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All the individual and focus group interviews and discus-

sions held as part of the exposure experience were recorded and

transcribed. The data were analysed qualitatively using methods of

Grounded Theory and using data and researcher triangulation.


The analysis showed that the participants found it highly

relevant to participate. Caregivers show a greater openness to listen

and more attention is given to the patients

experiences and concerns.

The participants experience this as an important change. Participants

report that open, not goal-oriented conversations inwhich they create

a supportive space for the patient lead to a better relationship with the

patient. They realize that open conversations from person to person,

help to better know the patient and bring them to interventions in care

focused on patients

needs. Participants describe having fear that the

conversation will not be good enough. They mention great satisfaction

in their contact with the patient as soon as they let their fear go.


Participation in the systematic exposure experience using

an open interviewwith a patient followed by a reflection process leads

to changes in attitudes of caregivers needed for person-centered care.


Moral distress in acute geriatric units

K. Versluys


, I. Vandecaveye


, L. Vanlaere


, N. Van Den Noortgate



R. Piers




Department of Geriatric Medicine, Ghent University Hospital,


Department of Public Health, University Center of Nursing and

Midwifery, Ghent University, Ghent,


Catholic School Assocation RHIZO,

Courtrai, Belgium


Moral distress (MD) is increasingly being recognized

as a concern for health care. This study explored the lived experiences

of MD among caregivers in acute geriatric units.


4 focusgroup discussions with health care providers of 4

geriatric units in Belgium (n = 28) were undertaken to understand the

geriatric caregivers confronted with MD. Datacollection and analysis

using principles of Grounded Theory (constant comparative method,

datatriangulatie, reflection) happened by three researchers.


MD is present in multidisciplinary geriatric teams and affects

the identity of health care providers at a deep level. Three levels

of barriers to deliver good care are described. Barriers in health care

providers, such as lack of knowledge and lack of mandate depriving

them from truly taking up a patient advocacy role. Barriers related

to patient and families, for example insoluble suffering in the patient

that causes feelings of powerlessness. Barriers belonging to the team

and the organisation, such as inefficiënt teamwork that counteracts

caregivers to deliver person-centered care. Although experiences of

MD can be an opportunity to discuss and facilitate improvements in

care, caregivers only describe negative effects of MD. A good team

climate helps to better cope with MD.

Key conclusions:

Geriatric care teamleaders should be aware of MD in

individual team members and facilitate a team approach addressing

barriers for good care.


Prevalence and clinical outcome of elderly patients presented with

atypical illness presentation in the emergency department

M.R. Hofman


, F. van den Hanenberg


, I.N. Sierevelt


, C.R. Tulner




Department of Geriatric Medicine, M.C. Slotervaart, Amsterdam, The



Very few information is available on the prevalence

and clinical outcome of elderly patients with atypical illness

presentation referred for emergency care. The objective of the study

was to determine the prevalence and clinical outcome of elderly

patients with atypical illness presentation referred to the emergency



Monocentric retrospective observational study on 355

elderly patients presented at the emergency department. Patients of

80 years and older were included. Data were extracted from the

electronical patient file.


A total of 355 patients were included, with a mean age of 86

years. In 53% of the cases, elderly patients demonstrated atypical

illness presentation. Most of the time this was due to falling. In 15% of

patients with atypical illness presentation, they reported no specific

symptoms of the underlying disease. Patients with atypical illness

presentation were more likely to have a longer stay in hospital, to

be discharged to a health facility, and to have a higher delirium

observation score. There was no significant difference in one-year



Atypical illness presentation in elderly patients is highly

prevalent in the emergency department. Falling accidents are the most

important reason for this. Patients with atypical illness presentation

have a worse clinical outcome. Accurate training of emergency staff is

necessary to recognize this group of patients to reassure proper clinical

monitoring and timely treatment.


Age-related changes of the left ventricular and association

with insulin resistance and leukocyte telomere length in the


O.N. Tkacheva


, E.V. Plokhova


, D.U. Akasheva


, S.A. Boytsov




Pirogov Russian National Research Medical University of the Ministry of

Health of the Russian Federation, Russian Gerontology Clinical Research



National Center of Preventive Medicine, Moscow, Russian



Cardiac aging is an independent risk factor for cardiovascular

disease. The main signs of the aged heart are a thickening of the left

(LV) ventricular walls and LV diastolic dysfunction. Insulin resistance

(IR) is exacerbating aging-related changes in the cardiac structure

and function. One possible mechanism underlying IR-induced car-

diac dysfunction with advancing age could be related to decreased

telomeres length of leukocytes (LTL). Telomeres are tandem repeats

of the DNA sequence at the end of chromosomes and protect DNA

molecule from damage. LTL is a marker of replicative aging. Our

hypothesis is that IR led to shorter telomeres and senescent

phenotypes in the heart.


We investigated 115 non-obese participants aged 60 to 91

years without history of CVD, diabetes and regular drug medication.

All the volunteers underwent standardized transthoracic echocardi-

ography with the available system (iE33; Philips), had an oral glucose

tolerance test. HOMA-IR was calculated as fasting insulin (mU/mL) ×

fasting glucose (mmol/L) (mmol/L)/22.5. IR was diagnosed in case of

HOMA-IR elevation >2.5 based on reference. LTL was measured by real-

time quantitative polymerase chain reaction. We determined the

relative ratio of telomere repeat copy number (T) to single-copy gene

copy number (S).


In older individuals HOMA-IR was significantly positively

related to LV septal wall thickness (r = 0.489, p < 0.001), LV posterior

wall thickness (r = 0.458, p < 0.001), E/Em (r = 0.379, p < 0.01) and

inversely correlated with E/A (r =

0,320, p < 0.01), Em/Am (r =


p < 0.01). LTL was significantly and independently associated with age




0.026, p = 0.015) and HOMA-IR (



0.176, p = 0.027). Results

of analysis of variance (ANOVA) showed that LTL was significantly

related to diastolic function indices regardless of age (p < 0.001). Older

subjects with higher HOMA-IR had a shorter telomeres (p = 0.046)

and more expressed LV hypertrophy and diastolic dysfunction to

compared to subjects with normal HOMA-IR. Individuals with IR did

not significantly differ from those with normal HOMA-IR in the

proportion of smokers, or levels of blood pressure and BMI.


These findings suggest that insulin resistance is asso-

ciated with more expressed signs of the aging heart and shorter LTL.

Accelerated telomere attrition appears to be the mechanism by which

impaired insulin resistance develops into cardiac aging.

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