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Oral presentations / European Geriatric Medicine 6S1 (2015) S5
–
S31
S13
of chest ultrasound and X-ray for the main diagnoses (i.e. heart
failure, pneumonia, pleural effusion) were calculated.
Results:
Overall diagnostic accuracy for pneumonia (46 patients)
was higher for ultrasound (92%vs72%), that proved more sensitive
than X-ray (92%vs53%) and similarly specific (98%vs94%). Similar
results were also obtained for pleural effusion (21 patients, accuracy
94% ultrasound vs 67% X-ray, sensitivity 97%vs59%, specificity
96%vs96%), but not for heart failure, where diagnostic performance
was equal (accuracy 84%vs83%, sensitivity 69%vs67%, specificity
97%vs97%). Chest CT was necessary for diagnosis only in 17% of
cases, while in 44 cases out of 97 (45%) ultrasound allowed to
establish diagnosis despite negative X-ray, thus preventing a CT
prescription.
Conclusions:
Bedside chest ultrasound can be an accurate and
effective part of diagnostic workup for frail multimorbid elderly
with respiratory symptoms, improving appropriateness in chest CT
prescriptions.
O-028
Risk of hospital readmission following acute care in a geriatric
unit
E. J¨amsen
1
, S. Haapasalmi
1
, S.-L. Kaistinen
1
, J. Valvanne
2
1
Hatanp¨a¨a Hospital, Tampere, Finland;
2
University of Tampere,
Finland, Tampere, Finland
Objectives:
Recurrent hospitalizations threat the health and
independence of vulnerable older adults. Our aim was to calculate
the incidence and to identify risk factors of hospital readmission
following acute hospitalization in a geriatric hospital.
Methods:
We analyzed the discharge records of 764 patients (mean
age 83.6 years, 70% females) treated in an acute care for elderly
unit of a large Finnish community and discharged directly home.
Mean follow-up was 7 months (range, 3–11). Incidence and risk
factors for readmission were analyzed using Kaplan–Meier survival
analysis and Cox regression analysis.
Results:
The rate of hospital readmission was 6% at 7 days, 19% at
30 days, 35% at 90 days, and 45% at 180 days after discharge. Higher
age (HR 1.02 for each year of age, 95% confidence interval 1.00–1.03),
receiving home care (HR 1.71, 1.34–2.17) and earlier hospitalizations
during the preceding six months (HR 2.33, 1.89–2.88) were
associated with an increased risk of hospital readmission. Fewest
readmissions occurred when the index hospital stay was 7–10 days
(41%), whereas 52% of those hospitalized for
>
10 days had later
readmission (HR 1.48, 1.10–1.99). Compared to patients treated for
pulmonary disease who had fewest new hospitalizations (39%),
cardiac (HR 1.53, 1.09–2.26) or urogenital disease (HR 1.59, 1.06–
2.37) increased the risk of hospital readmission, whereas dementia
diagnosis had not effect (HR 0.90, 0.70–1.16).
Conclusions:
Our readmission rate is comparable to previous
reports from non-geriatric units. Higher age, need for home care as
well as long and repeated hospitalizations predispose to hospital
readmission.
O-029
Association of impaired cognition and adverse outcomes in
older patients presenting to the emergency department; the
APOP study
J. Lucke
1
, J. de Gelder
2
, B. de Groot
1
, A.J. Fogteloo
1
, C. Heringhaus
1
,
G. Blauw
2
, S. Mooijaart
2
1
Leiden University Medical Centre, Leiden, Netherlands;
2
Netherlands
Objectives:
Older patients attend the emergency department (ED)
at higher rates and are at increased risk of adverse outcomes,
compared to younger patients. Cognitive dysfunction associated
with an even higher risks, but there is no feasible tool to screen
for cognition in the acute setting. The present study investigates
the association between cognition with mortality and functional
decline in acutely presenting older patients.
Methods:
A prospective follow up study among all patients aged
70 and over presenting to the ED of a university teaching hospital
(LUMC) in the Netherlands. Descriptive data including cognition,
measured by the Six-Item Cognitive Impairment Test (6CIT) was
obtained. 6CIT is administered in 2–3 minutes and measures
cognitive impairment. Follow-up data consisted of 90-day mortality
and 90-day functional decline, defined by 1 point increase in Katz
ADL score and/or new institutionalisation.
Results:
757 (76.6%) unique patients were included with a 93.3%
follow up rate. The mean age was 78.7 years and 364 (48.1%) were
male. Impaired cognition (6CIT
>
9) was significantly associated
with both mortality (OR 3.51, 95% CI 1.96–6.27, p-value
<
0.001) and
functional decline (OR 1.75, 95% CI 1.08–2.82, p-value 0.023) after
adjustment for age, gender, level of education, dementia, number
of different medication used at home and time of arrival.
Conclusions:
We showed that impaired cognition measured with
6CIT in older patients presenting to the ED was associated with
both mortality and functional decline after 3 months. These results
emphasize the importance to screen systematically for cognitive
dysfunction in acutely presenting older adults.
Geriatric education
O-030
Geriatric teaching in Spanish Medical Schools after the
implementation of the European higher education area
J. Mateos-Nozal
1
, L. Garc´ıa Cabrera
2
, B. Montero-Errasqu´ın
1
,
M. L ´azaro del Nogal
3
, A.J. Cruz-Jentoft
2
, J.M. Ribera Casado
4
1
Hospital Ram´on y Cajal, Madrid, Spain;
2
Spain;
3
Hospital Cl´ınico San
Carlos, Madrid, Spain;
4
Facultad Complutense, Madrid, Spain
Objectives:
To compare the prevalence and main characteristics of
the teaching of Geriatrics at undergraduate level in Spain before
and after the implementation of the European Higher Education
Area (EHEA).
Methods:
Review of the curricula and geriatric teaching programs
of all medical schools using a national survey in 2014. Data were
compared with those obtained in a similar survey performed in
2007.
Results:
The number of medical schools increased from 28 in 2007
to 40 in 2014. Geriatric training was listed in their undergraduate
curricula in 75% and 72.5% of the schools, respectively. The survey
answer rates were 92.9% and 94.4%. The prevalence of real Geriatric
training according to the surveys was 65.4% vs 73.5%, and it was
mandatory in 73.7% vs. 92.9% of those schools with geriatric
teaching. Geriatricians were involved in 42.1% of the teaching
programs in 2007 and in 81.5% in 2014. Approximately 70% of
the teaching at both time points included theoretical and practical
aspects, training was done in geriatric care settings in 42.9% in
2007 and 100% in 2014.
A careful review of the content of teaching showed that in
average only 50% of the recommendations of the UEMS European
Undergraduate Curriculum were included, with few contents on
patient respect, ethical issues and medication use.
Conclusions:
An increase in the prevalence of Geriatric training and
in the involvement of geriatricians and geriatric settings has been
observed after the implementation of the EHEA. Some potential
areas for improvement were identified, especially in the content of
Geriatric teaching.