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P317: Integrated home care technology assistance in frail older patients with heart failure: Aim and design of the Care@Home project funded by the Apulian region
Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234
to give older people access to their own sensor data should be further explored in cooperation with the older people. P316 Home-monitoring of mobility and activity – two case studies from the GAL-NATARS study L. Dasenbrock1 , E.E. Steen2 , M. Becker3 , K. Holtkamp4 , P. Bente5 , M. Dolle ¨ 3 , C. Lammel-Polchau3 , M. Schulze3 , M. Marschollek3 , R. Haux6 , A. Hein2 , G. Kolb4 , M. Meis7 , H. Meyer Zu Schwabedissen5 , H. Remmers8 , W. Thoben9 , J. Wang6 , K.H. Wolf6 , J.M. Bauer10 1 Carl von Ossietzky Universit¨ at Oldenburg, Germany; 2 Department of Health Services, Carl von Ossietzky Universit¨ at Oldenburg, Oldenburg, Germany; 3 Peter L. Reichertz Institute for Medical Informatics, Hannover, Germany; 4 Department for Geriatric Medicine, Bonifatius Hospital Lingen, Lingen, Germany; 5 Department for Geriatric Medicine, Braunschweig Medical Center, Braunschweig, Germany; 6 Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig, Braunschweig, Germany; 7 H¨ orzentrum Oldenburg, Oldenburg, Germany; 8 Division of Nursing Science, Faculty of Human Sciences, University Osnabr¨ uck, Osnabr¨ uck, Germany; 9 OFFIS – Insitute for Information Technology, Oldenburg, Germany; 10 Department of Geriatric Medicine, Carl von Ossietzky Universit¨ at Oldenburg, Oldenburg, Germany Background: Even in high age older persons prefer to live independently. Especially in those living alone functional decline should be detected at an early stage. The aim of the GAL-NATARS study was to identify a deterioration of mobility and activities by a home-monitoring system. Methods: Community-dwelling subjects (age ≥70, rehabilitation for fracture) were monitored for 3 months. Time of absence (ToA) from their apartments was categorized by sensor-events (1–30min, 30–90min, 90–240min, 4–8h, <8h/day and week). ToA at week (W) 1, 8, 12 were compared to assessments of physical function and mobility (PFM). Mobility was evaluated by 4m gait-speed (GS in s), chair rise (CR in s), Tinetti (points), Timed up&Go (TuG in s), and falls. Results: Exemplarily data from 2 subjects are presented. Case 1: 17% ToA. On 11 days no leaving of the apartment was observed. Distribution of ToA: W1: 6 × 1–30min, 2 × 30–90min; W8: 1 × 1–30min, 1 × 30–90min, 1 × 90–240min, 1 × 4–8h, 1 × >8h; W12: 4 × 1–30min, 2 × 30–90min, 4 × 90–240min, 3 × 4–8h. PFM at W1/8/12: GS 5.5/3.6/4.5; CR not possible (np)/16/15; Tinetti 27/25/27; TuG 13/12/10; 1 fall (W7). Increases of ToA were associated with improvement of PFM. Case 2: 14% ToA. 13% of ToA were a consequence of a hospital stay (HS). Distribution of ToA: W 1/8/12: HS/0*/0*. PFM at W1/8/12: GS 9.9/8.8/5.6; CR np/np/25.9; Tinetti 18/19/21; TuG 34/27/17; 1 fall (W7). PFM improved but no change of ToA was observed. Conclusion: The tested home-monitoring system has the capacity to measure ToA in community-dwelling physically impaired older persons. Further analyses will show if sensor-based data can reliably indicate changes of PFM. P317 Integrated home care technology assistance in frail older patients with heart failure: Aim and design of the Care@Home project funded by the Apulian region 1
1
1
2
3
D. Sancarlo , F. Giuliani , A. Greco , A. Leone , M. Manuzzi , M. Pistoia3 , P. Siciliano2 1 IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; 2 CNR-IMM, Lecce, Italy; 3 Eresult, Cesena, Italy Introduction: Heart failure is the leading cause of hospitalization in the elderly. About 20% of discharged patients tend to be rehospitalized with a poor prognosis.
S181
Aim of the Care@Home project funded through the call: “ICT Apulian Living Labs” (European Regional Development Fund. 2013– 2014) is to implement and evaluate an IT system capable of providing to frail older persons affected by heart failure the possibility to remain in their own home as long as possible thanks to an integrated telemonitoring system reducing also the mortality and the rehospitalisation rate. Methods: In the pilot cohort study will be included 40 patients aged >65 years, consecutively discharged from a Geriatric Unit, with a diagnosis of heart failure and high mortality risk, evaluated through the use of a multidimensional prognostic index. All patients will underwent a Comprehensive Geriatric Assessment at the beginning and at the end of the study. Each patient will be followed for two weeks at his home using a small telemonitoring system represented by a small sensor, evaluating the following parameters: EKG, respiratory rate, motility, risk of falls and temperature, connected to a computer-server capable to collect, directly and indirectly, other data such as weight, blood pressure, urine output, pulse oximetry, sending the data to a central database accessible by all the actors involved in the care process. Conclusions: The application of this home care system in this appropriate selected population could facilitate the developing of individualized care plans, improve the multidisciplinary communications and reduce adverse outcomes.
