- Email: [email protected]
P-196: Dementia Village Singapore: visions of the future
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
life situations and in geriatric care, their relatives, professional caregivers and the health care stakeholders is mostly unknown. Existing research data from a general population is not transferable for an end-of-life care population. Therefore, an interprofessional team of nursing scientists, psychologists, health economists and physicians from different departments of university realize MEndoL, which aims to develop a patient- and family-centered approach for handling MRSA/MRE in end-of-life care, taking into account the complex situation of hospitalized patients and their relatives. Methods: The study uses a mixed methods approach and is conducted across two research phases and at two study centers. In a first phase, patients and relatives are interviewed using semi-structured questioning to explore information and communication in clinical setting and the individual consequences due to complaints, therapy and hygienic measures. Transcripts are analyzed using principles of Grounded Theory and MAXQDA software. In the second research phase, results are shared in focus group discussions. Results: We will present first categorizations and hypothesis about the impact of MRSA/MRE infection and colonization on geriatric patients and their relatives. Conclusions: A synthesis of the research findings will result in a best practice guide for handling MRSA/MRE in end-of-life care. The guide will be developed using expert consensus. The project is funded by Bundesministerium fur ¨ Bildung und Forschung (BMBF). There are no conflicts of interest to be reported. P-194 Terminal change in functional decline of nursing home residents with and without advanced dementia N. Theill University of Zurich, Zurich, Switzerland Background: Decline in physical functioning has been reported to indicate impending death of residents in long-term care. However, the role of dementia remains unclear, as well as time of onset of terminal decline and the amount of change compared to preterminal decline. Objectives: To investigate terminal change in functional decline of nursing home residents with advanced, mild or no dementia. Methods: Mulitphase growth models were applied to retrospective data of the last 24 months of 44,811 deceased residents (mean age at death: 87.46±7.17, 67.6% women) of 358 Swiss nursing homes between 1998 and 2014. Physical functioning was assessed with the activities of daily living (ADL) index of the Resident Assessment Instrument-Minimum Data Set (RAI-MDS). Results: Results revealed an acceleration of functional decline between two and three months before death in all three groups. For individuals without dementia, terminal decline was 1.5 points per month compared to 0.1 points during pre-terminal decline. While residents with mild dementia only showed slight differences in end-of-life trajectories compared to the non demented residents, advanced dementia was related to a lower physical functioning as well as less severe rate of terminal decline. Conclusion: Impending death of nursing home residents is indicated by terminal change in functional decline between two to three months before death. Although global level of physical functioning is lowered in residents with advanced dementia, they still show a considerable increase in end-of-life functional decline.
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P-195 Treatment-related differences in health related quality of life and disease specific symptoms among colon cancer survivors: Results from the population-based PROFILES registry S. Verhaar1 , P. Vissers2 , H. Maas3 , L. van de Poll-Franse2 , F. Erning4 , F. Mols2 1 AIOS, Tilburg, Netherlands; 2 UVT, Tilburg, Netherlands; 3 Netherlands; 4 IKNL, Utrecht, Netherlands Objectives: The goal of this study was to compare health related quality of life (HRQoL) and disease-specific symptoms between colon cancer patients treated with surgery only (SU) and surgery and adjuvant chemotherapy (SU+adjCT). Results were stratified for those aged <70 and ≥70 years. HRQoL of patients was also compared with an age- and sex-matched normative population. Methods: Patients diagnosed with colon cancer and surgically treated between January 2000 and June 2009, as registered within the population-based Eindhoven Cancer Registry, received a questionnaire on HRQoL (EORTC QLQ-C30) and diseasespecific symptoms (EORTC QLQ-CR38) in 2010. EORTC QLC-C30 questionnaire was also completed by the normative population (n = 685). Results: 1606 (72%) colon cancer survivors responded to our questionnaire. 