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Initiating a prompt-to-action tool for comprehensive geriatric assessment in an acute inpatient setting
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
manual chronometry or Gaitrite electronic-walkway (GEW) device. Questioning if performing a 5-walk-paradigm was feasible. Method.– Patients hospitalised in acute geriatric ward between September and November 2011 had systematic registration of sarcopenia and cognitive parameters one week after admission. Patients able to walk 10 m performed a walking test on a GEW. 5-walks-paradigm registrated normal - fast - slow pace, pace during working and semantic memory task. Manual chronometry over 4 m and normal speed registration on the 6.1 m walkway was performed simultaneously. SPSS studied correlations between the parameters. Results.– One hundred and eighteen patients were admitted to the geriatic ward. Sixty-six patients (59%) performed gait analysis. Significant difference between the chronometer and gaitrite speed values. Only 43 patients (36% of total, 65% of all walkers) could perform the 5-walk-paradigm and 49 patients (74.3%)could perform an acceleration test (difference normal -fast speed). 75% of all patients were at risk for malnutrition. Seventy-three percent were Katz O or A profile performing 5-walk-paradigm. Correlations were found between gaitspeed and handgrip, swing time variability and handgrip, base of support and MNS, MMSE and handgrip, acceleration and MAC-AMC parameters and BMI and acceleration. Conclusion.– Gaitspeed analysis is not feasible as a general screening test for sarcopenia in hospitalised patients. Difference between manual and electronic measurements is significant incomparable. 5-walk paradigm is only usable in relative independent patients. Larger sample is needed to conclude on correlations between gait dynamics and sarcopenia parameters. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.081 P081
Unmet complex care needs of frequent emergency department, visitors in a tertiary medical center in Taiwan M.-Y. Chou a,b,d,e,∗ , M.-C. Liao e,f , C.-K. Liang a,e,g , Y.-T. Lin e,g , L.-K. Chen a,c,h , Y.-K. Lo e,g , M.-S. Tu d a Aging and Health Research Center b Institute of Public Health c Institute of Health Welfare and Policy, National Yang Ming University d Department of Family Medicine e Geriatric Medicine Center f Department of Emergency Medicine g Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital h Center for Geriatrics and Gerontology, Taipei Veterans General Hospital Background.– Frequent visitors of the emergency department (ED) were often also heavy users of other health-care services, suggesting that they may have multiple unmet complex care needs. The purpose of this study was to evaluate the complex care needs of ED frequent visitors in a tertiary medical center. Methods.– From February to October 2011, elderly who visited the ED of the medical center for three times or more within one month were recruited for study. Comprehensive Geriatric Assessment (CGA), comprising of Karz Activity of Daily Living (ADL) Index, Geriatric Depression Score-short form (scored ≥ 2 means depressed mood), short portable mental status questionnaires (< 8 means cognitive problem), Confusion Assessment Method, Braden Scale, Registered Nurses Nutritional Risk Classification, were performed for them by a trained nurse and geriatricians interviewed these patients for further management. Results.– Overall, 41 patients (mean age 82.6 ± 5.9 years, 81.0% males) were enrolled for study. Among them, 87.8% had visual problems, 70.7% had polypharmacy, 70.7% had pain problems, 63.4% had constipation, 56.1% had depressed mood, 56.1% under hypnotics
S57
use, 53.7% had hearing problems, 51.2% had gait problems, 51.2% had risk of malnutrition, 46.3% had cognitive problems, 46.3% had acute functional decline (lost more than one ADL), 46.3% had urine incontinence and 46.3% had the history of falls. Conclusion.– ED frequent visitors had multiple complex care needs, which may not be well recognized in traditional management. CGAbased practice and geriatricians’ interview for ED frequent visitors may facilitate identifying unmet care needs to reduce the frequency of ED visits for these patients. http://dx.doi.org/10.1016/j.eurger.2012.07.082 P082
Initiating a prompt-to-action tool for comprehensive geriatric assessment in an acute inpatient setting R. Moorchilot a,∗ , L. O’Loughlin a , R. Morris a , A. Gordon b Health Care Of Older People, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom b Division Of Rehabilitation And Ageing, University of Nottingham, Nottingham, United Kingdom
a
