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

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Objectives: To identify which factors are related with a clinically
relevant improvement of QoL in patients that completed an interven-
tional program in a GDH.
Methods: Prospective observational study including all patients
admitted and discharged between January 2007 and December 2011.
We excluded patients with MMST < 10, aphasia or poor collaboration.
We evaluated at admission and discharge: QoL using the Notthigham
Health Profile (NHP) (range: 0 – indicating better QoL- to 100), socio-
demographic variables (age, sex, referral source, living arrangements),
functional and mental variables (Barthel, Lawton, TimedUP&Go,
Tinetti, MMST, Yesavage), and other variables (main diagnosis,
number of medications, number of sessions, geriatric syndromes,
Charlson). Moderate improvement of QoL was defined as a decrease in
the NHP score at discharge implying an effect size ≥0.5. Bivariate
analysis was performed.
Results: We included 331 patients. However, the final study sample
consisted of 246 patients because for 85 patients the NHP register
at discharge was missing. QoL Improvement was identified in 82
patients. Factors associated with improvement were: female sex
(68.3% vs 54.3%, p = 0.035), higher NHP total scores at admission
(45.7 ± 19.7 vs 30.7 ± 19.7, p < 0.000) and higher individual dimensions
scores at admission (energy: 47.9 ± 33.9 vs 28.6 ± 31.3, p < 0.000; sleep:
51.9 ± 32.1 vs 30.9 ± 31.6, p < 0.00; social isolation 32.3 ± 22.0 vs 17.8 ±
21.1, p < 0.000; pain: 42.8 ± 32.3 vs 28.8 ± 27.9, p < 0.001; physical
mobility 55.4 ± 29.4 vs 47.5 ± 29.5, p = 0.048; emotional reactions 43.7
± 28.5 vs 30.7 ± 26.4, p = 0.001).
Conclusions: Female sex and having a worse perception of QoL at
admission was related with a clinically relevant improvement in QoL
after an interventional program in a GDH.
P-244
Perception of quality of life (QoL) according to the Nottingham
Health Profile (NHP): factors influencing the final score after an
interventional program in a geriatric day hospital (GDH)
E. de Jaime 1, S. Burcet1, O. Vazquez1, R. Miralles1, M.L. Rodriguez1,
E. Sevilla 1, M.C. Delgado1, S. Mojal2, A. Renom-Guiteras1. 1Geriatric
Service Centre Fòrum del Parc Salut Mar, 2Insitut Municipal
d ’Investigacions Médiques, Barcelona, Spain
Objectives: To identify which factors at admission to an interventional
program in a GDH influence the final score of a QoL questionnaire.
Methods: Prospective observational study including all patients
admitted and discharged between January 2007 and December 2011.
We excluded patients with MMST <10, aphasia or poor collaboration.
We evaluated at admission and discharge: QoL using the Notthigham
Health Profile (NHP) (range: 0 ¨C indicating better QoL- to 100), socio-
demographic variables (age, sex, referral source, living arrangements),
functional and mental variables (Barthel, Lawton, TimedUP&Go,
Tinetti, MMST, Yesavage), and other variables (main diagnosis, number
of medications, number of sessions, geriatric syndromes, Charlson). A
multiple linear regression analysis was performed considering as
dependent variable the NHP score at discharge.
Results: Out of 369 patients, 38 (10.2%) were excluded and in 85
(25.6%) NHP was not register at the time of discharge, remaining 246
for study. In the multiple linear regression analysis the following
factors at admission were associated with a higher final NHP score (R2
0.537, p < 0.000): higher NHP score (¦Â = 0.642), lower functional
status according to the Barthel Index (¦Â = -0.102) and higher number
of medications prescribed (¦Â = 0.110).
Conclusions: Lower perception of QoL, lower functional status and
higher number of medications prescribed at admission to a GDH may
influence the final QoL score after the interventional program. Further
studies should confirm these results.
P-245
Structure, process and outcome indicators for the evaluation of
in-hospital geriatric co-management programmes: an
international two-round Delphi study
M. Deschodt1,2,3, B. Van Grootven1, L. McNicoll 4, D. Mendelson5,
S. Friedman5, K. Fagard2, K. Milisen1,2, J. Flamaing2. 1Department of
Public Health and Primary Care, KU Leuven University of Leuven,
2Department of Geriatrics, University Hospitals Leuven, Belgium;
3Department of Public Health, University of Basel, Switzerland;
4Department of Internal Medicine, Brown University, Providence, RI,
5Department of Medicine, University of Rochester, Rochester, NY, USA
Objectives: We aimed to find consensus on appropriate and feasible
structure, process and outcome indicators for the evaluation of in-
hospital geriatric co-management programmes.
Methods: A systematic literature search was conducted to draft a
preliminary list of quality indicators. Two investigators experienced
in geriatric care independently scored all indicators as “relevant”,
“relevant after rephrasing” or “not relevant” for inclusion in the Delphi
questionnaire. A consensus meeting decided the final inclusion of
indicators. The questionnaire was pilot-tested by two geriatric care
professionals who did not participate in the Delphi study. Thirty-
three people with at least two years of clinical experience in geriatric
co-management were invited to rate the indicators on a scale from 1
to 9 for their (a) appropriateness and (b) feasibility to use for the
evaluation of a geriatric co-management programme. Consensus
was determined over two iterative rounds using the RAND/UCLA
Appropriateness Methodology.
Results: Twenty-eight experts (16 from the USA and 12 from Europe)
participated in both Delphi rounds (85% response rate). After round
one, consensus was observed on fourteen indicators. After round two,
consensus was observed on 31 indicators considered both appropriate
and feasible. Eight relate to structure indicators (e.g. use of geriatric
order sets, implementing a geriatrics education program), seven to
process indicators (e.g. organizing daily patient rounds and meetings
with nurses), and sixteen to outcome indicators (e.g. length of stay and
readmission rate).
Conclusions: The final indicator set supports the implementation
and evaluation of geriatric co-management scientific studies and
programme development.
P-246
The effectiveness of in-hospital geriatric co-management
programs: a systematic review and meta-analysis
B. Van Grootven1, K. Milisen1,2, J. Flamaing1,2, M. Deschodt1,2,3.
1Department of Public Health and Primary Care, KU Leuven University of
Leuven, 2Department of Geriatrics, University Hospitals Leuven, Belgium;
3Department of Public Health, University of Basel, Switzerland
Objectives: Geriatric co-management programs are emerging as a
promising strategy to manage frail elderly on non-geriatric units. We
aimed to determine the effectiveness of in-hospital geriatric co-
management on functional status, length of stay, mortality, readmis-
sion rate, complications or the number of patients discharged home up
to one year follow-up.
Methods: Databases MEDLINE, EMBASE, CINAHL and CENTRAL were
searched from inception to 6 May 2016. Reference lists, trial registers
and PubMed Central Citations were additionally searched. (Quasi-)
Experimental studies published in English, Dutch, German, French or
Spanish were included if they included patients aged 65 years or old
and reported the effect of an in-hospital geriatric co-management
intervention. Study selection, data extraction and assessment of risk of
bias was performed independently by two authors. Data were pooled
in a fixed-effects meta-analysis where appropriate.
Results: Twelve studies and 3,590 patients were included. Geriatric co-
management improved functional status and reduced the number of
patients with complications in 3 of 4 studies. Co-management reduced
length of stay (MD,−1.88 [95% CI, −2.44 to −1.33]), but had no effect on
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S93