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Introduction:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
P-199
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
Introduction:
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.
Methods:
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.
Results:
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
–
1.46,
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).
Conclusion:
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.
P-200
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
Introduction:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
P-201
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
Introduction:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
P-202
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
Introduction:
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.
Methods:
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
–
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