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Development of physical performance after acute hip fracture. A pragmatic study in a regular clinical geriatric setting
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
inability to take food orally and be discharged from hospital to home. http://dx.doi.org/10.1016/j.eurger.2013.07.334 P271
Comparison of outcome in patients more than 70 years admitted from hospital to intermediate or ordinary care in a nursing home J.F. Abrahamsen , A. Tressel , E. Engtrø , C. Haugland , R.M. Nilsen , A.H. Ranhoff Storetveit nursing home, Community of Bergen, Bergen, Norway Introduction and objectives.– In Norway, community-living older patients, not able to go home after acute hospitalization, are offered stay in ordinary short time units (STU) in nursing homes (NH). Storetveit nursing home has a 36-bed STU and a 19-bed intermediate care unit (ImCU) staffed with a geriatrician and multidisciplinary staff. The patients in the ImCU are selected based on: no major cognitive impairment, and expectance of being able to return home within 14 days. The present study compares the outcome between patients in the two units. Methods.– Data from patients in the ImCU are registered prospectively in a patient registry. Data from patients treated in the STU in the same time period, are collected from NH and community files. The patient groups were compared. Results.– Six hundred and seventeen patients were included from the ImCU and 234 from the STU. No differences were observed concerning age (median 85 years) and sex. The patients in the ImCU and the STU had significant different outcomes; respectively length of stay 14 vs. 24 days, discharge home 80% vs. 39%, transferal to other nursing homes 16% vs. 43%, death 0.3% vs. 14%. Six-months mortality was 11% vs. 31%, median days alive were 84 vs. 28. Key conclusions.– The patient population in the ImCU had significantly better outcomes. The selection criteria for the ImCU, even they were based on subjective evaluation, probably contributed to this. Only a randomized trial can answer whether better multidisciplinary treatment given in the ImCU contribute to the improved outcome. http://dx.doi.org/10.1016/j.eurger.2013.07.335 P272
Predictors for return to own home after acute hospitalization and intermediate care in nursing home J.F. Abrahamsen , E. Engtrø , C. Haugland , R.M. Nilsen , A.H. Ranhoff Storetveit nursing home, Community of Bergen, Bergen, Norway Introduction and objectives.– Storetveit nursing home has organized a 19-bed intermediate care unit staffed with a geriatrician and increased multidisciplinary staff. A heterogeneous group of selected elderly (70+ years) community-living patients with acute illness and/or trauma are transferred after acute hospitalization for further treatment and rehabilitation. The aim was to explore factors associated with returning to own home after stay in the intermediate care unit. Methods.– A prospective observational study was initiated July 2011. Prehospital information, comprehensive geriatric assessment and patient outcome were registered on all consecutive patients. The data was analyzed with univariate and multivariate regression analyses by SPSS 19 software for Windows. Results.– Six hundred and seventeen patients with median age 85 years have been included, 61% with medical and 39% with orthopaedic diagnoses. The median length of stay was 14 days (range 2–30). Eighty percent of the patients were returned to their
S103
own home, 16% transferred to other nursing homes, 3.6% readmitted hospital and 0.3% died. Physical function (Time up and go, TUG), activities of daily living (Barthel ADL index), cognition (MiniMental State Examination, MMSE) and haemoglobin concentration, were all significantly associated with return home in multivariate regression analyses. Key conclusions.– A high score on physical function test TUG and Barthel ADL index score at discharge, indicating a more independent patient, were the strongest predictors for being able to return home after postacute intermediate care in nursing home. These parameters can be improved by adequate training and rehabilitation, while low cognitive function and haemoglobin are less possible to modify. http://dx.doi.org/10.1016/j.eurger.2013.07.336 P273
The relationship between handgrip-pinch strength and age in young and older adults A. Baskent a , C. Kilic b , G. Bahat b , A. Tufan b , T. Selcuk Akpinar b , B. Saka b , N. Erten b , M. Akif Karan b a Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey b Division of Geriatrics, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey Introduction.– This study has investigated the effect of age in handgrip and pinch strength in adults. Methods.– The handgrip and pinch strength were evaluated in total 72 voluntary healthy subjects. Young and older adults ages were between (25–45) and (65–85) years. Baseline hydraulic hand dynamometer and baseline hydraulic pinch gauge were evaluated. The grip and pinch strength were evaluated three times; and means values were received. Data were analyzed with SPSS. Results.– Mean of grip and pinch strength in young adults were higher than the older adults group (P < 0.05). In both groups the results of grip and pinch strength were higher at men than the women (P < 0.05). In both groups positive correlation between grip and pinch strength were statistically significant (P < 0.05). There were statistically significant differences in both groups between dominant and non-dominant hand for all the evaluations (P < 0.05). Conclusions.– This study showed that the grip and pinch strength decreasing with age. The findings of this study can be used for the assessment and planning of rehabilitation programmes in the elderly. Especially it can be focused on hand muscles strength exercises. http://dx.doi.org/10.1016/j.eurger.2013.07.337 P274
Development of physical performance after acute hip fracture. A pragmatic study in a regular clinical geriatric setting C. Davidpremkumar , A. Åsa , H. Maria , N. Rolf , A. Gunnar Örebro University Hospital, Orebro, Sweden Introduction.– Hip fracture is a leading cause of mortality, morbidity and disability in older people and up to 50% never regain their previous functional level. There is a challenge to develop rehabilitation process and to improve assessment of physical function over time after hip fracture. The aim of the present study was to prospectively assess physical performance in hip fracture patients from the early postoperative phase until 4 months after surgery in an observational pragmatic study.
