European Geriatric Medicine - Supplement 1 - Volume 6 - September 2015

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S34 Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
showing bleeding in the mid-esophagus. To arrest bleeding an
injection of epinephrine was administered.
A control gastroscopy showed pulsatile bleeding in the mid-
esophagus, three clips were placed.
CT angiography: arteriography of the right subclavian artery is
identified where thyrocervical trunk with branch supplying the
goiter, with active bleeding and esophageal contacting area where
hemostatic clips are evident. That branch is embolized
Conclusions: There are multiple hemodynamic changes that occur
with giant goiters; we describe a rare case of hematemesis due to
fistula as a result of recurrent goiter.
P-008
Association of renal function with cognitive and functional
status in older patients presenting to the emergency
department; the APOP study
J. de Gelder1 , M. Kallenberg1 , B. de Groot2, J. Lucke2, A.J. Fogteloo2 ,
A.J. Rabelink1, M. van Buren1, G. Blauw3, S. Mooijaart 3
1LUMC, Leiden, Netherlands; 2Leiden University Medical Centre,
Leiden, Netherlands; 3Netherlands
Objective: Older patients represent a growing population in
the Emergency Department (ED). These patients are especially
vulnerable for experiencing negative outcomes and deterioration in
functioning. Furthermore, the prevalence of impaired renal function
increases with age, which may be an additional risk factor for
poor clinical outcome. In the present study we aim to study the
association of renal function with cognitive and functional status
in older patients presenting to the ED.
Methods: We initiated the prospective Acutely Presenting Older
Patient (APOP) study, in which we included patients aged 70
and over presenting to the ED. Data collection included renal
function, Six Item Cognitive Impairment Test (6CIT) for cognition,
and Identification Seniors At Risk score (ISAR) and Katz Index of
Independence in Activities of Daily Living (Katz-ADL) for functional
status.
Results: In 570 out of 757 included patients (75.3%) kidney function
was measured. Odds ratios for cognitive impairment, adjusted for
age and gender, were 1.80 (95% CI 1.11–2.92) with eGFR 30–60 and
1.85 (95% CI 0.79–4.30) with eGFR <30 (p for trend 0.018).
Adjusted odds ratios with ISAR were 1.83 (95% CI 1.23–2.74) with
eGFR 30–60, and 3.22 (95% CI 1.36–7.63) with eGFR <30 (p for trend
<0.001). Adjusted odds ratios with Katz-ADL were 1.31 (95% CI 0.82–
2.09) with eGFR 30–60 and 4.26 (95% CI 2.07–8.76) with eGFR <30
(p for trend 0.001).
Conclusion: Impaired renal function is associated with cognitive
and functional impairment in older patients presenting to the ED.
In the future, early identification of these vulnerable patients may
enable a more tailored trajectory
P-009
Palliative sedation in an acute Geriatrics unit
S. Fern ´andez-Villaseca1, J. Alb ´eniz-L ´opez1 , B. Montero-Errasqu´ın2,
J. Mateos-Nozal2 , E.M. S ´anchez-Garc´ıa1 , P. Fern ´andez-Montalb ´an1 ,
A.J. Cruz-Jentoft3
1H.U. Ram´on y Cajal, Madrid, Spain; 2 Hospital Ram´on y Cajal, Madrid,
Spain; 3 Hospital Universitario Ram´on y Cajal, Madrid, Spain
Objectives: To describe the characteristics and evolution of patients
who died during admission to an Acute Geriatric Unit (AGU). To
determine the use of palliative sedation in them.
Methods: Descriptive, longitudinal and retrospective study of
patients who died in an AGU from 2013 to 2014. Medical records
were reviewed to assess the dying and sedation process.
Results: 137 patients died (13.9% of total admissions). Mean age
91.3±5.0 years. 55.8% dependent for all BADL, 60.2% had severe
dementia (GDS≥6). 30.1% were living in a nursing home. Main
diagnosis on admission: respiratory infections (48.2%) and heart
failure (10.9%). Mean hospital stay: 6.7±6.0 days.
Most frequent immediate cause of death: infection (61.3%). Of those
who died, in 14.3% palliative sedation was started at the emergency
department, 16.8% died within 24 hours of admission. 17.5% died
unexpectedly. 65% received symptom treatment, 30% of whom
required palliative sedation, started 5.7±1.0 days after admission
(by the geriatrician in 71.4%). Primary refractory symptoms treated
with palliative sedation were dyspnea (69%) and pain (16.7%),
midazolam was always used for sedation. In 95.5% the decision was
agreed with the family. Amongst sedated patients, other treatments
were limited in 95.2%, mostly the antibiotics (52.4%).
Conclusions: Most patients who died in Acute Geriatric Care had
total functional dependency and advanced dementia. The main
cause of death were lung infections. One fifth died during the first
24 hours of admission. Palliative sedation was used in a relevant
number of subjects after a shared decision making process that
involved family members.
P-010
Multidisciplinary evaluation of elderly people – experience
of an internal medicine ward
J.P. Figueiredo Gomes1, J. Esp´ırito Santo 1 , D. Mota1, D. Donaire2 ,
R. Garcia1, B. Barbosa1 , J. Pereira de Moura1 , A. Carvalho1
1CHUC, Coimbra, Portugal; 2CHUC, Coimbra
Introduction: Nineteen percent of people in Portugal are 65 years
of age or older, with around fifty percent of the hospitalised patients
belonging to the same age group. Only a holistic evaluation can help
treating this population to higher standards.
Objective: We have proposed to analyze the cognitive, functional
and nutritional state, as well as the risk of falling in a group of
elderly patients admitted to an Internal Medicine ward.
Methods: The Mini Mental State Examination (MMSE), the
Montreal Cognitive Assessment (MoCA), the Mini Nutrional
Assessmente (MNA)] and 2 scales [the Geriatric Depression Scale
(GDS) and the Morse Fall Scale (MFS)] were applied, between the
1st of March and the 30th of September 2014, in the first forty-eight
hours following admission.
Results: 163 people (aged between 73 and 97 years) were
approached, but 70 (42.9%) were excluded. Sixty-eight (73.1%) were
women. 34 patients (36.6%) had cognitive impairment according to
the MMSE, a score that was higher when using MoCA [72.0% (67)].
The MNA retrieved that 21.5% (20) of people suffered undernutrition
and 30.1% (28) had a normal nutritional status. Only 23.7% (22) of
people were not found to be at risk of depression. The majority had
a mild dependence [58.1% (54)] with 6.5% (6) suffering a severe
dependence. In MFS, 53.8% (50) had a high risk of falling whilst
only 3.2% (3) did not present any risk.
Conclusion: Most elderly patients admitted to the Hospital
presented with a range issues, which should be taken into
consideration when assessing these patients.
P-011
Long-term survival after hospital discharge in centenarians
J. Fonseca1, A. Nogueira2 , J. Gomes2 , D. Ferreira2 , P. Mendes2 ,
P. Lopes3, H. Clemente2 , R. Ferreira2, ´E. Ferreira1 , H. Esperto2 ,
M. Ver´ıssimo2, A. Carvalho2
1Coimbra Hospital and University Centre, Coimbra, Portugal; 2Centro
Hospitalar e Universit´ario de Coimbra, Coimbra, Portugal; 3Centro
Hospitalar e Universit´ario de Coimbra, Tent´ugal, Portugal
Objectives: In the last census conducted in 2011, were identified
1791 centenarians, from a total of 10 million inhabitants of Portugal.
The increase of centenarians requiring hospitalization is a reality.
The main purpose of the study was to analyze the long-term
survival of centenarians after hospitalization for acute illness.