smoking, 34% of patients smoked regularly with an average amount of cigarettes 42,3 per day. The half of smokers had a strong or very strong nicotine addiction. No patients reported an alcohol consumption or use of illicit products.

**Conclusion:** In the elderly, dependence on psychoactive substances can affect daily life and be responsible of somatic, cognitive and psychiatric complications. The BZDs are the most often involved. It is therefore essential to respect their indications, contraindications and educate patients.

P-422

**The course of geriatric syndromes from admission to three months post-discharge and their effect on adverse outcomes: results from the Hospital-ADL cohort study**

R. van Seben¹, L.A. Reichardt¹, J.J. Aarden², M. van der Schaaf², R.H.H. Engelbert³, J.A. Bosch⁴, B.M. Buurman⁵. ¹Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands; ²Department of Rehabilitation, Academic Medical Center, The Netherlands & Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; ³Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; ⁴Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; ⁵Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands & Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands

**Introduction:** Studies have addressed the prevalence of geriatric syndromes during hospitalization and showed their association with adverse outcomes. However, data on their course post-discharge and association with recovery are scarce. This study assessed the course of geriatric syndromes from admission until discharge and then monthly until three months post-discharge and their impact on functional decline, readmission, and mortality.

**Methods:** A multi-center cohort study, the Hospital-Associated Disability and Impact on Daily Life (Hopital-ADL) study, was conducted, including 400 acutely hospitalized patients aged ≥70 years admitted to an internal, cardiology or geriatric ward from six Dutch hospitals. Geriatric syndromes assessed included: fatigue; malnutrition; fall risk; fear of falling; shortness of breath; incontinence; pain; dizziness; depressive symptoms; cognitive impairment.

**Results:** 80% of patients experienced fatigue at admission, which remained present among 50% up to three months post-discharge. 40% were malnourished at admission, and still 20–30% in the first three months post-discharge. Almost 40% experienced a fall six months prior-hospitalization, and 11–12% had a fall in the first, second and third month respectively. 40% were afraid to fall at admission, 30% in the first months post-discharge. 15–35% experienced shortness of breath, incontinence, pain and dizziness during and post-hospitalization. 22% experienced depressive symptoms at admission, 11% post-discharge. 20% was cognitive impaired at admission, which decreased to 11% post-discharge. At admission and post-discharge, depressive symptoms, malnutrition, fear of falling, shortness of breath and pain were associated with functional decline, readmissions and mortality.

**Conclusion:** Our study underpins the importance of addressing geriatric syndromes in transitional care interventions.

P-423

**The frequency of short and long term readmissions in the geriatrics ward**

F.O.K. Kocak¹, S. Şahin¹, H. Şimşek², F. Akcicek¹. ¹Ege University

Hospital, Department of Internal Medicine, Division of Geriatrics, Izmir, Turkey; ²Dokuz Eylül University Hospital, Department of Healthcare, Izmir, Turkey

**Introduction:** Patient readmissions increase the mortality and morbidity and also cause a heavy financial burden. The purpose of this study is to determine the frequency of readmissions in the geriatric ward and related factors.

**Methods:** 129 patients who have been admitted to the Geriatrics Ward of Ege University between April 2016–2017 were reviewed retrospectively. The demographical data, medical histories and the reasons of admission of the patients were obtained from the electronic files.

**Results:** 39 (30.2%) of the admitted patients were male whereas 90 (69.8%) of them were female. The average of age was 79.6+7.5 (65–100). The average admission period was 13.5+8.5 (2–51)(SS:0.7). 60.5% of those patients had 3 or more chronic disease. 17 patients have been readmitted within a year (13.1%). Despite no significant relation has been found between the frequency of readmission and the age or gender, it was seen that it is related to the coronary artery disease (fisher's p:0.029). Even if there is not any significant relation between the number of diseases and the frequency of readmission, while performing Cox regression analysis, it was seen that when the number of diseases increase, the possibility of readmission increases 5.9 times and the reason of obtaining a confidence interval of 1–34.4 was correlated with having limited number of patients.

**Conclusions:** There is a significant relation between the coronary artery disease and the frequency of readmission. It is necessary to carry out studies covering higher number of patients in this respect.

P-424

**The hidden abscess**

S. Ponnambath, R. Hinton, A. Miller, F. Rickard, S. Kestenbaum, J. Brazier, H. Kirk, E. Barton. University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom

**Case report:** A 91 year old lady was admitted with a fall and confusion. Past medical history included TIA, hypertension, cognitive impairment and diverticular disease. Examination revealed decreased power in the right upper and lower limb, right upper motor neuron facial nerve palsy and right sided sensory loss. She had sustained a laceration to the right leg. CT brain revealed intraparenchymal haemorrhage within the left frontal lobe. She underwent rehabilitation with significant improvement. 3 weeks into the admission she developed fever and elevated CRP. Examination did not reveal localised infection. Investigations including a leg wound swab, urine culture, blood cultures, chest radiograph and trans-thoracic echocardiogram were all normal. No confirmed source of infection could be identified, and the fever and inflammatory response continued. She appeared otherwise well and was haemodynamically stable. A dental team visited the ward to review all our patients' oral hygiene. They noted this lady's bottom teeth were loose though not painful, and recommended imaging with an orthopantomogram. This revealed a dental abscess, which explained her recurrent fever. She was treated with intravenous coamoxiclav, responded well and the CRP normalised. The infection resolved fully and she made a good recovery.

**Conclusion:** Our case reinforces the need to take a broad and thorough approach when investigating occult infections, as well as highlighting the value of ready access to dental care for patients during long inpatient admissions. Dental abscess is not commonly thought of and can be easily missed.
## P-425

### The importance of a quick treatment

E. García Tercero¹, T. Martínez Maroto¹, V. Landaluce Pelligra¹, M. Araujo Ordoñez¹, L.A. Porta Gonzalez¹, R.M. García Tercero². ¹Hospital Virgen del Valle, Toledo, Spain; ²Hospital General Universitario Alicante, Alicante, Spain

A woman (78 years-old) goes to Emergency, referring in the last two weeks to intense headache and double vision with an intermittent look to the left. The day of admission wakes up with worsening pain and drooping eyelid. FFCC: conscious and oriented. No alterations of the language. PPCC: anisocoric pupils with right mydriasis not reactive to light. Paralysis of the upper right, lower right, and right internal binocular diplopia in all positions of the eye except for the right lateral view. Right parietal ptosis contacting upper pupil border. V, VII, VIII and normal low pairs. F.of eye not papiledema (Valued by normal AV ophthalmology in both eyes). Tone and force conserved in the four extremities 5/5. ROT ++/++++. Bilateral flexor RCP. Superficial and painful tactile sensitivity conserved in the 4 extremities. No dysmetria or dysdiadochokinesias. Analytical: Normochromic normocytic anemia. Rest as normal. VSG 57. Biochemistry: without alterations.

**Differential diagnosis:** Tumor metastasis, ophthalmoplegic mi- graine, cerebral aneurysms, temporal arteritis (Comparative ta- ble is included where the final diagnosis is indicated). TREAT- MENT: Methylprednisolone 1g i.v. 3days. Subsequently prednisone 60mg/day when the visual loss stabilized.

**Discussion:** Giant cell arteritis is the most common form of systemic vasculitis affecting the elderly with potentially severe systemic and ophthalmologic complications. It's a diagnostic challenge because of its clinical presentation, which has a wide and variable spectrum of signs and symptoms. In the case of the patient, treatment with corticosteroids was started, improving rapidly from the clinic so it was not possible to perform a biopsy of the temporal. It evolved favorably and in the month-to-month review was asymptomatic

## P-426

### Trajectories of depressive symptoms and apathy from hospitalization to three months post-discharge; The Hospital-ADL study

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

Depressive symptoms and apathy are both causes for and a consequences of hospitalization among older persons. Depressive symptoms and apathy are highly heterogeneous in its course, and psychological or physical recovery may be related to distinct tra- jectories. These trajectories are unknown in the context of acute hospitalization and possibly important for post-hospital recovery. Therefore, the aim of this study was to identify distinct trajectories of depressive symptoms and apathy from acute hospitalization until three months post-discharge and to study the incidence of functional decline and mortality three months post-discharge in these trajectories. We conducted a multicenter prospective cohort study, the Hospital-Associated Disability and impact on daily Life (Hospital-ADL) study, including 400 acutely hospitalized patients of 70 years and above. Data were collected in six Dutch hospitals. We identified three depressive symptoms consistently trajectories among acutely hospitalized patients: 1]high level of depressive symptoms (10%), 2]moderate level of symptoms (28%), and 3]min- imal symptoms (62%). Percentages of functional decline in the first, second and third group were 32%, 31%, and 12%, respectively. Mortality rates per group were 25%, 17%, and 5%, respectively.

We identified three apathy trajectories: 1]consistently high level of symptoms (19%), 2)], 2]consistently moderate level (23%), and 3]moderate level of symptoms and decreasing post-discharge (15%). Percentages of functional decline were 23%, 7%, and 15% respec- tively. Mortality rates per group were 14%, 3%, and 0% respectively. These distinct trajectory groups of depressive symptoms and ap- athy provide information about the possible prognosis of these symptoms and functional recovery after an acute hospitalization.

## P-427

### Two men with unexplained weight loss

F. Rickard, S. Ponnambath, E. Stratton, T. Allain, R. Hinton, A. Miller, L. Nel, C. Holmes. University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom

**Case report:** We present two cases of 70 year old men: both British, Caucasian, heterosexual, and working in professional roles. The first presented with unexplained diarrhoea and colonoscopy showed lymphocytic colitis. Over next 6 months he developed ophthalmic shingles and lost 12kg in weight. He then presented with left sided weakness. MRI showed acute and multiple old right cerebellar infarcts. He was diagnosed with post-zoster stroke syndrome and treated with intravenous aciclovir and antiplatelets. Further testing revealed him to be HIV and syphilis positive, with CD4 count of 80 and viral load of 28474 and commenced on ART. The second had a 4-week history of deteriorating cognition on a background of 4 years of chronic ill health, including muscle wasting and weakness, 16kg weight loss, recurrent oral candida, and Bell's Palsy. MRI brain revealed cerebral volume loss. He then presented with thrombocytopenia and worsening confusion. Testing revealed him to be HIV positive, with CD4 count of 28 and viral load >1 mil- lion. Diagnoses of HIV-associated dementia and immune mediated thrombocytopenia were made. IVIg and HAART were commenced and his confusion improved.

**Discussion:** The age distribution of newly diagnosed HIV is chang- ing, with diagnoses in older adults increasing. Late diagnosis is associated with HIV-related morbidity and mortality in UK, and older adults, particularly white, heterosexual men, are at increased risk of late diagnosis. Both gentlemen had been investigated for conditions which, in hindsight, were HIV-related and according to British HIV Association guidelines should have triggered an HIV test.

## P-428

### Understanding the phenomenology of unplanned admissions in patients with Parkinson's disease, to drive service development and quality

A. Thomson, C. Miller, L. Partington, P. Cotton. Salford Royal Hospital

**Introduction:** Patients with idiopathic Parkinson's disease (iPD) may be admitted to hospital with unanticipated acute illness. An understanding of the factors associated with hospital admission could be used to design a bespoke service to enhance patient care and safety, and promote discharge home.

**Methods:** All unplanned iPD admissions to the Emergency Assess- ment Unit (EAU) of a University teaching hospital between 1st January and 31st December 2014 were identified by electronic search for coded cases. Retrospective electronic case note review of each admission was undertaken.

**Results:** 80 patients (male 52.5%, mean age 77.2 years) accounted for 136 admissions. 26/80 (32.5%) were known to have dementia. The principle diagnoses on admission were falls (24.3%), delirium (9.6%) and immobility (7.4%). The overall delirium rate was high (30.2%) and strongly associated with mortality. Medication errors in the first 24 hours of admission were also common (76.9%), with 137/563 (24.3%) doses missed. Mean length of stay was noted to be
longer on non-Geriatric specialty wards (23.1 days versus 16 days). 65.4% never saw a member of the iPD team during their stay.

**Conclusions:** Having determined patterns of admission and targets for quality improvement, an in-reach programme was developed in 2015. This involved a timetabled Geriatrician-led presence by a member of the iPD team on the EAU, and incorporated an Emergency Care Bundle to address medication management, delirium screening/intervention and other strategies. This framework has further evolved to include an email alert system for admissions and enhanced follow-up for the duration of that patient's stay.

P-429

Why can I see two doctors?

E. García Tercero¹, V. Lalanduce Pelligra¹, T. Martínez Maroto¹,
M. Araujo Ordoñez¹, M. Alonso Seco¹, R.M. García Tercero².

¹Hospital Virgen del Valle, Toledo, Spain; ²Hospital General Universitario Alicante, Alicante, Spain

A 76-year-old woman who has been admitted for dizziness, fever and general malaise for two days. In Urgencias, ITU is targeted. And enter with ceftriaxone 2g/24h. At the first day she had, partially yielding with antipyretics. It also refers to frontally predominant headache and vomiting. Decreased consciousness level. Her family finds her more oblivious than previous days. In the face of suspected encephalitis, a large study is urgently conducted and empiric treatment with acyclovir is initiated. No allergies, Diabetes, ex-moderate drinker, colonic diverticulosis. Medication: Metformin 850mg/12h. Exploration: Conscious, bradypsychic. Well moisturized, perfused and colored. AC: rhythmic without blows. AP: normal. EEII: without edema. NEURO: normal. Analytics: CT CRANEAL and RM CRANEAL: normal. EEG: Irritative activity with pseudoperiodic complexes ofBilateral temporal topography predominating to the right. PCR for HSV1: positive. Diagnosis: Herpetic encephalitis. Treatment: Acyclovir 800mg/8h – 14 days. Evolution: It presented a favorable evolution. After 2 weeks of treatment, the patient was discharged with severe amnestic sequelae. Herpetic encephalitis is a serious disease, with a high mortality rate and neurological sequelae in relation to others. It is mainly caused by HSV 1 by 90%. The clinical presentation together with EEG, MRI and CSF analysis are key in its diagnosis. The treatment is intravenous acyclovir at a dose of 10 mg/kg/8 h for 10–21 days. A high diagnostic suspicion and a fast onset of treatment dramatically change the prognosis, improving survival. It's recommended to initiate antiviral therapy in the first four days to avoid mortality and short-term complications.

Area: Geriatric rehabilitation

P-430

ACCRA Project: Agile Co-Creation for Robots and Aging

L. Fiorini¹, G. D'Onofrio², R. Limosani¹, D. Sancarlo², A. Greco², F. Giuliani³, A. Kung⁴, P. Dario¹, F. Cavallo¹. ¹Scuola Superiore Sant'Anna; ²Complex Unit of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della sofferenza", San Giovanni Rotondo, Foggia; ³ICT, Innovation and Research Unit, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia; ⁴Trialog, Paris, France

**Introduction:** European population is getting older. This is the result of a simultaneous drop in fertility rates, longer life expectancies and a shift of the post-war baby boom generations to the top of the age pyramid. This demographic shift implies the understanding of healthy aging and age-related diseases as one of our future challenges. The aim of ACCRA (Agile Co-Creation for Robots and Aging) is to enable the development of advanced ICT Robotics based solutions for extending active and healthy ageing in daily

life by defining, developing and demonstrating an agile co-creation
development process.

**Methods:** ACCRA robotics solutions will be designed and developed to be tested in three different domains: walking support, house-work, conversation in four countries (i.e. Italy, France, Netherlands and Japan). ACCRA project consists of three robotic applications which aims to promote the independent living by means of per-sonal mobility application, to support the daily life management thanks to housework application and to promote conversation rehabilitation tailored on personal attitude by means of dedicated software programme. Additionally, ACCRA project will be designed and developed on open source framework (i.e. ROS, FIWARE, univer-sAAL and Rospex) to promote the interoperability among scientific community.

**Conclusions:** The availability of new solution to increase indepen-dence and increase quality of life in a sustainable manner appear to be mandatory considering the actual socio-economic situation over the industrial countries.

P-431

An intervention project for the community-dwelling elderly
living in a rural area of Izmir to prevent falls

B. Deger¹, F. Sarac², S. Savas², F. Akcicek². ¹Institute of Health Sciences, Ege University; ²Geriatrics Section, Department of Internal Medicine, School of Medicine, Izmir, Turkey

**Introduction:** Balance disorders (BD) are one of the most important risk factors leading to falls. The purpose of the present study was to determine the elderly people with BD and history of falls, the etiologies, and to identify the elderly who need aids and to supply support for them in a rural area.

**Materials and methods:** A total of 639 elderly living in a rural area over 65 years of age who were selected by stratified random sampling were enrolled. The study was performed as face to face survey study at homes of the elderly. BD was determined by "Berg Balance Scale" (BBS).

**Results:** The frequency of BD and falls in the previous year were 34.6% and 39.1%, respectively. The mean of BBS score was 43.49. Older age (mean: 73.99±6.6) (p<0.001), female sex (p<0.001), presence of defective vision (p=0.001) and impaired walking (p<0.001), increase in the number of chronic disease (p<0.001) and drugs used (p<0.001), presence of incontinence and nocturia (p<0.001), no regular physical activity (p<0.001), loneliness (p<0.001), absence of free time activity (p<0.001), a history of falls (p<0.001) were associated with BD. The support supplied will be discussed.

**Conclusion:** BD and falls are common in the elderly, and it is crucial to prioritize preventive health services in the elderly population.

P-433

Assessment of burden and its associated factors among the
caregivers who provide home care to their family members over
the age of 65

C. Sogut, P. Dundar, B. Cengiz Özyurt. Celal Bayar University Faculty of Medicine Public Health Department, Manisa, Turkey

**Aim:** Care needs of the elderly are an important issue affecting the well-being of caregivers and the elderly in Turkey due to the burden placed on family members. This study aimed to the burden and find out the factors associated with burden among caregivers who involve in the home care for their family members, who are at least 65 years old in Manisa, Turkey.

**Method:** This cross-sectional study comprised 156 individuals above the age of 65, who applied to home care service and their 156 family members, who provide them home care. Data were collected with the Personal Information Form, Katz Index of Activities of Daily Living and Zarit Caregiver Burden Scale. In order to carry out this
research, legal permissions have been taken both from the Clinical Research Ethical Committee of the Medical Faculty of Celal Bayar University. All data was evaluated using descriptive analysis and t-test, Mann-Whitney U Test, ANOVA, Kruskal-Wallis test, Pearson correlation analysis.

**Results:** The average burden of caregivers have been shown to be 29,7 with a standard deviation of 14,08. Most of the caregivers have been identified as individuals, who are woman, married, with children, with low educational degree, with social security, and housewives. Having the caregiver in the lower social class, having the patient's daughter-in-law, extended family structure and patient's bad health perception are the reasons that increase the caregiver's burden.

**Conclusion:** The study determined that primary caregivers bore a heavy burden of care. Therefore, caregivers' burden of care levels and difficulties should be determined, and they should be given professional support including counseling services.

## P-434

### Audit of accident and emergency re attendance following discharge from Discharge-to-Assess Unit Wellington House

S. Jay¹, L. Wentworth², J. Kelly², J. Williams². ¹University of Manchester, UK; ²University Hospital of South Manchester, UK

**Introduction:** Wellington House (WH) is a novel unit operating a discharge-to-assess model in South Manchester, UK. The unit accepts frail patients from the acute hospital who require further assessment of cognitive impairment or time to correct deconditioning. The goal is to facilitate safe discharge to a patient's own home, thereby reducing 24hr care admission through promotion of patient independence. Accident and Emergency (A&E) re attendance following a stay at WH was examined, alongside independence indices, to determine the effect of WH on future acute presentation.

**Method:** The audit period was defined as December 2014 to January 2016, all patients who were treated at WH during this time were identified. Data was collected regarding the number of A&E attendances by the cohort in the 6 months before their stay and in the 6 months after their stay. Further data was collected concerning the cohort's Bartel independence index score on admission and on discharge.

**Results:** There were 444 A&E attendances by the WH cohort in the 6 months before their stay, and 202 attendances in the 6 months after their stay. This represents a reduction of 55%. Average Bartel independence on admission was 9, which raised to 14 on discharge.

**Conclusions:** WH cares for a frail elderly population and achieves an increase in their independence status. The model results in a marked reduction in A&E attendance among the cohort.

## P-435

### Audit of readmissions following admission to Discharge-to-Assess Unit Wellington House

S. Jay¹, L. Wentworth², J. Kelly², J. Williams². ¹University of Manchester, UK; ²University Hospital of South Manchester, UK

**Introduction:** Wellington House (WH) is a novel discharge-to-assess unit operating in Manchester, UK. It accepts patients from the acute hospital who are deconditioned or require further assessment of their cognitive impairment. WH focusses on enabling safe discharge to a patient's own home and reducing 24hr care admission by promoting patient independence and early mobilisation. Avoidable and non-avoidable readmissions to the acute hospital following discharge from WH were reviewed, with a view to determining the effect of WH on future hospital admission.

**Methods:** All readmissions between December 2014 and January 2016 were examined. Data was collected pertaining to presenting complaint and length of stay (LOS) using a standardised proforma.

Avoidability of the readmissions was assessed both objectively and subjectively.

**Results:** Of the 220 patients treated at WH during the audit period 33 were readmitted, giving a readmission rate of 15%. The LOS on readmission was 3 days shorter than during the original admission. Most patients were readmitted with different problems to their original admission. The number of patients readmitted with falls fell by 70%. 14% of the readmissions were felt to be potentially avoidable by staff or processes at WH, the principle culprit being communication errors.

**Conclusions:** The WH model produces a low readmissions rate with a reduced length of stay compared to original admission. The service is effective at treating the reason for admission, particularly with regards to falls. There is scope for improvement in staff communication.

## P-436

### Characteristics and rehabilitation outcomes of older parkinsonian patients attending a day hospital

A. Fallon¹, L. Kilbane¹, S. Quinn², S.P. Kennelly¹. ¹Department of Age-Related Healthcare, Tallaght Hospital, Dublin 24; ²Physiotherapy Department/Age-Related Healthcare, Tallaght Hospital, Dublin 24

**Introduction:** Day hospitals provide older people with ambulatory access to multidisciplinary team (MDT) assessment, though there is limited evidence on their effectiveness. The Irish National Clinical Programme for Older People recommends developing Day Hospitals as hubs, coordinating care needs of patients with complex conditions and co-morbidities such as Parkinson's disease (PD). This study aims to examine characteristics and rehabilitation outcomes of older patients attending a day hospital, including those with PD.

