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DRESS syndrome in elderly patients: Is it more dangerous? A report of 6 clinical cases
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
the life of an elder resident also increases their desires to work with older adults. http://dx.doi.org/10.1016/j.eurger.2013.07.472 P410
Association of sleep quality with physical performance among Korean aging people K.J. Eun Seoul, Republic of Korea Background.– The elderly population is currently increasing. Subjective and objective measures of sleep demonstrate an increase in sleep and wake disturbances with advancing age. The purpose of this study is to evaluate the correlation between the duration and quality of sleep with physical performance. Methods.– The Short Physical Performance Battery(SPPB) and sleep questionnaire (sleep quality and sleep quantity were included) were performed on random sample nested in the Korean Longitudinal Study of Ageing (KLoSA) panel. The associations of sleep duration and quality with SPPB were examined using logistic regression analysis. In both cases depression was stratified. Results.– A total of 402 subjects aged over than 45 years who performed sleep questionnaire and SPPB in the KLoSA was included. In multivariable-adjusted models, there were associations between better subjective sleep quality and normal SPPB (P = 0.04) in female. Compared to fair sleep group, well sleep group was more likely to have abnormal SPPB (adjusted odds ratio [aOR] = 0.46, 95% confidence interval [CI] = 0.22–0.95) in female. Sleep quality shows significantly positive association with normal SPPB score. But the relationship between sleep duration and normal SPPB score was not significant. Conclusion.– In our study, the better sleep quality is associated with the better physical function (higher SPPB score) in aging population, especially in female group. http://dx.doi.org/10.1016/j.eurger.2013.07.473 P411
DRESS syndrome in elderly patients: Is it more dangerous? A report of 6 clinical cases E. Meira , C. Canha , E. Ferreira , H. Esperto , F. Santos University Hospital of Coimbra, Coimbra, Portugal Introduction.– Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome (DS) is a drug-induced condition characterized by an extensive rash, fever, hematologic abnormalities and multiple organ involvement (kidneys, liver, lungs or heart). The clinical acknowledgment is crucial for an immediate intervention, above all in elderly patients, where organ functions are often impaired or weakened. Goals.– A review and characterization of elderly inpatients with diagnosis of DS in Internal Medicine department. Methods and results.– Six elderly patients were evaluated with diagnosis of DS within 2008 and 2012, identified by electronic codification system. The mean age was 80.8 years old (±5.5), with predominance of female gender (76%). The drug most implicated was allopurinol (83%). Two patients had past history of dress syndrome. At admission, all patients presented severe rash, eosinophilia, hepatitis and renal failure (2 patients needed hemodialyis). Leukocytosis was present in 83.3%, followed by facial edema (50%) and fever (33.3%). No reports of pneumonitis and/or carditis. All patients received systemic corticosteroid. The mean time of hospitalization was 17.0 days (±16.5), and all patients were discharged.
S145
Until now, there is no record of late complications in further followup. Conclusions.– The drug most responsible of DS in elderly inpatients of our department was allopurinol. The mortality rate was 0%, probably due to early intervention and prompt therapy. The only uncontested treatment is interruption of the implicated drug. The use of systemic corticosteroid is reserved to life-threatening situations. More randomized controlled studies are needed to improve the approach of DS in elderly patients. http://dx.doi.org/10.1016/j.eurger.2013.07.474 P412
The appropriateness of red cell transfusion in patients aged over 65 H. Mozam , A. Muhid University of Birmingham, Birmingham, United Kingdom Introduction and aims.– More than two-thirds of red cell transfusion episodes occur in patients aged over 65. Apart from being a relatively expensive resource (1 pack = c£125), inappropriate use can put recipients at undue risk of complications such as acute transfusion reactions. The British Committee for Standards in Haematology (BCSH) recommends the use of restrictive transfusion triggers. We aimed to identify the indications for transfusion in patients over the age of 65 and level of adherence to current transfusion guidelines. Methods.– We selected 60 inpatients aged over 65 from a sample of 417 who had received a red cell transfusion between 1st December 2010 to 28th February 2011 at Sandwell General Hospital, Birmingham. Online clinical data archives were used to obtain patient demographics, indications and pre-transfusion haemoglobin (Hb) results. Results.– All 40 patients with a pre-transfusion Hb < 8 were transfused appropriately. Of the remaining 20 patients with a pretransfusion Hb > 8, six patients were transfused inappropriately. Half of these had a Hb > 10 but in the remaining three no clinical indication was recorded. Overall, in 28% of patients no indication could be identified from online records. Key conclusions.– Current transfusion guidelines were being adhered to, however, 10% of transfusions were inappropriate. Thirty-seven percent of patients were over-transfused by a mean Hb of approximately 1 g/dL which equates to a cost of c£2750 in this sample. The key recommendation is for prescribing doctors to clearly document the reason for administration of packed red cells in medical records. The implications of over-transfusion are still not fully understood. http://dx.doi.org/10.1016/j.eurger.2013.07.475 P414
Vascular, endothelial and cardiac autonomic changes following yoga therapy in elderly subjects increased pulse pressure G. Patil Satish , G.B. Dhanakshirur , M.R. Aithala Department of Physiology, Shri B.M. Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India Introduction.– In elderly, the age-related physiological changes in vascular, endothelial and autonomic function are major contributors for development of hypertension. Age-related increase in arterial stiffness increases systolic blood pressure (SBP) and decreases diastolic blood pressure (DBP) thus causing widening of pulse pressure (PP). Increased SBP and PP are major contributors to large and small vessel disease, may lead to stroke, myocardial infarction, dementia, renal failure and death. The present study was aimed to evaluate the effect of yoga therapy for 3 months on arte-
