20 / 290
participants were randomized to
“
home visit
”
(HV),
“
telephone
consultation
”
(TG), or
“
control group
”
(CG). The intervention was
individualized nutritional counseling one, two, and four weeks after
discharge. The risk of readmission was analysed as intention-to-treat
(ITT) and as per-protocol (PP) using the Cox proportional hazard
regression model.
Results:
208 patients were randomized (HV = 73, TG = 68, CG = 67) and
included in the ITT-analysis. HV had a lower risk of readmission to
hospital compared to CG (HR = 0.4; 95% CI: 0.2
–
0.9, p = 0.03). No
difference was detected between TG and CG (HR = 0.6, 95% CI: 0.3
–
1.3,
p = 0.18). 166 patients completed the full intervention and were
included in the PP-analysis (HV = 53, TG = 46, CG = 67). HV had a lower
risk of readmission to hospital compared to CG (HR = 0.1; 95% CI: 0.03
–
0.6, p < 0.01). TG had also lower risk of readmission compared to CG
(HR = 0.2, 95% CI: 0.07
–
0.8, p = 0.02).
Conclusion:
Individualized nutritional follow-up performed as home
visits reduces readmission to hospital 30 after discharge in malnour-
ished geriatric patients who live alone. Nutritional counselling
performed over the telephone can reduce readmission to hospital,
but only among patients who receive the full intervention.
O-047
Adults 70
–
89 with heart disease, lung disease or diabetes mellitus
have an antibody response comparable to healthy adults 70
–
89
after receiving 23-valent pneumococcal polysaccharide vaccine
K. Kawakami
1
, H. Kishino
2
, S. Kanazu
2
, N. Toshimizu
2
, R. Yokokawa
2
,
K. Takahashi
2
, M. Kohn
3
, L. Musey
3
.
1
Nagasaki Kawatana Medical Center,
2
MSD K. K., Tokyo, Japan;
3
MSD, West Point, USA
Introduction:
Many countries recommend that adults with chronic
disease be vaccinated with pneumococcal polysaccharide vaccine
(PPSV23) because of their increased risk for pneumococcal disease. To
explore the immunogenicity of PPSV23 in these patients we examined
antibody responses in adults age 70
–
89 with chronic disease after
primary vaccination and revaccination compared to healthy adults in
this same age group.
Methods:
We measured serotype-specific IgG geometric mean
concentrations (GMC, 14 serotypes) and opsonophagocytic activity
titers (OPA, 6 serotypes) 4 weeks after vaccination in a community-
based cohort vaccinated >=5 years earlier (N = 161) or never vaccinated
(N = 81) with PPSV23.
Results:
For each serotype the GMC and OPA titers did not differ
significantly between each of the groups with co-morbid conditions
and the group without any of those conditions, with the exception of
significantly higher GMC titers against serotype 7F in the revaccination
groups with lung disease and heart disease, and serotype 3 in the
revaccination group with heart disease. The GMC also were not
significantly different between those with 0, 1 and 2
–
3 of these
conditions.
Key conclusions:
GMC and OPA responses to PPSV23 vaccination and
revaccination in older patients with heart disease, lung disease or
diabetes mellitus were not significantly different from older patients
without these conditions, even if they had more than one of these
condition or if they had been previously vaccinated. These results
support the recommendation to vaccinate these patients at increased
risk with PPSV23.
O-048
Norovirus disease leads to higher healthcare usage in older adults
with chronic medical conditions
T. Verstraeten
1
, B. Jiang
2
, H. Bogaerts
3
, J.G. Weil
3
.
1
P95
Pharmacovigilance and Epidemiology Services, Leuven, Belgium;
2
Takeda
Development Center Americas, Inc., Deerfield, Illinois, USA;
3
Takeda
Pharmaceuticals International AG, Zurich, Switzerland
Introduction:
Global estimates suggest that each year norovirus
infections cause over 200,000 deaths and US$65 billion in costs,
mostly affecting elderly adults and young children. It is also estimated
that over 80% of US adults over 65 years suffer from at least one chronic
medical condition. We assessed the impact of norovirus acute
gastroenteritis (NGE) on health care utilization by US adults with a
range of chronic underlying conditions.
