key: cord-0005593-wnk3mmg2 authors: nan title: Abstracts of the 14th International Congress of the European Geriatric Medicine Society: 10–12 October 2018, Berlin, Germany date: 2018-10-04 journal: Eur Geriatr Med DOI: 10.1007/s41999-018-0097-4 sha: 1faae7ce711b362a267c1354586398343181087c doc_id: 5593 cord_uid: wnk3mmg2 nan Introduction: Recently, a network of Orthogeriatric and Orthopedic Units (Gruppo Italiano di OrtoGeriatria, GIOG) was created in Italy to collect data of older patients admitted to hospital wards after hip fracture (HF). We report some data regarding the detection of postoperative delirium (POD). Methods: 2570 patients (76.3% females) aged [ 65 years were recruited in 14 hospitals after HF from 2016 to March 2018 . Information about residence before fracture, pre-operative cognitive impairment (POCI), type of anaesthesia and involvement of a geriatrician as consultant were collected. POD development was assessed on the 1st day after surgery with routinely employed instruments. Multivariate logistic p-values are reported. Results: POD occurred in 636 patients (24.7%), with huge heterogeneity among centers (11.7-38.8%, p \ 0.001). Delirium was significantly associated with gender (30.6% female vs. 22.9% male, OR = 1.6, 95% CI 1.2-2.1), age (30.0% C 85 years vs. 18.2% \ 85 years, OR = 1.7, 95% CI 1.3-2.1); POCI (40% severe POCI vs. no-POCI, OR = 5.6, 95% CI 4.0-7.9); geriatric involvement (25.1% yes vs. 19.2% no, OR = 2.8, 95% CI 1. 3-6.4) . No association was found between POD and type of anesthesia (24.8% general vs 24.7% other, p = 0.38) and living at home before fracture (23.9% yes vs 33.5% no, p = 0.86). No significant difference in median time from hospitalization to surgery was found between patients with POD (42.0 h; I-III quartiles 24.0-63.3) and those without POD (40.0 h, I-III quartiles 23.0-58.0; p = 0.59). Conclusions: We found a huge heterogeneity in delirium detection among centres, at least partially related to patient and organizational characteristics. Diffusion of tools to systematically detect delirium is urgently required. Factors associated with institutionalization after 1 year of hip fracture impairment 17.3%, ), CIRS-G 12 (IQR = 9-16); BI 90 (IQR = 75-95), , 56.5% used walking aids, LI 4 (IQR = 1-7); HbAd 12.67 ± 1.66, HbDi 10.44 ± 1.00. Intracapsular fracture 50.2%, time until surgery 3.97 ± 2.22 days, heart failure (HF) 14%, delirium 22%, length of stay 13.44 ± 9.78 days; 3.8% were institutionalized before the fracture and 20.9% after 12 months. Factors associated with institutionalization after 1 year: age C 85 (p = 0.010), moderatesevere cognitive impairment (p \ 0.0005), FAC \ 4 (p = 0.001); HF (p = 0.05), BI at admission (p = 0.002) and at discharge (p \ 0.0005), length of stay (p = 0.002). Multivariate analysis: IB at discharge (OR: 0.9; 95% CI; 0.94-0.99; p = 0.026), length of stay (OR:1.1; 95% CI; 1.1-1.2; p = 0.002) and HF (OR:9.0; 95% CI; 1.1-80.5; p = 0.049). Conclusions: The main risk factors for institutionalization following a hip fracture are IB at discharge, length of stay and to develop HF during the hospitalization. As a consequence, age, comorbidity and complications should not be considered isolated variables in the prediction of institutionalization. Predicting 12-month mortality in emergency surgery patients assessed by an elderly care liaison service: Salford POP-GS I), perceived ability to manage falls (PAMF), fall-related posttraumatic stress (6 questions based on DSM-IV criteria) psychological inflexibility (Acceptance and Action Questionnaire, AAQ-2), history of falls and motor performance (Short Physical Performance Battery, SPPB). Cross-sectional data were analyzed using path analysis. Results: Low motor performance had significant direct effects on FES-I (p B 0.01), whereas 1-item FoF was significantly and directly determined by fall-related posttraumatic stress (p B 0.05). Posttraumatic stress significantly mediated the effects of high psychological inflexibility on 1-item FoF (indirect effect, p B 0.05). Being female (p B 0.01) and history of falls (p B 0.01) were significantly and directly associated with low perceived ability to manage falls. Discussion: Results indicate that the assessment of fall-related concerns by FES-I during an early stage of stationary rehabilitation maybe is insufficient to capture FoF in its whole nature. FES-I targets fall-related concerns related to activities of daily living which cannot be performed by hip fracture during the early stage of recovery. In this context the relevance of psychological inflexibility and posttraumatic stress symptoms was emphasized. Nutrition and functional outcomes in older adults admitted to rehabilitation units: a multi-centre cohort study risk of being frail in old age for men (ORa = 1.04; 1.01-1.1) and women (ORa = 1.07; 1.02-1.13). In conclusion, our data shows that obesity duration increased the risk of being frail in life over sixty years old. Early weight control may participate to healthy aging. Introduction: Identifying people at risk of early functional decline in activities of daily living (ADL) is essential for initiating targeted preventive interventions. The aim of this study is to develop and validate a prediction model for the onset of functional decline in 3-year follow-up in young older adults aged 65-75 years. Methods: We conducted a pooled analysis of four population-based cohorts, including participants of 65-75 years old who reported no functional limitations at baseline. Functional decline was assessed with two items on basic ADL and three items on instrumental ADL. Multiple logistic regression analysis was used to develop a prediction model, with subsequent bootstrapping for optimism-correction. We applied internal-external cross-validation to assess model discrimination and calibration across the cohorts. Results: 2560 people were included (mean age 69.7 ± 3.0 years, 47.4% female) of whom 572 (22.3%) reported functional decline at three-year follow-up. The final prediction model contained 10 out of 22 predictors: age, handgrip strength, gait speed, five-repeated chair stands time (non-linear association), body mass index, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, arthritis, and depressive symptoms. The optimism-corrected model showed good discrimination with a C statistic of 0.72. Calibration intercept was 0.06 and calibration slope was 1.05. Internal-external cross-validation showed consistent performance of the model across the four cohorts. Conclusions: Based on pooled cohort data analyses we showed that the onset of functional decline in ADL in three years in people aged 65-75 years can be predicted by specific physical performance measures, age, body mass index, depressive symptoms, and chronic conditions. O-29 ,,Active health promotion in old age'': who benefited from participation? Compression of morbidity assessed in the Longitudinal Urban Cohort Ageing Study (LUCAS) over 13.8 years and standard MDT groups (n = 155 per group) between May 2017 Hospital Pharmacy, RWTH Aachen University Hospital, Germany Introduction: This project aims to measure the effect of a clinical pharmacist on trans-sectoral adherence in terms of drug therapy safety and hospital readmissions. Methods: The study is conducted as a before/after comparison and will end in 12/2019 (clinicaltrials NCT03412903). In the ongoing control phase, the pharmacist only surveys the patient's medication history. In the following second phase, he will additionally ascertain the patient's adherence and carry out a thorough medication review. Finally, he will prepare a comprehensive paragraph in the discharge report discussing medication changes and persisting drug interactions. This shall provide the general practitioner (GP) with all necessary information aiming a broader acceptance of discharge medication. Apart from the main outcome-i.e. number of hospital readmissions and days spent at home within 6 months after discharge-the time to readmission, differences between pharmaceutical/medical medication history ascertainment and the acceptance of the supposed medication regime by the GP will be analysed. Preliminary results: 28 patients have been meanwhile included since 02/2018. In 10 cases the medication histories showed clinical relevant mistakes; three cases were inconclusive. The mean time spent at home was 16.8 days in the first month (n = 15, SD = 12.32) with four reported hospital readmissions. In 6 of 17 cases, drug therapy recommendations were not accepted by the GP. Clinical Relevance: First results of AGITATE show a relevant information loss regarding drug therapy at the interface of out-and inpatient care, which could potentially harm the patient. The first phase will serve as a comparison for the second phase, in which a clinical pharmacist provides counselling for both patients and medical professionals. The effect of this service on all outcomes will be evaluated. O-36 Fifty percent reduction of falls and fractures among elderly in nursing homes Christian Molnár 1 1 Familjeläkarna SÄ BO Fall-related injuries is one of the most common causes of death and reduced life quality among elderly in Sweden. With the goal to halve the incidence of falls and fractures we developed a new way of organising the multiprofessional team around patients living in nursing-homes, together with the establishment of a small central organisation collecting data and presenting regular feed-back to the team. Two year follow-up data shows a stable decline of the number of falls and fractures by more than 50% in the units working according to the new method as opposed to units not yet having implemented it. These results implicate a persistent and somewhat surprisingly great effect of the importance of how we organise the multiprofessional team around the patient in preventing falls and fallrelated injuries. Area: Comorbidity and multimorbidity O-37 Influence of cognitive impairment on cardiac mortality after percutaneous coronary intervention in very elderly patients Tomoko Tomioka 1 , Kento Fukui 1 , Yoshitaka Ito 1 , Hiroki Shioiri 1 , Jiro Koyama 1 , Kanichi Inoue 1 1 Southmiyagi Medical Center, Miyagi, Japan Introduction: Percutaneous coronary intervention (PCI) for patients with ischemic heart disease is a favorable strategy to obtain risk reduction of cardiac mortality, even for very elderly patients. However, influence of cognitive impairment (CI) on the mortality after PCI hasn't been estimated, so that we estimated it herein targeting very elderly patients. Methods: We retrospectively examined 102 patients above 80 years old who were performed PCI from 2012 to 2014 at our facility. We categorized them into the CI group (less than 20 points by Mini-Mental State Examination and/or already diagnosed as CI by neurologists) and the non-CI group. We then evaluated the cardiac mortality during 1 year after PCI in both groups, and estimated the involvement of CI on the cardiac mortality by multivariate analysis adjusted for classical risk factors and CI. Furthermore, in the CI group, we estimated the prognostic factors including family structure on the cardiac mortality. Results: Among 102 patients, 42 were in the CI group. The cardiac mortality was 68 and 24% in the CI and the non-CI groups, respectively (OR 4.5, , P \ 0.05). In all subjects, CI was the independent predictor of the cardiac mortality with 12.9 of OR (95% CI 1.5-211.5, P \ 0.05). Additionally, in the CI group, patients, living only with a partner who was also suffering from CI, were independently predisposed to higher risk on cardiac death (P \ 0.05). Conclusions: These results suggest the CI significantly influence the cardiac mortality after PCI, and we should consider the patient's living surroundings including family structure. O-38 Repeated cerebrospinal fluid removal procedure in older patients with Idiopathic Normotensive Hydrocephalus ineligible for surgical treatment common in patients without OH (p = 0.02). At multivariate analysis, age (OR 1.03; p = 0.02), nitrates (OR 9.95; p = 0.04), alpha-blockers (OR 2.58; p = 0.05) and benzodiazepine (OR 2.41 ; p = 0.01) were predictors of OH; ACEi (OR 0.53; p = 0.01) showed a protective role. If analysis was stratified by age, ARB were predictive of OH in patients aged 80 or older (OR 13.72; p = 0.007) . Conclusions: OH is frequent in hypertensive patients. Age, nitrates, alpha-blockers and benzodiazepine are predictive of OH, whereas ACEi have a protective role. ARB are associated with a higher risk of OH in patients aged 80 or older. O-41 QT Dispersion in masked hypertention: an arrhythmogenic risk factor (G-MASH-QT) Introduction: Detection of blood pressure above normal limits with ambulatory blood pressure measurement (ABPM) when office measurements are normal is defined as masked hypertension (MH) 1 . QT dispersion (QTd) is defined as the difference between the longest QT interval and the shortest QT interval in 12-channel electrocardiography (ECG), and it increases the risk of arrhythmia 3 . Hypertension is known to cause QTd, but the relationship between MH and QTd was not previously examined. Our aim was to examine the relationship between MH and QTd. Methods: 74 normotensive patients were enrolled. MH was diagnosed by ABPM according to ESC13 guidelines. Patients with atrial fibrillation, branch block, ST segment changes, those using drugs that can affect QT, and patients with coronary artery disease were excluded. In the V1-V6 leads, the QT intervals were measured, the minimum-maximum values were determined and their difference was recorded in milliseconds. QTd was compared in patients with and without MH. Results: MH was detected in 30 (40%) patients with a mean age of 71.0 ± 5.9. QTd was significantly higher in the MH group than the normal group [52 (0-100) vs. 40 (0-80), respectively; p: 0.025]. Logistic regression analysis showed that MH was associated with QTd and increased the risk 3.4-fold (p: 0.017; OR: 3.4; %95 CI 1. 2-9.2) . Conclusions: In this study, an arrhythmogenic indicator QTd was found to be significantly higher in masked hypertension. QTd is related to life span, cardiac mortality, and cerebrovascular events. Therefore, the relationship between QTd and MH is very striking. ECG of all MH patients should be examined and it should be known that they are at risk for arrhythmia. Background: Hospital readmission risk is high in multimorbid patients aged C 75 years old. A condition of ''hospital-dependence'' may arise: patients get adapted to the hospital care and, once discharged, may experience quick health status decline, requiring readmission despite appropriate treatments. The clinical characteristics of this patient-category are still poorly investigated. Aim: To retrospectively describe the characteristics of 118 patients aged C 75 who were urgently admitted to Parma University-Hospital, the only hospital facility of the district, at least 4 times in 2015. Methods: For each patient and admission, data on multimorbidity (Cumulative Illness Rating Scale Comorbidity Score, CIRS-CS, and Severity Index, CIRS-SI), frailty (Rockwood Clinical Frailty Scale, RCFS), functional dependence, mobility, polypharmacy, caregiver, length of stay (LOS) and interval between consecutive admissions were extrapolated from clinical records. Mortality during the years 2015 and 2016 was assessed on the institutional database. Results: At the first admission, patients (72 F, age 83.7 ± 4.9) had a high burden of polypharmacy (median number of drugs 8.5, IQR 6-11) and multimorbidity (CIRS-CS 15.8 ± 4.1, CIRS-SI 2.9 ± 1.1). However, most (55.5%) were fit or pre-frail according to RCFS (score [1] [2] [3] [4] . At multivariate models, CIRS-SI was significantly correlated with LOS (b ± SE 2.32 ± 0.92, p = 0.01) and readmission interval (b ± SE -22.92 ± 9.84, p = 0.03). By the end of 2016, 66% of patients had died. Baseline frailty (RCFS [ 4) was the only significant predictor of mortality (RR 1.62, 95% CI 1.14-2.30, p = 0.007). Conclusions: At baseline, most patients with multiple readmissions had severe multimorbidity and polypharmacy, but exhibited an unexpectedly low prevalence of frailty/disability. When present, frailty represented the main risk factor for mortality. Longitudinal trajectories of multimorbidity in old age: The role of childhood circumstances, education, life-long work stress, and late-life social network Methods: Results from two separate antibiotic stewardship inter-Introduction: Knowledge of pharmacotherapy in older patients is essential for all doctors. It is described that this knowledge is often insufficient, but the level of this insufficiency is unclear. Aim: Gain insight into the current level of applied knowledge of pharmacotherapy and polypharmacy of residents and consultants. Secondarily, the trainability on the knowledge by an online course was studied. Methods: The applied knowledge of pharmacotherapy and polypharmacy of residents and consultants from different clinical specialties were assessed, using formative multiple choice assessments as part of an online course regarding frail older patients. Explanatory variables to predict the level of knowledge were studied. The effects of an online course were studied using repeated ANOVA. Results: 448 residents and 331 consultants were included in 2016-2017. They had a mean pre-test score in pharmacotherapy of 74% (SD 15.5) vs 72% (SD 15.2) and polypharmacy pre-test score of 75% (SD 14.3) and 74% (SD 16.5) , respectively (p = 0.01). Surgical specialties had lower pre-test scores compared to those with a medical specialty (p \ 0.001). There were no predicting variables for higher scores. With the course as intervention, an increase in scores of both groups (within groups, p \ 0.001) was obtained with a betweengroup difference between surgical and medical specialty (p = \ 0.001). Clinical specialty appeared to influence the increase of knowledge of pharmacotherapy (p = 0.006). Conclusions: Differences in basic applied knowledge of pharmacotherapy and polypharmacy were seen between clinical specialties, with surgical specialities having a slightly lower level. No differences were found between residents and consultants. An online course can increase the level of knowledge in both medical and surgical specialties. structured interviews, small group educational sessions and transfer of knowledge for example by explicitly discussing clinical uncertainty in clinical case conferences. Results: Recognition of clinical uncertainty is the first step: labelling the vague, unpleasant feeling as such. Some residents link that feeling to personal functioning, others to the complexity of the patient. Everyone recognises uncertainty as a source of distress. To enhance coping discussions with fellow residents, in broader discussion groups and one-on-one, are helpful. Explicitly labelling the aspect of clinical uncertainty in discussions with faculty provides space for reflection and diminishes a feeling of loneliness in complex situations. Conclusions: With simple interventions we aim to improve coping of residents with clinical uncertainty to ultimately improve wellbeing of residents and quality of care for patients. O-53 How to organize a geriatric curriculum during financial crisis? Geriatric training from scratch and hypnotics. This could potentially improve quality of care by keeping residents in their environment and their awareness. Validity of sensor-based, habitual physical activity and gait analysis in older persons with cognitive impairment after discharge from geriatric rehabilitation Introduction: Complex drug regimens and inappropriate prescriptions are frequent in nursing home (NH) residents and are associated to negative health-related outcomes. Deprescribing may reduce polypharmacy, limiting the use of potentially inappropriate medications and buffering their negative consequences. The present study investigates the predictors of deprescribing among NH resident on polypharmacy (5 + drugs) . Methods: Longitudinal multi-centre cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Participants were assessed through the interRAI-LTCF tool. One-year trajectories of deprescribing where detected through linear mixed models and predictor of deprescribing via multivariate logistic regressions. Results: Among 2095 participants on polypharmacy (age 84 years; 74% women), 1142 (55%) presented a deprescribing pattern over 1 year. In fully adjusted analyses, deprescribing was positively associated with cognitive decline (severe vs. none-mild OR 1.75; 95% , and with the presence of a geriatrician in the facility (OR 1.31; 95% CI 1.07-1.61). A negative association was detected with age, cancer, dyspnea and severe dependency (P \ 0.05 for all). An interaction between age and the presence of a geriatrician was detected. Conclusions: Cognitive impairment and the availability of a geriatrician in the facility is associated with deprescribing in NH residents on polypharmacy. However, several clinical characteristics hinder this outcome. Further studies investigating predictors and outcomes of deprescribing in frail older adults are warranted. Predictive ability of physical and cognitive deficits in the Kihon Checklist for incident dependency and mortality in Japanese community-dwellers Shosuke Satake 1 , Hiroshi Shimokata 2 , Kazuyoshi Senda 1 , Hidenori Arai 1 , Kenji Toba 1 1 National Center for Geriatrics and Gerontology, Obu, Japan, 2 Institute of Health and Nutrition, Nagoya University of Arts and Science, Nisshin, Japan Introduction: The Kihon Checklist (KCL) is a self-administered questionnaire for older adults to assess their multiple functions in their daily livings. In this study, we examined predictive abilities of deficits in physical and cognitive domains of the KCL for independency and survival during 3 years. Method: Of all senior residents in the Higashiura town, the municipal government identified independent older residents who were uncertified by the long-term care insurance (LTCI). We sent the KCL to the residents and asked them to send it back to us after answering all questions. We finally selected older residents who filled in all questions of the KCL as the eligible subject. Baseline characteristics and the data on KCL of the subjects were registered. Information about an incident LTCI certification and death in 3 years was given by the municipal government. Results: We classified the subjects into 4 groups based on the deficits in physical and cognitive domains of the KCL (no deficit [ND] ; n = 3286, only cognitive deficit [CD] ; n = 1413, only physical deficit [PD] ; n = 387, and both deficits [BD] ; n = 456). Compared with ND, the Cox proportional hazard model adjusted for age and sex indicated that CD, PD and BD significantly predicted the risk of dependency, with the hazard ratios (HRs) of 1.633, 2.470, and 3.642 , respectively. On the other hand, the mortality could be significantly predicted in the BD with a HR of 2.764. Conclusion: Both physical and cognitive deficits in the KCL showed a significant predictive ability of the incident dependency and mortality. Effect of cumulative exposure to medications with anticholinergic and sedative properties on dynamic gait characteristic in geriatric patients with the Drug Burden Index (DBI) [3] , (DBI = 0; 0 [ DBI \ 1; DBI C 1). Multivariate analyses with functional components as the dependent variables and the DBI as the independent variable were conducted. Analyses were adjusted for comorbidities, cognitive status, Timed Up and Go, Geriatric Depression Scale and frailty as covariates. Results: Five functional components were extracted representing, 'Regularity', 'Pace', 'Synchronization', 'Stability', and 'Variability'. The DBI was associated with 'Pace' (F(2,181) = 4.07, p = 0.019). When controlling for covariates, the DBI effect (F(2,179) = 3.9, p = 0.021) remained significant. Conclusion: The use of anticholinergic and sedative drugs, in addition to co-morbidities and frailty, significantly affect gait dynamics (pace). A limitation of the DBI is that it does not take into account the effects of other drugs and their interactions. The DBI is a valuable tool for identifying and deprescribing potentially inappropriate medications and could be included in comprehensive geriatric assessment. Background: There is an established cross-sectional association between orthostatic hypotension (OH) and late life depression. The aim of this observational longitudinal study was to clarify the longitudinal association between baseline symptomatic OH (sOH) and incident depression in a sample of over 3000 people aged C 50 years. Methods: This study was embedded within the Irish Longitudinal Study on Ageing, and data was analysed from Waves 1, 2 and 3. Participants with baseline depression at Wave 1 were excluded. At 2 and 4 year follow-up, a score C 9 on the 8-item Centre for Epidemiological Studies Depression Scale was used to define incident depression. SOH was defined as a drop in systolic blood pressure (BP) by C 20 mmHg or diastolic BP by C 10 mmHg at 30 s post standing in conjunction with orthostatic symptoms such as dizziness, using beat-to-beat BP measurements. Results: 7% (226/3174) of the study sample had sOH-30. One tenth (300/3174) had incident depression by 4-year follow-up. Participants with incident depression were almost twice as likely to have sOH at baseline compared to those without incident depression (Linear regression: 0.13 (95% CI: 0.08-0.19) vs. 0.07 (95% CI: 0.06-0.08)). Weighted logistic regression models demonstrated that sOH predicted incident depression with an odds ratio of 1.94 (95% CI: 1.18-3.19) after controlling for covariates including subthreshold depressive symptoms. Asymptomatic OH did not predict incident depression. Conclusion: This study demonstrates that sOH predicts incident depression in a population-representative sample of older people and may therefore represent a potentially modifiable risk factor for late life depression. the process. Analysis revealed six themes influencing the patient's experiences of participation: (1) The complexity of the elderly patient's state of health, (2) Management and hospital routines, (3) The norm and preferences for returning home, (4) The challenges of communication, (5) The asymmetric relationship between health personnel and the patient, (6) The significance of a care network. Conclusions: The results demonstrate that there is a gap between published health policy regarding elderly patients' participation and the professionals' opportunities to fulfil this policy in clinical work. To promote elderly patients' experience of participation in discharge processes, effective approaches that facilitate participating are needed. Is the term 'Care of the Elderly' (CoE) pejorative, outdated and needs to be replaced? A patient and staff survey in a district general hospital in United Kingdom on patient and public perception Introduction: The term ''Care of the Elderly'' is synonymous with medicine for the older people in National Health Services. Older people are sometime perceived in a positive light but negative perceptions predominate. This can have a significant negative impact on the quality of care elderly patients receive. Continuous service review, need for change with innovative ideas is therefore essential to deliver highest standard of care to our older population. Methods: Patient feedback suggested that term 'elderly' is derogatory. To obtain wider public and patient's understanding, a survey was conducted. Patient/staff were asked about their thoughts of term 'Care of the Elderly'. List of options to choose from initially was generated by multidisciplinary team. Department of Medicine for Older People-(DMOP)Department of Older Person Care-(DOPC)Department of Care of Whole Person-(DCWP) Department of Ageing and Health-(DOAH) Senior Adult Medical Service-(SAMS) Acute Medicine for Mature Adults-(AMMA)Geriatric Medicine-(GM) Results: Total 183 respondents, 42% patients/relatives, 58% staff72% respondents suggested change. 36% of change group were patient/ relatives. 93% chose a name from available options. 7% suggested other names. 31% respondents in change group also said the term 'care of the elderly' was discriminatory, derogatory or outdated and it inferred frailty when many older people don't feel elderly. 59% change group proposed Senior Adult Medical Service-SAMS. Conclusion: Survey suggested strong reservations about the term 'Care of the Elderly' and therefore a need to change and rebrand our services to older population within National Health Services. Background: Intersectoral health tries to bridge the medical and nonmedical approaches to wellbeing. Social prescribing is a means for a health professional to refer to a link worker who can encourage or signpost a patient to sources of practical and emotional support. These supports are often community based, and provided by the voluntary sector. Examples could be dance classes, social outings, and debt or counselling services. An up-to-date, easily accessible database is vital for such signposting. Methods: We engaged school students, volunteers and work experience programmes to conduct an on-street census of every business, service and amenity in our hospital catchment area. These data were organised and made available in an online web portal of services that can be used to generate a personalised social prescription. Results: 700 kms of streets were mapped (population 198,000) . 6084 individual assets were recorded. Of these, 463 were health-related, 302 were sport and fitness related, and 323 were community supports. These assets were made available at an online portal to generate social prescriptions. The mapping exercise resulted in new links between the hospital and local schools, colleges, and community centres. Conclusion: There is a wealth of assets in the community that can be ultilised to supplement the traditional medical approach to health with a social prescription that addresses the social, emotional, or practical needs of patients. Measuring the impact of communicative robots on older people in care facilities: do age, gender and stage of dementia matter? Kazuko Obayashi 1 , Naonori Kodate 2 , Shigeru Masuyama 3 1 Social Welfare Corporation Tokyo Seishin-kai, Tokyo, Japan, 2 School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland, 3 Tokyo Medical University, Tokyo, Japan The effectiveness of using socially assistive technologies in care settings has not been sufficiently assessed, despite much discussion on the inevitability of their use. The purpose of this paper is to examine how age, gender and stage of dementia can affect the effectiveness of using communicative robots in nursing facilities. The participants were 51 older people cared for in three nursing homes (43 females and 8 males; aged 86.6 ± 8.0 years) in Tokyo. The control group consisted of 14 females (aged 86.5 ± 6.3 years). Three types of communicative robots were assigned to the participants for eight successive weeks. Five goals for nursing care were selected for each participant prior to the allocation of a robot, and the changes were evaluated every day. Overall, the positive effects on residents' quality of life were observed [1] . We examined the correlations between age, gender and stage of dementia, and the degree of improvements. Statistical data were analyzed using software package R. The intervention group showed a greater improvement in its assigned goals than the control group. There was no difference between the genders. Concerning the stage of dementia, greater improvements were found in participants with moderate dementia (Stage IIb or more) than those with mild dementia (Stage IIa or lower). Communicative care robots have great potential for enhancing older people's capabilities, even among those with middle stage dementia. Reference: [1] Obayashi K, Kodate N, Masuyama S. Socially assistive robots and their potential in enhancing older people's activity and social participation. JAMDA, May 2018; 19 (5) , 462-463. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Concurrent validity of a mobile sensor-based gait analysis system on a smart walker in oder adults with gait impairments This abstract presents a step towards the development of a datacentric approach for addressing frailty in elderly populations living in smart-cities, as experimented within the City4Age Project [1] [2] . Datasets have been collected at six Pilot sites-in Athens, Birmingham, Lecce, Madrid, Montpellier and Singapore-through a mix of advanced unobtrusive technologies. An appropriate computational model [3] has been used for mapping such datasets to relevant frailtyrelated domains, used in geriatrics (such as in the Lawton IADL scale or Fried Frailty Index). Analysis of the experimental results allowed to derive preliminary insights into the effectiveness of technologybased data collection-e.g. in terms of relative accuracy, data interdependency, etc. This is important to support smart-cities' digital policies for the deployment of age friendly environments [4] . Moreover, ground truth data has been collected at the Athens and Birmingham Pilot sites, using the Functional Ability Index [5] , to label datasets with a relevant frailty status. This allowed to investigate the application of supervised machine learning algorithms for the automatic detection of early frailty onset. A preliminary proof-ofconcept demonstrated the feasibility of this approach, to support costeffective screening of the elderly population. Finally, digital communication technologies (e.g. smartphone-based messaging apps, such as WhatsApp) have been tested at the Lecce Pilot, in order to ''coach'' elderly participants and nudge them towards healthier behaviour through an appropriate mix of messages, conveying educational material (e.g. on nutrition, physical activity, etc.), information about local socializing or cultural events, or data about own performance along various domains. Robotic balance evaluation with hunova in older people: correlation with Short Physical Performance Battery (SPPB) standing dynamic conditions (SA: p = 0.01; OAP: p = 0.04; OML: descriptions were registered and clearly taken into account in ED Methods: data derived from ATHENA, a retrospective observational study, which included elderly patients (C 65 years) admitted for AHF to the Emergency department (ED) of a tertiary University teachinghospital and transferred to this settings of care in the period 01.12.2014-01.12.2015 . Results: 401 patients were enlisted; 15% from cardiology, 15% from geriatrics and 70% from internal medicine. Mean age was 83.5 years, resulting higher in geriatrics (86.9 years) versus internal medicine (83.4 years) and cardiology (81.0 years), P = 0.001. Females were 52.6% without statistically significant differences between the three settings. Patients with HFpEF were 47.4%: 36.8% from cardiology, 55.1% from geriatrics and 44.8% from internal medicine, P = 0.147. In-hospital mortality was 8.9% and it was higher in geriatrics (18.6%) compared to cardiology (14.8%) and internal medicine (5.7%), (P = 0.002). Independent predictors of in-hospital mortality were related with Barthel index (OR 0.98, 95% CI 0.97-1.00, p = 0.028), systolic blood pressure in ED (OR 0.96, CI = 0.93-0.99, p = 0.014), cognitive impairment (OR 5.33, p = 0.031) Effect of systemic intensive care unit triage on long-term mortality among critically ill elderly patients in France: a randomized clinical trial Introduction: The high mortality rate in critically ill patients has led to questioning of the beneficial effect of intensive care unit (ICU) admission. The objective of this study was to determine whether a recommendation for systemic ICU admission in critically ill elderly patients reduces 6-month mortality compared with usual practice. Material: Multicenter, cluster-randomized clinical trial of critically ill patients (age C 75 years), free of cancer, with preserved functional status and nutritional status, was performed. Centers were randomly assigned either to use a program to promote systematic ICU admission of patients (n = 1519 participants) or to follow standard practice (n = 1518 participants). The primary outcome was death at 6 months. Secondary outcomes included ICU admission rate, in-hospital death, functional status, and quality of life at 6 months. Results: 3036 patients were included in the trial (median age, 85 years). Patients in the systematic strategy group had an increased risk of death at 6 months (45%vs 39%; relative risk [RR], 1.16; 95% CI, 1.07-1.26) despite an increased ICU admission rate (61% vs 34%; RR, 1.80; 95% CI, 1.66-1.95). After adjustments, patients in the systematic strategy group were more likely to be admitted to an ICU (RR, 1.68; 95% CI, 1.54-1.82) and had a higher risk of in-hospital death (RR, 1.18; 95% CI, 1.03-1.33) but had no significant increase in risk of death at 6 months (RR, 1.05; 95% CI, 0.96-1.14). Functional status and physical quality of life at 6 months were not significantly different between groups. Background: Quick Sequential Organ Failure Assessment (qSOFA) is recommended for acute sepsis management. Altered mental state, respiratory rate C 22/min, and systolic blood pressure B 100 mmHg give one point each, and qSOFA C 2 is associated with poor outcome. With the aim to improve cognitive assessment in the Emergency Room (ER), we used 4AT (rapid screening of alertness, cognition, attention and fluctuation of symptoms) in addition to qSOFA. 4AT C 4 indicates delirium or cognitive impairment, and a 4AT of 1-3 might indicate cognitive impairment. Methods: From October 23rd 2017 to May 14th 2018, patients aged C 65 years with suspected infections admitted to a local Norwegian hospital were screened by ER nurses with qSOFA and 4AT. Time spent on 4AT was reported. Delirium diagnoses and in-hospital mortality were retrieved from patient records. Results: 4AT-and qSOFA-scores were available for 111 patients (mean age 81, range 65-98). Median time spent on the assessment with 4AT was two Minutes (mean 2.6). Among 39 patients with a qSOFA-point given for altered mental state, 4AT revealed signs of cognitive impairment in 37 (95%). 4AT revealed signs of cognitive impairment in 26 out of 72 patients (36%) where qSOFA did not reveal altered mental state. In total, 29 patients (26%) had delirium during the hospital stay. The overall in-hospital mortality was 4.5%. Conclusions: 4AT is a rapid assessment of cognitive impairment feasible for use in the ER. 4AT improved the assessment of cognitive impairment in patients aged C 65 years with suspected infection. We found a high prevalence of delirium. Area: Cognition and dementia O-82 Association between blood pressure variability and findings on magnetic resonance imaging in memory clinic patients LM van den Ingh 1 , RAA de Heus 2 , AL Meendering 3 , JAHR Claassen 2 1 Radboudumc, department of Geriatric Medicine, Nijmegen, The Netherlands, 2 Radboudumc, department of Geriatric Medicine, Nijmegen, The Netherlands. Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands, 3 Radboudumc, department of Geriatric Medicine, Nijmegen, The Netherlands Introduction: Emerging evidence suggests a role for high blood pressure variability (BPV) in the association between blood pressure (BP) and cognition, but the pathophysiological mechanisms remain unclear. The aim of this study was to investigate the association of day-to-day BPV with white matter hyperintensities (WMH) and cerebral atrophy on magnetic resonance imaging (MRI). Methods: In this cross-sectional study, data from 93 memory clinic patients were analyzed. BP was measured twice in the morning and evening for 1 week. BPV was expressed as coefficient of variation (COV). WMH were assessed with the Fazekas scale (0-3). Additionally, the global cortical atrophy (GCA) and medial temporal lobe atrophy (MTA) were scored. ANCOVA was conducted to investigate BPV in different groups of Fazekas, GCA or MTA, corrected for age and mean BP. As a second step, smoking status, diabetes, use of antihypertensives, medical history of hypertension and hypercholesterolemia were added in the analysis. Results: Higher Fazekas score was significantly related to BPV (COV of systolic BP), controlling for age, F(3,77) = 3.176, p = 0.029. Controlling for mean systolic BP reduced the statistical significance of this association, F(3,76) = 2.640, p = 0.056. Planned contrasts showed higher COV of systolic BP for Fazekas 1, 2 or 3 compared to Fazekas 0 (p = 0.047, 0.010 and 0.019, respectively). Secondary analysis showed that smoking status and hypercholesterolemia significantly influenced the correlation between COV and Fazekas (p = 0.040 and 0.036, respectively). No significant associations were present for GCA and MTA with BPV. Conclusion: These results suggest an association between BPV and WMH, but not with other markers of neurodegeneration. More research is recommended to further explore this association. Efficacy of hearing aids on the cognitive status of patients with Alzheimer's disease and hearing loss: a multicenter controlled randomized trial Introduction: This study evaluated the cognitive benefit of hearing aids (HA) in older patients with Alzheimer'sdisease (AD) and hearing loss (HL) after a 6-and 12-month period of utilization. Methods: A multicenter double-blind randomized placebo-controlled trial was conducted in patients aged more than 65 years. A group was equipped with active HA for 6 months (active group) and a second group had placebo HA for 6 months (placebo group) followed by a secondary activation phase for a further 6 months (semi crossover procedure). Both groups were retested after a 12-month period. The primary endpoint was the change from baseline of the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS Cog) after a 6-month period in both groups and after 6 months of secondary HA activation in the placebo group. A smaller cognitive decline should be obtained with HA use; an increase in ADAS Cog score of less than 6 points was defined a success. Results: Fifty-one patients aged 68 to 99 years were included; 38 attended the 6-month visit: 18 in the active group and 20 in the placebo group. At 6 months, 14 (82.4%) successes were noticed in the active group, and 15 (88.2%) in the placebo group (p = 1.0); delta ADAS Cog in the active group was 1.8 ± 5.3 and 1.3 ± 5.3 in the placebo group (p = 0.8). In the placebo group, after the secondary HA activation, no significant improvement was observed. Conclusion: No significant effect of HA use was observed after 6 months of follow-up in patients with AD and HL. Delirium and other complications during hospital stay related to femoral nerve block vs conventional pain management among patients with hip fracture: A randomised controlled trial Background: The aim of this study was to investigate whether Femoral Nerve Block (FNB) can reduce complications during hospital stay, with special focus on delirium, compared to conventional pain management with opioids among patients with hip fracture, including those with dementia. Patients and methods: In a prospective randomized controlled trial, 236 consecutive patients with hip fracture [ 70 years were assigned to preoperatively either receive FNB and opioids if required (intervention group, n = 116) or conventional pain management using opioids if required (control group, n = 120). The FNB was given as soon as possible after admission. Delirium was set according to DSM-IV-TR criteria based on Nursing Delirium Screening Scale, Mini Mental State Examination, Organic Brain Syndrome Scale and documentations in the medical records. Preliminary results: Most participants, 157 (66%), were women, mean age was 84 (± 6.7) years and 109 (46%) participants had dementia disorders. Forty-four patients (38.9%) developed delirium preoperatively in the intervention group compared with 59 (49.2%) patients in the control group (p = 0.116). Common postoperative complications were postoperative delirium, malnutrition, anaemia, constipation and urinary infection with no significant difference between the groups. A subgroup analysis among patients with dementia, intervention group had significantly less number of complications (6.1 ± 1.9 vs 6.8 ± 1.6, p = 0.038) compared with controls. Conclusion: Femoral nerve block is a safe and efficient pain management for patients with hip fracture but did not reduce the incidence of complications. However, patients with dementia that received FNB suffered less number of complications. Symptom profiles in Alzheimer's disease patients with and without cerebrovascular disease The relationship between peripheral inflammation and progression of Alzheimer's Disease Introduction: Neuroinflammation may play an important role in the pathogenesis of Alzheimer's disease (AD) . We wanted to examine if inflammatory activity at baseline could predict cognitive and functional decline among patients with amnestic mild cognitive impairment (MCI) and AD dementia after 2 years. Methods: Samples of serum were collected from 245 patients with aMCI and AD dementia at baseline, and analyzed for 14 inflammatory markers (interleukin (IL)-1b, -1ra, -6, -10, -12p40, -17a, -18, -22, -33, tumor necrosis factor (TNF), CD40 ligand, interferon (IFN)-c, CCL2 and -4) by bead-based multiplex immunoassay. All patients were followed up after approximately 2 years (18-36 months). Disease progression was measured by the annual increase in the Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) and annual decrease in the Mini-Mental State Examination (MMSE) test. Results: The CDR-SB score increased with a mean of 1.63 (1.83 SD) , the MMSE sum score decreased with a mean of 1.67 (2.44 SD) per year. The markers IL-1b, IL-10, IL-12p40, IL-17a, IL-22, IL-33 and IFN-c were below the lowest standard curve point in more than 50% of the patients and were excluded from further analysis. We did not find a significant association between increased levels of inflammatory markers and either CDR-SB or MMSE change, by using univariate and multiple regression analysis. Key conclusions: Increased levels of IL-1ra, IL-6, IL-18, CD40L, CCL2, CCL4, TNFa and CRP at baseline were not significantly associated with a faster cognitive decline measured by annual change in CDR-SB-and MMSE after two years of follow -up. A multi-level, mixed methods evaluation of Irish national dementia strategy implementation plan Background: Ireland's first National Dementia Strategy (NDS) was launched in 2014, aiming to meet the needs of people living with dementia in Ireland, now and in the future. This was followed by the €27.5 m National Dementia Strategy Implementation Plan (NDSIP), a joint initiative between the Irish Department of Health, Health Service Executive, and Atlantic Philanthropies to implement significant elements of the Irish NDS between 2014 and 2017. Aim: The aim of this research is to evaluate the multi-level impact and progress-to-date of the NDSIP. Methods: A mixed-methods approach was used. Perspectives of stakeholders on executive, strategic, and operational levels were explored through semi-structured focus groups, interviews, and online surveys. Stakeholders included people living with dementia, caregivers of people living with dementia, health and social care providers, not-for-profit organisations, representatives of government departments, and other stakeholders who were involved in the development, monitoring and implementation of both the NDS and NDSIP. Results/conclusions: Results are discussed in relation to the progress and multi-level impact of the NDSIP from the perspectives of all stakeholders. Comparisons are drawn between the experiences of people with dementia, caregivers, not-for-profit organisations, and health and social care service providers in 'resource intensive' and 'resource-limited' regions in Ireland. Cognitive decline and survival in Parkinson's disease dementia and dementia with Lewy bodies: longitudinal data from the Swedish dementia registry Background: It is not yet fully understood whether dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) are distinct disorders or two subtypes of the same entity. There is a gap of knowledge on differences in longitudinal clinical outcomes between DLB and PDD. Objective: In DLB and PDD patients compare the longitudinal trend of cognitive decline and mortality. Methods: 1110 DLB and 764 PDD patients who were registered in the Swedish dementia registry (SveDem, http://www.svedem.se) at the time of diagnosis during 2007-2015 were included. Cognitive status using mini-mental state examination (MMSE) was assessed at baseline and each follow-up visit. The rate of cognitive decline and mortality risk were compared between the two groups. Results: The rate of cognitive decline did not differ between DLB (1.1 MMSE units/year) and PDD (1.2 MMSE units/year) groups after 2-years follow-up. Antipsychotic drug use in DLB and higher comorbidity burden in PDD were the most important determinants of faster annual cognitive decline. There was no significant difference in the median survival time between DLB (4.0 years) and PDD (4.1 years) groups. Conclusion: There were no differences between the rate of cognitive decline and mortality between DLB and PDD in clinical routine settings at least over 2 years suggesting that DLB and PDD may be similar disorders with different phenotypes. However, comorbidity burden and antipsychotic use influence the rate of cognitive decline. Development of the highly reproducible standardized evaluation system for dementia care by thinking model of artificial intelligence Yuki Sasaki 1 , Shogo Ishikawa 1 , Shinya Kiriyama 1 , Yves Gineste 2 , Miwako Honda 3 1 Shizuoka University, Shizuoka, Japan, 2 Kyoto University, Kyoto, Japan, 3 National Hospital Organization Tokyo Medical Center, Tokyo, Japan Background: As population of dementia increase, need of educations for caregivers became crucial. A French multimodal care methodology, Humanitude, has shown improvement of Behavioral Psychological Symptoms of Dementia, reduction of incidence of delirium in elder patients, and reduction of the burden of caregivers. Since traditional on-site training has limitation to numbers of trainees, effective standardized mass training is needed to educate highly skilled healthcare professionals. Methods: A multiple-thinking-model based on the concept of Marvin Minsky was developed for interaction between people with dementia and their caregivers. The video analysis system, consisted of hierarchical evaluations about 9 basic elements of Humanitude, was created with the thinking model of artificial intelligence. The videos which contain 5 min oral care by healthcare professionals were used for the evaluation. The certified trainers of Humanitude watched the videos and made hierarchical and narrative evaluation based on the multiplethinking-model. They independently watched the videos and gave 3-grade evaluation of 9 elements of Humanitude and narrative 6-grade evaluation of the multiple-thinking-model. There was no interaction among trainers during the evaluation. Results: 6 certified trainers of Humanitude enrolled the study. In 3-grade evaluation, the kappa statistic was 0.711. The narrative evaluation with Minsky's 6-grade thinking model showed the significant correlation among the trainers. Conclusion: Video analysis of care by artificial intelligence thinking model is highly reproducible and standardized for the trainers to teach. Since video based remote training can reduce time-cost and financial-cost of training, this evaluation system for dementia care contributes to mass training. Sub-typing of dementia after TIA and stroke: comparison of clinical diagnostic criteria for vascular dementia in a longitudinal population-based study Introduction: Sub-typing of post-TIA/stroke dementia may be aided by application of vascular dementia (VD) diagnostic criteria. We examined rates of VD obtained using the well-established NINDS-AIREN criteria versus the recently developed VASCOG criteria in a population-based study of TIA/stroke. Methods: In a longitudinal study of all TIA/stroke occurring within a defined population of 92,728 (Oxford Vascular Study/2002 -2012 baseline clinical assessment and CT/MR brain imaging were performed with follow-up to 5 years. Multiple overlapping methods including face-to-face interview were used to ascertain dementia. VASCOG and NINDS-AIREN criteria were applied in patients with dementia and agreement assessed with kappa statistic. Results: Among 2305 TIA/stroke patients (mean/SD age 73.7/13.0), 432 (18.7%) had dementia during follow-up. Using VASCOG criteria, 194 (44.9%) patients fulfilled criteria for probable VD versus 90 (20.8%) using NINDS-AIREN criteria. Rates of possible VD varied even more widely at 21 (4.9%) by VASCOG criteria vs 293 (67.8%) by NINDS-AIREN. Many patients did not fulfil criteria because of failure to meet imaging requirements (n = 123/51.6%-VASCOG and n = 175/54.3%-NINDS-AIREN), followed by no history/signs of stroke (n = 84/35.3%-VASCOG) or lack of a temporal relationship between cerebrovascular disease and dementia (n = 274/85.1%-NINDS-AIREN). Agreement between NINDS-AIREN and VASCOG for the diagnosis of probable/possible VD was low at 36.6% (kappa 0.22, p \ 0.001), but increased to 75.0% for the diagnosis of probable VD (kappa 0.47, p \ 0.001). Conclusion: The proportion of post-TIA/stroke dementia cases classified as VD differs depending on the applied diagnostic criteria. A history of TIA (rather than stroke) and strict imaging requirements are key reasons for failing to meet criteria for VD diagnosis. Area: Delirium O-91 Anticholinergic drug burden and delirium: a systematic review Angelique Egberts 1 , Rafael Moreno-Gonzalez 2 , Gijsbertus Ziere 3 , Francesco Mattace- Raso 3 However, in all studies using the ARS, an association was found between anticholinergic drug burden and delirium. Is there a role for vitamin D in preventing delirium? Evidence from mendelian randomization Kirsty Bowman 1 , David Melzer 2 1 University of Exeter Medical School, 2 University of Exeter Medical School UK, University of Connecticut Health Center USA Introduction: Delirium is associated with increased mortality risks, admittance to nursing homes and high health care costs. Many delirium episodes may be preventable. There has been increased interest in the role of vitamin D in cognitive impairment. A recent analysis showed that genetically determined higher levels of vitamin D were associated with reduced risks for Alzheimer's disease. Evidence is limited for the role of vitamin D with delirium using large community-based studies. Methods: We used 313,121 European participants from the UK Biobank, a healthy volunteer cohort, who were aged 60 years by the end of the follow-up. We used a Mendelian randomization approach to minimize confounding and reverse causation. We tested the associations between individual vitamin D altering variants and a vitamin D genetic risk score with incident hospital delirium episodes during B 9.9 years of follow-up. Results: The mean age of the participants was 61.7 years (s.d. 4.7 years), 544 subjects had a delirium episode. We found genetically determined higher levels of vitamin D were associated with a reduced risk of incident delirium (Hazard Ratio 0.74 [95% CI 0.62, 0.87] per 10 nmol/L increase in genetically instrumented vitamin D), with a dose-response across the variants. Results were little altered after adjusting for time spent outdoors or a calcium genetic risk score. Key conclusions: We found that those with vitamin D increasing genetic variants have a reduced risk of delirium, providing evidence of causality. Our results may pave the way for trials on increasing low vitamin D levels to potentially preventing delirium. Our evidence base for delirium: is there age discrimination? Desmond O'Neill 1 , Sean Kennelly 2 , Emmet Jordan 2 1 Tallaght University Hospital, Dublin, Ireland, 2 Tallaght University Hospital, Dublin, Ireland Introduction: Delirium among hospital inpatients is highly prevalent and is associated with a variety of adverse outcomes. One of the strongest risk factors for developing delirium is advanced age. Age bias has been identified in a number of studies of conditions related to geriatric medicine-whether it is present in trials examining delirium is currently unknown. This study aims to systematically review the literature and identify the extent to which ageism is present in delirium studies. Methods: All randomised control trials (RCT) in systematic reviews with 'delirium' in their title on the Cochrane Database were assessed. Patient gender and exclusion criteria were also recorded. These were compared to prevalence studies of delirium and assessed for discrepancies. Results: 45 RCTs were identified, 38 of which were eligible for inclusion, comprising 16,276 participants. The mean age of patients was 71.7 years, at least 6 years younger than the mean age of patients developing delirium in hospitals internationally. In addition to this, 16 trials (42.1%) excluded patients based on pre-existing cognitive impairment and 2 trials excluded based on advanced age. Key conclusions: This study identifies a clear difference between patients included in delirium studies and patients experiencing delirium in clinical practice. This is particularly troubling as the difference lies in patient age and cognitive impairment-two of the strongest predictors for developing hospital delirium. To ensure evidence based practice, future trials must include a larger sample of our older population, and include patients with cognitive impairment. Delirium assessment in dementia patients: relationship with anticholinergic burden Introduction: Delirium is a frequent clinical complication in elderly people. The objective of this study was to evaluate the prevalance of delirium and its relationship with anticholinergic burden in patients with dementia admitted in LTC facilities. Methods: A prospective observational study was performed in seven ANASTE LTC facilities over a 2-month period. The screening for delirium was performed by the Confusion Assessment Method (CAM) and by the Delirium Rating scale (DRS). Diagnosis of delirium was performed according to DSMV criteria. The anticholinergic burden was evaluated according to score of the Anticholinergic Burden Scale (ACB). We used MMSE to evaluate the cognitive impairment and Neuropsichiatric Inventory to evaluate the behavioural problems. Hypokalemia (K \ 3.5 mEq/l) and hypernatremia (NA [ 145 mEq/l) were also assessed. Statistical analysis was performed using Fisher Test and Odds Ratio (OR) with related confidence interval (C.I.) at 95% estimated for the primary endpoint. Results: We have enrolled 268 patients (61.1% F, mean age 83.3 ± 8.9; 31.3% M, mean age 81.3 ± 8.8) of these 68% suffer from dementia. In dementia patients the prevalance of delirium was 43.7%. We found a positive correlation between delirium and anticholinergic burden (OR: 2.566; C.I. 1.5, 4.3; p \ 0.005), severe cognitive impairment (OR:2.75; C.I. 1.57, 4.81 ; p \ 0.005), NPI item for Delusions (OR: 5.42; C.I. 3.08, 9.5) and hypernatremia (OR:1.47; C.I. 0.84, 2.59). Among ACB1drugs, Furosemide, Alprazolam, Digital Trazodone, Risperidone were often prescribed. Among ACB 2-3 drugs, promazine quetiapine and olanzapine were the most prescribed. Finally, the CAM had a sensibility of 89% and specifity of 96% and DRS 56 and 82% respectively to detect delirium in dementia patients. Conclusion: There is a close correlation between anticholinergic burden and delirium in people with dementia, recognize this causal link can improve the management of delirium. Introduction: Reliable epidemiologic studies in delirium are required to inform service development but the majority of existing data are from selective cohorts focussed on incident delirium. We therefore determined rates of prevalent versus incident delirium in all consecutive admissions to acute (internal) medicine. Methods: Admissions to our acute medical team during 2 month blocks over five periods (2010, 2012, 2015, 2016, 2017) were screened on admission with a short cognitive test and the confusion assessment method (CAM) and at least every 48 h thereafter. Delirium was diagnosed using DSM-IV criteria and defined as prevalent (present within 48 h of admission) or incident (occurring at least 48 h after admission). Results: Among 1463 patients (mean age = 69.4/19.6 years, 689 (47%) male, 212 (14.5%) with a known dementia diagnosis), delirium occurred in 350 (23.9%) overall but was strongly related to age ranging from 32/484 (6.6%) at \ 65 years, to 44/228 (19%) at 65-74 years and 274/746 (36.6%) at C 75 years, ptrend \ 0.001. Prevalent delirium occurred in 239/350 (68%), incident delirium in 64 (18%) and 47 (13%) had both prevalent and incident delirium. Patients with delirium had more dementia (102/350 (29%) vs 75/1113 (6.7%), p \ 0.0001) but were as likely to be living at home as nondelirious patients (274/350 (78%) vs 820/1113 (74%). Conclusions: Most delirium occurs in non-institutionalised patients without a known dementia diagnosis and is much more likely to be present on admission than to occur during admission. Delirium screening should therefore be routine at first assessment of (older) patients presenting to acute medicine. Area: Geriatrics in organ disease O-97 Clinical examination of peripheral arterial disease and ankle: brachial index in a nation-wide cohort of older subjects. Practical implications Introduction: Prevalence of peripheral arterial disease increases with age and is related to increased morbidity and mortality, especially in older adults. The clinical diagnosis includes the measurement of ankle-brachial index (ABI). We aimed to check the prevalence of abnormal ABI, and the value of physical examination of arterial system in detection of ABI \ 0.9. Methods: We performed subgroup analysis of patients included in the PolSenior survey in whom we measured ABI, performed detailed physical examination of arterial system, and assessed laboratory and questionnaire factors related to atherosclerosis. Patients were divided according to ABI strata of \ 0.9, 0.9-1.4 and [ 1.4 and summary clinical score of abnormalities on physical examination was proposed. Using logistic regression we obtained areas under the curve (AUC). Results: The mean (SD) age of 860 participants (53.5% men) was 74.7 (10.6) years. ABI \ 0.9 was found in 19.9% participants and it was linked to higher overall cardiovascular risk. In the \ 0.9 ABI group 62.7% group vs. 73.9% in normal ABI group, and 75.7% in ABI [ 1.4 (p = 0 .02) could walk more than 200 meters. Higher clinical score was associated with lower ABI. Full physical examination (AUC = 0.67) followed by examination of lower extremities (AUC = 0.65) showed strongest diagnostic value for presence of ABI based PAD (nie rozumiem!). Neither ABI nor clinical examination were good predictors of inability to walk over 200 meters. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Key conclusions: Full clinical examination, although moderately, may add to detection of PAD. The ability to walk 200 meters is not a good measure of PAD in older subjects. Pre-transplant polypharmacy: an alert associated with a higher risk of hospitalizations after kidney transplantation in older recipients Background: Age is no longer a limit to kidney transplantation (KT) access for patients with end stage renal disease, but recipients older age and frailty are associated with poor outcome after KT, especially hospitalizations for complications. Pre-KT comorbidity, polypharmacy and sarcopenia could be contributors to frailty. Our objective was to identify factors associated with a higher number of days of hospitalizations during the first year post-KT. Methods: Recipients older than 70 years who underwent KT between 2009 and 2016 in our center were included in this retrospective study. The burden of complications was assessed by the number of days of hospitalization during the first year post-KT. We tested pre-KT comorbidities, polypharmacy and sarcopenia, as well as KT characteristics, as potential factors associated with post-KT complications. Muscle mass was assessed by measuring the L4 psoas area on abdominal computed tomography. Results: A hundred and thirteen patients were included. Median age was 74 ± 3 (70-85). Median number of days of hospitalization during the first year post-KT was 32 ± 25 . Pre-KT polypharmacy [ 5 and 10 drugs was the only factor associated with a number of days of hospitalization higher than the median (OR = 3.7, 95% CI = 1.2-14.3 and 8.3, 95% CI 2.3-36.7, respectively), even after adjusting for age and Charlson comorbidity index in a multivariate analysis. Low muscle mass was not associated with an increased risk of hospitalization. Conclusion: in older KT recipients, pre-transplant polypharmacy is associated with post-transplant complications and hospitalizations, independently of comorbidity. Pre-KT geriatric interventions should be implemented to reduce polypharmacy. Age is an individual risk factor for not being referred to adjuvant chemotherapy in resected UICC III colorectal cancer patients: a nation wide cohort study Introduction: International guidelines recommend that resected stage III colorectal cancer (CRC) patients should be treated with adjuvant chemotherapy without age restriction. The aim of this study was to assess the association between age and referral to an oncologist for postoperative adjuvant chemotherapy for patients with stage III CRC. Methods: This was a nation wide cohort study with prospectively collected data. Study period was from 2014 to 2016. Data were provided by the Danish Colorectal Cancer Group Registry, which has a completeness of 99%. Univariate analysis was performed and significant factors were used in a multivariate logistic regression (comorbidity, performance status (PS)). Results: A total of 2791 patients with resected stage III CRC were included. In the fully adjusted model, patients [ 80 years of age had an increased risk (OR (95% CI)) of not being referred to an oncologist (10.85 (7.70-15.28 )) compared with patients \ 75 years of age. Other significant factors associated with no referral in the model included American Society of Anesthesiologists score (ASA), PS, postoperative complications, and geographic region. Conclusion: Patients [ 80 years have an increased risk of not receiving the recommended postoperative adjuvant chemotherapy. Comparison of tools for the identification of frail communitydwelling older people in primary care settings: frail, but according to which tool? Introduction: No consensus has been reached regarding which tools are the most adequate to identify frail patients in primary care (PC). We aimed to analyse the characteristics of community-dwelling frail individuals aged C 75 years as identified by four tools (Timed up and Go test -TUG, Short Physical Performance Battery -SPPB, Tilburg Frailty Indicator-TFI and Gérontopôle Frailty Screening Tool -GFST) in order to assess the performance of these tools when applied in PC. Methods: A prospective cohort study of 2 years of follow up was performed in two regions of Spain. The analysis reported here is based on baseline data, collected via face-to-face interviews. Multiple correspondence analysis (MCA) and cluster analysis were used to analyse groups of individuals. Cohens Kappa was calculated to measure the concordance. Results: 865 individuals were recruited, 53% women, with a mean age of 78 years. The tools yielded different prevalence rates of frailty: 38, 55, 29 and 31% for the TUG, SPBB, TFI and GFST, respectively. TUG and SPPB showed a moderate concordance (Cohens Kappa 0.49 (95% CI 0.44, 0.54)). Four clusters of participants emerged. Cluster 1 (N = 263) contained patients categorized as robust by most of the tools studied, whereas clusters 2 (N = 199), 3 (N = 183) and 4 (N = 220) grouped patients classified as frail by at least one of the tools. Significant differences were found between clusters. Key conclusions: frailty is highly prevalent. The studied tools identify different profiles of frail patients. TUG and SPPB constitute a sound approach for the identification of frailty in PC. Association between frailty tools and functional status in frailty and no frailty subjects (frailtools study): preliminary results Conclusion: According to the tool used, frailty subjects showed different SPPB scores, however in non-frailty subjects no many differences punctuation in SPPB were found. Socio-demographic and health characteristics associated with transitions between frailty states over three years in the MAPT study Methods: The PRIME study recruited 1280 older adults at hospital discharge from 5 hospitals in England between 2013 to 2015 [2] . MRH and associated healthcare use within 8-weeks post-discharge were identified by senior pharmacists using 1 hospital readmission data, 2 primary care records, 3 patient telephone interviews. Based on the Rockwood approach [3] , we developed a frailty index including 55 deficits from multiple domains (morbidity, cognition, mood, strength and mobility, nutrition, daily function). Frailty was defined using the established cut-off of 20% deficits [4] , and internally validated using Kaplan-Meier plots comparing survival in frail and nonfrail patients. We then used logistic regression analysis to investigate the relationship between frailty and MRH requiring healthcare. Area: Biogerontology and genetics O-104 Acute cytokine production upon stimulation with lipopolysaccharide associates with cardiovascular mortality risk independent of circulating markers of chronic inflammation Background: The risk of a cardiovascular event is transiently increased after infection, which suggests a role for the immune response in its pathogenesis. The aim of this study is to investigate whether acute cytokine production upon stimulation with lipopolysaccharide associates with cardiovascular, non-cardiovascular and all-cause mortality and whether this association is dependent on chronic inflammation. Methods: In 403 subjects from the PROspecitve Study of Pravastatin in the Elderly at Risk (PROSPER) trial, with a mean age of 75.1 years, we determined acute cytokine production at baseline by ex vivo stimulating whole-blood samples with lipopolysaccharide and measuring the production of interleukin (IL)-6, tumor necrosis factor (TNF)-a, IL-12, IL-1b, IL-10, and IL-1RA production within 24 h. A composite acute cytokine production score was calculated by averaging the individual acute cytokines production values after sexspecific standardisation. Serum IL-6 and high-sensitivity C-reactive protein (hs-CRP) were measured as circulating markers of chronic inflammation. Subjects were followed for 12.8 years and cardiovascular, non-cardiovascular and all-cause mortality was recorded. Results: A higher acute IL-6, TNF-a, IL-1b, and IL-1RA production was associated with a significantly higher cardiovascular and allcause mortality risk. The hazard ratio (95% confidence interval; P-value) per standard deviation increment in the acute cytokine production composite score was 1.89 (1.26-2.85 ; P = 0.002) for cardiovascular mortality risk and 1.39 (1.12-1.74 ; P = 0.003) for allcause mortality risk. Adjusting these relations for circulating markers of chronic inflammation did not change the results. Conclusion: A higher acute cytokine production associates positively with cardiovascular and all-cause mortality risk independent of chronic inflammation. Association of a regulatory anti-oxidant and drug-metabolising gene with multi-morbidity and adverse drug reactions in older adults Introduction: Multimorbidity and adverse drug reactions (ADR) are problems associated with ageing populations. Exploring underlying genetic predispositions might help to risk-stratify patients for early intervention. The nuclear factor erythroid 2-like 2 (Nrf2) protein regulates antioxidant and de-toxifying effectors in the cell. Nrf2 expression declines with age, potentially increasing vulnerability to multimorbidity and ADR. We hypothesise that single nucleotide polymorphisms (SNPs) at 3 loci in the Nrf2 gene are associated with multimorbidity and ADR in older adults. Methods: One-hundred and twenty-seven patients were recruited from a sub-population of the PRIME study (a multicentre prospective cohort study that followed older adults over 8-weeks post-discharge to determine ADR status). Donated genetic material was sequenced to determine genotype at 3 loci: rs6721961, rs35652124 and rs6706649 and then analysed for association with ADR (Naranjo Algorithm) and multimorbidity ([ 2 conditions defined by the Charlson Index (CI)). Results: One-hundred and twelve patients (mean age 76.6 ± 7.3 years, 55.4% female) were successfully genotyped. In patients aged 65-79, those with the rs35652124 A allele showed increased odds of having [ 2 co-morbidities (OR 9.03 95% CI 1.16-70.2, p = 0.0127). Individuals with the CGG haplotype in this age-group showed reduced odds of multimorbidity (OR 0.11, 95% CI 0.01-0.86, p = 0.001). No association between Nrf2 geno/haplotype and ADR was identified. Conclusions: Polymorphisms in the Nrf2 gene are associated with multimorbidity, but not ADR, in older adults. Telomere length according to age and sex in adults and in children Athanase Benetos 1 , Carlos Labat 2 , Simon Toupance 3 , Masayuki Kimura 4 , Sylvie Gautier 3 , Patrick Rossignol 3 , Abraham Aviv 4 1 CHRU Nancy, Vandoeuvre-lès-Nancy, France, 2 INSERM U1116 Nancy, Vandoeuvre-lès-Nancy, France, 3 CHRU de Nancy, Vandoeuvre-lès-Nancy, France, 4 Rutgers University NJ, USA Background: People with shorter leucocyte telomere length (LTL) are at higher risk for mortality and age-related diseases. Since LTL is longer in women than in men and decreases with age, it is important to define its usual values according to age and sex. The aim of this study was to present the age/LTL relationship in adults men and women and in children. Methods: We present data of 1421 adults (928 men and 493 women) aged 53 ± 15 years included by our research group in 3 different cohorts (ERA; n = 427, TELARTA; n = 452 and STANISLAS; n = 542) and having telomere measurements and a complete clinical evaluation including phenotypes of cardiovascular aging. We also studied the age/LTL relationship in children \ 15 years of the STANISLAS cohort (n = 110 mean age 12 ± 3 years). LTL was measured using TRF Southern blot analysis, which is recognized as the most reproducible method. Results: In adults the linear relationship age/TL was LTL (Kb) = 8.22-0.026 9 age in men and 8.55-0.028 9 age in women. In both sexes this relationship was very significant (p \ 0.00001) and the slopes were similar. Mean LTL differed significantly between men (6.74 ± 0.74 Kb) and women (7. 22 ± 0.77 Kb) (p \ 0.0001). In children also the decrease in LTL with age was highly significant (p \ 0.005) but the slope was almost threefold steeper as compared to the adults: LTL (Kb) = 9.10-0.073 9 age. Conclusions: This study presents LTL reference values according to sex and age. Age-related decrease is similar in adult men and women (26 vs. 28 bases/year), but it is much stronger in children (73 bases/ year) pointing out the important role of early life in the determination of LTL later in life. Pronostic value of routine biomarkers in older patients with cancer: pooled analysis of three prospective cohorts Bordeaux University Hospital, Bordeaux, France, 11 APHP, Hôpital Européen Georges Pampidou, Paris, France Introduction: To assess pronostic value of routine biomarkers in older patients with cancer. Methods: A pooled analysis of three prospective multicentre cohorts, ELCAPA, PHRC Aquitaine and ONCODAGE was conducted. Patients aged 70 years or older, with cancer were included. Biomarkers collected were plasmatic C-reactive protein, albumin and a combined score: Glasgow Prognostic Score (GPS). The GPS comprised three categories (0: CRP B 10 mg/L, albumin C 35 g/L; 1: CRP B 10 mg/L and albumin \ 35 g/L, or CRP [ 10 mg/L and albumin C 35 g/L; 2: CRP [ 10 mg/L and albumin \ 35 g/L). The primary endpoint was overall survival at 12 months. Multivariable Cox models were used, adjusting for age, sex, localisation, metastatic status, performance status, frailty screening index, the G8. Discriminative properties were assessed using Harrell C index and NRI (Net Reclassificatio Improvement). Results: Overall 1800 patients were analysed (ELCAPA: N = 543, PHRC Aquitaine: N = 253, ONCODAGE: N = 1004; mean age: 78.5 ± 5.5 years; 61.7% of men; 28.9% metastatic; most frequent localisations: breast (34.9%) and colon-rectum (17.7%); 70.7% of patients screened at risk of frailty with G8). Overall survival was 71.1%. GPS was independently associated with death (among normal G8: GPS 1: Hazard Ratio (HR) = 4.48; 95% Confidence Interval (95% CI) = [2.03; 9 .89], GPS 2: 11.64 [4.54; 29 .81], among anormal G8: GPS 1: 2.45 [1.79; 3.34 ], GPS 2: 3.97 [2.93; 5.37 ]. The addition of GPS to the clinical model (Harell C: 0.82 [0.80; 0.83] ) improved discrimination (Harell C: 0.84 [0.82; 0.85] , NRI: 11% [5; 19] ). Conclusion: GPS could be used in older patients with cancer to help decision-making and prognosis assesment. Area: Oral and dental health O-108 The association of oral health with body weight within 10 years in community-dwelling older adults participants reported being edentulous (FW:34.4%) and 55.8% to wear dentures (FW:62.3%). Toothache while chewing was the oral problem with the lowest (B:5.2%, FW:6.6%) and xerostomia with the highest prevalence at both time points (B:24.3%, FW:30%). In the long term better self-rated oral health was positively (b = 0.650, SE = 0.298, p = 0.029) and being edentulous (b = -1.739, SE = 0.753, p = 0.021) as well as wearing complete dentures (b = -1.591, SE = 0.779 p = 0.041) were negatively associated with BW. No further oral health variables showed an association with BW. Key conclusions: In community-dwelling older adults poorer selfrated oral health, being edentulous and wearing complete dentures may contribute to weight loss in the long term. Background: Evidence on the risk of hip fracture (HF) associated with individual antidepressants (ADs) is scarce, because most studies addressed only AD classes. However, risk profiles can vary widely between individual agents. We assessed the risk of HF associated with individual ADs in older adults. Methods: We conducted a case-control study nested in a cohort of new users of ADs aged C 65 years, based on the German Pharmacoepidemiological Research Database (GePaRD) during 2005-2014. Incident cases of hospitalization for HF were identified and matched to up to 100 controls per case using incidence density sampling. Use of AD was ascertained at index date (ID; cases: date of HF; controls: matched date) based on the duration of the last dispensation. Current use was defined as use overlapping ID. We estimated adjusted odds ratios (aORs), with 95% confidence interval (CI), using conditional logistic regression with remote users of any AD as reference category, adjusting for co-morbidities and co-medications. Results: Among 706,561 cohort members, 39,853 cases were identified and matched to 3,979,510 controls (in both groups: 79.8% women; median age 81 years). Current users had aOR (95% CI) of 1.51 (1.47-1.56 ) for citalopram, 1.51 (1.38-1.65 ) for duloxetine, 1.48 (1.34-1.63 ) for escitalopram, 1.47 (1.35-1.61 ) for venlafaxine, 1.46 (1.39-1.53 ) for amitriptyline, 1.45 (1.35-1.55 ) for sertraline and 1.45 (1.27-1.66 ) for fluoxetine. The aOR was lower for paroxetine (1.36; 1.20-1.55) , trimipramine (1.14; 1.04-1.26) and mirtazapine (1.13; 1.08-1.17) . Conclusions: In this large cohort, mirtazapine and trimipramine had a lower risk than most examined individual SSRI, SSNRI and amitriptyline. Poly-de-prescribing to treat polypharmacy: efficacy and safety of the Garfinkel method Doron Garfinkel 1 1 Wolfson Medical Center Holon and Homecare Hospice, Isarael Cancer Association Background: This study evaluated efficacy and safety of the Garfinkel method of poly- de-prescribing (PDP) in older people with polypharmacy. Methods: In a longitudinal, prospective study in Israel; PDP of C 3 prescription medications recommended to 177 people age C 66 with polypharmacy. C 3 years later, Likert scale questionnaires were used to evaluate clinical outcomes including changes in functional, mental and cognitive status, sleep quality, appetite, continence, major complication, the rate of hospitalizations, mortality, and family doctor's cooperation. Results: PDP was achieved by 122 participants; B 2 drugs were discontinued by 55 'non-responders' (NR group). The average age was 83.4 ± 5.3 in PDP and 80.8 ± 6.3 in NR (p = 0.0045). Follow up C 3 years in all. The prevalence of most diseases/symptoms was comparable. The main barrier to de-prescribing was the family doctor's unwillingness to adopt PDP recommendations (p \ 0.0001). The average number of medications at baseline in the NR and PDP, was 10.49 vs.10.20 (NS), and in the last follow-up 10.67 vs. 3.84, respectively (p = 0.0001). PDPs showed significantly less deterioration in functional, mental and cognitive status, sleep quality, appetite, sphincter control, and less major complications (p \ 0.002 in all). The rate of hospitalizations and mortality was comparable. Health improvement occurred within 3 months after PDP in 83% and persisted for C 2 years in 68%. Conclusion: This longitudinal research proves that in older people poly-de-prescribing is both safe and beneficial, being associated with significantly better quality of life, as compared to clinical outcomes of those who adhere to conventional recommendations and take all medications based on all specialists' clinical guidelines. O-111 Simplification of medications prescribed to long term care residents (SIMPLER): a cluster randomised controlled trial to reduce unnecessary medication regimen complexity in residential aged care Janet Sluggett 1 , Esa Chen 1 , Jenni Ilomäki 2 , Megan Corlis 3 , Sarah Hilmer 4 , Jan Van Emden 3 , Choon Ean Ooi 5 , Kim-Huong Nguyen 6 , Tracy Comans 7 , Michelle Hogan 3 , Tessa Caporale 3 , Susan Edwards 8 , Lyntara Quirke 9 , Allan Patching 10 , J Simon Bell 5 Introduction: Antiepileptic drug (AED) use among older persons may lead to adverse drug events, and therefore to higher number of hospital days. We compared the accumulation of hospital days between AED initiators and non-initiators among persons with Alzheimer's disease (AD) as well as between individual AEDs. Methods: We conducted an exposure-matched cohort study among persons diagnosed with AD in 2005-2011 (n = 70,718) as identified from Finnish health care registers. For each AED initiator, one noninitiator matched on age, sex and time since AD diagnosis was selected. Accumulation of hospital days was measured during a twoyear follow-up. Association between AED initiation or use of individual AEDs and accumulation of hospital days was assessed using negative binomial model. Results: AED initiators (n = 4878) were hospitalized on average for 42.3 (SD: 87.9) days and matched non-initiators 28.0 (SD: 66.0) days during the two-year follow-up. Zero hospital days were observed for 31.4% of the AED initiators and for 41.4% of the non-initiators. Number of accumulated hospital days during the follow-up was 52% higher (adjusted incidence rate ratio, aIRR: 1.52, 95%, CI: 1.38-1.67) among AED initiators than the non-initiators. Among pregabalin (aIRR: 0.61, 95% CI: 0.52-0.72), gabapentin (aIRR: 0.59, 95% CI: 0.44-0.80) and clonazepam (aIRR: 0.72, 95% CI: 0.54-0.96) initiators the number of accumulated hospital days was 28-41% lower than among initiators of valproic acid. Key conclusions: AED initiators are at increased risk of higher number of hospital days than non-initiators. Pregabalin and gabapentin were associated with lower number of hospital admissions than valproic acid. Introduction: Multi-morbidity and polypharmacy are common among older people. However, population-based utilization data in this age group is limited. Leveraging the Danish nationwide health registries, we aimed to characterize the drug use among Danish people C 60 years. Methods: A descriptive study assessing the drug use in 2015 in the Danish population age C 60 years. Drug use at specific therapeutic subgroups and chemical subgroups and its dependence on age were described using descriptive statistics. The patterns of combination of drugs were analysed by using latent class analysis. Results: We included 1,424,775 persons (median age 70 years, interquartile range (IQR) 65-77; 53% women). The median number of drugs groups was five per person (IQR, (2) (3) (4) (5) (6) (7) (8) . The most used single drug groups were paracetamol (5.9%), statins (5.7%), and platelet aggregation inhibitors (4.1%). The most used drug groups were cardiovascular drugs (18%), nervous system drugs (14%) and alimentary tract and metabolism (11%). The distribution of the therapeutic groups was in large consistent with age. Eighteen classes with different drug combination patterns were identified. One class without any drugs (21% of the population), and 11 classes with an expected number of drugs over five were identified. Conclusions: The use of drugs is extensive both at the population level and increasing with age at an individual level. Cardiovascular, analgesics, and psychotropic drugs were the most prevalent drug classes. Eighteen different drug patterns were identified. The drug patterns have the potential to be used in further studies about risk prescriptions. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 O-114 Non-adherence to cardiovascular drugs in older patients with depression: a population-based cohort study 1 São Francisco Xavier Hospital, Occidental Lisbon Hospital Centre, Portugal, 2 Faculty of Medicine, University of Lisbon, Portugal Introduction: Hip fracture (HP) is associated with considerable morbidity and mortality, especially in the elderly. Polypharmacy is considered an important risk factor for falling and has been demonstrated to predict outcome after HP. We aim to study polypharmacy in this population and its possible association with adverse outcomes during a hospital admission for HP. Methods: Retrospective study of elderly admitted to an Orthogeriatric Unit for HF between June 2016 and August 2017. Patients were included in two groups accordingly to the number of drugs at admission: group A-no polypharmacy (less than 6 drugs) and Bpolypharmacy (6 or more drugs). Results: 257 patients were included. 58% of them met the criteria for polypharmacy. The most prescribed drugs in group B were: proton pump inhibitors (55%), diuretics (43%) and benzodiazepines (42%). Patients in group B had worse functional status before hospital admission, as demonstrated by a lower Barthel index (78.8 points vs A: 93.3), lower Holden classification (3.9 points vs A: 4.17) and higher Cumulative Illness Rating Scale-Geriatrics (10.5 points vs A: 6.5) . Group B had also more risk factors for falling (mean 8.8 vs A: 5.9), longer preoperative time (4.9 days vs A: 3.5) and hospitalization time (11.9 days vs A: 7.8) and more complications during hospital admission (mean 2.8 vs A: 2.1). Key conclusions: Polypharmacy is prevalent in this population and is associated with worse outcomes after hospital admission. It is essential to review the patients' drugs, in order to provide them a better quality of life. Predictors of self-reported adherence to direct oral anticoagulation in a population of elderly men and women with non-valvular atrial fibrillation Introduction: Populations are aging, with people over the age of 50 living with multiple long-term conditions and taking multiple medications (polypharmacy). Medication is the single most common healthcare intervention, generating the third highest cost of health expenditure. Up to 11% of all unplanned hospital admissions are attributable to medicines related harm. The European Union has identified the reduction of avoidable harm in healthcare as a key priority. The SIMPATHY consortium explored how polypharmacy programmes can be implemented to improve medication safety and prevent patient harm by addressing the appropriate polypharmacy. Methods: This was achieved by case studies of 9 EU countries and how programmes were implemented, a literature review, benchmarking survey across the EU and also a modified Delphi to determine the consensus across the EU. Results: Within the nine case studies, polypharmacy management was only addressed in 4 countries and only in one nationally. Over a 1000 participants completed the EU wide benchmarking survey including 100 patients. These findings were sometimes at odds with the case studies highlighting the lack of programmes to manage polypharmacy. From the Delphi, Consensus was obtained for statements relating to management, development and measurement but not the time taken to implement such a change. Conclusions: Results highlight importance of change management and theory-based implementation strategies, and collaborative working of policy makers and clinicians to develop, implement or scaling up programs to address polypharmacy. Delphi indicated the vision statements were too ambitious and not achievable by the specified timeframe of 2025. Area: Ethics and end of life care O-118 Educating nursing home staff in palliative care to improve end-oflife care and to reduce burdensome hospitalisations: baseline findings and feasibility of a randomised, controlled trial Helsinki University Hospital, Unit of Primary Health Care and Helsinki University, Department of General Practice and Primary Health Care, Helsinki, Finland Introduction: Varying efforts have been made to support good quality end-of-life care in nursing homes. One prior educational trial has shown favorable outcomes in reducing hospitalizations among dying nursing home residents. However, these positive outcomes have not been replicated in larger scale trials. Our aim is to investigate in this cluster-randomized educational trial whether staff education in palliative care will 1) improve the residents' health-related quality of life (HRQOL), 2) reduce unnecessary hospitalizations during a two year follow-up compared to control group in usual care. Secondary endpoints include symptoms and proxies' satisfaction. Methods: We recruited 340/625 residents in five nursing homes in Helsinki. At baseline, all participants were assessed for HRQOL (15D), symptoms (ESAS, PAINAD), hospital use, advance care plans and proxies' satisfaction of care. The staff in intervention wards was given four 4-hour education sessions discussing the principles of palliative care (introduction, advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations) using constructive learning methods with staffs' own patient cases. Results: Mean age of participants was 84 years, 76% were females. The intervention and control groups did not differ in respect to demographics, terminal diseases, comorbidities, nutritional status, MMSE or functioning. Of about 180 staff members, 102 completed the educational intervention. The educational sessions had lively discussions and the participants gave an overall score of 4.6/5 for the education. Conclusions: We have successfully randomised nursing home wards in this palliative care education trial and completed staff education with very positive feedback. The knowledge and attitudes of Flemish geriatric nurses regarding tiredness of life and euthanasia: a survey study Introduction: The prevalence of thoughts of possible death to self, increases from 6.4% in 80 years to 13.4% in 90 years old. Flemish nurses are frequently confronted with euthanasia requests of older persons being tired of life, although euthanasia is not legalized for this indication in Belgian law. Therefore we wanted to explore the knowledge and attitudes of nurses regarding euthanasia and tiredness of life. Methods: A survey, consisting of four case vignettes and five multiple choice questions, was send to nurses employed in acute (2 hospital wards) and chronic care setting (1 nursing home and 1 home care organisation). Results: A sample of 151 nurses (92.7% female, median age 42 years) was obtained. Nurses in chronic care were significantly more confronted with tiredness of life (n = 76; 32% at least once a week) than nurses in acute care (n = 75; 20%) (p = 0.02). The mean knowledge score was 62.1% ± 24.4 in chronic care and 73.6% ± 21.6 in acute care (p = 0.01). Although 79.5% of the nurses were aware of the fact that euthanasia was legally not an option, 43% would agree upon the act. No significant differences were noticed between settings and level of education. Conclusion: The law on euthanasia is rather well known among Flemish nurses. A discrepancy is noticed between the knowledge of the illegality and the positive attitude to proceed to euthanasia in older people with tiredness of life. Physicians should be aware of this attitude of nurses and foresee ongoing discussions with nurses on this topic. older adults who did not experience spousal loss and followed-up for 1 year. Risk of adverse event was calculated with adjusted conditional fixed effect Poisson regression modelling. Results: 42 918 bereaved older adults were included and matched with an equal number of married controls. Mean age was 78.9 years (SD = 7.2), 68.3% were women. All-cause mortality significantly higher among bereaved older adults (49.2 per 1000 person-years) than among matched controls (30.8 per 1000 person-years). Adjusted incidence risk ratio for 1-year mortality was 2.36 (95% CI 2.17-2.58). Excess risk of mortality was higher among men (IRR = 2.62, 95% CI 2.32-2.97) than among women (2.24, ). Bereaved older adults were also at increased risk of acute cardiovascular event (IRR = 1.72, 95% CI 1.58-1.88), hip fracture (1.88, 95% CI 1.63-2.16), pneumonia (IRR = 1.31, 95% CI 1.18-1.46), acute renal failure (IRR = 1.67, 95% CI 1.26-2.22), and self-harm (IRR = 18.73, 95% CI 9.83-35.7). Risk of unplanned hospitalization during the first year after spousal loss was higher among bereaved older adults than among controls (IRR = 1.31, 95% CI 1.28-1.35). During the first 90-day period after the index date, we observed a 65% increase in the use of benzodiazepines and a 10% increase in the use of selective serotonin reuptake inhibitors among cases, while no variation was noted in the control group. Conclusion: Bereavement has a significant and rapid impact on both fatal and non-fatal health outcomes among surviving spouses. This demonstrates the need for appropriate support of recently bereaved older adults. Physical restraining is a common practice in end-of-life management of nursing home residents with dementia: a crosssectional study Introduction: End-of-life care is a central issue in nursing homes and is frequently pointed at because of a lack of resources. Poor care outcomes have been often reported especially for residents with dementia. Our aims were twofold: first to assess whether the diagnosis of dementia was associated with specific patterns of end-of-life care during the last 6 months of life, and second to compare care pattern of residents with dementia according to living status at 6 month. Methods: Secondary, cross-sectional analysis and prospective study IQUARE. 