- Email: [email protected]
Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. Integrated Systematic Care for older People–the ISCOPE study
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9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
makers must know how many patients are identified as well by the public health insurance. Objectives are to describe epidemiologic trends of dementia identified in the public health insurance databases in France between 2007 and 2011. Methods/Material.– Permanent sample of beneficiaries, a representative 1/97 sample (n = 665,000) of usual public health insurance beneficiaries. Inclusion criterias: individuals aged over 60 and identified in one of the public health insurance databases as suffering from dementia. Results.– In the public health insurance databases, prevalence of dementia raised from 3.6% to 3.9% over 60 (P < 0.05) and from 14.3% to 15.1% over 85 (P < 0.05) between 2007 and 2011. Prevalence increased with age and was more important for women for both study years. There were no significant difference in age or gender distribution. The incidence rate raised from 9.1‰ to 9.3‰ over 60 and from 35.7‰ to 35.9‰ over 85 (NS). Four hundred and twentyeight thousand eight hundred and thirty individuals in 2007 and 457,253 in 2011 were identified as suffering from dementia in the whole French population. Specific dementia drugs consumption decreased from 65.7% to 52.0% (P < 0.01). There were no significant changes in the one-year mortality rate between 2007 and 2011. Conclusion.– Dementia prevalence raised in the 4-year period. Our results, compared to longitudinal cohorts estimations, suggest that many patients are still unidentified. They also suggest a decreasing pharmacological approach in the treatment of dementia. http://dx.doi.org/10.1016/j.eurger.2013.07.560 P493
Which residential long-term care (LTC) facilities have residents at high risk of acute hospitalisation? Why would we want to know? Which method of selection might we use? J.B. Broad , T. Lumley , T. Ashton , M. Boyd , N. Kerse , M.J. Connolly University of Auckland, Auckland, New Zeland Background.– Good clinical care within LTC facilities potentially reduces acute hospitalizations. By identifying facilities with residents at high risk of acute hospitalization (high-use), it may be possible to improve management and avoid hospital-acquired clinical problems. We present and compare several methods of identifying high-use facilities, and discuss their appropriateness. Methods.– Records of 149 LTC facilities (21 characteristics) and 6271 residents (160 characteristics) were collected in 2008 in a census-type survey in greater Auckland. They were linked to routinely-collected information for pre- and post-survey hospitalizations for conditions classified as potentially reducible/avoidable. We compared simple event rates to rankings derived from statistical models that accounted for facility- and resident-level characteristics, and from residuals in those models. Results.– The overall event rate was 0.35 events per person-year of follow-up, with the single best predictor being rate during a recent 3-month period. Different methods selected different facilities: those ranked higher than 10th/149 by crude rates ranked as low as 48th/149 in models that adjusted for facility-level information, or even lower when using model residuals. Key conclusions.– When wishing simply to identify facilities with highest rates of hospital presentations, then recent presentation rates suffice. When wishing to inform service design, statistical models to identify factors most associated with events are appropriate. However, when the purpose is to identify and target a few high-use facilities where changes may be achievable, facilities with large residuals in models adjusting for facility- and resident-level care needs may be more appropriate. The purpose of identifying high-use facilities should determine the method choice. http://dx.doi.org/10.1016/j.eurger.2013.07.561
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A study of the cognitive deterioration in the elder J. Bernad , A. Vazquez , J. Gerhard , A. Montoliu , L. Bernad , C. Santamaria ICS, Vilassar de Mar, Spain Aims.– 1. Detection and prevention of the patients with Cognitive Deterioration (DC). 2. Evaluation of the weariness of the minder in the DC. 3. To give information to the patients and the minders. 4. Planning of activities in patients with DC. Material and methods.– Center of Primary Attention semiurban (CAP). Population: majors of 70 years. Cohort of major of 70 years and in program of Home Attention (ATDOM). Tests: Zarit, TIN, Minimental State Examination (MMSE), Scales of Global Deterioration of Resisberg-Fast (GDS), Barthel. Electronic history (E-cap). Excel. Results.– Creation of stable and multidisciplinary groups of study Formation of the minders for groups Population > 70 years = 4.333, 2834 women (65.4%) and 1499 men (34.6%). Population ATDOM = 267; 196 women (73.4%) and 71 men (26.6%). Prevalency DC > 70 years = 2.6 (3.28 women and 1.49 men). By aetiologies: Alzheimer (50.94%), vascular (33.96%), not specified dementias (13.20%), disorders of memory (1.89%). Conclusions.– 24.1% of DC is in ATDOM. Alzheimer is the most frequent cause of DC. The prevalence of DC in our community is similar to the general. It is necessary for a special attention to the wear of the minder. http://dx.doi.org/10.1016/j.eurger.2013.07.562 P495
Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. Integrated Systematic Care for older People–the ISCOPE study J.W. Blom , W.P.J. den Elzen , A.H. van Houwelingen , M. Heijmans , T. Stijnen , W.B. van den Hout , J. Gussekloo Department of Public Health and Primary Care, Department of Medical Statistics, Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands Introduction.– Although for older people a pro-active integrated horizontal way of working by general practitioners (GPs) is advocated, feasibility and cost-effectiveness are yet unknown. Methods.– In the ISCOPE-study, a cluster-randomised trial, older persons aged ≥ 75 years in 59 general practices were screened using a simple mailed questionnaire on 4 health-domains: functional, somatic, mental and social. GPs in intervention practices made a care plan using a functional geriatric approach for those participants with problems on ≥ 3 domains. The GPs in the control group continued care as usual. Outcome measures: competence to perform activities of daily living, quality of life (QoL), satisfaction with delivered care, cost-effectiveness. Results.– Out of 11,476 registered eligible older people, 7285 (63%) participated in the screening. Twenty-six percent (n = 1.921) had problems on ≥ 3 domains. For 225 out of 288 randomly chosen persons with complex problems a care plan was made. There were no effects on daily functioning, QoL, health care use or costs. Older patients for whom a care plan was made were more satisfied with the care offered by their GP (97.8% vs 93.7%, P = 0.039), and GPs experienced better organization and more stability in the care. Conclusion.– There was no effect on functioning, QoL or health care costs with this proactive, integrated intervention for older people with complex problems. However, GPs experienced stability in the care, and the older persons were more satisfied with their GP. Pro-
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
active integrated horizontal care using care plans for older people with complex problems can be a valuable tool in general practice. http://dx.doi.org/10.1016/j.eurger.2013.07.563 P496
Hypodermoclysis (subcutaneous infusions) – a simple and easy-to-teach tool to avoid hospital admissions due to dehydration in frail nursing home (NH) residents
spirometry. We will be applied to address cognitive rehabilitation protocols, with outpatient multidisciplinary team. Results.– The project involves taking charge of a term of 60 days to about 20 patients, a total of 60 patients followed at home. Indicators to measure: reduced access to specialist visits, economic evaluation, reduction improper admission, reduced inpatient days, optimizing consumption of drugs, improving the quality of life of patients, reducing stress of caregivers. http://dx.doi.org/10.1016/j.eurger.2013.07.565 P498
J. Zeeh Geriatrische Fachklinik Georgenhaus, Sozialwerk Meiningem, Meiningen, Germany
Oncogeriatric activity in Lorraine, France: Organization of a regional oncogeriatric coordination unit
Introduction.– Dehydration is an important cause for acute physical and cognitive decline in frail elderly. Hypodermoclysis (HDC) used to be widely unknown in our country until a decade ago. Thus, dehydrated NH residents were usually transferred to hospital for intravenous rehydration. Methods.– We offered lectures and training sessions to the nursing staff of 10 homes with a total of 1000 beds in our catchment area between 2005 and 2011. The chief nursing officers were interviewed before 2005 and after 2011, and questioned about their use of and experience with HDC and, if appropriate, reasons for their non-use of this technique. Results.– Before 2005, only 10% of NHs practised HDC, whereas after 2011, 90–100% of homes did so. Hospital admissions fell markedly although it was difficult to assess the true incidence. Unfamiliarity with the technique of HDC, doubts about it’s efficiacy and fear of off-label-use of i.v. infusions were the main reasons not to practise HDC. Conclusions.– By the means of information and training of nursing home staff, HDC could be established in most homes as a treatment of acutely unwell, dehydrated elderly NH residents without the need for hospital admission.
