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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S103
Results:
Recovery was divided into 3 groups: (1) Rapid, able
to return home after median 14 days in IC (n = 785, 82%);
(2) Slow, requiring additional transfer to other nursing home after
IC, but still able to return home within 2 months (n = 106, 11%).
(3) Poor, requiring transfer to other nursing home after IC and still
in a nursing home or dead at 2 months (n = 66, 7%). After 6 months,
the recovery and mortality of patients with rapid or slow recovery
was rather similar, 87% were living at home, 9 and 8% were dead.
In patients with poor recovery, only 20% were living at home and
41% were dead.
Conclusions:
Although the majority of patients selected for
treatment in the IC unit were able to recover and return home,
a group of patients needed extra time, up to 2 months, to recover,
and another group had a poor chance of recovering and returning
home.
P-267
Results of specialized geriatric fall clinic intervention for older
patients with orthostatic intolerance
H.E. Andersen
1
, K. Storm Piper
2
, M. Kirchhoff
3
, N. Florescu
3
, P. Dyhr
Hansen
1
1
University Hospital Hvidovre, Glostrup, Glostrup, Denmark;
2
University Hospital Glostrup, Glostrup, Denmark;
3
University
Hospital Gentofte, Hellerup, Denmark
Introduction:
Geriatric fall clinics are well established in Denmark.
Work-up and treatment for conditions as orthostatic intolerance
and vestibular dysfunction requires special equipment and
experience. To deal with this challenge a new approach in terms of
specialized fall clinics was made.
Objective:
Evaluation of the specialized fall clinic intervention.
Method:
Elderly fall patients with symptoms suggesting
orthostatic intolerance and/or vestibular dysfunction were referred
to the specialized fall clinics. Assessment for orthostatic
intolerance included tilt-table-test with carotid-sinus-massage
and measurement of dizziness and functional ability with
Dizziness-Handicap-Inventory (DHI), Dynamic-Gait-Index (DGI)
and 30-second-Chair-Stand (CS). Individualized interventions i.e.
counselling, physical counter pressure manoeuvres, medication
adjustment, fludrocortisone, physical training and patient education
were offered. Effect was evaluated after the training period and 3
months after.
Results:
155 patients were referred (74% females, mean age 78
years) October 2013 to December 2014. Symptoms: dizziness (92%),
falls (65%) and syncope (26%). 55 patients were diagnosed with
orthostatic intolerance (OI): 31 (56%) orthostatic hypotension at
active standing, 28 (51%) orthostatic hypotension at passive tilt and
5 (9%) reflex syncope. 26 patients with OI were also diagnosed
with vestibular dysfunction. 44 patients with OI received physical
training. A significant improvement was found in dizziness (DHI
p
<
0.011) and functional ability (DGI p
<
0.000; CS p
<
0.001). 23 OI
patients reported syncope at referral, only 3 at follow-up
Conclusions:
Specialized geriatric work-up and intervention for
elderly fall patients with dizziness and syncope due to orthostatic
intolerance, for some combined with other risk factors i.e. vestibular
dysfunction, seems to be an effective approach.
P-268
Geriatric fall clinic interventions improve functional ability
in old patients with vestibular dysfunction
H.E. Andersen
1
, M. Kirchhoff
2
, N. Florescu
2
, K. Storm Piper
3
, P. Dyhr
Hansen
1
1
University Hospital Hvidovre, Glostrup, Glostrup, Denmark;
2
University Hospital Gentofte, Hellerup, Denmark;
3
University Hospital
Glostrup, Glostrup, Denmark
Introduction:
Geriatric fall clinics are well established in Denmark.
Work-up and treatment for conditions as vestibular dysfunction and
orthostatic intolerance requires special equipment and experience.
To deal with this challenge a new approach in terms of specialized
fall clinics was made.
Method:
Elderly fall patients with symptoms suggesting vestibular
dysfunction or orthostatic intolerance were referred to two
specialized fall clinics in Copenhagen. Assessment included
videonystagmography, caloric testing, tilttabel test, measurement of
dizziness and functional ability with Dizziness Handicap Inventory
(DHI), Dynamic Gait Index (DGI) and 30 second Chair Stand (CS).
Individualized interventions i.e. repositioning manoeuvres, physical
training, medication review and patient education were offered.
Effect was evaluated at the end of the training period and 3 months
after.
Results:
155 patients were referred (74% females, mean age 78
years) October 2013 to December 2014. Symptoms were dizziness
(92%), falls (65%) and syncope (26%).
Vestibular dysfunction was diagnosed in 108 (70%) patients
(24% Benign Paroxysmal Positional Vertigo, 30% peripheral
vestibular asymmetry, 24% other peripheral dysfunction, 37%
central vestibular dysfunction with MR signs of infarction or white
matter lesions). 26 patients with vestibular dysfunction were also
diagnosed with orthostatic intolerance. 85 patients with vestibular
dysfunction received physical training in the fall clinics.
A significant improvement was found in dizziness (DHI p
<
0.000)
and functional ability (DGI p
<
0.000; CS p
<
0.002).
Conclusions:
Specialized geriatric work-up and intervention for
elderly fall patients with vestibular dysfunction, for some combined
with other risk factors i.e. orthostatic intolerance, seems to be an
effective approach.
P-269
The complexity of elderly fall patients
–
results from a geriatric
fall clinic
H.E. Andersen
1
, M. Glud Christensen
2
, K. Storm Piper
3
1
University Hospital Hvidovre, Glostrup, Glostrup, Denmark;
2
Universitu Hospital Hvidovre, Glostrup, glostrup, Denmark;
3
University Hospital Glostrup, Glostrup, Denmark
Introduction:
Multifactorial fall assessment and intervention has
been found effective in preventing fall in elderly people. We present
data from a Danish fall clinic.
Method:
Fall patients referred underwent a standardized
multidisciplinary quantitative assessment program: vision,
sensibility, orthostatic blood pressure, cognitive and emotional
function, nutritional status, medicine use and functional ability
measured by 30-second-Chair-Stand (CS), Bergs-Balance-Scale
(BBS), and Dynamic-Gait-Index (DGI). Patients with symptoms of
vestibular dysfunction were examined with videonystagmography.
Individualized interventions were made and physical training was
offered. Assessment at the end of the training period was done.
Results:
133 patients were referred throughout 2014, 61% women,
mean age 78. Risk factors identified: 84 (65%) had vision
impairment, 75 (58%)reduced sensibility, 21 (16%) vestibular
dysfunction, 35 (27%) orthostatic intolerance, 45 (34%) use of
psychotropic medicine, 19 (15%) cognitive dysfunction, 32 (25%)
emotional dysfunction, 17 (13%) malnutrition, 31(23%) vitamin D
deficiency, 16 (12%) cardiac arrhythmia at event recording, 82 (64%)
impaired muscle strength by CS, 62 (53%)impaired balance by BBS
and 75 (58%)by DGI. Most patients had several risk factors.
107 (80%) patients received physical training: 39 patients in the
community, and 68 in the fall clinic (twice a week; mean number
of training sessions: 13.5). At the end of training a significant
improvement was found in strength (CS p
<
0.001) and in balance
(BBS p
<
0.001; DGI p
<
0.000).
Conclusion:
Geriatric fall clinic assessment is feasible and identifies
multiple risk factors in elderly fall patients. Physical training
improves functional ability.