European Geriatric Medicine - Supplement 1 - Volume 6

Oral presentations / European Geriatric Medicine 6S1 (2015) S5

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S31

S23

admission. Once admitted these patients have long lengths of stay

and can develop hospital acquired complications ie infections, falls,

delirium (BGS 2012). An early CGA reduces hospital admission and

enables patients’ access to community services that are able to

support and improve independence. An early CGA also decreases

length of stay if admission is necessary.

O-062

Multidimensional frailty indicators in a nationwide GP

database predict mortality in the elderly: MPI_Age results

S. Janet

, A. Fontana

, F. Giorgianni

, A. Pilotto

, M. Sturkenboom

G. Trifiro’

University of Messina, Messina, Italy;

IRCCS Casa Sollievo della

Sofferenza, San Giovanni Rotondo, Italy;

Italy;

Erasmus Medical

Centre, Rotterdam, Netherlands

Objectives:

To identify multidimensional indicators and evaluate

their additional value in a previously developed primary care

morbidity score (QOF) for the prediction of one month and one

year mortality in elderly persons, using The Health Improvement

Network (THIN), a UK nationwide general practice (GP) database.

Methods:

Patients ≥65 were identified in THIN during 2000–

2012. THIN was mined to identify multidimensional indicators

of older people. Then, 1-month and 1-year mortality were

predicted using Cox models with following covariates: model

1) age+sex; model 2) age+sex+QOF score and model 3)

age+sex+QOF score+multidimensional indicators. Discriminatory

power of prediction models was assessed by computing the c-

statistic.

Results:

1,193,268 subjects aged ≥65 years were identified in THIN.

The most frequently registered multidimensional indicators were

mobility (4.6%), accommodation (1.98%), cognition (0.55%) and

dressing ability (0.44%). Model 1 had a lower discriminatory power

for mortality prediction than model 2. A significant improvement

on 1-year and 1-month mortality prediction was seen by adding

accommodation into the model 2: from c=0.71 to c=0.75 (p

0.001)

and from c=0.72 to c=0.78 (p

0.001), respectively. 1-year mortality

predictions for dementia patients improved from 0.62 to 0.64

(p = 0.004) adding the accommodation indicator.

Conclusions:

Multidimensional indicators were not frequently

recorded in the THIN database but improved the accuracy of a

model incorporating age, sex and QOF score to predict 1-month

and 1-year mortality among community-dwelling older people;

prediction was less marked for dementia patients. The use of such

indicators in GP databases is a newer approach which may improve

mortality prediction among elderly persons.

O-063

Drug prescribing in the elderly hip fracture patient

–

results

from The Trondheim Hip Fracture Trial

M. Heltne

, I. Saltvedt

, A. Prestmo

, O. Sletvold

, O. Spigset

NTNU/Helgelandssykehuset, TILLER, Norway;

St. Olav University

hospital and Norwegian University of Science and Technology,

Trondheim, Norway;

NTNU/St.Olavs Hospital, Trondheim, Norway;

NTNU/St.Olavs Hospital, Trondheim

Objectives:

To investigate patterns of drug prescription in the

Trondheim Hip Fracture Trial.

Methods:

Elderly home-dwelling patients with hip fractures

were randomized to traditional orthopaedic care (OC) in an

orthopaedic ward or comprehensive geriatric care (CGC) in a

geriatric ward. Drugs used at admission and discharge were

analyzed with regard to drugs started or withdrawn during the

hospital stay, polypharmacy (≥5 drugs), anticholinergic burden

using the Anticholinergic Risk Score (ARS) and the Duran scale,

and drugs increasing fall risk, and drugs used for osteoporosis, pain

and constipation.

Results:

397 patients were enrolled, 199 to OC and 198 to CGC.

Mean age was 83 years, 73.4% were females. Mean number of

drugs at admission and discharge were 3.8 and 7.1 in the CGC

group versus 3.9 and 6.2 in the OC group, p = 0.0015 at discharge.

At discharge significantly more patients in the CGC group used

analgesics, laxatives, vitamins and drugs for osteoporosis. Use of

the Duran scale (non-validated) showed a statistically significant

higher anticholinergic burden in CGC patients, while using the ARS

(clinically validated) showed no significant difference.

Conclusion:

Drug prescription patterns and routines for review of

drug regimens were different between the OC and the CGC group in

the Trondheim Hip Fracture Trial. Surprisingly, at discharge patients

in the CGC group used more drugs than the OC patients, while

potentially less favorable anticholinergic profile in CGC patients was

dependent on measurement method. Whether these differences

are related to the more beneficial outcomes in the CGC group is

unknown.

O-064

Into the black box of Geriatric Assessment

–

From assessment

to outcomes

W. Rietkerk

, S. Zuidema

UMCG, Meppel, Netherlands;

Netherlands

Objectives of the study:

Life-expectancy is surely rising. In the

search for a solution for increasing morbidity and health-care

consumption, integrated elderly care is extensively studied the

last decade. Part of it is a comprehensive geriatric assessment.

We implemented a multi-domain CGA with emphasis on patient

empowerment for which frail and pre-frail home-dwelling elderly

are invited. Until today effects of integrated care projects are

falling short and their efficacy is not thoroughly understood. For

developing efficient and effective care projects we unraveled the

steps taken to come to effects in our intervention.

Methods used:

Home-dwelling elderly eligible for our intervention

(65+ and (pre)frail, measured by Groningen Frailty Indicator and

case-complexity (Intermed)) and their general practiotioners were

interviewed about their role in the CGA and their motivation

for participation. Data was transcribed and analysed by thematic

analysis with

Atlas.ti

Results obtained:

From CGA to effects multiple sequential

steps can be distinguished for an advice to be executed:

receiving, remembering and understanding, discussing, accepting

and complying. They all need to be overcome to come to effects.

These steps are looked to different by patient and their doctor and

they sometimes have opposed expectations in their role in these.

Conclusions reached:

To get from CGA to effects a difficult path

with multiple steps lies ahead, with lack of clarity who is in the

lead. The GP is not feeling full responsibility because ‘non-medical’

topics are attended. Improving patient self-management skills can

help getting the patient to follow the path towards better CGA

outcomes.

O-065

How Finnish geriatricians perform comprehensive geriatric

assessment in clinical practice?

H. Kerminen

, E. J¨amsen

, P. J¨antti

, H. Huhtala

, T. Strandberg

J. Valvanne

University of Tampere, Tampere, Finland;

Hatanp¨a¨a hospital,

Tampere, Finland;

University of Tampere, Finland, Tampere;

University of Oulu, Oulu, Finland;

University of Tampere, Finland,

Tampere, Finland

Objectives:

Comprehensive geriatric assessment (CGA) is one of

the most important evaluation tools in geriatrics. In this study we

aimed to clarify how Finnish geriatricians apply CGA in their clinical

practice.