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O-074
Shared decision-making in oncology, are patient preferences
different in elderly?
H. Burkhardt, C. Gaster.
Universitätsmedizin Mannheim
Background:
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.
Methods:
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.
Results:
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
0.19).
Discussion:
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.
O-075
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
1
, J. Fox, K. Wardle
1
, E. Feilding
1
, Z. Alio
1
,
D. Copeland
1
, J. Mort
1
, M. Moatari
2
, A. Gomez-Quintanilla
1
.
1
Ageing and
Complex Medicine, Salford Royal NHS Foundation Trust,
2
Surgical
Directorate, Salford Royal NHS Foundation Trust, United Kingdom
Objectives:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
O-076
The interaction between preoperative muscle weakness and
obesity and recovery after total hip arthroplasty
E. Oosting
1,2
, T. Hoogeboom
3
, J. Dronkers
1
, M. Visser
1
, R. Akkermans
3
,
N. Van Meeteren
2,4
.
1
Gelderse Vallei Hospital, Ede,
2
Maastricht
University, Maastricht,
3
Radboud university medical center, Nijmegen,
4
Top sector Life Sciences & Health, The Hague, the Netherlands
Introduction:
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.
Methods:
In this prospective cohort study, preoperative obesity
(BMI > 30 kg/m
2
) 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
2
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
confounders.
Results:
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
–
9.11).
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.
O-077
Delaying hip fracture surgery increases perioperative
complications
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
Introduction:
To analyze the differences in clinical outcomes and
mortality related to surgical delay (>48 hours) in older patients with
hip fracture.
Methods:
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.
Results:
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
–
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