## P-326

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

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

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

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

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

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

## P-327

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

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

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

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

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

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

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

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

## P-328

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

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

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

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

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

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

## P-329

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

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

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

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

**Materials and methods:** Twelve subjects participated in the STS
test. Seven of which were healthy young subjects (25±5.7 years), and five were elderly subjects (80±7.8 years). All subjects performed sit-to-stand motion 5 times at spontaneous pace. The muscle activity was quantified using specific descriptors such as contraction timing and intensity. Two 8×8 HD-sEMG grids were placed on the right and left femoral muscles. Simultaneously, the trunk maximum acceleration obtained by the IMU during STS test was measured. The results between young/older and men/women were compared. In addition, the statistical correlation was computed for age, sex, and body mass index (BMI) of the subjects.

**Results:** The results showed that the sex did not have a significant influence on the motor efficiency in the STS test. However HD-sEMG descriptors related to muscular activity, and the trunk maximum acceleration are discriminant with the age (p<0.001**). The BMI has also significant impact on specific descriptors (P<0.01**).

**Conclusion:** The obtained results demonstrated the potential of the combination of HD-SEMG and IMU data processing for evaluating functional motor abilities. Further developments are promising for the evaluation of motor aging and sarcopenia for clinical routine.

**Acknowledgements:** This work has received support from "Agence National de Recherche" ANR-11-IDEX-0004-02 under Idex "Sorbonne Universités" in the investments for the future program.

## P-330

### Family participation in the care of patients in a geriatric ward.
A literature study

I.V. Gomez Bruinewoud, M.C. Faes. Department of Geriatric Medicine, Amphia Hospital, Breda, The Netherlands

**Introduction:** Family participation during hospital admittance is associated with good nursing practice. Participation of the family in hospital care promotes recovery and well-being of the geriatric patient. The aim of this study is to explore methods of structuring family participation in the hospital care of geriatric patients.

**Methods:** A PubMed, Cochrane, Medline and Biomed Central search was performed. The search terms participation, partaking, hospital, geriatric ward, family member, informal caregiver, relatives, aged, inpatient and elderly were used. All publications were screened for relevant information in title and abstract. The full text of relevant articles was read.

**Results:** 126 articles were identified, after screening title and abstract, the full text of 9 articles was read. Structured multicompartment intervention programs such as the Hospital Elder Life Program (HELP) have been successful in preventing delirium in frail older patients by using trained volunteers. The FAM-HELP program on family caregiver training and intervention to prevent delirium was proven feasible. Cultural aspects determine the degree of participation of family members in hospital care. The participation of family in hospital care should be planned and structured to ensure a safe and satisfying experience for patients and caregivers.

**Conclusion:** There is limited information on methods of structuring participation of family members in hospital care of geriatric patients. The FAM-HELP program is feasible, but focuses mainly on delirium prevention. More research concerning integrating family members in hospital care and extending it to other areas beyond delirium prevention is needed.

## P-331

### Follow-up by phone of elderly cancer patients treated with oral chemotherapy or oral targeted therapy: Results of field experience in a comprehensive cancer center

E. Cini. Institut Paoli Calmettes, Aix Marseille Université, Marseille, France

**Introduction:** Oral therapy (OT) of cancer is widely used. To secure the use of OT in elderly patients (EP) we created a Program of

by phone weekly follow-up (PWPC) assured by a trained nurse practitioner (NP).

**Methods:** Our Program created at the instigation of French Ministry of Health was driven by a medical oncologist (MO) and a NP. Every EP beginning an OT met the NP to detail OT side effects and plan a weekly schedule of phone call (PC). Each PC was standardized with questions concerning, observance, and specific SE. According to the answers, preplanned actions were implemented. Toxicity alerts were triggered and MO advice was required. After 3 months follow-up if no toxicity > grade 2 was observed, EP went out of the PWPC.

**Results:** Between 2015 and February 2017, 244 EP entered the Programm. Mean age was 79 (70–94). 142 EP had solid tumors and 102 hematological diseases. 94% of EP had locally advanced or metastatic disease. Mean duration of follow-up was 159 days (1–515). Mean duration of PC was 8 mn. 39% of EP went out of the PWPC because of tumoral progression, 26% because of good tolerance, 26% because of toxicity, 9% because of EP's refusal or on non medical ground. 39 unplanned hospital admissions occured, only 8 were triggered by the NP. No toxic death occurred.

**Conclusion:** PWPC was widely accepted by EP. Only a randomized trial comparing this Program versus usual care could prove superiority of this follow-up in EP under OT for cancer.

## P-332

### Geriatric outpatient consult in a general Portuguese hospital

R. Tourais Martins, J. Milho, P. Marques, E. Doutel Haghighi. Hospital Vila Franca de Xira

**Introduction:** Geriatric medicine is slowly growing in Portugal, a country where it had been sparse until a few years ago despite the increasing elderly population. With the rising awareness of the challenge involving the aging-related medical issues, it became clear that medical institutions had to adapt. Therefore a multidisciplinary Geriatric Outpatient Consult (GOC) was created in our general hospital on May 2016.

**Methods:** A retrospective, observational and descriptive study was conducted by evaluating the demographic and clinical characteristics and the initial comprehensive geriatric assessment of patients referred for a first GOC from May 2016 to April 2017. Demographic and variable analysis was conducted using Excel 2013®.

**Results:** 50 patients were referred to GOC, 68% were female. Mean age of 81,8years. 46% were referred after an Internal Medicine ward admission. 82% patients took more than 4 drugs, with a median number of drugs taken of 8, reduced to 6 after the first consult. Median Katz score and Lower-Brody score were 5 and 2, respectively. 20% were malnourished and 38% were at risk of malnutrition. 30% and 22% patients had mild and severe cognitive impairment, respectively. 48% had a Yessavage score >6. 84% had more than 3 active medical problems identified.

**Conclusion:** It is clear that there's a population benefiting from being evaluated in GOC. Being in its early beginning, there's still room for improvement but with time we hope to show positive results in terms of enhanced health outcomes for Portuguese elderly patients that could be replicated in other hospitals.

## P-333

### GeroS – gerontological public health indicators inextricably linked by CEZIH

S. Tomek-Roksandic, B. Kolaric, Z. Šostar, M. Huić, I. Popek, N. Tomasovic-Mrcela, S. Mravak, M. Maltaric, M. Lukic, S. Predavec, A. Balenovic, T. Benjak, S. Matijevic-Hlatki. Reference Centre for Health Care of the Elderly of the Ministry of Health of the Republic of Croatia, Center of Health Gerontology, Andrija Štampar Teaching Institute of Public Health

At the initiative of the Ministry of Health Reference Centre RH for
elderly health care - the Center for Gerontology Health Teaching Institute for Public Health "Dr. Andrija Štampar" and the Croatian Institute for Health Insurance established the aims and objectives in the field of computerization of monitoring gerontology and geriatric health care for the elderly. The main goal is to link the provision of gerontological health care at all three levels, from primary health care for the elderly in homes for the elderly with the use of geriatric nursing documentation for geriatric health care to the hospitalized geriatric insured on long-term treatment and to geronto dental services. Gerontology services accompanied Gerosa infection, inextricably linked within CEZIH's (Central Croatian central information system) refer to the monitoring and evaluation of health needs and functional ability of gerontological insured and geriatric patients. The ultimate goal of the project is the computerization of the entire health care for the elderly and geriatric patients, regardless of ownership of institutions in which they are located, as well as Gerontologic insured persons and the elderly in long-term treatment in hospitals and palliative geriatric and psycho geriatric care to gerontological public health indicators were all in one place, the central health care system, integrating it with CEZIH infection via GeroS. Computerization of health care for the elderly will cover the medical services provided to the elderly, but individual gerontological approach which includes institutional and non-institutional care for the elderly provided by the Gerontology Center. All these gerontology health information will be collected in GeroS, CEZIH subsystem for the monitoring and evaluation of health needs and functional ability of geriatric patients and Gerontology insured provided objectification of identifying and evaluating and links all three levels of health care for the elderly. The system will be inextricably linked to CEZIH infection, the most important segments of gerontological health care will be recorded in the planned gerontology e-cards. This will make the entire health system is efficient, adequate, accessible and properly regulated legislatively, with evaluation of geriatrics health care, and the purpose of promoting the protection of the elderly and the rationality of the growing geriatric health care spending.

P-334

Impact of admission medication reconciliation in elderly at risk
of loss of autonomy

A. Potier¹, L. Argoullon¹, C. Motte², L. Bucy², V. Zirabe²,
A. Kearney-Schwartz², C. Perret-Guillaume². ¹Department of
Pharmacy, University of Lorraine, Nancy, France; ²Geriatrics and
Internal Medicine Department, University of Lorraine, Nancy,
France

**Introduction:** Elderly patients at risk of loss of autonomy already benefit from an Hospital Discharge Form including clinical, pharmaceutical and medico-social informations. A clinical pharmacist carries out pharmaceutical analysis and treatment optimisation in a 60-bed geriatric department. This study aims at assessing the impact of the implementation of admission medication reconciliation (MR) in a 20-bed part of the department.

**Methods:** A prospective observational study was carried out from November 2016 to March 2017. The pharmacist consults at least 3 sources of information to establish the best possible medication history (BPMH) on every patient admitted. Proactive MR helps to write the admission medication order (AMO) whereas retroactive MR includes identifying and documenting discrepancies by comparing the BPMH to the AMO in order to amend the AMO where needed. The evaluation uses the standardised MedRec indicators.

**Results:** 143 of the 151 patients benefited from MR, among which 83.9% within 24 hours of admission. MR was proactive in 14% of cases. 187 medication errors were intercepted at admission, on average 1.5 per patient, and eventually 1.1 were corrected. The number of undocumented intentional discrepancies was 0.4 per

patient. 61.8% of patients presented with at least one medication error. 4.4 sources were consulted per MR for information gathering.

**Conclusions:** The large number of medication errors intercepted and corrected at admission demonstrates that MR performed by a clinical pharmacist is a necessary starting point for treatment optimisation and must be combined with a program aiming at reducing the risk of early re-hospitalization.

P-335

In-hospital non-surgery-related mortality is the highest in patients suffering from nervous system, respiratory and cardiovascular diseases: A 5-year cohort study of 6,581,081 hospitalizations in seniors

M. Puzianowska-Kuznicka ¹,², M. Walicka ³, M. Chlebus ⁴,
A. Sliwczynski ⁵, M. Brzozowska ⁵, D. Rutkowski ⁵, L. Kania ¹,³,
M. Czech ⁶, A. Jacyna ⁵, E. Franek ¹,³. ¹Mossakowski Medical Research
Centre, PAS, Warsaw, Poland; ²Centre of Postgraduate Medical
Education, Warsaw, Poland; ³Central Clinical Hospital of the Ministry
of the Interior and Administration, Warsaw, Poland; ⁴University of
Warsaw, Warsaw, Poland; ⁵National Health Found, Warsaw, Poland;
⁶Warsaw University of Technology, Business School, Warsaw, Poland

**Introduction:** Hospitalizations of elderly patients are more frequent than of younger individuals, consume a large amount of financial resources, and carry a high risk of being prolonged and terminated with death. Therefore, the aim of this study was to assess in-hospital non-surgical mortality in a very large group of patients.

**Methods:** Data from the database of the National Health Fund insuring almost 100% of Polish citizens were used for analysis regarding 15,345,025 hospitalizations of adult patients not related to surgical procedures, including 6,581,081 hospitalizations of seniors (≥65 years), that occurred between 2009 and 2013.

**Results:** The mean mortality rate increased with age from 0.12±0.01% in the 18–24 years old group to 4.17±0.08%, 7.39±0.12%, 14.87±0.20%, and 26.65±0.30% in the 65–74, 75–84, 85–94, and ≥95 years old groups, respectively. The mean odds ratio for in-hospital non-surgery-related death also increased with age, reaching 229±15.06 in the ≥95 years old group vs. the youngest adults. In seniors, the mean mortality rate was highest in these suffering from the nervous system, respiratory, as well as heart and vascular diseases (10.22±0.35%, 9.54±0.25% and 7.84±0.27%, respectively), while the lowest mortality rates regarded bone and muscle, as well as head and neck diseases (1.26±0.08% and 0.62±0.08%, respectively).

**Conclusions:** The in-hospital non-surgery-related mortality significantly increases with age. In the elderly, it was highest due to the nervous system, respiratory and cardiovascular diseases. Hospitalizations due to the bone and muscle, as well as head and neck diseases were associated with a low risk of death, even in oldest-old.

P-336

Interest and impact of pocket ultrasonography screening in a
geriatric unit

N. Azulay¹, C. Arlaud², E. Ferrer², J.M. Turpin², L. Van Eslande²,
S. Gonfrier², C. Raffaelli¹. ¹Hospital Pasteur II, CHU de Nice, France;
²Hospital de Cimiez, CHU de Nice, France

**Material and method:** We ran a interventional cross descriptive study in a short term geriatric unit. After consenting, each patient was examined with a pocket-size ultrasound and Doppler device (iViz, Sonosite, Seattle, USA). The examination concerned 15 organs and his duration shouldn't exceed 15 minutes. The impact on patient care was judged after the examination by the pratician in charge of the patient, and was divided in 4 categories: Direct, delayed, neutral, and negative.
**Results:** During 6 months, 501 patients were examined. Median time used was 13 minutes. The examination resulted in a direct impact in 35% and in a delayed impact in 23% of cases, for a total of positive impact of 58%. Negative impact concerned 0.8% of patients. Double reading of ultrasound iconography gave an excellent concordance between both readers. Abdominal examination was the most important part of the examination, and cervical was the less important one. Having a direct impact in patient care didn't impact significantly the duration of stay of patients.

**Conclusion:** Running a routine ultrasound examination at patient's entry in a geriatric unit has a direct impact in patient care in 35% of cases. The versatility of ultrasound's applications, and the recent progresses made with mobility and miniaturization are perfectly adapted with the polypathologic profile of geriatric patients.

## P-337

### Literature review: comparison of the treatment of institutionalized patients exhibiting a degenerative dementia in specialized care units and in conventional extended stay care units between 2006 and 2016

M.-A. Sanchez¹, A. Letty¹, P. Denormandie¹, S. Sanchez². ¹Institut du Bien Vieillir; ²Centre hospitalier de Troyes

**Introduction:** The number of individuals living in designated lodgings for elderly individuals (DLEI) in France continues to increase, amounting to close to 9% of the individuals over the age of 75 in 2012. The aim of our work was hence to provide a review of the recent literature from 2006 to February 2016 regarding the treatment of institutionalized patients exhibiting a neurodegenerative illness in specialized care units compared to conventional care units, according to specific criteria for quality of life, maintenance of higher functions, and in terms of behavioral changes or loss of autonomy.

**Methods:** This involved a selective literature review carried out by a digitally-assisted search. The selected studies had to be less than 10 years old at the time of the data collection. The articles had to be published in English, or in French so as to include published studies that specifically addressed features relating to the French care system. Only studies addressing differences in treatments between specific (SCU) and non-Specific (n-SCU) units were considered, the others being excluded.

**Results:** To compare treatment in SCUs and in n-SCUs, the studies used reproducible and validated scores for assessing quality of life, cognition, behavioral issues, as well as autonomy in each of the units. Use of medicinal therapeutics, hospitalization rates, and physical restraints were also often investigated. Our work focused on recent studies taking into account the latest measures put in place in DLEIs comprising SCUs. A literature review carried out in 2012 that took into account historical studies did not find that SCUs were generally better in regard to providing care for patients with dementias.

**Conclusion:** In conclusion, by specifically considering only the more recent studies, this work has allowed knowledge of the merits of development of specialized units to be updated, particularly in terms of the treatment of dementias.

## P-338

### Management of geriatric syndromes in older adults with cancer: First experience from a newly founded oncogeriatric unit in a German hospital

A.-S. Schmidt, A. Frey, J. Thönes, T.W. Köninger, R.-J. Schulz, V. Goede. *Oncogeriatric Unit, Dept. of Geriatric Medicine, St. Marien Hospital*

**Introduction:** It is unclear which type of clinical setting and infrastructure is best to manage geriatric syndromes in cancer

patients. We here report routine care data after having established an Oncogeriatric Unit as part of a large geriatric clinic at the St. Marien Hospital in Cologne, Germany.

**Methods:** Older adults with cancer were enrolled into the newly founded unit to receive geriatric evaluation and intervention.

**Results:** From January to March 2017, a total of 60 patients were enrolled (53% males, median age 80 years, median Barthel index 45 points). Most were referred from other hospitals (9 from oncology clinics, 16 after tumor surgery, 33 from non-oncology clinics). Referrals were mainly driven by immobility or falls, delirium, and nutritional problems. In 58% and 32% of the patients, respectively, cancer/cancer treatment was key for referral or highly relevant for geriatric intervention planning. The spectrum of cancers included solid (72%) and hematological (28%) malignancies with colorectal cancer, prostate cancer, and lymphoma being most common. In 10 patients (17%), chemotherapy was administered immediately before or after staying at the unit. Oral cancer treatment had to be administered in 7 patients (12%) while staying at the unit. Two patients (3%) received radiation therapy and 4 patients (6%) died. In patients having completed a comprehensive geriatric care program, median increase of the Barthel index was 10 points.

**Conclusions:** Oncogeriatric units within geriatric clinics allow a focused management of geriatric syndromes in older adults with cancer. Comprehensive geriatric care in such patients results in functional improvement.

## P-339

### Measurement of quality of care in elderly in Turkish hospitals using LPZ tool

B. Saka¹, C. Kocaturk², I. Tasci³, S. Akin⁴, S. Şahin⁵, T. Atli⁶, P. Tosun⁷, M. Cankurtaran⁸, H. Yavuzer⁹, M. Varli¹⁰, A. Curgunlu¹¹, A. Tufan¹², Z.A. Ozturk¹³, S. Nalbant¹⁴, M. Firtina¹⁵, M.A. Karan¹⁶. ¹Istanbul University Istanbul Faculty of Medicine; ²Health Sciences University, Yedikule Chest Diseases Hospital; ³Health Sciences University, Gulhane Faculty of Medicine; ⁴Erciyes University School of Medicine; ⁵Ege University School of Medicine; ⁶Ankara Guven Hospital; ⁷Health Sciences University, Erzurum Teaching Hospital; ⁸Hacettepe University School of Medicine; ⁹Istanbul University, Cerrahpasa Faculty of Medicine; ¹⁰Ankara University School of Medicine; ¹¹Istanbul Bilim University School of Medicine; ¹²Marmara University School of Medicine; ¹³Gaziantep University School of Medicine; ¹⁴Maltepe University School of Medicine; ¹⁵Nutricia Turkey, Istanbul; ¹⁶Istanbul University, Istanbul Faculty of Medicine

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

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

**Results:** 281 patients were taken into the study (%53 males). LPZ tool showed 47.2% PU risk, 12.8% stage ≥1 PU and 5% nosocomial PU. Active/reactive support surface (43.8%) and repositioning (33.8%) were used to prevent and treat PU. 42% of the patients had UI (n=118). Main interventions for UI were urinary catheters, medications, bladder training and inlay pads/underslips. Malnutrition (MN) risk was 43%. 68 patients had dysphagia. Energy/protein rich snacks were given to 24.1%, oral nutrition supplements to 15.6% and parenteral nutrition to 8.5%. Fall risk, fall prevalence in the last 12 months and in the hospital were 62.3%, 28.8% and 8.5% respectively. Interventions were evaluation of drugs, exercise, alarm system, low bed and restraints. 18 mechanical, 5 physical, 18 medical and 6 psychological restraints were reported. 171 patients were
complained from pain. 77.2% received pharmacological treatment for pain (paracetamol: 52.6%, NSAI: 15.8%, opioids:22.8%).

**Conclusion:** This study provided important data about 6 care problems in hospitalised elderly in Turkey. Annual measurement of risk/prevalence, preventive measures and treatment interventions will provide better hospital care plans for elderly.

## P-340

### Overcoming challenges of digital self-management in older adults with multimorbidity: The promise of social connectedness?

J. Kuiper¹, A. Jacobs¹, J. Doyle², E. Murphy³, S. Smith², C. Hannigan³, J. Dinsmore³. ¹imec-SMIT, Vrije Universiteit Brussel, Brussels, Belgium; ²NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland; ³TCPHI, Trinity College Dublin, Dublin, Ireland

**Introduction:** Digital self-management for older people holds promises for aging well. However, the adoption readiness remains limited due to barriers in e.g. digital literacy, health and support. Furthermore, older people with multimorbidity (PwMs) are at increased risk of experiencing social disconnectedness. This living lab study explores the role of social connectedness in dealing with the challenges of digital self-management.

**Methods:** Data was collected in Belgium and Ireland as part of the ProACT project, which aims to develop a digital integrated health ecosystem to support self-management for older PwMs. Semi-structured interviews and focus groups were conducted with 38 older PwMs, 17 informal carers, 29 formal care workers and 41 healthcare professionals (HCPs). Subsequently, several co-creation sessions were held with PwMs and informal caregivers. Interviews and focus groups were transcribed and analysed using thematic analysis.

