- Email: [email protected]
Predictive factors for fear of falling after hip fracture
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141
Introduction.– Bisphosphonate therapy may have biological effects beyond bone health, including effects on cardiovascular, immune and muscle function. We examined the association between bisphosphonate use and functional outcomes in the rehabilitation of older people. Methods.– This was a retrospective cohort analysis of routine data collected from the Dundee Medicine for the Elderly Service between 1999 and 2011. Data on admission and discharge 20-point Barthel score was combined with comorbid disease, biochemistry, haematology and community prescribing data. The cohort was split into four groups: current bisphosphonate users, previous users (prescribed prior to admission); subsequent users (prescribed only after admission); and never users. Difference in Barthel between admission and discharge was analysed, adjusting for baseline Barthel score, age, sex, comorbid disease, medication burden, recent hip fracture, baseline albumin, calcium, renal function and haemoglobin. Results.– Two thousand seven hundred and ninety-seven patients were included in this analysis. Mean age was 84.1 (SD 7.5); 1153 (41%) were male, and the mean baseline admission Barthel score was 10.5 (SD 3.8). After adjustment for the above covariates, current bisphosphonate therapy was associated with a greater improvement in Barthel score (5.0 points, 95% CI 4.3 to 5.7) compared to the never users (3.8 points, 95% CI 3.6 to 3.9, P < 0.001) and previous users (3.4 points, 95% CI 2.8 to 4.0, P < 0.001) groups. However, there was no difference from those not taking bisphosphonates, but who started use after discharge from rehabilitation (5.1 points, 95% CI 4.6 to 5.5, P = 0.82). Conclusion.– Bisphosphonate therapy is not causally associated with improved functional outcomes from inpatient rehabilitation. http://dx.doi.org/10.1016/j.eurger.2013.07.349 P286
Predictive factors for fear of falling after hip fracture
S107
P287
Hemoglobin level as a predictor of rehabilitation outcome in older Chinese patients J.K.H. Luk a,b,c , P.K.C. Chiu a,b,c , L.W. Chu a,b,c a Department of Medicine, Queen Mary Hospital b Acute Geriatrics Unit, Grantham Hospital c Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong Background.– The relationship between hemoglobin (Hb) level and rehabilitation outcome of older patients is still controversial. This study investigated the relationship between Hb and rehabilitation outcomes of older patients. Methods.– It was a retrospective study performed in a step down hospital. Data of first Hb levels (1st-Hb) and last Hb levels (Last-Hb) during admission were collected. Change of Hb levels (= Last-Hb minus 1st-Hb) during hospitalization was determined. The Last-Hb were segregated into: < 8.9 g/dl; 9 to < 11.9 g/dl; 12 to < 13.9 g/dl and ≥ 14 g/dl. Absolute functional and motor gain were determined by Barthel Index (BI) and Elderly Mobility Scale (EMS), expressing as BI and EMS efficacy. BI and EMS efficiency were deduced by the efficacy divided by the length of hospital stay (LOS). Satisfactory motor and functional outcomes were discharge EMS ≥ 15 and BI ≥ 75. Results.– One thousand three hundred and ninety-seven patients including 793 (57%) women and 604 (43%) men were studied. Their average age was (mean ± S.D) 82.3 ± 7.1. Significant improvement in EMS and BI across all 4 Last-Hb groups on discharge was observed. The EMS and BI efficacy and efficiency were the same in 4 Last-Hb groups. 844 (60%) patients had Hb drop during admission and they had significantly poorer discharge EMS and BI scores compared with those without Hb drop (P < 0.001). Last-Hb was an important positive predictor for satisfactory functional outcome (odds 1.13, CI = 1.02 to 1.25, P < = 0.023). Conclusion.– Maintaining a higher Hb level and preventing Hb drop during rehabilitation may benefit rehabilitation of older patients.
