32 / 290
The 6MWT was the primary outcome measure and gait speed (the 10-
meter walking test, 10mwt), mobility (the Short Physical Performance
Battery, SPPB) inclusive chair-rise and the handgrip-strength (Jamar
hand dynamometer) were secondary outcome measures.
Results:
Within-group analyses revealed that at 3 months the follow-
ing values were significantly different and improved (p < 0.05) from
baseline to 12 weeks: the 6MWT (meters, 32%), 10mwt (26%), SPPB
(23%) and chair-rise (22%).
Key conclusion:
SMS-guided outdoor walking and one strength
exercise may be effective in improving walking capacity, gait-speed,
mobility and chair-rise after acute stroke.
LB-3
Vitamin D supplementation to prevent depression and poor
physical function in older persons: results of the D-Vitaal study,
a randomized placebo-controlled trial
E.J. de Koning
1,2
, N.M. van Schoor
1,2
, H.W.J. van Marwijk
2,3,4
,
P.J.M. Elders
2,4
, B.W.J.H. Penninx
2,5
, P. Lips
2,6
.
1
Dpt. of Epidemiology and
Biostatistics, VU University Medical Center (VUmc),
2
EMGO Institute for
Health and Care Research, VUmc,
3
Primary Care Research Centre, Institute
of Population Health, University of Manchester, Manchester, United
Kingdom,
4
Dpt. of General Practice and Elderly Care Medicine, VUmc,
5
Dpt. of Psychiatry, VUmc/GGZ inGeest,
6
Dpt. of Internal Medicine,
Endocrine Section, VUmc, Amsterdam, the Netherlands
Introduction:
Depressive symptoms and declining physical function
are interrelated conditions and common in older persons. Previous
observational studies suggests that low serum 25-hydroxyvitamin
D (25(OH)D) levels are related to both mental and physical function-
ing. However, results from supplementation trials are inconsistent,
possibly due to suboptimal study designs.
Methods:
The D-Vitaal study is a randomized, double-blind, placebo-
controlled trial using a daily dose of 1,200 IU vitamin D3 versus
placebo for 12 months to investigate effects of the supplementation on
depressive symptoms, functional limitations and physical perform-
ance in older persons at high risk of developing more substantial
mental and physical health problems. Subjects (N = 155, age 60
–
80
years, community dwelling) were included if they had mild depressive
symptoms, at least one functional limitation and low vitamin D status
(25(OH)D 15
–
50/70 nmol/L, depending on season). The data were
analyzed with linear mixed models analyses.
Results:
The supplementation substantially increased serum 25(OH)D
levels in the intervention group (mean 25(OH)D after 6 months: 85
(SD: 16) nmol/L versus 40 (SD: 23) nmol/L in the placebo group).
Compliance (>80% tablet intake) was 89.7%. Intention-to-treat ana-
lyses showed no significant differences between the treatment groups
on depressive symptoms and physical performance. Pre-specified
subgroup analyses showed that the supplementation marginally
improved functional limitations in participants with baseline 25(OH)
D levels above 50 nmol/L (ratio:
−
0.22; 95% CI:
−
0.42,
−
0.03), but this
effect was attenuated in per-protocol analyses.
Key conclusions:
Vitamin D supplementation did not improve
depressive symptoms or physical functioning in older persons at risk
for declining mental and physical health.
LB-4
Inflammation and frailty in the elderly: a systematic review and
meta-analysis
N. Veronese
1
, P. Soysal
2
, B. Stubbs
3,4
, P. Lucato, C. Luchini
5
, M. Solmi
1
,
R. Peluso
1
, G. Sergi
1
, A. Turan Isik, E. Manzato
1
, S. Maggi
6
.
1
University of
Padova, Padova, Italy,
2
Center for Aging Brain and Dementia, Department
of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir,
Turkey,
3
Physiotherapy Department, South London and Maudsley NHS
Foundation Trust, Denmark Hill, London SE5 8AZ,
4
Health Service and
Population Research Department, Institute of Psychiatry, Psychology and
Neuroscience, King
’
s College London, De Crespigny Park, London, Box SE5
8AF, United Kingdom,
5
University of Verona,
6
Aging Branch, Institute of
Neuroscience, National Research Council-CNR, Padova, Italy
Introduction:
The pathogenesis of frailty and in particular the role of
inflammation is poorly understood. We examined the possible
association between inflammation and frailty utilizing a systematic
review and meta-analysis.
