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Functional assessment of the elderly
Abstracts
doi:10.1016/j.ejim.2013.08.682
ID: 794 Forms of presentation of ANCA associated vasculitis – The 10 year experience of a medical intermediate care unit A. Lages, M.J. Silva, A. Pinheiro, M. Amorim, R. Pimentel, P. Dias, V. Braz, G. Rocha, F. Friões, J. Almeida
DP
doi:10.1016/j.ejim.2013.08.681
disorders and 32.3% had significant sensory losses (visual and/or hearing) with an increased risk of falls. About two-thirds were prescribed with 5 or more drugs, increasing the risk of drug interactions and iatrogenia. We didn't find differences concerning functional impairment between age groups (65–74 years versus 75–84 years versus over 84 years, p b 0.05). Discussion: Our new score emphasizes the importance of functional and social data evaluation in an Internal Medicine ward. Although we could not find statistical significance, age seems to be an important determinant of functional disability and, in order to reduce our small sample bias, we will analyze patients admitted in six months in our department. Important clinical outcomes such as inhospital mortality, readmissions and out-of-hospital mortality rates will also be evaluated. Conclusions: The results of activities of daily living, functional and social status evaluation may have important clinical implications and should generate alerts to health care providers and social workers in order to provide better care to the geriatric population.
OF
Objective: Pharmacotherapy of acute coronary syndromes in the last decade developed in the context of new clinical trials and revised guidelines. The aim was to assess the development in administration of six major therapeutic classes during the treatment of acute myocardial infarction (MI) in the years 2003–2011 at the Hospital Znojmo. Methods: We used data from MI registries performed in 2003–2007 (Pilot registry of myocardial infarction) and 2008–2011 (ALERT-CZ = acute coronary syndromes — longitudinal evaluation of real-life treatment in non-PCI hospitals in the Czech Republic). In total, we collected information about 2038 consecutive patients treated with this diagnosis at the department of internal medicine in Hospital Znojmo. We evaluated the use of selected drug groups during hospitalization: acetylsalicylic acid (ASA), clopidogrel, parenteral antithrombotic drugs (heparin/LMWH/fondaparinux), beta blockers, ACEi/ARB and statins. Results: We have seen substantial development in the use of assessed drug groups except ASA and heparin. This can be seen mainly for ACEi/ARB, beta-blockers and statins, where the administration has increased from 20 to 30 % to about 50–65 % during the period 2003–2011. The data about ASA and heparin are comparable for all years with frequency of administration approximately 80–90 %. Conclusion: We observed substantial development in pharmacotherapy of MI patients treated in the internal ward of a nonacademic hospital in the years 2003–2011. Stable high frequency of aspirin and heparin usage is explained by their long-term use and several decades of proven results. In contrast, other groups of drugs like thienopyridines confirmed their role in the treatment of acute coronary syndromes in the last few decades.
RO
e264
Unidade de Cuidados Intermédios de Medicina, Serviço de Medicina Interna, Centro Hospitalar de São João, Porto, Portugal Aims: To characterize the population admitted for antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis to our medical intermediate care unit and its form of presentation. Material and Methods: Review of clinical files from 22 patients with positive ANCA antibodies or clinical suspicion of autoimmune vasculitis, admitted between January/03 to December/12 to our intermediate care unit. Results: Thirteen patients were female (59%). The mean age was 58 years (32–83). Fifty-nine percent presented with rapidly progressive renal failure (RPRF), 27% with pulmonary–renal syndrome, 9% with mononeuritis multiplex and 5% with isolated respiratory failure. The predominant antibody was p-ANCA (MPO) corresponding to 68% of patients, c-ANCA (PR3) corresponding to 18% and then p-ANCA associated with anti-GBM corresponding to 5%. In 2 patients the autoimmune panel was negative, but renal biopsy was compatible with immune vasculitis. Only 3 patients showed no renal involvement, and all of them had anemia at presentation. Sixty-three percent had plasma creatinine (pCreat) over 5 mg/dl, all of them (n = 14) requiring hemodialysis at admission with half dying in a short period of time. Every patient presenting with pulmonary–renal syndrome was submitted to plasmapheresis and immunosuppressant therapy (steroids and cyclophosphamide). The totality of patients presenting with RPRF received immunosuppressant therapy, but only 4 of them were treated with plasmapheresis. In patients with mononeuritis multiplex and respiratory failure only immunosuppressant therapy was instituted. Forty-six percent (n = 10) died within 6 months of clinical diagnosis, of which 2 presented with pulmonary–renal syndrome and 8 with RPRF. Twelve patients are alive, 32% (n = 7) in regular dialysis program, 14% (n = 3) with no renal alterations, 4% (n = 1) with chronic kidney disease and 4% (n = 1) had a kidney transplant (presented with RPRF). Discussion and Conclusion: Vasculitides associated with ANCA are systemic autoimmune diseases of unknown cause that affect small to medium sized blood vessels. They include granulomatosis with polyangiitis (formerly Wegener's granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly ChurgStrauss syndrome). Five to 10% of patients do not develop antibodies. It appears most frequently in the sixth decade of life, but it can affect
