A B S T R A C T S
Abstracts of the 14th International Congress of the European
Geriatric Medicine Society
10–12 October 2018, Berlin, Germany
Contents
EuGMS 2018 – Oral Communications Abstracts ... S2 Area: Metabolism and nutrition... S2 Area: Pre and post operative care ... S5 Area: Geriatric rehabilitation ... S7 Area: Frailty and sarcopenia ... S8 Area: Longevity and prevention ... S11 Area: Comorbidity and multimorbidity ... S14 Area: Geriatric education ... S17 Area: Comprehensive geriatric assessment ... S20 Area: Psychiatric symptoms and illnesses... S23 Area: Organisation of care and gerotechnology ... S23 Area: Vaccines and immunization... S26 Area: Urology and continence management ... S26 Area: Acute care... S26 Area: Cognition and dementia ... S29 Area: Delirium... S32 Area: Geriatrics in organ disease... S34 Area: Biogerontology and genetics ... S37 Area: Oral and dental health... S38 Area: Pharmacology ... S39 Area: Ethics and end of life care... S42 EuGMS 2018 – Poster Abstracts ... S45 Area: Pharmacology ... S45 Area: Pre and post operative care ... S68 Area: Vaccines and immunization... S79 Area: Biogerontology and genetics ... S83 Area: Frailty and sarcopenia ... S87 Area: Geriatric education ... S125 Area: Geriatric rehabilitation ... S136 Area: Geriatrics in organ disease... S154 Area: Longevity and prevention ... S166 Area: Metabolism and nutrition... S181 Area: Oral and dental health... S195 Area: Organisation of care and gerotechnology ... S197 Area: Acute care... S210 Area: Cognition and dementia ... S231 Area: Comorbidity and multimorbidity ... S263 Area: Comprehensive geriatric assessment ... S289 Area: Delirium... S312 Area: Ethics and end of life care... S320 Area: Psychiatric symptoms and illnesses... S328 Area: Urology and continence management ... S333 Author index ... S336 https://doi.org/10.1007/s41999-018-0097-4
EuGMS 2018 – Oral Communications Abstracts
Area: Metabolism and nutrition O-1
Prevalence of malnutrition using harmonized definitions in older adults from different settings in Europe and New Zealand: a MaNuEL study
Dorothee Volkert1, Melanie Streicher1, Eva Kiesswetter1, Gabriel Torbahn1, Eibhlis M. O’Connor2, Mary O’Keeffe2, Mary Kelly2, Eileen O’Herlihy3, Paul W. O’Toole3, Suzanne Timmons4, Emma O’Shea4, Patricia Kearney5, Judith van Zwienen-Pot6, Marjolein Visser6, Isabelle Maıˆtre7, Virginie Van Wymelbeke8, Claire
Sulmont-Rosse´9, Gabriele Nagel10, Marion Flechtner-Mors11, Sabine Goisser1,
Ruth Teh12, Antje Hebestreit13
1Institute for Biomedicine of Aging, Friedrich-Alexander-Universita¨t
Erlangen-Nu¨rnberg, Nuremberg, Germany,2Dept Biological Sciences, and Health Research Institute, University of Limerick, Limerick, Ireland,3School of Microbiology and Alimentary Pharmabiotic Centre, University College Cork, Ireland,4Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland,5Dept Epidemiology and Public Health,
University College Cork, Cork, Ireland,6Dept of Health Sciences,
Faculty Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, The Netherlands,7USC 1422 GRAPPE, Ecole Supe´rieure d’Agricultures (ESA), SFR 4207 QUASAV, INRA, Angers, France,8Centre Hospitalier Universitaire Dijon Bourgogne, Unite´ de Recherche Poˆle Personnes Aˆ ge´es, Dijon, France,9Centre des Sciences du Gouˆt et de l’Alimentation, AgroSup Dijon, CNRS, INRA, Universite´ Bourgogne Franche-Comte´, Dijon, France,
10Institute of Epidemiology and Medical Biometry, Ulm University,
Ulm, Germany,11Medical Center, Division of Sports and Rehabilitation Medicine, University of Ulm, Ulm, Germany,
12University of Auckland, School of Population Health, General
Practice and Primary Health Care, Auckland, New Zealand,13Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
Introduction: Prevalences of malnutrition in older people vary widely because of different diagnostic criteria. This study compares prevalences using harmonized definitions.
Methods:Prevalences of low BMI (\ 20 kg/m2; age-specific \ 20 if \ 70 years and \ 22 if C 70 years), weight loss (WL), severe decrease in food intake (SDFI) and of combined BMI \ 20 and/or WL in participants aged C 65 years were compared.
Results:Fifteen samples with 5956 participants were included: 7 con-sisting of community-dwelling persons, 2 in geriatric day hospitals, 3 in hospitalized patients and 3 in nursing homes. Mean age of participants was between 67 and 86 years. Prevalences increase from community-dwellers to nursing homes residents and varied between and within the settings. Compared to BMI \ 20 kg/m2, using age-specific cut-offs
doubled the prevalence. The criteria age-specific BMI and WL showed opposing prevalences. WL and SDFI appear to be important criteria to detect malnutrition in men but they seem to be no sensitive markers in higher age groups. Prevalence of BMI \ 20 kg/m2and WL did not exceed 2.6%. The highest prevalences were observed based on com-bined definitions when only one of the criteria had to be present. Conclusion:Prevalences for different criteria vary which may be explained by functional status. Prevalences double when using an age-specific BMI versus a BMI \ 20 kg/m2. The criteria age-specific BMI and WL showed opposing prevalences. WL and SDFI appear to be important criteria to detect malnutrition in men but do not seem to be sensitive in higher age groups.
O-2
MNANutritional screening identifies COPD patients with higher rate of complications
Kala Kaspar1, Behnaz Shakersain1
1Nestle´ Health Science, Lausanne, Switzerland
Introduction:This review aimed to describe the evidence on clinical screening and prognostic relevance of nutritional status evaluated by Mini Nutritional Assessment (MNA) in chronic obstructive pul-monary disease (COPD) patients.
Methods: A comprehensive literature search in major electronic databases, including MEDLINE, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews, irrespective of date and language was performed by two independent reviewers. Published prospective and cross-sectional studies of patients diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, that evaluated nutritional status by the full or short MNAtool were included.
Results:All of the 27 relevant search hits were included (22 focused on COPD patients, 1 on pulmonology ward patients, 1 on assisted living facility residents, and 3 on community dwelling older adults). A study of COPD clinic patients (mean age 71 years, 75% men) found 69% were malnourished or at-risk, and higher rates were observed in more severe COPD stages. Poor MNA score could identify COPD patients with: (1) more severe COPD symptoms (9/9 studies), (2) compromised body composition (15/17 studies), (3) poor physical performance (10/11 studies), and (4) higher rate of compli-cations (5/5 studies). Those with poor MNAscore had 31% higher risk of COPD exacerbations, 3-fold higher risk of hospital readmis-sions in 6 months [HR: 2.9]; and 3-times higher risk of mortality within 3 years [OR: 3.33].
Conclusions: Timely nutritional screening and intervention is rec-ommended for optimal COPD management. MNA is a useful screening tool with prognostic value in COPD patient care.
O-3
The role of health considerations in food choice of community-dwelling older adults with functional limitations
Hanna Maria Rempe1, Eva Kiesswetter1, Dorothee Volkert1, Gudrun Sproesser2, Cornel Christian Sieber1, Ellen Freiberger1
1Institute for Biomedicine of Aging, Friedrich-Alexander-University
of Erlangen-Nu¨rnberg, Germany,2Department of Psychology,
University of Konstanz, Germany
Background:Interventions focusing on an adequate nutrition usually imply a health-oriented eating behavior. However, little is known about the role of health considerations in food choice of functionally impaired older persons and furthermore about other motives under-lying their eating behavior. Hence, aims of this study were a) to identify the main motives influencing food choice and b) to investi-gate factors related to a weak health-oriented eating motivation (WHEM).
