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cardiac revascularization in elderly. Common ideas its usually taught
that PCI is a complex procedure and often complicated in elderly
patients in comparison with younger patient. Few data are available in
the literature and particularly in Algerian population about this.
Purpose:
To explore the relationship between older age and pro-
cedural success and in-hospital outcomes among a large unselected
population undergoing percutaneous coronary intervention (PCI).
Methods:
Data were collected as a part of a prospective registry of all
percutaneous coronary interventions performed in an Hospital school
between January 2014 and June 2015. Our population has been divided
in two groups related to age <70 and 70 years and above. The statistical
analysis were performed using Pearson
’
s Chi-squared test with Yates
continuity correction, Fisher
’
s Exact Test for Count Data; Alternative:
two.sided proportion with effectifs <5 and Welch Two Sample t-test;
Alternative: two.sided averages and logistic regression for multivariate
analysis.
Results:
Six hundred ninety seven hospitalizations for PTCA were
performed with 130 of them (18.65%) in patients at over 70 years old.
Were less likely to bemale gender (68.4 vs 83.1% OR 0.63 IC 0.41
–
0.96 P
value <0.05). less likely to have a history of smoking (18.9 vs 38.2% OR
0.37 IC 0.23
–
0.60 P value:<0.0001). but more likely to have a history of
kidney failure (11.8 vs 4.8% OR 2.63 IC 1.30
–
5.33 P value <0.01). but all
others criteria (multivessel disease, complex lesions, urgently and
unstable presentation, angiographic success, post procedural compli-
cation and in-hospital death). did not vary In the elderly compared
with younger age group.
Conclusions:
The percutaneous transluminal coronary angioplasty is
safe and feasible without increasing risk of in hospital complication in
elderly Algerian population.
P-005
Are START criteria suitable for older, hospitalized patients with
geriatric syndromes? A prospective study in an acute geriatric ward
J.B. Beuscart
1,2
, M. Lemaitre
1
, J. Convain
1
, D. Lecoutre
3
, M. Dambrine
3
,
A. Charpentier
1
, Y. Boumbar
1
, E. Boulanger
1
, B. Decaudin
3
, F. Puisieux
1,2
.
1
CHU Lille, Geriatrics Department,
2
Univ. Lille, EA 2694,
3
CHU Lille,
Pharmacy Department, Lille, France
Introduction:
The START criteria are widely used to detect potential
prescribing omissions (PPOs) in patients aged 65 years and older.
However, it remains unknown if they are suitable for very old patients
with geriatric syndromes. The objective of this study was to assess
whether START criteria remained appropriate in older patients
hospitalized in an acute geriatric ward.
Methods:
This prospective study took place in an acute geriatric ward
fromMay to December 2014. A medication review was performed in 4
steps: (1) Day 2: medication reconciliation; (2) Day 3: PPOs were
detected according to the START criteria and comorbidities recorded in
health records; (3) During hospitalization: geriatric evaluation and
diagnostic reassessment for all comorbidities related to START criteria;
(4) Discharge: multidisciplinary meeting to decide whether to correct
the detected PPOs according to these data.
Results:
A medication review was performed for 261 (52.3%) of 499
consecutive hospitalized patients. The mean agewas 84.1 (± 6.3) years.
At day 3, 377 PPOs were detected in 117 (67.8%) patients. After geriatric
evaluation, diagnostic reassessment, and multidisciplinary decision,
only 42 (11%) PPOs were corrected. The main causes of not following
the START criteria were: (1) comorbidity considered obsolete after
diagnosis reassessment; (2) acute medical events or diseases; (3)
severe geriatric syndromes.
Conclusion:
START criteria appeared poorly adapted to very old
patients hospitalized in an acute geriatric ward. They should not be
applied in these patients without a rigorous diagnostic reassessment
of comorbidities and geriatric syndromes.
P-006
Multidisciplinary peri-operative assessment to empower patient
decision making and improve perioperative and post-operative
management for older urology patients
C. Bowler, R. Hodson, M. Valasubramaniam, V. Palit, V. Pinto.
University
Hospital of North Tees
Introduction:
A recent review within the author
’
s organisation
identified the need to change the pre assessment service to improve
patient outcomes for older people undergoing planned urology
surgery. The aim was to identify high risk patients and offer a
patient centred service to improve the peri-operative pathway, reduce
the risk of harm, improve safety and reduce morbidity and mortality.
Method:
Using the Model for Improvement a new MDT perioperative
assessment service based on the CGA approach was developed by a
geriatrician, anaesthetist and a urologist to effectively address the
complexities presented by this patient group. Baseline data of 12
patients that had traditional nurse led preoperative assessment was
collected and compared with 18 patients that had MDT perioperative
assessment.
Results:
Patients seen in the nurse led-pre-assessment clinic had
shorter lengths of stay (median 3 days) compared to the MDT pre-
assessment clinic (median 4 days)however, co-morbidities tended to
be higher in the MDT patients. 7 patients in the MDT group declined
surgery following discussion of risk/benefits with the team, in contrast
no patients declined surgery in the nurse assessment group, however,
2 operations were cancelled on the day of surgery and post-operatively
two patients required urgent referral for medical management.
Patients felt empowered to make decisions regarding surgery and
were very positive about the MDT approach.
Key conclusions:
The results suggest that multidisciplinary peri-
operative assessment, optimisation and targeted interventions may
reduce the risk of adverse outcome in older persons undergoing
surgery. This will potentially benefit all older persons undergoing
surgery.
P-007
Does admission to specialist Geriatric Medicine Wards lead to
improvements in aspects of acute medical care for patients with
dementia?
R. Briggs
1
, E. O
’
Shea
2
, A. de Siún
2
, P. Gallagher
2,3
, S. Timmons
2,3
,
D. O
’
Neill
1,2
, S.P. Kennelly
1,2
.
1
Centre for Ageing, Neuroscience and the
Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin,
Ireland;
2
Irish National Audit of Dementia Care in Acute Hospitals. Cork:
National Audit of Dementia Care,
3
Centre for Gerontology and
Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
Background:
People with dementia are among the most frequent
service users in the acute hospital. age-attuned comprehensive
assessment of physical, mental health and social care needs on a
specialist ward represents current best practice in this setting. Despite
this, there is little evidence demonstrating improved care processes
specifically on specialist Geriatric Medicine Wards (GMW). Therefore,
the aim of our study was to review whether admission to a specialist
ward leads to improvements in important aspects of care for people
with dementia.
Methods:
We analysed combined data involving 900 patients from the
Irish and Northern Irish audits of dementia care. Data on baseline
demographics, admission outcomes, clinical aspects of care, multi-
disciplinary assessment and discharge planning processes were
collected.
Results:
Less than one-fifth of patients received the majority of care on
a specialist GMW. Patients admitted to a GMW were less likely to
undergo a formal assessment of mobility compared to non-geriatric
wards (119/143 (83%) vs 635/708 (90%), OR = 0.57 (0.35
–
0.94)) and
were more likely to receive newly prescribed antipsychotic medi-
cation during the admission (27/54 (50%) vs 95/2809 (36%), OR = 1.95
(1.08
–
3.51)). Patients admitted to a GMW were more likely to have
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S30