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Falls and anemia – cause and effect, mutual relationship
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
literature. Future research investigating relationship between vitamin B12 levels and falls are needed. http://dx.doi.org/10.1016/j.eurger.2013.07.212 P149
Falls and anemia – cause and effect, mutual relationship P. Weber , H. Meluzínová , J. Hrubanová , D. Weberova , H. Matˇejovská-Kubeˇsová , V. Polcarová , K. Bieláková , P. Ambroˇsová , P. Canov Department of Geriatrics, Faculty Hospital and Masaryk University, Czech Republic Background.– Although falls are more prevalent as aging proceeds, it cannot be assumed that it happens due to aging alone. Their causes in old age are mostly multifactorial interactions of numerous internal and external factors. Aim of the study.– The prospective long-term study of data was targeted to make an analysis of prevalence of falls in anemic patients in comparison to the non-anemic 65+ years. admitted to the geriatric department and evaluation of pertinent influence of age, gender and immobility on occurrence of falls. Patients and methods.– During the considered period of four years (2009–2012) the authors treated 5,845 elderly patients aged 65+ years. (79.9 ± 8.6 years.) All the patients were admitted nonselectively from the catchment area of Brno city where 120 000 inhabitants live. Among them a subgroup of 556 (9.5%) old anemic patients (aged 81 ± 7.0 years.) with decreased hemoglobin (< 110 g/l) and clinical signs of anemia was chosen. All the presented patients underwent a complete intern examination (assessment of iron, ferritin, transferin, B12, folat, zinc inclusive) and complex geriatric assessment, too. Results.– Falls at hospital admission in average was present in 1553 non-anemic persons (29.4%) in comparison to 365 falls among anemic patients (65.4%). The occurrence between male and female anemic groups is not statistically significant (62.2% vs. 67.4%). Conclusions.– Authors emphasize that anemia appears to us as significant risk factor for falls in the elderly, similarly for both genders. Therefore falls in old anemic patients represent a large public health problem that has serious medical and economic consequences. http://dx.doi.org/10.1016/j.eurger.2013.07.213 P150
The influence of heart failure (HF), atrial fibrillation (AF), chronic kidney disease (CKD) and 25(OH)d serum level on fall risk P. Weiler , B. Hölzl Landesklinik St. Veit im Pongau, Salzburg, Austria Introduction.– The influence of heart failure (HF), atrial fibrillation (AF), chronic kidney disease (CKD) and 25(OH)D serum level on fall risk. The incidence of HF, AF and CKD is increasing with age. Polypharmacy, low vitamin D serum levels are common in elderly patients. Aim of the study was to measure valid parameters and to analyze the influence on fall risk. Methods.– One hundred consecutive patients, mean age 86 (80–96), 82% female, were included. NT-pro BNP, GFR (MDRD) and 25(OH) Dserum level were measured. Additionally the prevalence of AF and the number of prescribed medication was documented. Fall risk was tested using a recommended assessment scale. KolmogorovSmirnov, Anova and Pearson-Correlation-Test were applied. Results.– NT-pBNP (median 1885 pg/ml with, 515 pg/ml without AF) correlated high significantly (P 0,0001) with AF. The risk of fall correlated (P 0,01) with AF (26% of all patients), with NT-pBNP
S65
higher than 700 (P 0,002) and GFR ≤ 44 ml/min/1.73 m2 (P 0,03). Correlation was inverse concerning NT-pBNP and GFR (P 0,02). Age ≥ 85 (P 0,03) and the number of medication ≥ 5 (P 0,04) correlated to a higher fall risk. 25(OH)serum level was highest in July (median 24) an lowest in November (median 11) (P 0,006) The correlation of the 25(OH)serum level to fall risk was not significant (P 0,55). Conclusion.– Beside polypharmacy and age, HF, AF and CKD significantly contribute to the elevated fall risk in elderly patients, low vitamin D serum levels seem to play a minor role. http://dx.doi.org/10.1016/j.eurger.2013.07.214 P151
