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P0011 SOCIAL SUPPORT AND QUALITY OF LIFE IN OLDER ADULTS
S12
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
P0009 VISUAL HALLUCINATIONS- A RATHER PLEASANT EXPERIENCE! CHARLES BONNET SYNDROME
Ravi Rangasamy, Udayaraj Umasankar, Aza Abdulla. Princess Royal University Hospital Introduction: -Visual hallucinations are generally unpleasant and distressing especially when they are part of a complex psychiatric condition. However, when it occurs as a sole manifestation in the presence of normal insight, it is often non distressing. Visual hallucination in the presence of normal insight and cognition is Charles Bonnet Syndrome (CBS). Although it commonly occurs in patients with visual impairment it is not a prerequisite for diagnosis. Objectives: To illustrate different types of visual hallucinations in CBS, its management and explore the literature. Materials & methods: We report 3 cases of Charles Bonnet Syndrome and discuss the details of associated visual hallucination Results: Case one - 93 year old lady presented with one week history of seeing images of her friends and relatives and sometimes pleasant images like angels. These images were stereotyped, recurrent, occurring mostly when she was alone in the evenings. She had full insight of her hallucinations and therefore she was not frightened of them. She had marked visual impairment. The clinical examination and investigations did not reveal any other cause. A diagnosis of CBS was made and she was managed successfully. Case two - A 92 year old women presented with the history of recurrent episodes of seeing the images of her son-in-law walking around her house. She had complete insight and started to ignore them from the onset. Clinical examination revealed no evidence of cognitive impairment. Importantly, she had no visual impairment. CT head scan showed changes consistent with small vessel disease only. Her management was based on reassurance that this was not a psychiatric condition and she became free of hallucinations within a month. Case three - A 75 year women had an episode of seeing a ‘jagged edge box’ with ‘wavy lines’. She experienced this in both eyes simultaneously but was not perturbed. Her cognitive status and neurological examination were normal. Although she appeared stressed, she did not display evidence of depression. Neuro imaging and blood tests were also normal. She was reassured about the nature of her visual hallucination and her symptom did not recur during the follow up over the next one year. Discussion & conclusion: A careful history and consideration of CBS as a possible cause of visual hallucination can lead to reduction of unnecessary investigations and associated anxiety. Unlike those associated with psychiatric symptoms, visual hallucination in CBS responds adequately to reassurance alone. Keywords: CBS-Charles Bonnet Syndrome
P0010 EARLY ORTHOGERIATRIC INTERVENTION IN NECK OF FEMUR FRACTURES DECREASES LENGTH OF HOSPITAL STAY
Brian Menezes, Fatima Hussain. St. Helens and Knowsley NHS Trust, United Kingdom Introduction: Neck of femur fracture (NoFF) is an emergency that affects older populations and carries a high morbidity burden. A regional audit in UK (2006) showed substantial delay in orthogeriatric review in these patients, prolonged hospital stay (mean: 31.9 days) and high mortality (12%). Since then, a multidisciplinary approach (improved referral mechanisms and prompter orthogeriatric input) was undertaken at our hospital. This study was undertaken to evaluate the clinical difference resulting from earlier medical intervention in this patient group. Objectives: To evalute the outcome of NoFF patients with early orthogeriatric review in terms of length of hospital stay and mortality. Materials & methods: All patients with NoFF admitted to a hospital in Merseyside – UK (August-October 2007) were identified using the ICD-10 code: S72. Those fitting the case definition were auditted retrospectively. Statistical associations were explored using Chi-square test. Case definitions/measures: Confirmed NoFF: Emergency admissions with radiologically confirmed neck of femur fracture. Delayed/no medical input: Patients with confirmed NoFF included in the regional audit of 2006 [all patients had no or delayed (≥7 days) orthogeriatric input]. Early medical input: All patients in the current study where medical input was obtained <7 days of admission. Measures: Prolonged length of hospital stay (≥10 days), in-patient mortality, institutional care on discharge and secondary bone prophylaxis Results: 74 patients with confirmed NoFF were identified (age range= 32-101