**Methods:** Data was collected for patients attending a Day Hospital incorporating a PD review clinic in a tertiary referral university teaching hospital from January-March 2012 and January-March 2016. Information on demographics, duration of rehabilitation and pre/post functional scores were collected. Electronic data was reviewed for PD patients, examining subtype, medications and rehabilitation outcomes.

**Results:** In 2012, a total of 150 patients attended day hospital for an average of 6.9 weeks. Mean age was 79.5. 24.7% (37/150) attended PD review clinic for an average of 5.4 weeks. In 2016, 123 patients attended, for 7.3 weeks on average. Mean age was 79.3. 30.9% (38/123) attended for PD review, for an average of 6.5 weeks. Though not electronically recorded for all, mean UPDRS motor scores increased from 13.4 in 2012 to 35.5 in 2016 and timed up and go from 12 to 17.5seconds.

**Conclusions:** Day hospitals are a valuable resource for older patients and review of rehabilitation outcomes is ongoing. Though fewer attended in 2016 than 2012, the increasing proportion of Parkinson's patients and higher average scores recorded suggest those attending may be increasingly complex.

## P-437

### Chronic dysfunctional foot in older persons

M.D. Clantau, B. Mitoiu, G. Gheorghievici, A.S. Nica, R. Nartea. University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania

**Introduction:** Older people frequently develop impaired balance and functional ability. One main cause of this affections is represented by the the foot and ankle problems. This conditions affect the quality of the life in elderly. One important role in the disability of this patients is played by the painful foot.

**Material and method:** In this study we want to demonstrate the relationship between the painful foot, the disability and the quality of life in older people. We selected 30 patients (17 women and 13
men), aged between 65-80 years old, who suffered from severe
foot pain associated with disability for the last 3 months or more.
We observed the walking speed, the endurance and we correlated
this with the analog visual scale. We modulated this with gender,
race, age, IMC, comorbidities, smoking status and the number of
other pain locations.

**Results:** We could observe that the incidence of foot pain is really high, and also is increasing in the last years. This symptom is directly proportional with the disability prevalence and also with the limitation of the activities of the daily living. Hallux deformities, calluses or corns, edema, hammer toes and pes planus are the main affections that cause this symptom.

**Conclusions:** The two components of pain, the sensory and the emotional, influence each other and correlated with the reduced functional ability, the increased risks of falls and the reduced physical and mental (depression) aspects influence the quality of life for older persons. This aspects are very important ones especially when the treatment solutions is in discus.

P-438

Effect of a novel elongation training (ELT) on frail old adults'
physical abilities

J. Miyazaki¹, A. Takahashi², A. Uematsu³, H. Koda¹, T. Saiki⁴.
¹Kyoto tachibana University, Kyoto, Japan; ²Akashi Ninju Hospital,
Akashi, Japan: ³Dokkyo Medical University, Tochigi, Japan;
⁴Ritsumeikan University, Kusatsu, Japan

**Purpose:** We developed an original ELT which is able to execute easily by a frail old adult. The purpose of this study was to examine effect of our ELT on frail old adults' physical ability.

**Methods:** 34 frail old adults (age: 83.1±6.7 yrs) who join to an ambulatory rehabilitation program participated in the study. They were randomly assigned to the ELT (ELT group, n=23) and to the standard physical therapy groups (control group, n=11). The training program consisted of 24 sessions administered over 12 weeks. Contents of single session for ELT group were 10 minutes ELT and 10 minutes physical therapy. Contents of single session for control group were 20 minutes physical therapy. We measured participants' physical abilities (muscle strength and lower leg muscle functions) in baseline, after 4, 8, and 12 weeks. The key analysis was 2-way mixed-design ANOVA, and a Bonferroni's contrast was used for post hoc test. Statistical significance was set for all analysis at p<0.05.

**Results:** There was no significant time by group interaction in all measured score. The time main effect was found in 30-second chair stand test, knee extensor strength, and 2 step test.

**Conclusion:** Results of this study suggested that our ELT produces effects to increase old adults' physical abilities in similar level with the standard physical therapy. The main merits of our ELT do not need other's help and old adults can execute our ELT easily in sitting and/or lying positions.

P-439

Effects of high-intensity interval training on the cardiac
rehabilitation in the elderly patients

J. Kim. Department of Rehabilitation Medicine, Wonkwang University
School of Medicine

**Objectives:** To investigate the effect of high-intensity interval training (HIIT) on the outcomes of cardiac rehabilitation (CR) in elderly patients and young patients after myocardial infarction (MI).

**Methods:** From January 2015 to December 2016, we retrospectively reviewed the medical records of the patients who received HIIT through the outpatient clinic. A total of 15 patients were enrolled, 6 of whom were elderly (≥55 year) and 9 were younger (<55 year). The HIIT program was composed of 10 minutes of warm-up, 30 minutes of interval aerobic exercise, and 10 minutes of cool down.

The interval aerobic exercise consisted of 3-minute usual intensity work phase (60–70% of heart rate/VO2 reserve) and 4-minute of high-intensity work phase (70–90% of heart rate/VO2 reserve) (Fig. 1). Exercise capacity was measured by symptom-limited exercise tests before and after hospital-based CR.

**Results:** A 115 patients were male and the mean age of the overall patients was 53.4±9.2 years. The mean age of the younger (<55 year) group was 47.2±4.2 years, and that of elderly group (≥55 year) was 62.7±6.3 years. Between before and after HIIT, resting heart rate and submaximal rate pressure product at stage 3 were significantly decreased and metabolic equivalent tasks, peak oxygen consumption and maximal oxygen pulse were significantly increased in the elderly group, but there was no significant difference in the younger group. In comparison of the percent changes in the exercise capacity before and after HIIT, there was no significant difference between the two groups.

**Conclusions:** There was significant improvement on exercise capacity in the elderly group compared to the younger group after HIIT. The degree of improvement in cardiopulmonary exercise capacity after HIIT between elderly group and younger group was similar. For improving cardiac function, active interventions in possible elderly groups are necessary.

P-440

Evaluation of physical training upon endocrine, physiological
and sexuality status in elderly men

C.R. Revnic¹, F. Revnic², C. Pena², B. Paltineanu³, S. Voinea¹. ¹UMF
“Carol Davila”, Bucharest, Romania; ²NIGG Ana Aslan, Bucharest,
Romania; ³UMF Tg. Mures, Targu Mures, Romania

**Introduction:** With rapidly growing geriatric population and with the improvement in quality of life, sexuality is becoming an increasingly aspect of aging.

**Objective:** Investigation of the role of physical training program of moderate intensity on endocrine modulation, amelioration of depression and sexual function in elderly men. Our study was done on 42 patients aged 60-82:21 active (groupA) and 21 sedentary (group B) admitted in Rehabilitation Clinique for different osteo-articular and postraumatic pathologies. Standard physical exercise program (F.Revnic et al. GERIATRIA, vol.XIV, nr.1 2002] was applied for 16 weeks.hTSH,T3, T4, HGH, Testosteron and Cortisol were evaluated before and after training with1234 DELFIA Research Spectrofluorimeter using Eu+ labbeled kits purchased from Pharmacia. The results were processed with a Multicalc program. Evaluation of muscle efficieny was done before and after training with Schwartzer Picker 2000 EMG

**Results:** 70% patients from group A were euthyroid, HGH, Testosteron and Cortisol were in normal range, with a positive attitude towards sexual life. 56% sedentary patients of group B presented hTSH values >61.U/ml corresponding to hypothyroidism with elevated levels of Cortisol and low levels of HGH and Testosteron. They exhibited anxiety with the following symptoms: irritability, agitated fear for the future, tiredness, difficulty in communication, sleep disorders and a negative attitude towards sex. After training,a decrease in Cortisol and an increase in Testosteron and HGH in group B was recorded with a positive consequence upon affectivity (interest in sex).

**Conclusion:** Physical training with its multiple aspects (cognitive, mental and socio-afective)had a great impact upon reorganisation of hypothalamo-pituitary-thyroid-adrenal-gonadal axis in elderly men connected with changes in many effector hormones secretion with a positive impact upon emotional well being, mental health and an increase in desire for sexual life
P-441

**Everyday life in older men living alone – a complex view needs a
holistic perspective**

P. von Heideken Wågert¹, S. Nygård², S. Cederbom¹,³. ¹Department
of Physiotherapy, School of Health, Care and Social Welfare,
Mälardalen University, Västerås/Eskilstuna, Sweden; ²Rehabilitation
Unit, Kungsör Municipality, Kungsör, Sweden; ³Department of
Physiotherapy, Faculty of Health Sciences, Oslo and Akershus
University College of Applied Sciences, Oslo, Norway

**Introduction:** To be an older man living alone might mean a de-
creased health, and good health is a strong predictor for increased
abilities in everyday activities. The life situation of this group is not
well studied and need to be explored in a greater extent. The aim
was to explore how older men living alone describe their everyday
activities as well as their ability, and what could facilitate their
ability, in performing everyday activities.

**Methods:** Qualitative semi-structured interviews were analysed with inductive content analysis. Eight men aged over 65 years, living alone with home help services, being able to walk and with sufficient cognitive ability were included.

**Results:** The analysis resulted in one theme "A will to make it on their own, but are dependent of a helping hand" and twelve categories. The men described a daily routine and it was important to be able to get out of their homes, to be physically active and to be part of a social context. Though, medical, psychological and environmental factors constrain these activities. Support from people in the participants' environment, improved medical conditions, and own strategies may facilitate everyday activities. The wish of performing everyday activities by themselves are strong, but also an acceptance of not being able to do this anymore.

**Conclusions:** The results reflect a complex view of these older men's everyday life. It is important for their independence that health care and rehabilitation staff have a holistic view and works from a biopsychosocial perspective.

P-442

**Factors associated to activities of daily living and gait recovery at
1-year follow-up in hip fracture patients admitted to an acute
orthogeriatric unit**

P.Y. Condorhuamán Alvarado, T. Alarcón, R. Velasco, P. Gotor,
I. Martin Maestre, J.I. Gonzalez Montalvo. Geriatrics Dept., Hospital
Universitario La Paz, Universidad Autonoma, IdiPaz, Madrid. Spain

**Introduction:** Hip fracture (HF) affects 50,000 people annually in Spain. Potential complications include long-term functional decline. The aim of this study was to assess the factors associated to functional recovery (FR) one year after HF.

**Methods:** A cohort of HP patients admitted to an Orthogeriatric Unit at a University Hospital was followed during 1-year. Socio-demographic, clinical, nutritional, functional, cognitive and analytic variables were analyzed. Functional status was assessed by Barthel Index (BI) and ability to walk by Functional Ambulation Classification scale (FACs). Patients were considered to have FR if the score of BI or FACs at 1-year was equal to or greater than baseline. A multivariate logistic regression analysis was ruled out with the variables associated to FR in the bivariate analysis.

**Results:** A sample of 103 patients was studied. At baseline all the patients were independent or slightly dependent (BI >65). One-year after HF, 54.4% and 75.7% of the patients had recovered or improved the BI and the ability to walk, respectively. In multivariate analysis, patients with FR of BI were younger (OR: 3.16) and had normal values of vitamin D at admission (≥30 ng/ml) (OR: 1.24). Patients with FR of FACs were younger (OR: 3.8) and had better cognitive status at admission – Pfeifer Questionnaire score <5 – (OR: 7.31) (All with p<0.05).

**Conclusions:** Age, levels of vitamin D and cognitive status at ad-mission play a role in long-term FR in patients with HF. (Supported in part by a grant from Nestlé Health Science to the IdiPAZ).

P-443

**Fatigue post-stroke – a 7 year follow-up study**

M.H. Ursin¹, G. Hagberg², H. Naess³, H. Ihle-Hansen²,⁶, B. Fure⁴,
B. Thommessen⁵. ¹Bærum Hospital and Diakonhemmet Hospital,
Norway; ²Bærum Hospital, Norway; ³Haukeland University Hospital,
Norway; ⁴The norwegian knowledge centre for the health service,
Norway; ⁵Akershus University Hospital, Norway; ⁶Hospital and Oslo
University Hospital, Norway

**Introduction:** Post-stroke fatigue (PSF) is a common and distress-
ing problem after stroke [1] but there is a lack of knowledge
on long-term prognosis. This study explores fatigue in an elderly
population with mean age of 72 years when suffering the initial
stroke. The cohort is followed for 7 years. The subjects included
were participants in the project "Cognitive impairment after stroke
and TIA" [2].

**Methods:** A longitudinal study of participants with first-ever stroke or TIA explored fatigue for 123 of 210 participants at the one-year follow-up. The Fatigue Severity Scale (FSS) measured fatigue at 1 and 7 years after the initial stroke. Sociodemographic characteristics reported was gender, age, education (more or less than nine years), vascular risk factors, weight and height. Body Mass Index (BMI) was calculated. The exclusion criteria were pre-stroke cognitive impairment and dementia.

**Results:** A total of 65 participants (49% women), mean age 80.7 years were included in the analyses, with registered score on FSS at 1 and 7 years post-stroke. Mean total fatigue score were 31.2 (SD=13.4) at one-year follow up and 30.53 (SD=13.6) at the seven-year follow up. In the multiple regression analyses FSS showed association with Trail making Test A (TMT-A) (p=0.001) and Trail making Test B (TMT-B) (p=0.001), Hospital Anxiety and Depression Scale (HADS); depression (p=0.03) and anxiety (p=0.01) at the one-year follow-up. Age, gender, education or neurologic impairments measured by NIHSS showed no significant associations to FSS (p>0.05).

**Conclusions:** The included participants reports fatigue at the seven-year follow at the same level as at the one-year follow-up. The results indicate that cognitive flexibility, attention and executive functioning, as well as depression and anxiety at one-year may predict PSF 7 years after stroke.

**References:**

[1] Wu S, Kutlubaev MA, Chun H-YY, Cowey E, Pollock A, Macleod MR, Dennis M, Keane E, Sharpe M, Mead GE: Interventions for post-stroke fatigue. Cochrane Database of Systematic Reviews 2015

[2] Ihle-Hansen H, Thommessen B, Fagerland MW, Oksengard AR, Wyller TB, Engedal K, Fure B: Multifactorial vascular risk factor intervention to prevent cognitive impairment after stroke and tia: A 12-month randomized controlled trial. Int J Stroke 2012

P-444

**FIT4FRAIL: Fitness training for frail elderly during orthopaedic
geriatric rehabilitation**

D. Visser¹, H.L. Gerrits², E.M. Wattel¹, A.J. de Groot¹, F.J. Meiland¹, C.M.P.M. Hertogh¹. ¹Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam; ²Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, The Netherlands

**Introduction:** Physical Fitness Training (PFT) is a core element of orthopaedic Geriatric Rehabilitation (GR), aimed at improving
physical functioning and independent living, but there are large
differences with respect to its implementation in current GR
programs. Lack of clear recommendations underlie this variation
among elderly care centres and it is likely that current programs
are sub-optimal. In addition, it is unclear which patient related
factors as well as environmental determinants are most important
in orthopaedic GR. Hence, it is unknown whether and how existing
knowledge on PFT can be translated to frail patients admitted to
orthopaedic GR.FIT4FRAIL aims to 1) develop recommendations
for PFT in orthopaedic GR programs and 2) study the feasibility
and effects of implementing these recommendations for PFT in
orthopaedic GR.

**Methods:** Three separate work packages are planned: 1. A systematic review and a Delphi study to obtain evidence based recommendations on the characteristics of PFT. 2. Identifying the specific characteristics, barriers and facilitators of current orthopaedic GR programs of geriatric care centres within the University Network (UNO-VUmc). 3. Designing and piloting a new PFT program in a sample of GR patients.

**Results:** Results will include 1) scientific evidence and expert opinions on preferred PFT in 2017, 2) characteristics and factors involved during current orthopaedic GR in 2019, and 3) knowledge on the feasibility and effects of a new PFT program in 2021.

**Conclusions:** Specific recommendations will be given for tailored Physical Fitness Training in orthopaedic Geriatric Rehabilitation.

P-445

Functional independence and related factors in older people
with osteoarthritis referring to hospitals in Mashhad, Iran in
2016

M. Ahmadpour¹, A.D. Kakhki¹, M. Zandi¹, P. Davidson². ¹Shahid Beheshti University of Medical Sciences, Tehran, Iran; ²Johns Hopkins University, Baltimore, Maryland

**Introduction:** Osteoarthritis is one of the leading causes of disabil-
ity and loss of functional independence in older people. This study
was conducted to describe functional independence and related
factors in older people with osteoarthritis in Mashhad, Iran.

**Methods:** This descriptive-correlational study was conducted on 300 older people with osteoarthritis above 60 years old attending clinics of rheumatology and rehabilitation in hospitals of Mashhad University of Medical Sciences in 2016. Self-report demographic and disease status and activities of daily living (ADL) questionnaires were used for data collection. Data were analyzed with SPSS software.

**Results:** The mean age of participants was 70.75 (±7.27) years. 61% of older people were female. 65% had body mass index (BMI) between 25% and 30%. 68.32% had osteoarthritis lower than 10 years and the knee was the most involved joint (40.66%). Taking a bath and a shower (54%), getting to the bathroom (69%), and walking (78%) were the most troublesome ADLs of older people. Younger participants who were male, married and lived with partner and children, of higher education and income, lower BMI, and shorter duration of osteoarthritis had more independence in activities of daily living.

**Conclusions:** Osteoarthritis impact on ADLs in older people. Tailed and targeted strategies are necessary to promote functional independence of older people in activities.

P-446

Functional recover after hip fracture in elderly patients

R. Nartea, I. Mitoiu Brindusa, M. Constantinovici, M.D. Clantau, A.S. Nica. INRMFB, UMF "Carol Davila", Bucharest, Romania

Hip fracture prevalence increased with advanced age. Sarcopenia,
age, comorbidities, cognitive status and environmental origin has

an impact in rehabilitation department. We studied functional
outcome after rehabilitation hip fracture in old elderly (75 years
and older) compared with young elderly (65–75 years) inpatients
admitted in 3rd Rehabilitation Clinic during July–December 2016.
On admission to rehabilitation treatment, old elderly have more
depressed mood in MMSE scale, were more cognitive impaired, and
more suffer from pain. Improvement in Functional Independence
Measurement (FIM) scale was found in both groups but significantly
better in young elderly than in old elderly. The change in FIM during
the rehabilitation period was in FIM total and in those parts of
FIM concerning locomotion. The mean duration of rehabilitation
stay was significantly longer in old elderly patients. On discharge
old elderly patients more suffer from pain and difference between
the groups according to the FIM, VAS and to the cognitive data
increased. Statistical data was analyzed using Windows version 10.0
and Epi Info7. Data was analyzed was given in mean ± standard de-
viation, minimum and maximum. The correlation test and student-t
were used for the comparison of parametric and non-parametric
results. P values of less than 0.01 were considered statistically sig-
nificant. Short-term results for most patients showed improvement
of pain, function and cognitive status followed by better tolerance
of physical therapy program. The limits of the study are given by
the small number of patients included, a lack of a medium and long
term assessment.

**Conclusions:** Age per se is indicator of frailty and determinate functional recovery after hip fracture.

P-447

Gender differences in functional mobility and physical activity
in older adults

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

**Objectives:** Functional mobility and physical activity (PA) are the basis of active aging and are closely associated with health status and quality of life. Gender is often described as a personal trait that can change the effects of social and environmental influences on behaviors such as functional mobility and PA. Since few attempts have been made to determine the gender effect, the aim was to investigate the gender differences in functional mobility and PA in older adults.

**Methods:** This cross-sectional study included age-matched female and male adults aged older than 65 years. Functional mobility measures included the 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), Four Step Square Test (FSST), Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and 30-Second Chair Stand Test (30CST), and Barthel Index (BI). PA was assessed with the International Physical Activity Questionnaire (IPAQ)-Short Form.

**Results:** There were 50 participants (25 female). The 6MWT and 30CST scores were significantly better in male participants (p<0.05), however there was no significant difference in 10MWT, FSST, BBS, TUG, and BI (p>0.05). PA level was significantly higher in male participants (p<0.05). IPAQ was significantly correlated with 6MWT and 30CST in males (p<0.05), however not in females (p>0.05).

**Conclusions:** Gender differences were observed in walking endurance, functional lower extremity strength, and PA. Because, PA was not associated with walking endurance or functional lower extremity strength in females, particular attention should be paid to investigate the other possible causes of gender differences such social or environmental in PA behavior.
P-448

**Impact of cognitive function on functional recovery after stroke and hip fracture: the FRAIL-BCN study**

C. Udina¹, A. Calle¹, M. Roqué², F. Lombardini¹, E. Calvo¹, E. Ruzafa¹, M. Mesas¹, M. Inzitari¹. ¹Parc Sanitari Pere Virgili, Barcelona, Spain; ²Fundacio Salut i Envelliment, Barcelona, Spain

**Introduction:** Stroke and hip fracture (HF) are frequent in older adults and associated with poor health outcomes. We studied the impact of cognitive function on functional recovery after stroke and HF in older adults.

**Methods:** Cohort study of patients ≥65 years old admitted to geriatric rehabilitation after stroke or HF (January 2015-January 2016). We assessed functional status at admission and after 30 days [Barthel Index (BI), Lawton Index (LI), Gait Speed (GS)], nutritional assessment, Charlson comorbidity index and polypharmacy at admission. Cognitive assessment included: Mini-Mental State Exam (MMSE), Symbol Digit Modalities Test (attention+psychomotor speed), Yesavage Geriatric Depression Scale and Confusion Assessment Method (for delirium). We selected improvement in BI (≥20 points), in BI's gait item (≥5 points) and in GS (≥0.1m/s) (day 30-admission) as outcomes.

