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G.A. Rollandi
2
.
1
Department Geriatric Care, OrthoGeriatrics and
Rehabilitation, E.O. Galliera Hospital,
2
Clinical Trial Unit, Scientific
Direction, E.O. Galliera Hospital, Genoa,
3
Department of Information
Technology, Bioengineering, Robotics and Systems Engineering, University
of Genoa,
4
Department of Sciences for Architecture, University of Genoa,
Italy
Background:
About 8% of hospitalized older patients prolong
their hospital stay despite being fit for discharge from the hospital
with an increased risk of disabilities and iatrogenic diseases due to
the prolonged hospital stay. Aim of this project was to create an
innovative model of protected discharge area equipped with auto-
mated monitoring technologies and architectural features in order
to prevent deterioration, improve autonomy, mobility and quality of
life (QOL).
Methods:
Hospitalized frail older patients who are fit for discharge
but cannot return home for non-clinical reasons were included.
The high-tech integrated systems included health monitors (heart
rate, blood pressure, pulse-oximetry, glucometer, body weight),
environmental sensors (cameras, RGB-D sensors), wearable devices
(accelerometers, localization tags) and an assistive robot (PadBot)
for older people. The data acquired were processed and modeled
by a software platform which includes a variety of data analysis
tools to ensure the safety of the older persons, by monitoring their
activities and degree of independence. In all subjects functio-
nal (ADL, IADL) and cognitive (SPMSQ) status, Multidimensional
Prognostic Index (MPI), the Quality of Life (SF12) and satisfaction
were also recorded.
Results:
Ten older subject (Male = 4
–
Female = 6, mean age = 77.4
+/
−
7.8 years) were included. The mean length-of-stay was 4.4+/
−
1.4
days. No significant changes occurred in functional, cognitive and
multidimensional parameters; QoL increased and satisfaction was
excellent.
Conclusions:
These preliminary data suggest that the MODIPO model
may be effective in promoting early discharge from the hospital, by
maintaining functional and cognitive abilities and improving QoL in
frail older subjects.
P-738
Spread the word: first geriatric unit in Portugal
F. Rocha
1
, R. Martins
1
, E. Haghighi
1
, J. Barata
1
.
1
Geriatric Unit, Internal
Medicine Department, Hospital Vila Franca de Xira, Portugal
Introduction:
The hospitalization of the elderly patient is often
associated with a functional decline and increased dependency. A
comprehensive geriatric assessment (CGA) in this setting has proven
its benefits by preventing or attenuating this decline. In order to
improve the quality of care provided to the elderly patient, Hospital
Vila Franca de Xira has founded a Geriatrics Unit.
Methods:
The Geriatrics Unit of Hospital Vila Franca de Xira is a pilot
project designed according to international models. Admission criteria
of inclusion and exclusionwere defined and disclosed to other hospital
health care professionals.
Results:
The Geriatrics Unit is composed by 12 beds on the Internal
Medicine ward. Patients can be admitted through the emergency
department, external consult or be transferred from other wards.
The rooms are being equipped with distinctive objects such as
big clocks on the wall and mini steppers to enhance mobility and
prevent functional decline. As for human resources the multi-
disciplinary team is being trained and includes attending physicians,
nurses, a physiotherapist, a nutritionist, a psychologist and a social
worker.
Key conclusions:
Adapting health care to the elderly people specific
needs is essential due to the aging of our population. Unfortunately
in Portugal this approach is still underused. This pilot project intends
to approach the patient based on the CGA in order to improve the
quality of life of the Portuguese elderly patients. It is time to spread
the word and implement this kind of units in a country where 19% of
the population is elderly.
P-739
Nurse staffing and elderly patient mortality in acute care hospitals:
a longitudinal study
C. Rochefort
1,2
, L.-A. Audet
1
, D. Buckeridge
2
, M. Abrahamowicz
2
.
1
University of Sherbrooke,
2
McGill University
Background:
Recent cross-sectional studies have suggested that
certain nurse staffing policies (e.g., using overtime hours or hiring
less qualified staff) may be associated with an increased risk of patient
mortality in acute care hospitals. This longitudinal study aimed to:
(a) further examine these associations in elderly patients and, (b)
determine if optimal staffing thresholds can be established.
Methods:
A dynamic cohort of elderly patients (
≥
65 years) admitted
to a Canadian university health network between January 2010 and
December 2014 was followed during the inpatient stay. Patient
exposure to two commonly used staffing policies was measured: (1)
overtime hour use and, (2) skill mix (the proportion of Registered
Nurses among the nursing staff). Cox regression models were used to
examine the association between these staffing policies and the risk of
patient death while adjusting for severity of illness and other risk
factors. To detect any staffing thresholds, flexible non-linear spline
functions were fitted.
Results:
Over the study period, 5,729 (4.5%) deaths were observed. In
multivariate analysis, every 5% reduction in skill mix per patient was
associated with a 5% increase in the risk of patient death (HR, 1.05; 95%
CI: 1.04
–
1.06). Similarly, every 5% increase in the proportion of
overtime hours per patient was associated with a 3% increase in the
risk of patient death (HR, 1.03; 95%CI: 1.01
–
1.05). No specific staffing
threshold could be identified.
Conclusion:
The findings of this study strongly suggest that improve-
ments in patient safety require a sufficient supply of adequately
trained Registered Nurses at bedside.
P-740
Smart medication dispenser
–
a new device to improve medication
adherence in older people
A. Santos
1
, D. Sofia
1
, N. Santos
2
, R. Nunes
2
.
1
Hospital de S. Francisco
Xavier,
2
Instituto Superior Técnico, Lisboa, Portugal
Introduction:
Multimorbidity and polypharmacy have become highly
prevalent amongst older people. Polypharmacy increases the risk of
noncompliance to pharmacotherapy and unintended medication
errors due to high complexity medication regimens, especially in
cognitively impaired patients. Failure of treatment and adverse
drug reactions can occur as a result of poor medication adherence.
New technologic devices that improve medication adherence can
be useful.
Objectives:
Development of a prototype of a medication dispenser,
which aims to improve medication adherence, especially in older
and/or cognitively impaired patients.
Methods and results:
The features of several products already
available on the market were analysed and several restrictions
and limitations were identified. Based on this analysis, a list of
required features and the overall architecture of the solution to be
developed were defined. One of the main requirements was to
create an open solution that enables communication with other
devices (smartphones and tablets) and the connection to the
Internet, allowing it to be tailored to different contexts. Given the
emphasis in the openness and remote interaction capacity, an
Application Programming Interface has also been created, allowing
third parties to develop and optimize applications to interact with
the dispenser in specific contexts, and allowing the automation of
configuration procedures (e.g. defining the drug regimen) and the
collection of events (e.g. failed doses and access attempts in hours
not allowed).
Conclusion:
The developed prototype fulfilled the proposed require-
ments, culminating in a modular, versatile and affordable solution,
which might improve medication adherence and consequently health
and quality of life of users.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S223