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Methods:
Patients admitted to an orthogeriatric unit who gave
informed consent for the biomarker
’
s study. Musclemass was assessed
using bioimpedance analysis, Janssen (J) and Masanés (M) reference
cutoff-points were used. Strengthwas assessedwith handgrip (Jamar
’
s
dynamometer). Assessment included socio-demographic data, cogni-
tive status (Pfeiffer, GDS-Reisberg), functional status (Barthel, Lawton,
FAC), nutrition (MNA, BMI), number of falls, medications. After one
year, by phone-call, mortality, functional status, cognitive status, visits
to Emergency Department (ED), hospitalizations, falls and institu-
tionalization were collected.
Results:
N = 87. Mean age:88.0 ± 4.7. Women:82.8%. Sarcopenia pre-
valence varied from 8.8%(J) to 33.7%(M). One-year-mortality: 16%.
Visits-to-ED:0.7 ± 1.1. Hospitalizations:0.2 ± 0.5. Falls:1.4 ± 1.6. No
ambulation: 38.1%. 45.7% had at least one visit to the ED, 20.5%
one or more hospitalizations. Independent for ADL 14.3%, severe
dependency 57.1%. Only 14.3% were independent in more than three
IADL. 55% had at least one fall, 15%
≥
4 falls after discharge. In
multivariate analysis, sarcopenia was not predictive of mortality. The
only predictive factor of mortality was male gender(p = 0.012).
Conclusion:
Sarcopenia, assessed by international (Janssen) and local
(Masanés) cutoff-points, did not predict one-year-mortality in this
small sample of patients hospitalized for the surgical treatment of a
hip fracture. This should be confirmed with a larger sample. Male
gender is a risk factor for one-year-mortality in this population.
Funded with a grant from FundaciónMutuaMadrileña
P-372
Prevalence of malnutrition in a post-acute care geriatric unit:
applying the new ESPEN definition
D. Sánchez-Rodríguez
1,2,3
, E. Marco
2,4,5
, N. Ronquillo-Moreno
1
,
R. Miralles
1,3
, O. Vázquez-Ibar
1,3
, F. Escalada
2,3,4
, J. Muniesa
2,3,4
.
1
Geriatrics Department, Parc Salut Mar,
2
Rehabilitation Research Unit.
Institut Hospital del Mar d
’
Investigacions Mèdiques (IMIM),
3
Universitat
Autònoma de Barcelona,
4
Physical Medicine and Rehabilitation
Department, Parc Salut Mar,
5
Universitat Internacional de Catalunya,
Barcelona, Spain
Introduction:
The European Society of Clinical Nutrition and
Metabolism (ESPEN) recently proposed a consensus definition of
malnutrition. Using these criteria, prevalence of malnutrition in
hospitalized older diabetic and community-dwelling population
(middle-aged, geriatric outpatients, healthy old, and healthy young
individuals) has been reported. However, determining prevalence in
older deconditioned in-patients due to an acute process is needed. Our
aim is to assess malnutrition in post-acute care applying ESPEN
definition.
Methods:
Eighty-eight in-patients aged
≥
70, body mass index
(BMI < 30 Kg/m
2
) were included (84.1 years-old; 62% women) by
screening for malnutrition risk using Mini-Nutritional Assessment-
Short Form (MNA-SF). ESPEN definition of malnutrition, i.e. low BMI
(<18.5 kg/m
2
) or a combination of unintentional weight loss and
low BMI/low fat-free mass index (FFMI) was applied. Malnutrition
biochemical markers were determined.
Results:
From 88 in-patients screened as
“
at risk
”
by MNA-SF, 27
(30.7%) noticed unintentional weight loss. First option of ESPEN
criteria (BMI < 18.5 kg/m
2
) found a prevalence of 4.5% (4 patients);
second option, (unintentional weight loss plus low BMI), 7.9% (7
patients), and third option (unintentional weight loss plus low FFMI),
17% (15 patients). Malnourished patients according to ESPEN criteria
were 17 (19.3%). No statistical differences in biochemical markers
were found between patients with and without malnutrition.