175 nursing homes in south-west France. Residents at baseline, stratified according vital status at 6-month follow-up and dementia diagnosis. Results: Among the 6275 residents enrolled in IQUARE study, 494 (7.9%) were dead at 6-months of follow-up; among them, 240 (48.6%) had a diagnosis of dementia. Among all residents with dementia (n = 2688), 240 (8.9%) were dead at 6-months of follow-up. Among residents who died during the first 6 months, compared to residents without dementia, residents with dementia were more disabled and malnourished. They are more likely to be exposed to physical restraints (OR = 1.65, 95% IC = 1.08-2.51), with a prevalence of 55.4%; and less likely to have anxiolytic prescription (OR = 0.58, 95%IC = 0.38-0.88). Among residents with dementia, residents dying within a delay of 6 months are more likely to be identified with ''end-of-life'' status (OR = 5.71, 95% IC = 3.48-9.37), but with only 15% of identification. They are more likely to experience pain (OR = 1.43, 95% IC = 1.04-1.97) and to be physically restrained (OR = 1.46, 95% IC = 1.08-1.98). However, pain and psychological distress management are not improved. Key conclusions: Poor quality indicators such as physical restraints are associated with end of life care for residents with dementia. Pain as a challenge in nursing home residents with cognitive impairment Introduction: In patients with dementia observational scales are recommended for use in the assessment of pain. Unfortunately, their application is rare-in consequence, pain is frequently underdiagnosed and undertreated in these subjects. The aim of the study was to assess analgesic treatment in nursing home residents (NHR) with cognitive impairment and to delineate the relationship between pain and behavioral disturbances. Method: The research was conducted in two nursing homes in Wielkopolska, Poland. The analyzed group consisted of 96 residents (78 female) with moderate and severe cognitive impairment in whom pain was assessed with the Abbey Pain Scale (APS) and agitation with the Cohen-Mansfield Agitation Inventory (CMAI). Medical files related to drug prescriptions were analyzed. Results: Analgesics were consumed by 33 individuals (34%); 24 (25%) received regular pain treatment, 7-as needed only (PRN) and 2 (2%)-both regular and PRN. In regards to non-opioid analgesia 13 persons (14%) received them regularly. No one received monotherapy with analgesics from the second step of the analgesic ladder, 2 (2%)received a strong opioid Relationship was found between the APS and CMAI (r = 0.45, p \ 0.0001). Subjects with a higher CMAI received sedative drugs more frequently (p \ 0.001) and despite having a higher APS (p = 0.001), this did not correlate with higher analgesia. Conclusion: Our study suggests that pain can be an important underlying cause of behavioral disturbances in older subjects with dementia. To reduce their frequency and to avoid excessive usage of sedatives, proper pain assessment and management is essential. Vascular risk factors and CSF findings in MCI Methods: Individuals aged 40-80 years with subjective cognitive decline (SCD) were recruited via advertisements and news-bulletins, and through referral to memory clinics. Normal controls were recruited through spouses of participants, or volunteers from the community. Participants underwent physical examination, medical history, cognitive testing with a standardized battery, biobanking, genetics, spinal tap, MRI and FDG-PET. Participants were classified as either SCD or mild cognitive impairment (MCI) according to cognitive screening. MCI was determined if score was B 1.5 SD below the normative mean on either CERAD delayed recall, Trailmaking B, COWAT, VOSP silhouettes, or MMSE B 27. Results: 721 participants were included. The MCI group was older (mean 65.1 vs mean 60.9 yr). The SCD group had lower Body Mass Index. In the MCI group, there were significantly elevated levels of CRP and pro-BNP, and also diabetes and coronary heart disease. There were more smokers in the MCI group. BMI of B 25 was associated with higher levels of CSF total/phospho-tau. Total cholesterol of 7.0 or more was associated with pathological levels of CSF Abeta42-amyloid, P-and T-tau. Conclusion: The association between elevated levels of CRP and pro-BNP and a higher total cholesterol in the MCI group could be interpreted as presence of inflammatory response in these individuals who are at risk for developing AD. Introduction: Many factors influence cognitive function. We evaluated influence of some socioeconomic factors upon cognitive disorders in elderly. Materials and methods: 975 consecutively admitted older patients were investigated. Gender distribution: 67% women, 33% men; age range 65-97, mean 81 years. Sample was divided into three age groups: young-old (65-74 years), old-old (75-84 years), very-old (85-97 years). Parameters considered: gender, age, level of education, place of residence (urban/rural), income, marital status, comorbidity, cognitive function at admission. Tests used for screening cognitive disorders: Mini Mental Status Examination (MMSE), Clock Drawing Test and Five Words Test. Results: Two neurocognitive disorders were evaluated: mild neurocognitive disorders (former mild cognitive impairment -MCI) and moderate to severe neurocognitive disorder (dementia). Higher risk of MCI in men than women: Odds Ratio (OR) 1.47. Adjusting for age and education OR was higher 1.67, adjusting for marital status OR was 1.71 in favor of men. Adjusting for disease burden we obtained 1.54 in favor of men. Higher risk of dementia for women, OR 1.61. Adjusting for age and education Odds Ratio increased to 2.2 in favor of women; adjusting for marital status value decreased to 1.3. Adjusting for comorbidity, risk of developing dementia in women as compared to men was 1.9. Odds of having dementia was higher in rural as compared to urban patients 1.3. Conclusions: Risk of MCI was higher in men, with low education and without spouse. Risk of dementia was higher in women, with lower education and higher comorbidity and from rural area. Can minimum nurse-to-patient ratios reduce patient mortality in acute care hospitals: A cohort study Rochefort Christian 1 1 University of Sherbrooke, Sherbrooke, Canada Introduction: In 2004, California became the first state to implement mandatory minimum nurse-to-patient ratios in hospitals. Since then, several other jurisdictions worldwide have implemented or are considering implementing such ratios. We examined whether failure to meet minimum nurse-to-patient ratios as set in California is associated with an increased risk of death. Methods: A dynamic cohort of adult medical, surgical, and intensive care unit (ICU) patients admitted between 2010 and 2017 to a large university health network in Quebec (Canada) was followed to examine the associations between patient cumulative exposure to work-shifts where nurse-to-patient ratios were below the minima set in California (i.e., 1:5 on medical/surgical wards, and 1:2 in the ICU) and the risk of death. The association between these ratios and the risk of death was assessed using a Cox regression model which adjusted for patient (e.g., age, sex, comorbidities), nursing unit (e.g., unit type) and other nurse staffing characteristics (e.g., nursing experience). Results: A total of 124,832 patients were followed, of which 4975 died during their hospitalization. Patients who died where, on average, older, had more comorbidities, and a higher severity of illness on admission than those who survived. After adjusting for patient, nursing unit, and other nurse staffing characteristics, we found that each 3-additional work-shifts where the nurse-to-patient ratios on medical-surgical wards were less than 1:5 was associated with an increased risk of death of 1.5% (HR: 1.015, 95% CI 1.008-1.022). We also noted that very few work-shifts in the ICU were below the minimum ratio set in California (i.e., 1:2) , and found that the cumulative number of shifts where the ICU nurse-to-patient ratios were below this threshold was not significantly associated with the risk of death. Discussion: Failure to meet the minimum nurse-to-patient ratio set in California for medical and surgical units increases the risk of death among patients admitted to these units. There is a pressing need for policies that will attract and retain greater number of nurses in hospitals to satisfy minimum staffing ratios. Is acute care ageist? Graham Ellis 1 , Phyo Kyaw Myint 2 1 waited more than 4 h in the ED in 2017. These differences become more extreme at longer lengths of stay where 1/200 adults 85 or older waited more than 12 h in the ED, compared to 1/1000 20-24-year olds and 1/100,000 5-9-year olds. Introduction: Arrhythmias induced by a change in ventricular wall stress might be important in clinical situations, for example, arterial blood pressure is more labile in hypertensive patients. Whether artemisinin (ART) can prevent ventricular tachyarrhythmias induced by pressure overload and induce atrioventricular block (AVB) compared with verapamil (VER) in SH rats was never studied. Methods: Transverse aortic constriction (TAC) surgery increased the left ventricular pressure, left ventricular wall stress, and, eventually, caused ventricular tachyarrhythmias. The SH rats that underwent TAC surgery comprised the ST group. The ventricular arrhythmia scores (VASs) and the rates of the different types of AVB were determined in the absence and presence of ART and VER. Results: PVC and VT were detected promptly and no VFs occurred after increases in wall stress in hypertrophic hearts. The SH rats that had undergone TAC had significantly reduced VASs when they were pretreated with 150 mg/kg ART (1.40 vs 4.30 , P \ 0.001), 300 mg/ kg ART (2.11 vs 4.30 , P \ 0.001), 0.5 mg/kg VER (2.75 vs 4.30, P \ 0.05), and 1.0 mg/kg VER (0.29 vs 4.30, P \ 0.001) compared with the VAS in ST group (4.30) . AVBs were only detected in the groups that had undergone TAC and had been pretreated with ART and VER. Key conclusions: Based on these findings, ART may be a promising medication for ventricular arrhythmias prevention during acute pressure overloads in SH rats. Like VER, ART tended to be associated with the occurrence of AVBs. The effect of hospitalization on potentially inappropriate medication use in older adults with chronic kidney disease University of Tasmania, Hobart, Australia, 2 The University of Sydney, Sydney, Australia Background: Potentially inappropriate medications (PIMs) use has been associated with increased morbidity and mortality in patients with chronic kidney disease (CKD). However, little has been published about PIMs use in hospitalized older adults (C 65 years) with CKD. Therefore, we aimed to measure the impact of hospitalization on PIMs use in older CKD patients. Setting: Australian tertiary care hospital. Participants: Older adults (C 65 years) with CKD (estimated glomerular filtration rate [eGFR)] of\ 60 mL/min/1.73 m 2 ) admitted to hospital between January and June 2015. Measurements: Inappropriate medication use was measured using the medication appropriateness index (MAI) and Beers criteria for medications recommended to be avoided in older adults and under certain conditions. Results: The median age of the 204 patients was 83 years (interquartile range (IQR): 76-87 years) and most were men (61%). Overall, the level of PIMs use (MAI) decreased from admission to discharge [median (IQR): 6 (3-12) to 5 (2) (3) (4) (5) (6) (7) (8) (9) ]. More than half of the participants (55%) had at least one PIM per Beers criteria on admission, which reduced by discharge (48%). People admitted with a higher number of medications (b 0.72, 95% CI 0.56 to 0.88) and lower eGFR values (b -0.11, 95% CI -0.18 to -0.04) had higher MAI scores after adjusting for age, sex and Charlson's comorbidity index (CCI). Conclusion: PIMs were commonly used in older patients with CKD. Hospitalization appears to lead to a reduction in PIMs use, but there is still considerable scope for improvement in these susceptible individuals. Potential inappropriate prescribing and the correlates among older persons in Nigeria and South Africa: a comparative study Sule Ajibola Saka 1 , Frasia Oosthuizen 1 , Manimbulu Nlooto 1 1 University of Kwa-Zulu Natal, Durban, South Africa Introduction: Potential inappropriate prescribing (PIP) impacts negatively on the quality of life among older persons worldwide. However, despite PIP being a global phenomenon, cross-country data that can influence interventions on a global or regional level are scarce. This study aimed to compare the prevalence of PIP among older persons in Nigeria and South Africa and to determine the risk factors for PIP in both countries. Methods: A retrospective evaluation of medical chart of older persons in one teaching hospital each, in Nigeria and South Africa was carried out. Older persons aged C 60 years that attended the outpatients' clinics of the hospitals between January and December 2016 were included. Information including patients' socio-demographics, medical histories, past and current medications were extracted from the patients' medical records. The PIP was evaluated using the 2015 updated American Geriatric Society-Beers Criteria. The PIP in both countries was compared, and the risk factors for PIP were determined using a multivariate regression model. Background: The prevalence of chronic diseases and polypharmacy increases with aging. However, influence of polypharmacy on mortality risk in older adults is still controversial. Purpose: To evaluate influence of polypharmacy on 5-years mortality in very old patients in Moscow population. Methods: Two hundred and thirty-seven patients (56 men) aged 85-98 (mean 88.2 ± 2.8) years were included in the observational prospective study during their planned admission to the hospital from 2011 to 2013. All patients had stable condition without evidence of acute illness or decompensation of chronic diseases. We estimated the number of any medications during hospitalization. The follow-up period was 5 years. Endpoint was all-cause mortality. Results: Median of follow-up was 3.67 years (min 2 weeks, max 6.03 years, IQR 2.72-4.54 years). Ninety-two patients (40.2%) died. During hospitalization, all patients received 4-21 (mean 10.8 ± 3.2) of any medications, including 1-11 (mean 5.1 ± 2.1) of injectable medications and 0-12 (mean 5.6 ± 2.2) of oral medications. Kaplan-Meier analysis showed that use of C 5 injectable medications was associated with increase of 5-years mortality (Chi square 5.8; p = 0.016). 5-years mortality in patients who received 1-4 injectable medications was 28.7%, and in patients who received C 5 injectable medications was 46.3% (p = 0.011). Cox regression with age and sex adjustment showed that use of C 5 injectable medications during hospitalization is associated with a 1.8fold increase of 5-years mortality risk (HR 1.78; 95% CI 1.11-2.88; p = 0.018). Conclusions: Thus, use of C 5 injectable medications during hospitalization may increase 5-years mortality risk in very old patients. A case report of Memantine-induced bradycardia in an 83 year old male Matthew Formosa 1 , Antoine Vella 2 1 Mater Dei Hospital (MDH), Msida, Malta, 2 Rehabilitation Hospital Karen Grech (RHKG), Pieta, Malta Introduction: To highlight a rare case of bradycardia as an adverse effect of Memantine therapy. Methods: Mr. JV, a 91 year old gentleman was seen by the Geriatrics Outreach team in a community residential home because of deterioration in his cognitive state as well as a worsening, recent onset hoarding syndrome. He had a MMSE score of 16/30 and met the criteria for the commencement of Memantine at 5 mg per day with a plan to escalate the dose to 10 mg if no untoward side effects were noted. It was felt prudent to check a resting ECG prior to commencing Memantine. The patient was seen 6 weeks later at a routine follow-up appointment where his cognitive state was noted to have improved slightly. An ECG was taken at this time and it was compared with his previous ECG, where an elongation of the patients PR interval as well as his QTc was noted. Results: Memantine was stopped and behavioural interventions were tried instead of medication. The ECG was repeated and the PR and QTc intervals returned to normal once Memantine was stopped. Conclusions: The authors recommend that the patients pulse rate be documented together with an ECG prior to starting Memantine. A repeat ECG and the patient's pulse rate should be checked 1 month after the commencement of Memantine or before if patient is noted to develop bradycardia. The linked anticholinergic risk scale: building a clinically relevant comprehensive listing of drugs with anticholinergic properties Lars Druiven 1 , Derek Dyks 2 , Allen Huang 3 1 LUMC, Leiden, The Netherlands, 2 The Ottawa Hospital, Ottawa, Canada, 3 The Ottawa Hospital, University of Ottawa, Ottawa, Canada Introduction: The Anticholinergic Risk Scale [1] , Beers [2] and START/STOPP criteria [3] and a systematic review [4] all highlighted potentially inappropriate drugs with anticholinergic properties. This study was done to link and validate the data and develop a working list of these drugs that can potentially be used for both clinical decision-making and research purposes. Methods: A master list of drugs with anticholinergic properties was compiled including data from previous studies [1] [2] [3] [4] . We used a modified Delphi technique and a web questionnaire to collect expert opinions from hospital pharmacists and geriatricians. Round one asked participants to rank 42 drugs on a categorical scale (high = 3, moderate = 2, low = 1, don't know) that was based on their clinical experience. Round 2 focused on drugs with blank or ''don't know'' responses and a basic drug monograph was attached as reference. Rating categories were compiled and means and standard deviations (SD) calculated. Results: The master list contains 92 drugs. 11/109 pharmacists and 5/12 geriatricians responded. The mean number of responses for each drug was 8.0 in round 1 and 5.4 in round 2. There was strong agreement for some drugs such as protryptyline (all raters scored 3) and less for others such as tropicamide (mean 2.28, SD 0.89). Key conclusions: We compiled a Linked Anticholinergic Risk Scale (LARS) of drugs with anticholinergic properties and a category of the potential severity of their clinical effects. The next step is a study using the LARS tool to explore the association of exposure to these drugs with patient outcomes. Prevalence and incident prescribing of drugs with anticholinergic properties in older adults admitted to an academic hospital Lars Druiven 1 , Derek Dyks 2 , Allen Huang 3 1 LUMC, Leiden, The Netherlands, 2 The Ottawa Hospital, Ottawa, Canada, 3 The Ottawa Hospital, University of Ottawa, Ottawa, Canada Introduction: Medications with anticholinergic properties belong to potentially inappropriate medications (PIMs) as described in the Beers [1] and STOPP/START [2] criteria. The prevalent use and incident prescribing of these drugs was studied in older adults admitted to hospital. Methods: A random sampling of 14,880 admissions of patients 65-years and older admitted during 2015 to a 1000-bed academic hospital in Canada was done. The cohort consisted of 100 patients admitted to the General Surgery (GS) and Internal Medicine (IM). The electronic records of their community meds and in-hospital prescribing were analysed. Index drugs were listed in the anticholinergic risk scale [3] . Results: Compared to patients admitted to IM, GS patients were younger (mean, 76 vs. 80-years), had shorter lengths of stay (8 vs. 13-days), were less often admitted from the Emergency Department (71 vs. 98%) and had lower documented dementia (5 vs 25%) . GS patients used less anticholinergic drugs in the community (mean number 0.56 vs. 0.87), were prescribed more in hospital (mean 2.14 vs. 1.87) and were administered similar amounts (mean 1.10 vs 1.45). Hospitalization resulted in an increase in the use of these drugs: average ratio of 1.60 for GS and 1.01 for IM. Key conclusion: The use of drugs (prevalent and incident) with anticholinergic properties in an academic hospital is high. This situation potentially places older patients at higher risk for adverse events. Factors leading to these findings need to be studied and interventions designed to improve the safety and quality of care of hospitalized older patients. (5):508. Diazepam as an oral hypnotic increases nocturnal blood pressure in healthy elderly R. Fogari 1 , A. Costa 1 , A. D'Angelo 2 , M. CottaRamusino 1 , D. Bosone 3 1 Clinical studies on the efficacy and safety of drugs often do not include older people. Hence, there is a lack of evidence as to the appropriateness of numerous drug treatments in the elderly. Undoubtedly, these circumstances often turn the drug therapy of older people into a risky experiment. To address this issue, the FORTA classification (A: Absolutely; B: Beneficial; C: Careful; D: Don't) was proposed as a clinical aid for physicians. The FORTA List was validated and expanded in a Delphi consensus procedure. To evaluate the effectiveness of FORTA we conducted a prospective randomized controlled trial in hospitalized elderly patients. Nearly half of our patients received standard care and the other half received standard care plus the FORTA method. In this study, we separately tested changes of drug prescriptions at the anatomical-therapeutic-chemical system (ATC) level for important diagnoses and compared over-and undertreatment rates between the groups. At the individual drug/drug group level, two items (e.g. loop diuretics) were significantly altered by FORTA when overall use changes between admission and discharge were compared between groups. In addition, FORTA also significantly improved undertreatment (e.g. beta receptor blocking agents or phenprocoumon to treat atrial fibrillation) or overtreatment (e.g. loop diuretics to treat arterial hypertension) for nineteen drugs/drug groups. Based on this study, FORTA is the first combined positive/negative labelling approach at the individual drug level which is effective in eliminating inappropriate prescribing and certainly ameliorates the drug treatment of older people. Medication management of osteoporosis prevention in nursing home residents in Europa: the shelter study Hein van Hout 1 , Graziano Onder 2 , Rob van Marum 3 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 S47 Introduction: Polypharmacy is one of the most important issues in geriatric pharmacotherapy. To tackle with polypharmacy in an acute care hospital, we started a clinical medication review team to optimize the medications and investigated the effect of the intervention on older patients with polypharmacy. Methods: We organized ''Geriatric Pharmacotherapy Optimization Team'' consisting of doctors, pharmacists, nurses, dieticians and rehabilitation therapists. Our team routinely reviewed the medication regimen and adherence based on comprehensive geriatric assessment (CGA) and medication review followed by a multidisciplinary team conference. From September 2016 to December 2017, we reviewed 58 cases, which were divided into two groups; three or more medication reduction group (C 3R) and less than three reduction group (\ 3R). The incidence of adverse drug reactions (ADRs) within 60 days was analyzed using the Chi square test. Results: In the C 3R group (n = 32), the average age was 79.6 (7.2(SD)) years old, and the average number of medications was 11.6 (3.4) at admission and 6.7 (3.5) at discharge. In the \ 3R group (n = 26), the average age was 78.9 (6.4) years old, the average number of medications was 9.9 (1.9) at hospitalization and 9.5 (3.0) at discharge. The incident of ADRs was significantly different between C 3R and \ 3R groups; 53.1% vs. 34.6% at admission, and 6.3% vs. 26.9% (p = 0.031) after 60 days. Conclusions: Multidisciplinary medication review and a team approach for in-patients with polypharmacy can reduce the number of medications and ADRs. Therefore, this approach could be recommended for older in-patients with polypharmacy. Analysis of evolution of appropriate prescribing antidepressants and cholinesterase inhibitors in a psychogeriatric ward in a Belgian hospital in order to decrease the use of antipsychotics P-14 Comparative safety of individual antidepressants regarding traumatic brain injury in older adults Background: Antidepressants (ADs), a useful therapeutic tool in depression and anxiety disorders, can increase the risk of Traumatic Brain Injury (TBI) because of adverse effects such as sedation or dizziness. Evidence on the comparative safety of individual AD in this regard is scarce. We assessed the risk of TBI associated with ADs in older adults. Methods: We conducted a case-control study nested in a cohort of new users of ADs aged C 65 years, based on the German Pharmacoepidemiological Research Database (GePaRD) during 2005-2014. Incident cases of hospitalization for TBI were identified and matched to up to 100 controls per case using incidence density sampling. Use of AD was ascertained at index date (ID; cases: date of TBI; controls: matched date) based on the duration of the last dispensation. Current use was defined as duration overlapping ID. We estimated adjusted odds ratios (aORs), with 95% confidence interval (CI), using conditional logistic regression with current users of mirtazapine as reference category, adjusting for co-morbidities and co-medications. Background: Previous register studies have shown poor compliance after discharge with changes made to the patients' medicine during admission. Follow up interview with the GPs found a wish for contact between the hospital doctor and the GP for discussion of eventual changes. The aim of the study was to enlighten the feasibility of a study of discussion of the patient's medicine between the hospital doctor and the GP on discharge proceeded by a comprehensive clinical pharmacist-led medication review. Method: Patients admitted to the Department of Geriatric Medicine, Odense University Hospital, Denmark during spring 2018 were screened by a clinical pharmacist. Main exclusion criteria were cognitive impairment or patients isolated due to infection or less than 5 drugs (inclusion criteria). Following the medication review suggestions for drug changes were given to the doctor. Within the first days after discharge the pharmacist contacted the GP for setting up a telephone-contact for discussion of the drug treatment. Results: Of the invited 62 patients, 51 accepted to participate. The clinical pharmacist suggested medication changes for 16 of the 25 intervention patients. For the 11 patients eligible for telephone-contact with GP, only 9 contacts were offered mostly due to practical problems. For 7 of these patients the GP wanted a discussion with the hospital doctor, and for 6 patients a contact between the hospital doctor and the GP was established (Data collection still going on May 2018). Discussion: Even though the GPs previously have expressed a wish for discussion of discharged patients' medicine with the hospital doctor it was very difficult to establish this contact due to practical problems. A large scale RCT seems hardly feasible. Methods to assess patient preferences in geriatric pharmacotherapy-a systematic review Introduction: When trying to individualize geriatric pharmacotherapy the elucidation of the older patient's treatment and outcome preferences should be considered during the prescription process. A systematic review was conducted to identify methods used to explore patient preferences in old age pharmacotherapy and to evaluate their appropriateness in the context of multi-morbidity. Methods: We searched three electronic databases (PubMed, Web of Science, PsycINFO) for studies reported in English or German. Studies were eligible for inclusion if they assessed individual treatment and outcome preferences in a population aged C 65 years or with a mean/median age of C 75 years. The current review focused on long-term pharmacological treatment options. We excluded qualitative studies as well as studies targeting preferences for lifesustaining treatments. Results: A total of 60 articles met our eligibility criteria, reporting 55 different instruments to assess patient preferences. Discrete choice experiments, medication willingness, health outcome prioritization tools, ranking exercises and Likert scale based questionnaires were the most commonly used preference elicitation techniques. Single studies investigated the feasibility of the analytical hierarchy process, adaptive conjoint analysis and maximum difference scaling. The majority of the instruments were designed for disease-specific or context-specific settings, only three instruments (Health outcome prioritization tool, STEP assessment, MediMol questionnaire) targeted the issue of geriatric multi-morbidity. Key conclusions: Up to now a broad range of elicitation methods have been applied to assess medication preferences in older patients. However, few instruments exist that aim at clarifying patient preferences in multi-morbidity-related polypharmacy, demonstrating a need for future tools tailored to this context. Introduction of non-vitamin K antagonist anticoagulants strongly increased the rate of anticoagulation in geriatric patients Marija Djukic 1 , Larissa Maria Braun 1 , Claudius Jacobshagen 2 1 Geriatric Center, Protestant Hospital Göttingen-Weende, Göttingen, Germany, 2 Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany Introduction: The benefit of anticoagulative treatment to prevent thromboembolism has been established in patients with atrial fibrillation and flutter (AF) of all age groups. Traditionally, anticoagulation was underused in geriatric patients with AF. Methods: Hospitalized geriatric patients treated in 2015 were retrospectively studied for the presence of AF and the use or non-use of anticoagulation. The risk of stroke and the indication for permanent anticoagulation were assessed using the CHA2DS2-VASc score. Results: 512 of 1320 patients showed a clear indication for therapeutic anticoagulation (38.8%). Of these, 431 patients (84.2%) had long-standing persistent ([ 1 year)/permanent AF or paroxysmal/ persistent ([ 7 days) AF as well as a CHA2DS2-VASc score of C 2 in men and C 3 in women. In this group, 378 patients (87.7%) received anticoagulation. Of all patients anticoagulated for AF, 221 received NOACs (58.5%), 176 received apixaban (46.6%), 32 rivaroxaban (8.5%), and 13 dabigatran (3.4%) . 107 patients received the vitamin K antagonist phenprocoumon (28.3%) and 50 patients high-dose low-molecular weight heparins (13.2%). In 26 patients (5.7% of all anticoagulated patients, n = 459) complications were documented. 13 complications (50.0% of those treated) occurred during treatment with NOACs, 5 (19.2%) during anticoagulation with phenprocoumon and 8 (30.8%) during treatment with low molecular weight heparins. No intracranial hemorrhages occurred, and 9 patients required transfusion or surgery to stop bleeding. Conclusion: The introduction of NOACs and an increased awareness of their benefits led to an increased use of anticoagulation from 52.8% (2011) to 87. 7% (2015) in geriatric patients with AF at our institution. researches, where PIM and polypharmacy assessed, increased. The aim of the study is to evaluate the number of PIM publications in Turkey. Methods: The number of published articles on Electronic PubMed records and Google Scholar engine about polypharmacy and PIM use from 2005 to 2018 in Turkey is evaluated. Results: There were 3 in 306 publications found from Turkey by the search result for 'potentially inappropriate medication' (2 observational, 1 retrospective). The 5 in 5307 articles were from Turkey according to the search of term 'polypharmacy', and all were observational. Search result for 'potentially inappropriate medication' words at Google Scholar, showed 15900 articles, where 36 were from Turkey (20 observational, 5 retrospective, 11 review). The term polypharmacy was included in all inappropriate drug use publications so that not needed to be re-scanned. Only one-third of the studies were about PIM. Key conclusions: Although observational studies are often easier and cheaper to conduct, polypharmacy and PIM publications are lacking. There are several reasons why not doing study on polypharmacy and use of inappropriate medications. Guideline for observational studies conducted on drugs in Turkey may be one of the most important reasons. The statutory and regulatory requirements are needed to be assessed in order to increase the number of observational drug studies. Optimizing pharmacotherapy on geriatric wards in Belgiumstronger together? reported to be associated with insulin resistance. In this study, we aimed to clarify the mechanism of insulin resistance at the site of amyloidoma using a mouse model. Methods: We generated an insulin amyloidoma mouse model by repeated subcutaneous injection of insulin amyloid fibrils, and performed insulin tolerance test at the site of amyloidoma. The interaction between insulin amyloid and native insulin was analyzed in vitro. Results: Subcutaneous insulin amyloidoma in mice revealed features similar to those of human insulin amyloidoma, and remained to be similar feature for a long time. Native insulin showed no significant hypoglycemic effect when administered into the site of amyloidoma. In vitro analysis showed that insulin amyloid fibrils strongly adsorbed native insulin. Conclusions: The effect of preformed insulin amyloidoma on trapping native insulin may be a cause of insulin resistance and poor blood glucose control in clinical cases with insulin amyloidoma. Quality and determinants of anticoagulation therapy by AVK in elderly subjects Introduction: Cardiovascular drugs like diuretics are risk factors for falling in older people. Our objective was to assess whether genetic polymorphisms affecting the diuretics efficacy modify the association between diuretics and falls. Methods participants: C 55 years from B-PROOF (primary study) and the Rotterdam Study (validation study). Cox proportional hazards models with diuretic exposure as time-varying determinant were used to calculate fall hazard ratios (HRs) . Interaction terms between diuretic use and single nucleotide polymorphisms (SNPs) were created to identify relevant SNPs. The participants were stratified into categories according to genotype and use/non-use of diuretics. Cox models were applied to determine fall risk of the categories. Results: Loop diuretics were associated with increased fall risk in the meta-analysis (HR 1.20, 95% confidence interval 1.04-1.39), whereas low-ceiling diuretics use was protective in the Rotterdam Study ), but not in B-PROOF. Three of the 32 assessed interaction terms were significant. In loop diuretic users, our results indicated a trend of higher fall risk (non-significant) in increased response-allele carriers of rs17268282. In B-PROOF, normal response-genotype carriers of rs1458038 using low-ceiling diuretics had increased risk (HR 1.60 [1.01-2.54 ]), and in the Rotterdam Study, decreased risk ), compared to nonusers. In lowceiling diuretic users, a lower fall risk was shown ) in increased response-allele carriers compared to normal response-allele carriers. Conclusions: SNPs may have a role in diuretic-related fall risk. However, this is the first study to address this issue. Genetic risk scores or a genome-wide association study could be next steps in further research. Falls, fractures and osteoporosis treatment among elderly outpatients in Moscow humerus -17.8% (n = 13), proximal femur-6.9% (n = 5)-as well as compression fractures of the vertebrae. Among patients who underwent low-traumatic fractures only 8.2% received bisphosphonates, 5.5% received only vitamin D and 2.7%-calcium with vitamin D. Conclusions: In our study, a high prevalence of repeated falls and osteoporotic fractures has been revealed. In spite of this, no more than 10% of patients with severe osteoporosis received anti-osteoporotic therapy. Further research is needed to determine whether this is due to the low detectability of osteoporosis and the prescription of the drugs or to the low adherence of patients to anti-osteoporotic therapy. Vancomycin dosing optimisation-lessons learnt from a PK/PD study Introduction: The process of aging is associated with altered pharmacokinetics (PK) and pharmacodynamics (PD) of many drugs. Dosing strategies derived from studies including younger and/or healthy individuals might not be appropriate. The aim of our study was to evaluate the frequency of optimal initial vancomycin dosing (with regard to the PK/PD parameters, i.e. the ratio of area under the concentration versus time curve to the minimum inhibitory concentration) in University Hospital Olomouc and to identify covariates enabling to predict optimal individual dosage regimen. Patients and methods: A retrospective analysis of vancomycin plasma levels determined during a 5-year period in patients aged C 65 years treated with i.v. vancomycin was performed. Pharmacokinetic modelling using MWPharm++ software was performed to assess individual PK/PD indices. Results: A total of 794 vancomycin concentrations obtained in 208 patients were included. Pharmacokinetic simulations showed suboptimal and supratherapeutic concentrations in 14% and 42% patients, respectively. Data were in clear contrast to those observed in individuals aged \ 65 yrs. During the same study period, 44 and 22% non-geriatric patients would be considered underdosed and overdosed, respectively. Creatinine clearance was the only covariate predicting over-and underdosing. Increased creatinine clearance by 1 ml/s/1.73 m 2 was associated with 8 times lower risk of overdosing. Conclusion: Optimal initial vancomycin dosing still remains challenging in clinical practice. Simple nomograms with creatinine clearance could improve vancomycin prescribing. Disclosure of interest: None declared. Approved by institutional ethics committee, Nr. 183/14. Supported by MH CZ-DRO (FNOl, 00098892). Anticholinergic burden before and after hospitalization in older adults with dementia: large increase due to antipsychotic medications Jonas Reinold 1 , Oliver Riedel 1 , Federica Edith Pisa 1 1 Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany Background: Hospitalizations can lead to increased use of medications, particularly in older adults with dementia who frequently use multiple medications including some with anticholinergic activity (MAC), despite strongly discouraged. Objectives: To evaluate changes in MAC use and anticholinergic burden during hospitalization in older adults with dementia and to evaluate factors associated with an increased burden. Methods: Retrospective cohort, including all inpatients aged C 65 years with a discharge diagnosis of dementia hospitalized at the University Hospital of Udine, Italy, 2012 Italy, -2014 . Only first hospitalization was included. Medications were identified in communitypharmacy dispensations within 3 months before hospitalization while medications prescribed at discharge were collected from Hospital Electronic Medical Records (EMR). Anticholinergic burden was assessed using the Anticholinergic Cognitive Burden score (ACBscore). Results: Among 1908 patients (64% women, median age 86 years), 68.6% used [ 1 MAC at discharge, 49 .1% before and 45.7% after hospitalization, and 38.4% had increased ACB-score at discharge. While cardiovascular medications (e.g. furosemide, digoxin and warfarin), were among the most commonly used MAC both before (29.2, 12.0 and 6.4%) and at discharge (29.7, 10.5 and 5.8%), use of antipsychotics, especially quetiapine and promazine, strongly increased at discharge (33%) compared to before hospitalization (12%). Patients with psychiatric conditions (1.91; 1.52-2.39 ), discharged from surgical (1.75; 1.09-2.80) or medical department (1.50; 1.04-2.17 ) and with cardiac insufficiency (1.41; 1.00-1.99) had greater risk of increased ACB at discharge. Conclusions: Use of MAC and ACB were considerably higher at discharge than before hospitalization and antipsychotics were the main drivers of this increase. Introduction: Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, cognitive and functional impairment, or at the end of life. The aim of this study was to investigate the priorities for conducting research in the field of geriatric pharmacotherapy. Methods: Twelve international experts from five research groups in geriatric pharmacotherapy and pharmacoepidemiology research (representing Australia, Belgium, Finland, Italy, and Sweden) were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network (OPPEN) workshop. A modified nominal group technique was used to explore and consolidate the priorities for conducting research in this field. Results: Eight research priorities were elucidated: underuse, overuse and misuse of medications; medications in frail and vulnerable patient groups; understanding and informing prescribing in people with polypharmacy and multimorbidity; person-centered practice and research; deprescribing and regimen simplification; methodological development; understanding unexplained variability in prescribing and medication use; and national and international comparative research. Participants identified current research gaps and future actions for addressing these priorities. Introduction: Impaired renal function is common in elderly patients, and their glomerular filtration rate (GFR) should be taken into account when prescribing renally excreted drugs. Normally, GFR at hospital discharge is used for drug dosing. However, GFR might change in the weeks following discharge. Methods: We conducted a prospective observational study. Patients C 70 years with MDRD \ 60 ml/min/1.72 m 2 , admitted to the geriatric ward of a large teaching hospital and discharged to a primary care setting were eligible to participate. MDRD was measured at three time points: at discharge from the hospital, 14 days and 2 months after discharge. We used 3 renal function groups: MDRD 50-60, MDRD 30-49 and\ 30 ml/min/1.72 m 2 . The primary outcome is the percentage of patients that change from renal function group after discharge. Secondly, we analysed risk factors for fluctuation of the renal function to identify this vulnerable group. Results: In total 65 patients were included with an average age of 84 years. Forty patients (62%) changed from renal function group at either the first or the second time point after discharge. Twenty-five patients (38%) remained stable during the whole period. At the second time point renal function increased in 11 patients (19%) , decreased in 15 patients (26%) and remained stable in 31 patients (54%) compared with discharge. Risk factors were dehydration at the time of admission (p = 0.012) and patients who are mentally competent (p = 0.046). Key conclusions: 62% of the patients older than 70 years with an MDRD \ 60 ml/min/1.72 m 2 during admission fluctuate in renal function group after discharge potentially leading to ineffectiveness or toxicity of drugs Objective: To analyze electronic and manual prescriptions regarding the occurrence of polypharmacy and potential types of medication errors in the context of primary care. Method: a descriptive, transversal and retrospective study, based on the evaluation of prescriptions filed at the pharmacy of the Basic Health Unit of the Federal District. We analyzed in the study 1500 s-line prescriptions that had at least one drug prescribed for chronic non-communicable diseases. The collection occurred between July 18 and September 29, 2017. Results: The total of the evaluation criteria proposed in this study were: illegibility (98.2%), abbreviations (97.7%), pharmaceutical form (57.6%), concentration (32.4%), polypharmacy was identified in 46% of users and this was directly related to the age of the user. The presence of all non-transmissible chronic diseases were positively and significantly associated with polypharmacy, among the ones that presented the greatest risk for the presence of polypharmacy were: arterial hypertension and dyslipidemia, increasing the risk of polycoding at 5.47 and 6.40 times respectively. Conclusion: Measures that improve the prescriptions and that involve the professionals involved in the care to the patient with the safety in the prescriptions and other actors involved in this process on the prescription of medicines. Strategies aimed at this profile of patients that are increasingly present today are needed, public policies that insist on promoting health and quality of life of this population profile in primary care are essential. Proton pump inhibitor use in residential aged care services: does it pass the acid test? Introduction: While proton pump inhibitors (PPIs) are generally well tolerated, frail older people who take PPIs long-term may be susceptible to dose-dependent adverse events. The objective of this study was to determine factors associated with high-dose PPI use in residential aged care services (RACSs Introduction: Inappropriate prescribing remains persistent in nursing home residents. Insight into barriers and facilitators of medication reviews aimed at improving prescribing is needed, because findings about their effectiveness were equivocal. Methods: Embedded in a cluster RCT, showing medications reviews to be successful in discontinuing inappropriate medication, we conducted semi-structured interviews about purposively sampled medication reviews (8 with 5 pharmacists, 8 with elder care physicians, 10 with nursing staff, and 6 with residents/relatives). Transcribed interviews were analysed with the constant comparison method. Results: The main theme on patient involvement was ''Fidelity'' (e.g. the patient perspective as a leverage whether residents perceived their medications as inappropriate vs. distortions by residents' bereavement, cognitive impairment, or submissive attitudes, requiring specific strategies e.g. consistent gauging). Themes on inter-professional collaboration were ''Clinicians' Tendentiousness'' (e.g. physicians valuing pharmacists making pharmacotherapeutic assessments independent from patient data and presuming pharmacists were able to infer indications from prescriptions vs. pharmacists valuing access to residents' medical charts; medication reviews being useful for reducing overprescribing possibly linked to physicians' treatment inclination), ''Level of Comprehensiveness'' (e.g. utility of inappropriate prescribing criteria vs. overload of impracticable alerts), and ''Interprofessional alliances'' (e.g. no consensus about involving nursing staff in medication review discussions vs. their pivotal role while executing changes; physicians' commitment to discontinue inappropriate medications being impeded by residents' dependence on medication in which case pharmacists could substantiate physicians' efforts). Conclusions: These insights underline the need for meta-communication with residents/relatives about their involvement and among clinicians about inter-professional collaboration to implement medication reviews in practice. Appropriateness of new oral anticoagulant dose adjustment in older adults NOAC prescribing is a significant problem and whether this is related to the existing diseases, demographic-data, CHADSVASc and HASBLED score, frailty and falls/fear-of-falls. Method: Older adults between the ages of 60-99 who have AF and under the treatment of NOACs admitted to outpatient clinic were included. Demographic data, clinical data were obtained. Frailty was evaluated by FRAIL-scale. For each patient the doses of NOACs were evaluated according to the recommendations of the guideline and it was categorized as appropriate or inappropriate-dose. Results: A total of 295 older-adults were included. The mean-age was 75.4 ± 7.6 years, and 64.4% of patients were female. Rivaroxaban was the most commonly used NOAC observed in 169 patients (57.3%). A total of 104 (35.6%) were prescribed a dose lower than recommended. Factors associated with inappropriate-low-dose use were weight, cerebrovascular disease and being older than 70 years of age. In regression analysis independent factor was age older than 70 years. Conclusion: Our study suggests that dose reduction is performed only in consideration of the age factor, contrary to the guideline recommendations in clinical practice. We observed that the use of inadequate low-dose medication was common and this condition was not related to falling/falling-fear or frailty. Antidepressants Introduction: Iatrogenic issues are responsible for 20% of elderly frail hospitalizations [1] , while 25% might be avoided [2] . Falls are one of major symptoms. Clinical pharmacy can reduce risk factors such as polypharmacy, medication complexity [3] . Objective: to evaluate the impact of pharmacist-led interventions at the MUPA-unit on re-hospitalization rate after discharge. Methods: 12 weeks longitudinal study in a teaching hospital; primary endpoint were 72-h and 30-day re-admissions rate. We compared two groups: (1) group with patients followed by a pharmacist (FPH) and benefited from medication reconciliation, pharmaceutical analysis, town-hospital network and (2) Introduction: This cross-sectional study was conducted on baseline data from the IDEM cohort (Benefit of systematic tracking of dementia cases in nursing homes) subgroup (N = 585). The aim of this study was to explore the association between anticholinergic burden and nutritional status among elderly nursing home residents. Methods: Malnutrition risk was determined using the Mini Nutritional Assessment (MNA) and high anticholinergic burden (level C 3) was defined using the Anticholinergic Drug Scale (ADS). Multivariate logistic regression was used to examine the contribution of high anticholinergic burden and associated potential confounding factors on the nutritional status of participants. Results: The average anticholinergic burden was 1.39 ± 1.46. After adjusting for potential confounding factors, there was no significant association between high anticholinergic burden and risk of malnutrition (OR = 1.03, 95% CI [0.52-2.03], p = 0.925). However, the risk of malnutrition was significantly higher for women, patients with a high Charlson Comorbidity Index score, history of fracture or falls, a low score on the MMSE (Mini Mental State Examination), AGGIR (Autonomie Gérontologique Groupe Iso-Ressources) and QOL-AD (Quality of Life in Alzheimer's Disease) assessments. Conclusions: The use of existing scales in clinical practice remains a challenge because of the complexity of calculating atropine exposure, the updating of scales, and the differences observed between anticholinergic burden and clinically proven adverse events. Perceptions on the interest and feasibility: community pharmacists-led medication reviews in elderly in primary care Conclusion: This study allowed to discuss with community pharmacists their expectations and needs to achieve MR. These results will have to be taken into account by REIPO and sanitary authorities to include representative of general practitioners into brainstorming workshops with pharmacists to improve collaboration. REIPO offers a wide range of training for health professionals wishing to upgrade their skills in therapeutics optimization in elderly patients. REIPO's aim is to integrate MR in the daily pharmaceutical activity of the largest number of community pharmacists in collaboration with physicians. Inhalation technique of dry powder inhalers in hospitalized geriatric patients: a cross-sectional study Background variables included age, sex, cognition (Orientation-Memory-Concentration (OMC)-score), comorbidity (Charlsoncomorbidity-index (CCI)), and ADL (Barthel-index). The record was checked for information regarding doctors InTec assessment. Results: A total of 39 patients (64% women) were included. Patients were old (80.6 (5.5) years (mean(SD)), had moderately reduced ADL (median[IQR])) and cognitive function ), and high comorbidity (CCI 3 [2] [3] [4] [5] ). Of these, 18(46%) had sufficient IC. In patients bringing own device (n = 29) 7(24%) used this correctly and 6 (20%) had sufficient IC. Doctors had tested 3/33(9%). Patients with sufficient IC were younger (78.7 (4.8) vs 82.3 (5.6) years, p = 0.038) and more likely to be men (71.4% vs 32.0%, p = 0.018). No significant differences were found between patients when addressing InTec in terms of IC, Barthelindex, OMC-score, or CCI. Patients with correct InTec were significantly younger (76.7 (3.9) vs 82.6 (5.6) years, p = 0.017), which stayed borderline significant when adjusting for sex, Barthel-Index, OMC-score, and CCI (p = 0.086). Numerous trials have shown that older people are often subjects to inappropriate and unsafe drug treatment. The main reason for this problem is that for most of the medications there is no evidence regarding efficacy and safety in older patients. This problem is worsened by the high prevalence of multimorbidity and therefore polymedication in this group. To raise the appropriateness of drug therapy in the aged, we have developed a clinical aid called the FORTA List. FORTA was originally invented by Wehling and validated and expanded by twenty experts in a Delphi consensus procedure in Germany/Austria. Subsequently, we evaluated FORTA's usefulness in a pilot clinical trial as well as in a controlled prospective trial. These trials revealed that FORTA significantly improves the quality of pharmacotherapy and reduces the frequency of adverse drug reactions. Based on these results, Delphi consensus validations of country/region-specific FORTA Lists were conducted in seven European countries/regions. 47 experts in total agreed to participate in our study. For each country/region, the overall mean consensus coefficient was higher than 0.9. FORTA Lists from six countries/ regions plus the German FORTA List were collated into the EURO-FORTA List including 264 items in 26 main indication groups. For only 4.2% of the proposed items the consensus results were different from the original/proposed FORTA class. This study produced seven new country/region-specific FORTA Lists as well as the EURO-FORTA List. The results of this project are going to increase the applicability of the FORTA List for international use. Non-adherence to antidepressants among older patients with depression: a longitudinal cohort study in primary care Background: Depression is common among older adults and is typically treated with antidepressants. Adherence is important for antidepressants to be effective. We aimed to determine the non-adherence rates to antidepressants among older adults in primary care, based on non-initiation, suboptimal implementation or nonpersistence. Methods: We selected all patients aged C 60 years and diagnosed with depression in 2012, from the NIVEL Primary Care Database. Non-adherence was divided into three components: non-initiation was defined as no dispensing within 14 days of the first prescription; suboptimal implementation, as fewer than 80% of the days covered by dispensed dosages; and non-persistence, as discontinuation within 294 days after first dispense. First, we determined the antidepressant non-initiation, suboptimal implementation and non-persistence rates. Second, we examined whether comorbidity and chronic drug use were associated with non-adherence by mixed-effects logistic regression (non-initiation or suboptimal implementation as dependent variables) and a clustered Cox regression (time to non-persistence). Results: Non-initiation, suboptimal implementation, and non-persistence rates were 13.5, 15.2 and 37.1%, respectively. As the number of chronically used drugs increased, the odds of suboptimal implementation (odds ratio 0.89; 95% CI 0.83-0.95) and of non-persistence (hazard ratio 0.87; 95% CI 0.82-0.92) reduced. Key conclusions: Non-adherence to antidepressants was quite common. Adherence is better when patients are accustomed to taking larger numbers of drugs, but this only provides partial explanation of the variance. General practitioners should be aware of the high rates of nonadherence. Elaborating on the efficacy and optimal length of antidepressant therapy might be prudent first steps to improve adherence. Rivaroxaban in real geriatric clinical practice: prescribing pattern and inappropriate dose prescription in patients with nonvalvular atrial fibrillation. Experience of a center Rivaroxaban is gaining currency in clinical practice to reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF). Elderly are under-represented in the trials that proved efficacy and safety of rivaroxaban, with 18% of patients over 80-years-old. Our goal was to report use of rivaroxaban in real geriatric clinical practice describing the pattern of prescription in a teaching-hospital. From January 2017 to April 2018, 53 patients, with a median age of 85, treated with rivaroxaban for NVAF were included. Demographic, biologic, therapeutic data with doses, coprescription and comorbidities were collected from the hospital's electronic records. They were then compared to ROCKET patient's profile. Patients were at low embolic risk compared to ROCKET study patients (mean CHADS2 2.72 ± 1.18 vs 3.5 ± 0.9; p \ 0.0001). They had lower rates of coexisting illnesses, regarding stroke histories (18.9% vs 54.9%, p \ 0.0001), diabetes (22.6% vs 40%, p = 0.013) and heart failure (37.7% vs 62.6%, p = 0.0003) anyway more ischemic cardiopathies (30.2% vs 16.6%, p = 0.014), and renal impairment (Cockcroft creatinine clearance 48 vs 67 mL/min, p \ 0.0001) were reported. Fourteen patients (26.4%) received an inappropriate dose despite guidelines that suggest adjusting prescription to renal function; 9 of them (64%) received a reduced dose instead of a standard dose. No predictive factors of underdosing were underlined. Inappropriate dose prescription of rivaroxaban is frequent in elderly patients treated for NVAF. Direct oral anticoagulants need to be prescribed with doses tailored to renal function if we want to reach efficacy and safety previously described in large clinical trials and registries. A survey on polypharmacy of older population in Japan; an analysis of health care claims data from a local city Masahiro Akishita 1 1 The University of Tokyo, Tokyo, Japan Aim: To clarify the status of drug prescriptions of general population including older adults in super-aged society, this study investigated the status of drug prescriptions by using the claim data of older adults in a local city in Japan. Methods: Drug prescriptions of older adults aged 65 years or older in a Japanese city (approximately 230,000 of population and 65 years or older was 34%) were investigated using health care claims data. Age group, sex, number of medical facilities used, and 8 most frequent diseases were assessed and whether these factors were associated with polypharmacy ([ 5 drugs) or not was analyzed using logistic regression analysis. Results: Total of 50,983 older adults (C 65 years) were analyzable and polypharmacy was seen in 35.3%. Polypharmacy was most frequent in the age group of 85-89 years (51.6%) and the number of medical facilities used was 1: 55.2%, 2: 30.7%, 3: 10.4%, and 4 or more: 3.7%. The prevalence of 8 major diseases was hypertension: 59.9%, dyslipidemia: 43.0%, peptic ulcer diseases: 41.5%, diabetes: 29.3%, neuralgia: 22.5%, arthritis 21.0%, osteoporosis: 18.9%, and coronary disease: 18.4%. In multiple regression analysis, older age, multiple use of medical facilities, and each disease were independently associated with polypharmacy. Key conclusion: In a city of super-aged society, the prevalence of polypharmacy was high and increased with age, multiple use of medical facilities, and diseases. Surprisingly, polypharmacy was most seen in the age group of 85-89, which is similar to the mean life expectancy of Japan. Overdose in vitamin K antagonist's administration in the elderly: clinical aspects The Department of Internal Medicine of the University Hospital of La Rabta, Tunis, Tunisia Introduction: Vitamin K antagonists (VKA) are widely used for the curative treatment of thromboembolic events. The aim of this study is to describe the clinical aspects of overdose in VKA administration and determine its hemorrhagic factors in elderly. Methods: A retrospective analysis was carried out with elderly patients treated with VKA. All patients with an INR greater than 4 were included. We studied patients gender and age, VKA use period, other associated drugs, indications, INR value, presence of hemorrhage and immediate management. Results: There were 31 patients complicated with 35 events of VKA overdose. Acenocoumarol was the only prescribed VKA. Sex ratio favored women (0.82). The average age of patients was 73.7 years. Forty one percent were smokers (n = 13). Multi-morbidity was seen in 19.35% of patients (n = 6). Indications were deep vein thrombosis in 83.87% (n = 26), superficial thrombophlebitis in one patient, pulmonary embolism in 19.35% (n = 6), portal vein thrombosis in on patient, inferior vena cava thrombosis in one patient. High level of homocysteine was found in 25.8% (n = 8), tumors in 2 patients, Behçet's disease in one patient, antiphospholipid syndrome in two patient, activated protein C resistance in one patient and indeterminate causes in 54.83% (n = 17). Most of events happened in the first 6 months of use: 40% (n = 14). Medium value of INR was 8.16 (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) . Overdose was complicated with hemorrhagic signs in 48.57% of events (n = 17). Hemorrhagic symptoms were mainly represented by hematuria (n = 8) and bruising (n = 5). Major bleeding episodes were found in 25.71% of events (n = 9) and they were represented by melena in 4 events (11.42%) and deep muscle hematoma in 5 events (14.28%). Miss use was observed in 31.42% (n = 11), indeterminate causes in 40% (n = 14), Drug interaction in 4 events (antibiotics, fibrate, nonsteroidal anti-inflammatory drugs). Kidney failure was found in 19.35% of patients (n = 6). VKA assumption was suspended transiently in all patients and vitamin K was prescribed in 34.28% of events (n = 12). Conclusion: VKA can cause serious side effects. The reduction in VKA overdose requires caregivers to manage overdose factors and provide proper patient education. A prospective three-year study of risk factors for repeated hospitalizations in patients of 65 years old and older Introduction: The development of effective and safe schemes of pharmacotherapy in elderly patients is an important problem of healthcare. Methods: A prospective three-year (2015-2017) observational study was conducted to analyze the impact of co-morbidities and different regimes of drug therapy in the prehospital stage for the frequency of repeated hospitalizations in patients 65 years old and older regardless of sex. Results: One hundred and forty seven patients (36.7%) from 401, included in the study had the repeated hospitalizations. The highest frequency (69 cases) of repeated hospitalizations was seen in participants of 75-84 years old. Anemia (OR 16.68, , p = 0.00793), bronchial asthma (OR 7.55, 95% CI 1.77-32.2, p = 0, 0063), diabetes mellitus (OR 0.4, 95% CI 0.24-0.69, p = 0.00091), arthropathy (arthritis, arthrosis) (OR 2.5, 95% CI 1, 37-4.55, p = 0.00294) and pain (OR 4.48, p = 0.0005) were associated with a higher risk of repeated hospitalizations. Prehospital pharmacotherapy analysis revealed that the use of acetylsalicylic acid (OR 1.91, 95% CI 1.29-2.84, p = 0.00115); losartan (OR: 1.92, 95% CI 1.17-3.17, p = 0.00952); enalapril (OR 1.97, p = 0.01) were also associated with the increased risk of re-hospitalization. Polypharmacy (defined as simultaneous administration of 5 or more drugs) was observed in 86 (58.5%) re-hospitalized patients and most often in persons 85 years old and older. Key conclusions: Further studies are required to assess the effect of the combination of risk factors for repeated hospitalizations in these patients. Association between socioeconomic status and medication-related harm in elderly patients: a multicentre prospective cohort study in England [1] . Lower socioeconomic status (SES) is associated with polypharmacy and inappropriate medication use [2] . Our study investigated the relationship between SES and MRH in older adults. Methods: Methods for this study are published [3] . Patients aged 65 + years were recruited at hospital discharge from 5 teaching hospitals in England between 2013 and 2015. Patients were followed up for 8-weeks by senior pharmacists to identify MRH using 3 data sources: hospital readmissions, GP records and patient interviews. Based on residential postcodes, Index of Multiple Deprivation quintiles [4] were used as a standard proxy measure for patient SES (1 least deprived, 5 most deprived). Logistic regression models, adjusting for confounders (age, gender, number of medicines, Charlson index, Barthel index), were used to examine the association between SES and MRH. Results: 1116 patients (median age 82; 58% female) were included. 413 patients experienced MRH, of which 301 (73%) experienced MRH from adverse drug reactions, 45 (11%) from non-adherence, and 67 (16%) from combinations of these and medication errors. In the univariate analysis, lower SES was significantly associated with MRH due to non-adherence (OR 1.27, 95% CI 1.08-1.49, p = 0.004). Multivariable logistic regression, controlling for confounders, found this relationship to remain significant (OR 1.39, 95% CI 1.07-1.82, p = 0.015). There was no association between lower SES and adverse drug reactions (OR 0.92, 95% CI 0.84-1.01, p = 0.092). Key conclusions: Lower SES is independently associated with MRH due to non-adherence, but not ADR. This association might be mediated by lower health literacy in patients with low SES. Introduction: Falls are a major health problem in older adults and are often associated with prescription drug use [1] . In many fall-risk increasing drugs large differences in the required doses can be due to genetic polymorphisms in drug-metabolizing enzymes [2] . We analyzed the drug-related risk of falling in community-dwelling elderly and the potential pharmacogenetic impact. Methods: Data of the ActiFE Ulm study were analyzed [3] . Participants were grouped as fallers and non-fallers according to a prospective recording over 1 year using fall calendars. Characteristics and use of drugs was compared using logistic regression analysis. Those drugs significantly associated with falls were classified according to their dependence on highly variable metabolism and transport based on information in drug labels and the pharmacogenomics databases. Results: In total, 1506 community-dwelling people aged 65 and older were enrolled. Of this cohort, 458 (32.3%) reported at least one fall with 162 (11.4%) reporting multiple falls, whereas 958 (67.7%) reported not being fallen. Polymorphic CYP enzymes were nominally more often involved in metabolism of substances taken by fallers, although not significant. Many drugs associated with falling were metabolized by phase II enzymes. Key conclusions: The impact of pharmacogenomics variation in the older adult appears to be moderate only. But confirmatory studies concerning the influence of pharmacogenomics interacting with age, drug metabolism, multimorbidity, and polypharmacy on drug-associated falls in the older adult are urgently needed [4] . Background: Cardiovascular diseases are frequent in elderly populations. Patients often need to take several drugs. Objectives: We aim to evaluate the frequency of cardiovascular drugs and assess a computer algorithm to reduce the number of drugs by substituting with polypill. Methods: Extraction of drug orders from patients admitted in a cardiogeriatric ward during 1 year (2015) . We listed all combinedfixed dose available on the market then using ATC code, spotted all cardiovascular drugs and combined every possible associations of two and three components; We created an algorithm proposing available combined-fixed dose and applied it into a random sample of 100 patients. The main criterion of judgment was the diminution of the number of drugs that would be obtained by substituting with combined fixed dose using the algorithm into the random sample (Student Test on matched data). Results: 505 patients were included. They took an average of 2.2 cardiovascular drugs. The most prescribed drugs were b-blockers (48%), statins (45%), anti-platelet agents (42%) and Angiotensin Converting Enzyme Inhibitor (42%). In France there were 87 fixed dose combined drugs marketed. In the 100 random patients sample there were 162 combinations of three components and 252 of two components. The algorithm showed that an available association could be employed in 10% of patients, reducing the number of pills from 220 to 210 (p \ 0.01). Conclusion: Systematic use of available fixed-dose drug combinations can reduce the number of pills taken by elderly patients with cardiovascular diseases. However, available commercial associations do not match well the most frequent combinations of drugs actually prescribed to these patients. Main title: Treatment of sleeping problems in acutely hospitalized older patients. Subtitle: Results from a survey among Dutch geriatricians Introduction: Sleeping problems among older patients are a hospital wide problem. There is insufficient evidence to support a specific treatment of sleeping problems in acutely hospitalized older patients. Based on the little evidence available, a national guideline was published about this topic in The Netherlands in 2015. We investigated how sleeping problems are treated in Dutch hospitals and whether medical doctors followed the recommendations in the guideline. Methods: A survey was conducted among geriatricians in Dutch hospitals between February and April 2018. It consisted of questions regarding non-pharmacologically and pharmacologically treatment preferences, whether geriatricians were informed and had knowledge of the guideline and acted accordingly. Results: In the survey 36% of the Dutch hospitals were represented. First choice of treatment was non-pharmacological treatment, such as treatment of symptoms associated with sleeping problems (e.g. pain, dyspnoea) and improvement of sleep environment. Pharmacological treatments were indicated as last option and prescribed sometimes. First choice of medication was benzodiazepines (47.5%) and second choice melatonin (18.3%). Only 32.8% of participating geriatricians had ever been informed about the guideline, the publication of the guideline has changed their treatment of older patients with sleeping problems. Treatment decisions were mostly based on advice of a more experienced colleague (47.5%) or on the Dutch national pharmacological manual (50.8%). Key conclusions: Geriatricians were not well informed about the guideline and acted partially accordingly. Besides adherence to the guideline more evidence based treatment is needed, as most treatments occur now practice based with a rather large practice variation. Reducing use of inappropriate medication by personalizing pharmaceutical care and optimal use of professional resources in nursing homes: PEP, a controlled demonstration study Background: Increasingly, frail seniors in Canadian nursing homes (NH) receive polypharmacy comprising inappropriate medications. PEP, initiated by the pharmacists of the greater Quebec City Health Board (30 NH), is an evidence based intervention to optimize pharmaceutical and nursing care, facilitated by expanded competencies empowering pharmacists and nurses. The objective was to evaluate whether PEP is: (1) reducing polypharmacy/inappropriate medications; (2) beneficial regarding adverse outcomes (emergency visits, hospitalization, falls); (3) cost-effective. Methods: PEP updates practices to recent legal changes using (1) tailored knowledge exchange sessions for pharmacists, nurses and physicians, (2) short information sessions for personal care workers and (3) leaflets for residents/their families. Pharmacists perform medication reviews in consultation with nurses, residents/families and physicians using published criteria aimed at deprescribing inappropriate medications. They use collective prescribing for a more timely treatment of minor illness such as constipation. The project was approved by the local ERB. Results: The intervention concerned 601 residents in 3 NH, a pilot (n = 96), an intervention (n = 263) and a control NH (n = 242). 10 months data show that PEP is feasible and support objective 1: the mean number of regular medications per resident fell from 12.0 in May 2017 to 10.2 medications in March 2018 in the intervention NH and from 9.9 to 9.3 in the pilot NH, as compared to 13.7 and 13.4 in the control NH. Discussion/conclusion: Preliminary data are creating a momentum to unroll PEP in further NH in the province of Quebec/Canada. Results from PEP may help to decrease inappropriate medication use in NH. Estimation of glomerular filtration rate in elderly hospitalised patients using cockcroft-gault and modification of diet in renal disease (MDRD) equations K Nagaratnam 1 , J Akerman 1 1 Royal Berkshire Hospital, Reading, UK Introduction: Dosing of several medications including antibiotics and anticoagulants is adjusted according to renal function. Glomerular filtration rate is the best index of renal function. Cockcroft-Gault (CG) equation is traditionally used to estimate Glomerular Filtration Rate (eGFR). Four variable Modification of Diet in Renal Disease (4vMDRD) equation has become available recently. Estimated GFR using 4vMDRD equation is readily available with routine lab results in our hospital. We aim to assess the impact of using CG and 4vMDRD equations to estimate GFR in elderly hospitalised patients. Methods: In this cross-sectional study we calculated the eGFR using CG equation (CG-eGFR) for inpatients in acute elderly care wards and compared it with eGFR reported with the lab results using 4vMDRD equation (MDRD-eGFR). Results: Total of 102 patients were recruited with the median age of 85-years, of which 60.7% (62/102) were females. Mean CG-eGFR vs MDRD-eGFR was 53 ml/min/1.73 m 2 vs 67 ml/min/1.73 m 2 (p \ 0.00). On average the difference between two estimates was 22 ml/min/1.73 m 2 . Only 31% of the patients were categorised in the same stage of Chronic Kidney Disease (CKD) by both methods. MDRD-eGFR overestimated renal function in CKD stages 30-44, 45-59, 60-89, [ 90 ml/min/1.73 m 2 compared to CG-eGFR; the discordance was 42, 87, 63 and 79% respectively. Conclusions: Our study demonstrated high discordance between the estimates of GFR using CG and 4vMDRD equations. Although it is readily available with the lab results judicious consideration is warranted when using MDRD-eGFR for drug dosing in elderly patients. Larger studies are needed to further evaluate this discrepancy in older patients. Observational study of management of curative anticoagulant therapy with direct oral anticoagulant among a hospitalized geriatric population S. Higuet 1 , J. Bourgeois 2 , J. Peeterbroeck 2 , C. Lelubre 2 , J. C. Wautrecht 2 1 CHU Charleroi, Charleroi, Belgium and GBHI, Dublin, Ireland, 2 CHU Charleroi, Charleroi, Belgium Introduction: With the use of new oral direct anticoagulants (NOACs) and their different guidelines it seemed interesting to analyze practices in real life in a geriatric hospitalized population. Methods: This is a retrospective study about all patient over 75 years old who was hospitalized in Geriatric ward (CHU Charleroi) between 01/10/2015 and 31/08/2017 and who received at least one dose of low molecular weight heparin(LMWH) and one dose of NOAC. Demographical data, reasons of anticoagulation, reasons of bridging and bleeding complications were analysed. Results: Patients were anticoagulated for the following reasons: atrial fibrillation (83.75%), pulmonary embolism (8.75%), atrial flutter (3.75%), deep vein thrombosis (3.75%). One quarter had a bridging, 31.25% received a new treatment and 43.75% had already a chronic treatment. Mean CHA2DS2-VASc was 5. The average length of stay (LOS) was 27.3 days. At the discharge, the majority (84%) had a NOAC. The main reason for ''bridging'' were gastroscopy and colonoscopy (55%) There were 8.75% bleeding complications. These bleeds were essentially digestive (3.75%) or intracranial (2.5%). Conclusion: Our results show that the main reason for anticoagulation is atrial fibrillation and there is a low rate of bleeding complications in geriatrics but the LOS is elevated. This study confirms that NOACS, used in geriatrics, give few complication but in reason of the different guidelines for the different molecules, a dissemination of the recommendations (of each NOAC as well as the algorithm of bridging) within the units would improve our practices. In-hospital adverse drug reactions in hospitalised older adults-a systematic review Conclusions: One in four over 65 years experience an ADR during hospitalisation, one third being severe, and almost half cardiovascular system drugs. Clinical outcomes associated with ADRs are generally poorly described in the literature. Benefit of statins after a first myocardial infarction in the oldest old. A cohort study using general practitioner data from the CPRD Pharmacology, Faculty of Science, Utrecht University, Utrecht, The Netherlands Introduction: Currently, in patients aged 80 and above, 50-80% use statins post myocardial infarction (MI). However, evidence to support initiation and use of statins in this population lacks. Therefore our aim was to investigate effects of cumulative statin use on MI, stroke or cardiovascular mortality (primary outcome) and on overall mortality in patients 80 years and older after first MI. Methods: A cohort study in the Clinical Practice Research Datalink was conducted between January first, 1999 and February 26, 2016. A total of 3900 patients aged 80 and above, hospitalised for first MI, surviving 30 days after discharge, without statin treatment 1 year before hospitalisation, were included. Time varying Cox regression was used to estimate HRs and 95% confidence intervals (CI) of statin treatment on the primary outcome and mortality, adjusted for confounders including frailty. HRs were converted into numbers needed to treat (NNT) and adjusted for 2 year mortality. Results: Comparing over 2 years statin treatment to no/less than 2 years statin treatment on the primary outcome resulted in a HR of 0.81 (95% CI 0.66-0.99) and a NNT of 59 over 3 years, increasing to 93 after adjusting for 36.2% mortality. Over 2 years statin treatment decreased mortality (HR 0.84; 95% CI 0.73-0.97). Conclusion: Protective effects of statins initiated after a first MI and continued for at least 2 years were found in patients aged 80 and older. When considering the mortality during and after hospitalisation and competing risks thereafter in old age, initiating statins may not benefit all. Clinical impact of potentially inappropriate prescriptions identified using STOPP/START criteria version 2 in older patients according to discharge setting: an Italian multicenter prospective study Introduction: Poly-pathology exposes older patients to polytherapy, potentially leading to adverse outcomes. The STOPP/START criteria are intended to optimize prescription in older patients [1] . Few studies have investigated potential inappropriate prescribing (PIP) using their updated version (STOPP/STARTv2), mainly retrospectively and in community-dwellers. Methods: Multicenter prospective observational study on patients C 65 years discharged from geriatric and medicine wards between March-June 2017. STOPP/STARTv2 were applied at discharge to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Death and readmissions at 6 months were investigated through telephone interviews. Variables associated with outcomes according to discharge setting (home vs medium/longterm care facility, MLTCF) were identified through multivariate logistic regression. Terminally-ill patients were excluded. Results: On a sample of 611 patients (mean age 81.6 years, 48.4% females, 34.2% MLTCF-discharged, mean drugs at discharge 7.7 ± 3.2), we recorded a 71.7% PIP prevalence, with PIMs being more common than PPOs (54.9% vs 47.3%). Among other variables, a higher number of drugs at discharge was associated with both PIMs and PPOs, while geriatric discharge was protective for both. At follow-up we observed a 25.0% mortality and a 30.9% readmission rate. Neither PIMs nor PPOs were found to be associated with overall mortality both in home-discharged and in MLTCF-discharged patients. A higher number of PIMs was significantly associated with hospital readmission in home-discharged patients (OR 1.37, 95% CI 1.13-1.68), along with cardiac (OR 1.68, 95% CI 1.03-2.74) and renal (OR 2.38, ) comorbidities, while the only variables associated with readmission in MLTCF-discharged patients were a higher drug burden (OR 1.27, ) and the presence of neurological comorbidities (OR 2.37, . Key conclusions: In this study we observed a high prevalence of PIP, involving both PIMs and PPOs. On MLTCF-discharged patients, with worse health and functional statuses, PIP according to STOPP/ STARTv2 was neither associated with death nor with readmissions. Among home-discharged patients, a higher number of PIMs was associated with hospital readmission. Introduction: DOACs (dabigatran, rivaroxaban, apixaban and edoxaban) were introduced in Norway from 2012, and are replacing warfarin as main oral anticoagulant in Norway. Although DOACs are thought to have less drug interactions than warfarin, interactions do exist and they may have most impact on the oldest, most vulnerable patients, due to polypharmacy and multimorbidity [1] . Methods Data is collected from The Norwegian prescription registry which is nationwide and includes all pharmacy dispensings. A case from Norwegian Medicines Agency adverse drug reaction database is presented. Results: Changes in the dispensing of oral anticoagulants from 2012 to 2017 (%): warfarin 18.87-9.71, dabigatran 0.82-2.49, rivaroxaban: 0.27-5.83, apixaban: 0.07-10.23 and edoxaban: 0.00-0.08. Changes in the age group [85] [86] [87] [88] [89] [90] . We received a report about an 87-year-old woman using dabigatran who 9 days after the start of Helicobacter Pylori eradication treatment with clarithromycin, amoxicillin and pantoprazole, was admitted to hospital. She had acute on chronic kidney failure and INR (international normalized ratio) was very high, a sign of dabigatran accumulation suspected caused by drug-drug (dabigatran-clarithromycin) and drug-disease (dabigatran-kidney failure) interactions. She was treated with dialysis and antidote idarucizumab. Key conclusions: We urge medical practitioners to be aware of the risk of drug interactions in the increasing elderly population using a DOAC. Reference: 1. Stöllberger C (2017) Drug interactions with new oral anticoagulants in elderly patients. Expert Rev Clin Pharmacol 10(11):1191-1202 Analyse of reasons to keep potentially inappropriate medications after a multidisciplinary evaluation in an acute geriatric unit Cindy Riffardy 1 , Armance Grevy 1 , Prudence Gibert 1 , Clara Lopez 2 , Nathalie Mitha 2 , Nabil Zerhouni 2 , Pierrick Bedouch 1, 3, 4 , Gaetan Gavazzi 2, 4 1 Pharmacy Department, Grenoble Alpes University Hospital, F-38000, France, 2 University clinic of geriatric medicine, Grenoble Alpes University Hospital, F-38000, France, 3 ThEMAS, CNRS/UGA TIMC-IMAG UMR 5525, F-38000, France, 4 University Grenoble Alpes, F-38000, France Introduction: Potentially inappropriate medications (PIM) in elderly are an iatrogenic illness source. However, interventions to reduce PIM usually do not allow a complete stop of all PIM. This study's objective is to measure the rate of PIM, which are finally continued after multidisciplinary reevaluation and record the reasons why PIM still remain. Method: Prospective study on prescriptions at admission (usual treatment) and discharge in patients over 75 years old hospitalized in acute geriatric unit from 01/25 to 04/25/2018. The aim of multidisciplinary intervention composed of a pharmacy students, pharmacy and medical residents and geriatricians, is to evaluate for each patient if PIM prescriptions according to v2 STOPP/START list are really inappropriate or not and to decide to stop or keep them. Results: In the study, 101 patients were included and 70.3% (n = 71) had at least 1 PIM at home. In all, 147 PIM were found and 72.8% (n = 107) were discontinued after the multidisciplinary intervention. There are two main situations where PIM are continued: discontinuation proposed to the general practitioner at distance of hospitalization, and treatments with clinical situation that justifies their use. These cases concerns benzodiazepines (40%, n = 16), neuroleptics (20%, n = 8), and proton pump inhibitors (PPI) (15%, n = 6). Conclusion: This study shows a high prevalence of PIM in hospitalized geriatric population and a beneficial effect of multidisciplinary intervention for their reassessment. PIM maintained at discharge are complex treatments to stop in the context of hospitalisation. A medication review at distance should be proposed to general practitioner in the discharge letter. Preventable iatrogenic acute renal failure leading to lactic acidosis: a still topical adverse effect! Cindy Riffardy 1 , Armance Grevy 1 , Prudence Gibert 1 , Clara Lopez 2 , Nathalie Mitha 2 , Nabil Zerhouni 2 , Pierrick Bedouch 1,3,4 , Gaetan Gavazzi 2, 4 1 Pharmacy Department, Grenoble Alpes University Hospital, F-38000, France, 2 University clinic of geriatric medicine, Grenoble Alpes University Hospital, F-38000, France, 3 ThEMAS, CNRS/UGA TIMC-IMAG UMR 5525, F-38000, France, 4 University Grenoble Alpes, F-38000, France Introduction: Although risk factors are well known, drug combinations leading to acute renal failure (ARF), which can cause metformin overdose, are still prescribed especially in geriatric population. Methods: We report a typical avoidable iatrogenic lactic acidosis case managed in our acute geriatric unit. Results: Mrs C, 89 years old, started suffering from lower back pain a month before hospitalization. Her usual treatment contains metformin for type 2 diabetes, valsartan/hydrochlorothiazide combination and rilmenidine for hypertension. A paracetamol/opium and non-steroidal anti-inflammatory (NSAIDs) drugs prescription (meloxicam and topical administration of diclofenac) is introduced. Due to an increase of pain 2 week later, a 30 mg long-acting and 10 mg immediate release morphine prescription is added. Three days later, Mrs C is admitted to the emergency department for delirium. Clinically, she presents a bradypnea (7/mn) and depressed conscious status. A lactic acidosis and a respiratory failure were diagnosed related to metformin overdose in an iatrogenic ARF context and a morphine overdose. She is then admitted to intensive care unit where she is dialyzed, an antagonization of morphine is done and her usual treatment is stopped. Three weeks later, we notice a partial recovery of the renal function (CrCl: 34 mL/min/1.73 m 2 (CKDEPI/3 months ago: CrCl: 51 mL/min/1.73 m 2 ). Conclusion: Although this adverse effect is well known, this case report reminds us the need for adapting metformin dosage with renal function, and to avoid combination of drugs at risk of ARF. Furthermore, NSAIDs drugs are potentially inappropriate medications in the elderly with a CrCl \ 50 mL/mn according to the STOPP list. Analyse of reasons to keep potentially inappropriate medications after a multidisciplinary evaluation in an acute geriatric unit Riffard Cindy 1 , Grevy Armance 1 , Gibert Prudence 1 , Lopez Clara 2 , Mitha Nathalie 2 , Zerhouni Nabil 2 , Bedouch Pierrick 1, 3, 4 , Gavazzi Gaetan 2, 4 1 Pharmacy Department, Grenoble Alpes University Hospital, F-38000, France, 2 University clinic of geriatric medicine, Grenoble Alpes University Hospital, F-38000, France, 3 ThEMAS, CNRS/UGA TIMC-IMAG UMR 5525, F-38000, France, 4 University Grenoble Alpes, F-38000, France Introduction: Potentially inappropriate medications (PIM) in elderly are an iatrogenic illness source. However, interventions to reduce PIM usually do not allow a complete stop of all PIM. This study's objective is to measure the rate of PIM, which are finally continued after multidisciplinary reevaluation and record the reasons why PIM still remain. Method: Prospective study on prescriptions at admission (usual treatment) and discharge in patients over 75 years old hospitalized in acute geriatric unit from 01/25 to 04/25/2018. The aim of multidisciplinary intervention composed of a pharmacy students, pharmacy and medical residents and geriatricians, is to evaluate for each patient if PIM prescriptions according to v2 STOPP/START list are really inappropriate or not and to decide to stop or keep them. Results: In the study, 101 patients were included and 70.3% (n = 71) had at least 1 PIM at home. In all, 147 PIM were found and 72.8% (n = 107) were discontinued after the multidisciplinary intervention. There are two main situations where PIM are continued: discontinuation proposed to the general practitioner at distance of hospitalization, and treatments with clinical situation that justifies their use. These cases concerns benzodiazepines (40%, n = 16), neuroleptics (20%, n = 8), and proton pump inhibitors (PPI) (15%, n = 6). Conclusion: This study shows a high prevalence of PIM in hospitalized geriatric population and a beneficial effect of multidisciplinary intervention for their reassessment. PIM maintained at discharge are complex treatments to stop in the context of hospitalisation. A medication review at distance should be proposed to general practitioner in the discharge letter. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 (19) and anticholinergics (15). Antidepressants (7), Digoxin (7) benzodiazepines (5), antibiotic prophylaxis 4 , high dose iron supplements 4 and verapamil (1) featured less prominently. Full implementation of the EU (7)-PIM list would have resulted in one-in-four medications being discontinued. High levels of medication consumption amongst older patients discharged from hospital reflects high symptom burden and continued prescribing of PIMs. Deprescribing tools focussing on common PIMs should be implemented widely as part of a comprehensive geriatric assessment to reduce patient harm from inappropriate prescribing. The OptimaMed intervention study to reduce medications of questionable benefit among nursing home residents with advanced dementia: first results The CAS is a validated functional outcome measure that allows an assessor to award an objective score based on a patients ability to complete three functional activities depending on the level of assistance they need to do so. The activities are: Get in and out of bed, Sit to stand to sit from chair and to walk. The score for each is 0 if not able to perform the task despite human assistance or cueing, 1 if able to with human assistance or cueing or 2 if able to with no human assistance or cueing. The aim of this study was to investigate how useful the CAS could be for measuring functional progress during rehabilitation of hip fracture patients. Methods: Prospective study of consecutive hip fracture patients admitted in a 6 months period to a UK teaching hospital. The CAS prior to fracture, on the first postoperative day and on discharge were collected. Results: 240 patients were admitted in the study period 18 patients were excluded; 4 who were treated conservatively and 14 who died. 222 were included; 163 females and 59 males with mean age of 83 and 79.6 years respectively. The average CAS before fracture was 5.6, on the first postoperative day was 2.2 and on discharge was 3.6. On discharge patients were generally able to do the activities with less assistance and mobilise further but the tool does not allow measurement of this level of improvement. Conclusion: The utilisation of the CAS for hip fracture patients allowed to evaluate the pre-fracture activity status retrospectively and provided the therapists with an objective and easy tool to assess the functional status and monitor the postoperative progress during the acute rehabilitation phase. However the tool is not sensitive enough to monitor small improvement in function. Experiences with community services in surgical and non-surgical hip fracture patients post-discharge in Singapore (2 or 3) and the services provided included medical stabilization, nursing care, rehabilitation and carer training. Nonsurgical patients had readmission rates of 0.33 at 1 month and 0.55 at 3 months post-discharge. In comparison, surgical patients had rates of 0.13 at 1 month post-discharge and 0.21 at 3 months. In non-surgical patients, mortality was 32.7% at 6 months post-discharge, compared to 4.7% in surgical patients. Conclusion: CCT is useful for the management of frail, medically complex patients who sustained hip fractures. Even within this frail group, surgical intervention seems to give much better outcomes. This continues to strengthen the case for encouraging operative management as it can prevent negative outcomes in this vulnerable population. Geriatrician case-note summarising improves income-dependent clinical coding in older patients undergoing vascular surgery Introduction: NHS hospitals are reimbursed for care provided based on clinical codes generated from patients' records. This is termed 'Payment by Results (PbR)' and is based on a national tariff system [1] . Whilst PbR was designed to reward efficiency and to focus care towards quality and innovation, there are inherent difficulties related to coding accuracy, which is largely dependent on clinical record quality [1] [2] [3] . Coding is performed by clinical coders, who are not permitted to interpret records. Failure to document secondary diagnoses and complications is a common source of under-coding and lost revenue [2, [4] [5] . We hypothesised that physician case-note summarisation would improve documentation and accuracy of coding in older vascular patients. Methods: During a 6 months run-up period (emerging project), we structured a multi-professional network (digestive surgeons, anesthetists, geriatricians, digestive oncologists, epidemiologists), we elaborated a innovative peri-operative geriatric intervention (Improved program) in digestive surgery setting based on evidence-based data. We build a dedicated evaluation plan by determinate the best design for assessing geriatric intervention in this complex context and choose the more appropriate endpoints. Results: We will include 554 patients aged 75 or more with resectable digestive cancer in a randomized controlled trial. The intervention is based on (1) a preoperative geriatric assessment, focusing on frailty parameters and developing a coordinated program of tailored geriatric interventions (2) a postoperative shared care with an integrated care model where both surgeon and geriatrician share responsibility for the patient management in surgical ward. This geriatric postoperative management will be focus on prevention and correction of complications, early mobilization, optimal nutritional support. The main endpoint is Grade II or higher post-surgical complications rate according Clavien-Dindo classification within 30 days after the surgical procedure. Conclusion: We expected to demonstrate a benefit of a peri-operative shared management model to decrease the risk of post-surgical complications in older patients with digestive cancer. Pelvic ring fractures in geriatric patients Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 allowed when radiological evidence of fracture consolidation. In 12 cases of type I fractures and 14 cases of type II fractures, a minor displacement of the fracture was observed at the 30 days X-ray control. Conclusions: Fragility pelvic fractures are a relatively new entity. Type I and II fractures can be treated conservatively, but in type II, a minimally-invasive fixation would be desirable that would allow greater fracture stability and a faster mobilization of patients. The effect of timing of surgery and comorbidities on in-hospital mortality of the geriatric hip fracture population Background: The incidence of postoperative complications after colorectal cancer surgery varies between publications, and complications occurring after discharge from hospital are often not reported. The aims of this study were to investigate the proportion of frail older colorectal cancer patients who developed complications after discharge from hospital, the severity of post-discharge complications, and the time point at which the most frequent complications occurred. Methods: Patients were included if they were 65 years or older, screened positively for frailty and were scheduled for colorectal cancer surgery. Included patients were followed prospectively in hospital and after discharge for 30 days after surgery. Complications were graded according to the Clavien-Dindo classification. Results: We included 114 patients. Median age was 79 years. Twenty-two patients (19%) were discharged without complications, but developed complications after discharge. These patients had shorter length of stay (6.5 versus 10 days), were more often discharged to their own home without assistance, and had higher 5-year survival (76% vs 54%) than patients who developed complications inhospital. Post-discharge complications were most frequently grade II. The most common types of complications that were diagnosed late in the postoperative course were urinary tract infections and superficial surgical site infections. Conclusions: Complications after colorectal cancer surgery in frail older patients frequently arise after discharge from hospital. Doctors should be aware of this and inform their patients. This is increasingly important as length of stay after surgery decreases. When complications are used as a quality measure, it should be clear whether only inhospital complications are registered. Protein energy malnutrition as predictor of poor outcome after hip arthroplasty Introduction: Chronic kidney disease (CKD) and acute kidney injury (AKI) have been found associated with poor prognosis after various types of surgery. However, the prognosis associated with these disorders has been seldom studied in elderly patients after hip-fracture surgery. Acute kidney injury was also associated with increased duration of hospitalization (+ 2.24 days, 95% CI [1.24-3.23] ). Conclusion: In elderly patients after hip-fracture surgery, CKD was associated with the incidence of post-operative AKI. However, AKI but not CKD was associated with poor prognosis. Interventions to prevent post-operative AKI are needed in elderly patients. Short-use post-operative administration of nonsteroidal antiinflammatory drugs in elderly patients with hip fracture Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are an efficient post-operative analgesic. However, their use is associated with potentially life-threatening side-effects, especially in elderly patients. The objective of this study was to evaluate the safety of a single administration of NSAIDs in a geriatric population after a hipfracture surgery. Methods: Patients admitted after hip-fracture surgery in a Post-Operative Geriatrics Unit between 2009 and 2017 were included in the analysis. Peri-operative administration of NSAIDs was collected and patients were prospectively followed-up. The primary end-point was defined by the occurrence of acute kidney failure (AKI) or blood transfusion during hospitalization in our unit. Logistic regression was performed with adjustment on confounders. Results: Seven hundred and forty-six patients were included (median age 87 years [82.0-91.0], 180 (24.1%) males, CIRS2 score 9.5 [6.0-12.0], duration of hospitalization 9 days [7] [8] [9] [10] [11] [12] Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Conclusion: A single administration of NSAIDs was not associated with an increase in adverse-effects in elderly patients after hip-fracture surgery. Before-and-after hip fracture in tose who live alone Introduction: Elderly patients indicate that wellbeing is important to them, but they tend to be less focused on perceived stress. Heart Rate Variability (HRV) could be used to monitor stress levels during hospital stay. Increased stress has been correlated with sympathetic dominance, whereas positive mood is associated with a shift toward parasympathetic activity. Unobtrusive wearables allow continuous monitoring of HRV data, which can be analysed by calculating the relative contribution of the parasympathetic branch (high frequency or HF) to autonomic regulation, as well as the sympathovagal balance (low frequency/high frequency or LF/HF) [1] . Methods: In this pilot study 35 patients aged 65 and up, admitted for planned and unplanned surgery were included. Anxiety was measured 4 times a day using the trait part of the State-Trait Anxiety Inventory (STAI-T). Heart rate variability was measured using a sensor patch (Health Patch). Log transformed HF and LF/HF values in the hour before the highest STAI-T were compared to the values in the hour before the lowest STAI-T scores using paired sample T Test. Results: Complete data was available for 24 participants. In the hour before the highest STAI-T Mean HF was significantly lower in 5 subjects and mean LF/HF significantly higher in 4 subjects. In most subjects there was no significant difference in HRV measurements. Conclusions: Perceived stress was not reflected in HF and LF/HF values. Discussion: HRV is not a good measure for pre surgery stress in elderly; this could be due to loss of complexity in the heart rate signal with ageing [2] . Introduction: Older patients have stated that subjective well-being is one of their most important treatment outcomes [1, 2] . We hypothesized that peri-operative anxiety could be an important factor in changes in well-being during chirurgical trajectories. Methods: Thirty-five patients aged 65 and up, admitted for planned and unplanned surgery were included. Wellbeing was measured shortly after admission and one month after discharge using the Personal Wellbeing Index (PWI: 0-100 (= best)). Anxiety was measured 3 to 4 times a day during hospital stay using the trait part of the State-Trait Anxiety Inventory (STAI-T: 6-24 (= most anxiety)). Change in PWI and STAI-T were correlated by Pearson's R. Group analysis was performed by comparing STAI-T among participants with an increased PWI to participants with a decrease. Introduction: The widespread use of bisphosphonate therapy as an affordable solution against osteoporosis has led to the occurrence of a complication of atypical fractures in the femur. The way these fractures appear and develop can include them in the category of stress fractures. The global population aging phenomenon will bring a new challenge for the medical system, namely establishing optimal diagnostic recommendations and treatment. Methods: The case presented is of a 64-year-old female patient who was diagnosed with a left subtrochanteric fracture following a low energy trauma. Bisphosphonate treatment was initiated 6 years ago, at menopause, the patient receiving 70 mg of alendronic acid weekly. After a period of 2 years, the patient developed a similar fracture at the right hip level. Results: The initial fracture, the one at the level of the left hip, was operated and a Dynamic Condylar Screw (DCS) system was used for osteosynthesis. Consolidation evolved with difficulty and healing was achieved after 6 months. In case of fracture at the right hip we chose a centromedular implant represented by the Gamma nail, healing occurring much faster, after a 3-month interval. Conclusions: Atypical fractures of the femur are a consequence of changes in micro and macro-architecture of bone induced by longterm treatment with bisphosphonates. These patients require rigorous follow-up because they often have similar lesions in the controlateral femur. Changes in bone metabolism cause the delay of the cure and a high rate of pseudarthrosis, the centromedular implant providing superior results to the DCS. Delirium in patients with acute hip fracture admitted to a multidisciplinary orthogeriatrics unit: Incidence, characteristics and associated risk factors Introduction: To determine the incidence and associated factors for delirium in patients C 65 years old with hip fracture admitted to an orthogeriatrics unit of a university hospital. Methods: Observational study of patients admitted to the unit between November 2017 and January 2018. We registered variables related to demographic, social, clinical characteristics, blood test results and perioperatory data. The primary outcome was to determine the incidence of delirium based on the Confusion Assessment Method (CAM) and DSM-V criteria. Multivariate logistic regression analysis was performed to analyse the variables. In-hospital mortality associated with the incidence of delirium was also evaluated. Results: We included 111 patients. Seventy-one women (64%), average age 85.5 ± 7.76. Procedence: Home 100 (90.1%), nursing home 6 (5.4%), others 5 (4.5% 4-5.3) . Conclusions: Despite the comprehensive geriatric intervention, the incidence of delirium is very high in elderly patients admitted for hip fracture, especially among the male patients and those with dementia. Suffering delirium increases the risk of mortality. Therefore, next to comprehensive geriatric intervention, the implementation of additional preventive measures to decrease the incidence of delirium in the acute phase of hip fracture is required. (1.3%) , and early infection of the surgical wound (1.3%); with an overall mortality of 8.9%. There were no statistically significant differences in the development of complications related to the administration of either prophylactic or therapeutic doses of enoxaparin or Vitamin K. Conclusions: One in five hospitalized patients for HF on anticoagulant treatment due to AF suffered from severe perioperative anemia and almost two thirds required RBC transfusion. Notably, full anticoagulation bridge therapy was used in most patients, when more than half presented with a high INR. Anticoagulation practices did not impact on complication rates. Influence of frailty in older patients undergoing emergency laparotomy: a prospective study Introduction: Frailty is an established predictor of poor outcomes in older people undergoing emergency laparotomy. However, there is limited evidence supporting the use of frailty scores in predicting mortality. This study describes the influence of frailty, measured using the Clinical Frailty Scale (CFS), in older people undergoing emergency laparotomy. Methods: All patients aged 75-years or older who underwent emergency laparotomy between 8th September 2014 to 30th March 2017 were included in this prospective non-randomised study. Frailty was defined as CFS score of 5 or more. The primary aim was to establish if there was a relationship between CFS score and mortality. Results: 113 patients were included and 37 (32.7%) had a CFS score of 5-9. Frailty became more prevalent with increasing age. There was no significant difference in length of stay between the cohorts but mean time to readmission was significantly longer in those with a CFS score of 1-4 compared to those with a CFS 5-9 (451 days vs 266 days, p = 0.009). 