52 / 290
and poisoning [21,4%], discharge to home [81,6%] and the means
length of stay of 178 minutes. The younger were used more the green
color of triage [24.3% vs. 16.1%] while the older used the orange color
[13.9% vs. 7.3%] statistically significant (p = 0.0001). For discharge to
home, the younger had a higher utilization [85.6% vs. 73.7%] and the
older was more than three times as great as for admission to ward
[RR = 3.01] fifteen times for mortality [RR = 15,73] and four times to
transfer to another facility [RR = 4,64]. Finally, the length of stay was
more high for older [219 vs 157 minutes; p = 0.0001], associated a high
severity [14.4% vs 7.5%; p = 0.0001].
Conclusion:
The older is related to the rate of admission to a ward and
mortality. The length of stay takes longer when is with high severity.
P-068
Test of MNA-SF in an acute geriatric department
R.A. Scheller
1
, K. Weil
2
, E. Holm
3
.
1
Odense University Hospital,
2
Malteser
Krankenhaus St. Franziskus-Hospital, Flensburg,
3
Nykøbing Falster
Hospital
Introduction:
Nutrition of geriatric in-patients requires special atten-
tion in order to secure a sufficient intake. With the present study, we
want to investigate the capability of the Mini Nutritional Assessment
(MNA) to identify patients, who do not need nutrition support.
Methods:
Patients acutely admitted to a geriatric unit were given
maximal oral nutrient support. On admission patients were screened
using MNA and trained nurses registered the total intake of calories
and protein. 67/80 patients got 3 registrations or more. Each patient
had at least one registration. Patients with significant impaired cogni-
tive status were excluded.
Results:
In total 200 patients were included with 18 samples during 3
months. 80 patients participated after mental screening. Mean Barthel
index on admission was 43 ± 29,5, mean age was 82.6 ± 6,9. According
to MNA score, 73 patients (91%) were malnourished (MNA score 0
–
7)
or in risk of malnutrition (MNA score 8
–
11), and 7 (9%) were in normal
nutritional status. All patients with MNA > 11 got more than 75% of
their energy need as recommended in Denmark.
Key conclusions:
A massive majority of acutely admitted geriatric
patients are in risk of malnutrition. Maximal nutrient support should
therefore be given as soon as patients are admitted. Initial direct
registration of calorie and protein intake can be used to guide further
nutrient support. Only 7/80 patients had an MNA > 11. Nutritional
screening with the MNA is therefore not useful in this patientgroup.
P-069
Utility of urine dipstick testing among elderly patients admitted to
the emergency department
S. Sintra, A. Matos, C. Filipe, P. Dias, I. Fonseca, A. Simão, M. Veríssimo,
A. Carvalho.
Centro Hospitalar e Universitário de Coimbra, Coimbra,
Portugal
Introduction:
The urine dipstick test (UDT) is a frequently ordered
rapid screening test to exclude the presence of a urinary tract infection
(UTI). This study aimed to evaluate indications and results of UDT in
acute care.
Methods:
Cross-sectional study of a convenience sample of emer-
gency department elderly patients who had UDT performed between
April 11 and April 17, 2016.
Results:
Of 1,342 patients, 154 underwent UDT on admission (median
age, 80 years; 50.6% women; 13.6% with urinary catheter). There were
specific symptoms or signs of UTI in 41 cases (26.6%), nonspecific
symptoms or signs in 25 cases (16.2%) and no symptoms or signs of UTI
in 88 cases (57.1%). UDT results were positive in 68 cases (44.1%). 55
patients underwent urine culture (of which 30.9% were positive). The
sensitivity of urine dipstick as a proxy for culture was 82.3%, with a
specificity of 56.4%. The sensitivity and specificity of UDTas a proxy for
urine culture by specific symptoms was 100% and 54.5% respectively.
Of 92 patients receiving antibiotics, 54 cases (58.7%) were for a non UTI
indication while 38 (41.3%) received antibiotics with no explanation
other than suspected UTI. Positive UDT results were associated with
increased probability of antibiotic prescription (p < .001) among
asymptomatic patients.
Conclusions:
As seen in the present data, most patients lacked an
appropriate clinical indication for UDT. The accuracy of UDT as an
indicator of a positive urine culture or specific symptoms of UTI is poor,
contributing to overdiagnosis and excessive use of antibiotics for UTI.
P-070
Acute hospital admissions in nursing home residents: a trigger to
think ahead!
J. Soh, J. O
’
Keeffe, D. O
’
Shea, G. Hughes.
St Vincent
’
s University Hospital,
Dublin, Ireland
Background:
Nursing Home Residents(NHRs) have complex health-
care needs due to advanced age, multiple comorbidities and high
levels of dependency. Acute hospital admissions of older people
are associated with risks and complications. Despite this, transfer of
NHRs to hospitals remains common. This study aims to examine the
relationship between acute hospital admissions and survival benefits
among NHRs.
Methods:
Retrospective analysis of NHRs with unscheduled admis-
sions to a tertiary hospital over a 2 year period, from 2014 to 2015.
Results:
There were a total of 1219 unscheduled admissions from 929
residents. This represented 4.8% of 25,336 unscheduled admissions
in the time period.62% were women and mean age was 85 years. Of all
admissions, 36% were recurrent admissions. 293 residents had more
than 1 admission.
The overall 6 month mortality of NHRs after hospital admissions was
34%. 18%(n = 167) died during their hospital stay, with 81% of deaths
occurred within the first 15 days. Following hospital discharge, a
further 16%(n = 124) died in nursing homes within 6 months. 40% of
this cohort died within 1 month of hospital discharge.
NHRs with more than 1 admission had poorer outcomes. Their overall
6 month mortality was significantly higher at 37.5% vs 28.5% in
residents with single admission (p = 0.006). In-hospital mortality
among re-attenders was 20.5%, compared to 16.8% in those with 1
admission (p = 0.17). Following hospital discharge, NHRs with more
than 1 admission had significantly higher 6 month mortality in their
nursing homes, compared to those with single admission (21% vs 13%,
p = 0.009).
Conclusion:
Acute hospital admissions are associated with poor
survival outcomes among NHRs. Hospital admissions, in particular
recurrent admissions, should prompt early discussions regarding
appropriate end of life care.
P-071
Functional focused care: content validity of function focused care
behavior checklist
J. Tavares
1
, J. Grácio
1
, L. Nunes
1
.
1
Coimbra University Hospital Centre
(CHUC)
Objectives:
The prevention of functional decline (FD) should be
considered a priority in the care of hospitalized older adults (OA).
A functional focused care (FFC) philosophy promotes independence
and physical activity during hospitalization. Nurses have a central role
in the implementation of FFC. This study aims to: (1) translate, adapt
and validate the FFC Behavior Checklist (FFCBC) for the Portuguese
population; and (2) evaluate content validity index (CVI) using an
expert panel.
Methods:
Principles of good practice for translation and cultural
adaptation were used. The analysis of content validity included CVI,
probability of a chance occurrence (pc) and modified Kappa (MK).
Seven experts (geriatric clinicians and researchers) evaluated the tool.
SPSS software, version 20, was used for the statistical analysis.
Results:
A preliminary version of FFCBC was obtained. This version
was revised in three rounds, the suggestions of experts were
incorporated into each review until all items reached a CVI
≥
0.8. In
the final version, there were 13 items with a CVI = 1 and 6 items with a
CVI = 0.856. The average value of the IVC was 0.96 and the universal
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S46