854 colon cancer patients aged ≥70 were included in this study, treated with SU (n = 643) or SU+adjCT (n = 211), with a matched normative control group of 98. No statistically significant differences on the scales of the EORTC QLQ-C30, both functioning scales as subscales, were observed between colon cancer patients treated with either SU or SU+adjCT and the normative population. Conclusion: No differences in HRQoL were found between colon cancer patients aged ≥70, 1–10 years after diagnosis, treated with either SU or SU+adjCT and a normative population aged ≥70. Longterm HRQoL does not justify withholding adjuvant chemotherapy. Furthermore, HRQoL-measurements in an elderly population may be complex and actual HRQoL instruments may lack the ability to discriminate HRQoL in elderly patients. P-196 Dementia Village Singapore: visions of the future X.Y. Yap1 , M.Y. Yap2 1 Changi General Hospital, Singapore, Singapore; 2 Changi General Hospital, Singapore Introduction: In place of traditional nursing homes, the Netherlands has pioneered the first dementia village in the world, the De Hogeweyk. We imagine how a similar-styled village can be built in Singapore, and its feasibility. The Dementia Village: Land scarce Singapore would be the perfect setting for a block of condominium-style apartments. It will be situated within a gated premise with security cameras, replete with pavements, cycling paths and gardens. Residents will be given the independence to walk around as they please. The village will be helmed by a myriad of healthcare staff who will “live” in the same community. They will patrol the village in their own clothes and look after the villagers in a discreet manner. The village will be self-equipped with its own facilities. There will be a grocery store, hair salon, restaurant, chapel and a GP clinic. There will also be a town hall, where villagers can mingle and have classes such as cooking and art therapy. It is hoped that the village will create a safe environment for dementia patients to live as normal a life as they could, in a dignified manner. Limitations: The cost of building and maintaining the compounds will be the main consideration, as well as manpower recruitment and training. Also criteria have to be put in place to achieve a deft balance between demand and supply.
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Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
Conclusion: A dementia village is a novel concept, that would result in a more active, comprehensive and humane way for dementia patients to live, without being handicapped by their condition.
Frailty and sarcopenia P-197 Development and validation of a self-administrated quality of life questionnaire specific to sarcopenia: the SarQoL C. Beaudart1 , J.-Y. Reginster2 , R. Rizzoli3 , E. Biver3 , Y. Rolland4 , I. Bautmans5 , J. Petermans2 , S. Gillain6 , F. Buckinx2 , J. Van Beveren2 , M. Jacquemain2 , P. Italiano2 , N. Dardenne2 , O. Bruyere ` 2 1 University of Li`ege, Liege, Belgium; 2 University of Li`ege, Li`ege, Belgium; 3 Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; 4 G´erontologie clinique et m´edecine interne, Toulouse; 5 Belgium; 6 Chu Liege, Chenee, Belgium Objectives: The aim of this study was to develop and validate a sarcopenia-specific quality of life questionnaire (SarQoL, Sarcopenia & Quality of Life questionnaire). Methods: The development part of the questionnaire was articulated in four stages: 1. Item generation; 2. Item reduction; 3. Questionnaire generation; 4. Pre-test of the questionnaire. To validate the SarQoL, we assessed its discriminative power (logistic regression), internal consistency (Cronbach’s alpha), construct validity (Spearman Correlation), test-retest reliability (ICC) and floor and ceiling effects. Results: The final version of the questionnaire consists of 55 items divided into 7 domains, translated into 22 questions to be rated on a 4-point Likert scale. The pre-test indicates that the SarQoL is easy to complete independently, in approximately 10 minutes. The SarQoL significantly discriminated sarcopenic subjects from non-sarcopenic ones (p < 0.001). Internal consistency was good with a Cronbach’s alpha= 0.87. The SarQoL had a good convergent validity with, for example, the domain of functional score (r = 0.52, p < 0.001) and vitality (r = 0.72, p < 0.001) of the SF-36 questionnaire. Divergent validity has been found with, for example, the EQ-5D pain (r = −0.12). Test-retest reliability was good with an ICC of 0.91 (0.82–0.95). Neither floor nor ceiling effects has been found. Conclusions: The first version of the SarQoL, a quality of life questionnaire specific for sarcopenic subjects, has been developed and has been shown to be understandable by the target population. This French version of the SarQoL is valid, consistent and reliable and can therefore be recommended for clinical and research purposes, and for translation in various languages. P-198 Systematic screening of sarcopenia in geriatric day hospital N. Berg1 , C. Gazzotti1 1 CHR Citadelle, Li`ege, Belgium Objectives: 1. Verify the feasibility to implement a simple tool of sarcopenia’s screening by patients admitted in the geriatric day hospital. 2. Measure the prevalence of sarcopenia for those patients. 3. Look for possible correlations with the origin of the patient, his sex, the amount of taken medicine and his autonomy. Methods: The patients aged 75 years or more are considered. A collection of geriatric basic data is realised for all the patients (new or not seen for one year). The sarcopenia’s evaluation follows the EWGSOP’s consensus. Results: During the period between 02.17.2014 and 02.09.2015, 428 patients benefited from a sarcopenia screening and the collection of geriatric data. Incidence of sarcopenia: 31.2% incidence.