Conclusions:
Applying ESPEN definition, malnutrition prevalence
was 19.3% in post-acute geriatric in-patients. Combining ESPEN
malnutrition criteria, with MNA-SF as a screening tool, seem to be a
valid, reliable, and feasible instrument in post-acute care. Further
work is needed to determine implications of ESPEN consensus
among related clinical conditions such frailty, sarcopenia, and
caquexia.
P-373
Validity of the Kihon checklist for predicting adverse health
outcomes in the clinical setting
S. Satake
1
, K. Senda
1
, Y-J. Hong
2
, H. Miura
1
, H. Endo
1
, H. Arai
1
.
1
National
Center for Geriatrics and Gerontology, Obu,
2
Ichishi Hospital, Mie, Japan
Introduction:
The Kihon checklist (KCL) was developed by the
Ministry of Health, Labor, and Welfare in Japan to identify at-risk
elderly who would require support/care in community-dwellers.
However, it is obscure whether this checklist could predict adverse
health outcomes in the clinical setting. This study was conducted to
validate the ability of the KCL for predicting adverse health outcomes
in regular outpatients with chronic diseases.
Methods:
Of 212 regular outpatients who had consulted with
geriatricians, 135 patients were analyzed in this study. We assessed
their physical functions, activities of daily living (ADL), comorbidity,
memory, andmood, as well as the KCL at registration. We had observed
the incidence of any adverse events, such as ADL decline, emergent
admission, moving into nursing home, or death for 2 years.
Results:
The mean age, body mass index (BMI), and Charlson
comorbidity index (CCI) were similar in the event group (n = 50) and
the non-event group (n = 85). The event group showed slower gait
speed, higher depressive score, lower cognitive score, and higher total
KCL score than the non-event group. The total KCL score had a multi-
collineality with actual measurements of physical, psychological,
and cognitive functions. Logistic regression analysis adjusted for age,
sex, BMI, and CCI showed that the classification of frailty status by
total KCL score (total KCL score
≥
8) was significantly associated with
the incidence of adverse health outcomes (odds ratio: 3.215 [95%
confidence interval: 1.355
–
7.627]).
Conclusion:
KCL showed a predictive ability for identifying frail
elderly patients who would have adverse health outcomes in the
future.
P-374
Kihon Checklist (KCL), as a surrogate marker of frailty, predicts
outcomes in Japanese elder outpatients with chronic obstructive
pulmonary disease (COPD)
K. Senda, S. Satake, I. Kondo, M. Nishikawa, H. Tokuda, H. Miura,
H. Endo.
National Center for Geriatrics and Gerontology, Obu, Japan
Introduction:
COPD is a prevalent, preventable and treatable chronic
systemic inflammatory disease. Kihon Checklist (KCL) is a self-
administrated questionnaire for screening users of preventive care
and remains to be investigated for clinical application.
Methods:
Stable COPD outpatients in National Center for Geriatrics
and Gerontology: 40 male and 3 female; 74.9+/
−
5.9 (65
–
87) years,
underwent comprehensive geriatric assessment (CGA). We followed
for 3 years with repeated annual CGA. We adopted cut-off value in
Obu Study of Health Promotion for the Elderly: walking speed
<1.0 m/s, grip strengthmale <26 kg, female <17 kg and 5% body weight
loss in 2 years.
Results:
Initial KCL was 5.2/25 +/
−
4.4 (0
–
18) and positively correlated
with Fried
’
s frailty (r = 0.71, p < 0.001). Of 7 frail by Fried, 5 were
KCL >8/25 (cut-off value for frailty by KCL). KCL was associated with
CGA parameters. During 3-year observation, 10 deaths (7: KCL > 4,
cut-off value for pre-frailty), 13 admissions for exacerbation of COPD
(9: KCL > 4), 13 falls (11: KCL > 4) and 16 emergency admissions (11:
KCL > 4) were observed. A frail by Fried (KCL = 16) died of suffocation
with aspiration pneumonia. Among dead 7 pre-frail, respiratory failure
(KCL = 8), 2 heart failure (6, 4), 3 cancer (6, 3,1), sepsis with pneumonia
and severe decubitus ulcer (5) were observed. A robust (KCL = 4) died
of heart failure and another (1) died of brain infarction.
Conclusions:
KCL was concordant with Fried
’
s frailty criteria and
might predict outcomes in COPD patients. KCL could be a useful
evaluation tool for inter-disciplinary integrated care team.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S128