European Geriatric Medicine - Supplement 1 - Volume 6

Poster presentations / European Geriatric Medicine 6S1 (2015) S32

–

S156

S41

in good health and hemodynamic compensation, without loss of

functional autonomy compared to the pre-infarction period. When

the clinical management of a patient is efficient even centenarians

can enjoy the best treatment with great and, in our opinion,

appropriate benefit.

P-035

Emergencies in primary care for digestive disorders

R. Martinez-Fuerte

, L. Sierra-Martinez

, N. Sanz-Gonz ´alez

Valladolid Este Primary Assistance Gerency, Valladolid, Valladolid,

Spain;

JCyL Primary Assistance Gerency, Valladolid, Valladolid, Spain

Objective:

To evaluate the prevalence of emergencies in primary

care for digestive disorders; to implement quality control plan and

continuing education for emergency care digestive pathology.

Methods:

1. Cross-sectional study of emergencies in primary care for

digestive disorders, served in a period of one year.

2. Were recorded and analyzed a total of 774 cases treated in

emergency primary care, from different points of view:

– age.

– Sex.

– Classification As under ICD-9-CM (The International Classifica-

tion of Diseases, Ninth Revision, Clinical Modification).

– Degree of urgency.

3. Motion Control Plan and Continuing Education for Urgent Care

Respiratory include: Logging diagnosis and emergency treatment

of the most common diseases, goal setting as indicators assessed

by a computerized system (completion of protocols, frequency

and estimate the percentage of mild cases sent urgently) and

control them through periodic clinical sessions.

Results:

n = 774. Age: ≤65 years: 76%, ≥65 years: 24%.

Gender: Male: 37.34%, Female: 62.40%. Heading ICD-9: Digestive

Pathology: 12.75%. Degree of urgency: Urgent 8.97%, Semi-

urgent 37.86%, Not Urgent 51.58%.

Conclusions:

The urgency for digestive diseases are 12.75% and

about 88% are semi-urgent or non-urgent. Control Plan is proposed

and Continuing Education for Urgent Care Digestive through peri-

odic clinical sessions (every three months) in the health centers.

P-036

Hospital at Home for acute geriatric patients

A. Tanderup

, J.-U. Rosholm

, J. Ryg

, A.T. Lassen

Odense University Hospital, Odense, Denmark

Introduction:

In the future there will be an increasing number of

acutely ill geriatric patients but fewer hospital beds. The solution

could be to hospitalize these patients at home with medico-

technological monitoring.

Objectives:

Feasibility of a “Hospital at Home” (HH) supported by

medico-technological solutions.

Method:

Within the first 48 hours after admittance geriatric

patients are assessed to see if they can be included in HH – that is,

not too ill to be cared for at home but in need of hospitalization.

After inclusion the patients are installed in their own home along

with the technology. The municipality nurse takes care of medicine,

cooking and other activity of daily living. The hospital is responsible

for the treatment and patients are assessed daily by a geriatric

doctor and nurse. When ready the patients are discharged to

their GP. Telemedicine is used for security when the patient is

alone. Monitoring of falls, wireless measurements of vital values

and direct patient-nurses contact via speakers and webcams is

used. A call-center to achieve and react on alarms is placed in the

geriatric ward.

Results:

The Model for Assessment of Telemedicine is used:

•

Health problem and technology

– Description of the acute ill elderly patient and the technical

set-up

•

Safety

– Mortality, readmission.

•

Clinical case study

– Description of the study design

– Clinical impact

•

Patient perspective

– Participants satisfaction

•

Economy

•

Organizational

– Evaluation of changes in the organization

•

Legal/ethical

– Is HH compliant with regulations?

The project is financed by public and private non-commercial

foundations.

P-037

Severe metformin-associated lactic acidosis

–

a case report

H. Temido

, J.P. Gomes

, R. Alves

, F. Parente

, I. Fonseca

Centro Hospitalar e Universit´ario de Coimbra, Coimbra, Portugal;

CHUC, Coimbra;

CHUC, Coimbra, Portugal

Introduction:

Metformin is a widely used oral antihyperglycaemic

drug utilized in the long term treatment of type 2 diabetes

mellitus. A potential complication of metformin treatement is the

development of non-hypoxic lactic acidosis. Although it is a rare

condition (estimated prevalence of one to five cases per 100,000

population) it has a reported mortality of 30–50%. Dehydration

in patients taking metformin can lead to this potentially fatal

condition.

Clinical case:

A 78-year-old male is brought to the emergency

department (ED) because of 72 hour history of vomiting and

progressive lethargy. He denied diarrhoea, fever, respiratory

or genitourinary complaints. He was obese, had long term

diabetes and was recently diagnosed arterial hypertension. He was

medicated with telmisartan/hydrochlorothiazide 80/12.5 once daily

and vildagliptin/metformin chloridrate 50/1000 twice daily.

At the admission to the ED he was conscious but disoriented,

dehydrated,

hypotensive,

complaining of abdominal pain.

His blood work showed elevated serum creatinine levels

(6mg/dl), hyperkalemia (6.7mmol/L), blood acidemia (pH 7.11)

with elevated lactate (

15mmol/L) and decreased levels of

bicarbonate (7.6mmol/L). Thinking of acute kidney injury and

metformin-associated lactic acidosis he immediately began

dialysis.

After reviewing his medical files we discovered he had a known

diabetic nephropathy without proper medical follow-up.

Conclusion:

The authors present this case as a reminder that

despite being the first line treatment in overweight diabetics, the

use of metformin demands a careful monitoring of renal function,

especially in older patients. The initiation of antihypertensive drugs

should also prompt renal function evaluation.

P-038

Detection of frailty among older patients in a Finnish county

hospital emergency department

K. Tolonen

, J. Tolonen

, J. Mattila

, T. Strandberg

, V.-P. Harjola

Oulunkyl¨a Rehabilitation Hospital, Helsinki, Finland;

Helsinki

University City Hospital, Helsinki, Finland;

Helsinki University Central

Hospital, Helsinki, Finland;

Mejland sjukhus, Helsingfors 29, Finland

Objectives:

Frailty in older people is associated with serious

complications including recurrent emergency department (ED)

visits and increased mortality risk. Several tools have been

developed for ED staff to recognize frailty in older patients. We

analyzed the usefulness of Identification of Seniors At Risk (ISAR)

and Triage Risk Screening Tool (TRST) instruments in a large Finnish

county hospital ED.