**Results:** Both the expected barriers in digital self-management, and the lack of social connectedness arose. HCPs and formal carers identified loss or lack of social contacts as a key factor in the deterioration of health, wellbeing and self-management abilities. Across stakeholders, the social context was considered an important determinant of PwMs motivation for self-management. Therefore, in ProACT, a tool is developed to support this. We present the concepts of this tool, and the feedback collected on them.

**Conclusion:** This study demonstrates the different dimensions of the importance of supporting social connectedness in digital care solutions for older PwMs. We also explored different concepts to support social connectedness, overcome the common challenges of digital self-management and increase adoption.

## P-341

### Potentially inappropriate prescribing in elderly patient: analyze before/after hospitalization

L. Argoullon¹, A. Potier², A. Valance³, M.A. Manciaux², A. Bonneville¹. ¹Pharmacy, CHRU Nancy, France; ²Geriatric, CHRU Nancy, France; ³Emergency CHRU Nancy, France

**Introduction:** In the context of improved medication management in the elderly patient, we were interested in the reevaluation of drug prescription during hospitalization. The aim of this study is to assess the prevalence of inappropriate prescribing in the elderly patient before and after hospitalization.

**Methods:** This is a descriptive and retrospective study of drug prescriptions in a non-geriatric unit. Prescriptions were analyzed using STOPP/START v2 tool.

**Results:** Seventy-two patients over 65 years-old were included. A polymedication of 5 or more drugs was reported in 76% of cases (n=55) at entry and in 90% (n=65) at discharge. Inappropriate prescribing rate with at least one STOPP criteria decreases from 58% to 29% after hospitalization (p<0.0005). Potential prescribing

omissions rate decreases from 46% to 42% after hospitalization (p<0.5465). Drugs most frequently involved were benzodiazepines (21%), antiplatelet agents (11%) and opiates (8%). There was improvement rather qualitative than quantitative of prescribing after hospitalization.

**Conclusion:** Collaboration between different health professionals seems essential to ensure optimal medication management. This pharmaceutical follow-up approach should make it possible to undertake a multidisciplinary collaboration.

## P-342

### Preliminary studies using wearable motion sensors to identify elderly persons with Parkinson's Disease

M.E. Williams¹, J.W.E. Williams², J.C. Williams³, ¹UNC Chapel Hill USA; ²McGill University Canada; ³UNC Wilmington USA

**Introduction:** Small wearable microelectronic sensors (accelerometers) can detect motion, gravitational acceleration, and velocity with six degrees of freedom (forward-backward, up-down, and side-to-side plus rotational vectors). The purpose of this study was to test the feasibility of using these motion sensors to create new analytical tools called biokinetographs (BKGs) to identify persons with Parkinson Disease (PD).

**Methods:** Twenty-two members of a PD support group with clinically diagnosed PD (mean age 68.6) and seventy-six members of a life-care community (mean age 80.3) agreed to participate. Subjects wore wristwatch-sized accelerometers attached with Velcro straps on their right wrist, sacrum, and over each ankle while walking a closed 30-meter course.

**Results:** Principal component analysis of the ankle sensor BKGs identified gait speed, right single stance time, double stance time, left heel strike amplitude, difference in toe off amplitudes and left spectral peak and right spectral frequency as discriminating PD from no PD subjects. A regression model using these variables identified 20 of 22 of the people with PD (90.9%) and 71 of 76 people without PD (93.4%). Remarkable visual differences in "functional walking signatures" are evident on the BKGs of persons with PD.

**Conclusion:** We conclude that BKG functional signatures may be associated with clinically obvious PD and suggest that this area is rich in potential for additional validation studies using this objective, noninvasive, wearable technology.

## P-343

### Role of dependency on overall survival in elderly cancer patients: results from a French study

A. Galvin¹, C. Helmer², C. Bellera¹, G. Coureau¹, B. Amadeo¹, V. Rondeau³, M. Rainfray⁴, P. Soubeyran⁵, F. Delva¹, S. Mathoulin-Pélissier ¹. ¹Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; ²Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Leha team, UMR 1219, Bordeaux, France; ³Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Biostatistics team, UMR 1219, Bordeaux, France; ⁴Department of Clinical Gerontology, Bordeaux University Hospital, Pessac, France; ⁵Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonie, Comprehensive Cancer Center, Bordeaux, France

**Introduction:** Several population-based studies have reported disparities on survival among elderly cancer patients related to age, gender, marital status, socioeconomic status, stage at diagnosis and comorbidities. However, these studies did not consider impairments, and none was carried out in Europe. Our aim was to study determinants of overall survival in French elderly cancer patients.

**Methods:** We merged data from four cancer registries (one general and three specialized) and three elderly cohort studies (PAQUID, 3-City and AMI) to identify elderly cancer patients. We included
subjects aged 65 years and over, alive January 1, 2005 and resident of Gironde, a French department, with a validated cancer diagnosis recorded in one of the four cancer registries from 2005 through 2014. Primary endpoint was all-cause survival. Studied variables were demographic and socioeconomic, cancer-related, health, dependency, neurocognitive and area factors. Cox proportional hazard models were fitted.

**Results:** We included 486 elderly cancer patients, 263 (54.1%) of which died by the end of the follow-up. In multivariate analyses, advanced age, male gender, residence in urban area, dependency, advanced stage at diagnosis and no treatment were associated with lower overall survival (p<0.05).

**Conclusions:** Association between age, gender and stage and survival are commonly reported in the literature. Regarding treatment, results are heterogeneous mainly because studies are about specific cancer types and/or treatments. Studies on urban residence are scarce and do not report any association. Dependency has not been studied, but studies in the general elderly population report an association with survival.

## P-344

### Structuring diabetes mellitus care in long term nursing home residents

D. Fitzpatrick¹, E. Ibrahim¹, S. Kennelly², D. O'Neill², M. Sherlock³.

¹Peamount Healthcare, Dublin, Ireland; ²Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Ireland;

³Department of Endocrinology and Diabetes, Tallaght Hospital, Dublin, Ireland

**Introduction:** Nursing home residents have more complex care needs with higher levels of comorbidity, disability and cognitive impairment. It is estimated that 1 in 4 nursing home residents has diabetes mellitus. These patients are particularly vulnerable and require special attention.

**Methods:** We compared current practice in the 44 long term residents in Peamount hospital with the standards recommended in the Diabetes UK "Good Clinical Practice Guidelines for Care Home Residents with Diabetes".

**Results:** Of 44 residents, 11 were diabetic. Only one resident was screened for diabetes on admission. Residents did not have specific diabetes care plans. There were no algorithms for the management of hypoglycaemia, hyperglycaemia or diabetic complications. 73% of residents with diabetes had a HbA1c checked in the last year, but there was no formal schedule of HbA1c monitoring. There was no protocol for screening for diabetic foot disease and retinopathy with low uptake of the national retinal screening and footcare programmes. In house access to dietetics and chiropody was provided.

**Conclusions:** Despite some elements of good practice, diabetes care was delivered on an ad hoc basis without screening for diabetes, individualised diabetes care plans, documented glycaemic targets, or scheduled monitoring for complications. National and local policy to guide management of diabetes mellitus in long term care needs to be developed. There should be individualised diabetes care plans and clear policies for the management of hypoglycaemia, hyperglycaemia and long term diabetes complications.

## P-345

### Surgical medical support team of Hospital Sur de Alcorcon and geriatric unit in Quironsalud Hospital group in Madrid: First 5 years

F.J. Soria Perdomo, L.M. Martín Rodríguez, J. Ramírez Peñaherrera, M. Pastor de Blas, C. Sánchez Mingo, R. García de Viedma, A.M. Moreno Collado. MD Quironsalud Hospital Group, Madrid, Spain

**Introduction:** Since 2012, in Hospital Quironsalud Sur de Alcorcon,

Hospital La Luz and Private consults of Fundación Jiménez Diaz private geriatric consults that are part of the consultations offered by Quironsalud. There is also a support team attending surgical patients in Hospital Sur de Alcorcon.

**Aims:** To study the activity of multidisciplinary team and the consultations in Quironsalud private hospitals to determine future areas of development.

**Methods:** Activity of geriatric unit were registered. It was recorded the number of consultations, also the visits for follow up both inside and outside the hospitals. E-consults were also recorded.

**Results:** Consultations of geriatric units receive an average number of 150 patients every month. Surgical support team performs 200 visits every month. Patients with comorbidities or frail were transferred to consultation.

**Conclusions:** In the last five years geriatric consultation is one of the services offered by Quironsalud Hospital Group. Contributing to increasing fidelity of elderly patients to our hospital. Also we had the possibility to create different geriatric circuits in order to work to different services such as Neurology and Psychiatry.

## P-346

### Telemedecine in nursing homes and geriatric evaluation: An option to therapeutic optimization. an observational study in Bordeaux University Hospital

N. Bourdin, E. Thiel, R. Fossaert, N. Salles. Geriatrics Department of Bordeaux University Hospital, Pessac, France

Geriatric items represent 62% of teleconsultations currently leading in Aquitaine for nursing home residents. An observational study was led since november 2014 to march 2017 for therapeutic optimization evaluation according to the START & STOPP list. A descriptive analysis and a stepwise logistic regression were performed. Therapeutic optimization represented 86% of total acts. Misuse was observed in 55% of cases (neuroleptics – 38%, antidepressants – 22%, cardiovascular treatments – 20%), underuse in 53% of teleconsultations (antalgic treatments – 35%, anxiolytics – 24%). Overuse concerned 11% of cases (anxiolytics – 28%, neuroleptics – 18%, antihypertensive treatments – 10%). Propositions to stop or decrease dosage was associated with: getting a diagnosis by experts (OR=2, p=0.004), at least one additional item covered during the teleconsultation (OR=2.5, p<0.0001), the presence during the telemedecine act of: care assistant (OR=1.6, p=0.03), coordinating doctor (OR=1.7, p=0.02), and psychologist (OR=1.6, p=0.03). Additional treatment or increase dosage was associated with: ≥1 comorbidity classified Cumulative Index Rating Scale for Geriatrics = 4 (OR=2.5, p=0.021), at least one additional item covered (OR=1.8, p<0.04), the presence of: family (OR=1.5, p=0.08), and care assistant (OR=1.8, p=0.008). Telemedecine represents one solution to therapeutic optimization for dependant nursing home residents. Its deployment must be encouraged according to french health autority.

## P-347

### That's how I always did it – Adaptability in older people

V. Moser-Siegmeth, D. Hebesberger, M. Weninger, M.-C. Gambal, M. Jelovcak, B. Prytek, I. Swietalsky, D. Würzl, C. Fida, V. Staus. Haus der Barmherzigkeit

Adaptability is the capacity to adjust without great difficulty to changing circumstances. Within our project, we aimed to detect whether older people lose this ability to adapt or not. There is lack of evidence in the literature how the adaptability of older people changes over the time. The following research questions were generated: (1) Are older residents of a long-term care facility able to adapt to changes within their daily routine? (2) How long does it take for older people to adapt? This study was designed as a convergent parallel mixed method intervention study carried out
within a four-month period and took place within seven wards of a long-term care hospital in Vienna, Austria. As a planned intervention, a change of meal-times was established. The inhabitants were surveyed with qualitative and quantitative questionnaires and diaries before, during and after the intervention. In addition, a survey of the nursing staff was carried out in order to detect changes of the people they care for and how long it took them to adapt. Quantitative data was analyzed with SPSS, qualitative data with a summarizing content analysis. The results show that the ability to adapt to changes does not deteriorate with age or by moving into a long-term care facility. This can be confirmed by the nursing staff. Although there are different determinants like the health status that make an adjustment to new situations more difficult. This study is able to serve as the basis for further research.

## P-348

### The benefit of mixed methods in a nursing research project

V. Moser-Siegmeth, D. Hebesberger, M. Weninger, M.-C. Gambal, M. Jelovcak, B. Prytek, I. Swietalsky, D. Würzl, C. Fida, V. Staus. *Haus der Barmherzigkeit*

Mixed methods research is an approach to inquiry involving collecting both quantitative and qualitative data. The core assumption is that the combination provides a more complete understanding of a research problem. In 2016 we initiated a project at seven geriatric units of a nursing home shifting the mealtimes towards evening. The aim of this intervention was to assimilate the day-structure of the nursing home towards the day-structure at home before entering. With the added value of mixed methods we try to detect whether adaptability gets lost over the time in nursing home residents. Working systematically through the literature, we found out that there is paucity of evidence pointing towards the meaning of adaptability. In order to close this gap we explored the topic with a convergent parallel mixed method intervention study by integrating the opinion of nursing home nurses on the one hand and patients on the other hand. Qualitative interviews and quantitative questionnaires with patients and nurses were carried out as well as a diary, which was kept by the patients. In our presentation we will provide an account of this particular aspect of the project and discuss the process of developing a mixed methods research design. We illustrate how the combination of qualitative and quantitative methods can help to better understand complex phenomena like the one under study and we critically appraise the pros and cons of our approach.

## P-349

### The experience of being a family caregiver in Flanders: Does tube feeding in patients with oropharyngeal dysphagia affect my quality of life?

T. Claey}s. Vives University College, Department of Health Care, Bruges, Belgium

**Introduction:** Flanders is facing an increasing number of challenges such as limited financial resources, socio-demographic changes, rising health care cost and increasing health demands. Due to this issue a shift from institutional care towards home care is noted. Many medical conditions, diseases and disorders require the use of tube feeding in non-institutional settings. For this reason the importance of informal caregivers is growing in the changing landscape of healthcare. The objective of this study was to examine how family caregivers in Flanders experience taking care for adult patients with oropharyngeal dysphagia who need nutrition support.
**Methods:** The qualitative methodology for this study was based on the grounded theory to analyze the experience of being an informal caregiver. Data were gathered by individual in-depth interviews. An inductive approach was applied to identify and categorize the

data. Selection of participants is based on ad random sampling but the appropriate number will be guided by data saturation. All in-depth interviews were tape-recorded, transcribed and scrutinized to identify the main themes.

**Results:** Ten informal caregivers participated the in-depth interviews. Saturation will determine the majority of qualitative sample size. The basic research question is an opportunity to delve more deeply into different issues of this topic if we want to investigate and understand the experiences of informal caregivers in Flanders. Further interviews are needed.

**Conclusions:** Informal caregivers do experience important changes in their lives and informal caregiver burden is well described in literature. Strategies are needed for family caregivers in Flanders to help and reduce the psychosocial, occupational and economic burden associated with informal care.

## P-350

### The geriatric patient in the global payment with standardization

N. Berg¹, C. Petit², P. Heirman³, N. Laport⁴. ¹CHR de Liège Service de gériatrie Belgium nicolas.berg@chrcitadelle.be; ²CHR de Liège, service de gériatrie Belgium; ³CHR de Liège, service RHM Belgium; ⁴CHU de Liège, Medical and Economic Studies Department Belgium

**Introduction:** The Belgian Ministry of Social Affairs and Public Health together with the National Institute for Health and Disability Insurance (RIZIV-INAMI) will be introducing a Global Payment with Standardization (GPS) the first of January 2018. This is a prospective hospital payment system for pathologies of low variability. In a first phase, it is estimated that €438 Million remuneration of medical specialists will now be distributed based on a lump sum per APR-DRG's (3M™). This replaces a fee-for-service payment system. However, this new system doesn't differentiate between age groups. The lump sum remuneration per APRDRG will not take in account if the patient is pediatric, adult or geriatric. Even when the medical approaches for the same pathology will clearly be very different.

**Methods:** We examine if it will be relevant to add age or admission in a geriatric ward as an extra criterion for the 32 APR-DRG's adopted in the new GPS system. We use data from two hospitals (one teaching hospital and one general hospital, 800-1000 beds each). Data from more than 20.000 hospitals stays from patients older than 70, hospitalized in 2014-2016 were analyzed.

**Results:** Data shows that although geriatric patients are not surprisingly more often classified in pathology groups with a higher Severity of Illness (less than 5% has a Sol of 1), this is not enough to explain and compensate the differences observed in medical approach, measured by the fee-for-service payment.

**Conclusions:** A refinement of the new GPS system for the geriatric patient is thus necessary

## P-351

### The multi-disciplinary team (MDT) is essential to reduce length of stay (LOS) in the acute frailty unit (AFU)

S. Mather, S. Pradhan, L. Oldham, N. Gillibrand. *Royal Bolton Hospital, Greater Manchester, UK*

**Introduction:** MDT assessments of patients can improve LOS. We aimed to assess whether a seven day enhanced therapy service improved LOS compared to standard five day in AFU.

**Method:** A retrospective observational study at Royal Bolton Hospital in Greater Manchester. Patients were admitted from assessment and emergency departments. The "enhanced" service was from 3/8/2014-31/7/2015 and the 'standard' five day from 18/8/2015-14/8/2016. Data was collected for demographics, LOS and admission reason. Our primary outcome was LOS. Our secondary outcomes were the LOS for patients awaiting 24hour care, intermediate care (IC), and discharge home. Data was analysed with Excel.
**Results:** In 2014/15 1272 vs 946 in 2015/16 were admitted. In 2014/15 common admission reasons were falls (280/22%), respiratory conditions (140/11%), urinary tract infection (UTI) (109/8.6%). In 2015–2016 common admission were falls (292/30%), respiratory conditions (66/7%), UTI (95/10%). Average LOS in 2014/15 was 8 days (d) (median=6, n=1272) compared with 10d (median=8, n=946) in 2015/16 (p<0.0000001). Average LOS in 2014–15 of those discharged to 24 hour care was 20d (median=17, n=60) and intermediate care was 11d (median=8, n=215). The average LOS in 2015–16 of those discharged to 24 hour care was 21d (median=15, n=33) and intermediate care was 14d (median=11, n=120). The average LOS of those discharged home increased from 5d (median=5, n=504) in 2014/15 to 6d (median=6, n=297) in 2015/16. Outlying patients were similar in both groups with 51/31 respectively.

**Conclusions:** LOS was improved with a seven day therapy service suggesting that having a proactive therapy team can enhance flow within an acute unit.

P-352

**The ROSIE project. A comprehensive review of field trials of social robots in the geriatric sector in France: practices, socioeconomic aspects and ethical framework**

M. Pino¹, E. Berger¹, L. Rochaix², J.C. Dupont², B. Dervaux³, I. Dufour⁴, E. Karoubi⁵, C. Monnet¹, A.S. Rigaud⁶. ¹Gérond'if; Hôpital Broca-LUSAGE, Paris, France; ²Hospinnomics, Paris, France; ³Université Lille 2; ⁴Gérond'if, Paris, France; ⁵Gérond'if, Hôpital Paul Brousse, Villejuif, France; ⁶Hôpital Broca-LUSAGE, Université Paris Descartes, CEN Stimco, Gérond'if, Paris, France

**Introduction:** In France more than 100 geriatric institutions are taking part in field trials of social robots. However, results from these tests are little known. This is mainly due to their exploratory nature and to the discontinuity between research and clinical practices. Despite the rapid progress of robot-mediated interventions, there is no guide to best practices in this area. Also, it lacks a consensual ethical framework to inform these interventions. Moreover, their economic and organizational impact have rarely been addressed. The ROSIE project's main objective is to conduct a comprehensive review of recent and current trials of social robots, within the field of geriatrics, in France.

**Methods:** Feedback from field trials will be collected through a survey and a series of case studies. Experiences will be analyzed adopting a multidimensional perspective (clinical, organizational, economic, social, ethical, ...).

**Results:** Outputs of the project will be: (1) an international state-of-the-art on the use of social robots in geriatrics; (2) a comprehensive inventory of field trials in France; (3) three tools to support the implementation and evaluation of these interventions: best practices guide, ethical chart, and methodological manual for their economic evaluation.

**Conclusions:** Results will help to better understand uses and limitations of robotic interventions: (a) clinical indications, (b) factors encouraging acceptance and adoption; (c) logistic requirements; (d) resources involved; (e) ethical issues. Besides its focus on these innovative practices, the project proposes an original approach by relying on existing trails and capitalizing on them.

P-353

**The use of a new telemedicine system in nursing home (NH)**

C. Dalla Costa, S. Barbieri, A. Bracco, E. Conterno, E. Lenta, L. Neri, D.N. Sabet, G. Viglino. Division of Nephrology, Dialysis and Clinical Nutrition, Department of Medicine, San Lazzaro Hospital, Alba (Cn), Italy

**Introduction:** Considering the difficulty of ensuring therapeutic-care's continuity for patients in NH, we started a monitoring project

through the use of a specific telemedicine system called eViSus®. Aim of this study was to verify the system's effectiveness in various therapeutic-care contexts.

**Methods:** Remote monitoring has been achieved through eViSus®, composed by:

* Totem station in NH: it consists of touchscreen display, high-resolution webcam, mic/speaker, PC, and communication box;

* Control Station in hospital: it consists of display, webcam and PC with client software. During the A/V remote sessions the operator controls zoom and movements of the remote totem camera.

* Central Control Server: server software in the cloud manages totem and control stations through encrypted channels preserving communications privacy and integrity.