Metabolism/Nutrition/Sarcopenia P318 The predicitive value of serum B12 and its use in guidelines and protocols J.H. Strating, M. Zeeman, J.B. de Kok Deventer Hospital, The Netherlands Background: Vitamin B12 deficiency is seen very often. In many protocols like the Dutch CGA guideline and delirium guideline serum B12 is advised as a screening tool. Serum cobalamin does not necessarily reflect a normal B12 status. The determination of methylmalonic acid is advised to find a true B12 deficiency, but this is not known by a lot of general practitioners and specialists. Methods: We performed a retrospective database research to analyse all vitamin B12 measurements that could be combined with a serum methylmalonic acid measurement in the period of 2005 until 2012 in the Deventer Hospital clinical chemical laboratory. A serum methylmalonic acid (MMA) of 340 nmol/L or higher was presumed the gold standard of a true B12 deficiency. Besides that, we undertook an email enquiry to investigate what treatment decisions general practitioners and specialists make with a given serum vitamin B12 result. Results: We found that in the group with serum B12 between 100– 200 pmol/L only in about 50% of the cases we could diagnose a true vitamin B12 deficiency (ie MMA >340 nmol/L). In our email enquiry we found that 65% of the physicians never determined a serum methylmalonic acid. Many physicians started cobalamin supplementation when serum B12 was below 150pmol/L. Table 1. B12 values compared to MMA values Serum B12 0–150 pmol/L Serum B12 >150 pmol/L
True B12 deficiency (MMA >340 nmol/L)
No B12 deficiency (MMA 0–340 nmol/L)
41 (A) 24 (B) Sensitivity: 0.63
51 (C) 54 (D) Specificity: 0.51
PPV: 0.45 NPV: 0.69
Sensitivity: A/(A + B); Specificity: D/(C + D). PPV, positive predictive value: A/(A + C); NPV, negative predictive value: D/(D + C).
Conclusion: Serum B12 levels do not predict true B12 deficiency, when compared to methylmalonic acid. Not many physicians
to give older people access to their own sensor data should be further explored in cooperation with the older people. P316 Home-monitoring of mobility and activity – two case studies from the GAL-NATARS study L. Dasenbrock1 , E.E. Steen2 , M. Becker3 , K. Holtkamp4 , P. Bente5 , M. Dolle ¨ 3 , C. Lammel-Polchau3 , M. Schulze3 , M. Marschollek3 , R. Haux6 , A. Hein2 , G. Kolb4 , M. Meis7 , H. Meyer Zu Schwabedissen5 , H. Remmers8 , W. Thoben9 , J. Wang6 , K.H. Wolf6 , J.M. Bauer10 1 Carl von Ossietzky Universit¨ at Oldenburg, Germany; 2 Department of Health Services, Carl von Ossietzky Universit¨ at Oldenburg, Oldenburg, Germany; 3 Peter L. Reichertz Institute for Medical Informatics, Hannover, Germany; 4 Department for Geriatric Medicine, Bonifatius Hospital Lingen, Lingen, Germany; 5 Department for Geriatric Medicine, Braunschweig Medical Center, Braunschweig, Germany; 6 Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig, Braunschweig, Germany; 7 H¨ orzentrum Oldenburg, Oldenburg, Germany; 8 Division of Nursing Science, Faculty of Human Sciences, University Osnabr¨ uck, Osnabr¨ uck, Germany; 9 OFFIS – Insitute for Information Technology, Oldenburg, Germany; 10 Department of Geriatric Medicine, Carl von Ossietzky Universit¨ at Oldenburg, Oldenburg, Germany Background: Even in high age older persons prefer to live independently. Especially in those living alone functional decline should be detected at an early stage. The aim of the GAL-NATARS study was to identify a deterioration of mobility and activities by a home-monitoring system. Methods: Community-dwelling subjects (age ≥70, rehabilitation for fracture) were monitored for 3 months. Time of absence (ToA) from their apartments was categorized by sensor-events (1–30min, 30–90min, 90–240min, 4–8h, <8h/day and week). ToA at week (W) 1, 8, 12 were compared to assessments of physical function and mobility (PFM). Mobility was evaluated by 4m gait-speed (GS in s), chair rise (CR in s), Tinetti (points), Timed up&Go (TuG in s), and falls. Results: Exemplarily data from 2 subjects are presented. Case 1: 17% ToA. On 11 days no leaving of the apartment was observed. Distribution of ToA: W1: 6 × 1–30min, 2 × 30–90min; W8: 1 × 1–30min, 1 × 30–90min, 1 × 90–240min, 1 × 4–8h, 1 × >8h; W12: 4 × 1–30min, 2 × 30–90min, 4 × 90–240min, 3 × 4–8h. PFM at W1/8/12: GS 5.5/3.6/4.5; CR not possible (np)/16/15; Tinetti 27/25/27; TuG 13/12/10; 1 fall (W7). Increases of ToA were associated with improvement of PFM. Case 2: 14% ToA. 13% of ToA were a consequence of a hospital stay (HS). Distribution of ToA: W 1/8/12: HS/0*/0*. PFM at W1/8/12: GS 9.9/8.8/5.6; CR np/np/25.9; Tinetti 18/19/21; TuG 34/27/17; 1 fall (W7). PFM improved but no change of ToA was observed. Conclusion: The tested home-monitoring system has the capacity to measure ToA in community-dwelling physically impaired older persons. Further analyses will show if sensor-based data can reliably indicate changes of PFM. P317 Integrated home care technology assistance in frail older patients with heart failure: Aim and design of the Care@Home project funded by the Apulian region 1
