- Email: [email protected]
EMAQ: New experience of a private geriatric unit in Spain
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
by a pharmacist placed by side of the medical and paramedical staff in NHs to improve the pharmacological end points by drug appropriateness. Methods.– One year observational study of 2050 residents (mean age 83 years, 23% M vs 77% F), in 25 NHs of the Local Health Authority (LHA) of Treviso. A clinical pharmacist by a dedicated software recorded age, gender, and medications for each NH residents, to identify elderly in severe polypharmacy. Drugs were classified by the Anatomical Therapeutic Chemical (ATC) code (ATC5) to identify chemical/therapeutic subgroup. Results.– The therapies mainly involved the blood and bloodforming organs (4053 DDD/1000/day), the cardiovascular system (1861 DDD/1000/day), the gastro-intestinal tract and metabolism (1355 DDD/1000/day), the nervous system (735 DDD/1000/day), the bone remineralization, mostly bisphosphonates (96 DDD/1000/day). The 73% of patients were in polypharmacy, prescribed on a number of drugs equal or greater than six: to 56.5% of them were prescribed 6–9 medications, to 22.5% 10–11 medications, while the remaining 21% from 12–21. Conclusion.– Considering the frailty of most elderly examined in this study and the extensive use of drugs, the pharmacist collaboration with NHs staff improved the therapeutic effectiveness and over that reduced the risk of drug-induced problems. Furthermore, as ‘pharmaceutical care provider’, the pharmacist improved the use of health care resources. http://dx.doi.org/10.1016/j.eurger.2013.07.549 P482
Geriatric outreach for acute surgical patients in Oxford S. Thompson , L. Rane Department of Geratology, John Radcliffe Hospital, Oxford, United Kingdom Introduction.– People aged 65 and over make up more than 50% of surgical inpatients. Recently, attention has been focused on the medical complexity of such patients and a potential role for geriatric services in optimizing outcomes has been highlighted. Where such services have been implemented, a growing body of evidence has shown an improvement in patient outcomes, with reduced complication rates and lengths of stay. Method.– We conducted an audit of the acute surgical ward at the John Radcliffe Hospital, Oxford, on a randomly chosen day on all patients ≥ 65 years (45% of all inpatients), to determine exact need for geriatric input on that ward, after which a pilot geriatric input of three ward rounds per week was implemented. We then conducted a re-audit on a randomly chosen date, to evaluate the effects of such intervention. Results.– Our test populations were roughly equivalent in terms of age (average 80 in the pre-intervention group, versus 82 in the post-intervention group) and number of drugs used on admission (average 5.6 versus 6). In the intervention group, the average length of stay was reduced from 25.1 to 17.9 days and the rate of medical complications fell from 67% to 20%. Delays, either preoperative or predischarge, were reduced from 33% to 4%. Key conclusions.– Geriatric input is highly beneficial in the management of older patients with acute surgical problems in Oxford. It has significantly improved patient outcomes, shortening length of stay and reducing complication rates. http://dx.doi.org/10.1016/j.eurger.2013.07.550 P483
Older persons attending the emergency department study (OPED) B. Drumm , A. Abdul Wahab , N. Raihan Md Nor , T. Coughlan , R. Collins , D. O’Neill , S.P. Kennelly AMNCH, Tallaght, Ireland
S165
Background.– Older patients account for an increasing proportion of the workload in emergency departments (ED). The aim of this study is to characterize the demographic profile and outcomes for older patients attending ED. Methods.– All patients aged ≥ 65 years attending an urban ED during January (1st–31st, 2012) were included and outcomes followed for 12 months. Data on demographics, ED attendances, admissions, mortality, and risk-screening scores were extracted from the electronic ED Symphony® record, clinical notes, and HIPE data. Patients were age-categorised as Group A: 65–74, Group B: 75–84, and Group C: ≥ 85 years for analysis (SPSS-20® ). Results.– Five hundred and fifty older patients (A: n = 260; B: n = 182; C: n = 108) attended ED in January (15.5% of ED attendances) of whom 345 were admitted (33.5% of admissions). Mean Charlson co-morbidity score was 5.1, 6.3, and 7.0 for each group respectively, indicating high levels of comorbid illness. Proportionally more patients in groups B + C had a positive triage risk screening tool (for identification of vulnerable older patients). Admission rates increased proportionally with age (A: 57%; B: 64%; C: 76%, P = 0.03). Similarly, inpatient length of stay, and 1-year mortality was higher in older groups. Thirty-day reattendance rates were similar for all groups (∼13%), and ED-recidivism was marginally higher in older groups (A: 43%, B: 50%, C: 52%). Conclusion.– Despite accounting for 10% of local catchment population, older patients account for 15% of ED attendances and a third of all admissions from ED. With increasing proportions of older patients necessitating review in ED, it is imperative to make this environment more gerontologically attuned. http://dx.doi.org/10.1016/j.eurger.2013.07.551 P484
