27 / 290
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.
O-071
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.
1
End-of-Life Care Research Group, Vrije
Universiteit Brussel (VUB) & Ghent University, Belgium;
2
Palliative Care
Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy;
3
Department of Geriatric Medicine, Ghent University Hospital,
4
Department of Medical Oncology, Ghent University, Ghent, Belgium
Introduction:
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.
Methods:
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.
Results:
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,
Cohen
’
s d .78). It improved symptoms and care needs (POS) (
−
2.62
[
−
4.96 to
−
.71]; p = .009, d
−
.51), but decreased satisfaction with care
(SWC-EOLD) as assessed by family carers (
−
4.00[
−
7.87 to
−
.12];
p = .04, d
−
.74).
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.
(ClinicalTrials.gov nr NCT01890239).
O-072
Use of physical restraints, evaluation of professional practices in a
French nursing home
F. Coccoz, F. Delamarre-Damier, on behalf of AGREE FRENCH NURSING
HOME RESEARCH ORGANIZATION.
Introduction:
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
–
The
physical restraint prescription is reevaluated every 24 hours.
Results:
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.
Discussion:
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.
Conclusion:
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
1994;42:960
–
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
1992;32:164
–
170. etc.
O-073
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
Background:
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.
Methods:
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.
Results:
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
≥
10
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.
Conclusion:
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
–
S27
S21