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placebo IV once daily for five days postoperatively. There were

significantly less delirious patients in the ondansetron group starting

on day 3 and persisting to day 5.

Key conclusions:

Ondansetron appears to be an efficacious agent for

the prevention and treatment of POD. Further large RCTs of high

quality are needed to confirm these results.


A cluster randomised trial: comfort around dying in older people

K. Beernaert, T. Smets, J. Cohen, R. Verhofstede, M. Costantini, K. Eecloo,

N. Van Den Noortgate, L. Deliens.


End-of-Life Care Research Group, Vrije

Universiteit Brussel (VUB) & Ghent University, Belgium;


Palliative Care

Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy;


Department of Geriatric Medicine, Ghent University Hospital,


Department of Medical Oncology, Ghent University, Ghent, Belgium


Many older people die in hospitals and the quality of

dying in acute hospital settings is often suboptimal. The aim of this

study was to assess the effectiveness of the Care Programme for the

Last Days of Life (CAREFuL) in improving the patient

s comfort in the

dying phase of older people in acute geriatric hospital wards. CAREFuL

involved a Care Guide for the Last Days of Life, training, supportive

documentation and an implementation guide.


We conducted a cluster randomised controlled trial at ten

hospitals in Flanders, Belgium (October 2012

March 2015: one year

baseline, sixmonths implementation, one year post-intervention). The

primary outcome was comfort around dying measured with the CAD-

EOLD by nurses.


Nurses completed post-intervention assessments for 132

(81%) of 164 of those in the intervention group and 109 (92%) in the

control group. Implementation of the CAREFuL programme signifi-

cantly improved comfort (CAD-EOLD) compared with the control

(cluster-adjusted mean difference 4.3 [95%CI 2.07 to 6.53]; p<.001,


s d .78). It improved symptoms and care needs (POS) (



4.96 to

.71]; p = .009, d

.51), but decreased satisfaction with care

(SWC-EOLD) as assessed by family carers (


7.87 to


p = .04, d


Key conclusions:

The CAREFuL programme resulted in a significant

improvement in comfort around dying and in symptoms and care

needs in the last days of life, but it also had a negative effect on the

satisfaction with care of those close to them mostly explained by a

significant improvement in the control group.

( nr NCT01890239).


Use of physical restraints, evaluation of professional practices in a

French nursing home

F. Coccoz, F. Delamarre-Damier, on behalf of AGREE FRENCH NURSING



The prevalence of physical restraints was estimated at

88% by direct observation in our long term facility department

(including bedside rails), and restraint prescriptions were not revalued

and no validated procedure was used at this time. Most commonly

used to prevent falls, contain agitation or limit ambulation, the

decision of contentionwasnot based on an accurate assessment of risk

In most cases the restraint is a risky situation which weakens the

elderly * Increase the risk of serious falls (x3) * Increase morbidity and

mortality * Accelerates the loss of autonomy * Create loss of freedom

with psychological and social consequences.

Material and methods:

For this evaluation of our professional

practices we use the French Health Authority audit method with 9

criteria (1) 1

Written Prescription stamped and signed by the

prescribing physician. This is a medical decision taken with the views

of various members of the care team2

Emergency criteria, confirmed

by a physician as soon as possible 3

Reasons of physical restraint

rated 4

Requirements made after multidisciplinary assessment of the

benefit / risk 5

Assessment of the risk/benefit noted in the record 6

Prescribed duration 7

Hardware prescribed: The use of bed rails

refers to the same precautions of use than any other restraint 8

Scheduled Monitoring risks noted in the record, regularly incorporates

the physical, psychological and environmental dimensions 9


physical restraint prescription is reevaluated every 24 hours.


After audit and training the prevalence of physical restraints

was estimated at 34% A prescription sheet was stamped and signed by

the physician. A target was done inthe nurse and nurse helper care

chart (To trace patient installationand monitoring of contention). A

prevention protocol and monitoring of physical restraints risks was

performed. A re-evaluation of indication during multidisciplinary

meetings was done. A medical examination was programmed at the

end of the prescription. Systematically an alternative to the contention

is suggested.


Older person and older relatives are not directly involved

in the 9 French Authority criteria In nursing home it is very difficult for

the physicians to reevaluate physical restraints every 24 h hours.


After our evaluation, safety of the practice was improved,

we obtained a multidisciplinary awareness. It was possible to reduce

the number of physical restraints without increasing the frequency of

serious falls or psychotropic prescription. An improvement of our

practices is still needed, using a personal evaluationto find appropriate

alternatives case by case, sometimes innovative. From 2015 we use

another indicator number of physical restraints with physician

prescription /total number of physical restraints

References protocole de l

audit ciblé HAS. Ejaz F K, Jones J A, Rose M

S. Falls among nursing home residents: an examination of incident

reports before and after restraint reduction programs. J Am GeriatrSoc


964. Kirkevold Ø, Engedal K. Prevalence of patients

subjected to constraint in Norwegian nursing homes. Scand J Caring

Sci 2004;18:281

286. Burton L C, German P S, Rovner BW. et al. Mental

illness and the use of restraints in nursing homes. Gerontologist


170. etc.


Polypharmacy and use of preventative medications in older people

near the end of life: choosing wisely?

L. Morin, D.L. Vetrano, A. Calderón-Larrañaga, D. Rizzuto, J. Fastbom,

K. Johnell.

Aging Research Center, NVS, Karolinska Institutet and

Stockholm University, Sweden


To evaluate the frequency of polypharmacy and the

prevalence of preventative medication use over the course of the last

year of life of older people in Sweden.


Nationwide, register-based study in the entire Sweden,

including all individuals who died at age 66 years or older between

January 1, 2007 and December 31, 2013. Linear mixed models were

computed to investigate the factors associated with change in

medication use.


511,843 older adults died between 2010 and 2013 met our

inclusion criteria. Mean age at time of death was 84.2 years, 31.7% of

the individuals were institutionalized, 42.4% had

4 chronic condi-

tions and 94.3% (n = 482,593) died from non-sudden causes. Over the

course of the last year before death, the average number of

medications increased from 7.6 to 9.6 (p < 0.001 for trend). During

the same period, the proportion of individuals exposed to


medications rose from 30.7% up to 47.4% (from 24.9% to 36.3% when

excluding analgesics). Cancer decedents, community-dwellers and

individuals aged 66

74 at time of death were found to have the

sharpest increase in their medication use. During the last month

before death, 53.8% of older people were exposed to antithrombotic

agents (including 44.9% platelet aggregation inhibitors), 41.1% to beta-

blockers, 30.6% to agents acting on the renin-angiotensin system

(including 21.4% ACE inhibitors),16.3% to lipid-modifying agents,15.4%

to calcium-channel blockers and 20.5% to mineral supplements.


Polypharmacy and long-term preventative drugs are

frequent in older people near the end of life. This raises important

questions regarding the adequateness of medication use in a context of

limited life-expectancy.

Oral presentations / European Geriatric Medicine 7S1 (2016) S1