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

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life according to the performed treatment (strategy invasive (SI) vs
conservative (SC)). The QL was analyzed with the 5D EuroQol scale
and its value index EQ-5D-5L by telephone survey in a follow up to
24.8 ± 5.7 months. Multivariate statistical analysis with SPSS version
18 stadistics.
Results: Expected more catheterization in that group Awas indicated
(82.2% low iCh vs 52.2% high Chi). Patients with conservative
management in Group A had older at admission (86.0 ± 5 SC vs
83.3 ± 4 SI; p = 0, 047) and increased renal dysfunction (CKD > 3 87.5%
SC vs. 62.2% SI; p = 0, 027) than those who performed coronary
angiography. In this group with low Chi, SI improved survival
significantly (p = 0.027) and also the QL (p = 0, 024). In Group B
(high Chi) decision to adopt an invasive attitude was related to higher
degree of independence (92.4% SI vs 49.2% SC; <0.001), fewer heart
failure (29.5% SI vs 40.8% SC; =0, 025) and improved renal function
income (56.8% CKD ≥ 3 SI vs 79% CKD ≥ 3 SC; p = 0, 002). However
in patients with high Chi there were no differences in survival to
adopt a SI or SC strategy. There are differences in this group in the QL
depending on the therapeutic management.
Conclusion: In our series, the Chi proved to be useful to select those
patients with low comorbidity that can benefit from an invasive
operation, improving both their survival and quality of life.
P-203
Thyroid function tests in elderly acutely ill inpatients – one year
retrospective study
R. Moreira da Cruz, A. Martins, M. Aveiro, M. Cruz, F. Sousa, F. Ribeiro,
G. Jesus. Baixo Vouga Hospital Center, Aveiro, Portugal
Introduction: The elderly are considered high risk population for
thyroid dysfunction. Thyroid function tests should not be routinely
undertaken unless the patient is considered high risk. In the acutely ill
patients thyroid functions tests are known to be altered and should not
be routinely performed.
Material and methods: Retrospective study with review of data of
elderly patients admitted in the Internal Medicine ward in 2015, with
the diagnosis of thyroid dysfunction. The goal was characterize the
thyroid dysfunction in the elderly and understand why thyroid tests
were performed.
Results: The study had 153 patients (67.3% feminine). 30 patients had
Hyperthyroidism and 132 hypothyroidism. Both groups had a median
age of 81 years. The diagnosis was unknown in 28.1% of patients. In the
hyperthiroidism group the most frequent motives to suspect dysfunc-
tion were known thyroid pathology (76.7%), heart failure (35.3%),
tachyarrhythmia (36%), medications (26.7%). In the hypothyroidism
group most prevalent motives were known thyroid pathology (57%),
heart failure (49.5%), dyslipidemia (42.2%), medications (21.9%),
oedema (21.1%), hyponatremia (17,4%), obesity (19.5%), rabdomyolisis
(11.4%), bradyarrithmia (13.8%). Mortality in the patients was 11.8%.
(6.7% of the patients in the Hyperthyroidism group and 13% in the
Hypothyroidism group).
Conclusions: There are no defined criteria onwhen to ask thyroid tests
in inpatients, although is well known that these can be affected in acute
illness and so they should only be evaluated only when dysfunction is
suspected. In our study the main reason for this evaluation was prior
thyroid pathology, heart failure, dyslipidemia and medications.
P-204
Indication and outcome of tilt table testing in older adults
N. Nordin 1, D. Tiwari2, M. Vassallo2. 1Geriatric Unit, Medical
Department, Hospital Sungai Buloh, Malaysia; 2Medicine for Elderly
Department (MFE), Royal Bournemouth and Christchurch Hospital,
United Kingdom
Introduction: Head up tilt (HUT) table testing is awidely accepted tool
in the clinical evaluation of patients with syncope. It is also useful in
assessing older patients with recurrent unexplained falls.
Methodology: Retrospective review of case notes, the indications,
appropriateness, outcomes and safety of HUT test, as well as evaluated
outcomes in patients ≥80 years compared to <80 years old. Cases were
analyzed using SPSS version 20.