years, mean= 79.8 years, male:female ration= 1:3.625). All cases were surgically corrected (mean admission-surgery period: 3.2 days). Mean length of hospital stay was 20.47 days. On comparing our findings with the data of the previous audit (2006), it was notable that early medical input significantly resulted in preventing prolonged length of in-patient hospital stay and transfer to 24-hour care insitutions on discharge. Mortality rates in patients with early medical review were halved and secondary prevention was significantly better. This is demonstrated in Table 1. Early medical input (N=74) Prolonged length of hospital stay Institutional care on discharge Mortality Secondary bone prophylaxis
19 (25.6%) 14 (18.9%) 4 (5.4%) 65 (87.8%)
Delayed/no medical input (N=83) 59 28 10 44
(71.0%) (33.7%) (12.0%) (53.0%)
p value
<0.0001 0.036 0.145 <0.0001
Conclusion: Early orthogeriatric input results in reduced mortality rates in patients with surgically corrected NoFF and significantly prevents prolonged length of hospital stay and institutional care on discharge. Secondary prevention is significantly better in this patient group. Keywords: Neck of femur fracture, orthogeriatric
P0011 SOCIAL SUPPORT AND QUALITY OF LIFE IN OLDER ADULTS
Serap Unsar 1 , Ozgul Erol 1 , Necdet Sut 2 . 1 Trakya University Edirne School of Health, Edirne, Turkey; 2 Trakya University Medicine Faculty, Biostatistics Department, Edirne, Turkey Introduction: Development of technology in health, prevention of diseases by early diagnosis and treatments reduced death rate and increased life span. By the advance of preventive health services, lifetime increased and the number of people older than 60 years increased in total population. Although lifetime increased, chronic diseases are still the major problem. Quality of life is an important criterion in order to evaluate the medical therapy of chronic diseases. Older age is one of the situations that quality of life was decreased. As a result of lack of family or significant others and reduced social support networks, elderly people could feel loneliness and have physical and emotional health problems. Objectives: The aim of the study was to investigate the social support and quality of life of older adults and the factors affecting these, also determine the relationship between social support and quality of life. Materials & methods: This cross-sectional study was planned between JuneDecember 2007 in two family health clinics in center of Edirne. The sample included 108 adults who were older than 60 years. Quality of life was measured with EuroQol Five Dimension Scale (EQ-5D) and social support was measured with Multidimensional Scale of Perceived Social Support (MSPSS). Results: The mean age of the group was 68.0±5.9, mean EQ-5D index score was 0.79±0.2 and total social support score was 58.01±20.01. Positive correlations were found between EQ-5D index score and social support total score, subgroups of family, friends and significat other scores (p=0.003,0.001,0.011,0.027,respectively). As the social support increased, quality of life of the older adults improved. There was a negative correlation between number of daily medications and EQ-5D index score (p=0.001). As the number of medications increased, quality of life was worsened. Male had higher EQ-5D index scores than female (p=0.009). Married participants had higher EQ-5D index scores and family subgroup scores of social support scale compared to widows (p=0.002;p=0.007, respectively). The ones living with their children had better EQ-5D index scores than the ones living with their sister (p=0.024). Participants living with their spouse and children had better social support family subgroup scores compared to ones living alone (p=0.001). Elderly who had regular sleep patterns had higher EQ-5D index scores compared to ones who had irregular sleep patterns (p=0.013). Discussion & conclusion: As the social support levels increased, quality of life scores increased too. In the content of geriatric rehabilitation programmes, with a multidiscipliner approach including geriatric nurse, geriatrist etc. we believed that giving nursing care, medical therapy, education and counselling to the older adults especially women, widows, having more medications and sleep problems could improve quality of lifes and social support levels. Keywords: older adult, social support, quality of life