77.9% of all patients survived to discharge (82.9% CFS 1-4 vs 67.6% CFS 5-9 p = 0.065) and 12-month mortality rate was significantly higher in the frail population (59.5% vs 28.9%, p = 0.002). Multivariate analysis showed that death within 12-months was 7.068 times more likely in frail patients. Conclusion: Frail patients undergoing emergency laparotomy have a shorter time to readmission and a higher 12-month mortality rate. We advocate the use of CFS in conjunction with other predictive factors in guiding decision making in older people requiring emergency laparotomy. Baseline characteristics, clinical outcomes and long-term survival of older patients admitted non-electively to general surgery with liver and biliary conditions Little is known about the impact of functional status on long-term survival and readmission rates in patients aged 75-years or older. This study describes baseline characteristics and clinical outcomes in older patients reviewed by our elderly care in-reach service. Methods: Prospective cohort study of all patients aged over 75-years admitted non-electively under general surgery with a diagnosis of biliary or liver disease between 8th September 2014 and 31st March 2017. Results: 171-patients were identified with a mean age of 83.1 ± 6.14-years and female predominance(60.8%). 98.2% had 2 or more comorbidities. 41.2% took 10 or more medications. 21% and 46.7% were dependent for basic and instrumental activities of daily living (ADLs) respectively. 29.2% and 15.2% had impaired mobility or cognition, and 47.6% were frail (Clinical Frailty Scale (CFS) score 5-9). The majority (63.7%, n = 109) were managed medically/noninvasively. 50 underwent endoscopic retrograde cholangiopancreatography (ERCP), 12 had a cholecystostomy and 12 had an inpatient cholecystectomy. Median length of stay was 9-days, with a 12-month readmission rate of 57.3%. Meantime from discharge to readmission was 232.7-days (3-1085, SD 256.3) . 35-patients (20.5%) were dead 12-months after admission to hospital. Strong predictors of mortality at 12-months included CFS score of 5-9, polypharmacy, ASA (American Society of Anaesthesiologists) class III-V and dependency for instrumental ADLs (p \ 0.05). Conclusions: The majority of older people admitted with biliary disorders are managed non-invasively. A fifth are dead at 1-year. Presence of frailty, dependency for ADLs, polypharmacy and ASA classification may be useful predictors of 12-month mortality. Factors that promote motor recovery in patients with hip fracture: data from the Italian Orthogeriatric Group (GIOG) study Bellelli 7, 9 1 Introduction: The Italian Orthogeriatric Group (GIOG) started in 2016 a database on hip fracture in elderly. The present analysis aimed to identify the factors that promote a complete recovery of the prefracture motor function. Methods: Of 2570 enrolled, we considered 587 patients (mean age 84 ± 7 years, 453 female) who were able to walk before the fracture and who had a follow-up. We compared data on pre-fracture motor function with that referring at 30 and 120 days of follow-up. Results: At 30 days of follow-up, the 24% of patients (140/587) recovered a complete pre-fracture motor function, while the percentage grown up to 44% (181/391) at 120 days. We found that a short term complete recovery (30 days) was significantly associated with continuous geriatric management, compared to only pre-operative or post-operative involvement (29% vs 19%, p = 0.07). Conversely, a long term complete recovery (120 days) occurred significantly in patients with fewer comorbidities (ASA score \ 3 55% vs ASA score C 3 42%, p = 0.02), and those in osteo-metabolic treatment (51% vs 39%, p = 0.02). We also observed that patients who experienced delirium during hospitalization had a worse longterm motor recovery. Key conclusion: The geriatric management could facilitate a complete short-term motor recovery when its occurred since hospitalization and continues throughout the length of hospital stay. Conversely, other factors could influence long-term motor recovery, such as comorbidity, osteo-metabolic therapy and the development of delirium, emphasizing a greater frailty of the elderly patient. Elderly hip fracture and cognitive impairment degrees Introduction: The aim of this study is to determine the influence of the cognitive impairment grades in the descriptive characteristics, complications and features at hospital discharge of older adults with hip fracture. Methods: We enrolled 534 patients with hip fracture, aged 75 years or older in an Orthogeriatric Unit of the University Hospital from León (Spain) , between December 2013 and November 2014. The cognitive impairment grades were divided into 3 groups (severe/moderate; mild; and no impairment). Descriptive characteristics, complications and ambulation capacity at discharge were collected. Results: Among the 534 participants, 499 (93%) underwent surgery. The mean age was 86.1 ± 7.3 years (75-105 years). Regarding the cognitive impairment grades, no impairment (n = 293; 77 men and 216 women; 121 subcapital and 172 pertrochanteric fractures; 11.49 ± 7.41 days), mild impairment (n = 109; 30 men and 79 women; 57 subcapital and 52 pertrochanteric fractures; 11.90 ± 5.28 days) and moderate/severe impairment (n = 132; 28 men and 104 women; 62 subcapital and 69 pertrochanteric fractures; 10.37 ± 5.81 days) did not show any statistically significant differences for sex (P [ .05), fracture type (P [ .05) or total hospital staying days (P [ .05). With respect to complications statistically significant differences were shown for delirium (P \ .001). With regards to features at hospital discharge, statistically significant differences were shown for destination (P \ .001), home move (P \ .05) and ambulation capacity (P \ .001). Conclusions: The cognitive impairment grades may determine the features and complications of older adults who suffer hip fracture. Assessing pre-operative frailty index as indicator of 90 daysmortality in a cohort of older vulnerable adults with proximal femur fracture Introduction: Hip fracture is often a fatal event in older people, associated with increased disability, morbidity and mortality, posing a significant public health concern. Predictors of adverse outcomes after hip fracture is essential to guide treatments, plan discharge and use of healthcare resources. Therefore, we sought to evaluate the ability of 25-items Frailty Index (FI) to assess the clinical variables associated with 90-days mortality in a group of elders undergoing hip fracture surgery. Materials and methods: A consecutive series of 284 elders over 65 years with proximal femur fracture was recruited in the Orthopaedic and Trauma Unit, Department of Emergency, Hospital Policlinic San Martino, Genoa, Italy. All patients underwent com-prehensive geriatric assessment pre-operatively. We retrospectively stratified patient's vulnerability on the basis of Frailty Index (FI), calculated using 25 items of the 70 provided by the list of the Canadian Study of Health and Aging (CSHA). Results: The mean age was 86.6 years ± 5.9 (range 72-103 years); 76% were females and 94% were community-dwelling. Elders presented a predominantly vulnerable phenotype (FI 0.445 ± 0.227) with fair functional status (Barthel Index 70.1 ± 25.1; ADL 4.06 ± 1.94), a severe risk for malnutrition (MNA-SF 9.19 ± 3.14) and multimorbidity (CIRS comorbidity index 3.99 ± 1.76; severity index 1.91 ± 0.33). After surgery, 88% reported at least one postoperative complication, 30% at least three complications. The inhospital and 90-days mortality were 2.8% and 15.2%, respectively. Surgical timing (t -4.03, p \ 0.0001), functional (Barthel Index t 4.4, p \ 0.0001; IADL t 3.35, p \ 0.0009) and cognitive decline (SPMSQ t -4.2, p \ 0.00001), poor nutritional status (MNA-SF t 3.99, p \ 0.0001), decreased grip strength (Hand Grip t 4.3, p \ 0.0001) and multimorbidity (CIRS comorbidity t -3.28, p \ 0.001; CIRS severity t -4.38, p \ 0.0001) were mostly associated with increased 90-days mortality. Patients who died presented a more significant impairment on Frailty Index (FI 0.141 vs 0.615; t -5.5, p \ 0.00001), resulting all extremely frail. Conclusions: Because among vulnerable elders high mortality after hip fracture surgery goes beyond the peri-operative, the assessment and stratification of frailty according to FI might be an useful tool able to delineate a possible trajectory of disability and survival. Assessing pre-operative frailty index as indicator of 90 daysmortality in a cohort of older vulnerable adults with proximal femur fracture Introduction: Hip fracture is often a fatal event in older people, associated with increased disability, morbidity and mortality, posing a significant public health concern. Predictors of adverse outcomes after hip fracture is essential to guide treatments, plan discharge and use of healthcare resources. Therefore, we sought to evaluate the ability of 25-items Frailty Index (FI) to assess the clinical variables associated with 90-days mortality in a group of elders undergoing hip fracture surgery. Materials and methods: A consecutive series of 284 elders over 65 years with proximal femur fracture was recruited in the Orthopaedic and Trauma Unit, Department of Emergency, Hospital Policlinic San Martino, Genoa, Italy. All patients underwent comprehensive geriatric assessment pre-operatively. We retrospectively stratified patient's vulnerability on the basis of Frailty Index (FI), calculated using 25 items of the 70 provided by the list of the Canadian Study of Health and Aging (CSHA). Results: The mean age was 86.6 years ± 5.9 (range 72-103 years); 76% were females and 94% were community-dwelling. Elders presented a predominantly vulnerable phenotype (FI 0.445 ± 0.227) with fair functional status (Barthel Index 70.1 ± 25.1; ADL 4.06 ± 1.94), a severe risk for malnutrition (MNA-SF 9.19 ± 3.14) and multimorbidity (CIRS comorbidity index 3.99 ± 1.76; severity index 1.91 ± 0.33). After surgery, 88% reported at least one postoperative complication, 30% at least three complications. The inhospital and 90-days mortality were 2.8% and 15.2%, respectively. Surgical timing (t -4.03, p \ 0.0001), functional (Barthel Index t 4.4, p \ 0.0001; IADL t 3.35, p \ 0.0009) and cognitive decline (SPMSQ t -4.2, p \ 0.00001), poor nutritional status (MNA-SF t 3.99, p \ 0.0001), decreased grip strength (Hand Grip t 4.3, p \ 0.0001) and multimorbidity (CIRS comorbidity t -3.28, p \ 0.001; CIRS severity t -4.38, p \ 0.0001) were mostly associated with increased 90-days mortality. Patients who died presented a more significant impairment on Frailty Index (FI 0.141 vs 0.615; t -5.5, p \ 0.00001), resulting all extremely frail. Conclusions: Because among vulnerable elders high mortality after hip fracture surgery goes beyond the peri-operative, the assessment and stratification of frailty according to FI might be an useful tool able to delineate a possible trajectory of disability and survival. Does previous functional status determine mortality after suffering hip fracture? Associated factors in 1 year followup Introduction: The mortality rate after osteoporotic hip fracture can reach 10% during admission in hospital and 30% after 12 months [1, 2] . Aim: to describe the factors that influence long-term mortality after a fragility hip fracture (FHF Introduction: The mortality rate after osteoporotic hip fracture can reach 10% during admission in hospital and 30% after 12 months [1, 2] . The aim of the study is to describe the factors that influence short term mortality after a fragility hip fracture (FHF). Methods: 3 years retrospective study (January 2015 and December 2017 , cognitive impairment 36.7%, ), CIRS-G 12 (IQR 9-16). Diabetes 25.7%. The 86.9% use antidiabetic drugs (insulin 23.0%, oral antidiabetic 70.5%). Glycated haemoglobin (HbA1c) 6.5 ± 1.2. The mean BI(b), BI(d) and BI(f) for diabetics was 82.49 ± 15. 2, 44.85 ± 18.2, 64.69 ± 29.4 and 85.82 ± 14.7, 45.22 ± 19.3, 70 .61 ± 26.6 for nondiabetic patients. Diabetic patients have higher comorbidity (p \ 0.0005), lower levels of haemoglobin (p = 0.009) and Vitamin-D (p = 0.018), use more drugs (p \ 0.0005), and have a time to surgery C 48 h (p = 0.031). Factors associated with satisfactory functional outcome after 1-year: normal cognitive (p = 0.023), BI(b) (p = 0.001), non-diabetes (p = 0.018), LI(b) (0 = 0.004), FAC(d) (p = 0.014) and non-Institutionalization (p = 0.023). In multivariate analysis the only independent predictors were BI(b) (OR 1.04; 95% CI 1.01-1.07; p = 0.007) and non-diabetes(OR 2.7; 95% CI 1.08-7.11; p = 0.033). Conclusions: The correction of anemia and levels of vitamin-D should be optimized in diabetic patients with hip fracture. There is no difference in the functional outcome at discharge of diabetic and nondiabetic patients with hip fracture, however they have worst functional outcome during the follow-up. Introduction: Drugs with effects on the central nervous system have been associated with an increased hip fracture risk through several mechanisms. Sedatives, anxiolytics and antidepressants may increase the risk of fall. Neuroleptics inhibit dopaminergic receptors and may therefore increase prolactin secretion and thus decrease bone mineral density (BMD). We aim to investigate the intake of these drugs in patients admitted for hip fracture in our Hospital and its relationship with evolution. Method: Observational, longitudinal, prospective study of 534 patients, aged 75 years or older, admitted for hip fracture during 2014. Variables: age, sex, cognitive and functional baseline and discharge status and taking of psychotropic drugs. The possible relationship between these variables was analyzed. SPSS Ò , v.22.0. Results: Among the 534 participants, 499 (93%) underwent surgery. 75.4% were women and the mean age 86.1 ± 7.3 years. Only 132 (25%) had a previous diagnosis of dementia. 64% walk independently. 26% live in nursing homes prior to fracture. 69% had Barthel [ 60. They take benzodiazepines 35%, antidepressants 32% and neuroleptics 9.7%. All were related (p \ .001) with worse ambulation at admission and discharge (p \ .01). Benzodiazepines were more frequent (49%) in the nonagenarian group (p \ .001) and antidepressants in women (35% vs. 23%). No relation was found (p [ .05) with in-hospital mortality or with the presentation of delirium. Conclusions: Patients with psychotropic drugs at admission have worse cognitive and functional status and also worse ambulation. The intake of benzodiazepines is high in the group of nonagenarians. Geriatric assessment during hip fracture admission improves the prescription of these drugs. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 S79 Objectives: We aimed to evaluate the immunogenicity of the herpes zoster live-attenuated vaccine (ZVL) in elderly and to determine whether it is influenced by frailty status and baseline cytokine levels. Methods: Community-dwelling elderly aged C 65 years were prospectively enrolled and administered ZVL after assessing their frailty status and cytokine levels. Humoral and cellular immunogenicity were assessed using enzyme-linked immunosorbent assays (ELISAs) for the varicella-zoster virus (VZV)-specific IgG antibody and VZV-specific enzyme-linked immunospot (ELISPOT) assays, respectively, before and 6-week after vaccination. Results: Sixty-nine participants (mean age, 72.3 years) were enrolled; 31 (44.9%) were prefrail-to-frail (P-F). Thirty-seven participants (53.6%) had a[ 2 geometric mean fold rise (GMFR) of IgG antibody 6-week after vaccination, 31.9% p more participants had C 10 spotforming cells (SFCs) and 42 subjects (60.9%) experienced [ 2-fold increase of GMFR of ELISPOT assay. The GMFRs of the antibody titres were similar in the non-frail and P-F groups (2.71 vs. 3 .55, respectively, P = 0.193); moreover, the baseline ELISPOT assay geometric mean values were not significantly different before (29.7 vs. 49.6, respectively, P = 0.296) and 6-week after vaccination (21.4 vs. 41 .0, respectively, P = 0.460). We observed no significant correlations between baseline cytokine levels and immunogenicity as assessed by antibody GMFR and difference of ELISPOT levels before and 6-week after vaccination. Conclusion: Approximately half of our community-dwelling elderly experienced a twofold rise in antibodies, and one-third more subjects showed C 10 SFCs ELISPOT response after ZVL administration. Our data suggest that the ZVL can boost humoral and cellular immunity to similar extents in P-F and non-frail elderly patients. Elderly living with HIV-portrait of a Portuguese population Introduction: The epidemiology of the HIV infection is changing, with significant increase in the number of elderly patients, due to prolonged survival following antiretroviral therapy (ART) but also to the rising of new diagnosis at an older age. Managing the HIV/AIDS elderly population presents numerous clinical and immunological challenges. Methods: HIV infected patients aged 65 or more years currently followed by the Infectious Disease Department at a tertiary center in Portugal were included in the study. Hospital records were reviewed. Results: There are 303 HIV infected geriatric patients (representing 15% out of 2017) at our center (73% men)-96% transmission by sexual contact. Viral co-infection has low expression (HBV 9%; HCV 1%). At diagnosis median viral load was 37,670 copies/mL and median CD4 cell count was 249 cells/mcL. Most patients (58%) were diagnosed following symptomatic infection, 17% of these had an AIDS-defining condition. In this study, 22% had one or more comorbidities (dyslipidemia 66%, diabetes 22%, kidney disease 20%, non-AIDS-defining malignancy 11%), with an average of 2.0 comorbid conditions/person. Our population shows a high adherence to ART (97%) and 88% have viral control. Key conclusions: As the HIV population ages and the rate of newly detected infections in the elderly rise, clinicians should be aware of the increasing need to balance HIV care and the management of comorbid conditions commonly associated including the potential interactions between ART and drugs used to treat age-related pathologies. The impact of the HIV/AIDS elderly population on the health-care system needs greater recognition and study. Immunization coverage in elderly: primary care physicians views and practices of the vaccination schedule and digital tools, immunization practice remains inadequate. The main objective of the study was to assess general practitioners (GPs) opinions and practices regarding older populations. Method: This study sought to identify the views of a sample of 250 GPs contacted through a local mailing list. A self-administered questionnaire was assessing socio-demographic characteristics of GPs, their views about vaccination, vaccine recommendations, barriers encountered, references they use routinely, their continuing education status. Results: 180/250 (72%) responded. GP's mean age was 42.5 years, 50% were urban GPs, 2/3 worked in a group. Two-thirds used a vaccine record. 99.5% were in favor of vaccination, 98.2% recommended influenza vaccination, 95.5% for the DTP, but only 52.2% for pneumococcal, 50% for pertussis, 21.1% for herpes zoster, Twothirds considered the illness ranges in severity, but only 5% recognized a collective interest and recommended at same level pneumococcal and pertussis vaccination. 40% used a vaccination record, 25.5% was awarded of the electronic health card. 48.8% were trained in vaccinating, 25% have taken part in a vaccinal campaign. Conclusions: Most of GPs are in favour of vaccination for elderly but very few recommended all vaccine and numerous discrepancies appeared between intentions and behaviours. Both theoretical and practical education should be enhanced on all aspect of vaccination. Impact of the adjuvanted recombinant zoster vaccine on pain and use of pain medication in adults aged ‡ 50 years Man aged 86 appears with a 72 hour rash in face, limbs and torso (back and chest). He never suffered from chickenpox before, therefore he is not vaccined for so. Aciclovir was prescribed, and yet an acute respiratory failure, anuria and hypotension were later developed. After admitted to intensive care unit (ICU), intubation and vasoactive drugs were required. He deceased mainly due to hemorragic chickenpox associated with dissiminated intravascular coagulation, pneumonia, hepatitis and glomerulonephritis. Methods and results: Laboratory dates of renal failure and stroke, as trombocytopenia, consumption of fibrinogen and complement with elevation of transaminases and lactate. Serum was positive for VZV (Varicella-Zoster Virus). Conclusions: Weakened cell-mediated immunity expected in elderly individuals could lead to more severe diseases. Delayed or weakened virus specific T-cell recognition has been shown to correlate with a more serious outcome in chickenpox (pneumonia, ataxia, encephalitis, hepatitis, and hemorrhagic conditions) that is much more common in geriatric population. Since the clinical features of breakthrough varicella are often mild, an accurate diagnosis of the clinical presentation is a difficult task. Chickenpox rash must be treated with antivirals applied onset within 24 hours. Aciclovir prescription is recommended for inmunosupressed patients. Vaccination for influenza and pneumococcus in an acute geriatric unit Introduction: Although the occurrence of cervical HPV infection in peri-and postmenopausal women remains widely controversial, this population has been targeted by screening programs for cervical cancer. Objectives: To investigate the occurrence of cervical HPV infection among peri-and postmenopausal women. Methods: A cross-sectional study was carried out and included a total of 70 women, aged 35-65 years (mean age 51.1 ± 8.4), who attended outpatient clinics of a public research hospital in São Luís, Brazil, in the period from 2015 to 2017. A questionnaire was applied to the participants regarding sociodemographic, behavioral and clinical variables. After completing the questionnaire, patients underwent the collection of endocervical material for identification and genotyping of HPV DNA using polymerase chain reaction (PCR) assay, followed by collection of material for oncotic cytology. Results: The prevalence of positive HPV DNA was 40%, being HPV 16 the most prevalent subtype (28.6%) and women aged 51-65 the most affected age group. Nevertheless, there was no statistically significant association between age and HPV-DNA status (p = 0.10). Women either positive or negative for HPV DNA showed similar characteristics regarding number of partners, condom use, smoking status, and history of sexually transmitted infections. Most non-infected women (59.5%) reported having a fixed partner, and this was shown to be a protective factor for HPV infection (p = 0.02; prevalence ratio = 0.50). Conclusion: Even though a high prevalence of high risk HPV was found in postmenopausal women, age was not associated with the occurrence of cervical HPV infection. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Introduction: Infections from the Influenza virus represent a hazard vulnerable subjects aged C 75 years who can lead to high morbidity and mortality. Because they work proximity to these patients, healthcare workers are at risk of infecting elderly patients. We aimed to determine the prevalence of influenza vaccine hesitancy and motors of vaccine acceptance. Material: The study was conducted during the 2017-2018 winter season. We determine rates to influenza infection confirmed in individuals aged 75 years or over and prevalence of influenza vaccine in health care worker. We propose them to completed a validated questionnaire on influenza vaccine to determine flu why vaccine uptake remains low among. Results: We report a case series of 56 elderly patients with influenza virus infection (55% were infected with influenza B virus) the leading cause of death in 15%. Vaccination coverage among health professionals was 19.5%: physicians (30%), nurses (29%) and administrative staff (25%). A validated questionnaire will be put in place on the web platform of the hospital center. It will be feasible in 120 s, participants were asked whether they had been vaccinated or not against the flu in the 2017/2018 flu season, and will allow a sociological analysis and behavior to refusal of vaccination. Conclusion: We expect to increase the vaccination coverage in health care worker putting in a ''new vaccine packing'' adapted to specific behavior by promoting citizen behavior £. Octogenarian women with an extensive skin rash on the leg Conclusion: Results show that there is relationship between early vascular wall changes and higher representation of opportunistic pathogens in the gut microbiome even in apparently healthy participants. We concede that gut microbiota composition shifts along with classical risk factors act together to influence vascular aging. Immune capacity determines outcome following surgery or trauma: a systematic review and meta-analysis Background: Immunological functions are altered following physical injury due to surgery or trauma. The inflammatory response elicited after injury is dependent on the magnitude of the initial injury. However, variability exists in the immune response induced where potentially only some patients are at risk of developing complications such as systemic inflammatory response syndrome after injury. This systematic review and meta-analysis examines whether lipopolysaccharide (LPS) induced cytokine production capacity of leucocytes can be used as a functional test to predict risk of developing complications after injury. Methods: Medline, Embase and Web of Science were systematically searched to identify original research articles that investigated the association between LPS induced cytokine production capacity in leucocytes and any clinical outcome or surrogate outcome measures after surgery or trauma. Meta-analysis was performed for clinical outcomes that have been investigated by two or more studies if sufficient information was supplied. Results: A total of 25 articles out of 6765 abstracts identified through the literature search were included in this review. Majority of the literature investigated the association of cytokine production capacity with the development of inflammatory complications (15 out of 25 articles). Meta-analyses demonstrated a significant standardized difference in means of cytokine production capacity between patients who developed an infectious complication compared to patients who did not for tumour necrosis factor alpha (TNFa), interleukin 6 (IL-6) and interleukin 8 (IL-8) on the first day of hospital admission for trauma patients or first post-operative day for surgical patients. No significant difference was observed for IL-1b. Conclusion: Based on the evidence currently available, it appears that at least for infectious complications, there is a potential role for cytokine production capacity as a prognostic marker. However, further research is required to establish a standardized LPS stimulation method and reporting system in order to determine a clinically meaningful stimulated cytokine production threshold which can be used in prognostic testing. Are skin senescence and immunosenescence associated intraindividually? With advancing age organs display functional deterioration. One of the factors that might contribute to this deterioration is an accumulation of senescent cells, cells that lost their proliferative capacity, but which are metabolically active. Whilst cellular senescence has been described in several organ systems, such as the skin and the immune system, it is less understood whether the senescence load, the number of senescent cells, in different organs is linked within the individual. To approach this question, we correlated senescence in dermal fibroblasts and in T-cells in 80 middle-aged and older individuals. The number of epidermal and dermal p16INK4a-positive cells in skin biopsies and immunosenescent CD4+ and CD8+ blood T-cells (i.e. end stage differentiated/senescent T-cells, including CD45RA-CCR7-CD28-CD27-,CD57+ and KLRG1+ T-cells) were compared using linear regression. Epidermal p16INK4a positivity was associated with neither CD4+ nor CD8+ immunosenescence composites. Dermal p16INK4a positivity was associated with the CD4+ immunosenescence composite. This association remained after adjusting for age, gender and cytomegalovirus serostatus. Dermal p16INK4a positivity was not associated with the CD8+ immunosenescence composite. Although we did find one significant association between skin senescence and immunosenescence, the results are not consistent over different skin layers and over T-cell subsets. We conclude that there is little evidence for a link between skin senescence and immunosenescence within individuals. Cellular senescence and chronological age in various human tissues: a systematic review and meta-analysis Methods: We searched Pubmed, Web of Science and Embase for articles that reported on senescence markers dependent on age in any human tissue. Out of 4838 unique articles, 51 articles were included in a systematic review, and 45 of these were suitable for meta-analysis. Data was extracted on the origin of tissue, senescence markers, age and gender distribution of donors and correlation coefficients. The Z-scores, transformed from the correlation coefficients through Fisher's method, were pooled under a random effects model using Comprehensive Meta-Analysis Software. Heterogeneity was reported with the I-squared test. Results: Overall, the correlation coefficient between senescence and age was 0. 276 (95% CI 0.225-0.325), with differences between tissue types. Highest mean correlation coefficients was found for brain (0.701), followed by lung (0.670). Mean correlation coefficient were lower for other tissues: artery (0.199), blood (0.290), eye (0.100), kidney (0.235), prostate (0.263) and skin (0.287). The I2 value was 67.7%. Conclusion: Senescence is significantly associated with chronological age in all human tissues. The effect size of association varies widely between tissues. Telomere dynamics relation with obesity Introduction: The relation between telomere dynamics and obesity remains unclear. Cross-sectional studies found associations between short leukocyte telomere length (LTL) and high body mass index (BMI) but longitudinal studies did not find any association between LTL attrition and BMI. In two parallel studies, we aimed to assess the relationship between obesity and telomere dynamics in different tissues. Objective: Pathogenetic relations common for both Alzheimer's disease and diabetes mellitus type 2 on the metabolic level [1] inspire our study searching for molecular and biochemical markers that enable early diagnosis of Alzheimer's Disease (AD). Previous studies indicate that serum concentrations of selected steroid hormones and amino-thiols could serve as effective biomarkers of AD [2, 3] . Methods: The analysis of steroid hormones is managed mostly with the use of gas chromatography-mass spectrometry, GC-MS. Steroid metabolome in patients with Alzheimer's disease and in controls is being compared and its relationship to glucose metabolism is being assessed. The aim of our study is to build a predictive model based on steroid data. Results: Some components of steroid metabolome differ between the group of Alzheimer's disease patients and healthy controls of the same age. Significant differences in levels of C21 and 5b-reduced metabolites of C19 steroids were found. Conclusions: According to preliminary results, some components of steroid metabolome are very promising in prediction of Alzheimer's disease. Our new study aims to simplify the prediction model and make it applicable to clinical practice, thanks to detection of neuroactive biomarkers in peripheral blood. Hip fracture (HF) is a common and devastating injury as well as a major health issue in old age. HF has a one-year mortality [ 30% in the elderly and is a frequent cause of institutionalization. The reasons for such poor outcomes in this trauma are multifactorial but we aim here at identifying immunological factors, which can influence and/or predict the outcome of hip trauma in elderly patients post-surgery. We analyze immunological parameters evocating of the Immune Risk Phenotype in sequential pre-and post-surgical blood samples collected from HF patients over 75 years of age. The study revealed that HF is associated with an immune scar depicting a transient T-cell leucopenia and an acute hyper-inflammation. Importantly, we show that blood level of a molecule released by activated monocytes (neopterin) is predictive of one-year mortality in these patients. Its plasmatic level correlated negatively with the time of survival after HF surgery. In conclusion, HF patients exhibit transient changes in innate and adaptive immunity. Meanwhile, profound acute inflammatory processes measurable pre-surgery occur, which are predictive of long-term survival after HF surgery. We propose to use the identified predictive biomarker to improve medical interventions and follow-up of patients at risk of death. The Diet-microbiota-intestinal permeability axis in older subjects: rationale of the MaPLE project Results: Zonulin, a protein involved in tight junction modulation, has been exploited as IP marker and revealed an increased permeability. The effect of the intervention has been evaluated on numerous markers related with IP and inflammation, including the gut microbial ecosystem (i.e. gut microbiota composition and related metabolites), blood bacterial loads and the serum/urine metabolomics. Key conclusions: Standard methodologies for IP evaluation cannot be easily applied in the older population, thus zonulin and total bacterial load can be considered valuable candidate biomarkers. The MaPLE project will contribute to identify non-invasive strategies to improve IP and related disorders in the older population. Background: Two different simple frailty scales were used to identify the prevalence and severity of frailty in older adults with acute medical conditions and geriatric syndromes admitted to acute geriatrics ward to assess the effect of frailty on discharge planning without additional clinical resources. Methods: Clinical frailty scales (CFS) and reported Edmonton frailty scales (REFS) were completed based on electronic medical records (EMR) and REFS questionnaire for 107 patients. Patients' demography, medical conditions and main outcomes (length of stay (LOS), 30-day readmission rates, discharge accommodations) were analysed divided into frail versus non-frail groups and according to frailty severities. Variables with P \ 0.2 in univariate analysis were included for multi-regression analysis to assess the impact of frailty on outcome measures. Results: Prevalence of frailty was 75 percent for both scales out of which approximately 50 percent have mild to moderate frailty. LOS was increased in the frail group and correlated with the severity of frailty. Demographic data and medical comorbidities were not statistically different. LOS, 30-day readmission rate and dementia were increased based on CFS severity. Patients transferred to rehabilitation units were not necessarily frail and same outcome as non-frail group. Frailty was the only significant variable for LOS in univariate analysis but not for 30-day readmission rates and discharge destination in univariate analysis. Conclusion: Severity of frailty is correlated with increased LOS. CFS may be more useful to detect frailty. The impact of frailty on discharge in an acute geriatric ward Background: To analyse prevalence and severity of frailty in patients admitted to an acute geriatric ward. To assess the effect of frailty and its severity on discharge. Methods: Clinical frailty scale (CFS) and Reported Edmonton frailty scale (REFS) were determined based on electronic medical records (EMR) and REFS questionnaire for 107 patients admitted to an acute geriatric ward over a 2 months period. Patients' demography, medical conditions, geriatric syndromes and main outcomes (length of stay (LOS), 30-day readmission rates, discharge accommodations) were analysed, divided into frail and non-frail groups and according to severity of frailty using two different scales. Patients transferred to rehabilitation units were analysed in the same way as described. Results: Prevalence of frailty was 75 percent from which moderately severe frailty (CFS = 29 percent, REFS 27.1 percent) was most common in both scales. Main admission diagnoses were falls (n = 35) and related fractures (n = 18), delirium (n = 14) and pneumonia (n = 14). Dementia (P = 0.01) and Parkinson's disease (P = 0.03) were more common in frail group with CFS but not with REFS. LOS increased in frail group (CFS P = 0.02, REFS P = 0.02) and correlated with severity in both scales (CFS not frail 7.9 days, mildmoderately 9.7 days, severe 11.5 days). Discharge destination (CFS P = 0.14, FEFS P = 0.10) and readmission rates (CFS P = 0.96, REFS P = 0.37) were not associated with frailty. Conclusion: CFS and REFS are useful to detect frailty which predicts prolonged hospital stay. CFS was easier to complete and its outcome was similar to REFS. Frailty needs to be incorporated into discharge plan. Vitamin B12 deficiency might be related to sarcopenia in older adults Introduction: Sarcopenia and dynapenia are related to repeated falls, depression, frailty, increased mortality and morbidity. Although malnutrition is the most blamed factor for sarcopenia, the role of micronutrients is unclear. The aim of this study is to evaluate relationship between vitamin B12 deficiency and sarcopenia in older adults. Methods: 742 patients, who attended to geriatric clinics, included study. All cases' skeletal muscle mass, walking speed and hand grip strength were recorded by bioimpedance, 4 m walking test and hand dynamometer respectively. The diagnosis of sarcopenia was defined according to European Working Group on Sarcopenia in Older People criteria. Results: The prevalence of sarcopenia and dynapenia was 28.7 and 32.5%, respectively. In the patients with sarcopenia, mean age, number of used drugs osteoporosis, falls in the last year, congestive heart disease, dementia and frailty were higher, and Mini Mental State Examination(MMSE), instrumental activity of daily living scores were lower (p \ 0.05). The vitamin B12 levels in patients with sarcopenia were similar to the patients without sarcopenia (p [ 0.05). The frequency of sarcopenia and dynapenia was higher in the patients with vitamin B12 levels less than 400 pg/mL, besides lean body mass, total skeletal mass and bone weight were lower (p \ 0.05). Key conclusions: Sarcopenia, which results in lots of negative clinical outcomes in older adults, might be related to vitamin B12 deficiency. Therefore, these patients should be periodically examined for vitamin B12 deficiency due to the potential negative clinical outcomes such as sarcopenia in older adults. Disentangling the relationship between muscle mass and frailty status: Insights from the GERILABS study W. S. Lim 1 , L. Tay 2 , A. Yeo 1 , S. Yew 1 , N. Hafizah 1 , G. Wan 1 , Y. Y. Ding 1 1 Tan Tock Seng Hospital, Malacca, Malaysia, 2 Sengkang Hospital, Singapore Introduction: Although low muscle mass has been linked to early manifestations in the natural history of frailty, contradictory findings exist about the impact of different definitions on frailty status. We aim to study the relationship between three widely used muscle mass definitions with frailty status in an Asian population. Methods: We studied 200 community-dwelling older adults from the GERILABS cohort study. We compared three DXA-based definitions of muscle mass: appendicular lean mass (ALM) adjusted for height squared (ALM/Ht2) using Asian Working Group cutoffs; ALM adjusted for body mass index [ALM/BMI]; and residuals of linear regression on ALM adjusted for fat mass and height (ALM-res). Frailty phenotype (robust, pre-frail and frail) was defined according to modified Fried criteria. We examined the relationship between frailty status and muscle mass using scatter plot with Lowess smoothing and multinomial logistic regression adjusted for age and gender. Results: Prevalence of frailty among those with low muscle mass was 8.8% (ALM/Ht2), 5.5% (ALM/BMI), and 4.4% (ALM-res) respectively. Conversely, among frail participants, the prevalence of low muscle mass was 72.7, 27.3 and 18.2% respectively. A linear relationship with frailty was observed for ALM/Ht2, but not ALM/BMI or ALM-res. In multinomial logistic regression, each unit increase in ALM/Ht2 was associated with 41% (95% CI 12-61, p = 0.010) lower odds of being pre-frail, and 70% (95% CI 9-90, p = 0.034) lower odds of being frail as opposed to robust. ALM/BMI and ALM-res were not associated with pre-frailty/frailty after adjustment. Conclusion: Our results support sarcopenia and frailty as inter-related but distinct entities, with muscle mass-frailty association inferences altered substantially by the definition employed. Contrary to earlier non-Asian studies, ALM/Ht2 was strongly, linearly and inversely related to pre-frailty/frailty status in our Asian cohort. Impact of sarcopenia on 1-year mortality among older hospitalized patients with impaired mobility Objectives: Aim of the present study was to investigate the associations between sarcopenia and 1-year mortality in a prospectively recruited sample of geriatric inpatients with different mobility and dependency status. Design and setting: Sarcopenia was diagnosed using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP). Hand grip strength and skeletal muscle mass were measured using Jamar dynamometer and bioelectrical impedance analysis, respectively. Physical function was assessed with the Short Physical Performance Battery. Dependency status was defined by Barthel-Index (BI). Mobility limitation was defined according to walking ability as described in BI. The survival status was ascertained by telephone interview. Results: The population comprised 198 patients from a geriatric acute ward with a mean age of 82.8 ± 5.9 (70.2% females). 50 (25.3%) patients had sarcopenia, while 148 (74.7%) had no sarcopenia. 14 (28%) patients died among sarcopenic subjects compared with 28 (19%) non-sarcopenic subjects (P = 0.229). After adjustment for potential confounders, sarcopenia was associated with increased mortality among patients with limited mobility prior to admission (n = 138, hazard ratio, HR: 2.52, 95% ) and at time of discharge (n = 162, HR 1.93, 95% CI 0.67-3.22). In a sub-group of patients with pre-admission BI \ 60 (n = 45), \ 70 (n = 73) and \ 80 (n = 108), the risk of death was 3.63, 2.80 and 2.55 times higher in sarcopenic patients, respectively. Conclusion: Sarcopenia is significantly associated with higher risk of mortality among sub-groups of older patients with limited mobility and impaired functional status, independently of age and other clinical variables. Relationship of muscle function to circulating myostatin, follistatin and GDF11 in older women and men Introduction: Myostatin, its inhibitor follistatin, and growth/differentiation factor 11 (GDF11) have been proposed as factors that could potentially modify biological aging. The study aimed to test whether there is a relationship between these plasma circulating proteins and muscle strength, power and optimal shortening velocity (topt) of older adults. Methods: The cross-sectional study included 56 women and 45 men aged 60 years and older. Every participant underwent examination which included anthropometric and bioimpedance analysis measurements, functional and cognitive performance tests, muscle strength of upper and lower extremities, muscle power testing with two different methods and blood analyses. Results: Women had higher plasma levels of myostatin and GDF11 than men. Men had higher plasma level of follistatin than women. In women, plasma level of myostatin was negatively correlated with left handgrip strength and mopt. Follistatin was negatively correlated with maximum power (Pmax), PmaxÁkg -1 and P70% leg press, and positively correlated with the Timed Up and Go (TUG) test. GDF11 was negatively correlated with body mass, body mass index, waist circumference, fat mass and the percentage of body fat. In men, there were no significant correlations observed between circulating plasma proteins and muscle function measures. Key conclusions: The circulating plasma myostatin and follistatin are negatively associated with muscle function in older women and the relationship between these proteins is more visible for muscle power than muscle strength. GDF11 has a higher association with the body mass and composition than muscle function in older women. Trends in frailty and its association with mortality across a period of 21 years: results from the longitudinal aging study Amsterdam Introduction: Frailty is an important predictor of mortality in older adults, but not much is known about cohort and period changes in frailty and its association with mortality. The aim of the current study was to investigate trends in frailty and the relationship between frailty and mortality across a period of 21 years. Methods: Data from 1995 to 2016 were used from the Longitudinal Aging Study Amsterdam. A total of 7742 observations of 2874 respondents aged 65-84 years across 6 measurement waves were included. Frailty was measured with a 32-item frailty index (FI), with a cut-off of 0.25 to indicate frailty. The outcome measure was 4-year mortality. Trends in frailty and its association with 4-year mortality were assessed using Generalized Estimating Equation (GEE) analysis. Results: The GEE analyses showed that the 4-year mortality rate declined between 1995 and 2016 in both people with and without frailty. In the same observation period, levels of frailty slightly increased. Across all measurement waves, frailty was associated with 4-year mortality (OR 2.57, 95% CI 2.03-3.25). The OR slightly increased in more recent measurement waves. However, there was no statistically significant interaction effect between frailty and time on 4-year mortality, indicating that the association between frailty and mortality remained the same during the period of observation. Key conclusions: Between 1995 and 2016, the prevalence of frailty increased among older adults aged 65-84 years, but the lethality of frailty did not change, as there was a stable trend in the frailtymortality relationship. Association of the SARC-F Questionnaire with muscle mass, strength, and power: data from the African American Health (AAH) study Background: Screening for sarcopenia in daily practice can be challenging. The SARC-F questionnaire may be considered as a suitable tool for community screening for sarcopenia. Our objective was to explore whether the SARC-F is related to muscle mass (MM), strength (MS) and power (MP). Methods: In the population-based African American Health (AAH) study, MM, MS and MP were evaluated in a clinical testing center in a subsample of n = 190 women. MM was measured using dual energy X-ray absorptiometry (DEXA). MS and MP were evaluated by knee extensor and flexor tests (using an isokinetic dynamometer; Biodex Medical Systems, Inc., Shirley, NY). The SARC-F self-report questionnaire items were coded using these 5 items: sluggishness, assistance in walking, rise from a chair, climb stairs, falls. The questionnaire score ranged from 0 to 10: [using a previously determined cut point] a sarcopenia was defined as a score C 4. Results: Participants with SARC-F C 4 had lower household income, worse self-rated health and poorer income than those with SARC-F \ 4. They also had a higher BMI than participants with SARC-F \ 4 (p \ .001). AAH women participants with SARC-F scores C 4 had significantly higher MM (p .022), lower MS (p .001) and lower MP (p \ .001) than participants with SARC-F scores \ 4. Conclusion: Participants who screened positive using the SARC-F questionnaire showed lower muscle function, predisposing them to greater vulnerability in functional activities. This, combined with the simplicity of use for SARC-F, justifies its use as the initial step in identifying the presence of sarcopenia. A European joint action towards frailty prevention and management Addressing the increasing demands for social and health care from the burden of chronic diseases and disability is a central priority for the European Union (EU). Frailty is at the centre of these two challenges. ADVANTAGE is the Joint Action (JA) co-financed by the EU and 22 Member States (MS) to build a common understanding on health and social care policies to prevent and manage frailty. ADVANTAGE conducted a systematic search on evidence supporting frailty prevention and management activities which crystalize on a State of the Art Report. Main results support that frailty management should be directed towards comprehensive and holistic treatment in multiple and related fields. Prevention calls for a multifaceted approach addressing life course factors. ADVANTAGE recommends that all persons older than 70 years attending health care services should be screened for frailty. Geriatric Comprehensive Assessment, incorporated for assessment of frailty and planning a personalized multidomain treatment render better outcomes. Therefore, we propose a number of instruments for the screening phase and others for the diagnostic one. Physical exercise (multidomain and strength training) in combination with adequate nutrition have proved to be the best treatment of frailty. Other useful actions are reduction of polypharmacy, moderate weight loss in combination with appropriate physical activity, Vitamin D supplementation in some cases, and use of ICTs. Sarcopenia and osteoporosis are interrelated in geriatric inpatients and associated with poor nutritional and functional state Introduction: Sarcopenia and osteoporosis have common underlying pathology and reinforce each other in terms of adverse outcomes. We looked into the degree of overlap between sarcopenia and osteoporosis in geriatric inpatients from the Sarcopenia in Geriatric Elderly (SAGE) study. Methods: All geriatric inpatients from SAGE whose dataset allowed for the diagnosis of sarcopenia (EWGSOP definition) and osteoporosis (WHO definition) were included. In addition to dual energy X-ray absorptiometry derived muscle mass and bone mineral density, functional (gait speed, hand grip, Barthel index) and nutritional characteristics (mini nutritional assessment short form (MNA-SF), body mass index (BMI)) were measured for comparison between sarcopenic, osteoporotic osteosarcopenic and normal (reference group). Results: 141/148 of SAGE participants (84 women, 57 men; mean age 80.6 + 5.5) met inclusion criteria. 22/141 (15.6%) were only osteoporotic, 19/141 (13.5%) were only sarcopenic and 20/141 (14.2%) osteosarcopenic (both conditions present). Prevalence of osteoporosis was higher in sarcopenic than non-sarcopenic (51.3% vs. 21.6%, p \ 0.001). Sarcopenic, osteoporotic and osteosarcopenic subjects had lower BMI, MNA-SF, handgrip and gait speed (all p \ 0.05) than the reference group. Barthel index was lower for sarcopenic and osteosarcopenic (p \ 0.05) but not for osteoporotic individuals (p = 0.07). BMI and MNA-SF were lower in osteosarcopenia compared to sarcopenia or osteoporosis alone (p \ 0.05) while there was no difference in functional criteria. Conclusion: Osteoporosis and sarcopenia go along with poor nutrition and reduced function in geriatric inpatients. Co-occurrence (osteosarcopenia) is common and associated with a higher degree of malnutrition than osteoporosis or sarcopenia alone. Association between gait speed with mortality, cardiovascular disease and cancer: a systematic review and meta-analysis of prospective cohort studies Brendon Stubbs 1 , Alberto Pilotto 2 , Emanuele Cereda 3 , Nicola Veronese 4 1 King's College London, London, UK, 2 EO Galliera Genova, Genoa, Italy, 3 Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, 4 Consiglio Nazionale delle Ricerche, Padua, Italy Introduction: Slow gait speed is associated with premature mortality, cardiovascular disease (CVD) and cancer, although a comprehensive meta-analysis is lacking. In this systematic review and meta-analysis, we explored potential associations between gait speed and mortality, CVD and cancer. Methods: A systematic search in major databases was undertaken until March 15th 2018 for prospective cohort studies reporting data on gait speed and mortality, incident CVD and cancer. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs), based on the model with the maximum number of covariates for each study between gait speed (categorized as decrease in 0.1 m/s) and mortality, incident CVD and cancer were meta-analysed with a random effects model. Results: Among 7026 papers, 44 articles corresponding to 48 cohorts were eligible. The studies followed-up a total of 101,945 participants (mean age 72.2 years; 55% women) for a median of 5.4 years. After adjusting for a median of 9 potential confounders and the presence of publication bias, each reduction of 0.1 m/s in gait speed was associated with a 14% increased risk of earlier mortality (45 studies; HR 1.12; 95% CI 1.09-1.14; I222 = 90%) and 8% increased risk of CVD (13 studies; HR 1.08; 95% CI 1.03-1.13; I223 = 81%), but no relationship with cancer was observed. Conclusions: Slow gait speed may be a predictor of mortality and CVD in older adults. Since gait speed is a quick and inexpensive measure to obtain, our study suggests that it may help identify people at risk of premature mortality and CVD. Introduction: Measurement of muscle mass is paramount in the screening and diagnosis of sarcopenia. Besides muscle quantity, also quality assessment is important. Currently used tools are not always feasible in daily practice (CT/MRI), or do not provide sufficient information (BIA/DEXA). Ultrasonography (US) could represent a relevant tool to give both quantitative and qualitative information on muscle. However, before its use in clinical practice, several methodological aspects still need to be addressed. Both standardization in measurement techniques as the availability of reference values are currently lacking. This study aims to provide an evidence-based standardization of assessing muscle with the use of US. Methods: A systematic review was performed for ultrasonography, older people and muscle assessment. Pubmed, SCOPUS and Web of Sciences were searched. All manuscripts regarding the use of US in assessing appendicular muscle were used. Description of US-specific parameters, localization of measurement and a quality assessment of the manuscript were noted. Results: In total, 358 of 14.830 abstracts were withheld. In total, 5 items of muscle assessment were found: thickness, cross-sectional area, echogenicity, fascicle length and pennation angle. In all, quality of description of US-specific parameters was poor, whereas description of localization was good. Key conclusion: With this study, a standardized method of assessing muscle and its specific components through means of ultrasonography is presented. This shapes a standardized design to use US on a large scale as a routine assessment for muscle screening. Further studies need to assess the usability of these proposed measurements in routine practice. Three-year adverse health consequences of sarcopenia in community-dwelling older adults according to five diagnosis definitions Introduction: Few studies having assessed this, our aim was to highlight the major outcomes of sarcopenia over a 3-year follow-up and to determine the power of 5 different definitions of sarcopenia to predict these outcomes. Methods: The SarcoPhAge project includes 534 community-dwelling older adults. Sarcopenia was defined as low muscle mass plus low grip strength and decreased physical performance. Data on adverse outcomes were recorded during a clinic visit or with a phone call. The association between sarcopenia and the occurrence of undesirable outcomes was tested using the Cox proportional hazards model or a logistic regression model. A sensitivity analysis was performed to determine the power of 5 definitions to predict outcomes. Results: 534 subjects were recruited (73.5 ± 6.2 years, 60.5% female). After 3 years, 33 participants were lost to follow-up. No association between sarcopenia and falls, fractures, disabilities or institutionalizations was highlighted. A higher number of deaths occurred in individuals with sarcopenia than in those who were not with (16.2% versus 4.6%, p-value \ 0.001). The probability of death within 3 years when presenting sarcopenia showed an approximately threefold increase (for 4 out 5 definitions). A longer hospital stay was observed in subjects with sarcopenia only when defined using the EWGSOP algorithm or the Asian Working Group criteria. Key conclusions: Over a 3-year period, sarcopenia at baseline was associated with an increased risk of mortality and with longer hospital stays. There were significant variations in the ability of the different definitions of sarcopenia to predict these outcomes. Relationship between within-visit blood pressure variability and skeletal muscle mass among Korean older adults Background: Sarcopenia is an important health issue in aging society. Although, hemodynamic factor is considered to be an important contributor in the development of sarcopenia, there were few studies regarding this topic. Thus, we tried to investigate the relationship between blood pressure variability and skeletal muscle mass in nation-wide large population cohort. Methods: This cross-sectional study was based on data acquired in the Korea National Health and Nutrition Examination Survey (KNHANES), conducted from 2009 to 2011 by the Korean Centers for Disease Control & Prevention. We included 3069 participants (age C 65 years, male 1342) for the analysis who had both blood pressure and whole-body dual energy X-ray absorptiometry (DXA) scan data. As an intra-individual within-visit blood pressure variability index, we calculated standard deviation (SD), coefficient of variation (CV), and maximum minus minimum BP difference (MMD) of systolic and diastolic blood pressure, which was measured 3 times. Appendicular skeletal muscle mass (ASM) was the sum of lean masses of both arms and legs. We adjusted ASM by body mass index. Results: Significant inverse relationship was observed between blood pressure variability index (SD, CV, and MMD) and adjusted ASM. Blood pressure variability index were significantly higher in the lowest quartile group both in male and female participants (p \ 0.05). In multivariate analysis, blood pressure variability index were significantly associated with ASM, even after adjusting confounding factors. Conclusions: Using the national representative database, we showed significant inverse relationship between within-visit blood pressure variability and skeletal muscle mass in Korean older adults. Considering the underlying mechanism of increased blood pressure variability, hemodynamic influence may play an important role in the development of sarcopenia. Anthropometric measurements and mortality in frail older adults Mario Ulises Perez-Zepeda 1 , Jonathan Easton 2 , Christopher Stephens 2 , Heriberto Roman-Sicilia 2 , Matteo Cesari 3 1 Instituto Nacional de Geriatria, Mexico, 2 Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, México, 3 Geriatric Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy Background: As the number of older adults increases, so does the number of frail older adults. Although anthropometry has been widely used as a way to stratify the overall mortality risk of a person, the significance of these measurements becomes blurred in the case of frail older adults who have changes in body composition. Therefore, the aim of this study is to determine the association of anthropometric measurements (body mass index, knee-adjusted height body mass index, waist-to-hip ratio and calf circumference) with mortality risk in a group of older Mexican adults. Methods: This is a longitudinal analysis of the Mexican Health and Aging sub-sample (with biomarkers, n = 2573) from the first wave in 2001, followed-up to the last available wave in 2015. Only frail 50-year or older adults (Frailty Index with a cut-off value of 0.21 or higher, was used) were considered for this analysis (n = 1298). A survival analysis was performed with Kaplan-Meier curves and Cox regression models (unadjusted and adjusted for confounding). Sociodemographic, health risks, physical activity and comorbidities were variables used for adjusting the multivariate models. Results: From the total sample of 1298 older adults, 32.5% (n = 422) died during follow-up. The highest hazard ratio in the adjusted model was for calf circumference 1.31 (95% confidence interval 1.02-1.69, p = 0.034). Other measurements were not significant. Conclusions: Anthropometric measurements have different significance in frail older adults, and these differences could have implications on adverse outcomes. Calf circumference has a potential value in predicting negative health outcomes or likewise. Association between antioxidant and frailty in elderly Tunisian patient; a cross sectional study Introduction: With the increase in population aging, a frailty syndrome is highlighted. We intended to understand the evolution of this syndrome by an antioxidant status estimation on frail patients aged 65 years old and up. Patients and methods: Frail subjects (n = 40) and non-frail subjects (n = 30) were concerned. The frailty status was made by means of SEGA m scale. An analysis of the biochemical parameters (glycemia, creatinine, urea, lymphocyte, CRP), oxidative stress parameters (Glutathion peroxydase (GPX), Superoxyde dismutase (SOD), Catalase, Diène conjugué CD, Malondialdéhyde (MDA), carbonylated proteins). Results: Our results showed high plasmatic levels of renal biomarkers (creatinine) and inflammation markers (lymphocyte and CRP) in frail patients with regard to non-frail. Besides, the frail elder had higher rates of lipids and proteins oxidation markers (DC : 0.17 ± 0.06 nmol/mg d'Hb vs 0.14 ± 0.06), MDA: 9.07.10-3 ± 3.85 9 10 -3 nmol/mg de protéine vs 8.89 9 10 -3 ± 2.26 9 10 -3 , and PC: 3.5 ± 0.69 nmol/mg de protéine vs 3.1 ± 0.9), compared with the non-frail. Higher activity (p \ 0.05) of antioxidant enzymes: GPX (83. 6 ± 27.1 U/mg Hb vs 73.3 ± 17.8), SOD (3.36 ± 0.93 U/mg Hb vs 27. ± 2 1, and catalase (0.15 ± 0.04 U/mg Hb vs 0.12 ± 0.03) were observed in frail elderly. Furthermore, a significant positive correlation was revealed between frailty score and catalase activity (r = 0.36; p \ 0.002), DC (r = 0.2, p \ 0.02) and MDA (r = 0.46, p \ 0.04°. In conclusion, this study suggests an installation of an oxidative stress and an inflammatory reaction in frail patients. A possible relation between these two phenomena could be suggested. Glutamine supplementation for urinary incontinence: a prospective, randomized, controlled double-blind study Aim: The objective of this study is to determine the effect of additional oral glutamine supplementation to Kegel exercise on pelvic floor strength and clinical parameters of urinary incontinence in females. Methods: It is a randomized, double-blind study. Digital test and a vaginal manometer were used for measuring the strength of the pelvic floor muscles. 24 h pad weight test was examined. Participants were randomized into 2 groups as oral Glutamine 30 g/day and placebo. It was asked to use the supplementation and Kegel exercises to all participants for 3 months. Basic and 3th month measurements were compared by Paired sample T-test and Wilcoxon tests in each group. The progression between measurements at basic and 3th months was compared between the groups by using Mann-Whitney-U test.(Clinical Trials protokol ID: 2014/1203). Results: There were 11 patients in the glutamine arm and 18 patients in the placebo arm. Mean age was 58.2 ± 6.6 years. Mean body mass-index was 32.9 ± 4.8 kg/m 2 . There was no age difference between the groups [glutamine 59 ± 3.8, placebo 57.8 ± 7.9 years, p [ 0.05]. In glutamine arm, vaginal muscle strength assessed by digital test was higher at the end of 3 months [2.9 ± 0.7 vs 4 ± 0.9; 0-3 months respectively, p = 0 Keywords: Frailty; Primary care. Introduction: Longevity should go with quality of life-reversing the frailty syndrome (SF) and its impact are central to this goal. SF is a risk factor for adverse health events: mortality, disability, falls and hospitalization. Most of the interventions to revert SF cant be implemented in primary care (PC). There is no standard model for the follow-up frail elderly in PC. Objective: Evaluate the efficacy of a PC geriatric intervention model in reversion SF. Methods: Randomized, unicentric, clinical trial, comparing usual care and a geriatric intervention model. 240 frail individuals followed in primary health care and community residents. Inclusion criteria: age [ 70 years; FS present; community residents and no institutionalization plan. Exclusion criteria: cognitive impairment, institutionalization, hospitalization \ 1 month. ''blinding'': The family doctor will not access to evaluations results. The evaluations will be available to Intervention geriatric team (IGT). Evaluators: can't be members of IGT; randomly assigned to evaluations; not have access to the results of previous evaluations. Intervention: IGT by 12 months. Individualized care, starts with a global assessment and a home evaluation. Nurse appointment every month. Medical appointment 2/2 months or 3/3 if frailty reverts. If nutrition risk-nutritionist appointment. Individualized care plan by IGT, after each evaluation. Evaluations: basal, 6 months and final. Conclusion: A model of geriatric follow-up that proves to be more effective in the reversion of frailty will be an advantage in PCs. The use of PC resources results in the operationalization of the model and possible immediate clinical application. Introduction: Many older patients experience polypharmacy and risk taking potentially inappropriate medications (PIMs) leading to adverse events. Recent studies have demonstrated the association between frailty and an increase in PIMs among community-dwelling older people and those with cancer. We evaluated whether frailty in hospitalised older patients is associated with polypharmacy and PIMs. Methods: A cross-sectional study of inpatients aged C 70 years admitted to one UK hospital. Frailty was assessed using the Fried Frailty Phenotype and FRAIL Scale. Polypharmacy and hyperpolypharmacy were defined as the concomitant use of five+ and 10+ medications, respectively. PIMs were identified using the Beers and STOPP criteria. Results: 201 participants (median age 80.7 years; 120 (60%) men) were recruited. 1738 medications were prescribed in this cohort, median 9 medications/patient. Frailty was identified in 56 and 36% using the Fried Frailty Phenotype and FRAIL scale, respectively. Polypharmacy (46%) and hyper-polypharmacy (41%) were also common. Frailty using both scales was significantly associated with polypharmacy (P \ 0.001). The Beers' criteria identified 90 PIMs in 57 (28%) patients. 33 (58%) received one and 24 (42%) received 2+ PIMs. 108 PIMs in 76 (38%) patients were identified using the STOPP criteria. 53 patients (70%) received one and 23 (30%) received 2+ PIMs. Both frailty tools were significantly associated with PIMs using the STOPP criteria but not using the Beers' criteria. Conclusions: Frailty in older inpatients was significantly associated with polypharmacy and PIMs using the STOPP criteria. Structured medication review is essential for older people in hospital. Association of independence in daily activities with muscle structure, strength and physical function in nursing home residents Introduction: Older people are often institutionalized in nursing homes as a consequence of functional decline accompanied by restrictions in independent living [1] . Physical capacity is an important determinant of functional limitations in older adults [2] , however, whether independence in activities of daily living (ADL) of nursing home residents is directly associated with a specific muscle parameter has not yet been investigated. This study explored the relationship between the level of independence in ADL in older, nursing home residents and muscle structure, strength as well as physical function. Methods: Independence in performing ADL was assessed in 30 older, nursing home residents (age, 85.6 ± 7.06 years; weight, 65.4 ± 15.41 kg; height, 1.60 ± .06 m), with the Resident Assessment Instrument. Residents were categorized as either independent or dependent in basic ADL. Muscle thickness and echo intensity, isometric grip-, quadriceps-and elbow-flexor strength, gait speed, timed sit-to-stand task and physical activity were determined by validated assessments. Relationships among variables were investigated using Spearman's correlation coefficient and logistic regression analysis. Results: The category of dependence in ADL correlated with handgrip strength (= -.38, p = .038), quadriceps strength (= -.67, p \ .01), elbow-flexor strength (= -.42, p = .032) and physical activity (= -.44, p = .015). After regression analysis, only quadriceps strength remained a significant determinant of dependence category (R2 = .66; Wald(1) = 5.97, p = .015). For every 0.1 kg decrease in quadriceps strength the risk of being dependent in basic ADL increased by 10%. Conclusion: Quadriceps strength has a strong, independent relationship with ADL performance in nursing home residents. Improving quadriceps strength may help to avoid further decline in physical function. Introduction: Frailty and osteoarthritis (OA) cause functional and movement limitation in elderly, which both have common pathophysiology and risk factors that have not been completely defined yet. The purpose is figure out the relationship between frailty and osteoarthritis for preventive and therapeutic approach in a community base cohort of elderly household dwellers. Methods: This is a cross-sectional analysis of cohort Bushehr Elderly Health (BEH) program. The sampling was multistage stratified-cluster method that representative of the general population, aged C 60 by interviewing in southern of Iran. Clinical OA defined with any symptoms in knee or other joints without history of Rheumatic disease or diagnosis of osteoarthritis by clinicians. Based on Fried Frailty phenotype criteria, individuals with three or more criteria considered as frail that examine as dependent variable in a univariate and several multivariable logistic regression models. Results: From older participants (N = 2315) female were 50.8%. The mean age was 69.27 (SD = 6.30) years old. The prevalence of frailty was 7.7% (N = 174) and osteoarthritis was 12.4% (N = 286). In Univariate model odds ratio (OR) of osteoarthritis for frailty phenotype was 1.99 (95% CI 1.35-2.93) . In final multivariable model after adjustment for age, gender, BMI, and smoking the OR of osteoarthritis for frailty phenotype was 2.44 (95% CI 1.57-3.78). Conclusion: Based on our results, osteoarthritis is a strong independent predictor of frailty phenotype in community elderly dwellers. It is needed further evaluation to understand the causal relationship through a longitudinal study. Introduction: In older adults frailty is linked to increase muscle atrophy due to inflammation, decline in humoral, cell-mediated immunity and hormone levels, overexpression of cytokines and sarcopenia. Due to poor appetite, reduced mobility and isolation, frail older people do not meet their caloric, protein and micronutrient targets with food alone, and often need the use of oral nutritional supplements (ONS) providing sufficient amounts of calories, protein and micronutrients in a relatively low volume to improve compliance. Polyunsaturated Fatty Acids (PUFA), vitamin E, vitamin D along with the protein bound amino acids glycine, arginine and tryptophan are proposed as active novel ingredients in the therapy of patients with sarcopenia and/or frailty; due to their combined effect in muscle atrophy thereby improving muscle protein synthesis (MPS). The study objective is to show efficacy of PUFA, vitamin E, vitamin D and the protein bound amino acids glycine, arginine and tryptophan as active ingredients to increase MPS in human myoblasts. Methods: The MyoScreenTM muscle wasting platform is based on the treatment of human primary myoblasts with TNF-alpha to induce muscle atrophy. We tested the ability of the active ingredients of Fresubin 3.2 kcal to increase whole protein synthesis measured by the Click-iT Ò HPG Alexa Fluor Ò Protein Synthesis Assay (Ther-moFisher) on the MyoScreenTM platform. Results: The active ingredients of Fresubin 3.2 kcal increased protein synthesis in primary human myoblasts after 6 days of treatment. Conclusion: The active ingredients of low volume Fresubin 3.2 kcal, increased protein synthesis in TNF-alpha incubated myoblasts and thus may reduce TNF-alpha related atrophy in muscles. Stages of frailty syndrome and mortality in older men and women 80+ Objective: The objective of the paper was to determine the dependence between the stage of the frailty syndrome (FS) in women and men and the risk of limitation of activities of daily living (ADL), hospitalisation and death in the 80+ age group. Methods: The study included 213 respondents (59 men and 154 women) aged 80 and over. Respondents were assessed using the Fried criteria: weight loss, weakness, low physical activity, slowness and exhaustion. All underwent assessment using Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS) and activities of daily living (ADL). Results: Frailty was found in 117 persons in the studied group. The analysis showed that the results in the frail group were much worse than the results in the pre-frail and non-frail groups in all the criteria looked at. After 12 months a significant deterioration of ADL, an increased risk of hospitalisation and death was observed in the frail group, with additional higher mortality among men in this group. Conclusion: The study shows that significant risk of hospitalisation, ADL deterioration and death occurs more often in the group of persons aged 80 or over with diagnosed FS than in the pre-frail and nonfrail group. Men are more at risk of death than women, especially in the frail group. The occurrence of the FS plays an important role in the prognosis and assessment of the need for health care among the elderly. Influence of type 2 diabetes and insulin therapy on muscles Introduction: Loss of muscle mass and function is the main cause of immobility in old age. Geriatric patients with type 2 diabetes (T2D) often suffer from mobility limitations. The aim of the current study is to investigate the association of T2D and the change in muscle mass or function in old age and whether it is influenced by insulin treatment in diabetics in the population-based KORA AGE study. Methods: In a population-based cohort study (KORA Age) the skeletal muscle index (SMI [kg/m 2 ]) and the hand grip strength (HS [kg] ) were measured at baseline (2009) and timed Up and Go (TUG [s]) test performed after a follow-up time of 3 years (2012). Multiple linear regression models were used to investigate the influence of T2D and insulin therapy on the change of muscle parameters (difference of baseline and follow-up values). Results: Among the 731 subjects (360 women (49.3%)) with a mean age of 74.6 ± 6.2 years) there were 16.1% (n = 118) with T2D (HbA1c 6.4 ± 0.7%), who were treated with insulin in 16.9% (n = 20). Patients with T2D showed a greater decrease in HK (women: -1.2 ± 4.3, men: -1.8 ± 5.4) and SMI (women: -0.2 ± 0.7, men: -0.2 ± 0.7) subjects without T2D (women: -0.5 ± 3.9, men: -0.4 ± 5.5). After adjustment for gender, age, BMI, physical activity, smoking, and multimorbidity, T2D remains significant with the change in SMI (p = 0.02), but not in HS (p = 0.07) and TUG (p = 0.76). Insulin therapy was significantly associated with the change in SMI (p \ 0.001), but not with HS (p = 0.18) and TUG (p = 0.09), compared to treatment with oral antidiabetic alone in subjects with treated T2D. Key conclusions: Patients with T2D showed an accelerated decline in muscle mass in subject over 65 years of age compared to subjects without T2D. Therefore, routine clinical muscle assessment in this high-risk population might be useful. Insulin therapy could be of benefit to the maintenance of muscle mass for the elderly with T2D. However, further studies are needed to confirm this result. Eccentric versus concentric training for increases in muscle mass and strength? The most effective training modality to prevent and treat sarcopenia is unknown. Traditionally concentric training is employed, but this may not be as effective/feasible as eccentric training. Twenty-two healthy men and women (70 ± 1 year) were randomized to stair-case training as concentric ([CON] walking up; elevator down), eccentric ([ECC] walking down, elevator up) or eccentric training + ([ECC +] carrying weights equivalent to 15% of bodyweight) 3 times/wk for 3-weeks (all subjects) or 6-weeks (ongoing; n = 5, 5 and 3 in CON, ECC and ECC + , respectively). Leg muscle-mass was estimated by thigh circumference (TC) and DXA-scanning, strength by 6 min walk test (6MWT), leg press test (LP) and 30-sec chair-stand test (30CST). Rate of perceived exertion (RPE) measured by Borg scale (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) . At 3-week the subjects had stair-walked 2.8 ± 0.5 [CON, upwards] , 3.4 ± 0.2 [ECC, downwards] and 2.2 ± 0.4 [ECC + , downwards] km, which by 6-week was 4.6 ± 1.0, 7.2 ± 0.6 and 7.3 ± 1.5 km, respectively. TC didn't change in either group; DXA revealed significant (P \ 0.05) 3-wk increases in muscle mass (by 1.7 ± 0.8, 2.8 ± 0.4 and 2.5 ± 1.0% in CON, ECC and ECC + , respectively), with no further significant increase by 6 week. 6MWT and leg press at 3-wk increased (P \ 0.05) only in ECC + (from 562 ± 26 to 619 ± 34 m; 94 ± 16 to 100 ± 15 kg). 30CST increased in all groups by 3-week (from 15 ± 1 to 18 ± 1 times). RPE was lower (P \ 0.05) in ECC + (11.5 ± 0.3) vs. CON (12.6 ± 0.4) at 3-week. ECC + is superior to CON for improvement in strength/performance, in spite of lower physical demand and should be considered a new training modality for frail elderly. In Background: Sarcopenia is a nutrition-related syndrome related to worse clinical outcomes, physical impairment, and mortality. Data regarding its prevalence in hospital settings is limited. We aim to assess the prevalence of sarcopenia in patients admitted to geriatric acute care units in 7 European countries, identifying risk factors associated with its presence or incidence, and evaluating its association with further negative outcomes during hospitalization and postdischarge. Methods: Design: Longitudinal, prospective European multi-centre study (Belgium, Germany, Italy, Lithuania, Portugal, Spain, United Kingdom) . Settings: Acute-care geriatric units. Participants: Patients aged [ 70 admitted to acute geriatric units. Exclusion criteria: disabling conditions that could directly affect muscle weakness, general and/or cognitive condition preventing administration of the tests. Main outcome measures: (1) Prevalence of sarcopenia at admission; (2) Risk factors associated with presence of sarcopenia; (3) Incidence of sarcopenia during hospital stay; (4) Negative outcomes during hospitalization (hospital-acquired infections, falls, length-of-stay, mortality) and post-discharge (institutionalization, readmission to hospital, mortality). Sarcopenia will be defined according to the European Working Group on Sarcopenia criteria: low muscle mass (mid-calf circumference \ 31 cm) plus either low handgrip strength (men \ 30 kg, women \ 20 kg) or walking speed \ 0.8 m/s. Information on demographics, comorbidities, medication, cognitive function, depression/anxiety, nutrition, and SARC-F will be collected. National and international ethics guidelines will be followed. Conclusion: Our study will provide data regarding prevalence and incidence of sarcopenia in hospitalized patients across Europe, allowing the identification of risk factors. Our results should help to develop preventive and treatment strategies for sarcopenia in this vulnerable population. Comparing SARC-F with SARC-CalF to screen sarcopenia in community living older adults Objectives: To compare the diagnostic value of the SARC-F combined with calf circumference (SARC-CalF) with the standard SARC-F to screen sarcopenia in community-dwelling older adults. Design: Cross-sectional, diagnostic accuracy study. Setting: Geriatric outpatient clinic. Participants: Older adults C 65 years. Measurements: Muscle mass, hand grip strength, and usual gait speed. Currently used diagnostic criteria EWGSOP, FNIH, IWGS, and SCWD were applied. SARC-CalF was performed by using two different calf circumference (CC) threshold: standard cut-off 31 cm (SARC-CalF-31) and national cut-off 33 cm (SARC-CalF-33). The sensitivity/specificity analyses of the SARC-CalF and SARC-F tools were run. Results: We included 207 subjects; 67 male and 140 female with a mean age of 74.6 ± 6.7 years. The prevalence of sarcopenia ranged from 1.9 to 9.2%. The sensitivity of SARC-F was between 25% (EWGSOP) and 50% (IWGS); specificity was about 82%. For SARC-CalF-31 and SARC-CalF-33 sensitivity was similar-between 25-50%-which pointed out that SARC-CalF was not superior to SARC-F for senstivity in this sample. Corresponding specificities for SARC-CalF-31 and SARC-CalF-33 were higher than SARC-F and were between 90-98%. The AUC values, which indicates the diagnostic accuracy of a screening test, were in general higher for SARC-CalF-33 than the SARC-F and SARC-CalF-31. Conclusions: We reported that addition of CC item to SARC-F improved the specificity and diagnostic accuracy of SARC-F but it didn't improve the sensitivity in a community-dwelling Turkish older adult population sample that had low prevalence of sarcopenia. The performance of SARC-CalF tool to screen sarcopenia is to be studied in different populations and living settings. Performance of SARC-F in regard to sarcopenia definitions, muscle mass and functional measures , chair sit-to-stand test (CSS), functional reach test (FRT), short physical performance battery (SPPB), SARC-F questionnaire, FRAIL questionnaire. Sarcopenia was evaluated with different definitions EWGSOP, FNIH, IWGS SCWD. Results: After cross-cultural adaptation, 207 subjects were analysed. Mean age was 74.6 ± 6.7 years, 67.6% were women. Against EWGSOP, FNIH, IWGS and SCWD definitions of sarcopenia, sensitivity of SARC-F were %25, 31.6, 50 and 40%; specificity were 81. 4, 82.4, 81.8 and 81 .7%, respectively. Positive predictive values (PV) were between 5.1-15.4% and negative PVs were 92.3-98.2%. Low MM, sensitivity were about 20% and specificity were about 81%. For low HGS, sensitivity of SARC-F were 33.7% (Turkish cutoff); 50% (FNIH cut-off); specificity were 93.7% (Turkish cut-off) and 85.8% (FNIH cut-off). Against low UGS, poor performance in CSS, FRT, SPPB and presence of positive frailty screening sensitivity were 58.3%, 39.2%, 59.1%, 55.2%, 52.1% while specificity were 97.3%, 97.8%, 88.1%, 99.3%, 91.2%, respectively. Conclusion: The psychometric performance of Turkish SARC-F was similar to the original SARC-F. It revealed low sensitivity but high specificity with all sarcopenia definitions. Sensitivity and specificity were higher for muscle function (MF) tests reflecting its inquiry and input on MF. Our findings suggest that SARC-F is an excellent test to exclude MF impairment and sarcopenia. SARC-F is relatively a good screening test for functional measures. Social frailty as a predictor for physical frailty and cognitive decline in community-dwelling elderly adults: from the Kashiwa Study Institute of Gerontology, The University of Tokyo, Tokyo, Japan, 2 Department of Geriatric Medicine, The University of Tokyo, Tokyo, Japan, 3 National Center for Geriatrics and Gerontology, Obu, Japan, 4 Introduction: Although social factors may contribute adverse health outcome in elderly adults, a little study addressed the longitudinal impact on physical weaken and cognitive decline. We aimed to examine the association between social frailty and new-onset frailty and cognitive decline in community-dwelling elderly adults. Methods: The longitudinal surveys with randomly selected community-dwelling older adults aged C 65 years were performed in annually from 2012 to 2014. We exclude physically frail individuals at baseline. Physical frailty was defined by the Cardiovascular Health Study index. Cognitive decline was determined using the Mini-Mental State Examination (MMSE) with deceased score of greater than 1.0 point per 1 year. Social frailty was operationally defined using a deficit accumulation model referred to previous study in Japan. Results: Of 1422 elderly who were included in this study. 