**Results:** From August 1st, 2016 to April 30st, 2017 the followings have been performed:

* 107 examinations in malnourished patients. Patient's clinical evaluation was always possible;

* 6 evaluations of 6 patients suffering from pressure ulcers. Human resources involved: a medical doctor and a dietician in hospital and a healthcare assistant in NH. Moreover, NH nurses were supervised by specialized nurses in hospital in the following activities (training and retraining):

* Vascular device's medications: 13 video-consults in 6 patients;

* Automated Peritoneal Dialysis management: 53 connection/disconnection procedures in 2 patients.

**Conclusions:** eViSus® system's benefits were numerous:

* Different clinical evaluations avoiding patient's transportation;

* Better audio/video quality compared to traditional video conferencing devices allowed to replace the face-to-face visit;

* Limited needs of human resources;

* Educational capability by experienced staff, with the chance of repeated audits, eventually practicable also at domicile.

P-354

**Value based health care in the elderly hospital population**

C.J. Kalisvaart, R. Vreeswijk, D. Zwijnenburg. Spaarne Gasthuis

Based on the research of Professor Porter (Harvard), Value-Based Health Care is a framework for restructuring health care systems with the overarching goal of value for patients—not access, cost containment, convenience, or customer service. It is outcome based. The International Centre of Health Outcomes (ICHOM) is a leading initiative for constructing evidence based methods to evaluate patient based outcomes. In the region of our hospital we decided to put this into practice for elderly patients with a hip-fracture. There is no ICHOM program for elderly patients with hip-fracture, so we concentrated on the program for frail elderly in combination with the Dutch hip-fracture audit. Based on these values we analysed data from previous years and constructed “mirror talks” with patients and their caregivers. From this information we used 6 values for outcome improvement for the coming 12 months: mortality, morbidity, delirium, length of hospital stay and costs, length of rehabilitation and costs and patient experience and satisfaction. We then divided the hip-fracture pathway into 3 major steps:1. The patient before the fracture: vulnerable at home or in the nursing home with all kind of problems (e.g. polyfarmacy, comorbidity, cognitive disorders and ADL-dysfunction) and (unknown) wishes regarding to treatment restrictions and rehabilitation institutions. We developed a leaflet for all the frail elderly in our region to store at home. 2. Intra hospital: from the ambulance to 3. The start of rehabilitation in a centre or at home. Now we are at a weekly basis evaluating effects on the 6 outcomes and costs with GP, rehab drs and (para0medics) to sharpen the program even further. With very satisfied patients.
P-355

**What older adults in Lithuania think about gerontechnologies, specifically fall detectors**

G. Damulevičienė¹, V. Lesauskaitė¹, A. Janavičiūtė²,
E. Kazanavičius², J. Knašienė¹, U. Markevičiūtė¹. ¹Geriatric
Department, Lithuanian University of Health Sciences; ²Kaunas
University of Technology, Lithuania

**Introduction:** Although the Lithuanian population is ageing, the expectancy of autonomous life in older people remains one of the shortest in Europe. Falls are particularly common in the older population and it is known that over 30% of people fail to get up unaided, which can result in severe consequences. Fall detection devices can noticeably reduce the fear of falling and ensure that the person receives aid in time. One of the aims of the research project supported by the Research Council of Lithuania "Smart Gerontechnology for Healthy Ageing" (grant No.SEN-06/2016) was to determine the knowledge about various technologies and the opinion about the usage of fall detection devices among older adults.

**Methods:** 308 patients (≥60 years): 56 patients of Geriatric Department and 252 older adults living in the local community were questioned about the usage of technologies and their opinion about fall detectors.

**Results:** The mean age of respondents was 75.8±6.1 years, 80.2% were female. A significant relationship was found between lower education and rarer usage of refrigerators, vacuum cleaners and washing machines, mobile phones and the Internet. A significant relationship was found between higher education and the intention to test new technical devices (P<0.001). 33% of respondents knew about fall detection, 80% of respondents wanted to use fall detection devices, especially females. Only 65.5% of respondents would have the Internet access if needed for the fall detection.

**Conclusions:** Older adults with higher education were more informed about technologies. Most of older adults would like to use fall detectors.

**Area: Acute care**

P-356

**A case of Cefepime-induced encephalopathy in an elderly patient**

J. Cabradilla, E. Marasigan, D.Y. Yoong. *Tan Tock Seng Hospital, Singapore*

Cefepime-induced encephalopathy has been sporadically reported worldwide. Previous reports documented cases of encephalopathy and seizures especially in patients with renal impairment. We report a case of an elderly gentleman with diabetic nephropathy who was given Cefepime. Cefepime was empirically started for catheter-related UTI and dose adjusted according to the creatinine clearance. On the 3rd day of Cefepime, patient developed oral and upper limb dyskinesia together with altered mental status. Blood tests did not show any electrolyte imbalances. Urine and blood culture were negative. Magnetic resonance imaging of the brain was negative for any acute lesions. Electroencephalogram was suggestive of severe diffuse encephalopathy. Cefepime was immediately discontinued. Patient received anti-convulsant medications to cover for a possible seizure. Within 4 days of discontinuing Cefepime, there was complete resolution of the symptoms and patient returned to his baseline sensorium. Based on this case, Cefepime-induced encephalopathy can still occur despite administering a renally adjusted dose. Closer monitoring of patients with renal impairment given Cefepime should be done especially in elderly patients. A revision of the recommended dose may be needed for elderly patients with renal impairment.

P-357

**A case presentation of a necrotic scalp rash misdiagnosed for a Herpes Zoster infection**

D. Kondova. *Department of Geriatric Medicine University Hospitals of Leicester, United Kingdom*

**Introduction:** Giant cell arthritis (GCA) is the most common form of systemic granulomatous vasculitis in elderly. Scalp necrosis is a rare unusual complication and can be the first presenting feature of GCA.

**Methods:** I am presenting a case of necrotic lesion affecting right temporoparietal area in a 75 years old man.

**Results:** The man presented to his GP with a necrotic skin rash with a size of five pence coin which was tender on palpation. He received a seven-day course of Acyclovir as it thought to be Herpes Zoster infection. The lack of resolution of symptoms post the antiviral treatment prompted the GP to seek second opinion. This man had a history of lethargy and a stone weight loss for a period of 4 month. He denied any other constitutional symptoms, polymyalgia symptoms or jaw claudication. He did not complain of headache but he reported tenderness at the abnormal area of skin necrosis and the adjacent vessel. On clinical examination, there was evidence of necrotic round skin lesion in the temporoparietal area and tender on palpation prominent vessel attached to it. The lesion was covered by a scab. There was no tongue necrosis or visual field defect. The biochemical markers for inflammation were raised. The differential diagnosis of GCA came as a possibility and this was confirmed with the temporal artery biopsy.

**Conclusion:** Skin necrosis is a rare clinical presentation of GCA. Clinically, it might be misdiagnosed as erosive pustular dermatosis, pyoderma gangrenosum or herpes zoster infection.

P-358

**Acute confusional syndrome in the elderly - case report**

M. Gonçalves, L. Brites, E. Gaspar, M. Veríssimo. *Internal Medicine Service of Centro Hospitalar e Universitário de Coimbra*

The acute confusional syndrome is a frequent reason to attend the emergency department (ED) in the elderly. It is an entity characterized by altered state of consciousness, global affection of cognitive functions, disorientation, psychomotor agitation/inhibition, and sleep-wake disorders, which arise suddenly, may be fluctuating or recurrent, and being most often associated with infection or iatrogeny. A 74-year-old woman went to the ED for disorientation and agitation with 4 hours of evolution. She was disoriented, non-cooperative, verborreic, subfebrile (37.8°C), hemodynamically stable, with no other changes. Analytically, leukocytosis (12,400 G/L) and anemia (hemoglobin 11.4 g/dl). Chest X-ray and rapid urine test not suggestive of infection. Computed tomography (CT) showed multiple expansive lesions with surrounding edema and left midline deviation, suggestive of brain metastases. She was admitted in the internal medicine department to investigate the possibility of occult neoplasm. Several complementary diagnostic tests were performed, including thoracoabdominal-pelvic CT scan showing pericymetric nodules in the liver and an area of eccentric parietal thickening in the sigmoid loop compatible with primary tumor lesion. Rectosigmoidoscopy with a biopsy confirmed a presence of adenocarcinoma. During the hospitalization she maintained corticotherapy with dexamethasone and, even after performing palliative cerebral radiotherapy, remained confusional. Thus, she was referred to a Palliative Care Unit after consensus in the therapeutic decision meeting. The acute confusional syndrome in the elderly, as demonstrated, requires high clinical suspicion, special attention to clinical data and a careful selection of complementary exams to the etiological diagnosis and for a correct therapeutic approach.
P-359

**An early geriatric follow-up visit results in more hospital-initiated treatments compared to an early geriatric follow-up phone call**

L. Holst Pedersen, I. Barat, M. Gregersen, E.M. Damsgaard. Aarhus University Hospital, Aarhus, Denmark

**Introduction:** In a previous study, we found that an early geriatric follow-up visit significantly reduced readmissions among geriatric patients admitted to the emergency department (ED). This effect was strongest the first week after discharge. Therefore, we investigated and compared hospital-initiated treatments performed during the first week after discharge in the intervention group and the control group, respectively.

**Method:** The study was a quasi-randomised controlled trial. The participants were 75 years or older, admitted to the ED with one of the following diagnoses: pneumonia, chronic obstructive pulmonary disease, dehydration, delirium, constipation, anaemia, heart failure, urinary tract infection or other infections. Patients were discharged directly from the ED. Intervention group patients received a follow-up visit, the patients in the control group received a phone call. Hospital-initiated treatment was registered through patient records.

**Results:** Treatment of 524 patients was registered from 1st December 2015 until 31th November 2016. During the first week after discharge more patients of the intervention group experienced changes in medication (77% vs 24%, <0.001), blood tests (57% vs 23%), increase in the amount of home care (17% vs. 6%p<0.001), and treatment with iv. antibiotics in the home (9% vs. 5%, p=0.05). Also, a tendency towards more patients having fluid replacement therapy was observed (15% vs. 10%, p=0.09).

**Conclusion:** An early geriatric follow-up visit resulted in more hospital-initiated treatments compared to an early geriatric follow-up phone call.

P-360

**Anticholinergic burden scales disagree on degree of burden in an older inpatient population**

C. Adams¹, T.J. Welsh². ¹Royal United Hospitals Bath NHS Foundation Trust; ²Royal United Hospitals Bath NHS Foundation Trust; University of Bristol

**Introduction:** Medications with anticholinergic properties are widely used in clinical practice. The concept of cumulative anticholinergic burden is widely accepted and has been associated with adverse outcomes. Any attempt to reduce anticholinergic burden relies on the methods used to quantify it. This abstract reports work from a quality improvement cycle testing the agreement between different anticholinergic burden scales on a cohort of older patients admitted to an acute frailty unit.

**Methods:** A retrospective review was completed of the first 100 admissions to the acute frailty unit from the 1st of February 2017. Medication on admission was recorded. Anticholinergic burden was then calculated using the Anticholinergic Cognitive Burden Scale (ACB), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Drug Scale (ADS). The median score per patient was compared.

**Results:** Data was available from 86 admissions. Mean age 83 (SD 7.5), 63% female. There was a significant difference in median anticholinergic burden as quantified by the different scales ACB 1 (IQR 0–3), ARS 0 (IQR 0–1), ADS 1 (IQR 0–2) P<0.001. There was a clinically significant difference in those identified as having significant anticholinergic burden ACB 23 (27%), ARS 12 (14%) and ADS 18 (21%).

**Conclusions:** The different scales do not agree on the cumulative anticholinergic burden experienced by individuals in this patient group. The clinical use of different scales to target and reduce anti-

cholinergic burden would result in meaningfully different changes to medication for patients. These findings are highly relevant to the development of potential interventions to reduce anticholinergic burden.

P-361

**Are patients who are admitted following a fall more likely to have a multi-factorial falls risk assessment (MFRA) than those admitted for other reasons?**

N. Vasilakis¹, S. Rai¹, C. Tsang², S. O'Riordan¹. ¹The Royal College of Physicians, London, UK; ²The Royal College of Surgeons of England, London, UK

**Introduction:** The National audit of inpatient falls (2015) evaluated hospital services primarily against NICE CG161 which makes recommendations to prevent falls for all hospital inpatients aged 65+. This included a case note review of up to 30 patients (per hospital) aged 65+ who were admitted for any non-elective reason (not just falls).

**Methods:** Using 23 questions in the audit relating to MFRA, comparisons were made between patients who were admitted for a fall or other reasons. The two patient groups were compared using the Mann-Whitney test or chi-square test, as appropriate.

**Results:** Approximately a quarter of patients were admitted because of a fall (23.5%; n=1,140/4,846). 12 of the 23 audit questions were statistically significantly more frequently reported for patients who were admitted because of a fall (p<0.05): 1. Asked about history of falls; 2. Assessed for cognitive impairment; 3. Assessed for presence/absence of delirium; 4. Assessed for fear of falling; 5. Mobility care plan; 6. Record of use of walking aids; 7. Lying and standing blood pressure measured; 8. Assessed for medications that increase falls risk; 9. Medication review with regard to falls risk; 10. Falls care plan; 11. Given written information about falls risk; 12. Given oral information about falls risk.

**Conclusions:** NICE CG161 states that all patients aged 65 years or older (not just those admitted following a fall) should be considered for a MFRA however, a range of assessments and interventions for prevention of falls were statistically more frequently reported for patients admitted because of a fall than for other reasons.

P-362

**Atypical illness presentation in elderly patients evaluated in the emergency room**

O. Saavedra¹, M. Bermudez¹, B. Cámara¹, G. Guzman¹, B. García¹, M. Fernández¹, C. Herrera¹, J.J. Solano². ¹Hospital Monte Naranco, Oviedo, España; ²Director of the elderly medicine department at Hospital Monte Naranco, Oviedo, España

**Introduction:** Elderly patients with an infectious disease, frequently manifest atypical symptoms which implies greater difficulty in making a proper diagnosis. Our objective was to determine the incidence of atypical symptoms in elderly patients evaluated by a team of geriatricians in the emergency department and the different forms of presentation of the disease.

**Methods:** We conducted a prospective descriptive study on 148 elderly patients presented at the emergency unit and diagnosed with pneumonia or urinary tract infection. Pneumonia was established as the appearance of pneumonic condensation in Rx and urinary infection as the existence of pyuria in the urinary sediment.

**Results:** A total of 148 patients were included, with a mean age of 87.5 years. 60.1% had pneumonia and 39.9% had a urinary tract infection (UTI). 54.1% were women, the average Barthel Index was 55 points, 45.3% had cognitive impairment and 58.8% lived with family. According to the triage Manchester were classified as minimum Urgent (yellow) 96.4%. 73.6% of the patients presented some atypical data (Pneumonia 66.3%, UTI 84.7%), in 27% of the
cases the clinic was exclusively atypical (Pneumonia 11.2%, UTI 51%). Patients with IB <40 or with cognitive impairment are more likely to present atypical clinic. We found no association between atypical clinical presentation or cognitive impairment and death during hospitalization.

**Conclusions:** Atypical illness presentation in elderly patients in the emergency department is highly prevalent, more common in patients with cognitive and/or previous functional impairment. These conditions were associated with higher mortality during admission.

P-363

Audit presentation on CT head requests in patients over the age
of 70 presenting to acute admissions units at Leicester Royal
Infirmary, United Kingdom

D. Kondova¹, F. Mehedi¹, C. Phyu², D. Lachani¹. ¹Department of
Geriatric Medicine, University Hospitals of Leicester, United Kingdom;
²Department of Acute Medicine University Hospitals of Leicester,
United Kingdom

**Introduction:** CT head (CTH) is an increasingly frequent investigation among elderly patients. It is commonly used in the assessment of CVAs; dementia; falls; acute neurological illness and staging of tumours. There is evidence that CT head is routinely requested to investigate patients with confusion, despite recommendations against the routine use. We conducted an audit looking at the CT head requests among elderly patients admitted in the Acute Medical Units at Leicester Royal Infirmary.

**Method:** We audited notes of 80 patients admitted in admissions units at LRI who had CT head between November 2016-January 2017. We looked at:

* Most common reasons for CTH requests.

* Were the requests in line with the current existing guidelines for CTH requests?

* Most common reasons for CTH requests in confused patients and their justification.

**Results:** Common reasons for CTH requests: Fall and head injury (35%), Fall without head injury (32%), confusion alone (25%), other (8%). 66% urgent (1 hr) CTH requests were not in line with the current NICE guidelines for CTH requests in head injury & stroke. 30% of CTH requests for delirium/confusion could be classified as low risk & inappropriate. Out of 77, 30 (39%) had previous CTH in 12 months & 16 (53%) were for same reason. 78% of CT scans requested did not show acute changes.

**Conclusion:** There would appear to be tendency to over investigate with CT head. We continue to order CT head in patients admitted with delirium (without always documenting guideline -compliant reasoning). There appear to be a lack of appreciation of guidelines when CT head were requested.

P-364

Barriers to older medical patient walking in hospital

R. McCullagh¹, D. Dahly², N.F. Horgan³, S. Timmons⁴. ¹Centre for Gerontology & Rehabilitation, School of Medicine, University College Cork; ²Health Research Board-Clinical Research Facility, Cork, Ireland; ³School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin; ⁴Centre for Gerontology & Rehabilitation, School of Medicine, University College Cork, Ireland

**Background:** We aimed to identify patient- and time-specific barriers to walking among older medical inpatients.

**Methods:** 154 medical inpatients aged ≥65 years, premorbidly mobile, with an anticipated length of stay ≥3 days, were recruited. Step-count (Stepwatch Activity Monitor) and potential barriers to walking were recorded daily until discharge or for a maximum of five weekdays. These included medical status, walking ability, tethering to the bed, agitation/confusion, reported fatigue, pain,

fear of falling, and instructed bed-rest. Linear mixed effects models were used to measure the associations between log-transformed daily step-count and potential barriers, adjusting for patient characteristics on admission: demographics, physical performance (SPPB), number of medications, and illness severity (CIRS-G).

**Results:** Complete data existed for 147 patients. In the fully adjusted mixed effects model, walking increased linearly (12%, 95% CI: 2% to 23%) for each observed day. However, the mixed effects model with patient-level random intercept and slope factors fit the data best, suggesting there was considerable patient-level variability in step-count. The ability to walk independently was associated with more daily walking (46%, 95% CI: 12% to 91%); while a fear of falling (-27%; 95% CI: -46% to -1%), tethering to the bed (-21%; 95% CI: -39% to -3%) and instructed bed-rest (-68%; 95% CI: -78% to -47%) were associated with less walking.

**Conclusion:** Daily walking was variable, even when adjusted for patient characteristics on admission. The results suggested that patients tethered to the bed, unable to walk independently, and fear falling may require more support to walk in hospital.

P-365

Benefits of an In-reach programme & Emergency Care Bundle for
patients with idiopathic Parkinson's disease

A. Thomson¹, R. Irving², C. Miller¹, L. Partington¹, P. Cotton¹.
¹Salford Royal Hospital; ²HEE-NW

**Introduction:** Previous analysis of unplanned admissions in patients with idiopathic Parkinson's disease (iPD) to our hospital in 2014 identified opportunities to improve specific areas of care. The aim of this study was to determine the benefits of introducing a reliable, structured assessment protocol to this group of patients.

**Methods:** A daily, Geriatrician-led in-reach visit to the Emergency Assessment Unit of a University teaching hospital was commenced. This incorporated an Emergency Care Bundle to prevent and address harms arising from medication errors, missed delirium and other elements of essential care. The project was deployed from August 2015. After a 12-month period, data was collated retrospectively and analysed. This was compared with the 2014 cohort.

**Results:** 90 patients (male 58.9%, mean age 77.3 years) accounted for 134 admissions. Mean age, sex and dementia prevalence (34.4%) were similar between the 2014 and intervention cohorts. 86/134 (64.2%) admissions were seen by the in-reach team. An increase in the proportion of patients seen within 24-hours of admission was observed from 8.8% to 61.2%, and a fall in those never seen from 65.4% to 23.9%. There were improvements across the spectrum of medication errors, but particularly a fall in missed doses (24.3% to 16.6%). There was a rise in detection of delirium (22.1% to 29.1%) and fall in median length of stay by 2 days.

**Conclusions:** Introduction of this simple, cost-effective intervention improved quality markers of care, reduced potential harms and enhanced patient flow, with additional benefits in staff education and expressed patient/caregiver satisfaction.

