European Geriatric Medicine - Supplement 1 - Volume 6

Poster presentations / European Geriatric Medicine 6S1 (2015) S32

–

S156

S115

P-313

Bedsores and osteitis in the elderly: how the infectious

complications and malnutrition affect prognosis, about a case

A. Martin-Kleisch

, A.-A. Zulfiqar

, J.-L. Novella

CHU Reims, Reims, France;

France

Objectives:

Bedsores are a major problem in geriatrics; the causes

are multiple and major consequences without a real prevention

policy.

Methods:

We illustrate this problem by a clinical case.

Results:

A lady of 89 years was referred for a fever lasting for several

days. She was followed for insulin-requiring diabetes, dyslipidemia

and mixed dementia, severe stage. The skin examination revealed

a stage IV pressure ulcer with bone contact by a stylus,

next to the sacral spine, accompanied by substantial purulent

discharge; This in a patient at the limit of cachexia, with

atrophy of the members. We realized laboratory tests revealing

an important inflammatory syndrome with a CRP to 136mg/L

(normal

10mg/l). Albumin was 26 g/L (normal

35 g/l). We did

not find abnormalities in blood counts except anemia 9.8 g / dL

in this biological inflammatory context. The infectious samples

were multiple. The urine culture showed an urinary infection by

Enterococcus faecalis. Samples at the ulcer showed the presence

of Enterococcus faecalis. The blood cultures were also positive at

the same germ. However, this bacterium was resistant to beta-

lactamins, macrolides and fluoroquinolones. Due to bone contact

with bacteremia, a basin scanner was performed, confirming a

sacred osteitis. We introduced antibiotics to bone penetration,

wide spectrum, which were glycopeptides, aminoglycosides and

rifampicyne. Due to a significant weakness, the patient died despite

the treatment instituted.

Conclusion:

Pressure ulcers exposed to infectious complications;

malnutrition is an aggravating factor to be fought inevitably.

P-314

Effective implementation of Herpes Zoster Vaccination (HSV)

programme among elderly

H. Al Hamad

, N. Nadukkandiyil

, E. Al Sulaiti

Hamad Medical Corporation, Doha, Qatar

Objective:

To improve the vaccination rates and documentation of

Herpes Zoster Vaccination (HSV) from zero % to 80% of geriatric in

and out patient by the end of March 2015 and 100% by end of June

2015 and to assess the effectiveness of programme by December

2015.

Methods:

Introduced HSV, in addition to existing adult vaccines

like pneumococcal and influenza vaccines. Staff education by

hand out and presentation about Zoster vaccinations indication,

contraindications, route of administration and implementation of

adult vaccine card. Data extraction from patient files to determine

baseline adult vaccination and documentation rates.

– Family meeting for consent and making vaccination a regular

practice for newly admitted patients who above 60 years

– Giving vaccines to unvaccinated patients with age above 60 years

– New registry for Zoster vaccination in geriatric setting and

prepare an addendum to antimicrobial policy as vaccination

programme for preventable infectious disease.

Results:

Vaccination programmme achieved highest rates by 4

months from Dec 2014 to March 2015 and it exceeded the goal

of 80% for in patients and out patients.

Conclusions:

– A follow up every month revealed a further improvement in rate

of vaccination among geriatric in patients and out patients in

Rumailah hospital.

– Health education and adult vaccination advocacy helped to

implement HSV vaccination in outpatient clinic.

– Implementing new documentation system for adult vaccination

card increased the vaccination rate to optimum level.

– Patients and families are willing to take vaccine once education

is provided in detail about complication of Herpes Zoster

infections.

P-315

Development and validation of attitudes towards vaccinations

T. Ocetkiewicz

, K. Szczerbinska

, P. Brzyski

, A. Prokop

Chair of Epidemiology and Preventive Medicine, Jagiellonian

University Medical College, Krakow, Poland;

Epidemiology and

Preventive Medicine Chair, Jagiellonian University Medical College,

Krak´ow, Poland;

Epidemiology and Preventive Medicine Chair,

Jagiellonian University Medical College, Krak´ow

Objectives:

The aim of the study was to develop and validate the

scale measuring positive and negative attitudes toward vaccinations

among older people aged 60 and more in Poland. Vaccination rates

and general knowledge about vaccination in this group are low

despite of higher risk of serious effects of communicable diseases

among older people.

Methods:

Correlation matrix was analyzed for both development

and validation stages separately. Factor structure of the scale was

assessed using Principal Component Analysis (PCA). Assuming that

personality and habitual traits and individual beliefs play significant

role in shaping particular attitudes, we compared scores of ATVS’s

subscales with the measurements of the following variables:

anxiety, copying with stress, self-efficacy, and health behaviours.

Results:

The scores of the positive subscale of ATVS correlated

positively with all subscales of Health-related Behaviours Inventory,

the most strongly with positive attitudes and proper nutrition

habits, as well as with self-rated health, and self-assessment of

risk of catching influenza or pneumonia. Some significant negative

correlations exist between the negative subscale of ATVS, and

both generalized self-efficacy and internalized locus of control.

Moreover, the negative subscale of negative attitudes correlates

negatively with self-rated health and self-assessment of risk of

catching influenza.

Conclusions:

The results support the assumption that the positive

attitude toward vaccinations correlates with pro-health behaviours:

the strongest is for positive attitude and proper nutrition habits.

P-316

The hidden abscess

S. Ponnambath

, M. Qadiri

Royal United Hospital, NHS, Bath, United Kingdom;

Yeovil District

Hospital, Yeovil, United Kingdom

Case report:

82-year-old man presented with shortness of breath

and fever. He denied abdominal pain. Past history included atrial

fibrillation on warfarin, hypertension, ischaemic heart disease, heart

failure, and recurrent urinary tract infection. On examination his

temperature was 38.9 degree celcius, O2 saturations 95% on 9L

oxygen, bronchial breathing at left base. Nil else significant on

examination. He was commenced on intravenous antibiotics for

bronchopneumonia. Chest xray showed possible consolidation left

lower zone. Bloods results showed raised infection markers, INR 3.1

and deranged liver functions. As he continued to spike temperature,

an ultrasound scan of abdomen was requested which showed

renal stone in right kidney and possible splenic abscess. This was

confirmed on a CT scan of abdomen. He was reviewed by the

surgeons who felt operating on him carries a very high mortality

risk in view of his medical background. The other option was to

consider CT guided abscess aspiration or drainage. Echocardiogram

was normal. Clinically it was felt that option of palliation should

also be considered. CT guided intervention was discussed with the

radiologist and patient and offensive pus was aspirated. He made

good recovery and was discharged home.

Conclusion:

We should keep an open mind when someone is

admitted with sepsis. The source of infection is not always chest or