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

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Aim: To implement and evaluate the impact of an enhanced thera-
peutic environment within an acute mental health unit on rates of
violence and patients’ sense of safety.
Project Design: A Quality Improvement project using PDSA cycles was
used to address patients ’ safety concerns and ward violence. Over a
six month period a project team worked with staff and patients
to enhance the therapeutic environment including: creating an
indoor garden, improved signage, staff training audit and feedback of
ward environment using observation and the Ward Atmosphere
Scale (completed by patients and staff). Outcome measures included
monthly rates of violence and aggression, anti-psychotics prescrib-
ing and staff sickness. Patients ’ and staff perception of safety was
measured using the Ward Atmosphere Scale (WAS).
Findings: Recorded incidence of physical aggression reduced by 40.4%
and incidences of verbal aggression by 59.3% (47 –28 and 81 –47
respectively). Patients self-reporting of “feeling safe” on the ward
increased to 100%. Rates of staff sickness reduced by 64% whilst
prescribing of anti-psychotics was reduced by 26.9% on admission.
There has been sustained improvement following the project.
Conclusion: The enhancement of the therapeutic environment
combining staff training and environmental changes improved out-
comes for patients and staff. Involving the patients and staff in all
stages of the redesign created a sense of ownership and pride.
P-860
Catatonia, an underdiagnosed disease
M. Valdés-Aragonés1, M.A. Caballero-Mora1, C. Ramón-Otero1.
1Hospital Universitario de Getafe, Madrid, España
Introduction: Catatonia is a neuropsiquiatric syndrome, characterized
by mutism, stupor, refusal to eat or drink, posturing, and excitement
or hypokinesis. In spite of its important symptoms, it is not diagnosed
correctly, delaying the treatment and increasing secondary compli-
cations. Benzodiazepines and ECT have been the main treatment for
years.
Case: Male 89 years old. Personal history of Alzheimer disease with
behavioral symptoms in treatment with risperidone. He walks with
a cane and is dependent for basic activities of daily living, he lives
in nursing home. Consultation for rigidity of 8 days of evolution,
negativism, oppositional and fluctuation in the level of consciousness.
He suffered a fall two days ago with a head trauma and symptoms
of respiratory tract infection. On physical examination, the rigidity,
mutism, oppositional, waxy flexibility, maintenance of antigravity
positions, positive Grasping and sweating are emphasized. Cranial CT,
electrocardiogram and chest radiography are normal, in analytical
highlights a sodium 124 mEq/L and CK 634 U/L. Initially, respiratory
tract infection is treated, hyponatremia and neuroleptics are removed,
but despite everything, evolution is torpid, so reassessing the patient
is diagnosed catatonia, with a score on the scale Bush-Francis 16/69.
It starts treatment with lorazepam 2 mg every 8 hours, responding
favorably and reversing symptoms.
Conclusion: Catatonia is an underdiagnosed disease which poses a
diagnostic challenge and we must think about it, as it produces a large
potentially reversible functional impairment with the establishment
of an appropriate early treatment.
P-861
Loneliness and self-stigma among older adults with mental health
problems in care homes
V. Tzouvara. King’ s College London
Background: Loneliness associates with negative effects on older
adult ’s health, while mental illness stigma associates with poor
quality of life including increase social avoidance and isolation. There
is, therefore, a potential inter-relationship between loneliness and
mental illness self-stigma in older age, yet a limited number of studies
aimed at examining it.
Aims: The aim of this study was: (a) to examine the inter-relationships
between loneliness and self-stigma among older adults with mental
health problems in nursing homes, and (b) to explore how this
population experiences loneliness and self-stigma.
Methods: A mixed-methods approach was utilised. The first phase
involved a questionnaire survey (n = 16), while the second phase
involved a qualitative study (n = 10).
Results: Low levels of self-stigma (56.3%) were reported. However, a
substantial number of older adults scored high on the self-stigma scale
(43.8%). A relationship between stereotype endorsement and marital
status (sig. = .010) was identified. More than half of the sample (68.8%)
reported feelings of loneliness. There was also a correlation between
loneliness, age (sig. = .062) and religiosity (sig. = .044). Seven themes
emerged from the qualitative analysis: “social loneliness’, “emotional
loneliness”, “emotional reactions”, “coping mechanisms”, “degree of
insight into illness”, “understanding and view towards mental illness”,
and “behavioural reactions”.
Discussion: The small sample size of the quantitative study reveals the
various methodological challenges in implementing research in long
term care facilities. However, the qualitative study provides useful
insights into the topic.
Conclusions:The study offers the platform for further investigation on
the topic, while discusses implications for policy and practice.
P-862
Geriatric depression under-diagnosis: a population study
E. Crisostomo1, M. Vasques2, J. Soares1, A.V. Vieira3, M.T. Verissimo1.
1CHUC, 2Medicina 7.2 – Hospital Curry Cabral -CHLC, 3UCSP-Mira,
Portugal
Introduction: Previous prevalence estimates of geriatric depression
have varied, showing that depression among the elderly might be
under-diagnosed and under-treated. Nonetheless there are few
population-based studies in Portugal.
Methods: The aim of this population-based study was to investigate
the depression prevalence among the elderly patients aged 65 or over
from a primary care facility in a rural setting (UCSP-Mira), applying a
well-defined instrument – the Geriatric Depression Scale 30 (GDS30).
The patients were randomly selected in the waiting room between 1st
December 2015 and 31st March 2016. Any patient not registered at
UCSP-Mira was excluded. Previous medical records were compared
with the calculated scores and the probable undiagnosed depression
rate was assessed. The previous use of antidepressants was character-
ized according to pharmacological major group, and related to the
population identified morbidities.
Results: The depression prevalence rate registered at UCSP-Mira 13,3%.
116 nondemented individuals were enrolled; this sample represented
5% of the elderly population registered at UCSP-Mira; approximately
half of the community-based elderly people who complied with the
test had self-reported indications of depression (GDS30 > 11). Over
89% presented morbidities when compared with 64% among those
who had not self-reported depression. A high percentage of elderly
patients were prescribed antidepressants regardless of previous
medical diagnosis or self-assessed depression.
Conclusion: The obtained results showed high rates of under-
diagnosis, which leads to an inadequate pharmacological approach.
This study raises medical awareness to this problem among the elderly
population, where diagnosis and further intervention is might be
more challenging.
Area: Urology and continence management
P-863
Urinary tract infections in elderly
B. Ben Dhaou1, Z. Aydi1, I. Rachdi 1, F. Daoud1, L. Baili1, S. Kochbati1,
F. Boussema1. 1Internal Medicine Department, Habib Thameur Hospital,
Faculty of Medicine, Tunis, Tunisia
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S256