P-366

Black and Blue... and Yellow

R. Hinton, S. Ponnambath, F. Rickard, A. Miller, R. Patel, R. Belcher, R. Preskey, D. Betney. University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom

**Case report:** A 77 year old lady with no medical history was admitted after a fall with a long lie. On examination she was noted to be jaundiced with scleral icterus, with confusion and signs of head injury. Blood tests showed macrocytic anaemia (Hb 90, MCV 108), platelets of 25, CK of 2860. Bilirubin was 28, with an ALT of 70 and ALP of 37. The CRP was raised and renal function was acutely impaired. The initial differential was between a hepatic or
haemolytic cause. She was treated with fluids and antibiotics for sepsis of unclear source. Abdominal ultrasound was normal. She was reviewed by Haematologist who felt her symptoms could be explained by B12 deficiency and advised intramuscular B12 replacement whilst awaiting the results of haematinics and haemolysis screen. Direct Coombs test was negative, folate was normal, but B12 level was markedly low at 50. Reticulocyte count 46.1 10 9/L. Blood film showed red cell anisopoikilocytosis, with oval macrocytes, no evidence of polychromasia, true thrombocytopenia, and neutrophilia with hypersegmented neutrophils. This blood film was suggestive of B12 or folate deficiency. Collateral history revealed she had poor diet for some years. After starting intramuscular hydroxocobalamin there was good reticulocyte response and normalisation of platelets.

**Conclusion:** Vitamin B12 deficiency is a familiar cause of low cell counts, but is less well known as a rare but recognised cause of jaundice due to high conjugated bilirubin. Untreated the haematological and neurological sequelae may be severe, and prompt recognition and treatment is essential.

## P-367

### Bleeding risk with direct oral anticoagulant and vitamin K antagonist in geriatric patients

F. Labouree, C. Boully, A.-C. Cadilhac, L. Caillard. Co-author

**Background:** Few "real world" data with direct oral anticoagulants (DOAC) are available in geriatrics population Objective: To compare the risk of bleeding in very old patients with non valvular atrial fibrillation (NVAF) hospitalized in geriatric care, receiving DOAC or vitamin K antagonist (VKA), with a follow up of one year.

**Methods:** Prospective, observational study in very old patients hospitalized in geriatric units with NVAF, included between January 2013 and June 2014. Follow-up data (bleeding events or death were obtained by phone calls to the General Practitioner. Major or non major bleeding events were defined according the ISTH criteria. Risk factors of hemorrhages were estimated using a logistic regression.

**Results:** Four hundred and forty-one patients (71% were female) were included (300 VKA and 151 DOAC users). Mean age was respectively 87.1 (SD 5.4) and 85.7 (SD 5.1) years. In the overall population mean MMSE was 19.1 (SD 7.2), HASBLED score was 2.3 (SD 0.9). Cockcroft creatinine clearance was 48.8 (SD 22.1) ml/min, albumin was 31.4 (SD 5) g/l. During the one year of follow up, 103 bleedings outcome were reported, with a lower tendency in the DOAC group (19.9%) compare to the VKA group (24.3%), p=0.06. Risk factor of bleeding with VKA were history of bleeding (OR: 5.36 (95%CI, 1.69-16.98)), creatinine clearance <40ml/min (OR: 2.30 (95%CI, 1.13-4.68)) and hypoalbuminemia (OR: 2.03 (95%CI, 1.06-3.90)). Risk factor of bleeding with DOAC was a lower platelet rate <250000/mm³ (OR: 2.69 (95%CI, 1.06-6.85)). Death rate was significantly lower in the DOAC group (21.8%) than in the DOAC group (33.3%), p=0.005.

**Conclusion:** These "real world" data in geriatrics population indicate that DOAC are well tolerated in comparison to VKA. Further studies in larger population are necessary to confirm these results

## P-368

### Can we modify the functional and cognitive trajectory in a hospital with exercise? A randomized clinical trial

N. Martinez-Velilla¹, A. Casas-Herrero¹, M. Lopez Sáez De Asteasu², F. Zambon Ferraresi², M. Gutiérrez-Valencia¹, F. Amu Ruiz², J.A. Renedo¹, B. Gonzalez Glaria¹, M. Gonzalo Lazaro¹. M. Izquierdo². ¹Servicio de Geriatria. Complejo Hospitalario de Navarra, Pamplona, Spain; ²Universidad Publica de Navarra, Pamplona, Spain

**Introduction:** Frail older adults have reduced functional and phys-

iological reserves, rendering them more vulnerable to the effects of hospitalization. Despite the theoretical support for the idea that exercise can prevent nosocomial disability, this idea has not been fully translated into clinical practice.

**Methods:** Randomized clinical trial in patients admitted to a Department of Geriatrics. Patients who met inclusion criteria were randomly assigned to the intervention (IG) or control group (CG). The intervention consisted of a multicomponent exercise training programme, composed of supervised progressive resistance exercise training at low-moderate intensities, balance-training, and walking for 5-7 consecutive days. Evaluations of function, cognition, depression and quality of life have been conducted at admission and previous to discharge.

**Results:** 267 patients have completed pre/post evaluations. Control group (CG) n=141, intervention group (IG) n=126). Dropout has been 59, due to different medical reasons. Mean age was 87.10, mean BMI 27.16, mean CIRS-G 12.04, mean MNA 23.41. In the IG, significant improvements were observed after the intervention in all the variables related with function: SPPB, gait speed, handgrip and Barthel (p<0.01), cognition MMSE, TMT-A, Isaacs test (p<0.005), depression: Yesavage 15 (p<0.05), quality of life: EQ-5D (p<0.05) and pain (p<0.05). The CG had no significant improvements in any of the cognitive, mood or quality of life parameters studied.

**Conclusion:** An individualized multicomponent exercise program is a feasible and an effective therapy in frail older adults admitted to a Department of Geriatrics and should be prescribed routinely

## P-369

### Causes and impact of surgical delay in patients undergoing hip fracture

C. González-Villaumbrosía, M.E. Baeza-Monedero, J. Martínez-Peromingo, C. Oñoro-Algar, B. García-Martín, A. Castañeda-Pastor, O. Caamaño-Selma, R. Barba-Martín. *Hospital Rey Juan Carlos, Madrid, Spain*

**Objective:** To study the causes of surgical delay (SD)-more than 48hours since the admission-, in patients with hip fracture and the impact in the hospital stay, thefunctional impairment, complications and mortality.

**Methods:** Observational study prospective that includes all patients admitted for fracture since 1st July 2015 and 15th February 2017 in a secondary hospital in Madrid. We did a descriptive analysis of the population characteristics, as well as an univariate analysis of differences between the two groups of patients to study (patient without SD and with SD more than 48 hours) by χ2 test and T for independent samples.

**Results:** n: 286 patients, of which 273 were treated surgically (95.5%). Of these, 61.9% was operated in the first 48 hours, 9.9% had SD due to treatment with anticoagulants or antiplatelet drugs, 6.2% by clinical instability and 20.1% by logistical problems. Analyzing the causes of DQ for days in the week, it was noted that only 18% of the patients who came to the emergency room on Friday was intervened in the first 48 hours in front of the 71.7% of the rest of the week days (p<0.001), due to logistical problems (52% vs. 13.9% respectively, p<0.001). Mortality, theaverage of complications and functional decline showed no statistically differences between the patients with SD and without SD. The hospital stay was higher, however, in patients with SD (12.9 Vs 10.3, p=0.007).

**Conclusion:** A high percentage of patients admitted for hip fracture does not intervene in time recommended by clinical guidelines due to logistical problems, being especially important in patients that are admitted in weekend. The SD was associated with a higher hospital stay, not existing in the present study differences between both groups in mortality, complications and functional impairment.
## P-370

### Clinical impact of a clinical pharmacist team's interventions in acute geriatric ward

M.-A. Cerfon¹, J. Bonhomme¹, A. Vignoles², M. Haution-Bitker², C. Falandry³, M. Bonnefoy², C. Rioufol⁴, S. Parat¹. ¹Dépt. de Pharmacie Clinique et Médicaments - GH Sud Hospices Civils de Lyon; ²Service de Court Séjour Gériatrique - GH Sud Hospices Civils de Lyon; ³Service de SSR Gériatrique - GH Sud Hospices Civils Lyon; ⁴Dépt. de Pharmacie Clinique Ontologique - GH Sud Hospices Civils de Lyon

Elderly patients are at increased risk of drug related problem (DRP) due to polypharmacy, pharmacokinetic and pharmacodynamic changes. In order to prevent and reduce DRP, a ward-based clinical pharmacist team conducts medical review in an acute geriatric ward. The objective of this study was to assess clinical impact of pharmacist's intervention (PI) on DRP identified on elderly hospitalized patients.

**Methods:** This prospective study was conducted in a 24-bed acute geriatric unit of a French university hospital from December 2016 to April 2017. Type of DRP and PI, defined by the French Society of Clinical Pharmacy's (SFPC) codification, were collected. PI's clinical impacts were assessed by a panel of nine geriatricians with the French validated tool CLEO of SFPC (6 levels: vital, major, moderate, minor, null, and negative).

**Results:** Total of 135 PIs were analyzed on 82 patients. Mean age were 84.7±6.8 years and mean number of medication 7.9±3.6 per patients. Geriatricians have accepted 97/135 PI. Most involved drugs were psychotropic, antithrombotic and analgesic drugs. Geriatricians' panel considered clinical impact of PI as: 3.7% vital, 17% major, 20.7% moderate, 37% minor, 12.6% null. 6.7% would have compromised the vital prognosis of the patient if PI were accepted by geriatricians. 80% of vital PI concerned drug induced QT syndrome and torsades de pointe.

**Conclusion:** The work of clinical pharmacist team permitted to avoid 1 vital DRP per 15 patients. Active involvement of clinical pharmacists in geriatric team leads to optimize drug therapies and ensure medication safety in elderly hospitalized patient.

## P-371

### Community based urgent care: An alternative to hospital admission

N. Nidh, P. Sarin, R. Keelan. University Hospital of South Manchester NHS Foundation Trust. UK

**Introduction:** The current and projected rise in the elderly population is putting traditional NHS care under unprecedented pressure. It has been estimated that up to 12% attendances to A+E could have their needs met elsewhere [1]. The recently published NHS 5 year forward view requires care providers to integrate care more, with a focus on out of hospital care [1]. The Integrated Community Urgent Care Service in South Manchester was designed to meet this need. The urgent care team is an integrated team which includes community nurses and social work assessors. Referrals are invited from any health or social care staff when it is identified that an urgent assessment and needs based care plan are required within 24 hours.

**Methods:** The service gathers data on reasons for referral and outcome of assessments. This data is gathered contemporaneously and this study has looked at 4 months of data.

**Results:** A total of 259 calls were received. 154 (59.5%) were referred to the urgent care team for assessment and 105 were forwarded straight to another appropriate community service. 132 (85.7%) were concerning admission avoidance. 9 (5.8%) were from A+E relating to admission deflection. 13 (8.5%) were regarding supporting transfer of care back into the community. Only 2 people required hospital admission following assessment.

**Conclusions:** The Integrated Urgent Care Service has demonstrated that an integrated health and social care assessment team can facilitate the co-ordination of local care in the community, avoiding unnecessary hospital admissions.

### References:

[1] NHS England (2017) NHS Five Year Forward View, Available at: https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/ (Accessed: 14th April 2017).

## P-372

### Comparison of independent predictors of emergency department length of stay in the 70+ population in the Nijmegen region, The Netherlands

Ö. Sir¹, Y. Schoon². ¹Department of Emergency, Radboud University Medical Center, Nijmegen, The Netherlands; ²Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands

**Introduction:** The amount of older patients attending the emergency department (ED) is increasing and contributing to crowding at the ED. Therefore, predictors for prolonged ED length of stay (ED-LOS) in the 70+ population was examined.

**Methods:** All patients ≥70 years who visited the ED of two hospitals, of which one university hospital (Radboudumc) in the year 2014 were included. A random selection of 2000 patients in each hospital was made. Data was collected retrospectively by examining all 4000 medical files. Prolonged ED-LOS was defined as a length of stay that lasted longer than 75th percentile of ED-LOS in the study population. Independent predictors of ED-LOS were established by logistic regression analysis.

**Results:** The 75th percentile of ED-LOS in Radboudumc was 293 minutes (mean 230, SD 115.5), versus 240 minutes in other hospital (mean 189, SD 91.1). All patient and visit characteristics differ significantly between hospitals (p<0.05), except for part of the day (p=0.79) and part of the year (p=0.12) on arrival. In both hospitals matching predictors for prolonged ED-LOS were, respectively: seen by specialism internal medicine (OR 2.7, 95% CI: 1.9–3.8; OR 3.0, 95% CI: 2.3–4.0); total amount of diagnostics and treatment (OR 1.5, 95% CI: 1.4–1.7); total amount of consultations (OR 2.3, 95% CI: 1.9–2.8; OR 2.6, 95% CI: 2.1–3.3); being hospitalized (OR 1.4, 95%, CI: 1.1–1.9; OR 2.6, 95% CI: 2.1–3.3) and moderate urgency category (OR 2.8, 95% CI: 2.0–4.1; OR 1.3, 95% CI: 1.003–1.8). Age, cognitive impairment, polypharmacy or higher co-morbidity index were not associated with prolonged ED-LOS.

**Conclusions:** Seen by specialism internal medicine, higher amount of diagnostics and treatment, higher amount of consultations, a moderate urgency category and being admitted to hospital were matching predictors for prolonged ED-LOS of both hospitals.

## P-373

### Determinants of self-rated health in older adults before and three months after an emergency department visit: a prospective study

F.J. van Deudekom¹, J. de Gelder¹, J.A. Lucke²,
A. Oostendorp-Lange¹, S. Anten³, G.J. Blauw¹, B. de Groot⁴,
S.P. Mooijaart⁵. ¹Department of Gerontology and Geriatrics, Leiden
University Medical Centre, Leiden; ²Department of Gerontology and
Geriatrics, Leiden University Medical Centre AND Department of
Emergency Medicine, Leiden University Medical Centre, Leiden;
³Department of Internal Medicine, Alijne Hospital, Leiderdorp;
⁴Department of Emergency Medicine, Leiden University Medical
Centre, Leiden; ⁵Department of Gerontology and Geriatrics, Leiden
University Medical Centre AND Institute for Evidence-Based Medicine
in Old Age (IEMO), Leiden, The Netherlands

**Introduction:** Older patients often experience adverse health out-
comes after an Emergency Department (ED) visit which potentially affects self-rated health (SRH). We investigated the determinants of decline in SRH during three months after an ED visit.

**Methods:** This was a multi-center prospective cohort study including acutely presenting older (≥70 years) patients in the Emergency Department (The Netherlands). Patients were asked to self-rate their health prior to the acute disease episode between 0–10, and a geriatric assessment was administered. The main outcome was a decline in SRH defined as a transition of a SRH ≥6 to a SRH <6 three months after the patient's visit to the ED.

**Results:** At baseline there were 1219 (81.2%) patients with a sufficient SRH and 283 (18.8%) patients had an insufficient SRH. After three months, 870 patients had a stable SRH (71.4%), 140 patients declined in SRH (11.5%). Independent predictors of decline in SRH were: male gender (OR 1.84), living in residential care or nursing home (OR 2.76), number of medications (OR 1.08), using a walking device (OR 1.73) and Katz-ADL score (OR 1.23). Patients with functional decline three months after an ED visit, show a steeper decline in mean SRH (0.68 points) than patients with no functional decline (0.12 points, p<0.001).

Conclusions Decline in SRH after an ED visit in older patients is mainly dependent on factors of functional capacity and functional decline. Preventive interventions to maintain functional status could be the solution to maintain SRH.

P-374

Developing a bedside vision screening tool as part of a multi-factorial falls risk assessment (MFRA)

N. Vasilakis¹, J. Windsor², S. O'Riordan¹. ¹The Royal College of Physicians, London, UK; ²NHS Improvement, London, UK

Introduction A comprehensive national audit in 2015 of 4,846 patients aged 65+ showed that only 48% of inpatients had a vision assessment by the third day of admission. NICE CG161 states that a MFRA should identify the patient's individual risk factors for falling in hospital and this may include visual impairment.

**Methods:** The RCP collaborated with the British and Irish Optic Society, The College of Optometrists, The Royal College of Ophthalmologists and the Royal College of Nursing and NHS Improvement to produce a straightforward bedside vision check tool.

**Results:** The tool is designed to alert staff to potential concerns that can then be discussed with the medical team for evaluation. The tool contains:

* Suggested questions to ask the patient to check general vision.

* Sample visual tests for distance and near vision.

* Information for clinicians about vision conditions common in older people.

* Guidance for improving immediate safety concerns relating to poor eyesight.

**Conclusions:** Compared with normal-sighted persons, individuals with a visual problems are almost twice as likely to fall and to have recurrent falls and resultant fractures [1,2]. Despite this, a recent audit revealed that less than half of older patients had a vision assessment when admitted to hospital. Feedback from audit site participants made it apparent that clinicians struggled to find a workable, standardised approach to basic vision assessment that is achievable in an acute hospital setting. We hope by providing clearer guidance may promote a better and more consistent approach.

References:

[1] Legood R, Scuffham P, Cryer C (2002) Injury Prevention 8.(2), 155–160

[2] Thomas Pocklington Trust (2013).

P-375

Development of a staff questionnaire for the national audit of dementia (care in general hospitals)

C. Hood, C. Snowdon. *Royal College of Psychiatrists, London, UK*

**Introduction:** The National Audit of Dementia measures the performance of general acute hospitals in England and Wales against criteria relating to the care of people with dementia. For Round 3 of the National Audit of Dementia, a staff questionnaire was created through consultation with frontline hospital staff, allowing comparison of data given by the hospitals at an organisation level and the experience of staff working on the wards.

**Method:** Ten pilot sites took part in workshops to establish questionnaire content and question format. The questionnaire was distributed in 199 hospitals across England and Wales to staff working with adults in inpatient facing roles. Questionnaires were returned anonymously.

**Results:** A total of 14,416 eligible questionnaires were returned. Staff experience was compared with organisational stated practice on aspects of care. 99.5% hospitals have a system to collect personal information about the person with dementia. 40% of staff said they could not access such information. 86% of hospitals have 24-hour food provision, but 73% staff said they could provide food between mealtimes. 98% of hospitals reported mealtimes free of clinical activity. 68% of staff agreed.

**Conclusions:** Creating a staff questionnaire for Round 3 allowed comparison between staff opinions and organisation reporting on key items relating to information supporting care and patient nutrition. This identifies gaps between hospital policies and practice at a national and local level.

P-376

Diagnostic efficacy of bedside-ultrasound to detect dehydration in elderly patients

H. Diederich, H. Burkhardt. *Universitätsmedizin Mannheim - Geriatrisches Zentrum*

**Background:** To determine whether an elderly patient is dehydrated or not often reveals challenging, as both, clinical and laboratory signs are unspecific and may be frequently flawed by age-driven factors.

**Methods:** Bed-side ultrasound was applied in a random sample of patients attending an emergency unit. Candidate ultrasound-markers had to be easily retrievable by bedside-ultrasound and associated with changes in fluid balance. Those were analyzed and compared with the clinical diagnosis. As there is no gold-standard available in a bedside-setting, a clinical synopsis was applied to identify patients with dehydration. A control group of patients without signs of significant disturbances of fluid balance was used as reference.

**Results:** Following the clinical algorithm 78 patients were classified as dehydrated and compared with 121 patients without signs of significant fluid dysbalance. There were significant differences found between these two groups concerning compressibility, variability of diameter assessed by M-mode and diameter during an inspiration maneuver of the vena cava inferior (<0.001). However, a ROC-analysis gave only moderate values for diagnostic efficacy for all these parameters, the best results in this context showed the diameter of the vena cava inferior while an inspiration maneuver was performed. AUC=0,73.

**Discussion:** Ultrasound can easily be applied in a bed-side setting and may support diagnosis of dehydration in the elderly. To confirm this diagnosis, however, remains challenging and still needs a synopsis covering both clinical and technical data.
P-377

**Is electroconvulsive therapy effective and safe in elderly with severe depression?**

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

**Background:** Depression in late life is an important public health problem. Between 30–40% of elderly depressed patients fail to respond to oral antidepressive treatments. Therefore electroconvulsive therapy (ECT) may be in alternative. The aim of this study was to assess the efficacy and safety ECT in depressed elderly patients.

**Patients and methods:** It is a retrospective (2013–2016) study including all inpatients aged over sixty years and treated by ECT for a severe depression.

**Results:** We gathered six cases, mean age was 65 (60 - 75 years), 83,3% were married and 66,6% had a law educational level Family history of mental illness was found in 16,6%. Personal history of depressive was found in 66,6%. Medical history of chronic illness was found over 33,3% of our patients. In all cases, several antidepressive oral treatments were tried before the ECT was indicated. The clinical characteristics were a severe depressive symptoms associated with: cognitive impairment (16,6%), psychotic features (50%), melancholic features (50%), with both psychotic and melancholic features (33,33%), suicidal thought or attempts (66,6%). The Global Assessment of Functioning scale increased significantly after ECT (25 vs 60, p<0.05). The Hamilton Depression Rating Scale dropped from 26 to 8 after ECT Incident during the ECT were noted in two cases (teeth and tongue injury and bradycardia).

**Conclusion:** Although our small sample, the results of our study suggest that ECT might be an effective and safe technique in elderly. It has to be considered as an alternative to oral treatment especially in resistant depressive episodes.