S104
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
Methods.– Assessment of seven physical functions at baseline 7–10 days after the surgery and follow-up after four months: 10-meter walk test, Timed up and go, 30-s chair stand test, handgrip strength, Berg balance scale, Functional Ambulation Category and general mobility. Results.– The 47% dropout patients were significantly older, often lived alone and used indoor walking aids. There was a large heterogeneity in all assessed variables at baseline and after four months. Therefore, the mean and median results are completed by figures showing all individual results at baseline and follow-up, compared to reference values and discussed in relation to degree of improvement. Conclusion.– The dropout group had poor health condition, which prohibits translation to the whole hip fracture population. The observed difference in physical functions at baseline and improvement at 4 months is essentially meaningless to report means and median data of functional assessment of hip fracture patients. There is a strong call for individualization in health analysis, targeting treatment and follow-up over time in hip fracture patients. http://dx.doi.org/10.1016/j.eurger.2013.07.338 P275
Physical exercise and geriatric major depression: The Seeds study G. Toni UO Cardiologia, Carpi, Modena, Italy Aim of the study.– Major Depression (MD) among the elderly causes sufferance and disability, is associated to increased cardiovascular risk and is often resistant to treatments. Literature indicates that physical exercise could be a valid therapeutical agent, but few studies investigated this issue. The study Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) is a multicentric trial comparing one protocol of training aerobic physical activity (PA), one lighter, socializing physical activity (SA) – both associated to antidepressant drug therapy – versus antidepressant drug therapy alone (AD). Methods.– Patients suffering from MD aged 65–85 were recruited from Primary Care and randomized to three treatment arms for 6 months. The efficacy of the treatments was evaluated by psychiatrists, geriatricians and cardiologists (maximum oxygen intake, VO2max, heart rate variability). Primary outcome was the remission from depressive symptomatology (Hamilton Depression Rating Scale score < 10) at 12 and 24 weeks. Results.– In the centre of Bologna East, 45 patients have now finished the study period (females, 68.6%; mean age 75.6 ± 5.8). The PA and SA interventions show good tolerability and were associated with significant improvements of VO2 max. At 12 weeks, 77.8% of patients in PA were in remission, compared to 18.2% in SA and 6.7% in AD (2 = 14.786, df = 2, P < 0.001). At 24 weeks, remission rate was still 77.8% for the PA arm, 63.6% for SA and 33.3% for AD (2 = 5.043, df = 2, P = 0.08). Conclusions.– Preliminary results show that treatments integrating physical activity and antidepressant drug are feasible, well tolerated and more efficacious for MD among the elderly compared to the antidepressant drug therapy. Further, the integrated treatment was associated with improvements of physical fitness even among older patients with MD. These data suggest a role for physical activity in the treatment of older patients with MD. http://dx.doi.org/10.1016/j.eurger.2013.07.339 P276
Bleeding in the first 24 hours after a hip fracture predicts functional recovery in older patients
˜ C.O. Minea , F.A. Quinonez Bareiro , M.S. Chiriboga Lozada , E. Valente Rodriguez , ˜ M. Araujo Ordonez Hospital Virgen del Valle, Toledo, Spain Introduction.– Hip fracture is a very bleeding event. Our objective was to determine if the bleeding in the first 24 hours after hip fracture, before the surgery, brings poor functional outcome in Rehabilitation Unit (RU). Methods.– An observational retrospective one year study was developed, involving all the patients with more than 70 years old and hip fracture, from a RU, in Toledo, that received surgical treatment after 24 hours of the event. We consider variables as age, gender, the hemoglobin level when hip fracture happens, at 24 hours; Barthel Index (BI) at admission, (BA) at discharge (BD) in the RU; the Functional Improvement was calculated (FI) (FI = BD-BA) and FI > 20 points has been considered an adequate outcome. Results.