9.7% of participants experienced developing frailty, and 4.7% experienced cognitive decline during the follow-up period. Baseline prevalence of social prefrailty (1/5 score) was 30% and it of social frailty (C 2/5) was 21%. Adjusted by confounding factors (such as age, instrumental activity of daily living), those who with social frailty were found to be significantly at risk of new-onset frailty (the hazard ratio, 2.10; 95% confidence interval, 1.2-3.4) , and cognitive decline (the hazard ratio, 1.76; 95% confidence interval, 1.0-3.1). Key conclusions: Our research showed strong impact of social frailty on the risk of new onset of physical frailty and cognitive decline in community-dwelling elderly adults. To prolong healthy life expectancy, considering interventions for social frailty via multidimensional approaches may be indispensable. Identifying important items of quality of life of frail older subjects: a qualitative study among patients and professionals Introduction: In recent years, there has been an increased focus on placing patients at the center of health care research. In this sense, the aim of this study was to identify important items of quality of life of frail older subjects. Methods: A Delphi survey was conducted among professionals in the field of frailty (i.e. members of the working groups on frailty from the EUGMS or ESCEO). We also performed two focus groups, one in frail community-dwelling older subjects and one in frail nursing home residents. Frailty was assessed using different definitions. Results: The important items to assess quality of life related to frailty, highlighted by frail patients themselves (n = 14) or by professionals (n = 35), have been indexed in 6 domains, based on the concept of intrinsic capacity proposed by the WHO: locomotion, sensory, vitality, psychosocial, cognition and others. Respectively 78 and 52 items have been highlighted by the Delphi Approach and the focus groups. Globally, professionals and older patients cited a majority of items from the domain of vitality (i.e. 14 items cited by both professionals and patients). Moreover, community-dwelling elderly cited many items in the psychosocial field (i.e. 8 items) while nursing home residents did not (i.e. 1 item). Professionals also place a lot of importance on locomotion (i.e. 13 items). Conclusion: The items identified both by the Delphi approach and the focus groups could be interesting to develop a frailty specific Patient-Reported Outcomes (PRO). Serum Klotho and mortality risk in nursing home residents: results from the SENIOR cohort Introduction: Several studies suggest that circulating Klotho, a single-pass transmembrane protein, could be associated with longevity. This study aimed to test the relationship between the level of serum Klotho and mortality among a specific population of nursing home residents. Methods: We followed subjects of the SENIOR study, a cohort of nursing home residents in Liège, Belgium, during 24 months, for the occurrence of death. In this population, a Klotho was measured at baseline to assess the relationship between the level of serum Klotho and survival. The IBL ELISA kit was used to measure soluble a Klotho protein in blood. The subjects were categorized in 3 groups according to the lower, middle and upper tertiles of serum Klotho. Results: Among residents followed for 2 years, a klotho dosages was available for 415 subjects. The mean age of these subjects was 82.9 ± 9.24 years and 332 (74.8%) of them were women. Deceased subjects had a baseline serum klotho level of 487.6 (385.9-599.4) pg/ mL and still alive subjects had a level of 510.2 (394.7-622.7) pg/mL (p = 0.32). The number of deaths observed during the follow-up wasn't significantly different according to the tertiles (p = 0.72). At last, after adjustment on age and sex, the survival time wasn't different according to the tertiles (p = 0.38). Conclusions: An isolated measurement of serum Klotho, at baseline does not seem to be a predictor of mortality at 24 months. Sarcopenia and its association with falls and fractures in older adults: a systematic review and meta-analysis Background: Sarcopenia is a potentially modifiable risk factor for falls and fractures in older adults, but the strength of the association between sarcopenia, falls and fractures is unclear. Purpose: To assess the literature and perform a meta-analysis of the association between sarcopenia with falls and fractures among older adults. Data sources: A literature search of MEDLINE, EMBASE, Cochrane and CINAHL from inception to May 2017. Study Selection: Published in English, mean/median age C 65 years, sarcopenia diagnosis, falls and/or fractures outcomes, any study population. Data Extraction: Pooled analysis was conducted of the association of sarcopenia, falls and fractures, expressed in odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses were performed by study design, population, sex, sarcopenia definition, continent and study quality. Heterogeneity was assessed using the I2 statistics. Data Synthesis: The search identified 2511 studies. Thirty-one studies (43962 individuals) were included in the systematic review. Three studies reported both outcomes falls and fractures. Twelve out of 19 studies reported a significantly higher risk of falls in sarcopenic compared to non-sarcopenic individuals; 12 out of 15 studies showed a significant association with fractures. Twenty-five studies (34117 individuals) were included in the meta-analysis. Sarcopenic individuals had a significant higher risk of falls (OR 1.82; 95% CI 1.61-2.05) and fractures (OR 1.73; 95% CI 1.47-2.03) compared to non-sarcopenic individuals. This was independent of study design, population, sex, sarcopenia definition, continent and study quality. Limitations: Results were expressed as crude or adjusted ORs with varying adjustments. Conclusions: A strong and consistent association between sarcopenia with falls and fractures in older adults strengthens the need to invest in sarcopenia prevention and interventions to evaluate its effect on falls and fractures. The effect of statin therapy on frailty status in elderly patients with atherosclerotic cardiovascular disease Methods: 628 patients (average age 74.08 ± 6.43 years, 48.73% is female) were involved in this study. The presence of frailty was verified by Fried's Frailty Criteria. All patients were prescribed moderate dose statins. Patients who met a Proportion of days covered (PDC) C 50% were assigned to the treatment group, while others were in the control group. After one year follow-up, the levels of frailty degree, walking speed and grip strength before and after treatment were analyzed, the changes between the treatment group and the control group were compared. Results: At baseline, 12.90% patients were frail (n = 81), 59.08% were pre-frail (n = 371) and 28.03% were robust (n = 176). Compared to non-frail patents (who are robust and pre frail), frail ones participants were more likely to be older, female and lower PDC C 50% (P \ 0.05). For non-frail patents, there were no statistically significant differences found in age, gender, BMI, disease constitution, comorbid disease number, baseline walking speed and grip strength between the treatment and control group (P [ 0.05). The mean scores of frailty was significantly decreased and the level of frailty were significantly improved after 12-month statin treatment (P = 0.000). Patients could benefit in grip strength from 6-month statin use (compared to baseline, P = 0.000; compared to the control group, P = 0.012). However, No changes were found in walking speed before and after statin usage (P [ 0.05). Conclusion: A moderate-intensity statin treatment in elderly non-frail ASCVD patients would not cause frailty deterioration, but improve frailty status as well as grip strength. Considering the evidences that statin usage could provide significant reductions in cardiovascular events and death, Using a moderate-intensity statin in elderly nonfrail ASCVD patients is generally safe and beneficial. A higher protein intake at breakfast does not compromise total daily protein intake in older adults Introduction: A protein intake of 25-30 g per meal is suggested to maximally stimulate muscle protein synthesis in older adults in order to prevent sarcopenia. Protein intake at breakfast is often low and therefore breakfast offers the potential for protein suppletion. Since protein is known for its satiating effects, we explored the association between the amount of protein intake at breakfast and total daily protein intake in older adults. Methods: Baseline protein intake was assessed by a 3-day dietary record in 507 community dwelling older adults of 55 years and older participating in lifestyle interventions at the Amsterdam Nutritional Assessment Center. Multiple linear regression analysis was used to examine the association between protein intake at breakfast (in g) and total daily protein intake (in g, and g/kg body weight), adjusted for energy intake (kcal/d), sex, age and BMI. Interactions were tested for sex, age and BMI but were not significant (p [ 0.80). Results: Mean age was 67.6 ± (SD) 7.3 years, 42% was female, and mean BMI was 30.0 ± 5.6 kg/m 2 . Total daily protein intake was 81 ± 24 g which equals 0.96 ± 0.3 g/kg and 17.6 ± 3.7 percent of total energy intake. Protein intake at breakfast was 14 ± 7 g. A 10 g higher protein intake at breakfast was associated with a 6.7 g (SE = 1.0; P \ 0.001) and a 0.06 g/kg (SE = 0.01; P \ 0.001) higher total daily protein intake after adjustment for confounders. Key conclusions: A higher protein intake at breakfast does not compromise total daily protein intake in community dwelling older adults. Background and aims: Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. There are only few data on sarcopenia in healthy general population. We evaluated the prevalence of sarcopenia and its association with functional and clinical status in a population of healthy ambulatory subjects over 45 years living at home, in Paris (France). Methods: This study was conducted selecting all ambulatory participants (n = 1445) aged 45 years and older from October 2008 to September 2011, consulting in the Institute of Physiology (Institut de Jaeger) from Paris (France) for a functional and muscular evaluation, and did not have limitations to moderate physical exercise. All were healthy people. All subjects performed a medical examination, associated with evaluation of muscle mass (body composition assessment using dual-energy X-ray absorptiometry) and of muscle function (by hand grip strength). Diagnosis of sarcopenia required the documentation of low muscle mass with low muscle strength according to the current international consensus definition of sarcopenia. Results: From 1421 participants (553 males and 868 females) definitively enrolled, 221 subjects (135 females and 86 males) (15.5%) were identified as sarcopenic. Results from multivariate logistic regression models showed that sarcopenia was inversely associated with BMI with those participants with BMI higher than 22 kg/m 2 showing a lower risk of sarcopenia relative to those with BMI less than 21 kg/m 2 (OR 0.72; 95% CI 0.60-0.91). Similarly, probability of sarcopenia was lower among subjects involved in leisure physical activities for 3 h or more per week (OR 0.45; 95% CI 0.24-0.93). According to the category of age [45-54; 55-64; 65-74; 75-84 and 85 years or more], the prevalence of sarcopenia in women increase from 9. 1; 12.7; 14.5; 19.4 ; to 33.3%, respectively. For the men, the percentage of sarcopenia increase with aging from 8.6; 15.6; 13.6; 63.8 to 45.5%, respectively. Conclusions: The present study suggests that among healthy ambulatory subjects over 45 years living at home, sarcopenia is frequent, even to the youngest subjects of the studied population, taking place from 9% from 45 years, until 64.3% for the subjects over 85 years. Our findings support the hypothesis that muscle mass and function are associated with BMI and physical activity, whatever the age of the subject. Depressive symptoms, handgrip strength, and weight status in US older adults Introduction: Handgrip strength is a valid indicator of broader physical functioning. Handgrip strength and weight status have been independently associated with depressive symptoms in older adults, but no study has yet investigated the relationships between all three in older US adults. This study investigated the relationship between physical function and depressive symptoms by weight status in older US adults. Methods: Cross-sectional data were analysed from the National Health and Nutrition Examination Survey waves 2011-2012 and 2013-2014. Physical function was assessed using a grip strength dynamometer. Depressive symptoms were assessed using the selfreported Patient Health Questionnaire-9. Weight status was assessed using Body Mass Index (BMI) and participants were categorised as normal weight/underweight (\ 25 kg/m 2 ), overweight (25 to \ 30 kg/m 2 ), and obese (C 30.0 kg/m 2 ). Associations between depressive symptoms and hand grip strength were estimated by gender-specific multiple linear regressions and BMI stratified multivariable linear regression. Results: A total of 2851 adults (51% female, mean age 69.2 years, mean BMI 29.0 kg/m 2 ) were included. Women with moderate to severe depressive symptoms had 1.55 kg (95% CI 0.85-2.25) lower hand grip strength compared to women with minimal or no depressive symptoms. No such association was observed in men. Among those with obesity, men (-3.72 kg, 95% CI -7.00 to -0.43) and women (-1.83 kg, 95% CI -2.87 to -0.78) with moderate to severe depressive symptoms both had lower handgrip strength. Conclusion: Among older US adults, women and people who are obese and depressed are at the greatest risk of decline in physical function. Effects of whole-body vibration exercise in combination with parathyroid hormone (1-34) on physical performance measures in osteoporotic women: a secondary analysis from a randomized controlled trial Introduction: Osteoporosis and falls are the leading causes of fragility fractures. Teriparatide (parathyroid hormone, PTH) is a bone anabolic agent [1] and whole body vibration exercise (WBV) has been shown to decrease the rate of falls [2] . The purpose of this assessor-blinded randomized controlled trial (RCT) was to investigate the effects of WBV + PTH vs PTH on physical function in osteoporotic women. Methods: This is a secondary analysis from a RCT with change in bone mineral density from baseline to 12 months as primary outcome yet to be obtained. Outcomes were short physical performance battery (SPPB; walking-speed, tandem balance-, five-times-sit-to-stand test), timed-upand-go (TUG), leg extension power, and handgrip strength at baseline, 3-, and 6 months of follow-up. Participants received teriparatide 20 lg/day and WBV were performed three times per week. The analyses were performed with intention-to-treat and mixed linear regression. Results: A total of 35 postmenopausal women (mean age 69 ± 7) were randomized to WBV + PTH (n = 17) or PTH (n = 18). After 6 months, 91.4% completed follow-up. SPPB improved from baseline to 3 months (p = 0.039) in the WBV + PTH compared to the PTH with a non-significant change at 6 months (median [IQR] 9 [7.5-10.5], 11 [9-12] , and 10 [8-12] (WBV + PTH) vs 10 [10-12], 10 [10-12], and 10 [9-12] (PTH)). No differences between groups were observed for leg extension power, TUG, or handgrip strength. Conclusion: Adding WBV to PTH yields a significant improvement in physical performance after the first 3 months. This suggests that employing WBV to those undergoing PTH-treatment could have an added benefit to its direct effects on bone by improving physical function. Introduction: Sarcopenia is used in older people to describe reduction in skeletal muscle mass and muscle strength. Blood pressure (BP) is directly and causally related to body size in the general population. It remains uncertain whether muscle mass is an important factor in determining blood pressure. The purpose of our study; the 24-hour ambulatory blood pressure changes in sarkopenic aged patients are different from those in non-sarcopenic patients. Method: Forty-two patients aged between 63 and 94 who applied to the geriatric clinic were included in the study. Demographic data and laboratory values of the patients were recorded. Blood pressure measurements were made with a 24-h ambulatory blood pressure meter. Muscle strength was assessed by handgrip test, muscle performance by 4-m walking test. Skeletal muscle mass was assessed by bioelectrical impedance analysis (BIA). Result: The patients were divided into two groups, 16 sarcopenic and 34 non-sarcopenic patients with a mean age of 78.22 ± 6.80. In sarcopenic group, daytime systolic blood pressures were found to be significantly lower than in non-sarcopenic group. Muscle mass (muscle mass assessed by BIA alone, without hand strength and walking speed) and ambulatory blood pressure data were assessed by Pearlson correlation analysis. There was statistically significant and negative correlation between muscle mass and blood pressure change. Key conclusion: When antihypertensive treatment is given in the patients with sarcopenia, it should be considered that there may be decrease in systolic blood pressure and the dose should be titrated by starting the treatment at low doses and monitoring the blood pressure closely. Short physical performance battery and obesity in Old Icelandic adults Alfons Ramel 1 , Olof G Geirsdottir 1 , Milan Chang 1 , Palmi V. Jonsson 1 1 University of Iceland, Reykjavik, Iceland Introduction: Associations between obesity, physical function and falls in old adults are not clear. Obesity is defined using body mass index (BMI), which does not discriminate between body fat and muscle mass. More sophisticated measurements of body composition might be better suited to explore associations between body composition and function. The aim was to investigate BMI and other anthropometric variables in relation to physical function and falls. Methods: Community dwelling subjects from Reykjavik, Iceland (N = 108, 78.3 ± 6.4 years, 76% female) participated in this crosssectional study. Anthropometrics (bio-electrical-impedance), grip strength, Short-Physical-Performance-Battery (SPPB), gait speed (400 m) and number of falls during the last 12 months were assessed. Results: Neither overweight (40.2%) nor obesity (35.3%) were associated with SPPB, gait speed or falls but with higher grip strength (5.2 ± 2.2 kg, P = 0.021 and 5.6 ± 2.3 kg, P = 0.021, respectively) when compared to normal weight (24.3%). BMI correlated significantly with indices of muscle mass (r = 0.4-0.7) and fat mass (r = 0.5-0.9) in both sexes. Measurements of segmental muscle mass were associated with better SPPB, grip strength and gait speed, corresponding measurements of body fat were associated with poorer function. No anthropometric variable was independently associated with number of falls. Key conclusions: Obesity defined by BMI is not related to strength but not to physical function in old adults. A possible explanation is that BMI is both related to fat and muscle mass. A segmental analysis of body composition shows that muscle and fat are related to physical function in the expected way. However, body composition is not related to falls in old Icelandic adults. Perspectives from patients attending a falls clinic-a qualitative study Introduction: Falls are associated with increased morbidity, loss of skills, and increased need for assistance. Furthermore, having fallen once increases the risk of falling again. This study explored the perspectives of older persons experiencing a recent fall and how the fall affected everyday life. Methods: A phenomenological-hermeneutical approach was used together with a qualitative explorative design. Semi-structured interviews were conducted and analyzed by systematic text condensation. Data was managed in NVIVO. Results: A total of nine patients (five women, four men) attending a Danish Falls Clinic were included. Median [IQR] age was 78 [76] [77] [78] [79] [80] [81] [82] [83] [84] years. The analysis provided four themes: ''Importance of getting professional help'', ''Maintaining meaningfulness in everyday life'', ''Help supplies'', and ''The silent patient''. The analysis emphasized that wishes and needs varied depending on what the older person found most meaningful in life. However, all patients expressed a wish not to fall again. Some patients expressed specific requests for help supplies, which tended to be more frequent among women. Whereas, ''silent patients'' rejected or didn't express any specific needs or wishes related to their fall. Key conclusions: This study provides knowledge about the differences in older person's wishes and needs after a fall, which highlights the importance of person-centered treatment of older fallers. The expression of no needs could represent a lack of knowledge or a social and cultural norm, where need for help is considered as a threat to the personal identity. This indicates that there might be reasons for providing better information in the society about fall prevention. Keywords: Health promotion, Prevention in vulnerable population Comprehensive geriatric assessment based frailty index (CGA-FI) as predictor of health outcomes in a geriatric acute care centre Background: Frailty is closely linked to health results. Frailty indexes (FI) and Comprehensive Geriatric Assessment (CGA) are multidimensional tools. FIs serve as quantitatively measure for frailty levels. They have excellent correlation with mortality, however aren't used in routine clinical practice. Objectives: Analyze frailty degree in patients admitted at our Geriatric Unit and assess how it influences their functional situation and correlation with mortality at 6 months after discharge from hospital. Methods: Retrospective, cross-sectional and descriptive study of a patient cohort admitted at an Acute Geriatric Unit from April to September 2017. We carried out a 6 month follow up and analyzed visits to emergency room, new hospital admissions, functional status and mortality. Statistical analysis was carried out with IBM SPSS. Results: We included 160 patients, with an average age of 84.6 years and 62% were female. Respiratory infections were the main reason for admission (32.5%). About 70% of patients came from the emergency service, 69% of them with severe dependence and 28% died during hospital stay. The average Frailty-CGA Index was 0.45, having 48% of patients a moderate frailty. After 6 months 64% of patients went at the emergency room at least once and 17.8% of them died, of which 47% had a moderate frailty and 43% an advanced frailty. Conclusions: Frailty assessment offers professionals a simple analysis to determine patient's reserve, vulnerability and situational diagnosis; it's crucial to establish therapeutic intensity intervention and measure efficacy afterwards. Frailty quantification methodizing will provide a framework in the interdisciplinary geriatric care teams. Validation of SARC-F for the screening of sarcopenia in elderly patients with dementia: a cross-sectional study Zaid Kasim 1 1 Department of Geriatric Medicine, University of Antwerp, Antwerp, Belgium Introduction: Screening for sarcopenia is essential in a geriatric population including patients with dementia. The SARC-F is a validated questionnaire for the screening of sarcopenia in elderly patients. However, using this questionnaire in patients with cognitive problems might be a problem. The objective of this study was to determine S100 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 whether the SARC-F questionnaire is useful in screening for sarcopenia in patients with dementia. Methods: This qualitative study was nested within a randomised controlled trial testing the feasibility of a home-based health promotion service for older people with mild frailty in two diverse areas of South England. Clients developed personalised goals around maintaining assets and devised strategies to achieve these in conjunction with project workers, whose role was to use COM-B to help identify barriers and facilitators to these and provide information, emotional/practical support, teach skills, as well as provide feedback. We conducted semi-structured interviews with 3 service providers and 16 clients and thematically analysed data. Findings: Interview data suggest that COM-B can be used to support behaviour change in mild frailty. Clients were able to identify a range of assets to improve/maintain. Project workers successfully worked with older people to assess their capability, opportunity and motivation to meet outcome goals, helped them develop related behavioural goals and work towards these. Most participants responded positively to this approach. However, further consideration needs to be made for people developing cognitive impairment, and the best approaches to support behaviour change in this group. The relationship between frailty and sleep quality in oldest old patients Introduction: The search for reliable indicators of biological age across different health outcomes has been ongoing for over three decades, and until recently, largely without success. We aimed to compare the prognostic accuracy of five geriatric health indicators: frailty index (FI), frailty phenotype (FP), walking speed (WS), multimorbidity, and the health assessment tool (HAT). Methods: Data from the Swedish National Study on Aging and Care in Kungsholmen, an ongoing population-based study including 3363 people 60+, were used. The ability of the five geriatric indicators to predict mortality (3-and 5-year) , unplanned hospitalizations (1-and 3-year) , and 2+ health provider contacts (6 months prior and after assessment) was compared using the area under the ROC curves (AUROC) from unadjusted logistic regressions. Predictive ability was tested also in younger (\ 75) and older participants. Results: FI, WS and HAT had the highest predictive power for mortality (3- Results: Mortality after 2 years was increased for frail compared to non-frail individuals in both the ambulatory and admitted cohorts. Patients in the ambulatory care cohort classified as frail by any scale were over twice as likely to die over the 2 years. There was also increased hospital use and costs in the ambulatory cohort with around S102 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 twice as many bed days and over £1000 more hospital costs for frail individuals. Shorter survival times meant there was less evidence of an association between hospital use and frailty in the admitted cohort. Conclusions: A better response to the needs of frail older people in hospital is required but especially for ambulatory patients at high risk of poor outcomes where admission avoidance alone is insufficient. Health and social care systems might wish to examine their current care provision for ambulatory frail older people with urgent care needs which have received less focus than admitted cohorts. Clinical variations between sarcopenic obesity and sarcopenia in geriatric patients: nomogram approach The Nuffield Trust, London, UK, 2 Newcastle University, Newcastle upon Tyne, UK Introduction: Frailty is a significant determinant of health care utilisation and costs, which also increase in proximity to end of life. The over 85 s are the fastest growing age group in many countries. We report relationships between frailty, proximity to death, hospital use and costs in the Newcastle 85+ cohort. Methods: Data from the Newcastle 85+ Study were linked with Hospital Episode Statistics and death registrations. Using both Fried (F) and Rockwood (R) definitions of frailty we analysed the relationship between frailty and mortality, hospital use and hospital costs over 7 years using descriptive statistics, Kaplan-Meier survival curves, Cox's proportional hazards and negative binomial regression models. Results: Those who were frail at baseline had a 2.8 (F)-2.9 (R)-fold increased risk of mortality after two years (2.3 (F) to 2.7 (R) over 5 and 7 years) compared to people who were non-frail. They spent 2.2 (F) to 2.4 (R) times more days in hospital over 2 years (1.3 (F,R)-1.6 (R) after 5 and 7 years) with associated increase in costs (R). However, baseline frailty (F,R) was not associated with Increased time spent in hospital during the last 90 days of life. Conclusions: Members of this 85+ cohort who were frail at baseline experienced higher mortality and hospital use over 2, 5 and 7 years, with some evidence of increased costs compared to those who were not frail at baseline. However, increased hospital use at end of life was more closely associated with proximity to death than with baseline frailty status. Prevalence of osteo-sarcopenia and osteo-sarcopenia obesity in healthy ambulatory subjects older than 45 years in France Introduction: This study aims to determine the prevalence of sarcopenia and osteopenia/osteoporosis among a population of 1508 healthy ambulatory subjects over 45 years living at home, in Paris (France). Methods This study was conducted selecting all ambulatory participants aged 45 years and older, consulting in the Institute of Physiology from Paris, for a functional, muscle and bone mineral density evaluation, and did not have limitations to moderate physical exercise. All were healthy people. Lombar, femoral bone mineral density and muscle body composition were measured with dual-energy X-ray absorptiometry. Skeletal muscle mass index and handgrip strength were used for sarcopenia diagnosis. Independent samples t tests determined group differences in body composition and functional ability according to recommended diagnostic cut points. Results: From 1409 participants definitively enrolled, prevalence of sarcopenia was 16.1% (135 females and 86 males) according to the EWGSOP definition. The prevalence of osteopenia in the cohort was 33.5% and osteoporosis was 17.9%, according to the standard WHObased T-score criterion. From the age of 45 years, more than 10% of the sarcopenic population suffers from osteoporosis. Osteosarcopenia begins from 45 years and the risk increases with the advanced in age. Sarcopenia increased as BMD decreased as follows: normal BMD: 5.7%, osteopenia 27.1%, and osteoporosis 34.2% respectively. After adjustment for age and BMI, the adjusted odds ratio (OR) (95% confidence interval) for sarcopenia was respectively 2.21 (1.36-4.28) for the osteopenic group, and 1.88 (1.15-3.84 ) for the osteoporotic group (p \ 0.05). Using the WHO definition, the percentage of sarcopenic obesity was 35.6% of our sarcopenic female population, and 33.7% of the sarcopenic males. In this sarcopenic obesity sub-population, 21.5% of women (29/135) and 22.1% of men (19/86) were osteoporotic. Brought back in the whole studied population, sarcopenic obesity and osteosarcopenic obesity were observed in respectively 5.6 and 3.4% of women; and in 5.3 and 3.5% of men. Conclusions: The present study suggests that among healthy ambulatory subjects living at home, osteosarcopenia is frequent and begin from 45 years. The prevalence of osteosarcopenic obesity is less frequent. Attention for sarcopenia are needed in subjects showing low BMD to prevent and manage poor quality of life and specific morbidity. Introduction: The multifidus spinae (MF) is an essential muscle for preserving an erect posture and for rotating the spine. This muscle undergoes significant atrophy with prolonged bed rest [1] and ageing [2] . The aims of the present study were to, (1) quantify the activity of the MF muscle during basic activities of daily living (ADL), (2) evaluate the reliability of ultrasound measures of MF cross-sectional area (CSA) and, (3) How may B-mode sonography help to assess muscle aspects in an acute care setting Heinrich Burkhardt 1 , Laura Parigger 1 1 Universitätsmedizin Mannheim-Geriatrisches Zentrum, Mannheim, Germany Background: There is an increasing interest in the assessment of muscular aspects to detect and quantify both sarcopenia and consequences of deconditioning in acute care medicine. At present the possible role of B-mode sonography in this context is discussed but has still to be evaluated. Methods: 84 inpatients (aged 65 and above) were included. They attended the geriatric ward due to a variety of clinical causes (e.g. pneumonia, fluid imbalance, heart failure). All received B-mode sonography measurements of the quadriceps femoris muscle and the gastrocnemius muscle. Measurement was standardized with regard to anatomical landmarks. Reliability oft the measurements was analyzed utilizing three repeated measurements (intra-observer). Also assessment of muscle strength of those muscles was included in the study protocol applying a hand-hold dynamometer and finally BIA was used to assess the presence of sarcopenia following current recommendations. Measurement of muscle strength and results of the BIA were subsequently utilized for validation analysis. Results: 44 women and 40 men, age 65-96 years (78) were included. 34 underwent an early rehabilitation protocol due to significant deconditioning. Activities of daily living (Barthel) ranged 0-100 (85). Complete data could be retrieved from 80 patients (4 declined the ultrasound examination). Cronbach alpha for the congruence of the repeated measurements showed 0.99 for m. quadriceps and 0.98 for m. gastrocnemius. Further positive correlations were found between muscle diameter, grip strength and skeletal muscle index derived from the BIA-data (0.29-0.49). Discussion: B-mode sonography can be easily applied in an acute care setting and reveals sufficient reliability. Further the expected correlation to established markers of muscle performance could be demonstrated. The orthogeriatric prevention service improves the adherence to treatments among functionally resilient older persons Introduction: Despite technological and organizational-procedural advances, femoral fractures cause high mortality, severe permanent disability, contributing to an increase in the consumption of social and health resources. The aim of this study is to evaluate the effectiveness of an orthogeriatric outpatient service in the prevention of refractures. Materials and methods: Observational clinical study conducted on 762 over-65 s with hip fracture outcomes discharged from the trauma and orthopedics department between February 2016 and February 2017. Of these 271 cases (patients received at the orthogeriatric surgery) and 283 are the controls (patients who they followed the usual route). Indicators of the outcome of the intervention are the percentage of patients who receive therapeutic indications aimed at preventing falls and re-fractures, those who adhere to these indications at follow-up and those who develop complications, including falls, re-fractures and use of social and health services. Results: The cases are more adherent to the indications received in particular as regards calcium/vitamin D supplementation and antifracture therapy. Finally, in this context, the indication received in S104 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 orthogeriatric surgery presents a better prescriptive appropriateness compared to controls. The results of our study suggest that an orthogeriatric outpatient management is potentially able to respond to the multiple care needs of the elderly with a fracture of the femur by taking care of the person. It is necessary to validate this model of assistance and verify its effectiveness in antifriction terms in order to structure corporate assistance paths. Impact of the rapid access clinic for the elderly in supporting older people with ''frailty'' in the community Introduction: The SARC-F is a validated questionnaire for screening for sarcopenia in older patients. However, it is challenging when using this questionnaire in patients with dementia. Medical caregivers or family can fill in (by proxy) the SARC-F questionnaire for these patients. The aim of this study was to validate the SARC-F-Proxy as a surrogate for the SARC-F in older patients with dementia. Methods: This study included patients aged 60 years or older with various grades and types of dementia, who were admitted to the ZNA Joostens PsychoGeriatric Hospital. SARC-F-Proxy was completed by medical caregivers and family members. Sarcopenia was defined using the EWGSOP's diagnostic criteria. Calf circumference, hand grip strength and gait speed were measured and used as variables for muscle mass, strength and function respectively. Results: This study included 174 patients, 59.2% female. Mean age of 83.3 yr (SD 7.1). Sarcopenia was identified in 110 patients with muscle measurements while SARC-F-Proxy identified 77 patients as possibly sarcopenic. SARC-F-Proxy had 70% sensitivity and 15% specificity with a positive predictive value of 59% and negative predictive value of 23%. Conclusion: SARC-F-Proxy is better than SARC-F as and has a good enough sensitivity to be used as a screening tool for sarcopenia among patients with dementia. Screening for frailty in the specialist oncology setting This is predicted to rise to 23.7% by 2025 [1] . Advancement in cancer treatments means more older adults are undergoing therapy and this cohort is more likely to be frail. Frail patients are less likely to tolerate cancer treatments, but screening for frailty is not routinely performed in the oncology setting. Current practice is to evaluate patients for treatment based on the Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) score; a tool not validated to assess for frailty. We looked at the correlation between PS and frailty screening tools. Methods: We evaluated in-patients aged [ 65 years across two wards at a specialist oncology center. Data was collected from electronic records and by undertaking the G8 frailty tool questionnaire. Results: 36 patients were included in the study (mean age 73 years). 83% of patients were frail. There was no significant correlation (Spearman's correlation p = 0.177) between age and G8 score. The area under the ROC curve of 0.39 comparing G8 with PS \ 2 (not frail) and PS C 2 (frail) suggests that PS does not reflect the burden of frailty detected by the G8. Conclusion: Frailty is highly prevalent in older cancer patients. The ECOG PS score does not correlate to frailty. A more suitable frailty assessment tool should be used to identify those who are most at risk of treatment-related toxicity and cancer mortality. Aim: The prevalence of hyperkyphosis is rising among elderly individuals. In previous studies, it was associated with paraspinal muscle composition, spinal extensor muscle weakness, and impaired lower extremity physical function. The aim of this study is to determine the relationship between hyperkyphosis and structural and functional muscle deterioration due to aging. Methods: The study included 142 participants who applied to our university's geriatric outstanding clinic from January 2017 to January 2018. The kyphosis grade was measured using the block method, where the participants were told to lie in a supine position on a radiology table. Blocks with thickness of 1.7 cm were placed under their heads to keep participants' heads in neutral position. The block of one and above was considered as hyperkyphosis. Results: Seventy-one of our participants were hyperkyphotic while the other 71 were normal. The mean age of the patients was 72.1 ± 6.90. Thirty-six of the participants were male (25.3%) and 106 were female (74.6%). The sarcopenia parameters are given in Table 1 . The walking speeds of the patients were significantly lower in the hyperkyphotic group than normal group (p \ 0.001). There was no significant difference between smooth muscle mass (SMM) and smooth muscle mass index (SMMI) in the two groups (p: 0.260 and p: 0.733). There was also no statistically significant difference in hand strength assessment (p: 0.157). Conclusion: Exercise-based treatments are preliminary for hyperkyphosis; however, there is no standard treatment yet. In addition to muscle strengthening exercises, new treatment modalities are needed. These may be promising in posture-related progressive kyphosis by increasing muscle strength. Mobility disorders and cognitive impairment predict disability and mortality in community-dwelling older adults Mika Okura 1 , Mihoko Ogita 2 , Hirenori Arai 3 1 Kyoto University Graduate School of Medicine, Kyoto, Japan, 2 Shiga University of Medical Science, Shiga, Japan, 3 National Center for Geriatrics and Gerontology, Obu, Japan Aim: This study aimed to examine whether the combination of mobility disorders and cognitive impairment was associated with mortality and the new long-term care insurance (LTCI) service requirement need. Methods: We analyzed cohort data for older adults in Kami town, Japan. The response rate to the self-reported questionnaire was 94.3% (n = 5094). The outcomes were new certifications for the LTCI service requirement and mortality in 3 years. The mobility disorders and cognitive impairment were determined by the Kihon checklist. Results: The prevalence of no-mobility disorders and no-cognitive impairment (GG), no-mobility disorders and cognitive impairment (GB), and mobility disorders no-cognitive impairments (BG), and cognitive impairments and mobility disorders (BB) were 46.8, 20.0, 18.3 and 14.9%, respectively. During the 3-year follow-up period, 5.2% (n = 262) died and 13.9% (n = 708) individuals were newly certified for the LTCI service requirement. As determined by multivariate analyses, GB (hazard ratio adjusted sex and age ( Background: The purpose of this study is to explore the optimal cutoff point of calf circumference (CC) as a simple proxy marker of appendicular skeletal muscle mass (ASM) and sarcopenia in the Korean elderly and to test the criterion-related validity of CC by analyzing its relationships with the physical function. Methods: The participants were 657 adults aged 70-84 years who had completed both dual energy X-ray absorptiometry (DXA) and physical function test in the first baseline year of the Korean Frailty and Aging Cohort Study (KFACS). Results: ASM and SMI (skeletal muscle index) were correlated positively with CC (male, ASM, r = 0.55 and SMI, r = 0.54; female, ASM, r = 0.55 and SMI, r = 0.42; all P \ 0.001). Testing the validity of CC as a proxy marker for low muscle mass, an area under the curve (AUC) of 0.81 for males and 0.72 for females were found and their optimal cut-off values of CC were 35 cm for males and 33 cm for females. In addition, CC-based low muscle groups were correlated with physical functions even after adjusting for age and BMI. Also, the cut-off value of CC for sarcopenia was 32 cm. (AUC; male, 0.82 and female, 0.72) Conclusion: The optimal cut-off values of CC for low MM were 35 cm for males, 33 cm for females and 32 cm for sarcopenia. Lower CC based on these cut-off values was related with poor physical function. CC may be also a good indicator of sarcopenia in Korean elderly. Trajectory of frailty over 4 years in community-dwelling older Japanese adults: a prospective longitudinal study Introduction: The aim of this study was to examine the 4-year trajectory of frailty of older community-dwellers. Methods: The data was collected by mail and field interview in 2013 and 2017. Questionnaires including the Kihon checklist (KCL) were distributed to 5401 older adults. The response rate was 94.3% (in 2013) and 81.5% (in 2017). At baseline, participants were divided into two groups according to the total scores of the Kihon checklist and the mobility disorder and cognitive impairment were defined based on mobility and cognitive domains of KCL. The participants who responded to the questionnaires at baseline and follow-up were classified into four groups according to the change of frailty status; RR (robust to robust), RF (robust to frail), FR (frail to robust), FF (frail to frail), and the percentage was calculated in each age group. Results: The percentage of mobility disorder was 59.2% (RR), 13.5% (RF), 8.9% (FR), 18.4% (FF), whereas that of cognitive impairment was 52.4%, 17.3%, 13.1%, 17.2%, respectively. Additionally, the percentage of deterioration in both motor and cognitive functions was higher in older groups. However, the percentage of improvement was not different among each age group. Conclusions: Approximately 10-20% of older people in the community were found to have mobility disorder or cognitive impairment. Considering the proportion of improvement in mobility and cognitive function, it is important to examine what factors are involved in the improvement. Assessment of bone and muscle measurements by peripheral quantitative computed tomography in geriatric patients Results: Initial KCL of COPD group was 5.2/25 ± 4.4 (0-18). With frailty evaluation by KCL, 9 were classified as frail (F, KCL C 8), 17 as pre-frail (7 C P C 4), and 17 as robust (3 C R). As J-CHS criteria, F/P/R in COPD group were 5/27/11. In control group, KCL was 6.1 ± 5.4 (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) , and F/P/R were 16/10/17 with KCL, and 10/19/14 with J-CHS. Eight of fatal 13 COPD cases were P (KCL C 4) and all 4 fatal cases in control were KCL C 9. Conclusion: COPD patients showed same level of frailty as geriatric syndrome outpatients at FPC, NCGG. Fatal case in this study showed higher KCL, which indicated possibility of KCL to evaluate not only physical function but prognosis for COPD and geriatric syndrome patients in integrated care settings by interdisciplinary team. Validation of the walkway ''SPEED-AGE'' Esther Objectives: Validate the ''SPEED-AGE'' walkway, a technological device whose objective is to measure the gait speed in the elderly in an automated way. Methods: The ''SPEED-AGE'' walkway is composed of two proximity sensors (start and end) that record the gait speed data in the patient's medical history through a computer program. We analyze 90 patients from the Falls Clinic of the Geriatrics Service. Participants walked first in ''SPEED-AGE'' and later in GAITRite, and gait speed test of SPPB. The GAITRite protocol of the Falls Clinic includes two measurements at usual pace, one at speed fast, one slow and one with dual-task. For the validation we use the walk to usual pace and the average of these 5 measurements of GAITRite. The association between gait speed determinations was performed by correlation analysis of Pearson, the Bland-Altman method and finally t-test was used to paired samples to quantify the differences between methods. Seventeen patients had some fall in the next six months, with a decrease from 3.3/year to 0.6/6 months (95% CI 19-3.5). The adherence to exercise was 75%. Conclusions: A multicomponent training program in elderly people with falls, improves physical function, affectivity, body composition and reduces the number of falls. Gait kinematic parameters analysis using an inertial sensor unit after 1 month of multicomponent exercise training (vivifrail) in frail/prefrail older adults with cognitive impairment: preliminary results of a randomized controlled trial including functional decline, falls, and institutionalization. Gait velocity has been reported as one of the strongest criteria to predict adverse outcomes and the most useful for the identification of physical frailty. Nevertheless, gait is a complex motor behavior with many measurable parameters besides velocity. Methods: In a randomized controlled trial, 48 community-living older adults aged older than 75 years with mild cognitive impairment or mild dementia were randomized into an intervention group (IG, n = 22) and a control group (CG, n = 26). The intervention consisted of a multicomponent exercise-training program based on the clinical physical exercise guide ''Vivifrail''. Evaluations of 5-m gait velocity test (GVT), verbal GVT and arithmetic GVT were performed at baseline and after 1 month of intervention in both groups. An inertial sensor unit (IU) was attached over lumbar spine (L3) to record the acceleration data. Results: The IG showed enhancements in the normal GVT after the intervention period compared with the baseline value in the root mean square (RMS) (mean change of 1.5; 95% confidence interval (CI) -0.1, 0.2), whereas no change was found in CG (-0.1; -0.3, -0.1)(p \ 0.05). No significant differences were found between groups in other parameters. Conclusions: A no supervised multicomponent exercise-training program improves some gait-related parameter, such as RMS, in frail/ prefrail community-dwelling older adults with mild cognitive impairment or mild dementia compared with the control group. The cut-off points and prevalence of low hand grip strength for sarcopenia in korean elderly based on the 7th KNHANES Introduction: Hand Grip strength (HGS) is an important index of low muscle strength to diagnose sarcopenia. We aimed to assess age-and gender-specific values of the HGS based on the Korean National Health and Nutrition Examination Survey (KNHANES) 7th and identify cut-off points for low muscle strength of HGS of Korean elderly. Methods: 5253 from the age of 20-80 years were subjected to measurements of HGS, including 2489 men and 2764 women. HGS was evaluated in both the dominant and non-dominant arm using the Digital hand dynamometer. HGS measurements were repeated three times, respectively and the greatest value was recorded. The cut-off value for low HGS was defined as below 2 SD values of healthy young adults in this study population. Results: The mean maximum HGS was increased from the age of 20-39 years. The peak in maximum HGS was in the age of 30-39 years range for both men and women. It was then decreased after 39 years. The cut-off values of low HGS for sarcopenia in male and female elderly populations were 29.6 and 16.5 kg, respectively. The prevalence of low HGS for sarcopenia was 25.7% in elderly men and 17.3% in elderly women respectively, and significantly increased with aging. Key conclusion: These data suggest useful reference values to assess HGS and may help in defining sarcopenia among the Korean population. Sit-to-stand and protein supplementation in the OPEN Study-a surprisingly feasible and welcome health concept for nursing home residents Introduction: In line with person-centered care, active ageing should be recommended all older residents when possible, e.g. in nursing homes (NH) meaningful activities such as physical activity should be offered regularly. In spite of the well-known health-related benefits of daily physical activity a majority of NH residents are inactive with limited social interaction. Following a cluster randomized health intervention trial (the Older People Exercise and Nutrition (OPEN) Study), where residents' were offered to conduct sessions of sit-tostand (STS) exercises together with oral nutritional supplement (ONS) individual interviews were conducted. The aim was to describe the residents' perceptions and experiences of the health intervention introduced. Methods: In-depth interviews were done in eight NH facilities with 20 residents having performed the 12 week ONS/STS intervention. The transcribed interviews were analyzed inductively, following a constant comparative method described in Grounded theory-a reliable technique to form theory and hypothesis in un-exploited areas. Results: This exercise and nutritional intervention was described highly feasible by the NH residents. Furthermore, the analysis displayed experiences ranging from neutral to mainly positive; from existential feelings of hope and trust; to driving forces to fulfil the health concept. Also, the intervention trial was described as a welcome contribution to fill the day and were perceived easy to perform and integrate in daily activities. Key conclusions: Health component interventions such as OPEN that bear hope of improvement, and contribute to a more meaningful day, are of interest to-and potentially beneficial for-a broader nursing home clientele. Diabetes and falls in the elderly Falling and diabetes are important public health issues associated with a risk of functional decline. Diabetic patients are known to have an increased risk of falling. Our study aimed to determine the prevalence of diabetes in the population of elderly patients seen at the multidisciplinary falling consultation at the University Hospital (CHRU) of Lille and to study the characteristics of falling diabetic patients. This is a monocentric retrospective study with prospective data collection. All patients seen between 1995 to 2011 were included. For data analysis for quantitative variables, we used the student test or the Pearson correlation test. For qualitative variables to analysis of variance according to a Fischer test. 1179 patients benefited from a multidisciplinary consultation of the fall between 1995 and 2011. Of the patients interviewed, 205 patients (17%) were type 2 diabetics. Among the significant differences identified between groups: diabetic consultants were on average younger, had a lower level of education, a lower ADL, a higher body mass index. The fear of falling was more often expressed by diabetics than non-diabetics and was accompanied by a greater restriction of leaving their homes. Diabetic patients consumed significantly more drugs and the high polypharmacy was almost twice as common in diabetics as in non-diabetics. Our study suggests that diabetics experience falling earlier in life. Once identified the subject at high risk of falling, appropriate care must be offered to reduce the risk of falls. For this, we can, with benefit, appeal to the geriatrician, an expert in this area. The multidimensional prognostic index predicts 90-day mortality in older medical patients admitted to an Emergency Department Merete Gregersen 1 , Else Marie Damsgaard 1 1 Background: Only a minor stress factor as well as an acute illness may result in increased vulnerability to sudden changes of health. A state of frailty may develop or deteriorate in hospitalized older person. This fragility may increase the risk of death. We wanted to examine whether the degree of frailty can predict 90-day mortality in older patients with medical diseases. Methods: All patients aged 65 years or more, consecutively admitted to the emergency department (ED) due to acute illness or relapse of chronic disease, were included. Terminal patients were excluded. The 'Multidimensional Prognostic Index' (MPI) based on comprehensive geriatric assessment was used to identify the moderately and severely frail patients. The 90-day mortality of these was compared to patients who were assessed to be non-frail. A trained interdisciplinary geriatric team collected the data from face-to-face interviews, patient charts, admission reports from home care, and relatives. Results: A total of 624 patients was included. Of these 23% were nonfrail, 33% moderately frail, 44% severely frail. More than half were women (52%). Mean age was 84 years (± 7.40). Both age and gender were associated with frailty. The risk of death increased proportionally with the degree of frailty. In the moderately frail, Hazard Ratio adjusted for age and gender, was 2.54 (95% CI 1.04-6.23, p = 0.04), in the severely frail 7.38 (95% CI 3.20-17.0, p \ 0.001). Key conclusion: MPI can predict short-term mortality in older medical patients acutely admitted to an ED. The tool is useful to identify frail patients for targeting comprehensive geriatric interventions. Conclusion: The prevalence of frailty was different depending on the tool used. Frailty was very prevalent in the geriatric ward though they present a good functional and cognitive status. The relationship between cognition and physical performance in non-demented older adults with sarcopenia Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Results: Mean age of 68 subjects was 78 ± 5.9 years. Mean value of MMSE was 28.12 ± 1.6, ADL 5.82 ± 0.46, IADL 7.19 ± 1.5. MMSE correlated negatively with age (p \ 0.0001), SARC-F (p = 0.002), chair stand time (p = 0.047), 400 m walk test (p \ 0.0001), Charlson index (p = 0.005), and positively with handgrip strength (p = 0.01), gait speed (p = 0.002), SPPB (p \ 0.0001), daily steps (p = 0.04) and 7 days step count (p = 0.02). In multiple linear regression analysis with MMSE as dependent variable adjusted for age, sex, handgrip strength, gait speed, IADL, daily steps, SARC-F, Charlson index significantly associated with cognition were sex (p = 0.009), gait speed (p = 0.046) and SARC-F (p = 0.0009). Conclusions: The non-demented subjects with sarcopenia present a decline in cognitive function related to deterioration in physical performance. Physical frailty and adverse drug events (ADEs) in the elderly inpatients Introduction: It is well known that the risk of adverse drug events (ADEs) are higher in the elderly and it was reported that ADEs occur 3 times higher in frail elderly people than non-frail older people. So that we need to take special care to prescribe medicines to the elderly patients. Our study investigated what kind of patient characteristics or what kind of prescription were related to the occurrence of ADE in elderly for reducing ADEs. Methods and materials: A retrospective observational study was conducted between September 2014 to October 2016, included 260 consecutive elderly inpatients (mean age 77.3 ± 6.6, male 29.4%) admitted to the department of Geriatric and Hypertension of Osaka University hospital. We examined frequency of ADE and the related factors with the occurrence of ADEs and relation between physical frailty and ADEs. Results: 69 ADEs were identified. By multiplex logistic-regression analysis, emergency admission, the number of the drugs and the comorbidities increase, and the phenotype of frailty; weight loss ([ 2 kg) in the past 6 months were associated with the occurrence of ADEs. Conclusion: Our results suggest the above three factors may be potential useful for identifying individuals at higher vulnerability to ADEs, and it might be better to distinguish those patients as ''Pharmaco-frailty''. Dose reduction and medication change may be considered based on organ impairment and not only patient's body weight but also body loss over those past few months, special management for the patients would be helpful for reducing ADEs in elderly patients. Dietary patterns and their relationship with functional capacity Introduction: The impact of dietary patterns rather than single foods or nutrients on health outcomes is increasingly recognized. The objective of this work was to describe the dietary patterns and their relationship with functional capacity in community-dwelling elder people. Methods: This was a cross-sectional study of 527 non-institutionalized functionally independent older people aged C 70 years from Gipuzkoa (Spain) . Functional capacity (by the Timed-Up and Go test-TUGT) anthropometric measures, presence of malnutrition (by the Mini Nutritional Assessment) and dietary data (type of food, frequency and amount) were collected. First, a multiple correspondence analysis (MCA) was performed to identify dietary patterns, considering frequency of food intake and compliance with food recommendations. Second, a cluster analysis was applied, based on MCA results, to identify groups of similar individuals. Results: The mean age was 76.2 (SD 5.2) years, 55% were women, 48% obese and only 3.3% were at risk of malnutrition. A 24.6% had a limited functional capacity according to the TUGT. Three groups of individuals were identified in the cluster analysis: cluster 1 (n = 285), cluster 2 (n = 194) and cluster 3 (n = 48). A gradient of decreasing functional capacity, poorer health status and worse dietary pattern (not complying with recommendations) was observed from cluster 1 to cluster 3. Key conclusions: An association between dietary patterns and functional capacity is observed. It is necessary to include nutritional screening and a subsequent dietary assessment in primary care to provide adequate nutritional care to elder population as an intervention to protect and improve their functional capacity. Pulse Université de Lorraine, CHRU de Nancy, France, 2 CHRU de Nancy, France Introduction: The aging process is known to be associated with an increase in arterial stiffness and frailty. Some studies have already shown that pulse pressure amplification (PPA) has an impact on cardiovascular mortality as criteria of arterial stiffness among older. The aim of the present analysis is to show that arterial stiffness might be an indicator of severe vascular frailty. Methods: 56 patients were enrolled in a cross sectional study for a 1 year period in the day hospital of Nancy university hospital. Cardiovascular check up, pulse wave velocity (PWV) and PPA were assessed with an arterial tonometer. Data were collected about Fried frailty criteria from patient's medical history. Subjects were then later classified as not frail, prefrail (one or two criteria) and frail (more than 2 criteria). Results: A total of 56 individuals older than 75 years (mean aged 83.02 ± 4.85, 48% of women) were analysed. Comparison according Spearman rank correlation with a risk of 5% showed a significant relationship between PPA and Fried frailty criteria (P \ 0.05, R 2 = 0.42). After adjustment for age, gender and mean arterial pressure this relationship persisted (p = 0.05, R 2 = 0.23). There was also a significant correlation between the frailty degree and Lawton instrumental activities of daily living scale (P = 0.01). Conclusion: There is a significant relationship between PPA and frailty degree. Pulse pressure amplification is a mechanical biomarker of ''vascular frailty'' which can be modified by the mean of pharmacological treatments. Nevertheless, a prospective multicentre study on a larger population is necessary. Determinants of physical function in community dwelling old adults Poor physical function is associated with adverse health outcomes in older adults. Several variables, e.g., nutrition, physical activity (PA), body composition, hematological variables, medication and cognitive function have been associated with physical function among older adults. However, findings from studies have been inconsistent and it is still unclear which factors are independent predictors of physical function. We conducted a cross-sectional study including 236 community-dwelling old people (age range: 65-92 years, 58.2% female) in Reykjavik, Iceland. Timed-up-and-go (TUG), 6-minutes-walk-for distance (6MWD), nutrition, PA, body composition, blood chemical variables, medication and cognitive function were assessed. We found bivariate correlations between physical function with body composition, strength, physical activity, number of medications, hematological variables, cognitive function, energy and protein intake. According to hierarchical linear models, body composition, strength, number of medications, PA and cognitive function were predictors of physical function but not hematological variables. Results were similar for both 6MWD and TUG and the strongest modifiable predictors in the final models were quadriceps strength/bodyweight (N/kg) ((+ 16.1 m, P = 0.001; -0.4 s, P = 0.001), physical activity (h/week) (+ 2.2 m, P = 0.001; -0.04 s, P = 0.021) and number of medications (-8.1 m, P = 0.003; + 0.2 s, P = 0.021). Physical function decreases with age. However, there are modifiable determinants of physical function among communitydwelling older adults, in particular strength for a given body weight, PA and number of medications, which might give the possibility to maintain or improve physical function in this age group. Different profiles of frailty among older and younger heart failure patients: preliminary data from the deus ex machina study Introduction: Frailty is prevalent among heart failure (HF) patients. This work intends to describe the frailty profiles in younger and older HF patients. Methods: Patients were recruited from an outpatient clinic in a University Hospital in Portugal. New York Heart Association (NYHA) HF classes were registered. Frailty was assessed using Fried phenotype. Mid-arm muscular circumference (MAMC) was estimated from mid-acromial-radial circumference and triceps skinfold. Results: Overall 86 patients were included: age 57 ± 13 (24-81 years), 66% men, 34% older than 65 years. Regarding NYHA class, 30, 53 and 17% were respectively at class I, II and III. Overall, 58% were pre-frail and 14% frail. Frailty was more frequent among NYHA III patients (p \ 0.001) and in men at the lowest MAMC tertile (p \ 0.001). While frailty was more prevalent at older ages (58%, p \ 0.05), 54% and 9% of younger patients were pre-frail and frail, respectively. Exhaustion (37%), low physical activity (35%) and weakness (35%) were the most frequent overall criteria (and for those aged \ 65), whereas among older patients, weakness was the most determinant criterion (62% vs. 21%, p \ 0.001). NYHA classification was not associated with age. Conclusions: As expected, frailty in HF patients is associated with older age and more severe NYHA class. Nevertheless, a considerable proportion of younger patients are frail/pre-frail and this syndrome shows different profiles between ages. Introduction: Fragility is a reversible geriatric clinical syndrome. The objective of this study was to assess the prevalence of frailty of elderly residents living with long-term care, to identify associated S112 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 factors and to propose effective interventions to prevent the loss of autonomy. Materials and methods: This is a descriptive and analytical study in January 2017 in an EHPAD in Tunisia. Fragility data were collected using a pre-established questionnaire on resident social data, the EGS using screening scales, and the frailty level by the SEGA-A score. According to this score, patients were classified into 2 groups according to their degree of fragility: not fragile, versus fragile and very fragile. Results: 53 residents were included with an average age of 77.42 ± 8.3 years. The average SEGA score was 9.36 ± 4.17. The prevalence of frailty in this EHPAD was 52.8% for fragile and very fragile vs 47.2% non-fragile. Fragility was higher among women. The modifiable factors associated with frailty, in our study, as in the literature, were poly-pathology, malnutrition according to the MNA score, depression, loss of autonomy, high risk of falling and dementia. In stepwise multivariable regression analysis, the presence of polypathology, dementia and undernutrition were independently associated with hypertension. Conclusion: The prevalence of frailty in EHPAD is important. These associated factors present a vicious circle which should lead to screening to set up a personalized plan of care and avoid loss of autonomy. The evaluation of daily functioning as part of the operational definition of frailty: a systematic review ). The identified instruments were analysed and categorised in basic-(b-), instrumental-(i-) and advanced-(a-) ADL. Results: In total 144 articles described 149 frailty instruments. A distinction can be made between a physical (n = 47), multidomain (n = 98), comorbidity (n = 1), and biomarker model (n = 3). At least one ADL was present in 77.9% of the instruments: 71.1% concerned b-ADL, 55.3% i-ADL and 33.6% a-ADL. Not all included ADL have the same aim, e.g. measuring physical activity, weakness, slowness etc. If these were excluded, the results would decrease to 53.0%, 50.3, 36.2%, and 10.1% respectively. Conclusion: ADL is present in the assessment tools. Circular reasoning can occur as disability in ADL can be seen as a predictor, a characteristic, or an outcome of frailty, but also as a predictor of negative health outcomes in the frail. Also, the meaningful concept of the included ADL across various instruments can be interpreted differently. Peculiarities of sarcopenia measured with bioimpedance in patients with diabetes mellitus type 2 in hospital settings Conclusion: Sarcopenia revealed in 38% of women with DM2. Sarcopenia was more often detected in patients with more severe peripheral neuropathy. Combination of severe stage of neuropathy with decreased muscle mass in S+ increases the risk of falls and fractures. S+ patients demonstrated decrease of skeletal muscle mass and fat mass. S+ patients characterized with more severe changes in the body composition not only in the skeletal muss, but also in the amount of fat mass and bone mineral density. The screening of frailty syndrome in different settings-the FRAILTOOLS study background Introduction: The frailty is a common geriatric syndrome but still there is a discussion how it should be measured in clinical and social settings. The FRAILTOOLS project was designed to evaluate the usefulness of selected frailty scales and establish which scale has the highest predictive value. Moreover, is to build frailty detection algorithms. In the context of FRAILTOOLS study arise this abstract. The main objective of this abstract is to review academic articles to determine which instruments are preferred by clinicians and researchers to detect frailty in different settings in the last decade. Methods: Keywords (frailty, frailty assessment tools, frailty assessment instruments, frailty screening) were extracted from articles (n = 147500) from different disciplines, retrieved from Google Scholar, from 2008 to May 2018. Articles that have been doubled have been excluded from the analysis. Results: At Google Scholar keywords: 'frailty' appeared 76000 times; 'frailty assessment tools'-25900, 'frailty assessment instruments'-17700 and 'frailty screening'-22800. The most common used scales were: Fried's criteria (n = 57700), FRAIL scale (41 400 Conclusion: The review of the Google Scholar database revealed that screening of frailty syndrome is not unified and at least 7 different scales are widely used to detect frailty in different settings and countries. Many studies have demonstrated the utility of certain assessment tools to evaluate frailty in populations, however the individual risk for disability has not been properly evaluated, which is the main interest in the FRAILTOOLS project. This abstract is part of the project "662887 / FRAILTOOLS" which has received funding from European Union's Health Programme (2014-2020). Profiling trends in clinical frailty scale, serum vitamin D levels and bone turnover markers: a prospective cohort of frail older adults in the West of Ireland Background: It has been suggested that inflammation plays a role in the pathogenesis of frailty and many studies have been carried out to understand the underlying mechanism until now. In this study, the relationship between frailty and inflammation was examined. Methods: 817 patients over 65 years of age who were referred to our clinic were included in the study. Comprehensive geriatric assessment was performed to all patients and Freid Criteria were used to assess physical frailty. Neutrophil count, lymphocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin, CRP/ albumin ratio (CAR), and neutrophil/lymphocyte ratio (NLR) were used as inflammatory markers. Results: The median age of the patients was 73 years (min-max: 65-94), 61.9% was female (n: 506) and 10.8% was frail (n:88). Median CRP was 0.41 mg/L (min-max: 0.10-2.62) in the non-frail group and 0.49 mg/L (min-max: 0.10-7.67) in the frail group (p: 0.167). The CAR was higher in the frail group but this correlation was not significant (p: 0.07). The median NLR was 2.17 (min-max: 0.21-10.17) in the non-frail group and 2.41 (min-max: 0.62-18.20) in the frail group and the difference between the two groups was significant (p: 0.014). ESR was significantly higher in the frail group (p \ 0.001). In multivariate analysis, when models with independently related factors created, it was found that ESR was related to frailty with statistical significance (OR: 1.026, %95 CI: 1.005-1.047, p: 0.015). Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Conclusion: It has been shown that there may be a relationship between frailty and inflammation in our study. Validation of frail scale in Turkish older adults Hacettepe University Biostatistics, Ankara, Turkey Background and aim: Frailty is a geriatric syndrome characterized by decreased physical activity, decreased gait speed, weight loss, muscle power loss which are caused by cumulative decline in many physiological systems. Frail older adults suffer from increased mortality, morbidity and health expenditures when exposed to stress factors. In order to determine the frailty in patients, practical, validated and reliable scales are needed. Conclusion: In this study, the FRAIL scale has been proven to be a reliable and valid screening tool in the assessment of frailty in Turkish older adults. The pain patterns in frail sarcopenic and osteosarcopenic subjects Background: Increasing age is associated with a parallel increase of geriatric syndromes such as frailty, a condition of decreased functional reserve that precedes disability, and can be associated with sarcopenia and osteosarcopenia (combination of osteoporosis and sarcopenia). Daily pain is prevalent among frail subjects but its role in sarcopenia and osteosarcopenia has not been fully investigated. Methods: We enrolled 70 subjects community-dwellers aged C 70 (40 sarcopenics, 30 osteosarcopenics). Sarcopenia was determined by DXA (FNIH criteria); osteosarcopenia was defined as the presence of sarcopenia and osteoporosis (T-Score B -2.5). To assess frailty we used SPPB (3 B x B 9) and hand-grip strength (\ 30 kg men, \ 20 kg women) and sites, duration and level of pain was investigated by NRS. Results: All osteosarcopenics (OS) and 85% of sarcopenics (S) reported pain. Greater, but not statistically significant, intensive pain (NRS = 7.12 ± 0.33) was observed in S than in OS (NRS = 6.7 ± 0.31), (p = 0.18). No significant difference was found in number of sites between S (2.94 ± 0.36) and OS (3.07 ± 0.33), (p = 0.4). Osteosarcopenics were more likely to have prolonged pain (C 1 year) (78%) than S (58%), (p = 0.09). In OS, stratified by muscle-strength, NRS was significantly different (NRS = 7.33 ± 0.45 weak vs NRS = 6.07 ± 0.37 no-weak, p = 0.02). A significant association emerges in S between NRS and gender: men had lower levels (NRS = 5.93 ± 0.53) than women (NRS = 8.05 ± 0:26), (p \ 0.001). Conclusion: Prevalence and pain intensity were high in both groups, without difference regarding the number of seats. In OS, was observed a longer duration of symptoms and an inverse association between muscle-strength and NRS. Only in S, men showed lower intensity of pain than women. Glomerular filtration rate (GFR) and its association with frailty in geriatric patients Background: Frailty is a novel concept in geriatric population and the related factors have still been investigated by the researchers to find out the pathological factors underlying frailty. In this study, we aimed to investigate the relationship between GFR and frailty status of geriatric patients. Methods: 447 elderly patients whose frailty status and GFR were known were included for the study. Frailty status of the patients was evaluated by Fried Frailty Scale and grouped as frail, pre-frail and robust. The patients were divided into four groups as quartile 1(Q1)(n = 112), quartile 2(Q2)(n = 112), quartile 3(Q3)(n = 112) and quartile 4(Q4)(n = 111). GFR was 88-111 mL/min in Q1, 77-88 mL/ min in Q2, 60-77 mL/min in Q3 and 7-59 mL/min in Q4. Results: The median age was 75 years (min-max: 60-97) and 274 (61.3%) patients were female. The median GFR level was significantly lower in frail group [66 mL/min (min-max: 7-109)] than both pre-frail [79 mL/min (min-max: 13-111)] and robust [81 mL/min (min-max: 26-102)] groups (p \ 0.001). Frailty frequency was detected to be significantly higher in Q4 (43.2%) than other quartiles, Q3 (21.4%), Q2 (17.9%) and Q1 (19.6%), (p \ 0.001). In the multivariate analysis model, GFR lower than 60 mL/min was found to be significantly and independently associated factor for frailty (OR: 2.598, 95% CI 1.527-4.421, p \ 0.001). Age (OR: 1.105, 95% CI 1.062-1.149, p \ 0.001), female gender (OR: 2.691, 95% CI 1.555-4.657, p \ 0.001), diabetes mellitus (OR: 1.747, 95% CI 1.007-3.031, p = 0.047) and dementia (OR: 6.216, 95% CI 2.916-13.252, p \ 0.001) were also found to be independently associated factors for frailty in multivariate analysis. Conclusion: In this study, we have found that GFR might be one of the independently associated factors for frailty. Further studies designed prospectively are needed to carry out exact relationship between these two entities. DECI project: analysis of cognitive scales and its relation with frailty in patients with mild cognitive impairment Introduction: DECI Project (Digital Environment for Cognitive Inclusion) is a multi-center, interventional study, designed for elderly with mild cognitive impairment to evolve traditional care organization models, through the support of digital technologies. Some studies suggest that frailty increases the risk of cognitive impairment and vice versa, interacting within a cycle of decline associated with ageing. The aim of this study was to analyze the relationship between cognition and frailty in elderly patients with mild cognitive impairment based on different cognitive scales. Methods: 111 patients were included, C 60 years old, with diagnosis of mild and very mild cognitive impairment in the Centro de Deterioro Cognitivo in Madrid. The presence of frailty was assessed with Fried Frailty Criteria and the cognitive tests evaluated were: Clock Drawing Test (CDT), semantic fluency, phonologic fluency and Clinical Dementia Rating (CDR). v2-distribution was used to analyze categorical variables. Results: Among the patients with mild cognitive impairment \ 15 (5%) were frail, 69 (62%) prefrail and 37 (33%) were robust. The mean age was 78 years. The CDT was similar between the three groups, p = 0.93. The majority of the sample had a CDR on 0.5, p = 0.41. The semantic fluency test was 7.8 on frails, 7.36 on prefrails and 9.35 on robusts, p = 0.26. The phonological fluency test showed a significant difference on frails (12.8 points), prefrails (13.3 points), and robusts (19.61 points), p = 0.015. Conclusions: The phonological fluency test showed a significant difference in patients with mild cognitive impairment among frails, prefrails and robusts. Evaluation of frailty in a Long Term Care and Convalescence unit at an Intermediate Hospital Introduction: Frailty is a state of vulnerability to stressors of high prevalence in our population. Patients who are admitted to intermediate hospital have a high rate of multimorbidity and chronicity, which is difficult to measure, and correlate with mortality. Methods: Prospective observational study of patients entered LTC and CU of a Intermediate Hospital during the period September 2017 April 2018. To evaluate the degree of frailty of patients whom are admitted at a long-term care (LTCU) and convalescence (CU) unit by using a new tool: Index fragil-VGI*, based on several items of the integral geriatric evaluation as well as its relationship with the diagnoses of admission and unit in which they are admitted. Family interview, the frailty questionnaire ''fragile-VGI index'' is applied, asking the patient's previous status (1 month before the current event), recording the data obtained in an Excel database. Results: We included 274 patients, 149 at the LTCU (58.18%) and 125 (41.81%) al CU. In the LTCU the average frailty index was severe (0.56) and at the CU was mild fragility (0.26). The diagnosis of dementia and/or delirium is the most related with moderate frailty. Trauma patients obtained mild frailty. Conclusions: AT the LTCU the sever frailty is more common, related to more elderly patients. The mild frailty index confirms the objective of enhancing autonomy and a need of personalized medicine. Planning a one-year follow-up in order to establish association between frailty index and mortality/number of hospital admissions. Introduction: Identify frail older adults in primary care is crucial to developed a geriatric care plan to prevent adverse outcomes. Frailty phenotype is considered a gold standard to recognize this geriatric syndrome and included five dimension: unintentional weight loss, hand grip strength (HGS), weakness, exhaustion, slow gait and low physical activity. Different cut-off has been propose to use in the HGS. Aim: Analyze the influence of three different HGS cut-offs in the prevalence of robust, pre-frail and frail older adults in primary care. Methods: A quantitative, observational and correlational study was conducted. It was developed in primary health care. The non-random sampling of convenience constituted by 136 older adults. Fragility was assessed using the phenotypic approach. For the dimension HGS, three cut-offs values (A, B, and C) were tested: A: \ 18 kg (women) and \ 31 kg (man); B: \ 20 kg (women) and \ 30 kg (man); C: \ 16 kg (women) and \ 26 kg (man). Results: Seventy (51.5%) of participants was women, the mean age average was 74 ± 6.2 years and more than a half report a good selfassessment of health (? %). The prevalence of robust, pre-frail and frail older adults was similar between the cut-off A and B, 18.4% vs 17.1%, 55.1% vs 54.8% and 26.5% vs 38.1%, respectively. With cutoff C less older adults was considered frail (19.3%) and more are classified was per-frail (60%) and robust (20.7%). Conclusion: There is no universal consensus about the best HGS cutoff value. However, this single dimension in the frailty phenotype have a significant role in the percentage of frailty in primary care and should be considered according to the purpose of the study or intervention. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Introduction: In order to respond to the needs that fragile older adults care requires, the inclusion of an assessment of fragility in primary health care is crucial. There are several tools designed to assess fragility. However, they require significant amounts of time related to the instruments complexity. There is a need for a simple tool to quickly and easily identify fragile older people. The Prisma7 represents one of these instruments. Aim: Examine the sensitivity, specificity of the Portuguese version of the Prisma7 when considering the Frailty Phenotype (FP) as the gold standard. Methods: A quantitative, observational and correlational study was conducted. It was developed in primary health care. The non-random sampling of convenience constituted by 136 older adults. To assess the fraity two tools were used: Prisma7 and FP. The sensibility and specificity of Prisma7 threshold cut-off of C 2 and C 3 was analyzed. Result: Seventy (51.5%) of participants was women, the mean age average was 74 ± 6.2 years and more than a half report a good selfassessment of health (60%). The cut-off C 2, showed a specificity, sensibility, positive and negative predicted values of 53, 58, 30 and 77%, respectively. The cut-off C 3, showed a specificity, sensibility, positive and negative predicted values of 97, 19.4, 70 and 77%, respectively. The results are not considered optimal. The PRISMA7 threshold (cutoff C 2) presented a better compromise between sensitivity and specificity when compared to cutoff C 3 (lower sensitivity and higher specificity). Other study of validation are need to determine the best threshold of Prisma7. Relations between frailty, multimorbidity and disability in specific activities in daily living in community-dwelling women: a cross-sectional study Andrius Apsega 1 , Asta Mastaviciute 1 , Marija Tamulaitiene 1 , Vidmantas Alekna 1 1 Vilnius University, Faculty of Medicine, Vilnius, Lithuania Introduction: The purpose of this study was to investigate relations between frailty, multimorbidity and disability in elderly women. Methods: A cross-sectional study in community-dwelling women aged 60 years and more was conducted. Frailty was defined using the frailty phenotype according to Fried et al. criteria. Multimorbidity was defined as the presence of two or more self-reported chronic diseases. Disability in specific activities of daily living (ADL) was defined as needing help or being unable to perform one or more basic or instrumental ADL assessed using Katz and Lawton scales. Statistical analysis was performed using Chi square test and Fisher exact test. Results: The data of 131 women was analysed. Mean age of all participants was 71.1 ± 7.11 years. Overall, 55.7% women were classified as robust, 16.8% prefrail and 27.5% frail. Among all women, 24.5% women had multimorbidity. Multimorbidity was identified in 15.1% of robust, 31.8% of prefrail and 38.9% of frail women. Those who were frail had higher rates of multimorbidity than prefrail and robust women (p = 0.017). Rate of ADL disability of frail women was 11.1% and no statistically significant differences were found between groups. Frailty was associated with higher rates of IADL disability (p = 0.001). We found that 25% of those who were frail reported difficulty in IADL. Difficulties in shopping and transportation were the most prevalent (33.3% and 41.7%, respectively). Key conclusions: Higher rates of multimorbidity and IADL disability were found in frail women compared to prefrail and robust women. Application of the STOPPfrail criteria to the frailest nursing home residents (NHRs): a COME-ON sub-study Background: The STOPPFrail criteria were recently developed to assist physicians in identifying inappropriate prescribing in frail older adults with a poor 1-year survival prognosis. Aim: To describe the prevalence of potentially inappropriate medication (PIM) in frail nursing home residents (NHRs), using the STOPPFrail criteria. We performed a post-hoc analysis of data from the COME-ON study, a multicentric cluster-controlled trial that evaluated the effect of a complex intervention on the appropriateness of prescribing, performed in 1804 NHRs over a 15-month period. For the present work, frail NHRs with a poor 1-year survival prognosis were identified using data on functional status, comorbidities, level of care and survival data. Twenty-one STOPPfrail criteria were applied to measure PIMs at baseline. Results: Three-hundred-six frail NHRs were included. Median age was 87 years (83; 92), 76% were fully dependent and dement, 63% died over the study period. In total, 189 NHRs (61.8%) had at least 1 PIM (median 1 PIM per resident, interquartile range 0-2, range 0-7). Among the 309 PIMs identified, the three most prevalent were: proton pump inhibitor at full dosage C 8 weeks (18%), calcium supplementation (16.3%) and anti-platelet therapy for primary cardiovascular prevention (15.7%). At least one of these three PIMs was found in 129 NHRs (42.2%). Conclusion: A large proportion of frail NHRs with poor survival prognosis had at least one PIM. Unnecessary drugs as well as drugs with unfavorable risk-benefit balance should be thoroughly reassessed and stopped in such a context in order to prioritize symptom control management. Frailty and lipid profile in elderly hospitalized patients Introduction: The relation between lipid profile and cardiovascular disease in frail and advanced-aged subjects is still debated. The main purpose of our study is to verify the correlation between lipid profile, frailty and mortality in a sample of elderly inpatients. Methods: We evaluated 131 subjects, 73 women (mean age: 81.3 ± 6.4 years) consecutively admitted at our Geriatrics Unit. A Frailty Index (FI) was computed taking into account 46 potential deficits collected as part of standard clinical and laboratory parameters. Results: Lipid profile appears significantly different between discharged patients (n. 118) and those who died during hospitalization (n. 13), respectively: total cholesterol 149 ± 40 mg/dl vs 126 ± 43 mg/dl (p = 0.003), HDL cholesterol 42 ± 16 mg/dl vs 31 ± 14 mg/dl (p = 0.001), LDL cholesterol 88 ± 32 mg/dl vs 74 ± 35 mg/dl (p = 0.02). Significant negative correlations were observed between frailty at admission and: total cholesterol level (r = -390, p = 0.001), HDL cholesterol (r = -359, p \ 0.001) and LDL cholesterol (r = -314, p = 0.001). Logistic regression model showed that in-hospital mortality was significantly associated with both frailty at admission (p = 0.02) and total cholesterol level (p = 0.017). Moreover, univariate analysis showed that in-hospital mortality was significantly associated with total cholesterol level regardless frailty (p = 0.001). Key conclusions: Our findings confirm the negative correlation between frailty and lipid profile, even in a sample of elderly hospitalized individuals. Specifically, frail elderly patients show low total, low HDL and low LDL cholesterol levels; therefore, this evidence better represents a general health biomarker rather than a cardiovascular risk factor in this specific range of subjects. Dementia as a factor of worse status and bad outcome in hip fracture patients. A study with 1-year follow-up Introduction: The number of demented patients with hip fracture (HF) is increasing as the population ages. The aim of this study was to examine the outcomes in demented HF patients, compared with those patients without dementia. Methods: All patients admitted consecutively with a frail HF during 1 year in an orthogeriatric unit at a university hospital were assessed. Baseline and admission demographic, clinical, functional, analytical and body-composition variables were collected at admission. One year after the fracture, patients or their carers were contacted. Patients were divided into two groups according to presence of dementia, which was defined as previous diagnosis or baseline Red Cross Mental Scale Score C 2. The differences between HF with and without dementia was evaluated with bivariate analyses. Results: A total of 509 patients were included. Mean age was 85.6 (± 6.9) years and 79.2% were female. Dementia patients (n = 171, 33.5%) were older (mean age 85.6 ± 6.9 vs 84.6 ± 6.96 years, p = .001), had worse baseline Barthel Index ( The prevalence and associated factors of sarcopenic obesity are not the same as those of sarcopenia in older patients Ploy Ruengsinpinya 1 , Prof. Prasert Assantachai 1 1 Siriraj Hospital, Mahidol University, Bangkok, Thailand Background: The coexistence of sarcopenia and high accumulation of fat mass, termed sarcopenic obesity, has been under focused recently. Since both conditions synergistically cause even more adverse health outcomes than each condition does, e.g. increase risk of disability, morbidity and mortality. Therefore, the prevalence of sarcopenic obesity and its associated factors are essential for policy planning and implication in daily clinical practice. Objective: To determine the prevalence and associated factors of sarcopenic obesity among older patients. The differences of prevalence and associated factors of sarcopenia and sarcopenic obesity are also evaluated. Materials and methods: This cross-sectional study recruited 186 patients aged over 60 years old who were followed up at the outpatient department, Siriraj Hospital. Appendicular muscle mass and body fat mass were evaluated by bioelectrical impedance analysis. Hand grip strength and usual gait speed were also assessed. Sarcopenic obesity was defined as sarcopenia based on the consensus of Asian Working Group on Sarcopenia plus obesity based on body fat mass by WHO criteria. Results: The prevalence of sarcopenic obesity was 5.4%, while that of sarcopenia was 7.5%. The associated factors of sarcopenic obesity were: increasing age, low education, high co-morbidity index and low physical activity. Meanwhile, the associated factors of sarcopenia were: increasing age, low BMI, poor nutrition status, high co-morbidity index and number of medications. Conclusion: The prevalence of sarcopenia was higher than sarcopenic obesity. Their prevalences and associated factors are different. Both conditions should be screened in clinical practice for older patients. Frailty status and mild-chronic hyponatremia in nursing home fallers admitted to emergency geriatric medicine unit (MUPA Unit) Introduction: Hyponatremia is the most common electrolyte disorder in older adults in nursing home. Studies have found that it increases morbidity and mortality. Approximately one in three older adults falls each year. Mild-chronic hyponatremia may predispose to falls and fractures which lead to dependency. Frailty status is a risk factor of S118 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 dependency. Little is known of the association between mild-chronic hyponatremia at Emergency Department (ED), fall prevalence and frailty status in elderly. Therefore we are investigating the link between frailty status, mild-chronic hyponatremia and risk of falls in nursing home patients admitted to MUPA Unit. Methods: We conducted a cross sectional study during four months including patients older than 75 years living in nursing home, admitted to MUPA Unit (Limoges CHU, France). Socio-demographic factors, falls event, Comorbidities, Medications, sodium levels were studied (hyponatremia was considered Na+ \136 mmol/l) and the short-CGA variables including the frailty score SEGA : not frail (SEGA B 8), frail (8\SEGA B 11) and very frail (SEGA[11) status. Results: Of 132 cases recruited, the mean age was 89 ± 5.2 and 72.2% were women. The prevalence of mild-chronic hyponatremia was 16.7% and the prevalence of falls was 25% in frail group. The prevalence of mild-chronic hyponatremia was 11.7% and the prevalence of falls was 18% in the group of very frail patients. Conclusion: Given that mild-chronic hyponatremia could be considered a risk factor for falls, the inclusion of the determination of sodium level at ED would be an indicator of frailty status of elderly admitted to MUPA Unit. Handgrip strength predicts 1-year functional recovery and mortality in hip fracture patients Conclusion: A standardized method is needed to enable more consistent measurement of grip strength and better assessment of sarcopenia together with standardized cut off values for specific groups. The results will be discussed with the other studies of low HGS values for Turkish population. Frailty in nursing homes. An indicator of seniors' longevity? Haÿ Paul-Emile 1 , Armaingaud Didier 1 , Josseran Loïc 2 1 Korian SA, Saclay, France, 2 APHP Paris-Saclay, France Introduction: Korian is a private group specialized in medical accommodation for elderly and dependent people. Its professional data warehouse hosts all residents' data, including the residents' care narratives (CN) fed on a daily basis. As residents grow older, they face multiple age-related syndromes. Among them frailty, a multifactorial process that seems undoubtedly linked to the end of life. Objective: To propose a simple and quick tool for early frailty detection in populations [ 70 years old, that would also be suitable for wide-scale administration by non-experts. Methods: A 10 items' screening scale investigating social isolation, physical and surroundings' negligence, inappropriate behavior, weight loss, iterative hospitalizations, falls, activities' reduction, sensory deficiency, unsuitable housing and polymedication was administered in 591 people (80.1 ± 5.4 years old, 58% women) in primary health care settings. Comprehensive geriatric assessment (CGA) was performed to 106 of those, as a standard means to identify frailty. Results: By applying multicomponent analysis and hierarchical clustering, 7 out of 10 items were considered pertinent, whereas those about unsuitable housing, sensory deficiency and polymedication were eliminated. Five distinct groups emerged from the answers' pattern, which could be attributed to specific frailty profiles. People found to belong to the ''low risk of frailty'' profile, were those who answered negatively to all 5 questions about lack of social support, negligence, weight loss, hospitalizations' and falls. Whereas this first group could be considered as ''normal'' (68.9%), three other clinical profiles were highlighted, a ''physical frailty'' profile (12.7%) mostly presenting falls and weight loss, a ''social/cognitive/affective frailty'' profile (14.7%), by merging 2 groups derived from the multicomponent analysis and a ''hospitalizations'' profile (3.7%), suggesting a rather established physical frailty status. Key conclusions: Further validation studies are required. However, this quick and simple frailty screening tool presents promising properties in distinguishing early frailty profiles and seems to be eligible for a step-wise approach of frailty detection and referral to CGA. Frailty and cognitive impairment in heart failure patients: preliminary findings from the Deus Ex Machina study Introduction: Frailty has enormous impact on acute hospital care and has been shown to be a more effective predictor type of hospitalization and mortality than conventional clinical measures. Aim: Association of type of hospitalization and mortality by frailty in tertiary hospital. Methods: Hospitalized patients admitted at a teaching public hospital were studied to determine the prevalence of frailty over a period of 12 months. We used clinical frailty scale (CFS) to stratified frailty. We used binary logistic regressions to evaluate the type of hospitalization, adjusted for age, internal medicine and hospital mortality. We considered a 95% confidence interval, and tests with a p-value \ 0.05 were considered to be statistically significant. Results: The records of 10656 patients, of hospitalization episodes, were reviewed. There were 54.1% females and median age of 66 years. The age group C 65 years was 53.2%, and with age C 75 was 33%. Emergency hospitalizations were present in 58.5% of the episodes, whereas 33.2% had frailty (RR = 4.55). Internal medicine (IM) accounted for 17.5% of the episodes, whereas 57.5% had frailty (RR = 3.95). Frailty had OR = 6.12 for hospital mortality, OR = 4.77 for internal medicine and OR = 3.23 for emergency hospitalizations. Conclusion: Our study reported that frailty was an independent predictor of emergency hospitalizations and higher hospital mortality. And, is associated an internal medicine inpatient. Impact: Frailty is a geriatric condition managed by Internal Medicine in our country. The internist must be able to manage these patients as a whole without fragmentation of care. This is especially true of the frailty patients. Frailty assessment by two different methods in acute hospitalised elderly patients (2004) (2005) and wave 6 (2015) of SHARE. Grip was measured with a Smedley dynamometer. We used the maximum from two attempts in each hand. We converted grip values to Z-scores using age-and gender-stratified British normative data. We grouped countries into northern, central and southern regions. We used linear regression to calculate mean differences in Z-scores between waves in each region, including after adjustment for height. Results: We used a total of 60,551 measurements of grip from the two waves. There was no significant change in mean grip Z-score between wave 1 and wave 6 in the central region. The northern and southern regions showed mean increases in Z-score of 0.17 (95% CI 0.13, 0.21) and 0.12 (95% CI 0.09, 0.15) standard deviations, respectively. These increases attenuated but remained after adjustment for height. We have shown secular increases in grip in two European regions, independent of secular increases in height. Further work will include investigation of other participant characteristics that may explain these changes. Osteosarcopenia and mortality in older Chileans Introduction: Sarcopenia and osteoporosis are among the main causes of physical disability in older people. When both coexist, the consequences can be devastating. The objective of this study is to describe the prevalence of osteo-sarcopenia and its association with mortality in Older Chileans. Methods: Follow up of ALEXANDROS cohorts designed to study disability associated with obesity in community-dwelling people 60y and older living in Santiago/Chile. At baseline 1119 (68.5% women, mean age 72 years ± 6.7) from 2372 participants had DEXA scan and the measurements for the diagnosis of sarcopenia. WHO standards for Bone Mineral Density (BMD) classified them in normal, osteopenia and osteoporosis. Sarcopenia was identified using the algorithm from the EWGS validated for Chile. Information about deaths was available for the 1119 subjects. Results: At baseline, Sarcopenia was identified in 19.5%, osteoporosis in 23.2% and osteo-sarcopenia in 8% of the total sample. Osteo-sarcopenia increased with age reaching 17.5% in C 80 years. Osteo-sarcopenia was found in 34.4% of osteoporotic people and 40.8% of the people with sarcopenia. After 5640 person/years of follow-up 86 people were died (osteo-sarcopenia 20.2%, osteopeniasarcopenia 11.7 and 6.1% of the people without these conditions). After adjusted Cox Regression analysis, the HR for death in people with osteo-sarcopenia was 2.16(95% CI 1.18-3.94). Conclusions: Although the prevalence of osteo-sarcopenia is 8%, when one of the conditions are present, the risk of osteo-sarcopenia increase to 34-40%. Considering mortality is more than twice in people with both conditions, Screening for the second condition, at least when one is present should be the rule at primary care. Mitochondrial respiratory chain function and content are preserved in the skeletal muscle of healthy very old men and women Introduction: The loss of mitochondrial function and content have been implicated in sarcopenia although they have been little studied in the very old, the group in which sarcopenia is most common. Our aim was to determine if mitochondrial function and content are preserved among healthy 85-year-olds. Methods: We recruited 19 participants (11 female) through their general practitioner and assessed their medical history and self-reported physical activity. We identified sarcopenia using grip strength, Timed Up-and-Go and bioimpedance analysis. We assessed mitochondrial function using phosphorous magnetic resonance spectroscopy, estimating tau1/2 PCr, the recovery half-time of phosphocreatine in the calf muscles following aerobic exercise. We performed a biopsy of the vastus lateralis muscle and assessed mitochondrial content by measuring levels of subunits of complex I and IV of the respiratory chain, expressed as Z-scores relative to that in young controls. Results: Participants had a median (IQR) of 2 (1,3) long-term conditions, reported regular aerobic physical activity, and one participant (5.3%) had sarcopenia. Sixteen participants completed the magnetic resonance protocol and the mean (SD) tau1/2 PCr of 35. 