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Nonagenarians have a poorer prognosis than younger

older adults. We aimed at analyzing clinical characteristics and

outcomes of hospitalized

90 years old patients, compared with

younger geriatric patients.


Consecutive elderly patients with exacerbated chronic

diseases admitted to a subacute intermediate care unit were evaluated

for demographic, social, clinical (main diagnosis, comorbidity, delir-

ium), functional characteristics at baseline, destination at discharge,

length of stay and readmission within one month. We compared

nonagenarians with patients 65

89 years-old.


Of 532 patients, 33.5% were

90 years old. In the

nonagenarians, global mortality (during admission +30 days after

discharge) was higher (p = 0.002), with no significant differences in

returning to the usual living situation at discharge (73% vs 77.7%) and

in readmissions rate within 30 days. The main diagnosis for both

groups was respiratory disease (48%). Comparing chronic conditions,

the nonagenarians had higher prevalence of dementia (p = 0.010),

heart failure (p = 0.011), chronic renal failure (p = 0.004), pressure

sores (p = 0.002) and dysphagia (p = 0.000). The incidence of delirium

was higher (p = 0.006). Nonagenarians had less prevalence of diabetes

(p < 0.001), chronic obstructive pulmonary disease (COPD) (p = 0.005)

and polypharmacy (p < 0.001). Regarding functional status, nonagen-

arians had worse previous Barthel index (p < 0.001).


In our sample, nonagenarians seem to have higher

comorbidity than younger older adults, except for diabetes and COPD,

more disability but lower polypharmacy. Returning to usual living

situation and readmissions at 30-days were comparable, despite

mortality was higher in the older group, probably increasing after

discharge. Further studies could investigate the reasons for reduced

polypharmacy and the transitions at discharge.


Continuous orthostatic hypotension and postprandial hypotension

are related to mortality

S.J. Moeskops, E.J. Roosendaal, J.H. Ruiter, T. Germans, T. van der Ploeg,

R.W.M.M. Jansen.

Northwest Clinics, Alkmaar, The Netherlands


In the elderly, orthostatic hypotension (OH) and

postprandial hypotension (PPH) are common causes of syncope.

Previous studies have suggested that OH and PPHmay be independent

predictors of mortality, however, very little is known about the

association between different patterns of OH and increased mortality.


315 patients were evaluated for classic OH (decrease of

blood pressure (BP) at 1 or 3 min in the upright position), continuous

OH (decrease in BP from 1 to 10 min), delayed OH (decline in BP after

3 min of standing) and postprandial hypotension (PPH). In 2016, all

medical records of patients were reviewed for mortality.


Mean age was 80 years (SD 6,6).16% had classical OH, 31% had

continuous OH, 7% had delayed OH and 54% had PPH. 11% of the

patients died and were significant more man (HR2.14, 95% CI 1.09

4.20, p = 0.03), with a higher Charlson index (HR 1.24, 95% CI 1.06


p = 0.00). Kaplan Meier analysis suggested an elevated mortality in

patients with continuous OH compared to classical OH (p = 0.07). Also,

an increased mortality in patients with PPH was demonstrated in

respect to those without (p = 0.04). Cox Regression showed a trend

between mortality and PPH adjusted for OH and diastolic dysfunction

(HR 2.00, 95% CI: 0.95

4.22, p = 0.07).


In these very old patients, continuous OH en PHH are

common and may be associated with increased mortality. In contrast

with the current guidelines, standing BP should be measured for 10

minutes to detect continuous OH.


Postprandial hypotension should always be evaluated in elderly

patients with unexplained falls and syncope

E.J. Roosendaal, S.J. Moeskops, J.H. Ruiter, T. Germans, T. van der Ploeg,

R.W.M.M. Jansen.

Northwest Clinics, Alkmaar, The Netherlands


Postprandial hypotension (PPH) is a common cause for

syncope and is associated with increased mortality. However, tests for

PPH is not included in the standard evaluation for unexplained falls or

syncope in older patients. Therefore, we evaluated PPH in older

patients with syncope and unexplained falls.


We evaluated 315 patients, aged 65 years or older for PPH

with a standardized meal test. Before and after the meal, blood

pressure (BP) was measured at 15, 30, 46, 60, 75 and 90 minutes.

PPH was defined as a drop of

20 mmHg systolic or

10 mmHg

diastolic BP after the meal.


The mean age was 80 years (SD 6.6). PPH was found in 54% of

all patients. Patients with unexplained falls had a significantly greater

BP drop at 60 and 75 min (p = 0.02) after the meal compared to the

group of patients with a syncope. Patients with PPH were significant

older (p = 0.001), used more frequent antihypertensive medications

(p = 0.001) including beta blockers (p = 0.05), and had more frequent

atrial fibrillation (p = 0.03) than thosewithout PPH. 57% of the patients

with PPH had also orthostatic hypotension (OH).


More than half of these very old patients with syncope

or unexplained falls had PPH. In addition, more than half of the patients

had both PPH and OH. Therefore, tests for PPH (i.e. meal tests or home

basedBPmeasurements) shouldbe a standardprocedure and shouldbe

incorporated in the guidelines for the evaluation of syncope and falls.


Different patterns of orthostatic hypotension in elderly patients

E.J. Roosendaal, S.J. Moeskops, J.H. Ruiter, T. Germans, T. van der Ploeg,

R.W.M.M. Jansen.

Northwest Clinics, Alkmaar, The Netherlands


Orthostatic hypotension (OH) is a common cause for

syncope in the elderly. Delayed OH, defined as a slow progressive

decreasing blood pressure (BP) after 3 min of erect posture, is more

common in the elderly than previously thought. To achieve a 3-min

orthostatic BP measurement recommended by current guidelines,

delayed OH would be missed. Therefore, we evaluated the prevalence

of different patterns of OH in older patients during a 10 minute

standing test.


We evaluated 315 patients of age

65 years with

unexplained falls or syncope for OH by standing BP measurements

for 10 minutes. Classic OH was defined as a decrease in systolic BP of

20 mmHg or

10 mmHg diastolic BP within 3 minutes of standing.

Delayed OH as a decrease in BP after 3 minutes of standing.


The mean age was 80 years (SD 6,6). 46% of the patients had

no OH. 16% had classical OH and 7% delayed OH. Interestingly, 31%

had OH after 1 min and remained low till 10 min, which we called

continuous OH. Patients with a syncope had a greater BP drop

compared to patients with unexplained falls (p = 0.01).


In these very old patients, there are different patterns of

OH. When standing BP is measured for only 3 min, the continuous and

delayed OH will be missed. More research is needed because

continuous OH might be associated with mortality.


Influence of comorbidity measured by Charlson index in elderly

patients who have an acute coronary syndrome

Molina Borao Isabel, Urmeneta Ulloa Javier, Sanchez Insa Esther, Lasala

Alastuey María, López Perales Carlos, Juez Jimenez Angela,

Auquilla Clavijo Pablo, Pérez Guerrero Ainhoa, Porres Aspiroz Juan

Carlos, Calvo Cebollero Isabel.

U.H. Miguel Servet


Comorbidity is a determining factor in patients with

ACS who influence the prognosis, the therapeutic management and

quality of life, with worse consequences in older people. The Charlson

index (Ch) is the most accepted method to quantify the comorbidity.

Our objective was to study the role of the iCh on the therapeutic

approach and the quality of life (QL) of these patients.


We followed consecutive patients aged

80 years hospita-

lized with ACS during 2013

2015. Among them, we divided into 2

groups (Chi < 5) and B (Chi > 5) analyzing survival and quality of

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