– From 108 patients, 65,7% were women. The mean age was 83.23 years. 28.6% of the patients presented a decrease of hemoglobin level more than 2 points and 42.8% less than one point. The patients that suffer less that 1-point loss of hemoglobin level and had a poor functional improvement (FI < 20) represented 41.7% and those with a FI > 20 represented 43.8%. For the patients with more than 2 points loss in hemoglobin level and a FI < 20 represented 41.7%, less than the patients with a FI > 20 (26.9%.). Conclusion.– The difference between the lost of more than 2 points of hemoglobin level in the first 24 hour before surgery and the functional recovery in RU seems to be related, but more study are necessary to establish a significative statistic relation. http://dx.doi.org/10.1016/j.eurger.2013.07.340 P277
Audit and feedback in acute geriatric wards C. König QIGG (Quality in Geriatrics and Gerontology), Graz, Austria Structured web-based documentation forms, comprising indicators of geriatric care (geriatric assessment tests, therapeutic interventions and discharge management), active (individual web based data query function with peer comparison, periodic meetings to discuss data) and passive (regular distributed printed reports) feedback mechanisms were implemented in voluntarily participating Geriatric Acute Care units. The primary aim of the quality improvement strategies was to ensure on-going surveillance of performance based on structured documentation in the complex geriatric therapeutic field. Overall, 22,279 patient data records were documented by the 18 participating units, representing 40% of all Austrian units. Following implementation an improvement in health care professionals’ compliance with desired practice of geriatric care (the documented completion rate for geriatric assessment tests, used as a primary outcome parameter, increased from 73% to 78%, P < 0.05), but not in patients’ discharge characteristics, was observed. http://dx.doi.org/10.1016/j.eurger.2013.07.341 P278
Geriatric rehabilitation for patients with advanced COPD E.F. van Dam van Isselt a,b,c , K.H. Groenewegen-Sipkema a,b,c , M. Spruit van Eijk a,b,c , N.H. Chavannes a,b,c , W.P. Achterberg a,b,c a Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 2, Postbus 9600, 2300 RC Leiden, The Netherlands
inability to take food orally and be discharged from hospital to home. http://dx.doi.org/10.1016/j.eurger.2013.07.334 P271
Comparison of outcome in patients more than 70 years admitted from hospital to intermediate or ordinary care in a nursing home J.F. Abrahamsen , A. Tressel , E. Engtrø , C. Haugland , R.M. Nilsen , A.H. Ranhoff Storetveit nursing home, Community of Bergen, Bergen, Norway Introduction and objectives.– In Norway, community-living older patients, not able to go home after acute hospitalization, are offered stay in ordinary short time units (STU) in nursing homes (NH). Storetveit nursing home has a 36-bed STU and a 19-bed intermediate care unit (ImCU) staffed with a geriatrician and multidisciplinary staff. The patients in the ImCU are selected based on: no major cognitive impairment, and expectance of being able to return home within 14 days. The present study compares the outcome between patients in the two units. Methods.– Data from patients in the ImCU are registered prospectively in a patient registry. Data from patients treated in the STU in the same time period, are collected from NH and community files. The patient groups were compared. Results.– Six hundred and seventeen patients were included from the ImCU and 234 from the STU. No differences were observed concerning age (median 85 years) and sex. The patients in the ImCU and the STU had significant different outcomes; respectively length of stay 14 vs. 24 days, discharge home 80% vs. 39%, transferal to other nursing homes 16% vs. 43%, death 0.3% vs. 14%. Six-months mortality was 11% vs. 31%, median days alive were 84 vs. 28. Key conclusions.– The patient population in the ImCU had significantly better outcomes. The selection criteria for the ImCU, even they were based on subjective evaluation, probably contributed to this. Only a randomized trial can answer whether better multidisciplinary treatment given in the ImCU contribute to the improved outcome. http://dx.doi.org/10.1016/j.eurger.2013.07.335 P272
