European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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Conclusions: Preliminary results suggest that the interRAI ED screener
can be used to rule out some of the outcomes. Further validation is
necessary to determine whether this instrument can be used in
clinical care.
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Anemia in older adults: it warrants further investigation
C. Jansson-Knodell 1, S. Collins1. 1Mayo Clinic, Rochester, MN, USA
Introduction: Care process models are evidence-based algorithms
used in clinical practice that can be instrumental in diagnosis and
disease management. They can be an effective way to provide cost-
effective care while not missing important diagnoses in the geriatric
population. This project chronicles the workup of anemia using a care
process model, which provides a definitive diagnosis and saves health
care expenses.
Methods: The utility of the anemia care process model is viewed
through the lens of a case: A 73-year-old female with a history of
atrial fibrillation on chronic anticoagulation with warfarin presented
without symptoms or concerns for a yearly physical. History revealed
no melena, hematochezia or blood donation. Physical exam was
unremarkable. Labs showed hemoglobin of 11.5 with an MCV of 101.7.
In elderly adults, these lab values merit further study.
Results: The stepwise workup included review of medication list
and alcohol history prior to confirming the finding with a repeat CBC
costing $251.19. The second tier of labs revealed normal peripheral
smear, reticulocyte count, vitamin B12 and folate, pernicious anemia
cascade, hemolysis labs, SPEP, UPEP, creatinine, TSH and liver function
tests costing $350. Bone marrow biopsy was pursued as the next
step costing $799.81; results were consistent with Myelodysplastic
Syndrome (MDS).
Conclusion: Anemia in the elderly warrants further investigation.
MDS is a condition that disproportionately affects older individuals
and should be in the differential diagnosis for macrocytic anemia. The
use of a care process model can facilitate a thorough, yet cost-effective
workup and improve detection of MDS.
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Need for dysphagia screening among elderly patients hospitalized
in a geriatric ward – a retrospective study
A. Kasiukiewicz1,2, K. Klimiuk2, B. Kuprjanowicz 1,2, B. Bien1,2,
Z.B. Wojszel 1,2. 1Department of Geriatrics, Medical University of
Bialystok, 2Department of Geriatrics, Hospital of the Ministry of the
Interior in Bialystok, Poland
Objectives: The aim of the study was to evaluate the prevalence and
determinants of swallowing problems among elderly patients hospi-
talized in the geriatric ward.
Methods: 427 patients aged 60 years or older were hospitalized in the
department during the period September 1st. 2015 – April 30th. 2016.
– 78% women; 85% of people 75 year old and older; average age-
81,6 ± 6,75 years. On the first day after admission the patients were
asked if they had any problems with chewing/swallowing food.
The evaluation of nutritional status (MNA Short Form, calf circumfer-
ence and laboratory tests), functional status and comorbidities was
conducted, based on medical records and scales used in comprehen-
sive geriatric assessment.
Results: The information on swallowing difficulties was available in
372 cases (87,12% of study population). 113 patients (30,4%) confirmed
problems with chewing or swallowing food. These patients were more
likely to have the risk of malnutrition (58,4% vs. 43,3%), reported
weight loss in the last year (20,7% vs. 17,2%) and were more frail.
Swallowing problems were reported by 45,8% of patients with
Parkinson ’s disease, 35,4% with the history of stroke, 33,3% treated
with neuroleptics, and 29,2% with dementia [MMSE – 16,5 (13–19), in
15,9% of cases it was not possible to obtain the information].
Conclusions: Dysphagia is a frequent problem in geriatric patients,
especially those with neurologic disturbances, and is associated with
the higher risk of malnutrition and frailty. Therefore it should be
treated as a geriatric syndrome and all elderly patients should be
evaluated for its prevalence.
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Fall risk factors in frail geriatric patients: how can we optimize fall
risk assessment?
L.H.J. Kikkert1,2, M. de Groot1, J.P. van Campen3, J.H. Beijnen4,
T. Hortobágyi1, N. Vuillerme2,5 , C.J.C. Lamoth1. 1University of Groningen,
University Medical Center Groningen, Center for Human Movement
Sciences, A. Deusinglaan 1, 9700 AD Groningen, The Netherlands; 2Univ.
Grenoble Alpes, EA AGEIS, La Tronche, France; 3Department of Geriatric
Medicine, MC Slotervaart Hospital, Amsterdam, The Netherlands;
4Department of Pharmacy, MC Slotervaart Hospital, 5Institut
Universitaire de France, Paris, France
Introduction: The burden associated with falling necessitates the
identification of fall risk factors that interventions could target.
Because frail geriatric patients often present with multiple impair-
ments caused by age and/or pathology, fall risk assessment remains a
challenging and complex process. Here, we modelled modifiable fall
risk factors, in which we hypothesize an increase in fall classification
accuracy.
Methods: 61 patients (mean age 79 ± 5.0 and mean MMSE 23.5 ± 4.2)
underwent extensive screening for: (1) Frailty (e.g., handgrip, thoracic
kyphosis, medication use), (2) Cognitive function (global cognition,
memory, executive function), and (3) Gait performance (stride-related
and dynamic outcomes assessed by tri-axial accelerometry). To
determine underlying properties of the gait pattern, a factor analysis
was performed on 11 gait variables. Partial Least Square– Discriminant
Analysis was used to build three classification models in which frailty-
related factors were supplemented with cognitive function and gait
performance.
Results: Factor analysis revealed a “pace”, “variability”, and “coordin-
ation” factor. Classification accuracy increased when cognitive vari-
ables and the extracted gait factors were added to frailty-related
variables (AUC = 93%). In particular, executive function, gait variability,
and gait coordination considerably increased specificity from 60% to
80%.
Key conclusions: Frail geriatric patients require a multifactorial fall
risk assessment. Although slow gait can classify fallers, preserved
executive function and gait quality can also characterize non-fallers
and in combination increase accuracy of identification of those who
might fall. We anticipate that individualized interventions could most
effectively modify fall risk factors in frail geriatric patients.
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“But I’m not a Geriatrician!” incorporating frailty assessment into
every encounter in the Emergency Department
L.K. Beales. ScHARR (School of Health and Related Research), University of
Sheffield, England, UK
Introduction: 24% of UK hospital trusts contain a dedicated geriatric
team in the Emergency Department(ED) [1]. The British Geriatric
Society has recommended use of “Comprehensive Geriatric
Assessment” (CGA) [2]. CGA is a challenge in a time-limited ED as a
Multi-Disciplinary Team(MDT) review is required. The use of frailty
assessment within EDs is not yet comprehensively evaluated or
utilised across the UK.
Methods: The methods and outcomes of CGA within EDs were
evaluated through systematic review of published literature via use of
search terms in OVIDMEDLINE, EMBASE, Cochrane Library (Inception-
December 2015). In total 318 articles fulfilled search criteria. 38 were
initially reviewed. Outcome effects were described by Odds or Risk
Ratios.
Results: Nine articles were included in final review [3–11]. CGA
included identification via nurse triage, occupational therapist and
physiotherapist review and MDT assessment (within ED or referral to
community). Benefit was seen with reduction in recurrent falls (OR
0.39 95% CI 0.23–0.66) [5], re-attendance (OR 0.6 95% CI 0.35– 1.05) [5]
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S96