European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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P-656
Paradoxical outcomes in cardiovascular profiles among elderly
people in Tanzania: a clinical based study
K. Leshabari 1,2. 1Clinical Research Unit, Candella Co. Ltd., 2Dept. of
Medicine- The Walter Hospital, Dar es Salaam, Tanzania
Objective: To analyse the association between blood pressure profile
and cardiometabolic parameters among elderly people attending
outpatient clinics in a typical sub-Saharan Africa environment.
Methods: A cross-sectional hospital based study was conducted in a
metropolitan city of Dar es Salaam in Tanzania. Study population
comprised of people ≥ 65 years old attending OPD settings. Data on
systolic and diastolic BP, Hb level, FBG/RBG, waist-to-hip ratio,
corrected serum Ca2+ and serum creatinine levels were analysed.
Log-linear models were fitted to analyse the association between
studied variables. SAS version 9.4 was used for data analysis.
Results: Findings from 502 elderly people were analysed. There was a
slight female preponderance in the study sample (M:F = 1:1.4) Median
agewas 73.2 years (range = 65 –94 years) Therewas a paradoxical trend
between systolic/diastolic BP and history of CVAwith age (P-value for
trend = 0.02). Serum Ca2+ levels and elevated BP levels were strongly
correlated ( ⍰ = 0.813, p < 0.01). Women outnumberedmen in reported
history of CVA (P < 0.01). Low Hb levels and low serum creatinine were
associated with multiple CVA history (⍰ = 0.507, p = 0.04).
Conclusion: Serum Ca2+ levels were inversely related to CVA events in
the elderly population in this study. Elderlywomenweremore likely to
have elevated serum Ca2+ than elderly men. Elderly with a history of
multiple CVA events were likely to have low Hb levels and low serum
creatinine. CVA risk was found to be less likely among elderly people
with elevat BP.
Recommendations: Further experimental studies are needed to
account for a probable causal relationship between serum Ca2+
levels and CVA protection in the elderly population.
Keywords: elderly; CVA; Dar es Salaam; Tanzania.
P-657
Cardiometabolic risk modeling using a typical high risk adult
population of sub-Saharan settings
K. Leshabari 1,2, B. Mphumuhila3, N. Mavura 4, R. Bushiri5, R. Kalikawe6.
1Clinical research unit, Candella Co. Ltd, 2Dept. of Medicine, The Walter
Hospital, 3Temeke Municipal Hospital, 4Mwananyamala Hospital,
5Amana Municipal Hospital, 6Muhimbili National Hospital, Dar es
Salaam, Tanzania
Objectives: To develop a simple, non-invasive cardiometabolic risk
tool for identification of adult at risk of diabetes mellitus in sub-
Saharan Africa.
Method: A cross-sectional analytical based opportunistic screening
was conducted among pre-defined high risk group residents of Dar es
Salaam, Tanzania. Data were collected using a locally prevalidated
questionnaire provided by Tanzania Diabetes Association after fasting
blood glucose measurements. Analysis was done using SAS version 9.2
by fitting linear models. Averbal informed consent was sought to each
participant before screening.
Results: We screened a total of 461 residents. Males predominated
the screened cohort (male: female = 2.3:1). Multiple logistic model
revealed age of the participant, family history of diabetes, systolic BP as
well as BMI to have a better explanatory power (p < .001) Spearman
correlation coefficient between being screened positive for diabetes
and family history of diabetes was strong and significant (γ = 0.673,
p = 0.002) No statistical significant effect was found between gender
and positive diabetes screening ( χ2 = 4.66, df = 1)
Conclusion: Age of participants, family history of both diabetes and
hypertension, BMI as well as systolic measures of BP were predictive of
diabetes in this study population. Adoption of non-invasive screening
for diabetes may be an alternative to the current invasive glycaemic
measurements in resource limited settings.
Key Words: Cardio-metabolic risk, diabetes, Dar es Salaam, Tanzania.
P-658
Glycaemic control according to health status in geriatric patients
with diabetes mellitus
A. Libiseller1, K.M. Neubauer1, A. de Campo2, T. Wiesinger2, N. Stolletz2,
G. Cuder1, B. Höll3, L. Schaupp1, P. Beck 3, J. Plank1, T.R. Pieber1. 1Medical
University of Graz, 2Geriatric Health Centers of the City of Graz,
3Joanneum Research ForschungsgesmbH Graz, Austria
Objectives: About 25% of people older than 70 years suffer from type-
2-diabetes. Due to the heterogeneity of the geriatric population
guidelines emphasize the need to individualize glycaemic goals
and to simplify treatment strategies with the main focus of avoiding
hypoglycaemia. The aim of this study was to assess glycaemic control
in patients with type-2-diabetes in geriatric care facilities based on the
individual health status.
Methods: 170 medical records of geriatric patients with type-2-
diabetes in 4 geriatric care facilities (64.7% female, age 80 ± 9 years,
HbA1c 51 ± 16 mmol/mol, BMI 27.9 ± 5.8 kg/m2) were retrospectively
assessed. Based on the individual health status, patients were allocated
to three groups (healthy n = 27, complex n = 86, poor n = 57).
Results: The overall blood glucose (BG) value was highest in the poor
health group with 188 ± 47 mg/dL (poor) vs. 167 ± 42 mg/dL (complex)
vs. 150 ± 34 mg/dL (healthy). 1.6% (poor) vs. 2.8% (complex) vs. 1.4%
(healthy) of all BG values were below 90 mg/dL. 37.2% (poor) vs. 23.4%
(complex) vs. 18.5% (healthy) received insulin as the main diabetes
therapy, but only 14.3% (poor) vs. 30% (complex) vs. 40% (healthy)
were treated with basal insulin.
Conclusion: Overall BG values were higher in the poor and complex
group. There were few low BG values in all groups. Although recom-
mended by international guidelines basal insulin therapy with its low
complexity and low hypoglycaemic risk is still underused, especially in
the poor-health group. Therefore the simplification of diabetes therapy
should further be considered.
Supported by: Research Studio Austria “GlucoTab” (FFG, project
844737).
P-659
Feed at risk
K.T. Ling, P. Das, T. Vedutla, G. Shorthouse. Department of Stroke and
Elderly Care
Background: Patients admitted to hospital often have swallowing
difficulty. Often alternative methods of feeding for example enteral
tube are considered. These patients unfortunately are deemed
unsuitable for PEG feeding or long term NG feeding due to severe
comorbidities. These patients are high risk of aspiration. Keeping them
nil by mouth puts them at risk of starvation and malnutrition. Our
search of National Guidelines does not give any guidance for risk
feeding for these patients. Healthcare professionals often find this to
be very challenging and a difficult issue to address. The feeding at risk
needs to be considered in light of the patients overall comorbidities,
wishes and prognosis. Decision should be ethically relevant.
Innovation To address these issues, we developed a “Feed at Risk ”
policy in our trust to aid oral feeding in these patients who are at risk of
aspiration. The policy helps patients, healthcare professionals and
family in arriving at the correct decision. Evaluation We decided to
do a retrospective audit of outcomes of patients who were managed
with the Feed at Risk policy. We audited 22 case notes from January
2014 to March 2016. Out of these 22 patients, 16 patients did not
have aspiration pneumonia. Of the other 6 patients who did have
aspiration pneumonia, 4 survived and 2 died.
Conclusion: Our results validates that feed at risk is a safe and effective
patient centred pathway for these high risk patients. Further studies
with larger cohort of patients are needed for further validation of this
practice.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S202