6 (11.3) seconds was in keeping with preserved mitochondrial function. Seven participants underwent muscle biopsy and the mean fibre Z-scores were -0.3 (0.4) and -0.7 (0.7) for complexes I and IV, respectively, suggesting preserved content of mitochondrial respiratory chain enzymes. Conclusion: Muscle mitochondrial function and content are preserved in a sample of healthy, well-functioning 85-year-olds, among whom sarcopenia was uncommon. The results from this study will inform future work examining the association between mitochondrial deficiency and sarcopenia. Systematic review on the pharmacotherapy of type 2 diabetes mellitus in functionally impaired elderly-sub-project of the Medication and Quality of Life in frail older persons (MedQoL) Research Group Introduction: The benefit-risk balance of pharmacological therapies may depend on the functional status of older patients. Functionality is considered to be a more appropriate predictor for health status than chronological age. The EMA recently recommended a list of assessment instruments on functional health to be used for baseline characterization of older populations in clinical trials [1] . Objectives: To conduct a systematic review to investigate the effects of anti-diabetic agents in older patients with type 2 diabetes mellitus and at least moderately impaired functional status. An additional aim was to compare different blood sugar targets (as defined by study authors) in this population. Methods: We systematically searched for randomised controlled trials (RCTs) and prospective non-randomised controlled trials (non-RCTs). In addition to MEDLINE, Embase and Central we also searched reference lists of included studies. Possible comparisons were antidiabetics versus placebo, no medication or versus another pharmacotherapy or comparisons of different blood sugar targets. Study selection, data extraction, and risk of bias assessment of the studies were conducted by two reviewers independently. Conflicts were resolved through discussion or a third person. Results: The searches identified 12,955 results on RCTs and 3933 results on non-RCTs. Screening, data extraction and risk of bias assessment will be completed in summer 2018 and results will be presented at the conference. Conclusion: Research on antidiabetic therapy in impaired older persons identified by functional status is currently an area in progress. This systematic review will summarize results of RCTs and prospective non-RCTs including an at least moderately functional impaired population. Reference: 1. European Medicines Agency: Physical frailty: instruments for baseline characterisation of older populations in clinical trials (2018). Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/ regulation/clinical_general/general_content_001232.jsp&mid=WC0b01 ac0580032ec4 S122 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Comparing the predictive accuracy of comorbidity and disability for frailty in patients hospitalized in a tertiary hospital Introduction: This is a substudy of an ongoing study that aims to identify biological markers for the early diagnosis of sarcopenia. The aim was to assess the prevalence of sarcopenia in elderly patients admitted for hip fracture to an Orthogeriatric unit and their characteristics. Methods: Patients admitted for hip fracture who agreed to participate in the study were included, excluding those carrying a pacemaker and those who have undergone urgent surgery. Muscle mass was assessed preoperatively using bioimpedance analysis, Janssen's (J) and Masanés (M) Spanish reference cutoff-points were used to define low muscle mass. Strength was assessed with handgrip strength (Jamar's dynamometer). Assessment included socio-demographic data, cognitive status (GDS-Reisberg), functional status (Barthel, FAC), nutrition (MNA-SF, BMI), number of falls, medications. Results: N = 150. Mean age: 87.6 ± 4.9. Women: 78.7%. Sarcopenia prevalence varied from 11.5% (J) to 34.9% (M). 67% had mild dependence, 18% moderate-severe dependence. 78% had independent ambulation before the fracture, 88% without technical aids or a cane, 40% reported two or more previous falls. 22% had mild dementia and 16% moderate-severe. 85% were on 4 or more drugs before admission. 13% presented malnutrition 13% and 42% overweight or obesity. In multivariate analysis, sarcopenic patients (M) had a lower body mass index (18.6 vs 24.3, p = 0.003), and no differences were found in any of the others variables. Conclusions: A third of the elderly patients admitted for hip fracture presented sarcopenia (according to the national Masanés cut-off points). Sarcopenic patients are similar to non-sarcopenic patients, except for a lower BMI. Low serum creatinine values overestimate renal function: the paradoxical relationship between mortality and eGFR in orthogeriatrics Introduction: Serum creatinine is strictly related to muscle mass. Our study aimed at investigating the relationship between mortality and renal function as estimated by glomerular filtration rate formulas (eGFR) in the orthogeriatric setting, where frailty and sarcopenia are highly prevalent. Methods: This is a prospective study carried out in the Orthogeriatric Unit of Careggi Hospital, including 569 consecutive patients aged 65 or older, with bone fractures requiring surgical treatment. Serum creatinine and cystatin C were determined at admission and GFR was estimated according to different formulas (CKD-EPIcr, CKD-EPIcr-cysC, CKD-EPIcysC, BIS-1, BIS-2). Mortality was analyzed using data from regional registers. Results: The study population had a mean age of 82.7 ± 8.2 years (77% female). The 75% was admitted for hip fracture. At admission mean serum creatinine and cystatin C were 0.93 mg/dL and 1.48 mg/ dL, respectively. During a 4.5-year follow-up, all-cause mortality was 42.7% (n = 243 patients). A preliminary analysis using Kaplan-Meier plots showed that participants with CKD-EPIcr eGFR [ 80 mL/min/ 1.73 m 2 had higher mortality than those with CKD-EPIcr eGFR 60-79 mL/min all over the follow-up duration. At approximately 2 years of follow-up, the curves referring to eGFR [ 80 mL/min/m 2 and eGFR \ 44 mL/min/1.73 m 2 overlapped. Key conclusions: All-cause mortality was similar in patients with eGFR [ 80 mL/min/m 2 and eGFR \ 44 mL/min/1.73 m 2 , after 2 years of follow-up. These data suggest that higher eGFRs probably result from low serum creatinine in patients with sarcopenia. Cystatin C may be a useful alternative renal marker, in the orthogeriatric setting. Prevalence of frailty and malnutrition in older people attending a health literacy event in Lisbon targeted to citizens, to promote healthy lifestyle behaviors, to screen for chronic diseases and to educate about its management. The Geriatrics Study Group of the SPMI (GERMI) set up a booth targeted to citizens 65 years-old or more to screen for malnutrition and frailty and to educate about their prevention. OBJECTIVES: To identify sociodemographic characteristics of citizens who attended the GERMI booth and the prevalence of malnutrition and frailty. Methods: Prospective study for 2 days. Screening and counseling was performed by doctors, medical students and physiotherapists. Malnutrition was screened applying Mini Nutritional Assessmentshort form (MNA-SF) and Frailty by gait speed (\ 0.8 m/s), timedup-and-go test (TUGT) time ([ 10 s) and PRISMA University of Leeds, Leeds, UK Current international guidelines do not include advice for clinicians on the management of blood pressure for older people with frailty. From both trial and observational literature and from our own qualitative research with older people, we summarise evidence to determine whether blood pressure should be managed differently in the context of frailty. We performed a meta-analysis of eight cohort studies comprising 161,081 older adults. This showed that for older people with frailty, lower blood pressure was associated with higher mortality. However, a systematic review of two randomised control trials measuring frailty showed that low blood pressure reduced mortality. We also report the findings of 20 qualitative interviews exploring factors influencing blood pressure treatment in later life with older people themselves. These findings demonstrate different representations of frailty: in the trial and observational literature; between physicians and older people themselves; and between older people with one another. We discuss these challenges, and consider how to develop better evidence to manage blood pressure in later life. The relationship between hemoglobin A1C(HbA1c) variability and frailty in elderly outpatients Introduction: Frailty is a geriatric syndrome that significantly affects morbidity and mortality in elderly patients. The frequency of chronic comorbidities such as diabetes mellitus (DM) can be seen more in frail elderly than not. There is a new area of interest in the literature in studies of the relationship between frailty and insulin resistance and DM. In this study, we aimed to investigate the relationship between HbA1c-variability and frailty. Methods: In a period of one year,452 elderly patients whose frailty status were known were included for the study. All patients underwent comprehensive geriatric assessment. Frailty status of the patients was evaluated by Fried Frailty Scale and grouped as frail, pre-frail and robust. 151(33.4%) of the patients had DM. The retrospective HbA1c values of these patients were reached. The relationship between frailty and HbA1c variability was evaluated in 76 patients with at least three HbA1c measurements. The following parameters were calculated for HbA1c variability: HbA1c mean (HbA1c-M), HbA1c standard deviation (HbA1c-SD) and HbA1c variation coefficient (HbA1c-VC). Results: The mean age of the patients was 76 ± 6 years and 46 (60.5%) patients were female. The most frequent concomitant comorbidity was hypertension with 86.8%. The rate of frail patients was 19.7%. Median HbA1c-M [7.93 (min-max: 6.61-9.60) vs 6.92 (min-max: 5.68-11.40)], median HbA1c-SD [0.93 (min-max: 0.19-2.69) vs. 0.58 (min-max: 0.17-2.69)] and median HbA1c-VC [0.13 (min-max: 0.03-0.36) vs. 0.09 (min-max: 0.03-0.36)] were found to be significantly higher in frail patients than in non-frail patients(p = 0.010, p = 0.016, p = 0.026, respectively). Conclusion: In this study, it has been shown that there may be relationship between HbA1C variability and frailty. Large prospective studies are needed to support these results. Osteoprotegerin as a novel marker of prognosis in elder patients: a cohort study Osteoprotegerin (OPG) is a cytokine in the tumour necrosis factor receptor superfamily. OPG has been linked to cardiovascular disease and to the development of heart failure after myocardial infarction. In patients with chronic heart failure, OPG levels are associated with mortality in patients with systolic heart failure of any cause. We aimed to elucidate in detail the role of OPG as a marker of mortality and CV risk in elder subjects suffered from heart failure. Therefore, we explored the possible link between OPG, sarcopenia and malnutrition. This is a cohort, multicentre study. Elder patients ([ 65 years) were collected and followed up for 3 years. Participants were separately divided into quartiles according to their baseline OPG levels and descriptive analyses of baseline characteristics were performed. Cumulative event rates (mortality, CV events) were calculated across quartiles of OPG with the Kaplan-Meier method and compared by use of a trend test. Cumulative event rates were also calculated stratifying patients on the basis of OPG levels and diagnosis of sarcopenia and/or malnutrition. Models were adjusted for the following clinical risk factors: age, sex, drugs, history of hypertension, history of diabetes mellitus, tobacco use, prior CV events, left ventricular ejection fraction, cognitive function. Among the 324 participants with a baseline measurement, the median level of OPG was 6.9 pMol/L. Sarcopenia and malnutrition showed to be significantly associated with elevation of serum OPG. Before and after adjustment for traditional clinical risk factors, elevated concentrations of OPG (4th S124 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 quartile group) remained independently associated with an increased risk of mortality or CV events (especially MI). Elevated serum OPG seems to be associated with an increased mortality and CV events. Further studies needed to explain the specific role of this protein in this particular type of patient. Introduction: Hip fractures is one of the most serious fracture that elderly may experience. Serum level of 25-hydroxy vitamin D 25(OH)D has been shown to be associated with risk of hip fracture. Other risk factors associated with hip fracture also tend to cluster among subjects with poor serum 25OHD status. Aim: To examine other risk factors than serum 25(OH)D that may predict the risk of hip fractures independent of serum 25(OH)D. The problem of poly-pharmacotherapy (11%) in the elderly patient with multimorbidity is now recognized. It is also known that such subjects take on average at least five or more active ingredients per day, with the risk of drug interactions and adverse reactions (remembering that the aging process is accompanied by pharmacodynamic and pharmacokinetic modifications able to modify the risk ratio-benefication of pharmacological treatment). Recent studies show that inadequate prescriptions in the elderly subject, poor therapeutic adherence (46%), cognitive impairment, fragility and rehospitalization can significantly and negatively influence the quality of life and the state of health. Therefore, the possibility of suspending an inappropriate active substance (deprescribing), in order to reduce the risks compared to the expected benefits, is still the subject of studies of international interest. In this perspective the integration between medical specialists Geriatrics/Internists/Pharmacologists, hospital/outpatient and local physicians specialists plays a fundamental role in the preparation of individual-personalized therapeutic pathways. To this end, a training course has been designed with a business -territorial value, repeated in different editions, aimed at (1) to improve the quality of the prescription that must be appropriate and safe (2) to verify the therapeutic adhesion by periodically reviewing the active ingredients taken by the patient (3) Background: Aging is a worldwide problem with increasing number of elderly people requiring institutionalized care in developing countries. This is a cross section observational study, which aims to identify the prevalence of sleep problems/disturbances in an institutionalized population of elderlies living in a philanthropic chronic care center with primary care hospital facilities located in an upper middle-income country-Lebanon. The study involved 192 institutionalized elderly persons who have been living in the institution for more than 1 month. After filling an informed consent form, the participants were required to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaires either on their own or by the nurses who take care of them. Our dependent variable was participants with a global PSQI score of five or more who were considered to have a sleep problem. The independent variables were demographic data, life style habits, current diseases and medications that were collected by the primary investigator from the participants' medical files. Statistically analysis was performed using the SPSS statistical analysis software. Results: Participants were between 60 to 102 years old with a mean age of 77.4 years (SD = 8.7 years). According to the global PSQI scores, the figure of 75% of the participants were found to have sleep problems (95% CI of 69-81%) with equal male to female distribution, in comparison to 27.6% of the participants who reported subjective sleep problems. Decreased activity and poor performance on memory tests were the only demographic and life style variables that had statistical association with sleep problems (OR 2.85, 95% CI 1.41-5.68 and OR 4.21, 95% CI 1.90-9.33 respectively). Alzheimer disease and schizophrenia were the only medical conditions that had statistical association with sleep problems. Alzheimer disease had a positive association (OR 2.28, 95% CI 1.05-4.94), while schizophrenia had a negative association (OR 0.46, 95% CI 0.23-0.92). Among the medications that were studied proton pump inhibitors were the only drugs that approached significant association with sleep problems on statistical analysis (OR 1.85, 95% CI 0.96-3.59). Conclusion: Sleep problems is a major issue in elderly persons present in 75% of persons living in an elderly chronic care center in Lebanon. Its prevalence is underestimated by the nursing staff and under reported by the patients. For that reason, it needs to be frequently assessed by using a standardized sleep assessment tool like the PSQI questionnaire. Our study found an association between sleep problems and decreased activity, and the failure to pass either mini mental state examination or clock drawing memory tests. Alzheimer disease was positively associated with sleeping problems, while schizophrenia was negatively associated with them. The chronic intake of proton pump inhibitors was the only drugs that approached statistically significant association with sleep problems in our analysis. Further randomized control studies are required to confirm our findings. Challenges of geriatrics and gerontology education in the eastern mediterranean region: reflection on the collaboration of MEAMA and ATG Abdulrazak Abyad 1 , Sonia Hammami 2 1 Middle East Academy for Medicine of Ageing, Tunis, Tunisia, 2 CHU F Bourguiba Monastir-Tunis, Tunisia As we enter the 21st century, and increasing number of older adults will need more services and medical attention. Assuming the majority of medical care for this population will be provided by primary care practitioners. Therefore, training in Geriatric care must become an integral part of the curriculum for internal and family medicine residency programs. The changing demographics of the population in the region have created imperative for medical schools to increase their emphasis on the education and training of medical students and residents in the care of the elderly. In attempt to answer the above problem and challenges The Middle-East Academy of Medicine of Aging (MEAMA) was started in 2002. So far the Academy had organized five postgraduate courses each with 4 sessions in a 2 year cycle. The organizers of the Middle-East Academy for Medicine of Ageing organise this course with support of many regional, government and international organizations. The Tunisian Geriatric Association (ATG) in Collaboration with MEAMA has launched the first intensive postgraduate course in geriatric medicine stimulating interest and knowledge in geriatrics. The course is made of 4 sessions, that last 2 days each and will be finished within a year. The course is geared toward physicians mainly internists and family physicians. The topics of the four sessions will cover the major issues of geriatrics practice and issues including First session: metabolic disorders Second session: osteoporosis, Vitamin D, Falls Assessment and Prevention, rehabilitation, sarcopenia. Third session: Cognitive disorders; Diagnosis and Management of Dementia, Delirium and Depression, Fourth session: Comprehend the major geriatric syndromes The last session took place in May 2017 in Monastir Tunisia. A total of 42 participants graduated from the course. Evaluation of the course will be presented. The same cycle will be repeated next year and will be opened to people coming from outside Tunis. What things in life are most important to older adults? And what do they know about geriatricians? (Spain) . Health-related aspects considered important were also consistent: mobility, not falling, no pain, sight and hearing, memory. ''Walking -being able to read -avoid depression due to losses'' (Greece), ''…water aerobics, healthy nutrition… correct medication'' (Finland). Conclusions: This was a small survey, but it gave interesting pan-European insights, re-emphasising the importance of holistic care of older people. Despite increasing awareness of an ageing population, it seems that the potential role of geriatricians is not currently well-communicated to older people, supporting the justification for making a video (translated into many languages) to promote geriatrics across Europe. Improving access to geriatric medicine training for core medical trainees through the new joint royal of physicians training board internal medicine curriculum Introduction: There is wide variability in postgraduate geriatric medicine training across Europe [1] with some countries not recognising geriatrics as a standalone specialty [2] . There have been calls to harmonise post-graduate training across the continent [3] . Against this backdrop we share an innovative educational approach, with potential for up-scaling across Europe, which encourages interest in the speciality and learning about core geriatric medicine competencies. Methods: The Association for Elderly Medicine Education (AEME) was established to encourage recruitment and education in geriatrics in the United Kingdom (UK) [4] . To increase engagement with doctors prior to specialisation AEME invited 'grassroots' UK geriatricians to organise regional educational events entitled Geriatrics for Juniors (G4J) Connect. Typical events provided practical advice on managing older patients and sessions designed to overcome negative perceptions of the specialty. Registration, advertising and feedback were co-ordinated through AEME's website. Social media was used for promotion. The events were free to attend through sponsorship, voluntary speakers and free venues. Results: Since 2014 there have been 21 G4 J Connect events in 15 UK cities. Mean number of delegates attending each is 49 (range 25-109). Modal event length is 3 h (range 2.5-6.5 h). Events typically took place in the evening in a city centre hospital. Feedback from delegates has been consistently positive, including decisions made to pursue a career in geriatrics following attendance. Key conclusions: G4 J Connect events provide a model for 'grassroots' geriatricians to engage healthcare professionals with geriatrics. We invite European geriatricians to collaborate with AEME and organise an event in their region. In 2008, 34.2 million Americans provided unpaid care to an adult over 50 years; 15.7 million cared for someone with dementia. 57% report that their daily lives are impacted by their caregiving responsibilities. Caregivers often lack knowledge and skills to ease their burden; those in underserved groups face additional barriers in accessing resources. Methods: In collaboration with community organizations and a Federal government grant through the Health Resources and Services Administration (HRSA), the Geriatric Resource Interprofessional Program (GRIP) was set up at Memorial Sloan Kettering Cancer Center (MSKCC). It spearheaded an educational program in South Asian communities in Queens. A focus group identified four areas of need. Culturally-competent, practical-skills oriented educational workshops on safe patient handling, cognitive impairment, caregiver burden and medication management were developed and implemented. Results: In 2016-2017, 134 caregivers attended 12 sessions at 5 locations. 88% were women; the average age was 62. Participants spoke 12 different languages and 76% were born in India. Knowledge increased significantly for the Cognitive Impairment [t(35) = -3.55, p.02] and the Safe Patient Handling workshops [t(9) = -3.74, p.05]. Caring for the Caregiver and Medication Management sessions did not yield significant results. The assessments showed improvement in knowledge about Cognitive Impairment and Safe Patient Handling. Qualitative data showed improved understanding, plans to share knowledge and to change behaviors. Challenges to the initiative included differences in literacy, multiple cultures and languages. Successes and barriers faced in implementing the initiative will be presented. Technology and social media: friend or foe Geraldine Donnelly 1 , Rebecca Cruise 1 , Ray Keelan 1 1 Wythenshawe Hospital, Manchester University Hospital Trust, UK Keywords: Methodological issue Personalized medicine Prevention and health systems. Introduction: Pressure on our Older Age department is growing. Community services require specialist input however resources are limited and consultant time is valuable. Social media and technology could increase efficiency and optimise patient care however we are concerned that guidance around the topic is not clear. Methods: Anonymous polls used to question doctors and medical students. Questions included using messenger services to discuss patient care, send photographs to acquire advice and use social media to share cases for education. Finally, we asked about exposure to professional guidance and teaching on the topic. Results: There were 150 respondents, 57% of which were aware of existing professional guidance and 38% had received formal education on the topic. 45% thought it acceptable to send an ECG and 30% a photo of a body part, to a colleague for the purpose of gaining advice. 56% would share an anonymized X-ray on Facebook for educational purposes and 13% use WhatsApp to handover patients. 11% of those questioned admitted that they don't always act appropriately on social media. There was limited variation across the grades. Conclusions: Despite guidance from the General Medical Council, the British Medical Association, the Medical Defence Union and the Royal Colleges of Physicians, practice is variable. There remains uncertainty on the appropriate use of social media and technology in the workplace potentially leaving clinicians vulnerable to criticism and prosecution. A national consensus should be reached on how to embrace technology to help improve education and aid patient care whilst avoiding governance issues. Do old adults know the purpose of their medication? A survey among community-dwelling people focusing on drugs frequently used and/or often involved in iatrogenic events. Methods: A cross-sectional survey was conducted in the canton of Vaud, Switzerland. Participants: 2690 community-dwelling older adults aged 68 years and over who reported at least one drug of interest. Measurements: Participants reported drugs currently taken and what they thought their purpose was. A good level of knowledge was defined as knowledge of the exact purpose or identification of the anatomical system or organ targeted by the drug. A multivariate logistic regression analysis was performed to identify the factors associated with a good level of knowledge of all the drugs of interest taken. Sample weights were used to provide representative estimates. Results: On average, 80.6% of the drugs were well-known. The most known were the non-steroidal anti-inflammatory drugs, antidiabetics, analgesics, and endocrinological drugs. The least well-known were platelet aggregation inhibitors, minerals, anticoagulants, and other narrow therapeutic index drugs. Overall, 66% of the participants had a good of knowledge of the purpose of all the drugs of interest. Polypharmacy and receiving help with drug management were negatively associated with a good knowledge (aOR4-5 drugs 0.45; 95% CI 0.29-0.71, aOR [ 6 drugs 0.20; 95% CI 0.13-0.31 and aORhelp 0.42; 95% CI 0.18-0.99). Conclusions: This study shows a need for therapeutic education among patients receiving multiple drugs and specifically anticoagulants and antiplatelet inhibitors. Perceptions regarding old age and geriatric institutions in the Lebanese society Introduction: In Lebanon, there is a lack of research on the perception of ageing. Our study aimed to explore the perceptions, beliefs and attitudes of Lebanese people regarding ageism and geriatric institutions. Methods: An observational cross-sectional study was conducted among a representative sample of the population in Beirut city, Lebanon. Data were collected through an anonymous structured selfadministered questionnaire written in Arabic, and exploring the demographics and participant characteristics, their perceptions regarding ageism and geriatric institutions, as well as their fear from ageism. Results: A total of 400 participants completed the survey: 50.3% were male, and only 7% were 65 years and more. Participants considered that old age starts from 64.23 ± 8.45 years. Most of them have negative perceptions of ageing: old age means diseases (28%), retirement (14.5%), solitude (12.9%), need and loss of autonomy (8.2%), and disability (7.5%). Our population seems to grow old with some concern, mainly about health problems (38.4%) and loss of autonomy (23.7%). Only 11.0% were not at all worried. Regarding the facilities for the elderly, almost half of respondents (51.6%) have a more positive opinion of these institutions, however 3.5% have entrusted elderly relatives to these facilities. The multivariate analysis showed a positive association between favorable perceptions of old age and higher respondents' socio economic status (p-value \ 0.05). Conclusions: Our survey emphasized the importance of creating a positive image of old age, where it is perceived as a period of life, not a disease. Elderly women and their fears: a pilot investigation Carlo Cristini 1 1 Univresity of Brescia, Owensboro, USA Objectives: In old age many fears may appear, linked to personal biography and to what future life may envisage. The forgotten anxieties of childhood, the unresolved conflicts of adolescence, the uncertainties along all the life-span are expressed in old age that also confronts the possible emerging issues related to age. The aim of this study was to know the most frequent fears in elderly women. Methods: A pilot sample of 30 women, aged 60-79 years, living in Milan, who reported to be in good psychophysical health, belonging to a cultural club, participated in the investigation. An interview, which was designed for the study, was administered together with the participants completing a measure of anxiety (SAS) and of depression (GDS). Results: The average age of the sample was 68.75 years. The majority had a tertiary level of education. The main fears were: dementia, loss of control, loneliness, existential void, difficulty cooping, disability, assaults, unforeseen events, pain and depression. The interviewees were concerned above all else that their worries will increase in the future; with respect to overall worries, they report that men are more afraid than women, older people are more worried than younger people, and immigrants more than the locals. They wanted ''fearful'' people to be helped and understood. The SAS and the GDS were in the normal range for all participants. Conclusion: The women expressed that they have fears linked to the years to come, but despite this they had a positive attitude to deal with these worries. Complementary and alternative medicine use by older adults in Turkey: literature review Ö zge Uzun 1 1 Near East University, Faculty of Nursing, Nicosia-TRNC, Cyprus Introduction: The use of complementary and alternative medicine (CAM) appears to be on the rise in the elderly population. CAM modalities are often used as self-care to enhance well-being, to support medical treatments, to prevent and to cure illnesses. Many herbal and biologic preparations offer promise, but they are largely of unproven benefit. The aim of this literature review was to investigate the use of CAM among older adults in Turkey. Methods: This literature search was carried out, using MEDLINE, PubMed, AMED, EBSCOhost, Science Direct, Google Scholar, Turkish ULAKBİM EKUAL databases. Key words included ''complementary and alternative medicines'', ''complementary and alternative therapies''; ''elderly'', ''older adults'', ''Turkey''. Results: In studies carried out on Turkish older adults, the rate of CAM use was varying from 54% and 59%. The most frequently used CAM therapies were use of herbal products (range 55.2-62.1%) and non-herbal supplements (range 43-53.5%). Other mainly used CAM types included prayer, exercise, massage, music, and thermal spring. Common reasons for use included improving physical and emotional well-being, protecting from disease, increasing immunity, relieving pain, praise, supporting medical treatments. Most of the older adults who used CAM methods believed that herbal products were not harmful, and they did not need to discuss these with their healthcare providers. Conclusions: According to the results of limited studies, CAM modalities have been frequently used by older adults in Turkey, but they generally do not inform healthcare providers that they have used these methods. Healthcare providers should give information and assist to older adults to choose CAM modalities safely and appropriately. Timed up and go test with a dual task in elderly, a tool for learning to practise by practising Introduction: The Timed Up and Go Test (TUG), the TUG with a cognitive dual task (TUGcog), and the TUG with a manual dual task (TUGman) are easy, inexpensive, quick and widely used clinical tool as a component of a multifactorial fall risk assessment. Objective: to determine scores of TUG, TUGcog and TUGman in communitydwelling older adults administered by nurse students and to evaluate their motivation, satisfaction and learning perception. Methods: Prospective study. Inclusion criteria: C 60 years, living at home, able to: walk alone without assistive devices, understand simple instructions, without cognitive limitations, carry a glass of water and count numbers. A survey was conducted to evaluate their learning perception. : 5) . Scores: motivation (mean: 8.25), satisfaction (mean: 9.12) and learning perception (mean: 8.87). Conclusions: Direct relationship between age and tests duration. No significant differences between TUG and TUGman. This could be explained by learning curve for students and patients. Perception by students: very positive. This report stresses the importance of 'learning by doing', which locates medical education within a triad of mutual benefit, comprising skilled practitioner, patient, and student practitioner. From family physicians' perspective to the geriatric patient Aim: Geriatric patients need to a comprehensive geriatric evaluation. The aim of present study is to evaluate the approach of primary care physicians to geriatric patients. Methods: 214 volunteer family physicians were participated in the study, between May 2017 and August 2017. Participants were asked to fill out a questionnaire about their demographic situations and approaches to geriatric patients. The data obtained was evaluated by using the SPSS 22.0 statistical program. Results: The 214 physicians between the ages of 24-65 were participated to the research. The ratio of physicians over 50 years of age was %52.5 and %69 of participants were male. The number of people living together with individuals aged 65 years and over was 33, and 57.6% of them were directing patients to a geriatric department when needed. While the proportion of physicians who had geriatric education was 31%, the ratio was 62.6% for the physicians under 50 years old. Having a geriatric education is more effective for questioning polypharmacy and especially in reduction of medication and directing patients to a geriatrics center. Physicians who are married and have children have been found to be more susceptible to vaccination of elderly individuals. Conclusions: According to present study, being older than 50 years and female were found more sensitive and willing in most of preventive medicine practices. Successful implementation of prevention medicine practices will provide reduction of morbidity of geriatric age group due to diseases, so it will decrease the need for hospitalization and cost of health care. Integrated care through training-joint GP/geriatric trainee clinics Towhid Imam 1 , Owen Ingram 1 , Tom Wilson 1 , Daniel Mullarkey 1 1 Croydon University Hospital, Croydon, UK Introduction: The challenges of an ageing population with increasing frailty, complex co-morbidity and poly-pharmacy, are well documented. A model of care was developed that retains the benefits of access and continuity that primary care provides, whilst also providing time for a more comprehensive assessment and specialist input. In addition, an opportunity is provided for trainees from different specialties to work together, facilitating joint working and learning. Methods: We developed a pilot joint clinic model, in which a Geriatric Specialist Trainee and GP ran a specialist geriatric clinic within primary care. Suitable patients with complex geriatric need were identified by GP colleagues and referred into the joint clinic. Clinic appointments were extended to 30 min to enable comprehensive geriatric assessment. Patient management plans were fed back to referring clinicians in the practice to enable whole practice learning. Results: We completed 4 clinics in 2 pairs of clinicians and saw 35 patients with an average age of 78. Common themes included cognitive impairment, urinary incontinence, poly-pharmacy and movement disorders. Evaluation was by qualitative structured interview with Geriatric Trainee, GP and Consultant supervisor. The feedback demonstrated learning in clinical knowledge, service structure and collaborative approaches to patient care. Key conclusions: The themes of learning from the structured interviews in this pilot study mirrored the learning in the Paediatric model, which had demonstrated a cost effectiveness and quantitative improvement in healthcare. This pilot project therefore provides an exciting template to improve both training of GPs and Geriatricians, facilitating closer working between primary and secondary care. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 GeriSim-a multidisciplinary approach to geriatric simulation Towhid Imam 1 , Vaughan Holm 1 1 Croydon University Hospital, Croydon, UK Introduction: Despite an increasingly aging population and the increasing age of patients in hospitals, there is a lack of simulation based learning to address managing this patient group. A multidisciplinary approach to this is a cornerstone of elderly care medicine. However, frequent rotations can create a lack of cohesion and understanding within teams. Methods: Junior doctors, physiotherapists, occupational therapists and nursing staff learnt about managing the elderly through simulated scenarios, case discussions and use of a unique geriatric simulation suit. This suit allowed the wearers to feel a variety of impairments that may limit their treatment of the older generation. Results: The feedback from the session demonstrated that geriatric simulation based learning is uncommon in undergraduate training across all disciplines. Undertaken after graduation it was found to be beneficial and applicable to daily practice. The participants' fed back that this format is needed to develop the skills to manage elderly patients as a multidisciplinary team. Key conclusions: As training is not organised across disciplines this format allowed the team to gain a greater understanding of each other's perspectives in managing the elderly. Simulation has a key role to play in developing teams to manage complex geriatric patients who commonly present to hospital in the UK. It is hoped that a greater understanding of the patient and each other in the team will increase the quality of care delivered to the older population. What the Frax? Junior doctors' perspective of bone health assessment Introduction: Well-established, evidence based, treatments for fracture risk reduction exist but remain underutilised. The first step in initiating treatment lies in assessment of fracture risk. Guidelines at both national and international levels stress the importance of using established tools, such as FRAX, to do so. However, this relies on healthcare professionals being aware of and confident in using such tools. We carried out a survey of junior doctors to assess awareness and use of FRAX as part of a wider quality improvement process. Methods: Junior doctors based at a district general hospital completed a questionnaire. Participants were asked about their awareness and confidence in using FRAX, when fracture risk assessment was indicated and their knowledge of common medications for osteoporosis. Participants remained anonymous. Results: Responses were obtained from 38 junior doctors. 27 (71.1%) had never used FRAX and 14 (36.8%) did not know how to access FRAX. 27 (71%) stated time was a barrier to calculating FRAX and 23 (60.5%) felt they did not have enough experience to use FRAX. 11 (29%) reported no confidence in prescribing bisphosphonates. 6 (15.8%) identified falls as a reason to assess bone health. Conclusions: Use of FRAX and confidence in initiating treatment was low. There was a lack of awareness of when fracture risk should be assessed. Unless understanding and confidence in using fracture risk assessment tools improves, rates of treatment are unlikely to increase. These data highlight an important gap in knowledge and support the development of specific educational interventions. Anticholinergic burden awareness within the older person's unit Introduction: Many medications used in everyday clinical practice have anticholinergic properties. Cumulative anticholinergic exposure (anticholinergic burden) has been linked to adverse outcomes in older people including falls and hospitalisation. Interventions to reduce anticholinergic burden may therefore provide benefit but any attempt at reduction relies on medical practitioners being aware of the concept and being able to identify appropriate medications. This project, as part of a larger quality improvement project, assessed the awareness, understanding and use of anticholinergic burden amongst medical practitioners working with older inpatients. Methods: Staff attending the Older Persons' Unit (OPU) departmental meeting were asked to complete a questionnaire asking about awareness, understanding and use of the concept of anticholinergic burden. Staff were then asked to identify 5 medications with anticholinergic properties out of 10 frequently used medications. Responses were anonymous. Descriptive statistics were then used to summarise these responses. Results: 26 members of clinical staff (doctors of all grades and medical nurse practitioners) completed the questionnaire. 20 (77%) reported being aware of the concept, 16 (62%) reported understanding the concept, 2 (8%) reported using anticholinergic burden scales. 0 correctly identified 5 medications with anticholinergic properties. Key conclusions: Understanding of cumulative anticholinergic burden was low and very few practitioners routinely used it in clinical practice. Unless understanding and awareness of the concept increases attempts at systematic reduction of anticholinergic burden will be challenging. These findings highlight an important gap in knowledge, even within a specialist unit, and support the development of specific educational interventions. Designing a blended course in pregraduate geriatric medicine through backwards design Methods: Initially, the learning outcomes of the whole course as well as each specific day were determined. A single core geriatric topic, such as delirium or dementia, was tutored each day. Week one utilized blended learning techniques with short daily pre-class learning tasks posted online in advance. Each day consisted of a mixture of Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 S131 group-based and individual active learning activities, short lectures (by either students or teacher), questions and reflection. Week two had a more traditional structure with a combination of students and teachers lectures, student-led case demonstrations, questions and reflection. In addition, a communication course were held during the second week. Student responses were measured by online feedback immediate after course cessation, individual reflection papers and the Faculty of Medicine official evaluation. Results: Overall, the students were enthusiastic with week one and no negative feedback was received on pre-class preparation. The students expressed great satisfaction in discovering the challenges and rewards associated with geriatric medicine. The student activities in week one and communication course in week two were highlighted as the most valuable parts of the course. For the educators, the pre-course workload were high but class time more inspiring during the blended week. Key conclusions: The transition for traditional lectures to student active teaching is time achieving, but rewarding. Role of gerontological centers (out institutional care)-Croatian model of successful practice for the elderly Spomenka The main goal is to keep the old person in his home in his local community as long as possible and to ensure his active lifestyle and thus active and healthy aging. Croatia faces an accelerated aging population-older than 65 and over was 17.70% of the population in 2011, while in the 2016 population estimates, the proportion of those over the age of 65 is 19.41%. (http://www.stampar.hr/gerontologija) So it's important to offer the elderly population a lot of opportunities for active and healthy ageing at the Gerontological centers. Role of Gerontological center is in providing multifunctional immediate care for the elderly in their local community, enables European and at the same time Croatian gerontological approach to implement integral programme in the health care of the elderly. Development of gerontological centers, promotion of out institutional care for the elderly in their local community and infrastructure connection with old age homes allows resistance to the present passivity and social isolation (loneliness) of the elderly to healthy active and productive ageing of Croatian old population. Zagreb started in 2004 with 3 Gerontological centers. In the meanwhile there are, because of the big success and demand for it, 12 Gerontological centers in Zagreb and in the entire Croatia there are 116 Gerontological centers. Monitoring nutritional status in the elderly via NRS 2002/GEROS/CEZIH web service Inappropriate nutritional status, especially over 65, is considered to be aggravated by their health and functional abilities, as well as increased mortality and geriatric consumption. Therefore, the NRS 2002 network service is implemented in the GeroS/CEZIH information system; Network Services NRS 2002 includes focused gerontology-public health indicators such as age, gender, primary and secondary diagnosis in geriatric patients, basic anthropometric measurements, functional abilities etc. Functional ability (physically and mentally) older people is one of the key determinants of assessment, monitoring and analysis of health care for the elderly. The innovative Internet service program NRS 2002/GeroS/CEZIH is used by doctors and other healthcare professionals in hospitals, family medicine teams, geriatric nurses in homes of elderly and nurses at the home of primary health care. The Center for Gerontology Public Health focuses on the analysis of monitoring through the NRS 2001/GeroS/CEZIH Internet Service (March 1, 2015 -May 4, 2018 for persons over the age of 65 (N = 422 geriatric and gerontological insured persons) based on physical mobility and mental independence towards the entities/place of nutrition. Using network services NRS 2002/GeroS/CEZIH establishes food risks in persons over the age of 65, monitoring defined and target determinants important for individualized access to gerontology and monitoring of therapeutic outcomes indicators for persons of inappropriate nutritional status and over 65 years of age. Gerontologic public health indicators via e-system GeroS/CEZIH On their initiative, the Reference Center for Health Care of the Elderly of the Ministry of Health of the Republic of Croatia, Department of Health Gerontology, Teaching Unit of Dr Andrija Š tampar Institute of Public Health and the Croatian Health Insurance Fund have set their common goals in the field of computerization of the gerontologic and geriatric health care at all three health care levels, from primary health care for the elderly in old people's homes and geriatric nursing documentation on geriatric health care of geriatric insured persons to long-term treatment, gerontologic care providers and geriatric dental services, along with the system connection to CEZIH (Central Croatian Health Information System) via GeroS link. The ultimate goal of the project is computerization of the complete health care provided to the elderly and the geriatric patients irrespective of the ownership of the institutions where they are accommodated, as well as the gerontologic insured persons and geriatric patients on long-term treatment in hospitals, palliative geriatric and psychogeriatric care, in order to have all these data at one place, in the central health care system, integrating it with the CEZIH via GeroS. Computerization of geriatric health care will cover health care services provided at the three health care levels, from general/family medicine and geriatric health care at old people's homes through longterm treatment of geriatric patients and visiting nursing services, home care and palliative geriatric care through services provided by Gerontologic Centers as extra-institutional care for geriatric insured S132 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 persons, geriatric dental services and geriatric nursing services. All this information will be collected in GEROS, a central system for gerontology, where overall health care services provided to gerontologic and geriatric patients will be recorded. The system will be connected to CEZIH, while the most relevant health care segments will be recorded in the e-Card. This will make the whole health care system efficient, appropriate, accessible and properly regulated, along with evaluation of the health care provided to geriatric insured persons and rationality of the growing geriatric health care utilization. Pilot study of aging game set up with medical students Background: With the aging of the population, future physicians will be faced with caring of older patients. Some feelings towards older people seem negative during group discussions. Few studies have already been conducted to evaluate the effect of ''aging game'', on attitudes, empathy and knowledge towards elderly. We led this pilot study to make students aware of physiological changes, and to improve their empathy towards elderly. Methods: Intervention-based pilot study led in a geriatric hospital, to medical student, during an internship in a geriatric ward. They filled self-report questionnaires including sociodemographic data, basic knowledge in geriatrics, empathy and attitude towards the elderly before and after experiencing aging game. Data were analyzed using McNemar test, paired sample student test and Wilcoxon test. Results: A total of 67 students were assessed. 60 students (90%) reported that aging game help them to realize difficulties of older patients. 43 students (64%) thought it was fully helpful. 18 students (27%) thought it was partially helpful. 55 students (82%) thought it has to be maintained in the teaching course and 5 students (7%) thought it should be continued but adapted. The analysis of modification about knowledge, attitude and empathy is still in progress. Introduction: The management of diabetes in adults with cognitive dysfunction presents many challenges for patients, caregivers, and medical providers. It is important to be aware of the complexity of daily self-care tasks required of people living with diabetes and to recognize the ways in which cognitive impairment can interfere with these tasks. A team approach involving the patient, family, and caregivers and including the use of allied health professionals and assistive devices, as well as simplification of medication regimens with a focus on avoiding hypoglycemia and symptomatic hyperglycemia, is needed for adults with moderate-to-severe cognitive impairment. Currently only 10% of Diabetic Patient with Cognitive impairment attending Geriatric Clinic were assessed and advised regarding their medication management capacities and documented. This may lead to costly and life-threatening hypo or hyper-glycemic emergencies that will negatively impact the diabetic patient quality of life. A quality improvement project was carried out from September 2015 to December 2015. Aim: To Improve the physician documentation of assessment and advice on medication management in Geriatric Clinics for Diabetic patients with Cognitive impairment from 10 to 50%. Methodology: -Data collection and analysis-Education sessions to the physicians-Assessment tools, as 1st Intervention. Results: By the end of December 2017, after implementation of action plans, the compliance rate increased from 10 to 100%. Innovations in geriatric medicine: Social media and the UKs first trainee-led research collaborative Methods: Using social media and a trainee-led ''grass-roots'' approach GeMRC has representatives from 14 of the 15 regions in the UK. We created national and regional websites to disseminate project information, and utilised a combination of e-mail communication, social networking, word-of-mouth, and dissemination through the British Geriatrics Society. Project ideas are generated by trainees at regular meetings and communicated to regional representatives. ResultsWe have successfully completed three national audit projects, and are refining the protocols for two Randomised Controlled Trials (RCTs), four abstracts were presented at the BGS national conference, one journal article and more than 100 trainees have been involved. Conclusions: The Geriatric Medicine Research Collaborative (GeMRC) offers an innovative approach to research. It facilitates the opportunity for trainees with limited research experience to participate in research that has early impact upon patient care. The use of social media and online networking allows rapid dissemination of project ideas which facilitates collection of much larger datasets and enhances the scientific validity of project outcomes. We welcome collaboration with European sites in the future. Competencies in geriatrics of internal medicine residents: a crosssectional study of Mexican trainees Sara Gloria Aguilar-Navarro 1 , José Alberto Á vila-Funes 1 1 National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico Educational curricula for medical students and residents has not been updated at the same rhythm as the demographic and epidemiological transitions require it. Internal medicine residents (IMR) rely in their experience and teachers during residency to adapt their knowledge to attend the needs of older adults. Not all IMR are exposed to geriatric courses or geriatric teams, which limits their education. The objective was to stablish if there is an association between the degree of exposure to geriatric medicine and the fulfillment of competencies in geriatric medicine for IMR. An anonymous survey was sent to IMR in Mexico City, asking to rate themselves on the fulfillment of the 26 competencies in geriatric medicine as well as the exposure they have to geriatric medicine. We analyzed de frequencies for each competence and made comparisons for level of training, hospitals, Medical School and degree of exposure to geriatric medicine.91 IMR responded, 65% of the sample were men, 47.7% do not have any kind of geriatric medicine exposure. There was no association between the degree of exposure to geriatric medicine and the fulfillment of competencies (P [ 0.095), with Medical School (P = 0.277) or with hospitals (P = 0.07). We found an association between the year of residency and the fulfillment of competencies (P = 0.0005). IMR are not educated enough in geriatric medicine in Mexico City, even though it seems this might not have an influence in the acquisition of competencies. There still need to improve the performance in these competencies which are the minimum required for IMR. Adapted physical activity's service: a support process for active ageing and empowerment in Genoa Socio-Sanitary Districts (2):133-137 Fostering academic geriatric medicine-the science forum of geriatrics in Germany Methods: With the goal to foster the development of scientific geriatric medicine in 2014 some colleagues founded the Science Forum of Geriatrics. Results: The Science Forum of Geriatrics nowadays has around 30 members including representatives from most university departments. Since his foundation it hosts an annual meeting on January with a mixture of presentations of senior and junior researchers as well as external keynote speakers. One major task is to promote networking, build research consortia, stimulate junior researcher to attend (including some travel funds) and to discuss research proposals. The Science Forum of Geriatrics has a close cooperation with the German Society of Geriatrics (DGG) and presented its work at the annual DGG conferences. During the first years the Science Forum of Geriatrics received financial funding for its work from the Robert Bosch Foundation. Conclusions: Since 5 years the Science Forum of Geriatrics established and developed various activities to foster scientific networks within geriatric academics and starts to attract young researchers. Geriatric patient knowledge and responsibility about their regular medication Results: Among the patients who didn't assume responsibility of the medication (n = 42, 63.6%), 88.1% were polymedicated (C 5 drugs) (p = 0.001) and medication was dispensed in a pillbox by 78% (p = 0.003). No significant differences were found between responsibility and gender, age or level of functional dependency. An association was found between poor education level and the nonresponsibility (p = 0.041). Regarding the system to remember the medication, those who assumed responsibility used mainly by memory (26.8%), followed by writing (25%), pillboxes (14.6%) or other means (4.2%) (p = 0.033). 58.3% took medication directly from the box/blister (p = 0.003). No relationship found between responsibility and interest to get more information about the treatment. Conclusions: In our study, polymedication and absence of scholarization were related to non-responsibility. No relationship found between responsibility and gender, age, or functional dependence. The system most frequently related to responsibility was memory. The postgraduate certificate in geriatric medicine is important to disseminate geriatric competence among different health care professionals in different settings The progressive aging of the population and the increase of frailty and disability in elderly people require geriatric preparation of health workers to ensure quality, safety care and respect of elderly human right. The University of Pavia organizes an annual multidisciplinary based MSci level Course of Geriatrics to provide general and specific skills in territorial geriatrics and the management of nursing home. It aims to develop in-depth knowledge of geriatrics for the professionals in geriatric care. Applicants must be graduated in Medicine, Psychology, Pharmacy, Economics, Nursing Sciences. The trainee will become expert in elderly multidimensional assessment with community oriented approach, with medical-legal-administrative knowledge, management and leadership skills. The professional figure trained in the MSci programme are: (1) General Practitioner (GP) expert in geriatric medicine (2) Geriatric coordinator in a GP association (3) Director/Health coordinator of nursing home (4) Psychologist/Doctor/Nursing operator in public and private clinics (5) Clinical Pharmacy in nursing home The Educational Structure consist in 6/7 modules: (1) Epidemiology, legislation and organizative models (2) Geriatrics and gerontology (3) Clinical care and assessment of Pharmacotherapy (4) Geriatric diseases of international and specialist interest (5) Emergencies and Urgencies (6) Medical-legal problems (7) Palliative Care in advanced dementia and/or end stage disease. It is important to organize a multi-centric European Geriatric Medicine Course to disseminate geriatric competence among different healthcare professionals in different settings. We are working to establish a European network with Universities who shared this vision and to gain experience by international collaboration. Area: Geriatric rehabilitation P-284 Prediction of geriatric rehabilitation outcomes: comparison between three cognitive screening tools Results: Cognitive impairment was found to interfere with the rehabilitation process. The MMSE was the best predictor of functional rehabilitation outcomes at discharge, compared to the IQCODE, while the MoCA did not predict these measures. In addition, when distinguishing between patients by ethnicity (Jewish versus Arab), the MMSE and the IQCODE predicted FIM upon discharge among Jewish patients, while only the IQCODE predicted FIM upon discharge among Arab patients. Key conclusions: The research findings show that cognitive assessment upon admission for rehabilitation-MMSE among Jewish patients and IQCODE among Arab patients-can help predict functional rehabilitation outcomes and make the appropriate adaptations in the rehabilitation program. The effect of dual task training on static and dynamic balance of older adults having institutionalized living: randomised trial Begüm Sarıpınarlı 1 , H. Serap İnal 2 1 Okan University, Istanbul, Turkey, 2 Bahcesehir University, Istanbul, Turkey Introduction: Balance is one of the most complex functions of mankind and is carried out in the presence of a secondary or multitask rather than alone in a daily living activity. Therefore, in the presented study it was aimed to observe the effects of dual-task on static and dynamic balance and to present if static and dynamic balance training under dual-task performance effect the static and dynamic balance ability positively among the older adults having an institutional living. Methods: The study presented is a randomized controlled clinical study. Fifty volunteer individuals (72.02 ± 6.60 years of age, ranging between 64 and 91; 12% female, n = 6, 88% male, n = 44) took part in this study. The assessments as Barthel Index (BI), Berg Balance Scale (BBS), and Berg Balance Scale Under Dual-Task Performance (BBS-DTP were performed. All volunteers were above 65 years old and living in the T.C Darulaceze Presidency. The participants were divided into two groups by computer-generated randomization table: Group A (n = 26, number of sessions = 5) and Group B (n = 24, number of sessions = 7). After static and dynamic balance training, given under dual-task performance, BBS and BBS-DTP scores were recorded again and compared with statistical analyzes both using the group and between the groups. Results: According to the outcomes, the balance score was not affected by dual-task performance, and no differences were found between groups (p [ 0.05). For both groups, the BBS score and the BBS-DTP score showed positive improvement after training sessions (p = 0.00). When sub-parameters were analyzed for BBS-DTP, Group B had more task significance compared to Group A. Due to BI classification of functional independence, both before and after training sessions, positive improvements were found for BBS and BBS-DTP scores (p = 0.00). Conclusion: Training had positive effects at every level of functional independence according to outcomes of BI. For both groups, significant progress was found in BBS and BBS-DTP scores, but not affected by the session numbers. Introduction: Recent literature shows that pain is a significant problem in stable chronic obstructive pulmonary disease (COPD) and is associated with worse health status and lower exercise capacity. The relation between pain and physical activity is important, since lifelong adherence to physical activity is essential to improve HRQoL and prognosis in COPD. Not much is known about pain in in relation to acute exacerbations (AECOPD) and post-acute pulmonary rehabilitation (PR). The primary aim of the present study is to investigate prevalence and characteristics of pain in older patients with COPD hospitalized for AECOPD and indicated for post-acute PR. Secondary aim is to investigate the relationship between pain and other symptoms and between pain and functional status. Methods: This cross-sectional observational study included 149 patients (mean age 70.8 (± 7.9) years, 49% male, mean FEV1% predicted: 35.3 (± 12.6)). Pain was assessed using the Brief Pain Inventory. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Results: Pain prevalence was 39.6% with moderate intensity and interference. Thirty-six percent of the patients with pain had no analgesic prescription and 40.7% reported no or only mild pain relief by pain treatment. In patients with pain, total symptom burden was higher and health status was more impaired due to more impaired experienced functional status. Key conclusions: Prevalence of pain in patients hospitalized for AECOPD and indicated for post-acute PR was 39.6%. Pain intensity and interference were moderate but pain treatment was suboptimal. Incorporation of standard pain assessment during AECOPD and postacute PR is recommended. Effect of a strength training program with TheraBands on cognitive and functional parameters in frail elderly over 90 years. controlled randomized pilot study Introduction: Fragility is defined as a state of vulnerability that carries a higher risk of adverse results (Clegg et al., 2013) . Because of this, the benefits of physical exercise on aging and especially on frailty have been the subject of recent scientific research. The aim of this study is to verify the effect of a strength training program with Therabands on cognitive status, functionality and general health in frailty institutionalized elderly population. Methods: After random selection, 17 frailty institutionalized elderly were allocated to an intervention group with therabands (TG) and a control group (CG). The TG (n = 9, 66.66% women, age = 92.56 ± 2.65) done 2 non-continuous weekly sessions of 1 h duration, for 12 weeks, of a strength training program with Therabands. The CG (n = 8, 87.50% women, age = 94.00 ± 3.63) done activities that the center required for them, but not related to physical exercise. A cognitive (Mini-mental and Pfeiffer test), functional (Barthel index, Five sit to stand test, and Fall Index), and health (12-SF) assessments was carried out, pre and post intervention. Results: After completing the intervention, significant intergroup differences were found in the variables of health (Mental health and mental component) and functionality (Five sit to stand and fall index) of improvement of TG over CG. Conclusion: A strength training program with Therabands in frail elderly people over 90 years old, brings about benefits in the functionality and cognitive health of these people. Are we over treating the blood pressure and making our elderly patients fall? Sai Hyne 1 , Malathi Suppiah 1 , Kali Kodavali 1 , Bharath Lakkappa 1 1 Community Hospitals, Northamptonshire Healthcare NHS Foundation Trust (NHFT), UK Introduction: Hypertension is one of the most preventable causes of premature morbidity and mortality. It is a major risk factor for ischaemic and haemorrhagic stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. The NICE guideline recommends lowering of blood pressure to below 150/80 in elderly patients over the age of 80 and 140/90 mm Hg for all others. Symptoms of postural hypotension are to be looked out for (NICE, 2016) . Low blood pressure (systolic below 110), in the very elderly is associated with increased mortality (Ravindrarajah et al., 2017) . In this audit, prevalence of low blood pressure in our community hospital patients was reviewed. Methods: All inpatient's above 80 years of age in two community hospitals, on a particular day in July 2017 were included. Blood pressure measured a day after admission and falls history was obtained. Results: There were 40 inpatients above 80 years of age, 18 were male and 22 female. Low blood pressure (systolic below 110) was found in 25% (10/40) of the patients. 9 out of these 10 patients (90%) were on anti-hypertensive medication. 77% (31/40) were admitted with a fall. Conclusions: Treatment for hypertension is beneficial in reducing morbidity and mortality from cardiovascular disease. However, overtreatment is common in the very elderly and this could increase the falls risk. The history of falls in patients with low blood pressure, on treatment with anti-hypertensives was stark. Therefore, we should be cautious in lowering the blood pressure excessively in the very elderly. The effect of empowerment programs on depressive symptoms of older adults in day care rehabilitation centers Introduction: Variation in the presentation of depressive illness among older adults may complicate assessment of depression, especially among those with multiple medical comorbidities and functional disabilities. The aim of this study was to evaluate the effect of empowerment programs on depressive symptoms of older adults in day care rehabilitation centers of Khorramabad, Iran. Methods: This is a cross-sectional and case-control study. The study sample was selected among older adults referred to day care rehabilitation centers of Khorramabad, through the convenient sampling. The sample was consisted of 40 elderly participants who randomly allocated to the experimental and control groups, each included 20 (8 men and 12 women). The research instruments included Beck Depression Inventory-II (BDI-II), and a questionnaire for gathering the demographic data. Empowerment program included lifestyle education, rehabilitation services, support and cultural services, sports and arts, tourism and leisure services. Empowerment programs was performed for 40 days and 3 h in a day. Results: The mean age of experimental and control group was 65.25 ± 5 and 64.95 ± 4.79, respectively. The results of t-test showed that there was a significant difference between mean score of BDI-II before and after intervention (P \ 0.047). Key conclusion: Findings of this study suggest that empowerment program have a positive impact on the elders' depressive symptoms, and it can be considered as an efficient intervention. Future research is needed to determine if such an empowerment program could be used with newly institutionalized elders to speed as well as enhance their adjustment to nursing home life. Towards better geriatric rehabilitation by structural measuring and evaluation of patient outcomes Introduction: Geriatric Rehabilitation (GR) aims to restore functioning and participation in older persons after an acute functional deterioration. Our academic network (UNC-ZH) initiated a roadmap for a core set of generic measurement instruments to evaluate outcomes and enhance GR quality. These are the first results. Objectives The aims: (1) structural and unambiguous use and evaluation of patient outcomes, (2) benchmark between GR departments and (3) scientific research. Methods: Development of (1) the core set by literature search, inventory of used instruments and discussions with experts to reach consensus; (2) digital application linked to patient file. (3) a pilot implementation study to evaluate user-friendliness and application in daily practice. Results: Literature review found no basis for a valid core set of instruments, but our full procedure (1) resulted in a set with valid measures for comorbidity (FCI), functioning and participation (Premorbid BI, USER, COPM, NPI-Q), and quality of life (EQ-5D-5L). The set is completed with additional information; age, gender, living environment, nutritional status, hospitalisation, therapy intensity and ICD-10 diagnoses. The set covers all domains of the International Classification of Functioning, Disability and Health. In the pilot, professionals were positive regarding the usefulness of the instruments, but some practical concerns about the digital application were revealed. Conclusion: The need for benchmarking, research and quality improvement in GR is evident-however, evidence is scarce. These are first steps in implementation and validation of a core set of generic instruments, in which the need for European cooperation is evident. Assessment strategies in early, ward-based rehabilitation in vulnerable, multimorbid geriatric patients admitted to acute medical care: a systematic review (4) exercise-based interventions (optional as part of complex interventions). Two reviewers independently extracted data. Results: The intervention program of 14 studies (34%) showed a high match to study outcomes. Physical performance tests were mainly used (63%) in the early acute rehabilitation phase, with a number of tests suggesting a risk of floor effects. Functional status instruments were mainly used (80%) at the end of the acute phase, with a tendency to show an inadequate responsiveness to change within the limited timeframe of early rehabilitation. Cognitive status of patients were reported in n = 24 (58%) of the studies and a specific cognitive intervention approach could not be found. Key conclusion: Identified assessments showed substantial limitations with respect to their match to the study interventions and different rehabilitation phases. Although PWCI represent a major subgroup in early rehabilitation, specific assessment strategies are hardly recognizable as part of the treatment. Cognitively frailty patients can be rehabilitated, preventing premature 24 hour care admissions Discussion: GAPP has been implemented for over 2 years now and suits proximally 80% of our geriatric inpatient population. An observational study is ongoing to objectify patients' progress. Motor performance in the transition between inpatient geriatric rehabilitation and home environment in cognitively impaired patients after hip or pelvic fracture Introduction: The aim of this study was to identify which factors are associated with QoL improvement among the patients attending a GRDH. Methods: Longitudinal study including those patients that attended the GRDH for a minimum of seven sessions between January 2007 and December 2011. We registered the following variables at baseline and at the end of the rehabilitation program: sociodemographic variables, NHP questionnaire (global score and subareas), Barthel Index and Lawton Index for activities of daily living, Timed Up and Go and Tinetti for mobility, and Mini-Mental Folstein and GDS-Yesavage for mental status. We considered QoL improvement if a decrease of the NHP score occurred with an effect size of C 0.50. We performed bivariate and multivariate analyses. Results: Of the 139 patients included (mean age 75.6 ± 13.0, 57.5% women), forty-seven experienced QoL improvement. In the bivariate analysis, being a woman and having attended a higher number of sessions were associated with an improvement of the QoL subarea emotion (p = 0.036) and social isolation (p = 0.019), respectively. In the multivariate analysis, a decrease in the Timed Up and Go score of C 10 s was associated with QoL improvement [global QoL (OR 3.11 Institute for Biomedicine of Aging-FAU Nürnberg-Erlangen, Germany, 2 Institute of Nursing Science at the University of Bielefeld, Bielefeld, Germany Background: Demographic change will bring us an increase in hospitalizations due to more older persons with comorbidities. As this group is vulnerable to stressors, hospitalizations promote loss of function, of quality of life, of independence as well as a higher infection rate leading to readmissions. Internationally an effective reduction of readmission rates in this population was demonstrated administering nurse support of the Transitional Care Model (TCM). Goal: The primary objective of the trans-sectional intervention project TIGER for geriatric patients is the reduction of readmission rates. Secondary outcomes are the increase in functional health status, quality of life and wound healing, and a decrease of risk of malnutrition. Method: TIGER is an RCT, the control group receiving usual care. In the intervention group the geriatric patients and their care givers will be supported by special nurses according to TCM-called ''Pfadfinder''. The Pfadfinder contact the geriatric patients already in the hospital and accompany them over 12 months in the ambulatory setting, integrating different modules of support. The target number of participants is 400. Inclusion criteria are 70 years and older, cognitive status measured by MMSE C 22, living in the vicinity of B 50 km, membership in a specific health insurance; being discharged to home. The ''First patient in'' was randomized in April 2018. The project will continue till August 2020. Perspectives: The TIGER project addresses the current transitional health care gap in Germany in the geriatric hospital population. The presentation will address recruiting aspects and present data of included patients. Geriatric rehabilitation in older patients with cardiovascular disease, a feasibility study Introduction: Considering the worldwide ageing populations and growing numbers of older patients with cardiovascular disease (CVD), studies on development, implementation and outcomes of specific geriatric rehabilitation (GR) programs for patients with CVD are needed. We developed and implemented a GR program for older patients with significant functional decline after hospital admission because of CVD: 'the GR-cardio program'. Aim of the program is to restore functional capacity to such an extent that discharge back home is possible, improve quality of life and prevent hospital re-admissions. The primary goal of the present study is to investigate feasibility of the GR-cardio program. Methods: This is a real life observational study with a follow-up period of 6 months in patients admitted to the GR-cardio program. We collected data on patient-and disease characteristics and course of functional status and quality of life. Six month after discharge data on re-admissions and mortality were collected. Results: In total 58 patients (mean age 78.8 (± 9.8) years) were included in the study. Co-morbidities were frequent and functional status and quality of life were severely impaired on admission but showed clinically relevant improvement during the program. Eightythree percent of all patients were discharged back home after a mean length of stay 38 days. Key conclusions: This study indicates that GR for patients with CVD is feasible and can probably offer substantial benefits. More research is needed and should focus on (cost)-effectiveness of the program and identifying patient characteristics that can predict which older patients with CVD are most likely to benefit. Pain as the main determinant of fall-associated self-efficacy after hip/pelvic fracture in geriatric rehabilitation Introduction: Low falls-related self-efficacy (FSE) might negatively affect rehabilitation outcome. Aim of the study was to determine established (age, sex, motor performance and depressive symptoms) and hitherto neglected determinants (pain) of FSE in geriatric patients after hip/pelvic fracture. Methods: In a cross-sectional design, 40 patients (82.1 ± 6.7 years) with hip/pelvic fracture without cognitive impairment (Mini-Mental State Examination: 28.3 ± 1.1) were assessed for demographic data, FSE (Short Falls Efficacy Scale International), motor performance (Short Physical Performance Battery), depressive symptoms (Montgomery-Å sberg Depression Rating Scale), and pain (Western Ontario and McMaster Universities Osteoarthritis Index, subscale pain). After univariate evaluation of correlations between FSE and established parameters, variables (p B .100) were included in a first multiple linear regression model with FSE as dependent variable. In a second model, the variable list has been extended by the parameter pain. The parameters were interpreted on the basis of significance (p B .05), standardized regression coefficients b, and determination coefficients R 2 . Results: In the first model, the included significant determinants motor performance (b = -.310, p = .034), age (b = .309, p = .032), and depressive symptoms (b = .358, p = .013) elucidated 39.4% of variance (R 2 = .394) for the FSE. In the second model, the parameters age (b = .317, p = .020) and pain (b = .338, p = .022) improved the explanation of variance up to 48.5% (R 2 = .485). The parameters motor performance (b = -.249, p = .072) and depressive symptoms (b = .227, p = .111) made no significant contribution. Key conclusions: These results provide first indications that the FSE, as an important parameter for positive geriatric rehabilitation outcome, is significantly influenced by pain and age in vulnerable patients after a hip/pelvic fracture. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 (2015), we explored the experiences and preferences of patient participation in IC of 15 patients and 12 relatives using semi-structured interviews. Thematic analysis based on Clarke and Braune (2006) were used to analyze the data. Results: The analysis disclosed a lack of choice in a predetermined pathway. Being deserving means to be sick enough and is associated with the compliant patient that fit the system. Some main additional features are the need of a rehabilitation perspective and patient engagement to enable co-production as well as the important contribution of relatives as advocates and allies. Finally, the results show the patients vulnerable voice in the meeting with experts' views. Key conclusions: All though most of the patients benefited from IC, patient participation in this context could indeed be structured in a more empowering manner. Patient participation in IC is influenced by underlying structures such as market, bureaucracy and psychology. Life-space mobility among multimorbid older persons with multiple impairments following rehabilitation Objectives: Though adherence is a strong determinant for success of home-based exercise interventions among geriatric patients with cognitive impairment (CI), effectiveness of motivational strategies to increase adherence to regular exercise and physical activity (PA) has rarely been tested. Aim of the current study is to describe adherence to a 12-week home-based mixed training and motivation intervention among patients with CI after discharge from geriatric inpatient rehabilitation. Methods: Secondary data analysis of a randomized-controlled intervention trial. Data from cognitively impaired (Mini-Mental Examination score: 23.5 ± 2.5) geriatric patients (81.5 ± 5.9 years), recently discharged from inpatient rehabilitation, in intervention group (n = 54) were analyzed. To achieve daily execution of functional training (strength, balance) and increase of PA, motivational strategies (outdoor activity, goal achievement, monitoring by pedometers) were implemented. Adherence to training and motivational strategies was documented on base of exercise logs (% of maximal sessions). To test for differences between week 2 and 12, Wilcoxon tests were conducted. Results: At week 2 adherence to training was 74.5%, outdoor activity 61.0%, goal achievement 43.4% and monitoring by pedometer 66.7%. At week 12 adherence rates to training (51.5%), outdoor activity (46.5%) and monitoring by pedometers (51.5%) were significantly lower (p = 0.001-0.022) than in week 2, except for goal achievement (34.5%; p = 0.170). Conclusions: The moderate to high adherence to our home-based mixed training and motivation intervention proved feasibility of this innovative motivational approach among geriatric patients with CI. Decreasing adherence indicated the potential need of more successive supervision to achieve long-term adherence and increased PA. Pressure ulcer risk and mortality in patients discharged to skilled nursing facilities Paul Takahashi 1 1 Mayo Clinic, Rochester, USA Introduction: Elderly patients discharged to skilled nursing facilities (SNF) for post-acute care are a high risk population. The Braden score, calculated to determine risk of developing pressure ulcers, includes elements that indicate frailty and functional dependence [1] . We conducted this analysis to evaluate the association between risk of pressure ulcers during hospitalization and mortality in this population. Methods: This was a retrospective analysis of 30-day, 6-month and 1-year mortality in patients discharged to SNF following hospitalization between January 1, 2009 and June 30, 2014. Braden scores, demographic, comorbidity, and mortality data obtained from clinical and administrative databases were analyzed to compare mortality rates in patients with Braden scores in the at-risk category during hospital stay to those not at risk. Results: There were 8616 discharges from Mayo Clinic, Rochester hospitals to ten area SNF that were served by its long-term care practice during the study period. 5385 had Braden scores in the atrisk category while hospitalized. The 30-day, 6-month, and 1-year mortality rates were higher (6.7%, 20.7% and 28.2% respectively) in patients with at-risk Braden score compared to those not at risk (1%, 5.5% and 8% respectively) (p \ 0.001). Conclusion: Patients at risk of pressures ulcers had persistently higher mortality rates suggesting that Braden scores during hospitalization may serve to identify high-risk patients at SNF admission. Reference: 1. Nancy Bergstrom et al (1987) The Braden score for predicting pressure sore risk. Nurs Res. 36 (4) P-304 Comparison of two fall risk screenings and fall prevention interventions in older in-hospital patients: an health economic evaluation Key-conclusions: From a health economic view, LUCAS was the favourable screening alternative. It produced an economic benefit as applied in an identical patients' fall-risk structure. The effects of decongestive physiotherapy on pain and sleep quality in elderly women with breast cancer related lymphedema Orçin Telli Atalay 1 , Atiye Kaş 2 , Sevda Yılmaz 2 , Nesrin Yagcı 2 1 Pamukkale University, Denizli, Turkey, 2 Pamukkale University, Denizli, Turkey Introduction: The incidence of lymphedema is increasing among elderly breast cancer survivors. Complex decongestive physiotherapy (CDP) is commonly used as a primary treatment. The aim of this study was to investigate the effects of CDP on pain and sleep quality in elderly breast cancer related lymphedema patients. Methods: Twenty-one women with breast cancer related lymphedema were assigned as two groups; CDP (n = 13, mean age = 65.16 ± 6.23) and control group (n = 8, mean age = 64.91 ± 8.12). The CDP group received manual lymph drainage, compressive bandages and exercise therapy (5/week for 4 weeks). The subjects in the control group were given self-massage and exercise therapy as home program. The upper extremity level of pain were assessed with visual analog scale. The Pittsburgh Sleep Quality Index was used for the assessment of sleep quality. The circumference measurements were done for the assessment of lymphedema. All the subjects were assessed at baseline and after CDP and home progam. Results: The level of pain and sleep quality in CDP group improved significantly (p = 0.04, p = 0.001 respectively).The extremity circumference also decreased in CDP group (p = 0.012). There was also a significant decrease in the extremity circumference of control group but there was not any change in terms of pain level and sleep quality (p [ 0.05). Significant differences were found between the two groups in terms of the decrease in edema, pain level and sleep quality (p = 0.042, p = 0.001, p = 0.029). Key conclusions: The CDP affects the level of edema, severity of pain and sleep quality positively in elderly women with breast cancer lymphedema. The Relationship between respiratory function and functional performance in elderly patients with COPD Introduction: The elderly is the primary target population for rehabilitation services. Elderly people are at risk for a significant decrease in function during hospitalization. The return to their natural and familiar environment has a positive influence on rehabilitation pace and outcomes as long as they have supportive families and communities. Methods: In a survey conducted by the social work department, we examined the overall satisfaction from home-based rehabilitation program. Telephone interviews were conducted among elderly orthopedic patients. The questionnaire included: waiting times for the program, satisfaction from the rehabilitation services and unmet needs. Findings: The overall satisfaction from rehabilitation outcomes was high among most participants (73%). However, participants reported on a long waiting time (Mean = 4.58, SD = 4.67 days) from the hospital discharge date, and that was associated with lower satisfaction. Most participants reported they didn't receive nursing services (76%) and doctor visits (46%). Participants reported on gaps in the program like: accessibility at home, emotional difficulties, loneliness, lack of response to the needs of caregivers and long term follow-up. Conclusions: As the world's elderly population continues to grow, there is a need to establish guidelines and to promote a home-based rehabilitation ''basket'', suitable for patients' and families' needs that will allow reduction in hospitalization days and in medications. The challenge health professionals are facing today is how to define the home-based rehabilitation ''basket'' and how to have it approved and implemented by policy makers. Associations of motor performance and qualitative/quantitative physical activity behavior in older persons with cognitive impairment after discharge from geriatric rehabilitation Introduction: Geriatric patients with cognitive impairment (CI) show deficits in motor performance and decreased physical activity (PA) behavior in everyday life. Aims of this cross-sectional study were the analysis of associations between motor performance, habitual PA and habitual gait behavior and the identification of modifiable, motor determinants of PA behavior in older persons with CI after discharge from geriatric rehabilitation. Methods: In multi-morbid, geriatric patients with CI motor performance was measured using the Short Physical Performance Battery (SPPB). A newly developed and validated activity monitor (uSense) captured innovative, qualitative parameters of gait behavior and quantitative parameters of gait and general habitual PA. Bivariate associations were calculated using Spearman correlations (rho). Parameters of motor performance and qualitative gait behavior with significant correlations were included in a linear regression model to identify motor determinants of PA behavior. Results: Motor performance showed high correlations with PA behavior in 110 older persons with CI (age = 82.3 ± 5.9 years, Mini-Mental State Examination = 23.3 ± 2.4). Qualitative gait characteristics during straight walking and turns showed moderate to high correlation with PA behavior. In the linear regression model mean turning velocity, gait symmetry, cadence and SPPB explained 45% of the variance (R 2 = 0.45) of PA behavior. The results showed a high relevance of motor performance for PA behavior in geriatric, multi-morbid patients with CI. Besides established motor performance variables (SPPB), innovative qualitative parameters of habitual gait behavior may be taken in consideration of rehabilitation or activity promotion programs respectively. Cognitive function in older adults admitted to a geriatric rehabilitation: does it really matter for functional recovery? Results from the FRAIL-BCN study Introduction: Cognitive impairment is associated with poorer functional outcomes (FO) in elderly undergoing rehabilitation; however its role on rehabilitation is controversial. Objectives: To assess the association between cognitive function and FO in older adults admitted to a geriatric rehabilitation unit after hip fracture or stroke. To evaluate differences on functional recovery prediction between Symbol Digit Modalities Test (SDMT) and Mini-Mental State Examination (MMSE). Methods: Prospective cohort study with patients C 65 years old admitted to a geriatric rehabilitation unit after hip fracture or stroke. FO were: absolute functional gain [ 20(AFG, discharge or 6 monthsadmission Barthel index) and walking recovery (WR, discharge or 6 months-admission walking Barthel index item). The association was assessed with Relative Risk (RR, 95% CI). Analyses were then stratified for diagnosis at admission. The discriminative capacity of SDMT and MMSE was assessed by comparing their AUC. Results: 202 patients were included [mean age (SD) 83.4 (± 6.7) years, 70% female]. Patients with MMSE C 20 had a RR = 2.22 (95% CI 1.33-3.72) of AFG [ 20 at discharge, results remained stable at 6 months (RR = 1.70, 95% CI 1.15-2.52). These results were confirmed only for hip fracture patients (Discharge: RR = 3.74, 95% CI 1.30-10.72; 6 months: RR = 2.55, 95% CI 1.09-5.99). WR at discharge and after 6 months was not related with baseline cognitive function; these results were confirmed also after diagnosis stratification. Comparing SDMT and MMSE, there was no difference in their functional recovery prediction. Conclusion: WR was not affected by cognitive function in older patients admitted to a rehabilitation unit. Furthermore, the effectiveness of rehabilitation program is maintained over 6 months after discharge. Therefore, rehabilitation should be considered in all patients, independently from their cognitive status. The safety, efficacy and acceptability of non-pharmacologic treatments for orthostatic hypotension in older people: a mixedmethods study Lisa J. Robinson 1 , Julia L. Newton 2 , Ruth M. Pearce 2 , Jake R Gibbon 1 , James Frith 2 1 Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK, 2 Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK Introduction: Older people with OH are frequently prescribed nonpharmacologic therapies. However the evidence supporting their use is limited, moreover uptake and adherence can be low. Methods: An exact, single-stage, phase 2 study was performed, with 80% power to demonstrate a 30% response rate and a 95% chance of rejecting interventions with response rates B 10%. This was complimented with semi-structured qualitative interviews, interpreted using thematic analysis. 