J.-Y. Niemier a , C. Perret-Guillame a , H. Rousselot b , I. Krakowski b , A. Benetos a a University Hospital of Nancy, Department of Geriatrics, Nancy, France b Institut de Cancerologie de Lorraine, Nancy, France
http://dx.doi.org/10.1016/j.eurger.2013.07.564 P497
Tele-geriatrics and tele-nursing: Hospital at home for elderly with chronic diseases D. Salerno , G. Cosenza , S. Falchero , M. Rollero ASL TO3, Turin, Italy Introduction.– The aim was to evaluate feasibility, effectiveness of new models of care at hospital level, innovative and customized for elderly patients with chronic diseases (cardiovascular, respiratory, metabolic, cognitive impairment, chronic neurological disorders), seeking to address the conditions clinics in collaboration with general practitioners, through the use of new technologies, leading instruments of telemedicine at home, with the aim of preventing and treating medical complications, cognitive disorders, in order to reduce: emergency, hospitalization, long-term care, burden of caregivers. Methods.– Pilot study uses a multidisciplinary team coordinated by reference hospital geriatrician: medical staff (hospital specialists and outpatient), family doctors, nursing home care. The clinical tool is the Multidimensional Assessment, will also consist of computerized medical records, be networked and read by specialists in hospital/outpatient and family physicians involved in the project. And being set up the helpline with medical, nursing, technical and sociomedical, operating daily from 8 a.m. to 20. Electromedical equipment will be used by mobile kit, brought to the home of the sick for the detection of the following clinical parameters: ECG, blood pressure, pulse oximetry, blood glucose, body weight,
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Introduction.– Lorraine Coordination Unit in Oncogeriatric (ULCOG) was created following a national a found of the National Cancer Institute (INCA) in 2012. This unit is supported by two different structures: a private cancer center and the University Hospital of Nancy. The assigned objectives are better tailored treatments for old patients with cancer, making accessible care for these patients, contributing to the development of research and support training and information in geriatric oncology. Method.– Create a steering committee, defining a dashboard with conducting an inventory taking into account the terrain and local constraints, defined lines and actions to be taken. For each action, we specify: the expected results, the responsible action, financial, technical and human allocated resources, the start and the end dates of the action, and performance indicators. Results.– Retrospective evaluation of the work done in relation to the timetable, list of challenges, adjustments to be achieved in terms of timing and corrective actions. Conclusion.– This is an ambitious project requiring coordination between two very different institutions working to federate several hospitals in the field of geriatric oncology, all over the region. The limited 3 years period which is imposed by the INCa may be short given the potential of the project. Nevertheless, the first feedbacks we have are very positive. http://dx.doi.org/10.1016/j.eurger.2013.07.566 P499
Quantity and characteristics of randomized controlled clinical trials including the elderly: A systematic review K. Broekhuizen , A.B. Pothof , S.P. Mooijaart Institute for Evidence-Based Medicine in Old Age, Department of Gerontology and Geriatrics, Leiden University Medical Center, Leide, The Netherlans Introduction.– While being the most frequent users of healthcare, the elderly are underrepresented in Randomized Controlled Trials (RCTs). In this review, we aimed to quantify the proportion of RCTs specifically designed for the elderly, and to assess the characteristics of these RCTs compared to RCTs not specifically designed for the elderly. Methods.– First, the PubMed database was searched for RCTs published between January 2011 and January 2012. From the results (n = 25,608), a random sample of 930 publications was drawn and checked for eligibility, which yielded 339 publications. Within this sample, we searched for RCTs specifically designed for the elderly
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
