- Email: [email protected]
P-233: Analysis of occurrence of geriatric giants during 17 years at acute geriatric department
S94
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
with missing data in both hand grip and walking speed, the overall prevalence of sarcopenia (32.7%; CI 95% 28–37%) steeply increased with age (p < 0.001). Patients with sarcopenia were more likely to have congestive heart failure, cerebrovascular disease, dementia, and severe ADL disability. Conclusion: Based on EWGSOP criteria, prevalence of sarcopenia is extremely high among acutely ill older adults. The EWGSOP algorithm, however, might not be suitable for routine clinical use in patients admitted to acute care wards since many patients are not able to perform the walking test.
Results: For three of the BIA PEs, ASM as derived from BIA correlated strongly with ASM as determined by DXA (r ranging from 0.96 to 0.97, p < 0.001). Of these three, the PE developed by Sergi et. al. performed the best with the lowest mean bias of 1.09 kg (CI: 0.84–1.34, p-value <0.001). For this equation, the 95% limits of agreement was between −2.50 and 4.68 kg and the root mean square error was 2.09 kg (CI: 1.72–2.47). Conclusions: The BIA PE developed by Sergi et. al. in older Italians can be used in Australian Caucasians when single frequency BIA is used.
P-233 Analysis of occurrence of geriatric giants during 17 years at acute geriatric department
Geriatric education
P. Weber1 , H. Meluzinova2 , H. Matˇejovska´ Kubeˇsova´ 3 , V. Polcarova´ 4 , D. Prudius4 , K. Bielakova´ 4 1 Masaryk University – DIASTOP, Ltd., Brno, Czech Republic; 2 DIASTOP – Masaryk University, Brno, Czech Republic; 3 Masaryk University, Brno, Czech Republic; 4 University Hospital, Brno, Czech Republic
P-235 A retrospective review of discharges of older people investigating contributions of clinical domains to cost of admissions
Objectives: With increasing age the degree of dependency and occurrence of great geriatric syndromes (GS), the so-called geriatric giants grow substantially. Methods: The prospective cohort study was aimed at conducting an analysis and comparison of geriatric syndromes (geriatric giants) among age different groups at admission time to the acute geriatric department. Setting, participants: Between 1995 and 2012 years we had altogether 12,210 elderly patients of an average age 80.57.0 y. (range 65–103 y.) hospitalised at the Department of Geriatrics. We divided the patient set into three different age subgroups (65–74 y.; 75–84 y. and ≥85 y.; e.g. 21.4%; 47.9% and 30.7%) and compared the results among them. Results: 3787 persons (31.0%) were without any GS. Growing tendency of the occurrence of all the geriatric syndromes in combinations with increasing age (p < 0.001) is obvious. Their occurrence in the above mentioned age different sets was according to individual geriatric syndromes and sex (female and male): falls 22.0%,27.8%,39.9% and 20.5%, 27.0%, 36.1%; immobility 26.4%, 29.3%,42.5% and 30.3%, 30.1% and 39.2%; incontinence 38.4%, 50.6%,69.5% and 38.2%, 47.4%,61.8%; dementia and cognitive impairment 13.4%, 23.4%, 38.1% and15.8%, 24.3%,33.2% respectively. Age cut-off for geriatric syndromes occurrence based on ROC analysis is for female sex 83.5–84.5 y. and for male sex 78.5–82.5 y. Conclusion: The increasing occurrence of geriatric giants with age and female gender has crucial importance not only for individuals and families but also for demands on costs of health and social care in oncoming decades. P-234 Prediction of appendicular skeletal muscle mass using bioelectrical impedance analysis equations in Australians S. Yu1 , A. Powell1 , K. Khow1 , R. Visvanathan1 1 The Queen Elizabeth Hospital, Adelaide, Australia Objectives: Appendicular skeletal muscle mass (ASM) is an important diagnostic criterion for sarcopenia in older people. Bioelectrial impedance analysis (BIA) offers a simple approach to measure ASM. To date, the performance of internationally developed BIA prediction equations (PE) in Australians is not known. The aim of this study was to validate the BIA PEs, against dual-energy X-ray absorptiometry (DXA) in healthy Australians. Methods: 195 (age 18–82 years old) healthy Australian Caucasians from the western suburb of Adelaide were investigated. ASM were measured using BIA (single frequency) and DXA. Four BIA prediction equations were assessed for their validity in this Australian population. Bland-Altman analysis was used to assess the predictive accuracy of ASM as determined by BIA against DXA.
