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Prevention of post stroke shoulder pain on an acute stroke service
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8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
the group with 80 to 90 years old, we found a higher functional independence between the younger patients. Conclusion.– Age per se is an indicator of frailty and determined the functional recovery after hip fracture. When we refer to patients with more than 90 years old and hip fracture, is difficult to reach the functional independence that they had previously, and this may get even more hostile when anemia is associated. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.124 P124
Profile of patients admitted in a medium-term care geriatric unit F. Rowlands a,∗ , A. Escolante Melich a , O. Toledo Sánchez a , R. Rivas Espinoza a , P.G. Schall b a Geriatría, Hospital Virgen del Valle, Toledo, Spain b Geriatría, CHT, Toledo, Spain Objectives and methods.– To determine the inclusion diagnoses in the rehabilitation program, the functional capacity using the Barthel Index (BI) previously (BP), when admitted (BA) and after discharge (BD), duration of hospitalization, the presence of anemia and cognitive impairment in the sample. A retrospective one-year study (2011) of 239 patients hospitalized in a medium-term care geriatric unit. We used the Pfeiffer test for detection of cognitive impairment and the BI to evaluate functional capacity. Mean functional improvement (FI) (FI = BD-BA) was utilized to determinate the rehabilitation efficacy, considering an increase of > 20 points as an adequate outcome. Results and conclusions.– Mean age 82.4 years old and 60.2% female. Hip fracture represented 47.7%; ischemic stroke 24.4%; hemorrhagic stroke 7.1%; immobility syndrome 17.2% and 4.6% were hospitalized for other causes (polimiositis, hip joint replacement, knee arthroplasty). The average hospital stay was 24, 21 days; 88.8% had no cognitive impairment, 12.1% have mild cognitive impairment and 6,8% had moderate cognitive impairment. Only 8% had severe dementia and 69.5% had anemia. Mean BA was 22.86 and BD was 53.54 with a FI of 30.68. For stroke events, FI was 28.06 and 36.35 for hip fracture. Anemia, older age and moderate-severe cognitive impairment were associated with worse functional gain. The rehabilitation program showed an adequate outcome in the FI. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.125 P125
Contacts to the emergency department by elderly patients referred to a rehabilitation unit D. Zintchouk ∗ , E.M. Damsgaard Department Of Geriatrics, Aarhus University Hospital, Aarhus C, Denmark
Introduction.– Elderly people account for up to 69% of emergency department visits. Aim.– The aim of this study was to determine the risk of emergency department visits for elderly patients referred to a municipal residential rehabilitation unit. Methods.– Data were collected on all elderly (70+ years old), referred to the rehabilitation unit Vikaergaarden in Aarhus Municipality between 1 April 2009 and 30 June 2010. Data on all hospital contacts within a three months follow-up period were obtained from the National Patient Database. Elderly with a cancer diagnosis were excluded. Results.– One hundred and seventy-three persons fulfilled the inclusion criteria. The mean age was 83.2 years (range 70–100), 85 (49%) were men. One hundred and thirty-five (78%) of the elderly were referred from an acute hospital ward, whereas 38 (22%) came from their own homes. Within three months of referral to the reha-
bilitation unit, 21 (16%) of patients referred from an acute hospital ward and five (13%) of persons from their own homes visited the emergency department. In total, they had 39 contacts (mean number per person 1.5 (range 1–4)). Conclusion.– This study seems to indicate that elderly patients referred to a municipal rehabilitation unit have a high risk of having contacts with the emergency department within the first 3 months. Further research should elucidate the predictive factors that characterize elderly persons who have hospital contacts after being referred to a rehabilitation unit, as well as measures to prevent such contacts. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.126 P126
Post stroke shoulder pain; prevalence and rates of detection on an acute stroke service K.P. James ∗ , M.F. Karim , S. Sengupta Department Of Medicine, Our Lady of Lourdes Hospital, Co. Louth, Ireland
Introduction.– Post stroke shoulder pain (PSSP) occurs in up to 30% of patients due to various causes; ranging from rotator cuff abnormalities and joint subluxation to neuropathic pain. PSSP restricts upper limb function and can limit rehabilitation, increasing length of stay and reducing quality of life. This study aimed to assess prevalence and detection by healthcare providers of PSSP. Methods.– A point prevalence study was conducted on the acute stroke and stroke rehabilitation ward. All patients with hemiparesis who were able to communicate pain were included. Medical records and nursing notes were reviewed to assess whether presence or absence of PSSP was documented. Patients were then interviewed following informed consent to establish whether PSSP was present. Fifteen patients (nine male, six female) were included (mean age: 76 years ±8.7). Among them, 66.6% (n = 10) had a left hemiparesis and 33.3% (n = 5) had a right hemiparesis. All patients had impaired upper limb function. Results.– Twenty percent (n = 3) of patients (three male; 0 female) reported PSSP. In two cases, there was no documentation of PSSP. One patient who had PSSP documented by their occupational therapist 32 days following stroke, subsequently underwent X-ray and MRI shoulder (both normal) and was treated with analgesia, shoulder positioning, range of motion exercises and a supportive device. Absence of PSSP was not documented for any patient. Conclusion.– This study highlights that PSSP if often underrecognised. Detection of PSSP in this study prompted investigation and treatment. Given its prevalence, healthcare providers should enquire regularly about the presence/absence of PSSP in order to minimize complications. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.127 P127