Sarcopenic patients have a mean age of 84.15 years, are institutionalized in 27.6% of the cases, a Katz’s scale average of 10.32/24 and an average number of medicine taken in 8.80. Respectively for non-sarcopenic patients the data are: 82.74 years (statistically significant difference SS), 26.7% institutionalized (statistically non-significant difference NS), Katz’s of 9.28 (SS) and 8.34 medicine taken (NS). 42.1% of sarcopenic patients are men and 23.9% of non sarcopenic (SS). Conclusions: The systematic screening of sarcopenia is possible at a practical level as part of the patient care in the geriatric day hospital. The prevalence of sarcopenia measured according to this flowchart is 31.2%. Sarcopenia ´ is more often found in men, older people and at the more dependent patients for the ADL. P-199 Frailty and Sarcopenia in Colombia: Results from the SABE Bogota´ Study C.A. Cano1 , R. Sampert-Ternet1 , M.G. Borda1 , A.J. Arciniegas1 1 Pontificia Universidad Javeriana – Hospital San Ignacio, Bogot´ a, Colombia Objective: Analyze the coexistence of frailty and sarcopenia in a sample of community-dwelling older adults and identify variables that increase or decrease the odds of developing these conditions. Methods: Data comes from the SABE Bogota´ Study, a cross-sectional study conducted in the capital of Colombia in 2012. A total of 2000 adults aged 60 years and older were interviewed and sociodemographic, health, cognitive and anthropometric measures were collected. The frailty phenotype the European Sarcopenia Working Group algorithm were used to define both conditions. Logistic regression analyses were used to identify factors associated with increased or decreased odds of developing frailty and sarcopenia. Results: A total of 135 older adults have frailty (9.4%) and 166 sarcopenia (11.5%). Older age and female gender significantly increased the odds of both frailty and sarcopenia (Frailty: Age OR 1.05, 95% CI 1.03–1.06, Gender OR 1.44, 95% CI 1.12–1.84; Sarcopenia: Age 1.04, 95% CI 1.02–1.07, Gender OR 1.51, 95% CI 1.05–2.17). Depression significantly increased the odds of frailty (OR 1.17, 95% CI 1.12–1.22) and smoking the odds of sarcopenia (OR 2.38, 95% CI 1.29–4.37). Conversely, higher function significantly decreased the odds of frailty (OR 0.74, 95% CI 0.64–0.86). Conclusions: There are potentially reversible factors that increase the odds of frailty and sarcopenia among older adults in Colombia. Frailty, sarcopenia and multimorbidity are overlapping, yet distinct conditions in our sample. Future studies need to identify interventions to prevent these conditions, and examine individuals that have frailty, sarcopenia and comorbidities to design interventions to improve their quality-of-life. P-200 Correlation between muscle mass and muscle strength among nursing home residents F. Buckinx1 , J.-L. Croisier1 , J.-Y. Reginster1 , J. Petermans1 , O. Bruyere ` 1 1 University of Li`ege, Li`ege, Belgium Background: This study aimed to assess the correlation between muscle mass and muscle strength among nursing home residents. Methods: One-hundred nursing home residents (85% of women) aged 80.1±10.1 years were included in this cross-sectional study performed in Liege, ` Belgium. Muscle mass, specifically appendicular lean mass divided by the square of the height (ALM/ht2 ), was assessed using a bioelectrical impedance analyzer (InBody S10). Muscle strength was measured with a hydraulic dynamometer (hand grip strength) and with a hand-held dynamometer (knee extensors, knee flexors, ankle extensors, ankle flexors, hip
life situations and in geriatric care, their relatives, professional caregivers and the health care stakeholders is mostly unknown. Existing research data from a general population is not transferable for an end-of-life care population. Therefore, an interprofessional team of nursing scientists, psychologists, health economists and physicians from different departments of university realize MEndoL, which aims to develop a patient- and family-centered approach for handling MRSA/MRE in end-of-life care, taking into account the complex situation of hospitalized patients and their relatives. Methods: The study uses a mixed methods approach and is conducted across two research phases and at two study centers. In a first phase, patients and relatives are interviewed using semi-structured questioning to explore information and communication in clinical setting and the individual consequences due to complaints, therapy and hygienic measures. Transcripts are analyzed using principles of Grounded Theory and MAXQDA software. In the second research