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Surgical delay is a predictive factor of worse functional outcome at discharge in hip fracture patients
S94
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
P205
Surgical delay is a predictive factor of worse functional outcome at discharge in hip fracture patients R. Hoyos Gallego ∗ , T. Alarcón , J.I. González Montalvo , J. Díez Geriatrics, Hospital Universitario La Paz, Madrid, Spain
Background.– Functional status of hip fracture patients after surgery could be improved if we knew the factors involved in the outcome of these patients. Method.– Four hundred and sixty-seven consecutive patients admitted to an acute orthogeriatric unit at a university tertiary hospital were assessed in order to know the variables that can predict their ambulatory status at discharge. The variables associated with a bad functional status (to need assistance of two people for walking) at discharge in the bivariate analysis were included in a logistic regression forward stepwise model. Results.– Mean age was 85.02(SD 6.98) years, 381(81.6%) were women and 362(77.5%) lived previously at home. Mean surgical delay was 3.25 (SD 2.13) days and mean hospital stay was 10.8 days (SD 4.38). Independent predictive variables for a bad functional status at discharge were: – age (B) 0.033 (Sig) 0.051 (Exp (B)) 1.034 (95% CI) 1.000–1.069; – worse previous walking: (B) 0.331 (Sig) 0.030 (Exp (B)) 1.393 (95% CI) 1.033–1.878; – previous Barthel Index: (B) –0.032 (Sig) 0.000 (Exp (B)) .969 (95% CI) .954–0.984; – days until surgery: (B) 0.142 (Sig) 0.007 (Exp (B)) 1.152 (95% CI) 1.040–1.277; – Charlson Index: (B) –0.192 (Sig) 0.031 (Exp (B)) 0.825 (95% CI) .693–0.983; – area under the ROC curve was 0.788 (95% CI 0.748–0.828) (P < 0.001). Conclusions.– Older age, worse previous functional status, delayed surgery and higher Charlson Index were independent predictive factors of a bad functional status at discharge in hip fracture patients. As days until surgery is the only modifiable factor of them, there is a need to reduce surgical delay. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.206 P206
Revision of undergraduate curriculum in geriatric medicine (EUMS-GMS) O. Sletvold a,∗ , L. Boelarts b , K. Mulpeter c , T. Masud d , K. Singler e , R. Roller-Wirnsberger f , A. Stuck g a Department Of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway b Department Geriatrics, Medical Centre Alkmaar, Alkmaar, Netherlands c Consultant Geriatrician, Letterkenny General Hospital, Letterkenny, Ireland d Healthcare Of Older People, Nottingham University Hospitals, Nottingham, United Kingdom e Geriatric Medicine, Klinikum Nuremberg, Nürnberg, Germany f Universitatsklinik Fur Innere Medizin, Medizinische Universitat Graz, Graz, Austria g Geriatrie Universitat Bern, Inselspital, Bern, Switzerland Text.– The number of older people in Europe is increasing both in absolute numbers as well as a proportion of the general proportion. The great majority of older people receive their medical care from doctors who are not geriatricians and the majority of this responsibility falls on general practitioners. Thus all doctors now require a firm grounding in ageing in their basic education and experience in geriatric medicine in their clinical education. Clinical geriatric medicine can be taught in many settings but
it must be a required part of the undergraduate experience. In 2003, the Geriatric Medicine Section of the UEMS (EUMS-GMS) developed recommendations on a curriculum on undergraduate training in geriatric medicine. The document outlined specific requirements for teaching institutions and teachers. Teaching of geriatric medicine should be an integral part of the whole curriculum starting in the basic sciences and progressing through to clinical teaching. The curriculum should be planned, organized and monitored by experts in old age medicine. Relevant topics and skills should be emphasized at all stages of teaching of geriatric medicine. The medical school must define what competences students should exhibit on graduation, and also ensure that it has sufficient educational resources for the delivery of the curriculum. In 2011, the UEMS-GMS decided on a revision of the 2003 curriculum. It was recommended that this revision should be based on a survey of undergraduate curricula on geriatric medicine across Europe. A working group has been established and the process of revision is underway. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.207 P207
