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The role of the gastrostomy tube to ensure adequate nutrition in

advanced dementia with dysphagia

about the clinical report

A. Moreira, A. Pereira.

Departement of Medicine, ULSM- Hospital Pedro

Hispano, Departement of Medicine, ULSM- Hospital Pedro Hispano,

Matosinhos, Portugal

Dementia is a progressive and irreversible disease, with an incidence

rate of around 50% in the population above 80 years. The nutritional

status of this is controversial. The questions relate to the refusal to eat,

dysphagia and risk of aspiration, dehydration and malnutrition. The

Percutaneous Endoscopic Gastrostomy (PEG) is a preventive measure

of respiratory infections by aspiration and a mean of maintaining

the nutritional status and adequate hydration. We report the case of

84-years-old man, totally dependent for daily life activities in


s dementia context in advanced stage (stage 7 of The

Global Deterioration Scale for Assessment of Primary Degenerative

Dementia). The patient was admitted several times due to respiratory

infection in last years. The medical team considered the clinical

suspicion of bronchial aspiration as the cause of recurrent infections.

In the last hospitalization the patient was progressively parlous,

malnourished with hypoproteinaemia and hypoalbuminemia. During

the hospitalization it was documented dysphagia and high risk of

aspiration. It was decided to suspend oral feeding and start feeding by

PEG. Currently, the patient has better nutritional status (with total

protein and albumin levels are normal) and has not been admitted

because of respiratory infection. The above clinical case illustrates one

of the most common realities in medical wards and the power

dilemma of oral feeding versus feeding by device. In the literature

there is no consensus or guidelines on this subject, only recommenda-

tions of some societies in favour of feeding by mouth, by changing the

food consistency, use of preferred foods and calorie supplements.


Vitamin D levels and hip fracture outcome

M. Neira Álvarez


, P. Lopez-Dóriga


, E. Arias Muñana


, A. Morales



, J.F. Gómez Cerezo




Hospital Infanta Sofía, Universidad

Europea de Madrid,


Hospital de Getafe, Universidad Europea de Madrid,

Madrid, Spain


To evaluate the relation between 25-hydroxyvitamin D

(25-OHD) levels and functional recovery as well as survival after

fragility hip fracture in elderly.


This is a prospective observational study in patients aged 65

years and older admitted with fragility hip fracture to a University

hospital from April 2013 to April 2014.

At time of admission were recorded: age, sex, type of fracture,

functional status (Barthel Index), mental status (Cruz Roja Index) and

hand grip strength. Serum levels of 25-hydroxyvitamin D (25


were measured in 121 patients by competitive enzyme immunoassay

technique (ADVIA Centaur, Siemens Healthcare Diagnostics). Blood

samples were taken for 25

OHD analysis within the first 72 hours of

admission. Follow-up was performed 3 months after discharge to

assess functional status and survival.


In total, 127 consecutive patients with hip fracture over the

age of 65 were evaluated


103 were women (81,1%). Mean age was

85,1 ± 0,6 years, being women older than men (p = 0.017). Barthel

Index at admission was 67,13 ± 2,6 and three months after discharge

was 49,5 ± 3,2. 19 patients died during the three months follow up


The mean 25-OHD level was 26,6 ± 1,8 ng/mL (4,2

105,1). 52 patients

had serum concentration of 25

OHD below 20 ng/mL (42,9%).

No relation was found between functional recovery and Vitamin D

levels (p = 0.77), neither was between mortality and Vitamin D levels

(p = 0.99).


Despite a relatively high prevalence of vitamin D defi-

ciency in fragility hip fracture patients, no relation was found with

hip fracture outcome or mortality.


Frailty fracture secondary prevention coordination: first step of

implementing a Fracture Liasion Service model

D. Padrón, L. Guardado


, P. Carrillo


, A. Membrilla


, A. Rubio


, J. Mora




Hospital Clínico San Carlos, Madrid, España


(1) To study the impact of a Fracture Liasion Service (FLS)

on clinical practice in secondary prevention of frailty fractures (FF) in

an Ortogeriatric Unit. (2) To describe the rates and causes of non-

adherence to pharmacologic treatment.


Sequential, comparative and follow-up study of hip fracture

patients. Two periods of study: January-June 2015: conventional care

(CC) and July 2015-April 2016: FLS care (educational information about

prevention and risk of new FF). We studied comparative rates of

antirresortive prescription and its adherence in 1-month and 6-month

visits at Orthopaedic Clinic.


n: 490 (CC: 209; FLS: 281). Mean age: 85.1 (SD 7.1); 79.9%

W. Baseline comparison: CC patients had better functional status

(Barthel Index 90 vs 78.5; p < 0.001) and more comorbidity (Charlson

Index 6.6 vs 5.8; p < 0.001) than FLS. At discharge, FLS patients received

more antirresortive treatment (63.3% vs 42.6%; p < 0.001). Follow-up

data: 136 FLS patients were followed for 6-months. At discharge, 90

of them (66.2%) were prescribed an antirresortive. At one-month visit,

60 patients (66.6% of that), and at 6-month visit, 39 patients (65.0%

of that) were respectively under treatment. The cumulative rate of

adherence of treatment at discharge was 43.3%. The main causes for

abandon were: stopping treatment by General Physician (GP) and side



(1) FLS implementation showed a significant increase in

antirresortive prescription. (2) Short efforts are not enough to warrant

an optimal rate of treatment adherence, mainly for GP decisions.

A wider plan is necessary to decrease the abandon rate in this in-risk



Chronic kidney disease in the elderly: nutritional assessment

M.E. Portilla


, L. Gómez


, R. Sosa


, F. Tornero


, J.A. Herrero


, C. Verdejo




Department of Geriactrics, Hospital Clinico San Carlos,


Department of

Nephrology, Hospital Clinico San Carlos, Madrid, Spain.


Malnutrition in elderly patients with Advanced Chronic

Kidney Disease (ACKD) is related to the development of frailty and the

occurrence of adverse clinical outcomes.


To describe the nutritional status in patients with ACKD

and evaluate the association between nutritional and clinical




65 years old, assessed in ACKD clinics (not on

dialysis) with estimated glomerular filtration rate (eGFR) < 20 mL/min

measured by CKD-EPI formula. Baseline variables: socio-demographic

data, functional status (Barthel, Lawton, Functional Ambulation

Classification), comorbidity (CIRS-G), etiology of kidney disease,

anthropometric measurements, body mass index (BMI) using WHO

and SENPE version (adapted to elderly), Mini Nutritional Assessment

(MNA), Ulibarri scale and lab tests.


80 patients, mean age 78.3 years (±7.4). MNA test showed

normal nutritional status 62.5%. BMI (SENPE version) showed normal

weight 76.3%. BMI (WHO version) showed normal weight 30%,

overweight 50%. Ulibarri scale showed normal nutritional status

44.4%. Comparison of different nutritional assessments with clinical

parameters, showed a significant association between normal nutri-

tional situation, assessed using BMI (SENPE version) and MNA, with

Barthel >80 (BMI SENPE: p = 0.02 and for MNA p = 0.03).


There is a wide variability between tests for the

assessment of nutritional status in the elderly. BMI (WHO version)

may overestimate the rates of overweight in the elderly. An optimal

nutritional status assessed by BMI andMNA, are associated with better

functional situation.

Poster presentations / European Geriatric Medicine 7S1 (2016) S29