Methods:
We performed a retrospective cohort study using
MarketScan data from 2002 to 2013, comparing rates of emergency
department visits, outpatient visits and hospitalizations for NGE
among patients with chronic conditions (renal, cardiovascular,
respiratory, immunocompromising, gastrointestinal, hepatic/pancre-
atic and neurological conditions and diabetes) with a healthy age-
matched population. We estimated the rates of these outcomes due to
NGE using an indirect modeling approach, stratified by 65
–
74, 75
–
84
and 85+ year-old age groups.
Results:
82.2% of elderly adults had one or more chronic condition.
Hospitalization rates for NGE were higher in all-risk groups compared
with otherwise healthy subjects. Highest rates were observed among
those with renal conditions (23.9
–
40.3 episodes per 10,000 person-
years across the increasing age groups) and chronic gastro-intestinal
conditions (12.6
–
62.8 episodes per 10,000 person-years), compared to
2.9
–
11.5 episodes per 10,000 person-years among those without
chronic conditions. Outpatient visits for NGE were also increased in
persons with chronic gastrointestinal or immunocompromising
conditions.
Conclusions:
Norovirus gastroenteritis leads to significantly higher
rates of healthcare utilization in older adults with a chronic medical
condition compared with otherwise healthy older adults.
O-049
Ageing with HIV: a huge challenge due to a high prevalence of
chronic comorbidities in a French population over 75
C. Allavena, C. Bernaud, F. Delamarre-Damier, S. Lariven, M.A. Valantin,
T. Ferry, L. Cuzin, A. Naqvi, A. Cabié, M. Hanf, F. Raffi.
DatAIDS study
group and AGREE FRANCE
Introduction:
HIV-infected adults on successful antiretroviral therapy
(ART) are expected to have close to normal lifespans, but will
increasingly develop age-associated comorbidities. Few data are
available in a geriatric HIV population.
Methods:
From the DatAIDS cohort, we selected patients with at least
one visit since 2004 and aged over 75 at the latest visit (geriatric
group). Their characteristics and comorbidities were described at the
censoring date (01/09/2014) and compared with the elderly popula-
tion, aged 50 to 75 (elderly group).
Results:
Characteristics of the 430 patients over 75 were as follow:
median age 78 years, 72% male, 37% homosexual contamination, 9%
hepatitis B or C co-infected, BMI < 18 in 22%, 34% at CDC stage C (AIDS),
with a median age at HIV diagnosis of 62 years (age > 75 at diagnosis in
8%) and a median duration of HIV infection of 17 years. Median nadir
CD4 and current CD4 were 144 and 494/mm
3
, respectively; 98% of the
subjects were on ART, virologically controlled in 89%. Most frequent
comorbidities were diabetes 22.3%, hypertension 42.3%, dyslipidemia
27.9%, cardiovascular disease 20.7%, neoplasia 22.6%, renal failure 14%
and depression 15.1%. The geriatric group had significantly more
frequent comorbidities than the elderly group: 40.2% vs. 24.7% had 2 or
3 comorbidities and 14% vs. 4.3% had more than 4 comorbidities (all
p < 0.05).
Conclusion:
Comorbidities dramatically increased in the geriatric HIV
population. New strategies are required for providing integrated HIV
and geriatric care to meet the long term and complex needs of older
HIV adults and to deal with drug-drug interactions.
O-050
Light physical activity predicts longevity in the Swedish older
population
M. Rennemark, J.S. Berglund, C. Jogreus.
Blekinge Institute of Technology
Introduction:
Physical activity gains health. It is positively related to
cognitive functions, good sleeping habits, muscle strength and
cardiovascular functions. In older ages, light physical activity is most
gainful. Since longevity is multi-determined, physical activity habits
Oral presentations / European Geriatric Medicine 7S1 (2016) S1
–
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