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

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Conclusion: Although the model has a good fit, its explanatory power
is not high, possibly due to the need for more patients and/or new
variables.
P-175
The complexity of biotechnological therapy in elderly patients
with rheumatoid arthritis
I. Figueiredo, S.G. Castro, M. Antunes, F. Magalhães, H. Gruner,
A. Panarra. Serviço Medicina 7.2 – Hospital Curry Cabral, CHLC
The management of the elderly patients with rheumatoid arthtritis
(RA) is very challenging and the use of immunomodulators must be
cautious. Immunosenescence is a known risk factor for imunossupres-
sion in the elderly, which is worsened by associated comorbidities,
like diabetes and polypharmacy. Age also modifies drug-related
pharmacokinetic parameters. Moreover, the majority of the clinical
trials exclude the elderly population. The authors present a 72-year-
old caucasian female patient with RA for 10 years, as well as diabetes,
heart failure, atrial fibrillation and obesity and, thus, polymedicated
(13 different medications). She did not fulfil the frailty criteria, with
a PRISMA score of 2, gait speed of 5 seconds and a Timed Up and Go
of 11 seconds. Initial therapy with methotrexate titrated up to 15 mg
and deflazacort 6 mg failed to control the disease, with persistent
active arthritis in the wrists, proximal metacarpophalangeal joints
and knees (DAS28 6,2), which led to severe immobilization and
limited outpatient clinic attendance. After tuberculosis screening,
anti-TNF therapy with etanercept was successfully started. DAS28
score decreased to 2,75 and the patient presents complete auto-
nomy after 1 year of follow up. Although clinical evidence supports
the use of biological agents in elderly patients, these patients are often
undertreated due to fear of drug-related side effects in a usually
polymedicated population. However, a great quality of life improve-
ment can be achieved by optimising DMARD therapy in RA patients
and, as in other diseases, the presence of frailtymay be the cornerstone
of decision making, but further studies are necessary.
P-176
Management of systemic sclerosis and peripheral arterial disease
in the elderly
B. Marques, S.G. Castro, I. Figueiredo, FG Magalhaes, M. Antunes,
H. Gruner, A. Panarra. Serviço de Medicina 7.2 – H. Curry Cabral, CHLC
Aging with autoimmune diseases is a reality. Development of
peripheral vascular disease in the elderly with systemic sclerosis
(SSc) is a challenge due to common pathophysiological mechanisms of
both SSc and atherosclerosis. Two Caucasian female patients, aged 78
and 76 years, independent, were diagnosed with SSc 20 and 15 years
ago, respectively. They presented with Raynaud’s, digital ulcers
and anti-Scl-70 antibody positivity. They had 4 and 5 comorbidities
respectively, including peripheral artery disease with leg ulcers
and hypertensive heart failure in the first, diabetes in the second
patient; prescribed drugs were 6 and 8 (including aspirin, bosentane,
nifedipine), with non-compliance in the previous 3 months. Frailty
was present in the second patient according to PRISMA criteria.
Both patients were admitted due to unilateral acute digital ischemia
in the toes. The ecodoppler/angio-CT confirmed bilateral distal
ischemia below the popliteal arteries in the first patient and bilateral
occlusion of posterior tibial and peroneal arteries in the second.
Full dose enoxaparin, intravenous prostanoid and sildenafil, together
with aspirin, sinvastatin and pentoxifilin, were unsuccessful.
Amputation below the knee was performed for progressive foot
necrosis in both cases. The first patient was discharged after 35 days
and at one year follow up is on a rehabilitation program at home,
the second showed progressive deterioration, developed sepsis
and died 45 days after admission. The cases underline the severity of
micro and macrovascular involvement in SSc. In fact, the role of
microvascular impairment in SSc is well-known, but less attention
is paid to macrovascular damage and early recognition improves
outcomes.
