race/ethnicity, healthcare use, comorbidities and immunocompro-
mise status.

**Results:** In 2007–2014, ~400,000 subjects were vaccinated (cover-
age >50% in 60+) and ~50,000 zoster episodes with >3000 PHN
cases occurred. VE against PHN was 82% (95% CI: 76–87) in the first
year, decreased in the second year, and then remained relatively
stable through year 5, with an average VE over the first 5 years
following vaccination of 72%, 69% and 61% in people vaccinated at
age 60–69, 70–79, and 80+ years, respectively.

**Conclusions:** Overall VE against PHN was ~70% in all 60+ age groups. VE against zoster and PHN in people 80+ was similar to younger 60+ groups, supporting vaccination of all eligible people, including the elderly who are at increased risk of zoster and PHN.

P-518

Efficacy of a short-term prophylactic antibiotic protocol in prostatic surgeries for elderly with indwelling catheter

C. Arlaud, C. Rambaud, J. Courjon, E. Demonchy, V. Mondain,
N. Retur, F. Lieutier, M. Durand, O. Guérin. CHU Nice

**Introduction:** Indwelling urinary catheters (IUC) are overused in the elderly population and represent a major risk factor for urinary tract infections (UTI) and loss of functional autonomy. Surgical procedures are available for catheterization cessation but healthcare associated infections can occur. We evaluated the efficiency of a specific antibiotic protocol implemented for the prevention of perioperative prostatic surgery infections.

**Material and methods:** A multidisciplinary team was established to include patients over 70 years with IUC eligible for an alternative treatment option using comprehensive geriatric assessment during a 1-year period in 2016. Based on preoperative urine analysis, patients received antibiotic therapy during 5 days (2 day before and 2 days after the surgery). Use of narrow spectrum drugs was prioritized. Favorable outcome was defined as the absence of UTI during the month after surgery.

**Results:** Twenty-two patients with a mean age of 84.3 years (72–93 years) were included among which 7 had a sterile urine analysis and 15 received the antibiotic treatment. The main bacteria involved were Klebsiella pneumoniae (n=4), Enterococcus faecalis (n=4), Escherichia coli (n=3), 4 urine analysis were polymicrobial. With only one post-operative infection, we recorded a 95.5% efficiency rate of our protocol.

**Conclusion:** These first results suggest that a 5 days perioperative antibiotic therapy for prostatic surgery in IUC carriers is effective for post-operative infection prevention. Monitoring data should allow to complete these results with a longer follow-up and validate the protocol.

P-519

Establishing an antibiotic stewardship team in a geriatric department of a German hospital and introducing an online evaluation and documentation tool

S. Langenfeld. St. Marien Hospital Köln

**Introduction:** Facing the challenge of the rise of multiresistent agents, especially in the Gram-negative field and Clostridium difficile as a result of decades of inconsiderate use of anti-infective substances it is highly important to rethink and to build structures to avoid further progression.

**Methods:** By establishing an antibiotic stewardship team structures were built to analyze resistance rates and the use of antibiotics. Recommendations in the choice of substances due to common and special infections were worked out considering the local characteristics. Therefore, we developed an online tool for evaluation and documentation of the orders of antiinfective substances before application.

**Results:** After the use of antiinfectives had another rise comparing 2015 to 2016 from 351,7 RDD per 100 cases to 386,0 we came to the decision to get more control of the use of antibiotics. Moreover, the cases of clostridium difficile infections had a rise of almost 29% comparing 2015 to 2016. Therefore, the antibiotic stewardship team was founded, consisting of three antibiotic stewardship experts, one out of each department, the hospital hygienist and a clinical pharmacist.

**Conclusions:** It's an urgent necessity to decrease the usage of antiinfectives to avoid further multiple resistance and unwanted side effects like clostridium difficile associated diarrhea. Therefore, we founded an antibiotic stewardship team and developed an online tool, which rises attention evaluating the definitive need for antibiotic therapy and documents antibiotic therapy for intermittent analysis.

P-520

Impediments for influenza and pneumococcal vaccination in geriatric oncology

D. Matelot, A. Martin, B. de Wazieres, A. Di Castri, L. Geronimi, C. Labarias, C. Le Guillou, F. Santoni, G. Solinas, V. Antoine. CHU Nîmes, France

**Background:** Influenza and invasive pneumatic diseases are more frequent and deadly in immuno-compromised older cancer patients. Vaccinations are recommended, however the majority do not receive the vaccine. The objective of this study was to assess characteristics of elderly patients with cancer preventing them from accessing and accepting influenza and pneumococcal vaccination.

**Methods:** More than 100 consenting patients over 75 years'old with progressive cancer (solid tumors or hemopathy, treated or not) were included in a French university hospital. Description of socio-demographics (age, sex, lifestyle), cancer (type of cancer, date of diagnosis, metastatic or not, curative treatment or not), comorbidities and geriatric characteristics (cognitive function, depression, nutrition, walking perimeter, autonomy for activities of daily living ADL/IADL), vaccination status against influenza and pneumococcal, opinion of the patient's general practitioner and oncologist regarding vaccination.

**Results:** We present socio-demographical and medical characteristics of patients associated with the absence of vaccination and discuss measures to enhance influenza and pneumococcal vaccination.

**Conclusion:** Accessing and/or accepting influenza and pneumococcal vaccination is still a challenge for elderly patients with cancer.

P-521

Improving factors of PPSV23 vaccine coverage rates in adults aged 65 years in Japanese municipalities – nationwide community-based survey

S. Kanazu¹, Y. Nishiwaki², M. Oba³, A. Watanabe⁴, Y. Murakami³.

¹Vaccines, Medical Affairs, MSD K.K., Tokyo, Japan; ²Department of Environmental and Occupational Health, Toho University, Tokyo, Japan; ³Department of Medical Statistics, Toho University, Tokyo, Japan; ⁴Research Division for Development of Anti-Infective Agents, Institute of Development, Aging and Cancer Tohoku University, Miyagi, Japan

**Introduction:** In the 23-valent pneumococcal polysaccharide vaccine (PPSV23) program for elderly in Japan, various measures including notification of program eligibility through newsletters, broadcasting and financial support to reduce out-of-pocket costs, are taken by municipalities to raise PPSV23 coverage rates. We investigated whether both notification methods and financial support raise the PPSV23 coverage rates in Japan.
**Methods:** A postal and web-based nationwide survey was sent in June 2016 to all municipalities of Japan (n=1741). We used a self-administered questionnaire to collect the PPSV23 coverage rates in adults 65 years. Details on notification method and out-of-pocket costs for vaccination were also collected by the questionnaire. Additional municipality-level variables were collected from the national statistics in Japan, including demographic, socioeconomic and health system indicators. Multiple regression was used to explore the effect of the notification methods and out-of-pocket costs on PPSV23 coverage rates adjusting for municipality-level factors.

**Results:** 1022 responded to the survey (response rate 58.7%). Median PPSV23 coverage rate among municipalities was 41.3% (IQR; 32.2–48.5%). In multiple regression, PPSV23 coverage increased with the number of notifications sent to an eligible individual (p<0.001, adjusted means; none; 23.7%, once; 42.8%, twice; 49.2%, three times and more; 47.4%). PPSV23 coverage decreased by 3.0% (2.3–3.7%) per 1000 Yen increase in out-of-pocket costs (p<0.001). The type of notification was not significantly associated with PPSV23 coverage (P=0.60).

**Conclusions:** The number of notifications, as well as out-of-pocket costs, were associated with PPSV23 uptake in Japanese municipalities.

## P-522
Influenza vaccination in 65 and over age adults in a Turkish county, Soke

H. Elbi¹, B. Deger². ¹Celal Bayar University, School of Medicine; ²Soke Municipality, Health Affairs Directorate, Turkey

**Introduction:** Seasonal influenza viruses, which are beginning to appear from autumn, are more lethal in less than 6 months and over 65 years. As a result of changes in the structure of influenza virus, different strains are emerging each year. The most effective method of prevention is influenza vaccination every fall. The aim of this study is to determine the frequency of influenza vaccination and to investigate the sociodemographic factors related to influenza vaccination in those who live in the Söke District of Söke Municipality Health Services Department over 65 years of age.

**Methods:** The study was carried out among people over 65 years of age who served by Söke Municipality Health Affairs Directorate. As a data source, a questionnaire consisting of 13 questions developed in the research team was used.

**Results:** A total of 641 persons (385 women, 256 men, average age 74.13±6.7 years) were reached. 88.9% of the patients with any chronic illnesses were detected. 22.3% of the participants stated that they had regular seasonal influenza vaccination every year and 8.9% had irregular seasonal influenza vaccination. When asked about who recommended seasonal influenza vaccination, 44.0% was recommended by the family physician and 45.0% was achieved by the non-physician. Among the vaccine recipients, the rate of influenza vaccination was 11.0% with the recommendation of physicians outside of the family physician.

**Conclusions:** Influenza is seen as a health threat for the elderly as it can lead to serious complications. Particularly fragile elderly are among the high risk groups because of influenza complications, which may lead to bacterial pneumonia and exacerbation of chronic illnesses. In the study conducted by Polat et al. In Antalya in 2006, the percentage of influenza vaccination in the population over 65 years of age was determined as 15.0%. The transition to the family medicine system from 2011 onwards in our country may explain the fact that the percentage of those who have influenza vaccine in our country (22.3%) is slightly higher.

## P-523
National prevalence study of healthcare associated infections and antibiotic use in nursing homes (France 2016)

A. Machut¹, Y. Lestrat², G. Gavazzi³, A. Berger-Carbonne². ¹CClin Sud-Est; ²Santé Publique France, Paris, France; ³University Hospital, Grenoble, France

**Introduction:** The first national point prevalence study (PPS) of Healthcare associated infections (HAI) and antibiotic use (AB) was conducted in French nursing homes (NH).

**Objectives:** Describe and measure prevalence of HAI and AB, raise awareness of HCW and prescribers, identify needs for intervention, training or additional resources.

**Methods:** PPS was proposed to a random sample of 719 NH selected among 7,387 French NH. Data were collected in May-June 2016, concerning NH organization and resources, HAI & AB use. We focused on urinary tract infection/UTI (including micro-organisms and resistance pattern), C. difficile infection/CDI, pneumonia/PNE, low respiratory tract infection/LRTI, influenza/FLU, skin & soft tissue infection/SSTI, wound & pressure sores infection/WPSI, scabies/SCA, catheter-related infection/CRI. Results were weighed according to sampling design.

**Results:** Data concerned 367 NH (51%) and 28,277 residents. Exposure to invasive procedures was low: 3.3% catheters (mostly subcutaneous), 1.7% urinary catheters and 0.9% surgery <30 days. Prevalence rates were 2.9% [CI 95%: 2.57–3.29] residents with HAI (med 2.5, range 0–21.1) and 2.8% [2.46–3.07] residents with AB (med 2.3, range 0–21.1). Among HAI, 36.9% were UTI, 24.0% IRB, 11.0% PNE, 20.4% SSTI, 5.6% WPSI, 1.3% CRI and 0.3% SCAB, 0.1% CDI. Only 68.8% of UTI were confirmed microbiologically: Enterobacteriaceae were predominant with 26.3% 3GC resistance and 13.3% EBSL. Concerning AB use, most frequent AB were 20.9% 3GC, 19.0% penic. A, 16.0% amoxicillin-clavulanate, 12.3% macrolides, and 11.4% fluoroquinolones. A high level of prophylaxis was observed (13.7%).

**Conclusion:** This PPS provides French NH with reference data and appears effective in monitoring local and national strategies for HAI prevention and AB use.

## P-524
Native aortic valve endocarditis due to Pseudomonas stutzeri in a ninety-one-year-old woman

R. Héquette-Ruz¹, A. Charpentier¹, I. Delabriere¹, C. Loiez², R. Le Guern², B. Guery³, F. Puisieux¹, J.-B. Beuscart ¹,⁴. ¹CHRU Lille, Geriatrics Department, F-59000 Lille, France; ²CHRU Lille, Institut de microbiologie, F-59000 Lille, France; ³Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland; ⁴Université de Lille, EA 2694 – Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France

**Introduction:** Pseudomonas stutzeri (P. stutzeri) is an aerobic, non-fermenting, Gram-negative bacteria. This environmental contaminant is usually isolated in soil and water; in human, P. stutzeri isolation is usually considered as contamination or colonization. Here we report the case of native valve endocarditis (NVE) due to P. stutzeri.

**Case description:** A ninety-one-year-old woman was admitted to our acute geriatric unit in August 2016 after she fell. Clinical examination findings were poor (no fever nor heart murmur or splenomegaly). Native aortic valve endocarditis was diagnosed according to European Society of Cardiology (ESC) 2015 modified diagnostic criteria with two major modified Duke's criteria: persistently positive blood cultures (five blood cultures positive for P. stutzeri) and trans-esophageal echocardiography positive for infective endocarditis (IE) with a 5 mm oscillating intra-cardiac mass on the posterior aortic cusp. FDG-PET did not contribute to find the source of infection nor extra-cardiac septic localizations. Clinical
cure was achieved after 6 weeks of intravenous administration of antibiotic combinations, with no need for surgical treatment.

**Conclusions:** To our knowledge, this is the first case of community-acquired native valve endocarditis due to P. stutzeri. Elderly patients are more likely to experience infections due to non-virulent pathogens. Malnutrition and immunosenescence may contribute to uncommon infections' susceptibility. This case emphasizes the need for clinical recommendations for diagnosis and treatment of non-HACEK Gram-negative endocarditis.

## P-525

### Perihepatitis associated with peritoneal tuberculosis mimicking male Fitz-Hugh-Curtis syndrome; a case report

S. Lee¹, H.P. Hong², S.H. Kwak³, D. Kim³, E. Kim³, J. Cho³, H.S. Choi³. ¹Department of Neuropsychiatry, Rogen Hospital, Dongducheon, Korea; ²Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea; ³Department of Emergency Medicine, Kyung Hee University Hospital

Perihepatitis is defined as inflammation of the peritoneal capsule of the liver. Fitz-Hugh-Curtis syndrome has been described as focal perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhoeae and Chlamydia trachomatis. The highest incidence occurs in young, sexually active females. There are few reports in the literature of Fitz-Hugh-Curtis syndrome associated with pelvic infection by Mycobacterium tuberculosis in female patients. But none were reported with male patients. We experienced a case of perihepatitis in a 72-year-old male patient, associated with peritoneal tuberculosis, mimicking male Fitz-Hugh-Curtis syndrome in ED, and we report a case with a review of the literature.

## P-526

### Pharmacokinetics of ertapenem administrated by subcutaneous or intravenous route in patients aged over 75. PHACINERTA, preliminary results

C. Roubaud-Baudron⁴, R. Legeron⁴, J. Ollivier¹, F. Bonnet², C. Greib², C. Cazanave³, D. Kobeh⁴, V. Cressot⁴, N. Monéger⁴, M.-N. Videau⁴, E. Thiel⁴, A. Lafargue⁴, A. de Thézy⁴, I. Bourdel-Marchasson⁴, J. Durrieu⁴, G. Pinganaud⁴, D. Breilh⁵.

¹PK/PD Group INSERM 1034, Pharmacokinetics and Pharmacodynamic, Bordeaux University, Bordeaux, France; ²Internal Medicine Dept, Bordeaux University Hospital, Bordeaux, France;

³Infectious Disease Dept, University Hospital, Bordeaux, France;

⁴Geriatrics Dept, Bordeaux University Hospital, Bordeaux, France;

⁵PK/PD Group INSERM 1034, Pharmacokinetic and Pharmacodynamic, Bordeaux University, Bordeaux, France

**Background:** Antibiotic administration through subcutaneous (SC) injection is common practice in France, especially in Geriatrics as an alternative to IV route in case of poor venous access or delirium. Ertapenem is a long-acting parenteral carbapenem indicated especially in the treatment of extended spectrum β-lactamase (ESBL) producing enterobacteria infection. Sparse PKPD data are available for such a practice.

**Methods:** Patients >75yo receiving ertapenem (1g once daily) for at least 48h (IV or SC, steady state) were prospectively included after informed consent was obtained. Ertapenem concentrations (H0, H+0.5h and H+2.5h) were determined by Liquid chromatography-mass spectrometry and analysed regarding the administration route. Using our data, AUC (area under the curve) between 0 and 24 hours (AUC0-24) was estimated using the trapezoid method. Computations were performed with the Monolix® software. Tolerance and efficacy were monitored as well.

**Results:** 10 (mean 87±7.0 yo) and 11 patients (mean 88±5.0 yo) were included in IV and SC group respectively. All patients completed the 3 blood collections. Mean ertapenem residual observed

concentrations were not different between IV (mean 11±8 ug/mL) and SC (11±7 ug/mL). At the end of the infusion, observed Peak concentration was 6-fold higher in the IV (186±98ug/mL) group compared to SC group (29±22 ug/mL) and 2 fold higher 2 hours after the end of the infusion (101±34 versus 58±36 ug/mL). Individual predicted AUC0-24h were not significantly different between IV and SC groups (986±302 versus 887±212 ug/ml*h, p=0.27). More results regarding safety and efficacy are on progress.

**Conclusions:** The preliminary results of this original pharmacokinetics study on ertapenem support the hypothesis that SC administration could be an effective alternative to IV route. Confirmation of these results could avoid or shorten hospitalisation of this population.

## P-527

### Predicting the 28-day mortality rate in elderly patients with community-acquired pneumonia: Evaluation of 11 risk prediction scores

H. Elbi, A. Bilge, H.I. Dayangac, O. Dikmen. Celal Bayar University, School of Medicine

**Introduction:** Community-acquired pneumonia (CAP) is the most frequent cause of infectious disease-related morbidity, and mortality among all patients. Elderly patients are at a higher risk of developing severe CAP because of many underlying disease, changes in the health status. In this study, we evaluated the performance of existing risk scores for predicting the 28-day mortality rate in patients presenting with community-acquiring pneumonia (CAP) in an emergency department.

**Methods:** We conducted a cross-sectional study at the Celal Bayar University Hospital in Manisa, Turkey. The records of consecutive elderly patients with CAP were reviewed for this retrospective study. All patients were followed-up to assess their outcome within 28 days of the admission. The discriminative performance of the 11 risk prediction scores for patients with CAP was assessed using the area under the receiver operating characteristic curve (AUC).

**Results:** A total of 151 elderly patients [mean age, 76.6±7.8 years (range, 65–94 years); 65.6% men] with CAP were evaluated. There were 30 deaths by 28-day, an allcause mortality rate of 19.9%. All scores except the CAP-PIRO achieved an AUC greater than 0.700, demonstrating fair discriminative power. All scores were evaluated by the Z-test to see if there were significant difference between them.

**Conclusion:** Four of the existing scores had good discriminatory power (AUC >0.800) to predict the 28-day mortality rate. The best discrimination was demonstrated by CURB-age, a score designed for the elderly patients with CAP. Only one score was under the level that is considered to indicate fair discriminative power (AUC <0.700). Additional research is needed to determine the best risk score for predicting early mortality rates of elderly patients following CAP.

## P-528

### Prediction of inhospital mortality in elderly patients with Chikungunya virus infection in Martinique (French West-Indies)

L. Godaert¹, S. Bartholet¹, F. Dorléans², F. Najiullah¹, M. Dramé³, J.-L. Fanon¹. ¹University Hospital of Martinique, Martinique, France; ²Agence régionale de santé, Martinique, France; ³University of Reims, Champagne-Ardennes, France

**Introduction:** Chikungunya virus (CHIKV) infection spreads following an endemic-epidemic pattern with high prevalence [1–3]. Excess mortality has been reported during outbreak [4–6]. We aimed to predict inhospital mortality in 65+ population hospitalised with CHIKV Infection.

**Methods:** The study was performed in the University Hospital of
Martinique from retrospective cases. Eligible patients were aged ≥65 years, admitted to any clinical ward from January to December 2014, and underwent RT-PCR testing for CHIKV infection. A predictive score was created using adjusted odds ratio of factors associated with inhospital mortality. ROC curve was used to determine the best cut-off. Bootstrap analysis was used to evaluate its internal validity.

**Results:** In all, 385 patients aged ≥65 were included (average age: 80±8 years). Half of them were female and 35 (9.1%) had died during the hospital stay. Seven variables were found to be independently associated with inhospital mortality (cardiovascular disorders: 12 points; concurrent respiratory infection: 10 points; concurrent sensorimotor deficit: 8 points; absence of musculoskeletal pain: 3 points; history of alcoholism: 3 points; concurrent digestive symptoms: 2 points; presence of confusion or delirium: 2 points). The area under the curve was excellent (0.90; 95% CI: 0.86–0.94). The best cut-off was score ≥8 points; sensitivity was 91% (82%-100%) and specificity was 75% (70%-80%).

**Conclusions:** Score based on easy-to-access clinical features has good discrimination and calibration properties in the elderly. It will be very helpful to help for early care management of elderly subject in the context of CHIK outbreaks.

### References:

[1] Sissoko D, Moendandze A, Malvy D, et al. Seroprevalence and risk factors of chikungunya virus infection in Mayotte, Indian Ocean, 2005–2006: a population-based survey. PLoS One 2008; 3:e3066.

[2] Staples JE, Breiman RF, Powers AM. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis 2009; 49:942–8.

[3] Petersen LR, Powers AM. Chikungunya: epidemiology. F1000Res 2016; 5.