Methods:This sub-study of the European trial ‘‘SPRINT-T’’ included 166 independently-living adults aged C 70 years with functional limitations (‘‘Short Physical Performance Battery’’ 3–9) in the area of Nuremberg (Germany). Using ‘‘The Eating Motivation Survey’’ (TEMS), 15 basic motives were recorded on a 7-point Likert scale ranging from 1 ‘‘never’’ to 7 ‘‘always applicable to eating behavior’’. In addition, gender (70.5% female), age (80.4 ± 5.2 years), body
mass index (29.5 ± 5.5), and frailty-status (Fried—phenotype) were assessed.
Results: ‘‘Appetite’’ (5.4 ± 1.4) was the most important eating motive, followed by ‘‘health’’ (4.7 ± 1.6) and ‘‘natural concerns’’ (4.6 ± 1.8). The probability (OR) of WHEM was 4.63 times higher for men than for women (95% CI 2.15–9.97). Adjusted for gender, frail participants (n = 50) compared to pre-frail participants (n = 99) were less likely to have WHEM (OR = 0.20; 95% CI 0.10–0.43). No further factors were associated with WHEM.
Conclusions:The importance of health as motive for food choice indicates that older people with functional limitations appear to be generally susceptible to health-related nutritional interventions. Par-ticularly in male and frail older adults personalized strategies and barriers towards a healthy diet should be considered.
O-4
Development and validation of a short food questionnaire to screen for low protein intake in community-dwelling older adults: the Protein Screener 55+ (Pro55+)
Hanneke A.H. Wijnhoven1, Liset E. Elstgeest1, Henrica C.W. de
Vet2, Mary Nicolaou3, Marieke B. Snijder3, Marjolein Visser1 1Department of Health Sciences, Faculty of Science, Vrije
Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands,2Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands,3Department of Public Health, Academic Medical Center, University of
Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
This study is conducted within PROMISS. In old age, sufficient pro-tein intake is important to preserve muscle mass and function. Around 50% of older adults (65+ years) consumes B 1.0 g/kg adjusted body weight (BW)/day (d). There is no rapid method available to screen for low protein intake in old age. Therefore, we aimed to develop and validate a short food questionnaire to screen for low protein intake in community-dwelling older adults. We used data of 1348 older men and women (56–101 years) of the LASA study (The Netherlands) to develop the questionnaire and data of 563 older men and women (55–71 years) of the HELIUS study (The Netherlands) for external validation. In both samples, protein intake was measured by the 238-item semi-quantitative HELIUS food frequency questionnaire (FFQ). Multivariable logistic regression analysis was used to predict protein intake B 1.0 g/kg adjusted BW/d (based on the HELIUS FFQ). Candidate predictor variables were FFQ questions on frequency and amount of intake of specific foods. In both samples, 30% had a protein intake B 1.0 g/kg adjusted BW/days. Our final model included adjusted body weight and 10 questions on the consumption (amount on average day or frequency in 4 weeks) of: slices of bread (number); glasses of milk (number); meat with warm meal (portion size); cheese (amount and frequency); dairy products (like yoghurt) (frequency); egg(s) (frequency); pasta/noodles (frequency); fish (frequency); and nuts/peanuts (frequency). The area under the receiver operating characteristic curve (AUC) was 0.889 (95% CI 0.870–0.907). The calibration slope was 1.03 (optimal slope 1.00). At a cut-off of B 0.8 g/kg adjusted BW/d, the AUC was 0.916 (96% CI 0.897–0.936). Applying the regression equation to the HELIUS sam-ple, the AUC was 0.856 (95% CI 0.824–0.888) and the calibration slope 0.92. Regression coefficients were therefore subsequently shrunken by a linear factor 0.92. To conclude, the short food ques-tionnaire (Pro55+) can be used to validly screen for protein intake B 1.0 g/kg adjusted BW/d in community-dwelling older adults.
An online version can be found at http://www.proteinscreener.nl. External validation in other countries is recommended.
O-5
Physical function after resistance training among old adults with metabolic syndrome
Olof Gudny Geirsdottir1, Alfons Ramel2, Milan Chang3, Palmi V Jonsson4, Inga Thorsdottir5
1The Icelandic Gerontological Research Center, Reykjavik, Iceland
and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland,2Faculty of Food Science and Nutrition,
University of Iceland, Reykjavik, Iceland and The Icelandic Gerontological Research Center, Reykjavik, Iceland,3School of Education, University of Iceland, Reykjavik, Iceland and The Icelandic Gerontological Research Center, Reykjavik, Iceland,
4Department of Geriatrics, National University Hospital of Iceland,
Reykjavik, Iceland and The Icelandic Gerontological Research Center, Reykjavik, Iceland,5Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
After attending this session, participants will know that older adults with metabolic syndrome improve significantly less in mobility function compared with those without after a resistance exercise programme. However, this obeseved difference is not explained by differences in physical activity and body mass index. Metabolic dysregulation affects physical performance among older adults. Metabolic syndrome (MetS) is an index of collected risk factors for cardiovascular disease/diabetes and the prevalence of MetS increases with aging. However, there is little information for the longitudinal association between MetS and physical function. We investigated the effects of a 12-week resistance exercise programme on physical function among community dwelling old adults with and without MetS. Total 236 subjects (73.7 ± 5.7 years, 58.2% female) partici-pated in the exercise intervention and 210 people completed the program. MetS was defined according to the NIH criteria (hav-ing C three risk factors, i.e., increased waist circumference, triglycerides, HDL cholesterol, blood pressure, fasting glucose). Objectively measured physical function included 6-min-walk-for-distance (6MWD), grip strength, timed-up-and-og (TUG) and knee extension strength. The prevalence of MetS was 33% (n = 78). The improvement of 6MWD from baseline to endpoint was 39.0 ± 33.2 m for people without MetS, and 22.1 ± 35.5 m for people with MetS. The linear regression model was performed to examine the association between baseline MetS and improvement of each physical performance after the intervention. Compared with those without MetS, those with MetS improved significantly less in 6MWD (b = - 14.6, 95% Confidence interval; - 26.5 to - 2.7, P \ 0.017) after adjusting for age, gender, physical activity and body mass index, and cognitive function, but no significant difference was found in other physical function. In conclusion, older adults with MetS improved significantly less in mobility function compared with those without MetS after the resistance exercise.
O-6
Happiness of the oldest old men is associated with fruit and vegetable intakes
Annele Urtamo1, Kaisu Pitka¨la¨1, Timo Strandberg1
Background:Positive emotions and happiness may improve health and prolong life. Diet quality, Mediterranean dietary pattern, fruit and vegetable, chocolate as well as fish consumption have been linked to positive affect, improved mood and reduced risk of depression in various studies. We examined how diet quality, food intakes, and nutrition related issues are associated with perceived happiness in the oldest old men.
Methods:The participants of this cross-sectional analysis of a lon-gitudinal study were the oldest old home-dwelling men (n = 338, mean age 88 years, range 82–97 years) from the Helsinki Business-men Study cohort. A postal health and nutrition survey was sent to them in 2016. Happiness was evaluated using the Visual Analog Scale of Happiness (0–100 mm). The nutrition survey included a 3-day food diary, Mediterranean Diet Adherence score and Diet Quality Index which is designed to measure adherence to Finnish nutrition recommendations. The participants were divided into quartiles cor-responding to their respective happiness scores. Diet quality scores, food intakes and other nutrition related indicators were classified into happiness quartiles.
Results:Perceived happiness was linearly associated with total fruit and vegetable intakes (p = 0.002) and inversely associated with age (p = 0.016), blood glucose levels (p = 0.049), skipping lunch (p = 0.023), reduced food intake (p = 0.002) and weight loss (p = 0.016).
Conclusions:Fruit and vegetable intakes indicated perceived happi-ness in the oldest old men while variables of poor appetite and ill health were inversely associated with happiness. Maintaining good nutrition and increasing fruit and vegetable consumption may be important for psychological health of older people.
O-7
Body-shape and falls among community-dwelling older adults in the Malaysian elders longitudinal research study
S.H. Kioh1, Sumaiyah M2, G.J. Tan3, S.B. Kamaruzzaman3, M.P. Tan3
1Ageing and Age-Associated Disorders Research Group, University
of Malaya, Kuala Lumpur, Malaysia,2Center for Innovation in
Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia,3Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Background:Results of existing studies on body mass index (BMI) and falls has been conflicting, which may be due to the value of BMI measurements that may be limited in this age group. The aim of this study was, therefore, to the relationship between waist: hip (WHR) and fall among community-dwelling older adults.
