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Aim:
To evaluate the effectiveness of an integrated health promotion
program in the overall physical health of community-dwelling people
aged 60 years and older in Taiwan.
Methods:
Data of subjects participating in the integrated health
promotion program (
“
3 Plus 1 Integrated Program
”
) provided by the
Yangsheng Foundation in 2014 were retried for analysis. All subjects
aged 60 years and older and were free from active diseases. Subjects
with significant impairment in activities of daily living or physical
activities were excluded for study. The
“
3 + 1 Integrated Program
”
consisted of series activities of exercises, healthy diet, health
behavior, and interpersonal relationship that continued for 12
weeks. Demographic characteristics, health behavior, living arrange-
ment, marital status, underlying chronic conditions, and medications
in use were collected. All subjects received assessment for anthropo-
metric measurements, cognitive function, depressive symptoms, and
evaluation of physical fitness, including timed up-and-go test (TUG),
2-minute step test (2m ST), 30-second chair stand test (30s CST), and
dominant handgrip strength (HG).
Results:
Overall, data of 80 subjects (mean age: 62.8 ± 6.6 years,
80% female) were retrieved for analysis after excluding data with
incompleteness. Among all participants, the most common chronic
condition was hypertension and almost none of the participants
were current smokers or having habitual alcohol drinking. Meanwhile,
the participants were physically fit, cognitive intact, having few
depressive symptoms, but 17.5% of them had the history of falls in the
past year and a half of all participants reported fear of falling. After the
12-week
“
3 Plus 1 Integrated Program
”
, the systolic blood pressure,
diastolic pressure, body mass index were significantly reduced
(131.7 ± 21.8 vs 136.3 ± 22.4 mmHg, P = 0.047; 74.2 ± 11.5 vs 77.0 ± 11.0
mmHg, P = 0.047, and 23.8 ± 2.8 vs 24.2 ± 2.8 kg/m
2
, P < 0.001, respect-
ively by using paired t-test). Meanwhile, the 2mST and 30s CST were
both significantly improved (115.3 ± 17.3 vs 104.6 ± 18.7 steps,
P < 0.001; and 23.9 ± 8.9 vs 20.3 ± 6.9 times, P = 0.001, respective
by paired t-test). The cognitive function, TUG and HG were not
significantly different before and after the program. Spearman
correlation showed that the reduction of diastolic blood pressure
was significantly associated with reduction in systolic blood pressure,
reduction in body mass index, and improvement of 2m ST (P all <0.05).
Conclusions:
The
“
3 Plus 1 Integrated Program
”
significantly improved
cardiovascular health and physical fitness, which may also prevent the
cognitive decline and depressive symptoms among community-
dwelling older people in Taiwan.
P-581
Polypharmacy in the elderly
A. Cochofel
1
, B. Filipe
2
, I. Pecellin
2
.
1
Unidade de Saúde Familiar Flor de
Lótus, Cacém,
2
Unidade de Saúde Familiar Quinta da Prata, Borba,
Portugal
Introduction:
In the elderly person the incidence of chronic
conditions that require a greater number of pharmacological pre-
scriptions is observed. Quaternary prevention is defined by the set
of actions that aim to prevent damage associated with medical
interventions, such as over-medication, and is governed by the
Hippocratic principle
“
primum non nocere
”
(first do no harm).
Objective:
Alert to the importance of reducing polypharmacy in
primary health care setting through quaternary prevention.
Methodology:
Research of scientific articles in the databases PubMed,
Scielo, UpToDate and Science Direct, written in Portuguese, Spanish
and English, published in the last five years, using the following
keywords: polypharmacy and drug prescription.
Results:
Polypharmacy, characterized as the use of multiple drugs or
more than are medically necessary, has a high prevalence in patients
over 65 years of age, making them a vulnerable age group since
the aging process causes pharmacokinetic and pharmacodynamic
changes predisposing to iatrogenic side effects. Adding to this are all
therapeutic changes made without medical advice, including supple-
ments and herbal drugs. The main consequences of polypharmacy are
the increased incidence of adverse drug reactions, decreased adher-
ence to therapy and increased costs, both direct (drugs) and indirect
(hospitalizations and hospital emergencies resulting from drug
interactions).