[4] Mavalankar D, Shastri P, Bandyopadhyay T, Parmar J, Ramani KV. Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India. Emerg Infect Dis 2008; 14:412–5.

[5] Cardona-Ospina JA, Henao-SanMartin V, Paniz-Mondolfi AE, Rodriguez-Morales AJ. Mortality and fatality due to Chikungunya virus infection in Colombia. J Clin Virol 2015; 70:14–5.

[6] Labeaud AD, Bashir F, King CH. Measuring the burden of arboviral diseases: the spectrum of morbidity and mortality from four prevalent infections. Popul Health Metr 2011; 9:1.

## P-529

### Prevention of nosocomial influenza in a French geriatric unit during influenza season 2016/2017

D. Nizigiyimana¹, D. Gantz², C. Masson², J. Lupo³, S. Levet², M.-R. Mallaret⁴, G. Gavazzi⁵, C. Landelle⁴. ¹University clinic of Geriatric Medicine, CHU Grenoble Alpes, Grenoble, France; ²Infection control unit, CHU Grenoble Alpes, Grenoble, France; ³Virology Laboratory, CHU Grenoble Alpes, Grenoble, France; ⁴Infection control unit, CHU Grenoble Alpes and University Grenoble Alpes/CNRS, ThEMAS TIM-C UMR 5525, Grenoble, France; ⁵University clinic of Geriatric Medicine, CHU Grenoble Alpes and University Grenoble Alpes/GREPI, EA 7408, Grenoble, France

**Introduction:** Influenza presents a life-threatening infection for geriatric patients, who might be nosocomially infected via healthcare workers (HCWs), patients or visitors. Our objective was to evaluate a multimodal strategy to prevent nosocomial influenza.

**Methods:** A multimodal strategy was implemented in a 32 bed Geriatric unit: HCWs' education on Influenza disease, promotion of Influenza vaccination (HCWs), rapid identification of influenza cases by PCR, isolation of influenza cases, curative and preventive use of oseltamivir, systematic use of mask for all HCWs and visitors (evaluated 2 times per week), and prospective survey of all influenza cases. All hospitalized patients were included. Nosocomial

influenza was defined by a time interval between admission and symptoms' onset >72 hours.

**Results:** Among 174 patients hospitalized (01.12.16 to 19.02.17) 98 (56%) patients have presented respiratory symptoms and were tested for Influenza; 26 (27%) patients were positive for Influenza A: 5 (19%) were nosocomial. Among 26 influenza cases, 16 patients were vaccinated and 4 were not vaccinated (vaccination status unknown for 6). Among 5 nosocomial influenza cases, 1 patient was vaccinated and 2 were not vaccinated (vaccination status unknown for 2). HCWs' influenza vaccination rate was 53% (26/49). Compliance with systematic use of mask was 83% (168/203) for HCWs and 75% (41/55) for visitors.

**Conclusions:** Despite the implementation of a multimodal strategy, nosocomial influenza cases occurred. Level of compliance for systematic use of mask was high for HCWs and should be encouraged for visitors. Influenza vaccination for HCWs and patients should be strengthened to prevent nosocomial influenza.

## P-530

### Prospective review of the quality of antibiotic prescriptions in an acute geriatric ward

C. Cuvelier¹, K. Diallo², C. Perret-Guillaume², A. Benetos², C. Pulcini². ¹HUG, Geneve, Suisse; ²Université de Lorraine, Nancy, France

**Objective:** We wanted to assess the compliance of antibiotic prescriptions to guidelines.

**Methods:** We conducted a prospective clinic study during 98 days. All the antibiotic prescriptions were analyzed after clinical and medical records examination, at the first day initiation (D1) and at 48h-72h (D3) and compared to reference. They were classified as unnecessary, not conform and conform prescriptions.

**Results:** 149 prescriptions were analyzed (61 to D1, 88 to D3). They were classified as unnecessary in 13% of cases to D1 and D3, and not conform in 49% and 39% of cases to D1 and D3 respectively. The wrong choice of the molecule, the extended duration and intravenous administration were the main causes of not conform prescriptions. We can not identified a non-compliance risk factor. The third generation cephalosporin was the major class of antibiotics prescribed.

**Conclusion:** Only the fragility and comorbidities can not justify the frequency of non-compliance in antibiotics prescriptions. Reduce probabilistic prescriptions and the duration of antibiotics can limit overuse of antibiotics. Take into account microorganisms identifications need to be improved. A second study to measure the efficacy of help to antibiotic prescriptions is necessary.

## P-531

### Psoas abscess due to Mycobacterium tuberculosis in a patient with total hip arthroplasty

M. Oviedo Briones¹, A. Rico¹, M. Grados², M. Quiles¹, R. Fernández¹, P. Condorhuamán Alvarado ¹. ¹Hospital Universitario La Paz, Madrid, Spain; ²Hospital Universitario de Getafe, Madrid, Spain

A 70 year-old female had a left hip arthroplasty eight years ago. She had a one-year history of fluctuating pain in her left hip treated with analgesics with partial relief of symptoms. She came to the hospital with complaints of five days of fever, pain and swelling of left hip and posterior aspect of the thigh. C-reactive protein was 75.5mg/L. A computed tomography (CT) showed an iliopsoas abscess (6.5×7×7.5cm). Needle aspiration was performed obtaining 120 ml of abscess fluid. Cultures were negative, and broad-spectrum antibiotics were started. After five days, there was persistent yellowish drainage through the wound opening. A surgical inspection revealed a pseudocyst with dense material near the prosthesis. It was completely aspirated. The prosthesis was not removed.
Drainage for the wound was sent for PCR amplification (Gene-Xpert MTB/RIF assay) for Mycobacterium tuberculosis (MTB), which was positive. Adenosine deaminase was 80UI/L. A week after beginning the tuberculostatic drugs, the drainage stopped. A new CT showed a remarkable decrease in the size of the collection. Psoas abscess is a collection of pus in the iliopsoas muscle compartment. It may be clinically difficult to diagnose because of its rarity, insidious onset, and non-specific clinical presentation. In this case her hip prosthesis might had been colonized by MTB protected inside the biofilm. In a Spanish review of 30 cases of psoas abscess, 17% were tuberculosis and 83% were pyogenic. MTB should be considered in where tuberculosis is common.

P-532

Pulmonary manifestations and death due to aspiration in patients diagnosed with ischemic and non-ischemic stroke

P. Terpstra¹, L. Terpstra², L. Oswald², W.G. Boersma². ¹Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands; ²Department of Pulmonary Diseases, Medical Centre Alkmaar, Alkmaar, The Netherlands

**Objectives:** To evaluate pulmonary manifestations and death due to aspiration in patients submitted for ischemic and non-ischemic stroke.

**Design:** Retrospective study.

**Setting:** Hospital care setting in the Netherlands, NWZ Alkmaar.

**Participants:** A retrospective medical records review was conducted for patients submitted at the neurological ward with a diagnosis of ischemic or non-ischemic stroke for the year 2009. Data collection included: demographics, comorbidity, mortality, cause of death, infection parameters and medication. Additionally we scored for the presence for known risk factors for pulmonary aspiration syndrome (PAS). Primary and secondary outcome measures The primary outcome is death due to PAS, secondary we investigated the known risk factors for aspiration among other pulmonary symptoms. Univariate and multivariate logistic analysis was performed.

**Results:** 303 patients were identified with ischemic and non-ischemic CVA in 2009; 155 (51%) subjects were female. In the entire group age ranged from 31–96 years, with a mean of 71 years. The majority of this group, 245 subjects (80%) were diagnoses as ischemic stroke. 25 out of 300 patients developed PAS. The diagnosis of PAS required the presence of a consolidation at chest X ray, increased CRP and fever >38.5 °Celsius in presence of one or more of the following: naso gastric tube feeding (p<0,001), impaired swallowing (p<0,001), documented vomiting (p=0,299), witnessed aspiration (p<0,001), lowered EMV ≤8 (p<0,001). All of these risk factors showed significance except for vomiting. Almost one third; 8 out of 25 patients (31%) who developed PAS died. Age >70 was non significant (p=0,054) for patient with PAS for a fatal outcome.

**Conclusions:** If PAS developed there was a high risk of mortality, almost one third of these patients died. Age >70 was close to be of significance. Of the previously described risk factors only witnessed vomited was non-significant. We re-established the value of the known risk factors. Awareness might assist the identification of high-risk patients for fatale outcome.

P-533

Screening for Chikungunya virus infection in the elderly: Development and internal validation of a new score

L. Godaert¹, S. Bartholet¹, F. Najioullah¹, J.-L. Fanon¹, M. Dramé².

¹University Hospital of Martinique, Martinique, France; ²University of Reims, Champagne-Ardennes, France

**Introduction:** This study aimed to derive and validate a score

for Chikungunya virus infection (CHIKV) screening in old people admitted to acute care units.

**Methods:** It was performed in the Martinique University Hospitals from retrospective cases. Patients were 65+, admitted to acute care units, for suspected Chikungunya virus infection (CVI) in 2014, with biological testing using Reverse Transcription Polymerase Chain Reaction (RT-PCR). RT-PCR was used as the gold standard. A screening score was created using adjusted odds ratio of factors associated with positive RT-PCR derived. A ROC curve was used to determine the best cut-off of this score. Bootstrap analysis was used to evaluate its internal validity.

**Results:** In all, 687 patients were included, 68% with confirmed CVI. Patients' mean age was 80±8, and 51% were women. Four variables were found to be independently associated with positive RT-PCR (fever: 3 points; arthralgia of the ankle: 2 points; lymphopenia: 6 points; absence of neutrophil leucocytosis: 10 points). The best cut-off was score ≥12; sensitivity was 87% (83%-90%) and specificity was 70% (63%-76%). The uncorrected C-statistic was the same as the bootstrapped C-statistic, namely 0.86 (95% CI: 0.83-0.89).

**Conclusions:** This score has good performances and good internal validation and could be helpful to screen elderly people with CHIKV, specially during outbreak in low- and middle-income countries.

P-534

Seasonal influenza and vaccination: Survey of Health Care Workers in a gerontologic department

S. Hesse, A. Morisot, S. Louchart de la Chapelle, A. Pesce. *Rainier III Gerontologic Center, Princess Grace Hospital, Monaco*

**Introduction:** Influenza is an acute viral infection that spreads easily from person to person, causing serious complications in certain risk groups. Despite WHO and European recommendations for Health Care Workers (HCW) to get vaccinated against seasonal influenza, low coverage is observed. In our department, influenza vaccine is around 25% in HCW (versus 80% in patients). Lack of comprehensive data on influenza vaccine among HCW presents a challenge for understanding low coverage, and to improve prevention. That is why we investigated the HCW perception and knowledge of influenza and vaccines.

**Methods:** Anonymous, self-administered questionnaires, distributed in Gerontologic Department, in autumns 2015 and 2016. Questions are about influenza knowledge, vaccines perception, reasons for getting vaccinated or not, influence of previous information campaign. Data are compiled and analyzed by the clinical research unit.

**Results:** Participation rate around 36%. Three socio-professional categories under represented (maybe less concerned by the subject). Link between non-vaccination and age. In prevention, among people who do not get vaccinated, 15% use homeopathic vaccine, 48% use vitamins, phytotherapy or special diet, 37% nothing. 70% underestimate influenza severity.

**Conclusion:** We observe a lack of confidence not only in influenza vaccination, but in vaccination in general (14% of respondents). These results help to adapt prevention campaign in information, arguments to improve, and people to be reached, even beyond HCW (as animation team, food service staff, administrative staff), and the way to diffuse the campaign (physicians seem more likely to recommend influenza vaccination to HCW they are working with). Moreover, they provide a baseline to measure future improvements in seasonal influenza vaccine uptake.
P-535

**The impact of dosing schedules on vaccination acceptability in older people in the UK**

I. Matthews¹, H. Dawson¹, I. Wood², L. Olding². ¹Merck Sharp & Dohme Ltd; ²Bryter Research

**Background:** Research with UK health care professionals indicated multiple-dose vaccines are less acceptable to older patients and could lead to reduced vaccine uptake compared with single-dose vaccines [Value in Health (2016), 19, A42]. Access to a medical appointment and population preferences were cited as likely issues. This survey aimed to explore these concerns with older people.

**Methodology:** One thousand individuals aged 65–89, randomly selected to be representative for age, gender, socio-economic grade and regionally across the UK were interviewed by telephone in October 2016.

**Results:** Difficulties affecting the ability of respondents to attend primary care were explored, with the most common reason given as 'Unable to get an appointment' (62%). Eighty per cent of respondents had received a vaccination within the last 2 years. When asked, 84% preferred vaccination courses to be completed in one dose over multiple doses and 79% preferred to have multiple different vaccinations in one visit, rather than individual appointments for each vaccine type. Only 37% of respondents agreed they would return for a subsequent dose of a vaccine if they had tolerability issues with the first dose.

**Conclusions:** Accessing primary care can be a challenge for older people and it is unsurprising that they express a clear preference for single-dose vaccines. This research suggests that the effectiveness of a multi-dose vaccination programme could be impacted if the first dose is associated with tolerability issues or difficulty getting a follow-up appointment for subsequent dose(s) with the result that people do not return to complete the course.

P-536

**The value of C-reactive protein in infection diagnosis and prognosis in elderly patients**

O. Karasahin¹, P.T. Tasar², O. Timur³, F. Yıldırım³, D.N. Binici³, S. Şahin⁴. ¹Regional Training and Research Hospital, Infectious Diseases Clinic, Erzurum, Turkey; ²Regional Training and Research Hospital, Geriatrics Clinic, Erzurum, Turkey; ³Regional Training and Research Hospital, Internal Medicine Clinic, Erzurum, Turkey; ⁴Ege University School of Medicine, Department of Internal Medicine, Department of Geriatrics, Izmir, Turkey

**Introduction:** Diagnosing infection in the elderly is difficult, but early diagnosis and treatment is critical due to the high incidence of morbidity and mortality in these patients. The aim of this study was to determine the value of C-reactive protein (CRP) level in the diagnosis and prognosis of infection in elderly patients.

**Study population:** This prospective study included inpatients in the palliative care unit during the 1-year period between January 2016 and January 2017. Patients' demographic data, comorbid diseases, clinical and laboratory findings, Acute Physiology and Chronic Health Evaluation (APACHE II) score, and Charlson Comorbidity Index were recorded. Blood and urine samples were collected from all patients at admission for culturing, as well as sputum samples from patients with respiratory symptoms. Cultures were repeated after 48 hours to determine microbiologic response according to the focus of infection.

**Results:** A total of 233 patients (50.6% females) with a mean age of 77.6±11.0 years were included in the study. A total of 199 instances of infection were diagnosed in 175 (75.1%) of those patients; 75.3% of the infections were detected at admission and 24.7% during hospitalization. At a cut-off value of 4.82, CRP value had 81.0% specificity and 75.4% sensitivity in the diagnosis of in-

fection. Among the patients with infection, there was no difference between those who died and those who survived in terms of baseline CRP level, but a significant difference emerged in CRP level at 48 and 96 hours. Factors which were found to significantly reduce survival time were the presence of chronic kidney disease, chronic obstructive pulmonary disease, hypoxia and tachycardia at admission, APACHE-II score over 20.5, initial albumin level below 2.44 g/dL, and serum CRP clearance rates of less than 11% at 48 hours and 20% at 96 hours.

**Conclusion:** In elderly patients with infection, initial CRP value alone does not have prognostic value, but changes observed in serial CRP measurement are a valid indicator of prognosis.

**Area: Longevity and prevention**

P-537

**A gender perspective on factors affecting quality of life when being a caregiver in old age; Findings from the Swedish National Study on Aging and Care (SNAC) study**

C. Fagerström¹, L. Sandin Wanker². ¹Blekinge Center of Competence, Sweden; Dept. of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden; ²Dept. of Health Sciences, Div. of Geriatric Medicine, Lund University, Sweden

**Introduction:** Elderly persons (60+) are an increasing part of the population. With higher age follows that more people often need care. All the care cannot be met by the public health services, why informal caregiving becomes more and more important, and the glaze often lands on the relatives. In this perspective the careers' individual health problems such as pain and how it affects the quality of life (QoL) when being a career, need to be addressed and highlighted. In this study, relationships between pain, QoL and taking care of a relative are investigated gender wise.

**Methods:** The SNAC random sample (n=3444) comprised individuals, from the southern part of Sweden (SNAC-Blekinge and GÅS-Skåne), aged 60–96 years, of which 54.0% were women. Pain and QoL (SF-12) were analyzed using descriptive statistics.

**Results:** In total 395 (11.5%) reported themselves as caregivers and of them 53.7% were women. The male caregivers were more often married, lived together with someone and reported better financial situation compared to the female caregivers. More than half of the caregivers reported pain. Even if the female caregivers were younger than the male (68.50 years, SD 8.57, 70.41 years, SD 9.68, p=0.039) they reported pain in higher intense than the male caregivers, mostly in the back and legs. They also scored lower mental QoL (53.20, SD 9.22) than the men (54.33, SD 9.08), p<0.003.

**Conclusions:** Although the women reported higher pain intense, the association between pain intense and QoL was higher in men (OR 1.32 vs OR1.17).

P-538

**A systematic review of the prevalence of oropharyngeal dysphagia in the nursing home population**

D. McCartan, R. Briggs, D. O'Neill. *Tallaght Hospital, Dublin*

**Introduction:** Oropharyngeal dysphagia (OPD) is an important cause of morbidity and mortality in the nursing home (NH) population. We reviewed the literature systematically to determine an estimate of prevalence of OPD in nursing home populations and to catalogue the methodology employed in identifying its presence.

**Methods:** We undertook a systematic review identifying original research papers that estimated a prevalence of OPD amongst a general NH population. The databases searched were Pubmed and Embase with keywords "dysphagia", "deglutition" and "nursing
home". The inclusion criteria comprised any paper identifying the prevalence of OPD (by any method) in older NH residents. In addition, we tabulated the methods, where described, of screening for OPD, and clarified how many reported engagement of Speech and Language Therapists (SLT) in assessment and/or management.

**Results:** We screened 2562 papers. 33 papers, published between 1996 and 2016, were included in the study with estimates of the prevalence of OPD in the NH population ranging from 12% to 88%. OPD estimates varied with the investigative methodology used with qualitative questionnaires revealing lower estimates to those obtained from objective measures. Referral to SLT was reported in just two papers.

**Conclusions:** The wide range of prevalence estimates found in this systematic review reflects the lack of standardisation in defining, investigating and managing OPD internationally. There is a need for larger local and international studies of the prevalence of OPD in NH residents with the aim of creating a systematic approach to OPD screening and management in this vulnerable population.

P-539

**Ageing cities: Planning with the future in mind**

A. Jakupaj, L. Stock. *Watford General Hospital*

By 2050, 89% of the UK's population will live in cities and 24% will be aged over 65 [1-3] There is also increasing recognition that cities should aim to meet the needs of an ageing population. The concept of an "age-friendly city" was developed by the World Health Organisation (WHO). The WHO identifies eight domains of age-friendly cities that enable older people to participate in all aspects of life, including social, economic, cultural and civic affairs [4-7]. 210 cities in 26 countries were identified as part of the Global Network Initiative of age friendly cities [8], with the USA, Spain and France having the highest number. Twelve cities in the UK are also members. We have examined the many ways in which two of these cities have expanded, adapted and progressed to care for an ageing population. We have researched projects and institutions that have already been set up in the United Kingdom in London and compared this to the existing social infrastructure in the USA in Madison, Wisconsin. In conclusion, we found that both the physical and mental environment play a key role in making cities better places for older people. Research shows that accessibility and safety are important factors in making housing, outdoor spaces and transport more age-friendly. Lessons learnt here have a high potential to be applied throughout the world. This project and recurrent themes from feedback indicate there is still more to be done - by national and local government, service providers, employers, and individuals, to make our cities more age-friendly and supportive of both physical and mental wellbeing.

P-540

**Arterial hypertension prevalence and blood pressure levels in centenarians: Preliminary results of the Moscow Centenarian Study**

O. Tkacheva¹, Y. Kotovskaya², N. Runikhina¹, N. Sharashkina¹, V. Ostapenko¹, D. Kashtanova¹. ¹Pirogov Russian National Research Medical University - Russian CLinical and Research Center of Gerontology, Moscow, Russian Federation; ²RUDN University, Pirogov Russian National Research Medical University - Russian CLinical and Research Center of Gerontology, Moscow, Russian Federation

**Aim:** The number of centenarians is increasing but they are still underinvestigated population. The aim of the Moscow Centenarian Study (NCT02876809) was to perform complex evaluation of centenarians living in Moscow. Preliminary results on arterial hypertension prevalence and blood pressure levels are reported in this abstract.

**Methods:** The study included 82 subjects (10 men) aged from 97 to 105 years living at home. All centenarians were visited by a geriatrician at home for comprehensive geriatric assessment and cardiovascular measurements. Medical history including history of arterial hypertension and current antihypertensive treatment was collected during interview with centenarians, their relatives/ carers and using medical notes if available. Blood pressure (BP) was measured twice with 1 min interval after at least 7 minutes rest in supine position by BPLab device (Petr Telegin, Nizhniy Novgorod, Russia) using its office mode.