**Results:** We enrolled 202 patients (mean age+SD=83.34±6.71; 69% women), 100 (49.5%) admitted after stroke and 102 (50.5%) after HF. Main baseline characteristics were (mean+SD): in stroke patients, BI=38.6±17.9; GS=0.11±0.15; LI=3.9±2.1; MMSE=21.8±6.0; National Institute of Health Stroke Score (NIHSS)=5.4±3.2. In HF: BI=46.6±17.7; GS=0.07±0.07; LI=4.1±2.2; MMSE=23.2±5.4. In logistic regression models, adjusted for sex, age and BI, in HF, MMSE was associated with GS improvement (OR=3.04, 95% CI: 1.21-7.61) and BI improvement (OR=4.01, 95% CI: 1.44-11.20). In stroke patients, cognitive measures were not independently associated with the outcomes.

**Conclusions:** In our sample, global cognition was associated with functional recovery after HF, but not after stroke. Our results reinforce the importance of cognitive assessment in geriatric rehabilitation, but MMSE may not be the better tool to assess cognition in subacute stroke patients.

P-449

**Indoor geriatric early rehabilitation; a randomised outcome study of 2,579 patients**

C. Angleitner. Department of Geriatrics and Remobilisation

**Introduction and aims of the study:** Indoor geriatric early rehabilitation is very well implemented and sufficiently standardized in many countries. But is indoor geriatric early rehabilitation sufficiently in functional outcome for patients from all assigning specialist departments?

**Purpose:** Is it possible to reach for all indoor geriatric early rehabilitation patients no matter from which department they come from a sufficient therapeutic progress in functional outcome?

**Methods:** The retrospective study includes all the patients from 2008 to 2015 which our department of Geriatrics and Remobilisation took over from the neurologic, traumotologic, orthopaedic and internal/cardiological departments. The development was measured with the FIM (functional independence measure). The take over FIM was taken inside 72 hours after arriving and the discharge FIM was taken inside the last 48 hours before leaving.

**Results:** The study contains 2,579 patients, 848 orthopaedic patients with an average age of 77.67 years, a residence time from 17.79 days and a FIM development from 98 to 113 points; 736 traumatological patients with an average age of 81.75 years, a residence time from 19.02 days and a FIM development from 84 to 103 points; 695 neurological patients with an average age of 77.20 years, a residence time from 20,66 days and a FIM development from 74

to 90 points as well as 300 cardiological/internal patients with an average age of 80.78 years a residence time from 18.18 days and a FIM development from 76 to 96 points. The IM development of all patient groups is 1.20 (±0.15 points) per therapeutic day. The recommended aim value of the American Rehabilitation Counselling Association (ARCA) amounts to 1 FIM point per therapeutic day.

**Conclusions:** It is possible to obtain a sufficient functional progress for all patients in indoor early geriatric rehabilitation independently from which specialist department they were overtaken from.

P-450

**Interrupted geriatric rehabilitation requiring transfer to acute hospital setting: Incidence and outcome**

C.N. Osuafor, S.N.M. Sahimi, S. Enduliri, F. McCarthy. Medicine for Elderly Department, St Mary's Hospital, Phoenix Park, Dublin, Ireland

**Introduction:** Elderly patients after acute hospitalization are at risk of functional decline. A period of rehabilitation to optimize a safe home discharge is often required. These patients may have their rehabilitation interrupted when they become unwell thereby requiring transfer to acute hospital setting. Our objective was to determine the incidence and outcome of interrupted geriatric rehabilitation.

**Methods:** A retrospective analysis of patients admitted into a 23-bed skilled geriatric rehabilitation ward in St Mary's Hospital, Phoenix Park from March 2012 to February 2016.

**Results:** 539 patients were admitted for rehabilitation over the study period. 50/539 (9.3%) patients had their rehabilitation interrupted and were transferred to acute hospital setting. 33/50 (66%) were females; Mean age 82.1±8.7 years (range 51–95 years). Final diagnosis after acute hospital transfer was acute severe infections (44%), traumatic fracture secondary to fall (10%), intraabdominal complications (10%), cardiac complications (8%), acute neurological event (6%) and others (22%). Of these patients, 42% had a fatal outcome, 32% returned for rehabilitation, 10% were discharged home and 8% were discharged to long term care. Patients who required acute hospital transfer and subsequently had a fatal outcome seemed more likely to be older and had higher Charlson Comorbidity Index compared to those who did not.

**Conclusions:** Interrupted geriatric rehabilitation requiring acute hospital transfer occurred in 9.3% of patients; acute severe infection was the commonest cause. These transfers are associated with significant mortality. Rehabilitation programs should focus improvement efforts on identifying suitable subjects for rehabilitation, optimizing care transitions and minimizing rates of transfers.

P-451

**Muscle ultrasound in the assessment of older community-dwelling patients with chronic obstructive pulmonary disease. Relationships between cross-sectional area of the muscle rectus femoris, handgrip strength, and fat-free mass**

D. Sánchez-Rodríguez¹, P. Mínguez-Blasco², C. Ramírez-Fuentes², F. Ostiz³, J.M. Muniesa⁴, E. Marco⁵. ¹Geriatrics Department, Parc de Salut Mar (Centre Fòrum - Hospital del Mar), Barcelona; Rehabilitation Research Group. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona; School of Medicine, Universitat Autònoma de Barcelona; School of Medicine, Universitat Pompeu Fabra, Barcelona; ²Physical Medicine and Rehabilitation Department Parc de Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona; ³Physical Medicine and Rehabilitation Department Centre d'Atenció Primària Sant Andreu, Institut Català de la Salut, Barcelona; ⁴Rehabilitation Research Group. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona; Physical Medicine and Rehabilitation Dpt. Parc de Salut Mar (Hospital del Mar – Hospital de l'Esperança); School of
Medicine, Universitat Autònoma de Barcelona; ⁵Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona; Physical Medicine and Rehabilitation Dpt. Parc de Salut Mar (Hospital del Mar – Hospital de l'Esperança); School of Medicine, Universitat Autònoma de Barcelona; Universitat Internacional de Catalunya

**Introduction:** The objective was to determine the relationship between rectus femoris muscle size, quadriceps strength, and body fat composition in older men with chronic obstructive pulmonary disease (COPD) and healthy controls.

**Methods:** This cross-sectional study included 18 community-dwelling robust men aged 65–80 years with stable, severe, or very severe COPD, and 17 healthy controls. Outcome variables were cross-sectional area and antero-posterior diameter on ultrasound of the nondominant rectus femoris muscle, maximum quadriceps strength measured by isometric dynamometry, and fat-free mass index (FFMI) assessed by electric bioimpedance.

**Results:** Compared with controls, COPD patients had lower quadriceps strength (mean difference 10.4 Kg, 95% CI: 5.2–15.5), area and anteroposterior diameter (mean differences 1.3 mm², 95% CI: -2.1 to 0.5 and 1.8 cm, 95% CI: -0.03 to 3.7, respectively), FFMI (mean difference 1.5 kg/m², 95% CI: -4.3 to -1.2) and 6-minute walking test (mean difference 148 m, 95% CI: -216 to 80). Cross-sectional area was 4.3 (SD 1.05) cm² in patients in front of 5.6 (SD 1.25) cm² in controls. A moderate correlation was observed between rectus femoris area and strength of the nondominant quadriceps (R=0.497, p=0.036), fat-free mass (R=0.584, p<0.001), dry lean mass (R=0.572, p<0.013), and FFMI (R=0.549, p<0.018).

**Conclusion:** Isometric dynamometry, electric bioimpedance, and muscle ultrasound provide complementary and relevant information that is useful in the assessment and monitoring of older patients during COPD rehabilitation.

P-452

Participation in medical rehabilitation among older Poles –
Results of PolSenior study

A. Szybalska¹, K. Broczek², P. Slusarczyk¹, E. Kozdron³, J. Chudek⁴,
M. Mossakowska ¹. ¹International Institute of Molecular and Cell
Biology in Warsaw, Warsaw, Poland; ²Department of Geriatrics,
Medical University of Warsaw, Warsaw, Poland; ³Department of
Recreation Methodology, Faculty of Tourism and Recreation, Jozef
Pilsudski University of Physical Education in Warsaw, Warsaw, Poland;
⁴Pathophysiology Unit, Department of Pathophysiology, Medical
Faculty in Katowice, Medical University of Silesia, Katowice, Poland

**Introduction:** The rehabilitation process' aim is restoring lost functions which contribute to improving the quality of life and maintaining independence. In this study, we evaluated the participation in medical rehabilitation among older Poles and its socio-economic and health-related determinants.

**Methods:** Data regarding medical rehabilitation were obtained from the nationwide, multidisciplinary PolSenior project (2007–2012) for 4,813 respondents (48.3% women) aged 65+. Socio-economic status, physical functioning, chronic pain occurrence, medication and formal disability occurrence were accounted for.

**Results:** One in six respondents (18.9% women vs 15.8% men, p<0.005) took part in medical rehabilitation in the past 12 months prior to the survey. Rehabilitation users underwent most commonly: electrotherapy or light radiation therapy (61.3%), massage (52.0%) and passive exercises (51.4%). Logistic regression analysis revealed that women aged 75+ had a lower chance of taking part in rehabilitation than the youngest ones (65–69 y.o.) and participation decreased with age. In men, this pattern was less regular. Village dwellers were less likely to use rehabilitation services than city dwellers. Higher education, functional independence, and multiple

medication use promoted participation in rehabilitation the most in both genders. Disability certificate holders and those who reported chronic pain were more likely to take part in analyzed services. Functional independence in women and men, as well as partial dependence only in men, were positively associated with utilization of rehabilitation.

**Conclusions:** Participation in medical rehabilitation was related to age, place of residence, the level of education, functional status, disability, chronic pain occurrence and medication, both in women and men.

P-453

Post-fall syndrome risk factors, a case-control study of 70 patients

M. Meyer, P. Le Borgne, T. Vogel, G. Kaltenbach, E. Schmitt.
*Strasbourg University Hospital*

**Introduction:** The objective of the study was to identify risk factors for post-fall syndrome.

**Methods:** We performed a case-control study in which we included every patient older than 70 years old admitted to the hospital after a fall. Patients who couldn't perform transfer, or couldn't walk indoors, patients with an acute neurologic or orthopedic condition directly responsible for the functional decline were not included. The post-fall syndrome was only held in cases of functional decline observed after a fall.

**Results:** The study was performed from March 29, 2016 through June 7, 2016. We included 70 patients. Twenty-nine patients exhibited a post-fall syndrome (41.4%). Risk factors for post-fall syndrome included age (p=0.002), walking disorder prior to the fall (OR=9.63 IC 95 p.100: 2.49; 37.30 p<0.001), the use of a walking aid prior to the fall (OR=9.10 IC 95 p.100: 2.38; 34.85 p<0.001), no unaccompanied outdoor walk in the week before the fall (OR=4.95 IC 95 p.100: 1.24; 19.79 p=0.017), visual impairment making close reading impossible (OR=3.48 IC 95 p.100: 1.18; 10.31 p=0.021), stiffness in ankle dorsiflexion (p=0.003), grip strength (p=0.002) and the fear of falling (OR=4.45 IC 95 p.100: 1.29; 15.42 p=0.014).

**Conclusions:** The study showed the existence of body funtions and structure impairments and activity limitations prior to the fall among patients exhibiting a post-fall syndrome. Identifying fallers presenting these risk factors as early as possible could ensure the best possible outcome in handling of psychomotor disadaptation.

P-454

Prevalence and consequences of unrecognized benign
paroxysmal positional vertigo in nursing homes

L. Pensart, L. Stiers, J. Spildooren. UHasselt, BIOMED (REVAL), Diepenbeek, Belgium

**Introduction:** Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of balance disorders and dizziness among elderly, affecting 11% of a group of 75-year old community dwelling individuals [1]. Even though fall incidents and balance problems are higher in institutionalized older adults, the prevalence of BPPV in residential care centers is unknown.

**Methods:** Forty-one institutionalized older adults (29 female, 11 male; average age, 86.6±5.96 years) were evaluated for the presence of BPPV by vestibular bedside testing (i.e. Dix-Hallpike-, side lying- and roll-test). Romberg test with eyes closed and Timed-up and go (TUG) were registered using APDM 3-axes wearable accelerometer sensors.

**Results:** Eleven residents had unrecognized BPPV (6 posterior canal, 3 horizontal canal, 2 combination horizontal and posterior canal). Group with and without BPPV was comparable for age, cognition (MMSE) and dizziness handicap inventory (DHI). Residents with BPPV had a significant higher sway area (0.55 m²/s<sup>text4</sup> versus 0.40
$m^2/s^4$; p=0.05) and sway velocity (0.44m/s versus 0.29m/s; p=0.01) during the Romberg test and a tendency towards less elevation at midswing during gait (0.78 cm versus 1.11 cm; p=0.06).

**Conclusions:** Prevalence of BPPV among residents in nursing homes is higher than in healthy community dwelling elderly. BPPV is in this population not related to vertigo or dizziness but to an increased fall risk.

**References:**

[1] Von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78: 710–715.

P-455

Prevalence of sarcopenia and frailty in older adults in geriatric rehabilitation and its association with malnutrition

J. Wojzischke¹, J.M. Bauer², S. Egert³, A. Hein¹, R. Diekmann¹.

¹Department of Health Services Research, Carl von Ossietzky University Oldenburg; ²Geriatric Centre University Heidelberg, Agaplesion Bethanien Hospital Heidelberg; ³Institute of Nutritional and Food Sciences - Nutritional Physiology, Rheinische Friedrich-Wilhelms-University Bonn

**Introduction:** Malnutrition is a common in geriatric rehabilitation patients and interacts strongly with sarcopenia and frailty. However prevalence data for sarcopenia and frailty based on standard definitions is still scarce in the field of geriatric rehabilitation.

**Methods:** Older adults ≥70 years consecutively admitted for a geriatric inpatient rehabilitation at the Division of Geriatric Medicine at the Rehabilitation Centre Oldenburg were included at admission (+3 days) in the present study. Sarcopenia was diagnosed based on the definition of the European Working Group. Frailty was diagnosed according to the Fried criteria and malnutrition was identified using the Mini Nutritional Assessment-Short Form (MNA-SF). Statistical analysis was done with Wilcoxon-Mann-Whitney U Test and Kruskal-Wallis Test (α=0.05) for MNA-SF scores of patients with and without sarcopenia or frailty.

**Results:** 122 patients (69.7% female, 81.5±5.6 years) were enrolled. The prevalence of sarcopenia was 38.4%. 63.9% of the patients were frail, 33.6% pre-frail and 2.5% were robust. Malnutrition was prevalent at 31.1%, 59.8% were at risk of malnutrition and 9.0% had a normal nutritional status. Mean MNA-SF score tend to be lower in patients with sarcopenia compared to those without sarcopenia (8.2±2.5 versus 9.2±2.3 points). According to the Fried criteria mean MNA-SF scores were the lowest in frail patients (7.9±2.2 points), followed by pre-frail patients (9.7±2.0 points) and robust patients (12.3±1.5 points). Results were not significant.

**Conclusions:** Sarcopenia and frailty were widespread among older adults in geriatric rehabilitation. MNA-SF scores were lowest in patients with sarcopenia and frailty without being significant.

P-456

Quality of life and its predictors of patients undergoing geriatric rehabilitation – A pilot study

S. Bordne¹, R.-J. Schulz², S. Zank³. ¹University of Cologne, PhD programme "Gerontological Research On Well-Being" (GROW), Cologne, Germany; ²Clinic of Geriatric Medicine and Rehabilitation, St. Marien-Hospital, Cologne, Germany; ³University of Cologne, Department of Rehabilitation Science, Cologne, Germany

**Introduction:** Given demographic change geriatric rehabilitation and the Quality of Life (QoL) of geriatric patients become more vital each day. Whereas the assessment of QoL is often limited to internal clinical criteria of success such as ADL or autonomy there seem to be other rather soft concepts such as Subjective Well-Being (SWB) which should be taken into account when looking at geriatric patients' QoL.

**Methods:** A pilot study is recently conducted with inpatients of a geriatric rehabilitation ward in Germany. At hospital admission QoL and potential predictors are assessed in a face-to-face interview. The instruments used in this study for functional criteria of QoL assess (I)ADL-abilities, mobility and autonomy. SWB as the other QoL facet is on the one hand represented by hedonic measures such as life satisfaction or affect and on the other hand by eudaimonic measures such as self-acceptance or meaning in life. Furthermore a wide range of medical and psychosocial parameters are included as antecedents (e.g. pain, control beliefs or social network).

**Results:** Due to this broad approach to QoL in geriatric inpatients the aim of this pilot study and following research is to derive a bio-psycho-social model for QoL in patients undergoing geriatric rehabilitation to get a comprehensive view on what constitutes and contributes to QoL in geriatric patients.

**Conclusions:** For future research such a model can be of great value as it may create a better understanding of important factors for reaching the geriatric aim of "Restitutio ad Optimum" for each geriatric patient.

P-457

Relationship between physical activity, risk and fear of falling in elderly people

K. Tamosiunaite¹, M. Tamulaitiene², V. Alekna¹, I. Tamulaityte-Morozoviene¹, ¹Faculty of Medicine of Vilnius University; Vilnius, Lithuania; ²Faculty of Medicine of Vilnius University; National Osteoporosis Center, Vilnius, Lithuania

**Objective:** To investigate the associations between physical activity, risk and fear of falling in elderly people.

**Methods:** The study involved community-dwelling Vilnius residents aged 65 years and over, without diseases or conditions which could dramatically decrease their mobility. A specially prepared questionnaire for demographic and falls data, the Tinneti test for assessment of fall risk, and physical activity questionnaire Physical Activity Scale for the Elderly (PASE).

**Results:** The study sample consisted of 94 elderly people aged from 65 to 88 years. Of all study subjects, 54.2% had experienced falls. Of those who fell, 61 percent had injuries, while 39 percent did not suffer any injuries. In those persons who experienced falls, fear of falling and risk of falling were higher than in those who did not fall (reported fear of falling in 90.2% versus 60.5%, p=0.015; Tinnetti test score 24.8 versus 21.3, p=0.015). Those who have experienced falls, more often stated they feel pain, depression or anxiety than those who did not experience fall. The moderate negative correlation between risk of falling and physical activity (r=-0.472; p<0.001) was found. No statistically significantly relationship was found between fear of falling and physical activity.

**Conclusions:** In persons who fell during the previous 12 months, the fear of falling and fall risk was higher than in those who did not fall. In community-dwelling people older than 65 years, the fall risk negatively correlated with physical activity.

P-458

The association between the walking endurance, walking speed, balance, and fear of falling in older adults

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

**Objectives:** Walking is an important physiological process that requires coordination of motor, sensory and central nervous systems.
Although evidence suggests that walking speed is associated with balance and fear of falling in older adults, their relationship with walking endurance is not yet known. Therefore, the aim was to investigate the relationship between walking endurance, walking speed, balance, and fear of falling in older adults.

**Methods:** Adults aged older than 50 years were included in this cross-sectional study. Walking endurance and speed were assessed with the 6-Minute Walk Test (6MWT) and 10-Meter Walk Test (10MWT), respectively. Balance was assessed with the Four Step Square Test (FSST), Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and 30-Second Chair Stand Test (30CST). Fear of falling was assessed with the Falls Efficacy Scale-International (FES-I).

**Results:** Ninety-four adults (51 female) with mean age of 71.1 (SD=10.6) years were included. The 6MWT had moderately correlated with the 10MWT, FSST, BBS, TUG, and 30CST (p<0.01). The 10MWT had week to strong correlations with the 6MWT, FSST, BBS, TUG, and 30CST (p<0.01). The 30CST, FES-I, and TUG were the significant predictors of the 6MWT with explaining 57.1% of the variance. The TUG was the predictor with explaining 90% of the variance in the 10MWT.

**Conclusions:** The study has indicated that better walking endurance and speed were associated with better balance and less fear of falling in adults older than 50 years. Additionally, the fear of falling is a strong predictor of the walking endurance.

P-459

The effects of complex decongestive physiotherapy in elderly
women with breast cancer related lymphedema

O.T. Atalay, A. Yilmaz, E. Baskan, N. Yağcı. Pamukkale University,
School of Physical Therapy and Rehabilitation

**Objective:** Older women have a higher incidence and worse survival rate from breast cancer than younger women. Lymphedema is a common complication of breast cancer treatment and breast cancer-related lymphedema (BCRL) continues to affect at least 20% of women undergoing breast cancer treatment with axillary clearance. Complex decongestive physio therapy (CDP) is the most common and effective treatment of BCRL among the others. The aim of this study was to analyze the effects of CDP in elderly women with BCRL.

**Methods:** Eighteen women with BCRL were included in the study. The mean age of subjects was 68,32±4,32 (min: 62, max: 78). The subjects received CDP for 5 times/week for 4 weeks. The extremity circumference, the range of motion (ROM) and muscle strength of subjects were also assessed before and after CDP. A goniometer was used for the measurement of ROM and the muscle strength was measured by a handgrip dynamometer. For the evaluation of volume reduction, circumferential measurements were used to calculate the volume of the arms with Frustum Formula.

**Results:** At the end of CDP, there was a significant reduction in the extremity volume of subjects (p<0,05). There was only significant increase in shoulder abduction in ROM assessments (p<0,05) but any significant difference was not found in muscle strength after the CDP (p>0,05).

**Discussion:** The CDP can be an effective treatment for volume reduction in elderly women with BCRL but some other conservative physiotherapy methods are needed to improve ROM and muscle strength.

P-460

The effects of osteopathic manipulative therapy on chronic low back pain: middle age versus older adults

N. Yagci, E. Aslan Telci, M. Oztop. Pamukkale University School of
Physical Therapy and Rehabilitation, Denizli, Turkey

**Introduction:** Osteopathic manipulative treatment appear to pro-

vide some benefits when used in addition to usual care for the treatment of chronic nonspecific low back pain. The aim of this study is to determine the effects of Osteopathic Manipulative Therapy (OMT) comparing middle aged and older adults with chronic low back pain.

