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P0025 PAIN TURNS THE GERIATRIC LIFE INTO A LIVING HELL
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 intense and rapid movements are essential, for example when reversing a forward fall.
P0023 15 YEARS OF A GERIATRIC INTERDISCIPLINARY UNIT - A DESCRIPTIVE STUDY
David Chivite Guillen. Hospital Universitari De Bellvitge Introduction: Most Acute Care Hospitals in Catalonia, Spain, have incorporated in the two past decades Geriatric Units (GU). Their aim is to help provide a comprehensive geriatric evaluation of elderly patients admitted to acute care wards, in order to improve in-hospital outcomes and facilitate hospital discharge. Objectives: to describe the results obtained by the GU of a tertiary care hospital after the first 15 years of its stablishment. Materials & methods: review of the GU databases Results: over the last 15 years more than 11000 patients have been evaluated by our GU; the number of consultations has been steadely increasing, with a ratio much higher than that of the total admissions to the hospital during the period studied (1993 - 2008 increase 754% vs 118%, p < 0.0001) Most patients evaluated are women (although the proportion of female/male ratio is nowadays almost 50%), with a mean age of 77.5 years, which has been steadely increasing within the period studied. Moreover, the proportion of patients 85 years of age or older has also significantly increasing, from 17% in 1993 to 27% in 2008 (p < 0.05). Services requesting most consultations to the GU have always been Traumatolgy & Orthopaedics and Neurology (mean proportion of consultations per year 39% and 19% respectively), although in the recent years there is a trend towards more consultations from other medical Services (Internal Medicine, Cardiology, Infectious Diseases ...)The most prevalent diagnoses have been femoral neck fracture and acute cerebrovascular diseases, with a sharp increase in the last 5 years of consultations related to chronic diseases such as heart failure, COPD, cognitive impairment ... affecting elderly, frail patients. About 10% of patients die before discharge; 30% are sent home after being provided with some kind of supportive care (Day Care centers, Day Hospitals, Rehabilitation facilities, home care, unskilled nursing homes), 50% are discharged to convalescence/subacute care facilities and 6% to long-term or palliative care; these proportions have not significantly varied within the period studied, but this comparison is likely biased by the ever changing availability and tipology of post-acute care beds in our area. Discussion & conclusion: consultations to the GU have increased steadily during the last 15 years, which probably may be explained by both the higher numbers of aged, frail patients admitted to acute care hospitals, and by the increased awareness by their attending physicians of the advantages of requesting geriatric consultation: besides playing significant support in the in-hospital management of such patients, our experience shows that GU may help finding post-acute care resources for most of these patients, therefore facilitating continuity of care for frail elderly patients who otherwise might be at high risk of poor short-term outcomes after an unappropiate discharge. Keywords: geriatric unit, geriatric consultation, discharge
P0024 THE ASSESSMENT OF THE QUALITY OF LIFE IN TWO GROUPS OF PATIENTS WITH OSTEOPOROSIS FROM ORADEA ROMANIA
Dorina Maria Farcas, Felicia Tirlea, Corina Moldovan, Liliana Vatca. University of Oradea, Faculty of Medicine Introduction: Osteoporosis is an important public health problem in older adults. It is more common in postmenopausal women and not only gives rise to morbidity but also markedly diminishes the quality of life in this population. Objectives: to assess the responsiveness of the Qualeffo- 41 Questionnaire on the quality of life in two groups of patients with osteoporosis (with and without vertebral fractures). Matherial & Methods: We studied two groups of patients from Oradea, Romania:first group consisted in 54 women with osteoporosis without vertebral fractures, and second group consisted in 52 women with osteoporosis and vertebral fractures (DXA method and vertebral radiography). In the first group the mean age was 60.17, standard deviation 4.35 and in the second group the mean age was 61.45, standard deviation 4.75 years. Each patient was assessed with Qualleffo 41 Questionnaire. All of the patients underwent a specific rehabilitation program consisted in physical exercises, twice a week for 12 months. Results: In both our groups of study the evolution was favourable at 6 months
