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Oral presentations / European Geriatric Medicine 6S1 (2015) S5
–
S31
with the outcomes of mobility, institutionalization and death after
hip fracture.
Methods:
Population-based prospective data were collected on
472 consecutive hip fracture patients aged 65 years and over
between January 2010 and December 2012. Declined vs. same or
improved mobility level, institutionalization and death during the
four-month follow-up were the outcomes. Age, gender, American
Society of Anesthesiologists scores, pre-fracture diagnosis of a
memory disorder, mobility level, living arrangements and MNA-SF
scores at baseline were the independent variables. Age-adjusted
and multivariate logistic regression and Cox proportional hazards
models were conducted.
Results:
At baseline, 41 (9%) of the patients were malnourished and
200 (42%) of the patients at risk of malnutrition according to the
MNA-SF. During the follow-up, 90 (19%) had died. In the multivari-
ate Cox proportional hazards model, malnutrition (HR 2.16; 95% CI
1.07–4.34) was associated with mortality. In the multivariate binary
logistic regression analyses, risk of malnutrition (OR 2.42;95% CI
1.25–4.66) and malnutrition (OR 6.10;95% CI 2.01–18.5) predicted
institutionalization while risk of malnutrition (OR 2.03; 95% CI 1.24–
3.31) was associated with decline in the mobility level.
Conclusions:
Malnutrition or risk of malnutrition as measured
by the MNA-SF were independent predictors of major negative
outcomes after hip fracture. Patients at risk of malnutrition as
measured by the MNA-SF may constitute a patient population with
mild to moderate malnutrition and are in need of specific attention
when nutritional interventions are designed after hip fracture.
O-080
Correlation between age, physiological fitness and
peri-operative risk
J. Angell
1
, S. Tolchard
2
, N. Dodds
3
, S. Lewis
3
, M. Pyke
3
,
A. Darweish
3
1
NorthBristol NHS trust, Bristol, United Kingdom;
2
Southmead
Hospital, Bristol, UK, Bristol, United Kingdom;
3
North Bristol NHS
Trust, Bristol, United Kingdom
Objectives:
To investigate the effect that age has on physiological
fitness and perioperative complications in major surgery.
Methods:
One hundred and seventy-two patients presenting for
major surgery underwent a cardiopulmonary exercise (CPEX) test
before surgery. Patients performed a standardised ramp protocol
(10 Watt/Kg/min) until they reached peak oxygen uptake (VO2
peak). All patients were followed up by note review at 30 days.
Results:
VO2 peak and anaerobic threshold (AT) did not correlate,
whereas the ventilatory equivalent for CO2 (VE/VCO2) and ASA did
correlate with age (r= 0.264 and r = 0.18 respectively). Thirty-one
percent of patients suffered a complication. The most common
complications were respiratory (28%). All cause complications were
independent of age, however, the mean age of those suffering
a respiratory complication was slightly higher (70 vs 74 years)
but was not significant (p = 0.06). Complications were significantly
higher in patients with a lower VO2 peak; lower AT and a higher
VE/VCO2 (p
<
0.05).
Conclusions:
Physiological fitness is a powerful predictor of
perioperative morbidity and with an ageing population there is
a perception that those presenting for surgery will naturally be at
higher risk of complications. We have found that advanced age does
not predispose those presenting for major surgery to complications.
VE/VCO2 was weakly correlated to age suggesting lung efficiency
declines with age. Physiological fitness is an independent predictor
of complications during the perioperative period and currently aids
risk stratification, decisions around levels of care and discussions
concerning individual risk.
O-081
“The last chance”
–
a qualitative study about patient
experiences of decision-making preceding Trans-catheter
Aortic Valve Implantation (TAVI)
E. Skaar
1
, A.H. Ranhoff
2
, J.E. Nordrehaug
3
, D.E. Forman
4
,
M.A. Schaufel
5
1
Helse Bergen, Haukeland University Hospital, Bergen, Norway;
2
Dep. of Clinical Science, University of Bergen and Kavli Research
Center for Geriatrics and Dementia, Oslo, Norway;
3
Department of
Clinical Science, University of Bergen, Bergen, Norway;
4
University of
Pittsburgh Medical Center, Pittsburgh, United States of America;
5
Uni
Research Health Bergen and Haukeland University Hospital, Bergen,
Norway
Objectives:
Little is known about older TAVI patients’ motivation
regarding the procedure. This study explores their experiences of
the preceding decision-making process.
Methods:
We conducted a qualitative study with semi-structured
interviews of ten TAVI-patients postprocedure (median 23 days),
aged 73–89, six of them women. A purposeful sample was made
regarding diversity in age, gender and complications. Analysis was
by systematic text condensation.
Results:
The patients experienced not having sufficient
knowledge to make an independent decision despite thorough
information preceding TAVI, and trusted their doctors’ treatment
recommendations. They felt they did not have a real choice due
to their condition’s severity, yet they experienced the decision
being based on their motivation and having the opportunity to
decline operative treatment. Several patients reported ambivalence
facing risk information associated with the procedure and differed
substantially regarding the level of details of which they required
knowledge. They had difficulties knowing what would be best for
them, and found it important that the doctor remained both honest
and optimistic. Patients appeared with lease of life when TAVI
treatment was decided, mobilizing hope trough fellowship with
others and a positive view on themselves. They did not report
worries about dying, viewing death as something that could happen
at any time in their age.
Conclusions:
Older patients are in a vulnerable and perplexed
position trying to make a proper choice regarding TAVI, despite
displaying resilience and courage. Cardiologists should consider
this when delivering information about this procedure to ensure a
valid informed consent.
O-082
Early return home after hip fracture is not unsafe
–
evidence
from the National Hip Fracture Database in the UK
A. Johansen
1
, C. Boulton
1
, R. Wakeman
1
1
National Hip Fracture Database, London, United Kingdom
Objectives:
Swedish patients discharged within 10 days of hip
fracture appear to be at increased risk of dying [Nordstr ¨om et al.
BMJ 2015;350:h696]. Given recent UK success in reducing length
of stay after this injury, we set out to examine the observation’s
relevance to NHS patients.
Methods:
The National Hip Fracture Database (NHFD) collated
information on
>
60 year olds presenting with hip fracture in
England, Wales and Northern Ireland during 2013.
Results:
During 2013, data on 65,535 people indicated higher
risk 30 day mortality for those discharged before 10 days
(2.7% cf. 1.4%) – with 104 ’excess deaths’ in this group. However,
we addressed confounding factors by examining mortality among
people admitted from their own home who successfully returned
there. Those discharged home before 10 days actually showed lower
mortality (0.4% cf. 0.6%).
The appearance of ’excess deaths’ was entirely accounted for by
other patient subgroups. A third (32) were people admitted from
their own home and discharged to care in an acute hospital,