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functional status at discharge and hospital mortality rate in patients
undergoing hip fracture.
Methods:
A cross-sectional study was performed, applying the four
Charlson
’
s indexes in 659 consecutive patients over 64 years admitted
with a fragility hip fracture from March 1st 2009 to November 30th
2012. Pearson
’
s correlation coefficient and comparison of medians
were used.
Results:
Mean age of patients was 85.03 (±7.03) years and 82.1% were
women. Acute average stay was 10.7 (±4.4) days and hospital mortality
was 2.7%. The association of Charlson
’
s indexes showed good Pearson
’
s
correlations among them, but weak correlations with length hospital
stay (0.186 to 0.219, p < 0.001) and with number of active medical
problems (0.400 to 0.517, p < 0.001). There were not statistical
differences among the scores in the different comorbidity indexes in
patients with good/poor functional status and hospital survival/
mortality.
Conclusions:
The four Charlson
’
s indexes did not provide additional
information in discriminating variations in the clinical parameters
analyzed in acute patients with hip fracture.
P-218
Overtreatment of type 2 diabetes in older people living in care
homes in the United Kingdom
N. Samarasekara, E. Dinsdale, A. Jain, M. Tang, S. Ninan.
Leeds Teaching
Hospitals Trust, United Kingdom
Introduction:
In the United Kingdom, fifty percent of older people
entering care homes die within fifteen months. For older people
with multiple co-morbidities and a short life expectancy, intensive
treatment of type 2 diabetes does not improve outcomes and may
cause harm with increased risk of mortality and hypoglycaemia.
National guidance recommends that HbA1c targets may be relaxed on
an individual basis for frail older patients but does not provide advice
on how to do so. American Diabetes Association (ADA) guidelines
provide a framework for HbA1c targets in older patients, depending on
frailty and co-morbidities.
Methods:
We reviewed the patient records of patients over 80
years old discharged after July 2015 and recorded co-morbidities,
most recent HbA1c level and current diabetes treatment. Based on
ADA guidelines, we used a definition of overtreatment as
“
HbA1c
<53 and on a hypoglycaemic
”
and
“
HbA1c 53
–
63 and either (i) three
or more co-morbidities OR (ii) dementia/falls/end of life and on
hypoglycaemic
”
.
Results:
In total 113 cases were reviewed. Based on ADA guidance, 38%
of patients were being over-treated for type 2 diabetes.
Key conclusions
A significant proportion of frail older people with
type 2 diabetes admitted from care homes in Leeds were over-treated,
increasing the risk of adverse events. Addressing this could lead to
benefits in terms of patient safety and hospital admissions.
P-219
A comparative study of bone health in Parkinson
’
s and non-
Parkinson
’
s patients presenting with fracture neck of femur
P. Shukla
1
, J. Hawkins
2
.
1
William Harvey Hospital,
2
William Harvey
Hospital, Ashford, UK
Introduction:
Patients with Parkinson
’
s disease (PD) have a sig-
nificantly increased risk of fracture, mainly of the hip. Many
studies have demonstrated that the bone mineral density (BMD) in
patients with Parkinson
’
s disease is lower compared with a non-
Parkinson
’
s disease (non-PD) patients. The causes for lower BMD in
PD are multifactorial. Some of these are modifiable either by physi-
cal exercise, dietary medication or pharmacological interventions.
Patients with PD do not get screened routinely for osteoporosis. Hence
they remain at increased risk of fracture, resulting in increased
morbidity and mortality.
The objective of this project was to study both groups (PD and non PD)
who presented with fracture neck of femur (NOF) and to identify
strategies to improve bone health in this group of patients.
Methods:
We conducted a retrospective comparative study of
fracture NOF in PD and non-PD patients who presented between
May 2013 and May 2015. 25 patients were randomly selected for both
groups.
We reviewed their records for previous falls, fractures and bone
health assessment. We also reviewed their old medical records to
check whether they had had any previous osteoporotic fracture or not.
If they had had any previous fractures, we looked at the adequacy of
assessment and treatment.
The results:
In an age matched analysis of the data between PD and
non-PD group, we demonstrated that 46% of PD patients had a
previous history of falls compared to 27% in non-PD. Of these, 82% in
PD and 64% in non-PD patients were mobilewith a Zimmer frame prior
to fracture NOF.
As expected, a significant proportion of PD patients were found to be
at increased risk of falls due to postural instability (54%) and postural
hypotension (36%) compared to non-PD (16% and 0% respectively).
Only 9% of patients with PD who had had previous falls had received
adequate bone health assessment compared to the non-PD group
(67%).
About 55% of PD patients had a previous osteoporotic fracture. Of
these 88% had osteoporosis and only 43% had received adequate bone
protection. Overall, 65% of PD and 16% of non-PD patients had
previously had an osteoporotic fracture.
64% of patients from each group were discharged to their primary
residence and 30% were sent for a period of rehabilitation.
Conclusion:
This study highlighted that patients with PD have a
higher risk of falls as well as osteoporosis. Combined together, this
poses a significant risk of fracture NOF. It was not clear from the study
why these patients were inadequately assessed and treated.
I propose that the patients with PD who are at risk of falls should have
an assessment with dual-energy x-ray absorptiometry (Dexa). And if
Dexa scan is suggestive of osteoporosis they should receive adequate
bone protection.
P-220
Characterization of elder in an infirmary
N. Silveira
1
, L. Pedro
1
, E. Campôa
1
, F. Azevedo
1
, R. Pinho
1
,
V. Machado
1
, L. Cabezuelo
1
, M. Grade
1
, D. Faria
1
, L. Arez
1
.
1
Department of Medicine 4, Algarve Hospital Center
–
Portimão
Hospital Unit, Portimão, Portugal
Objective:
World population ageing is becoming more and more
a global theme in discussion. The characterization and comprehen-
sion of elderly and their specifications will allow to create stra-
tegies adapted to the geriatric population with more quality of life.
This study aims to characterize an elder population that needed
hospitalization.
Methods:
We selected all patients admitted in our Department of
Medicine between 2010 and 2015. Data was obtained through an
Institutional record named Assistential Quality Nucleus Studies
(NESQA). Statistical analysis was calculated with SPSS 23.
Results:
Of the total sample of 15,441 admitted patients we verified
12,129 were aged equal or higher than 65 years (mean 80.9 and
standard deviation 7.8 years), from which 50.6% were male. The vast
majority of admissions was from the emergency room (82.6%) and
presented with important Charlson Comorbidity Index (median score
of 5, 21.8% presented with a score of 4). Death rate in this subgroup was
of 16.5%.
Conclusion:
Our elder population has a high mortality rate estimated
by Charlson Comorbidity Index (85% for a score higher than 5 points,
52% for a score of 4). These studies applied to the older population are
important in order to create better long term care units specialized in
geriatrics allowing this population to keep an active role in society
with quality of life.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S86