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

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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
patients.
Methods: 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).
Conclusions: 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.
P-868
A quality improvement project of “trial without catheter” practice
– promoting continence care
C. Micallef1, P. Spiteri1, S. Buttigieg 2, A. Vella1. 1Department of Elderly
Medicine, Karin Grech Rehabilitation Hospital, 2Deparment of Medicine,
Mater Dei Hospital, Malta
Objectives: 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.
Methods: 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.
Results: 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.
Conclusion: 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 ” which
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.
Reference
[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:
P-869
Factors associated with elevated post-void residual volume in a
comprehensive geriatric outpatient assessment after hip fracture
in older women
M. Nuotio1, T. Luukkaala2. 1Department of Geriatric Medicine, Central
Hospital, Seinäjoki, 2Science Centre, Pirkanmaa Hospital District,
Tampere, Finland
Objectives: 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.
Methods: 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).
Results: 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.
Conclusions: 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
LB-1
Has dementia research lost sense of reality? A descriptive analysis
of eligibility criteria of Dutch dementia research protocols
R.L. van Bruchem-Visser1, K.R. Jongsma2, S. van de Vathorst2,
F.U.S. Mattace Raso1. 1Section of Geriatric Medicine, Department of
Internal Medicine, Erasmus Medical Centre, PO Box 2040, 3000 CA
Rotterdam, 2Medical Ethics and Philosophy of Medicine, Erasmus Medical
Centre, PO Box 2040, 3000 CA Rotterdam, the Netherlands
Background/objectives: 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.
Methods: Dementia studies registered at between
2006 and 2015 were analysed. Study characteristics, funding and
eligibility criteria were described and analysed using a standardized
score-sheet.
Results: 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–S259 S258