The first 1000 patients within a hospital at home service G. Ellis , T. Marshall , C. Ritchie NHS Lanarkshire, Airdrie, United Kingdom Background.– In an age of increasing demographic pressure and economic restriction admission avoidance, hospital at home (HaH) services have been developed to potentially reduce pressure on hospital beds. Recent research has shown potential benefits, suggesting safer, more desirable and less expensive care. Methods.– We report the immediate and 30-day outcomes for older adults admitted to an admission avoidance HaH service. Patients over 75 (excluding stroke and ACS) referred for admission are reviewed within their own house by a nurse practitioner and consultant geriatrician. If admission is avoidable, an MDT will plan and provide ongoing care for the acute period in a similar fashion to inpatient care. Physiotherapy, occupational therapy and psychiatric nurse support are available, and home help is available immediately. Results.– Patients admitted to the service were a mean age of 81 (range 37–101). Sixty percent were female. Eighty-nine percent of referrals were from the GP (4% A&E, 3% ESD services, 4% other). On the initial presentation, 18.8% were admitted initially with 78.9% managed at home. Thirty-day outcomes showed an overall mortality rate of 9.7% (14.0% admitted, 8.5% non-admitted patients, X2 , P = 0.026 reflecting case mix differences). At 30 days, 66.6% of patients were still supported at home without further admission to hospital while 18.7% had been admitted one or more times. Conclusions.– With full MDT and specialist input, admission avoidance HaH can supplement existing CGA services. http://dx.doi.org/10.1016/j.eurger.2013.07.552 P485
EMAQ: New experience of a private geriatric unit in Spain
S166
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
F.J. Soria Perdomo , M. Herrera Abian , J. Velasco García-Cuevas , L.M. Martín Rodríguez , A.M. Moreno Collado Hospital Sur Alcorcón (IDC Salud), Alcoron, Spain Introduction.– Since summer 2013, Hospital Sur from IDC salud in Alcorcón (13 km from Madrid city) is a small hospital (70 beds) which opened a multidisciplinary team in order to follow all inpatient in surgical services such as general surgery or traumatology with special interest in fragile patients. Two geriatricians and one internal medicine specialist are part of “Equipo Médico de Apoyo Quirúrgico” (Surgical Support Medical Team). Aim.– To evaluate the activity of EMAQ in its first six months of work (second semester of 2012). Material and methods.– Descriptive retrospective study of patient seen by EMAQ’s team. Results.– 60.66 of patient seen by EMAQ’s team were 65 years or older. The mean average of visits each month increased from 9.6 to 28.5 in general surgery service (compared to the average of medical visits to surgical patients prior our team’s opening). Before our team began to work every month 61 visits were performed by a clinician, after that we performed 155 visits each month. And in first month of 2013 we made an average of 213 visits every month. Now, in every consult of our three members, at least 20% of our patients was first seen in the surgical ward of the hospital by EMAQ. Conclusions.– The EMAQ’s experience is a new experience of a multidisciplinary team with geriatricians working in a private hospital. The follow up of patients seen in surgical ward of our hospital is one of our mean areas of growth. http://dx.doi.org/10.1016/j.eurger.2013.07.553 P486