phase, results are shared in focus group discussions. Results: We will present first categorizations and hypothesis about the impact of MRSA/MRE infection and colonization on geriatric patients and their relatives. Conclusions: A synthesis of the research findings will result in a best practice guide for handling MRSA/MRE in end-of-life care. The guide will be developed using expert consensus. The project is funded by Bundesministerium fur ¨ Bildung und Forschung (BMBF). There are no conflicts of interest to be reported. P-194 Terminal change in functional decline of nursing home residents with and without advanced dementia N. Theill University of Zurich, Zurich, Switzerland Background: Decline in physical functioning has been reported to indicate impending death of residents in long-term care. However, the role of dementia remains unclear, as well as time of onset of terminal decline and the amount of change compared to preterminal decline. Objectives: To investigate terminal change in functional decline of nursing home residents with advanced, mild or no dementia. Methods: Mulitphase growth models were applied to retrospective data of the last 24 months of 44,811 deceased residents (mean age at death: 87.46±7.17, 67.6% women) of 358 Swiss nursing homes between 1998 and 2014. Physical functioning was assessed with the activities of daily living (ADL) index of the Resident Assessment Instrument-Minimum Data Set (RAI-MDS). Results: Results revealed an acceleration of functional decline between two and three months before death in all three groups. For individuals without dementia, terminal decline was 1.5 points per month compared to 0.1 points during pre-terminal decline. While residents with mild dementia only showed slight differences in end-of-life trajectories compared to the non demented residents, advanced dementia was related to a lower physical functioning as well as less severe rate of terminal decline. Conclusion: Impending death of nursing home residents is indicated by terminal change in functional decline between two to three months before death. Although global level of physical functioning is lowered in residents with advanced dementia, they still show a considerable increase in end-of-life functional decline.
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P-195 Treatment-related differences in health related quality of life and disease specific symptoms among colon cancer survivors: Results from the population-based PROFILES registry S. Verhaar1 , P. Vissers2 , H. Maas3 , L. van de Poll-Franse2 , F. Erning4 , F. Mols2 1 AIOS, Tilburg, Netherlands; 2 UVT, Tilburg, Netherlands; 3 Netherlands; 4 IKNL, Utrecht, Netherlands Objectives: The goal of this study was to compare health related quality of life (HRQoL) and disease-specific symptoms between colon cancer patients treated with surgery only (SU) and surgery and adjuvant chemotherapy (SU+adjCT). Results were stratified for those aged <70 and ≥70 years. HRQoL of patients was also compared with an age- and sex-matched normative population. Methods: Patients diagnosed with colon cancer and surgically treated between January 2000 and June 2009, as registered within the population-based Eindhoven Cancer Registry, received a questionnaire on HRQoL (EORTC QLQ-C30) and diseasespecific symptoms (EORTC QLQ-CR38) in 2010. EORTC QLC-C30 questionnaire was also completed by the normative population (n = 685). Results: 1606 (72%) colon cancer survivors responded to our questionnaire. 854 colon cancer patients aged ≥70 were included in this study, treated with SU (n = 643) or SU+adjCT (n = 211), with a matched normative control group of 98. No statistically significant differences on the scales of the EORTC QLQ-C30, both functioning scales as subscales, were observed between colon cancer patients treated with either SU or SU+adjCT and the normative population. Conclusion: No differences in HRQoL were found between colon cancer patients aged ≥70, 1–10 years after diagnosis, treated with either SU or SU+adjCT and a normative population aged ≥70. Longterm HRQoL does not justify withholding adjuvant chemotherapy. Furthermore, HRQoL-measurements in an elderly population may be complex and actual HRQoL instruments may lack the ability to discriminate HRQoL in elderly patients. P-196 Dementia Village Singapore: visions of the future X.Y. Yap1 , M.Y. Yap2 1 Changi General Hospital, Singapore, Singapore; 2 Changi General Hospital, Singapore Introduction: In place of traditional nursing homes, the Netherlands has pioneered the first dementia village in the world, the De Hogeweyk. We imagine how a similar-styled village