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P110: Walking difficulties predict mortality among Finnish war veterans. Results from the Veteran Project 1992 survey
Poster presentations, Thursday 18 September 2014 / European Geriatric Medicine 5S1 (2014) S83–S158
Methods: With the aim to evaluate feasibility and accuracy of the Multidimensional Prognostic Index (MPI), a validated tool predictive of mortality, a multicenter study was carried-out. From all consecutive patients aged ≥65 years who underwent haemodialysis were collected information on basal/instrumental activities of daily living (ADL, IADL), cognitive status (Short Portable Mental Status Questionnaire, SPMSQ), nutritional status (Mini Nutritional Assessment, MNA), risk of pressure sores (Exton-Smith Scale, ESS), comorbidity (Cumulative Illness Rating Scale, CIRS), number of medications and co-habitation status. From these information the MPI was calculated according to a validated algorithm and expressed as three grades of risk, i.e. MPI-1 = low risk; MPI-2 = moderate risk; MPI-3 = severe risk of mortality. All patients were followed for up two years and mortality/survival status recorded. Results: 309 patients (62.5% men; mean age 76.40±6.53 years) were included. 114 subjects (36.9%) were in MPI-1, 164 (53.1%) in MPI-2 and 31 (10.0%) in MPI-3 risk-class group. A significant difference among the three MPI groups was observed in ADL, IADL, SPMSQ, MNA, ESS and CIRS (all domains p < 0.0001). 166 patients (mean age 76.50±7.0 years) were followed-up to 2 years. Mortality rates were significantly different between patients of MPI-3 vs. MPI-1/MPI-2 risk-class after one month (8.6% vs. 0.7%, p = 0.008) and after two years (39.1% vs. 17.5%, p = 0.017). ROC curves were 0.77 (95% CI 0.47–1.0) and 0.64 (95% CI 0.51–0.76) at one-month and two-year follow-up, respectively. Conclusions: MPI demonstrated excellent feasibility and good accuracy to predict short- and long-term mortality in older patients with end-stage CKD on haemodialysis. P109 Number of medications as a proxy measure to predict physical prefrailty and frailty in a hospitalised population M.Y. Azad1 , R. Ullegaddi2 , T. Masud1 1 Nottingham University Hospitals, United Kingdom; 2 Chesterfield Royal Hospital, Chesterfield, United Kingdom Introduction: Increasing frailty is associated with much morbidity, mortality and institutionalisation. The number of medications used has been advocated as a simple proxy measure for both comorbidity and frailty. The aim of this study was to determine if the number of medications used could predict frailty status in a hospitalised population. Methods: We measured physical frailty using the Morley FRAIL scale in 4 medical and 2 surgical hospital wards in patients aged >60 years. We did not include those taking antidepressants and with Abbreviated Mental Test score of <7 to exclude mentally frail patients. Number of medications was determined from the prescription chart. ROC curves were used to define appropriate cut-offs for prefrailty and frailty. Results: 184 participants were assessed of whom 92 (47% >80 years; 59% women) fulfilled the inclusion criteria. Median number of medications was 7 (IQR, 4–10). Proportion (95% CI) of participants classified as Frail, Pre-frail and Robust were 52% (50.6%-53.4%), 36% (34.4%-37.6%) and 12% (10.1%-13.9%) respectively. ROC curve analysis showed the cut-off for prefrailty was 5 medications (AUC = 0.738), and for frailty was 7 medications (AUC = 0.654). Using these medication cut-offs the proportion of inpatients defined as prefrail or frail was 67% and as frail was 53%. Conclusion: These data suggest that the number of medications being taken by hospitalised older patients can usefully predict the frailty status, without the need to administer time consuming formal frailty tests. This may allow appropriate interventions for frailty at an earlier stage, which requires further study.
