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

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P-664
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
Alzheimer’ 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.
P-665
Vitamin D levels and hip fracture outcome
M. Neira Álvarez1, P. Lopez-Dóriga2, E. Arias Muñana1, A. Morales
Fernandez1, J.F. Gómez Cerezo1. 1Hospital Infanta Sofía, Universidad
Europea de Madrid, 2Hospital de Getafe, Universidad Europea de Madrid,
Madrid, Spain
Obectives: To evaluate the relation between 25-hydroxyvitamin D
(25-OHD) levels and functional recovery as well as survival after
fragility hip fracture in elderly.
Methods: 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 ‐OHD)
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.
Results: 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
(15%).
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).
Conclusion: 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.
P-666
Frailty fracture secondary prevention coordination: first step of
implementing a Fracture Liasion Service model
D. Padrón, L. Guardado1, P. Carrillo1, A. Membrilla1, A. Rubio1, J. Mora1.
1Hospital Clínico San Carlos, Madrid, España
Objectives: (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.
Methods: 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.
Results: 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
effects.
Conclusions: (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
population.
P-667
Chronic kidney disease in the elderly: nutritional assessment
M.E. Portilla1, L. Gómez1, R. Sosa1, F. Tornero2, J.A. Herrero2, C. Verdejo1.
1Department of Geriactrics, Hospital Clinico San Carlos, 2Department of
Nephrology, Hospital Clinico San Carlos, Madrid, Spain.
Introduction: Malnutrition in elderly patients with Advanced Chronic
Kidney Disease (ACKD) is related to the development of frailty and the
occurrence of adverse clinical outcomes.
Objectives: To describe the nutritional status in patients with ACKD
and evaluate the association between nutritional and clinical
parameters.
Methods: Patients ≥ 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.
Results: 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).
Conclusions: 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–S259 S204