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Introduction:
Malnutrition is a frequent condition in the elderly that
can result in poor health outcomes. Our aim was to analyze outcomes
at 6 and 12 months (6M and 12M) of a cohort of patients
≥
75 years
admitted in an Internal Medicine Ward according baseline nutritional
status.
Methods:
Prospective longitudinal cohort study of 100 patients.
Comprehensive geriatric assessment at baseline, including nutritional
assessment (Mini Nutritional Assessment (MNA), bioimpedance,
anthropometry, serum total protein (TP) and albumin). Barthel score
at 12M, survival and hospital readmission at 6 and 12M assessed by
phone contact and hospital record analysis.
Results:
One patient lost during follow-up. Average age 83.7 years, 63%
males, average Cumulative Illness Rating Scale Geriatrics 11.2, average
baseline Barthel score 63.6, 32% cognitively impaired. 70% malnour-
ished according MNA. Cumulative mortality: 6M 48.4%, 12M 53.5%.
Therewas statistically significant association between: mortality at 6M
and MNA categories (p 0.015), albumin (p 0.032) and TP (p 0.007);
mortality at 12M and MNA categories (p 0.026), body mass index
(BMI) (p 0.026), albumin (p 0.041) and TP (p 0.003). Kaplan-Meier
survival curves supported these results. Predictors of rehospitalisation
were not identified. Higher TP was associated with emergency
department admission (p 0.017). Higher BMI was associated with
maintenance of functional status at 12M. Bioimpedance parameters
were not predictors of outcome.
Conclusion:
Malnutrition according MNA, lower BMI, lower albumin
and TP are predictors of poor outcome of hospitalized older patients.
Higher BMI is a protective factor as it is associated withmaintenance of
functional independence.
P-641
Hyperthyroidism in elderly hospitalized patients: what can we
do better?
I. Ferrando Lacarte, B. Gamboa Huarte, C. Deza Perez, M. González
Eizaguirre, E. García-Arilla Calvo.
Geriatrics Service, Hospital Nuestra
Señora de Gracia, Zaragoza, Spain
Introduction:
In August 2015, The European Thyroid Association
Guidelines on Diagnosis and Treatment of Endogenous Subclinical
Hyperthyroidism were published, collecting current evidence, trying
to resolve discrepancies identified in the management of this
condition. We set at objectives to know clinical practice performed
in patients with hyperthyroidism and subclinical hyperthyroidism
(type 1 and type 2) in a geriatric service.
Methods:
Descriptive analysis, reviewing patients admitted from June
to December 2014 (318 patients). Collected sociodemographic para-
meters, personal history, functional status (Barthel index), forecast
mortality (Charlson index), biochemical parameters, and one-year
mortality. SPSS v19.
Results:
Thyroid background 10.7%, 4 (1.3%) hyperthyroidism.
Admission: 12 (3.8%) TSH below the normal range: 4 hyperthyroidism
(36.4%), 2 subclinical hyperthyroidism type 2 (18.2%) and 5 subclinical
hyperthyroidism type 1 (45.5%), one unclassifiable (not FT4 available).
Subclinical hyperthyroidism prevalence: 2.2%. Any patient received
treatment at discharge and only three follow-up recommendationwas
made. Postdischarge 4 (40%) patients are monitored (3 primary care, 1
endocrine) and require treatment 2 (20%). Hospital mortality: 25%
hyperthyroidism; Subclinical hyperthyroidism type 1 20%; Subclinical
hyperthyroidism type 2 0%. Year mortality: 0% hyperthyroid patients;
Subclinical hyperthyroidism type 2 50%; Subclinical hyperthyroidism
type 1 25%.
Conclusion:
The prevalence of subclinical hyperthyroidism in our
sample is in the lower limits of the results of the NHANES III
study. Despite the low prevalence, mortality associated data, 20% and
50% per year, should make us reflect and deepen the knowledge
and approach of subclinical hyperthyroidism in patients older than
75 years.
P-642
Nutritional risk in heart failure
–
a retrospective study
I. Figueiredo, S. Guerreiro Castro, G. Magalhães, M. Antunes,
M. Perestrelo, H. Gruner, A. Panarra.
Serviço de Medicina Interna 7.2,
Hospital Curry Cabral, Centro Hospitalar Lisboa Central
Heart failure (HF) has high morbidity and mortality rates, especially if
associated with comorbidities, aging and poor nutrition. Our aim is
to evaluate the nutritional risk in HF and its impact on length of
hospital admission, infectious complications, readmissions within 1
and 6 months and mortality. We performed a retrospective study
of all patients admitted to the Medical ward in 2015 with HF (ICD-9)
who had a nutritional evaluation, by analyzing the files. Age, sex,
dependency status and comorbidities were characterized through the
Charlson Score (CS) and stratified by the Malnutrition Universal
Screening Tool (MUST) in low (LR), medium (MR) and high risk (HR),
with evaluation of the referred endpoints. Of a total of 3014 patients,
331 were admitted with HF, of which only 119 had nutritional
evaluation. Of these 119, 63.9% were womenwith a median age of 82.9
years and 76.5 years for men. MUST stratified the patients in: 59.7% LR,
7.6% MR and 29.4% HR. CS (4
–
13) was 7.9 in LR, 7.1 in MR and 8.2 in HR.
Regarding the endpoints, CS was 7.9 when infectious complications
were present, 8.2 in readmissions within 1 month and 8.8 within 6
months and 7.8 in mortality. The incidence of nutritional risk was the
same as other studies, in spite of a different evaluation tool. After
crossing data with CS, it seems to be related with readmissions and
infectious complications. There is a possible bias as a nutritional plan
can be initiated by the nutritional team on patients at risk.
P-643
Feeding of dementia inpatients within the Buckinghamshire
Healthcare NHS Trust: a survey exploring the views and experience
of foundation doctors and nurses
M.V. Foy
1
, B.V. Nagyova
1
, D. Begent
1
.
1
Buckinghamshire Healthcare NHS
Trust, Buckinghamshire, United Kingdom
Introduction:
The progression of dementia presents the healthcare
teams with complex feeding challenges, especially towards the end
stages of the disease. The Royal College of Physicians developed a
guidance document for the management of patients with swallowing
difficulties [1]. At present, we do not have trust guidelines to assist
with the feeding of dementia inpatients. Within our organization,
foundation doctors and nurses are the first responders when feeding
problems arise. We set out to investigate their views and experience
regarding the feeding of dementia inpatients, with the aim to find out
if they were facing any issues, and what these were.
Methodology:
We undertook two qualitative surveys for foundation
doctors and nurses caring for inpatients with dementia within our
organization
’
s hospitals. The questions were in multiple choice and
open formats.
Results:
33 doctors and 39 nurses answered. 30% of doctors and 79% of
nurses mentioned they had experienced issues regarding the feeding
of dementia inpatients. The main challenges described by both
surveyed cohorts were related to: low oral intake resulting in poor
nutrition; communication issues and discordances with the family;
alternative feeding routes; and poor swallow with potential risk of
aspiration pneumonia.
Conclusion:
The issues described by both populations were wide-
ranged, and most of them well understood in relation to dementia.
Both surveyed cohorts wouldwelcome further training on this subject.
Our project supported the development of trust guidelines for the
assessment and management of patients with swallowing difficulties,
which are currently awaiting approval by the trust.
References
[1] Royal College of Physicians and British Society of Gastroenterology.
Oral Feeding Difficulties and Dilemmas: A Guide to Practical Care,
Particularly Towards the End of Life
. London. Royal College of
Physicians, 2010.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S198