**Methods:** One hundred four participants with chronic low back pain were included in the study. They were divided into two groups by age: middle-aged adults (45-64 yr; n=71), and older adults (65-84 yr; n=33). All groups received OMT (soft tissue mobilization and vertebral mobilization) three times in a week for 4 weeks. Pain intensity (Visual Analog Scale; VAS), disability level (Roland Morris Disability Questionnaire and depressive symptoms (Beck Depression Scale) were evaluated before and after treatment program.

**Results:** The results indicate that there were significant improvements in pain intensity, disability level, and depressive symptoms in the two groups (p<0.0001). There were no any significant differences between the groups (p>0.05).

**Conclusions:** Osteopathic manipulative therapy can be used to recovery low back pain symptoms in both middle aged and older adults. This means OMT is a safe method which can also be in older adults.

P-461

The evaluation of the balance in geriatric hypertensive
individuals

F. Hajebrahimi, H. Özbek, Z.C. Algun. *Istanbul Medipol University*

This study is designed to evaluate the relationship between the balance performance of the geriatric hypertensive and normotensive individuals and find out the effect of hypertension in the balance behavior of the elderly people. 61 geriatric people were included in our study. All the patients were 65 years old and older and were participating to our study with their own approval. Demographic information of the participants has been recorded. Basic activities of daily living are measured by the KATZ Index of ADLs, cognitive status is measured by Standardized Mini-Mental State Examination, depression status is measured by Geriatric Depression scale, Quadriceps muscle strength is measured by hand held dynamometer, ankle dorsiflexion range of motion is measured by goniometer, gait is measured by Timed Up and Go Test and balance performance is measured by Nintendo Wii. The systolic and diastolic blood pressure is measured before the balance test. Hypertensive group had higher performance time in Timed Up and Go test than normotensive. (p=0.030). Parameters of "Completed seconds in Wii Single Leg Balance Test", "Performance score in Wii Single Leg Balance Test" and "Wii fit age" between both hypertensive and normotensive groups were determined significant in the statistical analysis (p<0.05). Hypertension seems to affect different parameters of balance among elderly people. For controlling their balance, elderly people should consider their high blood pressure beside their falling history.

P-462

The impact of physical training upon bone and skeletal muscle
remodeling in elderly female with osteoporosis

C.R. Revnic¹, F. Revnic², C. Pena², B. Paltineanu³, S. Voinea¹. ¹UMF
“Carol Davila”, Bucharest, Romania; ²NIGG Ana Aslan, Bucharest,
Romania; ³UMF Tg.Mures, Targu Mures, Romania

Our study was done on 48 elderly female patients aged between 65-78 years old with osteoporosis divided into three groups of 16 patients each: Group A without specific antiosteoporotic medication (only Ca++ and Vitamin D and Kineto program), Group B with antiosteoporotic medication, Ca++Vitamin D and Kineto program, Group C without physical effort, Kineto program with antioseo-
porotic medication, Ca++ and Vitamin D. Kineto program has been
performed for the first two weeks in kinetotherapy laboratory,
three times/week for 50 minutes. At home the patients have been
instructed to follow up the training with daily walks in alert rhythm
for 30 minutes and to perform heel drops 50/day. HGH and Cortisol
serum levels were evaluated before and after training with 1234
DELFIA Research Spectrofluorimeter using Eu+ labelled HGH and
Cortisol kits purchased from Pharmacia LKB. Motor neuron training
was achieved with a Schwartzer-Picker EMG of biceps and triceps
muscle using 4 kg weight training.

**Results:** Our data pointed out that kineto program can prevent or reduce the % of bone loss in elderly postmenopausal female. Supplementation with calcium and vitamin D improves the efficiency of physical exercise upon BMD by stimulation of hGH secretion with anabolic effects upon all type of cells from the body and by decreasing the levels of Cortisol known as stress hormone with a negative impact upon bone metabolism.

**Conclusion:** The decline with aging in hGH secretion is not irreversible and physical training is one of the ways which can stimulate hypothalamus and anterior pituitary lobe to produce hGH in elderly female patients with osteoporosis

P-463

The impact of physiotherapy program on pain intensity and fear avoidance behavior in patients with chronic non-specific low back pain: Age differences

N. Yagci, E. Aslan Telci, M. Oztop, S. Sekeroz. Pamukkale University
School of Physical Therapy and Rehabilitation, Denizli, Turkey

**Introduction:** Fear avoidance behavior associated with low back pain is a condition that has adverse effects on physical activity, quality of life and mental state in the elderly. The aim of this study is to compare the effect of the Conventional Physiotherapy Program (CPP) on pain intensity and fear avoidance behavior in elderly and young adult patients with Chronic Non-specific Low Back Pain (CNLBP).

**Methods:** Twenty-three elderly patients with CNLBP (65–85 yrs; mean age: 68.67±4.70 yrs) and 19 young adults with CNLBP (18–39 yrs; mean age: 30.53±6.64 yrs) were included in this study. Both groups were treated with CPP consisting of Hotpack, Ultra-sound, TENS and exercise (total 14 sessions). Pain intensity was assessed with Visual Analogue Scale and fear avoidance behavior was assessed with Tampa Kinesiophobia Scale before and after treatment.

**Results:** In both groups, there was a decrease in pain intensity and fear avoidance behavior after treatment compared to before treatment (p=0.001). There was no difference between the groups in terms of improvement in pain intensity (p>0.05), while improvement of fear avoidance behavior in young adult patients was found to be higher than in elderly patients (p=0.031).

**Conclusions:** The results of our study showed that the applied treatment program provided more improvement in fear avoidance behavior in young adult patients with CNLBP compared to elderly patients with CNLBP. We believe that the application of the necessary patient education and treatment strategies for eliminate the factors that cause this behavior in the elderly will provide more healing.

P-464

The results of a rehabilitation program in elderly with low back pain

R. Nartea, A.S. Nica, M. Constantinovici, I. Mitoiu Brindusa. INRMFB, UMF "Carol Davila" Bucharest, Romania

Our clinic has a day care unit specialized in rehabilitation programs
adapted for different types of pathologies, low back pain being one

of the most frequent diagnosis. In geriatrics we often have different
comorbidities intricating the basic ethiology so the response varies.
We have worked on a prospective study including 21 out patients
aged between 71 and 86 with chronic sharpened low back pain
lasting from one to three months with history of NSAID treatment.
Their comorbidities included cardiovascular changes, chronic ob-
structive pulmonary disease and chronic kidney disease. They have
been included in a rehabilitation program consisting of physical
and occupational therapy, low frequency electrotherapy and TENS,
Laser therapy and manual therapy. Their pain using VAS scale and
their capacity of walking using the six minutes walking test were
assessed in the beginning and in the end of ten rehabilitation
sessions. The results show the positive effect of the rehabilitation
program with an improvement of the pain level but with no signifi-
cant changes regarding the capacity of walking. In order to improve
both pain and functionality a rehabilitation program created for the
elderly should include more sessions spread on a longer period of
time. A further assessment step should be included as a medium
term evaluation.

P-465

The role of low power laser therapy, kinetotherapy and physiotherapy in the management of degenerative osteoarticular pathologies in elderly patients

C.R. Revnic¹, F. Revnic², C. Pena², B. Paltineanu³, S. Voinea¹.

¹UMF "Carol Davila", Bucharest, Romania; ²NIGG "Ana Aslan", Bucharest, Romania; ³UMF Tg Mures, Targu Mures, Romania

**Aim of study:** To see to what extent Low power Laser therapy (LPLT) combined with kinetotherapy (KT), physiotherapy (PT) and antiinflamatory medication (AIM) contributes to amelioration of osteoarticular pathology in elderly population and the impact upon daily living activity (DLA) and quality of life (QOL). 200 patients aged between 55-75 years old were admitted in Rehabilitation Clinique, with degenerative pathology of locomotor system: 95 with Scapulohumeral periarthritis (SHP), 81 women and 14 men, simple painful shoulder (SPS)and 105 cases with bilateral gonarthrosis (BG) 85 women and 20 men. Patients were included into 2 groups: A (LPLT) + (AIM) + (PT) and (KT) and B: (AIM) and (PT). After (LPLT) treatment combined with (KT), (PT) + (AIM) in group A there was an amelioration of local algic phenomena – the score on Pain Scale being under 3; For 74 (SHP) patients with pain scale between 3 and 4, pain has decreased from 2 to 1; i.e. 78,2%. For 19 patients with 2 and 3, pain scale has decreased from 1 to 0, i.e. 19,5%. For 2 patients with the initial value 5, Pain intensity has decreased from 3 to 2, i.e. 3%. 3.

**Conclusions:** Apliation of (LPLT) in degenerative pathology of lo-
comotor apparatus in elderly patients associated with (KT) had net
benefic antialgic and antiinflamatory effects than in group B. DLA
amelioration for (SHP) was approx. 80% and for knee articulation
~86%, resulting in: an increase in well being state, in professional
and social reinsertion, and in family reintegration. In this con-
text (LPLT) is strongly recomended in treatment of degenerative
and post traumatic pathologies and their complications in elderly
patients either in hospital or in Ambulatory

P-466

The role of physiokinetotherapy in the management of
Parkinson's disease

C.R. Revnic¹, F. Revnic², C. Pena², B. Paltineanu³, S. Voinea¹. ¹UMF "Carol Davila", Bucharest, Romania; ²NIGG "Ana Aslan", Bucharest, Romania; ³UMF Tg.Mures, Targu Mures, Romania

**Objective:** Evaluation of physiokinetotherapy (PKT) program as-
sociated with medical treatment for Parkinson's disease (P.D) in
different evolutionary stages.

**Material and method:** 42 patients aged between 40–79 years
old with P.D. evaluated by clinical neurological examination have been taken in our study. A three weeks (PKT) program has been performed including: thermotherapy designed for amelioration of muscular pain and rigidity, sedative massage applied before and after kinetotherapy for P.D. stage II and III patients and also for patients imobilised in bed, along with electrotherapy and continuous magnetodiaflux.

**Results and discussion:** Out of 14 patients in stage IV on Hoehn & Yahr scale, 6 have achieved amelioration of walking, without a substantial amelioration of posture. 5 out of 10 patients in stage III improved posture during walking, but walking has been performed with small steps.P.D. patients stage IV improved daily living activities (ADL) (12 out of 14 patients at the end of 3 weeks therapy) did not required any assistance for ADL but, the remaining two patients required partially assistance. For P.D. patients stage III at the end of three weeks treatment, 9 out of 10 have recovered, only one need assistance for dressing. For patients in stage II the effort for getting dressed was less than before treatment. No significant amelioration for patients in stage V was recorded.

**Conclusions:** PKT program improved control over gross motor movements such as walking, improved posture and greater confidence in performing daily activities in P.D. patients. The progresivity of PKT program is very important and must be continued at home and in advanced P.D.stages there is necessary cooperation of family members

P-467

The use of trained volunteers to encourage increased
ambulatory activity among hospitalised older people:
a feasibility study

S. Lim ¹,², G. Strike ³, M. Baxter ³, A. Purkis ³, A. Rogers ²,
A.A. Sayer ¹,²,⁴,⁵, H.C. Roberts ¹,²,³. ¹Academic Geriatric Medicine,
University of Southampton, UK; ²NIHR CLAHRC Wessex, University of
Southampton, UK; ³University Hospital Southampton NHS FT, UK;
⁴Ageing, Geriatrics & Epidemiology, Institute of Neuroscience,
Newcastle University; ⁵NIHR Newcastle Biomedical Research Centre in
Ageing and Chronic Disease, Newcastle University and Newcastle upon
Tyne NHS Foundation Trust

**Introduction:** Sedentary behaviour among older inpatients is associated with functional decline, social isolation, prolonged hospitalisation and nursing home admission. The objective of this study was to explore the use of trained volunteers to promote increased ambulatory activity among older inpatients.

**Methods:** This pre-post feasibility study was conducted on acute Geriatric Medicine wards at one hospital. Inclusion criteria were patients aged ≥70 years, who were able to walk prior to admission and provide consent. Participants received twice daily volunteer-led bedside exercises or walking sessions on weekdays. Participants who were not independently mobile performed exercises only. The StepWatch Activity Monitor measured mean daily step count before and during the intervention as the primary outcome.

**Results:** 42 patients (mean age 87.2 years, SD 4.6) had their activity measured (median daily step count 636 steps, IQR 298–1468) pre-intervention. 17 volunteers received half-day training including competency assessment. 50 patients (mean age 86.2 years, SD 5.1) were recruited to the intervention group and 310 activity sessions were offered. The median daily step count of the intervention group was 912 steps (IQR 337–1824), an increase of 43.4%. Adherence to the activity sessions was 74.2% (230 sessions). Common reasons for declined participation were patients feeling unwell or tired, and the need for clinical care. No falls or adverse incidents were reported.

**Conclusion:** Volunteers can be recruited and trained to safely encourage older inpatients to increase ambulatory activity, with an average increase of 276 steps/day. Research into the acceptability and impact of this intervention is on-going.

P-468

Use of new technologies in the treatment of post-stroke hemiplegia

R. López-Liria¹, J. García-Molina², F.A. Vega-Ramírez³,
P. Rocamora-Pérez ¹. ¹Department of Nursing Science, Physiotherapy and Medicine. University of Almería. Almería. Spain; ²Physiotherapist. Almería. Spain; ³Torrecárdenas Hospital, Almería. Spain

**Objective:** To find alternative techniques to Bobath treatment in post-stroke hemiplegia, through literature search in different databases, its impact on research and clinical practice and the current lines of development.

**Method:** Systematic review. The search was conducted in the databases Medline, Pubmed, Web of Science and Dialnet, using the following descriptors: hemiplegia, virtual reality, rehabilitation, stroke, new treatment, telerehabilitation and Wii, in the last 10 years. Exclusion criteria were non hemiplegic patients after cerebrovascular disease, or non alternative technique to conventional physiotherapy treatment. Jadad scale was used for articles assessment.

**Results:** 14 articles were selected, in which different treatments for post-stroke hemiplegia based on new technologies were applied. All results supported the advantages of using new technologies in the treatment. Twelve of them focused on virtual reality (as Tetrax Biofeedback, Wii Balance Board), one was related to robotics, and one addressed the issue of telerehabilitation. The variables under study were: main motor function (gait and balance) and ability to perform activities of daily living. The scales used for the assessment were Timed Up and Go Test, Berg scale, Step test, Time up and Down Stair test, 10 metre walk test, Gait Speed test, Two minutes walk distance test, Caregiver burden scale, Activities-Specific Balance scale and Barthel index.

**Conclusion:** The use of new technologies in addition to conventional physical therapy can constitute a great combination for the treatment of post-stroke hemiplegia, being adaptable to each case, increasing patient's adherence to treatment and allowing assistance regardless the patient's location.

P-469

Utility of inpatient rehabilitation in elderly acute stroke patients
bound for placement in nursing homes

K.H.R. Goh, N. Tang, E. Chew. National University Health System, Singapore

**Background:** Singapore is facing rapid societal ageing and the numbers of elderly nursing homes are projected to increase [1]. Currently elderly patients bound for placement at nursing homes receive lower prioritisation for rehabilitation. The increase in volume of elderly nursing home residents highlights the need for more active rehabilitation of acutely debilitated elderly to optimise function and decrease burden of care during institutionalisation.

**Objective:** To evaluate the utility of active inpatient rehabilitation under specialised inpatient rehabilitation team for elderly acute stroke patients heading for nursing home versus those planned for home.

**Methods and results:** A retrospective review of 81 geriatric stroke patients in 2015–2016 receiving inpatient rehabilitation was conducted. FIM (Functional Independence Measure) scores (total, motor and cognitive components) and FIM efficiency was compared [2]. 11 patients were discharged to nursing homes, while the rest went home. The mean FIM gain of total, motor and cognitive scores among patients going to nursing home were 19.5 (SD = 7.6), 15.3 (SD = 5.8) and 4.3 (SD = 3.7) respectively. Comparatively, the mean FIM gain among patients going home were 18.6 (SD = 10.7), 14.9 (SD = 8.3) and 3.6 (SD = 5.4).

**Conclusion:** There were no statistically significant difference in the length of stay, improvement and efficiency of scores between
patients placed in nursing homes and those who went home. This suggests a role for active inpatient rehabilitation of elderly stroke patients planned for nursing home placement optimising function which translates into reduced burden of care [3]. Further prospective studies need to be done.

**References:**

[1] Yap Mui Teng, Kang Soon Hock and Chua Chun Ser, Scenarios of future population growth and change in Singapore, IPS update, March 2011.

[2] Linacre, John Michael, et al. The structure and stability of the Functional Independence Measure. Archives of physical medicine and rehabilitation 75.2 (1994): 127–132.

[3] Hamilton, B.B., et al. Cost of disability as measured by the Functional Independence Measure (FIM™) instrument: spinal cord injury. NIDRR Project H133G90157 (3rd ed.) Center for Functional Assessment Research, Buffalo (NY) (1997).

P-470

Validation of post-stroke rehabilitation profiles in older adults

L.M. Pérez¹, J. Salas¹, R. Galvadà², J. Castro¹, A. Barrios¹,
N. Martínez¹, M. Gallofré³, M. Inzitari¹. ¹Parc Sanitari Pere Virgili,
Barcelna, Spain; ²Department of Computer Science, Universitat
Politécnica de Catalunya, Barcelona, Spain; ³Pla Director Malaltia
Vascular Cerebral, Department of Health, Government of Catalonia,
Barcelona, Spain

**Introduction:** Despite the high prevalence of stroke in older adults, evidence on post-stroke rehabilitation is scarce. We previously developed (Pérez LM, et al, PlosOne 2016) a classification of post-stroke rehabilitation complexity in older adults, and aim at assessing external validity in a different cohort.

**Methods:** Cohort study enrolling stroke survivors ≥65 years old admitted to an intermediate care hospital during 2016. According to baseline characteristics (stroke severity, cognitive status, current and previous functional status, available caregiver), patients were assigned to 3 rehabilitation profiles, through a decision tree. We analyzed between-profiles differences on functional improvement (FI, Barthel Index), relative functional gain (Montebello/Heineman index), length of hospital stay (LOS), rehabilitation efficiency (FI/LOS), home discharge and costs using multivariable regression models.

**Results:** We enrolled 170 post-stroke survivors (mean age 79.0±9.3, female 48.8%, 83.5% ischemic stroke), classified in: a) Lower Complexity with Caregiver (LCC, N=68), b) Moderate Complexity without Caregiver (MCN, N=52), and c) Higher Complexity with Caregiver (HCC, N=50). In logistic regression models, both LCC and MCN, compared to HCC, showed higher chances of functional improvement (OR=4.9, 95% CI: 2.1–11.1 and OR=3.8, 95% CI: 1.7–8.8, respectively), higher relative functional gain (OR=4.4, 95% CI: 1.6–10.8 and OR=4.5, 95% CI: 1.7–11.9, respectively, top Vs lower tertiles), and higher chance of home discharge (OR=12.2, 95% CI: 4.9–30.5 and OR=4.0, 95% CI: 1.7–9.3). Compared to MCN, LCC had a higher likelihood of home discharge (OR=2.1, 95% CI: 1.2–7.1). Other outcomes showed no differences between profiles.

**Conclusion:** In our sample, we confirmed differences in functional outcomes among post-stroke profiles. This classification could help to design tailored interventions to optimize recovery.

P-471

ViTA (Virtual Trainer for Aging): Developing of an experimental
system to improve the life of people with dementia

P. Leo¹, G. D'Onofrio², D. Sancarlo², F. Ricciardi³, M. De Petris³,
F. Giuliani³, G. Ciarambino³, S. Peschiera¹, A. Failla⁴, F. Renzi¹,
A. Greco². ¹Research & Business Unit, IBM; ²Complex Unit of
Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della
sofferenza", San Giovanni Rotondo, Foggia; ³ICT, Innovation and

Research Unit, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia; ⁴Fondazione IBM Italia

**Introduction:** By the year 2050 more than 130 million people over the world will suffer of dementia. A number of areas are under investigation to slow the pathology progression that can complement the pharmacological treatments such as nutrition, physical and cognitive training and social support. In this context we starting to develop the project VITA (Virtual Training for Aging) with the aim to collect and improve the memory of people with dementia.

**Methods:** ViTA is an experimental system based on the cognitive platform IBM Bluemix integrating a number of cognitive services already available on that platform as well as integrates additional research components developed for the project. The system will be available through a Tablet. Caregivers will interact with it to collect fragments of memory and organizes them into a knowledge map in which each fragment is linked to the other through emotional-awaresitories. Patients could access to the system to review their memories and stories leveraging a conversational interface based on speech and textual interaction modalities in addition to traditional interactive interface. ViTA will be tested in the next few months on a small cohort of elderly people with mild cognitive impairment in the Geriatrics Department of the IRCCS Casa Sollievo della Sofferenza. Every patients will be evaluated with a multidimensional assessment and complete neuro-psychological battery including also quality of life and caregiver burden.

**Conclusions:** This innovative system based on cognitive and emotion-oriented care approach will try to improve cognitive, emotional and social functioning by supporting patients with dementia.

P-472

Volunteer-led mobilisation of older inpatients: qualitative study of stakeholders' views

A. Baczynska¹, K. Ibrahim², A.A. Sayer³, H. Roberts¹. ¹Academic Geriatric Medicine, University of Southampton; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; NIHR CLAHRC: Wessex, University of Southampton; ²Academic Geriatric Medicine, University of Southampton; NIHR CLAHRC: Wessex, University of Southampton; ³Academic Geriatric Medicine, University of Southampton; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; NIHR CLAHRC: Wessex, University of Southampton; Ageing, Geriatrics & Epidemiology, Institute of Neuroscience, Newcastle University; NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle-upon-Tyne NHS Foundation Trust

**Introduction:** Mobilisation of older inpatients can reduce medical complications and loss of function. Time-pressured nurses and therapists report that this activity is frequently compromised. The aim was to explore a wide range of views on trained volunteers supporting mobilisation in hospital.

**Methods:** Semi-structured interviews and focus groups were conducted with 20 inpatients, 7 relatives, 28 staff members and 3 mealtime volunteers at one UK hospital. Interviews were audiotaped, transcribed verbatim, coded and analysed thematically by two researchers to identify commonalities and differences among the participants.

