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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S105
Conclusion:
Patients with cognitive impairment, a Low BMI and
a high MUST are less likely to show an impovement in Barthel
Score with Rehabilitation when compared to cognitively impaired
patients with a low MUST or BMI≥20 kg/m
2
. Nutrition may be a
reversible risk factor to improve rehabilitation outcomes in this
group of patients.
P-274
Should patients with severe cognitive impairment be offered
rehabilitation after acute illness?
I. Cardoso
1
, L. Poynter
1
, J. Kwan
2
, J. Sharma
3
, S. Allen
1
, M. Vassallo
1
1
The Royal Bournemouth Hospital, Bournemouth, United Kingdom;
2
University of Hong Kong, Hong Kong, Hong Kong;
3
United
Lincolnshire Hospital NHS Trust, Lincoln, United Kingdom
Objectives:
To evaluate the outcomes of rehabilitation in patients
with moderate to severe cognitive impairment and clarify whether
such patients benefit from rehabilitation.
Methods:
We performed a prospective cohort study of 116
patients (70F), mean age 86.3 (SD 6.4) in a rehabilitation unit
for older people in the UK. Group 1: 89 patients with moderate
cognitive impairment (MMSE 11–20) and Group 2: 27 patients
with severe cognitive impairment (MMSE 0–10). Each patient had a
personalised rehabilitation plan dependent on the patients’ abilities
with formal input from physiotherapists, physiotherapy assistants
and occupational therapists and informal therapy from nursing
staff. Barthel activity of daily living score (BS) was recorded on
admission and discharge as well as length of stay and discharge
destination.
Results:
Of the home discharges in Group 1, 32/37 (86.5%) patients
improved their BS compared to 10/28 (35.7%) of placement
discharges (p = 0.0001). In Group 2, 6/6 (100%) home discharges
showed an improvement compared to 3/7 (42.8%) patients
discharged to placement (p = 0.07). In both groups a discharge home
required an improvement in at least three Barthel domains (BD). In
Group 1 a discharge home was associated with significant different
improvement in BDs than a placement discharge (3.27 v 1.86:
p = 0.007). A similar pattern was noted for severe dementia patients
(3.5 v 1.14; p = 0.1). Improvement in BDs can happen regardless of
the level of impairment on admission.
Conclusion:
Patients with moderate /severe dementia demon-
strated significant improvements in BS and BDs which translated
into home discharges.
P-275
Point prevalence of healthcare-associated infection and
antimicrobial use in a rehabilitation setting for older people
U. Clancy
1
, K. O’Connor
2
1
MUH, Cork, Ireland;
2
St Finbarrs Rehabilitation Hospital, Cork, Ireland
Introduction:
Healthcare-associated infection is a common
problem in acute hospital inpatients. The aims of this study were to
study nosocomial infection and antimicrobial use in a rehabilitation
unit for older people.
Methods:
All patients were studied in a geriatric rehabilitation
unit. The point prevalence of patients receiving a prescribed
antimicrobial was measured. There were no exclusion criteria.
Results:
Sixty-nine patients were studied. 59.42% were female;
40.58% were male. The mean age was 80 (SD=8.9 years).
Median length of stay at the time of the study was 23 days
(IQR 9–49). The point prevalence of rehabilitation inpatients
on antibiotics was 21.7%. 7.3% had a urinary tract infection
(n = 5). 5.8% (n = 4) had a lower respiratory tract infection. Other
antimicrobial indications documented in the patient notes included
Clostridium difficile
, colovesical fistula, epididymoorchitis, latent
TB and wound infection. Of those on antibiotics, 46.7% were on
coamoxiclav (n = 7), 13.3% were on metronidazole (n = 2) and 13.3%
were on trimethoprim (n = 2). All UTIs had confirmed laboratory
evidence. There were no statistically significant associations
between antibiotic use and length of stay, age or gender.
Conclusions:
Nosocomial infections can limit rehabilitation
potential. This study highlights the importance of vigilance
surrounding identification and diagnosis of infections in this group
of older patients.
P-276
How to enhance meaningful activities for nursing homes
residents: insights from focus groups with staff members
E. Cornelis
1
, R. Vanbosseghem
2
, V. De Smet
2
, E. Gorus
3
,
L. Van Malderen
3
, D. Van De Velde
2
1
Universitair Ziekenhuis Brussel, Jette, Belgium;
2
Artevelde University
College, Gent, Belgium;
3
Vrije Universiteit Brussel, Jette, Belgium
Objectives:
Meaningful activities of daily living (MADL) are
essential to promote the identity of nursing homes residents (NHR)
and seem to improve their quality of life and autonomy. Although
NH are expected to offer a range of activities, they don’t fulfil the
needs of residents and are often meaningless. This study explores
the insights of NH-staff to realize MADL.
Methods:
This qualitative study used eight semi-structured
multidisciplinary focus groups, including occupational therapists
(n = 21), nurse assistants (n = 20), recreational therapists (n = 20)
and NH managers (n = 5). All interviews were audiotaped and
coded line-by-line. Data were analysed open-minded, using content
comparison to determine the preconditions and influencing factors
of organizing MADL.
Results:
All participants agreed on the importance of MADL for
NHR. However, most MADL were organized spontaneously and
relied on the ‘gut feeling’ of the caregivers. To realize MADL,
it appeared crucial to know the life history, needs, wishes and
capacities of NHR. However, caregivers perceived this as time
consuming. Because MADL seemed to be a dynamic concept, which
was strongly related to the changing abilities of NHR, a consequent
and continuous monitoring of MADL was needed. Nevertheless
an achievable, well-structured approach to identify, realize and
monitor MADL was lacking. Remarkably, NHs didn’t have protocols
to enhance MADL, neither they used tools to evaluate and improve
MADL.
Conclusions:
MADL should be organised in a more structured and
transparent manner. This study indicates the need for a practical
guideline to enhance the realisation of MADL for NHR.
P-277
An exploratory study on the effects of mobility training in
chronic stroke patients using repeated fMRI
A. de Campo
1
, B. Landsmann
2
, D. Pinter
2
, G. Pichler
1
, E. Pirker
2
,
W.M. Schippinger
3
, T. Gattringer
2
, F. Fazekas
2
, C. Enzinger
2
1
Geriatric Health Centers Graz, Graz, Austria;
2
Medical University of
Graz, Graz, Austria;
3
Austria
Objectives:
Previous studies demonstrated changes in sensorimotor
network activations after stroke that have been interpreted as
partly compensatory. Locomotor and balance trainings may improve
mobility and cognition and normalize and increase cerebral
activations. We aimed to test these assumptions in an exploratory
study to inform subsequent intervention studies.
Methods:
In the intervention group eight participants
(73.3
±
4.4 yrs) with chronic lacunar ischemic stroke (mean interval
3.7 years after the event) and residual gait disturbance received
guided five week training focussing on mobility, endurance and
coordination. Before and after this intervention, they underwent
clinical, neuropsychological and gait assessments and brain MRI
including a functional ankle movement paradigm. Sixteen healthy
controls (68.8
±
5.4 yrs) followed the same assessment-protocol
without receiving guided training.