**Results:** Arterial hypertension was reported by 64 (78%) centenarians and 29 (45%) of hypertensive subjects used antihypertensive drugs. Average supine BP was 147±26/74+14 mm Hg. Minimal systolic BP was 105 mmHg, maximal 215 mmHg, for diastolic BP respective values were 30 and 110 mmHg. Systolic BP <120 mmHg was found in 19%, 120-139 mmHg - in 25%, 140-159 mmHg - in 29%, 160-179 mmHg - in 11%, >180 mmHg - in 16%. Diastolic BP <60 mmHg was observed in 21%, 60-69 - in 3%, 70-79 mmHg 37%, 80-89 mmHg - 25%, 90-99 mmHg in 10%, >100 mmHg in 5%. Predominant type of arterial hypertension is isolated systolic hypertension: 41% isolated elevation of SBP, 15% - systolo-diastolic hypertension.

**Conclusion:** The preliminary results of Moscow centenarian Study demonstrate wide ranges of systolic and diastolic BP in centenarians. BP impact on physical status and cognitive functions should be evaluated for better understanding of health status in centenarians

P-541

**Assessment of awareness of cancer screening of Turkish patients admitted to geriatric outpatient clinic**

H.D. Varan, O. Deniz, S. Kaya, M.C. Kızılarslanoğlu, B. Göker. Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine

**Introduction:** The aim of this study is to evaluate the awareness of cancer screening of Turkish geriatric patients.

**Material and methods:** Patients aged 65 years or older, admitted to the geriatric outpatient clinic, were included in this study. A questionnaire assessing awareness of cancer screening were applied to the patients consequently.

**Results:** A total of 111 patients were included in this study. Median age was 72 years (min-max: 65-87) and %56.8 of them were female. Of all patients, 64.9% had knowledge about cancer screening and 37.8% of the patients learned from television, 18.2% of them from doctors and 23.2% from their relatives or neighbors. The three most common cancers known to be screened were lung, breast, and bowel (38.2%, 34.5% and 22%, respectively). When asked to the patients "have you ever been screened for cancer?" 30% of the patients answered "Yes". However, the rate of applying at least one type of cancer screening tool in medical history was 51.4% of the patients. Three most commonly performed screening tools were mammography, pap-smear and fecal occult blood test (32.1%, 22.9% and 22%, respectively). While 90% of the patients thought that cancer screening was required and useful, 1.8% thought it was unnecessary and useless.

**Conclusion:** It was shown in this study that vast majority of the patients declared they had knowledge about cancer screening, but the rates of implementation of these preventive medicine applications were lower than expected. It is important to try to increase the implementation of preventive medicine in clinical practice.
## P-542
### Assessment of physical activity in patients with diabetes mellitus type 2

M. Daszkiewicz, K. Lindner, R. Bywalec, M. Sobieszczańska. Clinic of Geriatrics, Wroclaw Medical University, Poland

**Introduction:** It is known that a regular intensity physical activity has cardioprotective effects, by decreasing atherosclerosis risk factors, including blood glucose level and insulin resistance.

**Methods:** A study group consisted of 80 patients (52 women and 28 men; mean age: 63.6±10.1 years), with defined diabetes mellitus type 2 (DMt2) lasting up to 7 years (mean: 4.4±2.1 years). Examined diabetics were treated only with oral hypoglycemic drugs. Besides the antropometric measurements (BMI, body mass index; WHI, waist hip ratio), biochemical parameters (e.g., fasting glucose, HbA1c, lipids, hs-CRP), and clinical examinations (RR, echocardiography, exercise and Holter ECG, and SCORE chart), also the questionnaire about life style (diet, tobacco smoking, body mass changes) was proposed to be answered. The questionnaire concerned also a physical activity of the examined diabetics; its frequency, intensity and caloric expenditure per week were assessed.

**Results:** The average time devoted to physical activity (walking, bicycle riding, garden works) was ca. 2 hours/week (550 kcal), which does not fulfill current recommendations. Of 80 patients, 20 (25%) did not take up any physical activity. Comparative analysis showed that the "active" diabetics had significantly lower WHR, lower blood glucose and HbA1c, lower hs-CRP and triglicerydes, as well decreased blood pressure and lower SCORE results (10.0±8.1 vs 17.5±14.3), as compared with the "non-active" diabetics.

**Conclusions:** The physical activity level in the examined elderly diabetics was generally unsatisfactory, however even small doses of exercises proved to be beneficial in context of cardiovascular prevention.

## P-543
### Assessment of the common predictors and their correlation in subjective wellbeing among elderly in Bohol, Philippines

J.A. Tariga¹, J. Cempron-Cutamora², ¹Amana Healthcare Medical and Rehabilitation Hospital; ²Cebu Normal University

**Introduction:** This study aimed to determine the predictors that affect the subjective well-being among elderly. The researchers intended to evaluate whether selected individual variables (educational attainment, health status, employment status, and presence of stressors), family variables (marital status, family size, family income, quality of family relationship and family support), and neighborhood variables (social relationships, church attendance, access to amenities/transportation, safe environment and community participation) influence the achievement of subjective well-being among elderly in Bohol, Philippines.

**Methods:** The researchers utilized a descriptive correlational design to identify patterns of relationship that existed between the variables and to measure the strength of the relationship. The study was conducted in the municipality of Sagbayan, Bohol, Philippines. The researcher utilized a self-made questionnaire, the Perceived Stress Scale, Spiritual Well-being Scale and the Satisfaction with Life Scale (SWLS) to gather the needed information relevant to the variables under study. Multiple regression using the SPSS software was utilized in the treatment of the data gathered.

**Results:** It was found out that the mean level of subjective well-being among elderly falls under the average level of life satisfaction (4.23) which means that the elderly are generally satisfied with the different aspects of their lives but there are certain domains that they would very much like to improve.

**Conclusion:** Increased levels of subjective well-being among el-

derly are significantly influenced by age, health status, perceived stress, community participation, family income and neighborhood safety. Implications of these results are noted for the development of programs and initiatives to enhance subjective well-being among elderly.

## P-544
### Awareness of cancer screening and vaccination among Turkish geriatric patients

H.D. Varan, O. Deniz, S. Kaya, M.C. Kızılsarlanoğlu, B. Göker. Gazi University School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey

**Introduction:** Preventive medicine, including cancer screening and vaccination, is crucial for improving quality of life, as well as decreasing morbidity and mortality in geriatric patients. The aim of this study is to evaluate the awareness of cancer screening and vaccination among the geriatric patients.

**Material and methods:** Patients aged 65 years or older, admitted to the geriatric outpatient clinic, were included in this study. Demographic characteristics of the patients were recorded. Two questionnaires assessing awareness of cancer screening and vaccinations were consequently applied. SPSS 16 version was used for the statistical analysis.

**Results:** A total of 111 patients were included in this study. Median age was 72 years (min-max: 65-87) and 56.8% were women. Of all patients, 83.6% had information about adult vaccination, however, vaccination rate (at least one kind of vaccine) was 48.2%. Influenza was the most frequently known and applied vaccine (59% and 39.1%, respectively). Adult vaccination had never been recommended to 54.1% of the patients previously. Patients were asked if they considered vaccination useful or harmful for older adults. 79% answered "useful". Of all patients, 64.9% had information about cancer screening and 37.8% learned from television, 18.2% from doctors and 23.2% from their relatives or neighbors. The three most common cancers known to be screened were lung, breast, and bowel (38.2%, 34.5% and 22%, respectively). Patients were asked if they have ever been screened for cancer, 30% answered "Yes". However, the rate of applying at least one type of cancer screening tool was 51.4% in the medical history of the patients. Three most commonly performed screening tools were mammography, pap-smear and fecal occult blood test (32.1%, 22.9% and 22%, respectively). While 90% of the patients thought that cancer screening was required and useful, 1.8% thought it was unnecessary and useless.

**Conclusion:** Majority of the elderly patients declared that they had knowledge about adult vaccination and cancer screening. However, the rates of implementation of these preventive applications were lower than expected. Further studies are needed to identify the underlying factors playing role in low implementation rates despite high level of awareness.

## P-545
### Benefits of a personalized, ergocycle-based endurance training program in the community-living elderly

C. Schnell, X. Sirlin, A. Derajinski, Y. Groc, Y. Passadori. Groupe Hospitalier Régional Mulhouse Sud Alsace, Mulhouse France

**Introduction:** The Centre d'Evaluation et de Remise en Forme (CERF) offers a personalized endurance training program for aged people with physical deconditioning and living in the Mulhouse area. The substance of the 18 training sessions is established after a medical examination and a VO2 Max measurement. Ergocycle-based endurance training aims at preserving a good health status preventing the development of frailty and promoting the pursuit of any regular physical activity. The program is achieved in a hospital environment, enabling a continuous monitoring.
**Methods:** This retrospective study based on 2016 data analyses the variations of hemodynamic and metabolic parameters during the program. The comparison covers the first and last sessions, whose implementation conditions (developed power and duration) are identical.

**Results:** 409 people entered the program. An intermediate sampling, based on 82 patients, with an average age of 67.9 [66; 69,71] years, shows a significant 22% improvement of the endurance, determined by the ventilatory threshold (VT1) (t=18.509; df=81; p<0.0001). Furthermore, a mean reduction in heart rate of 5 beats per minute is observed for a similar effort. However, the forced vital capacity (FVC) isn't significantly modified. Final outcomes and analysis of every metabolic, hemodynamic and spirometric data will be detailed in the final publication.

**Conclusion:** Entering a managed and personalized training program provides, with only 18 sessions, a significant improvement of endurance. The complete data analysis will allow us to assess the impact of the medical and sports history on the people's potential for improvement

## P-546

### Blood pressure and 5-years survival of the very elderly treated hypertensive patients

Y. Kotovskaya¹, N. Vororbjova², O. Tkacheva². ¹RUDN University, Pirogov Russian National Research Medical University - Russian Clinical and Research Center of Gerontology, Moscow, Russian Federation; ²Pirogov Russian National Research Medical University - Russian Clinical and Research Center of Gerontology, Moscow, Russian Federation

The aim of the study was to evaluate impact of on-treatment blood pressure (BP) level on 5-year total mortality in the very elderly subjects living in the community.

**Methods:** One hundred and sixty-three patients (42 men) aged 75-98 years (mean age 87,5±3,5 years, 28% were 90 years and older, 94% received antihypertensive treatment) were followed-up. Baseline systolic BP (SBP) was 137±16 mmHg, diastolic BP (DBP) was 77±10 mmHg, pulse pressure (PP) was 60±13 mmHg. Kaplan-Meier analysis and Log Rank (Mantel-Cox) test were applied to evaluate 5-years survival of patients.

**Results:** Baseline SBP varied from 100 to 200 mmHg (median (Me) 140 mmHg, interquartile range (IQR) 130-140 mmHg), DBP was from 50 to 100 mmHg (Me 80 mmHg, IQR 70-80 mmHg), PP varied from 30 to 100 (Me 60 mmHg, IQR 50-70 mmHg). Patients distribution by SBP level: <130 mmHg was observed in 20,9%, 130-139 - in 21,5%, 140-149 - in 42,3%, 150-159 - in 11,7%, >160 - in 7,9%. Me of follow-up was 3,83 years (min 2 weeks, max 5,43 years, IQR 3,11-4,42 years). Sixty-five (40%) patients died. There was no significant difference in SBP, DBP and PP between those who died or survived. Kaplan-Meier survival curves revealed no significant relationship between SBP, DBP and PP values above or below median value: for SBP χ²=0,017, p=0,897; for DBP χ²=0,047, p=0,828; for PP χ²=1,67, p=0,196.

**Conclusion:** The study revealed no significant impact of BP on 5-years survival of the very elderly hypertensive subjects with treated and well-controlled according to the current European guidelines on arterial hypertension. Additional factors should be considered to determine predictors of survival in this population.

## P-547

### Cardiovascular risk factors and diseases in centenarians: Preliminary results of the Moscow Centenarian Study

O. Tkacheva¹, Y. Kotovskaya², N. Runikhina³, N. Sharashkina³, D. Kashtanova³, V. Ostapenko³. ¹Pirogov Russian National Research Medical University - Russian Clinical and Research Center of

Gerontology; ²RUDN University, Pirogov Russian National Research Medical University-Russian Clinical and Research Center of Gerontology; ³Pirogov Russian National Research Medical University-Russian Clinical and Research Center of Gerontology

**Aim:** The number of centenarians is increasing but they are still an underinvestigated population. Traditionally centenarians are considered to be an example of "healthy aging" meaning people free from cardiovascular diseases with favorable cardiovascular risk factors profile. The aim of the Moscow Centenarian Study (NCT02876809) was to perform complex evaluation of centenarians living in Moscow. Preliminary results of analysis of cardiovascular disease and risk factor prevalence are reported in this abstract.

**Methods:** The study included 82 subjects (10 men) aged from 97 to 105 years living at home. All centenarians were visited by a geriatrician at home for comprehensive geriatric assessment and cardiovascular measurements. Medical history evaluations was based on medical notes (presumably) and/or interview with centenarians, their relatives/carers. Blood samples for metabolic risk factors assessment were obtained in fasting conditions.

**Results:** Positive medical history of arterial hypertension was found in 64 (78%) centenarians, coronary heart disease in 52%, documented history of myocardial infarction in 20%, chronic heart failure in 32%, stroke 21%, peripheral arterial disease in 4%, diabetes mellitus in 4%. The use of antihypertensive drugs was reported by 35%, statins by 4%, aspirin by 18%. Mean fasting glucose was 4,98±1,9 mmol/l, HbA1c 5,88±0,58%. Lipid profile was evaluated in 64 centenarians: total cholesterol (TCh) 5,04±1,18 mmol/l, triglycerides (Tg) 1,09±0,36 mmol/l, LDL 3,26±0,92, HDL 1,37±0,36 mmol/l. TCh >5,0 mmol/l were observed in 14 (22%) centenarians, Tg>1,7 mmol/l in 1 (2%), LDL>3,0 mmol/l in 17 (27%), low HDL (<1,2 in female, <1,0 in male) in 28 (44%).

**Conclusion:** The preliminary results suggest that Moscow centenarians are not free from cardiovascular disease though cardiovascular risk factors prevalence seems to be significantly lower than usually reported for elderly and very elderly population. Exceptional longevity achieved by the evaluated people may suggest that they have protective mechanisms against long-term exposure to cardiovascular risk factors.

## P-548

### Cohort study of the oldest-old of Japan: the Arakawa 95+ study

H. Niimura¹, Y. Eguchi¹, H. Kida¹, W. Nishimura¹, M. Takayama², M. Mimura¹. ¹Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; ²Department of Foreign Language and Liberal Arts, Keio University School of Science and Technology, Yokohama, Japan

**Introduction:** In Japan, with the progressive ageing of society, the population of the oldest-old is expected to increasing, however, the characteristics of this population remain to be precisely studied. We established a population-based cohort of persons aged 95 years or older (95+) and conducted a baseline survey.

**Methods:** The subjects of this study were the residents of Arakawa ward in Tokyo who were 95+ years old on January 1st 2016, and provided informed consent for participation in this survey. We mailed questionnaires to assess their physical, mental and social health-related factors. We visited homes or nursing homes and conducted face-to-face interviews with the participants who provided responses to our questionnaires, and assessed their mental health, cognitive function and physical functioning. We also mailed simplified questionnaires to those subjects who did not respond to the full questionnaires.

**Results:** Of the 210,000 residents of Arakawa ward, 50,000 were 65+ years old and 542 were 95+. We excluded dead residents, mailed 457 questionnaires, received 40 replies, and visited 26
participants. We mailed 363 simplified questionnaires, to which 128 provided responses. The mean age of the responders (N=168) was 98.5±2.4 years. The diagnoses in the 26 participants that we visited (97.7±2.1 years old) were as follows; dementia, 9 (35%); dementia+depression, 3 (12%); mild cognitive disorder (MCI), 10 (39%); MCI+dementia, 2 (8%); normal health, 7 (27%).

**Conclusions:** The participants of the questionnaire survey and face-to-face interviews were healthier than the non-responders. The diagnostic criteria for dementia in the oldest-old should be discussed from the perspective of their social function level.

## P-549

### Creativity and well-being in older adults: a correlational study

C. Cristini¹, F. Nannini², G. Cesa-Bianchi³, E. Bologna⁴, E. Riva¹, M. Cesa-Bianchi³, A. Antonietti². ¹University of Brescia, Italy; ²Catholic University of the Sacred Heart, Milan, Italy; ³University of Milan, Italy; ⁴Fondazione Ferrero, Alba, Italy

**Objectives:** During the old stage of life, creativity helps individuals to be active and stimulates skills and capabilities that are declining. In addition, it leads people to find a new meaning in their life. Being creative, as many artists and scientists showed, enable persons to consolidate and improve well-being, overall when cognitive functions are concurrently trained. The aim of this study was to assess possible relations between creativity and well-being in the elderly.

**Methods:** A sample of 139 adults, aged 60–85 yrs, were involved in the investigation. Part of them were living at home and the other part were hospitalized. They were administered two tools to measure the inclination to activate creative thought processes (WCR test) and the ability to elaborate stimuli in a divergent way (a subtest from the TTCT) and the self-report scale "Satisfaction With Life".

**Results:** Positive correlations between the creative measures and the level of life satisfaction emerged. Different patterns of correlations according to the age level of participants were found, supporting the notion that creativity play different functional roles in supporting subjective well-being. Differences in both creativity attitude and skills, as well as in well-being, due to hospitalization were recorded.

**Conclusion:** Findings showed that creativity, thanks to the opportunity to focus on curiosity and passions it promotes, allows elderly people to achieve goals and look for new experiences, thus realizing themselves. In addition, the creative attitude leads affective relations to grow so that people are motivated in living, learning, and discovering.

## P-550

### Effect of haptic supplementation provided by a cane on postural control and gait parameters during locomotion in older adults

M. Vintrou¹, C. Amiot², A.-L. Couderc², A. Amranie², B. Aymes², P. Villani², J.-J. Temprado³. ¹AP-HM, Hôpital Sainte Marguerite, Service de recherche clinique, Pôle gériatrique, Marseille France; ²AP-HM, Service de Médecine Interne Gériatrie et Thérapeutique, Hôpital Sainte Marguerite, Marseille, France; ³Aix Marseille Univ, Institut des Sciences du Mouvements, UMR 7287, Marseille, France

Many older adults who use a cane to move, use it to slightly touch the ground rather than as mechanical support. The present study aimed to assess the benefits of these different uses. 17 participants (6 women, 11 men; age: 83.1±5) were included in the experiment. As a preamble, we verified that the participants were sensitive to haptic supplementation in a static postural task paradigm inspired from Albertsen's study. Then, three walking conditions were completed, at preferred speed, on the GAITrite walkway: without cane (WC1), with a cane used as mechanical support (WC2) or as light touch (WC3). Gait speed, cadence, stride length, Basis of Support

(BS), stance time (in % of gait cycle), and acceleration of Center of Mass (CoM) were measured. Results showed that gait speed, cadence, and stance phase were deteriorated in WC2 and WC3, relative to WC1. No difference was found between WC2 and WC3. Stride length decreased with light touch as compared to simple walking. No significant difference was found between WC2 and WC1. Finally, the amplitude of the CoM in AP direction significantly increased in WC2 relative to WC1. No effect of light touch was found. These results suggest that using a cane deteriorates gait parameters, independent of the type of use. Notably, only cane use as mechanical support improves the control of the center of mass in the anteroposterior direction. The question remains however of whether a longer period of familiarization of cane use could result in positive effects.

## P-551

### Elderly falls in Turkey: A review

B.T. Dikmen, N. Bayraktar. Near East University, Nicosia, Cyprus

**Introduction:** Falls which are important health problems of older adults result in medical and socio-economic burden. This problem may cause to increase in mortality rates, disability and dysfunction, anxiety and depression, loss of confidence, and post-fall syndrome and reduced quality of life among the elderly people. This review provides an overview to studies about elderly falls in Turkey.

**Methods:** A literature search (2006–2017) was carried out, using MEDLINE, CINAHL, Pub Med, Science direct, Web of Science, Scopus, Cochrane library, Turkish Medical Index and related institutional websites. Key words included "Older adults", "Elderly", "Falls".

**Results:** It was determined that the studies were conducted between 2006 and 2017; a prospective study was about identifying risk of falls in elderly, a cross-sectional study was about complete comprehensive geriatric assessment and questioned for fall history, three of the descriptive study was about evaluation of balance in elderly fallers and frequency, features, and related factors for falls in a group of subacute stroke patients, two prospective, single-blind, randomized and controlled trial was about comparison of the effectiveness of programmes on older adults at risk of falling.

**Conclusions:** Especially we realized that it was a important problem in Turkey and there was insufficient as a number of studies. This review explored that we need more studies about falls in geriatric patient Turkey. It could be a reference for future studies.

## P-552

### Elderly people as vulnerable group in disasters

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

**Introduction:** Disasters are extraordinary and catastrophic events that occur somewhere in the world every day. The World Disasters Report noted a 60% increase in disasters in the last decade. Disasters result in high numbers of deaths and injuries, and economic loss. Elderly people are among the most vulnerable population for disasters. This review provides an overview to relevant literature on elderly people as vulnerable group in disasters.

**Methods:** A literature search (2000–2017) was carried out, using MEDLINE, Pub Med, Science direct, Scopus, Cochrane library, Turkish Medical Index and related intuitional websites. Key words included "Older adults", "Elderly", "Disasters", "Vulnerable groups".

