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certain aspects of discharge planning initiated, including com-

pletion of a single plan for discharge (78/118 (66%) vs 275/611 (45%),

OR = 2.38 (1.58

3.60)). Surgical wards performed more poorly on

certain aspects including having a named discharge co-ordinator (32/

71, 45%), and documentation of decisions regarding resuscitation

status (18/95, 19%).


Relatively low numbers of patients with dementia

received care on a specialist GMW. There appears to be a more

streamlined discharge planning process in place on these wards but

they did not perform as well as onewould expect in certain areas, such

as compliance with multidisciplinary assessment and antipsychotic



Dementia in the acute hospital: the prevalence and impact of

dementia in acutely unwell older patients

R. Briggs, A. Dyer, S. Nabeel, D.R. Collins, J. Doherty, T. Coughlan,

D. O

Neill, S.P. Kennelly.

Centre for Ageing, Neuroscience and the

Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin,



People with dementia are among the most frequent

service users in the acute hospital. The recent Irish National Audit of

Dementia (INAD) has highlighted some important deficiencies in the

care of people with dementia in the acute setting.


We examined acute dementia care over a three year period

from 2010

2012 in a 600 bed university hospital, to clarify the service

activity and costs attributable to acute dementia care.


929 patients with dementia were admitted during the study

period, accounting for 1,433/ 69,718 (2%) of all inpatient episodes,

comprising 44,449/454,169 (10%) of total bed days. The average length

of stay (LOS) was 31.0 days in the dementia group and 14.1 days in

those over 65 years without dementia. The average hospital care cost

was almost three times more (

13,832) per patient with dementia,

compared to (

5,404) non-dementia patients, accounting for 5%


20,000,000) of the total hospital casemix budget for the


Discussion Service activity attributable to dementia care in the acute

hospital is considerable. Moreover, given the fact that a significant

minority of cognitive impairment goes unrecognized after acute

admissions, it is likely that this is under-representative of the full

impact of dementia in acute care. The money currently being spent on

acute dementia care is considerable, but it is being used to provide a

service that does is not tailored specifically to its users

needs. With

a further imminent increase in activity attributable to patients with

dementia likely to occur it is now time to rethink dementia care

processes and pathways in the acute hospital.


The brain stormer


case presentation

L. Carter-Brzezinski


, A. Nelson


, S. Ponnambath


, C. Holmes





Royal Infirmary, Bristol, United Kingdom


A retired female lawyer in her 60s was admitted to

the acute medical take with a two-month history of weight loss, heat

intolerance, anxiety and tachycardia. On the day of admission, the

patient was found collapsed on the floor, unable to mobilise. She had

no significant past medical history and was on no regular medications.

On examination, the patient demonstrated bilateral exophthalmos,

left sided facial droop, left arm and leg weakness but was GCS 15.

Cardiovascular examination revealed a pan-systolic murmur and an

irregular pulse at 133 beats per minute.


This patient was managed in resus in

conjunction with the intensivists. Blood tests revealed raised

inflammatory markers and markedly deranged thyroid function

(T4 > 100, T3 33.9, TSH < 0.2). ECG confirmed atrial fibrillation. CT

head demonstrated a subacute infarction in the right middle cerebral

artery territory. Blood tests later confirmed the presence of anti-TPO



and Management: The investigations demonstrate diagnosis


thyroid storm

on admission. We propose the hyperthyroidism led

to atrial fibrillation and subsequent embolic infarct of the right middle

cerebral artery. The patient was managed with high dose propylthiour-

acil, beta blockers, antibiotics and aspirin. She rapidly deteriorated and

required admission to ITU for respiratory support.


Although genuine thyroid storm is incredibly rare, this

case demonstrates that hyperthyroidism is a common cause of atrial

fibrillation, giving rise to embolic strokes. We recommend all potential

stroke presentations should have a thyroid screen on admission.


Falling down the steps of glioblastoma multiforme

a case report

A. Cochofel


, B. Filipe


, P. Marques


, M. Santos




Unidade de Saúde

Familiar Flor de Lótus, Cacém,


Unidade de Saúde Familiar Quinta da

Prata, Borba, Portugal


Glioblastoma multiforme (GBM) is the most common

malignant neoplasm of the central nervous system, carrying a grim

prognosis [1]. The clinical presentation is highly variable, depending

upon the exact location and growth rate of the lesion, which makes the

diagnosis difficult.

Case presentation:

A 68-year-old male with an unremarkable history

presents to his family doctor with dizziness and weakness of the lower

extremities with 3 weeks

duration and no additional symptoms. The

patient reported 2 episodes of falling off stairs, both with no apparent

trauma. Physical examination revealed significant gait disturbance

towards the left side, with no meningeal signs. The patient was

medicated with betahistine 16 mg and a CT brain scan was ordered.

About one week later the patient began experiencing left sided

hemiparesia and left sided facial paresia for which he was brought to

the emergency department, where an MRI of the brain showed a

probable right nucleobasal high-degree glioma with extension to the

homolateral mesencephalon

. A biopsy of the lesion confirmed the

diagnosis of GBM (IV degree, WHO). Due to its location the tumor was

considered inoperable. The patient was discharged from the hospital,

medicated with dexametasone 0.5 mg and levetiracetam 250 mg,

and began chemotherapy and physiotherapy. Patient is currently

under regular observation in ambulatory care, maintaining residual

symptoms of nausea, vomiting and diarrhea.


This case illustrates the importance of maintaining a

high index of suspicion for new onset of brainstem and cerebellar

symptoms that fail to respond to treatment for more common



[1] Bleeker Fonnet E.; Molenaar Remco J.; Leenstra Sieger (2012).

Recent advances in the molecular understanding of glioblastoma.

Journal of Neuro-Oncology

108 (1): 11

27. doi:

10.1007/s11060- 011-0793-0


An atypical presentation of lung neoplasm on elderly patient

C. Silva, A. Ribeiro, J. Mateus, D. Oliveira, D. Catarino, T. Vaio, R. Santos,

A. Carvalho.

Serviço de Medicina Interna A

Centro Hospitalar e

Universitário de Coimbra, Portugal

The lung neoplasm presents by ambiguous symptoms provoked by

tumor local effects, metastasis or a paraneoplasic syndrome. It leads to

frequent late diagnosis which treatment pass many times to palliative

care. This case reports one of several atypical presentation of this


We presents a male patient, 75 years, dement, ex-alcoholic and ex-

smoker, admitted for asthenia, anorexia, nausea, vomiting, diarrhea

and fever associated with epigastric pain. 3 days before it was

interpreted as an acute gastroenteritis (GEA) treated with ciproflox-

acin and pantoprazole. For persistence of symptoms, the elevation of

inflammatory parameters and worsening of renal function, was

hospitalized. At 3rd day a sudden pleural effusion appeared, requiring

Poster presentations / European Geriatric Medicine 7S1 (2016) S29