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Page Background

Sequential cycles of plan-do-study-act (PDSA) were utilised as the

model for improvement.


Baseline assessment indicated that 0/51 patients were

assessed for depression prior to the project. Screening was then

attempted in 153 patients. It was not possible in 31 due to severe

confusion. Of the remaining 122, 92 (75%) were not depressed,

outcome was uncertain in 18 (15%), 12 (10%) were depressed. This led

to a management change for eight patients.


Depression screening in hospitalised older people is

feasible. It improves outcomes but along with effective communica-

tion and education, needs normalising into routine systems and

processes. Switching to GDS-5 clarified


outcomes asso-

ciated with GDS-4. The project has now spread to another Acute

Trust. Depression screening is included in Comprehensive Geriatric

Assessment and routinely carried out. Data indicates 43.5% of screened

patients have evidence of depression. This is communicated in their

problem list, treatment plan and to their GP on discharge.


Functional and cognitive impairment, social environment, frailty

and adverse health outcomes in older patients with head and neck

cancer, a systematic review

F.J.A. van Deudekom


, A.S. Schimberg


, M.H. Kallenberg



M. Slingerland


, L.A. van der Velden


, S.P. Mooijaart




Department of

Gerontology and Geriatrics, LUMC,


Department of Otorhinolaryngology

and Head and Neck Surgery, LUMC,


Department of Nephrology, LUMC,


Department of Medical Oncology, LUMC,


Department of Head and Neck

Surgery and Oncology, Netherlands Cancer Institute, Amsterdam,


Institute for Evidence-based Medicine in Old Age (IEMO), Leiden,

The Netherlands


Older head and neck cancer patients are at increased risk

for adverse health outcomes but little is known about which geriatric

assessment associates with poor outcome. We aimed to study the

association of functional and cognitive impairment, social environ-

ment and frailty with adverse health outcome and their predictive

value in patients with head and neck cancer.


Four libraries were searched for original studies reporting

on an association of functional or cognitive impairment, social

environment and frailty with adverse outcomes after follow-up in

head and neck cancer patients.


Of the 4,158 identified citations 31 articles were included.

The mean age was over 60 years in twelve studies (39%). Geriatric

conditions were prevalent: between 40 and 50% of the included

participants were functional impaired, around 50% had depressive

symptoms and around 40% did not have a partner. Functional impair-

ment was assessed in eighteen studies, two studies reported on a

cognitive test, eight studies examined mood and social status was

depicted by fourteen studies. None of the included studies addressed

frailty or objectively measured physical capacity such as hand grip

strength, gait speed or balance tests. Out of 41 reported associations,

64% reported a significant association of impaired functional or

cognitive performance, mood or social environment with adverse

health outcomes.


Functional and cognitive impairment, depression and

social isolation are highly prevalent and associate with increased risk

of adverse health outcomes in head and neck cancer patients. These

measurements may guide decision-making and customize treatments.

More research is needed to further improve clinical usability.


Economic evaluation of nurse-led multifactorial care to prevent or

postpone new disabilities in community-living older people:

results of a cluster randomized trial

J. Suijker


, J. MacNeil-Vroomen


, M. van Rijn


, B. Buurman



G. ter Riet


, S. de Rooij


, E.M. van Charante


, J. Bosmans




Department of General Medicine, Academic Medical Centre,


Department of Internal Medicine, Section of Geriatric Medicine,

Academic Medical Center,


ACHIEVE Centre of Expertise, Faculty of Health,

Amsterdam University of Applied Sciences, Amsterdam,



Center for Geriatric Medicine, University Medical Center Groningen,


Department of Health Sciences and the EMGO Institute for Health and

Care Research, Faculty of Earth and Life Sciences, VU University,

Amsterdam, the Netherlands


To evaluate the cost-effectiveness of nurse-led multi-

factorial care to prevent or postpone new disabilities in community-

living older people in comparison with usual care.


We conducted an economic evaluation alongside a cluster

randomized trial with one-year follow-up. Participants were aged

70 years and at increased risk of functional decline. Participants in

the intervention group (n = 1,209) received a comprehensive geriatric

assessment and individually tailored multifactorial interventions

coordinated by a community-care registered nurse with multiple

follow-up visits. The control group (n = 1,074) received usual care.

Costs were assessed from a healthcare perspective. Outcome measures

included disability (modified Katz- ADL index score), and quality-

adjusted life-years (QALYs). Statistical uncertainty surrounding

Incremental Cost-Effectiveness Ratios (ICERs) was estimated using

bootstrapped bivariate regression models while adjusting for con-

founders. Cost-effectiveness planes and acceptability curves were used

to report statistical uncertainty.


There were no statistically significant differences in Katz-ADL

index score and QALYs between the two groups. Total mean costs

were significantly higher in the intervention group (EUR 6,518

(SE 472)) compared with usual care (EUR 5,214 (SE 338)); mean

difference EUR 1,244 (95% CI 309; 2,337). Cost-effectiveness accept-

ability curves showed that the maximum probability of the interven-

tion being cost-effective was 0.14 at a willingness to pay (WTP) of EUR

50,000 per one point improvement on the Katz-ADL index score and

0.04 at a WTP of EUR 50,000 per QALY gained.


The current interventionwas not cost-effective compared

to usual care to prevent or postpone new disabilities. Costs were

significantly higher in the intervention group.


Preventive home-visits and nurse-led care coordination: a

qualitative study on the experiences, needs and preferences of

community dwelling older people

M. van Rijn


, N. Hoogteijling


, J. Suijker


, S. de Rooij


, B. Buurman



E.M. van Charante




Department of Internal Medicine, Section of

Geriatric Medicine, Academic Medical Center,


ACHIEVE Centre of

Expertise, Faculty of Health, Amsterdam University of Applied Sciences,


Department of General Medicine, Academic Medical Centre, Amsterdam,


University Center for Geriatric Medicine, University Medical Center

Groningen, The Netherlands


The aim of this study is to examine the experiences,

needs and preferences of community-dwelling older people concern-

ing preventive home-visits and nurse-led care coordination in the



From the intervention arm of a cluster randomized trial,

eleven participants were purposively selected. These participants

had an increased risk on functional decline and were interviewed at

home, using semi-structured interviews. All interviews were audio

recorded, transcribed, and analyzed independently by two researchers

using a thematic analyses approach.


Older people found it important that the general practitioner

(GP) keeps an eye on them. Certain roles of the GP can be delegated to

a nurse, particularly psychosocial aspects, but it is important that

the GP remains involved. Although the aim of the visits and the role

of the nurse was sometimes unclear, older people appreciated the

attention. This attention gave the feeling of being seen and created a

sense of safety.


The results of this qualitative study show the importance

of tailor made care in community dwelling older persons. Preventive

home visits coordinated by a nurse can contribute to efficient primary

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