**Results:** Several studies have found that older adults are more affected by disasters compared with younger people. Disaster statistics frequently demonstrate higher mortality and morbidity rates for older adults. In the 2011 Japanese Tsunami, 77% of died people were elderly. This group is more vulnerable to the negative impacts of disasters due to biological, psychological and social
changes associated with aging. Having the highest prevalence rates for multiple chronic conditions, limitations in activities of daily living, physical and cognitive disabilities, and sensory impairments makes older adults particularly vulnerable to physiological stresses during disasters.

**Conclusions:** Despite greater vulnerability to disasters, most fatalities, injuries, and damage caused by disasters are preventable. Preparing older adults for disasters with comprehensive disaster management plans may improve the health-related quality of life of older people and, thereby may reduce the damage that occurs in disasters.

## P-553

### Engaging older people with health data and technologies – a citizen engagement project

J. Taylor¹, T. Tay², L. Hassan¹, K. Holmes¹, S. van der Veer¹. ¹Health e-Research Centre, Farr Institute for Health Informatics Research, University of Manchester, Manchester, UK; ²School of Medicine, University of Manchester, Manchester, UK

**Introduction:** Engaging older people with health data and technologies research is challenging. We designed a public engagement project that aimed to capture older people's view through a novel technique known as "community reporting". Community Reporters (CR) is an open platform, global interface that allows members of the public to upload their personal stories as short video recordings onto the web.

**Method:** CR training was held over a 6-week period. Participants were taught to create, edit and upload their own videos. Their first CR project was based on the "health data" theme. Participants were also provided with "smart watches" (accelerometer based activity trackers) and encouraged to create videos documenting each others experiences.

**Results:** All 18 participants created video content despite variable familiarity with technology. Over 30 videos are available to view on the CR website (https://communityreporter.net, datasaveslives project). Motivators to engagement with health data and technology included: intrigue into personal data, a desire to collect objective data to inform health professionals, and perceived benefit of the devices as part of a positive personal attitude to health. Trepidation related to unfamiliar technologies was a common theme, with many participants highlighting the need for dedicated support in any future research projects. A survey of participants whom undertook the CR training reported the programme was both enjoyable and worthwhile.

**Conclusions:** This project has highlighted multiple motivators and barriers to engagement with health data and technologies research by older communities. The CR scheme can be used as an effective public engagement technique.

## P-554

### European pattern of pleasure for elderly: A cross-sectional study about well-being representations

P. Denormandie¹, A. Letty², S. Sanchez³. ¹Institut du Bien Vieillir; ²Institut du Bien vieillir; ³Centre hospitalier de Troyes

**Introduction:** Since a few years concepts such as "ageing in health", "ageing with success", ageing with "high function level" or "ageing well" are frequently used.

**Objective:** The main goal of our survey was to describe the representation of pleasure and their patterns in the population over 65 years old in 4 European countries. The second aim of our study was to create a pattern of representation by country in the elderly population to individualize, for each country analyzed, their own features.

**Results:** Our results showed different typology concerning the way

of "living Well, ageing Well" and also more or less surrounded by relatives. The geographic typology of approach enables us to differentiate specific profiles from "fragile and aged" to "familial hedonist" with, in the middle, the "sociable" and the "independent" ones.

**Discussion:** Well ageing is a large definition depending on various items including the state of mind. Designing a category in which the patient could be placed, could lead to a better global health caring. As a preventive action, public health policy could be including those descriptions to improve the well ageing of elderly.

## P-555

### Evaluation of osteoporosis among inpatients with hip fracture – a quality improvement intervention

L. Gustavsson, A. Koldestam. Sahlgrenska University hospital, Sweden

**Background:** Osteoporosis is an undertreated condition in Sweden. 12% receive bone-specific treatment following an osteoporosis related fracture, according to The National Board of Health and Welfare.Geriatric Medicine Mölndal (GER-SU/M) is the center for all hip fractures (HF) at Sahlgrenska University Hospital (SU), a 2000-bed teaching hospital in Western Sweden.Fracture liaison service (FLS) is a model of care to identify persons with osteoporosis after a low impact fracture. An FLS was introduced at SU in 2014 and was extended to cover hospitalized HF patients at GER-SU/M in 2015. The aim of this study was to evaluate the impact of a basic FLS, consisting of a standard protocol for blood chemistry tests and flowcharts to support individualized treatment recommendations, on the quality of osteoporosis care after HF.

**Methods:** We performed reviews of medical records of all HF patients in defined periods comprising 12–16 weeks/year 2015 (year 1) and 2016 (year 2), with December 2014 considered baseline. Outcome was defined as number of documented osteoporosis assessments and bone-specific treatment at discharge.

**Results:** The proportion of documented osteoporosis assessment was 24% (10/42) at baseline, increased to 82% (293/359) in year 1 and to 93% (224/242) in year 2 (p-value for trend <0.001). Treatment rates were 9.5% (4/42) at baseline, 18% (64/359) in year 1 and 29% (70/242) in year 2 (p<0.001).

**Conclusions:** After introduction of the FLS the number of osteoporosis assessments among patients with HF has significantly increased, as well as the proportion of in hospital initiated treatments.

## P-556

### Exercise patterns in older adults randomized to moderate- or high-intensity training: The Generation 100 study

L. Skarsem Reitlo¹, H. Viken², N.P. Aspvik³, J.E. Ingebrigtsen³, S. Bucher Sandbakk⁴, X. Tan⁵, U. Wisløff², D. Stensvold⁴. ¹K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; ²K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; ³Department of Sociology and Political Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway; ⁴K.G.Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; ⁵Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

**Introduction:** Few studies have investigated how older adults exercise when they are not under controlled laboratory settings. The aim of this study was to describe the exercise patterns among older adults randomized and instructed to perform moderate-intensity
training (MIT) or high-intensity training (HIT) over a one year period.

**Methods:** Frequency, rating of perceived exertion, type, location and social setting of exercise were assessed using exercise logs from 618 older adults (70–77 years, 291 women) randomized to MIT or HIT. Participants completed exercise logs after each exercise session they performed during one year.

**Results:** The mean number of exercise sessions per week was 2.2±1.3 in both training groups with 1.3±0.8 versus 0.4±0.5 performed with high intensity in HIT and MIT, respectively. Walking was the most common type of exercise in both groups, but MIT had a higher proportion of sessions with walking and resistance training than HIT, while HIT had a higher proportion of sessions with jogging, cycling, swimming, dancing and combined endurance and resistance training. Exercise location was most often reported to be outdoors in both groups, but HIT exercised more frequently at a gym or sports facility than MIT. Both groups performed an equal amount of exercise sessions alone and together with others.

**Conclusions:** This study provides new knowledge of how older adults included in an exercise randomized controlled trial exercise in a free-living situation. Our findings indicate that older adults randomized to MIT versus HIT have different exercise patterns.

P-557

Growth hormone, insulin-like growth factor-1, insulin resistance and leukocytes telomeres length as determinants of vascular aging in subjects free of cardiovascular diseases

I.D. Strazhesko¹, O.N. Tkacheva², E.N. Dudinskaya²,
A.S. Kruglikova³, D.U. Akasheva³, E.V. Plokhova³,
N.V. Sharashkina², N.V. Brailova⁴, V.S. Pykhtina³, O.Y. Isaykina³,
M.S. Pokrovskaya³, V.A. Vygodin³, D.A. Skvortsov³, S.A. Boytsov³.
¹National Center for Preventive Medicine, Moscow, Russia; Lomonosov
Moscow State University, Moscow, Russia; ²The Pirogov Russian
National Research Medical University, Moscow, Russia; ³National
Center for Preventive Medicine, Moscow, Russia; ⁴The Pirogov Russian
National Research Medical University

**Introduction:** Increased carotid-femoral pulse wave velocity (c-f PWV), intima-media thickness (IMT), atherosclerotic plaques number (ASP) are considered as important aspects of arterial aging - basis for cardiovascular diseases (CVD). Growth hormone (GH) and insulin-like growth factor (IGF)-1 deficiency and "short" leukocytes telomeres length (TL) have been proposed as independent predictors of CVD. The aim of this study was to determine the role of GH/IGF-1 in their interaction with TL and cardiovascular risk factors in vascular aging process.

**Methods:** The study group included 303 participants (104 males and 199 females) mean age 51.8±13.3 years, free of known CVD, diabetes mellitus, antihypertensive and lipid lowering medications. IMT and ASP were determined by ultrasonography in both left and right carotid arteries. c-f PWV was appreciated with the help of SphygmoCor (AtCor Medical). TL was determined by qPCR. Serum IGF-1 and GH we measured using immunochemiluminescent analysis.

**Results:** Through multiple linear regression analysis, in "younger" group (mean age 40.9±8.7, n=144) unlike the "older", GH/IGF-1 were significantly associated with arterial wall characteristics. C-f PWV was positively associated with HOMA-IR (p<0.0001) and negatively associated with GH (p=0.03) and TL (p=0.004). IMT was positively associated with HOMA-IR (p=0.0001), negatively associated with GH (p=0.05) and IGF-1 (p=0.004). ASP was positively associated with HOMA-IR (p=0.0001) and negatively associated with IGF-1 (p=0.045).

**Conclusions:** 1. GH/IGF-1 along with insulin resistance and TL determine the main parameters of arterial aging in healthy participants. 2. GH/IGF-1 axis demonstrates vascular protection in aging

P-558

Healthy Ageing Through Internet Counselling in the Elderly (HATICE) – an ongoing randomised controlled trial

N. Coley¹, S. Andrieu¹, F. Mangialasche², M. Barbera³,
C. Beishuizen⁴, C. Brayne⁵, W.A. van Gool⁶, J. Guillemont⁷,
S. Jongstra⁶, E.P. Moll van Charante⁸, T. van Middelaar⁶, L. van
Wanrooij⁶, M. Hoevenaar-Blom⁶, T. Ngandu⁹, B. van de Groep¹⁰,
Y. Meiller¹¹, H. Soininen³, M. Kivipelto¹², E. Richard¹³. ¹INSERM,
University of Toulouse UMR1027; Department of Epidemiology and
Public Health, Toulouse University Hospital, Toulouse, France; ²Aging
Research Center, Karolinska Institutet/Stockholm University,
Stockholm, Sweden; ³Institute of Clinical Medicine/Neurology,
University of Eastern Finland, Kuopio, Finland; ⁴Department of
Neurology, Academic Medical Center, University of Amsterdam;
Department of General Practice, Academic Medical Centre, University
of Amsterdam, Amsterdam, The Netherlands; ⁵Department of Public
Health and Primary Care, Cambridge Institute of Public Health,
University of Cambridge, United Kingdom; ⁶Department of Neurology,
Academic Medical Center, University of Amsterdam, Amsterdam, The
Netherlands; ⁷INSERM, University of Toulouse UMR1027, Toulouse,
France; ⁸Department of General Practice, Academic Medical Centre,
University of Amsterdam, Amsterdam, The Netherlands; ⁹Chronic
Disease Prevention Unit, National Institute for Health and Welfare,
Helsinki, Finland; ¹⁰Vital Health Software, Ede, The Netherlands;
¹¹Department of Information and Operations Management, ESCP
Europe, Paris, France; ¹²Institute of Clinical Medicine/Neurology,
University of Eastern Finland, Kuopio, Finland; Chronic Disease
Prevention Unit, National Institute for Health and Welfare, Helsinki,
Finland; Division of Clinical Geriatrics, Department of Neurobiology,
Care Sciences and Society, Karolinska Institutet, and Karolinska
University Hospital, Stockholm, Sweden; ¹³Department of Neurology,
Academic Medical Center, University of Amsterdam, Amsterdam;
Department of Neurology, Donders Institute for Brain, Cognition and
Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands

**Background:** Cardiovascular disease (CVD) and dementia share several risk factors. It is unknown whether treatment of the latter reduces the risk of dementia. eHealth offers opportunities for large-scale delivery of prevention programs encouraging self-management of risk factors. We aim to investigate whether a multi-domain internet intervention to optimise self-management of cardiovascular risk (CVR) factors can reduce the risk of CVD, cognitive decline and dementia.

**Methods:** We developed and currently test in the Netherlands, Finland and France an internet intervention in a multi-centre, prospective, randomised, open-label blinded endpoint trial with 18-months intervention in persons aged 65 and older with increased CVR. The intervention group uses an interactive internet platform with coach support to stimulate a healthy lifestyle. The control group has access to a static platform. Primary outcome is a composite score of systolic blood pressure, low-density-lipoprotein and body mass index. Main secondary outcomes include effect on CVR factors, incident CVD, mortality, cognitive functioning, mood and cost-effectiveness.

**Results:** Between March 2015 and September 2016 we recruited 2725 persons. Median age is 69, 40% has higher education and 30% has a history of CVD. During the first 12 months of the trial, adherence to the intervention was good with over 50% logging in at least 5 times per 3 months. Follow-up will end in January 2018.

**Conclusions:** A large multi-national trial using an internet intervention to improve CVR profile is feasible. Whether this leads to a reduced risk of CVD and dementia is under investigation. Final results are expected in mid 2018.
P-559

**Heart structure and function in centenarians: preliminary results of Moscow Centenarian study**

Y. Kotovskaya¹, O. Tkacheva², N. Runikhina², D. Akasheva³, N. Sharashkina², V. Ostapenko², S. Boytsov³. ¹RUDN University, Pirogov Russian National Research Medical University - Russian Clinical and Research Center of Gerontology, Moscow, Russian Federation; ²Pirogov Russian National Research Medical University - Russian Clinical and Research Center of Gerontology, Moscow, Russian Federation; ³National Center of Preventive Medicine, Moscow, Russian Federation

**Objective:** Centenarians are still represent an underinvestigated population. There is large body of data on heart structure and function changes with ageing, but very few data available for centenarians. The aim of the Moscow Centenarian Study (NCT02876809) was to perform complex evaluation of centenarians living in Moscow. Preliminary results of echocardiography are reported in this abstract.

**Methods:** Echocardiography was performed with a portable device In 64 (8 male) aged from 97 to 105 years. Medical history including history of arterial hypertension, myocardial infarction, heart failure and current treatment was collected during interview with centenarians, their relatives/ carers and from medical notes if available. Aorta diameter, left atrium size and volume index (LAVI), systolic and diastolic dimensions and volumes of left ventricle (LV), LV mass index (LVMI), ejection fraction (EF) were evaluated. LV hypertrophy was diagnosed if LVMI was >95 g/m² in females or >115 g/m² in males, concentric LV geometry if relative wall thickness (RWT) >0,42. LV-arterial coupling was calculated as Ea/Ees, Ea=end systolic pressure (ESP)/stroke volume, Ees=ESP/end systolic LV volume. Ea/Ees 0,5–1,2 was considered as optimal. The data are presented as Mean+SD Results. Mean aortic root diameter was 3,5±0,34 cm and in 8 (12,5%) subjects exceeded 3,8 cm. Mean LAVI was 41,8+14,3 ml/m² and was moderately-to-severe abnormal (>42 ml/m²) in 28 (43,75%) subjects. Normal LVMI and RWT was found in 13 (20,3%) centenarians. Concentric LV remodeling was observed in 15 (23,4%), concentric LVH 24 (37,5%), eccentric LVH in 12 (18,7%). Two subjects had EF <40% (history of MI in both), 62 subjects had EF >50%. Structural abnormalities typical for heart failure with preserved EF (LV end diastolic volume <97 ml/m² and LAVI>34 ml/m² or LVH) was observed in 46 (71,9%) centenarians. Ea/Ees <0,5 was observed in 11 (17,2%) subjects, and Ea/Ees>1,2 - in 2 (3,1%) subjects.

**Conclusion:** LV structure of centenarians is characterized by concentric LV geometry in 50,9%. Despite high prevalence of the heart structure typical for heart failure with preserved EF majority of centenarians have normal values Ea/Ees.

P-560

**Hip fracture in older age caused by a decline of cognitive and cardiovascular functions**

R. Csanády-Leitner¹, H.K. Lackner¹, W. Maurer-Ertl², F.J. Seibert².
¹Dept. Phys., Med. Univ. Graz, Austria; ²Dept. Orth. & Trauma Surg., Med. Univ. Graz, Austria

**Introduction:** Health status is positive related to cognitive and cardiovascular functions in older age. A decline of this performance lead to hip fractures often triggered by falls. Evaluating the potential differences between patients of femoral fracture (FF) and coxarthrosis surgery (CS) cognitive and cardiovascular functions including fall analyses were studied.

**Methods:** Men and women according to hip replacement due to FF after falls and CS recruited at the Medical Clinic Centre Graz were investigated from October 2016 till May 2017. Testing time was between the third and tenth day after surgery. Data were collected, following a special timeline and circadian rhythms, using a

cognitive performance battery (CPB) – Stroop Test. Continuous ECG recordings during performance were conducted associated with data collection in BMI, wade circumference, fear and frequency of falls.

**Results:** 86 patients between 60–85 years with FF (n=25), CS (n=36) and control group (n=25), mean age+SD=73.1±7.0 years were tested. Results of CPB indicated significant differences in the FF group compared to the other groups testing the interference of Stroop Test, H(2)=25.995, p<0.00 as well as heart rate variability parameters like average RR (ms), H(2)=15.149, p<0.001. Furthermore frequency and fear of falls were significant higher, BMI and wade circumference significant lower in the FF group.

**Conclusions:** Results of this pilot study show significant differences among the groups related to cognitive and cardiovascular functions. Based on these preliminary findings we are encouraged to test more patients detecting potential distinctions to lower risk of falls and fractures in the future.

P-561

**Human longevity – Are we ready to go for it?**

K. Piotrowicz¹, J. Baran¹, K. Bierau², A. Chan², T. Grodzicki¹.
¹Jagiellonian University Medical College, Kraków, Poland; ²Percuros, Leiden, Netherlands

**Introduction:** Secret of longevity in humans is a burning but still unanswered question.

**Methods:** CHARMED Project, designed as a Research and Innovative Staff Exchange (RISE), intends to characterize a green microenvironment of the small community of the Marches Region in Italy (Nemi town), and study its impact on health and well-being of older adults as a way forward for health tourism dedicated to and tailored for old people. 4-step scientific research is expected: 1) To characterize local ecosystem of Nemi (the climate, air quality, noise levels and flora- with the use of, inter alia, optical spectroscopy and UV-Vis and NIR spectrometers) and its impact on health and quality of life of elderly people from the local community (the customized questionnaires, salivary and blood samples for immune status and stress monitoring, function and blood tests); 2) To analyze target population of elderly visitors to Nemi and to identify their specific needs (health analytics, oxidative stress markers and immune components); 3) To implement landscaping and urban infrastructure changes, as well as social and therapeutic horticulture, food lessons and dietary counseling, and physical exercises personalized for elderly visitors; 4) To analyze the economic impact of implemented strategies and to calculate health cost benefits.

**Results and conclusions:** We aim to achieve an innovative transfer of knowledge and interactions between academic experts as well as different organizations from non-profit, public and industry, to create an inventive social-economic infrastructure for health tourism based upon environmental-impacting factors for improving the physical and psychological well-being of older individuals.

**Acknowledgements:** The CHARMED project is funded by the European Commission under the Marie Skłodowska Curie Actions RISE program from 2017 to 2020.

P-562

**Impact of environmental modifications on the quality of life of residents with dementia**

D. Curto¹, P. Cano¹, C. Garcia¹, J.F. Tomas², M. Cuesta². ¹Sanitas Mayores Sanitas ELA-Bupa; ²Sanitas ELA-Bupa

**Introduction:** An ongoing initiative which carries out transformations and adaptations of spaces in our care homes so that these areas increasingly respond to the necessities and functional, environmental and comfort requirements of residents living with dementia, their families, as well as the people who work in them.
**Methods:** Many improvements have been carried out in many care homes, some small, others more ambitious, from refurbishments of bedrooms, bathrooms, dining rooms and lounges to the creation of new areas such as terraces, bathrooms, staff rooms and adaptations of dementia floors.

**Results:** Dementia care means a continued reformulating global model, to adapt dementia floors to the necessities of our residents with dementia, covering: the adaptation of the physical environment in common areas, corridors, creation of Snoezelen rooms (multisensory rooms), bathrooms and bedrooms. A pilot programme in a care home in the dementia floor has undergone the following changes:

* Adaptation of the corridors (materials, lighting etc).

* Elimination of the nurses' station, (tablets are now used for this control), in order to create a rest point simulating a natural space with benches to rest on and also to receive therapies, as well as having natural sounds emanating from inbuilt speakers at all times. The pillars are decorated in such a way as to simulate trees and on touch seem real – they even have moss interspersed with the bark.

* Concealment of elements which are susceptible to generating stressful situations, like lift doors and emergency exits.

**Conclusions:** An environmental refurbishment centered on the dementia residents needs results in a reductions of critical incidents (falls, severe consequences, a reductions of psychoactive drugs) that allows a better care and an improvement of quality of life of residents.

## P-563

### Investigation of cognitive function in the oldest-old using ACE-III

Y. Eguchi, N. Hirose, H. Niimura, Y. Arai, M. Mimura. *Keio University School of Medicine, Tokyo, Japan*

**Introduction:** Though ageing is the greatest risk factor for the onset of dementia, some of the oldest-old have comparatively well-preserved cognitive function and appear capable of performing complex tasks. We used Addenbrooke's Cognitive Examination-III (ACE-III) to investigate cognitive function in the oldest-old, which has not been fully elucidated.

**Methods:** ACE-III was administered to community-living oldest-old (aged 90 years and centenarians) who consented to participate.

