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

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S42 Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
Methods: Between 1 March and 31 May, 2014, all patients aged
≥75 years admitted to ED by paramedics were included to the
study. ISAR and TRST tests were done at admission. ICPC- and
ICD-10 codes were recorded with discharge data from ED. 90-day
mortality and recurrent ED visits were related to ISAR or TRST
positivity (≥2 points).
Results: We recruited 775 patients (mean age 84, SD 5.4) with
820 visits. ISAR test was performed in 533 and TRST in 816 visits.
Overall 90-day mortality was 14%. ISAR-positive had more ED visits
than ISAR-negative (P = 0.002) during follow-up, whereas 90-day
mortality risk was raised among TRST-positive (P< 0.001). In Cox
multivariate analysis ISAR positivity was linked to recurrent ED
visits (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.0–1.8),
and TRST positivity to mortality (HR 3.4, 95% CI 1.5–7.7).
Conclusions: Our results support using both ISAR and TRST for risk
stratification in older ED patients. TRST seemed to be more useful
in mortality prediction and ISAR in recurrent visit prediction. Tests
may be generated as part of electrical patient database software
making them more easily introduced in everyday ED work.
P-039
Prevalence and etiology of anaemia in older persons
V. Van Ouytsel1, M. Deschodt2, E. Joosten 1, J. Flamaing 3
1UZ Leuven, Leuven, Belgium; 2Department of Public Health and
Primary Care KU Leuven and University Hospitals Leuven, Leuven,
Belgium; 3Department of Geriatric Medicine University Hospitals
Leuven and KU Leuven, Leuven, Belgium
Objectives: Anaemia is an important clinical problem in older
persons and the etiology is unknown in a significant number
of patients. Aim of this study is to determine the prevalence of
anaemia, the spectrum of underlying etiologies and the prevalence
of unexplained anaemia (UA) in hospitalized older patients.
Methods: We conducted a cohort study with retrospective data
collection, including all patients aged >75 years admitted to the
geriatric ward of a university hospital between 01/01/2014 and
31/05/2014. Anaemia was classified according to the WHO criteria.
Demographic and clinical data, length of stay (LOS) and standard
laboratory measures were compared between patients with a clear
cause of anaemia (ACC) and those with UA.
Results: Of the 203 included patients, 64% (n = 130) were
anaemic. Anaemic patients had a mean age of 84.9±5.4 years
and were mostly female (63%). UA accounted for 19.2% of
cases. The most common etiologies in ACC were chronic
inflammation (33%), chronic kidney disease (13%) and iron
deficiency anaemia (12%). Haemoglobin levels were lower
(mean±SD 10.0± 1.6 vs. 10.8±1.0 g/dL; p = 0.006), platelet counts
were higher (mean±SD 268.2±103.5 vs. 212.2±86.0×109/L;
p = 0.015) and LOS was longer (mean±SD 14.9±9.6 vs. 10.6±7.4
days; p = 0.04) in patients with ACC versus UA, respectively.
Conclusions: This study confirms that anaemia and UA are common
in hospitalized older patients. Anaemia is more severe and LOS is
longer in patients with ACC than UA.
P-040
Acute functional decline in patients admitted for acute
geriatric care
V. Vevatne1, A.H. Ranhoff2, S. Alaburic1, T. Svendsen1 , L. Mensen1 ,
T. Engstad1, A. Engvik1
1Diakonhjemmet Sykehus, Oslo, Norway; 2 Diakonhjemmet Hospital,
Oslo, Norway
Background: Acute functional decline often cause hospitalization
of older people. The aim of this study was to find characteristics
of patients admitted to our acute geriatric ward with symptoms of
acute (during the last 2 weeks) functional decline such as impaired
mobility, falls, delirium, food and fluid deficiency, and incontinence,
in order to develop efficient care pathways.
Material and Methods: This is a prospective observational cohort
study with the aim to improve quality of care, of acutely admitted
older (65+ years) patients. Patient administrative data and patient
record information including main diagnoses and characteristics
were included in a quality database. Acute functional decline was
defined as episodes of falls, rapid cognitive decline and/or reduced
general condition leading to ADL impairment within two weeks
prior to admission.
Results: Of all patients admitted to our geriatric ward in 2014
(614), (262, 63.9%) were female, mean age was 84.9, and 410
(66.7%) had acute functional decline. Most common main diagnoses
were infections in the respiratory (42, 10.2%) and urinary tract
(35, 8.5%) system, cardiac disorders (56, 13.7%), and cognitive
impairment (dementia and delirium) (40, 9.7%). Other main
diagnoses were cerebrovascular events, injuries, malignancies,
alcohol-related, anemia, dehydration and electrolyte disturbances
as well as adverse drug effects.
Interpretations: Many patients have acute functional decline when
admitted to an acute geriatric ward. Infections and cardiac disorders
and different cognitive problems were the most common main
diagnoses in these patients. A care pathway should include a broad
medical as well as comprehensive geriatric assessment.
P-041
Geriatricians at the front door: pilot scheme in the emergency
department of Salford Royal NHS Foundation Trust
A. Vilches-Moraga1, S. Pradhan1, J. Wallace1, T. Pattison1,
O. Gaillemin2, J. Fox1
1Salford Royal NHS Foundation Trust, Salford, Manchester, United
Kingdom; 2Salford Royal Hospital NHS Foundation Trust, Salford,
Manchester, United Kingdom
Objectives: Advanced age is a strong predictor for Emergency
Department (ED) attendance and hospital admission. Older people
experience higher complication rates and longer lengths of stay
compared with their younger counterparts.
We hypothesised that a consultant geriatrician employing
Comprehensive Geriatric Assessment (CGA) within the ED would
deliver significant clinical benefits.
Methods: Between 30th June and 1st August 2014, older adults
presenting to ED between 10am and 8pm with a geriatric syndrome
and/or frailty received timely geriatrician review, structured CGA
and targeted multidisciplinary interventions.
Results: 168 patients with mean age 84.9 years were included. 102
(61%) were female. Mean number of co-morbid conditions were
2.47 (1–7), 71 (42%) had dementia, 67 (40%) were from care homes
and 102(61%) were dependent for activities of daily living. Mean
length of stay was 6.5 days (0–55 days), with a 30-day readmission
rate of 10.1% (cf 18.2% for all over-80s presenting in 2013). The
conversion rate was 68.6% (cf 70% for all over-80s presenting in
2013). 30 day mortality rate was 1.79%.
Median length of time to see a geriatrician from presenting in
ED was 1hour 52-minutes (compared with 32-hours in July 2013).
Patients were assessed by a mean of 1 doctor prior to seeing a
geriatrician (compared with 4 in July 2013).
Conclusions: For frail older people, prompt geriatrician
involvement and MDT targeted interventions impact on clinical
outcomes such as length of stay, readmission rates and mortality,
as well as improving quality of care and patient experience.