S17
and more significantly at 12 months, but the Qualeffo score improved more in the first group (without vertebral fractures) than in the second group (with vertebral fractures). It shows an improvement in quality of life of the patients from our study. Discussion&Conclusion: A healthy lifestile including regular physical exercise has a beneficial role in osteoporosis. Qualeffo-41 proved to be a valid tool in assessing favourable evolution under physical exercise programe in patients with osteoporosis. Keywords: osteoporosis, quality of life,Qualeffo-41 Questionnaire
P0025 PAIN TURNS THE GERIATRIC LIFE INTO A LIVING HELL
Bahar Guciz Dogan 1 , F Topal 2 , A Timuroglu 2 , Hikmet Pekcan 1 , S Palit 3 , E Songur 1 , Gulay Sain Guven 3 . 1 Prof., Hacettepe University Faculty of Medicine Dept. of Public Health; 2 Intern Doctor, Hacettepe University Faculty of Medicine Dept. of Public Health; 3 Assoc. Prof., Hacettepe University Faculty of Medicine Dept. of Internal Medicine Objective: To determine the prevalence of pain and its relationship with daily activities in a group of geriatric/elderly (≥ 65 year-old) people. Methods: This cross-sectional study was conducted in an urban settlement of Ankara, Turkey. The universe was 806 ≥65 year-old habitants and sample size was calculated as 260. Considering potential loses, it was decided to increase the sample size to 300. At the end, a total of 272 subjects recruited into the study. A structured and pre-tested questionnaire was administered at home visits. Informed consent was obtained before implementation of the questionnaire. A visual Analog Scale which is ranked 0 to 10 was used to determine the severity of pain. Results: Females constituted 52.2% of the study group. The mean age of females and males were 71.7±5.8 (min. 65, max. 87 years) and 72.5±5.6 (min. 65, max. 91 years) respectively. More than half of the women, and 20.0% of men were illiterate. 12.7% of women and 4.6% of men was living alone. Of the females, 21.1% was ever-smoker. This figure was 63.8% for males. Almost three out of four of females (73.9%) and more than half of the males (58.5%) stated that they had at least one diagnosed chronic disease. The most stated common disease was hypertension. 85.9% of females, 61.5% of males complained of generalized pain within last year lasting at least 3 weeks. The prevalence of pain was not associated with age, marital status, and health security; only in males, secondary school or over graduates reported pain significantly more. The five most common localizations of pain were knee (40.1%), shoulder (13.2%), lumbar area (12.1%), hip (11.8%) and head (9.9%). According to the scoring with the Visual Analog Scale, 32.1% of patients (35.4% of females, 22.2% of males) with knee pain scored their pain as more than 5 points. This figure was 22.2% (33.3% of females, 6.7% of males) for shoulder pain, 15.2% for lumbar pain (16.3% of females, 16.7% of males), 61.3% for hip pain (57.9% of females, 66.7% of males) and 40.7% for headache (42.1% of females, 37.5% of males). There was no significant difference on the severity of pain due to localization by age. Patients that complained pain, reported they had difficulties getting dressed (11.1%), combing (6.9%), dining (5.6%), going to toilet (15.3%) and having bath (43.1%). No one reported any difficulty related to washing face and hands. Of them, 25.0% declared that they can not do physical exercise and/or walking due to their pain. Conclusions: Generalized pain is common in geriatric group. Pain compromises their quality of life in very basic aspects. Physicians dealing with this age group should pay attention to this problem and should ask specifications of pain in detail. In-service training should be given to the auxiliary health personnel on pain in general, and the symptoms and localizations of some diseases like rheumatoid arthritis, osteoporosis, and osteoarthritis in special. Key words: Pain, geriatric patient
Gastroenterology P0026 NIGHT SWEAT AND FEVER WITH LIVER MASS ON THE CT SCAN
Laith Alrubaiy. Ysbyty Gwynedd NHS Trust A 24 year student from Bangladesh presented to the acute medical admission unit with one month sweating and loss of appetite. He denied any diarrhoea or loose bowel motion. The patient had marked tenderness in the right upper