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Building a prognostic tool to identify elderly comorbid patients in
high risk for readmission
N. Gual1,2, P. Burbano1, C. Arnal 1,3, A. Contra1, A. Calle1,2, M. Inzitari1,2.
1Parc Sanitari Pere Virgili, 2Universitat Autònoma de Barcelona, 3Hospital
Universitari Vall d′Hebron, Barcelona, Spain
Objectives: Older adults with multi-morbidity present a high risk of
early readmission after discharge. Although many risk factors for
readmissions have been described, studies on older patients are
scanty. Our aim is to create a clinical prediction tool to identify higher
risk of readmission.
Methods: During 2014–2015, consecutive elderly patients hos-
pitalized for exacerbated chronic conditions were recruited.
Demographic, clinical, functional and social data, discharge destin-
ation and readmissionwithin the 30 days were collected. Independent
predictors of readmission were identified by logistic regression, and
the resulting Odds Ratios (OR) were combined to create a weighted
prognostic indicator. This tool was validated in a second sample of
patients admitted to the unit during 2016, using ROC curves.
Results: In 2014–2015, 640 patients were recruited (mean age + SD
= 85,2 + 7,7; 63,4% female), 76,4% discharged to their usual living
situation. Readmission rate was 19% (N = 84). The Odds Ratio (OR) of
the significant risk factors in the logistic regression were: previous
admission (OR[95%CI] = 1,7[1,1–2,9]), heart failure (OR[95%CI] = 1,4
[0,9–2,4]), chronic renal failure (OR[95%CI] = 1,7[1,0–2,9]), polyphar-
macy (OR[95%CI] = 2,4[1,4–4,0]) and length of stay (OR[95%CI] = 2,1
[1,1– 4,3]). The new indicator ranged from 0 to 9 (mean + SD = 4,1 + 2,3).
The validation sample included 532 patients (mean age + SD = 86,0 +
6,5, 58,2% women, 76,1% discharged home and 19,1% readmitted).
The AUC was 0,65.
Conclusion: In our samples of old multi-morbid patients risk for
readmission was high. Combining risk factors based on their ORs
leaded to a poorly predictive tool. This might be attributable to high
complexity and variability of patient’s characteristics, which should be
investigated, or methodological issues.
P-178
Results from a geriatric fall clinic – risk factors
A. Güzel, K.S. Piper, H.E. Andersen. Geriatric Section, Medical
Department, Glostrup, AHH/Department of Physio- and Occupational
Therapy, Rigshospitalet, Glostrup
Introduction: To prevent fall in elderly people multifactorial fall
assessment and intervention has been effective. This study reports data
from a Danish geriatric fall clinic. Materials and methods Referred fall
patients underwent a standardized multidisciplinary quantitative
assessment program. Risk factors as vision, sensibility, vestibular func-
tion, orthostatic blood pressure, cognitive and emotional status,
nutritional status, medication status and functional ability tests as
Chair Stand (CS), Bergs Balance Scale (BBS) and the Dynamic Gait Index
(DGI), were identified and individualized interventions were offered.
Results: 162 patients were referred throughout 2015. 123 gave infor-
med consent and were included. 79 women (64,2%) and 44 men
(35,8%), mean age 76,9. Risk factors identified: vision impairment: 74
(60%), reduced sensibility: 74 (60,2%), vestibular dysfunction: 17
(13,8%), orthostatic hypotension: 47 (38,2%), cardiac arrhythmia at
event recording: 23 (18,7%), polypharmacy: 80 (65%), psychotropic
medicine: 47 (38,2%), cognitive dysfunction: 23 (18,7%), emotional
dysfunction: 27 (22%), malnutrition: 7 (5,7%), vitamin D deficiency: 13
(10,6%), impaired muscle strength: 68 (55,3%), impaired balance by
BBS: 56 (45,5%) and DGI: 71 (57,7%). 97 (78%) patients received physical
training. 41 patients in the community and 56 patients in the fall clinic.
At the end of the training period a significant improvement was found
in strength (CS p < 0,027) and in balance (BBS < 0,001; DGI < 0,000).
Conclusion: Multifactorial fall assessment and intervention identifies
multiple risk factors in elderly fall patients and multifactorial
intervention including physical training improves their functional
ability.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S75