Prevention of post stroke shoulder pain on an acute stroke service
K.P. James ∗ , M.F. Karim , S. Sengupta Department Of Medicine, Our Lady of Lourdes Hospital, Co. Louth, Ireland Introduction.– Post Stroke Shoulder Pain (PSSP) occurs in up to 30% of patients with hemiparesis. PSSP may limit rehabilitation resulting in prolonged hospital stay and reduced quality of life, thus prevention is preferable. This study aimed to assess the use PSSP prevention measures on an inter-disciplinary stroke service. Methods.– A retrospective cohort study was conducted on an acute stroke and stroke rehabilitation ward. All patients with hemiparesis were included. Medical records and nursing notes were reviewed
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
to establish if PSSP prevention was used. Thirty-four patients were eligible for inclusion. Sixteen patients (ten male, six female) had a stroke with hemiparesis (11 left, five right) and were included (mean age 75.5 years ± 8.6). All patients had impaired upper limb function. Results.– One hundred percent (n = 16) of patients were receiving physiotherapy and had been prescribed upper limb range of motion exercises. 100% (n = 6) of patients were receiving occupational therapy for upper limb function. Among them, 43.7% (n = 7) were documented as receiving shoulder positioning. Among the patients, 0% (n = 0) was using shoulder support devices prophylactically. Three patients developed PSSP despite preventive measures. One patient underwent plain X-ray of the shoulder and MRI shoulder, both of which were normal, and was subsequently prescribed a shoulder support device. Conclusion.– We found satisfactory rates of physiotherapy and occupational therapy techniques to prevent PSSP. Less than 50% of patients had been prescribed and were formally documented as receiving positioning techniques to prevent PSSP. This study highlights the importance of the use of measures to prevent PSSP. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.128 P128
The association of telemonitoring on hospice referral: A pilot randomized trial P. Takahashi a,∗ , J. Pecina b , H. Van Houten c , N. Shah c , J. Naessens c , B. Thorsteinsdottir a , G. Hanson a a Department Of Internal Medicine, Mayo Clinic, Rochester, USA b Family Medicine, Rochester, USA c Health Science Research, Rochester, USA Introduction.– Telemonitoring is an important method of medical care delivery. Hospitalization is an important outcome; however, many frail individuals suffer chronic illnesses and may require palliative care or hospice. We don’t know if telemonitoring increases hospice use. We conducted a secondary analysis of a clinical trial to answer this. Aim.– Determine the association of hospice enrolments between telemonitoring and usual care in adults with comorbid conditions. Methods.– This was a randomized controlled trial (secondary analysis). Primary outcome was hospice enrolment, and secondary outcome was total hospice time. The study occurred at an academic medical center. Participants were over 60 and had a high risk of hospital admission. Primary outcome was percent hospice enrolment within a year of study enrolment. Chi Square was used for analysis of percent enrolment with a t test for days of hospice enrolment. Results.– The average age in the cohort was 80.3 years. Nine patients (8.8%) in the telemonitoring group were enrolled in hospice, compared to four patients (3.9%) in usual care (P value 0.15). The mean number of days in hospice was 57.9 days (SD 99.2) for the telemonitoring group, and 119.3 days (SD 123.8) in usual care (P value 0.36). Discussion.– In this study, there was no difference in percent hospice enrolment between telemonitoring and usual care. While there was no statistical difference, there was a two-fold increase in percent hospice enrolment. This pilot study was underpowered; however, it generated findings for larger studies to look at end of life care in this population. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.129