TE
ID: 789 Functional assessment of the elderly M. Miranda, Y. Martins, L.P. Tavares
Internal Medicine Department — Santa Maria da Feira Unit, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
UN
CO
RR
EC
Introduction: Elderly patients are heavy consumers of health care and age remains the best predictor of morbidity burden and mortality risk. A comprehensive functional assessment has the potential to decrease overall health care costs and improve patients' quality of life and survival. Authors present a new screening tool (“AVD-DezIs” score) to evaluate older adults hospitalized in an Internal Medicine ward. Objective: The aim of this study is to functionally assess geriatric patients hospitalized in an Internal Medicine ward and to determine the impact on clinical outcomes. Material and methods: We included all geriatric patients (above 64 years of age) hospitalized in the Internal Medicine Department, in the first two months of the study. Functional assessment was performed using the new AVD-DezIs score: 4 items on basic activities of daily living (bADLs), 5 items on instrumental activities of daily living (iADLs) and 11 items on functional and social profile (depression/pain, instability, immobility, incontinence, inanition (malnutrition), incoherence (cognitive impairment), insomnia, insecurity, isolation, financial insufficiency and iatrogenia. Burden of medical disease (Charlson index) was also evaluated. The statistic analysis was performed with Microsoft Office Excel 2007 and SPSS 20.0. Results: The results for March and April are presented. Of all the patients admitted to the Internal Medicine Department, 70.4% (n = 266) were older adults. Of those, 56.1% were women and the mean age was 80.1 (SD 7.4) years. Most of the patients had important comorbidities such as diabetes (43.6%), chronic kidney disease (40.6%), heart failure (37.2%), pulmonary disease (29.3%) or cognitive impairment (26.6%). The most frequent reason for hospital admission was respiratory infections (pneumonia in 23.3%), followed by acute heart failure (12.8%) and decompensated chronic pulmonary disease (9.0%). Seventeen percent of the patients were unable to perform any bADLs and 44.7% unable to perform any iADLs. Sixty-three percent (63%) of patients had motor and balance
doi:10.1016/j.ejim.2013.08.682
ID: 794 Forms of presentation of ANCA associated vasculitis – The 10 year experience of a medical intermediate care unit A. Lages, M.J. Silva, A. Pinheiro, M. Amorim, R. Pimentel, P. Dias, V. Braz, G. Rocha, F. Friões, J. Almeida
DP
doi:10.1016/j.ejim.2013.08.681
disorders and 32.3% had significant sensory losses (visual and/or hearing) with an increased risk of falls. About two-thirds were prescribed with 5 or more drugs, increasing the risk of drug interactions and iatrogenia. We didn't find differences concerning functional impairment between age groups (65–74 years versus 75–84 years versus over 84 years, p b 0.05). Discussion: Our new score emphasizes the importance of functional and social data evaluation in an Internal Medicine ward. Although we could not find statistical significance, age seems to be an important determinant of functional disability and, in order to reduce our small sample bias, we will analyze patients admitted in six months in our department. Important clinical outcomes such as inhospital mortality, readmissions and out-of-hospital mortality rates will also be evaluated. Conclusions: The results of activities of daily living, functional and social status evaluation may have important clinical implications and should generate alerts to health care providers and social workers in order to provide better care to the geriatric population.
OF
Objective: Pharmacotherapy of acute coronary syndromes in the last decade developed in the context of new clinical trials and revised guidelines. The aim was to assess the development in administration of six major therapeutic classes during the treatment of acute myocardial infarction (MI) in the years 2003–2011 at the Hospital Znojmo. Methods: We used data from MI registries performed in 2003–2007 (Pilot registry of myocardial infarction) and 2008–2011 (ALERT-CZ = acute coronary syndromes — longitudinal evaluation of real-life treatment in non-PCI hospitals in the Czech Republic). In total, we collected information about 2038 consecutive patients treated with this diagnosis at the department of internal medicine in Hospital Znojmo. We evaluated the use of selected drug groups during hospitalization: acetylsalicylic acid (ASA), clopidogrel, parenteral antithrombotic drugs (heparin/LMWH/fondaparinux), beta blockers, ACEi/ARB and statins. Results: We have seen substantial development in the use of assessed drug groups except ASA and heparin. This can be seen mainly for ACEi/ARB, beta-blockers and statins, where the administration has increased from 20 to 30 % to about 50–65 % during the period 2003–2011. The data about ASA and heparin are comparable for all years with frequency of administration approximately 80–90 %. Conclusion: We observed substantial development in pharmacotherapy of MI patients treated in the internal ward of a nonacademic hospital in the years 2003–2011. Stable high frequency of aspirin and heparin usage is explained by their long-term use and several decades of proven results. In contrast, other groups of drugs like thienopyridines confirmed their role in the treatment of acute coronary syndromes in the last few decades.
