing.

## P-615

### Efficacy of venous compression on symptomatology of orthostatic hypotension and blood pressure in patients aged 75 years and over: a prospective multicenter case/control study

S. Krypciak¹, L. Corsin¹, A. Durand¹, F. Canouï-Poitrine², E. Paillaud¹. ¹Henri Mondor Hospital - APHP. Department of Internal Medicine and Geriatrics, Créteil, France; ²Henri Mondor Hospital - APHP. Department of Public Health, Créteil, France

**Introduction:** Orthostatic hypotension is common and increases with aging. It has important consequences on the morbidity, mortality and autonomy of elderly patients. The compression stockings are part of the recommendations to combat orthostatic hypotension, but few studies have been carried out.

**Method:** A prospective, multicenter case/control study was conducted in the geriatric departments of 2 hospitals with the aim of demonstrating the efficacy of class II compression stockings on symptoms and blood pressure in orthostatic hypotension. Patients' histories, treatments and physical characteristics were investigated to find predictive factors for good or poor response to compression stockings.

**Results:** 213 patients were tested and 38.5% of patients experienced orthostatic hypotension. After 48 hours of corrective measures, only 35 patients were able to benefit from orthostatic hypotension tests without and with compression stockings and have been analyzed. This study shows an improvement in the symptoms of orthostatic hypotension when taken as a whole (p=0.02) but not independently. There was also a decrease in the blood pressure drop with a significant difference (p<0.008) in favor of the effectiveness of the compression stockings. Diabetes and beta-blockers are factors leading to a lower response of compression stockings.

**Conclusion:** These data should strengthen our convictions in order to improve therapeutic education among patients. However, studies of larger scale and against placebo are still necessary to conclude to the effectiveness of the stockings.

## P-616

### Evaluation of the impact of the schedule of the drug taking on the ingestas of seniors hospitalized in after-care and rehabilitation

L. Maljean, P. Gibert, A. Grevy, N. Zerhouni, S. Lumal, G. Gavazzi. CHU Grenoble Alpes

**Introduction:** Fight against undernutrition is an important stake in the older population. Moreover, polypharmacy represents a well-known risk of undernutrition. Traditionally, drugs are administered before the meal. However, it has already been proposed to administer the drugs after the meal in order to increase the amount of food ingested. The goal of this study is to evaluate the impact of the schedule of drug taking on the ingestas.

**Methods:** It is an observational study on patients hospitalized in rehabilitation in the Grenoble-Alpes university hospital. The ingestas has been evaluated by the weight of food ingested (in grams) and the patient's view was requested.

**Results:** Fifty-five meals were evaluated. The results show that scheduling the administration of drugs after the meal increased the amount of food ingested by 9.4% for the breakfast and 15.4% for the supper. It is interesting to note that none of the patients refused to take their drugs after the meal. Moreover, some patients explained that the administration of drugs before the meal resulted in an appetite loss, especially nutritional supplement and sachets.

**Conclusions:** This observational study shows that the schedule of drug taking is an interesting lead in the fight against undernutrition of older individuals. It is however quite difficult to set up in short-care geriatric unit. Studies on feasibility and efficiency in a larger population are required.

## P-617

### Factors determining the use of anticoagulant therapy in geriatric patients with atrial fibrillation – retrospective analysis

A. Kasiukiewicz, Z.B. Wojszel. Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland

**Introduction:** Atrial fibrillation (FA) is a common disease in geriatric patients. The patients are at high risk of ischemic stroke but also at risk of severe bleeding during anticoagulation.

**Methods:** Retrospective analysis of patients hospitalized in the Department of Geriatrics in the period 01.09.2014–30.04.2015. Information on anticoagulant therapy before and after discharge and the patients' functional status were collected. Based on available data, the risk of ischemic stroke (CHA2DS2VASc scale) and the risk of bleeding (HAS-BLED scale) were determined.

**Results:** 427 patients were hospitalized during the period of the study (mean age 81.6±6.75 years, 85% of patients over 85, 78% of women). Among them, 98 patients with FA (22.95% of the population) were reported. Mean CHA2DS2VASc scale was 5.03±1.39 pts (min value - 3 pts) and HAS-BLED was 2.33±0.83 pts. Antithrombotic
agents were used in 58.16% of patients before admission and in 71,43% at discharge. Anticoagulation was discontinued in 6.12% and started in 19.39% patients. There were no statistically significant differences in CHA2DS2VASc and HAS-BLED scales between patients treated with anticoagulants and without treatment, whereas patients left without antithrombotic prophylaxis were more likely to be at risk of falls and orthostatic hypotension, malnutrition, and often lived alone.

**Conclusions:** FA geriatric patients, despite high risk of ischemic stroke, are often under-treated with anticoagulation. This is often associated with "geriatric" risk factors for the adverse effects of anticoagulant therapy.

P-618

General practitioners collaboration for pharmacist-led
medication review

S. Qassemi¹, N. Tesquet¹, F. Eyvrard¹, L. Rouch², C. Mccambridge¹,
P. Cestac². ¹Department of Pharmacy, Purpan Hospital, Toulouse
University Hospitals, Toulouse, France; ²Department of Pharmacy,
Purpan Hospital, INSERM UMR 1027 Toulouse University Hospitals,
Toulouse, France

**Introduction:** To identify potentially inappropriate prescriptions and reduce iatrogenic events, different actions may be proposed. Among them, a structured medication review (MR) can be provide by french pharmacist in collaboration with general practitioner. MR is supported by a professional Network for the Community Pharmacy (REIPO) structured around the city of Toulouse (Occitanie area, France). The main objective of this study is to identify the impediments and the levers to the implementation of a pharmacist led MR in primary care.

**Methods:** A national questionnaire was sent to 8939 pharmacies via the LGPI software of pharmagest. The survey was conducted, during a two week period from April 7–22, 2017.

**Results:** The main barrier identified was the fear of physicians non-adherence for 69.7% of pharmacists interviewed (n=276/396). However, 71.5% (n=283/396) of them think that they can identify physician with whom they could collaborate. The second obstacle identified was the human resources lack, 52% of pharmacists (n=205/396). Then there was the lack of financial means (n=163/396), the fear of poor patient adhesion (n=153/396), and the lack of knowledge about elderly therapeutic optimization (n=108/396). From the perspective of the pharmacists interviewed, the main advantage is an improvement in the patient's medication management (90.7%, n=359/396).

**Conclusion:** In view of the main obstacle, the REIPO is already working closely with representative of general practitioners. It offers a wide range of training for health professionals wishing to upgrade their skills in the optimization of therapeutics of the elderly. The REIPO aim is to bring together the largest number of pharmacists in order to be able to deploy the MR in collaboration with physicians.

P-619

GPs' continuation and acceptance of medication change at
sectorial transitions of geriatric patients – A qualitative
interview study

A.G. Strehlau¹, A.B. Almarsdottir², J. Søndergaard³, J.U. Rosholm¹.
¹Dept. of Ger. Med., Odense University Hospital, Denmark; ²University
of Copehangen, Denmark; ³University of Southern Denmark

**Background:** Follow-up in general practice on the medical pre-
scriptions initiated during hospitalization is often perceived to be
inadequate, leading to unintended drug interaction and over or
under dosage of medication. But only little is known about the GPs'
view on the patients transition from the hospital to general practice.

**Objective:** We conducted a qualitative interview study to understand the GPs' views on medication changes for their patients by hospital physicians in a geriatric ward, and the GPs' actions after discharge. Setting: Ten general practitioners in Denmark.

**Methods:** Qualitative semi-structured interviews using a phenomenological approach.

**Results:** The GPs' primary reason for discontinuity was miscommunication, but there was a multiplam of factors including delayed discharged letters involved. The general practitioners did not in general express disagreement with the changes made in hospital. There is a great variation in the GPs' way to handle medication changes etc.

**Conclusion:** The reason for poor continuity of medication changes in sector transition are primarily caused by procedural errors in the follow-up of the patient after discharge, and by insufficient communication between the primary sector and the hospital.

P-620

Health status of the patients exposed to low-dose versus
high-dose carbon disulfide

H. Cho¹, J.E. Oh², Y.G. Lee³, C.Y. Cho¹. ¹Department of Family Medicine, Soonchunhyang University Hospital, Soonchunhyang University, Seoul, Korea; ²Department of Family Medicine, Soonchunhyang University Hospital, Soonchunhyang University, Cheonan-City, Korea; ³Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital, Soonchunhyang University, Seoul, Korea

**Introduction:** The purpose of this study is to garner useful information through a comparative analysis of health status between the low-dose and the high-dose carbon disulfide (CS2) exposed patients.

**Methods:** The low-dose exposed group was defined as those exposed under 5 ppm (CS2 time weighted average concentration), and the high-dose exposed group was defined as those exposed 5 ppm and over. Study subjects were 663 workers of Wonjin Rayon Co., Ltd. located in South Korea. Multiple logistic regression analysis was used in this study.

**Results:** The high-dose exposed patients were more vulnerable to anxiety, felt higher level of depression, showed decreased cognitive function, and had difficulty to prepare food, compared with the low-dose exposed patients. The high-dose exposed patients lagged behind the low-dose exposed patient in total sleeping time and quality of sleep.

**Conclusions:** The vulnerability of the high-dose exposed patients in terms of mood, mental and sleep health needs to be acknowledged as the various characteristics of the individual that appears according to CS2 exposure. A variety of disease prevention and health promotion programs that focus on the health status of the patients need to be personalized and put them into practice.

P-621

Iatrogenic alerts in elderly patients with hip fracture in a
dedicated orthogeriatric care pathway

L. Zerah¹, T. Lamy², J. Cohen-Bittan², R. Haddad¹, C. Villain¹,
M. Verny³, H. Vallet¹. ¹Unit of Peri-Operative Geriatric care, Groupe
Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de
Paris (APHP), Paris, France; Sorbonne University, University Pierre and
Marie Curie (UPMC) Paris 06, University Hospital Department Fight
Aging and Stress (DHU FAST), Paris, France; ²Unit of Peri-Operative
Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance
Publique-Hôpitaux de Paris (APHP), Paris, France; ³Unit of Peri-
Operative Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière,
Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Sorbonne
University, University Pierre and Marie Curie (UPMC) Paris 06,
University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France 3. Centre National de la Recherche Scientifique (CNRS), UMR 8256

**Introduction:** Elderly people are at risk of repeated hospitalizations, some being drug-related and preventable. In 2011, French experts (Haute Autorité de Santé (HAS)) selected 5 "iatrogenic alerts" (IAS), from the existing sets of explicit criteria, to assess the appropriateness of medication in elderly patients. We aimed to examine IAs evolution before and after HAS' publication in patients with hip fracture, particularly prone to drug related problems, managed in a dedicated orthogeriatric care pathway.

**Methods:** A retrospective study with time series analysis was set up to analyze the prevalence of IAs between 2 periods: 2009–2012 and 2012–2015. All patients (>70 years) admitted after hip fracture surgery into a dedicated unit of perioperative geriatric care were included. IAs were defined as: (1) long half-life benzodiazepine (BZD); (2) antipsychotic drug (APD); (3) co-prescription of 3 psychotropic drugs or more (PD), (4) co-prescription of 2 diuretics or more (DIU) and (5) co-prescription of 4 antihypertensive drugs or more (AHD).

**Results:** 495 patients (86±6 years) were included and 20% of them had an IAs' prescription (N=101) with a prevalence of: 2% for DIU, 3% for APD in patients with dementia, 4% for AHD, 6% for BZD and 6% for PD. Only the prevalence of APD in patients with dementia had decreased between 2012–2015 vs 2009–2012 (respectively: 2% vs 5%, p=0.03).

**Conclusion:** The prevalence of IA in our population was low. After the publication of HAS' recommendations on IAs in the elderly only APD prescriptions decreased.

## P-622
Improving Medication Prescription in the Context of Advanced Care Planning for Patients Receiving Nursing Home Care (IMPETUS): Study protocol of a cluster randomized controlled trial

C.A.M. Pouw¹, M.S. Smalbrugge¹, J.G. Hugtenburg², R.J. van Marum¹, C.M.P.M. Hertogh¹. ¹Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; ²Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands

**Introduction:** Nursing home (NH) residents in the Netherlands have a limited life expectancy (mean survival 1.5–2 years) and suffer from the combined burden of advanced disease, functional impairment and severe care dependency. It is increasingly recognized that prescribing for these patients is better guided by a geriatric-palliative care (GPC) approach, with a focus on quality of life, comfort and medication-safety rather than on life extension. However, current prescribing practice lags behind: inappropriate prescribing is highly prevalent among NH residents. This study aims to align medication prescription with GPC goals in NH residents, by means of an Advance Care Planning with multidisciplinary medication review intervention.

**Methods:** A cluster randomized controlled trial will be performed in 2×20 long term care wards of University Affiliated NH, including 480 patients. NH patients are eligible if they wish GPC or have an indication based on their life-expectancy (≤1.5–2 years). The intervention consists of biannual structured multidisciplinary medication reviews followed by ACP discussions with patients/surrogates, compared to usual care. Primary outcome measures are medication appropriateness. Secondary outcomes are falls, hospitalizations, mortality, quality of life and patient/surrogate satisfaction with involvement in decision-making. A qualitative process analysis will also be performed.

**Expected results:** This study is expected to increase appropriateness of medication prescription (reduction of chronic and preventive medication, increase prescriptions for symptom management) without increase in mortality, hospital admissions, or adverse effects. We expect no negative effect on quality of life, and a positive effect on patient/surrogate satisfaction in decision-making.

## P-623
Inappropriate drug prescriptions: Comparison of three tools for aiding drug prescriptions in the elderly

L. Godaert¹, S. Dechavigny¹, M. Dramé², J.-L. Fanon¹. ¹University Hospital of Martinique, Martinique, France; ²University of Reims, Champagne-Ardennes, France

**Aim:** To compare the proportion of prescriptions containing at least one inappropriate drug, as identified using three tools for optimizing drug prescriptions in the elderly.

**Methods:** Cross-sectional, observational study based on the analysis of prescriptions of patients discharged between 1 September and 31 October 2014 in a short-stay geriatrics unit at the Louis Domergue de Trinité Hospital in Martinique (France). Each prescription was analysed using 3 tools, namely one for general medicine (Vidal® drug dictionary) and two tools specifically designed for geriatrics (the Laroche list of potentially inappropriate medications, and the STOPP-START toolkit). The number of prescriptions containing at least one inappropriate medication was recorded as evaluated with each tool. These prescriptions were then compared to investigate whether the two geriatric tools identified the same prescriptions as being inappropriate.

**Results:** In total, 53 prescriptions were analysed. The male-female sex ratio was 0.70. The average age of the patients was 84.5±6.2 years. Analysis according to the Vidal® drug dictionary identified the greatest number of inappropriate prescriptions (28.3% of all prescriptions). The proportion of prescriptions containing at least one inappropriate drug was lower with the two tools specific to geriatrics (11% for the Laroche list and 7.5% for the STOPP START method).

**Conclusion:** The general medicine Vidal® drug dictionary identified more inappropriate prescriptions than the tools specifically designed for geriatrics. The tools for aiding drug prescriptions in the elderly identified different drugs as being inappropriate.

## P-624
Inter-rater reliability of STOPPFrail [Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy] criteria amongst 12 physicians

A.H. Lavan, D. O'Mahony, P. Gallagher. Cork University Hospital and University College Cork

**Introduction:** STOPPFrail is an explicit tool, developed by Delphi technique, to assist physicians with deprescribing medications in frail older adults with limited life expectancy. The aim of this study was to evaluate the inter-rater reliability of applying STOPPFrail amongst physicians.

**Methods:** Twenty datasets were collated. The datasets comprised frail multi-morbid patients with a mean age of 79.3 (SD 5.68) years, a median number of 7 (IQR4–8) conditions and a median of 9 (IQR 7–11) medications. Two of the STOPPFrail originators reached complete agreement (Gold standard [GS]) in terms of the prescribing appropriateness for each case according to STOPPFrail. Of 181 prescribed medications, 91 were deemed inappropriate by GS assessment. Twelve physicians (3 Consultant Geriatricians, 3 Geriatric Medicine trainees, 3 General Practitioners and 3 Palliative Care physicians) independently applied the STOPPFrail tool to the datasets.

**Results:** Eighteen of twenty cases met STOPPFrail inclusion criteria.
ria. These were correctly identified by 9 physicians: 3 physicians correctly included at least 16 of the 20 cases. The median kappa co-efficient between raters and the GS was 0.75 (IQR 0.73–0.83). Consultant Geriatricians stopped on average 8 more medications than others, 94 vrs 86, p=0.005. It took physicians on average 2.7 (SD 0.94) minutes to apply STOPPPFrail to each case.

**Conclusions:** The inter-rater reliability of STOPPPFrail criteria is good when tested between physicians practising in different specialties.

## P-625

### Investigation of prescribing and utilization practices for injectable iron in the geriatric services of a university hospital center

A. Tanty, P. Gibert, M. Baudrant, A. Grevy, P. Bedouch, G. Gavazzi.
*CHU Grenoble Alpes*

**Introduction:** The management of martial deficiency, is an important and frequent issue in the hospital management of geriatric population. Currently two specialties of injectable iron are mainly used (iron sucrose and carboxymaltose). There are no consensus references detailing in which situations to use one or the other of these 2 specialties. The aim of this study is to analyze the practices of use of injectable iron within the geriatric services of our university hospital center.

**Methods:** Retrospective observational study, including all the patients of 3 geriatric units. The data collection was made from a computerized extraction of injectable iron prescriptions over a period of one month, from December 1, 2016 to December 31, 2016.

**Results:** 26 patients were included. The mean age was 87.7 years [±5.5 years]. The average length of stay was 23.8 days [±15.6 days]. Patients in the sucrose group received on average 120 mg [±45 mg] iron vs 1000 mg [±223 mg] on average for the carboxymaltose iron group. In total, 54% (n=14) of the prescribed martial balances investigations were adapted according to the frenche Haute Autorité de Santé recommendations. Overall, 77% (n=20) of patients who received injectable iron had a martial deficiency.

**Conclusion:** This study shows an important difference in terms of iron dose received according to the prescribed specialty. The balance of anemia is not always well done before iron prescription. These results have to be confirmed but improvement in the management of martial deficiency is needed.

## P-626

### ITP in the elderly over 75 years: Epidemiological, clinical, biological and therapeutics characteristics. About a retrospective study

A. Toumi¹, J.-L. Pennaforte², N. Kadri³, J. Doucet³, E. Andres⁴.

¹Hospital of Troyes; ²University Hospital of Reims; ³University Hospital of Rouen; ⁴University Hospital of Strasbourg

**Introduction:** Idiopathic thrombocytopenic purpura (ITP) can also occur in the elderly over 75 years. At present, there are no specific data on the care of subjects aged 75 and over.

**Methods:** This is a retrospective study, focusing on a population of subjects above age 75, and having been previously diagnosed with ITP, by the Department of Internal Medicine University Hospital of Reims. The collection period spans the years between 2009 and 2015.

**Results:** Fifteen patients were enrolled. The average age of diagnosis was 83.9 years, females representing 11 cases (73.3%). The initial clinical presentation is dominated by a significant medical history of hemorrhagic bleeding. We note the presence of autoimmune diseases, previous diagnosis of ITP, including one case bullous dermatosis autoimmune, a case of autoimmune hemolytic anemia, and scleroderma. Two haematologic malignancies (cutaneous lymphoma, LLC) were also observed. A diagnosis of systemic lupus was

raised concomitantly. After the diagnosis of ITP, vasculitis ANCA was observed (in the suites). During the diagnostic phase, the mean platelet count was 14,46G/l. one case of Evans syndrome was diagnosed. The first line of treatment is based on oral corticosteroid therapy for 14 of the cases. We observed: a month, in order to obtain a complete response for 9 patients, a partial response in 3 patients, 2 patients failed to respond; At 6 months, a complete response for 0 patients and recurrence for all patients was recorded. Polyvalent immunoglobulins have not been successful for patients, collected either alone or combined with corticosteroid therapy; as well as for platelet transfusions. Splenectomy was performed for a single patient with recurrence observed after 6 months. Alternative treatments used include: mycophenolate mofetil, in a case of partial response, dapsone for 2 patients with partial responses (with hepatic adverse events occurring after 2 years of its introduction), the cellcept for 2 patients, with a partial response for one patient, and a failure for the other (associated with adverse effects such dysuria and gastric heaviness), danazol for one patient with failed results, eltrombopag used for a single patient with adverse events that led to his stopping. Rituximab had been used for 3 patients with a complete response for one patient and a partial response in the other two. Romiplostim was used for one patient with a complete response following the use of Rituximab, which had provided a partial response for this patient. We incurred a loss of 5 patients. We noted one death within 1 month of the initial charge.

**Conclusion:** Large-scale studies should be conducted in this age population, in order to standardize these practices.

## P-627

### Low-dose pregabalin causes tremor in an old patient: A case report

L. Maljean, P. Gibert, A. Grevy, M. Mallaret, G. Gavazzi.
*CHU Grenoble Alpes*

**Introduction:** Neuropathic pain is a common issue in the elderly care. The current recommendations are tricyclic antidepressant (amitriptyline) or selective serotonin reuptake Inhibitor (Duloxetine) or antiepileptic (gabapentin, pregabalin). However, these recommendations are quite large and there are no specific guidelines for the older patients. The initial choice of the drug is often made based on prescriber's habits and reevaluated based on tolerance.

