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applications in selected procedures and accurate measurement of

urine output in critically ill patients. The purpose of this study was

to evaluate the impact of iatrogenic UC in hospitalized geriatric



Prospective study including all geriatric patients (65 years

or older) admitted to an Internal Medicine ward at our center in

April 2016 who have UC during the hospital stay. RESULTS: In this

period, 78 patients were admitted, 64 (82%) were geriatric. Among

these, UC was performed in 43 (65%). Pneumonia and heart failure

were the two most common causes of hospital admission. Median

UC duration was 8 days (1

36). Most patients had no absolute

indication for its use (60%). The most common reason for inappropri-

ate UC was monitoring of urine output in non-critically ill patients.

CAUTI incidence was 8% and 22% patients were still on UC when

discharged from hospital. Older patients (90 vs 81 years) and those

with a longer duration of UC (18 vs 8 days) were more likely to develop

CAUTI, although such differences were not statistically significant

(p < 0,05).


Most patients had inappropriate UC. Our sample size

probably limited our outcomes. Nevertheless, duration of catheteri-

zation and age appear to be important risk factors for developing

CAUTI. These results suggest that clinicians shall seek a multimodal

approach in order to reduce unnecessary UC use.


A quality improvement project of

trial without catheter


promoting continence care

C. Micallef


, P. Spiteri


, S. Buttigieg


, A. Vella




Department of Elderly

Medicine, Karin Grech Rehabilitation Hospital,


Deparment of Medicine,

Mater Dei Hospital, Malta


To assess the

trial without catheter

(TWOC) practice in

two geriatric hospitals, introduce a standard operating procedure

(SOP) and improve the current practice and documentation thus

promoting continence care in the elderly.


Data collection from patients

notes and discussions in

interdisciplinary meetings including a consultant geriatrician with

special interest in continence care and a continence nurse specialist.


Poor documentation and variability in practice was noted in

both hospitals. This led to the disregard of factors which potentially led

to a failed TWOC. Standardisation and improved documentation were

achieved after introducing a SOP.


TWOC is as important as catheterisation. Service pro-

vision and documentation can be improved by standardising the

practice through discussion between professionals caring for the

elderly. 15

25% of elderly in-patients require catheterisation [1].

Trial without catheter

(TWOC), is therefore a common procedure.

However, there is a lack of guidelines to standardise it, with healthcare

trusts following their own SOPs. The only evidence-based review

available is that published by

The Cochrane Collaboration


aims to establish the best practice for TWOC based on the results of

randomised and quasi-randomised controlled trials. The lack of

standardisation was noted in two geriatric and rehabilitation centres

on the Maltese Islands. This quality improvement project assessed

TWOC procedures, compared them to the suggestions laid out by the

Cochrane review and changed practice by establishing an SOP, a

documentation form and educating doctors and nurses involved in

continence care of elderly patients.


[1] Griffiths R, Fernandez R. Strategies for the removal of short-term

indwelling urethral catheters in adults.

Cochrane Database of

Systematic Reviews

2007, Issue 2. Art. No.: CD004011. DOI:

10.1002/ 14651858.CD004011.pub3.


Factors associated with elevated post-void residual volume in a

comprehensive geriatric outpatient assessment after hip fracture

in older women

M. Nuotio


, T. Luukkaala




Department of Geriatric Medicine, Central

Hospital, Seinäjoki,


Science Centre, Pirkanmaa Hospital District,

Tampere, Finland


Elevated post-void residual (PVR) volumes in older

patients may suggest detrusor underactivity (DU), a poorly under-

stood geriatric condition. We examined the prevalence and factors

associated with elevated PVR volume in a sample of older women

undergoing comprehensive geriatric assessment (CGA) after hip

fracture in an outpatient setting.


The data consisted of 409 women aged 65 years and over

invited for an outpatient CGA including PVR measurement with a

bladder-scan 4

6 months after the hip fracture. PVR of 160 ml or more

was deemed elevated. Age-adjusted univariate logistic regression

analyses were conducted separately for each domain of the CGA with

odds ratios (ORs) and 95% confidence intervals (CI).


Of the patients 64 (15.6%) had elevated PVR. In the CGA,

difficulties in physical activities of daily living, longer time on the

Timed Up and Go, malnutrition as measured by the Mini Nutritional

Assessment and urinary or faecal incontinence were associated

with elevated PVR. Increased age, moderate to severe renal dysfunc-

tion, taking four or more medications, impaired cognition, depressive

mood, constipation, difficulties in instrumental activities of daily

living and nocturia were not significantly associated with elevated

PVR. Of the patients with elevated vs. non-elevated PVR, 12.5% vs. 2,6%

(p = 0.002), died within one year of the hip fracture.


The association of elevated PVR with disability, malnu-

trition and incontinence in older women with hip fracture suggests

connection between DU and frailty. PVR measurement may be

included in the CGA especially in the frail older patient.

Late Breaking Abstracts

Poster presentations


Has dementia research lost sense of reality? A descriptive analysis

of eligibility criteria of Dutch dementia research protocols

R.L. van Bruchem-Visser


, K.R. Jongsma


, S. van de Vathorst



F.U.S. Mattace Raso




Section of Geriatric Medicine, Department of

Internal Medicine, Erasmus Medical Centre, PO Box 2040, 3000 CA



Medical Ethics and Philosophy of Medicine, Erasmus Medical

Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands


A substantial proportion of dementia

patients are excluded from research participation, while for extrapo-

lation of the research findings it is important that the research

population represents the patient population. The aim of this study is

to provide an analysis of dementia research and its exclusion criteria in

order to get a clearer picture whether the research participants

represent the general dementia population.


Dementia studies registered at


2006 and 2015 were analysed. Study characteristics, funding and

eligibility criteria were described and analysed using a standardized



The search yielded 103 usable study protocols. The number of

trials has increased over the years, and 35% of the studies were

industry-financed. Alzheimer

s disease was the most researched type

of dementia (84%). In observational studies the most frequently

observed exclusion criterion is a neurological condition, in drug

studies and other intervention studies the most frequently used

exclusion criterion is a somatic condition. 86% of all protocols had at

least one exclusion criterion concerning comorbidity. Most studies

focused on mild or moderate dementia (78%).

Poster presentations / European Geriatric Medicine 7S1 (2016) S29