the life of an elder resident also increases their desires to work with older adults. http://dx.doi.org/10.1016/j.eurger.2013.07.472 P410
Association of sleep quality with physical performance among Korean aging people K.J. Eun Seoul, Republic of Korea Background.– The elderly population is currently increasing. Subjective and objective measures of sleep demonstrate an increase in sleep and wake disturbances with advancing age. The purpose of this study is to evaluate the correlation between the duration and quality of sleep with physical performance. Methods.– The Short Physical Performance Battery(SPPB) and sleep questionnaire (sleep quality and sleep quantity were included) were performed on random sample nested in the Korean Longitudinal Study of Ageing (KLoSA) panel. The associations of sleep duration and quality with SPPB were examined using logistic regression analysis. In both cases depression was stratified. Results.– A total of 402 subjects aged over than 45 years who performed sleep questionnaire and SPPB in the KLoSA was included. In multivariable-adjusted models, there were associations between better subjective sleep quality and normal SPPB (P = 0.04) in female. Compared to fair sleep group, well sleep group was more likely to have abnormal SPPB (adjusted odds ratio [aOR] = 0.46, 95% confidence interval [CI] = 0.22–0.95) in female. Sleep quality shows significantly positive association with normal SPPB score. But the relationship between sleep duration and normal SPPB score was not significant. Conclusion.– In our study, the better sleep quality is associated with the better physical function (higher SPPB score) in aging population, especially in female group. http://dx.doi.org/10.1016/j.eurger.2013.07.473 P411
DRESS syndrome in elderly patients: Is it more dangerous? A report of 6 clinical cases E. Meira , C. Canha , E. Ferreira , H. Esperto , F. Santos University Hospital of Coimbra, Coimbra, Portugal Introduction.– Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome (DS) is a drug-induced condition characterized by an extensive rash, fever, hematologic abnormalities and multiple organ involvement (kidneys, liver, lungs or heart). The clinical acknowledgment is crucial for an immediate intervention, above all in elderly patients, where organ functions are often impaired or weakened. Goals.– A review and characterization of elderly inpatients with diagnosis of DS in Internal Medicine department. Methods and results.– Six elderly patients were evaluated with diagnosis of DS within 2008 and 2012, identified by electronic codification system. The mean age was 80.8 years old (±5.5), with predominance of female gender (76%). The drug most implicated was allopurinol (83%). Two patients had past history of dress syndrome. At admission, all patients presented severe rash, eosinophilia, hepatitis and renal failure (2 patients needed hemodialyis). Leukocytosis was present in 83.3%, followed by facial edema (50%) and fever (33.3%). No reports of pneumonitis and/or carditis. All patients received systemic corticosteroid. The mean time of hospitalization was 17.0 days (±16.5), and all patients were discharged.
S145
Until now, there is no record of late complications in further followup. Conclusions.– The drug most responsible of DS in elderly inpatients of our department was allopurinol. The mortality rate was 0%, probably due to early intervention and prompt therapy. The only uncontested treatment is interruption of the implicated drug. The use of systemic corticosteroid is reserved to life-threatening situations. More randomized controlled studies are needed to improve the approach of DS in elderly patients. http://dx.doi.org/10.1016/j.eurger.2013.07.474 P412
The appropriateness of red cell transfusion in patients aged over 65 H. Mozam , A. Muhid University of Birmingham, Birmingham, United Kingdom Introduction and aims.– More than two-thirds of red cell transfusion episodes occur in patients aged over 65. Apart from being a relatively expensive resource (1 pack = c£125), inappropriate use can put recipients at undue risk of complications such as acute transfusion reactions. The British Committee for Standards in Haematology (BCSH) recommends the use of restrictive transfusion triggers. We aimed to identify the indications for transfusion in patients over the age of 65 and level of adherence to current transfusion guidelines. Methods.– We selected 60 inpatients aged over 65 from a sample of 417 who had received a red cell transfusion between 1st December 2010 to 28th February 2011 at Sandwell General Hospital, Birmingham. Online clinical data archives were used to obtain patient demographics, indications and pre-transfusion haemoglobin (Hb) results. Results.– All 40 patients with a pre-transfusion Hb < 8 were transfused appropriately. Of the remaining 20 patients with a pretransfusion Hb > 8, six patients were transfused inappropriately. Half of these had a Hb > 10 but in the remaining three no clinical indication was recorded. Overall, in 28% of patients no indication could be identified from online records. Key conclusions.– Current transfusion guidelines were being adhered to, however, 10% of transfusions were inappropriate. Thirty-seven percent of patients were over-transfused by a mean Hb of approximately 1 g/dL which equates to a cost of c£2750 in this sample. The key recommendation is for prescribing doctors to clearly document the reason for administration of packed red cells in medical records. The implications of over-transfusion are still not fully understood. http://dx.doi.org/10.1016/j.eurger.2013.07.475 P414
Vascular, endothelial and cardiac autonomic changes following yoga therapy in elderly subjects increased pulse pressure G. Patil Satish , G.B. Dhanakshirur , M.R. Aithala Department of Physiology, Shri B.M. Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India Introduction.– In elderly, the age-related physiological changes in vascular, endothelial and autonomic function are major contributors for development of hypertension. Age-related increase in arterial stiffness increases systolic blood pressure (SBP) and decreases diastolic blood pressure (DBP) thus causing widening of pulse pressure (PP). Increased SBP and PP are major contributors to large and small vessel disease, may lead to stroke, myocardial infarction, dementia, renal failure and death. The present study was aimed to evaluate the effect of yoga therapy for 3 months on arte-