**Methods:** We are reporting a case, notified to the pharmacovigilance, of tremor caused by low dose pregabalin.

**Discussion:** The patient, man, 86 years old, was hospitalized for myeloma. He presented neuropathic pain on the left leg. A treatment by pregabalin 50mg twice a day was introduced which was quite effective. The doses of pregabalin were adapted with the renal clearance of the patient (38 ml/min). Seven days later, important tremors at rest appeared. The tremors quickly and spontaneously improved after the stop of pregabalin. The pharmacovigilance concluded by the imputability of pregabalin in the tremors.

**Conclusion:** This case shows that pregabalin can causes adverse effect even at a lower dose than recommended. The treatment should be introduced at the lower dose possible and increase regarding the efficiency. Also, given the lack of specific recommendations, specific studies in the older population should be performed.

## P-628

### Medical treatment in frail elderly heart failure patients

M. Brockhusen¹, E. Nielsen¹, S. Arnspang², J.-U. Rosholm³.

¹Medical Student, University of Southern Denmark, Odense, Denmark;

²University of Southern Denmark, Odense, Debmark; ³Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark

**Background:** Many elderly suffer from heart failure along with
other concomitant diseases. The existing pharmacological guidelines for treating heart failure are based on studies where frail elderly often are excluded. The concomitants diseases result in polypharmacy if the guidelines for all patient's diseases are followed and therefore prioritization between the recommended drugs is desirable.

**Objectives:** To determine whether guideline recommended pharmacological treatment of chronic heart failure can be adjusted to a frail elderly population including prioritization between recommended drugs.

**Methods:** A systematic search in the PubMed and EMBASE databases was conducted using relevant search-terms; rendering 7039 hits. Studies were included only if they focused on pharmacological treatment of heart failure in frail elderly patients. No original studies matched the inclusion criteria, whereas three reviews matched.

**Results:** None of the reviews presented clear pharmacological guidelines. They all stated that the treatment of frail, elderly heart failure patients needs to be individualized taking concomitant diseases, current medication and patient expectations into account. Some recommendations could be laid down:

* In any episode of congestion patients should be treated with diuretics.

* ACE-inhibitors are indicated in all systolic heart failure patients.

* Beta-blockers may be added to the treatment if tolerated.

* Digoxin is only indicated if the patient remains symptomatic.

**Conclusion:** This study revealed that guideline recommended treatment can be used in a frail elderly population, if tolerated and when taking concomitant diseases and treatments into account. Diuretics is the most important drug for the elderly heart failure patients.

## P-629

### Medication appropriateness for elderly nursing home residents with a limited life expectancy: A Delphi consensus study

C.A.M. Pouw¹, M.S. Smalbrugge¹, J.G. Hugtenburg², R.J. van Marum¹, C.M.P.M. Hertogh¹. ¹Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; ²Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands

**Introduction:** Dutch nursing home (NH) residents are generally (very) old. They suffer from multi-morbidity and often use a large number of drugs. Medication inappropriateness is highly prevalent in this group. The Screening Tool to Alert to Right Treatment (START) and Screening Tool of Older Persons' Prescriptions (STOPP) are commonly used tools to enable physicians to assess medication appropriateness. However, these criteria may not be applicable for frail elderly with a limited life expectancy. The aim of this Delphi study is to adjust the current START/STOPP to these patients.

**Methods:** An online Delphi study, based on the 2015 START/STOPP criteria [1]. We invited international pharmacists/clinical pharmacologists, geriatricians, elderly care physicians and general practitioners with expertise on the subject. In the first round, we ask for each medication group whether the expert considers it appropriate to start this in our target patients, and if not, whether they would stop it (on 4-point Likert Scales). Consensus is defined as ≥70% of the participants answering (very) inappropriate or (very) appropriate. Participants are also asked to offer suggestions to adjust the STOPP.

**Results:** 23 international experts agreed to participate in the study. The first round is currently in process, final results are to be expected in August 2017.

**Conclusions:** We expect to need three rounds. The results will be used to develop adjusted START/STOPP criteria which will be applied in a cluster randomized controlled trial aimed at increas-

ing the appropriateness of medication in NH residents in the Netherlands with a limited life expectancy (1.5–2 years).

**References:**

[1] O'Mahony D, O'Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age and Ageing 2015

## P-630

### Medication management and adherence – A diagnostic study of an elderly population in central Portugal

H. Neves¹, M. Almeida², S. Duarte², V. Parola¹, A. Coelho¹, I. Gil², 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:** With ageing a multitude of problems may arrive, either due to genetic predisposition, lifestyle habits or other problems, that lead to the need of medication, requiring the need to implement strategies by the elderly and their families, to improve medication management and adherence. As such, it is important to understand their knowledge, difficulties and strategies used, to develop nursing interventions targeting this phenomenon.

**Methods:** A descriptive study was developed in elders who use daycenters, in Coimbra-Portugal. Data collection was obtained through a questionnaire with 4 open-ended questions and 26 close-ended questions.

**Results:** From the questionnaire's application, 128 answers were obtained. Regarding risk factors, 24,4% failed at least one question regarding spatial and/or temporal orientation, 76,4% had visual deficits, 35,8% lived alone, and 21,8% did not know how to read or write. As for adherence, 88,6% considered important taking their medication daily, and 79,7% believe in its benefits in their life quality. Interestingly, 15,4% admitted taking non-prescribed medication, with 35,0% using natural products. Difficulties mentioned were "forgetfulness" or memory loss (37,4%). When asked to prepare a pill, 9,8% were incapable of preparing, and 7,3% showed difficulties. The most commonly mentioned strategies for adherence were pillboxes with separators (31,7%) and asking for another person's support/help.

**Conclusions:** This study shows memory loss, and sensorial or cognitive impairments are difficulties that need to be considered when addressing this phenomenon. Also, pillboxes' use and capacitation of the caregiver are strategies that need to be considered when developing interventions regarding medication management and adherence.

## P-631

### Medication reconciliation in elderly cancer patients treated with chemotherapy

A.-L. Couderc¹, F. Correard², C. Tabélé², S. Levillain¹, R. Brun³, A. Daumas⁴, P. Bertault-Peres³, P. Villani¹, S. Honoré². ¹Service de Médecine Interne, Gériatrie et Thérapeutique, Hôpital Sainte Marguerite, AP-HM, Marseille, France; ²Pharmacie, Hôpital Timone, AP-HM, Marseille, France; ³Pharmacie, Hôpital Sainte Marguerite, AP-HM, Marseille, France; ⁴Médecine Interne et Thérapeutique Post-Urgences, Hôpital Timone, AP-HM, Marseille, France

**Introduction:** Medication reconciliation (MedRec) is considered to be an important strategy for increasing the safety of medication use. However, few studies have been carried out showing the effect of a multidisciplinary approach and MedRec program in elderly cancer patients. The objective is to measure the effect of an oncogeriatric approach integrating MedRec program on elderly cancer patients treated with chemotherapy.

**Methods:** A monocentric prospective study was implemented to
evaluate the overall survival, rate of readmission hospital and admission emergency at 1st, 2nd, 3rd month, acceptance rate of dosage drug and inappropriate medication.

**Results:** From 01/01/2017 to 04/03/2017, 79 patients were received in oncogeriatrics day hospital; mean age was 81.9±4.7. However data could be analyzed only for the first 38 patients. Death rate was 5.3%. Among the other 36 patients, 23 received chemotherapy, 6 were under active surveillance, 3 received palliative care, radiotherapy was applied for 2 patients, 1 patient had surgery, and 1 had another treatment. Readmission hospital rate was 23.7% and admittance to emergency was 21% for the first 3 months. Acceptance rate of dosage drug modification was 10/26, since data are not available for 10 patients. Chemotherapy adaptation was carried out in 18.2% of cases. Out of 22 patients with chemotherapy, 63.7% are still performing their chemotherapy, 13.6% completed it and 22.7% prematurely stopped it. Data will be available only by 6 months.

**Conclusions:** Increasing number of older patients (frail population) with cancer it could be incorporate "pharmaco-geriatric-specific" evaluations to reduce inappropriate medications, use of health care resources and adverse events.

## P-632

### Optimization of drug treatment by using FORTA: Results from the FORTAMED study

F. Pazan<fnref n="1" />, H. Burkhardt<fnref n="2" />, H. Frohnhofen³, C. Weiss⁴, C. Throm⁵, A. Kuhn-Thiel⁶, M. Wehling<fnref n="1" />. ¹Clinical Pharmacology, Medical Faculty Mannheim, Heidelberg University; ²University Hospital Mannheim, Heidelberg University; ³University Witten-Herdecke, Faculty of Health, Department of Medicine; ⁴Medical Faculty Mannheim, Heidelberg University, Department of Medical Statistics, Biomathematics and Information Processing; ⁵Agaplesion Markus Krankenhaus, Department of Cardiology and Angiology, Frankfurt am Main; ⁶MEDIAN Klinik Sonnenwende, Bad Duerkheim

Clinical studies on the efficacy and safety of drugs often do not include older people. Thus, there is a lack of data as to the appropriateness of numerous drug treatments in this vulnerable group. Indeed, these facts often turn the drug therapy of older people into a "field experiment". To address this problem, the FORTA classification (A: Absolutely; B: Beneficial; C: Careful; D: Don't) was proposed as a clinical aid for physicians. The FORTA List was developed in a Delphi process. To evaluate the effectiveness of FORTA we conducted a prospective randomized controlled trial in hospitalized elderly patients. Nearly half of our patients received standard care and the other half received standard care plus the FORTA method. In this study, we separately assessed changes of drug prescriptions at the anatomical-therapeutic-chemical system (ATC) level for eleven important diagnoses and compared over- and undertreatment rates between the groups. At the individual drug/drug group level, eight items (e.g. loop diuretics to treat arterial hypertension) were significantly altered by FORTA when use changes between admission and discharge were compared between groups. Furthermore, FORTA also significantly improved undertreatment (e.g. ACE inhibitors or statins to treat coronary heart disease) or overtreatment (e.g. thiazides to treat heart failure) for seventeen drugs/drug groups. Based on this trial, FORTA is the first combined positive/negative labelling approach at the individual drug level which is effective in reducing inappropriate prescribing and certainly ameliorates the drug treatment of older people.

## P-633

### Phenobarbital related confusion, dysarthria and ataxia

C. Michael. Christie Hospital NHS Foundation Trust, Manchester, UK

An 83 years old male was admitted following a fall; he had tried

to stand up off a stool, turned, fell and was unable to weight bear. X-ray showed fracture left neck of femur. His wife said that he has been confused, walking with a sway "like a drunk" with numerous falls in the last six months and his speech was slurred. Past medical history included atrial fibrillation and myocardial infarction. He had epilepsy - the last seizure was several years ago. He was on Warfarin, Bisoprolol 2.5mg once daily, Phenobarbital 30mg in the morning, 30mg in the afternoon and 60 mg nocte and Primidone 250mg three times daily. On examination he was slow to respond. His pulse was 70 and blood pressure 95/50, He had tachypnea and fever. Both his CRP and WCC were high. Diagnosis: The admitting team attributed the falls and his slow response to phenobarbital and primidone side effects. He also had a chest infection. Treatment: Antibiotic was started for the chest infection. The team decided to gradually reduce phenobarbital and primidone and ultimately replace these with newer antiepileptics. Five days later the confusion improved and the patient was more alert and rapid to respond. His wife and family noticed the marked difference and the therapist said "he is a different man".

**Discussion:** Primidone is a structural analogue to phenobarbital and is metabolized to phenobarbital. The side effects of phenobarbital include hypotension, drowsiness, lethargy, ataxia and hallucination. Decades ago phenobarbital and primidone were sometimes co-prescribed. Currently it is rare to prescribe these two medications together. It could be a challenge to reduce or stop one of them, especially if the patient has been fit free. If indicated, reduction or discontinuation should be done cautiously and slowly and by a specialist.

**Conclusion:**

* Side effects of drugs need to be considered in the differential diagnosis of confusion and falls especially in the elderly.

* It is important to remember that primidone is metabolized to phenobarbital.

## P-634

### Polypharmacy among oldest-olds from the island of Sardinia: preliminary results

P. Mannoni<fnref n="1" />, G. Luciano<fnref n="1" />, M. Biggio<fnref n="1" />, A. Errigo<fnref n="2" />, G. Pes<fnref n="1" />.

**Introduction:** Populations characterized by exceptional longevity have become a useful model to understand the aging process and the occurrence of age-related diseases. In 2000, a hot-spot of population longevity was identified in 6 villages in the mountain area of the Sardinia island, Italy, where the highest life expectancy in the world has been recorded. In the present study, a cohort of 50 nonagenarians living in these villages was interviewed to investigate health status, physical performance, and the use of medicaments.

**Method:** The frequency of common chronic illnesses, in correlation with the main pharmacological treatments, has been evaluated.

**Results:** The frequency of chronic disorders were: arthrosis (19.8%), hypertension (19.2%), diabetes (11.2%), osteoporosis (5.2%), stroke (5.2%), cardiovascular disease (4.3%), cancer (2.6%). These subjects had been treated mostly with the following class of drugs: non-steroidal anti-inflammatory drugs (17.3%), ACE-inhibitors (17.3%), acetylsalicylic acid and other antiplatelet drugs (13.3%), metformin (12.0%), loop diuretics (8.0%), calcium and vitamin D (8.0%), calcium antagonists (5.3%), beta-blockers (4.0%), thiazides diuretics (4.0%), bisphosphonates (4.0%), proton-pump inhibitors (2.7%), insulin (2.7%), angiotensin-II receptor blockers (1.3%).

**Conclusions:** Although these are preliminary results from an ongoing survey, we have observed that 56% of study participants including oldest-old healthy people and oldest-olds with several diseases have never been treated with any medicament. The other

<footnote n="1">¹Department of Clinical and Experimental Medicine, Sassari, Italy;</footnote>

<footnote n="2">²Azienda Ospedaliero-Universitaria, Sassari, Italy</footnote>
44% of oldest-olds were treated with pharmacological therapy. Thus, we may conclude that even though these elderly subjects display age-related diseases, frequently untreated, they can attain advanced age, likely due to exposure to potential favorable factors shared by the population.

P-635

**Polypharmacy, drug-drug interactions and anticholinergic load in HIV-infected elderly patients compared to uninfected ones**

F. Spagnoli¹, P. Magro², E. Focà³, A. Marengoni⁴, N. Gabbiadini⁵,
G. Romanelli⁴, F. Castelli³. ¹Post-graduate school in Geriatrics,
University of Brescia, Brescia, Italy; ²Post-graduate school in Infectious
Diseases, University of Brescia, Brescia, Italy; ³University Department
of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy;
⁴Department of clinical and experimental sciences, University of
Brescia, Brescia, Italy; ⁵Medical School, University of Brescia, Italy

**Aim:** To evaluate polypharmacy, potentially serious drug-drug interactions (DDIs) and anticholinergic burden in older people with and without HIV infection.

**Methods:** Two samples of 65+ year-old Italian persons were investigated; 225 were HIV positive outpatients and 200 HIV negative community-living people. Number and type of drug prescriptions were collected. Polypharmacy was defined as the co-prescription of 5+ drugs; potentially serious DDIs were identified by a validated computerized prescription support system; the anticholinergic load was calculated according to the Anticolinergic Cognitive Burden Scale.

**Results:** The mean number of prescribed drugs was higher in HIV+ persons compared to the HIV- ones (6.1 vs 4.8; p<0.001), as well as the prevalence of polypharmacy (73.3% vs 48.5%, p<0.001). Despite the mean number of potentially serious DDIs did not significantly differ between the two samples, the percentage of persons with at least one potentially serious drug-drug interaction was higher in the HIV+ sample compared to the HIV- one (73.3% vs 48.5%, p<0.001). On the other hand, the mean anticholinergic load was lower in HIV+ persons (0.15 vs 0.59, p<0.001). In multivariate analysis, adjusted for age and gender, HIV infection was independently associated with polypharmacy (OR=4.0; 95% CI: 2.4–6.7), at least one potentially serious drug-drug interaction (OR=1.9; 95% CI: 1.1–3.2) and a lower anticholinergic load (OR=0.28; 95% CI: 0.17–0.46).

**Conclusions:** Despite anticholinergic load was lower among HIV-
patients, HIV infected patients had a higher burden of polyphar-
macy and a higher risk of potentially serious drug-drug interactions.

P-636

**Prevalence of potentially inappropriate medication (PIMs) according to STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail Adults with Limited Life Expectancy) in an older frailer cohort with a limited life expectancy**

A.H. Lavan, P. Gallagher, D. O'Mahony. Cork University Hospital and University College Cork

**Introduction:** STOPPFrail is an explicit tool, developed by Delphi technique, to assist physicians with deprescribing medications in older frailer patients with limited life expectancy. The objective of this research was to identify potentially inappropriate medications (PIMs) according to STOPPFrail in a representative population.

**Methods:** Comprehensive multi-disciplinary applications for nursing home placement, between January and June 2016, were retrospectively reviewed. Each application comprised detailed data regarding diagnosis, medications, function and cognition. STOPPFrail criteria were applied where appropriate.

**Results:** 464 assessments were analysed. 38 were excluded because of incomplete information. STOPPFrail was applied to 274 (64.3%) patients; 152 patients did not meet STOPPFrail inclusion

criteria. The STOPPFrail group were older (84 (SD 7) vs 77 (SD 13) years, p<0.001), had 1 more medical condition (7 (SD 2) vs 6 (SD 2), p<0.001), were more dependent (Barthel 8 (SD 4.29) vs 12 (SD 4), p<0.001) and more likely to have dementia (73.4% vs 42.8%, p<0.001). There was no difference in the median number of medications between the groups; 8 (IQR 5–10.5) vs 7 (IQR 5–10), p=0.490. STOPPFrail identified 894 PIMs in 247 patients (90%); a median of 3 per patient. The most common PIMs were medications without indication (66%), nutritional supplements (40%), high dose proton pump inhibitors (32%), lipid-lowering therapies (29%) and neuroleptics (25%).

**Conclusions:** PIMs are commonly prescribed for frailer older patients with limited life expectancy in whom nursing home admission is deemed appropriate. 90% of such patients were prescribed at least one PIM. Application of STOPPFrail criteria to this cohort has the potential to optimise medication use.

P-637

**Proton pump inhibitor use and risk of hip fractures among community-dwelling persons with Alzheimer's disease – A nested case-control study**

S. Torvinen-Kiiskinen¹, A.-M. Tolppanen², M. Koponen¹,
A. Tanskanen³, J. Tiihonen⁴, S. Hartikainen⁵, H. Taipale⁶. ¹Kuopio
Research Centre of Geriatric Care, University of Eastern Finland,
Kuopio, Finland; School of Pharmacy, University of Eastern Finland,
Kuopio, Finland; ²School of Pharmacy, University of Eastern Finland,
Kuopio, Finland; Research Centre for Comparative Effectiveness and
Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland;
³Department of Clinical Neuroscience, Karolinska Institutet, Stockholm,
Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital,
University of Eastern Finland, Kuopio, Finland; National Institute for
Health and Welfare, Helsinki; ⁴Department of Clinical Neuroscience,
Karolinska Institutet, Stockholm, Sweden; Department of Forensic
Psychiatry, Niuvanniemi Hospital, University of Eastern Finland,
Kuopio, Finland; ⁵Kuopio Research Centre of Geriatric Care, University
of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of
Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio
University Hospital, Kuopio, Finland; ⁶Kuopio Research Centre of
Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of
Pharmacy, University of Eastern Finland, Kuopio, Finland; Department
of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

**Introduction:** Hip fractures are major health concern among older persons with Alzheimer's disease (AD), who usually use many concomitant drugs for several diseases. Objective of this study was to investigate whether the use of proton pump inhibitor (PPI) is associated with risk of hip fractures among community-dwelling persons with AD.

**Methods:** In this nested case-control study, we included 4,224 (mean age 84.1) community-dwelling persons with AD, who encountered hip fracture, from nationwide MEDALZ cohort. For each hip fracture-case at the date of hip fracture, 16,852 controls (mean age 84.0) without hip fracture were matched. We investigated PPI use at the index date and during 10 years before. Conditional logistic regression was used to investigate the association between PPI use and hip fracture.

**Results:** PPI use at the index date was associated with an increased risk of hip fracture (adjusted OR 1.12, 95% CI: 1.02–1.23). The risk was increased in short-term use (<1 year) from the index date (adjusted OR 1.29, 95% CI: 1.14–1.45). No association was found between longer duration of use (>1 year), or cumulative use and risk of hip fractures.

**Conclusions:** PPI use was modestly associated with an increased risk of hip fracture among persons with AD. The risk was evident in short-term use but no association was found for long-term use. Thus, our findings do not support previous assumptions that
long-term PPI use would be associated with an increased risk of hip fractures.