can be built in Singapore, and its feasibility. The Dementia Village: Land scarce Singapore would be the perfect setting for a block of condominium-style apartments. It will be situated within a gated premise with security cameras, replete with pavements, cycling paths and gardens. Residents will be given the independence to walk around as they please. The village will be helmed by a myriad of healthcare staff who will “live” in the same community. They will patrol the village in their own clothes and look after the villagers in a discreet manner. The village will be self-equipped with its own facilities. There will be a grocery store, hair salon, restaurant, chapel and a GP clinic. There will also be a town hall, where villagers can mingle and have classes such as cooking and art therapy. It is hoped that the village will create a safe environment for dementia patients to live as normal a life as they could, in a dignified manner. Limitations: The cost of building and maintaining the compounds will be the main consideration, as well as manpower recruitment and training. Also criteria have to be put in place to achieve a deft balance between demand and supply.
S84
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
Conclusion: A dementia village is a novel concept, that would result in a more active, comprehensive and humane way for dementia patients to live, without being handicapped by their condition.
Frailty and sarcopenia P-197 Development and validation of a self-administrated quality of life questionnaire specific to sarcopenia: the SarQoL C. Beaudart1 , J.-Y. Reginster2 , R. Rizzoli3 , E. Biver3 , Y. Rolland4 , I. Bautmans5 , J. Petermans2 , S. Gillain6 , F. Buckinx2 , J. Van Beveren2 , M. Jacquemain2 , P. Italiano2 , N. Dardenne2 , O. Bruyere ` 2 1 University of Li`ege, Liege, Belgium; 2 University of Li`ege, Li`ege, Belgium; 3 Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; 4 G´erontologie clinique et m´edecine interne, Toulouse; 5 Belgium; 6 Chu Liege, Chenee, Belgium Objectives: The aim of this study was to develop and validate a sarcopenia-specific quality of life questionnaire (SarQoL, Sarcopenia & Quality of Life questionnaire). Methods: The development part of the questionnaire was articulated in four stages: 1. Item generation; 2. Item reduction; 3. Questionnaire generation; 4. Pre-test of the questionnaire. To validate the SarQoL, we assessed its discriminative power (logistic regression), internal consistency (Cronbach’s alpha), construct validity (Spearman Correlation), test-retest reliability (ICC) and floor and ceiling effects. Results: The final version of the questionnaire consists of 55 items divided into 7 domains, translated into 22 questions to be rated on a 4-point Likert scale. The pre-test indicates that the SarQoL is easy to complete independently, in approximately 10 minutes. The SarQoL significantly discriminated sarcopenic subjects from non-sarcopenic ones (p < 0.001). Internal consistency was good with a Cronbach’s alpha= 0.87. The SarQoL had a good convergent validity with, for example, the domain of functional score (r = 0.52, p < 0.001) and vitality (r = 0.72, p < 0.001) of the SF-36 questionnaire. Divergent validity has been found with, for example, the EQ-5D pain (r = −0.12). Test-retest reliability was good with an ICC of 0.91 (0.82–0.95). Neither floor nor ceiling effects has been found. Conclusions: The first version of the SarQoL, a quality of life questionnaire specific for sarcopenic subjects, has been developed and has been shown to be understandable by the target population. This French version of the SarQoL is valid, consistent and reliable and can therefore be recommended for clinical and research purposes, and for translation in various languages. P-198 Systematic screening of sarcopenia in geriatric day hospital N. Berg1 , C. Gazzotti1 1 CHR Citadelle, Li`ege, Belgium Objectives: 1. Verify the feasibility to implement a simple tool of sarcopenia’s screening by patients admitted in the geriatric day hospital. 2. Measure the prevalence of sarcopenia for those patients. 3. Look for possible correlations with the origin of the patient, his sex, the amount of taken medicine and his autonomy. Methods: The patients aged 75 years or more are considered. A collection of geriatric basic data is realised for all the patients (new or not seen for one year). The sarcopenia’s evaluation follows the EWGSOP’s consensus. Results: During the period between 02.17.2014 and 02.09.2015, 428 patients benefited from a sarcopenia screening and the collection of geriatric data. Incidence of sarcopenia: 31.2% incidence.
