88 / 210
S80
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
of a hospital PS protocol – were included. Patients who died in the
emergency department and ICU were excluded.
Results:
169 patients sedated with midazolam were included (45%
before and 55% after the protocol), 53.9% and 46.2% were women,
mean age 81.1 and 82.3 years respectively. Most were hospitalized
in medical services (93%). The main refractory symptom in need
of PS was dyspnea (47.4% vs 46.2%); no refractory symptom was
identified in medical records in 5.3% and 10.8% of the patients.
After protocol implementation, consultations to the Palliative
Care Team decreased (35.5% vs 19.4% p = 0.018). Subcutaneous
drug administration decreased (15.8% vs 3.2% p = 0.012), although
induction dose of midazolam increased (1.3% vs 28% p
<
0.001),
the right rescue doses were more frequently used (0% vs 24.5%
p
<
0.001), as well as the maintenance dose for PS (1.5% vs 33.3%
p
<
0.001). Sedation level was measured in an increased number of
patients (7.9% vs. 31.5%, p
<
0.001).
Conclusion:
After the implementation of a protocol for palliative
sedation, the use of drugs, and the assessment of sedation
improved. However, many other aspects of palliative care were
unchanged or impaired. More efforts need to be done in
implementing the protocol in order to make it effective.
P-180
Palliative sedation in older vs younger hospitalized dying
patients
L. Garc´ıa Cabrera
1
, J. Mateos-Nozal
1
, E. Baeza-Monedero
1
,
L. L ´opez-Fando
2
, L. Rexach-Cano
2
, A.J. Cruz-Jentoft
3
1
Hospital Ram´on y Cajal, Madrid, Spain;
2
Hospital Ramon Y Cajal,
Madrid, Spain;
3
Hospital Universitario Ram´on y Cajal, Madrid, Spain
Objective:
To assess how palliative sedation (PS) is performed in
older, compared to younger patients dying in the hospital.
Methods:
Observational retrospective study. All subjects
>
17 years
old who died in the hospital in a 3-months period were included,
except those who died in the ED and the ICU.
Results:
278 patients died, 83.1% were older than 70 years, 47.9%
were women, 87% were hospitalized in a medical service. Reasons
for dying were cancer (31.3%), heart failure (15%), organ ischemia
(14.5%).
PS was used in 134 patients: 59.6% of those below 70 years old and
45.9% of the older ones. Consultations to the Paliative Care Team
were more frequent in the younger (33.3% vs 16%, p = 0.04). DNR
orders were more used in younger (59.3% vs 30.5%).
The main refractory symptom in need for PS in older patients
was dyspnea (33.3% vs 63.2%, p = 0.05), while pain was more
frequent in younger (55.6% vs 24.8%, p = 0.002). The drug used for
PS was midazolam (100% vs 80.2%, p = 0.04), morphine was used
in 15.1%. Induction and maintenance doses of midazolam were
correct in 24.3% and 33.3% of older. Rescue doses were indicated
more frequently in younger (88% vs 55.1%, p = 0.003) The level of
sedation was not assessed in 46% (22.2% vs 51.2%), 19.5% of older
showed agitation.
Conclusion:
PS was used frequently both in young and old
hospitalized patients, being refractory dyspnea and pain the most
common symptoms. Midazolam was the drug of choice. Many
aspects of PS were different in younger and older patients.
P-181
The process of nurse-led telephone-based care coordination
and follow-up of elderly cancer patients
G. Gavazzi
1
, N. Zerhouni
1
, N. Mitha
1
, E. Jourin
1
, C. Turin
1
,
P. Guillem
1
1
University of Grenoble Alpes, Grenoble, France
Objectives:
Because of limited ressources for medical geriatric
evaluation we examine the feasibility of a nurse-led telephone-
based follow-up of elderly cancer patients.
Methods:
Between January 2013 and December 2014 all patients
with cancer at any stage aged 70 years and older addressed
to the geriatrician by an oncologist, surgeon or radio therapist
were assessed at baseline and enrolled in a nursing telephone-
based follow-up. Selected geriatric conditions included in the
comprehensive geriatric assessment were collected at baseline
and at J30 and J120. Those geriatric conditions are as follows:
functional status as assessed by the Activities of Daily Living (ADL)
and Instrumental Activities of Daily Living (IADL) scales, nutritional
status using the Body Mass Index (BMI) and the Mini Nutritional
Assessment-short form, history of falls. And change in the social
environment.
Results:
A total number of 174 patients took part of the follow-
up after an outpatient geriatric evaluation (baseline). The mean
age was 83 years. 52% of patients were females. Main tumor sites
were lung (almost 40%). All patients who were alive at the date
of the telephone interview could participate to the follow-up. The
median survival time of the total group from the geriatric baseline
evaluation reached about 6 months. Evolution of ADL,IADL and
others parameters will be presented.
Conclusions:
Utilization of limited geriatric oncology resources
may be optimized by performing a training nurse-led telephone-
based follow-up.
P-182
Legal guardians’ decisions in a dedicated PEG clinic
E. Gil
1
, A. Hirsch
1
1
Bnai Zion Medical Center, Haifa, Israel
Objectives:
Despite a growing body of cumulative data indicating
no advantage placing a tube feeding in advanced dementia patients,
percutaneous endoscopic gastrostomy (PEG) is still a common
practice in advanced dementia patients in Israel. A unique clinic was
established, aimed to give patients’ legal guardians a comprehensive
understanding of the procedure, and to recommend comfort
feeding, as an alternative to tube feeding.The clinic appointments
are conducted by a geriatrician and a gastroenterologist, and last
about an hour each. The conversation always consists of information
about the course and prognosis of end stage dementia, the futile
nature of tube feeding in these patients, as well as more technical
information about the procedure and its known complications.
Our aim is to evaluate legal guardians’ decision making after this
thorough discussion.
Methods:
Data of the first 40 legal guardians of advanced dementia
patients who attended the clinic were analyzed retrospectively.
Results:
Most of the guardians were family members of the
patients: 29 were descendants, 2 were spouses, 5 were other
relatives (siblings, nephews). Only 4 were public guardians.
In two cases there was an absolute contra-indication for
gastrostomy placement. Of the 38 remaining cases – 33 guardians
decided to sign up the informed consent form despite our
recommendations. 5 guardians decided to withhold the procedure
and start (or continue) comfort feeding.
Conclusion:
The vast majority of advanced dementia patients’
legal guardians decided to place a gastrostomy, contrary to the
professional information and recommendations presented.
More research (preferably qualitative) is needed to understand the
reasons for the surprising results.
P-183
Hospice Home Immersion Project: advancing medical
education
M. Gugliucci
University of New England College of Osteopathic Medicine, Biddeford,
United States of America
Background:
The University of New England College of Osteopathic
Medicine Hospice Immersion project was piloted in Maine, USA,