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Rehabilitation outcomes in upper limb fractures in older people
S110
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
Methods.– During the implementation of the innovation programs, we performed a prospective study in GR including patients admitted to a skilled nursing facility (SNF). Two cohorts of patients were included (March–June 2011 [n = 383] and March–June 2012 [n = 355]). At admission and discharge, information about patient characteristics, and the outcomes of the process of implementation were collected among elderly care physicians; physiotherapist; and nursing staff. In addition, patients and informal caregivers received a questionnaire to measure their experiences with GR within 4 weeks after discharge. Primary outcome measure was successful rehabilitation operationalized as a short length of stay, discharge home and independency in ADL. Results.– In total, 16 Dutch SNFs participated with their innovation program. Main components of the programs were the development of a continuous care chain, better communication, implementation of intensive treatment and education of the multidisciplinary team members. Overall, 738 GR patients participated (median age 79 years (QR 71–85.0), 64% females); categorized in stroke (n = 268), elective joint replacement (n = 117), traumatic injuries (n = 178), and other (n = 175). The first results of the innovation programs show shorter length of stay and more discharge home. Key conclusions.– This national incentive resulted in the development of integrated effective care for geriatric rehabilitation in the 16 participating SNFs. http://dx.doi.org/10.1016/j.eurger.2013.07.359 P296
The prevalence of depression in elderly in-patients in community hospitals N. Denny , J. Fee , S. Thompson University of Oxford, Oxford University Hospitals NHS Trust, Oxford, United Kingdom Introduction.– Depression is prevalent among general medical inpatients more or equal to 60 years old, yet the reported prevalence varies considerably [1], and has not been adequately described in the community hospital setting. Description of the prevalence of depression among in-patients with moderate-severe cognitive impairment is also lacking. The objectives of this study were to establish the point prevalence of depressive symptoms in elderly in-patients in community hospitals and to identify the point prevalence of patients unsuitable for screening with GDS-15 due to cognitive impairment. Methods.– One hundred and seven patients were identified on 5 wards in 3 community hospitals in Oxfordshire. All in-patients were included subject to their consent. Patients were excluded if they were less than 60 years old, confused, dysphasic, currently prescribed antidepressants or had moderate-severe cognitive impairment (AMTS ≤ 5). Selected patients were subsequently asked the Whooley screening questions and completed GDS-15. Results.– One hundred and two patients consented. Fifty-three were excluded; 30 had moderate-severe cognitive impairment, 23 were prescribed antidepressants, 3 were < 60 years old, 3 were confused and 4 were dysphasic. Ten patients met multiple exclusion criteria. 49 patients were selected; 27 (55%) screened Whooley positive and 13 (27%) scored more or equal to 7 on GDS-15, suggesting significant depressive symptoms that met criteria for further assessment. The median GDS-15 score was 4 (range 1–13). Key conclusions.– These results are consistent with previous studies [2,3] and highlight the potential role of screening for depression in elderly in-patients. Twenty-nine percent of patients had cognitive impairment that precluded the use of GDS-15 [4]; consideration must be given to alternative means of detecting depression in this cohort. Reference [1] Royal College of Psychiatry. Who Cares Wins 2005. [2] Shah DC, et al. Postgrad Med J 2000;76(893):153–6.