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BelRAI software for standardized data exchange between geriatric health care organizations E. Devriendt a,∗ , N. Wellens a , L. Vesentini b , L. Van Eenoo b , A. Declercq b , P. Moons a , J. Flamaing c , K. Milisen a a Centre For Health Services And Nursing Research, KU Leuven, Leuven, Belgium b Lucas-centre For Care Research And Consultancy, Policy Research Centre For Welfare, Public Health And The Family, Katholieke Universiteit Leuven, Leuven, Belgium c Department Of Geriatric Medicine, Leuven University Hospitals, Leuven, Belgium Introduction.– BelRAI is a web-based software system including various comprehensive geriatric assessment instruments of the interRAI Suite enabling evidence-based care planning and data exchange. The aim was to evaluate data exchange across health care facilities. Methods.– The progress of data exchange between three hospitals, 14 homecare organizations and five nursing homes, was evaluated by questionnaires and six recorded focus groups which were transcribed verbatim and were coded independently by two researchers. Results.– For all participating organizations this study was a first introduction to standardized data exchange and the first use of a web-based patient record. Data transfer between hospitals and residential care was satisfactory. Home care organizations had some organizational problems (e.g. fragmentation of staff working at different locations), which hampered data exchange. The hospitals received 34 BelRAI-files at admission and sent out 159 files after discharge. It was found very useful to receive a completed BelRAI-file at (re)admission. The received standardized assessment, informed clinicians accurately about the premorbid condition and the level of independence. If necessary, the care could be adjusted according to transferred information. Furthermore, previous assessments implied a gain of time for the subsequent assessment during hospital stay. There are some important prior conditions for communication across settings: user-friendly webbased software, collaboration between all care partners including physicians, and the appointment of staff for coordination tasks. Conclusion.– Organizations caring for the same patient need a tool to exchange data in a systematic way. The BelRAI web-based software offers this possibility when the above-mentioned conditions are fulfilled. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.130 P130
Doctors and patients as consumers in a world of herbal medicine APPS
W. Woo , C. Lisk ∗ Department Of Medicine, Barnet Hospital, London, United Kingdom Introduction.– Older patients are increasingly using herbal medicines. It is therefore important for healthcare professionals as well as patients to have access to safe and valid information. In recent times, the use of smart phones by health care professionals and patients has revolutionized the way we access healthcare information. It is estimated that the number of health related apps for use will grow to more than 13000 by August 2012. This has the ability to empower consumers; however inaccurate information poses a significant risk. We therefore sought to review all apps on herbal medicines available in the app store for the iphone and ipad. Methods.– All herbal medicine apps available were reviewed by a junior doctor and Consultant Physician in Medicine. Non-English apps and junk apps were excluded. Apps were then sorted out
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
the group with 80 to 90 years old, we found a higher functional independence between the younger patients. Conclusion.– Age per se is an indicator of frailty and determined the functional recovery after hip fracture. When we refer to patients with more than 90 years old and hip fracture, is difficult to reach the functional independence that they had previously, and this may get even more hostile when anemia is associated. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.124 P124
Profile of patients admitted in a medium-term care geriatric unit F. Rowlands a,∗ , A. Escolante Melich a , O. Toledo Sánchez a , R. Rivas Espinoza a , P.G. Schall b a Geriatría, Hospital Virgen del Valle, Toledo, Spain b Geriatría, CHT, Toledo, Spain Objectives and methods.– To determine the inclusion diagnoses in the rehabilitation program, the functional capacity using the Barthel Index (BI) previously (BP), when admitted (BA) and after discharge (BD), duration of hospitalization, the presence of anemia and cognitive impairment in the sample. A retrospective one-year study (2011) of 239 patients hospitalized in a medium-term care geriatric unit. We used the Pfeiffer test for detection of cognitive impairment and the BI to evaluate functional capacity. Mean functional improvement (FI) (FI = BD-BA) was utilized to determinate the rehabilitation efficacy, considering an increase of > 20 points as an adequate outcome. Results and conclusions.– Mean age 82.4 years old and 60.2% female. Hip fracture represented 47.7%; ischemic stroke 24.4%; hemorrhagic stroke 7.1%; immobility syndrome 17.2% and 4.6% were hospitalized for other causes (polimiositis, hip joint replacement, knee arthroplasty). The average hospital stay was 24, 21 days; 88.8% had no cognitive impairment, 12.1% have mild cognitive impairment and 6,8% had moderate cognitive impairment. Only 8% had severe dementia and 69.5% had anemia. Mean BA was 22.86 and BD was 53.54 with a FI of 30.68. For stroke events, FI was 28.06 and 36.35 for hip fracture. Anemia, older age and moderate-severe cognitive impairment were associated with worse functional gain. The rehabilitation program showed an adequate outcome in the FI. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.125 P125
Contacts to the emergency department by elderly patients referred to a rehabilitation unit D. Zintchouk ∗ , E.M. Damsgaard Department Of Geriatrics, Aarhus University Hospital, Aarhus C, Denmark