A review of the outcome of conservatively managed impacted, undisplaced intracapsular hip fracture C. Porter , P. Wearing , A. Chatterjee Royal Berkshire Foundation Trust, Reading, UK Introduction.– The available evidence to guide decisions regarding operative or conservative management of impacted intracapsular femur fractures is limited. Method.– A patient database was created using information from electronic discharge letters, patient records and the national hip fracture database covering admissions from 1st January 2008 to 31st December 2011. Clinical outcomes were followed up over three years. Data was collected on the following outcomes – patient demographics, admission residence and discharge destination, length of stay, admission outcome, readmission, and complications. Results.– Thirty patients were included in the study, 86% were female, aged 75 to 100 years. Twenty-four percent (24%) of patients failed conservative management and required surgical intervention. Eight patients (32%) were readmitted for related reasons during the follow up period. Twenty percent of patients were readmitted with falls. Two patients (8%) developed avascular necrosis. Five patients died during their admission. Three patients were delayed to theatre during their initial admission. Mean length of stay – 14.7 days (2–45). Mean length of stay of patients delayed to theatre – 16 days (11-24). Average operative length of stay of 16.8 days for the same period. The average total length of stay for patients re-admitted was 36 days. Eighteen patients (60%) returned to their admission residence, three patients (10%) required an increase in care. Conclusions.– The conclusions of this study are limited due to the small number of patients involved. Further comparative trials are required before definite conclusions can be drawn regarding conservative management of impacted hip fractures. http://dx.doi.org/10.1016/j.eurger.2013.07.215 P152
Predictors for falls in elderly hospital patients R. Püllen , U. Laupheimer , E. Hermann Agaplesion Frankfurter Diakoniekliniken, Institut für Biostatistik und mathematische Modellierung, Germany Background.– In contrast to elderly patients living at home or in old people’s homes, for patients in hospitals only few data are available to date on the risk factors leading to falls. Materials and methods.– Between 1.7.2010 and 31.12.2010, all falls in a geriatric hospital department were recorded prospectively. A control group was formed from those patients in the same hospital during the same period who did not fall. Taking into account the risk factors to be analyzed, the control group size was set at 243 patients. Existing diseases and medication of the patients falling and not falling were taken from their patient files.
literature. Future research investigating relationship between vitamin B12 levels and falls are needed. http://dx.doi.org/10.1016/j.eurger.2013.07.212 P149
Falls and anemia – cause and effect, mutual relationship P. Weber , H. Meluzínová , J. Hrubanová , D. Weberova , H. Matˇejovská-Kubeˇsová , V. Polcarová , K. Bieláková , P. Ambroˇsová , P. Canov Department of Geriatrics, Faculty Hospital and Masaryk University, Czech Republic Background.– Although falls are more prevalent as aging proceeds, it cannot be assumed that it happens due to aging alone. Their causes in old age are mostly multifactorial interactions of numerous internal and external factors. Aim of the study.– The prospective long-term study of data was targeted to make an analysis of prevalence of falls in anemic patients in comparison to the non-anemic 65+ years. admitted to the geriatric department and evaluation of pertinent influence of age, gender and immobility on occurrence of falls. Patients and methods.– During the considered period of four years (2009–2012) the authors treated 5,845 elderly patients aged 65+ years. (79.9 ± 8.6 years.) All the patients were admitted nonselectively from the catchment area of Brno city where 120 000 inhabitants live. Among them a subgroup of 556 (9.5%) old anemic patients (aged 81 ± 7.0 years.) with decreased hemoglobin (< 110 g/l) and clinical signs of anemia was chosen. All the presented patients underwent a complete intern examination (assessment of iron, ferritin, transferin, B12, folat, zinc inclusive) and complex geriatric assessment, too. Results.– Falls at hospital admission in average was present in 1553 non-anemic persons (29.4%) in comparison to 365 falls among anemic patients (65.4%). The occurrence between male and female anemic groups is not statistically significant (62.2% vs. 67.4%). Conclusions.– Authors emphasize that anemia appears to us as significant risk factor for falls in the elderly, similarly for both genders. Therefore falls in old anemic patients represent a large public health problem that has serious medical and economic consequences. http://dx.doi.org/10.1016/j.eurger.2013.07.213 P150