[3] Yohannes AM, et al. Int J Geriatr Psychiatry 2008;23(11):1141–7. [4] Katz IR. J Clin Psychiatry 1998;59(Suppl. 9):38–44. http://dx.doi.org/10.1016/j.eurger.2013.07.360 P297
Rehabilitation outcomes in upper limb fractures in older people P. Wearing , K. Christodoulou , B. Bering , R. Senniappan , A. Chatterjee Elderly Care Department, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, United Kingdom Introduction.– The management of neck of femur (NOF) fractures in the United Kingdom is guided by the Best Practice Tariff. Upper limb fragility fractures also have a significant impact, however the management of these patients is not standardised. Less is known about the physical and functional recovery of upper limb fractures. Methods.– Retrospective case note review of 40 female patients admitted to the Royal Berkshire Hospital between October 2009 and March 2011 who sustained either a NOF fracture or an upper limb fracture was undertaken. Data was recorded in a structured proforma. Results.– There were 20 patients in each group. The mean age of patients with NOF fractures was 89, patients with upper limb fractures was 82. Mean length of stay was equivalent in both groups (33 vs. 32). All patients were assessed by an occupational therapist and a physiotherapist. 60% of NOF fracture patients were discharged home, 20% required community rehabilitation and 10% required placement. Similarly, 65% of the upper limb fractures went home, 15% rehabilitation, 20% placement. Conclusion.– From our observations, mean length of stay and discharge destination were similar in both groups. It would appear that the most vulnerable group of patients with upper limb fractures have similar rehabilitation needs to NOF fractures. Upper extremity fractures in older people often require prolonged hospitalisation to improve functional independence at considerable healthcare cost, in a similar fashion to NOF fracture patients. They require specialist-structured rehabilitation involving occupational therapy, physiotherapy and orthogeriatricians. http://dx.doi.org/10.1016/j.eurger.2013.07.361 P298
Main differences in functional recovery after arthroplasty of the knee or hip R. Rodriguez , R. Selvera , S. Garcia , R. Cantera Hospital Cruz Roja, Madrid, Spain Introduction.– The arthroplasty of the knee and hip is considered one alternative in the treatment of functional deterioration of patients with degenerative osteoarticular pathology. The objective of our study was to find out the main differences in functional recovery of geriatric patients who enter a medium-stay unit (MSU) for rehabilitative treatment after a planned operation of arthroplasty. Methods.– Retrospective study, patients in the MSU after arthroplasty (knee or hip), during 2010–2012. The following variables were analysed: sociodemographic, functional (Red Cross Physical Scale (CRF)) and the Barthel Index (IB); mental (Red Cross Mental Scale (CRM), social, the functional gain and the overall stay associated with each kind of arthroplasty were analysed. We use statistical packet SPSS 17.0. Results.– Three hundred and thirty-two patients, average age 75 years, 250 women. Arthroplasty: knee 73.2%/hip 25.9%. Significant differences (P < 0.05) in: sex: men: knee 65.9%/hip 31.7%, women: knee 75.6%/hip 24%. Functional status before and at discharge: CRF
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
Methods.– During the implementation of the innovation programs, we performed a prospective study in GR including patients admitted to a skilled nursing facility (SNF). Two cohorts of patients were included (March–June 2011 [n = 383] and March–June 2012 [n = 355]). At admission and discharge, information about patient characteristics, and the outcomes of the process of implementation were collected among elderly care physicians; physiotherapist; and nursing staff. In addition, patients and informal caregivers received a questionnaire to measure their experiences with GR within 4 weeks after discharge. Primary outcome measure was successful rehabilitation operationalized as a short length of stay, discharge home and independency in ADL. Results.– In total, 16 Dutch SNFs participated with their innovation program. Main components of the programs were the development of a continuous care chain, better communication, implementation of intensive treatment and education of the multidisciplinary team members. Overall, 738 GR patients participated (median age 79 years (QR 71–85.0), 64% females); categorized in stroke (n = 268), elective joint replacement (n = 117), traumatic injuries (n = 178), and other (n = 175). The first results of the innovation programs show shorter length of stay and more discharge home. Key conclusions.– This national incentive resulted in the development of integrated effective care for geriatric rehabilitation in the 16 participating SNFs. http://dx.doi.org/10.1016/j.eurger.2013.07.359 P296
The prevalence of depression in elderly in-patients in community hospitals N. Denny , J. Fee , S. Thompson University of Oxford, Oxford University Hospitals NHS Trust, Oxford, United Kingdom Introduction.– Depression is prevalent among general medical inpatients more or equal to 60 years old, yet the reported prevalence varies considerably [1], and has not been adequately described in the community hospital setting. Description of the prevalence of depression among in-patients with moderate-severe cognitive impairment is also lacking. The objectives of this study were to establish the point prevalence of depressive symptoms in elderly in-patients in community hospitals and to identify the point prevalence of patients unsuitable for screening with GDS-15 due to cognitive impairment. Methods.– One hundred and seven patients were identified on 5 wards in 3 community hospitals in Oxfordshire. All in-patients were included subject to their consent. Patients were excluded if they were less than 60 years old, confused, dysphasic, currently prescribed antidepressants or had moderate-severe cognitive impairment (AMTS ≤ 5). Selected patients were subsequently asked the Whooley screening questions and completed GDS-15. Results.– One hundred and two patients consented. Fifty-three were excluded; 30 had moderate-severe cognitive impairment, 23 were prescribed antidepressants, 3 were < 60 years old, 3 were confused and 4 were dysphasic. Ten patients met multiple exclusion criteria. 49 patients were selected; 27 (55%) screened Whooley positive and 13 (27%) scored more or equal to 7 on GDS-15, suggesting significant depressive symptoms that met criteria for further assessment. The median GDS-15 score was 4 (range 1–13). Key conclusions.– These results are consistent with previous studies [2,3] and highlight the potential role of screening for depression in elderly in-patients. Twenty-nine percent of patients had cognitive impairment that precluded the use of GDS-15 [4]; consideration must be given to alternative means of detecting depression in this cohort. Reference [1] Royal College of Psychiatry. Who Cares Wins 2005. [2] Shah DC, et al. Postgrad Med J 2000;76(893):153–6.