Introduction.– Elderly people account for up to 69% of emergency department visits. Aim.– The aim of this study was to determine the risk of emergency department visits for elderly patients referred to a municipal residential rehabilitation unit. Methods.– Data were collected on all elderly (70+ years old), referred to the rehabilitation unit Vikaergaarden in Aarhus Municipality between 1 April 2009 and 30 June 2010. Data on all hospital contacts within a three months follow-up period were obtained from the National Patient Database. Elderly with a cancer diagnosis were excluded. Results.– One hundred and seventy-three persons fulfilled the inclusion criteria. The mean age was 83.2 years (range 70–100), 85 (49%) were men. One hundred and thirty-five (78%) of the elderly were referred from an acute hospital ward, whereas 38 (22%) came from their own homes. Within three months of referral to the reha-
bilitation unit, 21 (16%) of patients referred from an acute hospital ward and five (13%) of persons from their own homes visited the emergency department. In total, they had 39 contacts (mean number per person 1.5 (range 1–4)). Conclusion.– This study seems to indicate that elderly patients referred to a municipal rehabilitation unit have a high risk of having contacts with the emergency department within the first 3 months. Further research should elucidate the predictive factors that characterize elderly persons who have hospital contacts after being referred to a rehabilitation unit, as well as measures to prevent such contacts. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.126 P126
Post stroke shoulder pain; prevalence and rates of detection on an acute stroke service K.P. James ∗ , M.F. Karim , S. Sengupta Department Of Medicine, Our Lady of Lourdes Hospital, Co. Louth, Ireland
Introduction.– Post stroke shoulder pain (PSSP) occurs in up to 30% of patients due to various causes; ranging from rotator cuff abnormalities and joint subluxation to neuropathic pain. PSSP restricts upper limb function and can limit rehabilitation, increasing length of stay and reducing quality of life. This study aimed to assess prevalence and detection by healthcare providers of PSSP. Methods.– A point prevalence study was conducted on the acute stroke and stroke rehabilitation ward. All patients with hemiparesis who were able to communicate pain were included. Medical records and nursing notes were reviewed to assess whether presence or absence of PSSP was documented. Patients were then interviewed following informed consent to establish whether PSSP was present. Fifteen patients (nine male, six female) were included (mean age: 76 years ±8.7). Among them, 66.6% (n = 10) had a left hemiparesis and 33.3% (n = 5) had a right hemiparesis. All patients had impaired upper limb function. Results.– Twenty percent (n = 3) of patients (three male; 0 female) reported PSSP. In two cases, there was no documentation of PSSP. One patient who had PSSP documented by their occupational therapist 32 days following stroke, subsequently underwent X-ray and MRI shoulder (both normal) and was treated with analgesia, shoulder positioning, range of motion exercises and a supportive device. Absence of PSSP was not documented for any patient. Conclusion.– This study highlights that PSSP if often underrecognised. Detection of PSSP in this study prompted investigation and treatment. Given its prevalence, healthcare providers should enquire regularly about the presence/absence of PSSP in order to minimize complications. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.127 P127
Prevention of post stroke shoulder pain on an acute stroke service
K.P. James ∗ , M.F. Karim , S. Sengupta Department Of Medicine, Our Lady of Lourdes Hospital, Co. Louth, Ireland Introduction.– Post Stroke Shoulder Pain (PSSP) occurs in up to 30% of patients with hemiparesis. PSSP may limit rehabilitation resulting in prolonged hospital stay and reduced quality of life, thus prevention is preferable. This study aimed to assess the use PSSP prevention measures on an inter-disciplinary stroke service. Methods.– A retrospective cohort study was conducted on an acute stroke and stroke rehabilitation ward. All patients with hemiparesis were included. Medical records and nursing notes were reviewed
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
to establish if PSSP prevention was used. Thirty-four patients were eligible for inclusion. Sixteen patients (ten male, six female) had a stroke with hemiparesis (11 left, five right) and were included (mean age 75.5 years ± 8.6). All patients had impaired upper limb function. Results.– One hundred percent (n = 16) of patients were receiving physiotherapy and had been prescribed upper limb range of motion exercises. 100% (n = 6) of patients were receiving occupational therapy for upper limb function. Among them, 43.7% (n = 7) were documented as receiving shoulder positioning. Among the patients, 0% (n = 0) was using shoulder support devices prophylactically. Three patients developed PSSP despite preventive measures. One patient underwent plain X-ray of the shoulder and MRI shoulder, both of which were normal, and was subsequently prescribed a shoulder support device. Conclusion.– We found satisfactory rates of physiotherapy and occupational therapy techniques to prevent PSSP. Less than 50% of patients had been prescribed and were formally documented as receiving positioning techniques to prevent PSSP. This study highlights the importance of the use of measures to prevent PSSP. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.128 P128
