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P-147: The relationship between oncological (ECOG PS), geriatric [Comprehensive Geriatric Assessment (CGA), and Rockwood Frailty Index (IF)] evaluation: preliminary results in a cohort of oncogeriatric patients
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
VHD patients undergone valve replacement surgery before and after HVC implementation were analysed. Results: Twenty-height older VHD patients admitted to the HVC between April 2014 and February 2015 underwent cardiac surgery. HVC patients were older relative to those treated in 2013 (n = 121) (79.1±4.3 vs. 76.5±4.2 years; p < 0.01), with no differences in gender distribution, VHD type and severity, NYHA class or number of comorbid conditions. The total length of hospital stay was unvaried, despite longer time spent in postoperative intensive care unit by HVC patients (159.4±166.7 vs. 86.0±70.0 hours; p < 0.001). The number of specialist consultations was reduced after HVC implementation (0.8±1.0 vs. 2.5±1.9; p < 0.0001). None of HVC patients died during hospitalisation, whereas 4 patients died in 2013 (p = 0.7). Conclusion: The implementation of a multidisciplinary clinical pathway dedicated to geriatric patients with VHD allows extending eligibility to surgery to older and frailer subjects and optimising the use of resources, without impacting mortality or length of hospitalisation. P-147 The relationship between oncological (ECOG PS), geriatric [Comprehensive Geriatric Assessment (CGA), and Rockwood Frailty Index (IF)] evaluation: preliminary results in a cohort of oncogeriatric patients F. Monacelli University of Genoa, Genoa, Italy Objective: CGA is the gold standard for elderly assessment to optimize cancer treatment and to stratify their biological condition (frail, pre-frail, fit). However, the method is time-consuming and of specialist expertise. Other tools did not provide the same specificity. We plan to compare different evaluation scales to assess the best predicting oncogeriatric tool. Methods: First visit included ECOG PS, CGA, IF, Short Form Health Survey-36 (QoL). Patients were assessed after 1 month for mortality, 3/6 and 12 months for QoL, functional status, performance status and overall mortality. Results: Fifty-two patients (29 females, 23 males), with solid tumour, mean age of 79±1.0 years were enrolled from January 2015 in an Italian hospital. Respectively, 10% of pt by ECOG PS, and 35% of pt by CGA were frail. By IF, 28 pts were frail (55%), 23 pre-frail (45%) and 1 was fit. The correlation between the last two tools was moderate (R=+0.60, p < 0.001). CGA unmasked several clinical problems: delirium (8%), depression (35%), insomnia (4%), pain (33%), malnutrition (35%), lack of social support (6%), cognitive deficit (14%), osteoporosis (10%), rehabilitation need (15%),others (8%). The overall mortality was of 7% (4/52 patients). The 30-day mortality after surgery was of 14% (3/21 pts) with 3 patients assessed as frail by both CGA and IF and one patient assessed as fit by CGA and pre frail by IF. Conclusions: The preliminary comparison between CGA and IF showed different predicitivity. The larger enrolment and follow up will contribute to identify the best predicting tool in oncogeriatrics. P-148 Transcatheter aortic valve implantation may modify the expected risk of mortality according to the Multidimensional Prognosis Index M. Paccalin University Hospital, Poitiers, France Objective: To assess the impact of transcatheter aortic valve implantation (TAVI) on expected prognosis according to the frailty status.
