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

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P-271
Application of comprehensive geriatric assessment for the
detection of older people at risk of suffering a hip fracture.
Case-control study
R. Ramírez-Martín1, J.I. González-Montalvo1,2,3, M.V. Castell-Alcalá 2,3,4,
T. Alarcón 1,3, R. Queipo3,5, P.P. Ríos-Germán1, A. Otero-Puime3,5.
1Department of Geriatric, La Paz University Hospital. Madrid,
2Department of Medicine, Autonoma University of Madrid, 3La Paz
University Hospital Research Institute, IdiPAZ, 4CS Dr. Castroviejo. Primary
Care (SERMAS), Madrid, 5Department of Preventive Medicine, Autonoma
University of Madrid, Spain
Objectives: 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).
Methods: 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.
Results: 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 2 (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).
Conclusions: 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.
P-272
Cardiac pacing in cardio-inhibitory Carotid Sinus Syndrome: when
should we pace? A Syncope Unit experience
G. Rivasi1, M. Rafanelli1, F. Tesi1, A. Ceccofiglio1, S. Venzo1, F.C. Sacco1,
S. Zannoni1, A. Riccardi1, N. Marchionni1, A. Ungar1. 1Syncope Unit,
Department of Geriatrics, Careggi Hospital and University of Florence,
Italy
Objectives: 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.
Methods: 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.
Results: 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
identified.
Conclusions: 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.
P-273
Does comprehensive geriatric assessment affect decision-making
& outcomes for older adults treated for upper gastro-intestinal
cancer
J. Pattinson, A. Sims, A. Cowley, T. Masud, R. Morris. Nottingham
University Hospitals NHS Trust
Introduction: 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.
Methods: 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
cohort.
Results: 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)
Conclusions: 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.
P-274
Use of a holistic assessment tool improves patient centred care
planning
C. Ruff. Norfolk Community Health and Care/Kings College, London
Background: 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 “task
orientation” and community patients not being treated in an holistic
way.
Methodology: 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–S259 S101