- Email: [email protected]
P267: An early intervention programme of tertiary prevention against osteoporotic fractures following peripheral fractures – experience in a district general hospital
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Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234
with 54.8% deficient (0–30 nmol/L; 119/217) and 23.0% insufficient (30–50 nmol/L; 50/217). Vitamin D deficiency was more common among males (69.6% males vs. 49.7% females) and younger patients (72.0% age 65–74 vs. 52.6% age >80 years). Of patients with vitamin D deficiency or insufficiency, 44.9% (70/156) were on rapid loading treatment with colecalciferol upon discharge. A further 62/156 (39.7%) patients were taking a supplement containing low dose vitamin D (Adcal D3) upon discharge. Conclusion: This study shows that vitamin D insufficiency is very common in geriatric patients with fractured neck of femur and highlights the clinical need for improved testing and treatment of this condition, thus improving secondary prevention of fragility fractures in a high risk population. P265 Patients’ self-report and caregivers’ perception of fear of falling in frail older patients with and without cognitive impairment M.C. Faes1 , B.W. Schalk2 , M.F. Reelick2 , G.A. Goluke-Willemse3 , R.A. Esselink2 , M.G.M. Olde Rikkert2 1 TweeStedenziekenhuis, Tilburg, The Netherlands; 2 Radboudumc, Nijmegen, The Netherlands; 3 Rijnstate Hospital, Arnhem, The Netherlands Introduction: Fear of falling (FOF) is a major health problem among frail older persons. FOF in patients may also have major emotional consequences for caregivers. Measuring FOF may be difficult in patients with severe cognitive impairment. This study evaluates the diagnostic accuracy of a caregivers’ report as screening instrument for FOF in frail older persons. Furthermore, it studies the emotional impact of patients’ FOF on caregivers. Methods: A cross-sectional study was conducted in dyads of frail older outpatients, with and without mild to severe cognitive impairment, and their caregivers. Patients’ FOF was studied by asking patients if they were afraid of falling (yes/no). Caregivers were asked if the patient was afraid of falling and if they were afraid the patient would fall. Anxiety in caregivers was measured by anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A:0–21). Results: 128 dyads were included. Mean MMSE score of patients was 25.6. 93 patients had FOF. 77% of the caregivers was afraid their significant other would fall. Proxy screening showed moderate sensitivity (81.7%) and low negative predictive value (55.3%) to detect fear of falling in patients. The specificity was 60%. Mean HADS-A score in caregivers was 4.9, indicating a low level of anxiety. Conclusion: These findings suggest that a caregivers’ negative response on the question whether the patient is afraid to fall, does not exclude patients’ FOF. Fear that their significant other may fall is present in most caregivers, but has a low impact on their general level of anxiety.
Method: A blinded, retrospective case-control study with 100 cases and 200 controls. The cases had a fall code and the controls, two subsequent patients, without a fall code. Patients were included if they had fallen, had an episode of syncope and had sustained a hip fracture or a Colles fracture. Results: Comparison of the primary registered fall coding with the secondary fall evaluation showed a sensitivity of 81.4% and a specificity of 90.5%. The association between a fall and sustaining a fracture showed an OR = 15.35, p-value <0.0000001 for the primary registered fall coding and an OR = 42.96, p-value <0.0000001 for the secondary fall evaluation. The association between a fall and an episode of syncope showed an OR = 1.9, p-value 0.02 for the primary registered coding and an OR = 2.1, p-value 0.01 for the secondary fall evaluation. Conclusion: The primary registered fall coding had an accepted accuracy, but potential fall patient may be overlooked. This study indicates that fall-related fractures can be used as a fall indicator and to estimate fall preventive interventions. Syncope should be included in the fall definition as it is an overlooked cause of a fall. P267 An early intervention programme of tertiary prevention against osteoporotic fractures following peripheral fractures – experience in a district general hospital K.S. Kok, A. Abdulla Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, United Kingdom Introduction: Osteoporotic fractures carry significant risks of mortality and morbidity particularly in the older person. Patients ‘at risk’ of future fragility fractures should have bone protection initiated which can reduce hip fractures by up to 50%. However, patients sustaining a peripheral fracture are often discharged directly from casualty without an osteoporosis or falls assessment. We aimed to develop an early intervention programme for identifying these patients and initiating bone protection. Methods: A postal questionnaire was designed aimed at identifying at-risk patients ≥65 years with a peripheral fracture following a fall, including questions on osteoporosis risk factors, type of fracture and circumstances surrounding the event. Two geriatricians assessed the replies including calculating FRAX scores, stratifying patients into low, intermediate or high-risk groups. Low-risk patients were reassured and provided with lifestyle and dietary advice. Medium and high-risk patients received additional information recommending further management for osteoporosis and/or falls. A further letter was also sent to the patient’s GP suggesting referral to an orthogeriatrician.