Conclusion:
Polypharmacy is a direct consequence of multiple patho-
logies, so re-evaluation of therapy in each consultation is crucial, with
the objective of improving the quality of life of the user, minimizing
drug interactions and iatrogenic effects.
P-582
Sex-specific associations of gait speed with all-cause mortality in
older adults
–
the ActiFE study
D. Dallmeier
1
, U. Braisch
1,2
, J. Klenk
2
, D. Rothenbacher
2
, W. Koenig
3
,
K. Rapp
4
, M. Denkinger
1
.
1
AGAPLESION Bethesda Clinic, Geriatric Center
Ulm/Alb-Donau, Ulm University,
2
Institute of Epidemiology and Medical
Biometry, Ulm University, Ulm,
3
Deutsches Herzzentrum München,
Munich,
4
Robert-Bosch-Krankenhaus, Stuttgart, Germany
Objectives:
Walking requires energy and coordination, demanding
the interaction of multiple organ systems. In this context gait speed is
related to functional ability and many aspects of health. We analyzed
the association between gait speed and six-year mortality in
community-dwelling older people.
Methods:
Gait speed over 4 meters was measured in subjects
≥
65
years participating at the cohort study Activity and Function in the
Elderly in Ulm (ActiFE Ulm). Cox-proportional hazards models
evaluated the association between gait speed and six-year mortality
adjusting initially for age followed by identified predictors of gait
speed: body mass index, short performance physical battery and
handgrip strength.
Results:
We observed 166 deaths among 1166 participants (mean age
75.2, 60% men, mean gait speed 1.0 m/s with no differences across
gender) representing an incidence rate (IR) of 25.2 deaths per 1000
person-years [95% CI 21.6
–
29.3]. We detected evidence of effect
modification by sex (p = 0.15). In age-adjusted analyses a 0.1 increment
in gait speed was associated with a hazard ratio (HR) of 0.73 [95% CI
0.64
–
0.84] in women (n = 466, 42 deaths, IR 15.5 [95% CI 11.3
–
20.8])
compared to a HR of 0.83 [95% CI 0.77
–
0.90] in men (n = 700, 124
deaths, IR 32.0 [95% CI 26.7
–
38.0]). Multivariable analyses attenuated
these associations with a HR of 0.81 [95% CI 0.65
–
1.01] inwomen and a
HR of 0.88 [95% CI 0.80
–
0.97] in men.
Conclusion:
The strength of the association between gait speed
and six-year mortality seems to vary between men and women,
pointing out the need for more sex-specific research among older
people.
P-583
Effectiveness of community based occupational therapy for
physical frail older people: a systematic review
L. De Coninck
1,2
, G. Bekkering
3
, L. Bouckaert
2
, A. Declercq
4
, M. Graff
5
,
B. Aertgeerts
1
.
1
Department of Public Health and Primary Care, KU
Leuven,
2
Departement OT, University College Artevelde, Ghent,
3
CEBAM
Belgian Center of EBM vzw Leuven,
4
LUCAS
–
Centre for Care Research and
Consultancy KULeuven, Belgium;
5
Department of Rehabilitation, Section
OT, Radboud University Medical Center, Nijmegen, The Netherlands
Background:
Living safely and independently is a priority goal. The
provision of high quality home care services results in a decrease in
the number of admissions in hospitals and residential care centers.
Occupational therapists aim, in collaboration with other health
professionals, to facilitate the independent living and participation
of older persons in everyday activities at home. The purpose of this
meta-analysis is to review the effectiveness of occupational therapy
(OT) interventions for community dwelling physically frail older
people.
Method:
Electronic databases (Medline, Embase, Cochrane Library,
Cinahl, Psychinfo and OTseeker) were searched for original studies.
This meta-analysis was carried out in accordance with the EPOC-
guidelines and using the Cochrane Handbook for Systematic Reviews
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S182