P0023 15 YEARS OF A GERIATRIC INTERDISCIPLINARY UNIT - A DESCRIPTIVE STUDY
David Chivite Guillen. Hospital Universitari De Bellvitge Introduction: Most Acute Care Hospitals in Catalonia, Spain, have incorporated in the two past decades Geriatric Units (GU). Their aim is to help provide a comprehensive geriatric evaluation of elderly patients admitted to acute care wards, in order to improve in-hospital outcomes and facilitate hospital discharge. Objectives: to describe the results obtained by the GU of a tertiary care hospital after the first 15 years of its stablishment. Materials & methods: review of the GU databases Results: over the last 15 years more than 11000 patients have been evaluated by our GU; the number of consultations has been steadely increasing, with a ratio much higher than that of the total admissions to the hospital during the period studied (1993 - 2008 increase 754% vs 118%, p < 0.0001) Most patients evaluated are women (although the proportion of female/male ratio is nowadays almost 50%), with a mean age of 77.5 years, which has been steadely increasing within the period studied. Moreover, the proportion of patients 85 years of age or older has also significantly increasing, from 17% in 1993 to 27% in 2008 (p < 0.05). Services requesting most consultations to the GU have always been Traumatolgy & Orthopaedics and Neurology (mean proportion of consultations per year 39% and 19% respectively), although in the recent years there is a trend towards more consultations from other medical Services (Internal Medicine, Cardiology, Infectious Diseases ...)The most prevalent diagnoses have been femoral neck fracture and acute cerebrovascular diseases, with a sharp increase in the last 5 years of consultations related to chronic diseases such as heart failure, COPD, cognitive impairment ... affecting elderly, frail patients. About 10% of patients die before discharge; 30% are sent home after being provided with some kind of supportive care (Day Care centers, Day Hospitals, Rehabilitation facilities, home care, unskilled nursing homes), 50% are discharged to convalescence/subacute care facilities and 6% to long-term or palliative care; these proportions have not significantly varied within the period studied, but this comparison is likely biased by the ever changing availability and tipology of post-acute care beds in our area. Discussion & conclusion: consultations to the GU have increased steadily during the last 15 years, which probably may be explained by both the higher numbers of aged, frail patients admitted to acute care hospitals, and by the increased awareness by their attending physicians of the advantages of requesting geriatric consultation: besides playing significant support in the in-hospital management of such patients, our experience shows that GU may help finding post-acute care resources for most of these patients, therefore facilitating continuity of care for frail elderly patients who otherwise might be at high risk of poor short-term outcomes after an unappropiate discharge. Keywords: geriatric unit, geriatric consultation, discharge
P0024 THE ASSESSMENT OF THE QUALITY OF LIFE IN TWO GROUPS OF PATIENTS WITH OSTEOPOROSIS FROM ORADEA ROMANIA
Dorina Maria Farcas, Felicia Tirlea, Corina Moldovan, Liliana Vatca. University of Oradea, Faculty of Medicine Introduction: Osteoporosis is an important public health problem in older adults. It is more common in postmenopausal women and not only gives rise to morbidity but also markedly diminishes the quality of life in this population. Objectives: to assess the responsiveness of the Qualeffo- 41 Questionnaire on the quality of life in two groups of patients with osteoporosis (with and without vertebral fractures). Matherial & Methods: We studied two groups of patients from Oradea, Romania:first group consisted in 54 women with osteoporosis without vertebral fractures, and second group consisted in 52 women with osteoporosis and vertebral fractures (DXA method and vertebral radiography). In the first group the mean age was 60.17, standard deviation 4.35 and in the second group the mean age was 61.45, standard deviation 4.75 years. Each patient was assessed with Qualleffo 41 Questionnaire. All of the patients underwent a specific rehabilitation program consisted in physical exercises, twice a week for 12 months. Results: In both our groups of study the evolution was favourable at 6 months