**Results:** Interviewees were generally positive. However staff thought recognition of unwell patients was important and patients awaiting social input would be most suitable. Volunteer related issues included: their roles and personal characteristics emphasised by therapists, legal responsibilities highlighted by doctors and nurses, training and supervision discussed by nurses and therapists. Environmental issues around timing, space, hospital routines and other patients' health status were noted by nurses and doctors. Concerns including potential staff miscommunication, additional
work for nurses and education regarding volunteers' role were explored by therapists. Many patients were very positive about this idea; others anticipated difficulties motivating participants and limited space in hospital. Relatives agreed that promotion of mobility and mental stimulation would be the main benefits of this programme. Only one relative believed it would be inappropriate to hand this task over to a non-member of staff.

**Conclusions:** In this qualitative study interviewees expressed positive attitudes to volunteer-led mobilisation of older people provided that specific issues are considered prior to implementation.

P-473

**War on constipation: Quality improvement project involving a multidisciplinary constipation prevention and management algorithm**

C.N. Osuafor¹, S. Enduliri¹, E. Travers¹, A.M. Bennett², M.E. Deveney³, S. Ali¹, F. McCarthy¹, C.W. Fan¹. ¹Medicine for Elderly Department; ²Dietetics Department; ³Nursing Department, St Mary's Hospital, Phoenix Park, Dublin, Ireland

**Introduction:** Constipation is common in older adults and often leads to increased incidence of adverse events and prolonged hospitalization. The aim of this project was to improve the quality of care of older adults undergoing rehabilitation in relation to prevention and management of constipation.

**Methods:** Quality improvement (QI) Plan-Do-Study-Act (PDSA) cycles were used. PDSA 1 was an initial audit of the incidence of constipation in our rehabilitation wards. PDSA 2 included meeting with key stakeholders and the multidisciplinary team (MDT) involved in the care of the patients and development of an algorithm for the prevention, early detection and effective treatment of constipation. PDSA 3 was a re-audit of the service after the introduction of the algorithm. PDSA 4 was the institutionalization of the developed algorithm.

**Results:** In the audit 2, 19% of patients were noted to be constipated compared to 33% in audit 1. 100% of patients in audit 2 who were constipated were on regular laxatives compared to only 30% of those in audit 1. 72% of all patients in audit 2 were on laxatives on as needed basis compared to 40% of patients in audit 1. The project also resulted in improved communication between patients and the MDT around their bowel habits.

**Conclusions:** Using a QI methodology, this project resulted in earlier detection, earlier intervention and overall reduction in incidence of constipation in older adults undergoing rehabilitation. The new algorithm was subsequently introduced to all the wards of our hospital

**Area: Geriatrics in organ disease**

P-474

**A clinical case of pulmonary vasculitis in the elderly**

P. Lopes, I. Alen, J.E. Mateus, D. Ferreira, M. Ferreira, J.F. Gomes, J. Porto, M. Veríssimo. Centro Hospitalar e Universitário de Coimbra

**Background:** Systemic vasculitis is a group of diseases characterized by inflammation of blood vessels with fibrinoid necrosis and resulting ischemic changes. In the geriatric population it has been frequently described with patient age playing an important role in both the diagnosis and treatment of these diseases. Vasculitis may mimic many common clinical situations of the elderly.

**Case report:** Female 84 years admitted to hospital for anorexia, asthenia, paleness with 15 days of evolution, associated with symmetric and additive polyarthritis, shoulderers, hips, and knees. She reported morning stiffness greater than 30 minutes. Conscious,

hemodynamically stable, fever 38.7°C, without other changes. No relevant personnel background. Blood tests: ESR 120 mm/h, RCP 12.6 mg/dL, Hb 10.5 g/dL, MCV 79 fL, WBC 14.9×10⁹/L. No analytical alterations of renal and hepatic functions. Chest x-ray, abdominal ultrasound, and urinalysis without changes. Initially the authors interpreted this clinical case as paraneoplastic syndrome or polymyalgia rheumatica. The patient did upper digestive endoscopy, colonoscopy, and bone scintigraphy without alterations. ANA: 160. At the end of one week of hospitalization, the patient has several episodes of hemoptysis, with severe acute respiratory failure. A thoracic CT scan: bilateral and symmetrical parenchymal densification without active hemorrhage. Subsequently, pANCA and MPO antibodies were positive. It made megadoses of methylprednisolone 1g for 3 days and later 80 mg of prednisolone daily. With the improvement of respiratory insufficiency, the patient performs biopsies, and the diagnose was pulmonary vasculitis.

**Conclusion:** Although lung vasculites are not frequent at this age, they may arise and adequate treatment should not be delayed.

P-475

**A systematic analysis on amino acid transporters of the aging blood-brain barrier**

N. Haaning Rasmussen. Aarhus Universitetshospital Skejby, Geriatrisk Afdeling, Danmark

**Introduction:** The blood-brain barrier (BBB) prevents toxic molecules to penetrate from the bloodstream to the brain. The BBB assures adequate delivery of nutrients such as amino acids, fatty acids, glucose. We investigated whether aging changes the ability of the brain capillaries to transport amino acids from blood to brain through the BBB.

**Methods:** Systematic literature review combined with database search for amino acid transport through the BBB and search for expression of amino acid transporters by the endothelium of the aging human brain. Our literature search revealed few human studies, we also performed our search in experimental animals such as rats and mice.

Results The systematic review of the literature revealed that research on nutrient transport at the BBB has been sparsely studied. We identified less than ten human studies. They did however demonstrate effects on transport of certain amino acids in the aging brain. This was also the case in aging experimental animals.

**Conclusion:** Examination of amino acid transport and their carriers at the BBB in the aging brain revealed that the availability of human studies is sparse. Studies in experimental animals were also few but support a hypothesis that the brain's uptake and transport of amino acids through the BBB correlates negatively with increasing age.

P-476

**Acute heart failure in elderly patients with mid-range ejection fraction: realworld evidence from ATHENA Registry**

S. Parlapiano¹, F. Orso², A. Pratesi³, A. Herbst¹, A.C. Baroncini², A. Lo Forte², C. Ghiara², E. Carrassi¹, G. Biagioni¹, F. Fedeli¹, M.L. Di Meo², N. Marchionni⁴, L. Gabbani⁵, M. Di Bari², A. Ungar², S. Baldasseroni². ¹University of Florence, Florence, Italy; ²Geriatric Intensive Care Unit, Careggi University Hospital, Florence, Italy; ³Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; ⁴Division of General Cardiology, Careggi University Hospital, Florence, Italy; ⁵Department of Medicine and Geriatrics, Careggi University Hospital, Florence, Italy

**Introduction:** Our purpose was to better characterize the new category of patients with heart failure mid-range ejection fraction (HFmrEF) and to compare them to those with HFpEF and HFrEF in a real world setting of elderly patients hospitalised for acute heart failure (AHF).
**Methods:** Data derived from the ATHENA retrospective observational study which included elderly patients (≥65 years) admitted with diagnosis of AHF (worsening or de novo) to the emergency department (ED) of a tertiary University teaching-hospital and transferred to cardiology, internal medicine and geriatric wards in the period 01.12.2014–01.12.2015.

**Results:** 246 patients were enlisted (patients with HFmrEF were 19.5%, 30.5% had HFrEF and 50.0% had HFpEF). Mean age was 83.8, 84.5 and 79.9 years for HFmrEF, HFpEF and HFrEF respectively, p<0.001; the prevalence of females was 41.7%, 67.5% and 32.0% for HFmrEF, HFpEF and HFrEF respectively, p<0.001. There were no significant difference regarding cardiovascular risk factors and main comorbidities between the three groups. A history of coronary artery disease, instead, was more frequently reported in patients with HFmrEF (41.7%) and in those with HFrEF (36.0%) compared to patients with HFpEF (19.5%), p=0.004. There was not significantly different in in-hospital mortality; the hospital length of stay was: 11.7 days, 9.4 days and 10.1 days for HFmrEF, HFpEF and HFrEF respectively (p=0.18).

**Conclusions:** Our study shows that patients with HFmrEF appear to be very similar to patients with HFpEF, except for the ischemic feature that seems to bring them closer to those with HFrEF.

P-477

**An unusual cause of heart failure in octogenarian patients**

V. Landaluce Pelligra, E. García Tercero, A. Escolante Melich.
*Complejo Hospitalario de Toledo*

79-year-old patient presented dyspnea on moderate exertion, associated in the last 15 days with increased edema in the lower limbs, testes and subjective increase of the abdominal perimeter with decreased diuresis rhythm. Physical examination: abolition of vesicular murmur in the left pulmonary base and generalized crackles, edema of abdominal wall and edema with foveas to root of limbs. In the tests, cardiomegaly, bilateral pleural effusion with interstitial edema and NT-proBNP 7174 pg/mL were evidenced. On the echocardiogram: left ventricle with increased thickness, suggestive refringence of infiltrate, moderately depressed LVEF. Cardiac MRI: Myocardial diffuse uptake compatible with amyloidosis pattern. Moderate biventricular systolic dysfunction. The patient presented alterations of ventricular contraction for 7 years, is admitted for medical treatment and study with 99mTc-DPD scintigraphy because of poor clinical status. It requires high doses of diuretics in infusion, obtaining a good negative diuresis balance and improvement of heart failure, however, it presents febrile peaks evidencing methicillin-resistant S. aureus in blood cultures. In view of the presence of a pacemaker, it is treated as bacterial endocarditis, scheduling removal of the device and delaying the scintigraphy. The patient presented poor evolution, passing away at 15 days. The senile amyloidosis reaches a prevalence of 36% in patients over 80 years, affects mainly men producing cardiac manifestation, the management is easier to control, with an average survival of 75 months, being the main cause of death arrhythmias and progression of HF. Our patient presented an evolution of 7 years, greater than the average of survival.

P-478

**Characteristic aspects of widespread pain in older adults**

G.I. Prada¹, R.M. Nacu¹, I.D. Alexa², A.G. Prada³, A. Kozma⁴.
¹N.I.G.G. "Ana Aslan", U.M.F. "Carol Davila", Bucharest, Romania;

²U.M.F. "Gr. T. Popa", Iassi, Romania; ³U.M.F. "Carol Davila", Bucharest, Romania; ⁴Institute of Anthropology "Fr. I. Rainer", Bucharest, Romania

**Introduction:** Chronic pain is a major condition often encountered in elderly and has significant consequences on quality of life. Study

objective was to identify specific patterns of widespread pain in elderly.

**Material and methods:** A transversal study was carried out on 584 subjects, age-range 50–92 years. They were divided into two groups, both presenting widespread pain: 292 adults (50–64 years), 292 elderly (75–92 years).

**Results:** Most patients were from urban area. Marital status: married adults significantly more prevalent (p<0.01), most elderly women were widows (p<0.01), elderly men were divorced (p<0.05). Obesity was more prevalent in elderly women. Alcohol consumption was declared only in men, slightly higher prevalence in younger group. Most adults had chronic pain for 5 years, while elderly had chronic pain for more than 10 years. For most subjects, irrespective of age, pain was cvasi-continuous. Exercise less involved in amplifying pain, while cold weather was more important in adult women (p<0.001) and elderly men (p<0.01). Most often localization of pain was vertebral regions, mainly lower back, and girdles. Morning fatigue, more intense in elderly (p<0.01). Other associated somatic symptoms; nocturia more prevalent in elderly men, muscle weakness more prevalent in elderly irrespective of gender, insomnia more prevalent in elderly slightly more often in women. Paresthesia, vertigo and headache were more frequent in elderly. Loss of short-term memory and attention deficit occurred in elderly.

**Conclusions:** Chronic widespread pain has an important impact on older people, is often associated with mood and cognitive disorders and requires a global management.

P-479

**Clinical presentation of giant cell arteritis: a study of 94 patients**

M.S. Hamdi, T. Ben Salem, M. Lamloum, I. Ben Ghorbel,
M.H. Houman. *Internal Medicine Department, La Rabta, Tunisia*

**Introduction:** Giant cell arteritis (GCA) is a granulomatous arteritis involving especially the extra cranial branch of the carotid arteries, usually occurring after 50 year-old. The aim of this study is to illustrate the epidemiological and clinical features of GCA in a group of Tunisian patients.

**Methods:** A retrospective, descriptive study interesting patients presenting GCA diagnosed between 2000 and 2015. ACR 1990 criteria were used.

**Result:** A total of 94 patients were included. Sex-ratio was 1.08. Mean age at diagnosis was 72 years (52–88 years) with a mean diagnosis time of 3 months. Hypertension was noted in 35% of patients while diabetes was observed in 13%. Headache was the revealing symptom in 63% of patients. Jaw claudication and scalp hyperesthesia were noted respectively in 56 and 47% of patients. cranial ischemic events occured in 13% of patients with only one case happening after diagnosis of GCA. Arthralgia, cervicalgia and fever were observed respectively in 22, 51 and 35% while polymyalgia rheumatic was present in 47% of cases. Anterior ischemic optic neuropathy was found in 31% of patients. Temporal pulse was absent or weak in 72% of patients. Laboratory evidences of inflammation were noted in 87% of patients. GCA was biopsy-proven in 55% of cases. Corticosteroids were prescribed in all cases, methotrexate in 20% of patients. Mean follow-up was 37 months. Recurrence was noted in 25% of patients.

**Conclusion:** No female predominance was found in our study. Headache is still the main feature of the disease and polymyalgia rheumatic was present in nearly half our patient.
## P-480

# Determinants of oral anticoagulants treatment in elderly patients with atrial fibrillation: Descriptive study and 1 year survival in 100 patients hospitalized in geriatric medicine

M. Deidda, I. Martin, J. Gauthier, S. Da Silva, E. Mazen, M. Dipanda, S. Asgassou, P. Manckoundia, P. Jouanny. Geriatric Department

**Introduction:** Atrial fibrillation (AF) is the most frequent arrhythmia in the elderly providing thromboembolic events in the lack of oral anticoagulants (ACO). Our study aims to evaluate the determinants of prescribing ACO through an analysis of the professional practices of geriatric and general practitioners and the outcome at one year.

**Methodology:** Firstly, retrospective descriptive study of 100 consecutive AF patients 75 years and over hospitalized in geriatric medicine in University Hospital of Dijon (Burgundy - France). Secondarily, prospective study of one year follow-up of patients by a survey of their general practitioners.

**Results:** Of the 100 patients included, 85% had a known history of AF. Of these, 74.1% were under ACO at entry. Treatment with ACO at discharge was significantly correlated with anticoagulant treatment at entry (p<0.0001). The significant determinants of non-prescription of ACO are hemorrhagic risk (Hasbled 2.9±0.9 vs 2.3±0.9; p<0.01) and comorbidities (Charlson 8.3±2.1 vs 7.2±2.2; p<0.05). Of the 93 patients discharged alive from the hospital, 81 were evaluated at 1 year. The mortality rate was 40.7% (33/81). Adverse events under ACO at one year were stroke (7%) and hemorrhage (15%). ACO treatment was significantly associated were lower mortality (23.3 vs 71.9%; p<0.05).

**Conclusion:** This study showed a high percentage of anticoagulation in patients throughout follow-up according to scientific recommendations. The choice of ACO treatment appears correlated with hemorrhage risk factors and frailty determinants. Despite a lower mortality rate under ACO treatment, the presence of significant adverse events could lead to first-line prescription of direct oral anticoagulants that seem to have a better ratio of efficacy/tolerance/ease of use, even in elderly polypathologic patients.

## P-481

# Diseases of older people referring to elderly centers of Tehran in 2016

A.D. Kakhki¹, Z.A. Saeedi¹, A. Delavar². ¹Shahid Beheshti University of Medical Sciences, Tehran, Iran; ²Allameh Tabatabai University, Tehran, Iran

**Introduction:** Aging is a natural experience that is usually accompanied by a variety of diseases. This study was conducted to describe older people's disease rate and the number of times they refer to Elderly Centers in Tehran.

**Methods:** This descriptive study was conducted on older people above 60 years old attending 20 Elderly Centers that were located in five regions of Tehran in 2016. 740 older people were selected from Elderly Centers based on convenience sampling. Self-report socio-demographic and disease rate questionnaires were used for data collection. Data were analyzed with SPSS software.

**Results:** 471 (63.6%) of older people were male and 269 (36.4%) female with a mean age of 69.76 (±7.5). 586 (83%) reported at least a chronic disease. Besides, 293 (39.4%) people had heart diseases, 165 (22.2%) musculoskeletal diseases, 149 (20.1%) endocrine diseases, and 88 (11.8%) urological and gynecological diseases. Moreover, 657 (88.5%) participants had referred to doctors and therapeutic centers at least once during the last year. 265 (35.7%) visited five or more. Furthermore, 266 subjects (35.9%) were hospitalized at least once last year.

**Conclusions:** The prevalence of diseases in older people is more than expected. Most older people refer to doctors and therapeutic

centers, which is indicative of the fact that they suffer from diseases and need varied health services in a developing country. Tailored and targeted strategies to improve the health status of older people are necessary.

## P-482

# Frailty in older patients receiving transcatheter vs surgical aortic valve replacement

J. Albéniz, P. Fdez-Montalbán, C. Lozano, L. Salido, M. Michelena, E. Sanchez, A.J. Cruz-Jentoft. HRYC Hospital Ramón y Cajal, Madrid, España

**Introduction:** To compare the prevalence of baseline frailty (using Fried's criteria) in older patients with severe symptomatic aortic stenosis treated having a TAVI with those receiving valvular surgery.

**Methods:** Single center, observational, descriptive study. Inclusion criteria: all patients admitted consecutively to receive an aortic valve replacement in a 16 month period. Sociodemographic, functional and clinical (EuroSCORE 1 and NYHA) variables were gathered. Frailty was diagnosed using Fried's criteria in three levels: robust, pre-frail and frail. Length of stay and hospital mortality were also noted.

**Results:** 107 patients were included (58.9% received a TAVI, 41.1% either an aortic valve replacement, 15.9% with simultaneous coronary surgery.TAVI patients were older (mean 82.0±8.3, vs. 78.0±4.7 years, p=0.01). There were no differences in gender or social status.Patients treated with TAVI were more dependent (mean BADL 5.3±0.9 vs. 5.8±0.4, p=0.06, mean IADL 5.3±2.2 vs. 5.8±1.5, p=0.27). Their mean EuroSCORE was higher (12.3±7.4 vs. 8.2±5.0, P=0.03) and they were in, worse cardiac functional class (73% vs. 24.4% in NYHA III-IV, p=0.01). Prevalence of frailty was similar on both groups: 30.2% frail in TAVI vs. 27.3% in surgery, pre-frail 28.6% vs 43.2%. There were no differences in walking speed or muscle strength. Length of stay was shorter in the TAVI group (9.3±11.7 vs. 10.9±16.2 days, p=0.04), with no differences in hospital mortality (1.6% vs. 2.7%, p=0.7).

**Conclusions:** Patients receiving a TAVI to treat aortic valve disease are older and more dependent than those surgically treated. They have higher EuroSCOREs and worse NYHA class. The prevalence of frailty is similar in both groups.

## P-483

# Gender influence in clinical, biological and histological features of giant cell arteritis

T. Ben Salem, S. Hamdi Mohamed, M. Khedher, I. Ben Ghorbel, M. Lamloum, M.H. Houman. Internal Medicine Department, La Rabta Hospital

**Introduction:** Giant cell arteritis (GCA) is the most common systemic vasculitis in elderly patients. The aim of this study is to compare GCA epidemiological, clinical, biological and histological characteristics according to gender.

**Methods:** A retrospective study including patient diagnosed with GCA between 2000 and 2015. GCA Diagnosis was based on 1990 ACR criteria. Patients were divided in two groups: group1 (men) and 2 (women) and were compared.

**Results:** Ninety-four patients were studied; sex-ratio (M/W) was 1.08. Mean age at diagnosis was significantly high in men (74.12±6.73 years vs 69.56±6.83 years; p=0.002). Mean delay to diagnosis was similar in the two groups. Headache was the most frequent revealing sign in both groups (respectively in 59% and 68% of patients). Regarding clinical features, there were no differences in the two groups; headache (93.9 vs 100%), jaw claudication (63 vs 50%), arthralgia (18.4 vs 26.7%), fever (43 vs 26%), polymyalgia rheumatica (51 vs 42%) and ocular manifestations (40.4 vs 40.9%). Elevated C-reactive protein (94.4 vs 77%, p=0.04) and hypergam-
maglobulinemia (51.3 vs 21.6%; p=0.007) were significantly more frequent in men. Histological features were similar in the two groups. Recurrence was observed in 45.7% of men and 23% of women (p=0.053).

**Conclusion:** Our study showed no significant difference between men and women concerning GCA clinical presentation, but biological data were more frequent in men. Outcome was similar in the two groups.

## P-484

### General practitioner and oncogeriatric supportive care in Lyon

M. Valero¹, C. Falandry¹, M. Bonnefoy¹, K. Mensah², A. Chabert³.

¹Centre Hospitalier Lyon-Sud; ²Princeton; ³Soins et Santé

**Introduction:** Age-related increase in cancer incidence and the development of outpatient treatments lead general practitioners (GPs) to play a pivotal role. To favor ambulatory care, there is a need to identify their treatment perceptions and difficulties.

**Methods:** A web survey was developed to evaluate GPs' clinical practices and perceptions on supportive care at home. It was validated within a testing cohort and sent by email to 697 GPs from Lyon area.

**Results:** The response rate was low (6,88%). A majority of GPs (87,50%) declared taking care of less than 5 patients per year. Considering practices, a majority reported regular assessments of pain (100%), depression (97,50%), undernutrition (96,87%) and quality of life (97,50%). They declared to frequently request unplanned hospital admissions (42.50%), since palliative complex situations are difficult to manage at home. Reimbursed paramedical aids (nurses, home care services, supportive care mobile team, physiotherapists) were more frequently known and used than non-reimbursed cares (dieticians and psychologists). Considering perceptions, main causes of GPs' difficulties were family exhaustion (84,61%) and caregivers' distress (74,35%). The lack of time (87,17%) and pay (66,66%) were two more important constraints than lack of training (33,33%).

**Conclusions:** Supportive care in cancer is complex and concern several areas. It seems to represent a weak proportion of GPs' practice and educational priorities. However, GPs claimed to perform a regular assessment of the most frequent symptoms associated with cancer and to prescribe reimbursed paramedical aids.

