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explored in frailty. Our goals were (1) to analyze the relationship
between tactile discrimination (TD) of the hand, avoidance behaviours
and attitudes towards social touch (BATST) and phenotype frailty
criteria (unintentional weight loss, self-perception of exhaustion,
decrease grip strength
–
GS, slow walking speed, low level of physical
activity), (2) to explore whether other variables can contribute to
explain the differences between pre-frail and frail elders.
Methods:
We performed a cross sectional observational study with
181 of institutionalized elders. From the initial sample we selected 50
subjects (68
–
99 years) who met the inclusion/exclusion criteria.
Results:
The results showed that increasing age is related to decline
of TD of the hand (p = 0.021) and to decrease in GS (p = 0.025); women
have significantly lower level of GS (p = 0.001); TD decrease is corre-
lated with higher avoidance BATST (p = 0.000) and with lower GS
(p = 0.000); Lower GS corresponds to more avoidance BATST (p =
0.003). Hand TD also can differentiate frail and pre-frail elderly
subjects in this sample (p = 0.037).
Conclusions:
Decreased TD of the hand may have implications on the
functionality and on interpersonal relationships. TD of the hand also
explains frailty levels in this sample. Hand TD should be used in
assessment and intervention protocols in pre-frail and frail elders.
P-386
Prevalence and evaluation of sarcopenia in patients admitted in
acute geriatric unit
S. Allepaerts
1
, J. Weber
1
, F. Buckinx
2,3
, O. Bruyère
2,3,4
, N. Paquot
5
,
L. Rougier
1
, J. Petermans
1
.
1
Geriatric Department, CHU of Liège,
2
Department of Public Health, Epidemiology and Health Economics,
University of Liège,
3
Support Unit in Epidemiology and Biostatistics,
University of Liège,
4
Department of Motricity Sciences, University of Liège,
Liège,
5
Diabetes, Nutrition and Metabolic Diseases, CHU of Liège, Belgium
Background:
Sarcopenia is a syndrome characterized by progressive
and generalized loss of skeletal musclemass and strengthwith a risk of
adverse outcomes such as physical disability, poor quality of life
and death. Aims: To examine prevalence of sarcopenia, identify
cofactors associated to sarcopenia and determine the nutritional
needs of patients hospitalized in acute geriatric unit.
Method:
Fifty-five patients (mean age 85.6 years) were prospectively
enrolled. Sarcopenia was defined according the European Working
Group criteria. Muscle mass was measured by Bio impedance analyse,
muscle strength by handgrip strength and physical performance by
gait speed and Short Physical Performance Battery. Nutritional assess-
ment was performed by the Mini Nutritional Assessment (MNA) and
biological data. Resting energy expenditure is measured using indirect
calorimetry. Three months after discharge, deaths, readmission, falls
and institutionalization were studied.
Results:
Twenty (36.4%) patients had the diagnosis of sarcopenia.
Patients with sarcopenia tended to be older (p = 0.05), were predo-
minantly of male gender (p = 0.002), had lower body mass index
(p = 0.002), albumin and pre-albumin level (p = 0.02 and 0.03), and
displayed lower MNA (p = 0.004). No significant differences were
found with activity of daily living and energy requirements measured
by calorimetry between groups. At 3 months the rate of death, read-
mission, falls and institutionalization were similar in patients with or
without sarcopenia.
Conclusion:
Prevalence of sarcopenia in patients hospitalized in
acute geriatric unit is likely high. Although undernutrition appears
a predominant cofactor of sarcopenia, there were no significant
differences on energy requirement and early outcomes. These results
require further investigations.
P-387
Hospitalisation for colorectal surgery or acute medical illness is
associated with weight loss in older adults
C. Welch, T.A. Jackson.
University of Birmingham
Introduction:
Acute sarcopenia secondary to hospitalisation is an
emerging concept affecting older adults. This is hypothesised to occur
due to a combination of muscle disuse and acute inflammatory
burden. Weight loss can be caused by sarcopenia, cachexia or
starvation, with overlap between these conditions.
Methods:
A retrospective study of routinely collected electronic data
for patients aged 65 years or older across cardiac surgery, colorectal
surgery and general medical specialties was conducted at the Queen
Elizabeth Hospital Birmingham (QEHB). Patients admitted during
2015 with length of stay of two days or greater were included. Weight
measurements on admission and discharge were collected. Patients
with estimated or incomplete weights and who died during admis-
sion were excluded. Outlying measurements beyond three standard
deviations from the mean were excluded.
Results:
80 patients admitted for an elective coronary artery bypass
graft, 62 for elective colorectal surgery and 2,345 under general
medicine with an infectionwere included in analysis. Medical patients
had a mean weight loss of 0.75 kg (p = 0.00) or 0.99% (p = 0.00) and
colorectal patients a mean weight loss of 1.76 kg (p = 0.01) or 2.26%
(p = 0.01). Mean change in weight was not significant for cardio-
thoracic patients but there was a trend towards weight loss; 0.67 kg
(p = 0.061) or 0.76% (p = 0.099).
Conclusions:
Patients admitted for an infective process under
general medicine or elective colorectal surgery lose weight between
admission and discharge; further research is needed to evaluate
the nature of the weight loss and its relationship with acute
sarcopenia.
P-388
Initiating frailty screening in primary care to identify high risk
older adults for CGA
A. Williams.
Church Street Practice
Introduction:
In primary care older, adults at risk of hospital admis-
sion are identified using risk stratification profiling. This approach may
fail to recognise frailty as a risk factor in hospital admission, thus
excluding patients from primary care interventions to reduce risk and
possibly avoid admission.
Aim:
To trial frailty screening in primary care using validated tools
in addition to risk profiling. Enhanced screen was used to identify
vulnerable patients for comprehensive geriatric assessment and
management. four cycles PDSA cycle (Plan-Do-Study-Act Cycle) were
undertaken, Cycle 1: the primary care team identified suitable frailty
screening tools for use within their practice, Cycle 2: training of staff,
Cycle 3: testing the integrating the Frailty Assessment Tool, Cycle 4:
upscaling screening.
Findings and conclusion:
A two stage approach to frailty screening
was adopted, patients self completion PRISMA 7 [1], staff completed
the Rockwood Clinical Frailty Scale [2]. 470 assessments completed
showed that thirty-three per cent of patients were frail and 20 per cent
as pre-frail, the previous Risk Stratification Profiling identified 27 per
cent (76/279) had been flagged as frail, and no level of frailty was
recorded. As a result of the enhanced screening a dedicated frailty
clinic led by the nurse consultant was established to undertake
Comprehensive Geriatric Assessment [3] as part of the frailty pathway.
One outcome has been an increase in anticipatory care planning with
patients. Concluding, that risk profiling without frailty screening
underestimates the high risk primary care population. Managing
frailty within a primary care team requires time and resources, but can
deliver real benefits to patients and families.
AcknowledgementsDr Peter Fletcher Consultant Geriatrician for his
interest and support throughout the project. Professor Alison Metcalf
(Supervisor Kings College London) for her guidance and support
throughout the project.
References
[1] Raiche M
et al.
(2010). Impact of PRISMA, a coordination-type
integrated service delivery system for frail older people in Quebec
(Canada): a quasi-experimental study.
J Gerontol B Psychol Sci Soc
Sci
2010;65B:107
–
18. doi:
10.1093/geronb/gbp027Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
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