Methods:This was a cross-sectional study using the first-wave data from the Malaysian Elders Longitudinal Study (MELoR) among older adults aged 55 years and above. Basic demographic characteristics, medical history, anthropometric parameters and 12-month falls history were recorded. The overall population was categorized into three WHR categories: pear-shaped (WHR \ 0.8 (women)/WHR \ 0.95 (men), avocado-shaped (0.81 \ WHR \ 0.85 (women)/0.96 \ WHR \ 1.0 (men) and apple-shaped (WHR [ 0.85 (women)/WHR [ 1.0 (men). Results:Of the 1335 participants with mean age 68.38 ± 7.15 years, 559 (41.9%) were considered apple-shaped, 430 (32.2%) pear-shape and 346 (25.9%) with avocado-shaped. Logistic regression revealed significant increase in risk of fall in the apple-shaped (OR = 2.026, 95% CI 1.478–2.778) compared to the pear-shaped group. After adjustment for potential confounders, being apple-shaped (aOR =
1.646, 95% CI 1.086–2.495) remained independently associated with falls.
Conclusions: Significant relationship was observed between body shape and falls, with those within the apple-shaped category more likely to falls. Using the WHR may be a more useful measure to determine the relationship between excess body fat and falls. Future studies should seek to determine the underlying mechanisms and to identify interventions which alter body shape as a potentially modi-fiable risk factor for falls in older adults.
O-8
From mitochondria to healthy aging: the role of branched-chain amino acids treatment: MATeR a randomized study
Fausto Giordano Pili1, Francesca Dutto1, Paola Porrino1, Patrizia D’Amelio1, Giulia Carignano1, Cinzia Ferreri1, Massimiliano Massaia1, Giovanni C. Isaia1, Francesca Sassi2, Ilaria Buondonno2, Enzo Nisoli3, Claudia Ravetta3, Chiara Riganti4
1Department of Medical Science, Gerontology and Bone Metabolic
Diseases, University of Torino, Turin, Italy,2Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Torino, Turin, Italy,3Department of Medical Biotechnology and Translational Medicine, Centre for Study and Research on Obesity, University of Milano, Milan, Italy,4Department of Oncology, University of Torino, Turin, Italy
Introduction:Protein energy malnutrition often affects old patients and contributes to determine frailty and sarcopenia, which increase disability, morbidity and mortality. An increased intake of branched chain amino acids (BCAAs) enhances muscle protein anabolism and physical performance. The aim of this study is to assess if BCAAs supplements improve physical performance and mitochondrial func-tion and biogenesis in old malnourished patients.
Methods: 155 old malnourished outpatients were randomized to receive dietary counselling or BCAAs supplements. At baseline and after 1 and 2 months patients were evaluated for cognitive perfor-mance, perceived health status, nutritional status, muscle performance, appendicular muscle and fatty mass. Concurrently, we evaluated mitochondrial activity, biogenesis and fusion and oxidative stress. The effect of treatment has been evaluated by a two-way ANOVA for repeated measures, and the correlation between meta-bolic parameters and clinical features by a Pearson’s coefficient correlation. A p value \ 0.05 was considered statistically significant. Results:In both groups treatment has shown to improve nutritional status, cognitive performance and resistance to muscular fatigue, perceived health status and muscle performance including mobility and balance (with consequent decrease in risk of falls), BCAA treated patients improved more significantly. BCAAs increase mitochondrial activity and energy production, which appears to be related to improvement in cognitive and muscular performances. The increased expression of specific genes shows that BCAAs enhance mitochon-drial biogenesis and fusion.
Conclusions: Administration of BCAAs is effective in increasing physical and cognitive performance in old malnourished patients: we suggest that this effect is due to the increase in mitochondrial bio-genesis and performance.
O-9
Determinants of malnutrition in older Persons: results from the European MaNuEL knowledge hub
Melanie Streicher1, Gabriel Torbahn1, Eva Kiesswetter1, Mary OKeeffe2, Mary Kelly2, Marjolein Visser3, Eibhlı´s OConnor2
1Institute for Biomedicine of Aging, Friedrich-Alexander-Universita¨t
Erlangen-Nu¨rnberg, Germany,2Department of Biological Sciences, and Health Research Institute, University of Limerick, Ireland,
3Department of Health Sciences, Faculty of Science, Amsterdam
Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
Introduction:Malnutrition in older persons is multifactorial in origin with a multitude of factors from all areas of life involved. Present knowledge about determinants of malnutrition is still fragmentary and mainly based on cross-sectional studies using different definitions and assessment tools for both determinants as well as malnutrition. Methods: Within the European Knowledge Hub ‘‘Malnutrition in older persons (MaNuEL)’’, a systematic review (SR) focusing on longitudinal studies relating potential determinants to incident mal-nutrition in older participants from all health-care settings was performed. Furthermore, secondary data analyses and meta-analyses of 6 community-based, longitudinal datasets from Germany, Ireland, The Netherlands and New Zealand (n between 209 and 1841, total n = 4844) were conducted using a harmonized set of 23 potential determinants and a uniform definition of malnutrition.
Results:The SR identified 23 articles revealing consistent evidence of low to moderate quality that poor appetite, difficulties feeding one-self, poor self-reported health, and hospitalization are determinants of incident malnutrition. Meta-analyses of the 6 datasets (malnutrition incidence after 1–3 years between 5.1 and 17.2%) found higher age, marital status, walking limitations, limitations climbing stairs, and previous hospitalization as determinants of incident malnutrition. Key conclusion: Regarding preventive approaches, poor appetite, functional limitations, poor self-reported health and previous hospi-talization need specific attention. Further initiatives of data pooling and efforts to standardize the assessment of malnutrition and its determinants are warranted to further understand the etiology of malnutrition.
Area: Pre and post operative care O-10
Variability in the detection of delirium among older patients with hip fracture: results from the Gruppo Italiano di Ortogeriatria (GIOG) National Registry
Elena Tassitro1, Piero Rapazzini2, Amedeo Zurlo3, Chiara Mussi4,
Maurizio Corsi5, Maria Lia Lunardelli6, Anita Andreano1, Giuseppe
Bellelli7, Patrizia Floris8, Monica Pizzonia9, Antonella Barone10,
Albert March11, Andrea Ungar12, Valter Galmarini13, Piera Ranieri14,
Giuseppe Bellelli1
1University of Milano-Bicocca, Milan, Italy,2Orthogeriatric Unit,
Circolo Hospital, Varese, Italy,3Orthogeriatric Unit, Arcispedale S Anna, Ferrara University, Ferrara, Italy,4Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy,
5Orthogeriatric Unit, S Gerardo hospital, Monza, Italy,
6Orthogeriatric Unit, S.Orsola Malpighi, Bologna, Italy,7Orthopedic
Unit, ASST Vimercate, Carate Brianza hospital, Vimercate (MB), Italy,8Orthogeriatric Unit, Hospital of Sondrio-ASST VAL, Sondrio, Italy,9Orthogeriatric Unit, San Martino hospital, Genova, Italy,
10Orthogeriatric Unit, Galliera hospital, Genova, Italy,
11Orthogeriatric Unit, Bolzano hospital, Bolzano, Italy,12Geriatrics
and Intensive Care Unit, Florence, Italy,13Orthopedic Unit, ASST Fatebenefratelli Sacco, Milano, Italy,14Orthopedic Unit,
Poliambulanza hospital, Brescia, Italy, Department of Medicine and Rehabilitation, S. Anna hospital, Brescia, Italy
Introduction:Recently, a network of Orthogeriatric and Orthopedic Units (Gruppo Italiano di OrtoGeriatria, GIOG) was created in Italy to collect data of older patients admitted to hospital wards after hip fracture (HF). We report some data regarding the detection of post-operative delirium (POD).
Methods: 2570 patients (76.3% females) aged [ 65 years were recruited in 14 hospitals after HF from 2016 to March 2018. Infor-mation about residence before fracture, pre-operative cognitive impairment (POCI), type of anaesthesia and involvement of a geria-trician as consultant were collected. POD development was assessed on the 1st day after surgery with routinely employed instruments. Multivariate logistic p-values are reported.