S117
P110 Walking difficulties predict mortality among Finnish war veterans. Results from the Veteran Project 1992 survey 2 R. Leskinen1 , T. Laatikainen2 , E. Levalahti ¨ , M. Peltonen2 , R.L. Antikainen3 1 Oulu City Hospital, City of Oulu, Finland; 2 National Institute for Health and Welfare, Helsinki, Finland; 3 Institute of Health Sciences/Geriatrics, University of Oulu, Oulu, Finland
Introduction: The aim of this study was to determine physical and mental conditions and their combinations that predict latelife mortality among Finnish war veterans without the wartime disability. Methods: In the Veteran Project 1992 survey, the questionnaire was sent in 1992 to all veterans (n = 242,720) living in Finland. The follow-up was continued until death, or to the end of December 2009. The explanatory variables of our study were age, impaired self-rated health, walking difficulties, falls, vision, hearing and cognitive impairment, fatigue, depression, multimorbidity, urinary incontinence, and living alone. The main outcomes were total and cardiovascular disease (CVD) mortality. Results: The strongest predictor of both total and CVD mortality was self-reported walking difficulties: HR 1.74 (95% CI 1.71–1.76) for total mortality and HR 1.98 (95% CI 1.95–2.02) for CVD mortality. Where there were no physical or mental conditions (risk factors) at the baseline, the absolute 10-year mortality risk for total morality was 0.414. The highest absolute single risk for total mortality was for walking difficulties (0.605), and with two risk factors, for a combination of walking difficulties and multimorbidity (0.730). Conclusion: Self-reported walking difficulties were the most important predictor for total and CVD mortality among veteran men. Our study demonstrates the critical importance of selfreported walking difficulties and multimorbidity as markers of high mortality risk among Finnish war veterans. P111 Vitamin D deficiency as a potential link to geriatric disabilities A.B. Skalska, K.M. Piotrowicz, T.K. Grodzicki Jagiellonian University Medical College, Poland Introduction: There is growing evidence on the regulatory role of vitamin D.Regarding its influence on homeostasis, the aim of the analysis was to compare vitamin D level in context of geriatric disabilities. Methods: Data is a part of the PolSenior Project. Vitamin D was measured by radioimmunoassay, in 4052 people aged 65– 104 years (mean:78.9±8.6); 52.2% men. Geriatric assessment included: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) scales, Mini-Mental State Examination, Geriatric Depression Scale. Falls, hearing and vision were assessed. Time Up and Go test (TUG) was performed. Respondents were divided according to the presence of disabilities; analyses were done in subgroups: 65–74, 75–89, 90+ years. Results: Presented in the table. Table: Vitamin D level according to the presence of geriatric disabilities
TUG-disability IADL-disability ADL-disability Falls Incontinence Dementia Depression Vision impairment Hearing impairment
Vitamin D level (ng/ml) Age 65–74 With Without disability disability
Age 75–89 With disability
Without disability
Age 90+ With disability
Without disability
44.9±21.9 39.7±20.4 33.1±16.6 38.8±18.9 30.6±14.5 42.7±21.1 41.2±19.7 45.4±22.3 46.4±24.6
36.6±19.8 34.2±18.8 30.1±18.3 34.5±19.5 30.0±18.6 35.0±18.9 35.0±19.0 37.5±20.1 36.1±19.1
44.5±23.7*** 42.5±21.1*** 39.3±20.5*** 39.0±20.7*** 38.6±20.4*** 39.7±21.1*** 40.5±20.8*** 39.0±20.8 39.2±20.8*
30.5±18.3 27.7±16.2 25.5±15.8 26.0±13.4 25.0±16.7 27.6±15.8 27.6±15.1 28.1±16.6 29.2±17.1
34.3±20.4 37.3±23.5** 30.5±16.8*** 30.4±18.7* 30.1±17.2*** 31.9±18.9* 30.7±19.2 31.7±18.5* 29.7±17.0
*p < 0.05; **p < 0.001; ***p < 0.0001.