Change on attitudes toward Alzheimer’s disease: Four years after a qualitative study of the role played by social representation on French general practitioners H. Lahjibi-Paulet , A. de Almedia , J. Le Guen , C. Lopez , A. Arregui , K. Maley , M. Gisselbrecht , O. Saint-Jean Assistance publique des Hôpitaux de Paris, Paris, France Introduction.– It is commonly thought that Alzheimer’s disease (AD) is underdiagnosed and that insufficient numbers of patients are receiving pharmacological treatment. These observations are often attributed to poor management of the disease by general practitioners (GPs) related to their lack of training in identifying cognitive decline. A first preliminary study in 2004 showed that social representations of the disease influence GPs’ attitudes toward making diagnoses in France. Priority seems to focus more on assisting GPs and families at the social level, rather than diagnosis or access to treatment. Methods.– We conducted a qualitative study, through 10 semidirective interviews and 2 focus groups focusing on their representations, of GPs in Paris and Toulouse. Results were compared to first qualitative study. Results.– Analysis of interviews revealed four general trends. GPs claimed an undeniable knowledge to make AD diagnosis. However, they are against the early diagnosis of AD. The image of AD remains highly negative, seen as a vehicle for human degradation. The GPs felt solitude and helplessness when faced with family’s distress. GPs declared always scepticism as to the efficacy of AD medications, granting a mediating role in the management of AD. Social programs remained insufficient and inadequate to the needs of patients. GPs deplored the excessive care of AD, talking about ethical issues, including euthanasia.
Conclusions.– While the quality of AD diagnosis by GPs has significantly improved in four years, social representations remained a barrier to its diagnosis. http://dx.doi.org/10.1016/j.eurger.2013.07.554 P487
Older worker well-being in health care setting S. De Simone , A. Esposito Institute for Service Industry Research, Naples, Italy Keywords: Well-being; Healthcare organizations; Old worker Text.– Healthcare organizations, in order to improve the efficiency, effectiveness and quality of services, had to enhance the central role of the worker. As today’s elders live longer and remain healthy for longer periods of time than did previous generations, more and more older employees continue to work. The research is aimed to discuss factors associated with employees’ well-being, including job demand, work organizational, personality traits, health and occupational stress. Three topics are addressed: what it is that constitutes employee well-being; why employee well-being is important for organization; how subjective and psychological well-being can be reliably enhanced. Then a survey in an Italian hospital is presented, in order to identify the organizational dimensions affecting old workers’ well-being. Specifically, survey data come from an important Paediatric Neapolitan hospital, characterized by a high number of ageing workforce. The instrument is a questionnaire, addressed to doctors and nurses, including the following sections: job demand; work organization and contents; interpersonal relations and leadership; work-individual interface; organizational values; health and well-being; personality traits; valence-expectancy; demographic variables. The expected results are: to know employees’ perceptions on all dimensions determining the quality of working life and relationships in the workplace; to identify the organizational dimensions affecting old workers’ wellbeing. Finally, various interventions in the workplace to improve older workers’ well-being are discussed. http://dx.doi.org/10.1016/j.eurger.2013.07.555 P488
Changes in institutional care and round-the-clock care during 26 years in Helsinki H. Takkunen , E. Takkunen Health Centre, Helsinki, Finland Text.– In Helsinki, the capital of Finland with 600,000 inhabitants, institutional care of the elderly has been prevalent. The aim was to study the changes of institutional and round-the-clock care of the elderly during 26 years using the public statistics of the City of Helsinki and National Institute for Health and Welfare, Finland. In 1985, on average 3540 people were daily at old-age and nursing homes. In long-term hospitals, on average 2094 beds were daily in use. On average 440 patients needing long-term care were waiting in acute wards. In 1985, there was institutional care for 16.1% of the Helsinkians aged 75 years or over. Round-the-clock service housing was practically unknown. In comparison, at the end of the year 2011, the number of clients at old-age homes was 2175 and the number of long-term patients in health centre hospitals was 367. In units of 24-hour enhanced service housing the respective number of clients was 3111. At the end of the year 2011, 5.1% of the Helsinkians aged 75 years or over were in institutional care. Roundthe-clock care, either institutional or enhanced service housing was for 11.8% of this age cohort. During 26 years, the proportion of the elderly being in round-the-clock care has decreased considerably, mainly due to improved functional capacity of the elderly. The
