157 / 290
Conclusions:
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.
P-458
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
Introduction:
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.
Discussion/Conclusion:
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.
P-459
Orthotic management of diabetic foot
M. Briôa, J. Matos, D. Lima, D. Ricardo.
Escola Superior de Tecnologia da
Saúde de Lisboa
Objective:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
P-460
The rising incidence of frailty in a community hospital?
–
a 6 year
analysis
A. McColl, F. Khan, Y. Sote.
Royal Berkshire Hospital NHS Foundation
Trust, UK
Introduction:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
P-461
Effects of an exercise protocol in frail and pre-frail elderly
R. Amaro
1
, N. Alegria
1
, M. Ramalhinho
1
, G. Afonso
1
, D. Morais
1
,
F. Pereira
1
, G. Araujo
1
, S. Miguel
1
, O. Santos
1
.
1
Serviço de Medicina Física
e de Reabilitação, Centro Hospitalar Lisboa Norte - Hospital Pulido
Valente, Lisbon, Portugal
Background:
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.
Objectives:
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.
Methods:
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.
Results:
Subjects showed a general improvement: 30% of the sample
changed their frailty status; in the Tinetti scale results TUG i.
–
TUG
f. = 3,5 seg.) and in the
Δ
Tin.i.
–
Tin. f. = 2), in the TUG (
Δ
(FRT i.
–
FRT
f. = 4 cm). We found the GFC results lacked expression.
Δ
FRT
(Limitations of the study included the size of sample, its heterogeinity
and a high prevalence of comorbidities among the subjects.
Conclusions:
This study suggest that frail and pre frail older adults
seem to benefit from this exercise intervention protocol.
P-462
Cardiovascular rehabilitation in the elderly
–
functional
assessment
M. Ramalhinho
1
, D. Morais
1
, G. Afonso
1
, G. Araújo
1
, F. Pereira
1
,
O. Santos
1
, S. Miguel
1
, A. Amaro
1
, N. Alegria
1
.
1
Serviço de Medicina Física
e de Reabilitação, Centro Hospitalar Lisboa Norte - Hospital Pulido
Valente, Lisbon, Portugal
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S151