makers must know how many patients are identified as well by the public health insurance. Objectives are to describe epidemiologic trends of dementia identified in the public health insurance databases in France between 2007 and 2011. Methods/Material.– Permanent sample of beneficiaries, a representative 1/97 sample (n = 665,000) of usual public health insurance beneficiaries. Inclusion criterias: individuals aged over 60 and identified in one of the public health insurance databases as suffering from dementia. Results.– In the public health insurance databases, prevalence of dementia raised from 3.6% to 3.9% over 60 (P < 0.05) and from 14.3% to 15.1% over 85 (P < 0.05) between 2007 and 2011. Prevalence increased with age and was more important for women for both study years. There were no significant difference in age or gender distribution. The incidence rate raised from 9.1‰ to 9.3‰ over 60 and from 35.7‰ to 35.9‰ over 85 (NS). Four hundred and twentyeight thousand eight hundred and thirty individuals in 2007 and 457,253 in 2011 were identified as suffering from dementia in the whole French population. Specific dementia drugs consumption decreased from 65.7% to 52.0% (P < 0.01). There were no significant changes in the one-year mortality rate between 2007 and 2011. Conclusion.– Dementia prevalence raised in the 4-year period. Our results, compared to longitudinal cohorts estimations, suggest that many patients are still unidentified. They also suggest a decreasing pharmacological approach in the treatment of dementia. http://dx.doi.org/10.1016/j.eurger.2013.07.560 P493
Which residential long-term care (LTC) facilities have residents at high risk of acute hospitalisation? Why would we want to know? Which method of selection might we use? J.B. Broad , T. Lumley , T. Ashton , M. Boyd , N. Kerse , M.J. Connolly University of Auckland, Auckland, New Zeland Background.– Good clinical care within LTC facilities potentially reduces acute hospitalizations. By identifying facilities with residents at high risk of acute hospitalization (high-use), it may be possible to improve management and avoid hospital-acquired clinical problems. We present and compare several methods of identifying high-use facilities, and discuss their appropriateness. Methods.– Records of 149 LTC facilities (21 characteristics) and 6271 residents (160 characteristics) were collected in 2008 in a census-type survey in greater Auckland. They were linked to routinely-collected information for pre- and post-survey hospitalizations for conditions classified as potentially reducible/avoidable. We compared simple event rates to rankings derived from statistical models that accounted for facility- and resident-level characteristics, and from residuals in those models. Results.– The overall event rate was 0.35 events per person-year of follow-up, with the single best predictor being rate during a recent 3-month period. Different methods selected different facilities: those ranked higher than 10th/149 by crude rates ranked as low as 48th/149 in models that adjusted for facility-level information, or even lower when using model residuals. Key conclusions.– When wishing simply to identify facilities with highest rates of hospital presentations, then recent presentation rates suffice. When wishing to inform service design, statistical models to identify factors most associated with events are appropriate. However, when the purpose is to identify and target a few high-use facilities where changes may be achievable, facilities with large residuals in models adjusting for facility- and resident-level care needs may be more appropriate. The purpose of identifying high-use facilities should determine the method choice. http://dx.doi.org/10.1016/j.eurger.2013.07.561
P494
A study of the cognitive deterioration in the elder J. Bernad , A. Vazquez , J. Gerhard , A. Montoliu , L. Bernad , C. Santamaria ICS, Vilassar de Mar, Spain Aims.– 1. Detection and prevention of the patients with Cognitive Deterioration (DC). 2. Evaluation of the weariness of the minder in the DC. 3. To give information to the patients and the minders. 4. Planning of activities in patients with DC. Material and methods.– Center of Primary Attention semiurban (CAP). Population: majors of 70 years. Cohort of major of 70 years and in program of Home Attention (ATDOM). Tests: Zarit, TIN, Minimental State Examination (MMSE), Scales of Global Deterioration of Resisberg-Fast (GDS), Barthel. Electronic history (E-cap). Excel. Results.– Creation of stable and multidisciplinary groups of study Formation of the minders for groups Population > 70 years = 4.333, 2834 women (65.4%) and 1499 men (34.6%). Population ATDOM = 267; 196 women (73.4%) and 71 men (26.6%). Prevalency DC > 70 years = 2.6 (3.28 women and 1.49 men). By aetiologies: Alzheimer (50.94%), vascular (33.96%), not specified dementias (13.20%), disorders of memory (1.89%). Conclusions.– 24.1% of DC is in ATDOM. Alzheimer is the most frequent cause of DC. The prevalence of DC in our community is similar to the general. It is necessary for a special attention to the wear of the minder. http://dx.doi.org/10.1016/j.eurger.2013.07.562 P495
Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. Integrated Systematic Care for older People–the ISCOPE study J.W. Blom , W.P.J. den Elzen , A.H. van Houwelingen , M. Heijmans , T. Stijnen , W.B. van den Hout , J. Gussekloo Department of Public Health and Primary Care, Department of Medical Statistics, Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands Introduction.– Although for older people a pro-active integrated horizontal way of working by general practitioners (GPs) is advocated, feasibility and cost-effectiveness are yet unknown. Methods.– In the ISCOPE-study, a cluster-randomised trial, older persons aged ≥ 75 years in 59 general practices were screened using a simple mailed questionnaire on 4 health-domains: functional, somatic, mental and social. GPs in intervention practices made a care plan using a functional geriatric approach for those participants with problems on ≥ 3 domains. The GPs in the control group continued care as usual. Outcome measures: competence to perform activities of daily living, quality of life (QoL), satisfaction with delivered care, cost-effectiveness. Results.– Out of 11,476 registered eligible older people, 7285 (63%) participated in the screening. Twenty-six percent (n = 1.921) had problems on ≥ 3 domains. For 225 out of 288 randomly chosen persons with complex problems a care plan was made. There were no effects on daily functioning, QoL, health care use or costs. Older patients for whom a care plan was made were more satisfied with the care offered by their GP (97.8% vs 93.7%, P = 0.039), and GPs experienced better organization and more stability in the care. Conclusion.– There was no effect on functioning, QoL or health care costs with this proactive, integrated intervention for older people with complex problems. However, GPs experienced stability in the care, and the older persons were more satisfied with their GP. Pro-
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
active integrated horizontal care using care plans for older people with complex problems can be a valuable tool in general practice. http://dx.doi.org/10.1016/j.eurger.2013.07.563 P496
Hypodermoclysis (subcutaneous infusions) – a simple and easy-to-teach tool to avoid hospital admissions due to dehydration in frail nursing home (NH) residents
spirometry. We will be applied to address cognitive rehabilitation protocols, with outpatient multidisciplinary team. Results.– The project involves taking charge of a term of 60 days to about 20 patients, a total of 60 patients followed at home. Indicators to measure: reduced access to specialist visits, economic evaluation, reduction improper admission, reduced inpatient days, optimizing consumption of drugs, improving the quality of life of patients, reducing stress of caregivers. http://dx.doi.org/10.1016/j.eurger.2013.07.565 P498
J. Zeeh Geriatrische Fachklinik Georgenhaus, Sozialwerk Meiningem, Meiningen, Germany
Oncogeriatric activity in Lorraine, France: Organization of a regional oncogeriatric coordination unit
Introduction.– Dehydration is an important cause for acute physical and cognitive decline in frail elderly. Hypodermoclysis (HDC) used to be widely unknown in our country until a decade ago. Thus, dehydrated NH residents were usually transferred to hospital for intravenous rehydration. Methods.– We offered lectures and training sessions to the nursing staff of 10 homes with a total of 1000 beds in our catchment area between 2005 and 2011. The chief nursing officers were interviewed before 2005 and after 2011, and questioned about their use of and experience with HDC and, if appropriate, reasons for their non-use of this technique. Results.– Before 2005, only 10% of NHs practised HDC, whereas after 2011, 90–100% of homes did so. Hospital admissions fell markedly although it was difficult to assess the true incidence. Unfamiliarity with the technique of HDC, doubts about it’s efficiacy and fear of off-label-use of i.v. infusions were the main reasons not to practise HDC. Conclusions.– By the means of information and training of nursing home staff, HDC could be established in most homes as a treatment of acutely unwell, dehydrated elderly NH residents without the need for hospital admission.
