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

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How best to deliver Comprehensive Geriatric Assessment (CGA) in
hospital: an umbrella review
P. McCue 1, A. McLeod1, S. Conroy2, H.C. Roberts3, S. Kennedy4,
S.G. Parker1. 1Newcastle University, 2Leicester University, 3University of
Southampton, 4University of Sheffield University, UK
Introduction: The aims of this umbrella review were to define key
elements, principal outcomes and beneficiaries of CGA in hospital
settings.
Methods: The protocol has been published elsewhere [1]. We searched
the Cochrane Database of Systematic Reviews, Database of Abstracts
of Reviews and Effects (DARE), MEDLINE and EMBASE. We selected
evidence syntheses in English (2005–present) describing CGA for
hospital inpatients over 65 years compared to usual care, or CGA in an
alternative setting. Evidence tables and narrative overview were
produced for definitions of CGA, setting and staff, participants and
outcomes.
Results: We reviewed 715 titles, 329 abstracts, 108 full articles
and selected 12 reviews for data extraction. The most widely used
definition of CGAwas: “a multidimensional, multidisciplinary process
which identifies medical, social and functional needs, and the
development of an integrated/co-ordinated care plan to meet those
needs. ” Commonly reported outcomes includedmortality, Activities of
Daily Living, dependency, length of stay (LOS), readmissions, living
at home and institutionalisation. The main beneficiaries were older
people (≤ 55 years) in receipt of acute care. In most studies frailty was
not explicitly identified as a characteristic of CGA recipients. Patient
related outcomes were not usually reported.
Conclusions: We confirm a widely used definition of CGA, a focus on
death, disability and institutionalisation as key outcomes and LOS
and readmissions as the operational goals. The main beneficiaries in
hospital are older people with acute illness. The presence of frailty has
not been widely examined as a determinant of CGA outcome.
Reference
1.
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Narrative and open dialogue practice in multidisciplinary
complementary services for hospitalized elderly in geriatric care
with a confirmed suspicion of abuse
O. Gavrilovici 1, A. Dronic2, I.D. Alexa3, A.I. Pîslaru3, A.C. Ilie3. 1Iasi
Department of Psychology, “Alexandru Ioan Cuza” University, 2Psiterra
Association, 3Iaşi Department of Internal Medicine, University of Medicine
and Pharmacy “Grigore T. Popa”
Introduction: Elder abuse is known to be highly underreported by its
victims, mainly because of an acute sentiment of fear and embarrass-
ment. Of all cases, the vast majority of cases are due to neglect and/or
emotional abuse.
Method: We present a qualitative descriptive case study of an inno-
vative multidisciplinary complementary service for senior persons
whowere hospitalized in a Geriatric Clinic, with a confirmed suspicion
of an experience of abuse. The context of this study is provided by
an action research project ran in Iasi, Romania as a public-private
partnership, including two universities, an university hospital, and
three professional nonprofit organizations (psychologists ’, social
workers’ , and nurses’ associations). The study was performed on a
group of 150 elderly exposed to psychological and emotional
forms of abuse. The qualitative component of the narrative data
used the thematic analysis networks (Attride-Stirling, 2001) to
inform on the “micro” level of the changes via narrative interviews
and open dialogues performed by highly trained, competent person-
nel. Interviews and narrative medicine groups were used to inform
on “mezzo ” (organizational) and “macro” (normative and cultural)
levels.
Conclusion: Our research confirms the impressive incidence of
psychological abuse in senior population. The study also underlined
the inherent conflict between the narrative perspectives and the
organizational rationality in healthcare services.
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Our experience with pain in old age
B. Potic, S. Vasilic, D. Milosevic, N. Despotovic, P. Erceg, S. Tomic.
Department for Geriatrics, CHC ‘Zvezdara’ , University of Belgrade, Serbia
Objectives: Pain should not be considered as a normal consequence of
aging. Pain is always do a pathology, other psysical or psychological;
and may be acute and chronic.
Material and methods: We analysed 50 patients, aged 65 to 85 years,
60% female and 40% male. In this group 20% patients had acute pain
which had identifiable temporal relationship with injury or disease.
Other patients (80%) had chronic painwhichwas asociated progressive
disease. 5% patients had dementia.
Patients were explored with lab tests, radiography, ultrasound (abdo-
minal and heart), compter tomography, magnetic resonance imaging,
McGill pain questionnaire, Visual Analoque Scale for pain.
Results: In this group several different diseases were diagnosed:
50% spondyloarthropathies; 38% diabetic neuropathies; 35% cancer
pain; 28% vascular diseases; 20% low back pain; 20% headache; 8%
postherpetic neuralgia; 3% heartburn; 2% trigeminal neuralgia.
Tests for pain evaluatio showed that pain was persistent and changed
mood, interpersonal relations and activity level.
The patients were treated with simple analgesics (Paracetamol,
NSAIDs, selective COX-2 inhibitors), opioid drugs and adjuvant analge-
sics (antidepressants and anticonvulsants), nonpharmacological ther-
apies (physical, psychological).
Conclusion: Evaluation of pain in old age, specialy in patients with
dementia reqiure more time to assimilate and respond to questions
regarding pain becauseof memory impairment or limited communi-
cation skills.
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Implementation of a Frailty Unit has further benefits to Older
People Assessment and Liaison Service (OPAL) in older patients
admitted to Ashford & St. Peter’s NHS Trust
R. Lisk, P. Watts, R. O’ Sullivan, J.P. Lennon-White, K. Stevenson,
C. Armitage, C.M.P. Chikusu. Ashford & St. Peter’s NHS Trust
Objectives Elderly patients are frequent users of our emergency care
pathway. These patients do not have a comprehensive geriatric
assessment (CGA) and have high length of stay (LOS).
Methods: The OPAL team was set up in Oct 2013 and was based in
MAU 8 am–6 pm. It involved early CGA for all patients >85 in MAU.
The OPAL team felt there could be more improvement as patients
in MAU get moved on quickly due to the AE 4 hr target pressures.
This prevented the team following up on their patients they had
completed a CGA. Therefore, in Dec 2015 we developed 7 day frailty
unit. The OPAL team joined up with the therapy team working
together in A&E, MAU and the frailty unit assessing over 75s presen-
ting as an emergency.
Results: OPAL reduced the LOS for the over 85s from 9.96 (April
12–March 13) to 9.55 days (April 14–March 15). From Dec 15–Feb 16,
over 1,000 new patients have been seen by the team (A&E, CDU, MAU,
frailty unit). The average LOS in the frailty unit is 2.94 days. Dec 15 – Feb
16 shows 2659 over 75s patients presenting with a LOS of 7.26 days.
Comparing this with Dec 14– Feb 15 showed 2,691 over 75s patients
with a LOS of 9.41 days. Despite the winter months, the LOS was better
when compared to the 3 months before (Sept– Nov 2015) which was
8.18 days.
Conclusion: Having a frailty unit with the team working across all
emergency areas provide additional cost savings to OPAL.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S100