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admission and at day 3 and decision of withdrawal of therapeutic

procedures were collected.


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.


Choosing Wisely Germany

Top 5 recommendations on over- and

underuse in geriatric medicine in Germany

M. Gogol.

Department of Geriatrics, Lindenbrunn Hospital,

Coppenbrügge, Germany


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.


The recommendations on overuse are: 1. Don

t prescribe a

medication without conducting a drug regimen review. 2. Don


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


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



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.


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


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.


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.


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


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).


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



Do you drive?

improving the documentation of driving status in

acute medical admissions

K. Hoyles


, C. Blyth




Doncaster Royal Infirmary, South Yorkshire,



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.


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.


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.


Retrospective analysis of patients with a diagnosis of urinary tract


R. Stephenson


, D. Ilyas


, M. Tang


, M. Mimms




Leeds Teaching Hospital



University of Leeds, Leeds, UK


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].


To evaluate the accuracy of diagnosis of UTI in older people and

estimate the degree of over-treatment.


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.


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.


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