Results:POD occurred in 636 patients (24.7%), with huge hetero-geneity among centers (11.7–38.8%, p \ 0.001). Delirium was significantly associated with gender (30.6% female vs. 22.9% male, OR = 1.6, 95% CI 1.2–2.1), age (30.0% C 85 years vs. 18.2% \ 85 years, OR = 1.7, 95% CI 1.3–2.1); POCI (40% severe POCI vs. no-POCI, OR = 5.6, 95% CI 4.0–7.9); geriatric involvement (25.1% yes vs. 19.2% no, OR = 2.8, 95% CI 1.3–6.4). No association was found between POD and type of anesthesia (24.8% general vs 24.7% other, p = 0.38) and living at home before fracture (23.9% yes vs 33.5% no, p = 0.86). No significant difference in median time from hospitalization to surgery was found between patients with POD (42.0 h; I–III quartiles 24.0–63.3) and those without POD (40.0 h, I-III quartiles 23.0–58.0; p = 0.59).
Conclusions:We found a huge heterogeneity in delirium detection among centres, at least partially related to patient and organizational characteristics. Diffusion of tools to systematically detect delirium is urgently required.
O-11
Factors associated with institutionalization after 1 year of hip fracture
Esther Lueje Alonso1, Lourdes Del Rosario Evangelista Cabrera2,
Karina Liz Quin˜ones Huayna1, Lucı´a Ferna´ndez Arana1, Victoria
Garay Airaghi1, Jesu´s Mora Ferna´ndez1
1Department of Geriatrics, Hospital Clı´nico San Carlos, Madrid,
Spain,2Department of Geriatrics, Hospital Universitario Severo Ochoa, Madrid, Spain
Introduction:Between fifteen and thirty percent of subjects living at home at the time of the fracture require institutionalization. The aim of this study is to determine the factors that influence institutional-ization in elderly one-year after suffering hip fracture.
Methods: Prospective 1 year follow up study (September 2015– March 2018). Patients aged [ 65 years admitted to the Orthogeriatric Unit with fragility hip fracture were included. Variables: baseline characteristics, comorbidity (CIRS-G, Charlson-Index), functional status (Barthel index-BI-, Functional ambulation classification-FAC-, Lawton index-LI-), haemoglobin upon admission (HbAd) and before discharge (HbDi), inhospital complications and destination at dis-charge. Multivariate logistic regression analysis was performed. SPSS version 25.0.
Results: 237 patients were included; age 85.46 ± 6.88, women 75.9%. Number of drugs 6 (IQR = 4–9), moderate-severe cognitive
impairment 17.3%, Charslon 5.9 (IQR = 4.90–7.25), CIRS-G 12 (IQR = 9–16); BI 90 (IQR = 75–95), FAC 5 (IQR = 4–5), 56.5% used walking aids, LI 4 (IQR = 1–7); HbAd 12.67 ± 1.66, HbDi 10.44 ± 1.00. Intracapsular fracture 50.2%, time until surgery 3.97 ± 2.22 days, heart failure (HF) 14%, delirium 22%, length of stay 13.44 ± 9.78 days; 3.8% were institutionalized before the frac-ture and 20.9% after 12 months. Factors associated with institutionalization after 1 year: age C 85 (p = 0.010), moderate-severe cognitive impairment (p \ 0.0005), FAC \ 4 (p = 0.001); HF (p = 0.05), BI at admission (p = 0.002) and at discharge (p \ 0.0005), length of stay (p = 0.002). Multivariate analysis: IB at discharge (OR: 0.9; 95% CI; 0.94–0.99; p = 0.026), length of stay (OR:1.1; 95% CI; 1.1–1.2; p = 0.002) and HF (OR:9.0; 95% CI; 1.1–80.5; p = 0.049).
Conclusions:The main risk factors for institutionalization following a hip fracture are IB at discharge, length of stay and to develop HF during the hospitalization. As a consequence, age, comorbidity and complications should not be considered isolated variables in the prediction of institutionalization.
O-12
Predicting 12-month mortality in emergency surgery patients assessed by an elderly care liaison service: Salford POP-GS Nicholas Springall1, Jenny Fox1, Areej Paracha1, Mollie Rowley1, Haroon Khan1, Luciana Miguel-Alhambra1, Alex Gomez-Quintanilla1, Genna Logue1, Amanda Pedersen1, Angeline Price1, Mohammad Moatari1, Arturo Vilches-Moraga1
1Department of Ageing and Complex Medicine, Salford Royal
Hospital, UK
Objectives:Almost half of patients admitted non-electively to gen-eral surgery are over 70-years of age. This study describes the demographic of older emergency general surgery (EGS) patients and factors that influence 12-month mortality in this population. Methods:Prospective study of consecutive patients aged 75-years or older admitted non-electively under general surgery between 8th September 2014 and 30th March 2017 and reviewed by our elderly care liaison team.
Results: 598 patients were included, with a mean age of 82.8 ± 5.6 years, and a female predominance (56.4%). At presenta-tion, 145 (24.5%) and 234 (39.1%) were dependent for basic and instrumental activities of daily living (ADL) respectively. 43 (7.2%) were residents in a care home and 288 (49.6%) were frail (Clinical Frailty Scale score of [ 4) Biliary conditions were the most common diagnoses (170, 28.4%). Complications affected the majority (466, 77.4%), with delirium affecting 136 (22.8%). Most (353, 59%) were managed medically, with 103 (17.2%) undergoing non-surgical pro-cedures and only 142 (23.7%) requiring surgery. Median length of stay was 8-days with a 30-day readmission rate of 9.2% (51). In-hospital mortality was 7% (42), rising to 29.2% (175) at 12-months. Strong predictors of mortality were ASA score III-IV (HR 2.62 IC 1.73–3.97), dependency for basic ADLs (HR 2.47 IC 1.56–3.89) and frailty (HR 1.94 IC 1.32–2.86)
Conclusions:Although the majority of older EGS patients survive an index hospital admission, a third are dead within a year. ASA score, presence of functional impairment, and frailty (measured using the Clinical Frailty Scale) are strong predictors of 12-month mortality.
O-13
Association between anticholinergic load and urinary retention after hip fracture surgery in patients over 75 years
Rebecca Haddad1, Charlotte Tomeo1, Judith Cohen Bittan1, Alice Gioanni2, Cedric Villain2, Marc Verny2, Jacques Boddaert3
1Unit of Peri-Operative Geriatric care, geriatric department, Hoˆpitaux
universitaires Pitie´-Salpeˆtrie`re-Charles Foix. DHU FAST, Assistance Publique Hoˆpitaux de Paris (APHP), Paris, France,2Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France,3Sorbonne University, University Pierre and Marie Curie (UPMC) Paris 06, University Hospital, Paris, France; Unit of Peri-Operative Geriatric care, geriatric department, Hoˆpitaux universitaires Pitie´-Salpeˆtrie`re-Charles Foix. DHU FAST, Assistance Publique Hoˆpitaux de Paris (APHP), Paris, France Introduction: Urinary retention (UR) is common after hip fracture surgery (HFS), which could be explained by several factors, including drug utilization with anticholinergic effects. Only two studies with conflicting results evaluate the association of anticholinergic load (AL) with UR in older patients after HFS. The objective of this study was to evaluate the association of AL measured by all existing scales with UR in this population.
Methods:All patients admitted after HFS in the Geriatric Perioper-ative Unit (UPOG) were included. UR was defined as the failure to urinate after indwelling catheter removal or the necessity of an indwelling catheter at any moment. AL was measured based on patients’ computerized prescriptions and considered all treatments received during hospitalization. AL was evaluated by several scales: Drug Burden Index (DBI-Ach), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), Anticholinergic Cognitive Burden Scale (ACB), Chew’s scale (Chew), Anticholinergic Activity Scale (AAS), Anticholinergic Load Scale (ALS), Clinician-Rated Anti-cholinergic Scale (CrAS), Duran’s scale (Duran) and AntiAnti-cholinergic Burden Classification (ABC).
