European Geriatric Medicine - Supplement 1 - Volume 6 - September 2015

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S150 Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
P-439
12 months impact of an Orthopaedic Early Supportive
Discharge (OSD) team in our hip fracture service
R. Lisk1, M. Krasuski1 , H. Watters1 , C. Parsons1 , K. Yeong1
1Ashford & St. Peter’s NHS Trust, Chertsey, United Kingdom
Objectives: NICE clinical guidelines says “Consider early supported
discharge as part of the Hip Fracture Programme, provided the
Hip Fracture Programme multidisciplinary team remains involved
and, the patient is medically stable and, has the mental ability
to participate in continued rehabilitation and, is able to transfer
and mobilise short distances and, has not yet achieved their full
rehabilitation potential.”
Methods: The OSD team is made up of a physiotherapist (band 7),
an occupational therapist (band 6), a nurse (band 6) and 2 therapy
assistants (band 3). The team working within the hip fracture unit
started reviewing patients on 1st March 2014 and has completed 12
months. There is a virtual board round led by the Orthogeriatrician.
Results: 12 months period, 178 patients (105 hip fractures) were
taken; 423 hip fractures presented. These patients are taken on
average 7 days post surgery. This has reduced our Trust Length of
Stay (LOS) for hip fracture patients from 21.5 days (March-Feb 2014)
to 18.2 days (March–Feb 2015) without a change in readmission
(7.89% to 7.57% respectively). Patients sent to the rehabilitation
hospital (part of the Trust) have reduced from 44.2% to 23.6%; hence
our Home to Home within 30 days has increased from 53.99% to
61.22%. Mortality remains unchanged 4.83% to 4.96%. 99.3% patients
said they were extremely likely/likely to recommend the service to
friends and family.
Conclusion: OSD should be part of all hip fracture service as it
reduces LOS and increases home to home discharge which leads to
significant savings.
P-440
Effectiveness of a specific multidimensional intervention
program in 509 hip fracture patients. Results at 3 and 6
months after discharge
R. Men ´endez1, T. Alarcon1, J.I. Gonz ´alez-Montalvo1, A. Otero1 ,
R. Queipo1, I. Mart´ın-Maestre 1, R. Velasco1
1Hospital Universitario La Paz, Madrid, Spain
Background: There are unknown factors affecting the outcome
of hip fracture (HF) patients. Among them five main factors are
Physical Function, Bone Health, Nutrition, Pain and Anemia (FONDA
factors in their Spanish acronim).
Objective: To assess the effectiveness of a specific intervention
program in HF patients addressed to correct FONDA factors at 3
and 6 months after discharge.
Methods: All HF patients admitted during one year in a university
Hospital were included. Besides of demographic, clinical, and
geriatric assessment variables, ability of walking, handgrip strength,
vitamin D, protein and albumin levels, muscle mass index (MMI)
(by Bioimpedanciometry), and anemia were assessed at admission
and three and six months after discharge.
Results: We included 509 HF patients, 134 of them were followed-
up after discharge. Mean age was 82.99 (±6.3) and 80.6% were
women. Main results are shown in the table.
Admission 3 months 6 months
MMI 8.6 (±2.2) 8 (±1.6) 8 (±1.7)
Handgrip strength 16.1 (±7.3) 19.3 (±6.8) 20 (±8)
Total protein 6.8 (±0.8) 6.8 (±0.5) 6.9 (± 0.5)
Haemoglobin 12.9 (±1.6) 13.3 (±1.3) 13.7 (±1.3)
Albumin 3.2 (±0.4) 4 (±0.4) 4.1 (± 0.4)
Vitamin D 16.2 (±8) 56.4 (±37) 41.6 (±19.8)
Barthel Index 96.1 (±5.2) (Previous) 87.2 (±15.4) 89.2 (±13.2)
Conclusions: HF patients treated by an intensive multidimensional
intervention program including the specific management of
physical function, bone health, nutrition, pain and anaemia achieve
a high rate of normalisation of their levels of clinical, functional
and analytic parameters and the vitamin D replenishment at a short
and medium term.
P-441
Multiple medication use and renal insufficiency predict
mortality in an older hip fracture population
H. Pajulammi1, H. Pihlajam¨aki2, T. Luukkaala3, M. Nuotio4
1Department of Geriatric Medicine, Sein¨ajoki Central Hospital,
Sein¨ajoki, Finland; 2Division of Orthopedics and Traumatology,
Sein¨ajoki Central Hospital and University of Tampe, Sein¨ajoki,
Finland; 3Science Center, Pirkanmaa Hospital District and University
of Tampere, Tampere, Finland; 4Sein¨ajoki Central Hospital, Sein¨ajoki,
Finland
Objectives: To examine pre- and perioperative predictors of
mortality after hip fracture.
Methods: Population-based prospective data were collected on
1245 consecutive hip fracture patients aged ≥65 years. Outcome
was mortality at 1 year. Independent variables were age, sex, body
mass index, fracture type, American Society of Anesthesiology
(ASA) score, delay to surgery, urinary catheter removal during
acute hospitalization, estimated creatinine clearance (eCCr) by the
Cockgroft-Gault formula, number of regularly taken medications,
use of hypnotic benzodiazepines and z-hypnotics (BZD-Z), diagnosis
of memory disorder, prefracture mobility, and living arrangements.
Results: In multivariate analysis by the Cox proportional hazards
model, the number of regularly taken medications (4–10, HR 2.80,
95% CI 1.68–4.47; or > 10, HR 4.04, 95% CI 2.36–6.92) and severe
renal insufficiency (eCCr <30ml/min, HR 2.55, 95% CI 1.49–4.37)
were strong predictors of mortality at 1 year. Other independent
predictors of 1-year mortality were male sex, older age, ASA score
4–5, mobility level and >72 hour delay to surgery. Use of BZD-Z
was not associated with mortality. In the age- and sex adjusted
univariate analyses ASA score 3, diagnosis of memory disorder, not
living in own home and not having the urinary catheter removed
during hospitalization also predicted mortality.
Conclusion: In older hip fracture patients, multiple medications
and severe renal insufficiency increase the mortality risk after
hip fracture. Careful assessment of comorbidities is essential in
the care of geriatric hip fracture patients. Geriatric patients with
increased risk of hip fracture require regular critical evaluation of
renal function and adjustment of medications.
P-442
Factors associated with poor clinical outcome in elderly hip
fracture
P. Saez Lopez1, N. Sanchez Hernandez 1, N. Alonso Garc´ıa1,
J.A. Valverde Garc´ıa1
1Complejo Asistencial de Avila, Avila, Spain
Objectives: Analyze the factors that determine the hospital stay
of geriatric patients with hip fracture, and describe the factors
associated with variables indicative of poor outcomes.
Determinate the influence of the application of a clinical pathway
for such results.
Methods: A total of 412 geriatric patients and that were admitted
for fragility due to hip fracture in the Hospital of Avila, Spain
between 2010 and 2013 were retrospectively analyzed. Variables
considered indicatives of poor outcomes were mortality, number of
complications during admission, number of drugs at discharge and
new institutionalization rate. In 2013 an integral clinical pathway
based on scientific concepts and review of evidence was applied.