P-378

**Early stage of non-Hodgkin lymphoma diagnosed by biopsy from head and neck area in elderly**

K. Natori, A. Shibuya, D. Nagase, Y. Mitsui, Y. Kuraishi, H. Izumi.
Division of Hematology and Oncology, Toho University Medical Center
Oomori Hospital

**Introduction:** The malignant lymphoma to develop from lymphoid tissues accounts for a major ratio in hematological malignancies. It is often that superficial lymphadenopathy is a diagnostic opportunity as for the non-Hodgkin lymphoma (NHL). Performed biopsy, head and neck area is very easy to approach. We reviewed the malignant lymphoma that led to a diagnosis by the biopsy of the head and neck area in elderly.

**Methods:** From 2003 to 2014, we intended for 80 patients whom malignant lymphoma was diagnosed from head, neck area and decided clinical stage I and II by Ann Arbor classification. We studied more than 65years patients about gender, site of biopsy, pathological findings, clinical stage, therapy, prognosis.

**Results:** All cases are 48 cases, male female ration is 25/23, median age 75years. Site of biopsy, cervical lymph node 17 cases, tonsil 5 cases, oral cavity 6 cases, nasal cavity 5 cases, laryngeal tumor 4 cases, papiloid gland 3 cases, eye lid 2 cases, eye cavity 1 case, maxillary antrum 2 cases. Clinicl Stage by Ann Arbor classification, stagel, 28 cases, II, 20 cases. Pathological findings, diffuse large B cell lymphoma (DLBCL) 32 cases, MALT 6 cases, follicular lymphoma 2 cases, NK/T cell lymphoma 2 cases, others 6 cases. About therapy, R-CHOP therapy or CHOP based therapy 38 cases, radiation therapy alone 4 case, best supportive care 2 cases, watchfull waiting 2 cases, other chemotherapy 2 cases. In DLBCL that was most popular pathological type, complete response rate was 84.6%, median survival time was not reached, 5-year overall survival was 69.9%, there

were no significant difference between male and female, less than 80 years and more than 80 years.

**Conclusions:** Head and Neck area are very important biopsy site for malignant lymphoma. And very good prognosis in Stagel&II elderly patients. Age was not influence for clinical outcome in more than 65 years.

P-379

**EBV-positive diffuse large B-cell lymphoma of the elderly: A differential diagnosis for sepsis**

R. Ortés-Gómez¹, G. Lozano-Pino², E. Villalba-Lancho²,
E. Pardal-De la Mano³. ¹Geriatric Unit, Virgen del Puerto Hospital,
Plasencia (Cáceres), Spain; ²Geriatric Unit, Virgen del Puerto Hospital,
Plasencia (Cáceres), Spain; ³Hematology Service, Virgen del Puerto
Hospital, Plasencia (Cáceres), Spain

**Introduction:** Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) of the elderly is an uncommon aggressive lymphoma subtype arising in immunocompetent patients >50 years. Disease in elderly could have an atypical presentation and compromised functioning. We report a fatal case of EBV-positive DLBCL of the elderly in an 84-year-old man presenting as a respiratory sepsis and multiorgan failure.

**Methods:** Mr. E., an 84-year-old man, was admitted to hospital with a 3-days history of asthenia, functional decline, fever, unintelligible speech, and delusions. It was associated since two months ago with anorexia, weight loss, and an exertional dyspnea. Imaging demonstrated pulmonary infiltrate at right lower lobe. Mr. E. was transferred to Acute Geriatric Unit with diagnosis of pneumonia and delirium. Empirical treatment with antibiotics was started despite which we observed persistent fever, elevated bilirubin and cholestasis. CT-scan showed pulmonary patched consolidation and retroperitoneal and mediastinal lymphadenopathy.

**Results:** He developed renal and liver failure, and shock, and he was referred to Intensive Care Unit. Nevertheless he worsened with multiorgan failure, metabolic acidosis, and pancytopenia, and, accordingly, it was done bone marrow aspirate. He died sixteen days after his hospital admission. Bone marrow aspirate showed a neoplastic polymorphous lymphoid population composed of Reed-Sternberg (HSR)-like cells which expressed CD20, CD30, EBV/LMP and MUM-1 and the diagnosis of EBV-positive DLBCL of the elderly was made.

**Conclusions:** Disease in elderly could have an atypical presentation and compromised functioning. EBV-positive DLBCL is an uncommon aggressive lymphoma subtype and has a worse survival than would be expected in patients with EBV-negative DLBCL.

P-380

**Education of emergency physicians in geriatrics improve knowledge and skills towards older patients admitted to the emergency department**

Ö. Sir¹, Y. Schoon². ¹Department of Emergency, Radboud university medical center, Nijmegen, The Netherlands; ²Department of Geriatrics, Radboud university medical center, Nijmegen, The Netherlands

**Introduction:** The amount of older patients attending the emergency department (ED) is increasing. Emergency physicians (EP's) regard care for older patients as time consuming and complex, while they lack sufficient geriatric knowledge and skills to provide adequate and timely care. This study evaluates the effect of a geriatric curriculum on knowledge, attitudes and medical treatment of EP's.

**Methods:** EP's of an university hospital participated in a one-year designed geriatric curriculum, started in 2016 with a six-week e-learning module followed by monthly eighth interactive sessions by a geriatrician. Effects were measured by multiple-choice knowl-
edge tests, questionnaires regarding emergency doctor's attitudes (Aging Semantic Differential and self-perceived knowledge (Needs Assessment Scale). Also, patient records were judged regarding presence of geriatric assessment components performed by the EP before and after the intervention.

**Results:** 13 EP's participated, all completed the six-week e-learning module, monthly session attendance differed between EP's (mean 6.3±2.6 hours). Knowledge on geriatric syndromes increased: before 5.1 versus after 6.8, p<0.01. Self-perceived knowledge increased significantly: before 41.8 versus after 54, p=0.000. There was no change in aging stereotype attitudes (before 94.6; after 91.5; p.027). EP's paid more attention to social support (before present in 30%, after in 52%; p=0.02) and activities of daily living (before 12%, after 28%; p=0.05) after intervention.

**Conclusions:** Geriatric education equips EP's with more knowledge and confidence to handle geriatric emergency presentations.

## P-382

### Evaluation of quality indicators for patients with acute cerebrovascular accident in Primary Care

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

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

**Background and aim:** Study on the quality of clinical care for acute cerebrovascular accident (ACVA) patients assigned in a Primary Care Health Center (HC) and to compare them with ACVA patients in the Health Area (HA) (during the period 2015).

**Method/Design:** Longitudinal evaluation: Palmer's Quality Cycle-Setting: An urban health care center. Population and Sample: Patients (total according to inclusion criteria, year 2015) with ACVA (n=315). Interventions:-Internal evaluation, dimensions: scientific-technica, quality, adequacy, accessibility, continuity of care; data related to the care process and intermediate results; explicit, evidence-based procedural criteria. Subjects: analysis of coverage. Analysis on the evolution of treatment compliance. The Z statistical test for comparing proportions, alpha 0,05.

**Results:** Compliance criteria (year 2015):-Population with a history of ACVA: HS 315, HA 5268.-Patients with ACVA, who have at least one TA <140/90 in the period: HS 190 patients (60.32%), HA 3326 patients (63.14%).-Patients with ACVA registered in the period 2015: HS 45 patients, HA 904 patients.-ACVA 2015 patients with Atrial Fibrillation (AF): CS 3 patientns, AS 163 patients.-ACVA 2015 patients with AF and anticoagulants: CS 3 patients (100%), AS 131 patients (80.37%).

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

## P-383

### Exacerbated chronic heart failure at moment of discharge

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

**Introduction:** Evidence-based clinical practice guidelines for treatment of CHF (chronic heart failure) are available worldwide, but its application is not always transverse to all patients. This has repercussions on patients and health care systems [1].

**Methods:** Retrospective study of the total admissions at an Internal Medicine Department of a Portuguese hospital, with the main diagnosis of CHF exacerbated by infratherapeutic treatment or natural evolution of disease. Data was obtained through SClinico system

and processed by SPSS 24.0® software. Were excluded patients who died during hospitalization. The aim was to evaluate the repercussions on 1-year rehospitalization and mortality, of long-term survival modifying pharmacologic therapy and control therapy of congestive symptoms recommended by the European Society of Cardiology (ESC) guidelines.

**Results:** Total of 176 hospitalizations with mean duration of 9.22±9.5 days. 58.7% were female, with a mean age of 77.4±11 years. At discharge, treatment was altered in 78.2% patients, 95.5% were on diuretics, 77.1% on ACE (angiotensin-converting enzyme) inhibitors/ARB (angiotensin receptor blocker), 73.7% on beta-blockers and 57.5% on both. 1-year rehospitalization rate was 44.1% and mortality rate 16.8%. Therapeutic adjustment in these patients at discharge was associated with fewer 1-year rehospitalizations (OR=0.31, 95% CI: 0.14–0.64, p=0.01), but without relation to mortality. Use of ACE inhibitors/ARB, beta-blockers and both at discharge was associated with lower 1-year mortality, respectively: OR=0.36, 95% CI: 0.16–0.84, p<0.05; OR=0.11, 95% CI: 0.05–0.26, p<0.01; OR=0.10, 95% CI: 0.04–0.29, p<0.01. The same did not occur with diuretics.

**Conclusions:** When the cause of exacerbation is infratherapeutic treatment or natural evolution of the disease, adjustment of the baseline medication at discharge appears to be beneficial in maintaining patient's clinical stability. Recommended survival modifying therapy should be ensured whenever possible in CHF patients.

### References:

[1] A.P. Maggioni et al. Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry. European Journal of Heart Failure (2013) 15, 1173–1184

## P-384

### Factors that predict outcome of intensive care treatment in very elderly patients

J.E. Mateus, D. Oliveira, M. Simões, S. Beirão, M.T. Veríssimo, J. Pimentel. Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal

**Introduction:** The aging of the population is a critical worldwide trend, with major consequences on health system. The aim of this study was to evaluate clinical characteristics and factors associated with mortality in very elderly subjects admitted to an ICU.

**Methods:** Retrospective analysis of patients aged 80 years or more admitted to a portuguese ICU from 2012 to 2016.

**Results:** In this period 3473 patients were admitted to the UCI, of which 732 (21.1%) were very elderly. Global ICU mortality rate was 13%. Among the very elderly: 58.9% were men, mean age 85 years, mean length of stay 11.8 days, mean APACHE II 21, mean SAPS II 50 and mortality rate 34.7%. Regarding the cause of admission: 35.3% had respiratory disfunction, 17.2% digestive disease and 16.9% septic shock. Trauma patients had a longer length of stay (19 vs 11 days, p<0.001). Patients with septic shock were younger (84.2 vs 85.2 years, p<0.05), had higher values of APACHE II (23 vs 20, p<0.001) and SAPS II (55 vs 50, p<0.05) and a higher mortality rate (43.6% vs 33.0%, p<0.05). Advanced age was not associated with increased mortality.

**Conclusions:** The very elderly admitted to the ICU had a higher mortality rate compared with subjects of other ages. However, advanced age was not associated with increased mortality. Therefore, ICU admission or treatment for very elderly patients must be carefully considered. It is not appropriate to refuse ICU admission or restrict treatment to patients simply because they are aged 80 or older.
P-385

Familial diseases are also expressed in elder age. Case report

C. Alcaraz López, J. Jaramillo Hidalgo, T. Lapeña Montero,
M. González Becerra, J. Gómez Pavón. HCCR. Hospital Central de la
Cruz Roja, San José y Santa Adela. Madrid, Spain

A 92-year-old male with sudden beginning fluid and solid dysphagia. History: vascular parkinsonism, mixed dementia and a brother with Myasthenia Gravis (MG); Barthel index 72/100; he lives with his family. Systemic examination: flaccid dysarthria and abundant secretions. During hospitalization: two aspirative pneumonias and, facing the impossibility of using mouth, a feeding tube was placed until percutaneous endoscopic gastrostomy placement. Both laryngoscopy and gastroscopy discard mechanics dysphagia and a cranial CT didn't show acute cerebrovascular pathology. Then, in order to his brother's diagnostic, we requested tests directed to MG diagnostic: high levels of AChR and a thoracic CT without thymoma were obtained. It wasn't possible to perform an electromyogram and the jitter wasn't valuable. Finally, with our diagnostic "Familiar late onset AChR positive non tymomathous Myasthenia Gravis" piridostigmine was inicialised with positive results. Late onset MG is influenced by immune system's aging. Although it's underdiagnosed, it's more and more frequent and it prevails in men [1,2]. It has got more severe symptoms; and ocular and bulbar forms prevail [2]. Myastenic crisis and seronegative and seropositive patients percentages are similar to early onset MG [2,3]. Thymoma is not usually present [4]. Cholinesterase inhibitors keep on being first line on treatment. Piridogtismine, prednisone, plasmapheresis and intravenous antibody are good options [2], being the last one first line in myastenic crisis. Thymectomy in non-thymomatous MG has not shown benefits [2,5]. Remissions are maintained around 90% [2]. In familial forms, the most frequent relationship is between brothers. Many intra-family variability clinical and treatments response were observed [6].

P-386

Feasibility of a hospital at home setup for older patients with an
acute medical illness: recruitment, patient acceptability,
healthcare professionals' experiences, and economic evaluation

A. Tanderup¹, J. Ryg¹, A. Lee², A. Touborg Lassen³, K. Birkemose
Mejer⁴, G. Lyngholm Soerensen⁴, B. Dinesen⁴, T. Larsen²,
T. Masud⁵, J.-U. Rosholm⁶. ¹Department of Clinical Research,
University of Southern Denmark, Odense, Denmark; ²Department of
Public Health, University of Southern Denmark, Odense, Denmark;
³Department of Emergency Medicine, Odense University Hospital,
Odense, Denmark; ⁴Department of Health Science and Technology,
Aalborg University, Aalborg, Denmark; ⁵Nottingham University
Hospitals NHS Trust, Nottingham, United Kingdom; ⁶Department of
Geriatric Medicine, Odense University Hospital, Odense, Denmark

**Background:** The older population is increasing with an expected increase in hospital admissions and associated cost. Out-of-hospital-treatment in the form of a hospital at home (HH) is a potential alternative, but the evidence is limited. This study aimed to test feasibility of performing a full trial of HH in acutely ill older patients.

**Methods:** We conducted a feasibility study in acutely ill patients ≥65 years admitted to the Emergency Department. Patients were included based on five main criteria: general eligibility, medical status, treatment requirement, cognition, and willingness to participate. Patients were transferred home within 36 hours with subsequent daily visits from healthcare professionals. Telemedicine technologies were used to increase the safety of the patients.

**Results:** Of 601 patients screened (median age=80 years, 56% female) only 7 (1%) were eligible and willing to participate. Main reasons for not participating were poor status of health and scepti-

cism towards the home admission. Patients admitted at home felt
safe and found several positive aspects. Health-care professionals
found that the HH intervention gave the opportunity to create a
patient-centred treatment. The intervention was not successfully
integrated because of the few cases resulting in unfamiliarity with
the setup. Economic evaluation found that HH had no economic
advantages over usual in-hospital admission.

**Conclusion:** HH for older acute medical patients was not feasible in the design that we tested. The severity and complexity of patients, together with the existing competences of the municipality health-care staff, does not justify proceeding to a large randomised controlled trial with this set up.

P-387

Frail and Older Person Advice and Liaison Service (FOPALS),
improving care for the frail and elderly people at acute hospitals

D. Chan, T. Ashrafi, C. Agogbua, D.L. Ngandu, J. Barrett, K. Amin, K. Haque, A. Ahonkhai, K. Lewis, D. Walker. *Queen's Hospital*

**Introduction:** With an increasing aging population, more elderly and frail patients presents to hospital with highly complex health and social needs. FOPALS (The Frail and Older Peoples Advice and Liaison Service) was established at Queen's Hospital in 2013 to address the local population's needs.

**Methods:** FOPALS consists of a team of geriatric consultants and specialist nurses. They provide advice and assessments for elderly and frail patients seen in the community as well as the Emergency department, 7-day a week, allowing early geriatric input. FOPALS use a local BHRUT Frailty score to objectively identify suitable candidates to be reviewed. Patients over 75 years of age and score >3 points from the BHRUT Frailty score*, will automatically be seen by FOPALS.

**Results:** Data was collected retrospectively from January 2015 to December 2016. A total of 9532 patients were seen by FOPALS during the study period. 74% of the patients fulfilled the FOPALS criteria. Over 1/3 of patients (34.6%) seen by FOPAL was discharged the same day. The average length of stay (LoS) for all patients seen by FOPAL reduced by half (6.65 days versus 11.25 days prior established FOPAL service). The 30-day re-admission rate also fell by 13% (from 33% down to 20.2%) with a 1-year mortality rate of 7.66%.

**Conclusion:** Since the introduction of the FOPALS service at Queen's Hospital, the unit has not only witness a significant reduction in unnecessary hospital admission but also a drastic reduction in the LoS for the elderly and frail patients.

1. Presence of 1 or more Geriatric Syndromes: 2 points

a. Falls

b. Reduced mobility from baseline

c. Confusion/Dementia OR 4-point-AMT <4

d. Incontinence

e. Significant comorbidities (>3) AND evidence of polypharmacy

f. End of Life Care

2. Require assistance with ADLs: 1 point

3. In-patient stay within the last 6 months: 1 point

4. Significant sensory impairment: 1 point

5. Malnutrition/low BMI: 1 point

Exclusion Criteria:

* Non-medical patients

• Acute stroke, GI bleeds and MI

* Patients requiring HDU/ITU

• Oncology emergencies

<footnote>*BHRUT Frailty Score:</footnote>
## P-388
### Frailty in hospital: a survey of UK clinicians

J. Taylor¹, J. Fox², P. Shah¹, A. Ali², M. Hanley¹, R. Hyatt³. ¹Central Manchester University Hospitals NHS Foundation Trust; ²Salford Royal NHS Foundation Trust; ³East Lancashire Hospitals NHS Trust

**Introduction:** Despite numerous national campaigns, frailty remains under-recognised in UK hospitals. We performed the first ever national survey of hospital clinicians designed to identify barriers to the identification and best practice management of frailty.

**Methods:** Electronic and paper based surveys were distributed to hospital-based clinicians across the UK. As well as statement-based agree/disagree/not sure questions across five domains (personal understanding of frailty, identification of frailty, assessments for frailty, management of frailty and education), this survey also included free text comment space to allow broader qualitative evaluation.

**Results:** 402 clinicians were surveyed across 24 specialties and 26 hospital sites. Consultants made up 54% of responders, specialty trainees 19% and junior doctors 24%. Although the majority were familiar with the term frailty, personal understanding was variable, especially amongst junior doctors. 74% of responders agreed frailty assessments should be undertaken for all older people admitted to hospital, yet only 36% felt this was currently feasible. Only 24% of responders reported they used validated assessment tools to identify frailty. Free text responses highlighted scepticism towards the clinical validity and utility of frailty as a clinical syndrome, the perceived value of so-called "end of the bed" assessments, and issues surrounding service capacity.

**Conclusions:** Results highlight multiple areas for improvement, and raise some interesting questions about the perceived value of frailty assessments in the acute setting. We recommend a particular focus on better training of staff, the promotion of validated frailty assessment tools, and investment in front line services for older people presenting to hospital.

## P-389
### Functional decline associated with hospitalization in an acute geriatric ward

G. Cristofori, Z. Rivas García, A. Socorro García, J. Baztán Cortés.
*Department of Geriatrics, Cruz Roja Hospital, Madrid, Spain*

**Introduction:** Objective is to describe functional decline associated with hospitalization in an acute geriatric ward and to evaluate related risk factors.

**Methods:** Descriptive, longitudinal study. 1317 patients admitted to the acute geriatric ward at Cruz Roja Hospital in Madrid, during 2009. Functional decline associated with hospitalization was defined as 5 or more points loss between discharge and pre-admission Barthel Index (BI). Exclusion criteria (N 441) were death, data loss, pre-admission BI less than 5 points. Bivariate analysis was performed for age, sex, length of stay, admission albumin, creatinine, hemoglobin, Charlson index, previous mental Cruz Roja score, previous and admission BI, living in nursing home, causes of admission (ictus, cardiac failure, neumonia, urinary tract infection, chronic obstructive pulmonary disease). Significative variables (p<0.05) were studied with multiple logistic regression analysis.

**Results:** 46.2% of patients suffered functional decline associated with hospitalization, with mean age 87 years (SD 6.4), 67.9% women. Significative association resulted with age, female sex, living in nursing home, length of stay, admission BI, ictus, chronic obstructive pulmonary disease, admission albumin. In multivariate analysis age (OR 1.02, CI 95%: 1.00–1.05, p<0.05), length of stay (OR 1.08, CI 95%: 1.05–1.1, p<0.01), admission BI (OR 0.98, CI 95%: 0.98–0.99, p<0.01), and ictus as cause of admission (OR 7, CI 95%:

3.27–14.96, p<0.01) were associated with functional decline during the hospitalization.