Results: On the 53 patients included (mean age 86.9 ± 5.4 years; 81.1% female), there was 18.9% of UR. The mean ± SD AL (scale) was: 0.72 ± 0.40 (DBI-Ach), 1.39 ± 0.95 (ACB), 0.28 ± 1.26 (ARS), 0.55 ± 0.89 (ADS), 0.73 ± 1.30 (ABC), 0.79 ± 1.12 (Chew), 1.39 ± 0.74 (Duran), 0.38 ± 0.86 (AAS), 0.72 ± 0.95 (ALS) and 1.45 ± 1.08 (CrAS). There was a significant association between AL and RU measured by ABC (p \ 0.05), and a trend of significance when measured by ACB (p = 0.13), ADS, Chew (p = 0.08) and ALS (p = 0.16).
Key conclusions:In patients after HFS managed in UPOG, there was an association between UR and AL measured by only one of the 10 existing scales. These preliminary results will be verified in a cohort of 764 patients.
O-14
Documentation of capacity and consent to surgery in a trauma unit
EC Pulford1, Ralhan S1, K Shah1, B Yiu1, V Borkar1
1Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Introduction: Previous audits have confirmed high prevalence of cognitive impairment, dementia and delirium in trauma inpatients aged [ = 60 years. Mental capacity for decision–making cannot be automatically assumed in this frail group. Our local standard is to undertake and document formal capacity assessment with respect to
consent for surgery if patient meets one or more of: known to have dementia, currently delirious, AMT = \8.
Methods:A follow up ‘snapshot’ audit was undertaken of inpatients aged [ 60 years on Trauma Unit, recording: pre operative Abbrevi-ated Mental Test (AMT) scores, diagnosis of dementia, cognitive impairment, delirium, any recorded assessment of mental capacity with respect to planned operation. Consent Forms used—Form 1 (capacity assumed, no space to document process of capacity assessment); form 4 (patient lacks capacity, form has specific section to document process of capacity assessment).
Results:A third of admissions met our local criteria, of these 54% had a documented assessment of mental capacity. Most were prompted by and recorded on a Consent Form 4. The remaining 46% of patients had no documentation of the capacity assessment process in the notes although it is assumed/implicit in the completion of Consent Form 1.
Conclusions:There are a significant number of patients meeting our local criteria for capacity assessment who consent to surgery using a Form 1 and do not have the process documented except ‘by assumption’. A revision of Form 1 and a re-audit is planned. This work received ethical approval from the Trust Audit Committee.
Area: Geriatric rehabilitation O-15
Pre-discharge rehabilitation after hip surgery reduces 30-day readmissions in older adults: National Health Insurance Service– Senior Cohort (2007–2012)
Nari Bu1
1Dept of Family Medicine, Kyung Hee Medical Center, Seoul, South
Korea
Background:Rehabilitation programs before and after hip surgery can shorten the length of hospital stay, reduce the incidence of complications, and reduce the readmission rate after surgery in older adults aged 65 years or over. The present study aimed to investigate the status of readmissions within 30 days after discharge and related factors in elderly people through the big data analysis using the sample data from the National Health Insurance Service-Senior Cohort (NHIS-SC).
Methods: The subjects of the present study were patients aged 65 years or older who underwent hip surgery between 2007 and 2012. The subjects undergoing hip surgery included those who underwent at least one surgery of the following during the period: replacement arthroplasty, revision arthroplasty, arthrodesis, internal fixation, reduction of fractured extremity and internal fixation. Each variable was selected for sociodemographic characteristics and clinical fea-tures of the subjects, and the characteristics of medical institutions according to 30-day readmission.
Results:Among 9008 study participants, 1628 (18.1%) were read-mitted within 30 days. Lower readmission rate was associated with longer hospital stay, greater number of hospital beds, and rehabili-tation before discharge; whereas a higher rate was associated with provincially located hospitals, getting of medical aid, accompanying fractures, ICU admission, and comorbidities.
Conclusions: Pre-discharge rehabilitation in patients aged C 65 years who underwent hip surgery can reduce readmissions, and efforts to increase daily living functions such as muscle strength and walking ability are very important.
O-16
Increasing life-space mobility in multimorbid older persons with motor and cognitive impairment
Phoebe Ullrich1, Christian Werner1, Tobias Eckert1, Martin Bongartz1, Rainer Kiss2, Ju¨rgen M. Bauer1, Klaus Hauer1
1Department of Geriatric Research, AGAPLESION Bethanien
Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany,2Department of Health and Social Affairs, FHM Bielefeld, University of Applied Science, Bielefeld, Germany Introduction:The study objective was to determine the effectiveness of a specific, standardized home-based training to improve life-space mobility (LSM) in community-dwelling, multimorbid, older persons with cognitive impairment (CI) after discharge from geriatric reha-bilitation, a high risk group for LSM restrictions and institutionalization.
Methods: A double-blinded, randomized, controlled trial including older persons with mild to moderate cognitive impairment (CI) was conducted by a 12-weeks home-based training intervention and 12-weeks follow-up period. The intervention group (IG) received supervised recommendations for a home-based balance-, strength-and walking- training including a tailored motivational strategy. The control group (CG) received supervised recommendations for low-intensity exercise while seated. LSM was evaluated by the validated Life-Space Assessment in Persons with Cognitive Impairment (LSA-CI).
Results: 118 older persons (age: 82.3 ± 6.0 years) with mild to moderate CI (Mini-Mental State Examination: 23.3 ± 2.4) were included. Analyses of covariance (ANCOVAs), with baseline LSM as a covariate, revealed a training-related significant increase in LSM as documented by the LSA-CI composite score and 3 sub-scores (change from baseline: p B 0.001–0.023, partial eta2: 0.06–0.20), with female gender, low baseline LSM and increased physical activity during the intervention as significant predictors for increase in LSM. Training gains were sustained during follow-up for the composite score and one of three sub-scores (p B 0.023–0.026; eta2: je 0.06).
Key conclusions:The training was feasible and sustainably improved LSM in multimorbid, older people with CI, thus representing a suc-cessful program for post ward rehabilitation to promote LSM in a high risk group for activity restriction and institutionalization.
O-17
Fear of falling in geriatric patients recovering from hip fracture: a matter of motor performance or emotion
Tobias Eckert1, Karin Kampe2, Michaela Kohler2, Diana Albrecht2, Klaus Hauer1, Clemens Becker2, Klaus Pfeiffer2
1Department of Geriatric Research, AGAPLESION Bethanien
Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany,2Robert-Bosch-Hospital, Department of Clinical Gerontology and Geriatric Rehabilitation, Stuttgart, Germany Objective: Aim of this study is to examine the relations between multidimensional FoF, psychological function and motor perfor-mance in geriatric patients with hip fracture after admission to inpatient rehabilitation.
Methods:Baseline data of a total of 115 cognitively intact (6-Item-Cognitive-Impairment Test B 10) geriatric patients with hip fracture (mean age: 82.5 ± 6.8 years) and present FoF confirmed to partici-pate in a randomized controlled clinical trial. During first week after admission following measurements were conducted: 1-item FoF, fall-related concerns (Short Falls Efficacy Scale-International, Short
FES-I), perceived ability to manage falls (PAMF), fall-related posttrau-matic stress (6 questions based on DSM-IV criteria) psychological inflexibility (Acceptance and Action Questionnaire, AAQ-2), history of falls and motor performance (Short Physical Performance Battery, SPPB). Cross-sectional data were analyzed using path analysis. Results:Low motor performance had significant direct effects on FES-I (p B 0.01), whereas 1-item FoF was significantly and directly determined by fall-related posttraumatic stress (p B 0.05). Posttrau-matic stress significantly mediated the effects of high psychological inflexibility on 1-item FoF (indirect effect, p B 0.05). Being female (p B 0.01) and history of falls (p B 0.01) were significantly and directly associated with low perceived ability to manage falls. Discussion:Results indicate that the assessment of fall-related con-cerns by FES-I during an early stage of stationary rehabilitation maybe is insufficient to capture FoF in its whole nature. FES-I targets fall-related concerns related to activities of daily living which cannot be performed by hip fracture during the early stage of recovery. In this context the relevance of psychological inflexibility and post-traumatic stress symptoms was emphasized.
