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Objective:
To determine the influence of vitamin D deficit on
functional recovery in post acute patients admitted in a functional
recovery unit.
Methods:
Prospective observational study January 2014 to December
2015. We analyze socio-demographic data, functional status at
admission and at discharge in the unity and levels of 25(OH)D on
admission.
Results:
135 patients (65% women) were admitted to our unit for
rehabilitation (20% of neurological patients, 23% deconditioning
patients, 57% orthopedic patients). Eighty-one por cent of patients
had 25(OH)D levels <20 ng/dL and 35.5% <10 ng/dL. The deficit of
vitamin D was present in 89.3% of neurological patients, in 80% of
the orthopedic patients and 75% of the deconditioning patients. We
divide the sample into three groups whose results are explained in
the table.
25(OH)D
ng/dl
n Age LoS
days
Admission
BI
Discharge
BI
HI
Admission
FAC
Discharge
FAC
<10
48 83.4 27.5 41.8
57.1
42.1 1.1
2.4
<20
61 80.1 27.8 45.2
62.3
46.4 1.0
2.6
>20
23 78.4 23.4 52.9
70.2
51.3 1.95
2.95
BI: Barthel index, FAC: Funtional Ambulation Categories, HI: Heinemann Index,
LoS: Length of stay.
Conclusions:
Vitamin D deficiency is extremely prevalent among
the studied population. In this study patients with lower vitamin
D concentration are older and have more dependence levels at
admission in the unit. Low vitamin D is associated with lower
functional recovery at discharge and with longer legth of stay.
P-680
Importance of antithrombotic therapy with new anticoagulants in
octagenarian and nonagenarian patients with nonvalvular atrial
fibrillation
R. Ayala
1
, M. Ramos
1
, R. Toro
2
, R. Borstein
3
, J. Gómez Pavón
4
,
G. Cristofori
4
, M. Quezada
1
.
1
Department of Cardiology, Hospital
Universitario Central Cruz Roja, Madrid,
2
Department of Internal
Medicine, University Hospital Puerta del Mar, Cádiz,
3
Department of
Hematology,
4
Department of Geriatrics, Hospital Universitario Central
Cruz Roja, Madrid, Spain.
Introduction:
The risk of cardioembolic stroke increases with age.
Antithrombotic prophylaxis is underused in the elderly population.
The definition of the ideal drug in this group of patients is a challenge.
Methods:
108 patients were included with non-valvular atrial
fibrillation (NVAF), glomerular filtration rate (GFR) >30 mL/m
2
and
a time in therapeutic range (TTR) <60% with acenocumarol.
Epidemiological, anthropometric, cardiovascular risk factors (CRF),
CHADS2 score and CHA2DS2Vasc data were collected. The risk of
bleeding was determined with HASBLED and HEMORRA2GES
scales. The new anticoagulant was appointed as a function of age,
GFR, BMI, cardiovascular disease history, peptic ulcer, gastrointestinal
bleeding (GIB), intracranial hemorrhage (ICH) and risk of falling.
Follow-up was one year.
Results:
57.1% were women. Median age of 82 ys (IQR 75
–
82). The
most common CRF were hypertension (HTA) (79%) and type 2 DM
(21%). The most frequent comorbidities were anemia (24.2%) and
chronic kidney disease (30.7%). The average CHADS2 scale was 3.5
and CHA2DS2Vasc 5 points, which was associated with increased
incidence of ischemic events (p < 0.01 and 0.03) . History of bleeding
events was present for gastric ulcer in 6.7%; GIB 2.9% and ICH1 9%.
Moderate bleeding risk was 57.1% according to HASBLED and 40.3%
using HEMORRAGES. Severe risk was 29.5% and 20.2% respectively.
With acenocumarol 12.55% had thrombotic events and 10.8% bleeding
events, while NACOS presented 2.7% thrombotic events and 2.7%
bleeding events.
Conclusion:
In the elderly with non-valvular atrial fibrillation,
antithrombotic therapy with new anticoagulants is safe and effective.