S71
Participants: Consecutive patients who underwent TAVI and a complete comprehensive geriatric assessment (CGA) between January 2013 and September 2014. Measurements: Baseline Demographic data and a cardiologic evaluation were recorded. The CGA included information on functional, cognitive and nutritional status; risk of pressure sore; comorbidities; medications; and social support network; the information was used to calculate the multidimensional prognostic index (MPI) for mortality using a previously validated algorithm. The final MPI score is divided into three levels of mortality risk: MPI-1, low risk (MPI ≤0.33), MPI-2, moderate risk (from 0.34– 0.66); and MPI-3, high risk (MPI ≥0.66).The vital status was assessed in March 2015 through visits or phone calls to the general practitioners. Results: 50 patients were enrolled; mean age: 86.5±4.2 years and mean European system for cardiac operative risk evaluation (EuroSCORE): 18.35±11.58. Thirty patients (60%) were in the MPI-1 group, 19 (38%) in the MPI-2 group and 1 patient in the MPI-3 group. The rate of mortality was 26% 1 year after TAVI. No association between EuroSCORE, age or MPI-score was found (p = 0.19; p = 0.52 and p = 0.51 respectively). Conclusion: In this study including very old patients, frailty was not associated significantly with increased mortality after TAVI. However, the results showed the effectiveness of this innovative procedure that may decrease the expected mortality between the most frail and the least frail according to the MPI. P-149 Are all the former Siberian deportees with posttraumatic stress disorder patients at risk? A. Parnicka1 , K. Piotrowicz2 , M. Mielima˛ka3 , K. Basista1 , J. Walczewska1 , A. Skalska2 , K. Rutkowski3 , T. Grodzicki2 1 Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krak´ ow, Poland; 2 Poland; 3 Jagiellonian University Medical College, Krak´ ow, Poland Objective: The primary aim of the analysis was to assess the group of elderly people suffering from the post traumatic stress disorder (PTSD) with the Identification of Seniors at Risk (ISAR) tool. The secondary aims were to test the relationships between ISAR and the Canadian Study of Health and Aging Clinical Frailty Scale (CSHACFS), muscle strength, and mobility according to the Timed Up and Go (TUG) test. Methods: The group consisted of the outpatients aged ≥60 years who had been deported during World War II or born in exile in the Soviet Union. PTSD was diagnosed according to criteria of the DSM-IV. Additionally, ISAR tool and the CSHA Clinical Frailty Scale were used, and the muscle strength and mobility were measured. Results: The mean(±SD) age of 68 patients:70.4±6.8 years (min.max.:60–88 years); 55.9% men. ISAR (median; Q1, Q3): 3.5 (2, 5) points; with higher results for women [4 (3, 5) vs 3 (2, 4) for men;p = 0.02]. At risk was 85.3% and 70.6% of the group, according to the threshold of two and three points, respectively. The three most common complaints: sight problems (77.9%), using >3 medications/day (76.5%) and serious memory problems (52.9%). There were significant correlations between ISAR and CSHA-CFS (r = 0.718, p < 0.001), and muscle strength (r = −0.433, p < 0.001), and the results of TUG (r = 0.415, p < 0.001), respectively. Conclusions: The application of ISAR tool revealed that most of the elderly patients with PTSD were vulnerable and at risk for future adverse outcomes. ISAR correlated well with the CSHA Clinical Frailty Scale as well as with the muscle strength and mobility.
VHD patients undergone valve replacement surgery before and after HVC implementation were analysed. Results: Twenty-height older VHD patients admitted to the HVC between April 2014 and February 2015 underwent cardiac surgery. HVC patients were older relative to those treated in 2013 (n = 121) (79.1±4.3 vs. 76.5±4.2 years; p < 0.01), with no differences in gender distribution, VHD type and severity, NYHA class or number of comorbid conditions. The total length of hospital stay was unvaried, despite longer time spent in postoperative intensive care unit by HVC patients (159.4±166.7 vs. 86.0±70.0 hours; p < 0.001). The number of specialist consultations was reduced after HVC implementation (0.8±1.0 vs. 2.5±1.9; p < 0.0001). None of HVC patients died during hospitalisation, whereas 4 patients died in 2013 (p = 0.7). Conclusion: The implementation of a multidisciplinary clinical pathway dedicated to geriatric patients with VHD allows extending eligibility to surgery to older and frailer subjects and optimising the use of resources, without impacting mortality or length of hospitalisation. P-147 The relationship between oncological (ECOG PS), geriatric [Comprehensive Geriatric Assessment (CGA), and Rockwood Frailty Index (IF)] evaluation: preliminary results in a cohort of oncogeriatric patients F. Monacelli University of Genoa, Genoa, Italy Objective: CGA is the gold standard for elderly assessment to optimize cancer treatment and to stratify their biological condition (frail, pre-frail, fit). However, the method is time-consuming and of specialist expertise. Other tools did not provide the same specificity. We plan to compare different evaluation scales to assess the best predicting oncogeriatric tool. Methods: First visit included ECOG PS, CGA, IF, Short Form Health Survey-36 (QoL). Patients were assessed after 1 month for mortality, 3/6 and 12 months for QoL, functional status, performance status and overall mortality. Results: Fifty-two patients (29 females, 23 males), with solid tumour, mean age of 79±1.0 years were enrolled from January 2015 in an Italian hospital. Respectively, 10% of pt by ECOG PS, and 35% of pt by CGA were frail. By IF, 28 pts were frail (55%), 23 pre-frail (45%) and 1 was fit. The correlation between the last two tools was moderate (R=+0.60, p < 0.001). CGA unmasked several clinical problems: delirium (8%), depression (35%), insomnia (4%), pain (33%), malnutrition (35%), lack of social support (6%), cognitive deficit (14%), osteoporosis (10%), rehabilitation need (15%),others (8%). The overall mortality was of 7% (4/52 patients). The 30-day mortality after surgery was of 14% (3/21 pts) with 3 patients assessed as frail by both CGA and IF and one patient assessed as fit by CGA and pre frail by IF. Conclusions: The preliminary comparison between CGA and IF showed different predicitivity. The larger enrolment and follow up will contribute to identify the best predicting tool in oncogeriatrics. P-148 Transcatheter aortic valve implantation may modify the expected risk of mortality according to the Multidimensional Prognosis Index M. Paccalin University Hospital, Poitiers, France Objective: To assess the impact of transcatheter aortic valve implantation (TAVI) on expected prognosis according to the frailty status.
