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implemented after 2 months. Advices to consult a physiotherapist,
to use a walking aid, behavioral or environmental modifications
were applied in 66.7%, 37.5%, 44.4% and 6.3% of patients respectively.
Patients disregarded the advices mostly for financial reasons or
because they considered the advices not helpful or unnecessary.
Vitamin D supplementation was deemed necessary in 88.9% during
the falls clinic consultation; 81.3% complied after 2 months.
Only 40% of patients followed the advice to reduce their fall risk
medication. Additional medical examinations were cancelled by
21.4% of patients mainly because of transport problems.
Conclusions:
Adherence of older persons to fall prevention advices
needs to be improved to reduce the risk of falling. Falls clinics
should prioritize and limit the advices and search solutions to
reduce compliance barriers.
P-385
Implementation of pain assessment tool changes nurses
attitudes towards pain management in nursing homes
U. Stering
1
, M. Schreier
2
, S. Pitzer
1
, B. Iglseder
3
, J. Osterbrink
1
1
Paracelsus Medical University Salzburg, Salzburg, Austria;
2
Institute
of Nursing Science and Practice, Paracelsus Medical University
Salzburg, Salzburg, Austria;
3
Department of Geriatric Medicine,
Christian Doppler Clinic, Salzburg, Austria
Objectives:
A systematic pain assessment in nursing homes is
necessary to detect pain and identify details for adequate treatment
planning. Used instruments must be valid, reliable, practicable and
easily integrable into the nursing assessment process. Aim of this
presentation is to show study results and strategies for systematic
pain assessment in nursing practice.
Methods:
A non-experimental pre-post-study in 12 randomly
selected Austrian nursing homes operated by the same company
was conducted. Pain of cognitively intact and impaired residents
was assessed using standardized questionnaires and observations.
Results were used to select instruments for a computer assisted
pain assessment integrating screening and detailed assessment.
The implementation of this tool was evaluated including
nurses’ perspectives on pain management and assessment with
standardized questionnaires.
Results:
Pain assessment using different instruments is common,
but raises after intervention from 61% to 84%. Most nurses use
self-assessments for cognitively intact residents, but very few use
the observation technique in cognitively impaired residents. At
baseline 68% of nurses stated they do not use any observational
pain assessments and 50% of those using such tools could not
name any. After the intervention, 87% of nurses stated to use a
form of proxy pain assessment and 80% rated the changes in pain
assessment favourable.
Conclusions:
The nurses’ attitudes towards pain assessment can
be positively influenced by implementing a systematic tool as
long as nurses receive training, the tools are practical in their
usage and they can be easily integrated and adapted for resident
documentation.
P-386
Outpatient care of a Portuguese geriatric patient
R. Tourais Martins
1
, M.J. Alves
1
, E. Doutel Haghighi
1
, J. Barata
1
1
Hospital Vila Franca de Xira, Lisboa, Portugal
Introduction:
In Portugal we often still rely on hospitalization
to expedite the study of a given patient’s pathology. We don’t
always remember the implications that this decision brings to
their life. This has become increasingly important since, due to the
current political and social conjecture and the economic difficulties
experienced in recent years, many people lost their economic
independence, increasing the responsibility load of the remaining
family sustainers.
Goal:
The authors present the case of a male patient, 89
years old, with known history of arterial hypertension, diabetes
mellitus, ischaemic heart disease, benign prostatic hypertrophy
and vertiginous syndrome, referred to an Internal Medicine
consultation due to normocytic and normochromic anemia. The
patient complained of melenas. The previous study showed iron
deficiency, augmented uremia, and an inconclusive upper digestive
endoscopy and colonoscopy.
It was suggested to the patient to be hospitalized for stabilization
and study of gastrointestinal bleeding. He refused and preferred
an outpatient approach due to having many financial and family
responsibilities – spouse with dementia and unemployed son
with schizophrenia – depending on him. Endoscopic capsule
revealed intestinal angiodysplasia. He was referred to an
Immunohemotherapy consultation and treated with oral and
intravenous iron with consequent anemia correction.
Conclusion:
It is becoming clearer to every geriatric practitioner
that outpatient care, when possible, is a valid and preferable choice
to follow our elderly patients. In a country where Geriatrics is
still in development, we reached the same conclusion. The patient
suggested the best choice.
P-387
Integrated long term care models in low middle income
countries remote and rural areas
S.I. Tsartsara
South East Europe Healthcare, Brussels, Belgium
Objectives of the study:
To create an integrated care management
model for elderly care in rural and outermost areas in Greece. To
develop community based targeted care bundle in case/disease
management, community care and at home, rehabilitation and
assisted living services by Health Ecosystems and the creation of
spin-off structures for their autonomy at territorial level.
Methods used:
1. Creation of Health Ecosystems in mountainous and insular
regions with remote areas and elderly population for chronic
patients and elderly people advocacy.
2. Activation of Living Labs and technological clusters in Greece to
handle eHealth and mHealth provision organization and create
the marketplace for AAL solutions.
3. Community and State Agreements with the local private medical
service providers and social workers to offer pro-rata free
services to elderly population in remote areas in exchange with
state compensation measures and incentives
4. Impact investment in those areas to sustain the Health
Ecosystems
Results obtained:
One pilot Health Ecosystem created in the
Region of North Aegean and Dodecanese in Eastern Greece with
the participation of all related social care givers, health providers,
GP and nurses, private companies, PPP, hospitals and clinics and
resorts. A Living Lab is coordinating Assisted Living Solutions.
Impact investment platform was organized. Community based
social care established and marketplace for Assisted Living solutions
set
Conclusions:
The model in LMIC to provide long term community
based care is related to the administrative and organizational
capacity of the regions as well as to the ability of the local
stakeholders to handle change management and in furthering
innovation in RLA.