Table of Contents Table of Contents
Previous Page  157 / 290 Next Page
Show Menu
Previous Page 157 / 290 Next Page
Page Background


A significant proportion of elderly patients was admitted

to long-term care. High dependent for ADL when evaluated by KZ

was of note. Elders with greater dependence associated with worse

vital prognosis.


Hypervitaminosis B12: earlymarker of breast cancer in the elderly?

C. Marinho, J.T. Nave, L.S. Pinheiro.

Internal Medicine Department 2,

University Clinic Hospital Santa Maria, Lisbon Faculty of Medicine


Low vitamin B12 levels are associated with conditions

such as anemia and neuropsychiatric/neurocognitive disorders,

while high vitamin B12 levels have been linked to a number of

other diseases, such as acute or chronic liver diseases, renal failure,

hematologic malignancies and other cancers. Breast cancer (BC) is the

worldmost common cancer among women (23% of the female cancers

that are newly diagnosed each year). It is also a major cause of cancer

related deaths among elderly women. The probability of developing

BC increases with age. Therefore, more than 50% of womenwith BC are

older than 65 years at time of diagnosis. Clinical Case: Female, 87 years

old was hospitalized due to unquantified weight loss, consumptive

frame, non-selective anorexia, asthenia and dyspnea for small efforts.

Analytical results demonstrated a normochromic anemia with

hypervitaminosis B12 > 2,000 ng/mL without a history of vitamin

B12 supplementation. No impaired renal or hepatic function and no

other major changes were observed. She was oriented to internal

medicine follow-up clinic. One month later a lump of right breast was

identified and mammary ultrasound and mammography confirmed

suspicious nodule with BI-RADs4 classification. Biopsy of the nodule

yielded invasive carcinoma of the breast. The patient was subsequently

referenced for oncology and surgery.


With this case we emphasized the import-

ance of hypervitaminosis B12 as neoplastic marker in patients without

renal or liver function impaired. The highest rate of vitamin B12 is

associated with poor prognosis.


Orthotic management of diabetic foot

M. Briôa, J. Matos, D. Lima, D. Ricardo.

Escola Superior de Tecnologia da

Saúde de Lisboa


It is estimated that by 2035 the global prevalence of

diabetes will rise to almost 600 million, and around 80% of these

people will live in developing countries. Foot problems complicating

diabetes are a source of a major patient suffering and societal costs.

Foot ulcers are the most prevalent problem, with a yearly incidence of

around 2

4% in developed countries. The aim of this study is to assess

the effectiveness of footwear and foot orthoses (FO) on the main

complications of the diabetic foot.


It is a study of cross-sectional descriptive and correlational

approach, with a sample selected by convenience. For this investiga-

tion the need to build a form consisting of demographic data, clinical

data, treatment data and complications was recognized. The param-

eter risk of falling was assessed by the Performance-Oriented Mobility

Assessment tool (POMA). The study was developed in a sample

comprising of 40 individuals with high level of foot complications.


The use of footwear and foot orthoses proved to be an impor-

tant feature of foot protection (p = 0,024). Individuals with appropriate

footwear and OF tended to have no ulcers (46,7%), while thosewithout

appropriate footwear and OF tended to have ulcer at least at least once

(88%). The risk of falling among users of footwear and OP was average,

while subjects who did not use footwear and OP the risk of falling was

high, verifying statistically significant differences (p = 0,034).


In fact, the evidence found shows that the diabetic foot

has important individual and social consequences and is predomin-

antly linked to the epidemic DM, deserving special attention. It

highlights the importance of more effective action for the prevention

of complications of patients with diabetic foot, as well as education of

the subject.


The rising incidence of frailty in a community hospital?

a 6 year


A. McColl, F. Khan, Y. Sote.

Royal Berkshire Hospital NHS Foundation

Trust, UK


Frailty is a state associatedwith accumulation of deficits

and loss of physiological reserve. Increasing severity of frailty is

associated with escalating care needs and greater risk of acute

deterioration. With an ageing population and a focus on care closer

to home there is a risk that the severity of frailty in community

hospitals may be rising. A service evaluation was undertaken to

determine this and aid in staff planning.


The multidisciplinary discharge letters of 225 patients

who were admitted to a local community hospital in July during 6

consecutive years (2010

2015) were reviewed. 17 records were

incomplete leaving 208 patients. A regression analysis was performed

to identify any significant trends.


From 2010 to 2015, there was an increasing percentage of

patients with incontinence (25.92% in 2010, 42.86% in 2015; p = 0.046),

diagnosis of dementia (11.11% in 2010, 28.57% in 2015; p = 0.011),

requiring assistance to mobilise (33.33% in 2010, 75.51% in 2015;

p = 0.007), requiring further care or rehabilitation at home (51.85% in

2010, 89.13% in 2015; p = 0.011) and average charlson co-mobility score

(1.00 in 2010, 2.20 in 2015; p = 0.032).


Over the 6 years there were statistically significant

increasing trends in multi-morbidity and dependency. These factors

all indicate that the frailty of patients in our community hospital is

increasing with time with an ensuing impact on staffing levels and

funding requirements.


Effects of an exercise protocol in frail and pre-frail elderly

R. Amaro


, N. Alegria


, M. Ramalhinho


, G. Afonso


, D. Morais



F. Pereira


, G. Araujo


, S. Miguel


, O. Santos




Serviço de Medicina Física

e de Reabilitação, Centro Hospitalar Lisboa Norte - Hospital Pulido

Valente, Lisbon, Portugal


Low physical activity has shown to be one of the most

common components of frailty and numerous studys have demon-

strated the importance of exercise in preventing and even reversing

this syndrome.


To describe an exercise protocol designed for pre frail and

frail older adults; to determine the effects of this exercise protocol in a

population of pre frail and frail adults.


38 frail (n = 19) and pre-frail (n = 19) older adults (mean

age = 80) were assigned to a 24 week group exercise program. Exercise

sessions took place twice a week, last for an hour and focused on

increasing strength and endurance and improving mobility and

balance. The Tinetti Balance Scale (TBS), Timed up and go Test

(TUG), Funcional Reach Test (FRT) and Gait Funcional Classification

(GFC) were applied before the programand by the end of the 24weeks.


Subjects showed a general improvement: 30% of the sample

changed their frailty status; in the Tinetti scale results TUG i.


f. = 3,5 seg.) and in the



Tin. f. = 2), in the TUG (


(FRT i.


f. = 4 cm). We found the GFC results lacked expression.



(Limitations of the study included the size of sample, its heterogeinity

and a high prevalence of comorbidities among the subjects.


This study suggest that frail and pre frail older adults

seem to benefit from this exercise intervention protocol.


Cardiovascular rehabilitation in the elderly



M. Ramalhinho


, D. Morais


, G. Afonso


, G. Araújo


, F. Pereira



O. Santos


, S. Miguel


, A. Amaro


, N. Alegria




Serviço de Medicina Física

e de Reabilitação, Centro Hospitalar Lisboa Norte - Hospital Pulido

Valente, Lisbon, Portugal

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