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P-173: Delirium in old patients with reactivated chronic diseases admitted to an intermediate care hospital
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Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
criteria: Inability to speak Norwegian and declined consent to participate. The Confusion Assessment Method (CAM) was used to identify the presence of PD for 5 consecutive days after treatment. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) the day before treatment and at 6month follow-up. Longitudinal regression analyses were used to establish the predictive effect of PD in cognitive function. Results: The majority (57%) of patients was female, and TAVI performed in 46% of the study population. As expected, patients in the TAVI group were older (p < 0.001), had more comorbidities (p < 0.001) and higher logistic EuroSCORE I(p < 0.001). Additionally, they had lower MMSE scores (p = 0.007). Still, proportionally fewer patients treated with TAVI than with SAVR experienced PD (44% vs. 66%, p = 0.013). No differences in cognitive function between baseline and follow-up, in any group, were revealed. However, patients undergoing TAVI and experiencing PD had lower MMSE scores compared to those without PD. Regression models revealed no baseline-adjusted predictive effect of PD. Conclusions: PD did not predict changes in cognitive function. This is an encouraging finding for octogenarian patients undergoing aortic valve implantation, for whom avoiding or delaying cognitive disability might have a higher priority than promoting longevity. P-173 Delirium in old patients with reactivated chronic diseases admitted to an intermediate care hospital N. Gual1 , G. Carrizo1 , A. Calle2 , A. Yuste1 , R. Lanseros1 , M. Inzitari3 1 Parc Sanitari Pere Virgili, Barcelona, Spain; 2 Parc Sanitari Pere Virgili, Spain; 3 Spain Objectives: Delirium in older hospitalized patients is common and leads to poor clinical outcomes. However, studies about delirium in intermediate care (IC) geriatric hospitals, receiving older adults with exacerbated chronic diseases from the emergency departments (ED), are scanty. We assessed incident delirium, its risk factors and short-term outcomes in this setting. Methods: We enrolled consecutive older patients transferred from ED to the IC Hospital Pere Virgili, Barcelona, during 3 months. Delirium was determined using the Confusion Assessment Method (CAM). We collected demographics, admission diagnosis, associated dementia, dysphagia, malnutrition, functional status (Barthel Index), comorbidity (Charlson Index), return to usual living situation at discharge and mortality. Results: Out of 261 patients (mean age+SD=85.2+7.4, 68% women, 53% admitted for respiratory problems, 41% with dementia), 119 (45.6%) developed delirium. In a multivariable logistic regression, dementia and age were associated with delirium (p < 0.001), and delirium with less home discharge (p = 0.003) and increased mortality (p < 0.001). Stratifying for dementia, 38 (25.2%) patients without dementia developed delirium; age, malnutrition, worse functional status and chronic renal failure were associated with incident delirium adjusting for confounders. Regarding patients with dementia: 80 (75.5%) developed delirium; age and admission diagnosis different from respiratory or heart diseases were associated with delirium; delirium did not predict discharge destination or mortality. Conclusions: In our sample, dementia and age are associated with incident delirium, which reduces home discharge and survival. Identifying risk factors for delirium might help to design prevention and management strategies in this setting
P-174 Undiagnosed prior cognitive impairment in delirium T. Jackson1 , A.M.J. Maclullich2 , J. Gladman3 , J.M. Lord4 , B. Sheehan5 1 School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom; 2 Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh; 3 University of Nottingham, Nottingham, United Kingdom; 4 School of Immunity and Infection, University of Birmingham Centre, Birmingham; 5 Medicine, Rehabilitation and Cardiac division, John Radcliffe Hospital, Oxford Objectives: Cognitive impairment is a risk factor for delirium, but the prevalence of previously undiagnosed cognitive impairment (dementia or mild cognitive impairment) in patients with delirium is unknown. Methods: We performed a prospective cohort study of people over 70 years admitted to hospital with delirium to establish the prevalence of previously unrecognised prior cognitive impairment. Delirium was diagnosed at baseline using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Mild cognitive impartment and dementia were diagnosed at 3 months in survivors using the International Working Group on Mild Cognitive Impairment criteria and DSM-IV