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

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References
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(2009). Frailty: defining and measuring of a concept. The Journal of
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[2] Slaets J.P.J. (2006). Vulnerability in the Elderly: Frailty. The Medical
Clinics of North America 90(4):593–601.
[3] Schuurmans H., Steverink N., Lindenberg S., Frieswijk N., Slaets J.P.
J. (2004). Old or frail: what tells us more? Journals of Gerontology
series A: Biological Sciences and Medical Sciences, 59(9):M962–965.
[4] Steverink N., Slaets J.P.J., Schuurmans H., van Lis M. (2001).
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Frailty Indicator (GFI). The Gerontologist, 41(special issue 1), 236–
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O-060
The influence of long term iodine deficiency on thyroid function
in old age
S. Andersen, K.M. Pedersen, M. Danielsen, L. Westergaard, P. Laurberg.
Aalborg University Hospital, Aalborg, Denmark
Objectives: Thyroid disorders are common in old age. The impact of
iodine intake on their occurrence has been detailed for younger
individuals. We previously found a high occurrence of thyroid
disorders among iodine deficient 68 year olds and now assessed the
importance of sustained iodine deficiency for the thyroid at 10-years
follow-up.
Methods: A population based study among subjects born 1918–1923.
We collected blood and spot urine samples for measurement of
thyroglobulin and thyroid function tests. A questionnaire was filled in
by 423 Randers dwellers aged 68 years at the first data collection. The
301 living in the same area at the age of 78 years were invited for a 10-
year follow-up using identical procedures as was 75–80 year olds in
Skagen.
Results: Participation rate was 57%. Urinary iodine (median;25–75%)
was 42(29 –71)/54(34–95) microgr/L at age 68/78 years in Randers and
160(126,228) microgr/L in Skagen (p < 0.001). At the age of 78 years
thyroglobulin was 14.6(8.7–31)/15.2(6.0–48) microgr/L in iodine
deficient men/women and 6.5(4.0 –12)/9.0(5.2–21) in the iodine
replete (p < 0.001/0.02). Thyroid disorders were more frequent
among 78 compared to 68 year olds (p < 0.001) with a rise in both
hyperthyroidism (p = 0.01) and hypothyroidism (p = 0.03). Hyper-/
eu-/hypotyroidism at ages 68 and 78 years occurred in 9.9/73.8/3.8%
and 17.3/54.9/8.1% (p < 0.001), and 14% of euthyroid individuals had
developed hyperthyroidism and 5% hypothyroidism after 10 years.
Conclusion: Thyroiddisorders are foundamongone in four78yearolds
with long-standing iodine deficiency. Still, it is seen in one out of six
with life-long recommended iodine intake but with a different pattern.
Area: Rehabilitation and geriatric education
O-061
Advanced nurse practitioner-led ambulatory care for older people:
safe and effective
N. Fox 1, K. Porter1, J. Chandler1, S. Greenwood1, P. May1, S. Sargeant1,
J. Tuck 1. 1Poole Hospital NHS Foundation Trust, Poole, United Kingdom
Objectives: The Rapid Assessment Consultant Evaluation (RACE)
Ambulatory Emergency Clinic (AEC) was set up in April 2015 to
address increased emergency activity and relieve acute hospital bed
pressures. It aims to assess, diagnose and treat older people, avoiding
hospital admission where appropriate. It is managed by a team of 6
Advanced Nurse Practitioners (ANPs) supported by a Consultant, with
Comprehensive Geriatric Assessment at its core.
Methods: Quantitative data from the first year of RACE AEC was
analysed using Quality Improvement techniques. Qualitative data was
extracted from Friends and Family results.
Results: The redesign has led to a 500% increase in clinic capacity. 50%
of patients seenwould have required hospital admission had the clinic
not been available, corresponding to an estimated 292 bed days saved
in the first six months. There was a significant reduction in overnight
admissions, and trends towards a shorter length-of-stay throughout
the department as a whole. In the case of one frequent attender, the
clinic’s holistic approach reduced presentations to secondary care by
75%. The clinic has attracted excellent feedback frompatients and their
relatives.
Conclusion: The ambulatory clinic provides comprehensive assess-
ment and investigations that historically would have required at
least an overnight admission, with obvious financial and operational
benefits. Patient and relative feedback has to date been very positive.
Ambulatory care is a useful model for assessing and treating older
patients in a timely fashion, as an alternative to hospital admission.
ANPs can provide safe and effective ambulatory care for older patients.
O-062
A dilemma in the “protected” hospital discharges for elderly
people: our experience
A. Castagna1, P. Gareri1, D. Zechini1, L. Manfredi1, V. Costa1, G. Russo2,
A.M. Condito2, M. Rocca1, G. Ruotolo2. 1Azienda Sanitaria Provinciale di
Catanzaro, 2SOC Geriatria “Pugliese-Ciaccio” Hospital, Catanzaro, Italy
Introduction: Time after discharges is critical, especially for indivi-
duals with complex care needs such as elderly adults. A possible
answer is employing care transition programs aimed to guarantee the
coordination among healthcare practitioners and continuity of
medical care on moving among different settings and different levels
of care.
Methods: A number of different health facilities have developed
privileged ways for promoting an ideal network service following
patient’s discharge; in other words we mean the so called “protected
discharges”. Since 2009 a virtuous route has been promoted between
ASP Catanzaro and “Pugliese-Ciaccio” Hospital, in Catanzaro, Italy. Our
interfirms and multiprofessional team performed 1.177 assessments
between January 2009 and December 2015. Mean age in the assessed
patients was 81,19 ± 10,5 years old (women 54%, men 46%).
Results: Our data show a increase in “protected discharges” in the 7-
year time 2009–2015. In fact, an increase in the mean for-month
“protected discharges” was observed; in particular the mean number
increased from 10,18 in 2009 up to 12,16 in 2015 (mean for month
14,01 2009–2015). The individualized health care settings were
medicalized nursing home facilities (65,4%), home care (14,6%),
rehabilitation facilities (16,9%), other (3,1%).
Conclusions: The continuity of care between hospital and out-of-
hospitalcare systems is the most important health care procedure in a
working Health Care System. In fact, the continuity of care means a
global caring for elderly people, shared by different actors and
different services aimed at care management and case management,
especially during the vulnerable time which patient passes through.
O-063
Developing a geriatric emergency medicine curriculum
S. Turpin, S. Conroy. University of Leicester
Introduction: Older people represent a growing proportion of
attendees in Emergency Departments across Europe. Traditionally
Emergency Departments have not focused on care for older people
especially those with frailty. Similarly, geriatric services have not
traditionally focused upon the care of older people in Emergency
Departments. This work seeks to bring together the two disciplines of
Geriatric and Emergency Medicine through a defined and validated
curriculum on Geriatric Emergency Medicine.
Methods: Domains and items for inclusion in the curriculum were
derived through a combination of literature reviewing and a nominal
groupworkshop. The domains and items underwent validation using a
Delphi technique involving the European Societies of Geriatric and
Emergency Medicine.
Oral presentations / European Geriatric Medicine 7S1 (2016) S1–S27 S18