## P-638
### Significant reduction in anticholinergic burden on an acute frailty unit

B.A.S. Wildblood¹, L. Clow¹, A.M. Mohan¹, C.A. Adams¹, T.J. Welsh¹,²,³. ¹Royal United Hospital Bath NHS Foundation Trust, Bath, UK; ²University of Bristol, Bristol, UK; ³Research Institute for the Care of Older People, Bath, UK

**Introduction:** A number of commonly used medications have mild anticholinergic activity of which practising clinicians may not be routinely aware. The cumulative effect of multiple such medications, known as anticholinergic burden, has been associated with adverse events such as falls, hospitalisation and increased mortality. Interventions that reduce anticholinergic burden may therefore be beneficial. This project formed part of a quality improvement cycle aiming to reduce anticholinergic burden on an acute frailty unit. The first stage in this process was to quantify the impact of current practice on anticholinergic burden and this is reported here.

**Methods:** A retrospective review was completed of the first 100 admissions to the acute frailty unit in February 2017. Medication on admission and discharge was recorded. The Anticholinergic Cognitive Burden Scale was used to quantify and compare anticholinergic burden on admission and discharge.

**Results:** Data was available from 86 admissions. Mean age 83 (SD 7.5), 63% female. 57 (66%) were taking at least one anticholinergic medication. At discharge the total number of medications prescribed remained unchanged while the total number of medications with anticholinergic properties was reduced from 101 to 79. The anticholinergic cognitive burden score was significantly reduced from median 1 (0–3) to 1 (0–2) P=0.04.

**Conclusions:** Medication review within the acute frailty unit significantly reduced median anticholinergic burden but left a proportion of people still on medications with anticholinergic properties. A more targeted approach to reducing anticholinergic burden may be more effective and these data will aid the development of suitable interventions.

## P-639
### The effect of drug adjustment on hospitalized patients and its examination

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

**Introduction:** Polypharmacy is known to cause various disadvantages in hospitalized patients. Therefore, we have tried to reduce the number of medications during hospitalization while careful monitoring.

**Methods:** We analyzed 253 patients, discharged from the geriatric ward in the University of Tokyo Hospital, from April 2016 to March 2017. We counted the number of medications on admission and at discharge. We divided the patients into three groups; patients with increased, the same and decreased number of oral medications at discharge. In those groups, we assessed the basic characteristics, comorbidities, and the number and types of medications.

**Results:** We collected 253 patients (111 men and 142 women), aged from 52 to 97 (82 on average). They were taking 7 medications on admission and it was significantly decreased to 6 at discharge on average. Out of them, the number of oral medications was increased in 21% (53/253), the same in 33% (83/253) and decreased in 46% (117/253). 23 patients were able to reduce 5 or more drugs, up to

15 drugs. Among patients with reduced number of medications at discharge, the mean number of discontinued drugs was 3.

**Conclusions:** In our inpatient services, we succeeded in reducing the average number of one medicine during hospitalization. Patients who were hospitalized for emergency could be reduced more medicine than expected patients. In addition, the decrease in cardiovascular drugs and peptic ulcer therapeutic drugs was conspicuous. We assume that the review after hospitalization of hypertension and gastrointestinal diseases and so on result in drug reduction.

## P-640
### The impact of age on the incidence of adverse drug events (ADEs) causing hospitalisation in cancer patients

A.H. Lavan¹, D. O'Mahony¹, D. O'Mahony², P. Gallagher¹. ¹Cork University Hospital and University College Cork; ²Cork University Hospital

**Introduction:** Over 60% of all cancers are diagnosed in patients' ≥65 years, many of whom have other co-morbidities. Multi-morbid people with polypharmacy have a high risk of adverse drug events (ADEs). The aim of this study was to ascertain the incidence of ADEs causing hospitalisation in older cancer patients and compare them to the non-cancer older population [1–3].

**Methods:** This prospective observational study included adults (≥16 years) admitted under a specialist tertiary oncology service. The proportion of patients experiencing a probable/certain non-trivial ADE, according to WHO-UMC causality assessment [4], causing/contributing significantly to acute admission was recorded.

**Results:** 265 participants participated; 54% female. 52.5% ≥65 years, 35.5% ≥70 years and 7.5% ≥80 years. The median age was 66 (IQR5–72). Older adults, compared to younger adults, had significantly more comorbidities, median 8 (IQR5–10) vs 5 (IR 3–6), p<0.001, and took more medications, 7 (IQR4–10) vs 4 (IQR2–7), p=0.026. The most common cancers were breast (18.5%), lung (18.5%) and colorectal (9.1%). 82 patients (30.9%) were affected by ADEs, in whom 74 caused/or contributed significantly to admission. ADE occurrence had no significant relationship to age (p=0.960), gender (p=0.399), length of stay (p=0.537) or number of daily drugs (p=0.533). ADE incidence was similar in older and younger adults for both non-cancer drugs (14.4% vs 9.5%, p=0.141) and cancer-specific drugs (13.7% vs 15.9%, p=0.469). The most commonly reported ADEs were neutropenia with associated infection in 23%, nausea/vomiting in 18.9% and major constipation in 17.6%.

**Conclusions:** Approximately 1 in 4 acute admissions in adult cancer patients are ADE-related. ADEs are caused by non-cancer drugs as frequently as cancer specific treatments in both older and younger adults. Older cancer patients experience ADEs at similar frequency to their younger counterparts. The ADE rates reported here for older cancer patients are higher than those previously reported in the general acute population.

**References:**

[1] Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. Jama. 1998; 279(15): 1200–5.

[2] Pirmohamed M, James S, Meakin S, Green C, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. Bmj. 2004; 329(7456): 15–9.

[3] Wiffen P, Gill M, Edwards J, Moore A. Adverse drug reactions in hospital patients. A systematic review of the prospective and retrospective studies. Bandolier Extra Evidence Based Healthcare. 2002.

[4] WHO. World Health Organization (WHO), Uppsala Monitoring Centre. The use of the WHO-UMC system for standardized case causality assessment. Available at: http://www.who-umc.org/graphics/4409.pdf.
# Area: Pre and post operative care

## P-641

### A change for a restrictive transfusion regimen in a hip fracture care pathway is associated with a shift of transfusion to rehab units. The UPOG-TRF2 study

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

**Introduction:** A restrictive transfusion strategy for elderly patients with hip fracture (HF) is safe and reduces cardiovascular outcomes, but it may postpone transfusion to rehabilitation units. We hypothesized that a change of transfusion regimen from a liberal to a restrictive regimen may cause a shift of transfusion to rehab units.

**Material and methods:** A retrospective analysis of a time series analysis of consecutive patients >70 years admitted for a HF to our UPOG, comparing a liberal transfusion regimen (LR) (Goal: hb level ≥10 g.dL-1, 1st period) to a restrictive regimen (RR) (Goal: hb level ≥8 g.dL-1 or transfusions according to symptoms, 2nd period). All transfusions from ED/OR to UPOG and rehab units were reported and compared according to transfusion regimen.

**Results:** 667 patients were included (86 y/o, CIRS 52 9 [6–12]), 193 in the LR group, 474 in the RR group. 396 patients (59%) were transfused for a total of 1003 red pack cells (RPC). In liberal regimen, 133 patients (69%) were transfused with 386 RPC (mean 2 per patients and 2.9 per transfused patient), 64 (33%) in ED/OR, 96 (50%) in UPOG, and 18 (9%) in rehab. In restrictive regimen, 263 (55%) with 617 RPC (mean 1.3 per patients and 2.3 per transfused patient), 105 (22%) in ED/OR, 222 (47%) in UPOG, and 87 (18%) in rehab.

**Conclusion:** Despite a transfusion shift to rehab units, a change for a RR is associated with a reduction of total transfusion during management of HF.

## P-642

### A post-surgical review of operative debridement of sacral pressure ulcers

S. Wozniak, K. Khan, K. Haag, J. Coleman. *Sinai Hospital of Baltimore, Geriatric Surgery*

**Background:** Pressure ulcers frequently found in the older population are associated with significant morbidity and mortality. Reviewing the literature, a limited number of studies exist reviewing 30 day post-operative occurrences in patients undergoing surgical debridement of decubitus ulcers.

**Aim:** The aim of this review is to better understand post surgical complications in older patients undergoing surgical debridement of decubitus ulcers.

**Methods:** Operative records were reviewed from 2012 to 2016 at a community based hospital. Records were reviewed for quantity and type of post-operative occurrences. Individual post-operative occurrences were reviewed with regard to patient age, gender, degree of sacral ulcer, and pre-existing co-morbidities. Further records were reviewed to ensure comparability in terms of debridement technique.

**Results:** The mean age of the patients was 64.1 years of age. Intra-operative anesthesia used: general 86.1%, monitored anesthesia care/IV sedation 12.7%, and local 1.3%, with an average surgical duration totaling 28 minutes. Mean hospital length of stay was 8 days with 80% of patients alive at 30 days. Upon quantifying post-operative occurrences it was found 61% (43/70) patients had no post operative occurrences, 20% (14/70) had 1 post-operative occurrence, 10% (7/70) had 2 post-operative occurrences, 5.7% (4/70)

had 3 post-operative occurrences and 2% (2/70) had 4 or more post-operative occurrences.

**Conclusions:** Higher post-operative occurrences were found with patients who had larger wounds or wounds with an active infection and a greater number of pre-surgical co-morbidities.

## P-643

### Association between anesthetic drugs and postoperative delirium in elderly patients with hip fracture in a dedicated orthogeriatric care pathway

L. Zerah¹, T. Lamy², J. Cohen-Bittan², A. Gioanni², M. Raux³, A. Mézière⁴, B. Riou⁵, H. Vallet¹, J. Boddaert⁶. ¹Unit of Peri-Operative Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris; Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France; ²Unit of Peri-Operative Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; ³Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris; Departments of Anesthesiology and Critical Care, GH Pitié-Salpêtrière, APHP, Paris, France; ⁴Department of Rehabilitation, GH Charles Foix, APHP, Ivry sur Seine, France; ⁵Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris; Departments of Emergency Medicine and Surgery, GH Pitié-Salpêtrière, APHP, Paris, France; ⁶Unit of Peri-Operative Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France 6. Centre National de la Recherche Scientifique (CNRS), UMR 8256

**Introduction:** Postoperative delirium (POD) is one of the most common complications after hip fracture surgery and is associated with a worse prognosis. The impact of anesthetic drugs on the incidence of POD has not yet been evaluated. Our main objective was to compare patients with or without POD with regard to drugs they received during anesthesia.

**Methods:** Between 2009 and 2016, all patients (>70 years) admitted after hip fracture surgery into a dedicated unit of peri-operative geriatric care were included.

**Results:** We included 559 patients: mean age: 86±6 years, 429 (77%) females, CIRS 52: 9 [6–12], ADL: 5 [3–6], number of drugs per day: 5 [3–8], length of stay: 11 [9–15] days. 220 patients (39%) suffered from POD after the surgery. We found no difference between the 2 groups with regard to drugs they received during anesthesia: cardiovascular drugs (atropine, prostigmine, ephedrine, neosynephrine, noradrenalin), induction and maintenance drugs (curare, sufentanyl, remifentanyl, propofol, etomidate, midazolam), anti-nausea drugs (corticoids, droleptan, ondansetron), antalgic drugs (paracetamol, tramadol, nefopam, nonsteroidal anti-inflammatory drugs, ketamine, morphine) or blood transfusion. Patients with POD were more likely to have dementia (59% vs 26%, p<0.001), anemia (98% vs 95%, p=0.05), swallowing disorders (56% vs 26%, p<0.001), bladder retention (30% vs 22%, p=0.04) and stool impaction (50 vs 37%, p=0.004) than others.

**Conclusion:** In comparison with comorbidities and acute complications, anesthetic drugs regimen may not influence occurrence of POD in a dedicated geriatric care pathway.
P-644

Association between cognitive status and outcomes in elderly patients with hip fracture in a dedicated orthogeriatric care pathway

L. Zerah¹, J. Cohen-Bittan², M. Raux³, A. Mézière⁴, C. Tourette⁵, C. Neri⁵, M. Verny⁶, B. Riou⁷, F. Khiami⁸, J. Boddaert⁶. ¹Unit of Peri-Operative Geriatric care, Groupe Hospitalier (GH)
Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France; ²Unit of Peri-Operative Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance
Publique-Hôpitaux de Paris (APHP), Paris, France; ³Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France; Departments of Anesthesiology and Critical Care, GH
Pitié-Salpêtrière, APHP, Paris, France; ⁴Department of Rehabilitation, GH Charles Foix, APHP, Ivry sur Seine, France; ⁵Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France; Centre
National de la Recherche Scientifique (CNRS), UMR 8256; ⁶Unit of Peri-Operative Geriatric care, Groupe Hospitalier (GH)
Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France; Centre National de la Recherche
Scientifique (CNRS), UMR 8256; ⁷Sorbonne University, University
Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France;
Departments of Emergency Medicine and Surgery, GH Pitié-Salpêtrière, APHP, Paris, France; ⁸Sorbonne University, University Pierre and Marie
Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France; Departments of Orthopedic
Surgery and Trauma, GH Pitié-Salpêtrière, APHP, Paris, France

**Introduction:** Dementia is associated with a worse prognosis of hip fracture, but the impact of a dedicated geriatric care pathway on the prognosis of these patients has not been evaluated. According to the cognitive status before surgery, our main objective was to compare mortality rate at 6 months; secondary outcomes were to compare in-hospital complications, the risk of new institutionalization and the ability to walk at 6 months.

**Methods:** Between 2009 and 2015, all patients (>70 years) admitted after hip fracture surgery into a dedicated unit of peri-operative geriatric care were included: patients with dementia (DP), without dementia (NDP) and with cognitive status not determined (CSND). Data are expressed as Hazard Ratio (HR) for multivariate cox analysis or Odds Ratio (OR) for multivariate logistic regression analysis and their 95% confidence interval (CI).

**Results:** We included 650 patients (86±6 years): 168 DP, 400 NDP and 82 CSND. After adjustment for age, sex, comorbidities, polypharmacy, pre-fracture autonomy, time-to-surgery and delirium, there were no significant differences for 6-month mortality (DP vs NDP: HR=0.7 [0.4–1.2], DP vs CSND: HR=0.6 [0.3–1.4], CSND vs NDP: HR=0.8 [0.4–1.7]); but DP and CSND were more likely to be newly institutionalized after 6 months compared to NDP (OR DP=2.6 [1.4–4.9], p=0.003, OR CSND=2.9 [1.4–6.1], p=0.004). 92% of population was walking after 6 months (63% with assistance): no difference was found between the 3 groups.

**Conclusion:** In a dedicated geriatric care pathway, DP and CSND undergoing hip surgery have the same 6-month mortality and walking ability as NDP.

P-645

Causes and consequences of surgical delay in older patients with hip fracture

S. Fernández-Villaseca¹, L. García-Cabrera², B. Montero-Errasquín¹, M.N. Vaquero Pinto¹, C. Miret Corchado³, M.L. Álvarez Nebreda¹, A.J. Cruz-Jentoft¹. ¹Hospital Ramón y Cajal, Madrid, Spain; ²Hospital Hestia Madrid, Madrid, Spain; ³Fundación Jiménez Díaz, Madrid, Spain

**Introduction:** The clinical consequences of surgical delay in older patients with hip fracture are controversial. We studied the clinical and survival differences in older patients admitted with a hip fracture according to the surgical delay and the reason of such delay.

**Methods:** Prospective observational study of all. All patients >79 years admitted with a hip fracture in an Orthogeriatrics Unit in 14 months, followed for 18 months. Subjects were classified in two groups: early surgery (≤48 hours from admission) and surgical delay (>48 hours).

**Results:** 468 surgeries, 33.1% with surgical delay (preoperative length of stay 5.3±2.1days vs 1.0±0.9 in early surgery). No differences in age, gender, functional and cognitive status or type of fracture between groups were found. The early surgery group had better nutritional status (MNA-SF: 10.8±2.8 vs 10.1±2.7, p=0.015), used fewer drugs (5.9±3.4 vs 7.2±3.6, p<0.001), polypharmacy (52.9% vs 68.2%, p=0.001), less clopidogrel (1.3% vs 12.8%, p<0.001) and coumadin (7.1% vs 20.4%, p<0.001), had a shorter length of stay (11.5±6.1 vs 15.6±6.7 days, p<0.001) and lower surgical risk (ASA score 2.5±0.6 vs 2.8±0.6, p<0.001). The surgical delay group had more medical complications [(81.2% vs 69.7%, p=0.005; the most frequent urinary infection (30.4% vs 20.6%, p=0.026)] without differences in surgical complications or in-hospital mortality. No differences in mortality at 1, 3, 6 and 12 months after surgery were found. Main reasons of surgical delay were: high INR 25.6%, clopidogrel 13.1%, operating room not available 36.7%, the latest was associated with higher mortality at 1 (6.7% vs 1.8%, p=0.05), 3 (13.5% vs 4.5%, p=0.012), 6 (21.8% vs 8.9%, p=0.004) and 12 months (33.2% vs 16.1%, p=0.001) and higher perioperative heart failure (15.0% vs 7.1%, p=0.042).

**Conclusions:** One third of our patients with hip fracture had a surgical delay, mainly due to coagulation disorders and unavailability of an operating room. Surgical risk, medical complications and length of stay were lower in those with early surgery.

P-646

Characteristics of elderly orthopedic patients' care

Ü.D. Yılmaz, N. Bayraktar. Near East University Faculty of Health Sciences, Nursing Department, Nicosia, Turkish Republic of Northern Cyprus

**Introduction:** As a result of increases in life expectancy, the world population is getting older and the proportion of the elderly in the total population has been increasing rapidly. During the twentieth century, life expectancy at birth increased from 48 to 74 years for males and from 51 to 79 years for females. The aging of the population brings significant health problems. The number of elderly patients undergoing orthopedic surgery has been also increasing due to changes in muscle and skeletal system with aging. This review provides an overview to relevant literature on characteristics of elderly orthopedic patients' care.

**Methods:** A literature search (2000–2017) was carried out, using MEDLINE, Pub Med, Science direct, Scopus, Cochrane library, Turkish Medical Index and related institutional websites. Key words included “Older adults”, “Elderly”, “Orthopedic patient”, “Nursing care”.

**Results:** Elderly orthopedic patients have many insufficiency and changes in the system and diseases. Development of anesthesia,
surgical techniques and perioperative care decreased perioperative mortality in the elderly group, mortality rate; 2.2% in the 60–69 age group, 2.9% in the 70–79 age group and 5.8–6.2% in the 80 and over age group. The main purpose in the care of the orthopedic elder is; preventing or minimizing complications, and maintaining the health of the patient at the highest level.

**Conclusions:** For effective treatment and care for the elderly, comprehensive evaluation of age-related changes, existing chronic diseases and the risks of orthopedic surgery should be performed and care should be planned.

P-647

**Characteristics of the patients with hip fracture admitted to the Public Hospitals of Castilla y León, Spain**

S. Jiménez Mola¹, P. Sáez López², A. Muñoz Pascual³, J. Idoate Gil⁴, E. Martín Pérez⁵, A. González Ramírez⁶, N. Pereira de Castro⁷.

¹Complejo Asistencial Universitario de León, León. Spain; ²Complejo Asistencial de Ávila, Ávila. Spain; ³Complejo Asistencial de Segovia. segovia. Spain; ⁴Complejo Asistencial Universitario de León, León.

Spain; ⁵Hospital San Juan de Dios, León. Spain; ⁶Complejo Asistencial Universitario de Salamanca. Spain; ⁷Complejo Asistencial de Burgos. Spain

**Introduction:** Hip fractures are a prevalent fragility fracture secondary to osteoporosis that involves high morbidity and mortality. Hip fracture registries are a good way to improve knowledge about this condition and its quality of care. The aim of this study is to describe the characteristics of the patients with hip fracture admitted to the Public Hospitals of Castilla y León during a period of time, and to analyze the variables that influence their hospital stay.

**Method:** The Castilla y León orthogeriatric work group elaborated a common register to collect data of hip fractures. Patients 75 and older hospitalized with hip fractures in the 13 public hospitals in the Community during November 2014 and October and November 2015 were included in the study. It is a multicentric, prospective and observational study in which clinical, functional, social variables, and in-hospital mortality, were collected.

**Results:** A total of 776 patients with a mean age of 86±6 were analyzed, 79% women. 33.4% were living in a nursing home prior to fracture. 93% underwent surgery. The surgical delay was 4±2.8 days, and the average hospital stay was 10±4.7 days. Only 9.5% received general anesthesia. The 66.5% of the patients had medical complications: 35.5% developed delirium, and 55.5% required a transfusion. 4.6% died during hospitalization. The average pre-surgical stay was related to the overall stay (p<0.001).

**Conclusions:** Hip fracture registers constitute an essential tool for evaluating the process and for improving the treatment quality of these patients.

P-648

**Comparison of cemented augmented PFNA and Gamma nail III in hip fracture surgery in elderly patients**

L. Zerah¹, R. Dayan², A. Morvan², J. Cohen-Bittan³, H. Vallet³, M. Raux⁴, B. Riou⁵, A. Mézière⁶, J. Boddaert¹, F. Khiami⁷. ¹Unit of Peri-Operative Geriatric care, Hôpitaux universitaires

Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France; Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France;

²Department of Orthopedic Surgery and Trauma, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France;

³Unit of Peri-Operative Geriatric care, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France; ⁴Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France;

Department of Anesthesiology and Critical Care. Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Paris, France;

⁵Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France; Department of Emergency Medicine and Surgery, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, APHP, Paris, France; ⁶Rehabilitation Geriatric Department.

Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Paris, France; ⁷Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France; Department of Orthopedic Surgery and Trauma, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France

**Introduction:** A stable fixation to allow immediate mobilization of elderly patients with full weight-bearing after hip fracture (HF) surgery is a challenge. The cement augmentation of the Proximal Femoral Nail Antirotation (PFNA) is a new internal fixation technique that causes minimum bone loss in femoral head and neck. We aim to demonstrate that cement augmentation of the PFNA was associated with a reduction of lateral blade migration.

**Material and methods:** All patients >70 y/o admitted for intertrochanteric HF to our emergency department were included from 2009 to 2016. Clinical and biological data were prospectively collected, including a 6-month follow-up. Comparison of patients treated with cement augmentation of the PFNA (PFNA group) and Gamma Nail III (GN group). Medical charts, with X-ray radiography ± CTscan were reviewed by 3 orthopedic surgeons to assess diagnosis of orthopedic complication. The primary endpoint was lateral blade migration. Secondary endpoint was in-hospital 6-month mortality.

**Results:** Monocentric retrospective study, 271 elderly were included: 57 (PFNA) and 214 (GN) patients. The two groups were comparable for age, sex and comorbidities. A lateral blade migration was reported in 12 patients (GN group) and 1 patient (PFNA group)(5.6 vs 1.7%, p=0.389 respectively). No complications related with cement augmentation were observed.

**Conclusion:** We observed no difference of lateral blade migration outcome in elderly patients admitted with an intertrochanteric fracture during a 6 month post-operative follow-up. Further studies are needed to determine the interest of cement augmentation of the PFNA.

P-649

**Effect of heterogeneity of weight status on all-cause mortality in older adults: a study on type 2 diabetes patients undergoing subtotal gastrectomy for cancer**

Y. Kwon¹, K.J. Kim¹, Y.-G. Park², S. Park¹, K.-H. Cho¹. ¹Korea University College of Medicine, Seoul, Republic of Korea; ²The Catholic University of Korea, Seoul, Republic of Korea

**Introduction:** The survival benefit of excess body weight across various subpopulation groups remains controversial. We assessed the effect of weight status on all-cause mortality among type 2 diabetes patients undergoing subtotal gastrectomy for cancer.

**Methods:** This was a retrospective study conducted to examine the medical charts of 210 patients with type 2 diabetes treated at two university hospitals. All patients had undergone subtotal gastrectomy for cancer between January 1993 and December 2012. Participants were classified as either normal weight (BMI: 18.5–24.99 kg/m²) or overweight/obese (BMI: ≥25 kg/m²). Weighted Cox proportional hazard regression models using inverse probability weighting were constructed to adjust the differences between groups.

**Results:** The mortality rate for the entire study population was 27.3% after a median follow-up duration of 7.5 years (interquartile range, 4.5–9.3 years; maximum, 15.3 years). The overweight/obese group had a significantly lower risk of all-cause mortality (hazard ratio, 0.46; 95% confidence interval, 0.38–0.62; p0=0.001) compared
to the normal weight group. The overweight/obese group was associated with lower all-cause mortality in patients <65 years of age (p=0.01 for interaction) with a possible association in patients with a diabetes duration <5 years (p=0.07 for interaction).

**Conclusions:** A significantly lower all-cause mortality was observed in the overweight/obese group of patients with type 2 diabetes compared to the normal weight group after undergoing subtotal gastrectomy for cancer, although the significance was not maintained in the subgroup of patients ≥65 years of age.

## P-650

**Emergency laparotomy in the older patient. Perioperative care of older people admitted to general surgery – Salford General Surgery (POPS-SG)**

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

**Objectives:** The purpose of our study was to describe the characteristics and clinical outcomes of a cohort of elderly patients undergoing emergency laparotomy and elderly care in reach input

**Methods:** We carried out a prospective non-randomised study of patients 75 or older admitted to general surgical wards following an emergency laparotomy. All individuals underwent comprehensive geriatric assessment, targeted multidisciplinary interventions and timely discharge planning.

**Results:** Between 08/09/2014 and 28/02/2017 we reviewed 81 emergency laparotomy patients. Average age of 82.5±5.0, 5, 53.1% females, 45.7% ASA class I-II, 3.7% lived in residential home, 85.2% and 54.3% were independent for basic and instrumental ADLs respectively, 70.4% mobilised with no aids or a cane, 11.1% cognitively intact and 89.7% continent. On discharge fewer patients were independent in basic ADLs (p 0.004) but there were no other significant differences in functional status. Patients presented 5.2±3.0 comorbidities. Hypertension (65.4%), ischemic heart disease (27.2%) and atrial fibrillation (24.7%) were the most frequent. Average medications on admission were 7.7±4.2. Anaemia (44.4%), delirium (32.1%), acute renal injury (29.6%) and constipation (24.7%) were the most common complications and only 6 patients (7.4%) were complication-free. Mean length of stay was 21.8±19.6, 4.9% were in hospital at 60 days, in-hospital mortality was 8.6%, observed 30 and 90 day mortality (after surgery) were 6.2% and 13.6% respectively and 30-day readmission 9.5%.

**Conclusions:** Older persons undergoing emergency laparotomy present significant comorbidity, polypharmacy, and high morbidity. We advocate global assessment and management by multiprofessional teams experienced in care of the older patient.

## P-651

**Geriatric depression in pre-operative older patients with meningiomas**

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

**Introduction:** The aim of this study is to examine if pre-operative older patients with meningiomas show differences in their depression levels when compared with healthy controls and patients with other types of chronic diseases.

**Methods:** Twenty-three pre-operative patients (11 females, 12 males) with meningiomas in various brain regions (8 right, 7 left and 8 bilateral,) and of various sizes participated in the study. Their mean age was 68.60 years (SD = 12.26, range 31–77), level of education 9.47 years (SD = 3.82) and time since the first signs of possible brain disease (headaches, fatigue, fainting) were 4.21 years (SD = 2.19). A control group of 20 healthy participants with similar demographics was examined (mean age = 69.25, mean education =

11 years) and a group of 19 patients with different types of chronic diseases were also examined (mean age = 69.10, mean education = 12 years). All three groups of participants completed the Geriatric Depression Scale (GDS).

**Results:** Results revealed that pre-operative older patients suffering from meningiomas report a higher total score in GDS with more symptoms of depression when compared with older patients who suffer from other types of chronic diseases and healthy older controls.

**Conclusions:** Future studies should clarify the possible factors that affect and differentiate the depressive symptomatology in patients with meningiomas.

## P-652

**Hip fracture outcomes in patients with Parkinson's disease**

R. Lisk, H. Watters, K. Yeong. Orthogeriatrics Department, Ashford & St. Peter's NHS Foundation Trust, Chertsey, UK

**Objectives:** Patients with idiopathic Parkinson's disease (PD) are at a high risk for fracture, tend to have a longer hospital stay and unlikely to return home within 30 days [1]. The aim of this audit was to establish if outcomes from hip fracture in people with PD can be improved with targeted interventions.

**Methods:** A PD sticker was created to highlight PD patients on the board round. We devised a PD Hip Fracture checklist which ensured: 1) Clinic letter printed on arrival2) PD medications prescribed and given on time3) Lying and standing blood pressure measurement4) Bowel care with regular laxatives and suppositories.PD medications were made available on the ward, with a poster reminder on the drug trolley & drug cupboard where the PD meds are kept. PD patients were prioritised by the therapists and regular educational sessions for staff.

**Results:** 28 PD patients pre-intervention (Dec 2012–14) were less independently mobile pre-operation (21.4%) compared to 808 non-PD (48.3%). Hence home to home after operation was only 28.5% with higher length of stay (LOS) of 26.1 days compared to non-PD patients which was 58.1% and 21 days respectively.Following the intervention (May 2015–16), home to home after operation improved to 40.9% with lower LOS of 15 days compared to non-PD patients which was 59.6% and 15.2 days respectively.

**Conclusions:** Targeted interventions improved outcomes for PD patients with hip fracture. Cost-effective interventions such as there are essential to reduce the burden of hospitalisation for patients, carers and healthcare systems.

**References:**

[1] Measuring the burden and mortality of hospitalisation in Parkinson's disease: A cross-sectional analysis of the English Hospital Episodes Statistics database 2009–2013 Vincent Low, Yoav Ben-Shlomo, Elena Coward, Suzanne Fletcher, Richard Walker, Carl E. Clarke

## P-653

**Hip fracture patients: survival versus mortality**

A. Michael¹, N. Obiechina², Z. Hussain¹, R. Bansal¹. ¹Russells Hall Hospital, Dudley, UK; ²Queen's Hospital, Burton on Trent, UK

**Introduction:** The in hospital mortality rate of hip fracture ranges between 2.7% to 15% in different studies.

**Aim:** To study the differences between hip fracture patients who survived and those who died during hospitalisation.

**Methods:** Retrospective analysis of the medical records of all hip fracture patients admitted in one-year period in a UK teaching hospital. Demographics, residence, ASA score, mobility and time to surgery data were collected, downloaded on excel and analysed.

**Results:** 527 patients were admitted in the study period and 59 died as inpatients (11.2%). 6 patient notes were not available. 48 had an
operation and 5 were treated conservatively.33/370 (9%) of women and 26/157 (17%) of men died. 44/417 (11%) of patients admitted from their own home died compared to 10/63 (16%) of those from residential care and 5/21 (24%) of those who had the fracture in hospital. None of the 4 patients with ASA 1 died, 5/118 (4%) of ASA 2 patients died, compared to 35/333 (11%) of ASA 3 patients and 13/51 (26%) of ASA 4 patients. 15/197 (8%) who were mobile without aids died, compared to 16/150 (11%) who were mobile with one aid and 15/86 (17%) who were mobile with two aids. However just 1/10 (10%) of those with no functional mobility died.37/407 (9%) of patients operated upon within 36 hours died, compared to 16/97 (16%) of those who had the operation after 36 hours. 6/23 (26%) of those who had no operation died. The documented cause of death in 2/3 of the patients was chest infection.

**Conclusion:**

* Men have higher inpatient mortality than women.

* Patients from nursing homes had a higher in hospital mortality than those living in their own homes.

* The higher the ASA score the higher the inpatient mortality.

* The poorer the mobility the higher the inpatient mortality.

* The more delayed the surgery after 36 hours the higher the mortality

## P-654

### Hip fractures: What I wish you had told me

L. McCluskey¹, V. Patel¹, J. Yeung¹, A. Simons². ¹University of Birmingham, Birmingham, United Kingdom; ²Heartlands Hospital, Birmingham, United Kingdom

**Introduction:** Hip fractures are associated with significant cost, distress, morbidity and mortality, with 10% of patients dying within 30 days (1). Patients approach hip fracture repair with expectations about their outcomes. Evidence shows that pre-operative expectations predict important post-operative outcomes; including healing time, quality of life and functional improvement (2). A key to addressing these surgical expectations is physician–patient communication. This project was a service evaluation of our service and the need for a hip fracture booklet to improve communication.

**Methods:** A service evaluation was carried on post-operative hip fracture patients at a large teaching hospital. Surveys were distributed and collected over a 1-month period. The aim was to determine: i) if patients wanted more information about their care; ii) common themes patients would like to have known about in relation to their care; iii) if patients would like to receive an information booklet about their care. A booklet was then designed and a focus group held to discuss it prior to implementation.

**Results:** i) 67% of the patients and relatives surveyed wanted to receive more information about their care. ii) Common themes included; What anaesthetic will I have? Will I be asleep? When will I walk again? What physiotherapy will I get? What is the timescale of hospital admission? iii) 100% of patient and relatives surveyed wanted a hip fracture booklet.

**Conclusions:**

* There is a need for the implication of a hip fracture booklet into our practice.

* Interestingly patients at the focus group requested that Advance Care Planning was included.

**References:**

[1] Scheier MF, Matthews KA, Owens JF et al. Dispositional optimism and recovery from coronary artery bypass surgery: the beneficial effects on physical and psychological well-being. Journal of Personality and Social Psychology, 1989; 57: 1024–1040.

[2] Mahomed NN, Liang MH, Cook EF et al. The important of patient expectations in predicting functional outcomes after total joint arthroplasty. Journal of Rheumatology, 2002; 29: 1273–1279.

## P-655

### Identification of frail elderly in need of intensive care monitoring after hip fracture surgery using the ISAR score

A.V. Silven¹, L.M.A. de Vries², J. Steens², J.O. Daal¹. ¹Department of Clinical Geriatrics, Westfries gasthuis, Hoorn, The Netherlands; ²Department of Orthopedic Surgery, Westfries gasthuis, Hoorn, The Netherlands

**Background:** Patients with hip fractures are often frail elderly. Guidelines suggest close postoperative monitoring to minimise the risk of complications. In our hospital, frail elderly are therefore closely monitored at the Intensive Care Unit (ICU). Since there are no validated tools to identify frail elderly in need of ICU monitoring, we use a modified version of the Identification of Seniors At Risk (ISAR) [1]. This study evaluated the use of the modified ISAR score as a predictor of necessary ICU admission in frail elderly after hip fracture surgery.

**Methods:** We retrospectively collected data of all patients aged ≥70 years with hip fractures who underwent surgery followed by ICU monitoring in the Westfries gasthuis hospital in 2015 and 2016. We analysed the ability of ISAR outcome for each patient to predict a necessary ICU admission, defined as one or more of the following interventions: administration of vasopressors, >6L oxygen/min, any form of rate control for heart rates <40 or >150 bpm, ≥4L IV crystalloid infusion within 24h and/or >4 units of blood within 24h.

**Results:** 186 patients were included in this study. Overall, 47.8% of ICU admissions were categorised as necessary. Accuracy of the ISAR score to predict a necessary ICU admission was analysed using the ROC curve. The area under the curve (AUC) was 0.506, which represents a worthless accuracy.

**Conclusions:** The modified ISAR score is not able to predict necessary ICU admissions in elderly patients after hip fracture surgery and is therefore not recommended as a preoperative screening tool [1.] Identification of Seniors At Risk-10 score, as used in the Westfries gasthuis hospital, Hoorn, The Netherlands1. Does the patient regularly need help in daily household activities like cooking, financial administration, preparing medication, etc.? (iADL) 2. Does the patient regularly need help in taking care of his or herself (getting dressed, personal hygiene, etc.)? (ADL) 3. Has the patient recently been contacting his/her family physician more often, or has he/she been hospitalised for one or more nights during the past six months? 4. In general, does the patient have problems in hearing or seeing? 5. In general, does the patient have problems with his/her memory? 6. Is the patient feeling down or depressive? 7. Does the patient use more than three different medications? 8. Does the patient have problems in mobility, or has he or she experienced one or more falls during the past six months? 9. Has the patient lost weight during the past six months, or does the patient have difficulties eating or drinking? 10. Has the patient had an episode of confusion during a previous illness or hospital admission?

## P-656

### Idiopathic normal pressure hydrocephalus in elderly: response to shunting and predictors of response taking into account frailty and Alzheimer LCS fluid biomarkers

L. Joly¹, M.-J. Fourriere², V. Bourdaire², A. Kearney-Schwartz², I. Gantois², C. Armand Malaplate², T. Jonveaux², O. Klein², A. Besozzi², A. Benetos². ¹CHRU de Nancy France, INSERM U1116, Université de Lorraine, Nancy, France; ²CHRU de Nancy, France

There are currently no European guidelines for the management of normal pressure hydrocephalus (HPN) in the elderly, on the one hand because of the difficulty of establishing a very precise nosological framework, and on the other hand because of the lack of large-scale randomized studies in this area. In 2015, the American Academy of Neurology developed a report of the
guideline development on the study of the international literature on idiopathic normal pressure hydrocephalus and its response to shunting and predictors of response with a view to standardizing care. Obviously, these guidelines didn't take into account the elderly patient's frailty, the presence of cognitive disorders and the value of degenerative cerebro spinal fluid biomarkers. The aim of our study is to propose, according to the data of the international literature, a mode of evaluation and management of the elderly patient suspected of HPN in collaboration with the different interlocutors that the patient will meet in his journey of care, and frailty characterization. We have prospectively recruited elederly patients over 65 years of age suspected of HPN in Nancy Lorraine Memory Hospital Center. All participants were submitted to a broad clinical and neuropsychological evaluation. Frailty was evaluated according to the Fried criteria. Cerebrospinal fluid analysis for Alzheimer's disease biomarkers was systematically analyzed. The main objective was to obtain more reliable answers in terms of diagnosis and surgical decision, of re-educative and neuropsychological follow-up of the elderly with standardized assessment.

## P-657

### Immediate and very long term results of colorectal cancer treatment in the elderly

M. Vigara¹, C. Cerdán², P. Gil¹, A. Viloria¹, J. Cerdán². ¹Hospital Clinico San Carlos; ²Clinica Santa Elena

**Introduction:** More than 50% of Colorectal Cancer occurs in patients over 70 years old, and its prevalence will increase in the next decades, in line with the increase in life expectancy. The aim of this work is to determine both, immediate postoperative results and long-term oncologic results in ancient patients electively operated on colorectal cancer.

**Material and methods:** A single centre retrospective study of patients undergoing elective surgery for colorectal cancer, between January-1991 and December-2012. The follow-up period ranges from 3 to 25 years. Frequencies of the different qualitative variables were studied with the Chi-square test. Long-term survival was analyzed using the Kaplan Meier and Log Rank method.

**Results:** 1031 patients. 571 males (55.4%), aged between 70 and 100 years, divided into five groups: 70-74, 75-79, 80-84, 85-89 and > =90 years. Potentially curative surgery was performed in 883 (85.6%). Palliative care: 137 (13.3%). Unresectable tumor: 44 (4.3%). From the 1031 patients just 32 required reoperation (4.3%). Evisceration happened in 28 (3.8%), hemoperitoneum in 8 (1%) and anastomotic leak in 23 (3.5%). Global 30 day mortality was 1.8%; 0, 1, 1.6, 1.7 and 11.8% by age groups. Overall 5-year survival: 76.6%. By age group: 82%, 80.5%, 71%, 69% and 57.4%, respectively.

**Conclusions:** 1. In our experience, with adequate pre- and postoperative care, the results obtained in the elderly are comparable to young patients, except those older than 90 years. 2. Age is not a limit to carry out an appropriate treatment in the elderly.

## P-658

### Impact of comprehensive geriatric care in trauma service on the length of stay (LOS) in elderly patients over 75 years old with femoral neck fracture (FNF)

F. Leborgne¹, F.-H. Brunschwig², C. Dahan¹, E. Clais¹, C. Rambaud¹, M. Sanchez¹, J.M. Turpin¹, E. Ferrer¹, R. Boulahssass³, C. Arlaud¹, G. Sacco¹, O. Guérin⁴, I. Bereder¹. ¹EMG CHU de Nice; ²SSR orthogériatrique CHU de Nice; ³UCOG PACA EST CHU de Nice; ⁴EMG CHU de Nice, FHU

**Introduction:** In 2016, at University Hospital of Nice (UHN), a collaboration between orthopedics surgeons and geriatricians was created in order to improve outcomes for older patients with a model of care "routine geriatric consultation within a trauma

service". We decided to measure the impact of the development of the orthogeriatric program on the LOS in trauma service.

**Methods:** Starting February 2016, the Mobile Geriatric Team (MGT) assessed each day in trauma service of UHN (42 beds) all patients over 75 years-old with an operated FNF. The MGT made a contribution to geriatric expertise (perioperatory analgesia adapted to elderly, personalized and comprehensive advices to limit geriatrics decompensations) and to short the LOS in trauma service (and thus shortening the time for hospitalization in rehabilitation care).

**Results:** Three hundred and ninety-one patients were been evaluated by the MGT (average age of 87). The average LOS in trauma service decreased from 9,98 to 7,01 days in 2016. This contributed to decrease orientation towards others hospitals to urgent surgery and to increase the number of elderly patients over 75 years-old operated for FNF to 40%.

**Conclusion:** The daily passage of MGT decreased from 3 days the average LOS in trauma service in frail patients over 75 years-old with FNF by faster transition in rehabilitation care.

## P-659

### Improving venous thromboembolism risk assessment and prophylaxis prescription in fracture neck of femur patients

I. Gunawardena, S. Gorgievská, R. Rajakunjaram, D. Nelson. Norfolk and Norwich University Hospital, United Kingdom

**Introduction:** In the absence of any prophylaxis, the rates of venography-assessed total and proximal Deep Vein Thrombosis (DVT) after hip fracture are 50% and 27% respectively in the 3 months after surgery. The incidence of fatal Pulmonary Embolism (PE) ranges from 1.4% to 7.5%. Best practice standards in keeping with NICE guidelines 1) All patients should undergo a Thrombosis Risk assessment (TRA) on admission to hospital2) Low Molecular Weight Heparin (LMWH) should be prescribed to all patients in whom it is indicated, according to the TRA. 3) Pharmacological venous thromboembolism (VTE) prophylaxis should be started at admission for all neck of femur (NOF) fractures. 4) Pharmacological VTE prophylaxis should be stopped 12 hours before surgery. 5) Pharmacological VTE prophylaxis should be restarted 6–12 hours after surgery.

**Methods:** Clinical practice was measured using a convective sampling method before and after the introduction of electronic prescribing (EP).

