European Geriatric Medicine - Supplement 1 - Volume 6

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

–

S31

S25

Results:

We analyzed 510 samples of 194 participants. Mean age

was 83.6 years and 63 (32.5%) patients developed delirium during

admission. Median melatonin level in persons that experienced

delirium was 51.4 pg/ml (IQR 57.2) and in those who did not 41.0

pg/ml (IQR 34.0), p-value 0.137. In a mixed model analysis, adjusted

for CAM score, pre-existing cognitive impairment, age, type of

anesthesia, prior delirium and benzodiazepine usage, melatonin

levels were associated with the day in relation to surgery.

Conclusion:

No association of delirium with plasma melatonin

levels could be demonstrated in this study. Melatonin is associated

with the perioperative period, suggesting that the secretion

patterns of melatonin could have changed. More research with

multiple blood sampling daily is needed to unravel the secretion

patterns of melatonin during delirium.

O-069

Physiological melatonin levels in healthy older people

R. Scholtens

, B. Van Munster

, M. Van Kempen

, S. De Rooij

AMC, Amsterdam, Netherlands;

UMCG, Amsterdam, Netherlands;

Leiden University Medical Center, Leiden, Netherlands;

UMCG,

Groningen, Netherlands

Objective:

Melatonin plays a major role in maintaining circadian

rhythm. Its secretion pattern and levels can be disturbed in persons

with dementia, psychiatric disorders, sleep disorders or with cancer

and possibly in older age. As melatonin suppletion is often applied

in older persons as sleep medication, it is important to know

if melatonin levels decrease in healthy ageing and/or secretion

patterns change. The objective of this study is to both determine

physiological levels and secretion patterns of melatonin in healthy

older people.

Methods:

We performed a systematic review and searched PubMed

and Embase from 1980 up to November 2014 for studies that

measured melatonin in healthy older people aged 65 years and

older.

Results:

19 studies were retrieved. The number of participants

ranged from 5 to 60 per study. Melatonin was mostly measured

by radioimmunoassay (RIA) and the number of measurements per

twenty-four hours varied from 1 to 96. Sixteen studies showed a

secretion pattern with a clear peak concentration, mostly at 02:00

or 03:00 am. Maximal concentrations varied greatly from 11.2 to

91.2 pg/ml. The maximal melatonin level in those mean aged 65–70

years was higher when compared to those aged 75 years and older,

53.1 pg/ml and 22.5 pg/ml respectively, p-value

0.05.

Conclusion:

The secretion pattern of melatonin does not change in

healthy ageing, but the maximal nocturnal peak concentration of

melatonin might decline. It is important to take this into account

when prescribing melatonin suppletion to older people.

O-070

Heterogeneous cognitive trajectories in the first year after

hip fracture

S. Beishuizen

Academical Medical Centre, Amsterdam, Netherlands

Objectives:

Heterogeneous patterns of cognitive change have been

identified in patients with mild cognitive impairment, Alzheimer’s

disease and after prolonged hospitalization. Hip fracture is

associated with subsequent cognitive impairment, especially when

delirium co-occurs. We examined the heterogeneity of cognitive

trajectories in the first year after hip fracture surgery in a population

of older patients.

Methods:

We enrolled 360 consecutive patients aged 65–102 years

old, who were admitted for surgical repair of a hip fracture. The

Mini Mental State Examination (MMSE) was obtained at admission,

discharge, and three and 12 months after discharge. Cognitive

trajectories were identified with Group Based Trajectory Modelling

(GBTM), using MMSE as outcome measure. For comparison, mixed

modelling was performed to estimate the rate of change in MMSE

score for the entire group.

Results:

185 (51.4%) patients had prior cognitive impairment and

114 patients (31.7%) experienced delirium during admission. Three

distinct cognitive trajectories were identified and labeled based on

initial MMSE score and course: (1) 27 moderate increase (54.9%), (2)

19 slow increase (25.1%) and 8 slow decline (20.0%), with an annual

rate of MMSE change of 2.00, 1.30 and −1.50 points respectively.

This did not correspond to the overall annual increase rate of 0.76

MMSE point that was estimated for the group as a whole with

mixed modelling.

Conclusion:

Our results extend the observation that heterogeneous

patterns of cognitive change exist in elderly, to a population of hip

fracture patients. Over half of older patients undergoing acute hip

fracture surgery show a favorable cognitive outcome.

O-071

Feasibility study of the long term impact of acute illness,

hospitalisation and delirium on cognitive outcomes after TIA

and stroke

S. Pendlebury

, A.-M. Haigh

, R. Thomson

, Z. Mehta

, P. Rothwell

Stroke Prevention Research Unit, Nuffield Department of Clinical

Neurosciences, Oxford, Oxford, United Kingdom

Objectives:

Post-stroke dementia is multi-factorial but previous

studies have tended to focus on the impact of cerebrovascular

disease alone. Delirium, associated usually with acute general

medical illness, predicts poor cognitive outcome in Alzheimer’s

disease and appears to worsen cognitive trajectory, but there are no

large studies of its impact on long-term outcome in cerebrovascular

disease. We aimed to determine the feasibility of studying the

impact of systemic illness, hospitalisation and delirium on long-

term cognitive outcome after TIA and stroke.

Methods:

We studied all surviving TIA and stroke patients recruited

previously (2002–2012) into a UK population-based study. From

01 July 2013, all patients admitted to hospital for any reason

were prospectively assessed. Co-morbidities, physiological and

blood parameters, abbreviated mental test score, delirium screen,

diagnosis and length of stay were recorded.

Results:

1565 of the TIA and stroke patients initially recruited

(mean age 68.9+13.3, range 21–102 years, 751 female, 676 TIA)

were still alive on 01 July 2013. During the subsequent 4 months,

there were 139 admissions in 123 patients (mean age 77.6+11.7

years, 57 female), of which 122 (88%) were unplanned: 88 (72%)

to acute medicine; 10 other medical; 16 surgery; 7 trauma. Among

acute medicine admissions, delirium occurred in 29/88 (30%).

Conclusions:

Older patients with previous TIA and stroke have

very high rates of hospital admission for acute medical illness

and associated delirium. There is therefore considerable potential

for delirium to contribute to cognitive decline and occurrence

is sufficiently frequent for prospective longitudinal studies to be

feasible.

O-072

Characteristic and outcomes of clinical subtypes of delirium

in old patients admitted in a sub-acute care unit

M.G. Carrizo

, N. Gual

, A. Calle

, F. Man

, J. Martin

, M. Inzitari

Hospital universitario Vall d’ Hebr´on, Barcelona, Spain;

Parc Sanitari

Pere Virgili, Barcelona, Spain;

Parc Sanitari Pere Virgili, Spain;

Spain

Objectives:

To examine incidence, characteristics and outcomes of

clinical subtypes of delirium in older patients hospitalized in a

sub-acute intermediate care unit after an emergency room visit.

Methods:

Prospective observational study of patients aged

≥65 years admitted to the sub-acute care unit of Parc Sanitari

Pere Virgili, Barcelona, during 3 months of 2015. Comprehensive

geriatrics assessment using standardized instruments including the

confusion assessment method (CAM) was performed. Patients were