by a pharmacist placed by side of the medical and paramedical staff in NHs to improve the pharmacological end points by drug appropriateness. Methods.– One year observational study of 2050 residents (mean age 83 years, 23% M vs 77% F), in 25 NHs of the Local Health Authority (LHA) of Treviso. A clinical pharmacist by a dedicated software recorded age, gender, and medications for each NH residents, to identify elderly in severe polypharmacy. Drugs were classified by the Anatomical Therapeutic Chemical (ATC) code (ATC5) to identify chemical/therapeutic subgroup. Results.– The therapies mainly involved the blood and bloodforming organs (4053 DDD/1000/day), the cardiovascular system (1861 DDD/1000/day), the gastro-intestinal tract and metabolism (1355 DDD/1000/day), the nervous system (735 DDD/1000/day), the bone remineralization, mostly bisphosphonates (96 DDD/1000/day). The 73% of patients were in polypharmacy, prescribed on a number of drugs equal or greater than six: to 56.5% of them were prescribed 6–9 medications, to 22.5% 10–11 medications, while the remaining 21% from 12–21. Conclusion.– Considering the frailty of most elderly examined in this study and the extensive use of drugs, the pharmacist collaboration with NHs staff improved the therapeutic effectiveness and over that reduced the risk of drug-induced problems. Furthermore, as ‘pharmaceutical care provider’, the pharmacist improved the use of health care resources. http://dx.doi.org/10.1016/j.eurger.2013.07.549 P482
Geriatric outreach for acute surgical patients in Oxford S. Thompson , L. Rane Department of Geratology, John Radcliffe Hospital, Oxford, United Kingdom Introduction.– People aged 65 and over make up more than 50% of surgical inpatients. Recently, attention has been focused on the medical complexity of such patients and a potential role for geriatric services in optimizing outcomes has been highlighted. Where such services have been implemented, a growing body of evidence has shown an improvement in patient outcomes, with reduced complication rates and lengths of stay. Method.– We conducted an audit of the acute surgical ward at the John Radcliffe Hospital, Oxford, on a randomly chosen day on all patients ≥ 65 years (45% of all inpatients), to determine exact need for geriatric input on that ward, after which a pilot geriatric input of three ward rounds per week was implemented. We then conducted a re-audit on a randomly chosen date, to evaluate the effects of such intervention. Results.– Our test populations were roughly equivalent in terms of age (average 80 in the pre-intervention group, versus 82 in the post-intervention group) and number of drugs used on admission (average 5.6 versus 6). In the intervention group, the average length of stay was reduced from 25.1 to 17.9 days and the rate of medical complications fell from 67% to 20%. Delays, either preoperative or predischarge, were reduced from 33% to 4%. Key conclusions.– Geriatric input is highly beneficial in the management of older patients with acute surgical problems in Oxford. It has significantly improved patient outcomes, shortening length of stay and reducing complication rates. http://dx.doi.org/10.1016/j.eurger.2013.07.550 P483
Older persons attending the emergency department study (OPED) B. Drumm , A. Abdul Wahab , N. Raihan Md Nor , T. Coughlan , R. Collins , D. O’Neill , S.P. Kennelly AMNCH, Tallaght, Ireland
S165
Background.– Older patients account for an increasing proportion of the workload in emergency departments (ED). The aim of this study is to characterize the demographic profile and outcomes for older patients attending ED. Methods.– All patients aged ≥ 65 years attending an urban ED during January (1st–31st, 2012) were included and outcomes followed for 12 months. Data on demographics, ED attendances, admissions, mortality, and risk-screening scores were extracted from the electronic ED Symphony® record, clinical notes, and HIPE data. Patients were age-categorised as Group A: 65–74, Group B: 75–84, and Group C: ≥ 85 years for analysis (SPSS-20® ). Results.– Five hundred and fifty older patients (A: n = 260; B: n = 182; C: n = 108) attended ED in January (15.5% of ED attendances) of whom 345 were admitted (33.5% of admissions). Mean Charlson co-morbidity score was 5.1, 6.3, and 7.0 for each group respectively, indicating high levels of comorbid illness. Proportionally more patients in groups B + C had a positive triage risk screening tool (for identification of vulnerable older patients). Admission rates increased proportionally with age (A: 57%; B: 64%; C: 76%, P = 0.03). Similarly, inpatient length of stay, and 1-year mortality was higher in older groups. Thirty-day reattendance rates were similar for all groups (∼13%), and ED-recidivism was marginally higher in older groups (A: 43%, B: 50%, C: 52%). Conclusion.– Despite accounting for 10% of local catchment population, older patients account for 15% of ED attendances and a third of all admissions from ED. With increasing proportions of older patients necessitating review in ED, it is imperative to make this environment more gerontologically attuned. http://dx.doi.org/10.1016/j.eurger.2013.07.551 P484