## P-485

### Geriatric assessment and frailty score predicts clinical outcome of transcatheter aortic valve implantation

E. Skaar¹,²,⁷, L.S.P. Eide³, T.M. Norekvål¹,², A. Hylen Ranhoff²,⁷, J.E. Nordrehaug², D.E. Forman⁴, A.W. Schoenenberger⁵, K.O. Hufthammer⁶, K.K.J. Kuiper¹, Ø. Bleie¹, E.J.S. Packer¹, J. Langørgen¹, R. Haaverstad¹,², M.A. Schaufel⁸. ¹Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;

²Department of Clinical Science, University of Bergen, Norway;

³Western Norway University of Applied Science, Bergen, Norway;

⁴University of Pittsburgh, USA; ⁵University of Bern, Switzerland;

⁶Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway; ⁷Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital Bergen, Norway; ⁸Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway

**Introduction:** Established risk scores prior to cardiac intervention have limitations in the elderly. Some patients may be too frail for endovascular intervention and will benefit more from a palliative approach. Our aim was, based on comprehensive geriatric assessment, to create a frailty score for risk prediction prior to Transcatheter Aortic Valve Implantation (TAVI).

**Methods:** We performed a prospective observational study in elderly patients (>70 years) accepted for TAVI at a university hospital during 2011–2015. All patients were evaluated by the Heart

Team and declined for open heart surgery. Prior to the procedure MMSE, SOF, NEADL, HADS and Charlson Comorbidity Index were performed. Based on expert opinions we developed a frailty score. Primary outcome was 1- and 2-year mortality. Secondary outcome was disabling stroke.

**Results:** 147 patients, mean age 84 (SD 4) years, whereof 80 (54%) women with severe and symptomatic aortic stenosis were included. All patients completed the MMSE and SOF. NEADL questionnaire was completed in 83% and the HADS questionnaire in 95%. Mean MMSE was 26 (SD 3) points, Charlson co-morbidity score 3 (SD 1), logistic EuroSCORE 17 (SD 9) %. All-cause mortality at 1- and 2-year was 8% and 11%, respectively. Within the first 6 months 3% suffered a disabling stroke. Calculation of a frailty score is in progress and will be presented.

**Conclusion:** Mortality and morbidity after TAVI in the present study is unexpectedly low. We will explore and present a frailty score to identify patients that may not benefit from TAVI.

## P-486

### Hip fractures in Lithuanian residents aged 80 years and over

M. Tamulaitiene¹, V. Alekna², M. Jaramaviciene², J. Jaramavicius², A. Mastaviciute². ¹Faculty of Medicine of Vilnius University; National Osteoporosis Center, Vilnius, Lithuania; ²Faculty of Medicine of Vilnius University; Vilnius, Lithuania

**Objective:** The aim of this study was to analyze epidemiological data of hip fractures in persons aged 80 years and over.

**Methods:** A retrospective study was performed on Lithuanian residents aged 80 and over, who sustained primary hip fracture. Data were collected from patient charts at 47 orthopaedic-traumatology inpatient departments. Treatment was categorised into 3 types: osteosynthesis (screws, plates, and intramedullary nails), arthroplasty (subtotal or total), and conservative treatment. The outcomes were rehabilitation, long-term care hospital, discharge home, transfer to another department, or death.

**Results:** In 2001–2010, a total of 10 093 hip fractures occurred in Lithuanian residents aged 80 years or more, 83.5% of them were females. Overall male:female ratio was 1:5, the highest ratio was found in 90–100 years age group (1:5.6). Age-standardised fracture rate was 729.2/100.000 (95% CI: 694.2–764.1) in men and 1246.3/100.000 (95% CI: 1219.7–1273.0) in women. Low energy traumas caused 93% of fractures. Mean duration of hospitalization was 12.2 days. Of all patients, 68.3% were treated using osteosynthesis, 19.5% – arthroplasty, and 12.2% were treated conservatively. Main outcomes were: discharge home (36.1%) and rehabilitation (34.4%). Death occurred in 2.8% of all cases (73% in women), and increased from 2.3% in 80–85 to 8.2% in 100+ years age group.

**Conclusions:** In 2001–2010, in Lithuanian residents aged over 80 years, the age-standardised hip fracture incidence was 729.2/100.000 in men and 1246.3/100.000 in women. Hip fractures were mostly caused by low energy trauma. Deadly outcome grew along with patient age.

## P-487

### Histopathology and prognostic outcome of endovascular thrombectomy for the elderly stroke patients

H. Ishibashi-Ueda¹, N. Funatsu², Y. Ikeda¹, K. Ohta-Ogo¹, M. Matsumoto¹, Y. Iwasaki³, K. Fujita³, M. Hayakawa³, K. Toyoda³.

¹Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan; ²Department of Neurosurgery, Gifu University School of Medicine, Gifu, Japan; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan;

³Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan

**Introduction:** Endovascular thrombectomy (EVT) for intracranial
thrombotic occlusion is performed for stroke patients regardless of ages. Histology of retrieved thrombi from cerebral arteries by catheter can provide useful information.

**Methods:** We histopathologically analyzed obtained thrombi by EVT from the consecutive 74 acute stroke patients (women 48.6%, 70 to 96 years) from January 2011 to March 2017. The average age was 80.4 years and the median age was 81.5 years. We divided the patients into 2 age groups, 37 seventies (70 to 80 years) as S group and 37 eighties and over (81 to 96 years) as E group, to compare the obtained thrombi and outcome between the 2 groups. Among the enrolled patients, 27 (73.0%) showed atrial fibrillation in both S group and E group.

**Results:** Successful reperfusion resulted in excellent prognosis revealed 51.4% in S group and 24.3% in E group (p<0.01). The fatal cases were recognized in 2 patients in each group respectively (5.4%). The remaining cases showed fair prognosis requiring continuous therapy. Obtained platelets and fibrin thrombi suspected to be cardiogenic emboli were found in 86.5% of S group and in 79.5% of E group. Atheromatous gruel which was suggested as athero-thrombi by the plaque rupture of local cerebral arteries was observed in 5 cases (13.5%) in S group and 3 (8.1%) in E group.

**Conclusion:** EVT can be effective for good outcome of stroke events. Successful EVT is sufficient procedure for even in the very elderly acute stroke patients to prevent poor prognosis.

## P-488

### Hyperuricemia and its determinants in elderly patients with persistent atrial fibrillation

M. Migliorini¹, S. Pupo¹, I. Giannini¹, A. Scardia¹, S. Boni¹, G. Boriani², C. Borghi³, N. Marchionni¹, L. Padeletti⁴, S. Fumagalli¹.
¹ICU Careggi Hospital University of Florence; ²Cardiology Division, University of Modena and Reggio Emilia, Modena, Italy; ³Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; ⁴University of Florence, Italy

**Introduction:** Recent evidence suggests that hyperuricemia could be associated to atrial fibrillation (AF) development and to its relapses after specific interventions. Aim of this study was to evaluate the predictors of hyperuricemia in a population of elderly patients undergoing external cardioversion (ECV) of a persistent form of the arrhythmia.

**Methods:** In all consecutive subjects we studied neurocognitive, mood and functional profile. Arterial stiffness (AS) was measured using the Cardio-Ankle Vascular Index (CAVI). Hyperuricemic (HU) patients were identified by concentrations of uric acid (UA) ≥6.5 mg/dL or by present therapy with allopurinol, Controls (C) had normal UA levels.

**Results:** We evaluated 57 subjects (age: 77±7 years; women: 33.9%; September 2015 - December 2016). Hypertension and chronic heart failure (CHF) were the main causes of the arrhythmia (33.3% and 54.4% of patients, respectively). HU subjects represented 40.4% of the whole population (UA – HU: 6.8±1.5 vs. C: 4.9±0.9 mg/dL, p<0.001). ECV effectiveness did not differ by HU status (HU: 100 vs. C: 88.2%, p=0.140). Logistic regression analysis showed that the presence of CHF (p=0.022) and creatinine concentrations (p=0.001) were directly associated to the HU condition. Conversely, a greater arterial stiffness characterized C subjects (p=0.009).

**Conclusions:** In elderly patients with persistent AF, hyperuricemia is common and it seems associated to CHF and renal function. Further studies are needed to clarify the inverse relation between the condition and AS, and to evaluate the existence of a link between UA and AF relapses.

## P-489

### Hypothermic patients admitted to a tertiary center in a five year period

J.E. Mateus, J. Fonseca, P. Lopes, C. Silva, D. Ferreira, J. Porto, M.T. Veríssimo, A. Carvalho. Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal

**Introduction:** Hypothermia can be caused by various factors including cold exposure, infection or endocrine abnormalities. Although hypothermia may be associated with an increased risk of mortality, its influence on the severity and outcome of critically ill patients is not well understood.

**Methods:** Patients aged 65 or more years admitted with hypothermia from 2012 to 2016 to a tertiary center in Portugal were included in the study. Patient characteristics, physiological data and mortality were assessed.

**Results:** In this period 151 patients were admitted with hypothermia: mostly women (64%), mean age 85 years. Comorbidities were common: 85% hypertension, 56% congestive heart failure, 31% chronic kidney disease and 26% diabetes. According to Katz Index of Independence in Activities of Daily Living, 52% were evaluated as very dependent. At admission mean temperature was 31.8°C, mean serum lactate was 1.9 mmol/L and mean pH was 7.33. Most patients had central nervous system dysfunction (85%) and cardiovascular dysfunction (60%). Regarding the cause of hypothermia, 67% had infection, 26% had endocrine abnormalities and 3% had cold exposure. Mean hospital length of stay was 10 days and hospital mortality was 30%. Lower temperatures were associated with lower pH (<28°C: 7.20 vs ≥32°C: 7.39) and a higher incidence of cardiovascular dysfunction (31.2 vs 32.8°C) and hematologic dysfunction (29.5 vs 32.0), p<0.05.

**Conclusions:** The elderly are at increased risk of developing hypothermia and its complications due to decreased physiologic reserve and chronic diseases that impair compensatory responses. Therefore, they should be urgently assessed if found to be hypothermic.

## P-490

### Impact of geriatric assessment for the therapeutic decision-making of breast cancer: results of a French survey. AFSOS* and SOFOG** collaborative work

I. Krakowski¹, H. Curé², E. Carola³, P. Soubeyran¹, O. Guérin⁴, G. Freyer⁵. ¹Bergonie Institute, Bordeaux, France; ²CHU Grenoble, La Tronche, France; ³Groupe Hospitalier Public du Sud de l'Oise, Senlis, France; ⁴Hôpital Cimiez, Nice, France; ⁵Hospices Civils de Lyon & Lyon University, Lyon, France

**Background:** Cancer management in the elderly is often considered as suboptimal and heterogeneous. Data are needed to understand decision making processes in this population.

**Methods:** A survey was performed in France to describe decision making in gynaecologic patients over 70. It followed a three steps method: (1) 101 representative physicians questioned about treatment-decision criteria; (2) simplified individual data were collected as well as (3) detailed data patients receiving chemotherapy. This analysis refers to breast cancer subgroup of patients.

**Results:** Main decision criteria were performance status, comorbidities and renal function. In adjuvant setting, the main concern was life expectancy, whereas it was quality of life in metastatic setting. Of the 631 patients entered in the simplified analysis, 41% had been evaluated by a geriatrician, 67% received chemotherapy. In the detailed analysis, patients older than 75 were more likely to receive a monochemotherapy and to be treated with weekly/divided dose. In adjuvant setting, respectively 19%, 55% and 26% of the patients were treated with regimen validated in the elderly, validated in a younger population and not validated. A G-CSF was prescribed in
48% of the patients, as primary prophylaxis in 78% and in 41% of patients with a risk of febrile neutropenia <10%.

**Conclusion:** Geriatric covariates become an increasing concern in the decision-making process. This survey also suggests an insufficient use of validated chemotherapy regimens. To date, age remains a risk factor for heterogeneity in oncologic practice justifying a persistent effort for elaborating and disclosing specific recommendations.

## P-491

### Interdisciplinary assessment in elderly patients with severe aortic stenosis: Decision making process for transcatheter aortic valve implantation

C. Roqueta¹, N. Farre², B. Vaquerizo², M.I. Martínez-Fernández³,
A. Sánchez-Carpintero², A. Mases⁴, R. Millan², M. Ble²,
A. Mas-Stachurska², M. Cladellas², S. Ruiz², N. Ribas², R. Serrat²,
A. Fort², J. Martí², O. Vázquez³. ¹Geriatric Medicine Department.
Parc de Salut Mar. Centre Fórum. Hospital del Mar/Universitat Autònoma de Barcelona. Barcelona, Spain; ²Department of Cardiology.
Parc de Salut Mar. Hospital del Mar. Barcelona, Spain; ³Geriatric Medicine Department. Parc de Salut Mar. Centre Fórum. Hospital del Mar. Barcelona, Spain; ⁴Department of Anesthesiology and Resuscitation. Parc de Salut Mar. Hospital del Mar. Barcelona, Spain

**Aim:** To evaluate transcatheter aortic valve implantation (TAVI) indication by an interdisciplinary team.

**Methods:** Thirty patients (50% women) with severe aortic stenosis were prospectively evaluated by an interdisciplinary team (clinical cardiologist, image specialist, invasive cardiologist, anesthesiologist, nurse and geriatrician). A geriatric assessment was performed: previous living situation, functional status [Barthel (BI) and Lawton index (LI)], walking speed (m/s), cognitive status [Mini-Mental Examination of Folstein (MMSE)], emotional status (GDS Yesavage), nutritional status [Mini-Nutritional Assessment abbreviated (MNA)], comorbidity (Charlson index) and number of geriatric syndromes.

**Results:** Mean age: 82.2±6.8. Twenty-two (73.3%) lived with family. TAVI was indicated in 17 patients (56.6%) and refused in 13 (3 asymptomatic, 2 lung cancer, 1 not attending controls, 1 high comorbidity, 3 no benefits for other cardiologic causes and 3 frailty). Mean values of geriatric assessment parameters in the 17 patients who received TAVI treatment were: age: 81.6±7.1; LI: 5.0±1.8; BI: 97.0±6.4; walking speed: 0.6±0.2; MMSE: 27.1±2.9; GDS Yesavage: 1.4±1.4; MNA abbreviated: 12.3±1.8; Charlson: 2.6±1.2; number of geriatric syndromes: 2.2±1.2 and in the 3 patients who in which TAVI was refused because of frailty: 82±8.8 (p=0.939); 2.0±1 (p=0.013); 74.6±19.2 (p<0.001); 0.4±0.1 (p=0.149); 20.6±2.3 (p<0.001); 2.3±2.0 (p=0.341); 11.6±2.3 (p=0.563); 1.6±1.1 (p=0.229) and 5.6±0.5 (p<0.001), respectively.

**Conclusion:** 1. Half of the patients evaluated by interdisciplinary team were considered appropriate for TAVI. 2. There were several causes for the exclusion of this therapeutic option. 3. Patients who were excluded due to frailty had significantly worse functional and cognitive status, and a higher frequency of geriatric syndromes.

## P-492

### Masked hypertension in geriatric age: an underdiagnosed problem associated with end organ damage

M. Esme¹, B. Yavuz², S. Asil³, R.T. Doğrul⁴, F. Sümer⁴, M.K. Kılıç⁴,
M.C. Kızılarslanoğlu⁴, H.D. Varan⁴, A. Sağır⁵, C. Balcı⁴, M. Halil⁴,
M. Cankurtaran⁴, B.B. Yavuz⁴. ¹Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey; ²Medical Park Hospital, Department of Cardiology, Ankara, Turkey; ³Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey; ⁴Hacettepe University Faculty of Medicine, Department of

Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey;
⁵Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine Psychologist, Ankara, Turkey

**Introduction:** Masked hypertension (MH) describes the state that blood pressure values are within normal ranges when recorded by office measurements but the average daytime blood pressure, mean blood pressure at night or the 24-hours average blood pressure values are above the normal range when recorded by ambulatory measurements. The prevalence of masked hypertension in geriatric age is not known. It is also a question whether masked hypertension leads to end organ damage in the early stages. The aim of this study is to investigate the possible associations between masked hypertension and end organ damage in geriatric population.

**Methods:** One hundred-two patients who were admitted to the Geriatric Medicine outpatient clinic of Hacettepe University, Faculty of Medicine, Department of Internal Medicine consecutively were included in the study. Patients who have been diagnosed with hypertension or dementia previously or using any antihypertensive medication were excluded. All patients underwent ambulatory blood pressure measurement procedures and values were recorded as three separate parameters, which were average daytime blood pressure, mean blood pressure at night and the 24-hours average blood pressure. Comprehensive geriatric assessment tests and neuropsychological tests were administered to all patients. The diagnosis of masked hypertension was based on the definitions in the 2013 guideline of the European Society of Cardiology (ESC).

**Results:** As a result of the analysis, 44 of 102 patients (43%) were diagnosed with masked hypertension. Median MMSE scores were 28 (18–30) in patients with masked hypertension and 29 (18–30) in normotensive group. Patients with masked hypertension had significantly lower scores on Mini-Mental State Examination (MMSE) test (p=0.011). The albumin/creatinine ratio in the masked hypertensive group was 9.61 mg/gr and in the group with normal blood pressure values, it was 7.12 mg/gr (p=0.021). In addition, left ventricular mass index (LVMI), which is one of the parameters showing the end organ damage and reflects the negative effect of hypertension on the heart, was found to be higher in the masked hypertension group than in the normal group. Mean LVMI scores were 107.76±16.37 in patients with masked hypertension and 100.39±19.32 in normotensive group. These differences in the ratio of spot urinary albumin/creatinine ratio and left ventricular mass index, which are the end organ damage parameter, were also statistically significant (p=0.021; p=0.046; respectively).

**Conclusion:** This study shows that geriatric patients with masked hypertension, compared to normotensive patients have decreased cognitive functions. In addition, urinary albumin excretion and left ventricular hypertrophy which are the parameters of end-organ damage caused by hypertension, were significantly higher in masked hypertension patients. These results show that masked hypertension may cause end organ damage and should not be overlooked in geriatric patients.

## P-493

### Monoclonal gammopathies in elderly patients

T. Ben Salem, M. Khedher, M.S. Hamdi, I. Ben Ghorbel, M. Lamloum, M.H. Houman. *Internal Medicine Department, La Rabta Hospital*

**Introduction:** Monoclonal gammopathies (MG) are common in the general population. The objective of this work is to describe clinical, biological characteristics and etiologies of MG in elderly patients.

**Materials and methods:** A retrospective study was performed in an internal medicine department over a period of ten years. All files patients with MG were studied (114). Clinical, biological and etiological features of patients aged over 65 years were analyzed and compared with younger patients.
**Results:** Forty-nine elderly patients with MG were studied; 27 men and 22 women. Their median age was 73.4±5.55 years. Mean level of monoclonal component was 33.7 g/l. GM isotypes were IgG (n=24), IgA (n=16) and IgM (n=4). Light chains were lambda or kappa, each one in 50% of patients. GM was frequently revealed with bone pain (16 cases). Poor general state was noted in 27 patients. Renal insufficiency and hypercalcemia were respectively observed in 27 and 23 patients. Anemia and thrombopenia was respectively found in 39 and 10 patients. There were no differences in clinical and biological data when compared to young patients. GM was related to multiple myeloma (n=33), lymphoma (n=2), cryoglobulinemia (n=2) and amyloidosis (n=2). Gammapathy of unknown significance was diagnosed in 6 patients. There were no differences regarding GM etiologies when compared to patients under 65 years old.

**Conclusion:** MG are common in clinical practice and specially in elderly. Etiological study is a real challenge for physicians. In our study, their spectrum wasn't different in elderly patients.

P-494

**Mortality and quality of life in elderly patients on dialysis in New Zealand: Results from the Dialysis Outcomes in the >65s Study (DOS65+)**

G.M.E. Pearson¹, R.J. Walker², S. Derrett², A. Samaranayaka², J.B.W. Schollum². ¹University of Bristol, Bristol, United Kingdom; ²University of Otago, Dunedin, New Zealand

**Background:** New Zealand (NZ), and indeed the world, has a growing population of elderly patients with end-stage renal failure (ESRF) requiring dialysis. Physicians and patients making decisions around dialysis require information on the prognosis and quality of life (QoL) associated with all available options. However, there is limited evidence available on dialysis outcomes in the elderly, particularly QoL.

**Methods:** The Dialysis Outcomes in the >65s Study (DOS65+) is a prospective longitudinal cohort study of patients >65 with ESRF. This is a cross-sectional analysis of mortality and QoL outcomes at baseline and 2 years.

**Results:** We found that mortality nor QoL vary with dialysis vintage, modality or location of treatment, whereas high burdens of co-morbidities and ESRF-related symptoms were associated with reduced QoL. Increasing age was found to be associated with mortality, however there was no correlation between age and QoL on dialysis. Contrary to previous studies on other diseases, we have shown no significant differences in mortality or QoL in ESRF between the various ethnicities in NZ. Interestingly, socioeconomic factors including living with others, family involvement and sense of community contribute significantly to QoL in our patients, and lack of family involvement was also significantly related to mortality.

**Conclusions:** Our findings are consistent with the growing body of evidence around dialysis outcomes in the elderly, highlighting several key variables contributing to survival and QoL on dialysis which should be considered by doctors and patients when making decisions about the management of ESRF.

P-495

**Multiple osteolytic lesions due to Primary Bone Lymphoma (PBL)**

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

**Background:** PBL is a rare entity. Usually is of Non-Hodgkin Lymphoma (NHL) type and of diffuse Large B-cell Lymphoma (DLBCL) subtype. It represents <1% of all NHLs'. Even rarer is the presence of multiple osteolytic lesions in the context of PBL.

