187 / 210
Late-breaking abstracts / European Geriatric Medicine 6S1 (2015) S177
–
S187
S179
those who received the study product and placebo (0.071 and 0.108
m/s, respectively (p = 0.06)).
Conclusions:
Observations from this study suggest improved gait
speed, i.e. 400M walk capacity, following a 24 week physical
activity program, but no further improvement was shown for the
investigational study product.
O-097
Effect modification by CYP2C9 genotypes on
benzodiazepine-related fall incidents, a meta-analysis
N. Van der Velde
1
, A. Ham
3
, G. Ziere
4
, L. Broer
3
, A. Enneman
3
,
S. van Dijk
3
, K. Swart
5
, J. van Wijngaarden
6
, N. van der Zwaluw
6
,
E. Brouwer-Brolsma
6
, R. Dhonukshe-Rutten
4
, N. Van Schoor
7
,
M.C. Zillikens
3
, T. van Gelder
3
, O. De Vries
4
, P. Lips
5
, D. Deeg
5
,
L. De Groot
4
, A. Uitterlinden
3
, A. Hofman
8
, R. Witkamp
6
1
Academic Medical Center, Amsterdam, Netherlands;
2
Erasmus MC,
Rotterdam, Netherlands;
3
Erasmus MC, Department of Internal
Medicine, Rotterdam, Netherlands;
4
Netherlands;
5
VU University
Medical Center, Amsterdam, Netherlands;
6
Wageningen University
and Research Centre, Wageningen, Netherlands;
7
EMGO Institute for
Health and Care Research, Dpt. of Epidemiology and Biostatistics,
Amsterdam, Netherlands;
8
Erasmus MC University Medical Centre
Rotterdam, Department of Epidemiology, Rotterdam, Netherlands
Objectives:
Benzodiazepine use is a well-known fall-risk
factor. Pharmacological effects of benzodiazepines vary between
individuals, and are potentially influenced by genetic variations.
Therefore, we investigated whether polymorphisms in genes
encoding drug metabolising enzymes – CYP2C9*2 and *3 – modify
benzodiazepine-related fall risk. Both variants encode for a decrease
enzyme metabolism phenotype.
Methods:
Data from 3 Dutch population-based studies, concerning
community-dwelling elderly, were used. Falls were assessed
using self-report or registry data. Benzodiazepine use was
based on pharmacy records or self-report. CYP2C9*2 and *3
genotypes were determined. Multivariate cox proportional hazard
models were used to determine benzodiazepine-related fall risk.
Results were stratified on CYP2C9 genotypes and subsequently
meta-analysed.
Results:
Of the 11,485 participants, 3,705 encountered a fall during
follow-up (total follow-up = 91,996 years). Compared to non-users,
current benzodiazepine use was associated with an increased fall
risk in all three studies, combined HR = 1.26 (95%CI 1.13; 1.40).
The presence of CYP2C9*2 and *3 alleles modified benzodiazepine-
related fall risk. Those carrying at least one variant *2 allele and
using benzodiazepines, had an 51% increased fall risk, compared to
non-users, HR = 1.51 (95%CI 1.11; 2.05). Those carrying no variant *2
alleles and using benzodiazepines had an 15% increased fall risk,
compared to non-users, HR = 1.15 (95%CI 1.01; 1.32). Results were
similar for *3 alleles.
Conclusion:
Our results indicate that CYP2C9*2 and *3 allele
variants modify benzodiazepine-related fall risk. These results
form a step towards personalized medicine in the field of
medication-related falls. However, since the exact role of CYP2C9
in benzodiazepine metabolism is not fully revealed, additional
research is warranted.
O-098
Long-term evaluation of the Ambulatory Geriatric Assessment
–
a Frailty Intervention Trial (AGe-FIT)
–
clinical outcomes and
total costs after 36 months
A.W. Ekdahl
1
, A.-B. Wirehn
2
, J. Alwin
3
1
Karolinska Institute, Helsingborg, Sweden;
2
Karolinska Institutet,
Sweden;
3
Linkoeping University, Link¨oping, Sweden
Objective:
To compare mortality and costs of health and social care
between participants with access to care based on Comprehensive
Geriatric Assessment (CGA) in an out-patient care setting with a
control group receiving usual care only. The comparison was done
36 months after inclusion.
Methods:
Randomized controlled trial.
Inclusion criteria:
community-dwelling, aged ≥75 years, ≥3 hospitalisations the last
year and ≥3 medical diagnoses. Mean age 82.5 years.
Results:
A total of 208 participants in the intervention group (IG)
and 174 in the control group (CG).
Participants in the IG lived longer than the participants in the CG.
27.9% (n = 58) in the IG versus 38.5% (n = 67) in the CG had died.
HR = 1.49; CI; 1.05–2.12; P = 0.026. Mean number of inpatient days
was lower in the IG (intervention 15.1 (SD 18.4), control 21.0 (SD
25.0), P = 0.01.
No differences in the overall costs between the IG and CG including
costs for home-help service and nursing home. Mean cost during
the 36-month period after baseline assessment expressed as
USD/patient (SD) in the IG was 71905 (85560) versus 65626 (66338)
in the CG: P = 0.43.
Conclusion:
Better survival and fewer days in hospital three years
after baseline assessment without increasing costs. This strengthens
the positive results of a care based on CGA not only in acute care
settings but also in outpatient care. A change of to-days health care
organization focused on a one organ/disease is needed to a more
comprehensive and preventive care of the oldest old.
Posters
P-462
Clostridium tetani
bacteraemia in an elderly man with
torticollis and infected necrotic wounds
A. Engvig
1
, A. Bucher
2
, T. Stubhaug
3
1
Diakonhjemmet sykehus, Oslo, Norway;
2
Department of Medicine,
Diakonhjemmet Hospital, Oslo, Norway;
3
Department of Microbiology,
Oslo university hospital, Oslo, Norway
Tetanus is a disease caused by tetanus toxin produced by
Clostridium tetani
. Although spores of
C. tetani
are ubiquitous,
tetanus remains rare in developed countries due to widespread
vaccination. However, a significant proportion of the elderly remain
unvaccinated and at risk. We describe here a case of
C. tetani
bacteraemia in a 77-year-old man with neck spasm – a finding
previously not reported in medical literature.
Clinical work-up of a 77-year-old man admitted unconscious to
hospital is described. Computerized tomography (CT) of the head
suggested that an intracranial hemorrhage had left the patient
helpless at his home for up to four days, leading to infected necrotic
wounds. Upon presentation he was noted to have torticollis, which
was confirmed by CT of the neck revealing neck muscle spasm. On
admission, the patient was septicaemic and blood cultures were
obtained, growing
Proteus mirabilis
and an anaerobic Gram-positive
rod identified as
C. tetani
by MALDI-TOF mass spectrometry and
16S rDNA sequencing. The patient’s necrotic wounds are considered
the likely source of the
C. tetani
infection.
The case is remarkable as
C. tetani
has not previously been isolated
from blood samples of a patient with tetanus. Tetanus should