The first 1000 patients within a hospital at home service G. Ellis , T. Marshall , C. Ritchie NHS Lanarkshire, Airdrie, United Kingdom Background.– In an age of increasing demographic pressure and economic restriction admission avoidance, hospital at home (HaH) services have been developed to potentially reduce pressure on hospital beds. Recent research has shown potential benefits, suggesting safer, more desirable and less expensive care. Methods.– We report the immediate and 30-day outcomes for older adults admitted to an admission avoidance HaH service. Patients over 75 (excluding stroke and ACS) referred for admission are reviewed within their own house by a nurse practitioner and consultant geriatrician. If admission is avoidable, an MDT will plan and provide ongoing care for the acute period in a similar fashion to inpatient care. Physiotherapy, occupational therapy and psychiatric nurse support are available, and home help is available immediately. Results.– Patients admitted to the service were a mean age of 81 (range 37–101). Sixty percent were female. Eighty-nine percent of referrals were from the GP (4% A&E, 3% ESD services, 4% other). On the initial presentation, 18.8% were admitted initially with 78.9% managed at home. Thirty-day outcomes showed an overall mortality rate of 9.7% (14.0% admitted, 8.5% non-admitted patients, X2 , P = 0.026 reflecting case mix differences). At 30 days, 66.6% of patients were still supported at home without further admission to hospital while 18.7% had been admitted one or more times. Conclusions.– With full MDT and specialist input, admission avoidance HaH can supplement existing CGA services. http://dx.doi.org/10.1016/j.eurger.2013.07.552 P485
EMAQ: New experience of a private geriatric unit in Spain
S166
9th congress of the EUGMS / European Geriatric Medicine 4 (2013) S142–S216
F.J. Soria Perdomo , M. Herrera Abian , J. Velasco García-Cuevas , L.M. Martín Rodríguez , A.M. Moreno Collado Hospital Sur Alcorcón (IDC Salud), Alcoron, Spain Introduction.– Since summer 2013, Hospital Sur from IDC salud in Alcorcón (13 km from Madrid city) is a small hospital (70 beds) which opened a multidisciplinary team in order to follow all inpatient in surgical services such as general surgery or traumatology with special interest in fragile patients. Two geriatricians and one internal medicine specialist are part of “Equipo Médico de Apoyo Quirúrgico” (Surgical Support Medical Team). Aim.– To evaluate the activity of EMAQ in its first six months of work (second semester of 2012). Material and methods.– Descriptive retrospective study of patient seen by EMAQ’s team. Results.– 60.66 of patient seen by EMAQ’s team were 65 years or older. The mean average of visits each month increased from 9.6 to 28.5 in general surgery service (compared to the average of medical visits to surgical patients prior our team’s opening). Before our team began to work every month 61 visits were performed by a clinician, after that we performed 155 visits each month. And in first month of 2013 we made an average of 213 visits every month. Now, in every consult of our three members, at least 20% of our patients was first seen in the surgical ward of the hospital by EMAQ. Conclusions.– The EMAQ’s experience is a new experience of a multidisciplinary team with geriatricians working in a private hospital. The follow up of patients seen in surgical ward of our hospital is one of our mean areas of growth. http://dx.doi.org/10.1016/j.eurger.2013.07.553 P486