**Results:** Participants were eleven subjects in their 90s, with a mean age of 93.2 years (range, 92–95 years) and 7 centenarians, with a mean age of 106.6 years (range, 105–108 years). The 90s group scored high on the mini-mental state examination, confirming the absence of dementia. The mean total ACE-III score of the 90s group was 88.1, which was above the cut-off score indicating dementia; that of the centenarians was 51.9, which was below the cut-off score. All subjects were able to perform visual counting (a visuospatial subtest involving counting the number of black dots without pointing), with a mean correct response rate of 95.8%.

**Conclusions:** The scores on the five cognitive domains of ACE-III in the 90s group indicated almost an intact cognitive functioning except for fluency and memory, and in centenarians, an overall decline with a particularly marked decrease in memory. Only visual counting had a high correct response rate, suggesting that the visual field of the oldest-old was relatively unaffected by ageing and brain degeneration. This study showed details of cognitive function in the oldest-old using ACE-III.

## P-564

### Is it feasible to evaluate ageing process by creating a single health metric? The ATHLOS Project approach

G. Soulis¹, F.F. Caballero², A. Sánchez-Niubó³, J.L. Ayuso-Mateos², J.M. Haro³, S. Chatterji⁴, D. Panagiotakos¹. ¹Department of Nutrition

and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; ²Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain; ³Parc Sanitari Sant Joan de Déu, Barcelona, Spain; ⁴Information, Evidence and Research, World Health Organization, Geneva, Switzerland

**Introduction:** Ageing is a complex phenomenon that is unique for each individual. It can be viewed as a continuous accumulation of diseases, but it can also be approached in a more comprehensive way taking into account the dimensions that are included in the health quantification approach, as proposed by WHO.

**Methods:** We used a two-stage factor analysis approach in 11,906 participants from the English Longitudinal Study of Ageing (ELSA), which included 45 items that fit with the proposed minimal generic set of variables defined in the WHO International Classification of Functioning (ICF). Evidence for a general factor underlying first-order factor were obtained. Then, a Bayesian multilevel Item Response Theory (IRT) approach was applied to create the health metric using the first six waves of the study.

**Results:** A single metric was developed, where variables of functioning, mobility, senrorineural, emotional and cognitive aspects have been proved to be the most important. The five first-order factors extracted explained a 63.1% of the total variance.

**Conclusions:** Although these variables are not new for geriatricians, since some of them are already evaluated during the Comprehensive Geriatric Assessment, the current work revealed that it is feasible to create a health metric based on a broader conceptualization of health characteristics. This can also be useful since it can help to quantify the effects of clinical and public health interventions and credibly evaluate their impact in the ageing process.

## P-566

### Lifestyle-Integrated Exercise Interventions delivered by use of ICT or an instructor - PreventIT Feasibility RCT

K. Taraldsen¹, M. Schwenk², J. van Ancum³, S. Mellone⁴, E. Boulton⁵, A. Zacchi⁶, C. Todd⁵, W. Zhang⁷, A. Maier³, C. Becker², R. Bergquist¹, B. Vereijken¹, J.L. Helbostad¹. ¹NTNU, Norway; ²RBK, Germany; ³VU, The Netherlands; ⁴UiB, Italy; ⁵UoM, UK; ⁶Doxee, Italy; ⁷EPFL, Switzerland

**Introduction:** The European population is rapidly ageing. Physical activity (PA) can improve health and function and reduce disability at old age. Older adults are at risk of being inactive, and activity declines significantly at time of retirement. To be able to reach recommended activity levels, behavioural change is needed. The PreventIT consortium has adapted an existing lifestyle intervention programme to home-dwelling young older adults who are recently retired (aLiFE). Furthermore, we have transferred the aLiFE programme to a mobile health application system based on smartphones and smartwatches, called eLiFE. The aim of the study is to investigate whether it is feasible to have young older adults between 61–70 years perform the aLiFE and eLiFE versus a control group.

**Methods:** This is an ongoing multi-centre randomised feasibility trial with three sites, Trondheim, Amsterdam, and Stuttgart. Eligible people are invited to take part in a three-armed feasibility RCT, with two behaviour change programmes (aLiFE and eLiFE) focusing on muscle strength, balance, and PA, and a "usual care" control group who receive generic activity advice Each site will include participants until 60 at each site are randomised.

**Results:** 9500 invitation letters have been distributed. 250 people have undergone risk assessment. At present 63 participants have been randomised, and the first participants have started the intervention.

**Conclusions:** Adherence and delivery of PA interventions are a challenge. In this trial we will get more knowledge about the
feasibility of two newly developed home-based interventions for a relatively young and healthy group of older adults.

## P-567

### Oxidative stress and ageing

S.D. Brincat<fnref n="1" />, A. Brincat², T. Hunter<fnref n="3" />. ¹Mater Dei Hospital, Msida, Malta; ²Sir Anthony Mamo Oncology Centre, Msida, Malta; ³University of Malta, Msida, Malta

**Introduction:** Nowadays, life expectancy has substantially increased due to advances in public health, medicine and nutrition. Ageing results from the accumulation of multiple deleterious changes predisposing the individual to diseases and eventually death.

**Aim:** To understand the physiological process of ageing with particular reference to the role of oxidative stress as proposed by the Free Radical Theory of Ageing.

**Methodology:** A literature review was conducted to unveil the insights of the mechanisms of ageing. A number of theories have been proposed to suggest the physiology underlying this phenomenon. This study focused on The Free Radical Theory of Ageing since it is considered as the most prevalent theory to elucidate the molecular mechanism of ageing.

**Results:** The Free Radical Theory of Ageing identifies free radicals as the cause of time-related changes attributed to ageing. Multicellular organisms necessitate high energy levels to drive the biological processes making the cell dependent on oxidative phosphorylation. This produces a wide range of radical and non-radical oxidants which are responsible for cellular damage. Damage to both nuclear and mitochondrial DNA induced by free radicals includes nitration, deamination of bases, deletion of purines and damage to DNA repair system. In order to cope with the bombardment of reactive oxygen species, cells have developed an antioxidant system composed of enzymatic and non-enzymatic components as a defence mechanism to maintain a redox state and safeguard against the toxic effects resulting from oxidative stress.

**Conclusion:** The Free Radical Theory stood the test of time as it is fundamental for the on-going research on ageing and lays fertile area for future research. This revolution in understanding the bodily response to oxidative stress leads to therapeutic and pharmacologic interventions to retard the development and progression of age-related conditions.

## P-568

### Participation in and adherence to an internet-based multidomain trial for the prevention of cardiovascular disease and cognitive decline in French, Finnish and Dutch older adults: data from the ACCEPT-HATICE ancillary study

N. Coley<fnref n="1" />, J. Guillemont², A. Rosenberg<fnref n="3" />, T. van Middelaar⁴, M. Barbera<fnref n="3" />, H. Soininen<fnref n="3" />, E. Richard⁴, M. Kivipelto⁵, S. Andrieu⁶.

**Introduction:** We compared reasons for participating in an eHealth

prevention trial, and adherence to the intervention in older adults from Finland (FI), France (FR) and the Netherlands (NL).

**Methods:** The 18-month "Healthy Ageing Through Internet Counselling in the Elderly" (HATICE) trial is testing an internet-based lifestyle intervention, with coach support, for prevention of cardiovascular disease and cognitive decline in 2725 European participants aged ≥65 years with cardiovascular risk factors/disease. For the ACCEPT-HATICE ancillary study, 341 participants completed an online questionnaire at the time of recruitment to explore determinants of participation.

**Results:** Participants from the three countries differed by age [median 67 (FI), 70 (FR) and 69 (NL) years, p<0.001], social support [median score (/12, higher scores represent more social support): 11 (FI), 9 (FR), 9 (NL), p=0.003], and locus of control [median "powerful others" external locus of control score (/12, higher scores indicate greater attribution of health to healthcare professionals): 7 (FI), 9 (FR), 8 (NL), p<0.001]. 51% of French participants stated that contributing to scientific progress was their main reason for participating, compared to 23% and 37% of Finnish and Dutch participants, respectively, while 24% of Finnish participants stated that receiving better medical care was their main reason for participating, compared to 11% and 13% of French and Dutch participants (p=0.009). Adherence to the intervention also differed between countries [proportion of subjects logging in ≥10 times in the first 6 months: 60% (FI), 79% (FR), 65% (NL), p=0.030].

**Conclusions:** Reasons for participation and intervention adherence differed by country, probably due to differences in participant characteristics, cultural factors, recruitment methods, and healthcare systems.

## P-569

### Physical and mental determinants related to the first fall in healthy old people

S. Gillain<fnref n="1" />, M. Boutaayamou², C. Schwartz<fnref n="3" />, N. Dardenne⁴, O. Brüls<fnref n="3" />, O. Bruyère⁵, J.-L. Croisier⁶, E. Salmon⁷, G. Garraux⁷, J. Petermans<fnref n="1" />. ¹Geriatric Department, University Hospital of Liège, Belgium; ²INTELSIG Laboratory, Department of Electrical Engineering and Computer Science, University of Liège, Belgium; ³Laboratory of Human Motion Analysis - LAMH, University of Liège, Belgium; ⁴Public Health Department, University of Liège, Belgium; ⁵Research Unit in Public Health, Epidemiology and Health Economics, University of Liege, Belgium; ⁶Science of Motricity Department, University of Liège, Belgium; ⁷Neurology Department, University Hospital of Liège, Belgium

**Introduction:** Falls and their consequences are a public health problem. To discern people those at risk to experiment a first fall is a key issue. The objective of this work is to highlight the physical or mental determinants of falls in healthy old people.

**Methods:** 105 healthy community-dwelling old people, without fall history, were recruited in a 2-years longitudinal study and screened for autonomy, fear of falling, visual impairment, co-morbidities, drugs, physical activities, nutritional status, body composition, grip strength, physical performances, mood and cognitive disorders and gait parameters. Falls incidence was measured every 3-month by a phone contact. SAS statistical package (version 9.4) was used. Fallers and non-fallers were compared by one-way analysis of variance (ANOVA) or by the Kruskal-Wallis test for quantitative parameters and by a chi-squared test for qualitative parameters. Results were considered statistically significant for p<0.05.

**Results:** At the end of the 2-years follow-up 35 people experienced at least one fall. The incidence of falls was associated with lower IADL (instrumental activities daily living) score (p=0.014), lower SPPB (short physical performance battery) score (p=0.015), lower fast walking speed (p=0.035), lower step length in comfortable walking condition (p=0.035) and lower step length in fast walking

<footnote n="1">¹INSERM-University of Toulouse UMR1027/CHU Toulouse, Toulouse, France; ²INSERM-University of Toulouse UMR1027, Toulouse, France;</footnote>

<footnote n="3">³Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio 70211, Finland; ⁴Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University</footnote>

<footnote>Medical Center, 6525 GA Nijmegen, The Netherlands; Department of Neurology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands; ⁵Center for Alzheimer Research, Karolinska Institutet, Stockholm 14157, Sweden; Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio 70211, Finland; Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki 00271, Finland; Center for Alzheimer Research, Karolinska Institutet, Stockholm 14157, Sweden; ⁶INSERM-University of Toulouse UMR1027/CHU Toulouse, Toulouse, France</footnote>
condition (p=0.01) at inclusion in faller people. Age, sex, drugs, co-morbidities, visual impairment, mood and cognitive status were not significantly different between the groups (p>0.05).

**Conclusion:** At inclusion and before the first fall, fallers and non-fallers showed different physical characteristics and daily activities. Multivariate analysis will be assessed to build an explicative model.

P-570

Prevention of balance loss and frailty

J.P. Farcy, J.B. Cook. *Nymbl Science*, USA

**Introduction:** Nymbl Science defines and measures a personalized "balance index" which incorporates both physical balance and cognitive impact on balance, then recommends specific, customized treatment to improve perception, cognition and action in order to prevent balance loss and frailty.

**Method:** The balance index is made of 2 numbers, each from 0 to 100. The first evaluates postural stability and strength, the second evaluates cognition in performing "double tasks" (e.g. counting backward or playing a video-game while maintaining a posture during a given time). Each of double tasks reinforces the effect of the other in order to both strengthen the musculoskeletal system and simultaneously engage the brain to stimulate brain plasticity. Nymbl uses a smart phone's internal motion sensors plus an external sensor worn at the ankle. The Nymbl mobile app directs the tests, analyses sensor's data, guides personalized training, and communicates data to the Cloud for further followup.

**Results:** Preliminary studies on a cohort of volunteers indicates excellent results based on significant improvement of balance index numbers after only 21 days of training. Full validation study is underway at the Imperial College of London led by Professor Alison McGregor.

**Conclusion:** Assuming that balance control is pivotal to maintaining and improving quality of life, an innovative concept such as this one presented by Nymbl Science is remarkable and significant to prevent falls and improve function and neurocognition.

P-571

Psychological predictors and consequences of hearing health behaviors in older adults

M. Marquet¹, A.L. Chasteen², J.E. Plaks², L. Balasubramaniam².

¹University of Liège, Liège, Belgium; ²University of Toronto, Toronto, Canada

**Introduction:** Hearing loss is a common chronic condition affecting older adults in Western populations [1,2]. Even if older adults could benefit from hearing aid use, they are reluctant to wear them [1]. The purpose of the present study was twofold: a) to examine whether older adults' implicit theories regarding the modifiability of abilities in general would predict their hearing health behaviors; and (b) to assess consequences of these behaviors on subjective aging.

**Methods:** One hundred and sixty-three older adults (Mean age =68.62, SD =5.40) completed, among other questionnaires, questions assessing their implicit theories of ability (i.e., seeing general abilities as fixed vs. improvable with effort [3]) and their subjective age (i.e., felt age, do age, look age, and interest age [4]). They also reported their perceptions of the benefits of various hearing health behaviors for slowing the effects of aging (i.e., getting their hearing tested and using hearing aids) as well as their intentions to engage in those behaviors.

**Results:** We found that the more older people considered that abilities are alterable, the more they perceived hearing health behaviors as being beneficial, which in turn increased their intentions to engage in these behaviors. Also, the greater their intentions, the younger subjective age they reported.

**Conclusions:** These relationships between implicit theories, hearing health behaviors, and subjective age are particularly important to take into account. Indeed, neglecting hearing problems and experiencing an older subjective age may have detrimental health-related outcomes over time [5, 6].

References:

[1] Feder, K., Michaud, D., Ramage-Morin, P., McNamee, J., & Beau regard, Y. (2015). Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013 Canadian Health Measures Survey. Health Reports, 26(7), 18-25.

[2] Lin, F. R., Thorpe, R., Gordon-Salant, S., & Ferrucci, L. (2011). Hearing loss prevalence and risk factors among older adults in the United States. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 66(5), 582-590. doi: doi:10.1093/gerona/glr002

[3] Dweck, C. S. (1999). Self-theories: Their role in motivation, personality, and development. Philadelphia, PA: Psychology Press.

[4] Kastenbaum, R., Derbin, V., Sabatini, P., & Artt, S. (1972). "The ages of me": Toward personal and interpersonal definitions of functional aging. The International Journal of Aging and Human Development, 3(2), 197-211.

[5] Bainbridge, K. E., & Wallhagen, M. I. (2014). Hearing loss in an aging American population: Extent, impact, and management. Annual Review of Public Health, 35, 139-152. doi: 10.1146/annurev-publhealth-032013-182510

[6] Kotter-Grühn, D., Kornadt, A. E., & Stephan, Y. (2015). Looking beyond chronological age: Current knowledge and future directions in the study of subjective age. Gerontology, 62(1), 86-93. doi: 10.1159/000438671

P-572

Regular exercise is associated with greater physical performance in elderly adults

A.L. Demoux¹, N. Capony². ¹Department of Geriatrics, Public Hospital of Marseille, North Hospital, 13015 Marseille; ²Department of Geriatrics, Public Hospital Of Marseille, North Hospital

**Introduction:** The positive effect of physical training in healthy elderly people is well documented, however there is little understanding of the aspects of performance contributing to this benefit. The aim of this study was to evaluate the impact of regular physical activity on muscle strength, and potentially related functional ability in elderly.

**Methods:** Fifty-eight (31 men, 27 women) non-disabled community-dwellers aged from 75 to 90 years were consecutively enrolled in general practitioners cabinets. They underwent a comprehensive geriatric assessment including physical activity questionnaire especially designed for the elderly, physical function by Short Physical Performance Battery (SPPB), and hand grip strength.

**Results:** According to the "Questionnaire d'Activité Physique pour les Personnes Âgées" (QAPPA), a group of exercisers (18 men and 11 women) and a group of non-exercisers (13 men and 16 women), the former presenting higher volumes and levels of physical activity, were identified. The two groups were similar for age, BMI, number of daily treatments, and number of previous falls; non-exercisers were likely more smokers and under anti-depressive treatment. The univariate analysis showed that high level of physical activity was significantly associated with a better nutritional status, lower Fried frailty score, faster mean walk speed, higher hand grip strength, and higher SPPB. However, only SPPB was significantly associated with physical activity in multivariate analysis (p<0.001).

**Conclusions:** This study showed that regular moderate-intensity training is independently associated with an improvement in physical performance in non-disabled community-dwellers aged > 75 yrs, suggesting a lower risk of falling.
P-573

**Relationships between functional physical fitness cardiovascular variables and quality of life in elderly**

D. Pietko Da Cunha. Universidade de Coimbra

**Introduction:** The performance of daily activities is crucial to the quality of life in old age, and physical fitness gets significant impact in this context. Cardiovascular variables are very important for morbidity and mortality in the generalpopulation, with particular relevance to the geriatric age group. The challengenowadays is to understand the factors that influence the quality of life, for the humanbeing to live longer without losing autonomy.

**Objectives:** To study the relationship between functional fitness, anthropometric, hemodynamic and blood variables and quality of life. Furthermore, toinvestigate how these variables predict quality of life of elderly people.

**Materials and methods:** Twenty participants over 60 years old from thegeriatric ambulatory of city of Cachoeirinha, in Brazil, had physical fitness tests forelderly people and had blood pressure (BP) and body mass index (BMI) measured. They had blood test to de- terminate lipid and glucose profiles. The quality of life wasassessed with the SF-36v2. Multivariate analysis of techniques of variance and linearregression were also used.

**Results:** Participants with normal glucose levels had lower BMI (p<0.05) than pre-diabetics and diabetics participants. The older adults with normaltriglycerides levels showed lower systolic and diastolic blood pressure (p<0.05). Age, sex and BMI explained 31.4% of the SF-36v2. Including systolic blood pressurein the model explanation raised to 43.6% the R2, increasing progressively to 53.8% when lower limbs strength was considered and to 64.7% with variable aerobicresistance.

**Conclusion:** BMI and BP, particularly systolic, cause great impact on generaland cardiovascular morbidity, as well as in the quality of life for seniors. The lowerlimb strength and aerobic endurance affect decisively their quality of life. The maintenance and optimiza- tion of these physical parameters positively impact thefunctional autonomy, and the level of independence of the elderly population.

P-574

**Renal ageing and glycation: implication of RAGE**

T. Teissier¹, V. Quersin², V. Gnemmi³, F. Delguste², N. Grossin², M. Daroux², F. Tessier², M. Frimat⁴, E. Boulanger². ¹University of Lille, Inserm, Regional University Hospital Center of Lille, U995 – Liric – Lille Inflammation Research International Center; ²University of Lille, Inserm, Regional University Hospital Center of Lille, U995 – Liric – Lille Inflammation Research International Center, Lille, France; ³Anatomopathology Department, Regional University Hospital Center of Lille, Lille, France; ⁴University of Lille, Inserm, Regional University Hospital Center of Lille, U995 – Liric – Lille Inflammation Research International Center, Nephrology Department, Lille, France

**Introduction:** Endogenous advanced glycation end-products (AGEs) are well-studied, especially for their effect on inflammation and fibrosis and possibly on ageing. Nonetheless, these effects have yet to be described for dietary AGE (dAGE). Here, we study whether a prolonged exposure to the dAGE carboxymethyl lysine (CML) can influence ageing in kidneys and whether the receptor for AGEs (RAGE) is a modulator of this process.

**Methods:** Wild-type (WT) and RAGE-/- male C57Bl/6 mice were fed with a control-diet (BSA) or a CML-rich diet (200 µg CML/g of food) for 18 months. Renal function markers were measured and histological analyzes were performed to assess kidney age- ing. Kidney amyloidosis was analyzed by staining, immunostaining and electronic microscopy. Immunohistochemistry was used to characterize amyloidosis and localize CML.

**Results:** We showed a RAGE-dependent production of CML into

kidneys of WT CML mice when compared to RAGE-/- CML mice, with a predominant tubular and endothelial localization. Im- munohistochemistry analyzes revealed amyloid deposits involving apolipoprotein A-II (APoAll). RAGE-/- mice were significantly pro- tected against CML-induced sclerosis (p<0.05), tubular atrophy (p<0.05) and ApoAll amyloidosis (p<0.01) when compared to WT CML mice. There is a positive linear correlation between sclerosis score and ApoAll amyloidosis score (r=0.92).

**Conclusion:** We suggest that dCML may induce RAGE-dependant fibrosis, sclerosis and amyloidosis in mice kidneys, aggravating renal ageing. Our data also show a dCML-induced CML production pathway that involves RAGE. Further studies are needed to confirm these data and determine specific signaling pathways.

