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

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Objective: To identify CCD of patients ≥65 years admitted to an acute
medical ward of a general hospital.
Methods: A cross-sectional study during one day. Multimorbidity
was defined as co-existence of two or more chronic conditions,
and diagnosed based on the results of history taking, physical
examination, and medical records, if available. We included Katz
scale for functionality. The elderly is aged 65 years, and oldest old is
greater than or equal to 85 years. There was the dichotomy of the
variables to be compared using the Fisher exact test for the value of
p < 0.05 and determination of the relative risk.
Results: 126 patients had admitted, and 82.5% (104/126) were
identified as elders, 54% of the patients were females, the median
age was 78 and interquartile range 68.0 –84.2 years. Concerning to
multimorbidity were identified 88.1% [n = 111] and to CCD 50%. When
stratifying the Katz index found without changing the functionality in
32.7%, moderate change 33.7% and serious deterioration 33.7%. We
note that CCD is associated with elderly [RR = 1.31; CI 1.10 to 1.55] and
almost duplicate with oldest old [RR = 2.10; CI 1.07 to 4.092].
Conclusion: In this reporting period we find that in general medical
wards, the inpatient profile is the elderly and oldest old associated
with a complex chronic disease.
P-191
Geriatric intermediate care and transitional care for frailty-related
patients
K. Loeffler. Geriatric Health Care Centers Graz, Graz, Austria
Introduction: As a result of demographic change and increasing life
expectancy challenges in providing health care for our eldest are
predicted. Due to these changes hospitals and geriatric care facilities
have to face patients with complicated clinical disorders as well as
unstable, multi-morbid elderly patients with cognitive restrictions.
Geriatric patients require a longer period of convalescence, which
demands the development of special care facilities between hospital
and long-term care. This study addresses the improvement of geriatric
care for unstable, multi-morbid elderly patients with cognitive
restrictions discussing the establishment of a “Geriatric Intermediate
Care Unit”.
Methods: Literature research was conducted to extract criteria
describing the target group. Existing geriatric care facilities were
examined, if they could meet the needs of these patients. Moreover,
currently existing intermediate care units were reviewed. Afterwards
eleven experts in the field of geriatric care within German-speaking
countries were interviewed about the clientele, the performance
content, entry and exit criteria and existing limitations in
implementation.
Results: The results of this study show that geriatric patients are
treated best within an integrate care system including a “Geriatric
Intermediate Care Unit” in which patients are given a longer period of
convalescence and are scanned and transferred to the suitable long
term care facility, rehabilitation or home care.
Conclusions: For the purpose of developing such units further
research is needed not only in defining the clientele but also
concerning accurate demand. Furthermore the term “Geriatric
Intermediate Care Unit” has to be discussed in the German-speaking
countries to find a standardized definition.
P-192
Evaluation of a new structured tool to revise the elderly ’s
prescriptions: DICTIAS-OBCv
F. Maronnat1, J. Belmin1, W. Jarzebowski1. 1CHU Charles Foix, Ivry sur
Seine, France
Introduction: Managing inappropriate prescriptions (IP) is a daily
problem in geriatrics. Within a population of hospitalized patients
under several medications we tried to evaluate a new tool to improve
medical prescriptions: DICTIAS-OBCv.
Methods: Observational retrospective study carried out on patients
admitted between June and October, 2014 in a geriatric ward.
Prescriptions at registration were revised using DICTIAS-OBCv.
Original prescriptions at registration and prescriptions revised
by DICTIAS-OBCv were both analyzed with START/STOPP tools
by spotting missing START prescriptions (MS) and prescriptions
matching STOPP criteria (S). The main criterion of judgement
was the evolution of the number of patients presenting at least one
IP (MS and/or S) after DICTIAS-OBCv, assessed by Mac Nemar Test. The
secondary criteria of judgement were the evolutions of the number of
global prescriptions and the number of patients presenting MS and S
prescriptions.
Results: 62 patients, aged 83.9 years on average, were included. After
revision by DICTIAS-OBCv, the number of patients with at least one IP
decreased from 53 to 13 patients (RR = 0.25; p < 0.001). Therewere 421
prescriptions at registration (mean = 6.8/patient) then 338 (mean =
5.5/patient) after revision by DICTIAS-OBCv (p < 0.001). The evolu-
tion of the number of patients with MS and S was the following one:
MS 41 to 7 patients (RR = 0.17; p < 0.001); S 41 to 7 patients (RR = 0.17;
p < 0.001).
Conclusion: DICTIAS-OBCv is efficient to improve medical prescrip-
tions in both qualitative and quantitative terms.
P-193
Pressure ulcers – casuistic
S.C. Martins, J. Olivério, A. Nunes, J. Machado, J. Marques, L.C. Matos,
A. Monteiro. Internal Medicine Department, Centro Hospitalar
Tondela-Viseu
Pressure ulcers are among the most common conditions encountered
in acutely hospitalized patients or those requiring long-term institu-
tional care, most frequently in the elderly population, associated
with a negative impact in the quality of life. There are various risk
factors identified. The most important include immobility, malnutri-
tion, reduced perfusion, and sensory loss. This work aims to describe
the geriatric inpatient population followed by the authors, during
the year of 2015, with respect to the presence of pressure ulcers
and its characteristics. In order to characterize the population, the
clinical codification sheets of all patients assigned to one Internal
Medicine specialist were requested. All patients with at least 85
years old were included. During that year there were 253 inpatient
episodes with a total of 245 patients. For statistical purposes we
considered all inpatient episodes as distinct cases. Of 253 cases, 36%
(n = 91) were no less than 85 years old. Of these 36.3% (n = 33) were
aged 90 or older. 8.8% (n = 8) had pressure ulcers with one patient
having 2 in different localizations. The majority were classified as
grade IV (n = 3) and one as grade III. There were none as grade I or II.
As we can see there were 4 cases with no reference to grade. With
regard to localization 4 were on heel, 2 on the hip and 1 on the
lower back. In 2 patients no classification was made. 50% of the cases
were bedridden, 25% had dementia and 37.5% had diabetes. A total of
3 patients lived in nursing home. The presence of pressure ulcers
constitutes a geriatric syndrome consisting of multifactorial patho-
logical conditions. The latest Portuguese epidemiological data are
related to hospital care, where the average prevalence of pres-
sure ulcers is about 11.5%. This work aims to sensitize physicians to
this condition as pressure ulcers are a public health problem and an
indicator of quality of care which prolongs hospitalization and
increases readmissions.
P-194
Risk model to predict mortality in older patients with heart failure
L.F. Arana1, J.M. Abarca1, E.L. Alonso1, F.J.M. Sánchez1, P.G. Gregorio1.
1Geriatric Medicine Department at Clínico San Carlos Hospital, Madrid,
Spain
Objective: The aim of this study is to develop a risk model to predict
six-month mortality in older patients admitted with acute heart
failure (AHF) in a Geriatric Department.
Methods: Observational cohort study that includes all patients
admitted to a Geriatric Acute Care Unit with AHF between January,
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S79