[3] Yohannes AM, et al. Int J Geriatr Psychiatry 2008;23(11):1141–7. [4] Katz IR. J Clin Psychiatry 1998;59(Suppl. 9):38–44. http://dx.doi.org/10.1016/j.eurger.2013.07.360 P297
Rehabilitation outcomes in upper limb fractures in older people P. Wearing , K. Christodoulou , B. Bering , R. Senniappan , A. Chatterjee Elderly Care Department, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, United Kingdom Introduction.– The management of neck of femur (NOF) fractures in the United Kingdom is guided by the Best Practice Tariff. Upper limb fragility fractures also have a significant impact, however the management of these patients is not standardised. Less is known about the physical and functional recovery of upper limb fractures. Methods.– Retrospective case note review of 40 female patients admitted to the Royal Berkshire Hospital between October 2009 and March 2011 who sustained either a NOF fracture or an upper limb fracture was undertaken. Data was recorded in a structured proforma. Results.– There were 20 patients in each group. The mean age of patients with NOF fractures was 89, patients with upper limb fractures was 82. Mean length of stay was equivalent in both groups (33 vs. 32). All patients were assessed by an occupational therapist and a physiotherapist. 60% of NOF fracture patients were discharged home, 20% required community rehabilitation and 10% required placement. Similarly, 65% of the upper limb fractures went home, 15% rehabilitation, 20% placement. Conclusion.– From our observations, mean length of stay and discharge destination were similar in both groups. It would appear that the most vulnerable group of patients with upper limb fractures have similar rehabilitation needs to NOF fractures. Upper extremity fractures in older people often require prolonged hospitalisation to improve functional independence at considerable healthcare cost, in a similar fashion to NOF fracture patients. They require specialist-structured rehabilitation involving occupational therapy, physiotherapy and orthogeriatricians. http://dx.doi.org/10.1016/j.eurger.2013.07.361 P298
Main differences in functional recovery after arthroplasty of the knee or hip R. Rodriguez , R. Selvera , S. Garcia , R. Cantera Hospital Cruz Roja, Madrid, Spain Introduction.– The arthroplasty of the knee and hip is considered one alternative in the treatment of functional deterioration of patients with degenerative osteoarticular pathology. The objective of our study was to find out the main differences in functional recovery of geriatric patients who enter a medium-stay unit (MSU) for rehabilitative treatment after a planned operation of arthroplasty. Methods.– Retrospective study, patients in the MSU after arthroplasty (knee or hip), during 2010–2012. The following variables were analysed: sociodemographic, functional (Red Cross Physical Scale (CRF)) and the Barthel Index (IB); mental (Red Cross Mental Scale (CRM), social, the functional gain and the overall stay associated with each kind of arthroplasty were analysed. We use statistical packet SPSS 17.0. Results.– Three hundred and thirty-two patients, average age 75 years, 250 women. Arthroplasty: knee 73.2%/hip 25.9%. Significant differences (P < 0.05) in: sex: men: knee 65.9%/hip 31.7%, women: knee 75.6%/hip 24%. Functional status before and at discharge: CRF