P-575

**Results from a geriatric fall clinic – reduced sensibility and electromyographically identified polyneuropathy**

L. Blok Madsen, A. Güzel, H.E. Andersen. Geriatric Section, Medical Department, Glostrup hospital

**Introduction:** Reduced sensibility is a well-known risk factor for falling and electromyographically (EMG) identified polyneuropathy (PN) is proven to be strongly associated with falls. This study reports data from a Danish geriatric fall clinic and aims to see how common reduced sensibility and EMG verified PN is among elderly fall patients.

**Materials and methods:** Referred fall patients underwent a stan- dardized multidisciplinary quantitative assessment program. Vibra- tory sensibility was tested with biothesiometry and tactile sensi- bility using a monofilament. Persons referred to EMG underwent a standard neurophysiological EMG.

**Results:** 162 patients were referred throughout 2015. 123 gave in- formed consent and were included.79 women (64,2%) and 44 men (35,8%), mean age 76,9. Reduced vibration sensibility was found in 74 (60,2%), reduced tactile sensitivity in 31 (25,2%). 27 (22%) had reduced tactile as well as vibratory sensibility. Two of them had already EMG diagnosed PN. Totally 40 of the patients with reduced sensibility were further examined with EMG. Polyneuropathy were verified in 18 (45% of the EMG examined). Totally the frequency of EMG identified polyneuropathy in the study population was 14,6%.

**Conclusion:** This study shows that reduced sensibility is very common in a geriatric fall population. The results suggest that polyneuropathy is a frequent condition among geriatric fall patients that perhaps should be given more attention in geriatric fall assess- ment in terms of further examinations i.e. EMG and blood samples to identify potential causes.

P-576

**Screening for age-related eye diseases – the impact of costs**

L. Martin. School of Health, Care & Social Welfare, Mälardalen University

**Introduction:** Screening for age-related eye diseases can suc- cessfully be performed by optometrists via tele ophthalmology. However, in some countries the screening visit has to be paid by the old person themselves. The out-of-pocket cost may deter some from presenting for examination. In other countries the screening is free of charge which might lead to that a wider range of people might attend, many of which do not need to be examined, leading to a "noise" in the system. The aim of the current study was to evaluate the effect of a temporary lowering the out-of-pocket cost for screening examinations for age-related eye diseases.

**Methods:** During a 2 month campaign with reduced prises for eye examinations, 218 people attended. Demographic data, as well as the proportion of referrals were compared to all examinations in the same setting during the year before as well as to the total
number of the examinations in the country-wide screening system (n=39 517).

**Results:** The persons examined during the campaign were significantly (p=0.0004) older both compared to the examined persons at the same setting the year before and to the total number in the country. No differences were seen in gender, or the proportion of foreign-born persons. The proportions of first-time visits and referrals were not significantly different between the two samples.

**Conclusion:** Reduced price attracted somewhat older customers but no difference in morbidity was observed.

## P-577

### Self-efficacy, gerotranscendence and positive personality traits help in preventing frailty and maintaining a high level of well-being among the oldest-old in Japan: The Arakawa 95+ study

H. Kida¹, H. Niimura¹, Y. Eguchi¹, W. Nishimura¹, M. Takayama², M. Mimura¹. ¹Keio University School of Medicine, Tokyo, Japan; ²Keio University School of Science and Technology, Tokyo, Japan

**Introduction:** Japan is fast becoming a super-aged society, and its oldest-old population is expected to increase even as the whole population will decrease in next 30 to 40 years. Therefore, it is important to ascertain whether the oldest-old will continue to live with a high level of well-being and enjoy successful ageing in a residential district. In general, people tend to become closed, sceptical and introverted with ageing. It is linked with frailty, that is decrease in walking ability, easy fatigability and weight loss. Past study reported that preventing frailty helped the oldest-old live a life with high level of well-being. In this study, we aimed to identify factors for preventing frailty among the oldest-old by examining the relationship between frailty, self-efficacy, gerotranscendence and personality characteristics.

**Methods:** Subjects are all the oldest-old residents, aged 95 years or older, live in Arakawa ward of Tokyo. Of 542 eligible subjects, 168 (31%) answered the questionnaire survey, 40 provided more detailed responses to the questionnaire survey, and 26 accepted visiting investigations.

**Results:** Inability to walk 400 meters was related with awareness of forgetfulness, low frequency of meetings with people, low frequency of going out, low self-efficacy and low extraversion. In addition, easy fatigability was correlated with neuroticism and inversely correlated with gerotranscendence and agreeableness.

**Conclusions:** Our study suggested that formation of self-efficacy, gerotranscendence and positive personality traits helped prevent frailty and contributed to acquisition of a high level of well-being among the oldest-old in Japan.

## P-578

### Sleep quality of elderly people living in their homes

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

**Introduction:** Because of the positive results in the field of technology and health, human life has been prolonged and life expectancy from birth has been reported to be 75 years. Sleep is the most basic daily life activity with its physiological, psychological and social aspects affecting human health. Sleep has become important in the growing elderly population as it is important in all age groups.

**Methods:** A literature search (2000–2017) was carried out, using MEDLINE, Pub Med, Science direct, Scopus, Cochrane library, Turkish Medical Index and related institutional websites. Key words included "Elderly", "Sleep quality", "Sleep problems".

**Results:** The prevalence of sleep disturbance is up to 35% in those aged 60 years and over, 50% in 65 years and over. The causes of

sleep problems in the elderly; loss of melatonin secretion, loss of consciousness, loneliness, rest homes and retirement. In terms of quantity-quality of sleep problems of elderly individuals; slow wave, decrease in efficiency, phase shift and increase in divisions. When sleep problems are examined; drowsiness, persistence of difficulty, early waking and daytime drowsiness.

**Conclusions:** The consequences of sleep disturbance; daytime sleepiness, fatigue, depression, anxiety, irritability, increased pain sensitivity, muscle tremors, immune suppression, decreased mental function, health and functional impairment. As a result, it is observed that elderly people live more insomnia and this affects healthy aging adversely. Holistic approach should be promoted by putting the evaluation of sleep qualities of elderly individuals into routine applications.

## P-579

### Studying prognostic factors in people over 90 years

R. Quílez, V. Guerrero, R. Sander, A. Narvión, A.C. Sanjoaquín, J. Galindo. *H. Sagrado Corazón Jesús, Huesca, Spain*

**Introduction:** Several studies show that age itself is not an independent factor in survival; however, we usually limit the use of diagnostic and therapeutic resources in people over 90 years. The lack of studies in these patients makes the usual scales not suitable in this population.

**Objectives:** Analyze the prognostic survival parameters and characteristics in people over 90 years.

**Methods:** A prospective longitudinal cohort study with people from the outpatient clinic over 90 years during 2015 and 2016 in Huesca. Analytical data, comorbidity, admissions, ER attending, primary care visiting and drug assessments were recollected. Statistical analysis was done with SPSS 23.

**Results:** A total of 288 patients. Average age: 94.5. 70.8% were women. Mean Barthel index: 70. Charlson index 2.7. Mortality per year: 18.7%. Comorbidities: HTA 78.5%, DM 29.2%, dyslipidemia 45%, heart failure 23.6%, stroke 18%, ischemic heart disease 13.5%, cancer 22%, anemia: 35.7%, renal failure 64.2%. Drug number: 6.7. Number of admissions per year 0.5. Emergency care admission in a year 1. Primary care visits per year 5.6. We found an increase in mortality rate trough a year in people with anemia (p<0.001), low albumin levels (p=0.03), male gender (p=0.03), high RDW, (p=0.001), kidney impairment verified by HUGE formula (p=0.003), suffering cancer (p=0.003) or CHF (p=0.001).

**Conclusions:**

* In this study, we didn't find a direct relationship in mortality between having a high Charlson index in people over 90 years.

* The amplitude in red cell distribution [1], could be useful as a prognostic factor in elderly people. With patients with renal impairment, applying the HUGE2 formula can be helpful

**References:**

[1] M. Olivares Jara, E. Santas Olmeda, G. Miñana Escrivà, P. Palau Sampio, P. Merlos Díaz, J. Sanchis Forés Ancho de distribución eritrocitaria y riesgo de mortalidad en pacientes con insuficiencia cardiaca aguda Med Clin (Barc), 140 (2013), pp. 433-438

[2] Heras M, Fernández-Reyes MJ, Guerrero MT, Sánchez R. Evaluación de la función renal en el anciano con la fórmula HUGE. Rev Esp Geriatr Gerontol. 2013;48:94-95

## P-580

### Telemonitoring to improve nutritional status and physical activity in older adults: a process and effect evaluation

M.N. van Doorn-van Atten, A. Haveman-Nies, J.H.M. de Vries, C.P.G.M. de Groot. Wageningen University, the Netherlands

**Introduction:** An optimal nutritional status and physical activity are essential for successful aging. However, more than 40% of the
European older adults are at risk of malnutrition and physical activity levels decline with age. As health care resources are scarce, increasing attention is being paid to novel technologies that support healthy ageing. This study aims to evaluate an intervention directed at telemonitoring of nutritional status and physical activity among Dutch community-dwelling older adults.

**Methods:** In 2016 and 2017, a non-randomized controlled study was conducted among 217 older adults (65+). The six-month intervention comprised telemonitoring of nutritional status, body weight, appetite, diet quality, and physical activity, feedback via a television channel, and when necessary guidance by a nurse or dietician. The control group received usual care. Outcome measures were nutritional status, diet quality (measured as compliance to the Dutch dietary guidelines and scored on a scale from 0–10), quality of life, functional status, physical performance, behavioural determinants, and process indicators.

**Results:** Preliminary analyses showed significant improvements in diet quality. The scores for intake of vegetables improved (1.6, 95% confidence interval (CI): 0.8–2.4), as well as for intake of fruits (1.1, 95% CI: 0.6–1.7), dietary fibre (1.1, 95% CI: 0.7–1.4), and protein (1.2, 95% CI: 0.1–2.3). More insights into the effectiveness of the telemonitoring intervention will follow.

**Conclusions:** This study will show the feasibility and effectiveness of a telemonitoring intervention concerning nutrition and physical activity in community-dwelling older adults, thereby contributing to the knowledge on how technology can assist in healthy ageing.

## P-581
### Telomere length and telomere attrition in chronic oxidative stress and inflammation

S. Toupance¹, I. Tzanetakou², M. Chahine³, P. Konstantopoulos²,
S. Gautier⁴, M. Korou², C. Lakomy¹, I. Doulamis², C. Labat¹,
A. Gkogkos², N. Settembre⁴, T. Moussallem⁵, K. Perreas⁶,
L. Frimat⁴, P. Yared⁵, E. Menenakos⁶, J. Hubert⁴, M. Vasiloglou⁶,
S. Malikov⁴, R. Asmar³, D. Perrea², A. Benetos¹. ¹INSERM UMRS
1116, Université de Lorraine, Nancy, France; ²Laboratory for
Experimental Surgery and Surgical Research “N S Christeas”, University
of Athens, Greece; ³Foundation-Medical Research Institutes, Beirut,
Lebanon; ⁴CHRU de Nancy, Université de Lorraine, Nancy, France;
⁵Lebanese University, Faculty of Medical Sciences, Hadath, Lebanon;
⁶Medical School of Athens, National and Kapodistrian University of
Athens, Greece

**Introduction:** Short telomere length (TL) is associated with atherosclerotic cardiovascular diseases (ACVD) and increased mortality. Inflammation and oxidative stress are believed to play a key role in telomere attrition and could explain the association between short TL and ACVD. The objective was to measure TL in skeletal muscle (MTL), which serves as a proxy of TL at birth, and in leukocytes (LTL) in three situations of increased oxidative stress and inflammation: ACVD, severe renal failure (SRF: clearance<30 ml/min) and morbid obesity (MO: BMI>40 kg/m²). The LTL/MTL ratio represents life-long telomere attrition.

**Methods:** MTL and LTL were measured by Southern blot in samples from 158 individuals (42 women) undergoing surgery (France, n=71; Greece, n=52; and Lebanon, n=35). Four groups were enrolled: control (CTL, n=44), ACVD (n=62), SRF (n=47) and MO (n=34).

**Results:** In all subjects, MTL was longer than LTL. LTL and LTL/MTL were shorter in ACVD patients (p<0.01, p<0.05 respectively vs CTL). No differences were observed between the groups of MO and SRF and the CTL.

**Conclusions:** This study confirms the presence of shorter telomeres in ACVD patients. By contrast, in two other situations with high chronic oxidative stress and inflammation, TL and TL attrition were not affected. We suggest that shorter telomeres observed in subjects with atherosclerotic disease are not the result of increased

telomere attrition by oxidative stress and inflammation but might rather antecede the clinical manifestation of the disease.

## P-583
### The “Centre for Memory and Mobility” in Luxembourg – A comprehensive approach to prevent age-associated memory and mobility declines

E. Bourkel¹, C. Federspiel², J.-P. Steinmetz². ¹Centre for memory and mobility, Luxembourg; ²Centre for memory and mobility, Luxembourg; ZithaSenior, Research & Development, Luxembourg

The “Centre for Memory and Mobility” located in Luxembourg City opened its doors in September 2015 and addresses people aged 60 years and older. A team composed of medical doctors, physiotherapists, occupational therapists, psychologists and social workers provides primary and secondary preventive healthcare programmes. On the patient’s first visit, the medical background and social key parameters (e.g., living situation, dependency) are assessed in a personal counselling interview. In a second step, therapists assess general cognitive functioning, balance, strength, gait performances and vital parameters. The assessed information guides the individual composition of the suitable intervention programme (mobility and/or cognitive training) for each patient. Interventions generally consist of 6, 12 or 18 weeks lasting mobility and/or cognitive training programmes, which can be attended once or twice a week. Patients are evaluated weekly during multidisciplinary staff meetings. After completion of their individualized training programme, the therapists re-evaluate mobility and cognitive parameters and discuss the effects of the training as well as suitable further interventions with the patients. Individual physiotherapy, psychological or social counselling, and neuropsychological diagnostics complement the Centre’s healthcare offer. To date, 133 patients have completed cognitive and mobility training programmes with positive results (see Bourkel, Steinmetz & Federspiel, 2016; Federspiel, Bourkel & Steinmetz, 2016). With the present work, we demonstrate the necessity and more importantly, the feasibility of a highly qualified structured preventive healthcare offer.

## P-584
### The HATICE trial in France: focus on the recruitment from a prevention centre

N. Coley¹, J. Guillemont², F. Martin³, S. Andrieu¹. ¹INSERM, University of Toulouse UMR1027; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France; ²INSERM, University of Toulouse UMR1027, Toulouse, France; ³Ageing Well Prevention Centre Agirc/Arrco: Cedip, Toulouse, France

**Background:** The Healthy Ageing Through Internet Counselling in the Elderly (HATICE) trial aims to investigate whether a multi-domain internet intervention to optimise self-management of cardiovascular risk (CVR) factors can reduce the risk of cardiovascular disease, cognitive decline and dementia. The 18-month trial is intended for persons aged 65 and older with increased CVR. It runs in the Netherlands, Finland and France. In France, half of the 368 participants were recruited from a prevention centre (Cedip). We explored the recruitment process among this specific population and examined to what extent Internet is a barrier to participation.

**Methods:** In France, Cedip participants were recruited among beneficiaries aged 65 and older via 2 channels: 1. beneficiaries coming to Cedip for their prevention check-up were invited to participate in the HATICE trial if considered eligible; 2. a self-completion questionnaire to assess main eligibility criteria was sent to 6591 beneficiaries who had attended a prevention check-up since 2012; eligible persons were then invited by phone to participate in the trial.
**Results:** Among the 1027 persons preselected via channel 1, 82.2% were not eligible. Main reasons for non-eligibility were low CVR (60.1%) and Internet illiteracy (23.3%). In the 3359 questionnaires that were returned (response rate: 51.0%), non-eligibility was certain for 52.2%, of whom 83.4% had low CVR and 39.5% had insufficient Internet skills. Acceptation rates before prescreening was 55.9% in channel 1 and 56.0% in channel 2.

**Conclusions:** Internet was an important barrier to participation in the HATICE trial in France, though not the main one.

## P-585

### The influence of cognitive and mobility training programmes on cognitive functioning among healthy elderly people and people with MCI

E. Bourkel¹, G. Hubsch¹, C. Federspiel², J.-P. Steinmetz². ¹Centre for Memory and Mobility, Luxembourg; ²Centre for Memory and Mobility, Luxembourg; ZithaSenior, Research & Development, Luxembourg

Cognitive and mobility training have a positive influence on cognitive functioning both in healthy elderly people and in people with mild cognitive impairment. The aim of this study is to further clarify the effect of a 12 week mobility and/or cognitive intervention on cognitive performances in healthy elderly people and mildly cognitively impaired people. The mobility and cognitive training were both conducted in small groups (maximum eight participants) which were homogeneous concerning the participants' respective cognitive and mobility capacities. The participants attended the cognitive training sessions once a week and the mobility training sessions at least once a week. In the cognitive intervention, mainly attention, memory strategies, cognitive flexibility, and language were trained. The mobility intervention mainly focussed on the training of general mobility, balance, coordination, gait stability, endurance, muscular strength, torso muscles and spine flexibility. The participants (N=63, age range = 58-92 years) either partook (1) in only a cognitive training programme, (2) in only a mobility training programme, or (3) in a combination of a mobility and a cognitive programme. The participants' cognitive abilities were assessed before and after the training programmes. Cognitive screening and attention tests were used. The effects of the interventions in the three groups are compared. The discussion of the findings focuses on the effects of the interventions and highlights the importance of facilitating structured cognitive and mobility training programmes for both healthy elderly people and people with mild cognitive impairment.

## P-586

### The prevalence of xosis among older people living in the community and its influence on quality of life

J. Knasiene¹, V. Jievaltaite², M. Jaras². ¹Lithuanian University of Health Sciences, Academy of Medicine, Department of Geriatrics, Kaunas, Lithuania; ²Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania

**Introduction:** Xosis is one of the most common complaints of older people, often remains undiagnosed. Identification of risk factors and the most common clinical manifestations would help to timely recognize and treat xosis, and to avoid its influence on quality of life.

**Methods:** Analytical cross-sectional study was performed. Questionnaire survey of older people (n=83, age 69,26±3,98 years), living in the community, was conducted by using the original questionnaire, developed by researchers.

**Results:** 58.1% of all surveyed currently experience xosis with duration 8.29±6.373 months. A statistically significant risk factor for development of xosis was usage of statins (p=0,048). The respondents most often complained about dry skin in face (26.8%), palms

(20.6%), calves (18.6%), forearms (13.4%). 57.1% of the respondents complained about dry skin flaking, 51% - dry skin redness, 47.9% - dry skin cracks, 55.1%-dry itching skin, 22.4% - pain, 83.7% felt uncomfortable because of their skin. Dry skin disturbed in household chores for 30.6% of the respondents, influenced the choice of clothes (36.7%) and leisure activities (49%), disturbed sports activities for 28.6% of the respondents.

**Conclusions:** Xosis is prevalent among 58,1% of older people, living in the community. Usage of statins has statistically significant influence on appearance of xosis (p<0,05). Xosis is usually localized in the skin of face, back of the head, palms, calves, forearms. Flaking, redness, cracking, itching and pain occurs together with xosis. Xosis influences the choice of clothes, leisure time, sports, household chores. Older people feel uncomfortable because of xosis.

## P-587

### Trajectories of health-related quality of life (HRQoL) domains among older businessmen

A. Urtamo¹, K. Pitkälä¹, H. Kautiainen¹, T. Strandberg². ¹University of Helsinki, Department of General Practice and Primary Health Care, and Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland; ²University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland, and University of Oulu, Center for Life Course Health Research, Oulu, Finland

**Introduction:** Health-related quality of life (HRQoL) has been used to assess healthy and functional ageing. Previous studies indicate that the stability in the trajectory of good physical functioning is associated with an optimal ageing. However, the trajectories of other HRQoL domains are less clear. We studied these trajectories in a 15-year follow-up among older businessmen.

**Methods:** This is a longitudinal study of the Helsinki Businessmen Study (HBS) cohort (born in 1919-34). HRQoL was assessed with the RAND-36 (SF-36) instrument in the years 2000 (n=1871), 2003 (n=1273), 2007 (n=1043), 2010 (n=911), and 2015 (n=497). RAND-36 includes 8 domains: Physical functioning (PF), Role physical (RP), Vitality (VT), Mental health (MH), Role mental (RM), Social functioning (SF), Bodily pain (BP), and General health (GH). These domains can be further condensed to Physical component summary (PCS), and Mental component summary (MCS). The linearity and statistical significances were analysed using NCSS software.

**Results:** We found that the trajectory of PF, an indicator of mobility disability, decreased linearly with increasing age. In contrast to PF, the scores of other domains of HRQoL first remained similar or even increased between years 2000 and 2003, and decreased linearly first after that. Similar trends were seen in the summary scores PCS and MCS.

**Conclusions:** Our study reveals variations in the trajectories of HRQoL domains in old age, especially between PF and other domains. These differences should be considered when HRQoL is related to healthy and functional ageing, and when summary scores of HRQoL are used.

