European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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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%).
Conclusion: 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
prescribing.
P-008
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,
Ireland
Background: 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.
Methods: 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.
Results: 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%
(almost €20,000,000) of the total hospital casemix budget for the
period.
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.
P-009
“The brain stormer”– case presentation
L. Carter-Brzezinski 1, A. Nelson1, S. Ponnambath1, C. Holmes1. 1Bristol
Royal Infirmary, Bristol, United Kingdom
Introduction: 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.
Method/Investigations: 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
antibodies.
Results and Management: The investigations demonstrate diagnosis
of “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.
Conclusion: 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.
P-010
Falling down the steps of glioblastoma multiforme – a case report
A. Cochofel1, B. Filipe 2, P. Marques1, M. Santos1. 1Unidade de Saúde
Familiar Flor de Lótus, Cacém, 2Unidade de Saúde Familiar Quinta da
Prata, Borba, Portugal
Introduction: 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.
Conclusion: 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
disorders.
Reference
[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:
P-011
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
pathology.
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–S259 S31