**Conclusions:** Older patients, admitted for ictus, with lower admission BI and longer length of stay have an higher risk of functional decline associated with the hospitalization

## P-390
### General practitioners' point of view and involvement in the admission of their elderly patients in intensive care unit

S. Peiffer¹, L. Zerah², A. Gioanni², J. Cohen-Bittan¹, M. Verny², J. Boddaert², H. Vallet². ¹Geriatric Department, groupe hospitalier Pitié Salpêtrière Charles Foix, Paris, France; ²Geriatric Department, groupe hospitalier Pitié Salpêtrière Charles Foix, Paris, France; Sorbonne Universités UPMC Univ Paris 06

**Context:** The population aged more than 60 years has tripled during the last 50 years and will triple again before 2050. The intensive care units (ICU) are affected by this demographic change, with 9 to 18% of their patients aged 80 years and more. Nevertheless, clear ICU admission guidelines as well as data considering general practitioner (GP) implication in ICU admission of their patients are still lacking. We aimed to evaluate the GP' point of view, and their involvement in the admission of their geriatric patients in ICU.

**Material and methods:** Retrospective study carried out in La Pitié-Salpêtrière hospital. All patients >75 years admitted in the geriatric ward after an ICU stay between November 2014 and May 2015 were included. Each attending physicians of patients were called between July and December 2015 to answer a survey including an individual clinical vignette about their patients or clinical situations of ICU admission.

**Results:** Twenty-five patients were included (age 84±5 years; CIRS52 score 12 [2–21].). Main diagnoses for ICU admission were acute respiratory failure (40%) and shock (36%). Twenty-two GPs answered the survey (medical experience 30 [25–30] years). None was contacted at the time of their patient's admission in ICU, whereas 86% (n=19) would have liked to. Moreover, GPs knew their patient's advance directives in 28% of case.

**Conclusion:** The GPs are rarely associated with ICU admission or care of their elderly patients. Since GPs have crucial information about patients wishes, they should be more involved in ICU management, for example by creating advanced care plans based on their personal advanced directives.

## P-391
### Geriatric assessment at the Acute Medical Unit: Improving the outcome

J. Blomgreen¹, A. Ekmann², H. Nygaard², A.K. Demény², M.R. Wejse¹, E. Pressel¹. ¹Dept. of Geriatric Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen; ²Emergency Department, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark

**Background:** Elderly patients at the Acute Medical Unit (AMU) at our hospital, count for 53% of all bed-days. Elderly patients are often characterized by complex health related problems, functional loss and atypical symptoms. Due to demographic changes these numbers are expected to rise. The aim of this study was to describe clinical characteristics of these patients and to investigate the effectiveness of an acute geriatric assessment conducted by a Geriatric Acute Team (GATE).

**Methods:** All patients >65 years admitted to the AMU, between March and June 2016, were screened for eligibility. Exclusion criteria were medical unstable conditions. Patients randomized to the case group, received an acute geriatric assessment and follow-up by a senior consultant in geriatric medicine, whereas, control patients received treatment by usual standard. Data were retrieved from medical journals.
**Results:** We randomized 72 and 96 patients to usual treatment and GATE, respectively. Average age was 81 years, triage level at admission was low and first measure of Early Warning Score was on average 2 (0–8).17% of the patients were delirious at inclusion, they used on average 7.7 pharmaceuticals and 68% had >3 simultaneous chronic diseases. Compared to usual treatment, assessment by GATE gave shorter hospitalization times at the AMU (p=0.03), fewer doctors attending the single patient (p=0.02) and fever 30-day readmissions (p=0.05).

**Conclusion:** Although elderly patients are less clinical affected by their acute disease at admission, they have a high grade of multimorbidity, polypharmacy and significant delirium rates. Hence, they benefit from an acute geriatric assessment.

## P-392

### Geriatric assessment may reduce re-visits in the emergency department in older patients with positive identification of senior at risk (ISAR) screening

K. Slankamenac¹, G. Haberkorn¹, O. Meyer², M. Gagesch², H.A. Bischoff-Ferrari², D.I. Keller¹. ¹Emergency Department, University Hospital Zurich, Zurich, Switzerland; ²Department of Geriatrics, University Hospital Zurich, Zurich, Switzerland

**Introduction:** The "Identification of Seniors at Risk" (ISAR) screening is a tool to identify older patients at risk for adverse outcomes. We investigated whether older patients with a positive ISAR screening have an increased risk for re-visits and health-service costs when admitted to the emergency department (ED).

**Methods:** In a pilot study, we enrolled 96 patients aged ≥70 yrs who received an ISAR screening in the ED. We compared the rate of ED re-visits and in-hospital costs between ISAR positive (≥2 pts) and ISAR negative (<2 pts) patients. A geriatric physician performed a single geriatric consultation (GC) during the stay in the ED to assess older patient's needs.

**Results:** Fifty patients (52%) were ISAR positive and showed an increased risk for ED re-visits (RR 6.5, 95%-CI 2.1–20.1, p=0.001). In 29 patients, a single GC was performed. In ISAR positive patients who received a single GC, the risk for ED re-visits decreased and was no more significant (RR 2.2, 95%-CI 0.4–13.9, p=0.38). ISAR positive patients with GC did not have higher in-hospital costs than ISAR negative patients without GC (p=0.85).

**Conclusion:** Older ISAR positive patients have an increased risk for ED re-visits. A single GC in the ED may reduce ED re-visits. Regardless of GCs in the ED, in-hospital costs were not increased in ISAR positive patients. Based on these findings, we are establishing a comprehensive outpatient geriatric assessment program to identify relevant risk factors for ED re-visits and to recommend preventive strategies in older patients.

## P-393

### Geriatric Assessment Team in Emergency Department. Resources management strategies

I. Fedyuk¹, D. Donniacono², B. Fontecha², L. Reig². ¹Resident Doctor, Department of Geriatrics and Palliative Medicine, Moises Broggi Hospital, Sant Joan Despí, Barcelona, Spain

**Introduction:** An evaluation by the Geriatric Assessment Team in Emergency Department can avoid admission of fragile patients in Acute Care Hospital (ACH). In our area, derivations of geriatric patients to Emergency Department are very frequent. We contemplate the implantation of an assessment team in the emergency department for specific attention, resources management and to avoid an inappropriate admission in ACH.

**Objective:** To analyse the impact of the establishment of this measure.

**Patients and method:** Observational retrospectively study with

historical cohort comparing the number of hospitalization avoided during the first trimester of 2017 in relation to the same period of the previous year.

**Results:** The number of admissions requested during the first quarter of 2017 was 580, 176 of these were cancelled in relation to the same period of 2016 where 491 admissions were requested and 83 were rejected, what represent the 16.9% of all admissions requested during the first quarter of 2016 and 30.3% of the requests made during the same period of 2017.

**Conclusion:** 1. During the first quarter of 2017 were relocated out of ACH 47.1% more patients than during the same period of 2016; 2. We cannot reduce the number of admissions in ACH due to increase of the total number of requests; 3. It was possible to maintain the same number of admissions in ACH despite the increase in the number of requests.

## P-394

### HFrEF, HFmrEF and HFpEF: Which is the treatment of choice at discharge? Real world data from the ATHENA registry

C. Ghiara¹, F. Orso¹, A. Pratesi¹, S. Parlapiano², A. Herbst², A.C. Baroncini¹, A. Lo Forte¹, G. Biagioni², F. Fedeli², M.L. Di Meo¹, L. Gabbani³, M. Di Bari¹, A. Ungar¹, S. Baldasseroni¹. ¹Geriatric Intensive Care Unit, Careggi University Hospital, Florence, Italy; ²University of Florence, Florence, Italy; ³Department of Medicine and Geriatric, Florence, Italy

**Introduction:** Heart failure is a highly prevalent condition in elderly. Prognosis has improved in HFrEF due to the availability of evidence based treatments. Currently, no treatments have proven efficacy in HFpEF patients and also in HFmrEF, new category of HF, introduced by the ESC.

**Methods:** Evaluate treatments at discharge in real world setting of elderly patients after AHF in three different groups: HFpEF, HFFrEF, HFmrEF. Data derived from ATHENA retrospective observational study which included elderly patients admitted with diagnosis of AHF to University hospital in the period 12.01.2014–12.01.2015.

**Results:** 246 patients were enrolled: 19.5% HFmrEF, 30.5% HFrEF and 50.0% HFpEF. Mean age was respectively 83.8, 84.5, 79.9 years, p<0.001. BBs and MRAs were only two classes of drugs that had a statistically different prescription rate across three HF groups: patients with HFmrEF received BBs in similar percentage to patients with HFrEF. MRAs prescription rate in HFmrEF was intermediate compared to the other two groups. Furthermore, the average number of drugs taken by patients at the time of discharge was 11.8 with no differences across the groups.

**Conclusion:** In the absence of evidences from randomised clinical trials, patients with HFmrEF are treated similarly to those with HFrEF. Also, a high percentage of patients with HFpEF receive treatments that only have been demonstrated to improve prognosis in HFrEF patients. Evidences from randomised clinical trials are needed to appropriately treat HFmrEF patients.

## P-395

### Identifying and managing older people with “frailty” in the Acute Medical Unit in a busy district general hospital in an effective and safe manner

C. Martin-Marero¹, G. Rolph², C. Mccann³, C. Dineros⁴, C. Farrant⁵, N. Jobzs⁶, N. Jetha⁷, M. Lethby⁷. ¹Consultant Geriatrician and Physician, Department of Care of the Elderly, West Middlesex University Hospital/Chelsea and Westminster NHS FT; ²Information Business Partner, Emergency and Integrated Care Division, Chelsea and Westminster NHS FT; ³Senior Clinical Specialist Nurse, Directorate of Nursing, West Middlesex University Hospital/Chelsea and Westminster NHS FT; ⁴Clinical Specialist Nurse, Directorate of Nursing, West Middlesex University Hospital/Chelsea and Westminster NHS FT;
⁵Senior Occupational Therapist, Therapy Department, West Middlesex University Hospital/Chelsea and Westminster NHS FT; ⁶Occupational Therapist, Therapy Department, West Middlesex University Hospital/Chelsea and Westminster NHS FT; ⁷Specialist Trainee in Geriatric Medicine and General Internal Medicine, Department of Care of the Elderly, West Middlesex University Hospital/Chelsea and Westminster NHS FT

**Introduction:** People aged 75+ are at high risk of hospital admission. The first 72 hours are key to accurately assess and manage them. There is growing evidence suggesting that "hospital at home" for selected patients offers advantages, lowering mortality and reducing functional decline. We created the multidisciplinary Acute Frail Elderly Team (AFET) to deliver the Comprehensive Geriatric Assessment within the AMU for the elderly. To identify suitable patients we used Improvement Methodology and developed a local WMUH-Clinical Frailty Score (CFS) based on Geriatric Giants and dependency. We used Rockwood-CFS concordance for comparison and scoring.

**Methods:** Identified patients are assessed/managed by AFET, with daily MDT meetings discussing each case, writing personalised care plans in our booklet for each patient and handing-over to AMU. AFET has strong links with community professionals and refers patients to these services facilitating safe, fast and effective discharges. To cover these, the Rapid Access Clinic for the Elderly (RACE) and outreach Richmond's Senior Health Clinic were developed. AFET outcomes are compared with other AMU patients and "usual care" patients transferred to wards using key metrics.

**Results and conclusions:** WMUH-CFS identifies a distinct and older cohort of patients with "Frailty"; – AFET majority of our patients are 85+, female preponderance and higher CFS with age; – AFET improves early discharge home of these patients minimising institutionalisation, falls, confusion and nosocomial infections, reduces readmissions and mortality in this cohort compared to usual care.

**References:**

[1] Rockwood et al. A Global Clinical Measure of fitness and frailty in elderly people. CMAJ 2005;173: 489-495/Canadian Study on Health & Aging. Reviewed 2008.

## P-396

### Impact of an In-reach programme & Emergency Care Bundle on delirium in patients with idiopathic Parkinson's disease

A. Thomson¹, R. Irving², C. Miller¹, L. Partington¹, P. Cotton¹.

¹Salford Royal Hospital; ²HEE-NW

**Introduction:** Previous analysis of unplanned admissions in patients with idiopathic Parkinson's disease (iPD) to our hospital in 2014, identified a high prevalence of delirium. The aim of this study was to determine whether the introduction of a reliable, structured assessment protocol would improve outcomes in iPD patients with delirium.

**Methods:** A daily, Geriatrician-led in-reach visit to the Emergency Assessment Unit of a University teaching hospital was commenced. This incorporated an Emergency Care Bundle to prevent and address a number of key elements of care, including delirium, in patient with iPD. The project was deployed from August 2015. After a 12-month period, data was collated retrospectively and analysed. This was compared with the 2014 cohort.

**Results:** 90 patients (male 58.9%, mean age 77.3 years) accounted for 134 admissions. Mean age was similar between the 2014 and intervention cohorts with delirium, although the incidence of known dementia higher in the intervention group (30% vs 42.9%). 86/134 (64.2%) admissions were seen by the in-reach team. There was a rise in detection of delirium (22.1% to 29.1%). The incidence of delirium developing after admission remained unchanged (8.1% vs 8.2%). The mortality rate in those patients with delirium at any

point in their admission fell from 10/41 (24.4%) to 7/50 (14%), with no change in mortality in the non-delirious groups (1.1% vs 2.4%).

**Conclusions:** Introduction of this simple, cost-effective intervention improved delirium identification and management in patients with iPD, and could be adapted for use across a variety of other healthcare settings.

## P-397

### Impact of anesthesia drugs on postoperative cardiovascular events after hip fracture surgery in elderly patients

H. Vallet¹, M. Baque², J. Cohen-Bittan², A. Gioanni¹, M. Verny¹, M. Raux³, A. Mézière⁴, B. Riou⁵, L. Zerah¹, J. Boddaert¹. ¹Unit of Peri-Operative Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP). 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; ³Departments of Anesthesiology and Critical Care, GH Pitié-Salpêtrière, APHP. Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France; ⁴Department of Rehabilitation, GH Charles Foix, APHP, Ivry sur Seine, France; ⁵Departments of Emergency Medicine and Surgery, GH Pitié-Salpêtrière, APHP. Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France

**Introduction:** Postoperative cardiovascular events (PCE) are frequent and strongly associated to hip fracture mortality. We aim to compare patient with or without PCE with regard to drugs they received during anesthesia in elderly patients with hip fracture.

**Methods:** Between 2009 and 2016, all patients (>70 years) admitted after hip fracture surgery into a dedicated unit of peri-operative geriatric (UPOG) care were included. The primary end point was drugs associated with PCE occurrence.

**Results:** 559 patients (age 86±6 years, CIRS 9 [6–12], 5 [3–6]) were included. In postoperative time, 145 patients (26%) presented ≥1 PCE. Patients with PCE were older (87±6 vs 86±6; p=0.02), with more comorbid conditions (CIRS 10 [7–13] vs 8 [6–11]; p=0.003) notably cardiovascular conditions (coronary artery disease 32% vs 14%; p<0.001, chronic cardiac failure 37% vs 11%; p<0.001). Remifentanyl, etomidate and transfusion were more frequently used during anesthesia in patients with PCE (10% vs 5% (p=0.01), 37% vs 25% (p=0.006) and 33% vs 23% (p=0.01) respectively), and remained associated with PCE in a multivariate logistic regression model (respectively OR=2.43 [1.13–5.17], p=0.02; OR=1.67 [1.06–2.61], p=0.02; OR=1.70 [1.12–2.61], p=0.01) whereas age and comorbid conditions were not.

**Conclusion:** Some anesthesia drugs are associated with the occurrence of PCE in elderly patients admitted in UPOG after hip fracture surgery. All drugs used during hospital care pathway should be considered to analyze potentially drug related-outcomes. Geriatricians and anesthesiologists will have to work together to determine optimized drug protocols, according to outcomes.

## P-398

### Intersectorial Clinical Unit (ICU) – A cooperative effort: Municipality and hospital

J. Bennedsen, S.T. Feizi, S.G. Dawids. Bispebjerg Hospital Denmark

**Introduction:** ICU is a joint hospital unit for fast track diagnosis and treatment of citizens above 64 years in the local municipality. It started 2013 and is staffed with nurses from Public Social Healthcare and hospital physician. The aim: to avoid many hospital admissions of elderly.
**Methods:** During the period June 2014–January 2016 patients in ICU were registered – inter alia – age, sex, blood samples, cultures, X-ray/CT-/MR-scan/ECG, endoscopy, diagnoses and outcome (hospitalization/ambulatory/home).

A follow up was made of readmissions to hospital or to ICU (with diagnosis) up to 6 months.

**Results:** Of 1001 patients visiting ICU 34% were admitted to hospital while 66% were discharged (51% were ended without further plans and 15% were sent to ambulatory follow up).

Within 30 days 18% of all the patients were readmitted to hospital or ICU. A considerable part of these required repeated transfusions due to cancer and other causes. Most frequent diagnoses were respiratory, cardiovascular, haematological and endocrine – mainly diabetics.

**Conclusions:** The combination of Public Municipal Health Care and hospital facilities appears to be a very efficient way to treat elderly patients. Rapid investigation and treatment is combined with optimizing the home situation or to place the patient temporary in a rehabilitation facility. These combined measures prevent deterioration of the patients' health condition.

## P-399

### Involvement of a geriatrician at a Dutch emergency department reduces length of stay for elderly

Ö. Sir¹, Y. Schoon², ¹Department of Emergency, Radboud University Medical Center, Nijmegen, The Netherlands; ²Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands

**Introduction:** The amount of older patients attending the emergency department (ED) is increasing and contributing to crowding at the ED. Geriatrician involvement at the ED in relation to ED length of stay (LOS) in the 70+ population was examined.

**Methods:** All patients ≥70 years who visited the ED of an university hospital in 2014 were included. A random selection of 2000 patients was made. Patient and visit related data were collected retrospectively by examining all 2000 medical files. Cases were divided for logistic regression analyses in groups divided by median and by quartiles of LOS.

**Results:** The 2000 patients (mean age 78.1years, SD6.1) represented 42% of the 70+ population that visited the ED in 2014. The median LOS was 216 minutes (mean 230, SD115.5). Independent protective factors for LOS were geriatrician involvement (OR 0.4, 95% CI: 0.2–0.6), surgical diagnosis (OR0.5, 95% CI: 0.3–0.9), multi-trauma patient (OR 0.2, 95% CI: 0.5–0.7) or resuscitation (OR0.01, 95% CI: 0.01–0.4). In contrast, we found that amount of diagnostics (OR1.6, 95% CI: 1.4–1.7), consultations (OR2.3, 95% CI: 1.9–2.7), lower urgency category (U3-U4; OR 7.6, 95% CI: 3.5–16.7), specialisms surgery (OR3.7, 95% CI: 2.4–5.7) and internal medicine (OR2.7, 95% CI: 1.0–3.8), hospital admission (OR1.4, 95% CI: 1.1–1.8) and afternoon arrival (OR1.4, 95% CI: 1.1–1.8) were independently associated with prolonged LOS.

**Conclusions:** Involvement of a geriatrician at the ED reduces LOS for elderly. The amount of diagnostics and consultations, lower urgency category, the specialisms surgery and internal medicine, hospital admission and arrival in the afternoon are independent predictors for prolonged LOS.

## P-400

### Is early geriatric follow-up within 24 hours after discharge able to reduce functional decline?

B.B. Jørgensen, M. Gregersen, E.M. Damsgaard. Aarhus University Hospital, Department of Geriatrics, Aarhus, Denmark

**Objectives:** Functional decline is observed in almost two thirds of elderly on admission to an emergency department. After discharge there is elevated risk of further reduction in physical function. The

aim is to examine whether early geriatric follow-up within 24 hours after discharge can reduce functional decline compared to those receiving standard geriatric care after discharge by home dwellers.

**Methods:** Community-dwelling 75+ years old adults were consecutively enrolled on admission to the Emergency Department where the patient's physical functional capacity was assessed. The patients were followed-up eight weeks after discharge with the same assessment. Outcome: Change in functional capacity as measured during hospitalization, based on a retrospective assessment of physical functioning 14 days before current illness evaluated by Functional Recovery Score (FRS) and again 8 weeks after discharge also by FRS.

**Results:** In total 153 patients were examined at the emergency department and followed-up eight weeks after discharge. Mean age was 86.2 years (±5.5) (range 75–101). Fifty nine percent were women. Using logistic regression analysis there was no significant difference in the two groups of having a functional decline measured eight weeks after discharge by FRS when adjusted for co-morbidity, dementia, previous injurious falls, and actual fall (Coefficient = -7.55 [95% CI: -16.3; 1.15]), p=0.09.

**Conclusion:** Early geriatric follow-up within 24 hours after discharge at home-dwelling elderly medicine patients can not reduce the risk of further functional decline compared to those receiving standard geriatric care after discharge.

## P-401

### Late-onset IgA vasculitis, clinical characteristics and outcomes

S. Hammami, I. Chabéne, R. Klii, M. Kechida, R. Mesfar, I. Kochtali. CHU F Bourguiba, Internal Medicine Department, Faculty of Medicine, University of Monastir, Tunisia

**Introduction:** Henoch–Schönlein purpura (HSP) is an acute systemic micro vascularitis that is common in children while it is very rare in adults, often presenting with signs of an acute abdomen. This disease is difficult to diagnose in adults and seems to differ from that in children by the incidence and severity of clinical sign. The aim of this study was to determine the clinical features and outcomes of IgA vasculitis in elderly (>65 years).