S71
Participants: Consecutive patients who underwent TAVI and a complete comprehensive geriatric assessment (CGA) between January 2013 and September 2014. Measurements: Baseline Demographic data and a cardiologic evaluation were recorded. The CGA included information on functional, cognitive and nutritional status; risk of pressure sore; comorbidities; medications; and social support network; the information was used to calculate the multidimensional prognostic index (MPI) for mortality using a previously validated algorithm. The final MPI score is divided into three levels of mortality risk: MPI-1, low risk (MPI ≤0.33), MPI-2, moderate risk (from 0.34– 0.66); and MPI-3, high risk (MPI ≥0.66).The vital status was assessed in March 2015 through visits or phone calls to the general practitioners. Results: 50 patients were enrolled; mean age: 86.5±4.2 years and mean European system for cardiac operative risk evaluation (EuroSCORE): 18.35±11.58. Thirty patients (60%) were in the MPI-1 group, 19 (38%) in the MPI-2 group and 1 patient in the MPI-3 group. The rate of mortality was 26% 1 year after TAVI. No association between EuroSCORE, age or MPI-score was found (p = 0.19; p = 0.52 and p = 0.51 respectively). Conclusion: In this study including very old patients, frailty was not associated significantly with increased mortality after TAVI. However, the results showed the effectiveness of this innovative procedure that may decrease the expected mortality between the most frail and the least frail according to the MPI. P-149 Are all the former Siberian deportees with posttraumatic stress disorder patients at risk? A. Parnicka1 , K. Piotrowicz2 , M. Mielima˛ka3 , K. Basista1 , J. Walczewska1 , A. Skalska2 , K. Rutkowski3 , T. Grodzicki2 1 Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krak´ ow, Poland; 2 Poland; 3 Jagiellonian University Medical College, Krak´ ow, Poland Objective: The primary aim of the analysis was to assess the group of elderly people suffering from the post traumatic stress disorder (PTSD) with the Identification of Seniors at Risk (ISAR) tool. The secondary aims were to test the relationships between ISAR and the Canadian Study of Health and Aging Clinical Frailty Scale (CSHACFS), muscle strength, and mobility according to the Timed Up and Go (TUG) test. Methods: The group consisted of the outpatients aged ≥60 years who had been deported during World War II or born in exile in the Soviet Union. PTSD was diagnosed according to criteria of the DSM-IV. Additionally, ISAR tool and the CSHA Clinical Frailty Scale were used, and the muscle strength and mobility were measured. Results: The mean(±SD) age of 68 patients:70.4±6.8 years (min.max.:60–88 years); 55.9% men. ISAR (median; Q1, Q3): 3.5 (2, 5) points; with higher results for women [4 (3, 5) vs 3 (2, 4) for men;p = 0.02]. At risk was 85.3% and 70.6% of the group, according to the threshold of two and three points, respectively. The three most common complaints: sight problems (77.9%), using >3 medications/day (76.5%) and serious memory problems (52.9%). There were significant correlations between ISAR and CSHA-CFS (r = 0.718, p < 0.001), and muscle strength (r = −0.433, p < 0.001), and the results of TUG (r = 0.415, p < 0.001), respectively. Conclusions: The application of ISAR tool revealed that most of the elderly patients with PTSD were vulnerable and at risk for future adverse outcomes. ISAR correlated well with the CSHA Clinical Frailty Scale as well as with the muscle strength and mobility.