J. Visschedijk , M. Caljouw , R. van Balen , W. Achterberg Leiden University Medical Center, Leiden, The Netherlands
http://dx.doi.org/10.1016/j.eurger.2013.07.351
Introduction.– Many factors are related to poor outcomes after a hip fracture, including age, gender, marital status, living situation, pre-morbid activities of daily living (ADL), physical performance and cognition. In addition, psychological factors, such as fear of falling (FoF), are associated with these unwanted outcomes. The present study aims to identify predictive factors for FoF and develop a predictive model for FoF after a hip fracture. Methods.– Cross-sectional study in a total of 100 hip fracture patients (aged ≥ 65) in 10 skilled nursing facilities (SNF). Participants were divided into a low and high FoF group, based on median FES-I score. Information on FoF was obtained by interviewing the participants. Possible predictive factors were collected, including demographic variables, aspects of functioning, psychological factors, and co-morbidities. For every predictor a univariate logistic regression was conducted. For the multivariate regression model a backward procedure was used in which variables with P < 0.05 were included. Results.– Walking ability and ADL before fracture, number of complications, ADL after fracture, anxiety and self-efficacy were univariate predictors for FoF. Multivariate analysis showed that walking ability before fracture (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14–0.83), ADL after fracture (OR 0.89, 95%CI 0.80–0.99), and anxiety (OR 1.22, 95%CI 1.05–1.42) were independent predictors for FoF. Key conclusions.– Impaired walking ability before fracture, impaired ADL after fracture, and increased anxiety predict FoF after hip fracture. This information enables healthcare workers to identify older persons who are particularly prone to have FoF.
“Fight like a ferret”: A novel approach of using art therapy (AT) in reducing anxiety in stroke patients undergoing rehabilitation
P288
http://dx.doi.org/10.1016/j.eurger.2013.07.350
K. Ali , D. Waller , T. Gammidge , J. Gaylard , A. Howard , G. Fanea Brighton and Sussex Medical School, Brighton and Sussex University Hospitals NHS Trust, University of Brighton, Brighton, United Kingdom Introduction.– Anxiety and depression are common post stroke. The holistic aspect of stroke rehabilitation to include psychological well-being is currently neglected, with emphasis put on physical recovery. Creative strategies such as Art Therapy (AT) can be beneficial during rehabilitation in sharing of information, installation of hope, and reducing isolation amongst stroke patients. Methods.– Stroke patients in a hospital rehabilitation unit who are able to consent were invited to participate in 2 weekly AT sessions (50 minutes) for 6 weeks. The sessions were facilitated by an experienced arts therapist using materials such as paints, crayons, clay, a camera and an Ipad. Hospital anxiety and depression scales (HAD) were measured at the beginning and end of the 6 weeks. Results.– Six male patients were recruited, average age 69 years (38–85). All patients attended at least 6 sessions. AT group discussions allowed patients to express openly feelings of frustration, anger and despair as well as resilience and hope for good physical and emotional recovery: “Fight like a Ferret” was an expression used by an AT group member. The group produced several art
Introduction.– Bisphosphonate therapy may have biological effects beyond bone health, including effects on cardiovascular, immune and muscle function. We examined the association between bisphosphonate use and functional outcomes in the rehabilitation of older people. Methods.– This was a retrospective cohort analysis of routine data collected from the Dundee Medicine for the Elderly Service between 1999 and 2011. Data on admission and discharge 20-point Barthel score was combined with comorbid disease, biochemistry, haematology and community prescribing data. The cohort was split into four groups: current bisphosphonate users, previous users (prescribed prior to admission); subsequent users (prescribed only after admission); and never users. Difference in Barthel between admission and discharge was analysed, adjusting for baseline Barthel score, age, sex, comorbid disease, medication burden, recent hip fracture, baseline albumin, calcium, renal function and haemoglobin. Results.– Two thousand seven hundred and ninety-seven patients were included in this analysis. Mean age was 84.1 (SD 7.5); 1153 (41%) were male, and the mean baseline admission Barthel score was 10.5 (SD 3.8). After adjustment for the above covariates, current bisphosphonate therapy was associated with a greater improvement in Barthel score (5.0 points, 95% CI 4.3 to 5.7) compared to the never users (3.8 points, 95% CI 3.6 to 3.9, P < 0.001) and previous users (3.4 points, 95% CI 2.8 to 4.0, P < 0.001) groups. However, there was no difference from those not taking bisphosphonates, but who started use after discharge from rehabilitation (5.1 points, 95% CI 4.6 to 5.5, P = 0.82). Conclusion.– Bisphosphonate therapy is not causally associated with improved functional outcomes from inpatient rehabilitation. http://dx.doi.org/10.1016/j.eurger.2013.07.349 P286
Predictive factors for fear of falling after hip fracture
S107
P287