Sarcopenic patients have a mean age of 84.15 years, are institutionalized in 27.6% of the cases, a Katz’s scale average of 10.32/24 and an average number of medicine taken in 8.80. Respectively for non-sarcopenic patients the data are: 82.74 years (statistically significant difference SS), 26.7% institutionalized (statistically non-significant difference NS), Katz’s of 9.28 (SS) and 8.34 medicine taken (NS). 42.1% of sarcopenic patients are men and 23.9% of non sarcopenic (SS). Conclusions: The systematic screening of sarcopenia is possible at a practical level as part of the patient care in the geriatric day hospital. The prevalence of sarcopenia measured according to this flowchart is 31.2%. Sarcopenia ´ is more often found in men, older people and at the more dependent patients for the ADL. P-199 Frailty and Sarcopenia in Colombia: Results from the SABE Bogota´ Study C.A. Cano1 , R. Sampert-Ternet1 , M.G. Borda1 , A.J. Arciniegas1 1 Pontificia Universidad Javeriana – Hospital San Ignacio, Bogot´ a, Colombia Objective: Analyze the coexistence of frailty and sarcopenia in a sample of community-dwelling older adults and identify variables that increase or decrease the odds of developing these conditions. Methods: Data comes from the SABE Bogota´ Study, a cross-sectional study conducted in the capital of Colombia in 2012. A total of 2000 adults aged 60 years and older were interviewed and sociodemographic, health, cognitive and anthropometric measures were collected. The frailty phenotype the European Sarcopenia Working Group algorithm were used to define both conditions. Logistic regression analyses were used to identify factors associated with increased or decreased odds of developing frailty and sarcopenia. Results: A total of 135 older adults have frailty (9.4%) and 166 sarcopenia (11.5%). Older age and female gender significantly increased the odds of both frailty and sarcopenia (Frailty: Age OR 1.05, 95% CI 1.03–1.06, Gender OR 1.44, 95% CI 1.12–1.84; Sarcopenia: Age 1.04, 95% CI 1.02–1.07, Gender OR 1.51, 95% CI 1.05–2.17). Depression significantly increased the odds of frailty (OR 1.17, 95% CI 1.12–1.22) and smoking the odds of sarcopenia (OR 2.38, 95% CI 1.29–4.37). Conversely, higher function significantly decreased the odds of frailty (OR 0.74, 95% CI 0.64–0.86). Conclusions: There are potentially reversible factors that increase the odds of frailty and sarcopenia among older adults in Colombia. Frailty, sarcopenia and multimorbidity are overlapping, yet distinct conditions in our sample. Future studies need to identify interventions to prevent these conditions, and examine individuals that have frailty, sarcopenia and comorbidities to design interventions to improve their quality-of-life. P-200 Correlation between muscle mass and muscle strength among nursing home residents F. Buckinx1 , J.-L. Croisier1 , J.-Y. Reginster1 , J. Petermans1 , O. Bruyere ` 1 1 University of Li`ege, Li`ege, Belgium Background: This study aimed to assess the correlation between muscle mass and muscle strength among nursing home residents. Methods: One-hundred nursing home residents (85% of women) aged 80.1±10.1 years were included in this cross-sectional study performed in Liege, ` Belgium. Muscle mass, specifically appendicular lean mass divided by the square of the height (ALM/ht2 ), was assessed using a bioelectrical impedance analyzer (InBody S10). Muscle strength was measured with a hydraulic dynamometer (hand grip strength) and with a hand-held dynamometer (knee extensors, knee flexors, ankle extensors, ankle flexors, hip