P266 Fall accidents in Danish elderly – coding quality at Emergency Departments A. Guzel ¨ 1 , L. Gjerum2 , J. Ryg3 , P. Schwarz4 , J. Lauritsen5 1 Research Centre of Ageing and Osteoporosis, Glostrup, Denmark; 2 Department of geriatric medicine, Herlev hospital, Copenhagen, Denmark; 3 Department of geriatric medicine, Odense University hospital, Odense, Denmark; 4 Research Centre of Ageing and Osteoporosis, Department M, Copenhagen University, Copenhagen, Denmark; 5 Accident Analysis Group, Odense University Hospital, Odense, Denmark Introduction: To validate the coding quality at two Danish Emergency Departments by evaluation of the fall-related coding among patients aged 65 + years. Furthermore, evaluate whether a hip fracture or a Colles fracture or/and an event of syncope affect the primary registered fall coding.
Figure: Distribution of Cohort.
Results: Between November 2013 and March 2014, 109 patients aged ≥65 years attended casualty with a peripheral fracture. 42% responded (mean age 69 years), 72% of whom had significant risk factors with only 32% receiving bone protection. 22% of these had not been reviewed for over five years. Conclusion: We demonstrate the benefit of introducing an early screening and tertiary prevention programme against future
Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234
osteporotic fractures following peripheral fractures. Although a virtual clinic is now in place, further development of a nurse-led service with geriatrician input is underway. P268 Feasibility of C-mill gait-adaptability training in older adults after fall-related hip fracture: user’s perspective and training content M.W. van Ooijen1 , M. Roerdink2 , C. Timmermans2 , M. Trekop3 , S. Arendse3 , E. Nijenhuis3 , T.W.J. Janssen2 , P.J. Beek2 1 VU University Amsterdam, Amsterdam, The Netherlands; 2 MOVE Research Institute Amsterdam, Faculty Human Movement Sciences, VU University, Amsterdam, The Netherlands; 3 PW Janssen, Zorggroep Solis, Deventer, The Netherlands Introduction: The ability to make step adjustments during walking, termed ‘gait adaptability’, is often reduced in older adults, which increases their risk for falling. This study aimed to evaluate content and user experience of gait-adaptability training on an innovative rehabilitation treadmill augmented with visual context (C-Mill, Figure 1) for older adults recovering from a fall-related hip fracture. Methods: Fifty-seven older adults (83±7yrs) with fall-related hip fracture were randomly allocated to 6 weeks of C-Mill training (N = 19), conventional treadmill training (N = 19) or conventional overground gait training (N = 19). Participant‘s experience with training was evaluated with a purpose-designed questionnaire. Walking duration, speed, distance and number of steps taken during training were registered by the instrumented treadmill for C-Mill and conventional treadmill groups. Walking duration and number of steps taken during a single overground gait-training session were manually assessed by two observers in a group of 38 representative older adults (81±7yrs). Results: All training groups rated the training useful, motivating, fun, challenging and enjoyable (median scores ≥7 on a 10-point scale, no differences; all p >0.05). Training content is presented in Table 1. Conclusions: C-Mill gait-adaptability training was well-received by older adults recovering from a fall-related hip fracture. Moreover, C-Mill gait-adaptability training allowed for task-specific practice of gait adjustments at a higher practice intensity than overground gait training (twice as many steps). In this ongoing trial (van Ooijen et al. BMC Geriatrics 2013; 3: 34), the relative efficacy of the three forms of gait training on gait, fear of falling and actual falls will be examined.