R. Abeyratne1 , A. Ali2 , A. Blundell1 1 Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; 2 United Kingdom Objectives: Despite trainees in geriatric medicine being required to meet curriculum objectives in management and finance, and consultants being accountable for departmental expenses, little formal teaching is received during training. We evaluated expenditure in domains familiar to clinicians, gaining insight into awareness and understanding of these areas. Method: Using the Patient Level Information and Costing Systems database, all discharges from the Healthcare of the Older People department over one week (n = 84) were retrospectively analysed. The total cost of the admission, drugs, radiology and pathology investigations and length of stay (LOS) were reviewed. Results: Average LOS was 15 days. The average expenditure on drugs, radiology and pathology was £507.75 per admission (£175.42, £210.65, £121.86 respectively); average total cost of an admission was £5,715.62. Further analysis demonstrated the biggest determinant of total cost was LOS (R2 = 0.65); each additional day after admission estimated at £316.07. Conversely, LOS had little statistical explanatory power of cost of drugs, radiology and pathology (R2 = 0.27, 0.06 and 0.29 respectively). A departmental survey (n = 27) demonstrated 33% of clinicians accurately estimated the cost of each additional day in hospital, 30% accurately estimated the total cost of drugs and radiology, but only 11% accurately estimated the cost of pathology investigations. Conclusions: In our study, LOS is the greatest determinant of the total cost of an admission. Individual ‘day-to-day’ clinical decisions impact little on total cost; their significance being in additional days they add to LOS. Geriatrics training scarcely addresses these issues, leaving significant gaps in non-clinical training relevant to delivering optimal patient care. P-236 The involvement of older patients in medical student education from the University of Oxford T. Aquilina1 , S. Thompson2 , K. Metcalfe3 , H. Hughes4 , L. Sinclair4 1 University of Oxford, Oxford, United Kingdom; 2 University of Oxford, Dept of Clinical Geratology, Oxford; 3 Oxford Medical School, Oxford, United Kingdom; 4 University of Oxford, Oxford Objectives: A survey was conducted in the John Radcliffe Hospital in Oxford, UK, to investigate the involvement of older patients in medical student teaching, and to gain an insight into which areas of education patients value most. Methods: After obtaining verbal consent, 65 patients over 65 years were asked to complete a questionnaire on their day of discharge. Questions included the patients’ level of interaction with medical
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
with missing data in both hand grip and walking speed, the overall prevalence of sarcopenia (32.7%; CI 95% 28–37%) steeply increased with age (p < 0.001). Patients with sarcopenia were more likely to have congestive heart failure, cerebrovascular disease, dementia, and severe ADL disability. Conclusion: Based on EWGSOP criteria, prevalence of sarcopenia is extremely high among acutely ill older adults. The EWGSOP algorithm, however, might not be suitable for routine clinical use in patients admitted to acute care wards since many patients are not able to perform the walking test.
Results: For three of the BIA PEs, ASM as derived from BIA correlated strongly with ASM as determined by DXA (r ranging from 0.96 to 0.97, p < 0.001). Of these three, the PE developed by Sergi et. al. performed the best with the lowest mean bias of 1.09 kg (CI: 0.84–1.34, p-value <0.001). For this equation, the 95% limits of agreement was between −2.50 and 4.68 kg and the root mean square error was 2.09 kg (CI: 1.72–2.47). Conclusions: The BIA PE developed by Sergi et. al. in older Italians can be used in Australian Caucasians when single frequency BIA is used.