**Objective:** To describe a 74 years-old female patient with PBL and multiple osteolytic lesions.

**Case presentation:** Patient was admitted for evaluation of an osteolytic lesion found in a plain radiography of the right ankle. She experienced difficulty in walking for one month. Her medical history was unremarkable. Her blood test, basal metabolic panel and tumor markers were normal. Magnetic resonance imaging (MRI) of the right ankle demonstrated a lytic lesion in the right fibula, with permeative extension in the surrounding tissues and multiple small osteolytic lesions in the fibula and the leg. Bone scintigraphy with technetium-99 showed high accumulation in multiple sites especially at the lower limbs and the pelvis. Bone marrow aspiration and biopsy were normal and Computed Tomography (CT) scans of the chest and the abdomen revealed no evidence of distal nodal or extranodal tissue involvement. She underwent a fine-needle aspiration biopsy of the lesion. The histopathological examination and immunohistochemistry revealed NHL, of DLBCL subtype and the patient was referred to the Hematology Department for specific treatment.

**Conclusion:** PBL should be considered in the differential diagnosis of multifocal osteolytic lesions. Timely diagnosis and treatment is mandatory as multifocal bone DLBCL patients exhibit a better prognosis compared to patients with other extranodal DLBCLs'.

P-496

**Myelodysplastic syndromes and giant cell arteritis in the elderly: A non-fortuitous association that geriatricians need to know**

A.-L. Gérard¹, J. Cohen-Bittan¹, A. Gioanni², P. Fenaux³, M. Verny⁴, O. Fain⁵, J. Boddaert⁴, L. Zerah⁴. ¹Department of Geriatrics, Unit of Peri-Operative Geriatric Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; ²Department of Geriatrics, Unit of Peri-Operative Geriatric Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; University Pierre and Marie Curie (UPMC) Paris 06, University Hospital Department Fight Aging and Stress (DHU FAST), Paris, France; ³Department of Senior Haematology, Hôpital Saint Louis, Paris 7 University, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; ⁴Department of Geriatrics, Unit of Peri-Operative Geriatric Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Department of Senior Haematology, Hôpital Saint Louis, Paris 7 University, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France. 4 Centre National de la Recherche Scientifique (CNRS), UMR 8256, Paris, France; ⁵Department of Internal Medicine, Hôpital Saint Antoine, UPMC, DHU i2B, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France

**Introduction:** The association between myelodysplastic syndrome (MDS) and autoimmune disease is well recognized in the literature, but large vessel vasculitis associated to MDS are really uncommon. Giant Cell Arteritis (GCA) occurring in the setting of MDS is important to recognize from the geriatricians in regard to prognosis and treatment options.

**Methods and results:** We present a rare case of a 79-year-old woman hospitalized for asthenia, weight loss, headache and two previous episodes of transient diplopia. Laboratory data revealed a major inflammatory syndrome (C-reactive protein (CRP): 204 mg/L) and an isolated lymphopenia at 780/mm³; the temporal artery biopsy confirmed GCA. Urgent corticosteroid therapy has been started (5 methylprednisolone bolus followed by 1 mg/kg/day of prednisone) and medical condition improved with a decrease of CRP (25 mg/L). Three-months later, the patient remained steroid-dependent (20 mg per day of prednisone) with the reappearance of asthenia and a CRP level at 93 mg/L. Laboratory data revealed pancytopenia and the emergence of circulating blasts justifying an urgent bone marrow aspiration leading to the diagnosis of MDS. Unfortunately, one month later, a new bone marrow aspira-
tion revealed an acute myeloid leukemia and chemotherapy was initiated.

**Conclusion:** In elderly patients with GCA, a poor response to steroids or steroid dependence should suggest the presence of associated MDS, particularly in presence of cytopenia. The association of MDS with vasculitis appears to predict adverse outcome, and may in particular precede transformation to overt AML. It seems judicious to treat MDS quickly, considering vasculitis as a paraneoplastic syndrome.

## P-497

### New assessment of clinical signs of subclinical hypothyroidism associated with aging

R. Gourmelon¹, S. Donadio-Andréi², K. Chikh², M. Rabilloud³, C. Falandry⁴, E. Kuczewski⁵, A.-S. Gauchez⁶, A. Charrié⁵, E. Disse⁴, C. Thivolet⁴, H. Du Boullay⁷, A. François-Joubert⁷, A. Vignoles⁵, C. Ronin², M. Bonnefoy⁸. ¹UCBL1, HCL, Faculté Médecine Lyon Est, 69003 Lyon, France; ²Siamed'Xpress, Hôtel Technologique Morandat, 13120 Gardanne, France; ³Service de Biostatistiques, Hospices Civils de Lyon, Lyon, France; ⁴UCBL1, HCL, Faculté de Médecine Charles Merieux, 69600, Oullins, France; ⁵Hospices Civils de Lyon, 69002 Lyon, France; ⁶UMR-S INSERM 1037, 38000 Grenoble, France; ⁷Laboratoire du Service de Médecine Nucléaire, Centre Hospitalier Métropole Savoie, 73000 Chambéry, France; ⁸Univ-Lyon, CarMeN laboratory, Inserm U1060, INRA U1397, UCBL1, INSA Lyon, Faculté de Médecine Charles Merieux, 69600, Oullins, France

**Background:** Subclinical hypothyroidism (SCH) is defined as the association of normal T4 and a high TSH. Two phenomena may have an impact on this syndrome outlines: the improvement of TSH dosing and the age-related variations of TSH bioactivity.

**Methods:** Eleven classical hypothyroidism clinical signs (hCS) were prospectively collected in a multicentric trial. We tested in a "young" vs "older" population (<60 vs ≥60 years old) SCH prevalence with a recent dosing test of TSH, T3/T4 ratios and the presence of hCS in patients with SCH vs euthyroidism.

**Results:** From 2012 to 2014, 807 "young" and 531 "older" individuals were included. The rate of TSH was higher in the "older" population (2.36mUI/L vs 2.14mUI/L, p<0.05). The T3/T4 ratio was a little lower (0.26 vs 0.27, p<0.01), illustrating a probable loss of TSH bioactivity. Considering the presence of hCS in the "older" compared to the "young" group, a paradoxical higher prevalence was shown in the euthyroid population (1.9 vs 1.6, p<0.01) but not in the SCH population (2.3 vs 2.6, p=0.41). The percentage of subjects with 3 or more signs increased when TSH becomes >4.05mIU/L (42.6% vs 25.0%) for young people but not in the elderly population (34.4% vs 33.9%). Only 3 hCS were related to SCH in "older" subjects.

**Conclusion:** While mean TSH and SCH prevalence are higher in the older population, the lower T3/T4 ratio and fewer hCS lead to consider a probable loss of bioactivity and perhaps the need to reevaluate the TSH reference range in that population.

## P-498

### Observational prospective cohort of elderly with hypervitaminosis B12: An important cancer prevalence

C. Arlaud, C. Rambaud, J.M. Turpin, S. Gonfrier, R. Boulahssass, O. Guérin. CHU Nice

Few studies were performed but suggest a link between cancers and hypervitaminosis B12. The aim of this study was to analyze the cancer prevalence of elderly with hypervitaminosis B12. An observational cohort study was conducted from November 2015 to May 2016 including all the patients >70 years with vitaminosis B12 >700 pg/ml in a referent geriatric center. The presence or malignancies discovered during the hospitalization was reported. Characteristics of cancer and socio-demographic data were also

collected. The realization of complementary exams during the hospitalization was mentioned. A total of 131 patients were included with 63% (n=82) women and mean age was 86 years (SD 5.7 years). The average vitamin B12 was 1267 pg/ml. Among the 131 patients, 25% (n=33) had a cancer identified by histology, 16% (n=21) highly suspicious images of neoplasms and 17% (n=22) had lesions suspected to be due to metastatic disease. About 5% (n=6) of all hypervitaminosis B12 result from hematological malignancies. Among the solid cancers, digestive (33.3%) and lung (16.7%) cancers were most frequent. The vitamin B12 levels was not significantly different between patients with neoplasia and the rest of the study population (1269 vs. 1264 pg/ml, p=0.965). Among 25% patients died, 43% are with known or suspected malignancies. With a quarter of patients dying during hospitalization, it also appears as a possible prognostic factor of mortality. Future research is warranted to complete these result establish the value of systematized clinical and paraclinical assessments in case of hypervitaminosis B12.

## P-499

### Overall survival in elderly patients with colorectal cancer: a population-based study in the Caribbean

C. Joachim¹, L. Godaert², M. Dramé³, J. Veronique-Baudin⁴, J. Macni⁵, J. Smith-Ravin⁶, J.-L. Novella⁷, R. Mahmoudi³, ¹Registre Général des cancers de la Martinique; ²University Hospital of Martinique; ³University Hospital of Reims; ⁴registre général des Cancers de la Martinique; ⁵Registre Général des Cancers de la Martinique; ⁶Université des Antilles; ⁷University of Reims

**Background:** Population-based Cancer registries (PBCR) play an important role in cancer surveillance and research. The aim of this study was to examine overall survival in elderly patients with colorectal cancer (CRC) by analysing data from the Martinique PBCR between 1993 and 2012.

**Methods:** The log-rank test was used to assess the statistical differences of the survival curves by each categorical variable: age at diagnosis, sex, histology, zone of residence, subsite, stage at diagnosis, and chemotherapy in incident. A multivariable Cox model was performed to identify independent prognostic factors for overall survival in elderly patients with colorectal cancer.

**Results:** Among 2230 patients included in the study, 60.8% were aged ≥65 years; mean age at diagnosis of these patients was 75.7±7.2 years. For the period 2008–2012, 532 elderly patients were analysed; mean age of those receiving chemotherapy was 73.0±0.4 versus 77.9±0.4 years for those not receiving chemotherapy (p<0.0001). Stage at diagnosis was evaluated in 87.8% (467/532) of patients; 63.0% (294/467) had stage III-IV and 49.3% of these patients (145/294) received chemotherapy. Chemotherapy was less frequently prescribed in patients aged 75–84 and ≥85 years as compared to those aged 65–74 years (41.1% and 15.0% versus 64.6% respectively; p<0.0001). Stage III-IV at diagnosis (HR=5.25; 3.70–7.45; p<0.0001), and not receiving chemotherapy (HR=3.05; 2.23–4.16; p<0.0001), were independent prognostic factors for overall survival.

**Conclusion:** Our study highlights the role of PBCR in evaluating cancer survival and patterns of care in elderly people of the French West-Indies. Chemotherapy was less frequently prescribed among the elderly.

## P-500

### Pharyngeal dilator muscle recruitment during increasing respiratory efforts in awake young and older healthy subjects

A. Brodsky, M. Somri, A. Oliven, R. Oliven. Bnai Zion Medical Center, Haifa, Israel

**Background:** Pharyngeal patency depends on interaction between peri-pharyngeal muscles. Older subjects are known to be prone
to obstructive sleep apnea compared to younger subjects. We hypothesized that recruitment of dilator muscles during increasing respiratory efforts differs between young and older healthy subjects.

**Methods:** Esophageal pressure (Pes), airflow and EMG of the genioglossus (GG) and other per-pharyngeal muscles (non-GG: styloglossus, geniohyoid, sternocleidomastoid and sternohyoid, 3 EMGs/subject) were recorded in 5 young (21.2±0.4yrs) and 7 older healthy subjects (68.6±8.7yrs), all validated as non-apneic by full night polysomnography. Data recorded during wakefulness, when subjects produced a range of negative Pes levels while breathing through a partially obstructed inspiratory port, was used to plot individual peak EMG/Pes slopes.

**Results:** Peak inspiratory EMG of all muscles increased with increasing respiratory efforts (larger negative Pes). The increase in GG and non-GG EMGs with increasing negative Pes were significantly steeper in the young as compared to the older subjects: -0.95±0.37 vs. -0.47±0.29 (p<0.05) and -0.87±0.31 vs. -0.40±0.24 (p<0.01) EMG%max/cmH2O for the GG and non-GG muscles, respectively.

**Conclusions:** With increasing respiratory efforts, older healthy men recruit dilator muscles significantly less than young men, suggesting age-related remodeling of neuromuscular drive. In addition to age-related anatomic-structural changes, alterations in control of breathing may contribute to the higher prevalence of sleep apnea in older subjects.

## P-501

### Primary cutaneous small vessel vasculitis. A case report

C. Palicio, M. González, Z. Rivas, A. Socorro, F.J.G. Pavón. Hospital Central Cruz Roja

**Objective:** We present the case of a 77-year-old woman admitted for blistered necrohemorrhagic cutaneous lesions in lower limbs.

**Methods:** The patient referred edema on her legs, with blistered purpuronecrohemorrhagic lesions. Initially up to her knees, they extended to the back side of both thighs and right hemithorax. In the emergency room she was diagnosed with cellulites and prescribed amoxicillin-clavulanic, but returned again for high temperature, dysuria and intense throbbing leg pain. Background: hypertension, lumbar canal stenosis, secondary hypothyroidism, cataract surgery, and appendectomy. Baseline status: Barthel 80/100, without cognitive impairment and lived alone.

**Results:** Physical examination revealed both heart failure data consisting on thigh edema that required intravenous deflective treatment and urinary retention. Attending to the lower limbs, she presentend confluent papules and plaques as well as vesicles and blisters up to 5cm diameter from feet to buttocks, and also along her back and right hemithorax. Steroid treatment with prednisone 50 mg and local cures with silver sulfadiazine were recommended by dermatology a on suspicion of vasculitis, and antibiotic treatment with meropenem was also associated due to necrotic ulcer related febrile syndrome. Cutaneous biopsia was informed as leukocytoclastic vasculitis of superficial vessels, without deposits of IgA, IgM and IgG.

**Conclusion:** This small vessel cutaneous disorder is mostly a self-limited condition in terms of duration and clinical involvement. A cutaneous biopsy and thorough initial differential diagnosis are necessary, as its clinical features can resemble multiple disorders.

## P-502

### Relationship between the severity of cerebral white matter hyperintensities and sympathetic nervous activity in the elderly

K. Kozaki, T. Obara, H. Hasegawa, T. Ebihara. *Kyorin University School of Medicine*

**Introduction:** Cerebral white matter hyperintensities (WMH), vi-

sualized on brain magnetic resonance imaging, represent an abnormality related to the development of geriatric syndrome and vascular events. Studies have suggested that low sympathetic nervous activity (SNA) might be associated with physical and cognitive dysfunction, leading to increased mortality in the elderly. In this study, we investigated the relationship between the severity of WMH and the SNA, measured by the heart rate variability (HRV).

**Methods:** We performed a cross-sectional study of 39 elderly patients (79.4±7.0 years old, 14 males and 25 females). Holter electrocardiogram (30 minutes) was recorded, thereafter, low frequency/high frequency (LF/HF), index of SNA, and other indices of the HRV were measured. In regard to the severity of the WMH, periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) were semi-quantitatively rated according to the previous method.

**Results:** The LF/HF was significantly lower in patients with apparent DWMH than those without DWMH. From the univariate regression analysis, the LF/HF showed significant negative correlations with the total and regional PVH, as well as DWMH. Multiple regression analysis showed that the negative associations remained significant between the LF/HF and DWMH (total, temporal, occipital area). Furthermore, fall risk index, one of the important geriatric syndrome, showed significant correlations with the LF/HF, total and the occipital DWMH.

**Conclusions:** The severity of DWMH was associated with the LF/HF and the fall risk, one of the important geriatric syndrome, suggesting that WMH, sympathetic nervous dysfunction, and the geriatric syndrome are interrelated.

## P-503

### Sinus rhythm restoration determines an improvement of physical performance in elderly patients with persistent atrial fibrillation

S. Pupo¹, A. Scardia¹, M. Migliorini¹, I. Giannini¹, S. Boni¹, F. Sacco¹, M. Di Bari¹, T. Potpara², N. Marchionni¹, S. Fumagalli¹.
¹ICU Careggi Hospital University of Florence; ²University of Belgrade, Belgrade, Serbia

**Introduction:** Atrial fibrillation (AF) is the most frequent arrhythmia of the elderly. Some evidence suggests that AF is associated with a faster physical functional decline. Aim of this study was to evaluate the impact of sinus rhythm (SR) restoration on physical performance of aged patients with persistent AF.

**Methods:** We studied all consecutive subjects undergoing external cardioversion (ECV) of the arrhythmia between March 2015 and August 2016. At baseline (BL) and at the follow-up (FU), patients were assessed using the Short Physical Performance Battery (SPPB).

**Results:** We evaluated 46 patients (age: 77±7 years; men: 65.2%; MMSE: 27.6±3.0; GDS: 4.0±2.5). Hypertension was the most frequent cause of AF (41.3%). At BL, median value of SPPB was 10/12 (33th-66th percentile: 8-11) and it was inversely associated with the CHA2DS2-VASc (p=0.003) and the GDS (p=0.001) scores. ECV was effective in 91.3% of patients. At FU (median: 141 days), SR was observed in 24/46 patients (52.2%), and it was associated with a significant improvement of SPPB (BL: 9.6±2.3 vs. FU: 10.9±1.6; p=0.002), whilst no changes were observed in patients with AF (BL: 8.6±2.2 vs. FU: 9.2±2.4; p=0.130). At multivariate analysis, the presence of SR, when compared to AF, was associated with an improvement of SPPB at FU (+1.1±0.4 points; p=0.018).

**Conclusions:** In elderly patients with persistent AF, SR restoration seems to be associated with an improvement of physical functioning. If these results will be confirmed, a rhythm-control strategy could be preferred in aged patients at risk of disability development.
P-504

Submandibular mass in the elderly – an unusual diagnosis

I. Rego Figueiredo, R. Vieira Alves, S. Guerrreiro Castro, M. Antunes, F. Lourenço, H. Gruner. S. *Medicina*, *Hospital de Curry Cabral, Centro Hospitalar Lisboa Central*

**Introduction:** The differential diagnosis of a submandibular mass is challenging in all ages, especially in the frail elder that does not complain, and always includes neoplasia and infections. Per- tinence of invasive exams is doubtful and concerning treatment expectations, palliative care must be considered.

**Case report:** An 88-year-old female patient, bedridden, with de- mentia and hypertension, was admitted with a 3-month history of prostration and on examination a right submandibular mass. Exhaustive studies showed no elevated inflammatory parameters (ERS 27 mm/h), negative viral serologies (HIV, HCV, CMV, EBV) and hemocultures. Complete ear nose and throat with nasoendoscopic examination was performed. Contrast enhanced CT-scan showed necrotic lymph nodes, fine-needle aspiration biopsy showed py- ocytes, panniculitis with neutrophilic and histiocytic infiltration, the gram was negative. There was no response to 2 courses of an- tibiotherapy, with persistence of the mass. The differential diagnosis of the subacute asymptomatic neck mass, was between metastatic neoplasia and tuberculosis.Further exams showed focal lesion on right mammary gland and biopsy triple positive invasive carci- noma. The cultural exam on the 52nd day, showed "mycobacterium tuberculosis". As such she started tuberculostatics and tamoxifen.

**Discussion:** Tuberculosis in the fragile elderly remains a frequent diagnosis as the inherent immunosenescence contributes to reactiva- tion of inactive mycobacteria from previous contacts. Initial clinical presentation of tuberculosis as a cold abcess of the submandibular gland is a rare clinical entity, especially as there was no evidence of concomitant tuberculosis elsewhere in the body, in this case, the presence of neoplasia contributed to the reactivation.

P-505

The clinical characteristics and the selection of medical services in the subjects with gastric cancers according to the age

J.H. Kim¹, H.H. Jeon², Y.W. Son², T.J. Jeon³, J.Y. Park³. ¹Dongguk University Ilsan Hosptial, Dongguk University college of medicine, Goyang, Republic of Korea; ²National Health Insurance Service Ilsan Hosptial, Goyang, Republic of Korea; ³Inje University Sanggye Paik Hospital, Seoul, Republic of Korea

**Introduction:** Gastric cancer is the fifth leading cause of cancer and the third leading cause of death from cancer making up 7% of cases and 9% of deaths in 2012. Behavioral patterns of subjects with gastric cancer are not unknown in terms of the selection of medical institution. We investigated the clinical characteristics of the subjects and the selection of medical services according to the age.

**Methods:** From January 2007 to December 2016, medical records of a total of 248 subjects with gastric cancer were retrospectively reviewed in two groups as aged younger than 40 years old and aged over 65 years old. The clinical findings were compared between the two groups.

**Results:** The mean age of the two groups were 35.8±3.6 yr old and 72.7±6.5 yr old, respectively. In old group, male was more frequent (67.7% vs 49.6%, p=0.04). Atrophic change (50.5% vs 7.3%, p<0.01) and intestinal metaplasia (48.1% vs 11.6%, p<0.01) were also more frequently observed. Moreover, cancer in the old group was more frequently located at lower body of the stomach (75.6% vs 63.0%, p=0.046) and treated by endoscopic submucosal dissection (27.7% vs 1.4%, p<0.01). Location at mid body (11.0% vs 25.9%, p<0.01) and surgical treatment (45.1% vs 63.5%, p<0.01) were less frequently observed in old group. However, transfer to other hospital (19.5% vs

22.6%, p=0.64) and proportion of EGC (55.6% vs 47.8%, p=0.25) were not different between two groups.

**Conclusions:** Although clinical characteristics of stomach cancer in the old group were different from those of the young group, there was no difference in terms of the referral to other hospital between two groups.

P-506

The relationships between health-related quality of life and well-being in women aged 60–74 years

A. Cernovas¹, K. Kluonaitis¹, M. Tamulaitiene², R. Stukas¹, V. Alekna¹. ¹Faculty of Medicine of Vilnius University; Vilnius, Lithuania; ²Faculty of Medicine of Vilnius University; National Osteoporosis Center, Vilnius, Lithuania

**Objective:** To investigate the relationships between health-related quality of life and well-being in elderly women aged 60–74 years.

**Subjects and methods:** This cross-sectional study was performed on community dwelling women aged 60–74 years. Exclusion crite- ria were musculoskeletal or nervous system diseases or conditions that could restrict the mobility. Data was collected by direct inter- viewing and recording the answers on a survey which consisted of sociodemographic questions and three questionnaires. Health- related quality of life was measured using European Quality of Life Five Dimensions (EQ-5D), well-being – Control, Autonomy, Pleasure, and Self-realization (CASP-19) and Satisfaction with Life Scale (SWLS) questionnaires. Correlations were determined using Spearman correlation coefficient.