**Methods:** All consecutive adult patients who were diagnosed with IgA vasculitis between Mai 2005 and January 2015, in the Internal Medicine department in Monastir university Hospital, were reviewed retrospectively.

**Results:** In total, 30 adult patients were diagnosed with IgA vasculitis, of whom 6 (20%) had late-onset disease. The mean age was 71.3 years (65–87). Clinically, the gastrointestinal symptoms were the most frequent (66,6%), type of acute pancreatitis and a leucocytoclastic digestive vasculitis. The articular and renal involvement was mentioned in 50% of patients, leading in two cases to a chronic renal insufficiency. The treatment was based on parenteral corticoids, prescribed in two cases. The evolution was good in 50% of patients. One patient was died by a nosocomial infectious pneumonia.

**Conclusions:** Patients with late-onset IgA vasculitis in elderly exhibit distinct clinical features characterized by greater renal involvement and worse renal outcomes. Thus, watchful follow-up might be needed for adult IgA vasculitis patients, in particular those with late-onset disease.

## P-402

### Long term evaluation of quality of life in elderly breast cancer

S. Messouak¹, F. Guinet¹, H. Bailly². ¹Oncology Department Montceau les Mines Hospital; ²Geriatric Department Dijon University Hospital

**Introduction:** Cancer mainly concern elderly people, particularly frail population. Progresses in oncological management have re-
sulted in a decrease in overall mortality and an improvement in the survival rate of patients. But the benefits in terms of quality of life are discussed.

**Objective:** To analyze the impact of cancer and its treatments on the quality of life of elderly women with breast cancer and their experience at a distance from initial management.

**Methods:** Quantitative mono-centric, descriptive, retrospective cohort study and qualitative study in the oncology department of the Montceau-les-Mines hospital between 30 June and 09 August 2016. The inclusion criteria were women over 65 years of age with breast cancer who had been followed for at least 1 year. The EORTC quality of life questionnaire was submitted to patients, as well as a measure of the ADL Katz and Charlson scores. Various medical variables (date of diagnosis, tumor extension, type of treatment and side effects) and socio-demographic variables (age, home care, place and lifestyle) were also taken into account. A descriptive analysis was first performed, followed by univariate analysis in search of significant associations between the quality of life and the various variables measured, followed by a multivariate analysis. For the qualitative study, semi-directive interviews were carried out, recorded and completely transcribed. The verbatims were then analyzed by software of textual analysis, allowing to show the emergent ideas and to prioritize them.

**Results:** 30 women were included in the study (mean age 81.3±4.9 years). Overall self-assessed quality of life correlated negatively with comorbidities (r=-0.351; p=0.0571) and number of hours of home help (R=-0.614; p=0.0002). Quality of life score was better in patients with T1 (68.7±16.8) or T4 (75±8.3) than in patients with T2 (53.7±19.6) or T3 (55.6±9.6) states. Peripheral lymph node invasion appeared to be associated with a better quality of life (69.3±12.4 vs 57.0±21.0, p=0.0586). No correlation was found between age nor treatments with quality of life. Patients with neurological side effects reported poorer quality of life (50.0±18.0 vs 67.7±15.9, p=0.0185). Multivariate analysis revealed two major axes: a first "energy/autonomy" axis where the variables of quality of life, emotional functions, executive functions and social activities were opposed to fatigue; a second axis "physical integrity" where the variable of the body image is opposed to the mammary and brachial symptoms. In the qualitative study, the most commonly reported side effect was alopecia (n=12; 40%). Alopecia (n=4; 13.3%) followed by surgery (n=3; 10%) were the most significant features of the history of the disease. Relativism was the most commonly occurring component of the disease (n=12; 40%). Some patients reported a lack of psychological support (n=2; 6.7%), while others reported overly aggressive therapies (n=2; 6.7%). The most important elements of their quality of life were the ability to perform household tasks (n=13, 43.3%), ability to walk or go out (n=12, 40%) and the presence of the entourage (n=10; 33.3%). Walking (n=13; 43.3%) and household tasks (n=13; 43.3%) were the mostly impacts by cancer management. Qualitative study showed that quality of life is possible with a positive evaluation despite a greater locoregional tumor evolution in patients who survived a potentially fatal situation. The nature of treatments does not seem to have a significant long-term impact on quality of life, but the occurrence of chemo-induced neuropathies is significantly related to a lower quality of life. Patients emphasize alopecia and surgery in the experience of their illness, sometimes with insufficient psychological support.

**Conclusions:** These results lead us to reevaluate our practices in order to guarantee a better quality of life to our patients by being more attentive to their expectations and by strengthening our collaborations with the other medical, surgical and paramedical actors during the management. In particular, it is advisable to care the occurrence of chemo-induced neuropathies in order to maintain good autonomy to ensure a better quality of life

## P-403

### Long term prognosis of upper gastrointestinal bleeding in the elderly population

A. Negers¹, N. Carbonell², L. Zerah³, A. Gioanni³, M. Verny³, C. Thomas¹, J. Boddaert³, D. Thabut⁴, H. Vallet³. ¹Geriatric Department, GH Hôpitaux Universitaires de l'Est Parisien - Saint Antoine Hospital, Paris; ²Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; ³Gastroenterology Department, GH Hôpitaux Universitaires de l'Est Parisien - Saint Antoine Hospital, Paris; ⁴Assistance Publique-Hôpitaux de Paris (APHP), Paris, France. ¹Geriatric Department and Unit of Peri-Operative Geriatric care, Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France. ²Gastroenterology Department, Groupe Hospitalier (GH) Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France

**Introduction:** Although upper gastrointestinal bleeding (UGIB) represents a frequent medical situation with a high in-hospital mortality rate in aged patients, data concerning long-term prognosis are lacking. We aimed to described evolution and recovery of aged patients with UGIB to provide original data essential to improve medical care.

**Material and methods:** Prospective observational study. All patients with gastrointestinal bleeding and upper endoscopy were included between June 2015 and may 2016. Comorbidities (CIRS score), autonomy (ADL and IADL) and frailty (Rockwood) were prospectively collected. Primary objective was the 6-month mortality. Secondary objective was 6 month functional recovery.

**Results:** Sixty-six patients were included (age 83±4 years, 55% women, CIRS score 12 [8–15], ADL and IADL 5.5 [4–6] and 2 [1–4] respectively, Rockwood 5 [3–6]). Main clinical presentation and etiology were respectively represented by melena (n=48, 73%) and gastroduodenal ulcers (n=44, 67%). Sixty-two percent of patients (n=41) presented at least one complication during hospitalization, and 30 day mortality rate was 15% (n=10). The 6 month mortality was 42%, with 89% of home return in survivors. Considering 6-month functional recovery, there was no difference between pre-hospitalization and 6-months ADL, IADL and Rockwood scores (6 month values respectively 4.5 [3–6] (p=0.09), 1 [0–3] (p=0.08), 6 [4–6] (p=0.4)).

**Conclusion:** Aged patients with UGIB experienced a high 6-month mortality rate, but no functional decline was observed in survivors at 6 months

## P-404

### Malignant lymphoma more than 80 years old cases

K. Natori, Y. Mitsui, D. Nagase, A. Shibuya, Y. Kuraishi, H. Izumi. Division of Hematology and Oncology, Toho University Medical Center Oomori Hospital

**Introduction:** Because of aging society, the number of non-Hodgkin's lymphoma (NHL) patients were increasing. So we investigated NHL of more than 80 years.

**Methods:** The subjects in this study were 80 cases who were histopathologically diagnosed as malignant lymphoma and more than 80 years old, from January 2003 to December 2014. Survival curves and the median survival times were estimated by the Kaplan-Meier method and any significant differences between the two groups were evaluated by the Log rank test. The authors and coauthors have no conflict of interest to disclose.

**Result:** All cases were 80 cases including male 38 cases, female 42 cases, median age was 82 years. Pathological findings, Hodgkin's lymphoma 3 cases, non-Hodgkin's lymphoma (NHL) 77 cases, in NHL, diffuse large B cell lymphoma (DLBCL) 48 cases, follicular
lymphoma 6 cases, intravascular large B cell lymphoma 3 cases, peripheral T cell type 3 cases. MALT 3 cases, others 17 cases. In DLBCL (48 cases) that was most popular pathological type of about therapy, R-CHOP therapy or CHOP based therapy 34 cases, radiation therapy alone 1 case, best supportive care 8 cases, other chemotherapy 3 cases, death before therapy 1 case. About clinical outcome, complete response rate was 45.8%, median survival time (MST) was 20M, 5-year overall survival rate (5y-OSR) was 40.8%, about gender, MST were male 10M, female 86M, 5y-OSR were 27.2%, female 55.2%. There were significant difference between male and female.

**Conclusions:** Even if elderly patients, especially 80 years old patients, necessary to aim to cure.

## P-405

### Management of arterial hypertension in patients over 80 years old hospitalized in a geriatric medical unit

M. Gryllaki, M. Kotsani, A. Kearney-Schwartz, A. Benetos. Geriatric Department, CHRU de Nancy, Université de Lorraine, France

**Introduction:** There is little evidence available regarding the optimal management of arterial hypertension (AH) in older frail adults. Benefit/risk balance should be evaluated in each opportunity, including acute hospitalization.

**Objective:** To investigate changes in antihypertensive treatment of geriatric patients during an acute hospitalization.

**Methods:** A retrospective, medical record based, study was conducted in patients ≥80 years old, hospitalized in a two months' period, for various reasons, in a Geriatric Medical Unit.

**Results:** We studied 119 persons (100 women), mean age 87.8±4.8 years. In 37.8% of cases there was a reason of hospitalization potentially related to AH. During the hospitalization 103 antihypertensive molecules were stopped and 38 were introduced, leading to a 27.1% reduction of the overall 240 molecules taken at admission. Ninety patients (76.5%) underwent antihypertensive medication changes. Antihypertensive drugs were reduced from 2.0 (±1.1) at admission to 1.5 (±1.1) at discharge (p<0.001), reflecting mostly diuretics' and renin-angiotensin inhibitors' reductions. In 74.7% of cases the reasoning of medication changes was not referred in the discharge letter. Mean systolic blood pressure (SBP) was 137.2 (±29.3)mmHg at admission and 129.8 (±21.4)mmHg at discharge (p=0.042). The prevalence of SBP<130mmHg was 43.7% at admission and 55.5% at discharge (p=0.05). Among those patients, 75.0% at admission and 45.5% at discharge received >1 antihypertensive drugs. The percentage of patients with SBP>160mmHg was reduced (21.8 vs 10.1%, p=0.016).

**Conclusion:** Despite the tendency to reduce antihypertensive medication during hospitalization, SBP levels remain low at discharge. Many patients with low SBP receive combination antihypertensive therapy and could be considered as overtreated.

## P-406

### Mobile Geriatric Unit: we will take care of you wherever you are

C. Girardi¹, G. Larissa², F. Meroni². ¹Ente osepdaliero Cantonale, Ospedale Regionale di Lugano, servizio sottocenerino di Geriatria, sede ospedale Italiano. Lugano - Svizzera; ²Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, servizio sottocenerino di Geriatria, sede ospedale Italiano. Lugano - Svizzera

**Introduction:** Emergency department and medical and surgical wards are always more confronted with the complexity of older patients.

**Methods:** Since September 2015 in the regional Hospital of Lugano a geriatric project is ongoing to improve the taking in charge of the elderly patients at their arrival in the emergency department and to take care of them throughout their stay in hospital by a transversal approach.

At the arrival at the emergency room, the patient undergoes to modified ISAR score and if it is positive MGU (Mobile Geriatric Unit) is contacted to evaluate the patient. The geriatrics inpatient are referred to medicine and surgery department, and the geriatrician cooperate in a multidisciplinary assessment. The geriatrician also attend constantly to grand rounds in surgery for taking in charge of complex geriatric patients. The clinical nurse specialist in geriatrics collaborates in educational training for nursing staff of various specialties to improve the total care of the elderly patients and to help the caregivers for an appropriate approach.

**Results:** Since September 2015, approximately 17% of patients in ED had more than 75 years, and 15% of these had a positive modified ISAR score. The 32% of these patients were hospitalized. The 30% had one of the great geriatric syndromes as reason of hospitalization. Patients with a positive ISAR in 25% had an hospital readmission, as described in medical literature, but we found a decrease in inappropriate hospitalizations.

**Conclusions:** A better taking charge of geriatrics inpatient and outpatient reduce inappropriate hospital readmission.

## P-407

### Multiple neoplasms including hematological malignancies of the more than 80 years elderly

K. Natori¹, D. Nagase², Y. Mitsui², A. Shibuya², Y. Kuraishi², H. Izumi². ¹Division of Hematology and oncology, Toho University Medical Center Omori Hospital; ²Division of Hematology and Oncology, Toho University Medical Center Oomori Hospital

**Introduction:** Progress of therapy and supporting therapy improved a prognosis. Synchronous type patients were difficult to treat. We reviewed synchronous type of multiple neoplasms including the hematological malignancies of more than 80 years old.

**Methods:** In the case that hematologic malignancy was diagnosed in our hospital from 1988 to 2015, we intended for double cancer 340 cases including hematological malignancy. We reviewed 46 multiple neoplasms of synchronous type of the more than 80 years. The examination factors are kind of the hematological malignancy, treatment, gender, tactics of therapy.

**Results:** All cases were 46 cases, including male 31 cases, female 15 cases, number of malignancies, double 39 cases, triple 6 cases, quadple 1 case. Hematological malignancies to constitute were non-Hodgkin's lymphoma (NHL) 24 cases, multiple myeloma 3 case, myelodysplastic syndrome 8 cases, acute leukemia 4 case, chronic leukemia 2 cases, others 6 cases, about solid cancer, gastric cancer 14 cases, prostate carcinoma 7 cases, lung cancer 6 cases, colon cancer 11 cases, pancreatic cancer 3 cases, breast cancer 4 cases, others 8 cases. About therapy, chemotherapy (CTx) + Ope 29 cases, CTx only 6 case, CTx + palliative therapy 5 cases, Ope + transfusion (TF) only 5 cases, TF only 1 case. About cause of death, 19 death cases, hematological malignancy 14 cases, solid cancer 5 cases.

**Conclusions:** Even if more than 80 years old synchronous multiple neoplasms, they have chance to survive.

## P-408

### Neuroleptic malignant syndrome giving rise to malignant hypertension in a Lewy body dementia patient

N. Aquilina¹, V. Bugeja². ¹Karin Grech Rehabilitation Hospital, Guardamangia Hill, Pieta' PTA1312, Malta; ²St. Vincent de Paul Institution, Ingiered Road, Luqa

**Introduction:** A 91 year old obese lady with Lewy body dementia (LBD) was on quetiapine, which dose recently upped from 25 to 50mg. She was found to be obtunded (Glasgow coma scale 9/15), flushed, warm and generally rigid, with leadpipe hypertonicity of limbs. Pyrexia of 41°C was present with rapid, shallow tachypnoea.
(35 breaths/minute) and hypoxaemia (89% saturation probe), with blood pressure (BP) of 300/160 mmHg.

**Method:** Fundoscopy revealed flame haemorrhages, urine was clear but a burgundy colour with dipstix showing full bilirubin and blood readings, examination not yielding additional findings. It was reasoned that microangiopathic haemolysis occurred from accelerated hypertension damaging arterial endothelia, which shear erythrocytes releasing free intravascular haemoglobin, original trigger being subacute neuroleptic malignant syndrome (NMS) from the quetiapine increment, which was stopped. Aggressive forced diuresis with running intravenous (IV) saline and 6mg bumetanide aliquots to flush the kidneys undertaken; BP controlled with IV labetalol. Left on paracetamol (for fever) with 8 hourly IV fluids and bumetanide to preserve good urine output. Haemoglobinuria cleared after 2 days.

**Results:** Creatinine kinase and renal function remained normal, indicating that rhabdomyolysis and renal damage was averted. Fragmented erythrocytes on blood film, unconjugated hyperbilirubinaemia, high lactate dehydrogenase and low haptoglobin confirmed haemolysis. She regained full consciousness and normal tone within a couple of hours.

**Conclusions:** LBD renders subjects sensitive to antipsychotic adverse reactions, not least NMS. Accelerated hypertension may complicate NMS, forced diuresis is imperative to avoid renal damage and wash out any myoglobin crystals in the event of rhabdomyolysis.

## P-409
### Optimizing the ISAR-HP to screen efficiently for functional decline in older patients

J. de Gelder¹, J.A. Lucke¹, L.C. Blomaard¹, E. Haenen¹, H.G. Klop¹, R.A.J. Smit¹, K. Mesri¹, B. de Groot¹, A.J. Fogteloo¹, S. Anten², G.J. Blauw¹, S.P. Mooijaart¹. ¹LUMC; ²Alrijne Hospital

**Introduction:** The Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP) has recently been included in guidelines as a frailty indicator to identify patients for comprehensive geriatric assessment. Previous studies showed that the conventional cut-off score classifies a high percentage of patients as high risk incorrectly. We aimed to optimize the predictive value of ISAR-HP by using different cut-offs in older acutely hospitalized patients.

**Methods:** A prospective follow-up study was performed in two Dutch hospitals. Acutely hospitalized patients aged ≥70 years were included. Demographics, illness severity parameters, geriatric measurements and the ISAR-HP scores were obtained at baseline. The primary outcome was a combined end point of functional decline or mortality during ninety day follow-up.

**Results:** In total 861 acutely hospitalized older patients were included, with a median age of 79 years, of whom 276 (36.1%) experienced functional decline or mortality. The conventional ISAR-HP cut-off of ≥2 assigned 432/765 patients (56.5%) as high risk, with a positive predictive value (PPV) of 0.49 (95% CI: 0.45–0.54) and a negative predictive value of 0.81 (95% CI: 0.76–0.85). Thus, 51% of those whom the ISAR-HP denoted as high risk did not experience the outcome of interest. Raising the cut-off to ≥4 assigned 205/765 patients (26.8%) as high risk, with a marginally increased PPV to 0.55 (95% CI: 0.48–0.62).

**Conclusion:** The ISAR-HP with the conventional cut-off of ≥2 incorrectly identifies a large group of patients at high risk for functional decline or mortality and raising the cut-off to 4 only marginally improved performance. Caution is warranted to ensure efficient screening and follow-up interventions.

## P-410
### Peculiarities of pneumonia in patients treated in the department of geriatrics

J. Knasiene¹, V. Medzeviciute². ¹Lithuanian University of Health Sciences, Department of Geriatrics, Kaunas, Lithuania; ²Lithuanian University of Health Sciences, Kaunas, Lithuania

**Introduction:** Pneumonia in the elderly often present with atypical symptoms and radiographic or laboratory tests can be uninformative.

**Methods:** Using an questionnaire, 83 patients were interviewed. Main factors inducing the occurrence of pneumonia and physical, laboratory, radiological data and their incidence were assessed.

**Results:** Patients had underlying diseases: cardiovascular 91.6%, cerebrovascular 54.2%, pulmonary 43.4%, neurological 26.5%, kidney 25.3%, chronic infections 18.1%, diabetes 14.5%, oncological 12%. Within 1 month, 30.1% of patients had intravenous therapy, 10.8% - wounds treatment. Within 3 month >2days, 37.5% were hospitalized and 10.8% were nursing home residents. Prostheses were worn by 62.3%, 16.9% of them did not have teeth, caries was observed in 13%. 51.9% of subjects did not have fever, 37.8% had no leukocytosis, content of neutrophils in 10.8% was within the normal range. No inflammatory infiltration was observed in 24.4%. The right lung was penetrated with infiltration in 39%, the left one in 20.8% left, and both in 20.8%. Hydrothorax evolved in 23.4% of patients.

**Conclusions:** Main factors inducing the occurrence of pneumonia in older age are severe comorbidities, interventional procedures, previous hospitalization, life in nursing home, poor oral hygiene. Interpretation of clinical pneumonia data in older age can be difficult: more than half of the subjects did not have fever, a third of them - leukocytosis. A quarter of subjects did not have any infiltration lesions, which complicates the diagnosis

## P-411
### Peripheral venous catheter replacement – implementation of new findings (research protocol)

J. Sousa¹, H. Neves¹, B. Augusto², C. Fernandes², A.F. Almeida², J. Ferreira², A. Cristina². ¹Health Sciences Research Unit: Nursing - Portugal Centre for Evidence-Based Practice: a Joanna Briggs Institute Centre of Excellence, Coimbra, Portugal; ²Neurologia A - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

**Introduction:** New evidence suggest routine replacement of peripheral venous catheters (PVC) should no longer be criteria. Instead, new studies have proven that clinical criteria versus routine criteria reduce the incidence of phlebitis. As such, and since implementation of previous guidelines that indicated the need of routine replacement lead to a yearly reduction of 3.5% in a neurology ward in a central hospital in Portugal, a new study answering these new findings will be developed in the same setting.

