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S78
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
criteria: Inability to speak Norwegian and declined consent to
participate. The Confusion Assessment Method (CAM) was used
to identify the presence of PD for 5 consecutive days after
treatment. Cognitive function was assessed with the Mini-Mental
State Examination (MMSE) the day before treatment and at 6-
month follow-up. Longitudinal regression analyses were used to
establish the predictive effect of PD in cognitive function.
Results:
The majority (57%) of patients was female, and TAVI
performed in 46% of the study population. As expected, patients
in the TAVI group were older (p
<
0.001), had more comorbidities
(p
<
0.001) and higher logistic EuroSCORE I(p
<
0.001). Additionally,
they had lower MMSE scores (p = 0.007). Still, proportionally fewer
patients treated with TAVI than with SAVR experienced PD (44%
vs. 66%, p = 0.013). No differences in cognitive function between
baseline and follow-up, in any group, were revealed. However,
patients undergoing TAVI and experiencing PD had lower MMSE
scores compared to those without PD. Regression models revealed
no baseline-adjusted predictive effect of PD.
Conclusions:
PD did not predict changes in cognitive function. This
is an encouraging finding for octogenarian patients undergoing
aortic valve implantation, for whom avoiding or delaying cognitive
disability might have a higher priority than promoting longevity.
P-173
Delirium in old patients with reactivated chronic diseases
admitted to an intermediate care hospital
N. Gual
1
, G. Carrizo
1
, A. Calle
2
, A. Yuste
1
, R. Lanseros
1
, M. Inzitari
3
1
Parc Sanitari Pere Virgili, Barcelona, Spain;
2
Parc Sanitari Pere Virgili,
Spain;
3
Spain
Objectives:
Delirium in older hospitalized patients is common and
leads to poor clinical outcomes. However, studies about delirium in
intermediate care (IC) geriatric hospitals, receiving older adults with
exacerbated chronic diseases from the emergency departments
(ED), are scanty. We assessed incident delirium, its risk factors
and short-term outcomes in this setting.
Methods:
We enrolled consecutive older patients transferred
from ED to the IC Hospital Pere Virgili, Barcelona, during 3
months. Delirium was determined using the Confusion Assessment
Method (CAM). We collected demographics, admission diagnosis,
associated dementia, dysphagia, malnutrition, functional status
(Barthel Index), comorbidity (Charlson Index), return to usual living
situation at discharge and mortality.
Results:
Out of 261 patients (mean age+SD=85.2+7.4, 68% women,
53% admitted for respiratory problems, 41% with dementia), 119
(45.6%) developed delirium. In a multivariable logistic regression,
dementia and age were associated with delirium (p
<
0.001),
and delirium with less home discharge (p = 0.003) and increased
mortality (p
<
0.001). Stratifying for dementia, 38 (25.2%) patients
without dementia developed delirium; age, malnutrition, worse
functional status and chronic renal failure were associated with
incident delirium adjusting for confounders. Regarding patients
with dementia: 80 (75.5%) developed delirium; age and admission
diagnosis different from respiratory or heart diseases were
associated with delirium; delirium did not predict discharge
destination or mortality.
Conclusions:
In our sample, dementia and age are associated with
incident delirium, which reduces home discharge and survival.
Identifying risk factors for delirium might help to design prevention
and management strategies in this setting
P-174
Undiagnosed prior cognitive impairment in delirium
T. Jackson
1
, A.M.J. Maclullich
2
, J. Gladman
3
, J.M. Lord
4
, B. Sheehan
5
1
School of Immunity and Infection, University of Birmingham,
Birmingham, United Kingdom;
2
Edinburgh Delirium Research
Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh;
3
University of Nottingham, Nottingham, United Kingdom;
4
School
of Immunity and Infection, University of Birmingham Centre,
Birmingham;
5
Medicine, Rehabilitation and Cardiac division, John
Radcliffe Hospital, Oxford
Objectives:
Cognitive impairment is a risk factor for delirium, but
the prevalence of previously undiagnosed cognitive impairment
(dementia or mild cognitive impairment) in patients with delirium
is unknown.
Methods:
We performed a prospective cohort study of people
over 70 years admitted to hospital with delirium to establish the
prevalence of previously unrecognised prior cognitive impairment.
Delirium was diagnosed at baseline using the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV-TR). Mild cognitive
impartment and dementia were diagnosed at 3 months in
survivors using the International Working Group on Mild Cognitive
Impairment criteria and DSM-IV criteria respectively. The group
with prior cognitive impairment had a higher burden of co-
morbidity (median co-morbidity index 2.0 vs 0.0, p = 0.002) and
frailty (median clinical frailty scale 5.5 vs 4.0, p
<
0.0005) than the
group with no prior cognitive impairment.
Results:
82 participants with delirium were followed up at
3 months: 5 (6.1%) had persistent delirium, 14 (17.1%) had
mild cognitive impairment and 47 (57.3%) had dementia. In 17
participants with prior dementia and 14 with prior mild cognitive
impairment the diagnosis had been unrecognised, amounting to
31/82 (38%) of all patients with delirium having some form of
previously undiagnosed cognitive impairment.
Conclusions:
Three quarters (61/82, 74.4%) of patients admitted to
hospital with delirium had evidence of prior cognitive impairment.
Given that over 1/3 of older patients with delirium were found
to have a previously undiagnosed cognitive impairment, the
development and evaluation of services to follow-up and manage
patients with delirium is warranted.
P-175
Are outcomes in older patients undergoing elective orthopedic
surgery related to anemia and blood transfusion?
C.-K. Liang
1
, C.-L. Chu
2
, M.-Y. Chou
3
, Y.-T. Lin
4
, T. Lu
4
, C.J. Hsu
4
,
H.-C. Lam
4
, L.-K. Chen
5
1
Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan;
2
Kaohsiung Veterans General hospital, Kaohsiung;
3
Center for
Geriatrics and Gerontology, Kaohsiung Veterans General Hospital,
Kaohsiung, Taiwan;
4
Kaohsiung Veterans General hospital, Kaohsiung,
Taiwan;
5
Taipei Veterans General Hospital, Taipei, Taiwan
Aim:
To evaluate whether anemia at admission predicts
postoperative delirium(POD) among older patients undergoing
elective orthopedic surgery, and the interrelationship of blood
transfusion(BT) in operation and anemia.
Methods:
This prospective cohort screened subjects aged over 60
years who were admitted for elective orthopedic surgery in a ter-
tiary medical center from 2011/04 to 2013/12. Age, gender, BMI, ed-
ucational level, surgery-related factors (ASA class, type of anesthesia
and surgery, receiving BT in operation), results of geriatric assess-
ment (hearing/visual impairment, cognition, depressive mood, co-
morbidity, malnutrition, polypharmacy, ADL, and IADL), laboratory
data, POD and length of hospital stay were collected for analysis.
To investigate the association of anemia, BT and POD, we grouped
patients based on baseline anemia or not, and receiving BT or not.
Results:
37/461 patients (8.0%) developed POD. Anemia at
admission and BT in operation are associated with POD and longer