**Results:** Clinical practice showed a significant improvement after introduction of EP particularly with regards to TRA on admission, which increased from 83% to 100%. The prescription of VTE prophylaxis after surgery improved from 46% to 73%. Recommendations and actions EP has improved clinical practice in VTE risk assessment and prophylaxis prescription. However, there is room for improvement. Regular education and staff awareness programmes need to be implemented to further improve patient care.

## P-660

### Indications for medical review in older surgical patients: the need for geriatricians in perioperative medicine

L. Koizia, A. Koizia, M. Sbai, G. Peck, D. Shipway. St Mary's Hospital, Paddington, United Kingdom

**Introduction:** The ageing demographics of European populations are well-recognised. Increasing numbers of older patients are admitted under acute general surgery. Data from national UK audits have demonstrated poorer outcomes for older surgical patients. Frailty, multi-morbidity and ageing physiology correlate with increased complications, morbidity and mortality. Perioperative geriatric liaison services can improve outcomes, but limited data have been published to describe indications for review and patient complexity. Data are required to emphasise the need for geriatri-
cians in perioperative liaison, and support the expansion of geriatric
surgical liaison internationally.

**Method:** Indications for review were prospectively collected in patients referred to a geriatric surgical liaison service. Data were categorised according to medical diagnoses and intervention.

**Results:** Over nine-months, 233 inpatient liaison reviews were conducted. Interventions included: high dependency review (24%); optimisation of fluid balance (20%); treatment of cardiac complications (16%); delirium management (16%); treatment of respiratory complications (15%); discharge planning (48%); complex communication (30%). Patients required multiple interventions to aid their management (mean 2.43 interventions per patient).

**Conclusions:** Indications for medical review in older surgical patients are diverse. Many patients suffer numerous complications affecting multiple organ systems. Under conventional services, these patients may have required numerous specialty referrals. The geriatrician's skillset combines acute internal medicine with knowledge of the geriatric syndromes, rehabilitation and discharge planning. These data illustrate that the needs of older surgical patients cannot be met by surgeons or anaesthetists alone. Geriatricians need to expand their role in perioperative medicine to meet the needs of the ageing surgical population.

P-661

Interventions in frail elderly patients with severe aortic stenosis,
possible candidates for implementation of aortic valve
transcatheter (TAVI)

C. Roqueta¹, B. Vaquerizo², M.I. Martínez-Fernández¹, N. Farre²,
A. Sánchez-Carpintero², N. Leiva¹, S. Burcet¹, M. Cladellas²,
R. Miralles³, 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; ³Geriatric
Medicine Department. Parc de Salut Mar. Hospital del Mar. Barcelona

**Aim:** To describe interventions in elderly frail patients with severe aortic stenosis.

**Patients and methods:** Prospective and descriptive study of patients evaluated by geriatrician for detection and intervention of frailty (to assess the possibility of TAVI indication). Demographic variables (age, sex), functional [Barthel index (BI), Lawton index (LI)], cognitive [Mini-Mental State of Examination of Folstein (MMSE)] and nutritional status [Mini-Nutritional Assessment abbreviate (MNA)] were registered. Short Physical Performance Battery (SPPB) was performed and stratified (0–3, 4–6, 7–9 and 10–12). Walking aids, levels of vitamin D (25-hydroxy) and polypharmacy review. Geriatric interventions performed: recommendations for physical exercise, request for a physical rehabilitation program, nutritional recommendations or enteral supplementation, adequacy of walking aids, polypharmacy revision and vitamin D supplementation.

**Results:** Forty-five patients (62.22% women); mean age: 82.62±6.09 years. Mean of the parameters evaluated: IB: 94.00±10.97; IL: 5.02±2.08; MMSE: 26.06±3.40 y SPPB: 6.88±2.69. SPPB categorized: 0–3 points: 3 (6.67%), 4–6 points: 18 (40%), 7–9 points: 15 (33.33%); 10–12 points: 9 (20%). MNA abbreviate: 33 (73.33%) good nutrition (12–14 points), 12 (26.67%) with risk of malnutrition (8–11 points). Intervention was performed in 17 (37.78%) patients: 13 (28.89%) physical exercise recommendations, 6 (13.33%) physical rehabilitation program, 13 (28.89%) nutritional recommendations or enteral supplementation, 6 (13.33%) adequacy of walking aids, 12 (26.67%) polypharmacy reduction and 20 (44.44%) supplementation with vitamin D.

**Conclusions:** Evaluated patients had a well preserved functional and cognitive status, and abnormal scores in the SPPB, suggestive of frailty. Intervention was performed in one-third of the patients. The most prevalent intervention was oral vitamin D supplementation.

P-662

Is there a requirement for Geriatrician input in emergency
surgical patients not undergoing surgery?

E. Howie, A. Crees, N. Bashir. *Musgrove Park Hospital, Taunton, UK*

**Introduction:** Older adults are commonly admitted under the care of surgeons with pathology not requiring surgery or for conservative management. We sought to evaluate the geriatric syndromes amongst this group and whether there is a role for Geriatrician input in their management.

**Methods:** A pilot service was provided by a Consultant Geriatrician/Specialist Registrar to older adults aged over 70 years admitted acutely to General Surgery between November 2016 - January 2017. Prospective data was obtained from direct patient assessment, medical notes and computer records. A proforma and database were completed for each patient, recording the geriatric syndromes identified and outcomes, including length of stay (LOS).

**Results:** 129 patients (mean age 81.5 years) total were reviewed. 35 patients required operations and 94 patients did not - within this group 13 patients had other, non-surgical procedures. Patients undergoing surgery were younger (78 years vs 83 years) and less frail (Clinical frailty score 3.3 vs 4.5). In patients not undergoing surgery, the main issues identified were new medical diagnosis (26%), falls (22.3%), malnutrition (18%) and delirium (highest incidence in those undergoing non-surgical procedures: 15.4% vs 8.6%). The average LOS was highest in the operative group (n=15 days).

**Conclusions:** The majority of older patients acutely admitted under the care of the surgeons do not undergo surgery. There are significant geriatric syndromes amongst this group, with patients undergoing non-operative procedures being particularly vulnerable. There is a clear role for Geriatricians in identifying issues and improving the management of these older surgical adults.

P-663

OPAL service reduces readmission and complication rates in
General Surgery

M. Rahman¹, L. Priestner¹, A. Watson², W. Baraza³. ¹Department of
General Surgery, University Hospital South Manchester, UK;
²University Hospital South Manchester, UK; ³Department of General
Surgert, University Hospital South Manchester, UK

**Introduction:** The poor care of older patients, has been highlighted in recent publications such as the National Confidential Enquiry into patient Outcome and Death (NCEPOD). Our general surgical service has employed a Consultant Physician with an interest in the perioperative care of older people (OPAL). We aimed to evaluate the new service.

**Method:** We performed a review of all general surgery patients aged above 75 years who were admitted to our unit in the 6 months before (Cohort A, n=188) and 6 months after (Cohort B, n=225) the OPAL service began. Fit patients over 75 were not seen by the OPAL service routinely. Those seen were frail, had poor cognitive function, poor mobility or complex comorbidities. Primary outcomes measured were the readmission rate and the incidence of post-operative complications. Secondary outcomes measured were length of stay and patient mortality.

**Results:** The two cohorts were well matched. The readmission and complication rates were reduced in Cohort B (14.9% vs 7.1% and 19.1% vs 11.1% respectively, p<0.05). There was no difference in length of stay or mortality between the groups.

**Conclusion:** Regular input from a specialist OPAL physician reduces the complication and readmission rate in elective and emergency surgical patients.
## P-664

### Outcomes in older patients discharged from acute surgery to intermediate care

M. Dos Santos, M. Tan, J. Fox, A. Vilches-Moraga. Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford, United Kingdom

**Background:** Intermediate care (IMC) is widely utilised to help older people regain independence after a hospital stay. We describe outcomes in older patients discharged from an acute surgical ward to IMC.

**Methods:** We identified all patients discharged to IMC from an acute surgical ward between September 2014 and September 2016 and conducted a retrospective case note audit. All patients had been assessed by our Perioperative Care of Older People Undergoing Surgery - General Surgery (Salford POPS-GS) in-reach service while a hospital inpatient.

**Results:** Within the study period, 29 older people with a mean age of 85.4±5.7 years were discharged to IMC. Most were females (73%). Multimorbidity (6.3±3.3 chronic illnesses), polypharmacy (7.6±3.5 medications), functional impairment (76% dependent for ADLs) and impaired mobility (only 8% mobilised with no aids or a stick) were the norm. Median length of stay in IMC was 24 days (3–67 days). While 9 patients (36%) were readmitted to hospital, there were no deaths. Continence and mobility were both shown to improve following an IMC stay. On admission, 24% of patients were incontinent and 89% were immobile or required a zimmer frame or crutches to mobilise. These figures improved to 11% and 68% respectively on discharge. 30-days after discharge from IMC, 8 patients (30%) had been readmitted to hospital, while 2 patients (7%) had died. None of the cohort lived in residential care on admission, but 2 patients (7%) were discharged to a care home.

**Conclusions:** Functional abilities can improve in an IMC setting in older surgical patients discharged from hospital. Readmission rates are high both from IMC units and after discharge home, perhaps reflecting the frail nature of the cohort discharged there.

## P-665

### Perineal repair for full thickness rectal prolapse in the elderly

I. Katsoulis¹, I. Karaitianos². ¹Department of Surgical Oncology, St. Savvas Cancer Hospital, Athens, Greece; ²Department of Surgical Oncology, St Savvas Cancer Hospital, Athens, Greece

**Introduction:** Full thickness rectal prolapse has an incidence of 1% among elderly people and is most common in females. Predisposing factors are old age, multiparity, hysterectomy, chronic dyschesia and deficiency of the pelvic floor musculature. Both abdominal and perineal procedures have been used for the repair of this condition. Although there are no evidence-based guidelines for the optimal surgical method, repair through the perineum is considered appropriate for elderly people or patients with co-morbidities due to the low risk for complications and faster recovery.

**Methods:** We retrospectively studied the records of 9 elderly patients with full thickness rectal prolapse who were treated with a perineal operative procedure.

**Results:** This case series consisted of 9 females with an average age of 76 years (range 67–98). Six patients were treated with Delorme repair and 3 with Altemeier rectosigmoidectomy combined with levatorplasty. In three patients, who were deemed unsuitable for general anaesthesia, surgery was performed under regional anaesthesia. The average hospital stay was 2 days (range 1–4). There were no perioperative complications. One patient, 6 months after a Delorme procedure, developed a partial recurrence of the rectal prolapse which was subsequently repaired with an Altemeier procedure. On follow-up, faecal continence was satisfactory in all patients.

**Conclusion:** Perineal procedures are safe and efficient for the treatment of full thickness rectal prolapse in the elderly.

## P-666

### Perioperative complications and hip fracture mortality

A. Michael¹, N. Obiechina², Z. Hussain¹, M. Waites¹. ¹Russells Hall Hospital, Dudley, UK; ²Queen's Hospital, Burton on Trent, UK

**Introduction:** Hip fracture is an orthopaedic and medical emergency with high in hospital mortality.

**Aim:** To study the intra and postoperative complications in hip fracture patients who died during hospitalisation.

**Methods:** Retrospective analysis of the medical records of all hip fracture patients admitted in one-year period in a UK teaching hospital. Demographics, intra and postoperative complications data were collected, downloaded on excel and analysed.

**Results:** 527 patients were admitted in the study period and 59 died as inpatients (11.2%). 6 patient notes were not available so 53 patients were studied. 48 had an operation and 5 were treated conservatively. 37/48 (77%) of patients who died had intraoperative complications; the most common was hypotension in 32/48 (67%) of patients. 32/48 (67%) had postoperative chest infection. 27/48 (56%) developed postoperative confusion. 12/48 (25%) had postoperative UTI. 11/48 (23%) had postoperative LVF. 6/48 (13%) had clinical evidence of fluid overload. The mean perioperative eGFR decline was 14%. 5/48 (10%) had perioperative stage 1 acute kidney injury (AKI), 2/48 (4%) had stage 2 AKI and 1/48 (2%) had stage 3 AKI. The mean perioperative haemoglobin loss was 16 gm/L (14%). 34/48 (71%) had other post operative complications. 17/48 (35%) had complications after being declared medically fit for discharge, most commonly chest infection 11/17 (65%).

**Conclusion:**

* Intra and postoperative complications are common in hip fracture patients who died during hospitalisation.

* 3/4 of patients who died had intraoperative complications.

* The postoperative complications were mainly medical. 2/3 of patients had chest infection, more than half had postoperative confusion, 1/4 had UTI, nearly a 1/4 had LVF and 1/4 had fluid overload. 16% had acute kidney injury.

* 1/3 of patients had the complications after being medically fit for discharge.

## P-667

### Postoperative haematoma on RIVAROXABAN: 2 case reports

T. Parent¹, L. Maljean¹, C. Bioteau¹, G. Gavazzi¹, J. Tonetti², G. Kerschbaumer², O. Seurat², S. Drevet¹. ¹Clinique universitaire de médecine gériatrique, CHU Grenoble Alpes, Grenoble, France; ²Traumatologie, CHU Grenoble Alpes, Grenoble, France

The use of Non-vitamin K antagonist oral anticoagulants (NOACs) is increasing rapidly and is now recommended in preference to vitamine K antagonist (VKA) in atrial fibrillation. The prevalence of geriatric traumatology is increasing and perioperative period is associated with a higher bleeding risk. We report two cases reported to pharmacovigilance. Case 1: Mr C, 85 years old, hospitalized for an loosening of the left Cotyloidal implant, on RIVAROXABAN (Atrial fibrillation, clearance 92ml/min). Bridging using LMWH and surgery on day 2. RIVAROXABAN reinitiated without bridging on day 5 after surgery. Onset of a large postoperative haematoma progressively getting worse with anemia (decreased hemoglobin from 124 to 98g/L) Case 2 Ms D, 89 years old, hospitalized for a left THA periprosthetic fracture, on RIVAROXABAN (Atrial fibrillation, clearance 35ml/min with adapted posology). Bridging with CALCIPARINE (not overdosed) and surgery on day 8. RIVAROXABAN reinitiated without bridging on day 5 after surgery. Onset of a large postoperative haematoma progressively getting worse with anemia
(decreased hemoglobin from 106 to 89g/L) secondarily superin-
fected with a need of surgical debridement. A retrorospective
study has found a small but significative increased risk of bleeding
following the procedure with RIVAROXABAN in comparaison to
VKA. Perioperative Guidelines exist for the management of NOACs
in scheduled surgery or for emergency invasive procedures. Actu-
ally, there is no recommendation for post operative re-processing.
Based on our elderly clinical experience, frailed or dependent,
we wonder on this theme as far as this population has a higher
thrombosis risk. Haemorrhagic complications has to be reduced
without increasing thromboembolic events. When NOACs should
be reinitiated and may bridging be considered? Declaration to phar-
macovigilance department is needed to optimize the use of NOACs
in real life. Few recommendations for the invasive non-programmed
procedures exist and they are based on expert opinion. Guidelines
should be clarified with prospective studies. Caution is needed
for the perioperative management of NOACs especially in geriatric
traumatology.

P-668

Post-operative hypoxemia and in-hospital complications of geriatric patients admitted in Unit of Peri-Operative Geriatric care after hip fracture surgery

L. Dourthe¹, L. Zerah², H. Vallet², A. Gioanni¹, A. Mézière³,
R. Haddad⁴, M. Doulazmi⁵, J. Cohen-Bittan¹, J. Boddaert²,
K. Kinugawa⁶. ¹Unit of Peri-Operative Geriatric Care, Geriatric
Department, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix.
DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris,
France; ²Unit of Peri-Operative Geriatric Care, Geriatric Department,
Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST,
Assistance Publique Hôpitaux de Paris (APHP), Paris, France; Sorbonne
University, University Pierre and Marie Curie (UPMC) Paris 06,
University Hospital, Paris, France; ³Geriatric Rehabilitation Unit,
Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST,
Assistance Publique Hôpitaux de Paris (APHP), Paris, France; ⁴Unit of
Peri-Operative Geriatric Care, Geriatric Department, Hôpitaux
universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance
Publique Hôpitaux de Paris (APHP), Paris, France; Neuro-Urology
Clinical Research Group (GREEN), Rothschild Hospital, Neuro-
rehabilitation department, 5 rue Santerre, Paris, France; ⁵CNRS, UMR
8256 Biological Adaptation and Aging, University Pierre and Marie
Curie (UPMC) Paris 06, Paris, France; ⁶Sorbonne University, University
Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris,
France; CNRS, UMR 8256 Biological Adaptation and Aging, University
Pierre and Marie Curie (UPMC) Paris 06, Paris, France 6. Functional
Exploration Unit, Hôpitaux universitaires Pitié-Salpêtrière-Charles
Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris,
France

**Introduction:** Delirium is a common complication following hip fracture surgery (HFS) in older people. Postoperative hypoxia has also been associated with delirium, but not specifically in geriatric patients. We tested the hypothesis that post-operative hypoxia is associated with in-hospital complications in patients with HFS.

**Methods:** Patients hospitalized in orthogeriatric unit after HFS were monitored for SpO2 with a pulse oximeter continuously up to 16h, covering one night. In-hospital complications were recorded in all patients.

**Results:** 46 patients with a mean age of 86±6 years old, and a mean oxymetry recording of 850,6±669 min (14hrs) were included in the analysis. Twenty-six patients presented a severe post-operative hypoxemia (time spent with SpO2<90% more than 20%) and 20 patients not (mean SpO2 at 88,3±7,0% vs 93,9±2,3% respectively; p<0.001). There was no significant difference between groups for age, gender, comorbidity (CIRS 52), physical status score (ASA), dementia, alcoholism, denutrition, depression, dehydrata-

tion, medication use (e.g benzodiazepine/hypnotics/morphine), av-
erage length of stay, mean oxymetry recording time. Hypoxemic
patients significantly suffered more COPD (19% vs 0%; p=0,038),
and were taking more diuretics and IEC/sartan medication. Among
in-hospital complications, delirium was more present in hypoxemic
patients (46% vs 15%; p=0,025), but falls, swallowing difficulty,
aspiration pneumonia, infections, heart failure, cardiac ischemia,
anemia and transfusions were not significantly different.

**Conclusion:** Preliminary data showed that post-operative hypoxia is associated with delirium in older patients in orthogeriatric unit after HFS. Further inclusions are ongoing and a clinical trial testing the benefit of oxygen therapy in preventing delirium is in perspective.

P-669

Predicting in-hospital mortality in older surgical patients:
a prospective cohort study of non-elective admissions

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

**Objectives:** Patients admitted as emergencies account for 80% of all in-hospital surgical mortality. Half of patients undergoing emergency general surgical procedures are old. We examine risk factors predicting in hospital mortality in older acute surgical patients.

**Methods:** All general surgical patients aged 75 years or older admitted non-electively between 9th September 2014 and 28th February 2017. The primary outcome measure was in-patient mortality. Univariate and Multivariate logistic regression analyses were undertaken to identify factors predicting in-hospital mortality.

**Results:** 577 patients were included in the study, mean age 82.9±5.7 years (56.2% female). The majority were living at home or with carers (92.9%) at the time of admission although 21.4% of patients were dependent for basic activities of daily living (ADLs). 76.6% of patients were managed non-operatively. Female sex (p<0.031), nursing home residence (p<0.001), dependence ADLs (p<0.001), cognitive impairment (p<0.001), restricted mobility (p 0.001) and urinary incontinence (p<0.001) were predictors of in-hospital mortality. Multivariate analysis: ASA class III-IV (OR 6.54 CI 1.50-28.47), dependence for basic ADLs (OR 2.63 CI 1.25-5.52), heart failure (OR 2.57 CI 1.19-5.54), and cognitive impairment (OR 2.54 CI 1.02-5.01).Type of treatment intervention, number of medications and number of co-morbidities were not predictive of in-hospital mortality (p>0.05).

**Conclusions:** This study highlights the predictive role of functional status, dependence and cognitive impairment when risk assessing older surgical patients presenting with acute surgical conditions. Accurate risk stratification requires global assessment by teams experienced in care of the older patient rather than the traditional focus on comorbidities.

P-670

Prediction of postoperative mortality in elderly patients with hip fracture: are specific and geriatric scores better than general scores?

H. Vallet¹, N. Na², Y. Le Manach³, M. Raux⁴, J. Cohen-Bittan⁵,
A. Mézière⁶, F. Khiami⁷, B. Riou⁸, J. Boddaert¹. ¹Unit of Peri-
Operative Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière,
Department Fight Aging and Stress (DHU FAST), Assistance Publique-
Hôpitaux de Paris (APHP), Paris, France; Sorbonne University,
University Pierre and Marie Curie (UPMC) Paris 06, University
Hospital, Paris, France; ²Departments of Emergency Medicine and
Surgery, GH Pitié-Salpêtrière, APHP, Paris, France; ³Departments of
Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote
School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada; ⁴Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France; Departments of Anesthesiology and Critical Care, GH Pitié-Salpêtrière, APHP, Paris, France; ⁵Unit of Peri-Operative Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière, Department Fight Aging and Stress (DHU FAST), Assistance Publique-Hôpitaux de Paris (APHP), Paris, France;

⁶Department of Rehabilitation, GH Charles Foix, APHP, Ivry sur Seine, France; ⁷Departments of Orthopedic Surgery and Trauma, GH Pitié-Salpêtrière, APHP, Paris, France; Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France;

⁸Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France; Departments of Emergency Medicine and Surgery, GH Pitié-Salpêtrière, APHP, Paris, France

**Background:** Elderly patients with hip fracture are at high risk of mortality. An accurate prediction of postoperative mortality is important for communicating information, in guiding decision-making, and management. We tested the hypothesis that specific or geriatric scores predict postoperative mortality better than general scores in this frail population.