criteria respectively. The group with prior cognitive impairment had a higher burden of comorbidity (median co-morbidity index 2.0 vs 0.0, p = 0.002) and frailty (median clinical frailty scale 5.5 vs 4.0, p < 0.0005) than the group with no prior cognitive impairment. Results: 82 participants with delirium were followed up at 3 months: 5 (6.1%) had persistent delirium, 14 (17.1%) had mild cognitive impairment and 47 (57.3%) had dementia. In 17 participants with prior dementia and 14 with prior mild cognitive impairment the diagnosis had been unrecognised, amounting to 31/82 (38%) of all patients with delirium having some form of previously undiagnosed cognitive impairment. Conclusions: Three quarters (61/82, 74.4%) of patients admitted to hospital with delirium had evidence of prior cognitive impairment. Given that over 1/3 of older patients with delirium were found to have a previously undiagnosed cognitive impairment, the development and evaluation of services to follow-up and manage patients with delirium is warranted. P-175 Are outcomes in older patients undergoing elective orthopedic surgery related to anemia and blood transfusion? C.-K. Liang1 , C.-L. Chu2 , M.-Y. Chou3 , Y.-T. Lin4 , T. Lu4 , C.J. Hsu4 , H.-C. Lam4 , L.-K. Chen5 1 Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; 2 Kaohsiung Veterans General hospital, Kaohsiung; 3 Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 4 Kaohsiung Veterans General hospital, Kaohsiung, Taiwan; 5 Taipei Veterans General Hospital, Taipei, Taiwan Aim: To evaluate whether anemia at admission predicts postoperative delirium(POD) among older patients undergoing elective orthopedic surgery, and the interrelationship of blood transfusion(BT) in operation and anemia. Methods: This prospective cohort screened subjects aged over 60 years who were admitted for elective orthopedic surgery in a tertiary medical center from 2011/04 to 2013/12. Age, gender, BMI, educational level, surgery-related factors (ASA class, type of anesthesia and surgery, receiving BT in operation), results of geriatric assessment (hearing/visual impairment, cognition, depressive mood, comorbidity, malnutrition, polypharmacy, ADL, and IADL), laboratory data, POD and length of hospital stay were collected for analysis. To investigate the association of anemia, BT and POD, we grouped patients based on baseline anemia or not, and receiving BT or not. Results: 37/461 patients (8.0%) developed POD. Anemia at admission and BT in operation are associated with POD and longer
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
criteria: Inability to speak Norwegian and declined consent to participate. The Confusion Assessment Method (CAM) was used to identify the presence of PD for 5 consecutive days after treatment. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) the day before treatment and at 6month follow-up. Longitudinal regression analyses were used to establish the predictive effect of PD in cognitive function. Results: The majority (57%) of patients was female, and TAVI performed in 46% of the study population. As expected, patients in the TAVI group were older (p < 0.001), had more comorbidities (p < 0.001) and higher logistic EuroSCORE I(p < 0.001). Additionally, they had lower MMSE scores (p = 0.007). Still, proportionally fewer patients treated with TAVI than with SAVR experienced PD (44% vs. 66%, p = 0.013). No differences in cognitive function between baseline and follow-up, in any group, were revealed. However, patients undergoing TAVI and experiencing PD had lower MMSE scores compared to those without PD. Regression models revealed no baseline-adjusted predictive effect of PD. Conclusions: PD did not predict changes in cognitive function. This is an encouraging finding for octogenarian patients undergoing aortic valve implantation, for whom avoiding or delaying cognitive disability might have a higher priority than promoting longevity. P-173 Delirium in old patients with reactivated chronic diseases admitted to an intermediate care hospital N. Gual1 , G. Carrizo1 , A. Calle2 , A. Yuste1 , R. Lanseros1 , M. Inzitari3 1 Parc Sanitari Pere Virgili, Barcelona, Spain; 2 Parc Sanitari Pere Virgili, Spain; 3 Spain Objectives: Delirium in older hospitalized patients is common and leads to poor clinical outcomes. However, studies about delirium in intermediate care (IC) geriatric hospitals, receiving older adults with exacerbated chronic diseases from the emergency departments (ED), are scanty. We assessed incident delirium, its risk factors and short-term outcomes in this setting. Methods: We enrolled consecutive older patients transferred from ED to the IC Hospital Pere Virgili, Barcelona, during 3 months. Delirium was determined using the Confusion Assessment Method (CAM). We collected demographics, admission diagnosis, associated