O-18
Nutrition and functional outcomes in older adults admitted to rehabilitation units: a multi-centre cohort study
Diana Lelli1, Alicia Calle2, Laura Mo´nica Perez3, Graziano Onder4, Alessandro Morandi5, Elena Ortolani4, Miriam Colominas3, Claudio Pedone1, Marco Inzitari3
1Campus Bio-Medico University of Rome, Rome, Italy,2Vall
d’Hebron University, Barcelona, Spain,3Parc Sanitari Pere Virgili, Barcelona, Spain,4Centro Medicina dell’Invecchiamento, Universita` Cattolica del Sacro Cuore, Rome, Italy,5Department of Rehabilitation and Aged Care of the Fondazione Camplani, Ancelle Hospital, Cremona, Italy
Introduction:Evidence about the role of nutritional status (NS) on functional outcomes (FO) after rehabilitation in older adults is scarce. Our aim was to analyse the association between NS and FO in older adults admitted to geriatric rehabilitation units.
Methods: The Sarcopenia And Function in Aging Rehabilitation (SAFARI) multi-centre study enrolled patients aged C 65 years admitted to geriatric rehabilitation units in Italy and Spain. FO were absolute and relative functional gain (AFG-RFG) in Barthel Index (BI) at 1 and 3 months after admission. The association between NS (Mini Nutritional Assessment-Short Form) and FO was explored using linear regression and mixed models, adjusted for potential confounders. Analyses were then stratified for diagnosis at admission. Results:We included 415 patients [mean age 81.4 years (SD:7.7); 67% female; 9.4% malnourished (MN), 42.7% at risk of malnutrition (RM), and 48% well nourished (WN)]. Admission diagnoses were hip fracture (39.5%), elective orthopaedic surgery (EOS) (29.5%), and stroke (31%). In adjusted linear mixed model, MN and RM partici-pants had lower BI compared to WN (MN: b: - 8.47, p = 0.023; RM:b: - 5.22, p = 0.031), differences between groups remained stable over time. After stratification for admission diagnosis, only MN patients admitted after EOS had worse FO, both at 30 days (AFG: b adjusted: - 13.54, p \ 0.001; RFG:b: - 32, p \ 0.001) and 3 months (AFG: b adjusted: - 17.79, p \ 0.001; RFG:b: - 26.77, p = 0.002).
Conclusions:In our sample, poor NS is associated with worse BI in older adults admitted to geriatric rehabilitation units; in patients undergoing EOS, MN is associated with worse FO. Our results doc-umented for the first time the importance to assess nutritional status before EOS.
Area: Frailty and sarcopenia O-19
Systematic review on pharmacotherapy for hypertension in functionally impaired elderly: sub-project of the Medication and Quality of Life in frail older persons (MedQoL) Research Group
Denkinger Michael1, Mu¨hlbauer Viktoria1, Brefka Simone1, Bollig Claudia2, Torbahn Gabriel3, Voigt-Radloff Sebastian2, Bauer Ju¨rgen4, Haefeli Walter E.5, Dallmeier Dhayana1
1AGAPLESION Bethesda Clinic Ulm, Geriatric Research Unit, Ulm
University and Geriatric Center Ulm/Alb-Donau, Germany,2Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany,3Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg and Institute for Biomedicine of Aging, FAU Erlangen-Nu¨rnberg, Germany,4Center for Geriatric Medicine, University of Heidelberg and AGAPLESION Bethanien Hospital, Heidelberg, Germany,5Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
Background: The 2013 guideline of the European Society of Cardi-ology on the management of hypertension leaves decisions on antihypertensive therapy in frail older patients to the treating physician, based on monitoring of the clinical effects of treatment (level of evi-dence: C). Due to the weak evidence, pharmacotherapy in this population is uncertain. As part of the ‘‘Medication and Quality of Life in frail older persons’’ study group we aim to review the evidence on pharmacotherapy for hypertension in functionally impaired older adults. Methods: We performed systematic literature searches for random-ized-controlled trials (RCTs) and prospective cohort studies (PCS) in Medline, Embase and Central. Trial were included if functionality was assessed, and participants were characterized as at least moder-ately functionally impaired. Inclusion of trials, data extraction and assessment of risk of bias was carried out by two reviewers inde-pendently. Conflicts were resolved by discussion with a third person. Results:From 15389 citations for RCTs and 4570 citations for PCS, 35 and 36 full texts, respectively, were identified as potentially rel-evant. Only 2 RCT and 4 PCS included functionally impaired older adults. Due to high heterogeneity, meta-analyses were not performed. Some trials show methodological issues, which will be presented at the conference.
Conclusions:The current literature does not allow reliable recom-mendations on the pharmacotherapy of hypertension in functionally impaired older patients. The assessment of functionality as well as the inclusion of frail older people in RCTs is urgently needed to shift pharmacotherapy of vulnerable patients from intuition to compelling evidence.
O-20
The impact of intramuscular adipose tissue on the 4-years mortality risk of hospitalized geriatric patients
Euge´nie Van Mieghem1, Scott Lamers1, Robin Degerickx1, Maurits Vandewoude2, Stany Perkisas2
1School of Medicine, University of Antwerp, Antwerp 2610,
Belgium,2University of Antwerp, Belgium; University Centre for Geriatrics, ZNA (Ziekenhuis Netwerk Antwerp), Belgium
Introduction:Intramuscular adipose tissue (IMAT) is an important factor in the decline of muscle strength and function, giving way to the process of sarcopenia. This study sought to determine the influ-ence of IMAT on the four-year mortality risk and it’s correlation with nutritional status and muscle mass, strength and physical performance.
Methods:All patients hospitalized at the geriatric department of the Saint-Elisabeth hospital in Antwerp (Belgium) from 01/08/2012–31/ 01/2013 were included. The IMAT and muscle mass were measured by a computed tomography (CT) scan of both upper legs. Subjects were divided into 4 groups according to percentage of IMAT in relation to the entire muscle bulk measured (0–20%, 20–40%, 40–60%, 60–80%). Muscle strength was measured by handgrip strength. Physical performance was measured by the Short Physical Performance Battery (SPPB). The nutritional risk status was assessed by the Mini-Nutritional Assessment-Short Form (MNA-SF). Results: A total of 302 subjects were obtained. In male subjects (n = 91), the IMAT has shown to be a significant factor (HR = 1.037; 95% CI 1.013–1.063) in determining the 4 years mortality risk. When comparing the 4 different male IMAT groups a significant difference in survival was noted (p = 0.047). In all subjects, a significant correlation was found between IMAT and muscle mass (PC = -0.606; p = 0.00), muscle strength (PC = - 0.305; p = 0.00) and physical performance (PC = -0.455; p = 0.00). No significant correlation was found between IMAT and nutritional status (PC = - 0.091; p = 0.203).
Conclusion:The IMAT is a significant prognostic factor in determin-ing the 4 years mortality risk in male hospitalized geriatric patients.
O-21
A cluster-randomized clinical trial of a daily physical activity combined with nutritional supplement in nursing home residents: the open study
H Gro¨nstedt1, S Vikstro¨m2, T Cederholm3, E Franze´n4, A˚ Seiger5,
A Wimo6, G Faxe´n-Irving7, AM Bostro¨m8
1Stockholms Sjukhem R&D unit, Stockholm; Allied Health
Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden,2Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden,3Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University & Department of Geriatric Medicine, Uppsala University Hospital, Uppsala & Karolinska University Hospital, Theme Aging, Stockholm, Sweden,4Stockholms
Sjukhem R&D unit, Stockholm; Department of Neurobiology, Care Science and Society, Division of physiotherapy, Karolinska Institutet, Stockholm & Allied Health Professionals, Function Area
Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden,5Stockholms Sjukhem R&D unit, Stockholm & Department of Neurobiology, Care Science and Society, Division of Clinical geriatrics, Karolinska Institutet, Stockholm, Sweden,6Department of Neurobiology, Care Science and Society, Division of neurogeriatrics, Karolinska Institutet, Stockholm, Sweden,7Stockholms Sjukhem R&D unit, Stockholm, Department of Neurobiology, Care science and Society, Division of clinical geriatrics, Karolinska Institutet Stockholm & Allied Health Professionals, Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden,8Stockholms Sjukhem R&D unit, Stockholm; Department of Neurobiology, Care science and Society, Division of nursing, Karolinska Institutet and Karolinska University Hospital, Theme Aging, Stockholm, & Western Norway University of Applied Sciences, Haugesund, Norway
Introduction: Chair rise are strongly associated with the ability to perform Activities of Daily Living. Protein deficiency seems to play an important role in the development of sarcopenia in older persons. Our aim was to investigate the effects of a 12-week combined daily intervention consisting of a sit-to-stand exercise (STS) and an oral protein-rich nutritional supplement (ONS) on physical function in nursing home residents.