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
P0009 VISUAL HALLUCINATIONS- A RATHER PLEASANT EXPERIENCE! CHARLES BONNET SYNDROME
Ravi Rangasamy, Udayaraj Umasankar, Aza Abdulla. Princess Royal University Hospital Introduction: -Visual hallucinations are generally unpleasant and distressing especially when they are part of a complex psychiatric condition. However, when it occurs as a sole manifestation in the presence of normal insight, it is often non distressing. Visual hallucination in the presence of normal insight and cognition is Charles Bonnet Syndrome (CBS). Although it commonly occurs in patients with visual impairment it is not a prerequisite for diagnosis. Objectives: To illustrate different types of visual hallucinations in CBS, its management and explore the literature. Materials & methods: We report 3 cases of Charles Bonnet Syndrome and discuss the details of associated visual hallucination Results: Case one - 93 year old lady presented with one week history of seeing images of her friends and relatives and sometimes pleasant images like angels. These images were stereotyped, recurrent, occurring mostly when she was alone in the evenings. She had full insight of her hallucinations and therefore she was not frightened of them. She had marked visual impairment. The clinical examination and investigations did not reveal any other cause. A diagnosis of CBS was made and she was managed successfully. Case two - A 92 year old women presented with the history of recurrent episodes of seeing the images of her son-in-law walking around her house. She had complete insight and started to ignore them from the onset. Clinical examination revealed no evidence of cognitive impairment. Importantly, she had no visual impairment. CT head scan showed changes consistent with small vessel disease only. Her management was based on reassurance that this was not a psychiatric condition and she became free of hallucinations within a month. Case three - A 75 year women had an episode of seeing a ‘jagged edge box’ with ‘wavy lines’. She experienced this in both eyes simultaneously but was not perturbed. Her cognitive status and neurological examination were normal. Although she appeared stressed, she did not display evidence of depression. Neuro imaging and blood tests were also normal. She was reassured about the nature of her visual hallucination and her symptom did not recur during the follow up over the next one year. Discussion & conclusion: A careful history and consideration of CBS as a possible cause of visual hallucination can lead to reduction of unnecessary investigations and associated anxiety. Unlike those associated with psychiatric symptoms, visual hallucination in CBS responds adequately to reassurance alone. Keywords: CBS-Charles Bonnet Syndrome
P0010 EARLY ORTHOGERIATRIC INTERVENTION IN NECK OF FEMUR FRACTURES DECREASES LENGTH OF HOSPITAL STAY
Brian Menezes, Fatima Hussain. St. Helens and Knowsley NHS Trust, United Kingdom Introduction: Neck of femur fracture (NoFF) is an emergency that affects older populations and carries a high morbidity burden. A regional audit in UK (2006) showed substantial delay in orthogeriatric review in these patients, prolonged hospital stay (mean: 31.9 days) and high mortality (12%). Since then, a multidisciplinary approach (improved referral mechanisms and prompter orthogeriatric input) was undertaken at our hospital. This study was undertaken to evaluate the clinical difference resulting from earlier medical intervention in this patient group. Objectives: To evalute the outcome of NoFF patients with early orthogeriatric review in terms of length of hospital stay and mortality. Materials & methods: All patients with NoFF admitted to a hospital in Merseyside – UK (August-October 2007) were identified using the ICD-10 code: S72. Those fitting the case definition were auditted retrospectively. Statistical associations were explored using Chi-square test. Case definitions/measures: Confirmed NoFF: Emergency admissions with radiologically confirmed neck of femur fracture. Delayed/no medical input: Patients with confirmed NoFF included in the regional audit of 2006 [all patients had no or delayed (≥7 days) orthogeriatric input]. Early medical input: All patients in the current study where medical input was obtained <7 days of admission. Measures: Prolonged length of hospital stay (≥10 days), in-patient mortality, institutional care on discharge and secondary bone prophylaxis Results: 74 patients with confirmed NoFF were identified (age range= 32-101