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Table 1. Characteristics of the three forms of gait training
Number of steps Walking duration (min) Walking distance (m) Walking speed (km/h)
Conventional treadmill training
C-Mill gait adaptability training
Overground gait training (additional group)
798 (417–1416) a 10.5 (5.6–15.0) 266 (89–417) 1.5 (0.9–2.0)
814 (426–1175) b 12.5 (6.8–14.1) c 321 (97–476) 1.6 (0.9–2.2)
343 (90–1180) a,b 8.5 (2.3–17.9) c − −
Results are presented as median (minimum–maximum). a,b Significant difference between groups, p < 0.001. c p = 0.017.
P269 A qualitative study into the attitudes of people with mild cognitive impairment and early stages of dementia, and their carers, about falls interventions and risk M. Peach1 , K. Pollock1 , R. Harwood2 , V. van der Wardt1 , T. Masud2 1 University of Nottingham, Nottingham, United Kingdom; 2 Nottingham University Hospital, Nottingham, United Kingdom Introduction: Falls are a common and serious problem for older people with cognitive impairment. Successful intervention to reduce falls risk could result in great benefit to patients and their families, and reduce costs. This study examines patients’ and family carers’ attitudes towards interventions to reduce falls risk and maintain independence. Method: 20 semi-structured, audio-recorded interviews were completed with older people with early dementia (MMSE >20) or mild cognitive impairment and their carers, exploring attitudes to falls risk and prevention. A thematic analysis of the interview transcripts was undertaken using the constant comparison method. Results: Participants acknowledged increasing caution and reduction or adaptation in activity to maintain safety. Changes were rationalised and absorbed into their lives but they asserted that ‘we’re doing OK’, and believed additional input unnecessary. Participants reported openness to interventions if needed in the future, and described taking things ‘a day at a time’, not thinking about the future or deteriorating abilities. Participants lacked awareness of the impact of falls and potential interventions to reduce risk. Engagement was also affected by practical constraints including transport, finance and time. Conclusions: There is a dissonance between the patient and professional perspective around the need for preventative interventions to reduce risk of falls. Services should respect the fragile boundary between supporting people and undermining their sense of wellbeing. Presenting services in an individually tailored, relevant way which maintains a positive self-image is an integral part of effective uptake. Presenting interventions positively asmaintaining activity and improving mental wellbeing should increase acceptance to patients and their carers. P270 Factors associated with fall rate in psychogeriatric residents 3 N.M. Kosse1 , M.H. de Groot2 , T. Hortobagyi ´ , C.J.C. Lamoth3 1 University Medical Center Groningen and University Grenoble-Alpes, Groningen, The Netherlands; 2 Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands; 3 Center for Human Movement Sciences, University of Groningen, University Medical, Groningen, The Netherlands
Figure 1. The C-Mill elicits step adjustments during walking by projecting virtual context on the belts’ surface (A). C-Mill gait adaptability exercises include visually guided stepping to a sequence of regular or irregular stepping targets (B), obstacle avoidance (C), speeding up and slowing down by maintaining position in a moving walking zone (D), and all of the above in a functional and interactive gait adaptability game (E).
