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P-179
Comorbidity and multidimensional progression of late onset
Alzheimer
’
s disease: a systematic review
M.L. Haaksma
1,
*, L.R. Vilela
1,
*, A. Marengoni
2,3
, A. Calderón-
Larrañaga
2,4,5
, J.-M.S. Leoutsakos
6
, M.G.M. Olde Rikkert
1
, R.J.F. Melis
1
.
1
Radboud University Medical Center, Nijmegen, The Netherlands;
2
ARC,
NVS Department, Karolinska Institutet, Stockholm, Sweden;
3
Department
of Clinical and Experimental Sciences, University of Brescia, Italy;
4
EpiChron Research Group on Chronic Diseases, IACS, IIS Aragón, Miguel
Servet University Hospital, Zaragoza,
5
REDISSEC, Carlos III Health
Institute, Madrid, Spain;
6
Division of Geriatric Psychiatry and
Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore,
MD, U.S.A.
*Authors contributed equally
Background:
Alzheimer
’
s disease (AD) is a neurodegenerative syn-
drome characterized by cognitive and functional decline and psychi-
atric symptoms. This systematic reviewaims to investigate the relation
between somatic comorbidity burden and multidimensional progres-
sion in late onset AD.
Methods:
We searched four electronic databases for observational
studies that examined cognitive or functional or neuropsychiatric
progression in relation to comorbidity in individuals diagnosed with
AD (age
≥
65). From the 7,960 articles identified originally, 11 studies
were included in this review.
Results:
Nine studies indicated that comorbidity burden is asso-
ciated with deterioration in at least one of the three dimensions of
AD examined. Strikingly, all but one of the long-term studies
(measurement intervals
≥
2 years) showed no association with
cognition, whereas all but one of the cross-sectional or short-term
studies (measurement intervals <2 years) found comorbidities to be
related to decreased cognitive performance. In addition, five out of
the seven studies analyzing functioning showed a short-term
association between comorbidity burden and decreased functional
performance.
Conclusions:
This systematic review provides evidence that com-
orbidity burden is associated with decreased cognition and function-
ing in AD. It seems likely that there is a reciprocal relationship between
somatic comorbidities and AD progression, since the association
appears to be immediate and transient on the long term.
P-180
Predicting pressure ulcer development in a long term care facility
with the Braden scale score on admission
K. Hammas
1
, M. Béchac
2
, F. Jégo
2
, M. Piron
2
, D. Somme
2
, P. Jarno
1
.
1
Epidemiology and Public Health Department, Rennes University
Hospital,
2
Geriatric Department, Rennes University Hospital, France
Objectives:
This study was part of a professional practice evaluation
regarding identification and management of pressure ulcer (PU)
risk in a long term care (LTC) facility. The aim of this study was to
examine PU development depending on Braden scale score (BSS) on
admission.
Methods:
A retrospective cohort analysis was performed in February
2015 using health records of all patients admitted to the LTC facility of a
French university hospital between July 2013 and June 2014. Patients
were separated in two groups, based on their BSS within the 30 days
following admission: a moderate to very high risk group (BSS < 15) and
a no risk or mild risk group (BSS
≥
15). A log-rank test was performed
to compare development of PU in the two groups. Patients admitted
with a PU were excluded for calculation of incidence and survival
analysis.
Results:
89 patients were included. On the 66 patients free of PU
on admission, 32 (48.5%) developed at least one PU, corresponding
to an incidence density of 9.5 PU per 100 persons-months. Median
length of stay without PU was 7.8 months (IC95% [2.8; 12.8]) in the
no or mild risk group, versus 5.5 months (IC95% [1.7; 9.3]) in the
moderate to very high risk group, with no significant difference
(p = 0.57).
Conclusions:
Some recent studies have questioned the predictive
validity of Braden scale for LTC facilities patients. In our study, nearly
half of patients developed PU during their stay, with no difference
depending on their risk group assessed on admission.
P-181
Nutritional and functional status among hospitalized elderly
people
H. Salma
1
, C. Fadwa
1
, M. Sameh
2
, A. Lobna
1
, G. Radhwan
2
, B. Zouhair
2
,
A. Othmen
1
.
1
Psychiatric Department
”
B
”
of CHU Hédi Chaker,
2
Internal
Medicine Department of CHU HédiChaker, Sfax, Tunisia
Objectives:
Due to their biological, psychological and social character-
istics, old persons are more likely to suffer from malnutrition and
dependency in activities of daily living (ADL). The aims of this study
were to describe the overall profile of hospitalized elderly people and
to assess their nutritional and functional status.
Methods:
A descriptive study including 60 inpatients aged over 65,
who were hospitalized in the Internal Medicine Department of
CHU Hédi Chaker, Sfax, during the period from September 2015 until
January 2016. Data collection was conducted via a questionnaire
exploring sociodemographic and medical data. The MNA-SF and the
ADL of KATZ scales were used to screen respectively risk of
malnutrition and dependence for ADL.
Results:
The average age of patients was 73,48 ± 6,57 years with a
slight female predominance (51.7%). The socioeconomic level was
mostly middling (83,3%). Over a third were widowers (35%). In our
study, 18.4% of elderly patients were living alone including 6.7% of
them was benefiting from the presence of a housekeeper. Social and
family problems were reported by 18.3% of patients. The further most
of patients (85%) have a history of medical conditions such as
hypertension (60%), diabetes (31,7%) or heart disease (21,7%). The
poly pathology had concerned 63.3% of subjects. According to MNA,
73.3% cases were at risk of malnutrition. Besides, 13.3% of elderly
patients were dependent.
Conclusion:
Functional dependence and especially malnutrition are
prevalent in elderly patients. Therefore, nutritional and functional
status should be screened in the institutionalized elderly to prevent its
complications.
P-182
Variability in communicating the management of swallowing
difficulties at hospital discharge: associations with readmissions
and mortality
R.K.M. Wong, A. Hillarious.
University Hospitals of Leicester- Leicester
Royal Infirmary Hospital, Leicester City, United Kingdom
Introduction:
Swallowing difficulties are common in frailty, being
associated with mortality and hospital re-admissions. We evaluated
associations between documentation of swallowing recommenda-
tions on hospital discharge as well as degrees of fluid consistency
modification and outcomes (re-admissions and mortality).
Methods:
We assessed the discharge documents of 40 patients (20
from geriatric wards, 20 from stroke wards) consecutively assessed for
swallowing problems, looking for corresponding recommendations.
Mortality and re-admissions were reviewed after six months.
Results:
Accurate swallowing recommendations were made in 19/40
patients (48%). Mortality rates at 6 months were high overall (20%
without documentation, 26% with documentation). There was an
association between higher hospital re-admissions in patients without
accurate documentation (52%) versus those with it (37%). Degrees of
fluid consistency modification did not bear much association with
mortality: stage 1 (54%), stage 2 (50%), normal fluids (43%). Being
recommended stage 2 fluids was associatedwith higher re-admissions
(27%) versus stage 1 (12.5%) and normal fluid (19%).
Conclusions:
We found sub-optimal recording of accurate swallowing
recommendations in hospital discharge letters. Where present, it
appeared associated with fewer hospital re-admissions, possibly from
improved transfer of recommendations to the community. There
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
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