**Methods:** Consecutive elderly patients (>75 years) admitted to our dedicated geriatric post-operative unit after hip fracture surgery were included and followed up over 6 month. The following scores were calculated: the American Society of Anesthesiology (ASA) score, PreOperative Score to predict PostOperative Mortality (POSPOM) score, Cumulative Illness Rating Scale (CIRS), Charlson score, and Nottingham Hip Fracture Score (NHFS).

**Results:** 508 patients were included (age 86±7 years). The 30-day and 6-month mortality rates were 4.1% (95% confidence interval (CI): 2.7–6.3%) and 14.4% (95% CI: 11.6–17.8%), respectively. For 6-month mortality, the area under the receiver operating curve (ROCAUC) was not significantly different between scores. The predictive characteristics of these scores were relatively poor as shown by the highest recorded values of ROCAUC (0.67 for CIRS) and positive likelihood ratio (2.06 for POSPOM) and high proportions of patients identified as intermediate risk ranging from 37.4% for CIRS to 77.5% for Charlson score. Similar results were obtained when considering 30-day mortality.

**Conclusion:** In elderly patients with hip fracture, specific and geriatric scores are not better than general scores in predicting 6-month mortality. All these scores performed poorly, suggesting that preoperative characteristics may not be crucial in identifying mortality risks in this frail population.

## P-671
### Preoperative identification of frail elderly with hip fractures: Which patients need postoperative intensive care monitoring?

A.V. Silven¹, L.M.A. de Vries², J.O. Daal¹, J. Steens². ¹Department of Clinical Geriatrics, Westfries gasthuis, Hoorn, The Netherlands;

²Department of Orthopedic Surgery, Westfries gasthuis, Hoorn, The Netherlands

**Introduction:** Recent guidelines advise intensive postoperative monitoring of frail elderly patients after hip fracture surgery. In our hospital, all patients aged ≥70 years with hip fractures are screened for frailty at the emergency department, to decide on postoperative admission to the Intensive Care Unit (ICU). In some patients though, there is no need for intensive monitoring. Therefore, it is important to establish critical factors for admittance. The objective of this study was to identify preoperative patient specific characteristics, which can predict clinically necessary ICU admission following hip fracture surgery in patients aged ≥70 years.

**Methods:** We retrospectively collected data of all patients aged ≥70 years with hip fractures who underwent surgery followed by ICU monitoring in the Westfries gasthuis hospital in 2015 and 2016.

Patient characteristics were related to necessary ICU admission. This was defined as one or more of the following: administration of vasopressors, >6L oxygen/min, any form of rate control for heart rates <40 or >150 bpm, ≥4L IV crystalloid infusion within 24h and/or >4 units of blood within 24h.

**Results:** 186 patients were included in this study. Overall, 47.8% of all ICU admissions were categorised as necessary. Preoperative characteristics significantly associated with an increased risk of necessary ICU admission were cardiac disease (odds ratio (OR) 2.30; 95% confidence interval (CI) 1.03–5.15; p=0.04) and age (OR 1.11; CI 1.04–1.19; p<0.01).

**Conclusions:** Higher age and the presence of any form of cardiac disease predict a higher chance of necessary ICU monitoring in elderly patients after hip fracture surgery.

## P-672
### Pressure ulcers are associated with six month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway

H. Vallet, J. Cohen-Bittan, M. Raux, A. Mézière, M. Verny, B. Riou, F. Khiami, J. Boddaert. Groupe Hospitalier (GH) Pitié-Salpêtrière – Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris – Ivry sur Seine, France

Pressure ulcers (PU) in hip fracture are associated with poor outcomes. Orthogeriatric management reduces PU incidence in hip fracture in the elderly. However, remaining factors and prognostic associated with PU in hip fracture patients managed in orthogeriatric care pathway are unknown. The objectives were to determine the prognostic of PU in the hip fracture in UPOG, and their associated factor. From June 2009 to April 2015, all consecutive patients, >70 years old, with hip fracture admitted to an Unit for Post-Operative Geriatric Care (UPOG) were screened. Patients were included if they were hospitalized for hip fracture and were excluded in presence of pathological fracture or if they were already hospitalized at the time of the fracture. In our unit, orthogeriatric principles are implemented, including a multicomponent intervention to improve PU prevention and management. Patients were followed until 6 months after discharge. 567 patients were included, with an overall 14,4% 6-month mortality (95% CI: 11.6–17.8%). Of these, 67 patients (12%) experienced at least one PU. Despite orthogeriatric management, PUs were significantly associated with a low albumin level (RR 0.90, 95% CI:0.84–0.96; p=0.003) and history of atrial fibrillation (RR 1.91, 95% CI:1.05–3.46, p=0.033), coronary artery disease (RR 2.16, 95% CI:1.17–3.99; p=0.014) and diabetes (RR 2.33, 95% CI:1.14–4.75; p=0.02). PU was associated with 6 month mortality (RR 2.38, 95% CI: 1.31–4.32, p=0.044). In elderly patients with hip fracture managed in an orthogeriatric care pathway, PU remained associated with poorly modifiable risk factors and long term mortality.

## P-673
### Procalcitonin and C-reactive protein for diagnosing sepsis in elderly patients after orthopedic surgery

H. Vallet¹, C. Chenevier-Gobeaux², J. Cohen-Bittan³, P. Ray⁴, G. Gavazzi⁵, A. Breining⁶, L. Epelboin⁷, M. Verny⁸, B. Riou⁹, F. Khiami¹⁰, J. Boddaert¹¹. ¹Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France; Sorbonne Universités, UPMC Paris 6, Paris, France; ²Clinical Chemistry Laboratory, Hôpitaux Universitaires Paris Centre (HUPC), APHP, Paris, France; ³Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France; ⁴Sorbonne Universités, UPMC Paris 6, Paris, France; Department of Emergency Medicine, Groupe Hospitalo-
Universitaire de l'Est parisien, site Tenon, APHP, Paris, France; ⁵Clinic of Geriatrics, CHU de Grenoble, Grenoble, France; ⁶Sorbonne Universités, UPMC Paris 6, Paris, France; Department of Geriatrics, Groupe Hospitalier Pitié Salpêtrière-Charles Foix, APHP, DHU FAST, Paris, France; ⁷Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Université de la Guyane, Institut Pasteur de La Guyane et Centre d'Investigation Clinique CIC Antilles-Guyane Inserm 1424, Guyane Française, France; ⁸Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France; Sorbonne Universités, UPMC Paris 6, Paris, France; UMR CNRS 8256, Paris, France; ⁹Sorbonne Universités, UPMC Paris 6, Paris, France; Department of Emergency Medicine and Surgery, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France; UMR INSERM 1166, IHU ICAN, Paris, France; ¹⁰Sorbonne Universités, UPMC Paris 6, Paris, France; Department of Orthopedic Surgery and Trauma, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France; ¹¹Unit of Peri-Operative Geriatric Care, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France; Sorbonne Universités, UPMC Paris 6, Paris, France; UMR CNRS 8256, Paris, France; Department of Emergency Medicine and Surgery, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France

**Introduction:** In the field of surgery in elderly patients, biomarkers may be of interest for diagnosis of infection, but data are scarce. We aimed to analyze the diagnostic performance of infection of pro-calcitonin (PCT) compared to C-reactive protein (CRP) in orthopedic surgery for elderly patients.

**Methods:** From July 2009 to July 2013, all patients admitted to our perioperative geriatric unit after trauma surgery were included in the study. Patients were excluded in presence of preoperative infection or antibiotics distribution, or if PCT was not measured. Clinical and biological data were prospectively collected. Medical charts were reviewed by 3 experts to assess bacterial sepsis diagnosis. Areas under the curve (AUC) and 90%-specificity thresholds were analyzed for PCT and CRP crude levels and their relative variations.

**Results:** Two hundred twenty-nine out of 527 patients were retained for the analysis (median (IQR) age 86 (81–90) y/o, CIRS 9 (7–12), ADL 5.5 (3.5–6.0), hip fracture 75%), of which 40 had bacterial infection (23 pneumopathy, 8 urinary tract infection, median delay 2 days after admission). For bacterial infection diagnosis, AUCs were 0.64 95% CI [0.57–0.70] for PCT crude levels, 0.65 [0.59–0.71] for PCT relative variations, 0.68 [0.61–0.74] for CRP crude levels, and 0.70 [0.64–0.76] for CRP relative variations. Ninety percent specificity thresholds were 0.75µ g/L for PCT crude levels, +62% for PCT variations, 222mg/L for CRP crude levels, and +111% for CRP variations.

**Conclusions:** Diagnostic values of PCT and CRP were low after trauma surgery in elderly patients. Relative variations of these biomarkers may be more informative than crude levels.

P-674

Prognosis of trauma elderly patients with hip fracture vs multiple fractures or polytrauma in a dedicated geriatric care pathway

A. Gioanni. 2. Unit of Peri-Operative Geriatric care, geriatric department, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France

**Introduction:** Prognosis of trauma elderly patients is due to severity of initial lesions, but the weight of multimorbidity, as reported in patients with hip fracture (HF), is less known. We aimed to compare phenotypes of morbidities and outcomes of elderly patients admitted with HF vs multiple fractures or polytrauma (MFP) managed in a dedicated care pathway.

**Methods:** Monocentric retrospective study of data prospectively collected between 2009 and 2014. Inclusion of consecutive patients >75 y/o, admitted in unit of perioperative geriatric (UPOG) care with HF or MFP. Data included comorbidities, Injury Severity Score score (ISS), trauma mechanism, complications, and 6-month follow-up for death, walk recovery or new institutionalization. The primary endpoint was 6-month mortality.

**Results:** 606 patients were included (age 86±6 y/o, CIRS 9 [6–12], ADL 5.5 [3.5–6], home living 75%), 522 with HF and 54 with MFP. HF patients were older (86±6 vs 84±5 y/o, p=0.001), had more comorbid conditions (CIRS 9 [6–12] vs. 7 [4–10], p=0.004) and dementia (40 vs 11%, p<0.001). ISS score was higher in MFP patients (9 [9–9] vs 9 [8–17], p<0.001). After 6-months, there was no difference for mortality between HF and MFP patients (respectively 16 vs 8%, p=0.15), but walking recovery was more frequent in HF patients (53% vs. 37%, p=0.03) and admission to new institution was less frequent (4% vs. 15%, p=0.03).

**Conclusion:** The weight of comorbid conditions could counteract the initial severity of lesions in elderly patients with trauma.

P-675

Prognostic value of fragmented QRS in elderly patients with hip fracture in a dedicated geriatric care pathway

A. Breining¹, H. Vallet², L. Zerah², A. Gioanni², N. Hammoudi³, J. Cohen-Bittan¹, M. Verny², A. Mézière⁴, F. Khiami⁵, B. Riou⁶, J. Boddaert². ¹Unit of Peri-Operative Geriatric Care, Geriatric Department, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France; ²Unit of Peri-Operative Geriatric Care, Geriatric Department, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris; Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France; ³Department of Cardiology, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; ⁴Rehabilitation Geriatric Department, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Paris, France; ⁵Department of Orthopedic Surgery and Trauma, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris; Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France; ⁶Department of Emergency Medicine and Surgery, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, APHP, Paris; Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France

**Introduction:** Fragmented QRS (fQRS) are due to terminal conduction delay after myocardial infarction, and are associated with coronary artery disease in younger patients. We aimed to describe electrocardiograms (ECG) before and after hip fracture surgery in elderly patients and to evaluate prognostic value of fQRS during hospitalization.

**Patients and methods:** Monocentric retrospective study, all consecutive patients >75 years with a hip fracture were enrolled. Clinical, ECG, biological data and outcomes were prospectively collected. Presence of fQRS was determined before surgery, and repeated ECG were analysed. Each 12-lead ECG was analysed by 3 independent readers. The primary end point was a composite criteria defined as in-hospital cardiovascular complication (arrhythmia, heart failure, acute coronary syndrome, troponin elevation).

**Results:** A total of 185 patients were enrolled. Before surgery, 91% of the patient were in sinus rhythm and 8% had atrial fibrillation. Twenty nine percent of the patients had a fQRS and 15% a J wave. During their stay in the geriatric post operative unit, cardiac and arrhythmics event occurred in 56% of the patients: 28% presented supraventricular extra-systoles, 21% ventricular extra-systoles, 11% paroxystic atrial fibrillation. Acute coronary syndrome (with and without ST-elevation) were observed in 7% of the patient. New
fQRS appeared in 9% of the patient. Pre-operative fQRS were not associated with any postoperative cardiovascular outcome whereas pre-operative Q wave was associated ACS (regression coefficient 0.31, p=0.04)

**Conclusion:** fQRS are a frequent pattern in elderly's ECG, but are not associated with in-hospital cardiovascular outcome after hip surgery.

## P-676

**Quality improvement project - Is there a need for an inpatient falls management pathway?**

A. Malik, R. Malik, E. Paling, A. Simons. Birmingham Heartlands Hospital, Heart of England Foundation Trust, Birmingham, United Kingdom

**Introduction:** Patients who present to hospital via the emergency services with a NOF fracture have an integrated care pathway which outlines quality standards. There is no pathway for patients who sustain these fractures as an inpatient. We identified patients who sustained a NOF as an inpatient and compared their pathway to those presenting to A&E with a suspected NOF.

**Methods:** We included all NOFs in the trust (Heart of England Foundation Trust) sustained as an inpatient in 2016 (1st January-31st December). We reviewed the time taken for doctor to review, time to analgesia, time to x-ray, time to theatre, time to Ortho-geriatric review and 30 day mortality. Data was collected from electronic records and case notes.

**Results:** 13 patients sustained a NOF fracture as an inpatient in the past 12 months. 38% were reviewed within 1 hour of the fall. No patients received analgesia within 30 minutes, and no patients had an x-ray within 1 hour, 11/13 patients were managed surgically. Mortality at 30 days was 30% compared with 7% for outpatient NOFs.

**Conclusion:** A separate pathway for patients who sustain NOFs as inpatients is required, to identify those with serious injury, ensure prompt analgesia, x-ray and a quicker transit to theatre. Mortality rates for inpatient NOF's are higher as the patients have more medical problems and are often unwell at the time of falling.

## P-677

**Simplified comprehensive geriatric assessment in older surgical patients admitted to General Surgery. Salford POPS-GS**

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

**Objectives:** Half of patients undergoing emergency general surgical admission are old. We examined variations in housing, mobility, cognition, functional status, continence and medications on admission compared to discharge, and between different treatment groups.

**Methods:** All general surgical patients aged 75 years or older admitted non-electively between 9th September 2014 and 28th February 2017 and reviewed by our in-reach service.

**Results:** 577 patients were included in the study, mean age 82.9±5.7 years, 56.2% female. 23.4% (135) underwent surgery, 17% (102) non-surgical procedure and 58.9% (340) medical management. The majority were living at home or with carers (92.9%) at the time of admission although 21.4% of patients were dependent for basic activities of daily living (ADLs). Patients managed medically presented more cognitive impairment (21.5% vs 16.7% vs 13.3% - p 0.034), were more dependent for basic (26.3% vs 16.7% vs 12.6% - p 0.002) and instrumental ADLs (51.2% vs 52% vs 43.6% - p 0.001), less mobile (69.7% vs 65.5% vs 81.7% p 0.043) and took more medications (8.7 vs 8.6 vs 7.4 - p 0.012). There were no other significant differences. Admission vs discharge more patients were independent for basic

ADLs (73.7%–83.3%–87.4% vs 73.3%–84%–77.6% p<0.001), less mobile (65.5%–72.5%–75.6% vs 63.3%–70%–68.3% p<0.001) and took fewer medications (8.7–8.6–7.4 vs 8.1–8.2–7 p<0.001). There were no other significant differences.

**Conclusions:** Patients undergoing surgical interventions and procedures were more independent, mobile and took fewer medications compared to those managed medically. Patients became less mobile and more dependent after hospitalisation in the medical and surgical intervention groups but not those undergoing procedures.

## P-678

**The first 7 months of an Orthogeriatric Unit in a general hospital - a new model of care towards outcome improvement?**

A. Santos¹, L. Costa¹, C. Claudino¹, R. Costa¹, S. Gomes¹, S. Duque¹,³, J.G. Consciência², L. Campos¹. ¹Orthogeriatric Unit, Internal Medicine Department, São Francisco Xavier Hospital, Occidental Lisbon Hospital Center; ²Orthogeriatric Unit, Orthopedics Department, Occidental Lisbon Hospital Center; ³University Geriatric Unit, Faculty of Medicine, University of Lisbon, Lisbon, Portugal

**Introduction:** Hip fracture (HF) frequently occurs in elderly, due to high risk of falls and osteoporosis. Multimorbidity and geriatric syndromes result in high vulnerability to perioperative complications, which can increase perioperative morbidity, impair gait rehabilitation and decrease quality of life. Several evidence has been published showing that co-management by orthopedics and medical specialties, performing routine medical assessment based on comprehensive geriatric assessment, can improve patients outcomes. Our goal is to analyse the first 7 months of a new Orthogeriatric unit that was opened grounded on potential benefit of this model of care.

**Methods:** Retrospective study of elderly admitted in an Orthogeriatric Unit due to HF (also including fractures associated to prosthesis) between June and December 2016 through hospital record analysis.

**Results:** 134 patients admitted, only 11 were not assessed by the geriatric team. Average age 83.87 years, 78.4% females, 42% widowed, 31% married, 79% living at home. Average baseline Barthel score 80.3, normal gait in 55%, average Cumulative Illness Rating Scale Geriatrics 7.45, cognitive impairment in 29%, 96% were admitted from the emergency department. Most frequent types of fractures were: intracapsular (n=71), intertrocantheric (n=38) and subtrocantheric (n=13). Surgical intervention was performed in average 4.2 days after admission, average length of stay (LOS) was 16.7 days and 10 patients died. Most frequent perioperative complications were: pain (87%), anemia (82%), delirium (34%).

**Conclusions:** There is a trend to improvement of LOS and time to surgery, comparing to the previous 17 months of standard care (LOS 19.6 days, 5.4 days).

## P-679

**What do Greek students and professionals know about the time a person with dementia is in need of palliative care?**

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

**Introduction:** There is scarce research about the beliefs of university students and professionals in the social, medical and other science fields in Greece regarding the need of the elders with a diagnosis of dementia for palliative care. The objective of this study is to explore when students and professionals living and working in Greece, consider a person with dementia in need of palliative care.

**Methods:** A questionnaire based on an existing case-vignette by van Riet Paap et al. (2015) was used. One hundred seventy-five participants from Greece (147 women; 158 not having a relative diagnosed with dementia; 29 student nurses, 34 professional
nurses, 52 psychology students, 22 professional psychologists, and 38 students of non-relevant sciences; M age = 27.72, SD age = 9.61; and for the 55 professionals M years of professional working experience = 11.76, SD years of professional working experience = 6.50) participated voluntarily in this study.

**Results:** Open responses to the "when" question revealed six categories: after her diagnosis/after the first symptoms; when she and her family cannot cope; at the advance of symptoms; all the time; when she behaves aggressively; I am not sure/there is no specific point. Professional status, age, and field of studies were not found to be significant predictors, and thus did not contribute to the participants' answers regarding the start of palliative care.

**Conclusions:** Professional-student status and relevancy of subject do not predict opinions of Greek participants for the proposed time point of considering a person with dementia in need of palliative care.

# Area: Psychiatric symptoms and illnesses

## P-680

### Antipsychotics use in the elderly and users' risk profiles: baseline characteristics of a German claims-based cohort

J. Reinold, B. Kollhorst, T. Schink, U. Haug, F.E. Pisa. Leibniz Institute for Prevention Research and Epidemiology – BIPS, Germany

**Background:** Antipsychotics are indicated for the treatment of psychotic disturbances. In the elderly they are frequently used in other indications, such as neuropsychiatric symptoms of dementia. However, balancing risks and benefits in these patients is challenging. Safety profiles of individual antipsychotics need to be considered in combination with the patients' risk profiles. However, patient populations have hardly been described before.

**Objective:** This study aims to describe patient characteristics, comorbidities and concomitant medications as well as preexisting conditions associated with adverse outcomes in elderly new users of antipsychotics.

**Methods:** Cohort study including patients aged ≥65 years with a first prescription for antipsychotics during 2005–2014, based on claims data of the German Pharmaco-epidemiological Research Database (GePaRD).

**Results:** 415,948 patients were included, 70.3% women, median age 80 years (interquartile range (IQR): 73–85). Treatment was most frequently started with Melperone (29.3%), Risperidone (13.4%) and Sulpiride (11.3%), in 3.6% of patients with >1 antipsychotic. Before starting treatment patients took a median of 8 (IQR: 5–11) different medications, 62.7% had Charlson Comorbidity index >2. 37.3% of patients had a diagnosis of dementia, and 85.3% a diagnosis related to pain. 58.3% of patients had a history of cardiovascular and 45.0% of cerebrovascular disease.

