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Shared decision-making in oncology, are patient preferences

different in elderly?

H. Burkhardt, C. Gaster.

Universitätsmedizin Mannheim


There is still some debate about age-related differences

of patient preferences concerning decision-making in oncology.

Especially a different acceptance of the modern concept of shared

decision-making in the elderly has been discussed.


To analyze patient preferences a set of vignettes exposing

different clinical settings were given to patients attending an oncology

clinic. They were asked to rate their preferences. Primary ratings then

were examined applying conjoint-analysis. Three factors were

included: clinical experience of responsible physician in oncology (2

years vs. 7 years), type of hospital (local hospital vs large oncology

center), type of physician-patient interrelation (informed, shared

decision-making, paternalism). To test for age related effects, the

conjoint-analysis was applied in two independent cohorts: cohort A:

patients aged below 65 years; cohort B: patients aged over 70 years.


71 patients (41 cohort A; 30 cohort B) were included. In both

cohorts patient-physician interaction revealed highest preference

values compared with type of hospital and physician experience.

Subsequent analysis of age on preference-values showed in the elderly

significant higher preference values concerning patient-physician

interaction (0.72 vs 0.50) and lower values concerning type of hospital

(0.13 vs 0.33). Further analysis of preferred type of patient-physician

interaction showed in both cohorts highest preference for shared

decision making without significant differences (0.36 vs 0.36) but in

the elderly significant higher values for paternalistic interrelation

(0.33 vs 0.25) and significant lower values for informed type (0.06 vs



Type of physician-patient interaction could be confirmed

as significant aspect in clinical settings in oncology. Both elderly and

younger patients prefer the shared-decision making concept in the

first place, followed by the classical paternalistic model. Only younger

patients show some sympathies to an interaction type leaving

decisions predominantly to the patient. Physicians are to be

encouraged to use a shared decision type of interaction in general

and especially also in elderly oncology patients.


Elderly medicine liaison service for older people admitted to

general surgical wards. Perioperative Care of Older People

Undergoing Surgery-Salford General Surgery (Salford POPS-GS)

A. Vilches-Moraga


, J. Fox, K. Wardle


, E. Feilding


, Z. Alio



D. Copeland


, J. Mort


, M. Moatari


, A. Gomez-Quintanilla




Ageing and

Complex Medicine, Salford Royal NHS Foundation Trust,



Directorate, Salford Royal NHS Foundation Trust, United Kingdom


Access to general surgery reduces drastically in older

patients. We describe the feasibility and impact of a proactive,

geriatrician-led liaison service targeting older people admitted to a

general surgical ward.


Patients over 74-years of age admitted to general surgery

underwent comprehensive geriatric assessment, targeted interven-

tions and timely discharge planning. There was close liaison with

surgical colleagues and a weekly multidisciplinary team meeting.


Between 9th September 2014 and 30th November 2015, 373

patients entered our study. Mean age was 81.9 years (70

98) with

female preponderance (55.4%). The majority of patients were admitted

non-electively (300, 80.4% vs 73, 19.6%); 131 individuals underwent

surgery, 27.1% a non-surgical procedure and 141 were managed non-

invasively. Most individuals lived in their own home (92.5%), were

independent in basic (81.4%) and instrumental (59.7%) activities of

daily living andmobilised with nowalking aids or using a stick (70.2%).

Comorbidity (5.0 ± 2.4 chronic conditions, range 0

14 and 95.1% two

or more) and polypharmacy (8.2 ± 4.3) were common. The commonest

presenting symptoms were abdominal pain and vomiting (59.3%).

Cancer (136, 36.5%), liver and biliary conditions (71, 19%) were the

most common diagnoses. Median and mean LOS were 9 days and 13.2

days respectively with a range of 1

207 days.


The deployment of an elderly medicine liaison service is

feasible and appears to progressively reduce length of stay in older

patients admitted to surgical wards irrespective of whether they have

surgery or undergo non-invasive treatment.


The interaction between preoperative muscle weakness and

obesity and recovery after total hip arthroplasty

E. Oosting


, T. Hoogeboom


, J. Dronkers


, M. Visser


, R. Akkermans



N. Van Meeteren




Gelderse Vallei Hospital, Ede,



University, Maastricht,


Radboud university medical center, Nijmegen,


Top sector Life Sciences & Health, The Hague, the Netherlands


In practice and literature there is still debate whether

preoperative obesity is negatively associated with the outcomes of

total hip arthroplasty (THA). Other evidence suggests that obesity and

muscle weakness act synergistically causing negative health out-

comes. The objective of this study is to investigate if muscle strength

modifies the relationship between preoperative obesity and recovery

after THA.


In this prospective cohort study, preoperative obesity

(BMI > 30 kg/m


) and muscle weakness (hand grip strength <20 kg

for woman and <30 kg for men) were measured of all patients

approximately 6 weeks before THA. Patients with a BMI<18.5 kg/m


were excluded. Outcomes were delayed inpatient recovery of function-

ing (>2 days to reach independence of walking) and

prolonged length

of hospital stay

(LOS, >4 days and/or discharge to extended

rehabilitation). Univariate and multivariable regression analyses

with the independent variables muscle weakness and obesity, and

the interaction of both were performed and corrected for possible



297 patients were included, 18% were obese and 7% also had

muscle weakness. Obesity was not significantly associated with

prolonged LOS (OR 1.36, 95%CI 0.75

2.47) or prolonged recovery of

functioning (OR 1.77, 95%CI 0.98

3.22). But the obesity-weakness

interaction was significantly associated with prolonged LOS (p =

0.046). Having both obesity and weakness was significantly associated

with prolonged LOS (OR 3.04, 95%CI 1.01


Key conclusions:

Muscle strength modifies the relationship between

preoperative obesity and recovery after THA. The results of this study

suggest we should measure muscle strength in addition to BMI (or

body composition) to identify patients at risk for prolonged recovery.


Delaying hip fracture surgery increases perioperative


L. García-Cabrera, N. Vaquero Pinto, C. Miret Corchado, S. Fernández-

Villaseca, B. Montero Errasquin, M.L. Álvarez Nebreda, A.J. Cruz-Jentoft.

Hospital Ramón y Cajal


To analyze the differences in clinical outcomes and

mortality related to surgical delay (>48 hours) in older patients with

hip fracture.


Prospective study in patients

80 with hip fracture admitted

to an Orthogeriatric Unit for surgical replacement. Data about social,

functional and cognitive status, type of fracture/surgery, time to

surgery, length of stay, medical/surgical complications and mortality

during hospitalization were collected. The patients were divided into

two groups according to surgical delay (before o later than 48 hours

from admission) to compare outcomes.


468 patients. 79% women, mean age 87 ± 5. Barthel 75 ± 25,

FAC 4 ± 1. 33% dementia. 22% in nursing homes. MNA:10 ± 2. Mean n°

comorbidities: 3 ± 2. Mean n° drugs before admission: 6 ± 3. 58% per/

subtrochanteric fractures. 33% were operated in the first 48 hours.

Mean time until surgery: 4 ± 3 days. Mean length of stay:14 ± 7 days.

Mortality during hospitalization: 4%. Comparing both groups, there

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