Methods:
A systematic literature search of major electronic databases
from inception until 05/2016 was conducted including articles
providing data on inflammatory biomarkers and frailty. Data were
summarized with standardized mean differences (SMDs) comparing
information of frail and pre-frail people vs. robust participants in
cross-sectional and with odds ratios (ORs) adjusted for the maximum
number of potential confounders by inflammatory parameters levels
at baseline for longitudinal studies.
Results:
From 1,856 initial hits, 35 studies (32 cross-sectional studies
n = 3,232 frail, n = 11,483 pre-frail and n = 8,522 robust, and 563
n = pre-frail + robust; 3 longitudinal studies n = 3,402 participants)
were meta- analyzed. Cross-sectional studies reported that compared
to 6,757 robust participants, both 1,698 frail (SMD = 1.00, 95%CI: 0.40
–
1.61) and 8,568 pre-frail (SMD = 0.33, 95%CI: 0.04
–
0.62) participants
had significantly higher levels of C reactive protein (CRP). Frailty
(n = 1,057; SMD = 1.12, 95%CI: 0.27
–
2.13) and pre-frailty (n = 4,467;
SMD = 0.56, 95%CI: 0.00
–
1.11) were associated with higher serum
levels of IL6 compared to people who were robust (n = 2,392). Frailty
and pre frailty were also significantly associated with elevated white
blood cell and fibrinogen levels. In three longitudinal studies, higher
serum of CRP (OR = 1.06, 95%CI: 0.78
–
1.44,) and IL 6 (OR = 1.19, 95%CI:
0.87
–
1.62) were not associated with frailty.
Key conclusions:
Frailty and pre-frailty are associated with higher
inflammatory parameters and in particular CRP and IL 6, but more
longitudinal studies are needed.
LB-5
Development of the EASI-ltc to assist in elder abuse detection in the
long-term care setting
M.J. Yaffe, S. Ballard, M. Wilchesky.
Department of Family Medicine,
McGill University, Montreal, Quebec, Canada
Introduction:
The Elder Abuse Suspicion Index (EASI) © is a validated
six question tool to facilitate identification of elder abuse (EA) and
neglect through enquiry by office-based family physicians of older
adults with MMSE scores of
≥
24. It is available in nine languages,
courtesy of international collaborations. We now report on EASI
modification for the more complicated enquiry of residents in long
term care (LTC) with similar level of cognitive functioning.
Method:
The design was multiphase mixed methods for instrument
development and construct validation. This included (1) literature
review for acts of omission and commission associated with EA
in LTC; (2) on-line survey of Canadian EA experts to rank importance
of each act for inclusion in a LTC EA detection tool; (3) incorporation
of top-ranked items into EASI, through word modification or
new questions; (4) EA expert focus group review of questions
for content and word selection; (5) further analysis of questions
by a focus group of front-line LTC workers for content and
acceptability; and (6) final incorporation of feedback into a tool for
LTC, the EASI-ltc.
Results:
The literature review generated 56 acts of EA (omission
or commission), and through overlap, were reduced to 26 descrip-
tors. 19/26 (73%) EA authorities ranked 11/26 acts consistently
highly, and 7/11 (63.6%) were already represented in the EASI. This
supported building on the EASI, and the resultant 9 questions in
the EASI-ltc were modified twice as a consequence of focus group
’
input. The tool preamble and instructions for use were also altered to
reflect LTC.
Conclusions:
The EASI-ltc has been shown to have content validity,
and appears appropriate for use in LTC on residents with MMSE
≥
24.
It is intended to raise suspicion about abuse such that more detailed
evaluation would be initiated. These assumptions will be examined in
the next phase of our research.
Oral presentations / European Geriatric Medicine 7S1 (2016) S1
–
S27
S26