Markedly elevated erythrocyte sedimentation rate in elderly. How significant clinically? O. Karaaslan Cengiz , S. Ergulu Esmen , M. Varli ∗ , S. Aras , A. Yalcin , V. Atmis , T. Atli Geriatrics, Ankara university, Ankara, Turkey
Introduction.– Erythrocyte sedimentation rate (ESR) despite being a fast and cheap test to evaluate acute phase response, has low sensitivity and specificity. Atypical courses and lack of specific signs and symptoms of the diseases in elderly restrict the use of ESR for diagnosis. We aimed to determine clinical importance and possible etiologies of markedly elevated ESR in elderly. Patients and methods.– Among 1682 patients admitted to Ankara University Geriatric Clinic during one year period were evaluated. A hundred and ten patients with ESR more than 80 mm/h were included into study and evaluated for the possible causes of ESR elevation. Results.– Etiology of elevated ESR was due to infectious diseases in 53 (48.2%), malignancy in 19 (17.3%), and collagen tissue diseases in 17 (15.5%) of patients. Some of the etiologies coexisted in ten (9.1%) patients. No specific etiology was detected in 31 (28.2%) patients. Among infectious diseases, pneumonia (n = 20/53, 37.7%) was the leading cause followed by urinary tract infections (UTI) (n = 17/53, 32.1%). Multiple myeloma (n = 7/19, 36.8%) was the leading cause among malignancies. Rheumatoid arthritis (n = 10/17, 58.8%) was the leading cause among collagen tissue diseases. Leukocyte count and C-reactive protein levels are useful to determine infectious diseases as a cause of markedly elevated ESR. Conclusion.– When markedly elevated, ESR is detected in a geriatric patient, before doing further expensive and invasive tests to define the etiology, infectious diseases, especially pneumonia and UTI, should be excluded. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.208 P208
Research on geriatric undergraduate training: A tale of two countries J. Mateos-Nozal , B. Montero-Errasquín , N. Pérez-Abascal , C. Sánchez-Castellano ∗ , A. Cruz Jentoft Geriatría, Hospital Ramón y Cajal, Madrid, Spain Objective.– To compare the number, topic and evolution of abstracts about Geriatrics training at the undergraduate level sent to the
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
P205
Surgical delay is a predictive factor of worse functional outcome at discharge in hip fracture patients R. Hoyos Gallego ∗ , T. Alarcón , J.I. González Montalvo , J. Díez Geriatrics, Hospital Universitario La Paz, Madrid, Spain
Background.– Functional status of hip fracture patients after surgery could be improved if we knew the factors involved in the outcome of these patients. Method.– Four hundred and sixty-seven consecutive patients admitted to an acute orthogeriatric unit at a university tertiary hospital were assessed in order to know the variables that can predict their ambulatory status at discharge. The variables associated with a bad functional status (to need assistance of two people for walking) at discharge in the bivariate analysis were included in a logistic regression forward stepwise model. Results.– Mean age was 85.02(SD 6.98) years, 381(81.6%) were women and 362(77.5%) lived previously at home. Mean surgical delay was 3.25 (SD 2.13) days and mean hospital stay was 10.8 days (SD 4.38). Independent predictive variables for a bad functional status at discharge were: – age (B) 0.033 (Sig) 0.051 (Exp (B)) 1.034 (95% CI) 1.000–1.069; – worse previous walking: (B) 0.331 (Sig) 0.030 (Exp (B)) 1.393 (95% CI) 1.033–1.878; – previous Barthel Index: (B) –0.032 (Sig) 0.000 (Exp (B)) .969 (95% CI) .954–0.984; – days until surgery: (B) 0.142 (Sig) 0.007 (Exp (B)) 1.152 (95% CI) 1.040–1.277; – Charlson Index: (B) –0.192 (Sig) 0.031 (Exp (B)) 0.825 (95% CI) .693–0.983; – area under the ROC curve was 0.788 (95% CI 0.748–0.828) (P < 0.001). Conclusions.– Older age, worse previous functional status, delayed surgery and higher Charlson Index were independent predictive factors of a bad functional status at discharge in hip fracture patients. As days until surgery is the only modifiable factor of them, there is a need to reduce surgical delay. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.206 P206