Introduction: Falls in psychogeriatric residents represent a costly but unresolved safety issue. Identifying fall risk factors and their inter-relationship may help to individualize prevention programs and increase the effectiveness. Therefore, we aimed to examine the relationship between patient characteristics and fall rate in psychogeriatric residents. Methods: Twenty nursing home residents with dementia (80±11 years; 60% male) living on a psychogeriatric ward participated. Based on patient records, we identified 66 patient
Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234
with 54.8% deficient (0–30 nmol/L; 119/217) and 23.0% insufficient (30–50 nmol/L; 50/217). Vitamin D deficiency was more common among males (69.6% males vs. 49.7% females) and younger patients (72.0% age 65–74 vs. 52.6% age >80 years). Of patients with vitamin D deficiency or insufficiency, 44.9% (70/156) were on rapid loading treatment with colecalciferol upon discharge. A further 62/156 (39.7%) patients were taking a supplement containing low dose vitamin D (Adcal D3) upon discharge. Conclusion: This study shows that vitamin D insufficiency is very common in geriatric patients with fractured neck of femur and highlights the clinical need for improved testing and treatment of this condition, thus improving secondary prevention of fragility fractures in a high risk population. P265 Patients’ self-report and caregivers’ perception of fear of falling in frail older patients with and without cognitive impairment M.C. Faes1 , B.W. Schalk2 , M.F. Reelick2 , G.A. Goluke-Willemse3 , R.A. Esselink2 , M.G.M. Olde Rikkert2 1 TweeStedenziekenhuis, Tilburg, The Netherlands; 2 Radboudumc, Nijmegen, The Netherlands; 3 Rijnstate Hospital, Arnhem, The Netherlands Introduction: Fear of falling (FOF) is a major health problem among frail older persons. FOF in patients may also have major emotional consequences for caregivers. Measuring FOF may be difficult in patients with severe cognitive impairment. This study evaluates the diagnostic accuracy of a caregivers’ report as screening instrument for FOF in frail older persons. Furthermore, it studies the emotional impact of patients’ FOF on caregivers. Methods: A cross-sectional study was conducted in dyads of frail older outpatients, with and without mild to severe cognitive impairment, and their caregivers. Patients’ FOF was studied by asking patients if they were afraid of falling (yes/no). Caregivers were asked if the patient was afraid of falling and if they were afraid the patient would fall. Anxiety in caregivers was measured by anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A:0–21). Results: 128 dyads were included. Mean MMSE score of patients was 25.6. 93 patients had FOF. 77% of the caregivers was afraid their significant other would fall. Proxy screening showed moderate sensitivity (81.7%) and low negative predictive value (55.3%) to detect fear of falling in patients. The specificity was 60%. Mean HADS-A score in caregivers was 4.9, indicating a low level of anxiety. Conclusion: These findings suggest that a caregivers’ negative response on the question whether the patient is afraid to fall, does not exclude patients’ FOF. Fear that their significant other may fall is present in most caregivers, but has a low impact on their general level of anxiety.
Method: A blinded, retrospective case-control study with 100 cases and 200 controls. The cases had a fall code and the controls, two subsequent patients, without a fall code. Patients were included if they had fallen, had an episode of syncope and had sustained a hip fracture or a Colles fracture. Results: Comparison of the primary registered fall coding with the secondary fall evaluation showed a sensitivity of 81.4% and a specificity of 90.5%. The association between a fall and sustaining a fracture showed an OR = 15.35, p-value <0.0000001 for the primary registered fall coding and an OR = 42.96, p-value <0.0000001 for the secondary fall evaluation. The association between a fall and an episode of syncope showed an OR = 1.9, p-value 0.02 for the primary registered coding and an OR = 2.1, p-value 0.01 for the secondary fall evaluation. Conclusion: The primary registered fall coding had an accepted accuracy, but potential fall patient may be overlooked. This study indicates that fall-related fractures can be used as a fall indicator and to estimate fall preventive interventions. Syncope should be included in the fall definition as it is an overlooked cause of a fall. P267 An early intervention programme of tertiary prevention against osteoporotic fractures following peripheral fractures – experience in a district general hospital K.S. Kok, A. Abdulla Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, United Kingdom Introduction: Osteoporotic fractures carry significant risks of mortality and morbidity particularly in the older person. Patients ‘at risk’ of future fragility fractures should have bone protection initiated which can reduce hip fractures by up to 50%. However, patients sustaining a peripheral fracture are often discharged directly from casualty without an osteoporosis or falls assessment. We aimed to develop an early intervention programme for identifying these patients and initiating bone protection. Methods: A postal questionnaire was designed aimed at identifying at-risk patients ≥65 years with a peripheral fracture following a fall, including questions on osteoporosis risk factors, type of fracture and circumstances surrounding the event. Two geriatricians assessed the replies including calculating FRAX scores, stratifying patients into low, intermediate or high-risk groups. Low-risk patients were reassured and provided with lifestyle and dietary advice. Medium and high-risk patients received additional information recommending further management for osteoporosis and/or falls. A further letter was also sent to the patient’s GP suggesting referral to an orthogeriatrician.