Predictors for return to own home after acute hospitalization and intermediate care in nursing home J.F. Abrahamsen , E. Engtrø , C. Haugland , R.M. Nilsen , A.H. Ranhoff Storetveit nursing home, Community of Bergen, Bergen, Norway Introduction and objectives.– Storetveit nursing home has organized a 19-bed intermediate care unit staffed with a geriatrician and increased multidisciplinary staff. A heterogeneous group of selected elderly (70+ years) community-living patients with acute illness and/or trauma are transferred after acute hospitalization for further treatment and rehabilitation. The aim was to explore factors associated with returning to own home after stay in the intermediate care unit. Methods.– A prospective observational study was initiated July 2011. Prehospital information, comprehensive geriatric assessment and patient outcome were registered on all consecutive patients. The data was analyzed with univariate and multivariate regression analyses by SPSS 19 software for Windows. Results.– Six hundred and seventeen patients with median age 85 years have been included, 61% with medical and 39% with orthopaedic diagnoses. The median length of stay was 14 days (range 2–30). Eighty percent of the patients were returned to their
S103
own home, 16% transferred to other nursing homes, 3.6% readmitted hospital and 0.3% died. Physical function (Time up and go, TUG), activities of daily living (Barthel ADL index), cognition (MiniMental State Examination, MMSE) and haemoglobin concentration, were all significantly associated with return home in multivariate regression analyses. Key conclusions.– A high score on physical function test TUG and Barthel ADL index score at discharge, indicating a more independent patient, were the strongest predictors for being able to return home after postacute intermediate care in nursing home. These parameters can be improved by adequate training and rehabilitation, while low cognitive function and haemoglobin are less possible to modify. http://dx.doi.org/10.1016/j.eurger.2013.07.336 P273
The relationship between handgrip-pinch strength and age in young and older adults A. Baskent a , C. Kilic b , G. Bahat b , A. Tufan b , T. Selcuk Akpinar b , B. Saka b , N. Erten b , M. Akif Karan b a Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey b Division of Geriatrics, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey Introduction.– This study has investigated the effect of age in handgrip and pinch strength in adults. Methods.– The handgrip and pinch strength were evaluated in total 72 voluntary healthy subjects. Young and older adults ages were between (25–45) and (65–85) years. Baseline hydraulic hand dynamometer and baseline hydraulic pinch gauge were evaluated. The grip and pinch strength were evaluated three times; and means values were received. Data were analyzed with SPSS. Results.– Mean of grip and pinch strength in young adults were higher than the older adults group (P < 0.05). In both groups the results of grip and pinch strength were higher at men than the women (P < 0.05). In both groups positive correlation between grip and pinch strength were statistically significant (P < 0.05). There were statistically significant differences in both groups between dominant and non-dominant hand for all the evaluations (P < 0.05). Conclusions.– This study showed that the grip and pinch strength decreasing with age. The findings of this study can be used for the assessment and planning of rehabilitation programmes in the elderly. Especially it can be focused on hand muscles strength exercises. http://dx.doi.org/10.1016/j.eurger.2013.07.337 P274
Development of physical performance after acute hip fracture. A pragmatic study in a regular clinical geriatric setting C. Davidpremkumar , A. Åsa , H. Maria , N. Rolf , A. Gunnar Örebro University Hospital, Orebro, Sweden Introduction.– Hip fracture is a leading cause of mortality, morbidity and disability in older people and up to 50% never regain their previous functional level. There is a challenge to develop rehabilitation process and to improve assessment of physical function over time after hip fracture. The aim of the present study was to prospectively assess physical performance in hip fracture patients from the early postoperative phase until 4 months after surgery in an observational pragmatic study.
