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Although the model has a good fit, its explanatory power

is not high, possibly due to the need for more patients and/or new



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.


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



Building a prognostic tool to identify elderly comorbid patients in

high risk for readmission

N. Gual


, P. Burbano


, C. Arnal


, A. Contra


, A. Calle


, M. Inzitari




Parc Sanitari Pere Virgili,


Universitat Autònoma de Barcelona,



Universitari Vall d

Hebron, Barcelona, Spain


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.


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.


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


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


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.


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.


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


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.


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).


Multifactorial fall assessment and intervention identifies

multiple risk factors in elderly fall patients and multifactorial

intervention including physical training improves their functional


Poster presentations / European Geriatric Medicine 7S1 (2016) S29