S17
and more significantly at 12 months, but the Qualeffo score improved more in the first group (without vertebral fractures) than in the second group (with vertebral fractures). It shows an improvement in quality of life of the patients from our study. Discussion&Conclusion: A healthy lifestile including regular physical exercise has a beneficial role in osteoporosis. Qualeffo-41 proved to be a valid tool in assessing favourable evolution under physical exercise programe in patients with osteoporosis. Keywords: osteoporosis, quality of life,Qualeffo-41 Questionnaire
P0025 PAIN TURNS THE GERIATRIC LIFE INTO A LIVING HELL
Bahar Guciz Dogan 1 , F Topal 2 , A Timuroglu 2 , Hikmet Pekcan 1 , S Palit 3 , E Songur 1 , Gulay Sain Guven 3 . 1 Prof., Hacettepe University Faculty of Medicine Dept. of Public Health; 2 Intern Doctor, Hacettepe University Faculty of Medicine Dept. of Public Health; 3 Assoc. Prof., Hacettepe University Faculty of Medicine Dept. of Internal Medicine Objective: To determine the prevalence of pain and its relationship with daily activities in a group of geriatric/elderly (≥ 65 year-old) people. Methods: This cross-sectional study was conducted in an urban settlement of Ankara, Turkey. The universe was 806 ≥65 year-old habitants and sample size was calculated as 260. Considering potential loses, it was decided to increase the sample size to 300. At the end, a total of 272 subjects recruited into the study. A structured and pre-tested questionnaire was administered at home visits. Informed consent was obtained before implementation of the questionnaire. A visual Analog Scale which is ranked 0 to 10 was used to determine the severity of pain. Results: Females constituted 52.2% of the study group. The mean age of females and males were 71.7±5.8 (min. 65, max. 87 years) and 72.5±5.6 (min. 65, max. 91 years) respectively. More than half of the women, and 20.0% of men were illiterate. 12.7% of women and 4.6% of men was living alone. Of the females, 21.1% was ever-smoker. This figure was 63.8% for males. Almost three out of four of females (73.9%) and more than half of the males (58.5%) stated that they had at least one diagnosed chronic disease. The most stated common disease was hypertension. 85.9% of females, 61.5% of males complained of generalized pain within last year lasting at least 3 weeks. The prevalence of pain was not associated with age, marital status, and health security; only in males, secondary school or over graduates reported pain significantly more. The five most common localizations of pain were knee (40.1%), shoulder (13.2%), lumbar area (12.1%), hip (11.8%) and head (9.9%). According to the scoring with the Visual Analog Scale, 32.1% of patients (35.4% of females, 22.2% of males) with knee pain scored their pain as more than 5 points. This figure was 22.2% (33.3% of females, 6.7% of males) for shoulder pain, 15.2% for lumbar pain (16.3% of females, 16.7% of males), 61.3% for hip pain (57.9% of females, 66.7% of males) and 40.7% for headache (42.1% of females, 37.5% of males). There was no significant difference on the severity of pain due to localization by age. Patients that complained pain, reported they had difficulties getting dressed (11.1%), combing (6.9%), dining (5.6%), going to toilet (15.3%) and having bath (43.1%). No one reported any difficulty related to washing face and hands. Of them, 25.0% declared that they can not do physical exercise and/or walking due to their pain. Conclusions: Generalized pain is common in geriatric group. Pain compromises their quality of life in very basic aspects. Physicians dealing with this age group should pay attention to this problem and should ask specifications of pain in detail. In-service training should be given to the auxiliary health personnel on pain in general, and the symptoms and localizations of some diseases like rheumatoid arthritis, osteoporosis, and osteoarthritis in special. Key words: Pain, geriatric patient
Gastroenterology P0026 NIGHT SWEAT AND FEVER WITH LIVER MASS ON THE CT SCAN
Laith Alrubaiy. Ysbyty Gwynedd NHS Trust A 24 year student from Bangladesh presented to the acute medical admission unit with one month sweating and loss of appetite. He denied any diarrhoea or loose bowel motion. The patient had marked tenderness in the right upper