109 / 290
Sequential cycles of plan-do-study-act (PDSA) were utilised as the
model for improvement.
Results:
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.
Conclusion:
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
“
Uncertain
”
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.
P-279
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
1
, A.S. Schimberg
2
, M.H. Kallenberg
1,3
,
M. Slingerland
4
, L.A. van der Velden
2,5
, S.P. Mooijaart
1,6
.
1
Department of
Gerontology and Geriatrics, LUMC,
2
Department of Otorhinolaryngology
and Head and Neck Surgery, LUMC,
3
Department of Nephrology, LUMC,
4
Department of Medical Oncology, LUMC,
5
Department of Head and Neck
Surgery and Oncology, Netherlands Cancer Institute, Amsterdam,
6
Institute for Evidence-based Medicine in Old Age (IEMO), Leiden,
The Netherlands
Objectives:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
P-280
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
1
, J. MacNeil-Vroomen
2
, M. van Rijn
2,3
, B. Buurman
2,3
,
G. ter Riet
1
, S. de Rooij
2,4
, E.M. van Charante
1
, J. Bosmans
5
.
1
Department of General Medicine, Academic Medical Centre,
2
Department of Internal Medicine, Section of Geriatric Medicine,
Academic Medical Center,
3
ACHIEVE Centre of Expertise, Faculty of Health,
Amsterdam University of Applied Sciences, Amsterdam,
4
University
Center for Geriatric Medicine, University Medical Center Groningen,
5
Department of Health Sciences and the EMGO Institute for Health and
Care Research, Faculty of Earth and Life Sciences, VU University,
Amsterdam, the Netherlands
Introduction:
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.
Methods:
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.
Results:
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.
Conclusion:
The current interventionwas not cost-effective compared
to usual care to prevent or postpone new disabilities. Costs were
significantly higher in the intervention group.
P-281
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
1,2
, N. Hoogteijling
1
, J. Suijker
3
, S. de Rooij
1,4
, B. Buurman
1,2
,
E.M. van Charante
3
.
1
Department of Internal Medicine, Section of
Geriatric Medicine, Academic Medical Center,
2
ACHIEVE Centre of
Expertise, Faculty of Health, Amsterdam University of Applied Sciences,
3
Department of General Medicine, Academic Medical Centre, Amsterdam,
4
University Center for Geriatric Medicine, University Medical Center
Groningen, The Netherlands
Introduction:
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
Netherlands.
Methods:
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.
Results:
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.
Conclusion:
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
–
S259
S103