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

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Methods: 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.
Results: 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.
Conclusion: 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.
P-318
Moral distress in acute geriatric units
K. Versluys 1, I. Vandecaveye2, L. Vanlaere3, N. Van Den Noortgate1,
R. Piers 1. 1Department of Geriatric Medicine, Ghent University Hospital,
2Department of Public Health, University Center of Nursing and
Midwifery, Ghent University, Ghent, 3Catholic School Assocation RHIZO,
Courtrai, Belgium
Introduction: 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.
Methods: 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.
Results: 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.
P-319
Prevalence and clinical outcome of elderly patients presented with
atypical illness presentation in the emergency department
M.R. Hofman1, F. van den Hanenberg1, I.N. Sierevelt1, C.R. Tulner1.
1Department of Geriatric Medicine, M.C. Slotervaart, Amsterdam, The
Netherlands
Introduction: 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
department.
Methods: 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.
Results: 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
survival.
Conclusion: 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.
P-320
Age-related changes of the left ventricular and association
with insulin resistance and leukocyte telomere length in the
elderly
O.N. Tkacheva1, E.V. Plokhova1, D.U. Akasheva2, S.A. Boytsov2.
1Pirogov Russian National Research Medical University of the Ministry of
Health of the Russian Federation, Russian Gerontology Clinical Research
Center, 2National Center of Preventive Medicine, Moscow, Russian
Federation
Aim: 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.
Methods: 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).
Results: 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 = − 0.342,
p < 0.01). LTL was significantly and independently associated with age
(β = −0.026, p = 0.015) and HOMA-IR (β = −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.
Conclusions: 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–S259 S113