years, mean= 79.8 years, male:female ration= 1:3.625). All cases were surgically corrected (mean admission-surgery period: 3.2 days). Mean length of hospital stay was 20.47 days. On comparing our findings with the data of the previous audit (2006), it was notable that early medical input significantly resulted in preventing prolonged length of in-patient hospital stay and transfer to 24-hour care insitutions on discharge. Mortality rates in patients with early medical review were halved and secondary prevention was significantly better. This is demonstrated in Table 1. Early medical input (N=74) Prolonged length of hospital stay Institutional care on discharge Mortality Secondary bone prophylaxis
19 (25.6%) 14 (18.9%) 4 (5.4%) 65 (87.8%)
Delayed/no medical input (N=83) 59 28 10 44
(71.0%) (33.7%) (12.0%) (53.0%)
p value
<0.0001 0.036 0.145 <0.0001
Conclusion: Early orthogeriatric input results in reduced mortality rates in patients with surgically corrected NoFF and significantly prevents prolonged length of hospital stay and institutional care on discharge. Secondary prevention is significantly better in this patient group. Keywords: Neck of femur fracture, orthogeriatric
P0011 SOCIAL SUPPORT AND QUALITY OF LIFE IN OLDER ADULTS
Serap Unsar 1 , Ozgul Erol 1 , Necdet Sut 2 . 1 Trakya University Edirne School of Health, Edirne, Turkey; 2 Trakya University Medicine Faculty, Biostatistics Department, Edirne, Turkey Introduction: Development of technology in health, prevention of diseases by early diagnosis and treatments reduced death rate and increased life span. By the advance of preventive health services, lifetime increased and the number of people older than 60 years increased in total population. Although lifetime increased, chronic diseases are still the major problem. Quality of life is an important criterion in order to evaluate the medical therapy of chronic diseases. Older age is one of the situations that quality of life was decreased. As a result of lack of family or significant others and reduced social support networks, elderly people could feel loneliness and have physical and emotional health problems. Objectives: The aim of the study was to investigate the social support and quality of life of older adults and the factors affecting these, also determine the relationship between social support and quality of life. Materials & methods: This cross-sectional study was planned between JuneDecember 2007 in two family health clinics in center of Edirne. The sample included 108 adults who were older than 60 years. Quality of life was measured with EuroQol Five Dimension Scale (EQ-5D) and social support was measured with Multidimensional Scale of Perceived Social Support (MSPSS). Results: The mean age of the group was 68.0±5.9, mean EQ-5D index score was 0.79±0.2 and total social support score was 58.01±20.01. Positive correlations were found between EQ-5D index score and social support total score, subgroups of family, friends and significat other scores (p=0.003,0.001,0.011,0.027,respectively). As the social support increased, quality of life of the older adults improved. There was a negative correlation between number of daily medications and EQ-5D index score (p=0.001). As the number of medications increased, quality of life was worsened. Male had higher EQ-5D index scores than female (p=0.009). Married participants had higher EQ-5D index scores and family subgroup scores of social support scale compared to widows (p=0.002;p=0.007, respectively). The ones living with their children had better EQ-5D index scores than the ones living with their sister (p=0.024). Participants living with their spouse and children had better social support family subgroup scores compared to ones living alone (p=0.001). Elderly who had regular sleep patterns had higher EQ-5D index scores compared to ones who had irregular sleep patterns (p=0.013). Discussion & conclusion: As the social support levels increased, quality of life scores increased too. In the content of geriatric rehabilitation programmes, with a multidiscipliner approach including geriatric nurse, geriatrist etc. we believed that giving nursing care, medical therapy, education and counselling to the older adults especially women, widows, having more medications and sleep problems could improve quality of lifes and social support levels. Keywords: older adult, social support, quality of life