Hemoglobin level as a predictor of rehabilitation outcome in older Chinese patients J.K.H. Luk a,b,c , P.K.C. Chiu a,b,c , L.W. Chu a,b,c a Department of Medicine, Queen Mary Hospital b Acute Geriatrics Unit, Grantham Hospital c Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong Background.– The relationship between hemoglobin (Hb) level and rehabilitation outcome of older patients is still controversial. This study investigated the relationship between Hb and rehabilitation outcomes of older patients. Methods.– It was a retrospective study performed in a step down hospital. Data of first Hb levels (1st-Hb) and last Hb levels (Last-Hb) during admission were collected. Change of Hb levels (= Last-Hb minus 1st-Hb) during hospitalization was determined. The Last-Hb were segregated into: < 8.9 g/dl; 9 to < 11.9 g/dl; 12 to < 13.9 g/dl and ≥ 14 g/dl. Absolute functional and motor gain were determined by Barthel Index (BI) and Elderly Mobility Scale (EMS), expressing as BI and EMS efficacy. BI and EMS efficiency were deduced by the efficacy divided by the length of hospital stay (LOS). Satisfactory motor and functional outcomes were discharge EMS ≥ 15 and BI ≥ 75. Results.– One thousand three hundred and ninety-seven patients including 793 (57%) women and 604 (43%) men were studied. Their average age was (mean ± S.D) 82.3 ± 7.1. Significant improvement in EMS and BI across all 4 Last-Hb groups on discharge was observed. The EMS and BI efficacy and efficiency were the same in 4 Last-Hb groups. 844 (60%) patients had Hb drop during admission and they had significantly poorer discharge EMS and BI scores compared with those without Hb drop (P < 0.001). Last-Hb was an important positive predictor for satisfactory functional outcome (odds 1.13, CI = 1.02 to 1.25, P < = 0.023). Conclusion.– Maintaining a higher Hb level and preventing Hb drop during rehabilitation may benefit rehabilitation of older patients.
J. Visschedijk , M. Caljouw , R. van Balen , W. Achterberg Leiden University Medical Center, Leiden, The Netherlands
http://dx.doi.org/10.1016/j.eurger.2013.07.351
Introduction.– Many factors are related to poor outcomes after a hip fracture, including age, gender, marital status, living situation, pre-morbid activities of daily living (ADL), physical performance and cognition. In addition, psychological factors, such as fear of falling (FoF), are associated with these unwanted outcomes. The present study aims to identify predictive factors for FoF and develop a predictive model for FoF after a hip fracture. Methods.– Cross-sectional study in a total of 100 hip fracture patients (aged ≥ 65) in 10 skilled nursing facilities (SNF). Participants were divided into a low and high FoF group, based on median FES-I score. Information on FoF was obtained by interviewing the participants. Possible predictive factors were collected, including demographic variables, aspects of functioning, psychological factors, and co-morbidities. For every predictor a univariate logistic regression was conducted. For the multivariate regression model a backward procedure was used in which variables with P < 0.05 were included. Results.– Walking ability and ADL before fracture, number of complications, ADL after fracture, anxiety and self-efficacy were univariate predictors for FoF. Multivariate analysis showed that walking ability before fracture (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14–0.83), ADL after fracture (OR 0.89, 95%CI 0.80–0.99), and anxiety (OR 1.22, 95%CI 1.05–1.42) were independent predictors for FoF. Key conclusions.– Impaired walking ability before fracture, impaired ADL after fracture, and increased anxiety predict FoF after hip fracture. This information enables healthcare workers to identify older persons who are particularly prone to have FoF.
“Fight like a ferret”: A novel approach of using art therapy (AT) in reducing anxiety in stroke patients undergoing rehabilitation
P288
http://dx.doi.org/10.1016/j.eurger.2013.07.350
K. Ali , D. Waller , T. Gammidge , J. Gaylard , A. Howard , G. Fanea Brighton and Sussex Medical School, Brighton and Sussex University Hospitals NHS Trust, University of Brighton, Brighton, United Kingdom Introduction.– Anxiety and depression are common post stroke. The holistic aspect of stroke rehabilitation to include psychological well-being is currently neglected, with emphasis put on physical recovery. Creative strategies such as Art Therapy (AT) can be beneficial during rehabilitation in sharing of information, installation of hope, and reducing isolation amongst stroke patients. Methods.– Stroke patients in a hospital rehabilitation unit who are able to consent were invited to participate in 2 weekly AT sessions (50 minutes) for 6 weeks. The sessions were facilitated by an experienced arts therapist using materials such as paints, crayons, clay, a camera and an Ipad. Hospital anxiety and depression scales (HAD) were measured at the beginning and end of the 6 weeks. Results.– Six male patients were recruited, average age 69 years (38–85). All patients attended at least 6 sessions. AT group discussions allowed patients to express openly feelings of frustration, anger and despair as well as resilience and hope for good physical and emotional recovery: “Fight like a Ferret” was an expression used by an AT group member. The group produced several art