**Conclusions:** In this cohort of elderly antipsychotics users, polypharmacy, risk factors for adverse outcomes and comorbidities, especially dementia, were common at baseline. Risks and benefits of an antipsychotics treatment have to be carefully weighed in this population.

## P-681

### Can we prevent the risk of escaping of old residents? The need for a specific tool

S. Bonin-Guillaume¹, E. Jouve², E. Poulin², V. Bertrand³,
T. Bautrand⁴. ¹Assistance Publique Hopitaux De Marseille; Aix
Marseille Université; ²Assistance Publique Hopitaux de Marseille;
³EHPAD Korian Loubiere; ⁴EHPAD Le Domaine de La Source

**Introduction:** Residents' escape episodes or elopement occur even

if most of the nursing homes (NH) have set up specific devices to prevent from this risk. Escaping is associated to a high burden of the caregivers and is often underreported. Currently there is a lack of a clear definition of escaping often included in other behavioral symptoms of dementia (BPSD) such as wandering, motor disturbance or agitation. Aim: describe the characteristics of escapers.

**Method:** Exploratory retrospective descriptive study. Population: NH residents with an escape episode reported to local authority between 2008 and 2009. Assessment: semi guided interview by an independent healthworker with the medical and nursing staffs.

**Results:** 9 NH volunteered to participate with 42 elopement records analyzed. Mean age was 78.7 years old (56–96); 63% over 80 y.o.; 60% males; 54% of the residents had severe disability. Most but not all of the them had dementia (23/42); 58% had previously experienced a similar episode; BPSD were often reported out of which 2 cases of apathy. Environmental factors were also reported such as recent admission to the NH (<6 months: 69%); living in a single room (54%), family visits (77%) particularly when more than twice a week (44%); 34% resided in a specific Alzheimer Unit.

**Conclusion:** A specific tool to assess the risk of escaping would emphasize patient centered-care and help to develop personalized devices. After reaching a pluridisciplinary consensual definition, such a tool has been developed and its validation is ongoing with the ESCAPE Study.

## P-682

### Elderly diabetic patients: influence of anxiety and depression on adherence to medication

R. Mendes¹, M. Cunha¹, S. Martins², L. Fernandes³. ¹Department of Internal Medicine. São João Hospital Centre/CHSJ, Porto; ²Center for Health Technology and Services Research/CINTESIS, UP. Department of Clinical Neurosciences and Mental Health. Faculty of Medicine, University of Porto; ³Department of Clinical Neurosciences and Mental Health. CINTESIS. Faculty of Medicine, University of Porto. Clinic of Psychiatry and Mental Health, CHSJ, Porto

**Introduction:** The prevalence of diabetes is growing worldwide, particularly in the elderly [1]. In diabetic patients, anxiety and depression are highly prevalent, which plays a negative role in medication adherence, as well as in metabolic control [2,3]. This study aims to analyze the association in elderly diabetic patients between symptoms of anxiety/depression and medication adherence.

**Methods:** This cross-sectional study was carried out in an outpatient department of Internal Medicine Service (CHSJ-Porto), with elderly patients (≥65 years) that had been diagnosed with diabetes. Patients were excluded if they were unable to communicate. Symptoms of anxiety/depression were assessed with the Hospital Anxiety and Depression Scale/HADS. Medication adherence was treated as a categorical variable (non-adherent, partially adherent, adherent).

**Results:** Overall 94 patients were included, mostly female (53.2%), married (63.8%) and with a mean age of 75.2 (sd=6.7) and mean education of 3.3 years (sd=2.0). Patients had on average 5.9 (sd=1.7) comorbidities and took 8.8 (sd=2.3) medications daily. In this sample, 30% of patients were non- or partially adherent. Based on HADS, 16.1% of patients presented depression and 25.8% anxiety. Significant differences between the three groups were found in anxiety and depression scores, both being higher among the non-adherent patient group, compared to the adherent and to the partially adherent groups (anxiety: median = 8 vs. 6,4, respectively, H=8.860, p=0.012; depression: median = 6 vs. 3,2, respectively, H=6.043, p=0.049).

**Conclusions:** The present findings of this association between symptoms of anxiety/depression and medication adherence, cor-
roborate those from previous studies. This research points to the importance of early identification and adequate treatment in order to enhance medication adherence.

**References:**

[1] Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2011. Atlanta, Georgia, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011

[2] Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K, Pouwer F. European Depression in Diabetes (EDID) Research Consortium Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. *Diabetologia* 2010;53:2480–2486.

[3] Capoccia K, Odegard PS, Letassy N. Medication adherence with diabetes medication: a systematic review of the literature. The Diabetes Educator 2016;42(1):34–71.

## P-683

### Elderly patients with syncope or falls showed high prevalence of psychiatric symptoms

J.J. Walgers, S.C. de Ruiter, T. Germans, M.G. Kat, J.H. Ruiter, R.W.M.M. Jansen. Northwest Clinics, Alkmaar, the Netherlands

**Introduction:** The prevalence of psychiatric symptoms has hardly been investigated in elderly patients with syncope. The aim of this study is to investigate the prevalence of psychiatric symptoms in patients 65 years or older with syncope in comparison with older patients with falls.

**Methods:** This observational cohort study included patients aged 65 years or older with at least one syncope or unexplained fall and who were evaluated at the fall and syncope day clinic. Primary outcomes were the prevalence of depressive and anxiety symptoms that were reported in the medical history. The secondary outcome was the use of psychotropic medication, Geriatric Depression Scale, and Patient Health Questionnaire.

**Results:** 378 patients were included with a mean age of 79.7±6.5 (SD) years; 194 patients with syncope and 184 patients with falls. Patients with syncope had more depressive symptoms than fall patients (33% vs. 23%, P=0.05). Sadness occurred significantly more often in the syncope group (P=0.05). No other significant differences were observed between syncope and fall groups. Anxiety symptoms were common in both syncope and fall group (20% vs. 19%, P=0.79). Also, we found a high prevalence of benzodiazepine use (22% vs. 16%, P=0.15) and antidepressants use (17% vs. 15%, P=0.63) in both syncope and fall groups.

**Conclusions:** Elderly patients with syncope or unexplained falls often have psychiatric symptoms and frequently use psychotropic medication. Elderly patients with syncope experience more depressive symptoms than elderly patients with falls. Therefore, elderly patients with syncope should also be evaluated for psychiatric symptoms.

## P-684

### Fear of falling, functional activity, and psychotropic medications in elderly patients with syncope or falls

J.J. Walgers, S.C. de Ruiter, T. Germans, M.G. Kat, J.H. Ruiter, R.W.M.M. Jansen. Northwest clinics, Alkmaar, the Netherlands

**Introduction:** Fear of falling (FOF) is common in elderly patients with syncope or falls. The aim of this study is to investigate which factors are associated with FOF.

**Methods:** We evaluated FOF in patients aged ≥65 years, who experienced at least one syncope or fall. Main outcomes were the use of psychotropic medication, functional activity, and the prevalence of psychiatric symptoms.

**Results:** 378 patients were included with a mean age of 79.7 (SD 6.5) years; 256 patients with FOF and 122 patients without FOF (non-FOF). The prevalence of FOF was 68% in patients with syncope and 67% in patients with falls (P=0.89). Compared with non-FOF patients, patients with FOF used more antidepressants (P=0.03) and benzodiazepines (P=0.00). FOF patients scored worse than non-FOF patients on the handgrip strength test (19.3±8.4 vs. 22.6±10.2, P=0.01), as a measure of functional activity. FOF was associated with more depressive symptoms (P=0.01) compared with non-FOF. The multivariate analysis showed no independent risk factor for FOF.

**Conclusions:** Two-third of elderly patients with syncope or falls have FOF, which seems to be associated with high use of antidepressants and benzodiazepines, decline in functional activity, and more depressive symptoms compared with non-FOF patients. However, none of these variables were an independent risk factor for FOF. Physicians taking care of older patients with syncope or falls should be aware of the high prevalence of FOF, with the associated functional decline, depressive symptoms, and high use of psychotropic medications.

## P-685

### Frailty evaluation in aging adults with autism spectrum disorder and intellectual disability (EFAAR study)

S. Miot¹,²,³, S. Crepiat², S. Couderc², E. Pernon², V. Gonnier², C. Jeandel³, A. Baghdadli²,⁴. ¹CNRS UMR 8246, INSERM UMR-S 1130, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Institut de Biologie Paris-Seine (IBS), UM119 Neuroscience Paris Seine (NPS), Paris, France; ²Centre de gérontologie clinique Antonin-Balmès, CHRU Montpellier, Montpellier, France; ³Centre de Ressources Autisme, Département de Psychiatrie de l'Enfant et de l'Adolescent, CHRU Montpellier, Montpellier, France; ⁴Centre de Recherche en Epidemiologie et Santé des Populations (CESP), Paris-Saclay University, Paris-Sud University, UVSQ, APHP, Paris, France

Few data are available about aging with autism spectrum disorders (ASD). Nevertheless a premature frailty is suspected. In general population, two models are used for frailty screening: the Fried's phenotypic model and the Rockwood's cumulative model. This later allows to calculating the frailty index (FI), which depends only on age. The principal aim of our monocentric and prospective study is to determine if FI is age-dependent in over age 20 and living in medico-social institutions of Languedoc-Roussillon adults with ADS and intellectual disability (ASD-ID). Secondary objectives are to evaluate the frailty prevalence and to verify the FI validity for fall, hospitalisation and death prediction in this population. At the time of enrolment, FI is calculated from 103 clinic and biological variables. In addition, ASD severity, adaptive and intellectual functioning, somatic and psychiatric comorbidities, and treatments are evaluated. The fall, hospitalisation and death occurrence is then collected each year during 5 years. Here we present preliminary results. To date, 23 patients aged from 21 to 62 years are included. The FI depends significantly on the age and ASD severity interaction. No frail patient is detected by the Fried's model, when 21.7% are defined frail with the Rockwood's model. As described in people with ID, the synergy of age and disease severity seems to influence the ASD-ID patient frailty. These results need to be confirmed in a bigger cohort. By follow-up our patients during 5 years, we hope to propose at term a new frailty phenotypic model adapted to people with ASD-ID.

## P-686

### Management of residual symptoms and psychotropic medication side-effects among older or soon-to-be-old adults with chronic mental illness

K.C. Chan¹, D.W.L. Lai², S.S.W. Yau³. ¹The Chinese University Of Hong
Kong, Hong Kong, China; ²The Hong Kong Polytechnic University, Hong Kong, China; ³New Life Psychiatric Rehabilitation Association, Hong Kong, China

**Background:** Individuals with persistent mental illness are not spared from the issue of aging. However there have been few studies which focus on the aging experience of this group of individuals, particularly the issues of residual symptoms and medication side-effects as these individuals age. Therefore it is the purpose of this presentation to explore these issues through qualitative study that targets this specific population group.

**Methods:** 61 individuals, aged 41 to 75 with chronic mental illness, were recruited from different mental health programs to participate in qualitative interviews. Interviews were audio-taped and transcribed. Narratives generated were subsequently examined using thematic analysis. Qualitative data from participants of the 3 age groups namely: mid-age (40–49); soon-to-be-old (50–59); and older adults (≥60) were compared with respect to their experience of residual symptoms and side-effects of psychotropic medications.

**Results:** Of the 61 interviewed, 31 were males, majority suffered from schizophrenia or other psychotic disorders (n=46). Residual symptoms common to all groups were rumination, anxiety, sleep problem and delusional ideations. Medication side-effects shared among the 3 groups included fatigue, drowsiness, weight gain and extra-pyramidal symptoms and appeared to be better tolerated in the older-adult group. The residual symptoms and medication side-effects tended to exacerbate the chronic physical conditions or arouse related apprehension in the oldest group, while their impact on the younger groups was often manifested as interference with the engagement in exercise, social, educational and wage-making activities.

**Conclusion:** Successful aging strategies should encompass the variation in residual symptoms and medication side-effects experienced during aging.

## P-687
### Prevalence of depressive symptoms in elderly people in Manisa, Turkey

B. Cengiz Özyurt¹, M. Serifhan², ¹Celal Bayar University Faculty of Medicine Public Health Department, Manisa, Turkey; ²Sehzadeler Community Health Center, Manisa, Turkey

**Objectives:** The aim of this study is to determine the prevalence of depressive symptoms in elderly population in Manisa and evaluate the potential risk factors.

**Methods:** The population of this cross-sectional study was 17760 elderly individuals who were living at the region of community health center in March-April 2017. The sample size was calculated using the software of Epi info 7.0; thereby, 546 geriatric individuals were enrolled. Each individual was randomly selected from his/her registration at the administrative office of Manisa Public Health Directory. All data were collected by face-to-face interview. A standardized questionnaire form, that is involved sociodemographic characteristics, Katz index and, Depression scale for geriatrics, was used. The rate of participation was 97.8% (n=534). The study activities were approved by the Celal Bayar University Institutional Review Board. All data was evaluated using descriptive analysis and chi square test. Logistic regression was used for multivariate analysis.

**Results:** The mean age of the study group was 72.70±6.35. The majority of individuals (78.6%) had a chronic disease which continuous drug administration was required, 56.3% was women, 44.3% was graduated from elementary school and 19.6% was living alone. The prevalence of depressive symptoms was 32.8%

**Conclusion:** Multivariate analysis demonstrated that the risk of depression is significantly high in individuals who were living alone,

need of support during daily activities, said that they perceived their health worse according to previous year, abused in the past year, insufficient income and past psychiatric illness history.

## P-689
### Seven-year outcome of depression in elderly high-altitude residents in Ladakh, India

M. Ishikawa, G. Yamanaka, A. Endo, J. Kizuki, T. Kawabe, H. Sakura. *Tokyo Women's Medical University Medical Center East, Tokyo, Japan*

**Background:** Studies have reported a positive association between suicide rate and altitude, suggesting a relationship between hypoxia and depression. Previously we reported that the prevalence of depression in high-altitude residents in Ladakh was low. This study aimed to analyze the clinical course of residents diagnosed with depression in a clinical interview during our previous health checkup in Ladakh.

**Methods:** The participants were two residents diagnosed with depression during our health checkup of 114 residents in Domkhar, Ladakh in 2009. Their 7-year outcome was analyzed through home visits. The interview was conducted in English with a local interpreter. The Religious Commitment Inventory-10 was used as an index of religious devotion. The Multidimensional Scale of Perceived Social Support was used as an index of social support and level of well-being was assessed using visual analog scale.

**Results:** The two residents diagnosed with depression achieved spontaneous remission without treatment. The interviews focused on religious devotion and social support. Both residents had strong religious devotion and were satisfied with their relationship with other residents. With regard to subjective quality of life, both residents were highly satisfied with the relationship they had with their family and friends. They reported that praying, listening to a priest's lecture, and visiting a religious facility made them feel better.

**Conclusion:** The results suggest that deep religious devotion and social support are helpful in defending against development of depression. One limitation of this study is that only two residents were included; thus, quantitative studies are required to clarify this issue.

## P-690
### The association between apathy and decline of physical functioning in depressed and non-depressed older persons during 2-years of follow-up

M.J. Henstra¹, T.C Feenstra², N. van der Velde ¹,³, R.C. van der Mast⁴, H. Comijs², M.L. Stek², D. Rhebergen². ¹Academic Medical Center, Amsterdam, The Netherlands; ²GGZ inGeest, Amsterdam, The Netherlands; ³Erasmus University Medical Centre Rotterdam, The Netherlands; ⁴Leiden University Medical Center, Leiden, The Netherlands

**Background:** In older persons, both apathy and depression (which frequently co-occurs with apathy) have been associated with poor physical functioning, a major health concern. We investigated the association between apathy and physical functioning in older persons without manifest dementia and whether this association is modified by depression.

**Methods:** We used data of 380 older persons (with and without depression) participating the Netherlands Study of Depression in Older Persons, with baseline-scores on the Apathy Scale and baseline- and 2-year follow-up-scores on at least one measure of physical functioning, including International Physical Activities Questionnaire (IPAQ, self-reported), WHO-Disability Assessment Schedule (WHO-DASII mobility-subset, self-reported), walking-speed or handgrip-strength. Multivariable linear regression analyses were performed to examine the association between apathy at baseline
and physical functioning at 2-year follow-up. We also investigated effect-modification by sex, age, and depression.

**Results:** Cross-sectionally, persons with higher baseline Apathy Scale-scores performed significantly worse on all measures of physical functioning. Longitudinally, higher baseline Apathy Scale-scores were associated with higher delta-scores on the IPAQ (B=-59.81) in the basic model, and higher delta-scores on the WHO-DASII (B=0.09) in all models. Apathy was not associated with higher delta-scores for walking speed or handgrip strength. Furthermore, sex, age, and depression did not modify any association.

**Conclusion:** In a Dutch cohort of older persons without manifest dementia, apathy was associated with more decline in self-reported, but not in objective physical functioning. Sex, age, and depression did not modify these associations. Maybe, in older persons with apathy, subjective decline precedes decline in physical performance tests.

## P-691

### The association between apathy and recurrent falling in a Dutch cohort of older individuals visiting a fall clinic

M. Henstra, C.M. Houbolt, L. Seppala, A. Scheffer, S. de Rooij, N. van der Velde. *Academic Medical Center, Amsterdam, The Netherlands*

**Background:** Apathy, a common and disabling behavioral syndrome in older individuals, has been associated with impaired physical performance and executive dysfunction. They share a pathophysiological pathway and the latter are both risk-factors for falling. This cross-sectional study examines the association between apathy and fallrisk in a cohort of 243 Dutch outpatients aged ≥65 years visiting a fall-clinic after a fall.

**Methods:** Information on the number of falls and recurrent falling was derived from the CAREFALL Triage Instrument. Multivariable regression and negative binomial regression analyses were used to assess Odds Ratio's (ORs) and Incidence Rate Ratio's (IRRs) and their 95% Confidential Intervals (CI95) for the association between apathy and recurrent falling (≥2 falls in the past 12 months) and number of falls respectively.

**Results:** Apathy was independently associated with recurrent falling in patients aged 65-75 years: OR 2.8 (CI95 1.1-7.4). The number of falls in the past 12 months was 46% higher in patients with apathy than in patients without apathy after adjustment for confounders (IRR 1.46 (CI95 1.0-2.1)).

**Conclusion:** In a Dutch population of older outpatients visiting a fall-clinic, apathy was associated with recurrent falling in patients aged 65-75 years and the number of falls. Hypothetically, apathy is especially relevant in relation to falling in the "youngest old" and maybe potential interventions modifying apathy should be targeted at this age group. Further research is necessary to elucidate the diagnostic accuracy of apathy as a risk-factor for recurrent falling and its potential role in fall-prevention strategies.

## P-692

### The associations between depressive state and well-being in elderly women

A. Cernovas¹, V. Alekna¹, M. Tamulaitiene², M. Fabijonavicius¹, I. Serbentaite¹, G. Sadauskaite¹. ¹Faculty of Medicine of Vilnius University, Vilnius, Lithuania; ²Faculty of Medicine of Vilnius University, Vilnius, Lithuania; National Osteoporosis Center, Vilnius, Lithuania

**Objective:** The aim of study was to investigate the associations between depressive state and well-being in elderly women.

**Subjects and methods:** The cross-sectional study was performed on Lithuanian community dwelling women aged 60 years and older. The exclusion criteria were musculoskeletal or nervous system diseases or conditions that could restrict mobility. Data were collected

by a survey consisted of sociodemographic questions and four specific questionnaires. Depression state was measured by Center for Epidemiologic Studies Depression Scale (CESD). Well-being was measured using: Control, Autonomy, Pleasure, and Self-realization (CASP-19), Satisfaction with Life Scale (SWLS) and The Positive and Negative Affect Schedule (PANAS). Correlation was determined using Spearman correlation coefficient.

**Results:** The study was performed on 161 women. Mean age of study sample was 69.9±5.1 years; the youngest woman was 60 years old, the oldest one - 84 years old. Average of special questionnaires scores were: CESD - 15.0±6.9; CASP-19 - 37.2±9.6; PANAS positive affect - 34.6±6.4, PANAS negative affect - 21.4±6.2, SWLS - 25.1±4.5. Our findings suggest that CESD score correlated with CASP-19 score (r=-0.36, p=0.03) and separately with three of CASP-19 domain scores: control (r=-0.38, p=0.02), autonomy (r=-0.36, p=0.02), and self-realization (r=-0.44, p=0.004). Correlation with pleasure domain was not found, as well as correlation with positive subscale of PANAS scores. Further analysis showed CESD score correlation between and SWLS (r=-0.42, p=0.01) and PANAS negative affect subscale (p=0.002; r=0.48) scores.

**Conclusions:** Our study showed that depressive state was associated with well-being: negatively with CASP-19 and SWLS and positively with and PANAS negative affect subscale.