Introduction.– Inpatient Comprehensive Geriatric Assessment (CGA) is supported by evidence from large meta-analyses and is central to good care. To audit local practice, we established a working definition of CGA comprising assessments of affect, cognition, continence, fall-risk, functional status, hearing, medical history, nutrition, physiological parameters, psychosocial circumstances, osteoporosis-risk and vision. An audit of our inpatient care records in 2008 found an average of 66% of domains to be referenced, 44% formally assessed and 10% actioned per patient. Methods.– We initiated a CGA prompt-to-action tool, a proforma in the patient’s notes prompting staff to record their assessment of CGA domains and initiate an action plan for problems identified. We assessed the tool in 54 consecutive admissions to a single ward over a month. Results.– The proforma was completed in all patients. On average 97.6% (SD 4.39) of domains were completed per patient. The areas most commonly incomplete were osteoporosis-risk and affect, which were missing for 7 (12.96%) and 3 (5.56%) patients respectively. Problems were identified for 53 (98.5%) patients and action was initiated in all cases. The most commonly identified problems were with functional status and visual acuity and the most commonly initiated action plans were change to care package and advice to consult an optician. Conclusion.– A CGA prompt-to-action can improve the performance of CGA in an acute geriatrics ward. It is, however, labour intensive. If the process is to work it must used by the broader multidisciplinary team. We are currently working with MDT members to identify how the tool can be made useful for them. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.083 P083
Feasibility of gaitdynamics in hospitalised sarcopenia patients A. De Cock a,∗ , E.A. Trevino a , M. Vandewoude b Geriatrics, AZ ST maarten, Mechelen, Belgium b Geriatrics, University of Antwerp, Berchem, Belgium
a
Aim.– Inquiries on the gait-dynamics in hospital patients performing a sarcopenia screening. Comparing gaitspeed using manual chronometry or Gaitrite electronic-walkway (GEW) device. Questioning if performing a 5-walk-paradigm was feasible. Method.– Patients hospitalised in acute geriatric ward between September and November 2011 had systematic registration of sarcopenia and cognitive parameters one week after admission. Patients able to walk 10 m performed a walking test on a GEW.
manual chronometry or Gaitrite electronic-walkway (GEW) device. Questioning if performing a 5-walk-paradigm was feasible. Method.– Patients hospitalised in acute geriatric ward between September and November 2011 had systematic registration of sarcopenia and cognitive parameters one week after admission. Patients able to walk 10 m performed a walking test on a GEW. 5-walks-paradigm registrated normal - fast - slow pace, pace during working and semantic memory task. Manual chronometry over 4 m and normal speed registration on the 6.1 m walkway was performed simultaneously. SPSS studied correlations between the parameters. Results.– One hundred and eighteen patients were admitted to the geriatic ward. Sixty-six patients (59%) performed gait analysis. Significant difference between the chronometer and gaitrite speed values. Only 43 patients (36% of total, 65% of all walkers) could perform the 5-walk-paradigm and 49 patients (74.3%)could perform an acceleration test (difference normal -fast speed). 75% of all patients were at risk for malnutrition. Seventy-three percent were Katz O or A profile performing 5-walk-paradigm. Correlations were found between gaitspeed and handgrip, swing time variability and handgrip, base of support and MNS, MMSE and handgrip, acceleration and MAC-AMC parameters and BMI and acceleration. Conclusion.– Gaitspeed analysis is not feasible as a general screening test for sarcopenia in hospitalised patients. Difference between manual and electronic measurements is significant incomparable. 5-walk paradigm is only usable in relative independent patients. Larger sample is needed to conclude on correlations between gait dynamics and sarcopenia parameters. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.081 P081