49.2±23.1* 46.8±22.2*** 45.4±21.8*** 46.0±22.1*** 45.3±21.9*** 45.3±21.9 46.4±22.4** 44.7±21.7 44.7±21.6
Methods: With the aim to evaluate feasibility and accuracy of the Multidimensional Prognostic Index (MPI), a validated tool predictive of mortality, a multicenter study was carried-out. From all consecutive patients aged ≥65 years who underwent haemodialysis were collected information on basal/instrumental activities of daily living (ADL, IADL), cognitive status (Short Portable Mental Status Questionnaire, SPMSQ), nutritional status (Mini Nutritional Assessment, MNA), risk of pressure sores (Exton-Smith Scale, ESS), comorbidity (Cumulative Illness Rating Scale, CIRS), number of medications and co-habitation status. From these information the MPI was calculated according to a validated algorithm and expressed as three grades of risk, i.e. MPI-1 = low risk; MPI-2 = moderate risk; MPI-3 = severe risk of mortality. All patients were followed for up two years and mortality/survival status recorded. Results: 309 patients (62.5% men; mean age 76.40±6.53 years) were included. 114 subjects (36.9%) were in MPI-1, 164 (53.1%) in MPI-2 and 31 (10.0%) in MPI-3 risk-class group. A significant difference among the three MPI groups was observed in ADL, IADL, SPMSQ, MNA, ESS and CIRS (all domains p < 0.0001). 166 patients (mean age 76.50±7.0 years) were followed-up to 2 years. Mortality rates were significantly different between patients of MPI-3 vs. MPI-1/MPI-2 risk-class after one month (8.6% vs. 0.7%, p = 0.008) and after two years (39.1% vs. 17.5%, p = 0.017). ROC curves were 0.77 (95% CI 0.47–1.0) and 0.64 (95% CI 0.51–0.76) at one-month and two-year follow-up, respectively. Conclusions: MPI demonstrated excellent feasibility and good accuracy to predict short- and long-term mortality in older patients with end-stage CKD on haemodialysis. P109 Number of medications as a proxy measure to predict physical prefrailty and frailty in a hospitalised population M.Y. Azad1 , R. Ullegaddi2 , T. Masud1 1 Nottingham University Hospitals, United Kingdom; 2 Chesterfield Royal Hospital, Chesterfield, United Kingdom Introduction: Increasing frailty is associated with much morbidity, mortality and institutionalisation. The number of medications used has been advocated as a simple proxy measure for both comorbidity and frailty. The aim of this study was to determine if the number of medications used could predict frailty status in a hospitalised population. Methods: We measured physical frailty using the Morley FRAIL scale in 4 medical and 2 surgical hospital wards in patients aged >60 years. We did not include those taking antidepressants and with Abbreviated Mental Test score of <7 to exclude mentally frail patients. Number of medications was determined from the prescription chart. ROC curves were used to define appropriate cut-offs for prefrailty and frailty. Results: 184 participants were assessed of whom 92 (47% >80 years; 59% women) fulfilled the inclusion criteria. Median number of medications was 7 (IQR, 4–10). Proportion (95% CI) of participants classified as Frail, Pre-frail and Robust were 52% (50.6%-53.4%), 36% (34.4%-37.6%) and 12% (10.1%-13.9%) respectively. ROC curve analysis showed the cut-off for prefrailty was 5 medications (AUC = 0.738), and for frailty was 7 medications (AUC = 0.654). Using these medication cut-offs the proportion of inpatients defined as prefrail or frail was 67% and as frail was 53%. Conclusion: These data suggest that the number of medications being taken by hospitalised older patients can usefully predict the frailty status, without the need to administer time consuming formal frailty tests. This may allow appropriate interventions for frailty at an earlier stage, which requires further study.