J.-Y. Niemier a , C. Perret-Guillame a , H. Rousselot b , I. Krakowski b , A. Benetos a a University Hospital of Nancy, Department of Geriatrics, Nancy, France b Institut de Cancerologie de Lorraine, Nancy, France
http://dx.doi.org/10.1016/j.eurger.2013.07.564 P497
Tele-geriatrics and tele-nursing: Hospital at home for elderly with chronic diseases D. Salerno , G. Cosenza , S. Falchero , M. Rollero ASL TO3, Turin, Italy Introduction.– The aim was to evaluate feasibility, effectiveness of new models of care at hospital level, innovative and customized for elderly patients with chronic diseases (cardiovascular, respiratory, metabolic, cognitive impairment, chronic neurological disorders), seeking to address the conditions clinics in collaboration with general practitioners, through the use of new technologies, leading instruments of telemedicine at home, with the aim of preventing and treating medical complications, cognitive disorders, in order to reduce: emergency, hospitalization, long-term care, burden of caregivers. Methods.– Pilot study uses a multidisciplinary team coordinated by reference hospital geriatrician: medical staff (hospital specialists and outpatient), family doctors, nursing home care. The clinical tool is the Multidimensional Assessment, will also consist of computerized medical records, be networked and read by specialists in hospital/outpatient and family physicians involved in the project. And being set up the helpline with medical, nursing, technical and sociomedical, operating daily from 8 a.m. to 20. Electromedical equipment will be used by mobile kit, brought to the home of the sick for the detection of the following clinical parameters: ECG, blood pressure, pulse oximetry, blood glucose, body weight,
S169
Introduction.– Lorraine Coordination Unit in Oncogeriatric (ULCOG) was created following a national a found of the National Cancer Institute (INCA) in 2012. This unit is supported by two different structures: a private cancer center and the University Hospital of Nancy. The assigned objectives are better tailored treatments for old patients with cancer, making accessible care for these patients, contributing to the development of research and support training and information in geriatric oncology. Method.– Create a steering committee, defining a dashboard with conducting an inventory taking into account the terrain and local constraints, defined lines and actions to be taken. For each action, we specify: the expected results, the responsible action, financial, technical and human allocated resources, the start and the end dates of the action, and performance indicators. Results.– Retrospective evaluation of the work done in relation to the timetable, list of challenges, adjustments to be achieved in terms of timing and corrective actions. Conclusion.– This is an ambitious project requiring coordination between two very different institutions working to federate several hospitals in the field of geriatric oncology, all over the region. The limited 3 years period which is imposed by the INCa may be short given the potential of the project. Nevertheless, the first feedbacks we have are very positive. http://dx.doi.org/10.1016/j.eurger.2013.07.566 P499
Quantity and characteristics of randomized controlled clinical trials including the elderly: A systematic review K. Broekhuizen , A.B. Pothof , S.P. Mooijaart Institute for Evidence-Based Medicine in Old Age, Department of Gerontology and Geriatrics, Leiden University Medical Center, Leide, The Netherlans Introduction.– While being the most frequent users of healthcare, the elderly are underrepresented in Randomized Controlled Trials (RCTs). In this review, we aimed to quantify the proportion of RCTs specifically designed for the elderly, and to assess the characteristics of these RCTs compared to RCTs not specifically designed for the elderly. Methods.– First, the PubMed database was searched for RCTs published between January 2011 and January 2012. From the results (n = 25,608), a random sample of 930 publications was drawn and checked for eligibility, which yielded 339 publications. Within this sample, we searched for RCTs specifically designed for the elderly