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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S69
other factors relevant to the geriatric population, to identify older
patients at risk for falling.
P-139
Older People Assessment and Liaison Service (OPAL) impact
in patients admitted to Medical Assessment Unit (MAU) at
Ashford & St. Peter’s NHS Trust
A. Smith
1
, K. Yeong
1
, R. Lisk
1
1
Ashford & St. Peter’s NHS Trust, Chertsey, United Kingdom
Objectives:
Elderly patients are frequent users of our emergency
care pathway. These patients do not have a comprehensive geriatric
assessment (CGA) and have high re-admission rates and length
of stay (LOS). The Trust’s vision was to ensure that every “older
person” gets the highest quality of care and treatment to meet
their needs
Methods:
The OPAL team was set up in Oct 2013 and is based
in MAU 8am-6pm. It involves early CGA (2hrs during the day and
14hrs at night) by a geriatrician, nurse, therapist, dietician and
pharmacist. All patients
>
85 and patients
>
75 with 3 or more
frailty triggers are seen.
Results:
During the 1st 6 months, 1148 patients (over 85s) were
seen with average age 88 yrs. Conversion from MAU to ward was
81.2% compared to 90% previously (Oct 12-March 13). LOS has
reduced from 10.1 to 9.1 days. This is significant as each bed costs
the Trust £260, potential saving of £300,000. We have reduced
readmissions from 20.7% to 15.3%.
2 separate snapshot audits pre OPAL (Aug 2013) of 18 patients and
post OPAL (May 2014) of 23 patients are shown in the table.
Pre OPAL
Post OPAL
Assessed by geriatrician
17%
100%
Timely CGA
12.5%
84%
Falls risk assessment in 24hrs
29%
75%
Lying/Standing BP
0%
63%
Medication Review
43%
87%
Physiotherapy within 24hrs
14%
100%
Occupational Therapist in 24hrs
0%
62.5%
AMTS documented
50%
89%
Collateral history obtained
35%
100%
Incontinent management plan
17%
100%
Conclusions:
Early CGA in MAU is cost effective and helps to
reduce conversions from MAU to ward. It also reduces LOS and
readmissions.
P-140
Pericardial effusion, and falls: case report
K. Lop ´ez
1
, S. Jimenez Mola
2
, M. Lopez Vi˜nas
2
, E. Martin Perez
3
,
F.J. Idoate Gil Gil
4
, M. Aller Fernandez
1
, T. Pedraz Gonzalez-Tablas
1
1
Obra Hospitalaria Nuestra Se˜nora de la Regla, Le´on, Spain;
2
Complejo
Asistencial Universitario de Le´on, Spain;
3
Hospital San Jouan de Dios
Le´on, Le´on, Spain;
4
Complejo Asistencial Universitario de Le´on, Le´on,
Spain
Objectives:
To assess the effects of geriatric approach in patients
with falls.
Introduction:
Falls are a common problem in the elderly. An error
in their management is that injury from the fall is treated, without
finding its cause. Thus a proactive approach is important to screen
for the likelihood of fall in the elderly. Fall assessment usually
includes a focused history and a targeted examination. Pericardial
effusion is a relatively common finding in everyday clinical practice.
Sometimes the clinical picture of the patient leads directly to the
search for pericardial effusion.
Case report:
89-year-old female, depression on tab escitalopram,
presented with a 3 months of falls and 5 episodes of
unconsciousness. The syncopal episodes lasted for 30 seconds
to 1 minute with complete recovery, 15 days history of cough
associated with mucopurulent expectoration. On admission, a
pulse rate of 80/min, blood pressure of 167/119mm of hg. On
physical examination, breath sounds were decreased bilateral,
aortic murmur. Hemoglobin level was 12.4 g/dL, leukocyte count
of 7270/cmm. The chest x-ray showed right cardiomegaly small
amount of pleural effusion. Transesophageal echocardiography:
large pericardical effusion the intrapericardical pressure was
elevated. We perform a pericardical drainage 600 cc. of serum
liquid.
Conclusion:
Falls are the leading cause of unintentional injuries and
injury-related disability, morbidity and mortality in the geriatric
population. Therefore, they may also lower quality of life.
The most frequent etiologies of pericardial effusion were: neoplastic
(36%), idiopathic (32%), and uremic (20%).
P-141
Classification of behaviors in dementia based on theories of
compliance and aggression
A.S. Luthra
Program for Older Adults, Homewood Health Centre, Guelph, Canada
Objective:
There is vast heterogeneity in use of terminology and
classification of behaviors in dementia with no universally accepted
classification system. The objective is to classify behaviors in
dementias based on impairment in theories of compliance and
aggression.
Methods:
Criteria proposed by Davis, Buckwalter and Burgio
(1997) were identified as the basis for classification of behaviors
in dementia. A review of literature was done with a view to
identify the “Specification of the Theoretical Construct” (STC) to
justify aggregation of similar behavioral symptoms into clinically
meaningful categories.
Results:
STC identified for these behavioral categories are theories
on compliance and aggression. Behavioral categories emanating
from this construct are; Oppositional Behaviors (OB) and Physically
Aggressive Behaviors (PAB).
Conclusions:
OB is the result of non-compliance to the directions
being given by the care provider. The types of OB are determined
by the level of developmental sophistication or conversely by the
degree of cognitive impairment in patients with dementia. PAB
are the result of perceived impediment by the patient in goal
attainment. This results in the emergence of negative emotions.
These emotions are ‘out of proportion’ to the stimulus. The purpose
of this behavior is to warn the care provider of the noxious nature
of their involvement in the present situation.
P-142
Classification of behaviors in dementia based upon theories
of regulation of emotions
A.S. Luthra
Program for Older Adults, Homewood Health Centre, Guelph, Canada
Objective:
There is vast heterogeneity in use of terminology
and classification of behaviors in dementia with no universally
accepted classification system. The objective is to classify behaviors
in dementias based on impairment in theories of regulation of
emotions.
Methods:
Criteria proposed by Davis, Buckwalter and Burgio
(1997) were identified as the basis for classification of behaviors
in dementia. A review of literature was done with a view to
identify the “Specification of the Theoretical Construct” (STC) to
justify aggregation of similar behavioral symptoms into clinically
meaningful categories.