S117
P110 Walking difficulties predict mortality among Finnish war veterans. Results from the Veteran Project 1992 survey 2 R. Leskinen1 , T. Laatikainen2 , E. Levalahti ¨ , M. Peltonen2 , R.L. Antikainen3 1 Oulu City Hospital, City of Oulu, Finland; 2 National Institute for Health and Welfare, Helsinki, Finland; 3 Institute of Health Sciences/Geriatrics, University of Oulu, Oulu, Finland
Introduction: The aim of this study was to determine physical and mental conditions and their combinations that predict latelife mortality among Finnish war veterans without the wartime disability. Methods: In the Veteran Project 1992 survey, the questionnaire was sent in 1992 to all veterans (n = 242,720) living in Finland. The follow-up was continued until death, or to the end of December 2009. The explanatory variables of our study were age, impaired self-rated health, walking difficulties, falls, vision, hearing and cognitive impairment, fatigue, depression, multimorbidity, urinary incontinence, and living alone. The main outcomes were total and cardiovascular disease (CVD) mortality. Results: The strongest predictor of both total and CVD mortality was self-reported walking difficulties: HR 1.74 (95% CI 1.71–1.76) for total mortality and HR 1.98 (95% CI 1.95–2.02) for CVD mortality. Where there were no physical or mental conditions (risk factors) at the baseline, the absolute 10-year mortality risk for total morality was 0.414. The highest absolute single risk for total mortality was for walking difficulties (0.605), and with two risk factors, for a combination of walking difficulties and multimorbidity (0.730). Conclusion: Self-reported walking difficulties were the most important predictor for total and CVD mortality among veteran men. Our study demonstrates the critical importance of selfreported walking difficulties and multimorbidity as markers of high mortality risk among Finnish war veterans. P111 Vitamin D deficiency as a potential link to geriatric disabilities A.B. Skalska, K.M. Piotrowicz, T.K. Grodzicki Jagiellonian University Medical College, Poland Introduction: There is growing evidence on the regulatory role of vitamin D.Regarding its influence on homeostasis, the aim of the analysis was to compare vitamin D level in context of geriatric disabilities. Methods: Data is a part of the PolSenior Project. Vitamin D was measured by radioimmunoassay, in 4052 people aged 65– 104 years (mean:78.9±8.6); 52.2% men. Geriatric assessment included: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) scales, Mini-Mental State Examination, Geriatric Depression Scale. Falls, hearing and vision were assessed. Time Up and Go test (TUG) was performed. Respondents were divided according to the presence of disabilities; analyses were done in subgroups: 65–74, 75–89, 90+ years. Results: Presented in the table. Table: Vitamin D level according to the presence of geriatric disabilities
TUG-disability IADL-disability ADL-disability Falls Incontinence Dementia Depression Vision impairment Hearing impairment
Vitamin D level (ng/ml) Age 65–74 With Without disability disability
Age 75–89 With disability
Without disability
Age 90+ With disability
Without disability
44.9±21.9 39.7±20.4 33.1±16.6 38.8±18.9 30.6±14.5 42.7±21.1 41.2±19.7 45.4±22.3 46.4±24.6
36.6±19.8 34.2±18.8 30.1±18.3 34.5±19.5 30.0±18.6 35.0±18.9 35.0±19.0 37.5±20.1 36.1±19.1
44.5±23.7*** 42.5±21.1*** 39.3±20.5*** 39.0±20.7*** 38.6±20.4*** 39.7±21.1*** 40.5±20.8*** 39.0±20.8 39.2±20.8*
30.5±18.3 27.7±16.2 25.5±15.8 26.0±13.4 25.0±16.7 27.6±15.8 27.6±15.1 28.1±16.6 29.2±17.1
34.3±20.4 37.3±23.5** 30.5±16.8*** 30.4±18.7* 30.1±17.2*** 31.9±18.9* 30.7±19.2 31.7±18.5* 29.7±17.0
*p < 0.05; **p < 0.001; ***p < 0.0001.
49.2±23.1* 46.8±22.2*** 45.4±21.8*** 46.0±22.1*** 45.3±21.9*** 45.3±21.9 46.4±22.4** 44.7±21.7 44.7±21.6