P266 Fall accidents in Danish elderly – coding quality at Emergency Departments A. Guzel ¨ 1 , L. Gjerum2 , J. Ryg3 , P. Schwarz4 , J. Lauritsen5 1 Research Centre of Ageing and Osteoporosis, Glostrup, Denmark; 2 Department of geriatric medicine, Herlev hospital, Copenhagen, Denmark; 3 Department of geriatric medicine, Odense University hospital, Odense, Denmark; 4 Research Centre of Ageing and Osteoporosis, Department M, Copenhagen University, Copenhagen, Denmark; 5 Accident Analysis Group, Odense University Hospital, Odense, Denmark Introduction: To validate the coding quality at two Danish Emergency Departments by evaluation of the fall-related coding among patients aged 65 + years. Furthermore, evaluate whether a hip fracture or a Colles fracture or/and an event of syncope affect the primary registered fall coding.
Figure: Distribution of Cohort.
Results: Between November 2013 and March 2014, 109 patients aged ≥65 years attended casualty with a peripheral fracture. 42% responded (mean age 69 years), 72% of whom had significant risk factors with only 32% receiving bone protection. 22% of these had not been reviewed for over five years. Conclusion: We demonstrate the benefit of introducing an early screening and tertiary prevention programme against future
Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234
osteporotic fractures following peripheral fractures. Although a virtual clinic is now in place, further development of a nurse-led service with geriatrician input is underway. P268 Feasibility of C-mill gait-adaptability training in older adults after fall-related hip fracture: user’s perspective and training content M.W. van Ooijen1 , M. Roerdink2 , C. Timmermans2 , M. Trekop3 , S. Arendse3 , E. Nijenhuis3 , T.W.J. Janssen2 , P.J. Beek2 1 VU University Amsterdam, Amsterdam, The Netherlands; 2 MOVE Research Institute Amsterdam, Faculty Human Movement Sciences, VU University, Amsterdam, The Netherlands; 3 PW Janssen, Zorggroep Solis, Deventer, The Netherlands Introduction: The ability to make step adjustments during walking, termed ‘gait adaptability’, is often reduced in older adults, which increases their risk for falling. This study aimed to evaluate content and user experience of gait-adaptability training on an innovative rehabilitation treadmill augmented with visual context (C-Mill, Figure 1) for older adults recovering from a fall-related hip fracture. Methods: Fifty-seven older adults (83±7yrs) with fall-related hip fracture were randomly allocated to 6 weeks of C-Mill training (N = 19), conventional treadmill training (N = 19) or conventional overground gait training (N = 19). Participant‘s experience with training was evaluated with a purpose-designed questionnaire. Walking duration, speed, distance and number of steps taken during training were registered by the instrumented treadmill for C-Mill and conventional treadmill groups. Walking duration and number of steps taken during a single overground gait-training session were manually assessed by two observers in a group of 38 representative older adults (81±7yrs). Results: All training groups rated the training useful, motivating, fun, challenging and enjoyable (median scores ≥7 on a 10-point scale, no differences; all p >0.05). Training content is presented in Table 1. Conclusions: C-Mill gait-adaptability training was well-received by older adults recovering from a fall-related hip fracture. Moreover, C-Mill gait-adaptability training allowed for task-specific practice of gait adjustments at a higher practice intensity than overground gait training (twice as many steps). In this ongoing trial (van Ooijen et al. BMC Geriatrics 2013; 3: 34), the relative efficacy of the three forms of gait training on gait, fear of falling and actual falls will be examined.
