41 / 290
admission and at day 3 and decision of withdrawal of therapeutic
procedures were collected.
Results:
Among 197 patients,106 were still hospitalised in ICU at day 3
in whose mean age was 84[±4], IGS II was 57[±14] and cause of
admission was hemodynamic failure in 67%(n = 71). Withdrawal
of therapeutic procedures, IGS II, number of organ failure at day 3,
number of organ supply at admission and day 3, evolution of total
SOFA score and evolution of number of organ supply were significantly
associated with in-hospital death. Three prognosis models were
realized, classifying correctly 70% of the patients. Model based on
SOFA score and its evolution was the most efficient.
Key conclusions:
Organ failure and its evolution at day 3 are key
element for prognosis evaluation. Prospective studies including
specific geriatric scores should improve the models to be suitable for
daily practice.
P-024
Choosing Wisely Germany
–
Top 5 recommendations on over- and
underuse in geriatric medicine in Germany
M. Gogol.
Department of Geriatrics, Lindenbrunn Hospital,
Coppenbrügge, Germany
Methods:
In a multistep approach, based on recommendations of
an expert panel of the German Society of Geriatrics (DGG) and the
Healthcare Section of the German Society of Gerontology and
Geriatrics (DGGG), a membership survey and a re-assessment of the
survey results, the expert panel identified 5 recommendations on
underuse in geriatric medicine in Germany.
Results:
The recommendations on overuse are: 1. Don
’
t prescribe a
medication without conducting a drug regimen review. 2. Don
’
t
recommend percutaneous feeding tubes in patients with advanced
dementia. 3. Don
’
t use antipsychotics as the first choice to treat
behavioral and psychological symptoms of dementia (BPSD). 4. Don
’
t
recommend screening for breast, colorectal, prostate or lung cancer
without considering life expectancy and the risks of testing, over-
diagnosis and overtreatment. 5. Don
’
t use benzodiazepines or other
sedative-hypnotics in older adults as first choice for insomnia,
agitation or delirium.
The recommendations on underuse are: 1. Decisions about diagnostic
and therapeutic procedures in elderly patients should be based on a
functional assessment and not on chronological age. 2. Falls and risk
for falling in elderly persons should be recognized for diagnostic and
therapeutic procedures. 3. Malnutrition in elderly patients should be
recognized for diagnostic and therapeutic procedures. 4. Depression in
higher age should be treated by psychotherapy in moderate and by
psychotherapy and antidepressants in severe cases. 5. Osteoporosis in
elderly persons should be recognized for diagnostic and therapeutic
procedures.
Conclusion:
The recommendations were accepted by the consensus
panel of the German Society of Internal Medicine (DGIM) which
comprised all specialities of internal medicine in Germany.
P-025
Out of hospital cardiac arrest in the elderly
J. Jácome, C. Patrício, S. Lino, H. Gruner, P. Barreto.
Viatura Médica de
Emergência Rápida
–
Centro Hospitalar Lisboa Central
Introduction:
An out of hospital cardiac arrest (OHCA) is defined as a
cessation of cardiac mechanical activity occurred outside a hospital
and without signs of circulation. The aim of this study was to evaluate
the circumstances and basic epidemiological indices of OHCA and
cardiopulmonary resuscitation (CPR) in the elderly.
Methods:
A retrospective analysis of prospectively collected data of
all OHCA resuscitation attempts in patients older than 65 years for a
2 year period, by the pre-hospital emergency medical service of a
tertiary hospital.
Results:
There were 183 patients included in the study, of which 37%
(n = 67) were male and 38,8% (n = 71) older than 85 years. There
were 8,7% (n = 16) bystander-witnessed arrests. The majority of OHCA
occurred from cardiac causes in 21%, non-cardiac causes were:
respiratory 9%, airway obstruction 5%, traumatic origin 4% and in the
majority there wasn
’
t a clear cause. The initial rhythm was asystole in
65% (n = 119), and only 4%(n = 8) of patients had an initial shockable
rhythm (ventricular fibrillation). Median CPR durationwas 21 minutes
(2
–
80 m). There were 29% (n = 53) patients without a CPR attempt and
31,1% (n = 57) without pre-hospital return of spontaneous circulation,
as such the overall pre-hospital case fatality was 81% (n = 148).
Discussion:
This work is in accordance to published data, revealing a
high rate of fatality associated to the non existence of a bystander
witness and an unfavorable initial rhythm that in the majority was
asystole.
P-026
Do you drive?
–
improving the documentation of driving status in
acute medical admissions
K. Hoyles
1
, C. Blyth
1
.
1
Doncaster Royal Infirmary, South Yorkshire,
England
Introduction:
Many medical conditions can impair a patient
’
s driving
ability. Driving status is regularly over looked, and in older patients,
gives a useful insight into functional ability. Driving is an emotive topic
as livelihood and independence may rely on it and there are important
medico-legal implications for Doctor
’
s. This project aimed to improve
awareness of driving rules amongst junior doctors.
Methods:
39 junior doctors completed a questionnaire to assess their
knowledge of driving rules. A prospective audit of inpatients over 75
years old with dementia or delirium was performed to establish
whether they had been asked about driving. A retrospective audit
looked at patients of any age diagnosed with seizure or unexplained
syncope to see if they had been given driving advice.
Results:
Only 10% of junior Doctors regularly ask patients whether
they drive. 90% have not received any formal teaching on driving rules.
Of 22 the patients with dementia or delirium, driving status was not
documented in any medical clerking. Of the 21 patients with seizure,
19% had driving status documented in their medical notes; just two
had received advice. From 31 patients with unexplained syncope, 24%
had driving status documented in their medical notes and just 1
received driving advice.
Key conclusions:
Doctors rarely receive formal teaching on driving
and when clerking, driving status is often overlooked. Based on the
results, local and regional teaching has been delivered and the medical
clerking booklets now include a temporary section on driving status in
the form of a stamp.
P-027
Retrospective analysis of patients with a diagnosis of urinary tract
infection
R. Stephenson
1
, D. Ilyas
1
, M. Tang
2
, M. Mimms
1
.
1
Leeds Teaching Hospital
Trust,
2
University of Leeds, Leeds, UK
Background:
Urinary Tract Infection (UTI) is a common but challen-
ging diagnosis in over 65
’
s presenting to medical specialties. Factors
such as inability to provide an accurate history and asymptomatic
bacteriuria contribute to over-diagnosis and inappropriate antibiotic
prescribing [1].
Aims:
To evaluate the accuracy of diagnosis of UTI in older people and
estimate the degree of over-treatment.
Methods:
We performed a retrospective analysis of casenotes and
laboratory results of 52 patients discharged between October 2015 to
December 2015 with a diagnosis of UTI.
Results:
A total of 48 patients,19(39.6%) male and 29(60% female), met
the inclusion criteria. 12/48 patients (25%) met predefined criteria for
UTI. A further 9 patients (18.8%) had asymptomatic bacteriuria. 56% of
patients had no evidence of UTI.
Conclusion:
Out of the 48 patients with a diagnosis of UTI on
discharge, only 12(25%) had clinical evidence which supported this.
We are currently working with colleagues in microbiology and
pharmacy to revise our guidance for UTI in older people to make
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S35