The influence of heart failure (HF), atrial fibrillation (AF), chronic kidney disease (CKD) and 25(OH)d serum level on fall risk P. Weiler , B. Hölzl Landesklinik St. Veit im Pongau, Salzburg, Austria Introduction.– The influence of heart failure (HF), atrial fibrillation (AF), chronic kidney disease (CKD) and 25(OH)D serum level on fall risk. The incidence of HF, AF and CKD is increasing with age. Polypharmacy, low vitamin D serum levels are common in elderly patients. Aim of the study was to measure valid parameters and to analyze the influence on fall risk. Methods.– One hundred consecutive patients, mean age 86 (80–96), 82% female, were included. NT-pro BNP, GFR (MDRD) and 25(OH) Dserum level were measured. Additionally the prevalence of AF and the number of prescribed medication was documented. Fall risk was tested using a recommended assessment scale. KolmogorovSmirnov, Anova and Pearson-Correlation-Test were applied. Results.– NT-pBNP (median 1885 pg/ml with, 515 pg/ml without AF) correlated high significantly (P 0,0001) with AF. The risk of fall correlated (P 0,01) with AF (26% of all patients), with NT-pBNP
S65
higher than 700 (P 0,002) and GFR ≤ 44 ml/min/1.73 m2 (P 0,03). Correlation was inverse concerning NT-pBNP and GFR (P 0,02). Age ≥ 85 (P 0,03) and the number of medication ≥ 5 (P 0,04) correlated to a higher fall risk. 25(OH)serum level was highest in July (median 24) an lowest in November (median 11) (P 0,006) The correlation of the 25(OH)serum level to fall risk was not significant (P 0,55). Conclusion.– Beside polypharmacy and age, HF, AF and CKD significantly contribute to the elevated fall risk in elderly patients, low vitamin D serum levels seem to play a minor role. http://dx.doi.org/10.1016/j.eurger.2013.07.214 P151
A review of the outcome of conservatively managed impacted, undisplaced intracapsular hip fracture C. Porter , P. Wearing , A. Chatterjee Royal Berkshire Foundation Trust, Reading, UK Introduction.– The available evidence to guide decisions regarding operative or conservative management of impacted intracapsular femur fractures is limited. Method.– A patient database was created using information from electronic discharge letters, patient records and the national hip fracture database covering admissions from 1st January 2008 to 31st December 2011. Clinical outcomes were followed up over three years. Data was collected on the following outcomes – patient demographics, admission residence and discharge destination, length of stay, admission outcome, readmission, and complications. Results.– Thirty patients were included in the study, 86% were female, aged 75 to 100 years. Twenty-four percent (24%) of patients failed conservative management and required surgical intervention. Eight patients (32%) were readmitted for related reasons during the follow up period. Twenty percent of patients were readmitted with falls. Two patients (8%) developed avascular necrosis. Five patients died during their admission. Three patients were delayed to theatre during their initial admission. Mean length of stay – 14.7 days (2–45). Mean length of stay of patients delayed to theatre – 16 days (11-24). Average operative length of stay of 16.8 days for the same period. The average total length of stay for patients re-admitted was 36 days. Eighteen patients (60%) returned to their admission residence, three patients (10%) required an increase in care. Conclusions.– The conclusions of this study are limited due to the small number of patients involved. Further comparative trials are required before definite conclusions can be drawn regarding conservative management of impacted hip fractures. http://dx.doi.org/10.1016/j.eurger.2013.07.215 P152
Predictors for falls in elderly hospital patients R. Püllen , U. Laupheimer , E. Hermann Agaplesion Frankfurter Diakoniekliniken, Institut für Biostatistik und mathematische Modellierung, Germany Background.– In contrast to elderly patients living at home or in old people’s homes, for patients in hospitals only few data are available to date on the risk factors leading to falls. Materials and methods.– Between 1.7.2010 and 31.12.2010, all falls in a geriatric hospital department were recorded prospectively. A control group was formed from those patients in the same hospital during the same period who did not fall. Taking into account the risk factors to be analyzed, the control group size was set at 243 patients. Existing diseases and medication of the patients falling and not falling were taken from their patient files.