Results: 93 patients were recruited over 2 years. The mean age was 72
years, [40 (43%) ≥ 80 years]. The majority of referrals came from
geriatric medicine. Light headedness was the commonest indication
for HUT in those ≥80 years (p < 0.014; OR: 0.35(0.125–1.008)).
Unexplained falls were also higher in this group,16/24 vs 7/46
[p < 0.003; OR 0.228(0.083–0.631)]. Blackouts/collapses were com-
moner in those <80 years [33/53(62.3%) vs 12/23(42.4%) p < 0.058; OR:
2.32(0.96–5.16)]. There was a significantly higher number of vasovagal
syncope confirmed by HUT in the <80 group, [29/31(93.5%) vs 13/19
(68.4%) p < 0.019; OR: 6.69(1.188– 37.7)]. Only 2 cases were diagnosed
with postural orthostatic tachycardia syndrome (POTS). 7/12 (58.3%)
of those age ≥80 with unexplained falls showed a positive HUT test
[P < 0.007, OR: 0.118(0.021–0.653)]. There was no association between
medications and outcomes. 91(97.8%) had no complications during
the test. Seizure (2/93) was the commonest complication during the
procedure.
Conclusion: In patients ≥80 years, unexplained falls is a strong
predictor for a positive Tilt Test. This finding adds to other studies
identifying unexplained syncope as an indication for the test. HUT is a
relatively safe procedure, and it should be reserved for relevant cases.
P-205
Prevalence of adrenal insufficiency in elderly medical admissions
in Hospital Sungai Buloh
I. Adam1, S. Shanmugam 1, N. Nordin2. 1Department of Medicine,
Hospital Sungai Buloh, 2Geriatric Unit, Department of Medicine, Hospital
Sungai Buloh, Malaysia
Introduction: Adrenal insufficiency (AI) is a life threatening disorder.
Primary AI is uncommon in elderly person. Most cases results from
rapid withdrawal if glucocorticoids from chronic administration,
hence the term tertiary AI.
Objectives: To study the prevalence and factors associated with
adrenal insufficiency among medical admissions in Hospital Sungai
Buloh.
Methods: The characteristics of patients were retrospectively analyzed
via datasets from electronic medical records.
Results: A total of 110 patients (63.6% male, 36.4% were aged 60 and
above) were recruited in the study. 25/46 (62.5%) of those aged >60
were diagnosed with Tertiary AI, p < 0.001 (OR: 0.275 (0.113–0.583).
There were no associations between age and primary or secondary AI.
31/39 (77.5%) >60 years, whilst 55.6% below aged 60 had reported
fatigue as the main symptom; p < 0.022 OR; 0.365(0.152–0.880). There
were no significant associations reported with age for abdominal
pain, myalgia, loss of weight, and even dizziness. Also, there was no
association between signs of AI with age. Both Pneumonia (52.5%,
p < 0.003) and uncontrolled Diabetes (52.5%, p < 0.04) were the main
reason for admission among elderly diagnosed with AI. This was
followed by acute coronary syndrome, p < 0.002. Other associated
diseases were insignificant. Hyponatremia was related to Tertiary AI
(56% > 60, and 33.3% < 60, p < 0.05). 4/25 (16%) of the elderly with
Tertiary AI had eosinophilia, p < 0.010. Tertiary AI was also associated
with traditional medications (p < 0.000).
Conclusion: Tertiary AI is the commonest type of AI in elderly
population, and this was significantly associated with fatigue as
the presenting symptom. Traditional medication plays a role in the
prevalence of AI. The high morbidity rate validates the need to have a
high suspicion of index for diagnosis.
P-206
Mortality and comorbidity in an Internal Medicine ward
R. Osório, T. Salero, A. Florêncio, C. Mendonça, A. Lopes.
Medicina Interna 1, Unidade de Faro, Centro Hospitalar do Algarve,
Portugal
Objective: This study has the objective of characterize mortality in an
Internal Medicine ward. We did a retrospective study of patients
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S82