Methods: A two-arm cluster-randomized controlled trial was per-formed in eight Swedish nursing homes. The 30-s Chair Stand Test was used as primary outcome. Adherence to the combined interven-tion within the interveninterven-tion group (IG; n = 60) was divided into ‘‘high dose’’ (‘‘HD’’) ([ 120 occasions of STS and [ 60 bottles of ONS for 12 weeks) and ‘‘low dose’’ (‘‘LD’’). The control group (CG; n = 60) received standard care. Data was analyzed using Student’s t test, p \ 0.05.
Results:120 residents, (mean (SD) 86 ± 5.4 years), were recruited at baseline, and 102 were available for follow up. There were no sta-tistical differences within or between the IG and CG regarding means of chair rises at baseline or follow-up. The mean number of chair rises increased significantly within the ‘‘HD-group’’ vs. the ‘‘LD-group’’. At baseline the mean numbers of chair rises were 6.8 for the ‘‘HD-group’’ (n = 21) and 5.7 for the ‘‘LD-‘‘HD-group’’ (n = 29) (p = 0.232). At follow-up the mean numbers of chair rise were 7.6 for the ‘‘HD-group’’ and 5.4 for the ‘‘LD-‘‘HD-group’’ (p = 0.02).
Key conclusions: Residents who adhered to the intervention improved their capability to perform chair rise. Trial Registration: ClinicalTrials.gov Identifier: NCT02702037.
O-22
The functional continuum in relation to survival in older adults: the FRADEA study
Emiel Hoogendijk1, Luis Romero2, Pedro Sa´nchez-Jurado2, Teresa Flores Ruano2, Silvia Lozoya Moreno2, Laura Plaza Carmona2, Borja Gil Garcı´a2, Ana Pe´rez Ferna´ndez-Rius2, Melisa Lo´pez Utiel2, Isabel Huedo Rodenas2, Leocadio Rodrı´guez-Man˜as3, Pedro Abizanda2
1VU University Medical Center, Amsterdam, The Netherlands, 2Albacete University Hospital, Albacete, Spain,3University Hospital
of Getafe, Spain
Introduction:The aim of the current study was to investigate whe-ther the functional continuum, based on a refined measure combining basic (BADL) and instrumental (IADL) activities of daily living and frailty, is associated with mortality in older adults during 10 years of follow-up.
Methods: Data were used from the Frailty and Dependence in Albacete (FRADEA) study, a population based sample of Spanish older adults. The current study included data of 924 participants over age 70 from the first measurement wave (2007–2009). At baseline, a functional continuum measure of 8 categories was constructed based on limitations in BADL using the Barthel Index, limitations in IADL using the Lawton IADL Index, and the criteria of the frailty pheno-type. Associations with 10-year mortality were assessed using Kaplan–Meier curves and Cox proportional hazards models. Results:The risk of mortality gradually increased towards the less functionally independent end of the continuum. The presence of mild, moderate or severe BADL impairment was associated with mortality, in models adjusted for age, sex, comorbidity and institutionalization. The analyses also revealed that those who were BADL independent, IADL dependent and pre-frail (HR = 2.27, 95% CI = 1.22–4.20), and those who were BADL independent and frail (HR = 3.74, 95% CI = 1.88–7.42) had an increased risk of mortality.
Key conclusions: This study showed that a functional continuum measure based on a combination of BADL, IADL and frailty pre-dicted survival in older adults. Interventions may be targeted at those who are becoming frail and are still functionally independent, as this group already showed an elevated risk of mortality.
O-23
Muscle fiber atrophy in neurogenic sarcopenia
Fabiana Tanganelli1, Stefanie Jarmusch1, Peter Meinke2, Uta Ferrari1, Fabian Hofmeister1, Stefan Hintze2, Benedikt Schoser2, Neuerburg Carl3, Mehaffey Stefan3, Drey Michael1
1Department of Medicine IV, geriatrics, University hospital, LMU
Munich, Germany,2Friedrich-Baur-Institute, Department of Neurology, University hospital, LMU Munich, Germany,
3Department of General-, Trauma- and Reconstructive Surgery,
Munich University Hospital, Nußbaumstr. 20, 80336, Munich, Germany
Background:Neurogenic sarcopenia based on loss of motor neurons and degeneration of the neuromuscular junction seems to be a sub-group of sarcopenia. Nothing is known about histological changes in neurogenic sarcopenia. Therefore muscle fiber diameter and vari-ability coefficient of type 1 and type 2 muscle fibers were measured in hip fracture patients.
Methods:Fiber diameters were measured from biopsies of the vastus lateralis muscle of patients with hip fracture (n = 19, 8 men and 11 women; 80.6 ± 76 years). To define neurogenic sarcopenia, Motor Unit Number Index (MUNIX) was measured. To define a metric measure for sarcopenia, a z-transformation from skeletal muscle index (SMI), derived from BIA and handgrip strength was calculated. All metric variables are presented as mean ± standard deviation. Pearson correlation coefficient and software SPSS statistics version 25 was used for statistical analysis.
Results:Fiber diameters of type1 were 60.7 ± 9.5 lm and of type 2: 46.3 ± 10.2 lm. MUNIX mean 95 ± 36 was measured. BIA (mean SMI: 8.93 ± 1.93 kg/m2) and handgrip strength (mean: 23.4 ± 9.4 kg) was used to calculate z-score. A correlation between z-score of sarcopenia and MUNIX (r = - 0.510, p = 0.030), MUNIX and Variability Coefficient (VC) of fiber type 1 diameter (r = 0.538, p = 0.021) and VC of fiber type 1 diameter and z-score of sarcopenia (r = - 0.640, p = 0.030) could be revealed.
Conclusion:Neurogenic sarcopenia plays a role in the development of muscle loss in hip fractured patients. Predominantly atrophy of type 1 muscle fibers seems to be a histological marker for neurogenic sar-copenia. Further investigations of muscle histology in that cohort should give a deeper insight in the genesis of this subtype of sarcopenia.
O-24
Standard error of measurement and smallest detectable change of the SarQoLquestionnaire: an analysis of subjects from 8 validation studies
Anton Geerinck1, Charlotte Beaudart1, Ivan Bautmans2,
Cyrus Cooper3, Fabiana De Souza Orlandi4, Jerzy Konstantynowicz5,
Beatriz Montero Errasquı´n6, Eva Topinkova´7, Maria Tsekoura8,
Jean-Yves Reginster1, Olivier Bruye`re1
1Department of Public Health, Epidemiology and Health Economics,
University of Lie`ge, Lie`ge, Belgium,2Frailty in Aging Research Group, Vrije Universiteit Brussel, Brussels, Belgium,3MRC Environmental Epidemiology Unit, Southampton General Hospital,
Southampton, United Kingdom,4Department of Gerontology, Federal University of Sa˜o Carlos, Sa˜o Carlos SP, Brazil,5Department of Paediatric Rheumatology, Immunology, and Metabolic Bone Diseases, Medical University of Bialystok, Bialystok, Poland,
6Department of Geriatrics, University Hospital Ramo´n y Cajal,
Madrid, Spain,7Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic,
8Department of Physical Therapy, Technological Institute of Western
Greece, Aigio, Greece
Introduction: The Sarcopenia Quality of Life (SarQoL) question-naire, a sarcopenia-specific patient-reported outcome measure, contains 55 items and produces 7 domain scores as well as 1 overall quality of life score (all between 0 and 100). This study aims to facilitate the inter-pretation of the SarQoLscores by calculating its standard error of measurement (SEM) and smallest detectable change (SDC).