dementia, dysphagia, malnutrition, functional status (Barthel Index), comorbidity (Charlson Index), return to usual living situation at discharge and mortality. Results: Out of 261 patients (mean age+SD=85.2+7.4, 68% women, 53% admitted for respiratory problems, 41% with dementia), 119 (45.6%) developed delirium. In a multivariable logistic regression, dementia and age were associated with delirium (p < 0.001), and delirium with less home discharge (p = 0.003) and increased mortality (p < 0.001). Stratifying for dementia, 38 (25.2%) patients without dementia developed delirium; age, malnutrition, worse functional status and chronic renal failure were associated with incident delirium adjusting for confounders. Regarding patients with dementia: 80 (75.5%) developed delirium; age and admission diagnosis different from respiratory or heart diseases were associated with delirium; delirium did not predict discharge destination or mortality. Conclusions: In our sample, dementia and age are associated with incident delirium, which reduces home discharge and survival. Identifying risk factors for delirium might help to design prevention and management strategies in this setting
P-174 Undiagnosed prior cognitive impairment in delirium T. Jackson1 , A.M.J. Maclullich2 , J. Gladman3 , J.M. Lord4 , B. Sheehan5 1 School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom; 2 Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Edinburgh; 3 University of Nottingham, Nottingham, United Kingdom; 4 School of Immunity and Infection, University of Birmingham Centre, Birmingham; 5 Medicine, Rehabilitation and Cardiac division, John Radcliffe Hospital, Oxford Objectives: Cognitive impairment is a risk factor for delirium, but the prevalence of previously undiagnosed cognitive impairment (dementia or mild cognitive impairment) in patients with delirium is unknown. Methods: We performed a prospective cohort study of people over 70 years admitted to hospital with delirium to establish the prevalence of previously unrecognised prior cognitive impairment. Delirium was diagnosed at baseline using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Mild cognitive impartment and dementia were diagnosed at 3 months in survivors using the International Working Group on Mild Cognitive Impairment criteria and DSM-IV criteria respectively. The group with prior cognitive impairment had a higher burden of comorbidity (median co-morbidity index 2.0 vs 0.0, p = 0.002) and frailty (median clinical frailty scale 5.5 vs 4.0, p < 0.0005) than the group with no prior cognitive impairment. Results: 82 participants with delirium were followed up at 3 months: 5 (6.1%) had persistent delirium, 14 (17.1%) had mild cognitive impairment and 47 (57.3%) had dementia. In 17 participants with prior dementia and 14 with prior mild cognitive impairment the diagnosis had been unrecognised, amounting to 31/82 (38%) of all patients with delirium having some form of previously undiagnosed cognitive impairment. Conclusions: Three quarters (61/82, 74.4%) of patients admitted to hospital with delirium had evidence of prior cognitive impairment. Given that over 1/3 of older patients with delirium were found to have a previously undiagnosed cognitive impairment, the development and evaluation of services to follow-up and manage patients with delirium is warranted. P-175 Are outcomes in older patients undergoing elective orthopedic surgery related to anemia and blood transfusion? C.-K. Liang1 , C.-L. Chu2 , M.-Y. Chou3 , Y.-T. Lin4 , T. Lu4 , C.J. Hsu4 , H.-C. Lam4 , L.-K. Chen5 1 Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; 2 Kaohsiung Veterans General hospital, Kaohsiung; 3 Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 4 Kaohsiung Veterans General hospital, Kaohsiung, Taiwan; 5 Taipei Veterans General Hospital, Taipei, Taiwan Aim: To evaluate whether anemia at admission predicts postoperative delirium(POD) among older patients undergoing elective orthopedic surgery, and the interrelationship of blood transfusion(BT) in operation and anemia. Methods: This prospective cohort screened subjects aged over 60 years who were admitted for elective orthopedic surgery in a tertiary medical center from 2011/04 to 2013/12. Age, gender, BMI, educational level, surgery-related factors (ASA class, type of anesthesia and surgery, receiving BT in operation), results of geriatric assessment (hearing/visual impairment, cognition, depressive mood, comorbidity, malnutrition, polypharmacy, ADL, and IADL), laboratory data, POD and length of hospital stay were collected for analysis. To investigate the association of anemia, BT and POD, we grouped patients based on baseline anemia or not, and receiving BT or not. Results: 37/461 patients (8.0%) developed POD. Anemia at admission and BT in operation are associated with POD and longer