**Results:** The study was performed on 66 women; their mean age was 67.06±3.37 years. It was found that 9 (13.6%) women were single, 24 (36.4%) married, 17 (25.8%) widowed, and 11 (16.7%) divorced. Analyzing education level we found that 6 (9.1%) women had secondary (secondary or vocational school), 5 (7.6%) post- secondary (junior college), 8 (12.1%) vocational (institute), 4 (6.1%) non-university higher (college) and 39 (59.1%) higher university education. Our findings suggest that EQ-5D score statistically sig- nificantly (p<0.001) moderately positively correlated with: total CASP-19 score (r=0.57) and separately with each of CASP-19 main domains scores – control (r=0.68), autonomy (r=0.63), pleasure (r=0.48), and self-realization (r=0.66). The data have revealed posi- tive moderate correlation between EQ-5D and SWLS scores (r=0.42, p<0.001).

**Conclusion:** Our study showed the positive associations between health-related quality of life and well-being: EQ-5D score moder- ately correlated with CASP-19 and with SWLS scores.

P-507

Unprovoked pulmonary embolism in older adults: incidence and prognosis

D. Justo¹, M. Aharoni², N. Horesh³, O. Rogowski⁴, A. Kremer⁵, H. Mayan⁶. ¹Geriatrics Division, Sheba Medical Center, Tel-Hashomer; Israel; ²Sackler School of Medicine, Tel-Aviv University, Israel; ³Surgery Department, Sheba Medical Center, Tel-Hashomer, Israel; ⁴Internal Medicine C, Sourasky Medical Center, Tel-Aviv, Israel; ⁵Geriatrics Division, Sheba Medical Center, Tel-Hashomer, Israel; ⁶Internal Medicine E, Sheba Medical Center, Tel-Hashomer, Israel

**Introduction:** The incidence of unprovoked pulmonary embolism (UPE) in older adults has been seldom studied, and its prognosis has never been studied, to the best of our knowledge.

**Methods:** A historical prospective study. The medical charts of all older adults (aged 70 years or more) with pulmonary embolism (PE) that were admitted to a tertiary medical center between 2010 and 2012 were reviewed. Patients were divided into three groups: UPE, provoked PE (PPE), and malignancy-associated PE (MAPE). PPE and UPE patients were those with and without obvious causes for PE,
respectively. MAPE patients were those with an active malignancy. The all-cause 1-year cumulative survival rates following admission were compared between the groups.

**Results:** The final cohort included 249 patients with PE: 161 (64.7%) were women; the mean age was 79.8±5.7 years. Overall, 36 (14.5%) patients had UPE, 81 (32.5%) patients had MAPE, and 132 (53.0%) patients had PPE. Overall, 30 (12.0%) patients died during their hospitalization, 76 (30.5%) patients died six months later, and 101 (40.6%) patients died within one year of admission. Relative to PPE and MAPE patients, the cumulative survival rate was significantly higher in UPE patients at every time point within one year of admission (p<0.05 and p<0.0001, respectively). Regression analysis showed that UPE was independently associated with reduced 1-year mortality (odds ratio 0.3, 95% confidence interval 0.1–1.0).

**Conclusions:** UPE in older adults is not uncommon, and its prognosis is better than PPE and MAPE in this population.

## P-508

### Using a multidimensional prognostic index (MPI) based on comprehensive geriatric assessment (CGA) to predict mortality in elderly undergoing transcatheter aortic valve implantation

M.-L. Bureau¹, E. Liuu¹, L. Christiaens², A. Pilotto³, J. Mergy², F. Bellarbre¹, P. Ingrand⁴, M. Paccalin¹, ¹Pôle de Gériatrie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France; ²Service de Cardiologie, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France; ³Department of Orthogeriatrics, Rehabilitation and Stabilization - Frailty Area - E.O. Galliera Hospital, Hospital of National Relevance and High Specialization, 16128 Genoa, Italy; ⁴Pôle Biologie, Pharmacie et Santé Publique, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France

**Background:** Selection of appropriate elderly who can benefit from transcatheter aortic valve implantation (TAVI) is challenging. We evaluated the prognosis of this procedure according to the comprehensive geriatric assessment (CGA) based on the multidimensional prognostic index (MPI).

**Methods:** Prospective observational monocentric study from January 2013 to December 2015. Consecutive patients aged ≥75 who underwent TAVI and a complete CGA were included. Baseline demographic, geriatric and cardiologic data were collected. CGA was used to calculate the MPI score that is divided in three groups according to the mortality risk. Follow up was performed until December 2016 and mortality rate was assessed at one, six and 12 months.

**Results:** 116 patients were included. Mean age was 86.2±4.2 years, mean European system for cardiac operative risk evaluation (EuroSCORE) was 19.2±11.3%, mean MPI score was 0.39±0.13. Forty-five (38.8%) patients belonged to MPI-1 group, 68 (58.6%) to MPI-2 group and three to MPI-3 group. MPI score and Euroscore were moderately correlated (Spearman correlation coefficient rs =0.27, p=0.0035). Mortality rate was significantly different between MPI groups at six and 12 months (p=0.040 and p=0.022). Kaplan Meier survival estimates at one year stratified by MPI groups was significantly different (hazard ratio HR =2.83, 95%confidence interval (CI) 1.38–5.82, p=0.004). Among variables retained to perform logistic regression analysis, the score of instrumental activities of daily living appeared the most relevant (p<0.001).

**Conclusions:** This study indicates that CGA based on MPI tool is accurate to predict prognosis in elderly patients undergoing TAVI procedure.

## P-509

### Using the multidimensional prognostic index to define risk in older patients undergoing a transcatheter aortic valve replacement

J. Albéniz, P. Fdez-Montalbán, C. Miret, A. Merello, L. Hernandez, E. Sanchez, A.J. Cruz-Jentoft. HRYC Hospital Ramón y Cajal, Madrid, Spain

**Introduction:** The multidimensional prognostic index (MPI) is a valid tool to classify older patients in different settings. We used MPI to describe patients selected for transcatheter aortic valvular replacement (TAVR).

**Methods:** Single-center, prospective, observational study. Inclusion criteria: older patients in need of an aortic valve replacement with TAVI for severe aortic stenosis. MPI used all domains of geriatric assessment (sociodemographic, functional, nutritional, cognitive, comorbility, number of medicines) to calculate an index that defines three groups according to the mortality risk: MPI-1 (≤0.33, low risk), MPI-2 (0.34–0.65, moderate risk) and MPI-3 ((≥0.66, high mortality risk). Clinical variables were also collected (EuroSCORE and NYHA).

**Results:** Sixty-three patients were included (mean age 83.0±8.3 years, 57% women). 91.1% were independent for BADL, 72.2% for IADL. Most of them lived with their families (77.8%) and some presented cognitive impairment (20%). 68.9% of them had >2 comorbidities in need of treatment and 54% severe polypharmacy. 95.5% were at risk of malnutrition risk. Mean MPI score was 0.33±0.15 (53.4% of the patients were in MPI-1 group, 42.2% in MPI-2, and only 4.4% in the high risk MPI-3). Mean EuroSCORE was 12.3±7.4%; 65.1% of the patients were in NYHA class III. Only one patient died during follow-up, prognostic value of MPI for mortality in this sample cannot be yet calculated.

**Conclusions:** Most older patients receiving a TAVI have a low or moderate mortality risk.

## Area: Infectious diseases and vaccines

### P-510

#### A case of a chest wall mass in elderly male

S. Brazão, R. Costa, C. Ferreira, N. Pedro, S. Leitão, L. Santos, T. Veríssimo, A. Carvalho. Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal

**Introduction:** Chest wall masses are caused by a spectrum of entities, and its etiology is diverse. A careful history and physical examination can guide the physician to the diagnose. Imaging can help to identify the location, size and composition, and biopsies are often required.

**Case report:** A 77-year-old man with a history of heart failure, presented with depressive mood, asthenia and anorexia with a weight loss of 20 kg. Concomitantly, presented with a 1 month, painless chest wall mass, with well defined contours, about 6 cm in diameter and elastic consistency. No trauma history. The mammary ultrasound revealed cystic formation that could correspond to a partially organized hematoma. The aspiration cytology revealed necrotic background without viable cells. Computed tomogram of the thorax: liquid collection in the left anterior thoracic wall, associated with irregularity and discontinuity of the 4th left costal cartilage; in the upper left lobe a nodulation with 22 mm, cavitated, that suggest pulmonary tuberculosis. PET: Hipodense masses in the left anterior thoracic wall, with increased FDG uptake. Acid-fast bacilli smear and culture of the sputum were positive, however HIV serology was negative. He started quadruple therapy with tuberculostatics and was discharged on the 26th day after negative smear.
**Conclusion:** In this case, the indolent onset of unspecific symptoms, made it difficult to diagnose Pulmonary tuberculosis, that was confirmed by positive culture and imaging. It's important to value all the symptoms so we can achieve the diagnosis, and prevent more serious complications.

## P-511

### A case report of thoracic spondylodiscitis, epidural and paraspinal abscesses without elevated inflammatory markers and fever

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

**Background:** More than 80% of patients with spondylodiscitis, epidural and paraspinal abscesses have elevated CRP and ESR levels and more than 50% present with leukocytosis. Fever may be absent.

**Objective:** To describe a83 years-old female patient with spondylodiscitis, epidural and paraspinal abscesses who never had neither fever nor any elevated inflammatory markers.

**Case presentation:** Patient was admitted for evaluation of paraspinal and epidural masses found in MRI, performed to investigate her persistent back pain. Her current diagnosis was spinal metastases. MRI revealed lesions at T6–T7 and T7–T8 discs, T6,T7 and T8 vertebral bodies, epidural and bilateral paraspinal regions. She reported no fever and inflammatory markers were not elevated (WBC: 9.480 K/µl, CRP <3.27 mg/l, ESR: 8 mm/h). The patient was referred for needle biopsy and the results revealed polymorphonuclear infiltration of the tissue specimen. Unfortunately the specimen was not sent for staining and cultivation. The patient denied the repetition of needle aspiration. The Orthopedics and Neurosurgery specialists suggested no operative intervention. Patient received Levofloxacin, Rifampicin and Clindamycin, followed by pos administration after 6 weeks. Both the effectiveness of treatment and the duration of therapy, had to be based only on MRI findings. After four months, the MRI was unchanged. After eight months, the lesions gradually retreated and finally resolved after 1.5 year of therapy.

**Conclusion:** Biopsy specimens from epidural and paraspinal masses must be sent for cultivation and staining as they may conceal infection, even in the absence of fever or elevated inflammatory markers.

## P-512

### Adult vaccination for pneumococcal disease: A comparison of the national guidelines in Europe

D. Mertens¹, C. Bonnave¹, B. Ghesquiere², K. Cobbaert², W. Peetermans³, J. Verhaegen⁴, M. Deschodt⁵, J. Flamaing⁶. ¹Dept. of Geriatrics, University Hospitals Leuven, Belgium; ²Dept. of Geriatrics, AZ Delta Roeselare, Belgium; ³Dept. of Internal Medicine, University Hospitals Leuven, Belgium; ⁴Dept. of Clinical Biology, University Hospitals Leuven; ⁵Dept. of Clinical & Experimental Research, University of Leuven, Belgium; ⁶Dept. of Geriatrics, University Hospitals Leuven; Dept. of Clinical & Experimental Research, University of Leuven, Belgium

**Background:** Pneumococcal disease constitutes a major global health problem. Adults aged 50 years or older and younger adults with specific chronic health conditions are at particular risk for invasive pneumococcal disease, associated with substantial morbidity and mortality. In Europe, two types of vaccines are used in adults for pneumococcal immunization: pneumococcal polysaccharide vaccine (PPV23) and pneumococcal conjugate vaccine (PCV13). The aim of this study is to provide an overview and compare the national guidelines for pneumococcal immunization for adults in Europe.

**Methods:** In November 2016, national guidelines on pneumococcal vaccination for adults of 27 European countries were obtained by Google search, the website of European Centre for Disease Prevention and Control and contacting public health officials. In our analysis we distinguished between age-based and risk-based guidelines.

**Results:** We observed great variability regarding age, risk groups, vaccine type and use of boosters. In age-based guidelines, vaccination is mostly recommended in adults aged 65 years or older, using PPV23. A booster is generally not recommended. An upper age limit for vaccination is reported in two countries. In the immunocompromised population, vaccination with both vaccines and administration of a booster is mostly recommended. In the population with chronical health conditions, there is more heterogeneity according vaccine type, sequence and administration of boosters. Asplenia is the only comorbidity for which all countries recommend vaccination.

**Conclusions:** There is great variability in European pneumococcal vaccination guidelines regarding age, risk groups, vaccine type and boosters. For ease of implementation, European unification of the guidelines is needed.

## P-513

### Atypical presentation of bacteremia in the elderly is a risk factor for death

C. Hyernard¹, A. Breining², S. Duc¹, C. Cazanave³, M. Lambert⁴, P. Mercie⁴, P. Duffau⁴, M. Rainfray¹, C. Roubaud-Baudron¹.

¹Geriatrics Department, Bordeaux University Hospital, Bordeaux, France; ²Geriatric Department, Groupe hospitalier Pitié Salpétrière-Charles Foix APHP, Paris, France; ³Infectious Disease Department, Bordeaux University Hospital, Bordeaux, France; ⁴Internal Medicine Department, Bordeaux University Hospital, Bordeaux, France

**Introduction:** The absence of typical signs of infection is described in elderly patients impacting diagnosis and prognosis. The objective of this study was to determine risk factors for mortality of bacteremia in this population and factors associated with atypical presentation.

**Material and methods:** We conducted an observational prospective study at Bordeaux University Hospital (France) in 2016. All consecutive patients ≥75yo with bacteremia were included. Atypical presentation was defined by the absence of temperature ≥38.3°C or <36°C, chills or severe sepsis. Mortality and functional status were recorded at 1 week (D7) and 3 months (M3). Results: 131 patients (mean age 85yo, 46.6% female) were included. D7 and M3 death rates were 9.2 and 41.4% respectively. In multivariate analysis, at D7, atypical presentation tended to be associated with death (odd ratio (OR)=3.4, 95% confidence interval (CI) (0.9–14), p=0.092). M3-mortality risk factors were: atypical presentation (OR=4.0, 95% CI: (1.3–11), p=0.013), nosocomial infection (OR=5.7, 95% CI: (2.0–15), p=0.001), congestive heart failure (OR=4.9, 95% CI: (1.9–12), p=0.001), and malignancy (OR=3.2, 95% CI: (1.1–9.0), p=0.029). Diabetic patients and those infected by Staphylococcus aureus were more likely to have atypical signs of infection. Bacteremia impact long term functional status: ADL score decreased from 3.6 (±2.0) (before bacteremia) to 2.9 (±2.2) 3 months later (p=0.003).

**Conclusion:** Elderly patients with bacteremia have a poor vital and functional prognosis in the short and long term. Physicians should be attentive to patients without infectious typical signs because of an increased risk of death. Blood sample should be considered in elderly, especially diabetic patients, with unexplained clinical manifestations.
## P-514

### Combined plasma elevation of CRP, intestinal-type fatty acid-binding protein (I-FABP), and sCD14 identifies older patients at high risk for healthcare-associated infections

E. Paillaud¹, S. Bastuji-Garin², A. Plonquet³, Y. Levy⁴, S. Hue³.

¹Groupe Hospitalier Henri-Mondor, Département de médecine interne et gériatrie, Creteil, France; ²Hôpital Henri-Mondor, Pôle Recherche Clinique et Santé Publique, Creteil, France; ³Hôpital Henri-Mondor, Service d'immunologie biologique, Creteil, France; ⁴Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de médecine, France

**Introduction:** We hypothesized that low-grade inflammation was driven by microbial translocation and associated with an increased risk of healthcare-associated infections (HAIs).

**Methods:** We included 121 patients aged 75 years or over in this prospective cohort study. High-sensitivity-C-reactive protein (hs-CRP) as a marker of low-grade inflammation, I-FABP as a marker of intestinal epithelial barrier integrity, and sCD14 as a marker of monocyte activation were measured at hospital admission of patients.

**Results:** HAIs occurred during hospitalisation in 62 (51%) patients. Elevated hs-CRP (≥6.02 mg/L, i.e., the median) was associated with a significantly higher HAI risk when I-FABP was in the highest quartile (odds ratio [OR], 4; 95% confidence interval [95%CI], 1.39–11.49; P=0.010). In patients with hs-CRP elevation and highest-quartile I-FABP, sCD14 elevation (≥0.65 pg/mL, i.e., the median) was associated with an 11-fold higher HAI risk (OR, 10.8; 95%CI, 2.28–51.1; P=0.003). Multivariate analyses adjusted for invasive procedures and comorbidities did not change the associations linking the three markers to the HAI risk.

**Conclusions:** Increased levels of hs-CRP, I-FABP, and sCD14 may reflect loss of intestinal epithelial barrier integrity with microbial translocation leading to monocyte activation and low-grade inflammation. In our cohort, these markers identified patients at high risk for HAIs.

## P-515

### Comparison between the clinical forms at the acute phase of Chikungunya virus infection as defined by the WHO, and the clinical presentation in elderly subjects

L. Godaert¹, S. Bartholet¹, F. Najioullah¹, S. Yactayo², M. Dramé³.

¹University Hospital of Martinique, Martinique, France; ²World Health Organization, Geneva, Switzerland; ³University of Reims, Champagne-Ardennes, France

**Introduction:** In Chikungunya virus infection (CHIKV) three clinical forms at the acute phase have been defined by the World Health Organization (WHO), namely acute clinical cases, atypical cases, and severe acute cases. We aimed to compare the clinical presentation presented by elderly patients during the acute phase of CHIKV with the definitions by the WHO.

**Methods:** Cross-sectional study performed in the University Hospital of Martinique from retrospective cases. Patients aged ≥65 years, who attended the emergency department with a positive biological diagnosis of CHIKV (RT-PCR), between January and December 2014 were considered eligible. They were compared to a randomly selected sample of younger controls (<65 years).

**Results:** A total of 267 elderly patients (80±8 years), and 109 controls (46.2±12.7 years) were included. In terms of clinical forms of disease, in elderly and controls, typical presentation was present in 8.2% and 59.6% (p<0.0001) respectively, atypical presentation was present in 29.6% and 5.6% (p<0.0001) respectively, severe presentation was present in 19.5% and 17.4% (p=0.65) respectively. In the elderly group, 114 (42.7%) could not be classified in any category (absence of fever, absence of joint pain, or both); In the controls group, 19 (17.4%) could not be classified (p<0.0001).

**Conclusions:** Only 8,2% of the elderly subjects presenting at the acute phase of CHIKV have typical forms. These results suggest that the most frequent clinical presentation of CHIKV in the elderly population differs from that most commonly observed in younger populations.

## P-516

### Early diagnosis of sepsis: Is quickSOFA a good screening tool?

I. Arnau-Barrés¹, À. Pedragosa², R. Miralles¹, R. Güerri-Fernández³.

¹Geriatrics Department, Hospital del Mar, Barcelona, Spain;

²Emergency Department, Hospital del Mar, Barcelona, Spain;

³Infectious Diseases Department, Hospital del Mar, Barcelona, Spain

**Introduction:** The qSOFA score, is offered as a quicker screening tool for sepsis that can be easily used at the bedside.

**Methods:** We conducted a retrospective cross-sectional study. The records of all patients older than 65, hospitalized between January and September 2016 with the diagnosis of sepsis (ICD-10) were reviewed. Clinical information at admission and vital signs, laboratory and microbiology results, APACHE2 score and qSOFA were obtained; and also 30-day-mortality. We performed descriptive and a multivariable analysis. A multivariate logistic regression model was fitted to study mortality predictors.

**Results:** A total of 223 patients were included. Median age (75 (IQR 71–82 years old)). 30-day-mortality was 22 patients (14%). Seventy-five patients (48%) presented with urinary tract infection, 45 (29%) with respiratory infection and 26 (11%) with abdominal infection. Bacteriemia was present in 95 patients (42%). No differences in qSOFA nor in 30-day mortality were found among different sites of infection nor in patients with bacteremia. At admission 40 patients (17%) with sepsis fulfilled the qSOFA criteria. The 30-day-mortality in patients who scored positive in qSOFA was of 12%. Moreover, in 70% of patients that fulfilled the SIRS criteria, qSOFA score was <2 (p<0.001). Multivariate logistic regression analysis revealed that albumin levels (OR=0.3, 95% CI: -0.17–0.56, p<0.0001), C-Reactive Protein (CRP) (OR=1.03, 95% CI: 1.02–1.23, p=0.07) and Charlson comorbidity index (OR=1.32, 95% CI: 0.978–1.806; p=0.007) were the independent risk factors for 30-day-mortality.

**Conclusions:** qSOFA is not a good predictor for the diagnosis of sepsis in elderly patients in our study. Only 24% of patients with confirmed diagnosis of sepsis fulfilled the qSOFA criteria, whereas 70% fulfilled SIRS criteria. The main predictors of mortality were: albumin, CRP and Charlson comorbidity index.

## P-517

### Effectiveness of live zoster vaccine in preventing postherpetic neuralgia (PHN)

P. Saddier¹, J. Bartlett², B. Fireman², M. Marks¹, J. Hansen², E. Lewis², L. Aukes², Y. Chen³, E. Bresnitz⁴, N. Klein², R. Baxter².

¹Pharmacoepidemiology Department, Merck & Co., Inc; ²Kaiser Permanente Vaccine Study Center; ³Pharmacoepidemiology Department, Merck & Co., Inc; ⁴Merck & Co., Inc

**Introduction:** A single dose, live attenuated zoster vaccine, is licensed in >50 countries for the prevention of herpes zoster and PHN. Duration of protection is evaluated in a long-term observational study. We previously reported that vaccine effectiveness (VE) to prevent zoster tended to decline over time and was on average 45–50% over 5 years in people ≥60 (60+) years. We present here the results of VE against PHN.

**Methods:** The study is conducted in a US healthcare plan as an open cohort that members enter unvaccinated when they become age-eligible for vaccination. PHN cases among vaccinated and unvaccinated zoster cases were identified as having a PHN-specific diagnosis code ≥90 days after first zoster code. VE against PHN was estimated using Cox regression adjusting for sex, birth year,