Change on attitudes toward Alzheimer’s disease: Four years after a qualitative study of the role played by social representation on French general practitioners H. Lahjibi-Paulet , A. de Almedia , J. Le Guen , C. Lopez , A. Arregui , K. Maley , M. Gisselbrecht , O. Saint-Jean Assistance publique des Hôpitaux de Paris, Paris, France Introduction.– It is commonly thought that Alzheimer’s disease (AD) is underdiagnosed and that insufficient numbers of patients are receiving pharmacological treatment. These observations are often attributed to poor management of the disease by general practitioners (GPs) related to their lack of training in identifying cognitive decline. A first preliminary study in 2004 showed that social representations of the disease influence GPs’ attitudes toward making diagnoses in France. Priority seems to focus more on assisting GPs and families at the social level, rather than diagnosis or access to treatment. Methods.– We conducted a qualitative study, through 10 semidirective interviews and 2 focus groups focusing on their representations, of GPs in Paris and Toulouse. Results were compared to first qualitative study. Results.– Analysis of interviews revealed four general trends. GPs claimed an undeniable knowledge to make AD diagnosis. However, they are against the early diagnosis of AD. The image of AD remains highly negative, seen as a vehicle for human degradation. The GPs felt solitude and helplessness when faced with family’s distress. GPs declared always scepticism as to the efficacy of AD medications, granting a mediating role in the management of AD. Social programs remained insufficient and inadequate to the needs of patients. GPs deplored the excessive care of AD, talking about ethical issues, including euthanasia.
Conclusions.– While the quality of AD diagnosis by GPs has significantly improved in four years, social representations remained a barrier to its diagnosis. http://dx.doi.org/10.1016/j.eurger.2013.07.554 P487
Older worker well-being in health care setting S. De Simone , A. Esposito Institute for Service Industry Research, Naples, Italy Keywords: Well-being; Healthcare organizations; Old worker Text.– Healthcare organizations, in order to improve the efficiency, effectiveness and quality of services, had to enhance the central role of the worker. As today’s elders live longer and remain healthy for longer periods of time than did previous generations, more and more older employees continue to work. The research is aimed to discuss factors associated with employees’ well-being, including job demand, work organizational, personality traits, health and occupational stress. Three topics are addressed: what it is that constitutes employee well-being; why employee well-being is important for organization; how subjective and psychological well-being can be reliably enhanced. Then a survey in an Italian hospital is presented, in order to identify the organizational dimensions affecting old workers’ well-being. Specifically, survey data come from an important Paediatric Neapolitan hospital, characterized by a high number of ageing workforce. The instrument is a questionnaire, addressed to doctors and nurses, including the following sections: job demand; work organization and contents; interpersonal relations and leadership; work-individual interface; organizational values; health and well-being; personality traits; valence-expectancy; demographic variables. The expected results are: to know employees’ perceptions on all dimensions determining the quality of working life and relationships in the workplace; to identify the organizational dimensions affecting old workers’ wellbeing. Finally, various interventions in the workplace to improve older workers’ well-being are discussed. http://dx.doi.org/10.1016/j.eurger.2013.07.555 P488
Changes in institutional care and round-the-clock care during 26 years in Helsinki H. Takkunen , E. Takkunen Health Centre, Helsinki, Finland Text.– In Helsinki, the capital of Finland with 600,000 inhabitants, institutional care of the elderly has been prevalent. The aim was to study the changes of institutional and round-the-clock care of the elderly during 26 years using the public statistics of the City of Helsinki and National Institute for Health and Welfare, Finland. In 1985, on average 3540 people were daily at old-age and nursing homes. In long-term hospitals, on average 2094 beds were daily in use. On average 440 patients needing long-term care were waiting in acute wards. In 1985, there was institutional care for 16.1% of the Helsinkians aged 75 years or over. Round-the-clock service housing was practically unknown. In comparison, at the end of the year 2011, the number of clients at old-age homes was 2175 and the number of long-term patients in health centre hospitals was 367. In units of 24-hour enhanced service housing the respective number of clients was 3111. At the end of the year 2011, 5.1% of the Helsinkians aged 75 years or over were in institutional care. Roundthe-clock care, either institutional or enhanced service housing was for 11.8% of this age cohort. During 26 years, the proportion of the elderly being in round-the-clock care has decreased considerably, mainly due to improved functional capacity of the elderly. The