1
1
2
3
D. Sancarlo , F. Giuliani , A. Greco , A. Leone , M. Manuzzi , M. Pistoia3 , P. Siciliano2 1 IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; 2 CNR-IMM, Lecce, Italy; 3 Eresult, Cesena, Italy Introduction: Heart failure is the leading cause of hospitalization in the elderly. About 20% of discharged patients tend to be rehospitalized with a poor prognosis.
S181
Aim of the Care@Home project funded through the call: “ICT Apulian Living Labs” (European Regional Development Fund. 2013– 2014) is to implement and evaluate an IT system capable of providing to frail older persons affected by heart failure the possibility to remain in their own home as long as possible thanks to an integrated telemonitoring system reducing also the mortality and the rehospitalisation rate. Methods: In the pilot cohort study will be included 40 patients aged >65 years, consecutively discharged from a Geriatric Unit, with a diagnosis of heart failure and high mortality risk, evaluated through the use of a multidimensional prognostic index. All patients will underwent a Comprehensive Geriatric Assessment at the beginning and at the end of the study. Each patient will be followed for two weeks at his home using a small telemonitoring system represented by a small sensor, evaluating the following parameters: EKG, respiratory rate, motility, risk of falls and temperature, connected to a computer-server capable to collect, directly and indirectly, other data such as weight, blood pressure, urine output, pulse oximetry, sending the data to a central database accessible by all the actors involved in the care process. Conclusions: The application of this home care system in this appropriate selected population could facilitate the developing of individualized care plans, improve the multidisciplinary communications and reduce adverse outcomes.
Metabolism/Nutrition/Sarcopenia P318 The predicitive value of serum B12 and its use in guidelines and protocols J.H. Strating, M. Zeeman, J.B. de Kok Deventer Hospital, The Netherlands Background: Vitamin B12 deficiency is seen very often. In many protocols like the Dutch CGA guideline and delirium guideline serum B12 is advised as a screening tool. Serum cobalamin does not necessarily reflect a normal B12 status. The determination of methylmalonic acid is advised to find a true B12 deficiency, but this is not known by a lot of general practitioners and specialists. Methods: We performed a retrospective database research to analyse all vitamin B12 measurements that could be combined with a serum methylmalonic acid measurement in the period of 2005 until 2012 in the Deventer Hospital clinical chemical laboratory. A serum methylmalonic acid (MMA) of 340 nmol/L or higher was presumed the gold standard of a true B12 deficiency. Besides that, we undertook an email enquiry to investigate what treatment decisions general practitioners and specialists make with a given serum vitamin B12 result. Results: We found that in the group with serum B12 between 100– 200 pmol/L only in about 50% of the cases we could diagnose a true vitamin B12 deficiency (ie MMA >340 nmol/L). In our email enquiry we found that 65% of the physicians never determined a serum methylmalonic acid. Many physicians started cobalamin supplementation when serum B12 was below 150pmol/L. Table 1. B12 values compared to MMA values Serum B12 0–150 pmol/L Serum B12 >150 pmol/L
True B12 deficiency (MMA >340 nmol/L)
No B12 deficiency (MMA 0–340 nmol/L)
41 (A) 24 (B) Sensitivity: 0.63
51 (C) 54 (D) Specificity: 0.51
PPV: 0.45 NPV: 0.69
Sensitivity: A/(A + B); Specificity: D/(C + D). PPV, positive predictive value: A/(A + C); NPV, negative predictive value: D/(D + C).
Conclusion: Serum B12 levels do not predict true B12 deficiency, when compared to methylmalonic acid. Not many physicians