Revision of undergraduate curriculum in geriatric medicine (EUMS-GMS) O. Sletvold a,∗ , L. Boelarts b , K. Mulpeter c , T. Masud d , K. Singler e , R. Roller-Wirnsberger f , A. Stuck g a Department Of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway b Department Geriatrics, Medical Centre Alkmaar, Alkmaar, Netherlands c Consultant Geriatrician, Letterkenny General Hospital, Letterkenny, Ireland d Healthcare Of Older People, Nottingham University Hospitals, Nottingham, United Kingdom e Geriatric Medicine, Klinikum Nuremberg, Nürnberg, Germany f Universitatsklinik Fur Innere Medizin, Medizinische Universitat Graz, Graz, Austria g Geriatrie Universitat Bern, Inselspital, Bern, Switzerland Text.– The number of older people in Europe is increasing both in absolute numbers as well as a proportion of the general proportion. The great majority of older people receive their medical care from doctors who are not geriatricians and the majority of this responsibility falls on general practitioners. Thus all doctors now require a firm grounding in ageing in their basic education and experience in geriatric medicine in their clinical education. Clinical geriatric medicine can be taught in many settings but
it must be a required part of the undergraduate experience. In 2003, the Geriatric Medicine Section of the UEMS (EUMS-GMS) developed recommendations on a curriculum on undergraduate training in geriatric medicine. The document outlined specific requirements for teaching institutions and teachers. Teaching of geriatric medicine should be an integral part of the whole curriculum starting in the basic sciences and progressing through to clinical teaching. The curriculum should be planned, organized and monitored by experts in old age medicine. Relevant topics and skills should be emphasized at all stages of teaching of geriatric medicine. The medical school must define what competences students should exhibit on graduation, and also ensure that it has sufficient educational resources for the delivery of the curriculum. In 2011, the UEMS-GMS decided on a revision of the 2003 curriculum. It was recommended that this revision should be based on a survey of undergraduate curricula on geriatric medicine across Europe. A working group has been established and the process of revision is underway. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.207 P207
Markedly elevated erythrocyte sedimentation rate in elderly. How significant clinically? O. Karaaslan Cengiz , S. Ergulu Esmen , M. Varli ∗ , S. Aras , A. Yalcin , V. Atmis , T. Atli Geriatrics, Ankara university, Ankara, Turkey
Introduction.– Erythrocyte sedimentation rate (ESR) despite being a fast and cheap test to evaluate acute phase response, has low sensitivity and specificity. Atypical courses and lack of specific signs and symptoms of the diseases in elderly restrict the use of ESR for diagnosis. We aimed to determine clinical importance and possible etiologies of markedly elevated ESR in elderly. Patients and methods.– Among 1682 patients admitted to Ankara University Geriatric Clinic during one year period were evaluated. A hundred and ten patients with ESR more than 80 mm/h were included into study and evaluated for the possible causes of ESR elevation. Results.– Etiology of elevated ESR was due to infectious diseases in 53 (48.2%), malignancy in 19 (17.3%), and collagen tissue diseases in 17 (15.5%) of patients. Some of the etiologies coexisted in ten (9.1%) patients. No specific etiology was detected in 31 (28.2%) patients. Among infectious diseases, pneumonia (n = 20/53, 37.7%) was the leading cause followed by urinary tract infections (UTI) (n = 17/53, 32.1%). Multiple myeloma (n = 7/19, 36.8%) was the leading cause among malignancies. Rheumatoid arthritis (n = 10/17, 58.8%) was the leading cause among collagen tissue diseases. Leukocyte count and C-reactive protein levels are useful to determine infectious diseases as a cause of markedly elevated ESR. Conclusion.– When markedly elevated, ESR is detected in a geriatric patient, before doing further expensive and invasive tests to define the etiology, infectious diseases, especially pneumonia and UTI, should be excluded. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.208 P208
Research on geriatric undergraduate training: A tale of two countries J. Mateos-Nozal , B. Montero-Errasquín , N. Pérez-Abascal , C. Sánchez-Castellano ∗ , A. Cruz Jentoft Geriatría, Hospital Ramón y Cajal, Madrid, Spain Objective.– To compare the number, topic and evolution of abstracts about Geriatrics training at the undergraduate level sent to the