## P-588

### Transition to long-term care by the elderly - Evaluation of the phenomena in Central Portugal (a research protocol)

H. Neves¹, V. Parola¹, A. Coelho¹, E. Santos¹, J. Tavares¹, S. Pereira², M. Almeida³, S. Duarte³, A. Cavaleiro³, M. Cordeiro³, I. Gil³, J. Apóstolo¹. ¹Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal; Centre for Evidence-Based Practice: a Joanna Briggs Institute Centre of Excellence, Portugal; ²Nursing School of Coimbra, Portugal; ³Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal

**Introduction:** The number of elders in Long Term Care Facilities
(LTCF) has been increasing significantly. In 2014, over 75000 elders lived in LTCF in Portugal. It is known that the increase in life expectancy, impact of work obligations in family support, increased comorbidities, and self-care needs are some of the reasons for this need of change from home to LTCF. However there is a lack of knowledge about how this transition is experienced by this population, and the potential impact in their lives.

**Methods:** A qualitative study, based on Meleis' Transition Theory, will be carried out in ten LTCF in Central Portugal, in elderly without history of cognitive impairment, and willing to participate in the study. Data will be collected using individual semi-structured interviews, and content analysis will be performed.

**Results:** Data collected from the interviews will allow us to understand how the transition process occurred/is occurring, which factors influence this process and consequences in the life experiences of the elderly.

**Conclusions:** This research will provide insight of how the transition process is occurring in the elderly, allowing a better understanding of this phenomenon. It is expected that the data collected will potentially allow for the development of nursing interventions that may optimize the transition process.

## P-589
### Who uses exercise in later life?

E. Clift¹, H. Roberts², A. Sayer³, A. Rogers⁴. ¹Health Education England, NIHR CLAHRC, Wessex; ²Academic Geriatric Medicine University of Southampton, NIHR CLAHRC Wessex; ³Academic Geriatric Medicine University of Southampton, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University; ⁴NIHR CLAHRC Wessex, University of Southampton Health Sciences

**Introduction:** Living longer brings the challenge of ageing well. Enabling older people to increase exercise and activity can improve health and social outcomes, functional ability, engagement with local community resources and quality of life. A key challenge is to reverse the trend for older people who reduce their activity by 50% from age 60 to 85 and to promote exercise alongside everyday community living. This study explores the lived experience of older people and their exercise practice in one English city.

**Methods:** An ethnographically informed approach was used to understand the local contexts. We undertook focus groups, with participants in local exercise classes, and non-exercise participants. The data was enriched with field notes and observations of the classes. Further focus groups and 1:1 interviews were undertaken with exercise providers, clinicians and service commissioners.

**Results:** Key themes identified relate to the charisma and capability of the instructor to tailor exercise to individual needs, familiarity and accessibility of the group, and social engagement with fellow participants. Non-exercise participants articulated the process of dis-engagement as they grow older. Clinicians were unaware of local provision, and unable to signpost older people appropriately. Exercise providers struggled to access routine referral routes. Commissioners understood barriers, but were disconnected from aspirational opportunities and the lived experience of service users.

**Conclusions:** Understanding local context, culture and older people's priorities is key for engagement in exercise. Clinicians and providers should develop awareness of local opportunities and their value to older people, to increase referral options that are appropriate and acceptable.

## Area: Oral and dental health

## P-590
### Association of functioning and nutrition with oral health and hygiene among old home care clients

E. Tuuliainen¹, K. Autonen-Honkonen², A. Nihtilä³, K. Komulainen¹, I. Nykänen⁴, S. Hartikainen⁵, R. Ahonen⁶, M. Tiihonen⁷, L. Suominen³. ¹Institute of Dentistry, University of Eastern Finland, Kuopio, Finland; ²Institute of Dentistry, University of Eastern Finland, Kuopio, Finland, Public Health Center, Oral Health Care Services, City of Äänekoski, Finland; ³Institute of Dentistry, University of Eastern Finland, Kuopio, Finland, Department of Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland; ⁴Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; ⁵Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; ⁶School of Pharmacy, University of Eastern Finland, Kuopio, Finland; ⁷Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland

**Introduction:** Vulnerable older people living at home are at increased risk of compromised oral health and hygiene. The aim of this study was to describe oral health and hygiene in a group of old home care clients and investigate how functional ability and nutrition are associated with them.

**Methods:** This study is a part of a multidisciplinary intervention study of 269 home care clients aged ≥75 years, living in Eastern and Central Finland. The data was collected using structured interviews to measure ability to function in activities of daily living (ADL), instrumental activities of daily living (IADL), comorbidity (Functional Comorbidity Index, FCI), depression (Geriatric Depression Scale, GDS-15), cognitive function (Mini Mental State Examination, MMSE), nutritional status (Mini Nutritional Assessment, MNA) and numbers of drugs used. The study included an interview of oral health and clinical oral examination.

**Results:** The majority of participants were at least moderately dependent on support for activities of daily living (ADL). The participants had, on average, 8.4 teeth. Dental plaque was detected in 77%, bleeding on probing in 84% and dental caries in 30%. In multivariate analyses, low functioning in activities of daily living was statistically significantly associated with occurrence of dental plaque (OR =0.95, 95% CI: 0.9–1.0). Lower functional ability, lower numbers of remaining teeth and higher amount of plaque were associated with bleeding on probing.

**Conclusions:** The results of this study suggest that functional ability is on important determinant of oral health and hygiene among older home care clients.

## P-591
### Promoting oral health and oral hygiene in a geriatric nursing home - A pilot

I. Dolhaniuk, V. Moser-Siegmeth, C. Dorner, S. Hämmerle, A. Terzic, U. Tarnawski, D. Metzenbauer, C. Fida, M. Patsch. *Haus der Barmherzigkeit*

The number of older people having their own teeth is rising. According to studies, oral health (OH) has great impact on health. The aim of the project is to achieve the best possible oral and dental hygiene. It is designed as an intervention study and carried out in a nursing home for one year. At the beginning the oral health status of the residents (n=77) was assessed with a quantitative
questionnaire. Also a survey with the nursing staff (n=36) regarding OH knowledge and performance-rating was conducted. As inter- ventions we implemented a special OH-training for the nurses, utilised a guideline and offer professional dental hygiene. Results of the residents self-assessment show that 86% rate their OH as good. Less than 10% report difficulties while speaking or eating. Similar results can be found within the external assessment, where the majority (70–95%) was assessed as healthy. Within the nurse self-assessment, 67% rate their knowledge of oral care as good. Only 15% rated it as sufficient. Almost all respondents (94%) confirmed the importance of oral care. In order to improve the OH status, regular dental examinations, followed by trainings are stated. The results show a positive result both in the self-assessment and in the external assessment of the residents. On the part of the nurses, a high value towards the topic, as well as a consistently positive assessment of the abilities and the OH health status of the residents.

P-593

**Telemedicine and programmed oral surgery in a**
**Odontogeriatrics Program**

M.V. Mejía Ramírez de Arellano, B. Garmendia Prieto, C. Alcaraz López, P.R. Saenz, J. Gómez Pavón. HCCR. Hospital Central de la Cruz Roja, San José y Santa Adela. Madrid, Spain

**Introduction:** The objective is to define the development of our Odontogeriatrics program along last 2 Years.

**Methods:** 19 patients from our Institutionalised, Home Visiting and Acute Geriatrics care programs. Patients are checked by the dentist thanks to telemedicine and he chooses the treatment: programmed oral surgery in our hospital or in other one. We have included patients since 2015 to the present. We have collected socio-demographic, clinical, mental (Mental Red Cross -MRC-Index), functional (Physical Red Cross -PRC- and Barthel -BI- Indices), geriatric syndromes, polifarmacy (>6 drugs), comorbidity (Charlson Index), surgical risk (ASA Index), and surgical activity performed features.

**Results:** One patient was rejected due to a deep vein thrombosis. Final N=18 (84% women, mean age 83.84±7.32 years). Patients profile: 68% severely dependent (MRC 4–5), 53% moderate-severe dementia (MRC >3), 74% polypharmacy, 26% high comorbidity (Charlson >3) and 57.89% high surgical risk ASA IV). The most frequent treatment has been complete dental pieces extraction or root remains retained extraction which had had frequent infections (57.89%) or severe complications (26.31%). Mean surgical delay was 9.33 days. The most frequent surgical complication was hemorrhage (15.79%). Mean number of extracted dental pieces was 6.38 (range 2 to 13 pieces).

**Conclusions:** Severe functional and cognitive dependence, high polypharmacy, high comorbidity and high surgical risk patients are the most benefited from the odontogeriatrics program.

P-594

**The association of oral complaints with mental disorders in**
**older patients**

A. Kossioni¹, G. Kossionis². ¹School of Dentistry, National and ²"Dromokaition" Psychiatric Hospital, Attica, Greece

**Introduction:** Psychiatric diseases, and particularly depression, anxiety and personality disorders, as well as psychiatric medications, have been associated with various self-reported oral complaints. The aim of this study was to investigate any variation in subjective oral complaints between older people with and without mental disorders.

**Methods:** An interview was performed in a group of older patients with mental disorders, with a mean age of 71.9 years residing

in a psychogeriatric ward and in a group of dental school patients without mental disease with a mean age of 70.2 years. The patients with mental illness were diagnosed for mood disorders, psychotic disorders, dementia, and other mental diseases. Descriptive statistics were performed, and chi-square and Mann-Whitney tests investigated any significant variation between variables.

**Results:** The non-mentally ill patients suffered more frequently from hypertension and cardiopathy, but received fewer medications (P<0.05). The prevalence of xerostomia in patients with mental disorders was 46.7%, burning mouth 22.7%, oral malodor 21.3% and dysgeusia 25.4%. The prevalence of these symptoms in people without mental disorders was 33.8%, 0%, 10.8% and 2.7% respectively. The differences between groups were statistically significant: xerostomia (P=0.049), burning mouth (P≤0.001), oral malodor (P=0.028) and dysgeusia (P≤0.001).

**Conclusions:** Dysgeusia, burning mouth and oral malodor self-perceptions were more frequent in older people with mental diseases; therefore, their prognostic value requires further investigation. The variation in xerostomia complaints between groups was marginal, as people without mental illness also suffered from general diseases associated with xerostomia (ie. diabetes) or received xerostomic medications (ie. for hypertension).

P-595

**The effect of individually tailored dietary and oral health**
**counselling among older home care clients on xerostomia**

A. Nihtilä, K. Komulainen, E. Tuuliainen, I. Nykänen, S. Hartikainen, A.L. Suominen. Faculty of Health Sciences, University of Eastern Finland, Finland

**Introduction:** A subjective feeling of dry mouth (xerostomia) is common among older adults and affects their quality of life, nutrition and oral health. Medical conditions, polypharmacy and dehydration are often found behind xerostomia. The aim of this study was to examine the effectiveness of a tailored dietary and oral health intervention among home care clients aged 75 years or over.

**Methods:** This intervention study is part of a population-based Nutrition, Oral Health and Medication (NutOrMed) study. Intervention group comprised 141 patients (84,3±5,5 years) and control group 108 (84,6±5,8 years). Home care nurses, nutritionists, dental hygienists and pharmacists carried out in-home interviews before a tailored intervention. Individual counselling on dry mouth care was given to all those suffering occasionally or continuously from xerostomia (n=80, 56,8%) including advice on topical therapies. Nutritional intervention included instructions to all with malnutrition or at risk of malnutrition (MNA score <24, n=120, 86,8%) on increasing the number of meals and energy and protein intake as well as liquid intake. 91,2% (n=73) of those suffering from xerostomia received both interventions.

**Results:** In the intervention group xerostomia decreased (7,1%) and liquid intake (21,6%) and eating fruits or vegetables (10,0%) increased. In the control group xerostomia increased by 2,8%, liquid intake decreased (5,4%) and eating fruit and vegetables slightly increased (2,1%).

**Conclusions:** The interventions reduced xerostomia most likely due to dietary changes. Comprehensive management of xerostomia including nutritional advice is important as topical therapies alone are often not enough.
## Area: Pharmacology

### P-596
**AGITE – a medication self-management and adherence in the elderly questionnaire**

H. Neves¹, M. Almeida², S. Duarte², V. Parola¹, A. Coelho¹, I. Gil², J. Apóstolo¹. ¹Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal; Centre for Evidence-Based Practice: a Joanna Briggs Institute Centre of Excellence, Portugal; ²Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Portugal

**Introduction:** Complex medication regimes are a reality for many older adults (OA). This requires the use of inner competences to allow for higher levels of adherence and self-care-management regarding medication. Health professionals require knowledge of these self-management and adherence behaviors to optimize and improve quality-of-life. The use of a questionnaire could prove to be a tool that systematize data collection with impact in the offer adequate interventions.

**Methods:** A systematic review of literature was developed to obtain the main categories that influence medication adherence and self-management. Afterwards, a questionnaire with open-ended questions was administered to twenty OA. Content analysis was performed by a group of experts in the area, leading to the development of nineteen closed-ended questions with a Likert scale approach for the scaling of responses. The questionnaire was named AGITE. After application of the final questionnaire to 128 elders in day centers in Central Portugal, exploratory factorial analysis (EFA) and internal consistency (IC) were performed.

**Results:** From the EFA, using varimax rotation, three main dimensions emerged: "Engagement", "Neglect" and "External Influences". Higher scores of "Engagement" indicate a responsible attitude towards self-management and adherence, while higher scores of "Neglect" tendency to cease medication without professional advice. People with high scores of "External influences" tend to follow medication without assuming control of the process. Overall the questionnaire dimensions demonstrate questionable to acceptable IC (0,6<α<0,8).

**Conclusions:** AGITE requires further testing to understand its clinical validity and potential to aid in adapting nursing interventions to the self-management and adherence profile.

### P-597
**An approach towards internationalization and computerization of the FORTA (Fit for The Aged) list**

F. Pazan, M. Wehling. *Clinical Pharmacology, Medical Faculty Mannheim, Heidelberg University*

Older people are the main recipients of drugs in many regions of the world. Numerous studies have demonstrated that a large division of older people is the "target" of inappropriate drug therapy. The reason is that for most of the medications there is hardly any evidence regarding efficacy and safety in the elderly. Furthermore, the presence of multimorbidity and as a result polypharmacy aggravates this issue. To effectively address this problem and to increase the appropriateness and quality of drug treatment in older people, our group has developed a clinical tool called the FORTA List. Wehling originally created FORTA, and the FORTA List was validated by 20 experts in a Delphi consensus procedure and updated in 2016. In addition, we evaluated FORTA's utility in a pilot clinical trial and in a randomized controlled prospective trial. These two trials revealed that FORTA significantly (p<0.001) improves the quality of drug treatment, and even some secondary endpoints (e.g. total number of ADRs) of our studies were improved. Based on these results,

we conducted a consensus validation of country-specific FORTA Lists in the UK, France, Poland, Italy, Spain, Nordic countries and Netherlands. Here, we used a self-developed algorithm to select top experts in the field of geriatrics with high experience in clinical pharmacotherapy. 46 experts agreed to take part in our study. The results of this study will be used to develop a European FORTA List and an application (FORTA-App) which will help to increase its international and clinical applicability.

### P-598
**An audit of non steroidal anti-inflammatory drug (NSAID) prescribing to high risk patient populations**

L. Daly¹, M. O'Mahony². ¹Ballinasloe Specialist Training Scheme in General Practice, Ireland; ²Glasson Health Centre, Ireland

**Introduction:** NSAIDs are associated with known morbidity/morbidity, particularly in High Risk patient populations, such as the elderly. Prescribing should be both carefully considered and monitored. Studies have shown 1/3 of adverse drug reactions (ADRs) requiring hospital admission may be attributable to NSAIDs. This Audit assessed prescribing in an Irish General Practice, and compared results to a 2015 National Audit of NSAID prescribing performed in Wales (similar patient cohort). Data gathered included: Among patients receiving repeat prescriptions for NSAIDs:

* Percentage considered "High Risk" for an ADR, this included all patients aged over 65.

* Rate of PPI co prescription.

* Percentage that had an eGFR documented in their records.

**Methods:** Healthcare Software, SOCRATES, was used to collect data of patients who received more than one prescription for NSAIDs in the period 01/07/2015 to 01/07/2016. Data was analysed using Microsoft Excel and basic statistical analysis.

**Results:** 43 patients received more than one prescription for an NSAID. 60% of those had at least one factor that categorised them as "High Risk". 58% of patients had a PPI co-prescribed and 77% had a recorded eGFR. These figures were higher than those found in the All Wales National Audit (46 and 56% respectively).

**Conclusion:** The overall positive findings in this Audit are likely attributable to repeat prescribing being performed solely by one doctor. This shows how important continuity of care, and knowledge of patients, is to optimise prescribing practice in patients with multiple co morbidities, or who are at High Risk of an ADR.

### P-599
**Analysis of remaining Potentially Inappropriate Medications (PIM) after revaluation of drug prescriptions in geriatric unit**

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

**Introduction:** Revaluation of drug prescriptions in geriatric units leads to improve the quality of prescription with the decrease of the number of Potentially Inappropriate Medications (PIM). But even after revaluation by a multidisciplinary team, some PIM still remain in prescriptions. The aim of this study is to analyze the remaining PIM at discharge in a geriatric unit.

**Methods:** We performed a 4-month prospective study of drug prescriptions of patients hospitalized in a geriatric unit of our hospital. Patients with PIM in their prescription at admission and for whom medication conciliation at discharge was performed were included.

**Results:** A total of 35 patients were included. At admission, 273 drugs were prescribed and 96 PIM identified (median of 8 drugs and 2 PIM per patient). After revaluation, 31 of these PIM (32.3%) remained at discharge. Among these PIM, 15 were psychotropic drugs (12 benzodiazepines and 2 antidepressants, 1 neuroleptic with failure to withdrawal), 8 proton pump inhibitors (PPI), 6 antiplatelet agents (APA) with no evidence-based clinical indication
and 2 antihypertensive drugs in old fallers. Benzodiazepines had short half-life without withdrawal planned for all of them. PPI were continued for patients with concomitant anticoagulant or APA (n=6). APA were mainly kept for patients with cardiovascular history such as hypertension or arrhythmia (n=5). For all of these patients, explanations or guidance were rarely found in hospitalization reports.

**Conclusions:** Most of PIM are stopped but the benefit-risk balance of the remaining PIM is most of the time difficult to evaluate. Their pursuit has to be justified and their future communicated to general practitioners.

## P-600

### Anticholinergic burden – A review of available scales and associated outcomes

T.J. Welsh¹, V. Van de Wardt², A.L. Gordon³, J.R.F. Gladman⁴.

¹Research Institute for the Care of Older People; Royal United Hospital Bath NHS Foundation Trust; University of Bristol; ²University of Nottingham; ³University of Nottingham; Derby Teaching Hospitals NHS Foundation Trust; ⁴University of Nottingham; Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands; NIHR Nottingham Biomedical Research Centre

**Introduction:** Cumulative anticholinergic exposure (anticholinergic burden) is associated with a number of adverse outcomes. An agreed approach to describing anticholinergic burden is needed in order to conduct research in this area. This review reports the results of a systematic approach to identify anticholinergic burden scales, the context in which they have been used and the outcomes linked with them.

**Methods:** The Medline, Embase, CINAHL and PsycINFO databases were searched for systematic reviews describing the use of anticholinergic burden scales. Abstracts and titles were then reviewed with eligible articles read in full. The final selection of studies was then analysed and appraised.

**Results:** Five reviews were identified for analysis which described 18 anticholinergic burden scales. Comparison of these scales showed variation in their derivation, content and quantification of anticholinergic activity. The Anticholinergic Risk Scale was used more frequently in care homes and hospital settings while the Drug Burden Index was the most commonly used scale in community and database studies. Association between anticholinergic burden and outcomes varied by scale and study - falls and hospitalisation were consistently found to associate with anticholinergic burden while mortality, delirium, physical function and cognition were not.

**Conclusions:** Anticholinergic burden scales vary in their derivation, content and association with outcomes. This review has shown that the concept of anticholinergic burden has been variably described and inconsistently defined using a number of scales with different content and quantification. The association between adverse outcomes and anticholinergic burden varies between indices and has not been conclusively established.

## P-601

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

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

**Background:** Antidepressants (ATDs) are a useful therapeutic tool in late-life depression and prescribed off-label for pain or sleep disturbances. They are frequently used in the elderly, but balancing the risks and benefits in these patients is challenging. The safety profiles of individual ATDs need to be considered in combination with the patients' risk profiles. However, patient populations have hardly been described in this regard.

**Objective:** This study aimed to assess patient characteristics, use of individual ATDs, co-medications and pre-existing diagnoses relevant to potential adverse events in elderly users of ATDs.

**Methods:** Population-based cohort study of elderly aged ≥65 years with a first prescription for an ATD during 2005–2014, based on claims data of the German Pharmacoepidemiological Research Database (GePaRD). Pre-existing diagnoses and co-medications were assessed any time before starting treatment.

**Results:** The cohort included 763,723 new users of ATDs (69.5% women, median age 73 years; interquartile range (IQR): 68–79). Treatment was most frequently started with Amitriptyline (19.9%), Citalopram and Opipramol (16.0%), Mirtazapine (15.2%), Doxepin (8.1%). Before starting treatment, patients took a median of 7 (IQR: 4–10) differ**Results:** The cohort included 763,723 new users of ATDs (69.5% women, median age 73 years; interquartile range (IQR): 68–79). Treatment was most frequently started with Amitriptyline (19.9%), Citalopram and Opipramol (16.0%) Mirtazapine (15.2%), Doxepin (8.1%). Before starting treatment, patients took a median of 7 (IQR: 4–10) different medications, 51.1% had Charlson Comorbidity index >2, 49% prior cardio- and 34.3% cerebro-vascular disease, 79.7% hypertension, 31.1% diabetes, 7.5% prior hip fracture.