S169
Table 1. Characteristics of the three forms of gait training
Number of steps Walking duration (min) Walking distance (m) Walking speed (km/h)
Conventional treadmill training
C-Mill gait adaptability training
Overground gait training (additional group)
798 (417–1416) a 10.5 (5.6–15.0) 266 (89–417) 1.5 (0.9–2.0)
814 (426–1175) b 12.5 (6.8–14.1) c 321 (97–476) 1.6 (0.9–2.2)
343 (90–1180) a,b 8.5 (2.3–17.9) c − −
Results are presented as median (minimum–maximum). a,b Significant difference between groups, p < 0.001. c p = 0.017.
P269 A qualitative study into the attitudes of people with mild cognitive impairment and early stages of dementia, and their carers, about falls interventions and risk M. Peach1 , K. Pollock1 , R. Harwood2 , V. van der Wardt1 , T. Masud2 1 University of Nottingham, Nottingham, United Kingdom; 2 Nottingham University Hospital, Nottingham, United Kingdom Introduction: Falls are a common and serious problem for older people with cognitive impairment. Successful intervention to reduce falls risk could result in great benefit to patients and their families, and reduce costs. This study examines patients’ and family carers’ attitudes towards interventions to reduce falls risk and maintain independence. Method: 20 semi-structured, audio-recorded interviews were completed with older people with early dementia (MMSE >20) or mild cognitive impairment and their carers, exploring attitudes to falls risk and prevention. A thematic analysis of the interview transcripts was undertaken using the constant comparison method. Results: Participants acknowledged increasing caution and reduction or adaptation in activity to maintain safety. Changes were rationalised and absorbed into their lives but they asserted that ‘we’re doing OK’, and believed additional input unnecessary. Participants reported openness to interventions if needed in the future, and described taking things ‘a day at a time’, not thinking about the future or deteriorating abilities. Participants lacked awareness of the impact of falls and potential interventions to reduce risk. Engagement was also affected by practical constraints including transport, finance and time. Conclusions: There is a dissonance between the patient and professional perspective around the need for preventative interventions to reduce risk of falls. Services should respect the fragile boundary between supporting people and undermining their sense of wellbeing. Presenting services in an individually tailored, relevant way which maintains a positive self-image is an integral part of effective uptake. Presenting interventions positively asmaintaining activity and improving mental wellbeing should increase acceptance to patients and their carers. P270 Factors associated with fall rate in psychogeriatric residents 3 N.M. Kosse1 , M.H. de Groot2 , T. Hortobagyi ´ , C.J.C. Lamoth3 1 University Medical Center Groningen and University Grenoble-Alpes, Groningen, The Netherlands; 2 Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands; 3 Center for Human Movement Sciences, University of Groningen, University Medical, Groningen, The Netherlands
Figure 1. The C-Mill elicits step adjustments during walking by projecting virtual context on the belts’ surface (A). C-Mill gait adaptability exercises include visually guided stepping to a sequence of regular or irregular stepping targets (B), obstacle avoidance (C), speeding up and slowing down by maintaining position in a moving walking zone (D), and all of the above in a functional and interactive gait adaptability game (E).
Introduction: Falls in psychogeriatric residents represent a costly but unresolved safety issue. Identifying fall risk factors and their inter-relationship may help to individualize prevention programs and increase the effectiveness. Therefore, we aimed to examine the relationship between patient characteristics and fall rate in psychogeriatric residents. Methods: Twenty nursing home residents with dementia (80±11 years; 60% male) living on a psychogeriatric ward participated. Based on patient records, we identified 66 patient