**Methods:** A two phase study of quantitative nature will be developed during a year period. Phase I will target understanding of potential gains of this change in criteria, through application of a checklist based on clinical data for PVC replacement and compared related with the time since placement. Phase II will target nursing team expertise through workshops in order to improve knowledge, and the introduction of the clinically-indication as routine for PVC replacement.

**Results:** It is expected that change in routine will improve phlebitis rates by increasing knowledge and expertise in the nursing team.

**Conclusions:** Guideline implementation are a challenge in macro and micro organisations. With globalisation and access to new information and findings, it is important to keep constant update to improve the standard of care with impact in the patients' quality of life.
## P-412

### Persistence of direct oral anticoagulants (DOAC) treatments and determinants of their discontinuation in a geriatric population

C. Boully, F. Labouree, L. Caillard, O. Hanon. Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Service de Gériatrie, Paris, France

**Introduction:** European guidelines underline the necessity of introducing an anticoagulant for elderly people with atrial fibrillation (AF). However, older age of the patients remains one of the main brakes preventing the prescription of anticoagulants and the continuation of the treatment appears to be low under vitamin K antagonist (VKA). The arrival of direct oral anticoagulants (DOAC) offered a new possibility of treatment of the AF but the continuation of the treatment is poorly known. The objective of the study is to evaluate the persistence of treatment by DOAC and to analyze the determinants of their discontinuation in a population of very old patients, hospitalized in geriatric care unit, presenting a non-valvular atrial fibrillation.

**Methods:** Prospective study, conducted between January 2013 and January 2015. One hundred and thirty two patients benefited from the initiation of a treatment by DOAC (dabigatran or rivaroxaban). The persistence of DOAC use and the determinants of their discontinuation during 6 months of follow up were analyzed by descriptive statistics and a model of logistic regression with adjustment on the age, the sex and confusing factors.

**Results:** The mean age of the population was of 85.2 (SD=4.8), 70% (n=91) were women 12% (n=16) had a history of bleeding, 38% (n=51) had a history of cerebrovascular event. The mean clearance according to Cockcroft formula was 57.4 ml/min (SD=19.86) and the mean score of thromboembolic risk CHA2DS2-VASC scores was 4.17 (SD=1.32). The rate of DOAC's persistence after a 6 month-period was 66% (n=89). The main causes of DOACs discontinuation were the onset of a bleeding event in 33% (n=14), a degradation of the renal function in 19% (n=8), a galenic problem in 9% (n=4), palliative care in 7% (n=3), a stroke in 5% (n=2), fall and fracture in 5% (n=2) and an unknown cause in 19% (n=8) The main determinants of DOAC discontinuation were younger age [OR (95% CI) =0.86 (0.77–0.95), p=0.004], a history of bleeding [OR (95% CI) = 4.04 (1.09–16.3), p=0.02], a clearance of creatinine lower than 50 ml/min [OR (95% CI) = 3.57 (1.4–9.6), p=0.008] and low albumin (<30g/l) [OR (95% CI) = 2.89 (1.15–7.51), p=0.02].

**Conclusion:** In this population of very old patients, the continuation of the DOAC appears to be relatively low (66%). In 50% of the cases, discontinuation of treatment resulted from a bleeding event or impairment of renal function. In a third of the cases, no justified reason of treatment discontinuation was found. Specific studies in geriatrics are necessary to better estimate the benefit-risk of the DOAC in very old patients with multiple disorders.

## P-413

### Prevalence in patients older than 75 years with gastrostomy placement

V. Landaluce Pelligra, E. Garcia Tercero, T. Martinez Maroto, M. Araujo, J.C. Manchipa. Complejo Hospitalario de Toledo

**Introduction:** Placement of gastrostomies in patients older than 75 years is increasing. We propose a retrospective study of 5 years (2011–2016) of patients who underwent gastrostomy in the Complejo Hospitalario de Toledo, to establish the most frequent geriatric profile to which a gastrostomy is placed and its outcome.

**Methods:** Using the collection book of the interventional radiology service we recorded the name and petitioner's service retrospectively with sex, age, institutionalization, functional scales (Katz), cause of request for gastrostomy placement, type of nutrition, current situation (deceased or alive) and comorbidity.

**Results:** n=197, 43.7% are men. 50.3% live in the house, 48.7% in residence. 29.9% of the gastrostomies were placed for stroke, 1.5% for mild dementia, 14.2% for moderate dementia, 44.7% for severe dementia. 74.6% of patients were hospitalized in geriatrics, 69.5% were hypertensive, 32% were diabetic, 34% were dyslipemic, 11.17% had chronic ischemic heart disease, and 15.74% pressure ulcers. 51.8% of the patients had a KATZ G, 11.2% KATZ F and the classification was not collected in 20% of the patients. 54.8% of the patients died, of which the cause of death was not collected in 71.6%, 15.2% died from pneumonia, 3.6% from digestive causes.

**Conclusions:** We can conclude that the most frequent is to place gastrostomy in a woman, who lives at home, has dysphagia secondary to moderate-severe dementia, is admitted to the geriatrics department, has hypertension and KATZ G index. She is given normocaloric/normoprotein nutrition and dies, ignoring the cause of death.

## P-414

### Proactive geriatric consultation for elderly orthopedic patients reduces mortality and length of stay

R. Tellem¹,². ¹Tel Aviv Medical Center, Tel Aviv, Israel; ²Tel Aviv University, Tel Aviv, Israel

**Background:** Traumatic injuries and osteoarthritis are leading causes for functional deterioration, morbidity and mortality in the older population. Following orthopedic interventions, older patients are susceptible to various medical complications - wound and systemic infections, VTE, delirium, pressure sores, and exacerbation of chronic medical conditions. Delayed identification and treatment of these complications may increase length of stay, morbidity and mortality and increases the risk for functional deterioration and unwanted institutionalization. Geriatricians are trained to perform early identification and treatment of these complications as well as to direct a multidimensional discharge plans. In the current study we made an adjustment to the standard care of older patients by employing a proactive geriatric consultation. Geriatricians served as an integral part of a multidisciplinary team providing care for older patients in the orthopedic division. The geriatricians conducted early post-operative evaluation and continued follow-up in selected patients.

**Design:** Retrospective single center cohort study.

**Setting:** Orthopedic division of a large tertiary academic hospital.

**Methods:** Retrospective data was collected for the years 2011–2015. (The intervention took place between 01.2015 and 31.12.2015). Time from operation to geriatric consultation, post-operative length of stay in the orthopedic division and perioperative mortality were compared for patients during the intervention period (n=736) and previous years (n=5786).

**Results:** Time from operation to geriatric consultation decreased (93 hours to 67 hours median time, P<0.01). Post-operative length of stay decreased (6.8 days to 5.9 days, P value <0.01). During intervention year mortality rate was reduced significantly (38 to 34 yearly death rate, P<0.001).

**Conclusions:** Integrating geriatricians into the multidisciplinary orthopedic team and applying a proactive geriatric approach led to reduced length of stay and mortality.

## P-415

### Risk factors for falls in hip fracture older patients admitted to an Orthogeriatric Unit during the first 7 months

L. Costa¹, A. Santos¹, I. Ferreira¹, M. Martins¹, R. Vaz¹, S. Pardal¹, S. Duque¹,³, J. Guimarães Consciência², L. Campos¹. ¹Orthogeriatric Unit, Internal Medicine Department, São Francisco Xavier Hospital, Occidental Lisbon Hospital Center, Lisbon, Portugal; ²Orthogeriatric Unit, Orthopedics Department, Occidental Lisbon Hospital Center,
Lisbon, Portugal; ³University Geriatric Unit, Faculty of Medicine, University of Lisbon, Lisbon, Portugal

**Introduction:** Hip fracture (HF) in elderly usually occurs as a complication of a fall. To prevent future falls it is important to understand the risk factors for falls (RFF) and to correct them. Our goal is to identify the most prevalent RFF in elderly assisted during the first 7 months of a new Orthogeriatric Unit.

**Methods:** Retrospective study of elderly admitted due to HF between June and December 2016 through hospital record analysis.

**Results:** 134 patients included (123 underwent comprehensive geriatric assessment, 124 underwent pharmacological assessment). Average age 83.87 years, 78.4% females. Average baseline Barthel score 80.3, average Cumulative Illness Rating Scale Geriatrics 7.45. 6.9 RFF per patient in average and the most prevalent were: fall-related drugs (FRD) use (81%, 2 FRD/patient), being female (78%), polypharmacy (5 or more drugs) (69%, 6.5 drugs/patient), limitation in activities of daily living (69%), older age (≥85 years) (53%), cognitive impairment (48%), use of mobility aids (48%), malnutrition (26%), inactivity (24%), falls history (21%), cerebrovascular disease (21%), diabetes (19%), obesity (18%), gait impairment (17%), anaemia (15%), living alone (15%) and sphincters incontinence (15%), visual impairment (14%), osteoarthrosis (14%), hyponatremia (13%), depression (12%) and osteoporosis (10%). 59% were consuming psychotropic drugs: benzodiazepines (32%), antipsychotics (19%), selective serotonin reuptake inhibitors (19%). Other FRD prescribed were: proton pump inhibitors (43%), antihypertensive drugs (33%) and diuretics (28%).

**Conclusions:** Prescription of FRD is a very prevalent RFF in patients admitted for HP and must be systematically assessed during the admission to prevent future falls.

## P-416

### Risk factors for negative outcome in elderly emergency department patients

Ö. Sir¹, Y. Schoon². ¹Department of Emergency, Radboud university medical center, Nijmegen, The Netherlands; ²Department of Geriatrics, Radboud university medical center, Nijmegen, The Netherlands

**Introduction:** The amount of older patients attending the emergency department (ED) is increasing. Execute interventions to reduce negative outcome in elderly are important. Therefore, risk factors for negative outcome were identified.

**Methods:** From all patients ≥70 years who visited the ED of an university hospital in 2016, 2000 patients were randomly selected. Patients and visit related information were collected retrospectively. Negative outcome was defined as: in-hospital mortality and/or ICU admission, and unplanned ED revisit within 30 days. Risk factors for negative outcome were determined by logistic regression analysis.

**Results:** Of the 2000 patients (mean age 78.3years, SD6.5), 222 (11.2%) had a negative outcome; 65 patients (3.3%) in-hospital mortality, 111 (5.6%) patients ICU admission and 46 (2,3%) patient who died in the hospital during or after ICU care combined. The total revisit rate within 30 days was 12.1% (n=228). The rates for discharges (12.9%;n=94) and admitted (11.6%; n=134) patients did not differ significant (p=0.39). A diagnosis in neurology (OR 4.2, 95% CI: 1.5–11.6), surgery (OR2.3, 95% CI: 1.0–5.1), pulmonology and cardiology (OR 2.9, 95% CI: 1.1–7.6) or multi-trauma (OR12.3, 95% CI: 1.2–127.1), ambulance transportation (OR3.5, 95% CI: 2.2–5.3) or trauma helicopter transportation (OR 30.8, 95% CI: 8.1–116.5) are independent factors predicting negative outcome.

**Conclusions:** Independent risk factors for negative outcome are diagnosis in neurology, surgery, pulmonology and cardiology or multi-trauma, next to transportation by ambulance or trauma helicopter.

## P-417

### Sleeping quality and sleep disturbing factors assessed by geriatric patients in single-bed or multiple-bed hospital

H. Saugbjerg Weng¹, M. Bredahl Sørensen¹, M. Gregersen². ¹VIA University College, Aarhus, Denmark; ²Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark

**Introduction:** Lack of sleep during acute hospitalization has single effects such as increase in infection rate. Also, it increases blood pressure, and the risk of behavioral and psychological changes. Thereby recovery after illness extends. Our aim was to explore sleeping quality and sleep disturbing factors in older patients in single-bed compared to multiple-bed rooms.

**Methods:** In a cross-sectional study, we consecutively included cognitive well-functioning older patients admitted to a geriatric ward before and after the ward was moved from a multiple-bed hospital to a newly built single-bed hospital. They were acutely admitted primarily due to infection, hip fracture, or stroke. By a short-form questionnaire each patient was asked once in the morning ≥2 days of hospitalization: "Did you sleep well during the night?", and "Did anything disturb your sleep?" If the patient had been disturbed, the causes of disturbances were registered.

**Results:** In total, 226 (111/115) patients were included. Mean age was 83.6 years (±8.0), and 63% were women. Overall, 69% of the patients slept well, and 46% were disturbed during night. More patients in single-bed rooms assessed their sleep as good compared to the patients in multiple-bed rooms (p=0.01). Quality of sleep and disturbances were associated (p<0.001). External disturbances e.g. noise from staff or fellow patient were fewer in single-bed (4% versus 14%) (p=0.01). Internal disturbances e.g. pain and urge to urinate were equal (15% versus 18%).

**Conclusion:** Older inpatients assess their sleeping quality better in single-bed than in multiple-bed rooms, and experience fewer disturbances during the night.

## P-418

### ST Segment Elevation Myocardial Infarction (STEMI) in the elderly over 75 years: retrospective study in a general hospital

M. Kerif¹, N. Kadri², J. Doucet². ¹Hospital of Troyes; ²University Hospital of Rouen

**Introduction:** Data on ST elevation myocardial infarction in patients aged over 75 years remains sporadic.

**Methods:** We completed a retrospective study at the Centre Hospitalier de Troyes, including all patients aged over 75 years treated by emergency physicians in pre-admissions or in emergency wards presenting with acute ST elevation myocardial infarction between January 2015 and February 2016 inclusive. We also identified a second group of subjects, aged below 75 years, with the same number of members, in order to be able to perform a cross-analysis.

**Results:** We retrieved details of 32 patients aged over 75 years, with a mean age of 84.56 years (75–100 years), of which 22 were women. The mean Charlson comorbidity score is estimated at 3.44 (1–8) and the mean Grace score is estimated at 216 (168–345). Reperfusion was performed by way of an angiogram in 46.75% of cases; no patient in this group was subject to thrombolysis. The mean time before performance of the initial angiogram is estimated at 5,149 minutes (or over 85 hours); approximately 21.9% of patients were treated by way of insertion of a stent. One half of angiograms were not accompanied by the insertion of stents. Mortality during hospitalization occurred in ten cases and, in total, 12 patients passed away within six months. Thirty-one patients aged below 74 years, with a mean age of 55.06 years (25–74 years) were included in a study over a shorter period, namely three months, with the majority being men (27 subjects). Angiograms were performed in 96.77% cases, whereas thrombolysis was performed in the cases of
only two patients. We did not record any mortality during hospitalization, nor at an interval of one month or three months. There are more female subjects among patients aged over 75 years and more male subjects among patients aged below 75 years (p<0.0001). Subjects aged over 75 years were more likely to have consulted their treating physician prior to attending the emergency ward (p=0.002). The Charlson score is more significant in subjects aged over 75 years (p<0.0001); the same applies for the Grace score (p<0.0001). Subjects aged over 75 years were provided with less access to angiograms than subjects aged below 75 years, and were less likely to benefit from a stent insertion (p<0.0001). Age≥75 years increases the risk of mortality during hospitalization (p=0.001), at one month (p=0.001) and at six months (p<0.0001). The prognosis for ST Segment Elevation Myocardial Infarction (“STEMI”) patients is bleak. Mortality at one year in patients aged over 80 years is seven times higher than for patients aged below 70 years in the ASC II register. In the GRACE register, age was highlighted as an independent factor correlated with the absence of reperfusion treatment during the acute phase, along with a history of surgical revascularization, diabetes, heart failure, and the absence of chest pain. In the PLATO ELDERLY study, angiograms were deployed in 56.6% of cases, with angioplasty a featuring in 73.2%. A recent study on sudden cardiac arrest in elderly patients based on the ACOS register shows that mortality during hospitalization was recorded at a rate of 12.5% among the medical treatment group, compared to 6% among the group that benefited from an invasive treatment strategy. In the FAST-MI register, 85.3% of patients aged below 65 years were treated via angioplasty or fibrinolysis in cases of STEMI, compared to only 53.6% of subjects aged over 85. According to Kuch, angioplasty is the single predictive factor for survival at 18 months. Coronary angioplasty in subjects aged over 85 years is thus technically feasible with a satisfactory success rate and acceptable rates of morbidity and mortality, given the severity of the coronary condition and the associated comorbidity. Mortality is the criterion used in studies to judge the effectiveness of coronary angioplasty in octogenarian patients, but it is also important to assess quality of life as suggested by Shah et al, demonstrating that angioplasty performed in subjects aged over 75 suffering from STEMI is an independent predictive factor for an improvement in long-term survival, and also demonstrating that their quality of life is comparable with that of a similarly aged, non-institutionalized control population.

**Conclusion:** STEMI in elderly subjects remains a current topic, both in terms of therapy and prognosis.

## P-419

### Stroke as first manifestation of essential thrombocythemia in a nonagenarian

I. Elhani, M. Pierre, P. Lescure. *Centre Hospitalier Universitaire, Normandie Université, UNICAEN, Caen, France*

**Introduction:** Essential thrombocythemia is a myeloproliferative disease characterized by an elevation of platelet count. On rare occasions it can cause ischemic disorders such as strokes. They can account for 0.54 to 1% of ischemic strokes. They are exceptional in the oldest-old population, in which the two major causes of ischemic strokes are embolism and atherosclerosis.

**Case description:** A 92-year-old woman with history of hypertension was admitted with broca's aphasia. We diagnosed her with left sylvian ischemic stroke. There was no evidence of atrial fibrillation, carotid stenosis, endocarditis, dyslipidemia or diabetes. Her platelet count had been measured over 6G/L several times in 3 years, and was each time attributed to an infectious or inflammatory event. There was no iron deficiency or chronic inflammation. She had no history of thrombosis or bleeding manifestations. The V617F mutation of JAK2 was positive. We diagnosed her with essen-

tial thrombocythemia. She was treated with a daily dose of 160 milligrams of aspirin.

**Conclusion:** Stroke revealing Essential thrombocythemia is rare. Even though the age of diagnosis is rarely over 70, clinicians must suspect a hematological neoplasm included in a geriatric population. Essential thrombocythemia can easily be suspected with a simple blood count. Persisting high platelet count should alert the physician and lead to a non-invasive detection of the V617F mutation of JAK-2, especially if ischemic manifestations are reported. Indeed, the preventive treatment by combined antiplatelet and cytoreductive therapy could be proposed to allow the maintenance of functional ability and quality of life in the elderly.

## P-420

### Symptom recognition in acute heart failure patients

J. Pereira Sousa¹, M. Santos². ¹Instituto Ciências da Saúde - Universidade Católica Portuguesa, Porto, Portugal; ²Centro de Investigação Interdisciplinar em Saúde, Porto, Portugal

**Introduction:** Heart Failure is a chronic disease that requires patients to develop appropriate self-care behaviours, and to be able to detect early symptoms and signs of disease as well. Difficulty in early detection of heart failure signs and symptoms can delay contact with healthcare providers, possibly leading to severe physiological changes and hospital admission. The aim of this study was to identify if Heart Failure patients were able to recognize symptoms of the disease, after an educational program about symptom recognition.

**Methods:** Through an exploratory study we analysed if Heart Failure patients, admitted to an Intensive Heart Failure Unit Care, receiving education about signs and symptoms at time of discharge, could mention them one week and one month after discharge.

**Results:** 28 patients were enrolled. One week after discharge patients were contacted by telephone and asked if they could mention Heart Failure symptoms. 74.1% could recognize dyspnoea, 44.4% tiredness, 29.6% weight gain, and only 14.8% mentioned ankle oedema. One month after discharge, in a clinic follow-up, 61.5% mentioned dyspnoea, 34.6% tiredness, 11.5% weight gain, and only 3.8% (one patient) referred ankle oedema.

**Conclusions:** These findings suggest that heart failure patients may benefit from a disease management program that facilitates earlier reconnaissance of signs and symptoms of this disease.

## P-421

### The consumption of benzodiazepine substances in the elderly

S. Hammami, I. Chabéne, A. Mhalla, L. Gaha. *CHU F Bourguiba, Department of Internal Medicine, University of Monastir, Tunisia*

**Objectives:** To evaluate the consumption of psychoactive substances (PAS) in elderly patients followed in outpatient psychiatry and geriatric and identify factors correlated with the dependence on benzodiazepine (BZDs) or tobacco.

**Methods:** We conducted a transversal study, over a period of six months, that involved 100 patients aged over 65 years. The patients answered the scale of "Fagerstrom" for the evaluation of the nicotine dependence and the cognitive scale of attachment to BZDs (ECAB).

**Results:** The mean age of patients was 69 years (65-82). The sex-ratio was 0,96; 82% of patients had not exceeded the level of secondary education and 72% of them were married. Thirty-five percent had a somatic co morbidity. The depressive disorder was the most common on (41%). Antipsychotics were prescribed in 56% of case, anxiolytics (BZDs) in 40% of patients. 73% of the our patients consumed regularly at least one PAS (the BZDs in 40% with a dependency ratio of 90%). 92,5% of patients consumed the BZDs for at least 2 years with an average dose 3,87 mg per day. Regarding