The association of telemonitoring on hospice referral: A pilot randomized trial P. Takahashi a,∗ , J. Pecina b , H. Van Houten c , N. Shah c , J. Naessens c , B. Thorsteinsdottir a , G. Hanson a a Department Of Internal Medicine, Mayo Clinic, Rochester, USA b Family Medicine, Rochester, USA c Health Science Research, Rochester, USA Introduction.– Telemonitoring is an important method of medical care delivery. Hospitalization is an important outcome; however, many frail individuals suffer chronic illnesses and may require palliative care or hospice. We don’t know if telemonitoring increases hospice use. We conducted a secondary analysis of a clinical trial to answer this. Aim.– Determine the association of hospice enrolments between telemonitoring and usual care in adults with comorbid conditions. Methods.– This was a randomized controlled trial (secondary analysis). Primary outcome was hospice enrolment, and secondary outcome was total hospice time. The study occurred at an academic medical center. Participants were over 60 and had a high risk of hospital admission. Primary outcome was percent hospice enrolment within a year of study enrolment. Chi Square was used for analysis of percent enrolment with a t test for days of hospice enrolment. Results.– The average age in the cohort was 80.3 years. Nine patients (8.8%) in the telemonitoring group were enrolled in hospice, compared to four patients (3.9%) in usual care (P value 0.15). The mean number of days in hospice was 57.9 days (SD 99.2) for the telemonitoring group, and 119.3 days (SD 123.8) in usual care (P value 0.36). Discussion.– In this study, there was no difference in percent hospice enrolment between telemonitoring and usual care. While there was no statistical difference, there was a two-fold increase in percent hospice enrolment. This pilot study was underpowered; however, it generated findings for larger studies to look at end of life care in this population. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.129
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BelRAI software for standardized data exchange between geriatric health care organizations E. Devriendt a,∗ , N. Wellens a , L. Vesentini b , L. Van Eenoo b , A. Declercq b , P. Moons a , J. Flamaing c , K. Milisen a a Centre For Health Services And Nursing Research, KU Leuven, Leuven, Belgium b Lucas-centre For Care Research And Consultancy, Policy Research Centre For Welfare, Public Health And The Family, Katholieke Universiteit Leuven, Leuven, Belgium c Department Of Geriatric Medicine, Leuven University Hospitals, Leuven, Belgium Introduction.– BelRAI is a web-based software system including various comprehensive geriatric assessment instruments of the interRAI Suite enabling evidence-based care planning and data exchange. The aim was to evaluate data exchange across health care facilities. Methods.– The progress of data exchange between three hospitals, 14 homecare organizations and five nursing homes, was evaluated by questionnaires and six recorded focus groups which were transcribed verbatim and were coded independently by two researchers. Results.– For all participating organizations this study was a first introduction to standardized data exchange and the first use of a web-based patient record. Data transfer between hospitals and residential care was satisfactory. Home care organizations had some organizational problems (e.g. fragmentation of staff working at different locations), which hampered data exchange. The hospitals received 34 BelRAI-files at admission and sent out 159 files after discharge. It was found very useful to receive a completed BelRAI-file at (re)admission. The received standardized assessment, informed clinicians accurately about the premorbid condition and the level of independence. If necessary, the care could be adjusted according to transferred information. Furthermore, previous assessments implied a gain of time for the subsequent assessment during hospital stay. There are some important prior conditions for communication across settings: user-friendly webbased software, collaboration between all care partners including physicians, and the appointment of staff for coordination tasks. Conclusion.– Organizations caring for the same patient need a tool to exchange data in a systematic way. The BelRAI web-based software offers this possibility when the above-mentioned conditions are fulfilled. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.130 P130
Doctors and patients as consumers in a world of herbal medicine APPS
W. Woo , C. Lisk ∗ Department Of Medicine, Barnet Hospital, London, United Kingdom Introduction.– Older patients are increasingly using herbal medicines. It is therefore important for healthcare professionals as well as patients to have access to safe and valid information. In recent times, the use of smart phones by health care professionals and patients has revolutionized the way we access healthcare information. It is estimated that the number of health related apps for use will grow to more than 13000 by August 2012. This has the ability to empower consumers; however inaccurate information poses a significant risk. We therefore sought to review all apps on herbal medicines available in the app store for the iphone and ipad. Methods.– All herbal medicine apps available were reviewed by a junior doctor and Consultant Physician in Medicine. Non-English apps and junk apps were excluded. Apps were then sorted out