Methods: Subjects were included from 8 international studies that examined the test–retest reliability of the SarQoL. The SEM, a measure of the error in the scores that is not due to true changes, was calculated by dividing the standard deviation of the difference between test and retest scores (SDdiff) by H2. The SDC, defined as change beyond measurement error, was calculated by multiplying SDdiff by 1.96.
Results:A total of 220 sarcopenic subjects, aged 77.0 ± 7.8 years and 65.0% female, were included. The SEM for the overall SarQoL score ranged from 1.07 to 4.20 for the individual studies, and was 2.98 in the pooled analysis. The SDC for the overall score ranged from 2.96 to 11.65 for the individual studies, and was 8.26 for all subjects.
Conclusions:This study shows that, for individual subjects, a change in overall quality of life of at least 8.26 (on a scale from 0 to 100) would have to be observed to confirm that a true change has occurred. It also demonstrates that the SarQoL is a precise instrument, with the observed scores within less than 3 points of the theoretical ‘‘true score’’.
O-25
Association between frailty and life-course obesity in community-dwelling elders: the GAZEL cohort
Landre´ Benjamin1, Czernichow Se´bastien2, Zins Marie1, Goldberg
Marcel3, Ankri Joe¨l1, Herr Marie1
1INSERM, U1168,2Georges Pompidou European Hospital, 3INSERM, UMS011
Frailty, an indicator of decreased physiologic resources, has been positively associated with obesity in the elderly. However, few studies had tried to capture the association between life-course exposure to obesity and frailty. This study aimed to assess the association between obesity duration in adulthood and the risk of frailty in life over 60 years old. This longitudinal study included 13205 adults from the GAZEL cohort (mean age 70 years). Adapted Fried’s frailty criteria were assessed by questionnaire. BMI categories were defined using self-reported height and annual self-reported weight from the 26 years follow-up and according to the World Health Organization cut-offs. Cross-sectional association between obesity and frailty was evaluated; among obese individuals, effect of obesity duration was estimated. We used multinomial regression adjusted for socio-demographic and medical confounders and odds-ratios (ORa) with 95% CI; results are presented separately for men and women. In 2015, 396 (4.4%) men and 310 (9.6%) women were considered as frail; 1351 (15%) men and 457 (14%) women were obese. A positive association was found between frailty and obesity status: ORa = 4.4 (3.2–6.2) in men and 8.1 (5.3–12) in women. Among the 1808 obese individuals, mean obesity duration was 16 years and each year spent in obese state increased the
risk of being frail in old age for men (ORa = 1.04; 1.01–1.1) and women (ORa = 1.07; 1.02–1.13). In conclusion, our data shows that obesity duration increased the risk of being frail in life over sixty years old. Early weight control may participate to healthy aging.
O-26
Muscle function, muscle mass and sarcopenia and its relation to independent ageing. A report from the Uppsala Longitudinal Study of Adult Men (ULSAM)
Kristin Franzon1, Bjo¨rn Zethelius1, Tommy Cederholm2, Lena Kilander1
1Department of Public Health and Caring Sciences/Geriatrics,
Uppsala University, Sweden,2Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Sweden
Introduction: Preserved independence is crucial to maintain high quality of life. We investigated the longitudinal relationship between sarcopenia, its components and independent ageing in very old Swedish men.
Methods:Participants of The Uppsala Longitudinal Study of Adult Men (mean age of 87 years) were investigated. Baseline sarcopenia was defined according to criteria suggested by the European Working Group on Sarcopenia in Older People, i.e. a Skeletal Muscle Index \ 7.26 kg/m2measured by dual energy X-ray absorptiometry and either gait speed \ 0.8 m/s or hand-grip strength \ 30 kg. At follow-up 5 years later, 129 of the participants were reinvestigated. The outcome, i.e. prevalent independent ageing at follow-up was defined as being community-dwelling, without a diagnosis of dementia, Mini Mental State Examination C 25 out of 30 possible points, independency in personal care and being able to outdoor-walking without assistance. Analyses were adjusted for age at base-line, smoking status, Charlson comorbidity index and total fat mass. Results:Baseline prevalence of sarcopenia was 19% (25/129). At follow-up, prevalence of independent ageing was 67% (87/129). There was no association between sarcopenia, skeletal muscle mass and independent ageing. Higher gait speed (odds ratio (OR) per one standard deviation increase 1.86, 95% confidence interval (CI) 1.21–2.86) and hand grip strength (OR 1.53, 95% CI 1.02–2.30) were associated with independent ageing.
Conclusions:Muscle function, measured as gait speed and hand grip strength, were associated with independent ageing, whereas there was no association between muscle mass alone or sarcopenia and inde-pendent ageing in very old men.
O-27
Telomere length and frailty: The Helsinki Birth Cohort Study Markus J Haapanen1, Mia-Maria Pera¨la¨2, Minna K Salonen2, Maria A Guzzardi3, Patricia Iozzo3, Eero Kajantie2, Taina Rantanen4, Mika
Simonen1, Pertti Pohjolainen5, Johan G Eriksson1, Mikaela B von
Bonsdorff4
1University of Helsinki, Helsinki, Finland,2National Institute for
Health and Welfare, Helsinki, Finland,3National Research Council, Pisa, Italy,4University of Jyva¨skyla¨, Jyva¨skyla¨, Finland,5Age Institute, Helsinki, Finland
Background: Telomere length is associated with aging-related pathologies. While the association between telomere length and
frailty has been studied previously, only few studies assessing lon-gitudinal changes in telomere length and frailty exist.
Methods:1078 individuals born in Helsinki between 1934 and 1944 were measured twice for leukocyte telomere length (LTL) using quantitative real-time PCR at the average ages of 61 and 71 years, and at the latter they were assessed for frailty according to Fried criteria.
Results:The mean ± SD relative LTLs were 1.40 ± 0.29 (average age 61 years) and 0.86 ± 0.30 (average age 71 years) for the cohort. A trend of shorter mean relative LTL across frailty groups was observed at 61 years (p = 0.016) and at 71 years (p = 0.057). Relative LTL at age 61 years was significantly associated with frailty: per 1-unit increase in relative LTL the corresponding relative risk (RR) of frailty was 0.28 (95% CI 0.08, 0.97), adjusting for several con-founders. Also, LTL at age 71 years was associated with frailty (RR 0.18, 95% CI 0.04, 0.81) after adjustment for sex, age and adult socio-economic status, but further adjustment attenuated the association. No associations between telomere shortening and frailty were observed during the 10-year follow-up.
Key conclusions:Shorter relative LTL was associated with frailty in cross-sectional and longitudinal analyses but telomere shortening was not, suggesting that short LTL may be a biomarker of frailty.
Area: Longevity and prevention O-28
Predicting the onset of functional decline in people aged 65–75 years old: pooled analysis of four European cohort studies Nini H Jonkman1, Marco Colpo2, Jochen Klenk3, Chris Todd4,
Trynke Hoekstra5, Vieri Del Panta2, Kilian Rapp3, Natasja M van
Schoor6, Stefania Bandinelli2, Martijn W Heymans6, Dominique
Mauger4, Luca Cattelani7, Michael D Denkinger8, Dietrich
Rothenbacher9, Jorunn L Helbostad10, Beatrix Vereijken10, Andrea B Maier11, Mirjam Pijnappels1
1Department of Human Movement Sciences, Faculty of Behavioural
and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands,2Laboratory of
Clinical Epidemiology, InCHIANTI Study Group, LHTC Local Health Tuscany Center, Firenze, Italy,31: Department of Clinical
Gerontology, Robert Bosch Hospital, Stuttgart, Germany. 2: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany,4University of Manchester, Manchester, United Kingdom,
51: Department of Health Sciences, Vrije Universiteit Amsterdam,
Amsterdam, The Netherlands. 2: Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands,
6Amsterdam Public Health Research Institute, Department of
Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands,7Department of Computer Science and Engineering, University of Bologna, Bologna, Italy,81: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany. 2: Geriatric Research Unit Ulm University and Geriatric Center, Agaplesion Bethesda Hospital Ulm, Ulm, Germany,9Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany,10Department of Neuromedicine and Movement Science,
Norwegian University of Science and Technology, Trondheim, Norway,111Department of Human Movement Sciences, Faculty of
Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands. 2: Faculty of Medicine Dentistry and Health Sciences, Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia.