## P-693

### The relationship between depression and perceived social support among community-dwelling elderly in Ladakh, India

A. Endo, M. Ishikawa, J. Kizuki, T. Kawabe, G. Yamanaka, H. Sakura. *Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan*

**Introduction:** Recent studies have reported a positive correlation between altitude and suicide rate. Suicide rate is known to be significantly associated with depression. According to our past study inLadakh, India, despite its location at a 12,000 feet high altitude, the depression rate was lowamong community-dwelling elderly. The purpose of the present study was to investigate the relationship between depression rate and perceived social support and religiosity among theelderly in Ladakh.

**Methods:** A total of 88 community-dwelling elderly aged 64.1 (± 12.6) years living in Domkharvalley, Ladakh, participated in this study. All participants underwent a medical check-up, and wereinterviewed using the Multidimensional Scale of Perceived Social Support (MSPSS), GeriatricDepression Scale (GDS), Religions Commitment Inventory-10 (RCI-10), and Visual Analog Scale (VAS) for subjective quality of life. We compared variables including age, sex, marital status, education levels, number of housemates and children, MSPSS, RCI-10, and VAS between theDepression group (GDS >6) and No Depression (GDS ≤6) group.

**Results:** The perceived social support from family and significant others were lower in theDepression group. There were no significant differences between the two groups in total MSPSSscores, social support from friends, or RCI-10 scores.

**Conclusions:** The No Depression group perceived more social support from family and significantothers than the Depression group. People in Ladakh are devout Buddhists and have survived theharsh environment of the high altitude by helping each other. This social background could haveinfluenced the low depression rate despite a high altitude.
# Area: Urology and continence management

## P-694

### Association of urinary incontinence with geriatric syndromes in community-dwelling highly functional people aged 65 and over

M. Kotsani¹, G. Soulis², A. Achimastos², I. Georgiopoulos².

¹HE.S.S.R.A. Hellenic Society for the Study and Research of Aging and
Aristotle University of Thessaloniki, 2nd Department of Internal
Medicine, Hippokratio Hospital of Thessaloniki, Thessaloniki, Greece;

²HE.S.S.R.A. Hellenic Society for the Study and Research of Aging,
Greece

**Introduction:** We investigated the prevalence of urinary incontinence (UI) and its association with common geriatric syndromes (GS), in a Greek community-dwelling population, aged ≥65 years.

**Methods:** Secondary database analysis of a cross-sectional study.

**Results:** We studied 402 persons (54.7% women), mean age 73.7 (±5.8) years. UI was reported by 42.3% of them; 34.4% as occasional accidents and 7.9% as a permanent phenomenon. People with UI in comparison to those without, were more likely to: be women (74.7 vs 40.1%, p<0.001), take more drugs (6.8±3.1 vs 5.7±3.2, p<0.001), present more chronic comorbidities (4.4±1.9 vs 3.7±2.0, p<0.001), lower MMSE scores (26.9±3.0 vs 27.7±2.2, p=0.001), higher 15-items' Geriatric Depression Scores (4.8±3.4 vs 3.5±3.1, p<0.001), higher disability in Global Disability Scale (27.7±15.3 vs 21.3±14.0, p<0.001), slower 3 meters' Timed-Up-and-Go (TUG) performance (11.5±3.5 vs 10.6±3.7sec, p<0.001), fall history (74.9 vs 56.9% p<0.001), higher pain levels (35.3 vs 62.5% with no, 44.7 vs 26.7% with low and 20.0 vs 10.8% with high pain levels, p<0.001) and globally more coexisting GS (2.3±1.3 vs 1.6±1.2, p<0.001), but did not differ in age (73.8±5.6 vs 73.7±6, p=0.807). They were also more likely to report anxiety and sleep problems (70.6 vs 53.9%, p=0.001) and lower self-rating health status (54.1 vs 64.7% in the high-ranking category, p=0.007). Neither diabetes nor diuretics, taken by 190 (47.3%) individuals, were associated with UI. Results remained similar after adjustment for sex, except for TUG test (p=0.313).

**Conclusions:** UI is highly prevalent even in relatively young community-dwelling populations and is associated with various other GS, which could all incur a negative impact on a person's functional status. Clinical awareness is required when assessing older adults with UI, since it could only be the tip of the iceberg.

## P-695

### Efficacy of transcutaneous posterior tibial nerve stimulation in older patients with overactive bladder syndrome

R. Haddad¹, C. Hentzen², G. Amarenco², G. Robain¹, GRAPPPA
Group (Research Group on Pelviperineology of the Elderly).

¹Rothschild Hospital, Sorbonne University, UPMC Univ Paris 06, AP-HP,
GRC 01, Group of Clinical Research in Neuro-Urology (GREEN); ²Tenon
Hospital, Sorbonne University, UPMC Univ Paris 06, AP-HP, GRC 02,
Group of Clinical Research in Neuro-Urology (GREEN), Paris, France

**Introduction:** The main objective of this study is to determine the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) in older patients with overactive bladder (OAB) syndrome. The secondary objective is to look for predictive factors of efficacy of this treatment.

**Methods:** All patients aged over 65 years with OAB syndrome for which TPTNS was introduced between 2010 and 2016 in 2 neurourology centers were included. Age, gender, etiology of OAB, urinary symptoms and detrusor overactivity (DO) were retrospectively collected. The main outcome was efficacy of TPTNS (i.e. purchase of the device between 3 and 6 months). Association between patient

characteristics and efficacy was examined in logistic regression models.

**Results:** A total of 271 patients were included (mean age 74.2 years; 63.8% of women), of whom 50.8% had neurogenic OAB (44.9% with parkinsonian syndromes). 75.6% had urinary incontinence and DO was found on urodynamic studies for 145 patients. The overall efficacy was 45.8%. None of the factors tested were significantly predictive of efficacy, especially age (≥75 years, p=0.54), stress urinary incontinence (p=0.48) and DO (p=0.39), whether neurogenic or not, except a center effect (p=0.03). This was not sustained after adjustment for age and DO.

**Conclusion:** TPTNS is an effective treatment in older patients with OAB syndrome. No predictive factors of efficacy were found, especially age and DO. If a center effect has been found, the place of TPTNS in OAB management (first line vs failure of a previous treatment) is under study.

## P-696

### Indication change from appropriate to inappropriate use of urinary catheters between medical and surgical hospitalized elderly patients

C.-M. Chang¹, F.-W. Hu², C.-H. Tsai³, C.-H. Chen⁴. ¹Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital; Institute of Gerontology, Department of Medicine, National Cheng Kung University, Tainan, Taiwan;

²Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan; ³Department of Nursing, College of Medicine, Tzu Chi University, Hualien, Taiwan; ⁴Department of Nursing, Chang Jung Christian University, Tainan, Taiwan

**Introduction:** Urinary catheterization is a commonly used procedure in hospital setting but may lead to complications. Our study was to compare risk factors between medical and surgical hospitalized elderly patients with or without change of appropriateness of urinary catheters.

**Methods:** From October 1, 2012 to October 31, 2013, hospitalized patients aged ≥65 years, with appropriate use of urinary catheters placed within 24 hours of hospitalization, were enrolled. Data were collected from medical records and standardized interviews with patients or surrogates. Indications for urinary catheters were assessed every day and inappropriate use was considered if no more indication existed.

**Results:** A total of 198 patients with appropriate use of urinary catheters was observed. Indication change from appropriate to inappropriate use of urinary catheters occurred in 36 (38.7%) of medical patients and 71 (67.6%) of surgical patients. Univariate analysis showed that the change to inappropriate use occurred more often among medical patients with higher comorbidities, for convenience by caregivers and by patients, while it occurred more often among surgical patients who were female, with cognitive impairment, ADL impairment, higher comorbidities, for convenience by caregivers and by patients, for comfort by patients, and less documentation for urinary catheters. Multiple logistic regression showed that the change to inappropriate use occurred more often among medical patients with higher comorbidities, and among surgical patients for comfort by patients.

**Conclusion:** There is higher rate of change from appropriate to inappropriate use of urinary catheters among surgical elderly patients. Education to caregivers and patients, and monitoring the changing indications and different risks among medical and surgical inpatients might be helpful.
## P-697

### Patient reported urinary incontinence and quality of life after radical prostatectomy

J. Aurelian¹, A. Capisizu², S.M. Aurelian², V. Jinga², P. Armean².
¹University of Medicine and Pharmacy “Carol Davila” Department of Urology, Bucharest, Romania; ²University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

**Introduction:** Radical prostatectomy remains the best treatment for localized and locally advanced prostate cancer, but complications like urinary incontinence and erectile dysfunction may alter the surgical outcomes and decrease the quality of life of prostate cancer patients. The objective of the study was to assess the impact of radical prostatectomy on urinary continence and quality of life after radical prostatectomy for prostate cancer.

**Methods:** We carried out a prospective study in "Prof. Dr. Th. Burghele" Clinical Hospital, Department of Urology. The study took place between 2015 - 2016 and we evaluated 134 patients diagnosed with prostate cancer in localized or locally advanced stage with the use of two questionnaires - QLQ-C30 and QLQ-PR25 pre and post radical prostatectomy. We divided the patients in 2 groups: a preoperative group and a postoperative group that underwent radical prostatectomy. The age distribution of the two groups was: for the preoperative group the mean was 63.52 years, and for the postoperative group the mean was 66.23 years.

**Results:** In operated patients over 65 years, the urinary symptoms were more severe compared to unoperated patients (p<0.005). After radical prostatectomy, 30.6% of patients have accused the presence of urinary incontinence. Urinary incontinence frequency was higher in patients over 65 years (38.1%), compared to patients below 65 years (23.2%). Overall health status scale scores (QLQ-C30) decreases postoperatively, representing a decrease of overall health.

**Conclusions:** Quality of life was seen as impaired by patients treated with radical prostatectomy. Age over 65 years brings reduced functionality and louder symptoms after radical prostatectomy, urinary incontinence being a disturbing complication.

## P-698

### Quality of life among elderly women with urinary incontinence

G. Jievaltiene¹, J. Knasiene², V. Jievaltaite³, M. Jaras³. ¹Lithuanian University of Health Sciences, Department of General Surgery, Kaunas Clinical Hospital; ²Lithuanian University of Health Sciences, Department of Geriatrics; ³Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas Clinical Hospital

**Introduction:** Urinary incontinence (UI) is a health problem prevalent in various age groups [1]. Due to anatomical and physiological peculiarities, it is more common in women and influences various aspects of quality of life [3,2]. Women still do not want to talk about UI and it causes that this problem often remains undiagnosed [4].

**Methods:** Women aged 65 years and more were surveyed. The original questionnaires were used with permissions: SF-36v2 – generic questionnaire of quality of life; I-QOL – specific questionnaire of quality of life. Statistical calculations were performed by using IBM SPSS 23.0 software package.

**Results:** 127 women participated in the study. Answers of SF-36v2 questionnaire showed that the mean of quality of life was 45 pts. The lowest scores were observed in subscales General Health (30 pts), Vitality (40 pts), and Bodily Pains (42 pts). Meanwhile Physical Functioning and Emotional Roles had highest scores (respectively-58 and 51 pts). Women with UI had statistically significantly poorer quality of life than other elderly women. I-QOL questionnaire revealed that the total quality of life was 71 pts on average. The best measured component was related with psychosocial impacts (75 pts) while avoidance behaviors and social embarrassment were

scored lower (68–69 pts). Comparative analysis of women with UI versus without UI revealed that the former group had statistically significantly lower quality of life.

**Conclusion:** Quality of life among elderly women with UI is lower than among other women. Also, study showed that UI is associated with quality of life aspects.

### References:

[1] Damián J, Pastor-Barriuso R, García López FJ, de Pedro-Cuesta J. Urinary incontinence and mortality among older adults residing in care homes. J Adv Nurs. 2017 Mar;73(3):688-699.

[2] Dumoulin C, Tang A, Pontbriand-Drolet S, Madill SJ, Morin M. Pelvic floor morphometry: a predictor of success of pelvic floor muscle training for women with stress and mixed urinary incontinence. Int Urogynecol J. 2017 Jan 12.

[3] Santini S, Andersson G, Lamura G. Impact of incontinence on the quality of life of caregivers of older persons with incontinence: A qualitative study in four European countries. Arch Gerontol Geriatr. 2016 Mar-Apr;63:92-101.

[4] Di Rosa M, Lamura G. The impact of incontinence management on informal caregivers' quality of life. Aging Clin Exp Res. 2016 Feb;28(1):89-97.

## P-699

### The use of a urinary tract management protocol in an integrated hip fracture unit to reduce urinary tract infections

Sin Yue, Jeanice Ker, Mallya Jagadish Ullal, Su Su, Wen Qi Mok, Pok Ling Yiap, Lee Hoon Yu, Siew Ming, Meliza Lim, Ai Ling Hong. *Khoo Teck Puat Hospital, Singapore*

**Introduction:** Globally, the incidence of Urinary Tract Infections (UTI) in hip fracture elderly is 23%-25%. UTI increases the risk of delirium, associated with an increased length of hospitalisation and is a common cause of readmission from community hospital. A comprehensive nurse-led urinary tract management protocol was introduced in the integrated Hip Fracture Unit (HFU) to reduce incidences of UTIs in elderly patients with hip fractures during the peri-operative period.

**Methods:** Firstly, a nurse-initiated protocol instead of a doctor-driven approach was introduced to prevent catheter-associated UTI (CAUTI). Nurses will remove patients' indwelling urinary catheter (IDC) on the morning of 2nd post-operation day. To avoid reinser-tion of IDC, nurses will initiate routine intermittent catheterisation (IMC) instead should trial-off-catheter failed. Additionally, high risk male patients will be administered PO Tamsulosin for a period of not more than 7 days to reduce their risk of post-operative urinary retention. Furthermore, all patients will undergo routine blood and urine tests to assess their risk of kidney injury, with intravenous hydration initiated as appropriate.

**Results:** Of the 357 hip fracture patients from January to December 2016, there were 58 cases of UTI (16%) of which 5 cases were CAUTI (1.4%). The readmission rate from community hospital was 1.4% (5 cases) while the incidence rate of delirium is also significantly lower compared to international data.

**Conclusions:** UTI is a common complication of hip fracture. A comprehensive nurse-led multidisciplinary urinary tract management protocol has successfully reduced the incidence of UTI especially CAUTI among our HFU patients hence preventing related complications.

## P-700

### Urinary catheter use and care in the acute hospital setting: a point prevalence study

D. McCartan, A. Fallon, C. MacMahon, R. Collins, S. Kennelly. *Tallaght Hospital*

**Background:** Urinary catheters (UC) are associated with poor out-
comes in hospitalised older adults including infection, delirium, and trauma. We sought to determine the point prevalence of UC use and to review the process employed for both the decision to catheterise and ongoing care thereafter. A basic nursing UC bundle is available, but there is no other resource to direct clinical decisions regarding UCs.

**Method:** In a single day all admitted patients in a tertiary university teaching hospital were screened for the presence of an in-dwelling UC. Clinical, nursing, ED and peri-operative notes were reviewed for evidence of clinical indication, catheter care records, and review of ongoing clinical need with view towards timely removal. Patients in critical care units were excluded.

**Results:** 56 of 386 eligible patients had an indwelling catheter with a point prevalence of 14.5%. 75% (42/56) of whom were aged ≥65 years, and 64% (36/56) were male. 86% (48/56) were newly inserted on current admission, with seven inserted due to brain and spinal injuries. In 14% (9/56) there was no indication recorded, with other indications including urinary retention 19.6% (11/56) or as part of haemodynamic stabilisation protocol 12.5% (7/56). Only 14.5% (7/48) of those with newly inserted UC had a trial-without-catheter (TWOC) and of these only 4 had formal urology input. 96% (54/56) had a complete nursing catheter care bundle.

**Conclusion:** Limitations in UC care were identified. Inconsistency in medical record keeping regarding both decision to catheterise and of review regarding early removal could be targeted with an appropriate protocol to prompt earlier TWOC, urology input when warranted.

## P-701

### Urinary incontinence in aged women: Prevalence and risk factors

G. Jievaltiene¹, J. Knasiene², V. Jievaltaite³, M. Jaras³. ¹Lithuanian University of Health Science, Department of General Surgery, Kaunas Clinical Hospital, Kaunas, Lithuania; ²Lithuanian University of Health Science, Department of Geriatrics, Kaunas Clinical Hospital, Kaunas, Lithuania; ³Lithuanian University of Health Science, Faculty of Medicine, Kaunas Clinical Hospital, Kaunas, Lithuania

**Introduction:** Urinary incontinence (UI) is a health problem prevalent in various age groups [1,4]. Based on scientific literature, incontinence is more common in women and the prevalence of it is over 30% [2,3]. There is still no effective predictive assessment framework for UI and more research is needed [4].

**Methods:** Elderly women who visited the general practitioner were surveyed. The original questionnaires were used: MMSE – minimal state examination, used for evaluation of cognitive function; GDS – geriatric depression scale, used for evaluation of depressiveness. Also, we asked elderly women their demographic data and their physical health. Statistical calculations were performed by using IBM SPSS 23.0 software package.

**Results:** 127 women participated in the study and mean age of participants was 76.6±7.50 years. The most common diseases were arterial hypertension (84%), urinary incontinence (77%), constipation (53%), and cardiac arrhythmia (48%). Study participants' mean body mass index (BMI) was 28.0±6.95 kg/m² (range 19–79). More than half (55%) of responders had no cognitive dysfunction, 21% had mild, 13% – moderate, and 11% – severe cognitive impairment. 78% of elderly women had certain level of depression (32% mildly depressed and 46% severely depressed), while 22% of women had no depression. Average GDS score was 9.6±4.01. The results demonstrated that the associated factors with UI (P<0.05) were cognitive impairment (OR=7.36), depressiveness (OR=3.62), history of gynecologic surgery (OR=3.53) and constipation (OR=3.22).

**Conclusion:** Prevalence of urinary incontinence in elderly women visiting the general practitioner is 77%. The main factor associated with urinary incontinence is cognitive impairment.

## References:

[1] Damián J, Pastor-Barriuso R, García López FJ, de Pedro-Cuesta J. Urinary incontinence and mortality among older adults residing in care homes. J Adv Nurs. 2017 Mar;73(3):688–699.

[2] Dumoulin C, Tang A, Pontbriand-Drolet S, Madill SJ, Morin M. Pelvic floor morphometry: a predictor of success of pelvic floor muscle training for women with stress and mixed urinary incontinence. Int Urogynecol J. 2017 Jan 12.

[3] Di Rosa M, Lamura G. The impact of incontinence management on informal caregivers' quality of life. Aging Clin Exp Res. 2016 Feb;28(1):89–97.

[4] Troko J, Bach F, Tooz-Hobson P. Predicting urinary incontinence in women in later life: A systematic review. Maturitas. 2016 Dec;94:110–116.

## P-702

### Urinary incontinence predicts the onset of cognitive impairment

N. Veronese¹, M. Noale¹, E. Musacchio², L. Sartori², G. Crepaldi¹.

¹National Research Council, Padova, Italy; ²University of Padova, Padova, Italy

**Introduction:** Urinary incontinence is a common condition in the elderly, particularly in demented people. However, if urinary incontinence could predict the onset of poor cognitive status is poorly known.

**Methods:** Data was gathered from the Progetto Veneto Anziani (Pro.V.A) dataset, a longitudinally assessed cohort of community-dwelling older people in Italy. The mean follow-up period was 4.4 years. Urinary incontinence was defined through self-reported questions regarding the activities of daily living. Cognitive impairment was assessed through mini-mental state examination (MMSE) using a score of less 24/30.

**Results:** In total 1,414 people were included, of them 540 (=38.2%) suffers from urinary incontinence. At baseline, participants with urinary incontinence were significantly older, females and had a lower MMSE score (27.1±1.8 vs. 27.3±1.7, p<0.0001). During follow-up, participants with urinary incontinence had a significant greater decrease in MMSE (-2.29±5.19 vs. -1.38±4.19, p<0.0001) than those without this condition. Subjects with urinary incontinence had a significant increased odd of cognitive impairment at follow-up compared to those without (Odds Ratio (OR)=1.17; 95% CI: 1.06–1.29, p=0.001), after adjusting for 13 potential baseline confounders.

**Conclusions:** Urinary incontinence is a common condition in the elderly and seems to increase the onset of poor cognitive status. Greater awareness is required for physicians to screen/investigate this population at potential higher risk of poor cognitive status.

## P-703

### Urinary retention in older patients with lower urinary tract symptoms: prevalence, associated factors and impact on management

R. Haddad¹, B. Peyronnet², M. Mezzadri³, G. Robain¹, G. Amarenco⁴, GRAPPPA Group (Research Group on Pelviperineology of the Elderly). ¹Rothschild Hospital, Sorbonne University, UPMC Univ Paris 06, AP-HP, GRC 01, Group of Clinical Research in Neuro-Urology (GREEN), Paris, France; ²Pontchaillou Hospital, University Hospital of Rennes, Rennes, France; ³Lariboisière University Hospital, Paris Diderot University, AP-HP, Paris, France; ⁴Tenon Hospital, Sorbonne University, UPMC Univ Paris 06, AP-HP, GRC 01, Neuro-Urology Clinical Research Group (GREEN), Paris, France

**Introduction:** The objectives are to determine the prevalence of urinary retention (UR) in older patients with lower urinary tract symptoms (LUTS), as well as factors associated with UR and impact of UR screening in the management of LUTS.

**Methods:** A cross-sectional multicentric study included all patients