S104
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
Methods.– Assessment of seven physical functions at baseline 7–10 days after the surgery and follow-up after four months: 10-meter walk test, Timed up and go, 30-s chair stand test, handgrip strength, Berg balance scale, Functional Ambulation Category and general mobility. Results.– The 47% dropout patients were significantly older, often lived alone and used indoor walking aids. There was a large heterogeneity in all assessed variables at baseline and after four months. Therefore, the mean and median results are completed by figures showing all individual results at baseline and follow-up, compared to reference values and discussed in relation to degree of improvement. Conclusion.– The dropout group had poor health condition, which prohibits translation to the whole hip fracture population. The observed difference in physical functions at baseline and improvement at 4 months is essentially meaningless to report means and median data of functional assessment of hip fracture patients. There is a strong call for individualization in health analysis, targeting treatment and follow-up over time in hip fracture patients. http://dx.doi.org/10.1016/j.eurger.2013.07.338 P275
Physical exercise and geriatric major depression: The Seeds study G. Toni UO Cardiologia, Carpi, Modena, Italy Aim of the study.– Major Depression (MD) among the elderly causes sufferance and disability, is associated to increased cardiovascular risk and is often resistant to treatments. Literature indicates that physical exercise could be a valid therapeutical agent, but few studies investigated this issue. The study Safety and Efficacy of Exercise for Depression in Seniors (SEEDS) is a multicentric trial comparing one protocol of training aerobic physical activity (PA), one lighter, socializing physical activity (SA) – both associated to antidepressant drug therapy – versus antidepressant drug therapy alone (AD). Methods.– Patients suffering from MD aged 65–85 were recruited from Primary Care and randomized to three treatment arms for 6 months. The efficacy of the treatments was evaluated by psychiatrists, geriatricians and cardiologists (maximum oxygen intake, VO2max, heart rate variability). Primary outcome was the remission from depressive symptomatology (Hamilton Depression Rating Scale score < 10) at 12 and 24 weeks. Results.– In the centre of Bologna East, 45 patients have now finished the study period (females, 68.6%; mean age 75.6 ± 5.8). The PA and SA interventions show good tolerability and were associated with significant improvements of VO2 max. At 12 weeks, 77.8% of patients in PA were in remission, compared to 18.2% in SA and 6.7% in AD (2 = 14.786, df = 2, P < 0.001). At 24 weeks, remission rate was still 77.8% for the PA arm, 63.6% for SA and 33.3% for AD (2 = 5.043, df = 2, P = 0.08). Conclusions.– Preliminary results show that treatments integrating physical activity and antidepressant drug are feasible, well tolerated and more efficacious for MD among the elderly compared to the antidepressant drug therapy. Further, the integrated treatment was associated with improvements of physical fitness even among older patients with MD. These data suggest a role for physical activity in the treatment of older patients with MD. http://dx.doi.org/10.1016/j.eurger.2013.07.339 P276
Bleeding in the first 24 hours after a hip fracture predicts functional recovery in older patients
˜ C.O. Minea , F.A. Quinonez Bareiro , M.S. Chiriboga Lozada , E. Valente Rodriguez , ˜ M. Araujo Ordonez Hospital Virgen del Valle, Toledo, Spain Introduction.– Hip fracture is a very bleeding event. Our objective was to determine if the bleeding in the first 24 hours after hip fracture, before the surgery, brings poor functional outcome in Rehabilitation Unit (RU). Methods.– An observational retrospective one year study was developed, involving all the patients with more than 70 years old and hip fracture, from a RU, in Toledo, that received surgical treatment after 24 hours of the event. We consider variables as age, gender, the hemoglobin level when hip fracture happens, at 24 hours; Barthel Index (BI) at admission, (BA) at discharge (BD) in the RU; the Functional Improvement was calculated (FI) (FI = BD-BA) and FI > 20 points has been considered an adequate outcome. Results.– From 108 patients, 65,7% were women. The mean age was 83.23 years. 28.6% of the patients presented a decrease of hemoglobin level more than 2 points and 42.8% less than one point. The patients that suffer less that 1-point loss of hemoglobin level and had a poor functional improvement (FI < 20) represented 41.7% and those with a FI > 20 represented 43.8%. For the patients with more than 2 points loss in hemoglobin level and a FI < 20 represented 41.7%, less than the patients with a FI > 20 (26.9%.). Conclusion.– The difference between the lost of more than 2 points of hemoglobin level in the first 24 hour before surgery and the functional recovery in RU seems to be related, but more study are necessary to establish a significative statistic relation. http://dx.doi.org/10.1016/j.eurger.2013.07.340 P277
Audit and feedback in acute geriatric wards C. König QIGG (Quality in Geriatrics and Gerontology), Graz, Austria Structured web-based documentation forms, comprising indicators of geriatric care (geriatric assessment tests, therapeutic interventions and discharge management), active (individual web based data query function with peer comparison, periodic meetings to discuss data) and passive (regular distributed printed reports) feedback mechanisms were implemented in voluntarily participating Geriatric Acute Care units. The primary aim of the quality improvement strategies was to ensure on-going surveillance of performance based on structured documentation in the complex geriatric therapeutic field. Overall, 22,279 patient data records were documented by the 18 participating units, representing 40% of all Austrian units. Following implementation an improvement in health care professionals’ compliance with desired practice of geriatric care (the documented completion rate for geriatric assessment tests, used as a primary outcome parameter, increased from 73% to 78%, P < 0.05), but not in patients’ discharge characteristics, was observed. http://dx.doi.org/10.1016/j.eurger.2013.07.341 P278
Geriatric rehabilitation for patients with advanced COPD E.F. van Dam van Isselt a,b,c , K.H. Groenewegen-Sipkema a,b,c , M. Spruit van Eijk a,b,c , N.H. Chavannes a,b,c , W.P. Achterberg a,b,c a Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 2, Postbus 9600, 2300 RC Leiden, The Netherlands