22 / 210
S14
Oral presentations / European Geriatric Medicine 6S1 (2015) S5
–
S31
O-031
Learning by living: life altering medical education immersion
research
M. Gugliucci
University of New England College of Osteopathic Medicine, Biddeford,
United States of America
Introduction:
Global increases in older adult populations and the
paucity or decrease in geriatricians in many countries, makes it
essential for all practitioners to be trained in older adult patient
care. Yet these patients are viewed negatively. “Admitting” medical
trainees into nursing homes for an extended period to live the life
of a resident provides a unique learning environment and uncovers
new models of care.
Methods:
Learning-by-Living™ utilizes a qualitative ethno-
graphic/biographic research design, whereby a “culture” is observed
by the researcher (medical trainee) living within an environment
(nursing home). Trainee volunteers (N = 33) were “admitted” into
10 nursing homes (2006–14) to live the life of an elder resident
24/7 for 2 weeks; complete with medical diagnoses and “standard”
procedures of care (toileting, transferring, bathing, and feeding).
Field Notes (data) included reporting objective and subjective
observations, experiences, and resident encounters. Data were
analyzed by thematic categorization and coding by manual and
QSR-N-Vivo Research Software standard protocols.
Results:
Data stages included arrival at the nursing home,
first days, daily life, and leaving. Salient themes included
friendship, dependence, routine, respect, and waiting. Trainee skill
attainment included improved ability to communicate using voice
tone/cadence, body language, word choices, touch, and eye contact.
Age disparities, disease, and frailty were non-issues in forming
interpersonal relationships.
Conclusion:
Learning-by-Living challenges stereotypes about aging
and expands medical trainees doctoring attitudes, skills and
knowledge. Admitting medical trainees into nursing homes to live
the life of an elder resident also increases their desires to work
with older adults.
Geriatric rehabilitation
O-032
Associations between fallrisk measured with Downton Fallrisk
Index and fall injuries in geriatric patients
E. Rydwik
1
, M. Mojtaba
1
, F. Alinaghizadeh Mollasaraie
2
1
Stockholm County Council, J¨arf¨alla, Sweden;
2
Stockholm County
Council, Huddinge, Sweden
Objectives:
The purpose of the study was to examine if there is
an association between fall risk (Downton Fall Risk Index) during
hospital stay at a geriatric clinic and a fall injury within 6 months
after discharge.
Methods:
A total of 6395 patients were included in the study.
Data extracted from medical records during the inpatient stay
and data on fracture or contusions after discharge retrieved from
the Stockholm County Council’s care database were analyzed with
logistic regression.
Results:
The study showed that 86% of the patients with a fall
injury (n = 1378) had a high fall risk measured with Downton Fall
Risk Index (
>
3 points). There were significant associations between
fall injuries and a high fall risk and the modules previous falls
and unsafe walking ability, respectively. There were no associations
between number of continuous medications or specific medications
such as SSR or Benzodiazepines with fall injuries. In addition there
was no association between fall injuries and the module cognitive
impairment. When stratifying for sex, men with a high fall risk had
a higher odds of fall injury (OR 2.1, 95% CI 1.6;2.8) compared to
women (OR 1.7, 95% CI 1.4;2.1).
Conclusion:
The study showed that patients with previous falls
and unsafe walking ability have a greater risk of fall injuries. This
population should be the focus for individualized multifactorial case
risk assessment and individualized multifactorial intervention.
O-033
Therapeutic validity of exercise therapy in RCTS
G. van der Sluis
Nij Smellinghe hospital, Drachten, Netherlands
Objectives:
Reviews on RCTs studying the merits of exercise therapy
use best-evidence synthesis to collate the best available evidence.
Remarkably, only the risk of bias (RoB) of included studies is
assessed, while the therapeutic validity of the interventions is
neglected. The purpose of this study was to (1) develop a rating
scale to assess the validity of exercise programs, and (2) study the
validity of exercise therapy in people with chronic conditions.
Methods:
In a Delphi study, consensus was reached among five
exercise experts on which aspects define therapeutic validity
in exercise therapy; resulting in the CONTENT scale (Figure 1).
Consequently, we performed 5 systematic literature searches to
identify RCTs that studied the merits of exercise therapy in people
with endstage osteoarthritis, THR, RA, COPD, and MI. Two reviewers
extracted data and assessed RoB (low if ≥60%) and therapeutic
validity (high if ≥6).
Results:
We identified 57 eligible RCTs. Inter-rater agreement (k)
was
>
0.70 for both the RoB and therapeutic validity scores. 19
studies (33%) had low RoB, 11 studies (19%) had high therapeutic
validity, and 7 studies (12%) had both low RoB and high therapeutic
validity. The figure demonstrates that specially items 3, 5, 7, 8 and
9 scored poorly (
<
25%).
Conclusions:
Only 12% of the RCTs had good RoB and therapeutic
validity. One of the major concerns was the lack of a rationale for
the exercise interventions, resulting in unclear patient selection
and unclear exercise dosing. Future reviews on exercise therapy
should address therapeutic validity in best-evidence synthesis.
O-034
Integrated music in nursing homes
–
an approach to dementia
care
A. Myskja
National Competence Center for Arts & Health, Ski, Norway
The lecture will present the key findings from the PhD work
Integrated Music in Nursing Homes – an Approach to Dementia
Care, spanning 14 nursing homes with 602 residents in the period
2000–2012. The following points will be presented:
•
An ethical and philosophical framework for dementia care.
•
What works? A methodological approach to evaluate
psychosocial interventions in a nursing home setting.
•
A brief review of the research status of psychosocial interventions
in dementia care with a particular emphasis on music
modalities.
•
Individual preference, foundation for successful psychosocial
care.
•
Individualized music – stages in the development of a method
tailored to nursing homes.
•
Applications of individualized music for agitation and
depression.
•
The role of music in wellbeing: Findings from a qualitative study.
•
Integrating music in a nursing home setting: An implementation
study in five nursing homes.
The presentation will be illustrated with clinical examples and
video clips.