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

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Conclusions: Health education, interdisciplinary coordination, multi
component interventions and constant good practice help to prevent
hospital acquired pressure ulcer.
P-076
The association between the introduction of a step down unit on
the ICU and readmission rates
E.F.A.M. van Beijsterveld1, R.E. van Bentum2, E.R. van Slobbe-Bijlsma 2,
A. de Jonghe 1, R. Vink2. 1Department of Geriatric Medicine, The Tergooi
Hospital, The Netherlands, 2Department of Intensive Care, The Tergooi
Hospital, The Netherlands
Objective: The aim of this study was to evaluate the readmission rates
after the introduction of a step down unit (SDU) on the intensive care
unit (ICU)
Design: Retrospective study.
Setting: A 12 bed Intensive Care Unit of teaching hospital in the
Netherlands.
Patients: The cohort include 1954 patients who received intensive
care treatment.
Interventions: Implementation of a Step Down Unit, a separate unit
connected to the intensive care unit, which provides a level of care that
is intermediate between the care on the ICU and the care on the ward.
The main purpose is bridging the sudden drop in care intensity after
transfer from the ICU to theward. Furthermore on the SDU there is less
intensive hemodynamic monitoring and great attention to mobilizing
and physiotherapy.
Measurements and main results: Between October 2013 and January
2016 a total of 1954 patients was admitted to the ICU. 118 were
discharged to the SDU. These patients were older, had a longer ICU stay
and higher APACHE scores compared to the overall study population.
After introduction of the SDU overall readmission rate was reduced to
4.4% (compared to 2012, readmission 7.4%). The majority of read-
missions was due to respiratory insufficiency. Patients and families
experienced the SDU as a very patient friendly service that eased
transfer to the ward.
Conclusions: The implantation of the SDU did reduce the rate of ICU
readmission.
P-077
Post-hospitalization symptoms experienced by older patients after
acute hospitalization and their impact on daily functioning: a
qualitative study
R. van Seben1, L.A. Reichardt1, D.R. Essink2, B.C. van Munster3,
J.A. Bosch4, B.M. Buurman1. 1Department of Internal Medicine, Section of
Geriatric Medicine, Academic Medical Center, Amsterdam, The
Netherlands, 2Athena Institute, Faculty of Earth and Life Sciences, VU
University, Amsterdam, The Netherlands, 3Department of Geriatrics, Gelre
Hospitals, Apeldoorn, the Netherlands, 4Department of Clinical
Psychology, University of Amsterdam, Amsterdam, The Netherlands
Background: The transition between hospital and home is a vul-
nerable period for acutely hospitalized older patients during which
they are at risk for adverse health outcomes.
Objective: It was aimed to characterize the effect of hospitalization on
an older individual’ s daily life and to inquire which post-hospitaliza-
tion symptoms patients experience in the first weeks post-discharge.
Design: A qualitative design.
Setting: A tertiary teaching hospital and a regional teaching hospital in
the Netherlands.
Subjects: Older patients (aged ≥ 70) were interviewed at home two-
week post-hospital discharge. All had been acutely hospitalized for at
least 48 hours before discharge.
Methods: Qualitative data were categorized into different categories
and themes.
Results: Twenty patients were interviewed. Most patients indicated
hospitalization had a negative impact on their physical health and
reported difficulties in their mobility and Instrumental Activities of
Daily Living (IADL) after hospital discharge. Patients typically ascribed
their inactivity to four main symptoms: fatigue – (“I’ m exhausted. It’ s
almost like I’ ve neglected myself”); apathy (“I don’t feel like doing
anything. So I sit in my chair most of the time”); unsteadiness
while standing (“I’m swaying back and forth”); and fear of falling
(“I would like to walk outside again but I feel so uncertain, I’ m afraid
I may fall”). Muscle weakness, weight loss and poor appetite were also
reported.
Conclusion: Patients were mainly affected in their mobility and IADLs,
which was almost without exception attributed to multiple symptoms
patients experienced. Our study provides information on the nature
and attributions of post-hospitalization symptoms older patients
experience.
P-078
Time of death: “48h ” − analysis of mortality after admission in
department of Internal Medicine
J. Vaz, J. Capelo, N. Monteiro, M. Soares, A. Mello e Silva1.1Department of
Internal Medicine, Egas Moniz Hospital, Lisbon, Portugal
Introduction: Mortality in 48 h inpatients, according to national
statistics (2014), was 104.843 deaths, due to cardiovascular causes
(30.6%), cancer (25%) and respiratory diseases (11.6%). In recent years,
health care-associated infections are pointed as an emerging mortality
cause and a study had shown an association between weekend
admission and worse patient outcomes.
Objective: To analyze mortality of less than 48 hours in an Internal
Medicine department in a 3 years period.
Methods: Retrospective study of mortality after admission from 2013
to 2015, through consultation the electronic process.
Results: 234 patients with 48 h-hospitalization; 46 died (22 female, 24
male; mean age 82.5 years); in 28 the main cause of death was
infectious (in 22 pneumonia). While 15 patients presented diagnosis
of malignancy only in 8 cancer was the cause of death. Cardiovascular
pathology was the cause of death in 10 patients. 50% of patients had
an hospitalization 6-month before. 56% presented expectable death by
clinicians (in patients with cancer r = .58, p-value < 0,001). In patients
where resuscitation procedures were initiated the average age was
82 y; 50% were total dependent for ADLs and 50% had cognitive
decline. The average length of stay in the emergency room was 0.92
days. Only 26% of patients had been transferred in weekend/holiday.
Conclusions: Mortality is higher in the elderly population. The main
causes of death were infectious (60%), cardiovascular (21%) and cancer
(17%). Age does not seem to have been an early predictor for
resuscitation maneuvers initiation and during the weekend mortality
wasn`t increased. Hilights: the morbimortality from community-
acquired pneumonia and health-care associated pneumonia.
Area: Biogerontology and genetics
P-079
Estimating the association of 5HTTLPR polymorphism with
delusions in Alzheimer’s disease
G. D’ Onofrio1, D. Seripa 1, D. Sancarlo1, F. Panza1,2,3 , G. Logroscino2,3,
A. Greco1. 1Geriatric Unit & Laboratory of Gerontology and Geriatrics,
Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza ”,
San Giovanni Rotondo, Foggia, 2Neurodegenerative Disease Unit,
Department of Basic Medicine, Neuroscience, and Sense Organs,
University of Bari Aldo Moro, Bari, 3Department of Clinical Research in
Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale
G. Panico, Tricase, Lecce, Italy
Objectives: The mechanisms underlying delusions in Alzheimer’ s
disease (AD) patients have not been fully clarified. 5HTTLPR is a 44-bp
deletion polymorphism in the promoter region of the serotonin
transporter gene SLC6A4, with 2 alleles; 1 termed long (l) and 1 short
(s). The aim of the study was to determine whether the 5HTTLPR
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S48