P-233 Analysis of occurrence of geriatric giants during 17 years at acute geriatric department
Geriatric education
P. Weber1 , H. Meluzinova2 , H. Matˇejovska´ Kubeˇsova´ 3 , V. Polcarova´ 4 , D. Prudius4 , K. Bielakova´ 4 1 Masaryk University – DIASTOP, Ltd., Brno, Czech Republic; 2 DIASTOP – Masaryk University, Brno, Czech Republic; 3 Masaryk University, Brno, Czech Republic; 4 University Hospital, Brno, Czech Republic
P-235 A retrospective review of discharges of older people investigating contributions of clinical domains to cost of admissions
Objectives: With increasing age the degree of dependency and occurrence of great geriatric syndromes (GS), the so-called geriatric giants grow substantially. Methods: The prospective cohort study was aimed at conducting an analysis and comparison of geriatric syndromes (geriatric giants) among age different groups at admission time to the acute geriatric department. Setting, participants: Between 1995 and 2012 years we had altogether 12,210 elderly patients of an average age 80.57.0 y. (range 65–103 y.) hospitalised at the Department of Geriatrics. We divided the patient set into three different age subgroups (65–74 y.; 75–84 y. and ≥85 y.; e.g. 21.4%; 47.9% and 30.7%) and compared the results among them. Results: 3787 persons (31.0%) were without any GS. Growing tendency of the occurrence of all the geriatric syndromes in combinations with increasing age (p < 0.001) is obvious. Their occurrence in the above mentioned age different sets was according to individual geriatric syndromes and sex (female and male): falls 22.0%,27.8%,39.9% and 20.5%, 27.0%, 36.1%; immobility 26.4%, 29.3%,42.5% and 30.3%, 30.1% and 39.2%; incontinence 38.4%, 50.6%,69.5% and 38.2%, 47.4%,61.8%; dementia and cognitive impairment 13.4%, 23.4%, 38.1% and15.8%, 24.3%,33.2% respectively. Age cut-off for geriatric syndromes occurrence based on ROC analysis is for female sex 83.5–84.5 y. and for male sex 78.5–82.5 y. Conclusion: The increasing occurrence of geriatric giants with age and female gender has crucial importance not only for individuals and families but also for demands on costs of health and social care in oncoming decades. P-234 Prediction of appendicular skeletal muscle mass using bioelectrical impedance analysis equations in Australians S. Yu1 , A. Powell1 , K. Khow1 , R. Visvanathan1 1 The Queen Elizabeth Hospital, Adelaide, Australia Objectives: Appendicular skeletal muscle mass (ASM) is an important diagnostic criterion for sarcopenia in older people. Bioelectrial impedance analysis (BIA) offers a simple approach to measure ASM. To date, the performance of internationally developed BIA prediction equations (PE) in Australians is not known. The aim of this study was to validate the BIA PEs, against dual-energy X-ray absorptiometry (DXA) in healthy Australians. Methods: 195 (age 18–82 years old) healthy Australian Caucasians from the western suburb of Adelaide were investigated. ASM were measured using BIA (single frequency) and DXA. Four BIA prediction equations were assessed for their validity in this Australian population. Bland-Altman analysis was used to assess the predictive accuracy of ASM as determined by BIA against DXA.
R. Abeyratne1 , A. Ali2 , A. Blundell1 1 Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; 2 United Kingdom Objectives: Despite trainees in geriatric medicine being required to meet curriculum objectives in management and finance, and consultants being accountable for departmental expenses, little formal teaching is received during training. We evaluated expenditure in domains familiar to clinicians, gaining insight into awareness and understanding of these areas. Method: Using the Patient Level Information and Costing Systems database, all discharges from the Healthcare of the Older People department over one week (n = 84) were retrospectively analysed. The total cost of the admission, drugs, radiology and pathology investigations and length of stay (LOS) were reviewed. Results: Average LOS was 15 days. The average expenditure on drugs, radiology and pathology was £507.75 per admission (£175.42, £210.65, £121.86 respectively); average total cost of an admission was £5,715.62. Further analysis demonstrated the biggest determinant of total cost was LOS (R2 = 0.65); each additional day after admission estimated at £316.07. Conversely, LOS had little statistical explanatory power of cost of drugs, radiology and pathology (R2 = 0.27, 0.06 and 0.29 respectively). A departmental survey (n = 27) demonstrated 33% of clinicians accurately estimated the cost of each additional day in hospital, 30% accurately estimated the total cost of drugs and radiology, but only 11% accurately estimated the cost of pathology investigations. Conclusions: In our study, LOS is the greatest determinant of the total cost of an admission. Individual ‘day-to-day’ clinical decisions impact little on total cost; their significance being in additional days they add to LOS. Geriatrics training scarcely addresses these issues, leaving significant gaps in non-clinical training relevant to delivering optimal patient care. P-236 The involvement of older patients in medical student education from the University of Oxford T. Aquilina1 , S. Thompson2 , K. Metcalfe3 , H. Hughes4 , L. Sinclair4 1 University of Oxford, Oxford, United Kingdom; 2 University of Oxford, Dept of Clinical Geratology, Oxford; 3 Oxford Medical School, Oxford, United Kingdom; 4 University of Oxford, Oxford Objectives: A survey was conducted in the John Radcliffe Hospital in Oxford, UK, to investigate the involvement of older patients in medical student teaching, and to gain an insight into which areas of education patients value most. Methods: After obtaining verbal consent, 65 patients over 65 years were asked to complete a questionnaire on their day of discharge. Questions included the patients’ level of interaction with medical