Table of Contents Table of Contents
Previous Page  107 / 290 Next Page
Show Menu
Previous Page 107 / 290 Next Page
Page Background


Application of comprehensive geriatric assessment for the

detection of older people at risk of suffering a hip fracture.

Case-control study

R. Ramírez-Martín


, J.I. González-Montalvo


, M.V. Castell-Alcalá



T. Alarcón


, R. Queipo


, P.P. Ríos-Germán


, A. Otero-Puime




Department of Geriatric, La Paz University Hospital. Madrid,


Department of Medicine, Autonoma University of Madrid,


La Paz

University Hospital Research Institute, IdiPAZ,


CS Dr. Castroviejo. Primary

Care (SERMAS), Madrid,


Department of Preventive Medicine, Autonoma

University of Madrid, Spain


To determine if some characteristics of the older obtained

by comprehensive geriatric assessment (CGA) serve to detect who of

them are in higher risk of suffering a hip fracture (HF).


Demographic, functional, cognitive and nutritional data and

vitamin D levels in a cohort of acute hip fracture patients and in a

representative cohort of community-dwelling older from the same

area were compared. Bivariate analysis of the variables in the whole

sample and in a subsample of subjects matched for age and sex was

performed. Then a logistic regression analysis of significant variables

was performed.


Five hundred and nine HF patients and 1,315 community-

dwelling older were included. HF patients were older and more

frequently women, had more frequency of disability and cognitive

impairment, lower hand grip strength, lower body mass index (BMI)

and higher frequency of vitamin D insufficiency compared with

community controls (p < 0.001). The variables most strongly asso-

ciated with the presence of HF in the multivariate analysis, besides age

and sex, were BMI <22 kg/m


(OR 5.11, 95% CI 2.45

10.65; p = <0.001),

disability (OR = 4.32, 95% CI 2.73

6.80; p = <0.001), muscle weakness

(OR = 3.01, 95% CI 1.90

4.77; p = <0.001) and vitamin D insufficiency

(OR = 2.13; 95% CI 1.452

3.14; p = <0.001).


There are several simple factors obtained through CGA

that are strongly associated with the presence of fragility HF. The

detection of underweight, disability, malnutrition, muscle weakness

and insufficiency of vitamin D can identify older people at risk and

help to implement in them prevention strategies.


Cardiac pacing in cardio-inhibitory Carotid Sinus Syndrome: when

should we pace? A Syncope Unit experience

G. Rivasi


, M. Rafanelli


, F. Tesi


, A. Ceccofiglio


, S. Venzo


, F.C. Sacco



S. Zannoni


, A. Riccardi


, N. Marchionni


, A. Ungar




Syncope Unit,

Department of Geriatrics, Careggi Hospital and University of Florence,



The efficacy of cardiac pacing in cardio-inhibitory Carotid

Sinus Syndrome (CI-CSS) is controversial, due to the lack of large

randomized trials and the recurrence of syncope after pacing.

The present study analyzed the recurrence of syncope in patients

with CI-CSS or Hypersensitivity (CSH) paced or not.


A retrospective analysis of clinical data on patients with

CI-CSS/CSH was performed, investigating the recurrence of syncope

(mean follow-up 61.2 ± 17.8 months). Datawere collected from clinical

records and patients interview.


1273 consecutive patients underwent Carotid Sinus Massage,

with a cardio-inhibitory response in 9.74% of the cases. Follow-up

data from 108 patients were available: 79 (73.1%) showed CI-CSS,

29 (26.9%) had CI-CSH. 76 patients (70.4%) underwent pace-

maker implantation, mainly for CI-CSS (85.5%). 15/108 patients

(13.9%) experienced a relapse of syncope; in the CI-CSS group,

syncope recurred in 16.9% of paced patients and in 7.1% of not paced

ones. Among those reporting syncope after pacing, the 81.8% had

neurally mediated prodromes, the 54.5% had a positive Tilt Test and

the 63.6% was on hypotensive drugs.14 CI-CSS patients refused pacing.

92.9% did not experience recurrence. No predictors of recurrence were



Symptoms recurrence was more common in paced

patients with CI-CSS, whereas those refusing the procedure showed

the lowest recurrence rate. Even if recorded in a small, highly selected

population, these data show that patient selection for pacing is not

effective if merely based on asystole. Clinical features suggesting

hypotensive susceptibility may help identifying patients who could

not benefit from pacing.


Does comprehensive geriatric assessment affect decision-making

& outcomes for older adults treated for upper gastro-intestinal


J. Pattinson, A. Sims, A. Cowley, T. Masud, R. Morris.


University Hospitals NHS Trust


Comprehensive Geriatric Assessment (CGA) in cancer

treatment is gaining prominence as a potential way of improving

outcomes amongst older patients. This prospective cohort study in

older adults with Upper Gastro-intestinal (UGI) Cancer aimed to

examine the effect of CGA on Cancer Multi-Disciplinary Team (MDT)

decision-making and key outcomes.


Consecutive patients (>70 yrs) referred to the UGI Cancer

MDT were invited for assessment in a multi-professional Geriatric

Assessment Clinic. All patients were assessed by geriatrician, nurse,

occupational therapist, physiotherapist, dietician and social worker.

Planned interventions were delivered and followed-up by the CGA

team. Surgical length of stay (los), unscheduled acute care episodes

and deaths were recorded and compared with a historical control



97 CGA patients (64% male) were compared with 99 (63%

male) controls. Age, co-morbidities and cancer diagnoses were similar

in both groups. Significantly more patients in the CGA group (33.0%)

received potentially curative surgical treatment than in the control

group (18.2%) (Chi-square = 5.654 p = 0.017). There was no effect on

palliative treatment decisions. CGA appeared to have no influence on

post-operative los but increased the occurrence of unscheduled

admissions (67.0% vs 51.5%, Chi-square = 4.870, p = 0.027). However,

there was no difference in total use of acute care between the two

groups. 6-Month mortality was significantly lower in the CGA group

(30.9% vs 48.5%, Chi-square = 6.304, p = 0.012)


CGA in UGI cancer assessment increases the proportion

of older patients receiving potentially curative surgical treatment and

improves 6-month survival. There is no apparent cost in terms of

increased use of acute care.


Use of a holistic assessment tool improves patient centred care


C. Ruff.

Norfolk Community Health and Care/Kings College, London


Community dwelling older adults are presenting with

increased levels of complexity. Community nurses

lack the knowl-

edge, skills and time to assess this complexity leading to



and community patients not being treated in an holistic



This Quality Improvement Project aimed to improve

patient centred care planning through the use of Holistic Assessment.

Plan, Do, Study, Act (PDSA) cycles were used to implement change

and evaluate effectiveness. PDSA 1: Community staff identified how

time could be made available for full assessment. PDSA 2: Staff

received training on the holistic assessment tool, including physical,

social, psychological and medicines management. Training included

pressure ulcer risk assessment, pressure ulcer grading and screening

for malnutrition. Consultation skills were also discussed. PDSA 3:

audit and feedback, supporting staff less confident about holistic

assessment, making joint visits and examining notes together. Team

discussion about how to support patients occurred at handover for

training purposes.

Poster presentations / European Geriatric Medicine 7S1 (2016) S29