P-681
Atrial fibrillation and death risk in an elderly inpatient population
A.R. Barbosa
1
, O. Gonçalves
1
, V.P. Dias
1
.
1
Centro Hospitalar de Vila Nova
de Gaia/Espinho, Vila Nova de Gaia, Portugal
Introduction:
Atrial fibrillation (AF) is the most common arryhtmia
affecting 10% of patients older than 89 years. It is considered to be an
independent risk factor for mortality. The goal of this research is to
acess the prevalence of AF and to evaluate its association with
mortality rate in hospitalized patients with 75 or more years old.
Methods:
Consultation of medical records of hospitalized patients
with 75 or more years old in an Internal Medicine department from
January to March 2015.
Results:
296 admissions, corresponding to 261 patients. Mean age of
84.66. The group of patients with AF and the non AF groupwere similar
in terms of age, gender, hospitalization reason and comorbidities,
except for heart failure which was more prevalent in the AF group.
Mortality rate was 23.4% with significant difference between groups
–
30% in the AF group and 17.7% in the non AF group.
Discussion:
The prevalence of AF in this sample is significantly higher
than what is described. Almost one fourth of the diagnosis was
made during hospitalization which leads to believe that maybe the
prevalence of undiagnosed AF is considerably higher. Although the
similarity between groups, the death rate was greater in the AF group.
Conclusion:
Since the prevalence of AF is so high in the elderly and it
affects mortality risk, it is imperative to identify these patients. More
studies are needed to access the real prevalence and to access cost-
benefit of Holter monitor
’
s use as screening test in addition to pulse
palpation.
P-682
Improved functional performance in geriatric patients during
hospital stay
A. Karlsen
1,2
, M.R. Loeb
2
, K.B. Andersen
2
, K.J. Jørgensen
2
, F.U. Scheel
2
,
I.F. Turtumoeygard
2
, A. Perez
1
, M. Kjaer
2,3
, N. Beyer
4
.
1
Dept. Geriatrics,
Bispebjerg Hospital, University of Copenhagen,
2
Institute of Sports
Medicine, Bispebjerg Hospital, University of Copenhagen,
3
Center for
Healthy Aging, University of Copenhagen,
4
Dept. Physical &
Occupational Therapy, Bispebjerg Hospital, University of Copenhagen,
Denmark
Objectives:
Older medical patients often experience hospitalization
associated decline in function and muscle strength. The time pattern
of this decline and the potential recovery over the period of hospital
stay is unknown.
Methods:
151 hospitalized geriatric patients, age 85.2 ± 7.2 years
(mean ± SD), were observed, and of these 3 sequential observations
were performed in 81 patients (day 2
–
4 (T1), day 5
–
8 (T2), and day
9
–
13 (T3)). Functional performance was assessed by De Morton
Mobility Index (DEMMI) and 30-s Chair Stand Test (30s-CST); muscle
strength was assessed by handgrip strength.
Results:
At T1 average DEMMI-score and 30s-CST were 49.7 ± 14.7 and
3.5 ± 4.2, respectively. Compared to T1, DEMMI-score was increased
at T2 (+3.7, p < 0,001, n = 81), and tended to increase further at T3 (+2.0,
p = 0.096; 30s-CST tended to increase at T2 (+0.5, p = 0.085) and was
improved at T3 (+1.5, p < 0.01). Handgrip strength was unchanged at
T1, T2, and T3 (18.8 ± 7.0 kg; 19.0 ± 6.8 kg; 18.7 ± 6.7 kg, respectively,
p = 0.82, n = 81). Improvements in DEMMI correlated with improve-
ment in 30s-CST (r = 0.53, p < 0.001, n = 151), with 48% of patients
demonstrating increase in only one of the parameters.
Conclusion:
In geriatric patients functional performance improved
during a hospital stay below 14 days, while no change was observed in
handgrip strength. It was notable that improvements in DEMMI-score
was more likely to occur in patients with low initial functional level,
whereas changes in 30s-CSToccurred more often in patients with high
functional level. This indicates that the two tests are complimentary to
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S208