**Conclusions:** Risk factors for adverse outcomes, co-morbidity and co-medications were common. This highlights the need for a careful risk-benefit assessment and the consideration of the individual agents' safety profiles when prescribing ATDs in the elderly, ent medications, 51.1% had Charlson Comorbidity index >2, 49% prior cardio- and 34.3% cerebro-vascular disease, 79.7% hypertension, 31.1% diabetes, 7.5% prior hip fracture.

**Conclusions:** Risk factors for adverse outcomes, co-morbidity and co-medications were common. This highlights the need for a careful risk-benefit assessment and the consideration of the individual agents' safety profiles when prescribing ATDs in the elderly.

## P-602

### Bone mineral density changes in postmenopausal women after a 2-year treatment course of bisphosphonates

D. Sladkeviciene, A. Mastaviciute, M. Tamulaitiene, V. Alekna. Vilnius University, Faculty of Medicine, Vilnius, Lithuania

**Introduction:** Osteoporosis is a disease characterized by a loss of bone mass with alterations of the bone tissue's microarchitecture resulting increased bone fragility and risk of fracture. Bisphosphonates are the most commonly used agents for osteoporosis.

**Methods:** A retrospective cross-sectional study was performed in The National Osteoporosis Center based in Vilnius and included 47 women aged 51 years and older. Exclusion criteria were malignancies, secondary osteoporosis. Written informed consent was obtained from each participant. DXA was used to measure hip and lumbar bone mineral density (BMD) (iDXA, GE Lunar, USA). BMD was measured twice: at the beginning of treatment and after 2 years ± 6 months. All participants answered face-to-face questionnaires addressing medications use after 2 years ± 6 months.

**Results:** The total of 47 postmenopausal women were investigated in the first visit: the youngest was 51 years and the oldest was 84 years old and the average BMD was 0.781 g/cm³ ±0.0131. In the second visit was measured BMD after 2 years use of bisphosphonate treatment course and the average BMD was 0.84 g/cm³ ±0.082. There was a significant difference between the first test and the second test results (p<0.001). Hip BMD for 32 of 47 women was measured above the least significant change (5%) and the mean was 13.59%.

**Conclusions:** The preliminary data of our study showed BMD statistical significant changes after two years of bisphosphonates treatment.
P-603

**Cerebrovascular accident related to the use of tranexamic acid:**
**A case report**

L. Maljean, P. Gibert, C. Brun, A. Grevy, G. Gavazzi. CHU Grenoble Alpes

**Introduction:** Tranexamic acid is an old drug (1986) mainly used in first intention for menorrhagia. It was recently reassessed by French Haute Autorité de Santé who suggests that it represents a high medical benefit. However, no study was performed in the older population. We report the case of a 91 years old woman, who was hospitalized for a stroke few weeks after the prescription of tranexamic acid for menorrhagia (500mg three times per day) in a context of uterine tumor.

**Discussion:** Thromboembolic event is a known but rare side effect of this drug (0.01 to 0.1%). Before prescribing tranexamic acid, prescribers have to ensure the absence of thromboembolic risk factors before using it. However, older patients often are at high risk of thromboembolic factor, age itself being a risk factor. This patient already had 4 risks factors and had aspirin as cardiovascular prevention. Aspirin could have been stopped before trying the use of tranexamic acid. Another issue is the adaptation of the drug dosage to renal function. According to the legal mentions, the dosage must be adapted depending on the serum creatinine values and not on the renal clearance as it is usually recommended in this population.

**Conclusion:** For these reasons, prescribers should very carefully think and reject all other option before the use of tranexamic acid in older individuals.

P-604

**Comparison of drug therapy on nursing home admission and at six months with the application of STOPP/START criteria version 2**

S.H. Sveinsson¹, P. Gunnarsson¹, O. Samuelsson², H. Hansdottir³,
A. Gudmundsson². ¹University of Iceland Pharmacology Department,
Reykjavik, Iceland; ²University Hospital of Iceland Geriatric
Department, Reykjavik, Iceland; ³Mörk Nursing Home, Reykjavik,
Iceland

**Introduction:** Nursing home residents are frail with multiple co-morbidities requiring the use of many drugs, increasing the risk of potentially inappropriate prescribing. The STOPP/START criteria were developed to identify such errors, where STOPP detects potentially inappropriate medications (PIMs) and START potential prescribing omissions (PPOs). The aim of the study was to evaluate drug therapy in two nursing homes in Reykjavik, with the application of the STOPP/START (version 2) criteria, on admission and at six months.

**Methods:** The study was retrospective. Included were residents admitted after January 1, 2013 that remained in the nursing homes for at least six months. Data collected included information about drug therapy, diagnosis, selected blood laboratory values and the resident's state of health according to selected Resident Assessment Instrument (RAI) variables.

**Results:** In nursing home A (n=88), the prevalence of residents with PIM were 94.3% both on admission and at six months, and the proportion of PIMs per total number of medications were 28.2% and 27.3%, respectively. In nursing home B (n=55), the prevalence of residents with PIM on admission and at six months were 90.9% and 96.4%, respectively, and the proportion of PIMs per total number of medications were 30.3% and 36.8%, respectively. The number of medications and PIMs were positively correlated at both time points in nursing homes A and B. Cognitive impairment was negatively correlated with the number of PIMs at six months in nursing home A and on admission in nursing home B. In nursing home A, the

prevalence of residents with PPO on admission and at six months were 73.9% and 68.2%, respectively, and in nursing home B, 85.5% and 90.9%, respectively. The most common STOPP criteria used was not a registered indication.

**Conclusion:** According to STOPP/START both PIMs and PPOs were highly prevalent both on admission and at six months in both nursing homes. Inadequate documentation of diagnoses was common. Better documentation and regular medication reviews using STOPP/START criteria, could be useful to reduce the high prevalence PIMs.

P-605

**Comparison of three score methods for predicting the risk of adverse drug reaction in older people in intermediate term care institutions**

P. Amoros¹, L. Puerta¹, A. Agustí¹, B. Llagostera¹, C. Mestres²,
M. Hernandez³. ¹Pharmacist Grup Mutuam, Barcelona, Spain; ²Dean
Facultat de Ciències de la Salut Blanquerna (Univeristat Ramon Llull),
Barcelona, Spain; ³Pharmacy Director Grup Mutuam, Barcelona, Spain

**Introduction:** In the last years, different risk scores to evaluate the risk of adverse drug reactions (ADR) in geriatric patients have been proposed. The risk screening is an important tool for pharmacists working in long term care institutions, in order to focus their interventions. We have assessed different tools to determine which will be more appropriate in our setting.

**Methods/Setting:** Three intermediate long term care institutions.

**Design:** Observational cross-sectional study. GerontoNet, BADRI and ADE Geriatric Risk Score, were applied using the electronic clinical record to all inpatients. Palliative patients were excluded. Data were recorded and evaluated using Microsoft Excel 2013®.

**Results:** A total of 248 patients were included. GerontoNet: 5 (medium level of risk) was the most frequent score. Items of comorbidities and ≥8 drugs were the most habitual. BADRI: Scores 1, 2 and 3 had similar frequency (low-medium risk). Comorbidities and length of stay ≥12 days were those most prevalent. ADE Geriatric Risk Score: The higher frequency was in the range 2–5 score (medium risk). Use of anticoagulants since <3 months and 7–9 of drugs were the predominant risk factors.

**Conclusions:** The three methods gave results of medium risk of ADR in our patients. Comorbidities and a high number of drugs are determinant factors, been always present in our patients. In our setting GerontoNet had limitations due to search for previous ADR information. A prospective study will be managed using BADRI and ADE Geriatric Risk Score.

P-606

**Computerised medication analysis designed to minimise inappropriate prescribing in older hospitalised patients: a systematic review**

K. Dalton¹, G. O'Brien¹, D. O'Mahony², S. Byrne¹. ¹School of
Pharmacy, University College Cork, Cork, Ireland; ²Department of
Geriatric Medicine, Cork University Hospital, Cork, Ireland and School
of Medicine, University College Cork, Cork, Ireland

**Introduction:** Prescribing medications for complex multi-morbid older patients is a challenging process. Computerised interventions have been suggested as an effective strategy to reduce potentially inappropriate prescribing (PIP) in this patient group. This systematic review examined the evidence of efficacy of computerised interventions designed to reduce PIP in hospitalised older adults.

**Methods:** A comprehensive electronic literature search was conducted using 8 databases from inception to end of March 2017. Studies were included if they were controlled trials (randomised or non-randomised) of computerised interventions which aimed to reduce PIP in hospitalised older adults (≥65 years).
**Results:** A total of 594 records were identified after duplicates were removed. Eight studies met the inclusion criteria - two randomised controlled trials, two interrupted time series studies, and four pre/post intervention studies. Studies were mostly at a low risk of bias. The acceptance rates of computer-generated recommendations ranged from 29% to 95% in the studies that assessed this outcome. The majority of studies showed either a significant reduction in the proportion of patients prescribed a potentially inappropriate medicine (PIM), or a reduction in PIMs ordered compared to control patients (p<0.05).

**Conclusions:** This systematic review concludes that computerised medication review interventions are associated with a significant reduction in PIP in hospitalised older adults. However, the majority of included studies only focused on a limited number of PIMs. Further studies are required that utilise robust validated software engines capable of targeting a wider range of PIP instances, and that can result in clinically significant improvements in patient outcomes.

## P-607

### Consensus validation of the POSAMINO (Potentially Serious Alcohol Medication Interactions in Older adults) criteria

A. Holton¹, P. Gallagher¹, C. Ryan¹, T. Fahey², G. Cousins¹. ¹School of Pharmacy, Royal College of Surgeons, 111 St Stephen's Green, Dublin 2, Ireland; ²HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland

**Objectives:** Older adults experience a disproportionate burden of alcohol-related harm. [1] Our objective was to develop an explicit list of potentially serious alcohol-medication interactions for use in older adults.

**Methods:** A systematic review, supplemented by a review of drug compendia and clinical guidance documents, was conducted to identify medications with the potential to interact with alcohol. The Project Steering Group (PSG) reviewed each criterion, resulting in an inventory of 52 potentially serious alcohol-medication interactions. BNF black dot warnings (n=8) were included in the final criteria as they represent "potentially serious" interactions. The remaining 44 criteria underwent a two-round Delphi process using an expert panel of 19 healthcare professionals from the UK and Ireland. Using an online questionnaire, panellists were asked to rate their agreement with each criterion, using a 5-point likert scale. Consensus was determined using the median response, interquartile range and comments.

**Results:** Thirteen criteria were accepted in round one. Following a review of comments, nine criteria were removed and eight additional criteria were developed for the second round. The remaining 30 criteria went to round-two, with 17 criteria reaching consensus, providing a final list of 38 potentially serious alcohol-medication interactions; central nervous system (n=15), cardiovascular (n=9), endocrine (n=5), musculoskeletal (n=3), infections (n=3), malignant disease and immunosuppression (n=2) and respiratory system (n=1).

**Conclusions:** POSAMINO is the first set of explicit potentially serious alcohol-medication interactions for use in older adults. These criteria will facilitate the risk stratification of older adults at the point of prescribing.

### References:

[1] Wadd S, Papadopoulos C. Drinking behaviour and alcohol-related harm amongst older adults: analysis of existing UK datasets. BMC Res. Notes. 2014;7:741.

## P-608

### Cooperation between geriatricians and general practitioners for improved pharmacotherapy in home-dwelling elderly people receiving polypharmacy - the COOP Study: study protocol

R. Romskaug¹, T.B. Wyller¹, E. Molden², J. Straand³, H. Kersten⁴, E. Skovlund⁵, K.H. Pitkälä⁶. ¹Department of Geriatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; ²School of Pharmacy, University of Oslo, Oslo, Norway and Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; ³Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway; ⁴Department of Research and Development, Telemark Hospital Trust, Tønsberg, Norway and School of Pharmacy, University of Oslo, Oslo, Norway and Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; ⁵Department of Public Health and General Practice, NTNU, Trondheim, Norway and Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; ⁶Department of General Practice, University of Helsinki, Helsinki, Finland and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland

**Background:** Polypharmacy and inappropriate drug use is associated with negative health outcomes among older people. Various interventions for improving drug treatment have been evaluated, but the majority of studies are limited by the use of surrogate outcomes or sub-optimal design. Thus, the potential for clinically significant improvements from different interventions is still unclear. The main objective of this study is therefore to evaluate the effect upon patient relevant endpoints of a cooperation between geriatricians and general practitioners on complex drug regimens in home-dwelling elderly people.

**Methods:** This is a cluster randomised, controlled trial where general practitioners participate with patients from their lists. The patients must be 70 years or older, use at least seven different medications and have their medications administered by the home nursing service. We plan to recruit 200 patients, with randomisation at physician level. The intervention consists of three parts: 1) geriatric assessment of the patient, combined with a thorough review of their medications; 2) a meeting between the geriatrician and general practitioner, where the two physicians combine their competence and knowledge and discuss the drug list systematically; 3) clinical follow-up, depending on the medication changes that have been done. The patients are assessed at baseline, 16 and 24 weeks, and the primary outcome measure is health-related quality of life according to the 15D instrument.

**Discussion:** Our choice of patient relevant outcome measures will hopefully provide new knowledge on the potential for clinical improvements after performing comprehensive medication reviews in home-dwelling elderly people receiving polypharmacy.

## P-609

### Development of national guidelines on the practice of crushing and/or opening solid dosage forms

L. Bernard¹, A. Lepelletier², C. Bezel³, M. Dambrine⁴, C. Devos⁵, E. Divoux⁶, J. Doucet⁷, P. Gibert⁸, M. Legrand⁹, D. Monzat¹⁰, R. Puech¹¹, R. Ratiney¹², E. Rémy¹⁰, H. Richard¹³, J. Rocquain¹⁴, A. Terrier-Lenglet¹⁵, R. Varin¹⁶, P. Cestac¹⁷, C. Mouchoux¹⁸. ¹Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, Clermont-Ferrand, France; ²Service Pharmacie, Hôtel-Dieu (site PTMC), CHU de Nantes, Nantes, France; ³CH Le Vigan, Pharmacie, Le Vigan, France; ⁴Institut de Pharmacie, CHRU de Lille, Lille, France; ⁵CH Armentières, Service Pharmacie, Armentières, France; ⁶Service Pharmacie, Centre Hospitalier de Lunéville, Luneville, France; ⁷Département de médecine interne-gériatrie-thérapeutique, CHU de Rouen, Rouen, France; ⁸Pôle Pharmacie, CHU de Grenoble, Grenoble, France; ⁹CHU Reims, Pôle Pharmacie Pharmacovigilance,
Reims, France; ¹⁰OMédIT Haute-Normandie, CHU de Rouen, Rouen, France; ¹¹Service Pharmacie, CH Lamballe, Groupe Hospitalier Gériatrique du Penthievre, Lamballe, France; ¹²Service Pharmacie, Hôpital Renê-Muret, Sevran, France; ¹³Pôle Pharmacie CHU Carêmeau, Nîmes, France; ¹⁴CH Aubagne, Pôle Pharmacie, Aubagne, France; ¹⁵CHU Amiens, Pharmacie, Amiens, France; ¹⁶Pôle Pharmacie, Hôpital Charles-Nicolle, CHU de Rouen, Rouen, France; ¹⁷Pôle Pharmacie CHU de Toulouse, Toulouse, France; ¹⁸Pharmacie, Hôpital des Charpennes, Hospices civils de Lyon, Villeurbanne, France

**Introduction:** Many elderly patients are unable to swallow tablets or capsules in their original form. Therefore, there is a growing practice of crushing or opening these medications in order to ease their administration to patients. However, this practice is at risk of drug inefficacy or toxicity for both the patients or the nursing staffs. In the absence of widely available and consensual guidelines, we developed harmonized national guidelines for the practice of crushing tablets or opening capsules for oral administration.

**Methods:** The Gerontology Study Group of the French Society for Clinical Pharmacy (SFPC), defined the guidelines specifications for each medication (drug name, dosage form, recommendation of opening or crushing. The data was collected from medication databases and pharmaceutical companies, and pooled in a standardized grid which was reviewed and validated by the group.

**Results:** This guideline was first published in the form of a simple electronic tool widely accessible via the SFPC web site (http://sfpc.eu/fr/) and easy to use by health-care professionals. It includes 3 parts: (1) an instruction manual on how to find and read data about the desired drug, (2) general good practices for the preparation and the administration of crushed medications, and (3) the entire list of chemicals along with information about the possibility of crushing or opening. Secondly, the guide was optimized into a dynamic database for easier and more efficient use.

**Conclusions:** The guide developed by our working group is a simple, accessible and dynamic tool, suitable for current practice. It integrates well with the management of elderly patients' medical care.

## P-610

### Differences between drugs related problems in aged and middle-aged patients: analysis of pharmacists medication order review during 8 years

F. Gervais, T. Novais, J. Bonhomme, L. Bourguignon, B. Charpiat, C. Darcissac, S. Dini, X. Dode, S. Goutelle, B. Mandy, L. Malet, S. Parat, C. Pivot, C. Mouchoux. GT "Pharmacie clinique adaptée à la personne âgée", *Hospices Civils de Lyon, Lyon, France*

**Introduction:** Involvement of clinical pharmacists to identify and correct Drugs Related Problems (DRP) through pharmaceutical interventions (PI) is supported by literature, underlying positive patient outcomes and improvement of care. Identifying specific DRPs and PIs occurring in aged patients compared to middle-aged patients should help to better manage at-risk patients. This study aimed to analyses differences in DRPs during medication order review between patients aged ≥75 and patients aged 18–75.

**Methods:** A retrospective analysis on DRPs documented at the French university hospital of Lyon - 8 hospitals - into a dedicated module of the French Society of Clinical Pharmacy website (Act-IP®), was conducted from beginning of 2008 to end of 2015.

**Results:** A total of 56241 DRPs were registered: 19071 among aged patient and 37170 among patient aged 18–75. A supratherapeutic dosage of benzodiazepines (4.03%) was the most frequent DRP in aged people. Compared to middle-aged, aged patients were, in particular, significantly associated with 1) type of DRPs: Non Conformity of the drug choice to guidelines (OR=1.693, 95% CI [1.520–1.887]), adverse drug reaction (OR=1.532, 95% CI [1.408–1.667]); 2) drug class: Cardiac therapy (OR=5.257, 95% CI [3.404–8.119]), Antithrombotic agents (OR=3.059, 95% [2.003–4.671]).

**Conclusion:** The medication review by pharmacists allows detecting DRPs effectively. This study highlights some directions that could be taken to improve prevention of DRP among aged patients: specific training to medical team, targeted information on safe drug use and a closer collaboration between physicians and pharmacists.

## P-611

### Do the recommended doses of drugs depend on the equation used to estimate glomerular filtration rate in acute geriatric care units?

F. Guerville, S. Duc, C. Roubaud-Baudron, N. Salles, I. Bourdel-Marchasson, M. Rainfray. *Gerontology Department, Bordeaux University Hospital, Bordeaux, France*

**Introduction:** There is no consensus about the most appropriate equation for estimated glomerular filtration rate (eGFR) in the elderly, especially for drug dose adjustment. In those patients, the agreement is low between Cockcroft-Gault equation eGFR (eGFR-CG) and Chronic Kidney Disease Epidemiology Collaboration equation eGFR (eGFR-CKDEPI). In a geriatric population, we investigated the proportion and characteristics of patients receiving drugs whose recommended prescription differs according to the equation used to estimate GFR, and the drugs involved.

**Methods:** Patients admitted in acute geriatric care units of our hospital were retrospectively screened. Drugs prescribed during hospitalization were recorded. Doses and contra-indications recommended according to adjustment on eGFR-CG and eGFR-CKDEPI were compared.

**Results:** Among 100 patients included, 31% received at least one drug with a recommended prescription discordance: 20% received at least one drug whose recommended dose was different between eGFR-CG or eGFR-CKDEPI adjustment, 4% received a drug with a relative contra-indication according to only eGFR-CG or eGFR-CKDEPI, 7% received both. Recommended prescription discordance was independently associated with an older age and a lower weight. Main drugs involved were benzodiazepines, anticoagulants and anti-infective drugs, prescribed to respectively 17%, 13% and 7% patients.

**Conclusions:** In this acute geriatric care units population, drug recommended dose adjustment was frequently discordant according to the equation used to estimate GFR, especially for benzodiazepines, anticoagulants and anti-infective drugs. Cautious prescription is needed in very elderly, thin patients. Further prospective studies are needed to improve guidelines for drug dose adjustment to kidney function in older patients, focusing on those therapeutic categories.

## P-612

### Drug induced erythroderma: A case report

S. Ponnambath, A. Miller, S. Helliar, R. Hinton, F. Rickard, A. Manley, L. Jefferson. *University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom*

**Case report:** A 89 year old man of Chinese origin was admitted with fever, poor mobility, severe, widespread skin rash and generalised pain. His past medical history included hypertension, COPD, chronic kidney disease and gout diagnosed several months previously and treated with allopurinol. His other medications included furosemide, lansoprazole and bisoprolol. On examination he had a widespread, erythematous, desquamating rash from head to toe. Blood tests revealed acute kidney injury with raised inflammatory markers. The working diagnosis was erythrodermic rash probably secondary to allopurinol, sepsis of unclear source and acute kidney