RO
e264
Unidade de Cuidados Intermédios de Medicina, Serviço de Medicina Interna, Centro Hospitalar de São João, Porto, Portugal Aims: To characterize the population admitted for antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis to our medical intermediate care unit and its form of presentation. Material and Methods: Review of clinical files from 22 patients with positive ANCA antibodies or clinical suspicion of autoimmune vasculitis, admitted between January/03 to December/12 to our intermediate care unit. Results: Thirteen patients were female (59%). The mean age was 58 years (32–83). Fifty-nine percent presented with rapidly progressive renal failure (RPRF), 27% with pulmonary–renal syndrome, 9% with mononeuritis multiplex and 5% with isolated respiratory failure. The predominant antibody was p-ANCA (MPO) corresponding to 68% of patients, c-ANCA (PR3) corresponding to 18% and then p-ANCA associated with anti-GBM corresponding to 5%. In 2 patients the autoimmune panel was negative, but renal biopsy was compatible with immune vasculitis. Only 3 patients showed no renal involvement, and all of them had anemia at presentation. Sixty-three percent had plasma creatinine (pCreat) over 5 mg/dl, all of them (n = 14) requiring hemodialysis at admission with half dying in a short period of time. Every patient presenting with pulmonary–renal syndrome was submitted to plasmapheresis and immunosuppressant therapy (steroids and cyclophosphamide). The totality of patients presenting with RPRF received immunosuppressant therapy, but only 4 of them were treated with plasmapheresis. In patients with mononeuritis multiplex and respiratory failure only immunosuppressant therapy was instituted. Forty-six percent (n = 10) died within 6 months of clinical diagnosis, of which 2 presented with pulmonary–renal syndrome and 8 with RPRF. Twelve patients are alive, 32% (n = 7) in regular dialysis program, 14% (n = 3) with no renal alterations, 4% (n = 1) with chronic kidney disease and 4% (n = 1) had a kidney transplant (presented with RPRF). Discussion and Conclusion: Vasculitides associated with ANCA are systemic autoimmune diseases of unknown cause that affect small to medium sized blood vessels. They include granulomatosis with polyangiitis (formerly Wegener's granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly ChurgStrauss syndrome). Five to 10% of patients do not develop antibodies. It appears most frequently in the sixth decade of life, but it can affect
TE
ID: 789 Functional assessment of the elderly M. Miranda, Y. Martins, L.P. Tavares
Internal Medicine Department — Santa Maria da Feira Unit, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
UN
CO
RR
EC
Introduction: Elderly patients are heavy consumers of health care and age remains the best predictor of morbidity burden and mortality risk. A comprehensive functional assessment has the potential to decrease overall health care costs and improve patients' quality of life and survival. Authors present a new screening tool (“AVD-DezIs” score) to evaluate older adults hospitalized in an Internal Medicine ward. Objective: The aim of this study is to functionally assess geriatric patients hospitalized in an Internal Medicine ward and to determine the impact on clinical outcomes. Material and methods: We included all geriatric patients (above 64 years of age) hospitalized in the Internal Medicine Department, in the first two months of the study. Functional assessment was performed using the new AVD-DezIs score: 4 items on basic activities of daily living (bADLs), 5 items on instrumental activities of daily living (iADLs) and 11 items on functional and social profile (depression/pain, instability, immobility, incontinence, inanition (malnutrition), incoherence (cognitive impairment), insomnia, insecurity, isolation, financial insufficiency and iatrogenia. Burden of medical disease (Charlson index) was also evaluated. The statistic analysis was performed with Microsoft Office Excel 2007 and SPSS 20.0. Results: The results for March and April are presented. Of all the patients admitted to the Internal Medicine Department, 70.4% (n = 266) were older adults. Of those, 56.1% were women and the mean age was 80.1 (SD 7.4) years. Most of the patients had important comorbidities such as diabetes (43.6%), chronic kidney disease (40.6%), heart failure (37.2%), pulmonary disease (29.3%) or cognitive impairment (26.6%). The most frequent reason for hospital admission was respiratory infections (pneumonia in 23.3%), followed by acute heart failure (12.8%) and decompensated chronic pulmonary disease (9.0%). Seventeen percent of the patients were unable to perform any bADLs and 44.7% unable to perform any iADLs. Sixty-three percent (63%) of patients had motor and balance