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

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P-032
The assessment of orthostatic blood pressure in an acute hospital
P. Kantachuvesiri1, T. Ong1. 1Queens Medical Centre – Nottingham
University Hospitals NHS Trust, United Kingdom
Background: Policies on falls management in hospital includes
assessment of orthostatic blood pressure (OBP). Accurate measure-
ment is paramount in falls assessment. A survey was conducted to
evaluate OBP assessment among healthcare staff according to our local
falls assessment policy.
Methods and sampling: Multidisciplinary healthcare team(MDT)
working in geriatric medicine, acute medicine and orthopaedics were
asked to complete a self-reported questionnaire. These departments
were chosen as their patient cohort represents a significant proportion
of “fallers”. The survey focused on previous falls training, OBP
assessment in eight case scenarios, how staff measured OBP (5-key
points: 1. lying patient flat; 2. minimum5-min flat; 3. measure BP lying
down; 4. standing patient up; 5. take BP immediately and 3-min after
standing), and significant OBP findings.
Results: 54/100 responses were obtained (10 doctors, 28 nurses
(band 5–7), 11 health care assistants (HCA), and 5 student nurses. 15
(27.8%), 9(15.8%), 30(55.6%) responses were from the acute medicine,
orthopaedic wards and geriatric wards respectively. 44(81.3%) had
received in-hospital falls training and 25/44(56.8%) in the past 6
months. Only 12(21%) participants correctly identified all the clinical
scenarios where OBP assessment was needed with no difference
among the MDT(p = 0.12). Only 5(10.4%) participants were able to
identify all the 5-key points of measuring OBP. Most did not identify
the need to lie flat for a minimum 5-min (72.9%); and measure BP
immediately and after 3-min standing (75%). No difference was
detected between geriatric and non-geriatric wards (p = 0.05). 52
(96.3%) participants recognised a 20 mmHg systolic-drop as signifi-
cant but only 33(62.3%) acknowledged a 10 mmHg diastolic-drop as
significant.
Conclusions: Despite a significant majority received hospital falls
training, OBP is still inaccurately measured across different directo-
rates by different MDT members. Incorrect assessment of OBP affects
patient management and can be considered a marker of suboptimal
hospital falls training. A review of local training is needed to address
this.
P-033
Clinical patterns of stroke in Lahore General Hospital, a Tertiary
Care center
M.I.H. Khan. AMC/PGMI/LGH
Background: Stroke is a leading cause of disability and the second
principal cause of death in the world. Two-thirds of strokes occur in
developing countries. It is becoming major health issue due to
increasing burden. The aim of this study was to analyze different
characteristics in stroke patients in Medical Unit 1 of Lahore General
Hospital, which is biggest referral hospital for Neurology patients in
Punjab, to identify the risk factors and help in targeting prevention in
our patients.
Methods: This retrospective study was carried out in Lahore General
Hospital, Lahore in January 2016, including data from January to
November 2015. The demographic data, clinical manifestations, risk
factors, side of weakness, cranial nerves involved, neurological
weakness and Glasgow Coma Scale, duration of stay in hospital and
outcome were included in the data. SPSS software for Windows
(version 21, SPSS Inc., Chicago, IL, USA) was used for the statistical
analysis of the data. For the comparison between categorical variables
Chi-square test was used. For other variables, t-test was used.
Results: A total of 235 patients with stroke, age 20 to 105 (mean ±
SD = 58 ± 14.6) were included. 127 (54%) had Ischemic stroke (IS) and
100 (42.6%) had hemorrhagic stroke (HS).127 (54%) were men and 108
(46%) were women. 17.9% of the patients with IS and 21.7% of the
patients with HS died (OR 0.65 95% CI 0.48–0.89). Hypertension,
diabetes and dyslipidemia were the most common risk factors.
Conclusion: Burden of stroke is high in Pakistan. Mean age of patients
with stroke is less. Hypertension, diabetes, dyslipidemia and smoking
are highly prevalent and hypertension is the most common. Ischemic
strokes are more common, mortality of intra-cerebral hemorrhage is
higher.
Key words: Stroke, Hypertension, Clinical patterns, Lahore
P-034
Norton scale as a predictor for 30-day hospital readmission among
older acute medical patients
D. Kirshner1, T. Dwolatzky1,2. 1Geriatric Unit, Rambam Health Care
Campus, 2The Ruth & Bruce Rappaport Faculty of Medicine at the
Technion-Israel Institute of Technology, Haifa, Israel
Introduction: Older people are at risk for hospital readmissions, and
reducing readmissions may improve quality of care and reduce health
care costs. While the Norton scalewas devised to predict the likelihood
of pressure sore development, it is useful for predicting length of
hospital stay, in-hospital complications and mortality in older
patients. We aimed to determine the value of the total Norton scale
score and its domains as a simple tool for predicting readmission
within 30 days in older patients admitted to acute internal medicine
wards.
Methods: A 6-year retrospective study was performed based on the
electronic records of medical inpatients 65 years and older, with the
primary outcome being readmission within 30 days. Data collected
included Norton scale on admission, patient demographics, first ward
of admission, length of stay and laboratory parameters. Bivariate and
multivariate logistic regression analyses were used to predict the risk
for readmission.
Results: We included 34,329 hospitalizations of which 18,044 (53%)
were women, mean age was 78.5 ± 7.8 years. Mean primary hospital-
ization length was 7.0 days. Overall, 30-day readmission ratewas 11.3%.
Based on multivariate logistic regression analysis, scores of 2/4 and 1/4
for the level of activity according to the Norton scale were associated
with increased risk for 30-day readmission (adjusted odds ratio [OR]:
1.33 and 1.64 respectively, 95% confidence interval [CI]: 1.22– 1.45 and
1.49–1.8 respectively, P < 0.001).
Key conclusions: The level of activity according to the Norton scale on
admission is useful for predicting the risk of 30-day readmission
among older patients.
P-035
Exploring how inflammation underlies adverse health outcomes
in acutely admitted older medical patients; associations between
different inflammatory patterns, and physical- and organ function
H.H. Klausen1, A.C. Bodilsen1,2, J. Petersen1,3, T. Bandholm1,2,4,
T. Haupt1, D.M. Sivertsen1, O. Andersen 1,5. 1Optimed, Clinical Research
Centre, Copenhagen University Hospital, 2Physical Medicine &
Rehabilitation Research-Copenhagen (PMR-C), Department of Physical
and Occupational Therapy, Copenhagen University Hospital, 3Section of
Biostatistics, Department of Public Health, University of Copenhagen,
4Department of Orthopaedic Surgery, Copenhagen University Hospital,
5The Emergency Department, Copenhagen University Hospital, Hvidovre,
Denmark
Introduction: In the general population, inflammation is associated
with age-related physical performance and organ function. This is
unknown in acutely admitted older medical patients.
Aim: Firstly, to investigate if systemic inflammation in acutely
admitted older medical patients is associated with physical perform-
ance, and organ dysfunction. Secondly, to investigate if the association
between organ dysfunction and physical performance is mediated by
systemic inflammation.
Methods: A cross sectional cohort study of medical patients (65+)
admitted to an Emergency Department. Physical performance was
assessed by four meter gait speed, handgrip strength and the de
Morton Mobility Index (DEMMI), and organ dysfunction by the
number of standard laboratory tests outside the reference range
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S37