Unmet complex care needs of frequent emergency department, visitors in a tertiary medical center in Taiwan M.-Y. Chou a,b,d,e,∗ , M.-C. Liao e,f , C.-K. Liang a,e,g , Y.-T. Lin e,g , L.-K. Chen a,c,h , Y.-K. Lo e,g , M.-S. Tu d a Aging and Health Research Center b Institute of Public Health c Institute of Health Welfare and Policy, National Yang Ming University d Department of Family Medicine e Geriatric Medicine Center f Department of Emergency Medicine g Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital h Center for Geriatrics and Gerontology, Taipei Veterans General Hospital Background.– Frequent visitors of the emergency department (ED) were often also heavy users of other health-care services, suggesting that they may have multiple unmet complex care needs. The purpose of this study was to evaluate the complex care needs of ED frequent visitors in a tertiary medical center. Methods.– From February to October 2011, elderly who visited the ED of the medical center for three times or more within one month were recruited for study. Comprehensive Geriatric Assessment (CGA), comprising of Karz Activity of Daily Living (ADL) Index, Geriatric Depression Score-short form (scored ≥ 2 means depressed mood), short portable mental status questionnaires (< 8 means cognitive problem), Confusion Assessment Method, Braden Scale, Registered Nurses Nutritional Risk Classification, were performed for them by a trained nurse and geriatricians interviewed these patients for further management. Results.– Overall, 41 patients (mean age 82.6 ± 5.9 years, 81.0% males) were enrolled for study. Among them, 87.8% had visual problems, 70.7% had polypharmacy, 70.7% had pain problems, 63.4% had constipation, 56.1% had depressed mood, 56.1% under hypnotics
S57
use, 53.7% had hearing problems, 51.2% had gait problems, 51.2% had risk of malnutrition, 46.3% had cognitive problems, 46.3% had acute functional decline (lost more than one ADL), 46.3% had urine incontinence and 46.3% had the history of falls. Conclusion.– ED frequent visitors had multiple complex care needs, which may not be well recognized in traditional management. CGAbased practice and geriatricians’ interview for ED frequent visitors may facilitate identifying unmet care needs to reduce the frequency of ED visits for these patients. http://dx.doi.org/10.1016/j.eurger.2012.07.082 P082
Initiating a prompt-to-action tool for comprehensive geriatric assessment in an acute inpatient setting R. Moorchilot a,∗ , L. O’Loughlin a , R. Morris a , A. Gordon b Health Care Of Older People, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom b Division Of Rehabilitation And Ageing, University of Nottingham, Nottingham, United Kingdom
a
Introduction.– Inpatient Comprehensive Geriatric Assessment (CGA) is supported by evidence from large meta-analyses and is central to good care. To audit local practice, we established a working definition of CGA comprising assessments of affect, cognition, continence, fall-risk, functional status, hearing, medical history, nutrition, physiological parameters, psychosocial circumstances, osteoporosis-risk and vision. An audit of our inpatient care records in 2008 found an average of 66% of domains to be referenced, 44% formally assessed and 10% actioned per patient. Methods.– We initiated a CGA prompt-to-action tool, a proforma in the patient’s notes prompting staff to record their assessment of CGA domains and initiate an action plan for problems identified. We assessed the tool in 54 consecutive admissions to a single ward over a month. Results.– The proforma was completed in all patients. On average 97.6% (SD 4.39) of domains were completed per patient. The areas most commonly incomplete were osteoporosis-risk and affect, which were missing for 7 (12.96%) and 3 (5.56%) patients respectively. Problems were identified for 53 (98.5%) patients and action was initiated in all cases. The most commonly identified problems were with functional status and visual acuity and the most commonly initiated action plans were change to care package and advice to consult an optician. Conclusion.– A CGA prompt-to-action can improve the performance of CGA in an acute geriatrics ward. It is, however, labour intensive. If the process is to work it must used by the broader multidisciplinary team. We are currently working with MDT members to identify how the tool can be made useful for them. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.083 P083
Feasibility of gaitdynamics in hospitalised sarcopenia patients A. De Cock a,∗ , E.A. Trevino a , M. Vandewoude b Geriatrics, AZ ST maarten, Mechelen, Belgium b Geriatrics, University of Antwerp, Berchem, Belgium
a
Aim.– Inquiries on the gait-dynamics in hospital patients performing a sarcopenia screening. Comparing gaitspeed using manual chronometry or Gaitrite electronic-walkway (GEW) device. Questioning if performing a 5-walk-paradigm was feasible. Method.– Patients hospitalised in acute geriatric ward between September and November 2011 had systematic registration of sarcopenia and cognitive parameters one week after admission. Patients able to walk 10 m performed a walking test on a GEW.