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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S71
VHD patients undergone valve replacement surgery before and after
HVC implementation were analysed.
Results:
Twenty-height older VHD patients admitted to the HVC
between April 2014 and February 2015 underwent cardiac surgery.
HVC patients were older relative to those treated in 2013 (n = 121)
(79.1
±
4.3 vs. 76.5
±
4.2 years; p
<
0.01), with no differences in gender
distribution, VHD type and severity, NYHA class or number of co-
morbid conditions. The total length of hospital stay was unvaried,
despite longer time spent in postoperative intensive care unit
by HVC patients (159.4
±
166.7 vs. 86.0
±
70.0 hours; p
<
0.001).
The number of specialist consultations was reduced after HVC
implementation (0.8
±
1.0 vs. 2.5
±
1.9; p
<
0.0001). None of HVC
patients died during hospitalisation, whereas 4 patients died in
2013 (p = 0.7).
Conclusion:
The implementation of a multidisciplinary clinical
pathway dedicated to geriatric patients with VHD allows extending
eligibility to surgery to older and frailer subjects and optimising
the use of resources, without impacting mortality or length of
hospitalisation.
P-147
The relationship between oncological (ECOG PS), geriatric
[Comprehensive Geriatric Assessment (CGA), and Rockwood
Frailty Index (IF)] evaluation: preliminary results in a cohort
of oncogeriatric patients
F. Monacelli
University of Genoa, Genoa, Italy
Objective:
CGA is the gold standard for elderly assessment to
optimize cancer treatment and to stratify their biological condition
(frail, pre-frail, fit). However, the method is time-consuming and of
specialist expertise. Other tools did not provide the same specificity.
We plan to compare different evaluation scales to assess the best
predicting oncogeriatric tool.
Methods:
First visit included ECOG PS, CGA, IF, Short Form Health
Survey-36 (QoL). Patients were assessed after 1 month for mortality,
3/6 and 12 months for QoL, functional status, performance status
and overall mortality.
Results:
Fifty-two patients (29 females, 23 males), with solid
tumour, mean age of 79
±
1.0 years were enrolled from January
2015 in an Italian hospital. Respectively, 10% of pt by ECOG PS,
and 35% of pt by CGA were frail. By IF, 28 pts were frail (55%), 23
pre-frail (45%) and 1 was fit. The correlation between the last two
tools was moderate (R=+0.60, p
<
0.001).
CGA unmasked several clinical problems: delirium (8%), depression
(35%), insomnia (4%), pain (33%), malnutrition (35%), lack of
social support (6%), cognitive deficit (14%), osteoporosis (10%),
rehabilitation need (15%),others (8%).
The overall mortality was of 7% (4/52 patients). The 30-day
mortality after surgery was of 14% (3/21 pts) with 3 patients
assessed as frail by both CGA and IF and one patient assessed
as fit by CGA and pre frail by IF.
Conclusions:
The preliminary comparison between CGA and IF
showed different predicitivity. The larger enrolment and follow
up will contribute to identify the best predicting tool in
oncogeriatrics.
P-148
Transcatheter aortic valve implantation may modify the
expected risk of mortality according to the Multidimensional
Prognosis Index
M. Paccalin
University Hospital, Poitiers, France
Objective:
To assess the impact of transcatheter aortic valve
implantation (TAVI) on expected prognosis according to the frailty
status.
Participants:
Consecutive patients who underwent TAVI and
a complete comprehensive geriatric assessment (CGA) between
January 2013 and September 2014.
Measurements:
Baseline Demographic data and a cardiologic
evaluation were recorded. The CGA included information on
functional, cognitive and nutritional status; risk of pressure sore;
comorbidities; medications; and social support network; the
information was used to calculate the multidimensional prognostic
index (MPI) for mortality using a previously validated algorithm.
The final MPI score is divided into three levels of mortality risk:
MPI-1, low risk (MPI ≤0.33), MPI-2, moderate risk (from 0.34–
0.66); and MPI-3, high risk (MPI ≥0.66).The vital status was
assessed in March 2015 through visits or phone calls to the general
practitioners.
Results:
50 patients were enrolled; mean age: 86.5
±
4.2 years
and mean European system for cardiac operative risk evaluation
(EuroSCORE): 18.35
±
11.58. Thirty patients (60%) were in the MPI-1
group, 19 (38%) in the MPI-2 group and 1 patient in the MPI-3 group.
The rate of mortality was 26% 1 year after TAVI. No association
between EuroSCORE, age or MPI-score was found (p = 0.19; p = 0.52
and p = 0.51 respectively).
Conclusion:
In this study including very old patients, frailty was
not associated significantly with increased mortality after TAVI.
However, the results showed the effectiveness of this innovative
procedure that may decrease the expected mortality between the
most frail and the least frail according to the MPI.
P-149
Are all the former Siberian deportees with posttraumatic stress
disorder patients at risk?
A. Parnicka
1
, K. Piotrowicz
2
, M. Mielima˛ka
3
, K. Basista
1
,
J. Walczewska
1
, A. Skalska
2
, K. Rutkowski
3
, T. Grodzicki
2
1
Department of Internal Medicine and Gerontology, Jagiellonian
University Medical College, Krak´ow, Poland;
2
Poland;
3
Jagiellonian
University Medical College, Krak´ow, Poland
Objective:
The primary aim of the analysis was to assess the group
of elderly people suffering from the post traumatic stress disorder
(PTSD) with the Identification of Seniors at Risk (ISAR) tool. The
secondary aims were to test the relationships between ISAR and the
Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-
CFS), muscle strength, and mobility according to the Timed Up and
Go (TUG) test.
Methods:
The group consisted of the outpatients aged ≥60 years
who had been deported during World War II or born in exile in
the Soviet Union. PTSD was diagnosed according to criteria of the
DSM-IV. Additionally, ISAR tool and the CSHA Clinical Frailty Scale
were used, and the muscle strength and mobility were measured.
Results:
The mean(
±
SD) age of 68 patients:70.4
±
6.8 years (min.-
max.:60–88 years); 55.9% men. ISAR (median; Q1, Q3): 3.5 (2, 5)
points; with higher results for women [4 (3, 5) vs 3 (2, 4) for
men;p = 0.02]. At risk was 85.3% and 70.6% of the group, according
to the threshold of two and three points, respectively. The
three most common complaints: sight problems (77.9%), using
>
3 medications/day (76.5%) and serious memory problems (52.9%).
There were significant correlations between ISAR and CSHA-CFS
(r = 0.718, p
<
0.001), and muscle strength (r = −0.433, p
<
0.001), and
the results of TUG (r = 0.415, p
<
0.001), respectively.
Conclusions:
The application of ISAR tool revealed that most of the
elderly patients with PTSD were vulnerable and at risk for future
adverse outcomes. ISAR correlated well with the CSHA Clinical
Frailty Scale as well as with the muscle strength and mobility.