European Geriatric Medicine - Supplement 1 - Volume 6

European Geriatric Medicine 6S1 (2015) S32–S156

Available

online

ScienceDirect

www.sciencedirect.com

Poster presentations

Acute care

P-001

Increased mortality in a Norwegian nursing home after

implementation of the Coordination reform

J.F. Abrahamsen

Storetveit Nursing homeMunicipality of Bergen and Kavli

forskningssenter for Geriatri og Demens, HDS, Bergen, Norway

Objectives:

The Coordination Reform (CoR) was implemented in

Norway January 2012 with a major aim to treat more elderly

patients in their local community. However, there has been concern

that older patients, as a result of this, are discharged too early from

the hospitals, and that more patients die after transfer to short-

time nursing homes (STNH). Our aim was to compare mortality

in patients admitted from hospital to a STNH, before and after

implementation of the Coordination reform.

Methods:

This was a retrospective study from a single 35 bed

nursing home ward that received patients from the two hospitals in

Bergen. Home-dwelling patients aged ≥70 years transferred before

(n= 186) and after (n = 177) the Co R were included and compared.

Results:

The patients that were transferred from hospital after

implementation of the CoR were older, median 88 compared to

85 years, p

0.001 and more patients died after transferal to the

nursing home; 27% versus 13% of the patients, p = 0.002. Median

number of days in the nursing home before death were 14 days

after, and 12 days before the CoR (n.s).

Conclusion:

The present study, though limited in size and

from a single institution, support the concern that after the

implementation of the Co R, more elderly patients die after

transferal to STNH during the initial period. This may imply both

a higher patient turnover and increased demand for nurses and

doctors to spend more time with patients and their families

concerning end of life decisions and care.

P-002

Medical admissions through the emergency department:

Who, how and how long?

P. Arvidsen

, E. Pressel

Department of geriatric medicine, Bispebjerg Hospital, University

of Copenhagen, Copenhagen, Denmark;

Medical doctor, Bispebjerg

Hospital, København NV, Denmark

Objectives:

The study aims to describe the clinical characteristics of

elderly patients admitted to medical wards through the emergency

department (ED).

Methods:

In a first part, we described demographic changes in the

uptake area and ED visits of older patients in a 900 bed university

hospital in Central Copenhagen from 2004–2014.

In a second descriptive-retrospective part we studied clinical

characteristics of patients

65 years admitted to the medical

wards through the ED in january 2014 (n = 132). We collected data

on presenting symptoms at admission, medication, comorbidity,

admission rates to stationary wards and mean length of stay.

Results:

The number of ED visits of persons

65 years increased

by 28.3% during the study period whereas the number of persons

aged ≥65 years in the uptake area remained stable.

The most frequent symptoms at ED admission were infections

(36.4%), falls/dizziness (18.9%) and lung diseases (15.2%). 69.4%

of patients had polypharmacy receiving a mean number of

9.4 medications. 72.7% were characterized by multimorbidity with

≥3 comorbidities, cardiovascular and endocrine diseases being the

most frequent.

38.4% of the patients were transferred to the pulmological

department and 21.1% to the geriatric department. Mean length

of stay was 9 days.

Conclusion:

The growing number of older ED patients are

characterized by multimorbidity and polypharmacy. They are often

in the need of early specialized care and geriatric assessment should

therefore be available in the acute clinical setting.

P-003

Comparison of FRAX and QFracture use in an osteoporosis

clinic population in determining whether to treat or not to

treat in fallers versus non-fallers

D. Aw

, J. Thain

, A. Ali

, T. Aung

, W.M. Chua

, O. Sahota

N. Weerasuriya

, L. Marshall

, F. Kearney

, T. Masud

Queen’s Medical Centre, Nottingham, United Kingdom;

Royal Derby

Hospital, Derby, United Kingdom;

United Kingdom;

St Mary Medical

Centre, California, United States of America;

Queen’s Medical Centre,

Nottingham;

Queen’s Medical Centre, Nottingham;

Nottingham

University Hospitals, Nottingham, United Kingdom

Objectives:

The UK National Institute for Health and Care Excellence

(NICE) guidelines for the assessment of fracture risk in osteoporosis

recommends the use of one of two web-based fracture-risk tools:

Fracture Risk Assessment Tool (FRAX) or QFracture. Unlike FRAX,

falls history is included as a variable in Qfracture. Our study aim was

to compare the outputs of these tools in fallers and non-fallers.

Methods:

We collected information required to populate

both fracture-risk tools from women consecutively attending

osteoporosis clinics. 10-year major osteoporotic (MO) and

hip fracture risks were calculated for both tools. We used

a 20% intervention threshold (MO) to determine treatment

recommendation differences between FRAX and QFracture, and

assessed concordance between the tools in fallers (at least 1 fall

previous year) compared to non-fallers.

Results:

100 women (mean age=70.1; SD=11.3 years; 61 fallers)

were studied. The mean (95% Confidence Interval) 10-year MO and

hip fracture risks in FRAX were 18.8%(11.1–26.5) and 7.1%(2.1–12.1),

and that of Qfracture were 22.4%(14.2–30.6) and 16.8%(9.5–24.1)

respectively. Concordance between the tools on whether or not to

treat was 67.2% in fallers and 82.1% in non-fallers. Qfracture treated

52.5% in the fallers group compared to 49.2% with FRAX, while in

the non fallers group 23.1% and 20.5% were treated respectively.

Conclusion:

Concordance between the tools was better in non-

fallers, with more fallers recommended treatment with Qfracture

compared to FRAX. Qfracture may thus be more appropriate to use

in fallers and this requires further study.