25 participants were recruited from a Falls S144 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Level of physical activity in men and women with chronic stroke. Karin Hellström 1 , Annika Bring 1 1 Institute for Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden Introduction: Community-dwelling stroke survivors generally show low levels of physical activity. An improved understanding of the factors influencing participation in physical activity after stroke is imperative to improve levels of physical activity. Furthermore, gender differences in physical activity have received little attention in stroke research. The objective of this study was to examine gender differences in physical activity, physical functioning and psychological factors and the association between these factors and physical activity in men and women 1-3 years post-stroke. Materials and methods: A total of 187 community-dwelling individuals with stroke (65-85 years old, 29% women) were included in a secondary analysis based on data from a cross-sectional study. The exclusion criteria were severe cognitive or language dysfunction or dementia. The level of physical activity was measured by the Physical Activity Scale for the Elderly (PASE). Physical function included balance, walking speed and mobility. Psychological factors included depression, health-related quality of life and fall-related self-efficacy. Falls and fear of falling were each measured with a single question. Results: There were no significant differences in physical activity levels between men and women. In multiple regression analyses, walking speed (p \ 0.001) was associated with physical activity in men, and balance (p = 0.038) was associated with physical activity in women. The results indicate that strategies to increase physical activity levels 1-3 years post-stroke could be improved by considering gender-specific factors. Published in Physiotherapy, Theory and Practice, April 2018. Management of chronic constipation in geriatric patients: 5 years prospective study Chronic constipation (CC) is one of the most frequent intestinal disorders in daily medical practice and is strongly influenced by life and nutrition conditions. In the general population of industrialized countries, the prevalence varies from 10 to 20% and increases with age, to more than 70% in the Nursing Home Residents. Two pathophysiological conditions are recognized: Slow Transit Constipation (SRT) characterized by prolonged transit time of stools through the colon and reduction of evacuations less than three per week, and Dyssynergic Defecation (DD) due to difficult or unsatisfactory expulsion of stool from the anorectum, that may result from a lack of coordination between abdominal muscles contraction and pelvic floor muscle relaxation. Literature data suggest an important role in rehabilitative therapy, ie anorectal biofeedback, especially in DD. In this study we have reported our data on the management of elderly patients in a geriatric clinic dedicated to the treatment of chronic constipation. From June 2012 to June 2017, 908 patients with constipation (mean age 61 ± 2.7 years, M ± ES, 337 M, 571 F) have been evaluated according to the criteria of Rome III, the Bristol scale (constipation = stool type 1-3) and the Wexner scale (constipation = [ 5/30) . After exclusion of secondary constipation, hygienic/ dietary requirements have been suggested for all patients, and prescribed osmotic fibers and/or laxatives (lactulose, macrogol) therapy and short-term, on-demand irritable laxatives (senna, bisacodile).All patients were asked to keep a daily diary on stool characteristics and were re-evaluated after 1, 3, 12 months. Patients who did not report treatment benefits after 3 months were treated with second-level drugs (prucalopride and/or linaclodide) and subsequently re-evaluate through functional tests included intestinal transit time and anorectal manometry, and, if indicated, initiated for rehabilitation treatment. The majority of patients reported benefit from therapy (Bristol scale type 3-4 with stools more frequent and soft, defecation and associated abdominal symptoms improved), with a reduction of laxative therapy. Introduction: After the acute hospital phase, hip fracture patients are either discharged home or to inpatient geriatric rehabilitation, where they are treated by a multidisciplinary team. The effect of quality and intensity of treatment as well as important (age-related) characteristics on functional outcome and quality of life are poorly studied. As such, no clear evidence-based guidelines determining type, quality, or intensity of training during rehabilitation admission exist. Method: The study has a mixed-methods approach with a large inception cohort and qualitative data-collection from elderly care physicians, physical therapists, patients, and primary caregivers. Patients are included after hospital admission at Bronovo Hospital, the Hague, with a hip fracture. They will be followed-up at 6 weeks, 3 months and 12 months in the outpatient clinic or place of residence during home-visits. Data collection includes information on patient and caregiver characteristics, comorbidity, functional abilities, cognitive abilities, quality of life, measures on sarcopenia, healthcareuse, psychological measures on coping and (proxy) fear of falling, and caregiver burden. Results and Key conclusions: In this study, we aim to determine which variables predict successful as well as non-successful rehabilitation and explore effective treatment programmes with the purpose of developing good practice care-pathways. In order to develop these care-pathways, it is important to gather information on patient-related factors, healthcare use during and after admission to postacute GR wards as well as caregiver burden and quality of life. Effects of nutritional interventions on nutritional and functional outcomes in geriatric rehabilitation patients: a systematic review with meta-analyses Introduction: Effect of supported (by procedural learning potentially affecting procedural memory) and non-supported exergame training using simultaneous motor and cognitive tasks have not been studied before. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Objective: To test training-and long-term effects of a standardized exergame training program on dual task-related memory performance (immediate recall) in older persons. Methods: RCT in n = 60 older persons (age 78.6 years). Intervention: supervised game-based training of motor-cognitive performance (dynamic postural control & memory training), 10 training sessions vs. unspecific strength/functional training. Sum score of achieved performance levels (scores) and duration/movement time (s) tested at different performance levels (2) (3) (4) represented study outcomes derived from internal exergame data stream for 2 test conditions (unsupported vs. procedural support). Results: Unsupported training increased total score (p [ 0.002) as well as duration of task in level 3 (p [ 0.001) with a trend for level 2 (p = 0.09) and level 4 (p = 0.08), while procedural support did not further improve training gains compared to unsupported test (total score: p = 0.241; level 2: p \ 0.001; level 3: p = 0.151). Results were sustained during a 3 months follow up for both conditions. Conclusion: Exergame training increased complex motor cognitive performances related to dynamic balance and memory performance in cognitively intact older persons independent from procedural support with training gains mostly sustained 3 months after training cessation. Test challenges may be sensitive to detect early memory deficits during dual tasking. Criteria for referral to geriatric rehabilitation, a scoping review A. J. de Groot 1 , L. M. Wattel 1 , J. C. van der Wouden 1 , R. van Balen 2 1 VUmc Amsterdam, Amsterdam, The Netherlands, 2 LUmc Leiden, Leiden, The Netherlands Introduction: In rehabilitation medicine a patients rehabilitation potential is assessed before admission. In the growing field of geriatric rehabilitation (GR), we need to find criteria and methods that target (triage) eligible GR clients by predicting their readjustment. Our aim is to examine the breadth of literature to find criteria, measures or methods that help select GR patients. Method: We searched PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library for articles published from January 2000 to present, using a search string on 'geriatric patients', 'rehabilitation', 'referral/triage' and 'in-hospital'. Two reviewers independently screened abstracts, a third researcher was consulted when necessary. We sorted the abstracts according to geriatric rehabilitation diagnosis, study population (i.e. patients or professionals) and focus of the research (e.g. prognostic measure, patients experience). Through purposive sampling in each category we reached the full text phase and charted results. Results: Out of 10,520 we included 1049 abstracts. GR diagnoses were stroke, other neurology, hip fracture, other traumatology, planned orthopaedic surgery, delirium and dementia, amputation, pulmonary rehabilitation, cardiac rehabilitation, cardiovascular disease, oncological disease and other medical diagnoses. The majority were patient studies of clinical and prognostic criteria. Conclusion: In this scoping review we found a variety of factors like age(ism), frailty, gender, cognitive impairment, functional status, comorbidity, family support and patients preferences related to GR referral. We will present a comprehensive overview of results and the foundation it offers for triage methods. The prevalence of malnutrition in a german geriatric rehabilitation population definition (n = 20 missing body composition data, due to e.g. presence of a pacemaker): 31% (n = 38) and 9% (n = 9) were malnourished according to MNA-SF and ESPEN criteria, respectively and 26% (n = 26) were sarcopenic. Thirty-four per cent (n = 11) of the patients who were malnourished (MNA-SF) were also sarcopenic, and 42% (n = 11) of the patients who were sarcopenic were also malnourished (MNA-SF); 89% (n = 8) of the patients who were malnourished (ESPEN) were sarcopenic, and 31% (n = 8) of the patients who were sarcopenic were also malnourished (ESPEN). 4 patients who were both sarcopenic and malnourished according to MNA-SF were not identified with the ESPEN criteria. Key conclusions: Around a quarter of patients is sarcopenic in this German geriatric rehabilitation population. There is significant overlap between malnutrition and sarcopenia, however, the overlap differs based on the diagnostic tool for malnutrition that is applied. Associations between nutritional and functional status of a german geriatric rehabilitation population (bw)] 35% (n = 40), (0.8 to \ 1.0 g/kg bw) 33% (n = 38); low energy intake (\ 25 kcal/kg bw) 55% (n = 64); vitamin D levels: (\ 25 nmol/l) 61% (n = 58), (25-\ 50 nmol/l) 18% (n = 17). SPPB, BI, TUG, muscle mass did not differ significantly between subgroups of protein and energy intake, and vitamin D level. HGS was significantly lower when vitamin D was \ 25 nmol/l vs. 25 to \ 50 nmol/l (p = 0.026). Key conclusions: Nutritional intake and vitamin D status are compromised in a majority of these geriatric rehabilitation patients. While parameters of physical function were not significantly different between groups of protein and energy intake, HGS varied with vitamin D status. However, nutritional intake already might be compromised earlier, during acute hospital treatment. Hip fracture geriatric rehabilitation: a mixed-method crosssectional observational study of patient characteristics and current practices in nutrition Background: Walking is one of the most complicated and common motor activity of daily life. With increasing age, the automatism no longer functions as it does in young age. Yet, the desire for a prolonged self-determined life and social participation grows. An important prerequisite for this is good mobility and independence in everyday life. In this context, assistive devices for improving independence play an important role. The aim of our work is to outline the first results of the functionality of a modular soft and flexible lowerlimb exoskeleton (XoSoft) in its penultimate and final stage of development. Methods/design: The objective is to gain an overview of the XoSoft's basic functionality. The testing design corresponds to the basic functionality with different tasks and conditions which are S148 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 subdivided into exercises without and with an activated device. Patients are questioned about the respective load in the legs and classified by a scoring system. A survey on pressure nuisances is carried out and determined precisely. The functionality of XoSoft as well as the acceptance of the users will be written and documented. Kinematics are recorded, analyzed and evaluated by motion analysis. Geriatric patients will be recruited at the Geriatrics Centre Erlangen. Discussion: Wearable exoskeletons require extensive technical expertise innovation. Still the most innovative systems cannot be successful should they fail to be accepted by their intended users. This research provides an important step into the exploration of wearable soft biomimetic lower-limb exoskeletons as assistive devices from a user's perspective and its impact on common locomotion tasks in daily life. Evaluation of cardio-circulatory parameters (heart rate, systolic and dyastolic blood pressure) and endocrine parameters (testosteron, HGH, Cortisol, HTSH) have been done before and after training. GDS was used to evaluate depression. Results: Our data pointed out the positive effects of physical training upon depression scores with a positive impact upon sleep quality and upon physical ability to perform movements with a better neuromuscular coordination increasing the patients self confidence and the ability to self support. There is an increase following training in Testosterone and HGH secretion and a decrease in Cortisol secretion with a positive effect upon mental health increasing the sense of well being, the confidence and optimism about life. Conclusion: Psychological changes that occur in elderly are associated with altered pharmacokinetics and physical training is an alternative for drug treatment of depression, stimulating brain function, enhancing the sleep and contributing to the increase in quality of life. Can person characteristics predict engagement in physical activity? Experience from the promoting activity, independence and stability in early dementia (PrAISED) intervention Results: There was no significant difference between the moderate and high intensity intervention groups in physical activity scores at follow-up. Physical activity at 12 months was not significantly related to any of the baseline measurements. Only DAD baseline scores showed a trend towards a significant relationship with physical activity follow-up scores (r = 0.36; n = 27; p = 0.07). The psychological and physiological measures used in this study at baseline were unable to predict engagement in physical activity following the PrAISED intervention. Other parameters such as personality traits or health beliefs should be explored to investigate characteristics of people with MCI or early dementia to predict engagement in physical activity. #Loseapad: An innovative idea to prevent deconditioning in hospitalized elderly patients-a quality improvement exercise in a senior adult medical services (SAMS) department in a UK Hospital. Introduction: Deconditioning leads to loss of muscle mass and strength, thus patient's ability to perform physical activities of daily living. Enabling independence and preventing deconditioning of older people in hospital is essential to prevent morbidity and unnecessary burden on health economy. Innovation: The idea came from one of our matrons, who gave the story how she was surprised to see her cognitively intact, continent father given a continence pad when he was admitted to hospital; hence #lose a pad was born. A poster was made to create awareness and to educate the staff to use fewer pads and thus promote patient independence. Project was started on three SAMS wards (Swift and Holly ward). Cost savings, length of stay (LOS) was measured before and after intervention. Results: Pre-intervention phase: (August 17-October 17) total cost of pads used on 3 wards: £6,538.98 average length of stay: 11.93 days post-intervention phase (November 17-January 18) total cost of pads used on 3 wards: £2,087.81 average length of stay: 11.06 days total savings: £4,454.17, projected annual savings of £17,816.68. Conclusion: Our intervention resulted in significant cost savings with reduction in length of stay despite winter pressure. Preventing deconditioning in older people is challenging but not impossible. Persistent efforts with innovation and continuous staff education are key to success. We plan to hold further training sessions including improvement days in an attempt to change the culture and methods we use to deliver care to our older population thus preventing deconditioning. Prognostic predictors of rehabilitation in patients aged 75 and older with ischemic stroke Introduction: Management of ischemic stroke in elderly is challenging, because of its growing incidence and its consequences on mortality and functional prognosis. Optimization of rehabilitation care in geriatric neurology would improve the chance of recovery. In this heterogeneous population, the identification of factors associated with prognosis is needed, to identify vulnerable patients. Objectives: to assess factors associated to adverse outcomes, such as death, aggravation of neurological (increasing value of NIHSS-National Institute of Health Stroke Score) and functional status (decreasing value of GIR-Groupes Iso Ressources). Hospital, France, from May 1st 2015 to May 1st 2017, including patients C 75 years, hospitalized in the geriatric neurology rehabilitation unit for ischemic stroke. Variables of interest: sociodemographic data, geriatric and neurologic parameters, comorbidities and medication. Results: 100 patients were included (53% men, mean age 85 ± 6 years, mean stay 44 ± 29 days). Mortality rate at 3 months were 20%, and 28% of patients had adverse outcomes according to our criteria. In univariate then multivariate analyses, a bad prognosis was significantly associated with high modified Charlson score (p = 0.01), high NIHSS (p = 0.02), cardio-embolic cause (p \ 0.001), and early complications such as epilepsy (p = 0.002) and swallowing disorders (p = 0.02). Conclusion: This study showed that after an ischemic stroke, optimal management in elderly should include an early identification of comorbidities, notably an atrial fibrillation, and skills in detection of epilepsy and swallowing disorders during the hospitalization. Short physical performance battery: study of content validity to Portuguese Results: In this process three assessment was necessary to obtain a consensus in the validation process. In the first and second evaluation more than 13.3% of the item showed a CVI \ 0.8. After reviewing these items, in the third evaluation, all had come to present a CVI = 1, and the average value of the IVC was 100% and the universal agreement of the IVC = 1 and pc value was 0.0625. MK was 1, which was considered excellent Introduction: In older people, hip fractures often lead to catastrophic disability and loss of independence. We investigated clinical predictors of walking recovery using data from the Gruppo Italiano OrtoGeriatria study. Methods: Prospective multicenter observational study of Italian patients aged C 65 undergoing surgery for hip fracture. N = 2570 patients were recruited in 14 Italian hospitals from 2016 to 2018. A telephonic 30-day follow-up was performed in a subgroup of 595 (23%). Of those, n = 587 (99%) were able to walk before the fracture (97% in the whole sample). In these patients, we assessed the association between selected pre-fracture clinical features and walking recovery, defined as the ability to walk with or without aids. Results: Walking recovery occurred in 83.5% patients and 19% had a full recovery or a better walking performance as compared to baseline. In a multivariable logistic regression model, walking recovery was significantly associated with younger age (OR 1.05 per year, 95% CI 1.01-1.10), pre-operative cognitive impairment (SPMSQ [ 3 errors, OR 0.34, 95% CI 0.17-0.67), independent pre-operative walking ability (OR 3.2, 95% CI 1.5-6.4), need for transfusion (OR 0.44, 95% CI 0.20-0.97), partial or full bone loading (OR 9.6, , lower ASA score (OR 4.3, , and postdischarge rehabilitation program (OR 2.82, . Conclusion: 30 days walking recovery was associated with younger age, lower level of multimorbidity and disability before the fracture and post-operative physiotherapy program. This information may help geriatrician in prognosis definition and tailoring post-surgery management. Introduction of discharge to assess on an elderly care ward: a quality improvement project Tim Pattison 1 , Arturo Vilches-Moraga 1 , Karen Smith 1 , Imogen Lyons 1 , Laura Hammond 1 1 Salford Royal NHS Foundation Trust, Salford, UK Introduction: Increased waiting time for social care and therapy cause significant delays in transfer of care in the UK. The Discharge to Assess model examines ongoing care needs in the home to deliver a personalised support plan. This study aims to determine the impact of embedding HomeSafe to the multidisciplinary team of an acute elderly care unit. Methods: Retrospective study of consecutive discharges from a geriatric ward between 1st January and 20th May 2018. Tests of change started on 5th April 2018, integrating the community team onto the ward to improve communication and understanding of discharge to assess process, expedite assessment by community team and allow early contact with relatives. Results: We included 247 patients with a mean age of 85 years and female predominance (70%). Overall discharge rate increased from 25 to 57 patients per month. Median length of stay was 7 days, however, HomeSafe patients median LOS was 11 days. Seven-day readmission was reduced from baseline. The rate-limiting step identified was the capacity of HomeSafe to take on the volume of new referrals, which was shown to triple. Conclusions: Communication between hospital and community health professionals is integral for the success of a discharge to assess team. The service increased the number of ward discharges with no increase in readmission or mortality rates. More data is required to streamline and determine the impact of this service. Physical activity and functional performance in persons over 70 years Introduction: Age-related changes decline physical activity and decrease functional performance that has been related with chronical diseases, morbidity and mortality. Many evidences suggest that functional performance is the key for health and functional independence in later life. The aim of this study was to compare physical activity and functional performance in 70-79 years and 80+ years age groups of elderly. Methods: The cross-sectional study was performed on communitydwelling ambulatory people. Inclusion criteria were: age 70 years and more, MMSE C 10 points. Participants were divided into two groups according age: group I (70-79 years, n = 33) and group II (80+ years, S152 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Introduction: Loneliness is a common, emotionally distressing experience and is associated with adverse physical, mental health and well-being in older people. The aim this of study is to investigate the associations between loneliness and hedonic well-being in community-dwelling persons aged 65 years and older. Methods: This cross-sectional study involved community-dwelling ambulatory people aged 65 years and over; were cognitively competent with MMSE C 10 points. Loneliness was valued by Revised University of California of Los Angeles Loneliness Scale (R-UCLA). Hedonic well-being was measured using three questionnaires: (1) the Positive and Negative Affect Schedule (PANAS) that consists of two scales to measure both positive affect (PA) and negative affect (NA); (2) Geriatric Depression Scale (GDS-SF); (3) GDS-SF-6.37 ± 4.19, SWLS-22.6 ± 6.11. Our study showed that R-UCLA score negatively moderately correlated with PANAS-PA (r = -0.5, p \ 0.001) and SWLS (r = -0.44, p \ 0.001) scores. Further correlation analysis revealed positive R-UCLA score association with PANAS-NA (r = 0.43, p \ 0.001) and GDS-SF (r = 0.59, p \ 0.001) scores. Conclusion: In people age and 60 years and older loneliness were associations positive emotions, depression and satisfaction with life. Muscle strength is associated with course of mobility among older persons after acute hospitalization: the Hospital ADL study association between muscle strength and the course of mobility over time including influencing factors. Methods: A multicenter, prospective, observational cohort study on older persons who were acutely admitted to one of the 6 participating hospitals was conducted by a multidisciplinary team. Mobility was assessed by the De Morton Mobility Index (DEMMI) and muscle strength by the JAMAR. Measurements were taken at admission, discharge, 1 and 3 months post-discharge. The longitudinal association between muscle strength and mobility was analysed with a linear mixed model and controlled for potential confounders such as age, gender, cognitive impairment, fear of falling and depressive symptoms. Results: A total of 401 older persons were included with a mean (SD) age of 79.6 (6.7) years. Mobility improved significantly from 57 points at admission up to 68 points at 3 months post-discharge. No improvement was observed from one-up to 3 months post-discharge. Even after controlling for potential demographic and psychological confounders, muscle strength was associated with the course of mobility (b = 0.64; p \ 0.01). Age, cognitive impairment, fear of falling and depressive symptoms were identified as confounders and gender as an effect modifier. Conclusion: For the development of an intervention to improve mobility in acute hospitalized older persons, a multifactorial approach (muscle strength in combination with factors such as fear of falling and depressive symptoms) focusing on the first month following hospital discharge is warranted. Alcoholism and fractures in women in a functional recovery unit Objective: To determine the clinical characteristics of women with alcoholism to income in a unit of functional recovery. Methods: Prospective observational study of a cohort of women with alcoholism admitted for rehabilitation of a fracture during the year 2017. We analyze Socio-demographic data and the cognitive, affective and nutritional situation and the hepatic function at admission to the unit. Results: During 2017, 168 patients (96 women) were admitted in our functional recovery unit. Six women, who were admitted for rehabilitation of a fracture (Hip fracture 2, pelvis fracture 2, vertebral fracture and rib fractures 1 and 5th metatarsal diaphyseal fracture 1 had a history of alcoholic dependence and recurrent falls. The average age was 74.3 years (63-83), 7.3 years younger than the mean of the unit. Three had university studies, and the 83.3% had a high economic level. Two patients had cognitive impairment and all had depressive symptomatology and had scheduled at least 2 psychodrugs. All patients had sings of malnutrition: Albumin mean 3.03 g/dL (2.6-3.4) , Prealbumin mean 15.6 mg/dl (11-18) and 83.3% had high Gamma-glutamyltransferase (GGT), mean of 124 U/l (45-268). Conclusions: (1) Alcoholic dependence is a cause of repeated falls and, consequently, of fractures in the women. (2) Women with chronic alcoholism are younger than the average, have a high purchasing power and a higher level of education. (3) There's always a depressive symptoms, a high consumption of psychotropic drugs, malnutrition and liver involvement. Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease that affects mainly the young woman, rarely the elderly clinical-biological characteristics in this population is important to know in order to avoid delayed diagnosis and therapeutic errors. Patients and methods: A retrospective descriptive study performed during a period of 17 years including patients with an age greater than or equal to 65 years were included in whom the diagnosis of LES was retained according to the criteria of the ARA. Results: Eight elderly patients had SLE among 97 lupus patients, including 3 men and 5 women (sex ratio H/F at 0.6).The average age was 69 years old. Extra-renal disease was frequently found with rheumatic disease in 6 patients (5 cases of arthritis, 2 cases of myalgia, one case of myositis and one case of isolated arthralgia). Mucocutaneous involvement was observed in 5 patients. It is detailed. Cardiac involvement was present in 4 patients, renal involvement was observed in 5 patients. Hematological involvement was observed in 5 patients. Seven patients had received corticosteroid treatment. The other treatments used are detailed. The treatment with synthetic antimalarials was stopped in a patient with the retinal toxicity that caused it. Discussion: Systemic lupus erythematosus is very rare after 65 years with an estimated frequency of 5% or less. Conclusion: The diagnosis is difficult to make because of the nonspecificity of many clinical lesions and the constant entanglement with comorbidities. Functional and cognitive status of patients after a transcatheter aortic valve implantation Introduction: Parkinson's disease (PD) is thought of primarily as a movement disorder with the main symptoms: tremor, bradykinesia, rigidity and postural instability. In practice, this more complex disease is associated with a broad spectrum of non motor symptoms (NMS). These are well recognised features of both early and advanced PD and have a significant impact on patients' quality of life. Nevertheless, non-motor symptoms are often overlooked in clinical practice. The UK National guidelines suggest that clinicians in Movement Disorder clinics should ask about non motor symptoms at least once per year as part of a routine review. This survey looked at our service performance, as our participation in the National Parkinson's Disease Audit highlighted insufficient detection of NMS. Methods: After obtaining verbal consent, 50 patients were asked to complete a validated questionnaire of non-motor symptoms in Parkinson's disease before their clinic appointment. Thirty questions covered 10 domains of non-motor symptoms frequently experienced by patients with Parkinson's disease. Results and discussion: The administration of a self-completed questionnaire significantly improved the rate of detection of NMS. The most common NMS were identified as excess salivation, gastrointestinal symptoms and sleep disturbances. Once symptoms were identified, appropriate interventions could be taken, depending on the individual case and problem. This survey had shown that simple intervention had improved detection rate as well as appropriate intervention and ultimately quality of care of older patients with PD. Safety of low-dose methotrexate for the treatment of bullous pemphigoid in older adults with and without chronic renal impairment Aims: Bullous pemphigoid is an autoimmune skin disease which affects primarily older adults. Low-dose methotrexate is a common alternative to systemic corticosteroids. However, there is little evidence about the safety of methotrexate, especially among patients with impaired renal function. Methods: We included older adults (C 70 years) diagnosed with bullous pemphigoid between 2006 and 2015 at a single university hospital in Sweden and treated with low-dose methotrexate. Data was collected in electronic medical records. Renal function was estimated with the CKD EPI equation for glomerular filtration rate (eGFR). Multivariate Cox proportional hazard modelling was used to estimate the risk of adverse outcomes during follow-up. Results: A total of 232 older patients were included. Mean age at time of diagnosis was 84.6 years (SD 6.7), 52.6% of patients were women, 41.6% lived in nursing homes, 31% had C 3 chronic comorbidities, and 37% had dementia. Median prescribed dose of methotrexate was 5 mg/week. During the period of exposure to methotrexate (including 90-day washout period after treatment discontinuation), overall mortality was 26.3 (95% CI 21.9-31.5) per 100 person-years. After adjustment for relevant confounders, we found no statistically significant difference in the risk of death when comparing individuals with eGFR [ 60 mL/min at baseline, eGFR [ 45-60 mL/min, and eGFR \ 45 mL/min (log-rank p = 0.11). There was also no association between eGFR at baseline and unplanned hospitalization for acute renal failure, liver failure, bone fracture, infectious disease, haematological event, or gastrointestinal event. Finally, clinician-reported outcomes (dose-decrease and treatment switch for clinical event, renal impairment or other biological adverse event) did not vary significantly according to eGFR at baseline, although older patients with eGFR \ 45 mL/min experienced higher rates of treatment switch or adverse clinical or biological events. Conclusion: In the absence of robust evidence from randomized clinical trials, our observational study suggests that low-dose methotrexate is safe for the treatment of bullous pemphigoid in older adults with impaired renal function. Regular clinical monitoring is warranted to prevent adverse events and adapt treatment regimen if necessary. Psychosocial assessment in patients with Congestive heart failure in an acute geriatric care unit Objectives: To identify psychosocial characteristics of patients admitted in an acute Geriatric unit with decompensated heart failure in relation to mortality and admission at 6 months of discharge. Method: Descriptive, prospective study of patients admitted to an acute geriatric unit with decompensated heart failure. Variables: age, sex, Inpatient-mortality, morbid history, medications, laboratory assessment, previous echocardiogram, New-York-Heart-Association-Functional-Classification, Charlson-Comorbidity-Index, Barthel-Index (BI), Short-Physical-Performance-Battery (SPPB), Mini-Nutritional-Assessment, Global-Deterioration-Scale (GDS), Yesavage Depression Scale, Pfeiffer Test (SPMSQ), Gijon's-socialfamilial-evaluation-scale (SFES), Minnesota-Living-with-Heart-Failure-Questionnaire (MLHFQ) and admission at 6-month. Results: N = 110, 62% women, age: 87.8 ± 4.5, average stay 9.7 ± 4.4 days. Inpatient mortality: 10.9%. 21.6% were readmitted within 1 month of discharge and 39% at 6-month. Yesavage \ 5: 54.5%, altered values were related to SPMSQ (r = -0.25), MLHFQ (r = 0.57), higher previous BI (P \ 0.05) and inpatient mortality (p \ 0.05). No cognitive impairment (GDS): 45.5% and mild Cognitive impairment: 30.9%. GDS correlated with SPMSQ (r = 0.6), Weight (r = -0.6) and previous IB (r = -0.3). SPMSQ was \ 3:66.3%. Patients with an impaired quality of life (MLHFQ) were more likely to take digoxin (p \ 0.05) and to have Dementia diagnose (p \ 0.05). The mean SFES was 6.6 ± 3.4 and correlated with Pfeiffer test (r = 0.3), Yesavage (r = 0.32) and MLHFQ (r = 0.38). Patients with worst quality of life (MLFQ), lower SPPB and lower heart rate were more likely to be admitted at 6-month. Conclusions: Most of our patients had mild or no cognitive decline, neither depression symptoms. Those with worst social support (SFES) were more depressed and had worst quality of life. Psychosocial assessment could be a predictor of mortality and admission at 6 months. We didn't find a relationship among the rest of the other variables. Background: Hematological malignancies can spread to the central nervous system (CNS) either as a focal lesion or leptomeningeal carcinomatosis. Marginal zone lymphoma (MZL) is a low grade non-Hodgkin's lymphoma and is generally an indolent disease. This case illustrates CNS invasion by MZL presenting as a delirium without B symptoms or any abnormalities on radiologic examinations. Case report: An 80 year old patient is described, presenting a subacute, progressive confusion. MMSE score was 21/30. The patient's medical history included monoclonal B-cell lymphocytosis (MBL) with a clone indicative for a MZL. After excluding most common etiologies through classical work-up including a normal head magnetic resonance imaging, a lumbar puncture (LP) was performed, showing an elevated protein and lymphocyte count. Beta-amyloid and tau protein levels in CSF were normal. Immunophenotyping of the lymphocytes confirmed CNS invasion by the MZL clone. Staging revealed mild splenomegaly. Prednisolone, intrathecal and systemic chemotherapy was initiated, leading to quick cognitive improvement with MMSE score of 28/30. Discussion: To the best of our knowledge a delirium in an older patient due to leptomeningeal carcinomatosis by a MZL has never been described. MZL is an indolent disease that rarely spreads to the CNS. To date, reports of CNS invasion by MZL describe focal intracranial lesions. After exclusion of common etiologies, physicians should remain vigilant when confronted with elderly presenting a confusional state with a prior history of MBL. This case demonstrates that the threshold for a LP should be low also for patients with normal imaging studies. Differences in time to stability and 1-year mortality among elderly patients with community-acquired pneumonia Introduction: Community-acquired pneumonia (CAP) continues to have a significant impact on elderly individuals, who are affected more frequently and with more severe consequences than younger populations. Methods: The principal aim was to assess the differences in the time to clinical stability (defined as normalization of heart rate, systolic blood pressure, respiratory rate, temperature, oxygenation status, ability to eat and mental status) and mortality (30 days) between both groups. As secondary objectives we analyze differences among the different therapies and analyze prognosis factors in clinical outcomes (performance at discharge, 1-year post episode mortality). Retrospective analysis of electronic charts from January to June 2017. Two groups defined: elderly ([ 65 years-old) (EP) and non-elderly (\ 65 years-old) (non-EP). Results: One hundred and thirty six episodes data of patients admitted throughout the 6-month study period. Elderly 82 (60%) and 54 non-EP 54 (40%).EP mean age EP 79 (SD 6) vs. non-EP 51 (SD 10). No differences were found in the clinical presentation, inflammatory-markers or empirical antimicrobial treatment. Time to stability was higher among EP mean: 6 days (SD 5) vs. non-EP 4 days (SD 3); p = 0.05. In a multivariable regression model the significant independent factors to time to stability were: being part of EP group [beta coeff 2.03 (95% CI 0.073-4.14); p = 0.049] and receiving Amoxicilin-Clavulanate [beta coeff -2.4 (95% CI -4.6 to -0.13); p = 0.03]. No differences in 30-day mortality were found (2(2.5%) in the EP group). However, mortality at 1-year after the CAP episode was higher among EP (13 (16%) vs 2(3%); p = 0.02). In the elderly group the factors associated with 1-year post CAP mortality were 6-month prior hospital admission (OR 6.26 95% CI 1.6-23.1; p = 0.006). Conclusions: In conclusion, in our series time to stability in CAP was higher among EP, and lower in those receiving amoxicillin-clavulanate. A prior hospital admission was strongly correlated with 1-year post episode mortality in the elderly group. Background: When treating older adults, a main factor to consider is functional status. Because appropriate assessments in clinical trials are frequently lacking, critical appraisal of treatment evidence with respect to functional status is challenging. Our aim was to identify and categorize assessments for functional status in clinical trials to allow for a retrospective characterization and indirect comparison of treatment evidence. Method: We conducted four different systematic reviews of randomized and non-randomized controlled clinical trials in older people with hypertension, diabetes, depression and dementia. All identified assessments that reflected functional status were analyzed. Assessments were categorized into four pre-defined different ''functional status levels''. If available from the literature, cut-offs were extracted. If not, they were defined by our expert group comprised of geriatricians, pharmacists, pharmacologists, neurologists, psychiatrists. Results: We identified 51 instruments for assessment that included measures of functional status. While some had clearly defined cut-offs across our predefined categories, many others did not. In most cases, no cut-offs existed for slightly impaired or severely impaired older adults. Missing cut-offs or values to adjust were determined by our expert group using a patient-centred approach and will be presented as described. Conclusion: All categorized functional status assessments are now suitable for a retrospective characterization of functional status in primary studies (e.g. RCTs and observational studies). Allocated categories only serve as approximations and should be head-to-head validated in future studies. Moreover, upcoming studies involving older adults should include and explicitly report functional status as a baseline characteristic of all participants enrolled. Functional and cognitive status of patients after an aortic valve replacement Introduction: Aim of the present study was to assess functional and cognitive status of patients 3 months after an aortic valve replacement. Patients and methods: Prospective, descriptive and unicentric study of patients with symptomatic severe aortic stenosis were evaluated by a geriatrician from April 2016 to December 2017. An interdisciplinary team decided the treatment for each patient [medical treatment, TAVI and aortic valve replacement (AVR)]. Socio-demographic variables (age, sex) were registered. Functional and cognitive status were evaluated before and 3 months after AVR. Functional status was performed by Barthel index (BI), Lawton index (LI) and Short Physical Performance Battery (SPPB). Short Physical Performance Battery values the balance (4 points), gait speed (4 points) and muscle strength of the lower extremities (chair stand test) (4 points). Cognitive status was performed by Mini-Mental of Folstein (MMSE). Results: Fifty-nine patients were evaluated (55.93% women); mean aged 81.55 ± 6.24 years. Twenty-nine patients received medical treatment, 23 TAVI and 7 AVR. All the patients who received aortic valve replacement were followed-up by a geriatrician. Mean of the parameters evaluated before AVR: LI:7.14 ± 1.46; BI:97.14 ± 4.87; SPPB:9.28 ± 1.38; SPPB ( Results: A total of 27 patients presented with CAD, 16 of whom were positive for HPV DNA, whereas 11 were negative. The presence of cervical HPV infection was strongly associated with CAD when women with and without HPV DNA were compared [odds ratio (OR) = 3.74; 95% confidence interval (CI) 1.16-11.96], after controlling for demographics, health/sex behaviors, medical comorbidities and CVD risk factors. This association was even higher when comparing women with cancer-associated HPV types to HPVnegative women (OR = 4.90; 95% CI 1.26-19.08). Conclusion: These findings support the hypothesis that cervical HPV infection might be associated with an increased risk of developing CAD among postmenopausal women. Population-based longitudinal studies are thus necessary towards further investigating this relationship. Vitamin D deficiency and risk of helicobacter pylori infection in older adults: a cross-sectional study Introduction: Vitamin D deficiency is known to cause increased predisposition to various infectious diseases and addition of vitamin D to antimicrobial treatment may improve treatment responses. However, the relationship between vitamin D and Helicobacter pylori (H. pylori) remains to be determined. In this study, we assessed the association between vitamin D deficiency and H. pylori infection. Methods: This cross-sectional study included patients aged 65 and over, who underwent gastroscopy and had gastric biopsy performed between 2010 and 2017. Of the 441 patients, 254 had available 25-hydroxyvitamin D level results and were included in the analyses. Patients were categorized into H. pylori (+) and H. pylori (-) groups, according to histopathological examination results of gastric biopsies. Serum 25(OH) vitamin D levels less than 20 ng/mL were defined as vitamin D deficiency. Results: Of all patients, 43 were H. pylori (+) and 211 were H. pylori (-). More patients had vitamin D deficiency (\ 20 ng/mL) in the H. pylori (+) group than the H. pylori (-) group (86 vs 67.3%, p = 0.014). The proportion of H. pylori (+) patients decreased across increasing quartiles of 25(OH) vitamin D levels (p for trend = 0.010). In multivariable logistic regression analysis, vitamin D deficiency was associated with increased odds of H. pylori infection after adjustment for age, gender, and Charlson comorbidity index (OR = 3.02, 95% CI 1.19-7.69, p = 0.020). Conclusion: Vitamin D deficiency can be associated with increased risk of H. pylori infection. The potential protective effect of vitamin D against H. pylori infection and its possible role in the treatment of H. pylori should be evaluated in prospective trials. Is reverse dipping pattern a risk factor for falls in hypertensive older adults? Introduction: Falls are one of the preventable geriatric syndromes which can lead to significant disabilities in older adults. In this study we aimed to assess whether nocturnal blood pressure (BP) changes are associated with falls. Methods: In this cross-sectional study, we included 199 hypertensive patients aged over 60 years. All patients underwent 24-h ambulatory blood pressure monitoring. Patients were classified according to changes in their nocturnal systolic BP from daytime systolic BP as follows: dipper (D) [ 10% decrease, non-dipper (ND) 0-10% decrease, reverse-dipper (RD) increase to any extent. Falls were defined as any fall history in the recent 1 year. Results: Out of 199 patients (61.3% female; median age 76.6, range 61-100), 47 (23.6%) had a history of fall, and 12.6%, 49.7%, 37.7% of patients had D, ND and RD BP patterns, respectively. Age, gender distribution, body mass index, Charlson comorbidity index, handgrip strength, gait speed, mini-mental state examination and geriatric depression scores were similar among BP dipping pattern groups. However, Mini Nutritional Assessment (median RD: 12, ND: 13, D: 13; p: 0.003) and Lawton instrumental activities of daily living scores (median RD: 12, ND: 15, D: 15; p: 0.039) were significantly lower in the reverse dipper group. Falls were significantly more common in the RD group (RD: 35%, ND: 16%, D: 20%; p: 0.016). In the multivariate logistic regression analysis after adjustment for age and gender, presence of RD pattern as opposed to ND pattern was significantly associated with increased risk of falls (Odds ratio: 3.0, 95% CI 1.4-6.3; p: 0.003). Conclusions: Presence of a reverse dipping pattern of nocturnal BP can be associated with increased risk of falls in older adults. Use of IDPP4 in elderly patients with diabetes and heart failure Objectives: To describe a sample of diabetic patients older than 75 years with heart failure (HF) and the influence of IDPP4 in our sample. Methods: Preliminary case-control study of diabetic patients, over than 75 years, with a protocolized follow-up in the Heart Failure and Vascular Risk Unit of Internal Medicine Service, recruited consecutively from January 2014 to April 2017. The minimum follow-up was 1 year. We collected basal characteristics, functional situation, comorbidities, drugs, lab tests in the first visit, left ventricular ejection fraction (LVEF) and frequence of emergency visits and hospitalizations due to HF and other cardiovascular events (CVD). Results: We included 153 patients (65% women, average age 83, within 75-98), 94% had hypertension, 78% dyslipemia, 66% atrial fibrillation, 23% previous stroke, 24% previous heart attack, 13% COPD, 75% NYHA class II-III, 85% Barthel [ 60, 83% LVEF [ 50%, 54% Glomerular filtration rate (GFR) \ 45 ml/min and they took an average of 13 ± 4 drugs. The median of the laboratory test results were: BNP 435 ± 658 pg/ml, glycosylated hemoglobin (HbA1c) 6.9 ± 1.2%, GFR 52.72 ± 21.96 ml/min, 28% use IDPP4, presenting higher HbA1c (7.3 ± 1.2% p = 0.001) and lower GFR (46.9 ± 20.5 ml/min p = 0.049). The most used IDPP4 is linagliptina 56%. In 1-year follow-up, there were no significant differences in emergency visits for HF (p = 0.73) or CVD (p = 0.40), nor in hospitalizations for HF (p = 0.73) or CVD (p = 0.48). Conclusions: In our preliminary analysis there were no difference in emergency visits or hospital admissions due to HF and CVD in association with the use of IDPP4 in elderly diabetic patients with HF. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Introduction: Aortic stenosis (AS) is prevalent in older adults, and can be treated by surgical aortic valve replacement. TAVI may be more appropriate in high-risk surgical patients. Clinically apparent stroke is detected in 5-17% of TAVI patients [1, 2] , while cerebral microembolization seems to occur in over 90% [2] . The cognitive impact of stroke and cerebral microembolization after TAVI is uncertain, but may accelerate cognitive decline. The primary aim of this study is to identify predictors of cognitive decline at 3 and 12 months after TAVI. Methods: This is a prospective observational study. . More than 80% (n = 53) were women, 65% (n = 43) had a loss of autonomy and more than 75% (n = 50) with malnutrition. Almost 32% (n = 21) patients had solid or hematologic cancer treated (12) or not (9). Metronidazole treatment is prescribed for 17.5% (n = 12), vancomycin 77% (n = 51) and fidaxomycin 5.5% (n = 3). Three-month mortality rate was 35% (n = 23). Among them, 57% (n = 12) patients solid tumors and hematologic malignancy, treated or not (p = 0.04). In multivariate analysis, predicting 3-month mortality among patients were: male sex Results: Gonarthrosis was significantly more prevalent in urban area irrespective of age (p \ 0.05). In rural area it was more prevalent in men (p \ 0.05), but in urban area was more prevalent in women (p \ 0.01). One in four patients presented diabetes mellitus, higher prevalence in men over 75 years (p \ 0.05). Almost all patients presented chronic pain, with a higher intensity and longer duration in older women. Prevalence of mood disorders was highest in older women (p \ 0.001). Age at menopause younger than 45 years was more prevalent in elderly women with depression (chi square = 9.762, p \ 0.05). In general sample depression was significantly more prevalent than anxiety (p \ 0.001). Majority of older women had combined mood disorders. Older patients in urban area without a family support network had significantly higher prevalence of depression (p \ 0.01), irrespective of gender. Older women had significantly higher prevalence of somatization as compared to other gender and age-group (p \ 0.01). Interestingly, over 75% of all patients reported favorable effects of medication for chronic pain. Conclusions: Recognizing and treating chronic pain due to gonarthrosis has complex effects including on mood in elderly. Nevertheless, pain is not the only factor involved in mood disorders in elderly. Patterns and complications of arterial hypotension in older people Introduction: Older people often present arterial hypotension and it has significant consequences: falls, syncope, myocardial infarction, stroke and even death. Study objective was to identify patterns and risk factors of this condition in elderly. Material and methods: A total of 387 subjects, age-range 50-95 years, were included. They were divided into two groups, both presenting arterial hypotension: 197 adults (50-64 years) and 190 elderly (75-93 years). Results: We identified three types of arterial hypotension in older people: orthostatic hypotension, post-prandial, post-exercise hypotension. In our sample, most cases had orthostatic hypotension, other variants had less than 4% prevalence. Parkinson disease was more often seen in older patients (p \ 0.05). Type 2 diabetes mellitus and chronic renal disease were also more prevalent in elderly (p \ 0.05). Smoking was more prevalent in adult males. Three groups of medicines were involved: psychoactive, anti-parkinsonian, vasodilator drugs. Age of menopause younger than 45 years was more prevalent in elderly women with arterial hypotension (chi square = 9.762, p \ 0.05). Anemia was significantly more prevalent in elderly (p \ 0.001). Stroke and myocardial infarction was significantly more prevalent in elderly patients (p \ 0.01). Vertigo and syncope occurred as complications of arterial hypotension more often in elderly (p \ 0.01), as well as falls, fractures and ischemic heart disease. Orthostatic hypotension was identified in elderly more than twice in adults. Headache and asthenia occurred more often in elderly (p \ 0.05). Conclusions: Recognizing arterial hypotension, its forms and addressing some of its most important risk factors, could improve standing and prevent falls and other complications in older people. Frailty index in elderly patients with severe aortic stenosis referred for transcatheter aortic valve implantation (TAVI) Results: Ten patients (7 men and 3 women) were collected. The average age was 77 ± 4.5 years (72-86). According to Durie and Salmon classification, patients were in stage III in 70% and stage II in 10% of cases. The T-score less than -2.5 SD, was observed in 60% of cases. The average cumulative dose of corticosteroid received per patient was significantly associated with spine T-score (p \ 0.011) and femoral neck T-score (p \ 0.012). Low bone density (T-score less than -2.5 SD), at the spine, was significantly associated with age over 65 years old (p \ 0.024), increase of 24 h proteinuria (p \ 0.001) and at femoral neck, with Durie and Salmon classification advanced stage (p \ 0.005), high bone marrow cell infiltration (p \ 0.004), IgA chain type (p \ 0.04) and double monoclonal peak in protein electrophoresis (p \ 0.05). Conclusions: In multiple myeloma, low bone density was observed in 60% of cases. Bone density decrease was associated age, to stage III of Durie and Salmon classification, heavy chain type Ig A and high dose corticosteroids. Steinbrocker score and the Health Assessment Questionnaire for rheumatoid arthritis over 65 years old Results: In CAD older than 10 years most patients (46.67%) were in class 3 for angina frequency; in disease less than 10 years old, 50% of patients were in class 4 (p \ 0.05). Physical limitation was more severe in urban patients and with disease less than 10 years old (26.7% class 1) as compared to patients with disease older than 10 years (13.34% class 1) (p \ 0.01; CI 2.367-0.245). Angina stability was influenced by comorbidities (p \ 0.01). Treatment satisfaction was not influenced by comorbidities (p \ 0.5). Angina perception was influenced by disease duration (higher for longer disease, p \ 0.05), comorbidities and income level. Physical limitation, disease perception were more affected in women (p \ 0.01%); frequency of angina more affected in men (p \ 0.05). Conclusions: Frequency of angina symptoms, physical limitation and disease stability were influenced by length of disease and comorbidities. Treatment satisfaction was not influenced by comorbidities and gender. Disease perception was influenced by comorbidities, length of disease and income level. A gender difference was noticed. The associations between gastroesophageal reflux disease and the central obesity of the elderly Introduction: Central adipose tissue not only has metabolic effects but also increase intra-abdominal pressure, which is associated with the development of gastroesophageal reflux disease (GERD). Abdominal visceral adipose tissue volume is associated with an increased risk of GERD. The aim of this study was to investigate the associations between erosive esophagtis (ERD) and minimal change esophagitis (MCD) in terms of central obesity. Introduction: Tako-Tsubo cardiomyopathy (TTC) is an acute reversible left ventricular dysfunction, which occurs in the absence of obstructive coronary artery disease. Its onset is frequently related to physical or emotional stress; the pathogenesis of this condition is unknown, but some authors hypothesized a catecholamine-induced myocardial stunning or a coronary spasm. Recurrence is uncommon, occurring in 3-10% of patients. Methods: We describe a fivefold recurrent TTC in a geriatric patient with left anterior descending (LAD) artery myocardial bridge. Results: A 70-year old patient was hospitalized in 2015 for chest pain presenting at rest, ST elevation and mild troponin I increase; the echocardiogram revealed a mild depression of left ventricular function and apical akinesis, suggesting TTC. Coronary angiography showed patent coronary arteries, confirming the diagnosis; a LAD myocardial bridge was detected, with no evidence of obstruction. During the following 3 years, the patient experienced four TTC recurrences, all with benign course and treated with medical therapy (beta-blocker and calcium-antagonist). For each episode, no physical or emotional stressor could be identified as a trigger. Conclusions: This is the first case report of fivefold recurrent TTC, presenting with two additional unusual features: the absence of triggering stress and a LAD myocardial bridge. The lack of triggers could support the hypothesis of a non-catecholaminergic etiology and suggest a role of myocardial bridging as potential substrate in the pathogenesis of TTC. Coronary spasm related to bridging may be supposed, in agreement with some studies reporting a higher prevalence of this finding in patients with TTC. Prostate and lung corpora amylacea in the elderly Introduction: Corpora amylacea (CA) are intraluminal contents frequently found in the elderly. However, histological and biochemical features of CA are still not fully understood. The aim of this study was to elucidate histobiochemical features of CA in the elderly. Methods: To determine the occurrence of CA, we performed Congo red staining in 50 prostate and 81 lung samples obtained from postmortem patients administered at Kumamoto University Hospital from 2007 to 2017. To identify the precursor protein of prostatic CA, we performed mass spectrometry for prostatic CA isolated from prostatic glands by means of laser microdissection. We also analyzed histobiochemical features of CA by means of immunohistochemical staining and immunoblotting with an anti-lactoferrin antibody. Results: We found prostatic CA in 43 (86%) of 50, and lung CA in 2 (2%) of 81 autopsied patients. Those CA contained amyloid deposits which were Congo red positive and showed apple-green birefringence under polarized light. Mass spectrometric analysis and immunoblotting revealed that full-length lactoferrin was the major component of CA. Immunohistochemical staining revealed that prostatic and lung CA were strongly stained with an anti-lactoferrin antibody. Conclusions: Prostatic and lung corpora amylacea contain amyloid deposits. Lactoferrin may be the major component of prostatic and lung corpora amylacea. Antihypertensive choice in older diabetics: an overview from geriatric perspective Introduction: Diabetes Mellitus and hypertension are two common diseases that often occur together. Cognitive status and physical performance may be affected by antihypertensive drugs. In this study, we aimed to investigate how antihypertensive agents affect cognitive and physical status in older diabetics. Methods: The study was conducted retrospectively and 453 (311 female vs. 142 male) diabetic patients were included. Patients were divided into groups according to the antihypertensive drugs they were using, groups were compared with independent-T test in terms of arithmetic means of mini-mental state examination (MMSE), geriatric depression scale (GDS), grip strength and gait speed. Risk analysis was done by logistic regression analysis. p \ 0.05 was considered statistically significant. Results: The average age of participants were 73.12 ± 6.18. MMSE arithmetic means were found to be higher among patients using ACE inhibitors and beta-blockers than those who did not use these drugs (25.49 ± 4.11 vs. 24.27 ± 4.72, p: 0.025; 25.30 ± 4.35 vs. 24 .07 ± 4.73, p: 0.006; respectively). ACE inhibitors and betablockers were found to reduce cognitive impairment risk (OR: 4.12, p: 0.042; OR: 4.38, p: 0.036; respectively). Also, calcium channel blocker users were found to have a slower gait speed than those who did not use (0.63 ± 0.13 vs. 0.66 ± 0.14, p: 0.034). Conclusions: We recommend that ACE inhibitors and beta-blockers should be preferred in diabetic patients with cardiovascular disease and/or dementia. We also suggest that ACE inhibitors should be preferred to angiotensin receptor blockers (ARBs), because in our study ARBs found no positive effect on MMSE. Additionally, it may be considered to avoid the use of calcium channel blockers to preserve functional status. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Incidental diagnosis of polycystic kidney disease (PKD) in a patient in his ninth decade; a case report In our patient, the presence of bilateral kidney enlargement with multiple cysts, without symptoms, signs or evidence of other cystic kidney disease was highly suggestive of PKD, even in the absence of family history. Genetic testing was not required especially that it would not affect the management, however the family could have preferred to do the test. The case highlight the variable expressivity of the genes, and it seems that some PKD cases are not diagnosed or not discovered. However new diagnosis of PKD in patients older than 80 years is rare. Interestingly, 4 years later, at the age of 87 years, Na and K remained normal, Kidney function and Haemoglobin remained stable with U 12.6 mmol/L, Cr 112 umol/L, eGFR 51 and Hb 110 gm/L. The effect of ultrasound on thromboembolic model of brain stroke in rat Background: Ultrasound (US) has been used in neuroprotection after cerebral ischemia; however, its use is controversial. Application of US in combination with fibrinolytic agents may improve fibrinolytic effects. In this study the effects of US, alone or in combination with tissue plasminogen activator (tPA), on brain ischemic injury were examined. Methods: We studied whether US alone or in combination with tPA is neuroprotective in thromboembolic stroke. To induce focal cerebral ischemia, a clot was formed in a catheter. Once the clot had formed, the catheter was advanced 17 mm in the internal carotid artery until its tip was 1-2 mm away from the origin of the middle cerebral artery (MCA). The preformed clot in the catheter was then injected, and the catheter was removed. The wound was then closed and the infarction volume, edema and neurological deficits were measured after MCA occlusion. Results: In control, US + low tPA, low tPA, US + high tPA and, high tPA groups, the infarct volume (%) was 34.56 ± 4.16, 17.09 ± 6.72, 21.25 ± 7.8, 13.5 ± 10.72 and 20.61 ± 6.17 (mean ± SD) at 48 h after MCA occlusion, respectively. The results indicate that US alone reduces the infarct volume by 30% compared to that of the control group (P \ 0.05). US improved neurological deficits and reduced brain edema significantly (p \ 0.05). Key conclusions: This study indicates that US appears to have a protective effect, alone and in combination with tPA, in an embolic model of stroke. Repeated transsphenoidal surgery or gamma knife radiosurgery in recurrent cushing disease after transsphenoidal surgery in elderly Background: This study compared Gamma knife radiosurgery (GKRS) and repeated transsphenoidal adenomectomy (TSA) to find the best approach for recurrence of Cushing disease (CD) after unsuccessful first TSA in elderly. Material and methods: Thirty-eight old age patients with relapse of CD after TSA were enrolled and randomly underwent a second surgery or GKRS as the next therapeutic approach. They were followed for a mean period of 3.05 ± 0.8 years by physical examination and hormone measurement as well as magnetic resonance imaging. Results: Patients admitted in Neurosurgery department for operation and stay in hospital for mean 4 days, but in Gamma Knife Center, they admitted in morning and Discharged at evening without any generalized anesthesia. No significant difference was observed in sex ratio, mean age, adenoma type, follow-up duration, and initial hormone level between the two groups. No significant relationship was found between preoperative 24-h free urine cortisol and disease-free months or tumor volume among both groups. There is significant less complications in GKRS group with less length of hospital stay and no delirium report after gamma knife procedure. Our statistical analysis showed higher recurrence-free interval in the GKRS group compared with TSA group. Conclusion: With longer recurrence-free interval, GKRS could be considered a good and safe treatment alternative to repeated TSA in recurrent CD especially in older community with less morbidity and complications. Searching for orthostatic hypotension in the elderly: getting up from a chair or from a bed is not the same ; p \ 0.05. In multivariable stepwise backward regression analysis, it was shown that in the study group, the more advanced age represents the independent risk factor for the higher HR and for the reduced HRV, expressed as lower SDANN values. Additionally, higher BMI and higher blood glucose concentration constituted the independent risk factors for higher HR. The use of beta blockers was the independent protective factor against higher HR mean and decreased HRV, and moreover, the normalization of blood pressure, the use of anti-platelet drugs and anticoagulant drugs also were protective factors against higher HR mean in 24-h ECG Holter monitoring. Conclusion: In patients with arterial hypertension and prior stroke, the advanced age constitutes the independent risk factor for the negative cardiovascular indices on 24-h ECG Holter monitoring. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Introduction: In Korea, carbon disulfide (CS2) toxicity was an important social problem from the late 1980s to the early 1990s but there have been few large-scale studies examining the prevalence of diseases after CS2 exposure discontinuance. So we investigated past working exposure to CS2 characteristics from surviving ex-workers of a rayon manufacturing plant including cumulative CS2 exposure index. Furthermore, we studied prevalence of their chronic diseases recently after many years. Methods: We interviewed 633 ex-workers identified as CS2 poisoning-related occupational diseases to determine demographic and occupational characteristics and reviewed their medical records. The work environment measurement data from 1992 was used as a reference. Based on the interviews and foreign measurement documents, weights were assigned to the reference concentrations followed by calculation of individual exposure index, the sum of the portion of each time period multiplied by the concentrations of CS2 during that period. Results: The cumulative exposure index was 128.2 ppm on average. Workers from the spinning, electrical equipment repair, and motor repair departments were exposed to high concentrations of C 10 ppm. Workers from the maintenance of the ejector, manufacturing of CS2 post-process, refining, maintenance and manufacturing of viscose departments were exposed to low concentrations below 10 ppm. The prevalence for hypertension, coronary artery disease, cerebrovascular disease, diabetes, arrhythmia, psychoneurotic disorder, disorders of the nervous system and sensory organ were 69. 2, 13.9, 24.8, 24.5, 1.3, 65.7, 72 .4% respectively. Key conclusions: We estimated the individual cumulative CS2 exposure based on interviews and foreign measurement documents, and work environment measurement data. Comparing the work environment measurement data from 1992, these values were similar to them. After identified as CS2 poisoning, there are subjects over 70 years of average age with disorders of the nervous system and sensory organs, hypertension, psychoneurotic disorder, cerebrovascular disease, diabetes, coronary artery disease, and arrhythmia. Because among ex-workers of the rayon manufacturing plant, only 633 survivors recognized as CS2 poisoning were studied, the others not identified as CS2 poisoning should also be investigated in the future. Assessment of functional status and cognition in elderly patients before cardiac surgery Tuberculosis is a pathology characterized by the multiplicity of clinical forms. This is especially noted in the elderly with a higher frequency of extra-pulmonary forms and multifocal forms to the detriment of the classic pulmonary forms. This is a retrospective descriptive study of the records of patients aged 65 years or older who were diagnosed with tuberculosis. Nineteen patients were included in our study. There were 11 men and 8 women with a sex ratio F/H at 1.37. The average age of our patients was 71.2 years (extremes: 65-82 years). The chest X-ray showed the presence of pulmonary nodules in 7 cases, pleurisy in 1 case and miliary tuberculosis in 1 case. Multifocal tuberculosis was noted in 5 of our patients. 11 patients had an extra-pulmonary localization of tuberculosis associated in 3 cases with pulmonary tuberculosis. The intradermal reaction was contributive to the diagnosis in 6 cases. The diagnosis of tuberculosis was retained on pathological arguments in 6 cases, after isolation of BK in 3 cases and it was a diagnosis of presumption in the rest of the cases. The average duration of antituberculous treatment was 7.1 months. Corticotherapy was associated in 7. Hepatic cytolysis with anti-tuberculosis treatment was noted in 4 cases and hepatic cholestasis in 3 cases. The evolution under treatment was favorable in 13 cases. In a geriatric environment, in the presence of an unexplained infectious symptomatology, the diagnosis of tuberculosis must be evoked even in the absence of favoring factors. Ogilvie syndrome and strok in elderly Introduction: Ogilvie's syndrome is an important dilatation of the colon without mechanical obstacle. This colectasia is due to an attack of the vegetative nervous system. Observation: 76 years man, hypertensive, with a history of complete arrhythmia by atrial fibrillation which has been admitted for heaviness of the left hemicorps brutal installation. The examination objectified a patient with left hemiplegia. The brain scan showed an ischemic stroke in the right Sylvian territory. At day 25, the patient had severe abdominal bloating associated with nausea and withdrawal. The examination finds a very distended abdomen sensitive in its entirety. The abdominal CT showed significant colonic distention without mechanical obstacle. In front of this table, an Ogilvie syndrome was strongly suspected and was confirmed by a colonoscopy which showed a colectasis without focal lesions and allowed exsufflation relieving the patient. Treatment with Prostigmine and antispasmodic has been associated with favorable evolution. The diagnosis of ogilvie syndrome should be evoked in case of any acute colic dilation in a particular clinical condition: metabolic disorders, heart failure, renal failure, neurological disease, retroperitoneal metastatic cancer, orthopedic, retroperitoneal or pelvic surgery. Its treatment is mainly based on neostigmine, possibly supplemented by endoscopic exsufflation and/or water-soluble enema. Colectomy are reserved for the rare failures of conservative treatments. Conclusion: Oglivie syndrome is a serious complication of cerebrovascular accidents, it must be known and treated early because of the evolutionary risk of cecal perforation (mortality 40%). Introduction: The world's population is not only growing larger, it is also becoming older. Early diagnosis of Chronic Obstructive Pulmonary Disease (COPD) has a large impact on quality and longevity of life for elderly. Diagnosis is sometimes missed as patients learn to limit their physical activities to escape the gradually emerging dyspnea on exertion. Spirometry is a standard, objective lung function test for diagnosis of airflow limitation but it is highly dependent on the performance technique and patient cooperation in contrast to Impulse Oscillometry (IOS) that can especially be recommended to elderly patients who have poor pulmonary functions with physical and mental limitations facing difficulty in caring out spirometry properly. Methods: We include 100 Elderly patients 60 years and above with no acute or chronic lung airways problems performed both spirometry and IOS. Results: The results appeared that IOSR5 is more sensitive than spirometry in an early detect patient with mild obstructive symptoms. There was a significant high agreement between obstruction diagnosis by IOSR5 and FEV1/FVC in spirometry. Linear logistic analysis done for factors affecting FEV1 and IOSR5 revealed that only age and BMI are significantly associated with both of FEV1 and IOSR5. Conclusion: IOS was found to be reliable in early detection of airway disease in elderly because IOS needs a lower dependency on cooperation during tidal breathing especially in those having difficulty in caring out the spirometry properly especially patient with cognitive impairment. Age and BMI are significantly associated with both of FEV1 and IOSR5. Functional fitness influencing bicycle riding in community dwelling older adults Results: The binomial logistic regression analysis showed that TUG (odds ratio: 0.29; 95% CI 0.12-0.68) was a significant variable that affected riding a bicycle. Key conclusion: Our results suggested that riding a bicycle is associated with TUG scores in community dwelling older adults. These results indicated that TUG scores are expected to be useful for determining the ability to ride a bicycle and for setting treatment goals. Role of impulse oscillometry in assessment of pulmonary functions among elderly Introduction: The world's population is not only growing larger, it is also becoming older. Early diagnosis of Chronic Obstructive Pulmonary Disease (COPD) has a large impact on quality of life for patients. Diagnosis is sometimes missed as patients learn to limit their physical activities to escape the gradually emerging dyspnea on exertion. Spirometry is a standard, objective lung function test for diagnosis of airflow limitation but it is highly dependent on the performance technique and patient cooperation in contrast to Impulse Oscillometry (IOS) that can especially be recommended to elderly patients who have poor pulmonary function with physical and mental limitations facing difficulty in caring out the spirometry properly. Methods: We include 100 Elderly patients 60 years and above (both males and females) admitted to Ain Shams University Hospitals with no acute or chronic lung airways problems. The results appeared that IOSR5 is more sensitive than spirometry to an early detect patient with mild obstructive symptoms. There was a significant high agreement between obstruction diagnosis by IOSR5 and FEV1/FVC in spirometry with the significant negative correlation between them. Linear logistic analysis done for factors affecting FEV1 and IOSR5 revealed that only age and BMI are significantly associated with both of FEV1 and IOSR5. Conclusion: IOS was found to be reliable in early detection of airway disease in elderly because IOS needs a lower dependency on cooperation during tidal breathing especially in those having difficulty in caring out the spirometry properly. Age and BMI are significantly associated with both of FEV1 and IOSR5. Homocysteine levels and increase thiolactonase activities in elderly patients at high risk of cardiovascular disease During the final month before death, the median number of prescribed drugs was 7 (IQR 4-10). Drug utilization was fuelled not only by opioids (44%) and non-opioid analgesics (59%), but also by the continuation of antihypertensives (46%), antiplatelet agents (35%), and calcium supplements (8%). Conclusion: Centenarians have a considerable burden of morbidity near the end of life, and live most often in nursing homes. Healthcare utilization should be optimized to avoid unplanned hospital admissions and reduce the prescription of unnecessary drugs. Better access to specialist palliative care is warranted for this particularly frail population. Blood pressure and long term mortality in the elderly: results of the Fiesole Misurata follow-up study Background: Individuals' perceptions of aging may influence their health in later life, with positive perceptions being associated with better health and more advantageous health behavior. Promoting positive perceptions in young adults may therefore be a valuable intervention into improving their future health. This experimental pilot study aims to explore how an age simulation suit can contribute to promoting positive perceptions of aging in this population group. Method: A total of 50 individuals was randomized into an intervention (n = 23) and a control group (n = 27). Individuals in the intervention group were asked to perform a standardized set of everyday activities while wearing the suit. Before (T0) and 4 weeks after the intervention (T1), an online questionnaire comprising several standardized instruments assessing, amongst others, four dimensions of perceptions of aging was administered. Additionally, qualitative interviews on the feasibility of the experimental set-up were conducted with 4 participants of each group. Results: Study participants had a mean age of 23 years. 38% were females. Individuals in the intervention group tended to have more positive perceptions of aging after the intervention (depending on the dimensions studied, Cohen's d ranged between 0.1 and 0.6). Differences, however, were not significant. Interviews supported the feasibility of the experimental set-up. Discussion: This pilot study suggests that age simulation suits may be a useful measure to modify individuals' perceptions of aging. The study may serve as a blueprint for a comprehensive randomized controlled trial thoroughly evaluating the benefits of age simulation suits on promoting positive perceptions of aging. Effects of a falls prevention programme on health-related quality of life in older home care recipients: a randomised controlled trial Background: Falls have serious consequences for quality of life (QOL) and contribute substantially to the global burden of disease [1, 2] . Home care is an important arena to address falls prevention and QOL, but this vulnerable group is underrepresented in health research [3] . This study explores the effects of a falls prevention programme on health-related quality of life (HRQOL), physical function and falls efficacy in older fallers receiving home care. Methods: The design is a parallel-group randomised controlled trial, where the intervention group performed a falls prevention programme based on the Otago Exercise Programme (OEP Introduction: More insight into survival and associated characteristics is necessary to better understand the prognosis of young onset neurodegenerative diseases, and for planning of specific services. This study investigated the survival rates of people with Young-Onset Dementia (YOD) and the relationship with age, gender, dementia subtype and comorbidity. Methods: Survival was examined in 198 community-dwelling participants in the Needs in Young-onset Dementia (NeedYD) study. People with Alzheimer's dementia (AD), vascular dementia (VaD) and frontotemporal dementia (FTD) were included. The primary outcomes were survival after date of symptom onset and date of diagnosis. The relationship between survival and age at symptom onset or diagnosis, gender, dementia subtype and comorbidity were explored using Cox Proportional Hazard models. Results: The mean survival time after symptom onset was 208 months and 120 months after diagnosis. Survival was associated with dementia subtype, with AD participants having a statistically significant lower survival rate compared to VaD participants. Furthermore, a younger age at diagnosis was associated with higher survival rates. Gender and comorbidity showed no association with both survival outcomes. Key conclusion: It is relevant to take into account the subtype of YOD when discussing the future perspectives of people diagnosed with YOD and their families. The uncertainty about prognosis and life expectancy, may be reduced by using our study outcomes when informing YOD persons and families about prognosis. Furthermore, intensive care support, including advanced care, is needed for a prolonged time. Introduction: Advancing age represents the strongest risk factor for Alzheimer's disease (AD) and the identification of biomarkers able to define what characterizes physiological aging from AD may represent a potential starting point for novel preventive strategies. Among these biomarkers telomeres seem promising targets. Interestingly, high intake of carotenoid-rich food may play a role in protecting telomeres. Accordingly, low serum b-carotene concentrations have been found in AD subjects when compared with controls. We aim at investigating the hypothesis that the lower b-carotene in AD might be associated with markers of accelerated cellular aging, including telomerase activity and shortened telomere length. Methods: The study was conducted in 93 old age subjects, 53 AD and 40 sex-and age-matched healthy controls. Telomerase activity in PBMC has been evaluated by a PCR-ELISA protocol. The b-carotene levels were obtained by HPLC and Apolipoprotein E (ApoE) genotype by RFL-PCR. Results: Subject affected by AD had significantly lower plasmatic levels of b-carotene (448 ± 66 mg/ml) as compared with healthy controls (497 ± 59 mg/ml, p \ 0.0001). In all population b-carotene significantly and positively correlated with telomerase activity controlling for gender (r = 0.280, p = 0.029). The association between bcarotene and AD risk (OR: 1.012, 95% CI 1.004-1.020, p = 0.004) was independent of age, gender, smoking habit and ApoE genotype. A final model having telomerase activity variability as the dependent variable while age, gender, smoking habit and b-carotene as independent variables, showed that b-carotene was independently associated with telomerase variability (b = 0.286, p = 0.035). Conclusion: Our data show that in this cohort lower plasmatic bcarotene levels are associated with lower peripheral telomerase activity and AD risk. Imperative focus on prevention: drug induced and drug aggravated dysphagia in the elderly patient To analyse the causes of oropharyngeal dysphagia in the elderly patient with focus on polypharmacy is the aim of this investigation. Methods: In a cross-sectional study based on a random sample of 200 patients admitted to a geriatric hospital comprehensive data were included besides the detailed list of drugs and an intensely clinical investigation of swallowing according to Stanschus as a screening method for oropharyngeal dysphagia performed in all 200 patients. Results: Within the 200 patients, mean age 84 ± 6.5 years, 65% female, prevalence of dysphagia is 29% (n = 58). Compared to women (21%) men reveal a higher rate (45%). Dysphagia is more often in nursing home residents (36%) versus own households (27%). With regard to concomitant diseases as diabetes mellitus, renal dysfunction, COPD and upper gastrointestinal illnesses there are no effects. Patients with dysphagia present 1.5 fold risk of pneumonia (95% CI 0.65; 3.58). Central nervous system diseases (CNS-D) pose a 6.9 fold sign. Risk of dysphagia (95% CI 3.7; 14.8). Another sign. Risk is associated with neuroleptics OR = 2.5 (95% CI 1.2; 5.04)adjusted for CNS-D (adj): OR = 1.9 (95% CI 0.88; 4.31); anti-Parkinson drugs: OR = 2.8 (95% CI 1.19; 6.73)-adj.: OR = 1.3 (95% CI 0.52; 3.51); benzodiazepines: OR = 4.4 (95% CI 1.01; 18.93)-adj.: OR 2 (95% CI 0.42; 9.5). With antidepressants we find a 2.1 fold risk for dysphagia (95% CI 0.96; 4.72), not affected by CNS-D-adj. Preliminary conclusion: As well as in patients with central nervous system diseases and without we can identify specific drug groups associated with risk of aggravating and even inducing dysphagia respectively. Restricted indication for neuroleptics, benzodiazepines and antidepressants might be a preventative contribution and requires implementation in future dysphagia guidelines. Increased risk of self-reported asthma in older, competing, crosscountry skiers Anette Hylen Ranhoff 1 1 Department of Clincal Science, University of Bergen, Diakonhjemmet Hospital, and National Institute of Public Health, Oslo, Norway Introduction: Regular physical activity is beneficial for health and longevity in all age groups. The effects of long-term, high levels of physical activity in old age are less known. The prevalence of asthma in competing cross-country skiers have been subject to several discussions. We wanted to study the prevalence of asthma in older, still competing, cross-country skiers. Methods: The Birkebeiner Aging Study recorded self-seported asthma and smoking habits for 555 participants in the 54 km Birkebeiner skirace in 2009, aged 65-90 years. The findings were compared to an age-and sex-matched cohort from the Tromso-6 population study. Validated and identical questionnaires regarding asthma, leisure-time physical activity, and smoking habits were used in both surveys. Chi square and T tests were used when appropriate. Results: The skiers had participated in the Birkebeiner race for a median of 14 times, indicating long-term, engagement in crosscountry skiing. 205(38%) of the skiers reported the highest level of regular, leisure-time physical activity, wereas only 1(0.2%) of the controls. The prevalence of self-reported asthma was 51(9%) and 44(8%) among the skiers and controls respectively (p = 0.5). A history of ever-smoking was reported for 199(36%) and 392(71%) respectively (p \ 0.001). Mean age of onset of astma was 45 and 46 yrs (p = 0.8) and there were no sex differences (p = 0.2). Key conclusion: long-term, competing, cross-country skiers have the same prevalence of self-reported asthma as the general population, despite a significantly lower exposure to sigarette smoke. Long-term, crosscountry skiing might be associated to an increased risk of asthma independent of smoking history. Risk factors associated with single and recurrent falls among community-dwelling elderly in Canada Introduction: Falls are a major public health concern among community-dwelling elderly in Canada. Objective: To identify and compare the risk factors associated with single and recurrent falls in elderly Canadians. Methods: This is a cross-sectional study that uses data from the Canadian Community Health Survey-Healthy Aging. It included 16,369 individuals aged 65 years and older. Data related to the incidence of single (one fall) and recurrent falls (C 2 falls) in the previous 12 months, as well as associated factors from selected variables (demographics, general health and functional condition, chronic conditions, medication use, and fall history) were examined by univariate analysis and multinomial logistic regression modeling. Results: This study found that 19.8% of the participants had experienced falls in the past year with 7.2% of them being recurrent fallers. The multinomial logistic regression modeling showed that participants who were males (OR 1.4; 95% CI 1.1-2.0) and perceived their health as being poor to fair (OR 1.4; 95% CI 1.1-1.8) were more likely to experience recurrent falls when compared to single falls. Relative to single fallers, recurrent fallers were also more likely to have arthritis (OR 1.3; 95% CI 1.0-1.7), urinary incontinence (OR 1.4; 95% CI 1.1-1.9), polypharmacy (OR 1.6; 95% CI 1.2-2.1) and fear of falling (OR 1.6; 95% CI 1.2-2.1). Conclusion: Findings of this study suggest that fall prevention efforts should consider a variety of risk factors in order to ensure the most effective interventions for this rapidly increasing and vulnerable population. Is CAIDE score an efficient tool in the prevention of Alzheimer's disease in general population? Introduction: Alzheimer's disease is one of the most devastating and costly condition worldwide. Due to the increase in life expectancy and to the population ageing it is estimated that the number of people with dementia will double in the next 30 years. In Romania there are about 300,000 people suffering from Alzheimer's dementia so far and it is estimated that the number will triple by 2025. Unfortunately, about 20% of this global number are diagnosed in the advanced stages of the disease, when even the best therapeutic plans are associated with modest results, institutionalization and very high costs. This is why early identification of people at risk of developing Alzheimer's disease becomes an absolute priority. Methods: CAIDE score is designed for general adult population as a tool that estimates the risk of Alzheimer's dementia in the next 20 years. Age, gender, education, systolic blood pressure, body mass index (BMI), cholesterol, and physical activity are used to count the score. An abnormal score should be the trigger to start prevention of chronic diseases in order to achieve a healthy ageing. Results: We present the partial outcomes of a prospective study that evaluates the predictive capacity of CAIDE score in the general adult population, and whether it can be improved by taking into account other mid-life risk factors. The evaluation of the cognitive status would be performed each year to monitor if there are changes in the normal evolution according to the ageing. If alterations of the cognitive status should occur, the identification of the responsable factor(s) should trigger specific prevention. Physical activity, cardiovascular risk and employment status of 60-to 65-year-old subjects Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Objectives: The aim of the study was to investigate if cardiovascular risk factors may differ according to workload, and if physical activity (PA) connected to health related behaviours and energy expenditure may produce the impact on cardiovascular risk factors profile in the elderly with different workload. Methods: 300 subjects aged 60-65 were divided into three equal groups of intellectual, manual workers and unemployed subjects. 50% were women. The subjects were examined for the presence of cardiometabolic diseases and major cardiovascular risk factors such as smoking, anthropometric indices, blood pressure, lipid profile, glucose, uric acid, homocysteine and metabolic syndrome. Result: Manual workers were more obese, had higher blood pressure and higher PA indices in comparison with other two group. PA connected to health related behaviours had a positive impact on body mass indices, lipids, glucose or uric acid, with no such an impact observed for PA-related energy expenditure. Conclusion: Higher cardiovascular risk may be observed in the group of manual workers. PA connected to health related behaviours has a positive impact on global cardiovascular risk and may decrease the risk of metabolic syndrome among seniors. No impact was observed for PA-related energy expenditure. Thus, employment status may play important role in how PA influences cardiovascular risk. Fear of falling in older adults in rural northern Greece Results: Results revealed that 9% of the participants expressed no fear of falling, 26% expressed a little concern about falling, and the rest 65% expressed a great concern. Fear of falling was not associated with age (r = 0.065, p = 0.555) or cognitive function (r = 0.184, p = 0.091). Conclusions: The fear of falling seems not to be related with factors, such as the advancing age, gender or even slight deterioration in cognitive functions. Future studies should clarify the possible factors that affect and differentiate fear of falling in older adults. Relationship between muscular performance trainability and other physical performances, and characteristics in resistance exercise among community-dwelling older adults Naoki Tomiyama 1 , Ryuichi Hasegawa 2 1 Seijoh University, Tokai, Japan, 2 Chubu University, Kasugai, Japan Introduction: Resistance exercise has been reported to be more effective for older adults with low muscular performance. Therefore, trainability might be affected by pre-intervention characteristics. The purpose of this study was to determine the factors influencing trainability for muscular performance in resistance exercise among older adults. Methods: The participants were attended a 9-week elastic band-based resistance exercise class. Pre-and post-class physical performance tests were performed by 281 participants. Muscular performance was evaluated using an arm curl test (AC) and 30-second chair stand test (CS). Balance performance was assessed using the timed up and go test (TUG) and four square step test. Flexibility performance was measured using the back scratch test and sit and reach test (SR). Other variables, including age, sex, height, weight, exercise habits, hypertension and diabetes mellitus, were examined. Multiple linear regression analysis was performed to examine whether trainability for muscular performance was relevant to other pre-intervention physical performances or characteristics. Results: AC results of trainability were associated with TUG (b = -0.368, P \ 0.000), exercise habits (b = 0.173, P = 0.001) and weight (b = 0.128, P = 0.019) adjusted for the pre-intervention AC. CS results of trainability were also associated with TUG (b = -0.283, P \ 0.000), exercise habits (b = 0.185, P = 0.001) and SR (b = 0.158, P = 0.007) adjusted for the pre-intervention CS. Conclusion: These results suggest that trainability for muscular performance is affected by pre-intervention characteristics, especially agility and exercise habits, among community-dwelling older adults. Relationships between functional physical fitness, variables cardiovascular and quality of life in elderly Background: Despite substantial risks Proton pump inhibitors (PPI) are often prescribed without indication and/or with too high dosages. In this context we analysed the current situation in nursing home residents. Methods: From baseline data of the cluster-randomized, controlled EPCentCare study (BMBF grant) a secondary data analysis was performed to investigate adequate prescription of PPI concerning (1) indication as well as, (2) Introduction: Hyperkyphosis is common in older adults and is associated with lower physical performance and a doubled fall risk [1, 2] . Several kyphosis measurement methods have been developed. However, the current gold standard kyphosis measurement-the Cobb angle-is poorly validated [3] [4] [5] . We aimed to investigate which of three kyphosis measurement methods associates best with physical performance and falls in geriatric outpatients. Methods: We measured kyphosis with the Cobb angle, blocks method and occiput-to-wall distance (OWD Resistance exercise is important for the prevention of sarcopenia and physical dependence of old adults. However, little is known whether overweight/obesity affect the outcomes of a resistance exercise program. Community-dwelling Icelandic old adults (N = 236, 73.7 ± 5.7 years) participated in a 12-week resistance exercise program. Anthropometrics, muscular strength and physical function were measured at baseline and endpoint. Group was defined retrospectively as normal, overweight and obese BMI level according to international cut off values. Statistical analyses were corrected for age and gender. Of the participants, 22.0% were normal, 41.4% were overweight and 36.6% were obese. BMI categories were neither related to drop-out (11.9%) nor to attendance (88.4%). All groups experienced improvements in outcome measurements, but improvements in individuals with obese BMI were less pronounced compared to normal BMI individuals. There was similar weight gain in the groups (+0.48 kg, P \ 0.001), however, normal BMI group gained more lean mass (+0.70 kg, P = 0.015), appendicular muscle mass (+0.42 kg, P = 0.007) but lost more fat mass (-0.75 kg, P = 0.081) as compared to obese BMI group. This resulted in a greater change in body fat percent in subjects with normal BMI as compared to obese (-1.5%, P = 0.014). Absolute gains in quadriceps strength were similar between groups, but relative to body weight, normal BMI group gained more than obese BMI group (+ 0.31 N/kg, P = 0.017). This translated into a greater improvement in 6-minutes-walk-for-distance (+ 24 m, P \ 0.001) in normal BMI group compared to obese BMI group. Interestingly, grip strength increased more in obese BMI group (2.4 lb., P = 0.020). Timed-up-and-go improved similarly in all groups (-0.64 s, P \ 0.001). Independently from their BMI status, older adults benefited from a resistance exercise program in terms of body composition and physical function. However, obese individuals improved significantly less than normal weight participants although there was similar attendance to the exercise classes. Great care has to be taken of obese elderly in order to maintain their physical independence as long as possible. Medication-related harm due to non-adherence may explain the relationship between polypharmacy and mortality mortality, Brighton UK, 3 Institute Of Pharmaceutical Science, King's College, London, UK Introduction: Strong evidence exists for a relationship between polypharmacy and mortality [1] , independent of comorbidity. The mechanisms underlying this relationship are unclear. Medication-related harm (MRH) may occur due to non-adherence or adverse drug reactions. We sought to determine if MRH due to non-adherence or adverse drug reactions may explain the association between polypharmacy and mortality. Methods: The PRIME study recruited 1280 older adults at hospital discharge from 5 hospitals in England between 2013 and 2015 [2] . Patients were followed up in the community for 8-week by senior pharmacists to identify MRH using data from hospital readmissions, GP records and patient interviews. Mortality data at 12 months postdischarge were obtained from hospital records. Non-adherence was determined using a modified version of a validated questionnaire [3] . Adverse drug reactions were assessed using the Naranjo algorithm [4] . Adjusted logistic regression models were used to investigate the relationship between (1) Introduction: Oropharyngeal dysphagia (OPD) is a significant cause of morbidity in the Nursing Home (NH) population with adverse associations including aspiration pneumonia and malnutrition. OPD has many aetiologies including stroke, dementia and COPD. A lack of guidelines persists in detecting and defining the presence and severity of OPD as well as in defining and managing optimal treatment in this vulnerable group. Methods: Medical and nursing notes, as well as Speech and Language Therapist (SLT) directives to kitchen and care staff on recommendations for food and fluid consistencies, were reviewed for evidence of OPD for each of the 42 residents of an Irish NH facility. Nursing care plans outlining ''swallowing difficulty'' of 7 types, SLT documentation of swallow assessment and of food and fluid recommendations were reviewed for content and consistency. Results: There was evidence of OPD in 18/42 (42%) residents, of whom 12/18 (67%) were women: dementia was a diagnosis in 8/18 (44%). Four patients expressed a preference not to adhere to safe swallow recommendations, one of whom received thickener despite a care plan to the contrary. Two patients had less stringent kitchen guidelines than SLT recommendations. ''Coughing/choking'' 6/18(33%) was the swallowing difficulty most commonly observed by nursing staff. Bedside review, mealtime observation and chart review formed the bulk of swallow assessments. Key conclusions: Screening for OPD should be a key consideration in the care of NH residents. Early objective SLT review is essential to provide clear swallow recommendations to nursing, care and kitchen staff thus eliminating the subjectivity of observational records. Dietary sodium restriction increases long-term risk of fall among middle-aged and older adults Conclusions: DSR was associated with an increased risk of falling among middle-aged and older adults; the associations were independent of demographic, health behavioral factors and related chronic diseases. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 (4) [ 90 min. The relationship between time spent in different categories and cholesterol, HbA1c and blood pressure was analyzed. Results: In total, 423 participants (58% men; mean age 72.7 years, SD 11.2) were included. Sedentary behavior in total (p = 0.003) and in bouts of more than 30 (p = 0.006) and 60 min (p = 0.013) was associated with a higher HbA1c in patients with diabetes mellitus, after adjusting for age, BMI and anti-diabetic drugs. The effect was comparable to the effect of oral antidiabetic medications. We found a negative relationship between blood pressure and sedentary behavior. Conclusion: Our finding supports our hypothesis that long bout sitting is more harmful than short bout sitting and that the impact of sedentary behavior varies between patient groups. The relationship between blood pressure and sedentary time might be explained by the coexistence of lower blood pressure with a low activity level in the frail patients. Stroke, major bleeding, and mortality outcomes in frail old anticoagulant users with atrial fibrillation and chronic kidney disease Purpose: Preventing stroke is important since it decreases activity of daily living and quality of life in old people. However, the balance between stroke reduction and increased bleeding associated with oral anticoagulant (OAC) therapy among frail old patients with atrial fibrillation (af) and chronic kidney disease (CKD) is controversial. Methods: 1173 patients aged C 75 who were admitted to the geriatric ward of the University of Tokyo Hospital between 2012 and 2017 were enrolled. From 175 af patients (men 47%, mean age 85.5 years), we identified 94 (men 48%, mean age 87 years) patients with CKD. We followed the patients for 1-5 years after baseline. Stroke, major bleeding and all-cause mortality was investigated for outcome. Results: Among them, 53.2% were taking OAC therapy. The incidence of stroke in those taking OACs were higher than those not taking OACs (HR, 5.85; 95% CI 0.01-0.89; P = 0.03) and major bleeding was marginally higher but not statistically significant (HR 4.58; 95% CI 0.84-85.0; P = 0.08). The incidence of mortality in those taking OACs were marginally lower but not statistically significant (HR 0.53; 95% CI 0.23-1.21; P = 0.13). Conclusions: Present study shows that frail old OAC users with af and CKD might have less benefit than younger users. Further studies are needed to clarify the medical appropriateness of the use of OACs. Fear of falling? Interventions to prevent or reduce fear of falling in community dwelling elderly: a systematic review Andrea Fink 1 , Daniela Schober 2 1 Medical University of Graz, Graz, Austria, 2 Institut für Pflegewissenschaft, Graz, Austria Introduction: At least every fifth person over 65 years of age is scared of falling and fall-related consequences. Particularly for community-dwelling elderly, a fall can cause a sudden change in their previous independence. Consequently, older people restrict their physical activity and become socially isolated, which further increases their risk of falling. Little attention has been paid to interventions in only few systematic reviews. The aim of this systematic review is to identify and summarize effective interventions to prevent or reduce fear of falling among community-dwelling older people. Method: A systematic literature search was performed using PubMed, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials and different search engines and reference lists were scanned for additional studies. Only English and German articles between 2005 and 2015 were included, which focus on people over 65 years and who were living at home during the trial. Two independent reviewers critically assessed the risk of bias in the included studies by using the ''risk of bias tool'' from the Cochrane Collaboration. If the interventions and diagnostic instruments were similar, the data were pooled in a meta-analysis. Results: A total of 18 studies were identified for inclusion in this review. In 14 studies, the fear of falling of community-dwelling elderly was significantly prevented or reduced by the following interventions: seven exercise trainings, one education program and six multicomponent interventions. Discussion: The results of this systematic literature review show the effectiveness of interventions with different components for the prevention or reduction of the fear of falling. Due to the variety of definitions of fear of falling, the different instruments for measurement, as well as differing study populations, the comparability of the included studies is questionable. In addition, the results have to be regarded with care, due to the included studies limited methodological quality. Further studies, especially from the nursing science perspective, with a special focus on certain high risk groups are required. Recruitment to the PrAISED feasibility study Relationship between health behaviors and marital adjustment and marital intimacy in multicultural old aged couples. Conclusion: More desirable health behaviors were observed in old aged couples who were highly adapted. Therefore, family physicians should be concerned with marital adjustment and other associative factors to evaluate and improve multicultural old aged couples' health status. The objective evaluation of hand dexterity using wearable fingertip sensors Hitomi Oigawa 1 , Tomohiro Umeda 1 1 Nara Medical University, Kashihara, Japan Introduction: Hand dexterity decreases with age. However, maintaining and promoting dexterity is important for extending healthy life expectancy. We used fingertip sensors to analyze and objectively evaluate the dexterous movement of the hands. Methods: Fingertip motion was measured and used to determine how many times a patient closed their hand in a 10-second test. We measured the movement of each fingertip using a wearable sensor (HapLog) that can measure the three-axis acceleration and contact pressure of the fingertip. The sampling frequency was 200 Hz and the acceleration range was 4 G. From the obtained time series data, we calculated the maximum and minimum values, compared the data of each finger and compared the frequency, and extracted the feature quantity. Results: It was found that it is possible to calculate the number of hand closures by analyzing the z axis acceleration data from the 10-second test. Moreover, by comparing the time series data of each finger, the features of the opening and closing motion of each finger could be detected. Finally, it was shown that it is possible to evaluate the awkwardness of opening and closing by frequency analysis. Conclusions: By using wearable sensors, it is suggested that analysis and evaluation of three-dimensional finger movement can be performed. In the future, in order to improve the evaluation accuracy, we collect more data of the 10-second test and the evaluation should be performed by machine learning. Process evaluation of an osteoarthritis disease management programme for older people with knee and hip osteoarthritis Introduction: Exercise plays a crucial role in osteoarthritis management in older people. Group-based interventions are effective at reducing pain and improving physical function and quality of life. Health professionals frequently encounter difficulties implementing such programmes, particularly ensuring high levels of patient attendance and participation. Objective: To conduct a process evaluation alongside the implementation of a new disease management programme for older people with knee and hip osteoarthritis to examine programme uptake, fidelity, barriers and facilitators to implementation. Methods: A mixed method design was used. Quantitative data were collected through routine monitoring of the service, including attendance records and outcome assessments. A fidelity checklist was used S178 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 during site-visit observations. Interviews were conducted with the intervention staff and purposefully sampled programme participants. Results: Fifteen participant interviews, four physiotherapist interviews and three site-visits were conducted. Facilitators of attendance included the development of a physiotherapist-patient rapport, participants' positive perception of exercise and previous experience of physiotherapy. Barriers to implementation included the intervention's vague structure and staff turnover. Conclusions: A group-based osteoarthritis intervention should consist of a well-structured and scheduled programme with emphasis on education aimed at improving participants' perception of exercise and developing a physiotherapist-patient rapport. This may help to maximise participation in osteoarthritis patients and ensure greater implementation success. Profiles of elderly people participating in prevention programmes of the 'Centre for Memory and Mobility' in Luxembourg The 'Centre for Memory and Mobility&constitutes a new offer in the provision of prevention programmes focusing age-associated mobility and cognitive declines. The Centre promotes general health and allows maintaining autonomy and independence in everyday activities by providing highly structured and evidence based cognitive and mobility training programmes. The aim of the present study is to identify the profiles of the population participating in the Centre's preventive measures by analyzing their cognitive physical, medical and social characteristics. To date, a total of 162 patients (age mean 77.4 years, SD 8.09) have visited the Center. Each patient's body mass index, grip strength, self evaluated state of health, general cognitive capacities and concentration capacities are measured on their first visit. Furthermore, each patient's social and medical characteristics are assessed. Using cluster analysis, the following three groups are identified: (1) ''Healthy patients'', (2) ''Patients with cognitive deficits'', and (3) ''Patients with physical deficits''. Moreover, we describe the social and medical characteristics for each group of patients, using a descriptive analysis. By October 2018, approximately 200 patients will have attended the Centre. The additional patients will be included in the cluster analysis. The discussion of the findings focuses on the characteristics of patients willing to partake in preventive programs which allow maintaining their autonomy and independence in everyday life. Furthermore, we discuss how the results help adapting preventive strategies to the individual needs of those patients. Introduction of an acute care navigation service and its impact on hospital admissions in the vulnerable population Through signposting patients to local services and regular contact by the team ensures their individual needs are met. The service identifies patients who are vulnerable in the community, the majority of whom are elderly. It is a non-clinical service comprising of three care navigators who liaise and share information between acute and community-based health services, social and third sector groups. Methods: To evaluate the services' impact on the number of ED attendances and non-elective inpatient admissions through comparing data 3 months before, and 3 months post referral. Results: In the 3 months prior to referral the 71 patients seen by the Care Navigators had 136 ED attendances with a resultant 106 inpatient admissions. In the following 3 months ED attendances reduced to 57, a reduction of 58% and admissions by 64, a reduction of 60.4%. The preservice admission data accounted for 612 bed days (length of stay plus one), which reduced to 312 for subsequent admissions, a 49% reduction. Key conclusions: 3 months post referral there was a significant reduction in ED attendances and hospital admissions with a huge improvement in inpatient stay. The service has supported those who frequently attend ED either through frailty or lifestyles crisis. This highlights the potential of the service to help prevent unnecessary admissions amongst the vulnerable population and free up hospital capacity with economic benefit. Loss of independence trajectories of older adults living in community: results of a cohort study Background: The loss independence is the inability for a person to decide, ensure some activities of daily life. The independence's loss depends on physicals, psychologicals, biological and socio-economic factors. Its risks factors knowledge may help to plan appropriate preventive measures to maintain independence. Objective: To identify of loss of independence trajectories and risk factors associated. Method: Independence assessing criterion used for this study was the SMAF (Système de Mesure de l'Autonomie Fonctionelle). Three methods: k-means, hierarchical ascending classification and Group-Based Trajectory Modeling was used to classify subjects in homogenous groups and performing independence trajectory. Multinomial logistic regression was used to identify the predictors of independence loss. Results: 221 subjects were evaluated between 2011 and 2014. The average of age was 86.1 (± 5). Women represented 64%. Polypathology and poly-medication prevalence rate were respectively 88%, 77%. Falls prevalence rate was 62%. 53% of population were dependent for ADL and 62% for IADL. Three distinct profiles of independence were identified: independent (68%), moderately independent (24%) and dependent (8%). Predictors of moderately independent were age. Predictors of the dependence were school level, lifestyle, family support, number of daily medications, urinary incontinence, cognitive disorders, nutrition, physical performance and frailty. Conclusion: Half of the population was independent. A quarter had moderate to severe dependence. To our knowledge, such a study has not yet been the subject of research. The results of this study indicate that some sociodemographic and physiological criteria are good predictors of moderate to severe independence loss. Introduction: Hyperkyphosis is present in 20-40% of communitydwelling older adults [1, 2] . Studies investigating the association with fall risk show conflicting results, and only two small cohort studies have a prospective design [3, 4] . Furthermore, several kyphosis measurement methods have been applied in research [5] . We aimed to investigate the association between hyperkyphosis and fall risk in community-dwelling older adults prospectively, using the current gold standard kyphosis measurement-the Cobb angle [5] . Methods: The Cobb angle was measured on DXA-based Instant Vertebral Assessments. Participants reported falls monthly during 2-3 years. Through multifactorial regression analysis, we controlled for potential confounding. Results: Almost half of the 1220 participants (mean age 72.9 ± 5.7 years) fell at least once during follow-up. Neither number of falls nor time-to-first-fall was statistically significant associated with hyperkyphosis in multifactorial analyses, in which we added age, gender, smoking, alcohol use and use of a walking aid (IRR 1.01, 95% CI 0.82-1.25, p 0.915; HR 1.02, 95% CI 0.81-1.27, p 0.892). In the Cox regression analysis, an interaction over time was found. However, unlike two small prospective cohort studies [3, 4] , we did not find an association in the first year of follow-up. Discussion: In contrast to previous studies [3, 4] , hyperkyphosis was not statistically significant associated with fall incidence in the multifactorial models in this large cohort of community-dwelling older adults. This difference may be due to the healthier population of this large cohort study and to variation in kyphosis measurement methods. In future studies, the correlation and validity of the various kyphosis measurement methods should be investigated in geriatric patients. Serum gamma-glutamyltransferase (GGT) is a novel type 2 diabetes risk factor, but little is known about the GGT on the development of diabetes in Korean elderly populations. We evaluated 257 women and 337 men, more than 65 years of age, without baseline diabetes. From the baseline health screening to the follow-up examination, the development of diabetes, based on changes in GGT quartile levels, was analyzed. The development of diabetes gradually increased with an increase in the circulating levels of GGT. After adjusting for confounders, for the highest quartile of GGT, hazard ratios of diabetes compared with the lowest quartile were 3.54 (95% confidence interval: 1.21-10.31, P = 0.021) in women and 5.08 (95% confidence interval: 2.39-10.80, P = 0.009) in men. These findings in Korean elderly populations suggest potential utility of GGT as an additional biomarker in predicting the development of diabetes. Nutritional status of the elderly after discharge from the acute geriatric unit: a pilot study Nutritional status of hospitalized old adults is often inadequate after discharge. The aim of the study was to assess dietary intake, food security and nutritional status of old adults after discharge. In this pilot study community-dwelling old adults (N = 13; 87.7 ± 5.6 years; MMSE C 20; no catabolic diseases) discharged from the Acute Geriatric Unit of the National University Hospital of Iceland were included. Anthropometrics, dietary intake, food security and quality of life (QoL) were assessed at discharge, 1 week (home) and 2 weeks later (home).Baseline BMI was 24.7 ± 5.1 kg/m 2 and there was significant weight loss during the 2 weeks period in participants (-2.6 kg, P = 0.0001) resulting in an endpoint BMI of 23.8 ± 4.7 kg/m 2 . Actual daily energy-(759.0 ± 183.4 kcal) and protein intake (35.1 ± 7.5 g) were significantly lower (both P \ 0.001) than the corresponding estimated requirements (2061.6 kcal; 82.4 g). Kitchen assessment revealed that 33% of all foods were expired and 24% of all foods had visible mold. Of the participants, 75% experienced loneliness and QoL (31.5 ± 8.6) was significantly lower than the age and gender dependent reference values of 50. Loneliness, malnutrition, inadequate dietary intake and food insecurity are serious problems in discharged old adults in Iceland. There is a great need for individualized nutritional therapy, during and after hospital stays to ensure proper dietary intake with the S182 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 aim to reduce malnutrition and re-admissions as well as to increase the quality of life of old adults. E-mail alerts about rapid weight loss and … increased mortality? Clalit Health Services, Tel Aviv, Israel Background: The benefit of alerting clinical staff to rapid weight loss in patients aged 75+ years to survival is uncertain. Methods: In a randomized, controlled trial, 362 patients with bodymass index (BMI) \ 23 kg/m 2 that dropped C 2 kg/m 2 during previous 2 years were assigned to have an alert electronic mail sent to their physician, and 344 were assigned to receive usual clinical care (control-group). The primary outcome of the trial was death from any cause. Results: In the following year, dietitian visits were recorded only for 22 patients (6%) in the alert-group and 14 patients (4%) in the control-group (odds ratio 1.5; 95% CI 0.78-2.9; P = 0.24). However, 77 patients (21%) died in the alert-group and 46 patients (14%) died in the control-group [hazard ratio 1.59; 95% CI 1.14-2.22; P = 0.007; number needed to harm (NNH) = 12.7]. In subgroup analysis, baseline vascular heart or brain diseases were associated with a significantly higher mortality rate in the alert-group than in the control-group [27 vs. 13%; hazard ratio (HR) 1.9; 95% CI 1.2-3.0; P = 0.004; NNH = 8], while having none of these diseases at baseline was associated with no effect of the E-mail alert on mortality [14% for both; HR 1.01 (0.6-1.7); P = 0.97]. Conclusions: In this trial, alerting clinical staff to rapid weight loss in patients aged 75+ years was not associated with higher dietitian visit rates but was associated with a significantly higher death than was usual clinical care. Nutritional evaluation of elderly patients before and after hospital admission in an internal medicine ward Background: Food items might have a synergistic and antagonistic effect on health. The Mediterranean diet has long been associated with lower incidence of cardiovascular disease and cancer. Objective: Our objective was to evaluate the adherence to a Mediterranean diet (MD) according to diabetes in elderly coronary patients. Methods: A total of 53 elderly coronary patients were involved in this study. They were divided into diabetic patient (n = 27; age = 68.3 years) and non-diabetics (n = 26; age = 68.7 years). The dietary habits of the patients were evaluated using 1-week diet recalls. 11 main components of the MD (non refined cereals, fruits, vegetables, potatoes, legumes, olive oil, fish, red meat, poultry, full fat dairy products and alcohol) were used. A total score (0-55) was calculated. Higher values of this diet score indicate greater adherence to the MD. Results: Compared to non-diabetics, individuals who developed diabetes had significantly higher mean values for, fasting glucose, triglyceride and urea levels. No significant differences between the nutrient intakes of the two subgroups. Nevertheless the diabetic patients group showed significantly higher magnesium intakes associated with higher vitamin C and folate intakes but lower vitamin E intakes the value of the MD score is about 28.53 for the non diabetic elderly CAD patients and 28 for the diabetic ones. There is a negative correlation between the MD score, diastolic and systolic blood pressure in non diabetic group. Conclusion: Adherence to MD could be the first efficient step to prevent these complications. The acceptability of offering fortified foods to older people whilst in hospital: a pilot study Introduction: Malnutrition is a significant problem amongst hospitalized older people, and can impede recovery. Oral nutritional supplements (ONS) may be poorly tolerated; food fortification could be a better alternative. We aimed to establish the acceptability of fortified foods to older inpatients including those who have dementia and frailty. Methods: The intervention involved offering older patients in two UK hospitals between-meal fortified foods (enhanced with protein and energy) three times a day for 6 days, over 2 weeks. Fortified foods included biscuits, soup, cake, and ice-cream, providing on average 210 kcal and 5 g protein/serving. The type and frequency of fortified foods ordered by patients was recorded. Patients' views were captured by a 10-point likeability scale. Interviews were conducted with 15 staff members to explore their views. Results: 169 patients ordered 500 portions of fortified foods. Ice cream was the most frequently requested food (199, 40%), followed by cakes (120, 24%) and soups (125, 25%) and least biscuits (56, 11%). Patients' likeability scores were high ([ 7/10) for all products. The median energy and protein intake per fortified food portion for men and women was 195 kcal and 145 kcal and 5.5 and 4.2 g, respectively. Staff reported a number of potential advantages of fortified foods: easy to eat, suitable for patients with dementia/modified diet, mitigate against sliding into frailty, and improve engagement with therapy. Few reported concerns, including missing main meals. Conclusions: This study revealed high likeability and acceptability of fortified foods in older inpatients. The results will inform the design of a definitive clinical trial. Protein intake characteristics of community-dwelling older adults with a low versus high protein intake 3 Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands Introduction: Adequate protein intake is essential for muscle health in old age, but low protein intake is common in older adults. This study aimed to compare community-dwelling older adults with low and high protein intake with regard to protein intake per day and per meal moment, and food sources of protein. Methods: This study is conducted within the PROMISS project. Data were used from 727 community-dwelling older adults aged C 70 years from the Dutch National Food Consumption Survey Older Adults 2010-2012. Protein intake was measured with two non-consecutive 24-h recalls by trained dieticians. Low protein intake was defined as below the Recommended Dietary Allowance of 0.8 g protein per kg adjusted body weight per day. Differences in the relative contribution of food groups to total protein intake between those with low and high protein intake were assessed with the Mann-Whitney U test. Results: Low protein intake was present in 15% of the participants. Mean total protein intake was 51.9 ± 10.7 and 80.9 ± 17.3 g/day in the low and high protein group, respectively. Protein intake was substantially lower in the low compared to the high protein group at all meal moments (breakfast 8.6 vs 12.0 g; lunch 14.3 vs 25.6 g; dinner 21.7 vs 32.0 g; all P \ 0.001). In both the low and high protein group, most protein was obtained from meat (12.1 vs 22.9 g), dairy (13.0 vs 18.9 g) and cereals (11.7 vs 16.2 g). However, the low protein group obtained less protein relative to their total protein intake from meat (22.1 vs 27.8% in the high protein group), but more from cereals (22.4 vs 20.1%) (all P \ 0.01). Conclusions: Dutch community-dwelling older adults with a low protein intake (* 15%) consistently ate less protein at all meal moments and obtained relatively less protein from meat, but more from cereals than those with a high protein intake. Prevalence of low protein intake in older persons: a multi-cohort approach within the PROMISS project (INRAN-SCAI) . The prevalence of low protein intake ranged from 13.2 to 45.0% in all older adults (9.0-45.0% in men; 15.9-47.0% in women). Conclusions: Based on this large-scale, multi-country study, the prevalence of a low protein intake in older people varies between countries but is substantial, about 13-45%. New strategies must be developed to encourage older people to increase their protein intake, especially in light of the current debate on increasing the RDA to 1.0-1.2 g/kg/day. Malnutrition and malnutrition risk can be associated with systolic orthostatic hypotension in older adults Background: Malnutrition and orthostatic hypotension (OH) are the two important geriatric syndromes, which have similar negative outcomes such as falls. The aim of the study is to detect whether there is any relation between malnutrition and OH. Methods: 862 geriatric patients, who had undergone comprehensive geriatric assessment (CGA), were included in the retrospective study. OH was identified as 20 and/or 10 mmHg dropped for systolic and/or diastolic blood pressures with the active standing test when patients got up from supine to standing position. Nutritional status was checked according to Mini Nutritional Assessment-Short Form (MNA-SF). Results: The mean age of the patients was 74 + 8.05, and 66.3% of them were female. The revalence of malnutrition, malnutrition-risk and OH were detected as 7.7, 26.9 and 21.2%, respectively. When OH, systolic OH, diastolic OH and control group were compared with CGA parameters and the effects of age and gender were removed, the frequency of falls and Timed-Up and Go Test were higher, activity daily living indexes and TINETTI-Balance scores were lower in systolic OH than without it (p \ 0.05). Systolic OH was more frequent in malnutrition-risk and malnutrition group than control group (p \ 0.002 and p \ 0.05, respectively). Diastolic OH was not associated with nutritional status (p [ 0.05). OH was only higher in malnutrition-risk group than robust (p \ 0.05). Conclusion: Our findings suggest that not only malnutrition but also malnutrition-risk may be associated with systolic OH, which leads to many negative outcomes in older adults. Therefore, nutritional status should be checked during the evaluation of OH patients. Introduction: In several studies, obesity has been associated with low levels of 25-hydroxy-vitamin D (25OHD). The detailed causes of hypovitaminosis D in obese individuals have not been clarified. The aim of the present work was to compare 25OHD in obese and normal-/overweight subjects with particular consideration of physical activity and fish oil intake. Methods: Community dwelling subjects from the Reykjavik area in Iceland (N = 229, 73.7 ± 5.7 years, 58.2% female) participated in this cross-sectional study. Leisure time physical activity (LTPA), dietary intake, body composition and background variables were assessed. 25OHD was measured in fasting blood samples. Results: Mean LTPA was 5.7 ± 5.6 h/week and the most common activities were walking and gardening. Mean concentration of 25OHD was 66.7 ± 28.1 nmol/L and 8.5/21.2% were below 30 and 50 nmol/L, respectively. Obese participants (n = 84) had lower 25OHD (-11.0 ± 3.8 nmol/L, P \ 0.001) and lower LTPA (-2.5 + 0.8 h/week, P = 0.001) than normal-/overweight subjects (n = 145). According to linear models corrected for various confounders and stratified by obesity status we found that LTPA (h/week) was associated with higher 25OHD in normal-/overweight participants only (1.6 nmol/L, P \ 0.001) but not in obese (-0.5 nmol, P = 0.394). On the other hand, fish oil intake was associated with higher 25OHD both in normal-/overweight (13.9 ± 4.5 nmol/L, P = 0.003) and obese subjects (16.2 ± 5.3 nmol/L, P = 0.003). Key conclusions: Our study shows that obese community dwelling adults in Iceland have lower 25OHD than their normal-/overweight counterparts. We also found that LTPA was associated with higher 25OHD in normal-/overweight, but not in obese participants. Fish oil was associated with higher 25OHD independently of obesity status and is therefore especially important for obese old adults. 3 Faculty of Nursing and Health Sciences, Notre Dame University, Beirut, Lebanon Introduction: Malnutrition in hospitalized patients is known to be associated with many adverse clinical outcomes and increased healthcare costs. Our study aimed to describe the nutritional status of older hospitalized patients and to evaluate the associated risk factors. Methods: This was an observational cross-sectional study conducted at a major tertiary teaching hospital in Beirut city. During a 7 months period, patients aged 60 and over and admitted in the medical and surgical departments of the hospital were invited to participate in the study. Data were collected by means of a questionnaire including sociodemographic and medical characteristics, the Arabic version of the Mini Nutritional Assessment, the Activity of Daily Living (ADL) scale, and the American Society of Anesthesiologists (ASA) score. Results: 171 participants aged 73.15 ± 8.06 years were included in the study. 52.0% of them were at risk of malnutrition and 13.5% were malnourished. Patients hospitalized in medical departments (16.2%) presented a high prevalence of malnutrition compared to those hospitalized in surgical departments (10.5%) (p value = 0.003). Moreover, low education level, high age, extended hospital stay, number of medical comorbidities, polymedication, high ASA score and low ADL score were significantly associated with malnutrition (p value \ 0.05). Conclusions: Malnutrition is prevalent in senior hospitalized patients and is associated with several specific risk factors. Screening and management of malnutrition should be considered a priority in order to improve the overall medical status of the elderly and to ensure a better quality of life. Associations between BMI, physical function and bone health in community dwelling old adults Background: The associations between BMI, physical function and bone health were investigated in a group of apparently healthy, physically active, community dwelling old adults. Methods: This was a cross-sectional study including 236 community dwelling old people (age range 65-92 years, 58.2% female). Bone mineral density (DXA), timed-up-and-go (TUG), six-minute-walkfor-distance (6MWD), anthropometrics, quadriceps strength and clinical blood variables were assessed. Results: Mean age was 73.7 ± 5.7 years. According to linear models corrected for age, smoking and gender, higher obesity was related to lower quadriceps strength relative to body weight, to lower physical function, i.e., lower gait speed and longer TUG time, as well as to lower 25OHD but to higher PTH. Of the participants, only 1% of men and 4% of women had osteoporosis, the corresponding numbers for osteopenia were 35 and 45%. Obesity was related to high bone mineral density (T-score) in femur, lumbar and total. Conclusions: In this highly functional cohort of old adults, obesity was related to poorer strength and less physical function in older adults which should make obese individuals more prone for falls and fractures. However, although obesity was also related to a poorer hormonal profile, obesity was related to higher BMD. Future studies need to determine the net effects of higher BMI and fall and fracture risk of obese elderly. Objective: To evaluate the efficacy of Morus nigra L. (black mulberry) leaf extract in comparison with hormone replacement therapy (HRT) and placebo for the treatment of climacteric syndrome. Methods: A randomized, double-blind, placebo-controlled trial was carried out and included a total of 62 climacteric women. Primary endpoints adopted were the severity of climacteric symptoms detected by the Blatt-Kupperman Index (BKI) and quality of life evaluated by the SF-36 scores. Secondary endpoints included biochemical tests, colposcopy and oncotic colpocitology findings, and adverse effects. Patients were randomly assigned into three experimental groups: Black mulberry (n = 20; Morus nigra L. capsules 250 mg/day); HRT (n = 20; capsules of estradiol 1 mg/day with or without norethisterone acetate 0.5 mg/day); Placebo (n = 22; placebo capsules 250 mg/day). After a 60-day treatment period, patients were reassessed. Results: IBK scores were decreased in both Black mulberry and HRT groups (p \ 0.05), but not in Placebo, after the experimental period. Four domains of SF-36 were improved in the Black mulberry group after treatment, compared to only one domain in TRH and three domains in Placebo (p \ 0.05). Biochemical profiles, oncotic colpocitology and colposcopy findings were similar between all groups (p > 0.05). Mastalgia and spotting occurred only among women exposed to HRT. Conclusion: The effects of Morus nigra L. leaf extract in climacteric symptoms were similar to HRT and superior to placebo. An additional improvement in quality of life and less side effects were also shown in patients treated with Morus nigra L. The effect of dark chocolate flavanols on cognition in older adults: a randomized controlled trial (FlaSeCo) Results: 100 (63% women) mean 69 years participated. They were highly educated mean 14.9 years (SD 3.6) and their health-related quality of life was good. Total cholesterol in whole group at baseline was 5.6 (SD 0.7) and after intervention 5.6 (SD 0.6). There were no statistically significant differences in changes in cognition between groups. Mean change (± SEs) in the time complete TMT A and B in intervention group was -4.6 (-7.1 to -2.1) s and -16.1 (-29.1 to -3.1) s and in controls -4.4 (-7.0 to -1.9) s and -12.5 (-22.8 to -2.1) s. Blood lipids, glucose levels, quality of life, depression and body weight remain unchanged. Conclusions: There was no effect of dark chocolate flavanols on cognition among healthy older adults in this study. Study also indicates that inclusion of dark chocolate daily in the diet had no harmful effects on blood lipids, glucose and body weight. Fractures related to OSteoporosis in Umbria: FROST-Umbria study Introduction: Standardized algorithms for estimation of fracture risk show low sensibility and specificity and remain unknown to general practitioners (GPs). This study aims to describe the prevalence of low bone mineral density (BMD), major fragility fractures, clinical risk factors and antifracture treatments in the general population visiting the GPs in Umbria region. Materials and methods: This is a prospective observational study conducted in persons aged 30 or more years, randomly selected from the database of GPs with a comprehensive evaluation including fracture risk, fracture history, diseases, drugs, functional status and lifestyle. Results: 1356 participants, mainly women (n = 756, 55%) with 63% (n = 847) of them aged more than 50 years. Low BMD was detected in 10% (n = 139) and history of fragility fractures in 9% (n = 109). Major clinical risk factors were female gender, family history, gait disorders and falls. Disease-causing bone disorders were detected in 5% (n = 7) and 9% (n = 10), drug affecting bone metabolism in 9% (n = 13) and 9% (n = 10) of persons with low BMD and previous fragility fractures. 56% (n = 62) persons with previous fragility fractures missed the diagnosis of low bone strength. Antifracture drugs and vitamin D are prescribed to 34% and 43% of persons with low BMD, but to 24% and 22% of those with previous fragility fractures and a combination therapy in 14% of persons with low BMD and 9% of those with a fragility fracture. Conclusions: Older adults are confirmed as high risk of fractures. The GPs should maximize the clinical judgment while using available algorithms. Fibrinolytic activity in metabolic syndrome or using anti-hypertensive medication), triglyceride level [ 150 mg/dl or HDL level \ 40 mg/dl in men and \ 50 mg/dl in women were accepted as MetS. Patients' biochemical parameters of follow up visits in the last month, were evaluated. Patient/control group were determined during 12 months. The serum of patients were stored at -800°C. PPARa, t-PA, PAI-1, tPA/PAI-1 complex and fibrinogen parameters were studied concurrently with ELISA technique. Results: No significant correlation was found between PPAR-alpha and fibrinolytic parameters in patients with MetS (p = 0.183). Significant associations were found between MetS and PAI-1, tPA, tPA/ PAI-1 complex and fibrinogen (p = 0.009/0.001/0.011/0.022, respectively). t-PA, t-PA/PAI-1 complex and PAI-1 can be used as markers (AUC:0.753, 0.717, 0.679 respectively) for evaluation of fibrinolytic activity in MetS. Fibrinogen and PPAR-alpha have low specificity and sensitivity. Conclusion: Fibrinolytic activity is increased in MetS, and t-PA, t-PA/PAI-1 complex and PAI-1 are more powerful predictors of this activity than others. Fibrinogen and PPAR-alpha weren't available as valid markers for this evaluation. Prevalence and predictors of subclinical micronutrient deficiency in German older adults: results from the population-based KORA-Age study Introduction: Subclinical micronutrient deficiency in older adults is associated with chronic age-related diseases and adverse functional outcomes. In Germany, the older population is at risk of insufficient micronutrient intake, but representative studies on micronutrient status in old and very old adults are scarce. Objectives: We estimated the prevalence of subclinical vitamin D, folate, vitamin B12 and iron deficiencies among older adults, aged 65-93 years, from the KORA-Age study in Augsburg, Germany (n = 1079), and determined associated predictors. Methods: Serum concentrations of 25-hydroxyvitamin D (25OHD), folate, vitamin B12, and iron were analyzed and compared to selected cut-offs for subclinical micronutrient deficiency. Predictors of subclinical deficiency were determined using multiple logistic regression analysis. Results: The prevalence of subclinical vitamin D and vitamin B12 deficiencies were high, with 52.0 and 27.3% of individuals having low 25OHD (\ 50 nmol/L) and low vitamin B12 concentrations (\ 221 pmol/L), respectively. Furthermore, 11.0% had low iron (men \ 11.6 lmol/L, women \ 9.0 lmol/L) and 8.7% had low folate levels (\ 13.6 nmol/L). Common predictors associated with subclinical micronutrient deficiency included very old age, physical inactivity, frailty and no/irregular use of supplements. Conclusion: Subclinical micronutrient deficiency is a public health concern among older German adults, especially for vitamins D and B12. The predictors identified provide further rationale for screening high-risk subgroups and developing targeted public health interventions to tackle prevailing micronutrient inadequacies among older adults. Exploring the views and dietary practices of older people at risk of malnutrition and their carers: the nutrition in later life study practice. There is little evidence on the views of older people and their carers regarding the management of malnutrition in the community. Aims: To explore the views and dietary practices of older people at risk of malnutrition and their carers, to identify gaps in knowledge, barriers/facilitators to eating, and to explore potential interventions to support nutrition in the community. Methods: Up to 40 semi-structured interviews with communitydwelling people aged C 75 years from general practices, identified as malnourished/at risk of malnutrition, and their carers. Thematic analysis is being used to identify key emergent themes and their meaning, with input from the research team including lay members. Findings: Early interview findings (n = 27) suggest that 'healthy eating' beliefs established in earlier life are maintained in later life. Some participants were aware of recent weight loss, reduced appetite or eating smaller portions, although they did not always understand why. Some reported reduced appetite and low energy which they considered part of normal ageing, whereas others attributed weight loss to acute illness, incomplete recovery following discharge from hospital, mental health issues and other conditions. Although only a few of them had discussed weight loss with their GP, many liked the idea of a nutritional intervention delivered in primary care. Some felt that the doctor was best placed to provide that support, whereas others would welcome advice from a nurse, dietitian or other trained professional. The importance of measuring nutritional status among elderly patients with previous cardiovascular disease in north-eastern of Romania Introduction: Of all the morbid conditions affecting the elderly, cardiovascular disease is the most common cause of mortality over which the subclinical nutritional deficiency often overlaps. Material and methods: The study group consisted of 481 elderly patients with a history of cardiovascular disease, divided into two groups, 319 patients with rhythm disorders and 162 without rhythm disorders, from the Geriatrics Department, ''Dr. C.I.Parhon '', Iasi. All patients were applied a questionnaire Mini assessment nutrition (MNA), validated screening malnutrition. Results and discussions: Age group shows a significantly higher percentage of people with malnutrition at the age of 75 years (76%; p = 0.011) and from 24% of people with normal nutritional status, 41.2% associate different degrees of obesity (p = 0,001).In the group with rhythm disorders, 59.2% of patients are at risk of malnutrition and 15.7% are malnourished. Similar percentages were also recorded in the group without rhythm disorders-60.5%, at risk of malnutrition and 15.4% malnutrition. Of those malnourished, 66.7% had rhythm disorders and 66.8% of patients with malnutrition risk had rhythm disorders (p = 0.995). Conclusions: Malnutrition and the risk of malnutrition among geriatric patients is a cardiovascular risk factor. Patients declared with a normal nutritional status through MNA and with obesity degrees require additional exploration to detect sarcopenic obesity. The absence of statistically significant percentage differences between the two studied groups allows us to affirm that malnutrition is not a direct factor for rhythm disorders. Relationship of nutrients intake to functional and cognitive status in community-dwelling and institutionalized older people: a casecontrol study Agnieszka Guligowska 1 , Małgorzata Pigłowska 1 , Tomasz Kostka 1 1 Department of Geriatrics, Medical University of Lodz, Lodz, Poland Objectives: The study is a case-control analysis of the relationship between nutrient intake, nutritional status and physical and cognitive functioning in two groups of elderly: community-dwelling (CD) and institutionalized (NH). Patients and methods: A total of 200 older subjects (aged 73 ± 10 years) from Lodz, Poland, participated in the study: 100 from nursing homes (31 men and 69 women) and 100 age-and sexmatched community-dwelling controls. Nutritional and functional status we assessed with Mini Nutritional Assessment (MNA), Mini-Mental State Examination (MMSE), activities of daily living (ADL) and Timed ''Up & Go'' test (TUG). The pattern of consumption of various nutrients was analyzed in detail. Results: There were no differences in energy intake but the NH group consumed significantly less animal protein, long chain poly-unsaturated fatty acids, dietary fiber, vitamins and minerals and more sucrose. According to MNA, only 19% had normal nutritional status (vs. 78% of CD group). Higher intake of sucrose and lower intake of protein, vitamins C, B6, B2, B3, folates, magnesium, iron, copper, phosphorus and potassium was associated with worse results in the ADL, TUG and MMSE tests. Conclusion: This analysis shows deeply unsatisfactory nutritional status and enormous deficiencies in the diet of institutionalized elderly. The observed relationships indicate the importance of intake of an appropriate level of protein, vitamins B and minerals, and limitation of sucrose intake. Stronger correlations in the CD group are likely associated with a greater diversity of their diet. A dangerous combination in geriatrics; obesity and malnutrition Aim: All societies, including Turkish society, are experiencing a dramatic growth in proportion of elderly individuals. Geriatric malnutrition and obesity are substantial health problems. The aim of this study is to investigate the prevalence of malnutrition and obesity in elderly individuals attending a geriatric outpatient clinic in Turkey. Methods: This study included 520 elderly patients. All patients underwent Mini Nutritional Assessment-Short Form (MNA-SF) test via face to face interview. The participants were divided into four groups, as follows: underweight group (BMI \ 22.0 kg/m 2 ), normal weight group (BMI 22.0-24.9 kg/m 2 ), overweight group (BMI 25.0-29.9 kg/m 2 ) and obese group (BMI C 30 kg/m 2 ). Results: The mean age was 71.8 ± 5.8 and 285 patients (54.8%) were female. 11 (2.1%) of them were underweight, 91 (17.5%) were normal, 193 (37.1%) were overweight and 225 (43.3%) were obese in conformity with BMI measurements. According to MNA-SF, 37 (7.1%) were diagnosed with malnutrition, 165 (31.7%) had a risk of malnutrition, and 318 (61.2%) displayed a good nutritional status. 68.7% of them were obese or at risk of malnutrition and 33.7% were both obese and at the risk of malnutrition. Conclusion: At least two of every three elderly patients exhibited malnutrition or obesity as a consequence of a disequilibrium in nutrition. To prevent malnutriton and obesity in old age, elderly patients should be evaluated comprehensively through several domains including assessment of medical, nutritional, or social statues, novel strategies should be found to promote physical activity through out the society and to raise awareness about the nutrition. Does adequate energy intake 2 weeks after discharge prevent weight loss and preserve ADL function eight weeks after discharge? Background: Disease-related malnutrition leads to poor appetite and decreased food intake. This affects the convalescence negatively in older adults after discharge from hospital. Objective: To compare the effect of adequate and inadequate energy intake 2 week after discharge on weight loss and ADL function when measured 8 weeks after discharge. Method: The study sample comprises two intervention groups from an RCT. Inclusion: Malnourishment or risk of malnutrition, 75+ years, home dwelling and living alone. Exclusion: Terminal illness, cognitive impairment and nursing home residency. At discharge, all patients received a diet plan covering their specific daily energy needs. Individualised nutritional counselling was given 1, 2 and 4 weeks after discharge. Based on patient reported data on daily food intake at week two after discharge, the patients were grouped into two groups (1) participants who had adequate energy intake (AQ) and (2) participants who had inadequate intake (IAQ). Weight loss and ADL was analysed using v 2 -test. Results: In our study, 111 patients were included 2 weeks after discharge (AQ = 48, IAQ = 63). Both groups had lost weight (AQ = mean 0.5 kg, IAQ = mean 1.6 kg), but in the IAQ group more patients had (p = 0.03). Mean ADL improved in both groups, but there was no significant difference between groups (p = 0.21). ADL deteriorated in 6% of AQ patients and 17% of IAQ patients (p = 0.06). Conclusion: Adequate energy intake 2 weeks after discharge from hospital may reduce weight loss. A trend towards maintained ADL was seen 8 weeks after discharge of patients who had adequate energy intake at week two. Systematic review of non-pharmacological interventions to prevent or treat malnutrition in older people. The SENATOR (ONTOP series) and MaNuEL Knowledge Hub project Andrea Correa-Pérez 1 , Iosef Abraha 2 , Antonio Cherubini 2 , Avril Collinson 3 , Dominique Dardevet 4 , Lisette CPGM de Groot 5 , Marian A. E. de van der Schueren 6 , Antje Hebestreit 7 , Mary Hickson 3 , Javier Jaramillo-Hidalgo 8 , S190 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Introduction: Systematic reviews (SRs) on malnutrition suggest that energy and protein intake can be improved, but results for functional or clinical outcomes have been inconclusive. Following the ONTOP methodology, we aimed to perform a review of SRs of non-pharmacological interventions in older patients with well-defined malnutrition using relevant outcomes agreed by a broad panel of experts. Method: SPubMed, Cochrane, EMBASE, and CINHAL databases were searched for SRs. Primary studies from those SRs, in any setting, were included. Quality assessment was made using Cochrane and GRADE criteria. Results: Nineteen primary studies from seventeen SRs were included. The most frequent intervention was oral nutritional supplementation (ONS) compared with usual care (11 RCTs). Meta-analysis was only feasible for six studies assessing changes in body weight (BW) and two studies for body mass index ( We used v 2 test to search a significant difference in the number of patients who received IVI between the 2 groups. Secondary, we selected 35 patients rehospitalized versus 35 non-rehospitalized with individual matching on the same 9 factors and also IVI administrations or not. We used v 2 test to search a significant difference in the presence of ID between the 2 groups. Results: ID supplementation with IVI in GRCRU patients reduced significantly the risk of 90-day rehospitalization after discharge from hospital (p = 0.0008).There is no significant difference in ID prevalence among the 2 groups (p = 0.23). Conclusions: The diagnosis of ID and its supplementation with IVI improve the prognosis of elderly hospitalized patients. It would be interesting to develop, standardize and systematize this care. Association of polypharmacy with nutritional status and daily living function in older outpatients Kaori Kinoshita 1 , Shosuke Satake 1 , Shuji Kawashima 1 , Keiji Nishihara 1 , Hidetoshi Endo 1 , Hidenori Arai 1 1 National Center for Geriatrics and Gerontology, Obu, Japan Introduction: To determine the association of polypharmacy with malnutrition and functional ability in daily lives among older people. Methods: Subjects were 396 independent outpatients of National Center for Geriatrics and Gerontology, Japan, aged C 65 years who had not been diagnosed as dementia. We assessed nutritional status using the short form of mini nutritional assessment (MNA-SF) and evaluated daily living function with Kihon-Checklist (KCL). Polypharmacy status was categorized as non-polypharmacy (0-5 drugs), polypharmacy (6 + drugs). We used ANCOVA and Logistic regression model to analyze the impact of polypharmacy on MNA-SF and KCL. Results: We identified 157 patients as polypharmacy. The MNA-SF was significantly lower in the polypharmacy group than in the nonpolypharmacy group (9.8 ± 2.9 vs 10.6 ± 2.6, respectively; P = 0.005). Polypharmacy was significantly associated with unintentional weight loss (C 2 kg/6 months) by logistic regression analysis [odds ratio (OR) 1.6, 95% confidence interval ( Introduction: Water is vital for biochemical processes to activity of the human body. Ageing is associated with many changes in the homeostatic systems involved in the regulation of water and electrolyte balance. This review provides an overview to relevant literature on fluid balance problems of older people. Methods: A literature search (2000) (2001) (2002) (2003) (2004) (2005) (2006) (2007) (2008) (2009) (2010) (2011) (2012) (2013) (2014) (2015) (2016) (2017) (2018) was carried out, using MEDLINE, Pub Med, Science direct, Scopus, Cochrane library, Turkish Medical Index and related intuitional websites. All references including researches or reviews were included in this search. Results: In the relevant literature, there are many references addressing fluid and electrolyte balance problems of the elderly people. Age-related physiological changes predispose elderly people to fluid imbalances which can cause morbidity and mortality with causes ranging from physical disability restricting access to fluid intake to iatrogenic causes including polypharmacy and unmonitored diuretic usage. Dehydration is the most common fluid and electrolyte problem among the elderly. Older adults are also susceptible to water retention and related electrolyte abnormalities. Key conclusions: As fluid imbalances in the elderly are associated with poor health outcomes, including increased risk of disability and mortality, prevention may improve health, functional status, and quality of life. Staff in institutions should be careful about the hydration status of any elderly people. Improved awareness, diagnosing and managing are important among health care providers to prevent fluid balance problems in elderly people. A social network intervention to promote diet quality in older adults: a pilot study Introduction: Higher diet quality (greater consumption of fruits, vegetables, wholegrain cereals) in older people is associated with better health. Social factors, such as social support, social networks and participation in activities, have been linked with higher diet quality in older people. This pilot study describes the implementation and evaluation of a social networking tool (GENIE-Generating Engagement in Network Involvement), which facilitates engagement with local support resources and activities. Using a randomised control trial design, the study aimed to assess the impact of GENIE on diet quality in a group of older community-dwelling adults with Chronic Obstructive Pulmonary Disease (COPD) and to compare changes with those in a control group. Methods: Twenty-two men and women [mean (SD) age 71.7 (6.7) years] were recruited from a local COPD Service. Diet was assessed by administered food frequency questionnaire; diet scores were calculated to describe diet quality at baseline and follow-up [median follow-up time in months (IQR) 3. Conclusions: These data indicate potential for beneficial effects of GENIE on quality of diet among older adults. It is not clear why diet quality declined among control participants during the study. Further evaluation in a larger group is needed. Cross-sectional study on prevalence of functional dyspepsia in community-dwelling older people Introduction: Chronic unexplained epigastric pain or burning, or postprandial fullness or early satiety, labeled as functional dyspepsia (FD), is a common disorder in older people which adversely impacts the quality of life. Methods: In cross-sectional study 300 community-dwelling older adults were questioned. We analyzed the following variables: gender, age, food, drugs, satisfaction with health status, most common symptoms of FD and SODA (severity of dyspepsia assessment) questionnaire. Results: FD symptoms were identified in 96 (31.9%) cases. There is no statistically significant difference in prevalence of dyspepsia between male and female (p = 0.128) and no correlation between age and FD symptoms (p = 0.276). Our findings show that there is relationship between FD symptoms and satisfaction with health status. Statistically significant is the satisfaction with its current state comparing healthy (8.68 ± 0.23) and FD people (5.99 ± 0.22) (p \ 0.01). Patients with FD are more likely to feel slightly unwell than healthy subjects (p \ 0.01). 18 (18.8%) of FD patients think that their symptoms are related to drug use. Patients with FD more often experienced symptoms related to drug use than healthy subjects (p \ 0.05). Also 80 (83.3%) respondents of FD patients think that their symptoms are related to consumed food. The observed difference is statistically significant between healthy and FD patients (p \ 0.01). Conclusions: Prevalence of dyspepsia was recorded for one third of older adults. There is no statistically significant difference in prevalence of dyspepsia between gender and age. And there is statistically significant relationship between FD symptoms and food, drugs use, satisfaction with health status. The prevalence of metabolic syndrome and lifestyle factors among community living older adults in iceland: cross-sectional study Introduction: Dysphagia is estimated to affect 50-70% of acute stroke patients [1] . In the acute phase, dysphagia management Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 S193 commonly centres on compensatory measures such as diet and fluid modification [2] . Fluid thickener is one such compensatory measure. Two varieties of thickening products are available-starch-based and gum-based. The gum-based product has seen growing use secondary to reported shortcomings of starch-based products, such as poor stability, product becoming too thick over time or becoming thin on contact with salivary amylase, and ambiguous instructions [3] . Method: Starch-based and gum-based thickening products were trialled on the acute stroke unit at two different time periods. During each period, drinks available to patients (at their bedside) were rated by a qualified SLT for their compliance with specific fluid consistency recommendation. Results: Total of 22 assessments were carried out. Compliance of the starch-based product was found to be poor; only 11% of drinks rated as appropriate to patient's specific SLT recommendation. The gumbased product was found to have improved compliance with 92% of drinks rated as appropriate. Conclusion: This audit demonstrates there is high incidence of patients with dysphagia receiving inappropriate fluid consistency due to poor stability of starch-based thickening products and gum-based product is likely to improve the compliance of recommended fluid consistency. Muscle mass, strength and physical function are known to decline with age. This is associated with the development of geriatric syndromes including sarcopenia and frailty. These conditions are associated with disability, falls, longer hospital stay, institutionalisation, and death. Moreover, they are associated with reduced quality of life, as well as substantial costs to health services. Dietary protein is essential for skeletal muscle function. Older adults have shown evidence of anabolic resistance, where greater amounts of protein are required to stimulate muscle protein synthesis. Research shows that resistance exercise has the most beneficial effect on preserving skeletal muscle. A synergistic effect has been noted when this is combined with dietary protein, yet studies in this area lack consistency. This is due, in part, to variation that exists within dietary protein, in terms of dose, quality, source, amino acid composition and timing. Research has targeted participants that are replete in dietary protein with negative results. Inconsistent measures of muscle mass, muscle function, physical activity and diet are used. The plasticity and diversity of the gut microbiome and its metabolome represent exciting future prospects for personalised medicine. The gut microbiome is substantially altered with ageing and the development of frailty. It remains an unexplored filter between diet and host physiology which may contribute to anabolic resistance. Research is needed on the role of dietary protein in muscle ageing and investigate the influence of the gut microbiome in relation to anabolic resistance, skeletal muscle mass and function. This review attempts to summarise these issues. Nutritional status among hip fracture unit patients in a Singapore's Hospital Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 frailty score (CFS), bone mineral density (BMD) and swallowing function assessment were retrieved from medical record. Results: 38 patients with mean age of 81 ± 10 years were studied. 65.8% (n = 25) was well-nourished, 26.3% (n = 10) was mild-tomoderate malnourished and 7.9% (n = 3) was severely malnourished. The mean BMI was 21.74 ± 3.30 kg/m 2 with 34.2% (n = 13) was found to have BMI \ 20 kg/m 2 . The premorbid energy and protein intake were 1347 ± 359 kcal/day (27 ± 6 kcal/day) and 42.2 ± 18.6 g/day (0.8 ± 0.3 g/kg/day) respectively which were lower than the recommended energy and protein requirement which were 30 kcal/kg/day and 1.0 g/kg/day. The mean serum 25-Hydroxy vitamin D level was 24.63 ± 9.92 lg/L with 73.7% (n = 28) had low serum 25-Hydroxy Vitamin D level (\ 30 lg/L). 63.2% (n = 24) had osteoporosis and 10.5% (n = 8) had osteopenia. The mean CFS was 5.03 ± 1.16 (mildly frail). 34% developed dysphagia after surgery. Key conclusions: One in three patients admitted to HFU was malnourished. One in three HFU patients developed dysphagia after surgery. High prevalence of osteoporosis and low serum vitamin D level were found among HFU patients. Comprehensive nutrition assessment and intervention, and routine swallowing assessment were warranted to optimize the recovery journey. Effect of oral nutritional supplementation in malnourished older adults in nursing-homes. PROT-e-GER study Introduction: To assess if oral nutritional supplements (ONS) improves the nutritional and functional status of malnourished residents. Methods: Prospective, multicenter observational study of people [ 65 years, who live in nursing-homes, in whom treatment is initiated with ONS (Fortimel Complete). Anthropometric (weight, height and BMI), nutritional scales (MNA) and geriatric assessment (Barthel, grip strength, MMSE) were recorded at the beginning and at 12 weeks. Results: We included 282 residents (85.4 ± 7.1 years, 67% women, MMSE 12 (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) . One hundred eighty-two participants were frail (65%); these were older (86.2 ± 7 vs 83.4 ± 7, p = 0.002), more dependent (Barthel 32 vs 70, p \ 0.001) and had a worse cognitive situation (MMSE 10 vs 14, p = 0.016).The results show that after 12 weeks of treatment there is an improvement in nutritional status (BMI basal 20.2 ± 3.0 kg/m 2 vs 12 weeks 21.2 ± 2.7 kg/m 2 , p \ 0.001) in functional situation [Barthel index basal 45 (15-70) vs 12 weeks 55 (20-80) p \ 0.001] (basal hand grip strength 11.9 ± 7.2 kg vs 12 weeks 14.0 ± 7.2 kg, p \ 0.001). The improvement in nutritional status is most evident in subjects in the lowest quartile of BMI (B 18.3 vs C 24.4 kg/m 2 ) (delta-BMI 1.3 ± 1.2 kg/m 2 in lower quartile, vs 0.0 ± 2.0 kg/m 2 in the highest quartile), while hand grip strength improves uniformly throughout the sample (delta HG-strength 1.3 ± 2.3 kg in lowest quartile vs 1.5 ± 7.4 kg in highest quartile). Key conclusions: ONS is associated with an improvement in nutritional and functional status at 12 weeks in malnourished residents, as shown by the BMI, Bathel and hand grip strength improvements. The ESPEN 2015 malnutrition consensus criteria for elderly people how effective screening at malnutrition? Introduction: Prevalence of falls is rising with age. Sarcopenic loss of muscles is a risk factor for falls in aged people. Sarcopenia is also acknowledged to be associated with dysphagia and dysfunctional chewing ability. Until now, however, it has remained unknown, whether impaired oral health might be associated with an increased risk of falling in geriatric patients. Methods: An interdisciplinary (geriatrician, surgeon, dentist) clinical controlled trial was performed on 40 geriatric in-patients [28 orthogeriatric patients with fall history versus 12 geriatric non-fallers (women 73%, mean age 83 ± 7)]. Study parameters comprised geriatric assessment results, parameters of oral health and quality of life as well as laboratory parameters of red blood, liver, kidney and thyroid gland. Results: Several oral health parameters revealed differences between groups: dysphagia (p = 0.043), impaired tasting abilities (p = 0.006), and dysphagia because of dry mouth problems (p = 0.013). Patients with fall history showed associations between subjective dry mouth and dysphagia (Spearman's rho = 0.5, p \ 0.05), unstimulated salivation rate and dysphagia (r = 0.4, p \ 0.05), and between stimulated salivation rate and prostheses hygiene (r = 5, p \ 0.05). Key conclusions: Oral health parameters such as dysphagia, tasting abilities, dry mouth and oral hygiene have an impact on fall probability among geriatric patients. Our results may help to raise awareness for occurring problems in the other disciplines and help to establish new interdisciplinary risk assessments in order to achieve and maintain the best possible quality of life for geriatric patients. Informal carers' experiences of identifying and managing oral pain and discomfort in community dwelling older people living with dementia Paul Newton 1 1 University of Greenwich, London, UK Introduction: Increased prevalence of dementia and poor oral health in older people is associated with an increased number of people living with dementia who experience oral pain and discomfort. Little is known about how oral pain impacts on people living with dementia in the community and their carers. This study aimed to explore informal carers' experiences of identifying and managing oral pain and discomfort in people living with dementia, and barriers and enablers they encountered. Methods: Focus groups with of informal carers of people living with dementia were conducted, transcribed verbatim, and analysed using thematic analysis. Results: Carers' accounts suggested that day-to-day contact was required to identify oral pain and discomfort, and a symptomology of the signs and symptoms was developed. Carers' accounts also highlighted problems in maintaining oral health, difficulties in accessing the mouth, managing dentures, competing demands, and difficulties in accessing treatment due to health service-, behavioural-and treatment-related barriers. Enablers included informal carers' pivotal role in the identifying and managing oral pain and discomfort in people living with dementia. Conclusions: Partnership work with dental professionals and carers, and clearer care pathways are needed to meet the oral health needs of people living with dementia who experience oral pain. An oral health screening and intervention program for older patients in acute care Introduction: Poor oral hygiene among older people has a marked effect on general health and wellbeing. Older age is often associated with an increased prevalence of dental caries, periodontal disease, dry mouth, fungal infections, ulceration and oral cancer [1] . The admission of an older person to an acute care hospital is an important point of care for enabling health screening. The aim of our study was to institute an oral health screening program by volunteer oral hygienists as part of a comprehensive care program. Methods: As part of the Hospital Elder Life Program [2] , frail older patients at risk for delirium and functional decline are provided volunteer support to maintain cognitive function, nutrition and hydration, and mobility. As an addition to this program, volunteer oral hygienists visited the patients, administered an oral health questionnaire, performed an oral examination and cleaning of dentures, and advised patients regarding ongoing oral health care. Results: A total of 100 patients over the age of 65 years hospitalized in acute care internal medicine departments at the Rambam Health Care Campus were visited by volunteer oral hygienists. Clinical findings included a coated tongue (30%), redness of the mucosa (20%), gingival swelling (18%), plaque accumulation (48%), and poorly-maintained dentures (34%). Staff and patient satisfaction with the visit and advice of the oral hygienist was high. Introduction: It is well known that there is an association between oral health and geriatric syndromes including malnutrition as well as chronic systemic illnesses. The Multidimensional Prognostic Index (MPI) predicts short-and long-term mortality in older subjects and has been validated for several acute and chronic diseases. The aim of this study is to identify associations between MPI and oral health. Methods: This study begun December 2017 and will include about 100 older subjects aged 65 or older hospitalized in a large German hospital. Besides a comprehensive geriatric assessment (CGA) and prognosis evaluation by means of MPI, an initial assessment of oral health is performed. To identify the oral health quality of life the Geriatric/General Oral Health Assessment Index (GOHAI) is used. To assess the current oral health status the Kayser-Jones Brief Oral Health Status Examination (BOHSE) and a specifically designed questionnaire including ''Decayed, Missing, and Filled Teeth-Index'' (DMFT) are used. After 6 and 12 months a reevaluation of dental diseases and use of dental treatment will be performed. Results: Until now, 34 patients (22 M, 77.8 ± 6.0 years, 12F, 73.2 ± 6.2 years) have been recruited. First results show a slightly positive correlation of MPI values to DMFT Index (q = 0.36, p [ 0.05) and a negative correlation to GOHAI Sum Score (q = -0.55, p \ 0.05). More results are expected in July/August 2018. Conclusions: MPI might correlate to oral health status and oral health quality of life. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Results: Geriatric orofacial changes occur in both hard and soft tissues. In either case, one of the inevitable consequences is oral malodor. Not only bacteria are the cause of bad smell noticed in the mouth. The destruction of proteins and sulfur-containing compounds on the tonsils and tongue surface can also cause bad odor in the mouth. One of the common complaints in the elderly is the mouth dryness (xerostomia) and it is an important source of oral malodor. Burning mouth syndrome is another cause of oral malodor in elderly individuals. The significantly relation of oral malodor and the accumulation of bacterial plaque on the tongue, oral dryness, burning mouth, and overnight denture wear is shown by Nalcaci and Baran (2008). Incorrect restorations, and implants, are another important cause of oral bad breath in the elderly. Key conclusions: Periodic intraoral and restorative controls should be done frequently and carefully in the elderly. In the elderly, oral malodor can be prevented by carefully controlling with physician and dentist. Viewpoint of dental care and mealtime care accompanying dementia progression. Ayako Edahiro 1 , Hirohiko Hirano 2 , Shuichi Awata 1 1 Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan, 2 Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan Objectives: Eating and swallowing dysfunctions are caused by progression of dementia. We examined the eating and swallowing dysfunctions in elderly peoples with Alzheimer's disease (AD) on the basis of FAST. Methods: Subjects included 175 elderly AD patients requiring care in Japan. The subjects' average age was 86.6 ± 6.1, and included 29 males and 146 females. Subjects underwent vital function tests (selffeeding assessment, screening test for swallowing dysfunctions, oralfunction assessment was included), cognitive assessment (ex. FAST), and a basic information survey. All data was classified by FAST and analyzed with SPSS ver.22 (IBM) for eating and swallowing dysfunctions. The protocol for the present study was designed in accordance with the Declaration of Helsinki. Results: Self-feeding assessment showed that eating difficulty occurred from the FAST6e stage (p \ 0.001). Signs of dysphagia, became pronounced especially after FAST7a (p = 0.042), and the dysphagia screening test with a stethoscope showed choking and/or wet hoarseness sounds in the pharynges increased after FAST6e (p = 0.022). Prominent difficulty in rinsing became apparent after FAST7b (p \ 0.001), and difficulty in gargling was seen after FAST6e (p \ 0.001). However, meal time lengthened (over 40 min) after FAST6b and was further lengthened (over 60 min) after FAST7b (p = 0.021). Conclusion: Eating and swallowing dysfunctions were greater with increasing severity of AD. These results showed that the decline in oral functions occurred after finding self-feeding dysfunction, difficulty in gargling and signs of dysphagia. It is necessary to offer predictive support for elderly patients with AD. We developed a viewpoint of dental care and mealtime care for Alzheimer's disease (AD). Oral hygiene status and blood biomarkers of cardiovascular and metabolic risk in elderly patients Objective: To investigate whether there is any correlation between the oral hygiene status and some blood biomarkers for cardiovascular and metabolic risk among elderly patients. Methods: A total of 201 individuals, of both genders and aged 60 years or over, were selected from an elderly community sample in São Luís, Brazil, and included in this study. A structured interview was carried out with the participants, followed by the visual evaluation of the oral cavity. The Simplified Oral Hygiene Index (OHI-S) scores were obtained and then categorized as follows: 0-1.2 = adequate; 1.3-3.0 = regular; 3.1-6.0 = inadequate. The cardiovascular/ metabolic risk biomarkers analyzed included total serum cholesterol, fasted glucose and triglyceride levels. A descriptive statistical analysis was used and the Pearson's correlation coefficients were calculated. Results: Most of the participants (78.1%) had not utilized dental services in the last year. Moreover, only 16.4% of them presented with adequate OHI-S scores. Still, a negative correlation between the number of years of study and OHI-S scores was shown (p \ 0.05). There was no statistically significant correlation between OHI-S scores and the values of total serum cholesterol, fasted glucose or triglyceride levels (p [ 0.05). Conclusion: In the present study, a group of elderly individuals presented with regular oral hygiene, which was correlated with their educational level. Cardiovascular and metabolic risk biomarkers were not correlated with the oral hygiene status. Area: Organisation of care and gerotechnology P-477 The elderly benefit when they join a social network Methods: A quality assessment and improvement study was conducted to assess the perceptions of members at a PACE. Information was collected on demographics, satisfaction, access to medical care, quality of medical care, strengths, and areas of improvements. Data was analyzed using paired 2-tail t tests. Results: The average age of participants was 74 ± 9. There were 8 males and 21 females. There were 20 Caucasian (includes Hispanic), 4 African American, and 5 unanswered. 14 participants lived at home by themselves and 15 lived with a family member. There was significant improvement in overall satisfaction after joining the PACE p \ 0.001 (living alone: p \ 0.001; living with family: p \ 0.01). There was significant improvement in access to a nurse p \ 0.001 (living alone: p \ 0.001; living with family: p \ 0.001) and primary care physician (PCP) p \ 0.01 (living alone: p \ 0.01; living with family: p \ 0.05). There was significant improvement in quality of medical care p \ 0.01 (living alone: p \ 0.01; living with family: p \ 0.05). The most common strength was friendly and caring community, while the most common area of improvement was the transportation schedule. Key conclusions: Members are significantly more satisfied overall, more satisfied with access to medical care, and more satisfied with the quality of medical care since joining the PACE. Living situation was an effect modifier for overall satisfaction, access to PCP, and quality of medical care. Vulnerability of Lithuanian older adults: potential users of gerontechnologies Introduction: According to statistical projections in 2060 each third (37%) Lithuanian will be an older adult. Demographic transition requires urgent solutions adjusting national health care system to the needs of an aging society. The quality and continuity of medical and social care should be ensured. Methods: The quantitative survey design was employed. Patients aged [ 60 years who stayed in a nursing unit for 90 days and longer participated in the study. The assessment was carried out on the day before their discharge. The interRAI Home Care Assessment System was applied for the assessment of the patients' independence level and care needs. In total, 100 patients were assessed. Results: Almost half of the discharged older patients (48%) had very weak cognitive abilities and 30%-moderately weak. The majority of patients (87%) did not have the abilities for meal preparation, 88%dish washing, house keeping and 89% managing of finances. 85% of patients on the discharge from the nursing unit were fully dependent on the nursing staff during bathing, 32% were in need of sufficient assistance during personal hygiene and 48% were bedridden. Conclusions: Low level of independence observed in older patients and their limited abilities for personal and daily living activities at the moment of discharge from the nursing unit evidence the need for home care service. Introduction: Accurate discharge summary documentation plays a crucial role in the continuing health care of patients discharged from hospital. The Academy of Medical Royal Colleges provides guidance on the structure and content of discharge summaries. Content required includes a social and functional assessment, a list of new diagnoses, and details of the patient's past medical history (PMH). Methods: We performed a baseline audit to assess Trust-wide performance, and then designed a series of measures (including FY1 year-wide teaching, and induction training for doctors during each rotation) designed to improve the quality of discharge summaries. We presented the project to the different specialties involved at their respective clinical governance meetings. We then designed a novel live-feedback system to help facilitate the improvements. This allows us to analyse discharge summaries on a monthly basis using a Plan-Do-Study-Act (PDSA) approach, and feed the results back directly to the doctors completing the summaries. Results: We audited 482 discharge summaries across 7 wards. Several aspects of were recorded poorly. Specifically, these were: social assessment (included in only 23%), PMH (50%), and a list of diagnoses (59%).Our first PDSA cycle was completed in February 2018. Subsequent cycles have seen our documented social assessments improve to 47%, and have shown improvements in the PMH and diagnoses documentation (to 82 and 65% respectively). Key conclusions: We identified several areas that are not being included in discharge documentation as required. We have designed a novel live-feedback system, performed monthly, that aims to improve the quality of this documentation. Hospital at home care for older patients with cognitive impairment: a protocol for a randomised controlled feasibility trial Introduction: An acute hospital admission is a stressful life event for older people, particularly for those with cognitive impairment. The hospitalisation is often complicated by hospital-associated geriatric syndromes, including delirium and functional loss, leading to functional decline and nursing home admission. Hospital at Home care aims to avoid hospitalisation-associated adverse outcomes in older patients with cognitive impairment by providing hospital care in the patient's own environment. Methods and analysis: This randomised, non-blinded feasibility trial aims to assess the feasibility of conducting a randomised controlled trial in terms of the recruitment, use and acceptability of Hospital at Home care for older patients with cognitive impairment. The quality of care will be evaluated and the advantages and disadvantages of the Hospital at Home care programme compared with usual hospital care. Eligible patients will be randomised either to Hospital at Home care in their own environment or usual hospital care. The intervention consists of hospital level care provided at patients' homes, including visits from healthcare professionals, diagnostics (laboratory tests, blood cultures) and treatment. The control group will receive usual hospital care. Measurements will be conducted at baseline, during admission, at discharge and at 3 and 6 months after the baseline assessment. The study findings will contribute to knowledge on the implementation of Hospital at Home care for older patients with cognitive disorders. The results will be used to inform and support strategies to deliver eligible care to older patients with cognitive impairment. Introduction: Accurate discharge documentation is critical in ensuring the safe handover of care from hospital to primary care clinicians. Our geriatric medicine department has a target of improving the quality of discharge documentation in our hospital. We have created a taskforce to overcome this challenge, and have learned some important lessons. Methods: Our first priority was to perform a baseline audit, and we successfully analysed 482 discharge summaries. We realised we could impact every discharged patient, and so we expanded our aims to include acute physicians and orthogeriatric surgeons within the remit. We designed a data collection tool that is simple to understand and collects 38 individual data points about each summary. We performed a survey of senior clinicians to identify the main areas to include. We designed a novel live-feedback system that allows us to provide direct feedback to the authors of the discharge summaries on a monthly basis. We designed a poster that allows us to identify required improvements in each clinical area. Results: We have seen an improvement in the quality of our discharge documentation, with an average of 65% of summaries containing required information (up from 44.2%). Having a multidisciplinary team, and involving our local Quality Improvement service, has allowed us to make more changes than we could individually. Key conclusions: The live-feedback system has proven useful in getting junior doctors engaged with the project. The local Quality Improvement service has allowed our project's data collection and analysis to improve beyond what we could initially perform. Introduction: Undernutrition is common among older hospitalized patients and nutritional status often declines during the stay. Undernourishment has serious negative implications for health and quality of life. Thus, nutritional support during hospital stay and follow-up care post-discharge is essential. Unfortunately, poor communication and coordination of nutritional information and care in transition between different levels of care is common. This study aimed to explore older patients' experiences of nutritional care during hospital stay and post-discharge and to investigate documentation of nutritional information in medical records. Methods: Semi-structured interviews with 15 older patients were conducted post-discharge. Inclusion criteria were documented nutritional risk or undernourishment (Mini Nutritional Assessment-MNA), age above 65 years and discharge to home care services. The interview guide focused on experiences of food, meals and nutritional care. Data were analyzed thematically. Eight hospital medical records were reviewed for nutritional documentation using a record investigation form. Results: Most of the patients were unaware their nutritional situation. They experienced lack of nutritional counseling and involvement in nutritional care both in hospital and at home. Not knowing the people from the care services made interaction with carers challenging. Unstructured and inadequate documentation of information in the medical records made it difficult to get an overview over the patients' nutritional situation. The results indicate lack of continuity of care and inadequate communication and involvement of elderly patients in their own nutritional health and care planning. Nutritional information was insufficiently documented in the medical records. Integrated Older adults in Iceland have a good access to the health care and social services that support elderly to maintain independent living. However, receiving informal care is common among older adults living in Iceland. The aim of this study is to analyze whether education is associated with the use of formal and informal care among older adults in Iceland. A survey of Icelandic older people was conducted including a national sample of 721 persons aged 65 years and older living in Iceland. Older adults living in nursing homes were excluded from the survey. The telephone survey included questions on socioeconomic status (education and occupation), social network, health status, activities of daily living, and the status of received help either from the community elderly care system and/or from close family members and friends. Among the total sample, 372 (52%) people reported to receive either type of care. Among those who received care, 197 (53%) people reported receiving informal care only. The status of receiving informal care had shown that people with higher education had a significantly lower risk to receive informal care compared with people with lower education [odds ratio (OR) 0.67, 95% CI 0.47-0.97, p = 0.031], however formal care was not significantly associated with education level. Informal care which is provided from the social network and family members are an important source for the elderly care system in Iceland. The contribution of informal care/help should be recognized when preparing the care of older people. After attending this session, participants will know about formal and informal care in Icelandic old adults. After attending this session, participants will know that receiving care is associated with education in Icelandic old adults. Prevalence and predictors of sleep disorders among institutionalized elderlies: a cross sectional study Mohamad Itani 1 , Ghassan Hamadeh 2 , Nabil Naja 3 S200 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Background: This is a cross section observational study, which aims to identify the prevalence of sleep problems/disturbances in an institutionalized population of elderlies living in a philanthropic chronic care center located in an upper middle-income country. Methods: The study involved 192 institutionalized elderly persons who have been living in the institution for more than 1 month. After filling an informed consent form, the participants were required to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire either on their own or by the nurses who take care of them. Our dependent variable was participants with a global PSQI score of five or more who were considered to have a sleep problem. The independent variables were demographic data, life style habits, current medical conditions and medications that were collected from the participants' medical files. Statistical analysis was performed using the SPSS software. Conclusion: Sleep problems is a major issue in elderly persons present in 75% of persons living in an elderly chronic care center in Lebanon. Its prevalence is underestimated by the nursing staff and under reported by the patients. Our study found an association between sleep problems and decreased level of activity, and the failure to pass either mini mental state examination or clock drawing memory tests. Alzheimer disease was positively associated with sleep problems, while schizophrenia was negatively associated with them. The chronic intake of proton pump inhibitors was the only drugs that approached statistically significant association with sleep problems in our analysis. Further randomized control studies are required to confirm our findings. The Methods: An audit was carried out at SVPR on patients over 65 years old who were administered fluids over a five day period. Documented information related to their fluid prescription was collected. A fluid prescription chart and its Standard Operating Procedure (SOP) document was then created by a focus group of doctors and nurses. Following staff education, the chart was piloted for 2 months on randomly selected wards. A re-audit was performed, discussions with stakeholders held, and final amendments made. The finalized protocol and chart were implemented in a staggered method until all wards of SVPR were included. A re-audit was then conducted. Results: The initial audit proved that there was barely any documentation on fluid prescription and monitoring. After implementation of the SOP and fluid prescription chart this improved dramatically. The focus group was instrumental in the creation of the SOP and chart, especially so in educating and promoting a culture change in the staff. Key conclusions: The importance of a fluid prescription SOP and chart to ensure safe fluid administration was made evident. The need for education and culture change when introducing a new concept to the hospital was also highlighted. Determining heart rate variability in elderly oncological patients using wrist-worn pulse wave monitor Introduction: Heart rate variability (HRV) has become an important marker for prognosis not only in cardiovascular, diabetic or renal patients, but also in oncological patients. Cancer is one of the most frequent disease in elderly and the need for proper treatment and care is increasing. HRV as an indicator of autonomic nervous system dysfunction is associated with cancer progression, cancer-related-pain intensity, cancer-related fatigue and even quality of life. This paper aims to determine an easy, noninvasive, low-cost method for determining HRV in elderly oncological patients. Methods: In this study we included patients over 65 years old with an established previous diagnose of cancer. To determine HRV using an easy, non-invasive, inexpensive method we compared a wrist-worn photoplethysmography (WWPPG) device to the classical ECG Holter. Also we wanted to determine the relationship between cancer progression and HRV and confirm HRV as a prognostic factor in oncological elderly patients. Results: Data obtained revealed that HRV parameters obtained using ECG Holter are comparable with HRV parameters obtained using WWPPG. WWPPG device can be used in elderly oncological patients in order to determine HRV. HRV can be, in certain circumstances, a prognostic factor in elderly patients with oncological disease. Conclusions: WWPPG is a new, easy to use, inexpensive, effective method in determine HRV in elderly oncological patients. HRV can be a parameter in establishing the prognostic in elderly oncological patients. Monitoring of malnutrition incidence among elderly according to age group through web-service NRS-2002/GeroS/CEZIH Background and Objective: Contrast-induced nephropathy is one of the leading causes of hospital-acquired acute renal failure (ARF). In less than 1 month two patients developed an ARF related to inappropriate administration of iodinated contrast media (ICM) in our acute geriatric unit. The objective of this case report is to analyse causes of these errors. Design: The 1st patient (81 years old) was hospitalized for a Light-Chain amyloidosis. During the hospitalization a CT scan of the chest/ abdomen/pelvis (CAP) was performed. An ICM have been injected by radiologist despite the creatinine clearance (ClCr) of 49 mL/mn and amyloidosis. Two days after the serum creatinine (SC) doubled and reached a peak of 456 lmol/L at day 4. Few days later the patient died of E. coli sepsis from a urinary tract infection. The 2nd patient (90 years old) was hospitalized for a pyelonephritis. Following lower gastrointestinal bleeding and alertness disorders a scanner of the CAP was requested. This CT was injected with ICM despite chronic renal failure worsening the known ARF (SC: 190 lmol/L day 1 to 237 lmol/L day 3). The patient died at day 5 because of a heart failure induced by the hyperhydration protocol established after the exam. Results: On both CT scan requests it was not specified not to inject ICM but the SC and CrCl were notified. For the 1st patient the CrCl was not excessively low (49 mL/mn) so ICM injection could be possible; however amyloidosis mentioned on the submission was a contraindication. About the 2nd patient the CrCl of 18 mL/mn was sufficient to contraindicate ICM administration. Conclusion: Benefit/risk ratio and alternative imaging need to be discussed between radiologists and prescribers when patient profile is at risk especially in geriatric population. Safety is the main priority; yet, process of care should be reexamined in a multidisciplinary way. We modified scan requests by adding a box to let the possibility to prescribers to inform that ICM is not wanted. Evaluation of motor abilities with aging using HD-sEMG and IMU data Introduction: Preliminary study obtained in older patients [1] by using the HD-sEMG and IMU techniques have shown that HD-sEMG descriptors related to muscular activity and the trunk maximum acceleration are discriminant with the age. The aim of this study is to characterize the motor abilities with aging, including middle-aged subjects and using new descriptors, by combining both techniques, embedded in a recent ambulatory portable device. Materials and methods: Nine subjects participated in the STS test. Three were aged 25 ± 2 years, four were aged 34.75 ± 3.09 years, and two were aged 57 ± 7.07 years. All of them performed sit-tostand motion 3 times at spontaneous pace. New features, were also tested in addition to previous descriptors [1] , in order to check their efficiency. For this purpose, 4 9 8 HD-sEMG grids were placed on the quadriceps muscle. Simultaneously, the trunk maximum acceleration was also measured. Thus, the results for the three age categories were statistically evaluated. The results showed that the statistical and also previous descriptors, tested on the three categories with ANOVA test, have a significant sensitivity to the motor efficiency with aging in the STS test (p \ 0.001***) in agreement with [1] . The obtained results demonstrated the potential of statistical and previous descriptors from HD-sEMG and IMU data recorded by an ambulatory device for evaluating functional motor abilities with aging. Acknowledgements: This work has received support from EIT Health BP2018. [1] EUGMS 2017 Congress, ''Evaluation of Motor Abilities in young and older subjects using HD-sEMG and IMU data'', IMRANI et al. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Physicians tend to consider the principal decision criteria to be less important after the training period. GPs express the importance of accessibility to specialists for additional advice in both 2014 and 2015; the distance between the patient's home and an adapted care facility and the interval before care begins are viewed as similarly important. Conclusion: Training and information sessions for physicians remain the most important tool for improving care practices. Such training strategies are more effective when carried out at the geographical scale at which the cancer professionals practice, allowing them to exploit their local organizational structure. The analysis of our data makes it possible to further integrate the patient into the care path, which remains a public health issue in terms of cost and organization. Cost-effectiveness analysis of a continuity care unit Introduction: Older people are at higher risk of re-hospitalization than other patients because of a higher frequency of polypathology, geriatric syndromes or social problems, but the association between repeated hospitalizations and the risk of occurrence of a new hospitalization has been less studied in this population. The objective was to analyze the relationship between repeated hospitalizations and the risk of new hospitalization in people aged 75 and over, after first hospitalization in medicine for an acute event. Method: Analysis by weakened survival models. The fragility approach is a statistical modeling concept that aims to represent heterogeneity in a study population caused by unmeasured covariates. In survival analyzes, which take into account the time elapsed before the occurrence of an event, these models make it possible to take into account repeated events over time. SNIIRAM-PMSI chain data on all persons aged 75 and over in the Valenciennois-Quercitain territory from 2014 to 2016 were used. These data contain all the information on hospitalizations (dates, durations, location, diagnoses) and deaths (hospital or home via the cross with CEPI-death). Results: Between April 01, 2014 and June 30, 2016, 28,496 patients were followed. The proportion of patients with at least one hospitalization is 73%. The use of specific models for the analysis of recurrent events, here successive rehospitalizations, demonstrate that the risk of re-hospitalization increased according to the number of previous hospitalizations. Conclusion: The risk of hospitalization is related to the presence of previous hospitalizations. The analysis of hospitalization by more concrete statistical models, allows a reliable approach and closer to reality. These models are necessary for the analysis of large databases. Elderly and technologies: between myths and reality Introduction: Currently, the picture of an old person using technology is still very negative. Indeed, it is often said that old people are not interested in technologies, can't understand their utility or have not the physical capacity to use them. These stereotypes can negatively influence the adoption of technologies with aging. Indeed, despite the increasing availability of new technologies for the benefit of old people, their use is currently extremely low. Methods: We therefore wanted to explore, through an online survey widely distributed in Wallonia (Belgium) (11,579 respondents), the perception and use of new technologies by the olders. Results: With regard to the use of technologies, analyses indicate that older people use the smartphone and the tablet less than younger. However, results show that this lower use does not appear to be related to an inability, but rather to the fact that people do not perceive it as useful (p \ 0.00). Furthermore, we note that the difficulties in using these technologies are relatively similar in the different age groups (41-50, 51-60, 61-70, 71-80, 81-90 years old) . The difficulties that can increase with age are generally related to the ergonomics of the device and not to a problem of sight (readability of the screen) or fine motor skills (writing with the touch keyboard). Conclusion: These data therefore seem to confirm that older people have the physical abilities to use new technologies and that they can be interested in them if they are useful and adapted to their needs. Impact of antibiotic stewardship program: a prospective audit and feedback study in a elderly's hospital Introduction: Quality care relies on identification of issues and moving current research into practice to address these issues through knowledge translation and implementation, to ensure people in the health and aged care system benefit promptly from the latest evidence. We describe the approach of a research institute, embedded in a large Australian health and aged care service provider, designed to underpin quality care of all older people using their service, and to build a knowledge base in this cohort. Method/process: Using a collaborative approach, older people, front line care staff, management and researchers work together to: identify and prioritise pressing issues; scope current evidence to address these issues; co-design interventions to be addressed with key stakeholders, building on the identified current evidence. The intervention is then piloted and evaluated, with adaptations made to the learnings before full evaluation. Results: A selection of current and past projects are presented: optimising diabetes management of older community-dwelling adults using remote consultancy, improving medication safety for home nursing clients through visiting pharmacist review, barriers to accessing services for older women living alone, and piloting a diabetes foot App. We discuss strategies for translating recommendations arising from the research into clinical practice, including the importance of relationships between the researchers, internal and external stakeholders. Key conclusions: Integration of researchers and research capacity into a health and aged care service provider, together with an inclusive co-design approach, has ongoing benefits for clients and residents, the staff, and more broadly, the health and aged care sector. Results: 409 subjects, mean age 81, were included. 65% had previous disability (22% Barthel Index score \ 40), 38% had dementia, 62% showed social distress. 54% of subjects was bedridden, 54% had important comorbidities, 13% active infections and 72% took more than 5 drugs. Delirium was present in 11% of sample at admission, while incident delirium was 12%. 70% of the sample underwent some kind of complications during stay; falls were 4%. Mean duration of recovery was 18 days; 56% of subjects was discharged at home while 28% was institutionalized; 8% was moved to ED and 0.2% died. At discharge 8% of patients shown behavioural and psychological symptoms of dementia (BPSD), 58% was able to walk, 32% had severe disability. Key conclusions: The population hospitalized in Geriatric IC is an example of society aging. Disability, comorbidities, dementia and social distress were highly prevalent and represent a challenge for health care. In these patients at discharge BPSD improved, one third of subjects regained walking ability. Our experience could help to improve strategy for disability's contraction and optimization of health care. Evaluating the benefits of connect house: an innovative step-down facility for patients awaiting care home placements Introduction: An innovative step-down facility (Connect House), under the shared ownership of community providers and local hospitals, was opened to address delays discharging patients awaiting care home placements. Comprehensive geriatric assessment (CGA) is provided by a multi-disciplinary team (MDT) including an onsite medical team and visiting Consultant Geriatricians. Methods: A retrospective case note review of 91 residents was mapped against metrics including MDT input, admission/ discharge Rockwood score, healthcare-associated morbidity, re-admission rates, advanced care plan (ACP) initiation and discharge destination. Results: All patients received a medical review. 83 (92%) patients saw physiotherapists, 82 (90%) social workers and 67 (74%) occupational therapists. At discharge, 17 (19%) patients improved their Rockwood score. 27 (30%) patients experienced delirium, 29 (32%) developed infections and there were 23 recorded falls. 16 of the 25 patients with pressure damage on arrival fully healed by discharge. A hospital re-admission was avoided on 95 separate occasions. ACPs were created for 21 (23%) patients. 9 (10%) patients were initiated on palliative care. 20 (22%) patients returned home, 50 (55%) were discharged to care homes, 17 (19%) were re-admitted and 4 (4%) died in Connect House. The mean length of stay (LOS) was 39.5 days. Conclusions: The coordinated CGA approach at Connect House led to patients improving functionally and returning home despite being highlighted in hospital as requiring long-term nursing care. The onsite medical team prevented re-admissions by addressing healthcare-associated morbidity, managing prolonged delirium and creating appropriate ACPs. Further work is required to identify factors that can reduce the LOS. Process evaluation of a complex intervention for optimizing appropriateness of prescribing in the nursing home setting (COME-ON study): focus on the interdisciplinary case conferences Introduction: The COME-ON study (Collaborative approach to Optimize Medication use for Older people in Nursing homes) assessed the impact of a complex intervention consisting of interdisciplinary case conferences (ICC, i.e. face-to-face medication reviews performed by an interdisciplinary team: general practitioner, pharmacist and nurse) supported by training and local concentrations [1] . Participants were requested to conduct three ICCs per nursing home resident (NHR) over a 12-month period. The process evaluation aimed to explore the implementation, mechanisms of impact and contextual factors that influenced the intervention [2] . Methods: Quantitative data on implementation were collected throughout the study period. Qualitative data were collected through multidisciplinary focus groups in 11 nursing homes (NHs). Results: 1675 ICCs were registered for 681 NHRs [median (P25-P75): 3 (2-3) per NHR]. Overall, healthcare professionals were satisfied with ICCs and perceived benefits for themselves. Their perception of the impact on NHRs varied from limited impact to positive impact in terms of number of medications or cost. Several barriers and facilitators to the implementation and the outcomes of the ICCs were identified. They related to: (a) the intervention (e.g. the face-to-face and interdisciplinary aspects contributed to the success of ICCs, despite organizational constraints); (b) HCPs (e.g. GP's attitude); (c) organizational level (e.g. presence of a leader); (d) external context (e.g. financial incentives). Key conclusions: Quantitative as well as qualitative data on experiences and satisfaction were essential to generate recommendations for Belgian policymakers on the future implementation of ICCs in NHs, for example in terms of frequency, format, prerequisites References: 1. Anrys P et al (2016) Collaborative approach to optimise medication use for older people in nursing homes (COME-ON): study protocol of a cluster controlled trial. Implement Sci 11 (1) LPZ is an annual international multicenter cross-sectional prevalence measurement of care problems on institution, department and patient level. Materials and methods: Measurement was done on November 2017 in 13 hospitals of Turkey. Patients C 65 years old were evaluated. This study was supported by Nutricia Turkey. Results: 298 patients were taken into the study (mean age 76.8 ± 7.9 years) from 13 hospitals. National/international guidelines were used for pressure ulcer (PU) in 100%, for urinary incontinence (UI) in 45.7%, for malnutrition (MN) in 91.6%, for falls in 100%, for restrictions in 57.5%, for pain in 87.1% and for delirium in 45.2% of the patients. PU risk was 73.5%, 12.8% stage C 1 PU and 6.4% nosocomial PU. Main interventions were active/reactive support surface, repositioning and moisturiser/barrier cream usage. 40.3% of the patients had UI. Main interventions were urinary catheters, medications, bladder training and inlay pads/underslips. 7.4% of the patients showed incontinence associated dermatitis. MN risk was 30.2% and 76 patients had dysphagia. Main interventions were energy/protein rich snacks, enteral feeding (12.8%) and parenteral nutrition (12.1%). Fall prevalence was 26.2% (nosocomial falls 9.1%) and restraints were used in 59 patients (53 mechanical, 14 physical and 16 pharmacological). 158 patients (53%) had pain. 47.3% received pharmacological treatment (paracetamol: 36.6%, NSAII: 10.1%, opioids: 11.4%, pregabaline: 5.7%). Delirium was diagnosed in 8.1% of the patients. Conclusion: Annual measurement of risk/prevalence, preventive measures and treatment interventions will provide better hospital care plans for elderly. Measurement of quality of care in elderly in Turkish Nursing Homes using LPZ tool LPZ is an annual international multicenter cross-sectional prevalence measurement of care problems on institution, department and patient level. Materials and methods: Measurement was done on November 2017 in 5 nursing homes of 3 big cities in Turkey. Patients C 65 years old were evaluated. This study was supported by Nutricia Turkey. Results: 680 residents were taken into the study (mean age 78.6 ± 8.0 years). National/international guidelines were available for only pressure ulcer (PU) in 100%, for malnutrition (MN) in 82.2% and for falls in 73.7% of the patients. PU risk was 55.3%, 2.2% stage C 1 PU and 1.9% nosocomial PU. Main interventions were active/reactive support surface, repositioning and moisturiser/barrier cream usage and heel suspension. 54.0% of the patients had UI and 26 patients (3.8%) had urinary catheter. 8.4% of the patients showed incontinence associated dermatitis. MN prevalence and MN risk were 14.6% and 17.6%. 93 patients (13.7%) had dysphagia. Main interventions were energy/protein rich diet, enteral nutrition (9.3%), parenteral nutrition (0.4%) and adjustment of meal consistency (18.4%). Fall prevalence was 14.3% (nosocomial falls 7.1%) and restraints were used in 280 patients (258 mechanical, 15 physical and 44 pharmacological, 28 psychological and 57 one-to-one supervision). 113 patients (16.6%) had pain. 19.1% received pharmacological treatment (paracetamol: 15.3%, NSAII: 3.4%, opioids: 0.7%, pregabaline: 2.5%). Sarcopenia was diagnosed in 445 patients (65.4%) according to SARC-F. Delirium was diagnosed in 1.2% of the patients (n = 8). Conclusion: Annual measurement of risk/prevalence, preventive measures and treatment interventions will provide better care plans for elderly. Effective communication between ward, pharmacy and patient is required to enable reliable flow through the discharge lounge Hassan Khan 1 , Arturo Vilches-Moraga 2 , Alison Blair 2 1 Manchester Medical School, Manchester, UK, 2 Salford Royal NHS Foundation Trust, Salford, UK Introduction: The purpose of a hospital discharge lounge is to provide a safe environment for patients to await medication and transport. With acute hospital bed occupancy in the English NHS running [ 90% and Emergency Departments consistently failing the 95% 4 h standard, pressure to maintain ''flow'' has concentrated focus on maximising discharge lounge use risking deterioration in patient care. Our aim was to understand the breakdown of time spent in the discharge lounge to optimise future development. Methods: Cross-sectional study of 88 patients attending the discharge lounge at Salford Royal Hospital during a week in April 2018. The patients were split into C 75 years and \ 75 years groups. Time for the various determinants facilitating discharge (prescribing and dispensing of medication, completion of discharge summary, awaiting transport etc) was measured. Results: 40 patients were aged C 75 years and 44 were \ 75 years. Mean time spent for patients C 75 years is 115.7 min with a standard deviation of 66.7 min; mean time spent for \ 75 years is 94.6 min with a standard deviation of 61.4. Mean time taken for pharmacy to be alerted to prescribed medication for dispensing is 67.7 min with a standard deviation of 97.3. Average wait for patients in the discharge lounge was 113 min if medication was prescribed before patient arrival, and 143 min if it was incomplete. Conclusions: The high variance of time spent in the discharge lounge supports completion of the discharge summary and improved communication between ward and pharmacy prior to patients' transfer to the discharge lounge. Introduction: Europe is challenged by a significant rise in 80+-year olds as well as expansion of morbidity in the coming decades. Yet, during the last decades hospital beds in most European countries have been reduced, and further reductions are anticipated. In Denmark, this mismatch is expected to be alleviated by digital health, and the introduction of acute community nurses (ACN). ACNs may act as 'frontline officers' for early identification in-home of older citizens at risk of acute admission. In collaboration with primary care physicians (PCPs) timely treatment may be initiated thereby potentially reducing acute hospital admission. Methods: The ''GERI-toolbox'' is a portable toolbox containing Point of Care Testing (POCT) tools, including blood testing, for inhome clinical assessment. Values are uploaded via mobile network (3G/4G) to a generic digital platform (GTP), accessible to treating PCP, ACN, and hospital physicians. Results: The GERI-toolbox was implemented March 1, 2018 in four Danish municipalities and is ongoing. Implementation has been challenging as it involves organizational changes and overcoming professional barriers. Yet, the GERI-toolbox has already become a success. Trained ACNs feel that their competences are appreciated, and the PCPs receive nurse reports of higher quality. Preliminary results are promising with respect of reducing acute admissions. The study ends December 31, 2019. Key conclusions: The GERI-toolbox likely supports early clinical decision-making and has the potential to prevent acute hospital admission of older citizens. The concept may be adapted to other health care systems in Europe and should be further evaluated in a future cross-national multicentre study. Choosing wisely: the French approach Introduction: ''Choosing Wisely'' is an international campaign led by scientific societies. It aims to reduce waste overuse in health care and avoid unnecessary tests and procedures by promoting patientphysician dialogue. Every scientific society drafts and communicates on 5 short recommendations to improve the appropriateness of care. Method: We will present the approach of the ''Choisir avec soins'' working group of the French Society for Geriatrics and Gerontology. We choose to work closely with a patients group and to operationalize directly our recommendations through a campaign addressed to geriatric wards to allow an evaluation of their practice. Result: The redaction of one recommendation has been given to the patient group, who decides to promote patient-physician dialogue on the level of care. Other recommendations concern screening for urinary tract infections, long term prescription of benzodiazepine, and antipsychotics for persons living with dementia. A recommendation on prescription review is currently being rewritten for more accuracy. We conducted two campaigns in 20 different wards, collecting data on 1036 patients. The results will be presented. Conclusion: Our dynamic approach allowed a strong collaboration with patients, a fast operationalization of recommendations, and a continuous adjustment to the context of care. The ENRICHME project was directed at development and evaluation of the impact of new solutions (including social robots) on supporting older people with mild cognitive impairment. The paper aims to present the results of a long-term (10 weeks) validation of the TIAGo robot (PAL Robotics, Spain) in the living environments of older persons in Poland. The validation was done with four persons (three women aged 66, 83 and 84 years, and one man aged 83 years); all of them had an ethnographic observation of qualitative parameters performed. The study also had a control arm (four subjects with standard care).All participants accepted the robot right after its presentation. They approached it with confidence, considered it safe and believed they could handle it with support from the ENRICHME team. They pointed out that (with the robot) there was someone to talk to at home, it was easier to cope with loneliness, and the house was more friendly. During the validation, participants were interested and engaged in various functions of the system. Their favourite option was ''cognitive games''. The reminders of medicines and appointments were also used on a regular basis, much like the dietary advice and healthy tips. The project confirmed that the TIAGo robot was real support for the participants, i.a. by increasing cognitive, physical and social activity. It also showed that it was essential to observe and monitor validations in the long term to realistically evaluate human-robot interactions, because of the confusion caused by the introduction of the robot. The role of volunteers in preventing hospital-associated deconditioning among older people: a feasibility and acceptability study Stephen Lim 1 , Kinda Ibrahim 2 , Richard Dodds 3 , Gayle Strike 4 , Mark Baxter 4 , Anne Rogers 5 , Avan Aihie Sayer 6 , Helen Roberts 7 1 Academic Geriatric Medicine, University of Southampton, Southampton, UK, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK, 2 Academic Geriatric Medicine, University of Southampton, Southampton, UK; NIHR CLAHRC Wessex, University of Southampton, Southampton, UK, 3 NIHR Newcastle Biome, Southampton, UK Introduction: Deconditioning is the physiological change associated with prolonged inactivity and bedrest. Low mobility levels among older inpatients is associated with increased risk of functional decline, institutionalisation and death. This study aimed to explore the feasibility and acceptability of training volunteers to encourage older inpatients to be more active. Methods: This pre-post study was conducted on acute medical wards for older people, using a mixed methods approach. Inclusion criteria included patients aged C 70 years who were mobile prior to admission. Two physical activity measures were used: the StepWatch Activity Monitor and GENEActiv. Volunteers were trained to deliver twice daily activity sessions which consisted of mobility and/or bedside exercises. Nurses, therapists, volunteers and patients were interviewed to determine the acceptability of the intervention. Results: 50 participants were recruited pre-intervention (mean age 87 years, SD 4.6), with a median daily step count of 626 (IQR 298-1468) and mean daily acceleration of 9.1 milligravity (SD 3.3). Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 16 volunteers were trained to deliver the intervention. 310 activity sessions were offered and 230 (74%) delivered. 50 participants (mean age 86.2, SD 5.1) received the intervention, with a daily step count of 912 (IQR 295-1824) and mean daily acceleration of 9.1 milligravity (SD 3.3). The intervention was well-received by patients. Staff members valued the help of volunteers in promoting increased physical activity among older inpatients. Key conclusions: Volunteers can be trained to deliver mobility and exercise interventions for older inpatients. A future controlled study is required to determine the impact of the intervention on patient outcomes. Intermediate Care in the framework of health care services for older persons: data from an Italian experience (Pisa) , from April 2017 to May 2018. ClinicaI, functional and social data were collected from medical records at discharge. Results: 205 subjects, mean age 79 and 55% women, were included. 96% of patients had previous disability (47% showing a Barthel Index score \ 40), 50% had dementia, 55% showed social distress. 84% of subjects was bedridden, 94% had important comorbidities, 65% active infections and 90% took polipharmacy. Delirium was present in 21% of sample at admission, while incident delirium was 5%. 25% of patients required artificial nutrition and 32% of the sample underwent some kind of complications during stay; falls were 2%. Mean duration of recovery was 11.5 days; 54% of subjects was discharged at home while 24% was istitutionalized; 10% was moved to Emergency Department and 6% died. At discharge 5% of patients showed behavioural and psychological symptoms of dementia (BPSD), 34% was able to walk, 81% had severe disability. Key conclusions: Between these older patients admitted to a Geriatric IC Unit, severe comorbidities, previous disability, polipharmacy, dementia and social distress were highly prevalent. At discharge, BPSD improved, one third of subjects regained walking ability but serious disability remained. This ''real word'' data could be useful to improve trajectories of public health planning. Potentially inappropriate prescriptions of antibiotics in older hospitalized patients: French experts' explicit definitions (a qualitative study) Context: Explicit definitions of potentially inappropriate prescriptions of antibiotics (antibiotic-PIPs) could provide an innovative approach to tackle antimicrobial resistance. In the field of geriatric medicine, it has been shown that explicit criteria for PIPs increase the appropriateness of prescriptions. A recent systematic review showed that explicit definitions of antibiotic-PIPs in older people have not previously been listed. Our objective was to develop explicit definitions of antibiotic-PIPs for older hospitalized patients. Method: We performed a qualitative study in accordance with the COREQ criteria (Consolidated criteria for reporting qualitative research), through focus groups involving French geriatricians and infectiologists. Audio recordings were transcribed then analyzed by two reviewers. Mentions related to explicit definitions were extracted and rephrased in definitions, which were classified according to the type of inappropriateness. The resulting list was corrected by an independent expert group and then validated by the whole focus groups participants. Results: Four focus groups involved 28 stakeholders; 22 (78.6%) had an antimicrobial stewardship activity. The analysis identified 96 explicit definitions: 63 (65.6%) corresponded to inappropriate choice of antibiotic, 17 (17.7%) to inappropriate use and 16 (16.7%) to overuse of antibiotics. Conclusion: Our study provides explicit definitions of antibiotic-PIPs, especially for older patients and public health challenges. This list will be refined through a Delphi survey to reach a consensus, which could deliver key messages for prescribers and open up new perspectives for the analysis of electronic healthcare databases to reduce inappropriate antibiotic prescriptions. Resource based active and healthy ageing as a product to finance long term community based care provision Stella I. Tsartsara 1 1 There is a need for healthcare policy coordination for various reasons. First, to scale up on-going innovative solutions adapted to a regional context to make sure as many people as possible can benefit from high value care services. Second, to reduce budgetary costs for Long-Term-Care (LTC) for elders at both regional and local level. This could get shaped by a sustainable funding model of social care whereby the finance of it is cut all over Europe, anchored to the organizational model at community scale, to assure the delivery of care in a sustainable manner, integrated into the administrative and institutional LTC setting of a region. This study proposal is inspired by the study ''Greece 2020'' suggesting a Greek National Strategy for Integrated Elderly LTC in Greece as opposed to in-hospital episodebased care, one of the 6 Rising Stars for Gross Domestic Product rise until the year 2020. This, however, is a challenge for most of the European Regions today specially in remote areas and in those EU countries with continuous cuts in social care. The research question: The primary research question at hand is: what is the potential of an innovative funding of ''Design-for-All Integrated LTC model'', to replace state and public LTC funding in EU Regions under economic crisis? The secondary research question is: How responsive is such a model to induce change in planning, organizing and funding LTC, in one pilot area of Greece? This pilot area is characterized by a reverse availability ratio of budgetary resources to the rising needs of elderly care in a co-morbidity context of an ageing population and a directly relevant ratio to the availability of resources to allow the necessary income to fund this LTC model. The current study will investigate what resources dispose some of the regions of Greece to create robust silver tourism services and products to fund a LTC model according to the needs of the pilot areas and what are the changes they should adopt, in organizational and LTC financing terms, to allow for cashable savings that would guarantee Return on Investment (RoI) and sustainability of the LTC provision at community level. A large part of this exercise concerns the mentality shift induced to the local actors to understand and endorse innovative funding in long term care run by own resources and not state funded. Study objectives: The main study objective is to assess the assets and needs for LTC in the selected Greek region and to construct a model that could sustainably finance LTC provision in the pilot area, via income generation from local economic growth, reinvested to fund LTC provision. The second objective is to observe the responsiveness of this model and how change in healthcare organization and funding is perceived by local authorities and how susceptible they are to that change. The specific objectives of this study are: (1) to map resources for local economic growth and the needs for elderly LTC of the selected municipality (pilot area); (2) to assess the costs and resources for the elderly LTC services integration in the area, the human and other resource capacity, the skills and needs for the LTC provision in relation to products or services (i.e. tourism) that would generate income from that model and guarantee the cashable savings of the investment return to sustain LTC provision. (3) Observation of the responsiveness of the model throughout the data collection and analysis and model preparation. Results: Initiating a innovative LTC financing model through Social Impact Investment in LMIC, requires the cooperation of all local actors and a consensus in revealing, valuating, and putting the income generated from the local resource at the service of public health through non profit trade and investment activities. The main obstacle was unawareness of innovation procedures in health financing that created reservation to express interest in the model of the present study, combined with a generally low developmental capacity of the municipal actors so as to exercise control over the assets of their community. Where this was the case, the local governor was not stronger from private interests that preferred to see the resource procured for profit making actions away from redistribution of the RoI at the service of public health, in this case long term care. On the contrary, where the municipality had prior experience from innovation procedures and had concluded successfully in the past such operations and business activities around the new models of care, the response was better and the commitment in the new learning process higher. In addition the cooperation with the private sector was managed in an inclusive way that streamlined RoI to public health purposes through the proposed model of this study. Education and awareness of LGAs in innovative LTC financing and organization procedures of new care models, are key for the local authorities to adopt change, since chronic care is primarily organized at community based level. Area: Acute care P-515 Gastrointestinal senile amyloidosis: a rare but relevant geriatric condition Methods: We present 2 female patients (age 82 and 88 years), who were admitted to our center for evaluation of chronic anemia with iron deficiency. One patient suffered from a previous endoscopic colonic perforation and was now readmitted for worsening anemia under oral anticoagulation due to atrial fibrillation. The second had unexplained iron deficiency and anemia for [ 1 year . Results: In both women on bidirectional endoscopy including capsule endoscopy no bleeding stigmata were identified. Iron resorption was normal. Endoscopic biopsies from the upper and lower gastrointestinal tract did show typical Congo-red staining in the perivascular submucosa. Further testing did not demonstrate any other typical organ involvement from amyloidosis. Laboratory analysis ruled out plasma cell disease, connective tissue disease and chronic inflammation. Symptomatic therapy is restricted to blood transfusion and iron supplementation. While amyloid deposits in the gastrointestinal tract lead to occult bleeding anticoagulation was stopped in the first patient. Conclusions: Although a rare manifestation of amyloidosis, staining for amyloid should be considered in elder patients undergoing gastrointestinal biopsy who have unexplained iron deficiency with anemia. Further diagnostic examination should focus on the type of amyloidosis. Therapy directs against the underlying cause or remains symptomatic in case of senile ATTR-Amyloid. Once a definitive diagnosis is made no repeat endoscopic exams should be performed given the high perforation risk in this patient cohort. Oral anticoagulation is relatively contraindicated. Parvovirus B19 infection in an 88-year-old woman: a case report Methods: We present a 88-year-old, home-dwelling women, who was admitted for jaundice, severe hemolytic anemia (haptoglobine \ 0.01 g/l, Hk 0.25) and huge hematomas of her upper limbs and her thighs without previous trauma. After exclusion of autoimmune and drug-induced hemolysis we found a primary infection with parvovirus B19 (positive IgM). Jaundice and hemolysis disappeared spontaneously. The hematomas were explained by an overdosing of phenprocoumon, subscribed for atrial fibrillation 3 years ago, following a higher absorption due to previous fasting and inappetence. Phenprocoumon was stopped. After IV application of vitamin K, PPSB and red blood cell transfusion the patient slowly recovered. Conclusion: In geriatric patients with acute onset of hemolytic anemia with ineffective erythropoiesis a primary infection with parvovirus B19 should be excluded. Multimorbidity and medication can worsen symptoms and outcome. An interdisciplinary approach may be helpful. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Introduction: Although trauma remains a leading cause of morbimortality across all ages, elder patients experience higher risk of severe disability and higher mortality than younger people since they are more susceptible to injury and more likely to take multiple medications, some of which may blunt their response to the physiologic stress of trauma. Case description: A 84 year old man presented to the hospital after a fall at home. He had a history of arterial hypertension and Parkinson disease and was treated with acetylsalicylic acid, levodopa and carbidopa. He had a Glasgow coma scale 15 and a nasal trauma with active bleeding and bone exposure. Cervical X-ray showed C4-C5 luxation and fracture of C5-C6 spinous processes, confirmed by CT scan. Four hours later the patient suddenly developed dyspnea and stridor progressing to cardiac arrest due to airway obstruction with blood. After 3 min cardiopulmonary resuscitation the patient was stabilized and admitted to the intensive care unit. One week later he underwent spinal surgery, after which he developed Acinetobacter baumannii pneumonia, successfully treated with trimethoprim-sulfamethoxazole. He was discharged 2 months later with a rehabilitation program. On follow-up evaluation 6 months after the fall the patient has quadriplegia and dysphagia. Surgical drainage of the epidural empyema was performed as well as knee arthrocentesis. The patient was given vancomicin and gentamicin for 6 weeks with clinical improvement and was discharged 3 months later. Methicillin-sensitive Staphylococcus aureus was isolated from three blood cultures, knee pus and epidural pus culture. Key conclusions: Successful treatment of subdural empyema usually requires a drainage procedure and antibiotic therapy for 6-8 weeks. With aging there is a progressive alteration of the immune system and its responses, resulting in immunodepression. This case illustrates the need to consider this rare but serious condition, even in the absence of a contiguous focus of infection or trauma/neurosurgery. A case of severe HSV gingivostomatitis in a previously immunocompetent septic shock elderly patient [1, 2] . In the ICU setting, risk factors for reactivation of HSV are: septic shock, Acute Respiratory Distress Syndrome (ARDS), used high dose steroids and abdominal infections [3] . Past studies have demonstrated that critically ill patients on high dose steroids are susceptible to developing viremia with HSV [3] . Case presentation: A 80-year-old male admitted with septic shock secondary to cholecystitis. He received high dose steroids for 9 days. On physical exam, he developed vesiculo-ulcerative lesions; extremely tender, hemorrhagic. The lesions were around perioral cutaneous tissue, vermillion border, buccal mucosa, gingiva, soft/hard palate, pharynx and tongue. Serum HSV-1 IgG antibody was [ 58 index and HSV-1 DNA level was 5043 copies/mL. He was managed with two weeks of IV acyclovir. As a result of a poor appetite due to excruciating pain in the oropharynx he required a gastrostomy tube feeding. The patient was discharged from hospital after clinical improvement. Discussion: Immunocompromised patients usually have atypical presentations [4] : more aggressive, extensive, slower healing painful lesions and prolonged infection leading to dissemination. Severe HSV gingivostomatitis leads to significant morbidity [4] , perhaps increased mortality in a previously immunocompetent elderly patient. To date no data studying use of prophylactic acyclovir in critically ill immunocompetent elderly patients (ie: comparing acyclovir prophylaxis vs wait-and-see strategy) [3] . Conclusion: Elderly patients with a critical illness who are seropositive for HSV might benefit from pre-emptive acyclovir. Introduction: There is growing interest in the complex health care needs of older people presenting to Emergency Departments (EDs). Geriatric Emergency Department (GED) guidelines provide recommendations on how to improve care for these patients. The aim of this study was to describe adherence to GED guidelines for older ED patients. Methodology: A prospective observational cohort study including ED patients C 70 years, during 2 months from 8 am till 11 pm. The following recommendations of the ACEP GED Guidelines were observed as a proxy for guideline adherence: use of urinary catheters, family presence, use of hospital bed instead of ED gurney and provision of food. The degree of a stressful environment was measured by counting the number of involved care providers and the number of door movements of the treatment room. Results: In total 998 older patients visited the ED, of which 605 (60.6%) were observed during their ED stay. Urinary catheters were used in 6.8% of all older patients. For 88.8% of patients family was present, 35.6% of patients were nursed on a bed and 7.4% of patients received food during their ED visit. The mean number of involved care providers was 8 (SD 3.7) and the median number of door movements was 41 (IQR 24-62). Conclusions: Geriatric Emergency Department Guidelines adherence is low. The use of urinary catheters and presence of family in the ED seems good, but there is room for improvement of hospital bed use, presence of food and stressful environmental factors. To make sure that routine care follows guidelines, interventions such as education programs and environmental changes seem necessary. During the conference this data will be compared with data after implementation of a system improvement program. Older patients' satisfaction with Emergency Department Care Introduction: The population of the UK is growing and people are living longer bringing extra strain on the health and social care system [1] . The NHS 5 years forward view and the Kings fund outlined the need to look at safe and appropriate alternative options to provide care for patients who otherwise would require hospitalisation [2] . In recognition of the problem, the Community Urgent Care Team in South Manchester was created to provide medical and social crisis care at home. Referrals are accepted from the community, A&E and hospital wards. This follow up study analyses the effectiveness of this intervention. Methods: All patients reviewed by the service in April to July 2017 were included in the analysis, which compared the number of admissions 6 months before and 6 months after the intervention. Results: 129 patients were reviewed in the 4 months. 78% of referrals were from the community therefore avoided patients presenting to A&E. Admission rates were reduced for 31% of people comparing 6 months before and after the intervention. Overall 65% of patients reviewed had no admissions in the 6 months post intervention, showing that patients stayed out of hospital rather than presenting at a later date. In addition, the service saved an estimated 18.5 bed days per month. Hospital functional deterioration was found in 35.48% of the patients and this was related to the nutritional alteration and delirium; of the patients did not have an adequate support network. The average hospital stay was 6.46 days and 13.34% of the patients attended corresponded to readmissions and suffered 9.26% complications. Conclusions: Encouraging the creation of geriatric services connected in a network that provides prevention and acute management of comorbidities can contribute to having an elderly population more independent and functional, in addition to saving health costs that allow the system a better distribution of resources. Our results are good when compared to the world literature and other centers-It then becomes an option to take into account in other institutions of the country that face a similar problem. Keywords: Aged, hospitalization, Acute Care, Hospital, Geriatrics Influence of health behaviors in the incidence of frailty Introduction: Frailty is a clinical state defined as an increase in an individual's vulnerability for developing adverse health-related outcomes. We propose that healthy activities could prevent the incidence of frailty. Methods: The Mexican Health and Aging Study is a nationally representative longitudinal study of Mexican adults 50 years or older with four waves of data collected so far. For the purpose of this manuscript, only the 2012 and 2015 waves are used. This study analyzes the association between health behaviors and incidence of frailty. Frailty was determined using a 39-item frailty index. Only respondents classified as non-frail at baseline (2012) were included in the analyses (n = 6087). Logistic regression models were used to assess the odds of incident frailty given the following health behaviors: exercise, vaccination, non-smoking, and screening activities. Confounding variables were included in the regression models. Results: At baseline, 55.2% of subjects were male and the mean age was 62.2 (SD ± 8.5) years, the incidence of frailty was 37.8%. Older adults that reported exercising in 2012 had a lower incidence of frailty in 2015 (48.9 vs. 42.2%, p \ 0.0001). From the activities assessed in the adjusted multivariate models, exercise was the only variable independently associated with lower odds of incident frailty (odds ratio of 0.79; 95% confidence interval 0.71-0.88; p \ 0.001). Conclusions: Older adults that exercised had a lower 3-year incidence of frailty, even when adjusted for confounding variables. This could be a strategy to reduce the incidence of frailty and its consequences. Acute stroke patients needing timely vascular interventions: a quality improvement project Introduction: Evidence has shown that Carotid endarterectomy reduces the 5 years absolute risk of ipsilateral ischemic stroke by 16.0% in patients with 70-99% carotid artery stenosis, and by 4.6% in patient with 50-69% stenosis [1] . We aim to refer symptomatic stroke patients with 50% or more carotid artery stenosis to the vascular surgery team within 1 week of symptom onset as recommended by the stroke guideline [2] . Methods: A clinical audit and re-audit was done over 2 years in a district hospital. Data were collected over specific period of time. The re-audit findings were compared to that of the initial. Results: A total of 220 patients were audited initially and 200 patients for the re-audit. There was 20% increase of carotid doppler scans done in 24 h, 4% increase in the quality of requests and 19% increase in compliance with time to referral to vascular surgeons within 1 week for stroke patients with significant carotid stenosis. 80% of referred stroke patients had carotid scans done within a week of symptom(s) onset as opposed to 69% from the initial audit. The results showed an improvement in time of carotid doppler scan testing and appropriate referral to the vascular surgeons within 1 week of acute stroke. We were able to achieve this by Nottingham University, Nottingham, UK Introduction: Some patients with dementia 'call out' repetitively whilst in acute hospitals. This persistent and disruptive vocal behaviour is widely believed to indicate distress or unmet need, but there is little empirical evidence about this problem in this setting. This study aimed to characterise the phenomenon, follow its natural history, and explore staff and family views on its causes and management. Methods: A mixed research methods case-series was undertaken of 30 older people who called out, across seven wards at two hospitals. We recorded baseline and ongoing quantitative measures of physical and mental health, undertook non-participant observations, family and staff interviews, and examined nursing documentation. Results: Participants had severe cognitive impairment (70% MMSE \ 10), poor functional ability, and 85% had delirium. There were high levels of disinhibition, anxiety, depression and pain. Mean length of stay was 29 days (compared with national age-standardised mean of 12 days). Within 3 months of recruitment, a third of participants had died, and more than half were readmitted. Staff stated that calling out indicated distress, and believed they could identify when there was a treatable cause. But they also believed that some cases were intractable, leading to avoidance of the patient, and potentially increasing the risk that 'real' needs will be neglected. Conclusions: Calling out is associated with severe cognitive and functional impairment and delirium. Health and nursing needs are high, and prognosis poor. Staff understand the theory of unmet needs, but may overestimate their ability to identify a cause. Acute geriatric daily board ward round (DBWR): a quality improvement activity (QIA) in a Tertiary Hospital, Singapore Changi General Hospital, Singapore, Singapore, 2 CGH, Singapore, Singapore Introduction: Inter-professional communication is the core of healthcare delivery and a key to an efficient in-patient care. Effective discharge encompasses efficient communication and teamwork amongst doctors, nurses and allied healthcare teams. A preliminary analysis of discharges from Geriatric Wards (GRM) showed that our readmission rates were high compared to non-GRM wards, along with a low ''before 1130 am'' discharges, (hospital wide initiative aims for discharges before 1130 am), primarily as a result of ineffective communication amongst teams. Methods Hence, a QIA visioning a safe, patient-centric discharge, to improve overall communication amongst teams; with a primary aim to improve discharges before 11.30 am and 30-day readmission rate, without an increase in mortality and average length of stay (ALOS), was conceived and implemented in our GRM ward; aided by Daily board ward round Introduction: Back pain is a common cause to attend the Emergency Department in elderly people. The differential diagnosis is varied, with a spectrum of pathologies of major and minor severity. Case report: A 68-year-old men was admitted due to two days history of constant left back pain, with increasing intensity and irradiation to the left upper quadrant of the abdomen. On physical examination he had no fever, was hemodynamically stable, with pain at the deep palpation of the left hypochondrium. Blood workup revealed leukocytosis (15.7 9 10 4 G/L) and lactate dehydrogenase elevation (585 U/L). Chest X-ray showed left pulmonary base hypotransparency. Abdominal ultrasound revealed a splenic nodular mass, heterogeneous, with 10 cm and, left pleural effusion. Several complementary diagnostic tests were performed, including a thoracoabdominal-pelvic CT scan showing multiple celiac and lomboaortic adenophaties, the largest with 9.5 cm and, a splenic mass of 13 cm. The biopsy of the splenic mass was inconclusive. Due to the patient's clinical worsening and mass growth, a splenectomy was performed. Histological exam revealed a diffuse large B cell lymphoma (DLBCL). He started treatment with rituximab-cyclophosphamide, doxorubicin, vincristine and prednisone, with clinical improvement. Conclusion: DLBCL is the most common histologic subtype of non-Hodgkin lymphoma (25%). There is a male predominance (55%), with median age at presentation of 64 years. Patients typically present with a rapidly enlarging symptomatic mass. DLBCL is curable in approximately half of cases with current therapy, however advanced age, poor performance status, and lower socioeconomic status are associated with worse outcomes. A rare cause of hemolysis Anaemia is a common finding in hospitalised elderly patients. Apart from frequent causes like gastrointestinal bleeding, major surgery and primary or secondary bone marrow dysfunction, hemolysis is one of the reasons that should be excluded. Here, we present an 83-year old woman that presented with increasing anaemia after recent hip surgery. Surprisingly, her laboratory results showed evidence of ongoing hemolysis. Further diagnostic work-up revealed acute hypothyroidism and ultrasound showed signs of thyroid inflammation consistent with Hashimoto thyroiditis. After excluding alternative causes we treated the patient successfully with steroids and thyroid hormones. In conclusion, this case emphasises the need to thoroughly assess the often multifactorial aetiology of anaemia in elderly patients and highlights that autoimmune disease may manifests for the first time in this age group. In general, it has to be considered that the prevalence of anaemia is high and that manifest thyroid dysfunction is rare, as shown in our patients in an arbitrarily chosen month. Sedative-hypnotic initiation and renewal at discharge in hospitalized older patients: an observational study A joint Wythenshawe Hospital and red cross innovation reduces reattendance and readmissions extend the operational hours of the service and an additional donation from a separate donor to provide a weekend admissions prevention service for patients who attend regularly due to loneliness and isolation. Safely reducing admissions in frail older people presenting to Emergency Department (ED) Lara Whitmore 1 , Bettina Wan 2 1 UCL, London, England, 2 UCLH, London, England Introduction: Older people have higher rates of attendance to ED and are more likely to be admitted. An interface service that safely reduces admissions in this group could alleviate pressures in hospitals and ensure that the right care is delivered in the right place. To develop this service we need to quantify the patients with health and social needs that could be met in the community. Aim: To assess the number of frail older people presenting to ED who could be safely discharged. Method: Two independent clinicians from the geriatric multi-disciplinary team screened 447 patients aged C 75 who presented to ED over 19 days. 256 of those who could be assessed were deemed frail based on a Clinical Frailty Score C 5. A joint decision was made to see whether patients could safely be discharged with alternatives for admission to hospital. This showed the proportion of avoidable admissions. Results: 67% of patients C 75 admitted from ED were found to be frail. 65% of these patients were admitted. 23% of these admissions were potentially avoidable if urgent medical follow up, intermediate care units and/or community support were available. Discussion: This study highlights the prevalence of frailty among elderly ED attendees. It also suggests that admissions can be avoided by the involvement of specialised clinicians, using admissions alternatives. This data, along with other data we have collected on the health and social characteristics this group of patients, has guided a 50 patient pilot study of an acute geriatric service in ED. Geriatric population features in a stroke hospitalization context Introduction: Blunt chest injury is thought to be an underdiagnosed condition in elderly patients presenting following minor trauma. Low energy mechanisms of injury can often lead to significant rib fractures and respiratory compromise in the geriatric population. Mortality from blunt chest trauma can be as high as 60%, with elderly patients known to have poorer outcomes. The aim of this review was to analyse the types of thoracic injuries being admitted to our unit and to identify predictors of poor prognosis and mortality. Methods: Data collected retrospectively on all patients over the age of 70 admitted with blunt chest trauma between January 2008 and August 2017. Details recorded on patient demographics, mechanism of injury, injury severity score, interventions and 30 day mortality. Data analysis was performed to identify those in need of invasive interventions and the risk factors for mortality. Results: 137 patients admitted during this time period with blunt chest trauma. The average age was 82.7 years (70-98.6) and the injury severity scores ranged from 1-34 (mean 9.8). The majority of thoracic injuries were caused by falls from less than 2 metres (72.3%). 30 day mortality was calculated at 8.0%. The presence of 3 or more rib fractures would appear to be an indicator of poor prognosis. Conclusions: A significant proportion of these thoracic injuries were caused by falls from less than 2 metres in this elderly population. These low energy injuries should not be underestimated, and a thorough evaluation of rib fractures seems vital in predicting adverse outcomes. A clinical evaluation of the diagnosis and management of urinary tract infections in secondary care Introduction: A Dieulafoy lesion (DL) is a congenital, abnormally large and winding submucosal artery that has the potential to bleed through a small mucosal erosion (1-5 mm) . It typically represents less than 2% of upper gastrointestinal bleeds, normally found in the lesser curvature of the stomach. Hematemesis and melena were the most common presenting symptoms. Gastroscopy being the main diagnostic and therapeutic procedure. Some case series have shown an increased incidence in men aged between 60 to 80 years. Case report: A 94 years old man, admitted to an acute geriatric unit with moderate-severe disability affecting activity of daily living, diabetic with retinopathy, iron-deficiency anemia since 2009 with normal endoscopic study, atrial fibrillation without anticoagulation therapy and taking 100 mg acetylsalicylic acid per day. Presented to hospital because of 3 episodes of haematemesis, tachycardia, hypotension and hemoglobin of 8.9 g/dL (regular of 11 g/dL) that required one blood transfusion. A gastroscopy was performed and showed a 5 mm vascular lesion without bleeding on the greater curvature. The patient received a combined therapy of 3 hemoclips hemostasis and adrenaline injection that was successful, 48 h later he started oral tolerance with no incidences. Conclusion: DL should be part of differential diagnosis in chronic iron-deficiency anemia and gastrointestinal bleeding with no-lesion endoscopic studio. Identifying the site of bleeding by endoscopy may be difficult, because of this it is not easy to visualize low dimension of mucosa break in the context of a large amount of blood or if the bleeding stops. Non-pathogenetic association between NSAIDs and DL has been identified in literature. Endoscopy combined therapy (pharmacological and hemoclips) could be the most effective method for the stopping of bleeding. Ensuring a safe transition from hospital to home: the critical role of the ANP in running a virtual clinic Results: It has been reported that a large number of re-admissions occur during the week after discharge, often attributed to inadequate communication between Primary and Secondary Care [2] . The ANP overcomes this issue by personally following the known, more able/less acute patient from admission to a safe transition home; this has contributed to a reduction in length of stay and a more efficient discharge rate. Objective: To study the profile of the patients, the characteristics related to fall and the grade and factors associated with make recommendations about prevention of falls (RPF) among patients aged C 65 years attended for fall in Emergency Departments (ED). Methodology: FALL-ER is a multipurpose prospective cohort study with a systematic sampling that included all patients aged C 65 years attended with a fall in 5 EDs during 52 days a year. We collected 68 variables. Patients were classified in function of receiving or not RPF (any of the following: exercise, education about prevention of falls, referral to a specialist and modification of drugs related to falls). Results: We included 1507 (93.6%) of 1610 patients. Patients were very old and had a high level of comorbidity, polypharmacy and previous geriatric syndromes. The fall usually occurred at home, and half of them without witness. Out of total a 48% had fear of falling, a 22% had acute functional impairment, a 16% was admitted and a 0.6% died during the hospitalization. 509 (33.8%) patients were made RPF. The arthrosis, decreased hearing acuity, self-reported cognitive impairment, medical care in the place of the fall, fear of falling, acute functional impairment and hospitalization were associated with a higher risk of RPF, and the decreased visual acuity with a lower likelihood. Conclusions: Only three of ten older patients attended for fall in ED received RPF although several characteristics related to the patient and the fall are associated with a higher probability of receiving it. Nurses' awareness on hospital acquired infection risks of the geriatric patients .00-01.59. These three outcomes were compared within control groups across these time windows in order to observe any baseline effect, then compared within time windows between patients with and without PD. This revealed that it is unlikely that time of day of admission has any impact on LOS, mortality and 30-day readmission rates for control patients, nor any extra impact for patients with PD. Disregarding time of admission, patients with PD overall had a statistically significant increase in LOS of 2 days on average (median) compared to patients without, and also had a relative increase in mortality of 40%, although this was not statistically significant. There was no clear effect of a PD diagnosis on 30-day readmission. These findings are consistent with previous literature that demonstrates increased LOS and mortality for patients with PD. However, as this is a service evaluation at a single centre, UHSM, and due to various other limitations on this study, these conclusions should be considered with caution. Using point-of-care C-reactive protein to guide antibiotic prescribing for respiratory tract infections in elderly nursing home residents (UPCARE): study design of a cluster randomized controlled trial (3) Cost-effectiveness and cost-benefit of the use of CRP POCT. Results/conclusions: Expected in 2020. The characteristics of head trauma from low-energy falls in the oldest-old patients Background: The population of oldest-old (aged C 85 years) is growing rapidly in Korea. The head trauma from low-energy falls is common in this population. A better understanding of head trauma from low-energy falls in oldest-old person is thus of increasing national and global importance. We therefore aimed to investigate the differences of head trauma between oldest-old patients who were injured by low-energy falls and young-to-middle-old (aged 65-84 years) patients or young adult patients. Methods: This was a single-center retrospective study. The medical records of head trauma patients from the Emergency Department after low-energy falls that occurred between November 2015 and December 2017 were analyzed. Patients were divided into an older adult group (aged C 65 years) and a young adult group (aged 18-64 years); the older adult group was subdivided into an oldest-old group and a young-to-middle-old group. Results: The underlying diseases (such as DM, HTN, dementia, Parkinson disease, malignancy, cerebrovascular accident), antithrombotic agent medication, and traumatic intracranial hemorrhage (TICH) were more in older adult group (p \ 0.001), but alcohol ingestion were more in young adult group (p = 0.016). Furthermore, more cases of TICH were found in the oldest-old group than in the young-to-middle-old group (p = 0.021). In the oldest-old group, TICH was significantly correlated with older age, hypertension, cardiac diseases, anticoagulant regimen, and other chronic conditions (p = 0.037, p = 0.033, p = 0.025, p = 0.029, and p = 0.024, respectively), whereas the correlation with sex, drinking status, and other underlying conditions was not statistically significant. Similarly, a binary logistic regression analysis of the variables considered significant in the univariate analysis was conducted to examine the relationship between TICH and older age. Of these variables, only 'very old age' was found to be independently significant (p = 0.025). Conclusion: The characteristics of head trauma from low-energy falls in the oldest-old patients are different from young adult patients or young-to-middle old patients. Especially, the risk of TICH from low-energy falls in the oldest-old patients was higher than in the young-tomiddle old patients. Therefore, physicians need to pay particular attention to the oldest-old patients, even to those with mental integrity and without neurological deficits. Five-year evolution of antihypertensive treatment after reduction of this treatment during hospitalisation in an acute geriatric unit Anna Kearney-Schwartz 1 , Axel Schumacher 1 , Elisabeth Steyer 2 , Pierre Gillet 3 , Athanase Benetos 1 1 Geriatrics Department Nancy University Hospital, Vandoeuvre-lès-Nancy, France, 2 General Practice Department Nancy University Hospital, Vandoeuvre-lès-Nancy, France, 3 Pharmacology Department Nancy University Hospital, Vandoeuvre-lès-Nancy, France Objective: To evaluate the short and long term evolution of antihypertensive medication after reduction of this treatment in polymedicated older subjects during acute care hospitalization. Methods: We analyzed the medication data of patients who had a reduction of the anti-hypertensive drugs during hospitalization in acute geriatric unit (T0: admission; T1: discharge). These patients were followed-up at 3 months (T3 M) and 5 years (T5Y) after discharge, or untildeath. The data collected were: number and class of antihypertensive drugs, blood pressure (BP), the reason for a possible increase of treatment and, if necessary, the date of death. Results: During the hospitalization, 59 out of 318 hospitalized patients had a reduction in the anti-hypertensive medications (mean age 86 ± 6 years). The number of drugs in the different times of the follow-up was: T0: 9.1 ± 3.2/2.1 ± 0.9 (total number/antihypertensive drugs) T1: 8.1 ± 2.7/0.9 ± 0.9 T3 M:8.2 ± 3.0/1.3 ± 1.0 T5Y: 8.0 ± 2.89/1.2 ± 1.0 Calcium antagonists and ARA2 were more frequently stopped, whereas ACE inhibitors more frequently initiated during hospitalization. Among the 42 patients who reached the T3 M visit, 40 kept the same number or had a reduction of the number of antihypertensive drugs during 5-year follow up. Conclusion: Reduction of the treatment operated during acute hospitalisation is largely sustainable in the short and long term. Review of the medical prescription in older patients during hospitalization could lead to a long term reduction of the poly-medication. Elderly patients with nosocomial pneumonia in an internal medicine department Discussion: As expected, the small wNP group of patients showed no difference concerning gender, age or nutritional status. However, these patients were more dependent, had a higher average Charlson score and used more medications, particularly PPI's. All of the outcomes, namely average length of stay, ICU admittance (23.5 vs 6.3%) and mortality (35 vs 12%) were either higher or more prevalent in the patients with nosocomial pneumonia. The role of echo doppler method in treatment and prevention of cerebrovascular disease in non diabetic and diabetic population with macroangiopathy , and unilateral CS associated with contralateral carotid occlusion (CO) occurred with higher frequency in the nondiabetic patients, than in diabetic ones. On the other hand, the remaining other findings, such as unilateral CS, unilateral CO, S/O of intracranial carotid artery (ICA) and vertebral/subclavian S were more frequent in the diabetic group. The findings allow us to conclude that the correct and early treatment of diabetes as well as a possible lowering of the risks for cerebrovascular disease are obligatory steps in the primary and secondary prevention of the cerebral ischemic events in diabetic patients with carotid atheromatous lesions. This consideration may help the physicians to have a deeper understanding of the pathophysiology, and to implement the necessary treatment and prevention of CVD in the diabetic population of high-risk. Predictors of long lenght of stay in a cohort of real elderly patients hospitalized for acute heart failure . Older patients can get lost in the ether between secondary and primary correspondence delays resulting in crisis events for these patients or even unnecessary readmissions to an inpatient bed. The Silver phone line was developed as a means of supporting these patients during the acute period after their discharge from AEC. It is a phone line manned by skilled Advanced Nurse Practitioners for Older People, operative 7 days per week. Its purpose is twofold; to provide a point of contact for older patients should they require clinical advice, signposting or just reassurance. Advanced Nurse Practitioners also undertake agreed virtual telephone consultations monitoring patient's ongoing symptoms, to impart outstanding test results and to ensure the patient is confident about being at home. The Silver Phone line ensures older patients have the appropriate safety netting in place after discharge from a fast paced patient pathway such as AEC. There has been an overwhelmingly positive response from older patients who feel that 'somebody cares'. Postural hypotension contributing to falls: a project to improve the practice of falls assessments in the elderly Introduction: Acute heart failure (AHF) is a clinical syndrome that typically affects elderly. Our purpose was to evaluate long-term prognosis and predictors of mortality of elderly patients hospitalized for AHF in different settings of care (Cardiology, Internal Medicine and Geriatric wards). Methods: Data derived from the ATHENA retrospective observational study which included patients aged 65 years or more, admitted for AHF to the Emergency department (ED) of a tertiary University teaching-hospital and transferred to the above described settings of care between 12.2014-12.2015. A telephone interview to evaluate vital status and functional level was conducted. Results: 401 patients were enrolled: mean age was 83.5 years, females were 51%. Telephone interviews were conducted among patients discharged alive (365 patients, 91%). One-year mortality was 33.2%, significantly higher for patients discharged from Geriatrics (45.8%) and Internal Medicine (32.5%) compared to Cardiology (17.3%), p = 0.009. During the total FU (median * 21 months), mortality rate was 49.7%, significantly higher in Geriatric (60.4%) and Internal Medicine (52.0%) wards compared to Cardiology (32.7%), p = 0.013. By multivariable analysis, independent predictors of long-term mortality were NT-pro BNP level in ED (OR 1.77, CI 1.03-3.04, p = 0.039) and Charlson Comorbidity Index (OR 1.30, CI Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 1.13-1.50, p = 0.001), with a protective effect of Beta-Blockers therapy at discharge (OR 0.53, CI 0.29-0.95, p = 0.033) and functional status evaluated through Barthel Index (OR .99, CI 0.98-1.0, p = 0.005). Conclusions: In elderly patients hospitalized for AHF, long term prognosis varies according to the different setting of care. Long-term mortality is high and is influenced by geriatric and cardiological variables. Acute ambulatory care in the community: processes of care and outcomes for a consecutive patient cohort from an Emergency Multidisciplinary Unit Barking Havering and Redbridge Hospital Trust, London, UK Introduction: Oxygen, used to treat hypoxia, is a commonly used drug and is often poorly prescribed. There have been instances whereby patient care has been delayed due to lack of or invalid oxygen prescriptions. It's British Thoracic Society's guidelines for all patients to have target saturations documented and it is our trust policy for all patients to have an oxygen prescription. The safety issues surrounding the prescription of oxygen are well-recognised and incorrect prescription in patients who are at risk of hypercapnia can be fatal. Methods: An audit was carried out looking at oxygen prescriptions and their validity across 4 acute geriatric medicine wards. Following the first data collection, educational interventions such as presentations, posters and emails were used. The prescriptions were then reaudited after the intervention. Results: 60 inpatient prescriptions were reviewed in each cycle. Age range 51-95, male-to-female ratio 7:8. Our first cycle revealed that 73% of patients did not have oxygen prescribed. Of the patients that had oxygen prescribed, 75% were appropriate for the patient, and only 13% of prescriptions were checked daily by the nursing team. Following our interventions these figures improved. We found that 30% of patients had an oxygen prescription and 89% of these were appropriate for the patient. We have demonstrated that oxygen prescription is inadequate and remains so after interventions. Educational interventions, such as posters, have not proven to be very effective in changing clinical practice. Further work needs to be done to provide a long-lasting change to improve patient care. Retrospective study of harms due to omitted doses of medications for Idiopathic Parkinson's Disease (IPD) in medical inpatients Blackpool Teaching Hospitals, Blackpool, UK Introduction: Although it's frequently stated that it's dangerous to omit medications for IPD there is surprisingly little data published on the effect of missed dosed on medical wards. Various harms are assumed (neuropsychiatric, declining mobility, dysphagia, prolonged length of stay, rigidity, neuroleptic malignant syndrome and death). Methods: Notes were retrospectively obtained for all patients who were either coded for IPD on the hospital discharge summary, or who had been dispensed medicines that were indicated for IPD, over a 3 months period at a medium sized general hospital. The notes were reviewed to identify patients who had IPD (vascular Parkinsonism, drug induced Parkinsonism, Parkinson's plus syndromes were excluded). Omitted doses were identified and the notes reviewed separately for potential harms. Harms were compared between patients who had missed doses, those who received all doses and those in who it was unclear if doses were missed, using Fisher's exact test. Results: 29 medical inpatients were identified with IPD (30 admissions). Seven patients died. The ages of the patients ranged from 67-89 years (mean 79.6). There were 18 males and 11 females. 21 patients missed at least one dose, 5 received all doses and in 4 admissions it was unclear. There were 7 deaths, all had missed doses (p = 0.19). There were 16 admissions associated with potential harms (including death), all had missed doses (p = 0.0001). Conclusions: Although the number of patients studied was small, the data suggest that there is a strong association of missed doses of medications for IPD and harms including death. Outcomes in cervical and upper thoracic vertebral fractures Katherine Horgan 1 , Jane Edmondson 2 1 Manchester University Hospitals NHS Foundation Trust, Manchester, UK, 2 Manchester University Hospitals NHS Foundation Trust, Manchester, UK Introduction: With the ageing European society, there is an increasing demand for geriatric emergency medicine. More research to acquire knowledge in this field is needed. Therefore, the Geriatric Emergency Medicine (GeriEM) taskforce aims to develop a European research agenda on GeriEM by collecting and prioritising research questions. Methods: A two-round Delphi study will be conducted. A broad scope of European national healthcare associations will be approached to invite emergency care physicians, geriatricians, nurses, general practitioners, and physiotherapists to fill in their research questions in our online survey (free-text responses). Furthermore, the survey was spread via the GeriEM website and social media. After quality check and categorization, respondents will be asked for inputs on priorities in a second round. By calculating mean priority ratings, the final top priority research questions in the field of geriatric emergency medicine will be listed. Results: The first round survey will be closed early summer 2018. Input will be quality checked and categorised. Expectedly, input of the second round will be finished in the fall. During EuGMS 2018, we will be able to present preliminary results. Conclusions: The list of priority research questions can guide researchers in the field of geriatric emergency medicine in the coming years. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Background: The Emergency Department (ED) is usually the first contact of older patients with the hospital system and an essential checkpoint to influence the patients' further trajectories. At this early stage of treatment, a comprehensive geriatric assessment (CGA)based identification of patients' prognosis and needs may improve clinical decision and patients quality of life (QoL) by reducing the length of hospital stay and rehospitalization. Methods: Patients aged 75 years and older (75 +) admitted to the ED of the University Hospital of Cologne were consecutively screened over a 3-month period for enrolment in the study. On admission, patients underwent physical and instrumental examination as well as CGA-based calculation of the Multidimensional Prognostic Index (MPI) and a questionnaire on QoL (EQ5D). Healthcare indicators were collected at baseline as well as at a phone-follow up interview three and 6 months after discharge. Results: Of the 1191 75 + patients admitted from October 2017 to January 2018, 175 were willing/able to participate and to undergo MPI completion. 80% was transferred to another ward, one fifth being discharged home. ''Feeling uncomfortable'' was the main symptom in 9% of the cases, with hypertension and heart diseases as main diagnoses. Forty-six 9% of the patients belonged to MPI-1 (low mortality risk at 1 month and 1 year), 45.1% to MPI-2 (medium risk) and 8% to MPI-3 (high risk) groups. Further analyses including follow-up results are ongoing. Conclusions: A structured CGA-based prognosis assessment in the ED might further improve clinical decision making and substantially influence healthcare resources allocation. High need of geriatric awareness in the Emergency Department: a Danish population-based cohort study Objectives: The objective was to describe the prevalence of geriatric target areas among acute older medical patients in the Emergency Department (ED) and the association between geriatric target areas and admission, length of admission, in-hospital mortality, 30 days post discharge mortality, 30 days hospital re-attendance, and 360 days loss of independency. Setting: ED of a large university hospital. Participants: All medical patients C 65 years of age from a single municipality with a first attendance at the ED during a 1 year period (November 2013 to November 2014). Primary and secondary outcome measures: Based on information from healthcare registers we defined prevalence of geriatric target areas as existence of impairment, recently increased impairment, polypharmacy, or comorbidity. Outcomes measured were admission, length of admission, post-discharge mortality, hospital re-attendance, and home care dependency 0-360 days following ED contact. Results: Totally, 3775 patients (55% women) were included, age 78 (71-85) years [median (IQR)]. Follow-up was complete. Prevalence of 0-4 geriatric target areas were 14.9, 27. 3, 25.2, 22.3, and 10 .3%, respectively. Number of target areas was significantly associated to hospital admission, length of admission, 30 day mortality, and hospital re-attendance after discharge. Among patients with no target areas 70% lived independent all 360 days after discharge, whereas all patients with C 3 target areas had some dependency or were dead within 360 days following discharge. Conclusion: Among older medical ED patients 50% had two or more geriatric target areas which were associated with poor outcome. This highlights the need of geriatric awareness and competences in the ED. Multidimensional Prognostic Index (MPI) predicts non-invasivemechanical-ventilation (NIV) success and mortality in older people with acute hypoxemic respiratory failure (AHRF) Background: AHRF is a frequent cause of hospitalization in older subjects. NIV may represent a possible treatment strategy in older patients, but no studies explored the usefulness of the Multidimensional Prognostic Index (MPI) in predicting the NIV outcomes. Aim: Evaluate the accuracy of CGA-based MPI to predict NIV outcome Methods: we enrolled patients older than 75 years, admitted to an Acute Geriatrics Unit for AHRF (PaO 2 /FiO 2 ratio \ 300) and treated with NIV plus standard medical therapy. MPI was assessed at admission according to standard methods. The primary outcome was 1 year-mortality rate; secondary outcomes were NIV success, i.e. improving the oxygenation index (OI, PO 2 /FiO 2 ratio C 300) and the days of OI improvement. Receiver operator characteristics (ROC) analysis was used to identify the best MPI cut-off to predict mortality in this population (MPI C 0.78). Results: We enrolled 15 patients (10 females, mean age 86.7 ± 5.2 years, mean MPI 0.75 ± SD), 8 with MPI C 0.78 and 7 with MPI \ 0.78. At baseline, no differences in arterial blood parameters were observed. MPI values C 0.78 (p \ 0.05) and NIV failure (p = 0.001) were significantly associated with 1-year mortality. NIV success was significantly higher in patients with lower MPI (p \ 0.05), regardless of basal PaO 2 /FiO 2 ratio. In NIV success group patients with MPI \ 0.78 improved OI in fewer days (4 vs 8 days, p = 0.06). Conclusion: In frail older patients with AHRF, MPI predicts 1-year mortality and NIV success, in terms of OI improvement and the time of OI improvement. Only in patients with lower MPI, NIV could reduce the mortality risk. What is the proportion of viral origin of infectious respiratory syndromes presented by elderly people hospitalized during the winter of 2017-2018? Results: 182 patients (88 ± 6 years, 56% female) were included (mean ADL score 4.2 ± 1.9 and Charlson score 2.6 ± 2.3). Viral PCR was positive in 106 (58%) patients: flu 67(63%) patients A (n = 23), B (n = 43) and A + B (n = 1), RSV (n = 11), Rhinovirus (n + 18), Bocavirus (n = 1), Metapneumovirus (n = 10), Coronavirus (n = 5) and Adenovirus (n = 1). Factors independently associated with a positive PCR were presence of a cough (OR 3.2 CI 1.6-6.3, p = 0.001), wheezing (OR 3.0 IC 1.3-6.7, p = 0.007) and low eosinophil level (OR 0.057 CI 0.01-0.57, p = 0.006). More than half of PCR positive patients received antibiotics (56%). In-hospital mortality was not different (13%). 3-Month morbi-mortality data are pending. Conclusion: Viral diagnosis was present in more than half of patients whith suspicion of pulmonary infection. The proportion of non-influenza viruses is notable. Presence of wheezings, cough and eosinopenia is more frequently associated with viral pulmonary infections. Intramuscular epinephrine as first-line treatment of anaphylaxis: still concerns about its safety in the elderly? Background: Anaphylaxis is a severe condition that can affect patients of all ages. Elderly patients must be considered particularly vulnerable to severe anaphylaxis due to many risk factors such as concomitant diseases and medications. Intramuscular administration of epinephrine is recommended as first line therapy for anaphylaxis We present a revision of the literature concerning efficacy and safety of epinephrine administration in older patients suffering of anaphylaxis. Method: We reviewed bibliographic data and guidelines on treatment of anaphylaxis published in the last decade. Results: There are no absolute contraindication to the administration of epinephrine through intramuscular route in a patient experiencing anaphylaxis since benefits outweigh the risks in the elderly and in patients with preexisting cardiovascular disease. There are no absolute contraindications to the prescription of self-injectable adrenaline in older patients at risk of anaphylaxis. Conclusion: Epinephrine autoinjectors should be prescribed for all patients with a history of anaphylaxis. Patients and their caregivers should be taught why, when, and how to inject adrenaline and should be equipped with a personalized written anaphylaxis emergency action plan. History of allergic reactions and anaphylaxis besides an emergency action plan should be noted in patient records in nonhospital care settings such as nursing homes and epinephrine should always be available. Further education of clinicians regarding the appropriate route of epinephrine administration in the management of anaphylaxis should be promoted to avoid adverse events. Its use should be promoted among clinicians in every setting. Burden of influenza in older patients over the 2016-2017 winter season in France Introduction: Flu is one of the most prevalent winter-season infections, with a poor prognosis in older populations. However, as viral diagnosis was difficult until the last years, available data on the burden of flu are based on mathematical models. We then aim to study the real impact of flu during the hospital stay in elderly populations. Methods: French multicenter retrospective study carried out in Infectious Diseases (ID) and Geriatric wards through a group of interest on infections in elderly (GInGer) gathering French National Geriatric (SFGG) and ID Societies (SPILF). The unique inclusion criterion was to get a positive influenza PCR on nasopharyngal samples within the outbreak (15.12.2016-30.03.2017) . Data on flu, oseltamivir, antibiotic, and outcome have been collected. Results: 49 wards participated to the study; among 8814 patients, 515 patients had a positive PCR out of 1268 NP samples. 126 (24.5%) were nosocomial; mean age was 86.7 years, mean ADL of 4.06. 77 (15%) came from Nursing Home. Mean Charlson index was 2.9, but 62 (12%) without comorbidity. Oseltamivir was used for 61% of cases during 5.08 days and antibiotic in 58.7% over 9.1 days. More than 50% patients presented a medical complication, death rate was 12.23%. Mean length of stay was 16.1 days. The real burden of flu seems high (nosocomial, antibiotic use, death rate, complications, length of stay), but flu seems to affect different subset of elderly patient. There is an urgent need to collect data on the burden of flu in different older populations to adopt preventive and therapeutic recommendations. Patients admitted directly home from Emergency Department may be more active and return faster to their activities of daily living M. Gregersen 1 1 Department of Geriatric Medicine, AUH, Aarhus, Denmark Introduction: Older patients are lying in bed 17 h per day which increases the risk of institutionalization, falls, poor quality of life, and death. Aim: examine whether patients discharged directly to their home from the Emergency Department (ED) and followed-up by either a geriatric team or a general practitioner have a better functional capacity when measured 8 weeks after admission compared to those who were admitted to a geriatric ward. Methods: Community-dwelling 75+ years old patients were consecutively enrolled on admission to the ED. A physiotherapist assessed the functional capacity by Functional Recovery Score (FRS) retrospectively 14 days before current illness and prospectively 8 weeks after discharge. Changes in functional capacity were compared in a logistic regression model. Results: A total of 157 patients were included. Fifty-eight patients (36.9%) were discharged directly to their homes and 99 (63.1%) were admitted to a hospital ward. The two groups were comparable in gender, age, comorbidity, previous functional capacity, mental status. Fifty-four percent of the patients who were discharged directly to their homes had either maintained or improved their functional capacity compared to only 36% in the group admitted to a hospital ward. Adjusted for baseline characteristics: [OR 2.1 (95% CI 1.05; 4.09)], p = 0.036. Conclusion: Patients discharged directly to their homes from the ED may be more active and return sooner to their activities of daily living. It is important to aim at a physically active hospitalization to prevent in-hospital functional decline. And if possible, discharge the patients early and treat them at home. Comprehensive geriatric assessment and frailty screening in a sample of elderly patients with severe aortic stenosis considering transcatheter aortic valve implantation Conclusion: Among elderly patients with SAS, those who finally receive TAVI treatment were younger, in better functional and mental status and less frequently frail than those that underwent medical treatment. Geriatric assessment and frailty screening tools could be useful to identify patients that finally receive one type of treatment or another. For many older people the Emergency Department (ED) is the main portal of entry to urgent care. In the ED 12-43% of the patients are elderly. They visit the Emergency Department more frequently, with more urgent diseases, need more diagnostics and stay longer. Furthermore, they have a greater chance of being hospitalised and being misdiagnosed. The acute medical problems of older people are often similar to those of younger adults but the presentation can be atypical or there can be a number of co-existing problems that make diagnosis difficult. Further difficulties occur in frailer, older adults who continue to manage at home despite the effects of increasing age and multiple medical problems. In these patients an apparently minor illness can lead to deterioration in a non-specific manner leading to immobility, a fall, or acute confusion and they need a more specific triage and a screening program for older ED patients. The social circumstances and the availability of social support may be of greater importance than the management of the medical illness. In the elderly, many common conditions can exist without their characteristic features. Instead, the elderly may have more than one nonspecific geriatric syndromes (eg, delirium, dizziness, syncope, falling, weight loss, incontinence, abdominal pain). These syndromes result from multiple disorders and impairments; nonetheless, patients may improve when only some of the precipitating factors are corrected. An even better strategy is to identify risk factors for these syndromes and correct as many as possible. Profile of the Emergency Department high frecquent user elderly patient More than half come from the metropolitan area. Social, mental and functional state were registered only 50%: most lived with family, had partial dependence on basic activities of daily living and cognitive impairment. The Charlson Index was 2.9. The average visits was 6 and the frequency was slightly higher in winter. Half of the patients attended on their own initiative. Medical pathology was the most frequent cause of visit. 2/3 didn't require admission. Conclusions: Age, being a woman, functional dependence, cognitive impairment, multimorbidity and living in the metropolitan area are frequent characteristics in the High-frequent user. Medical pathology, which doesn't require admission, and without having consulted in primary care, can be an intervention target. The heterogeneity of the data collection in ED, limit the results of this study. Collaboration with primary care physicians would help to better define the profile of these patients. Sarcopenia and related factors in hospitalized patients Introduction: Patients admitted to the hospital due to an acute illness may develop sarcopenia due to the acute illness itself or previous chronic diseases, decreased physical activity and nutrition and appetite problems. We aimed to investigate sarcopenia and associated factors in patients admitted to our inpatient clinic. Materials and methods: Between April 2017-December 2017, prospectively with patients admitted to the study. Patients were evaluated with bioimpedance analysis (BIA), normal gait speed (NGS) and hand grip strength (HGS) within the first 48 h after admission and BIA, NGS and HGS measurements were repeated during discharging. Age, height, weight and gender data were also recorded. Findings: A total of 143 patients admitted to the study were included. The mean age of the patients was 62.3 ± 17.6. The prevalence of sarcopenia was 24%. There was a significant difference the HGS (21.8 ± 11.4 at the time of admission and 23.9 ± 10.4 at the discharge) between admission and discharge. The difference between the mean values of the BIA muscle analysis (47 ± 9.2 on admission and 44.8 ± 7.4 on exit) between admission and discharge was found to be statistically significant (p = 0.02). There was a significant positive correlation between hand grip strength and BIA muscle analysis at admission and discharge. This suggests that patients recovering from acute illness may have improved muscle function, although there is no increase in muscle mass (Table 1) . Conclusion: In the study, it was determined that muscle function measured by HGS and NGS was better at the discharge. This suggests that recovery of acute disease can improve muscle function without changing muscle mass. A pilot of a pharmacy acute care of the elderly team Introduction: The addition of pharmacy services to a ward based Health Care of the Elderly (HCOE) team improves quality of care [1, 2] . A pilot ward based HCOE pharmacy service was set up to evaluate patient care benefits. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Methods: A pharmacy team was attached to orthopaedic HCOE teams over 8 weeks in 2017. Activities included HCOE ward rounds, medicines histories/reconciliations and reviews. Interventions were analysed by activity then graded by significance to patient care using a pharmacy intervention tool. To examine improvements pre/post pilot data were collected from Decision Support. A survey of clinicians exposed to the pilot service was undertaken. Results: A total of 148 patients were studied. 87% of patients had admission reconciliations and 59%/28% had discharge/transfer reconciliations. 1178 interventions were performed, 72% of these resulted in change. Addition of a medicine were 19% of these and reconciliation/history 25%. Grading was: avoidance of catastrophic harm 0.5%, of major harm 14%, of moderate harm 23% and of minor harm 5%. Pre/post pilot data showed a significant increase in the number of patients seen by a pharmacist from 50 to 76% (p \ 0.0001) and the use of kiwicrush (laxative) from 1% of patients to 27% (p \ 0.0001). When surveyed 9/12 clinicians thought the service met their expectations and saved them time. Conclusions: The embedding of a pharmacy service into a geriatric team increased the number of patients exposed to pharmacy expertise, avoided harms from catastrophic to minor, increased the use of laxatives, met clinician expectations and saved other clinicians' time. Results: 38 patients with Alzheimer's disease, mean age of 75.6 ± 3.4 years, 69% were females, education 8.3 ± 4.8 years; 39 patients with MCI mean age of 72.2 ± 6.8 years, 85% were females, education 11.2 ± 4.2 years. We founded positive to B. burgdorferi 11/38 (29%) with Alzheimer's disease, 9/39 (23%) with MCI and 11/108 (10%) of controls. In patients with Alzheimer's disease, an OR 3.65 (CI 95% 1.2-11.1) adjusted for education and a history of cerebrovascular disease (CVD) was estimated, and in patients with MCI an OR of 3.2 (CI 95% 1.1-9.1) adjusted for a history of diabetes mellitus and CVD was estimated. There were tick bite in 2 cases. Conclusions: There is an increased risk of Alzheimer's disease and MCI in seropositive IgG patients to B. burgdorferi. How common are neurocognitive disorders in patients with diabetes and chronic kidney disease: results from a community cohort of patients in North Wales Introduction: Chronic kidney disease (CKD) affects nearly 9% of global populations and is strongly associated with older age. Neurocognitive disorders (NCD) which include mild cognitive impairment (MCI) and dementia are rising as population's age throughout the world. This study aim is to report the crude prevalence of mild to major NCD in a clinical cohort of older adults with mild to moderate CKD (stages 3-4) and diabetes. Results: Upon neuropsychological assessment and application of DSM-V criteria, 86/178 (48%) of the cohort had a NCD ranging from mild (n = 49) to major symptoms (n = 37). Neuropsychological predictors for mild or major NCD entered into a stepwise regression analysis found that Fluency and Memory impairment accounted for over 66% of the variance, p \ 0.0001. Conclusions: To our knowledge this is the first study in the UK to report that cognitive changes occur in a significant number of older adults with CKD and concomitant diabetes. The unexpected finding was that prior to cognitive assessment, none of the cohort had a preexisting diagnosis of cognitive impairment, suggesting that the current prevalence and incidence rates of NCD in the general population are significantly underestimated. Background: Cognitive impairment is a frequent problem among older patients attending the Emergency Department (ED) which can be the result of pre-existing cognitive impairment, delirium, or neurologic disorders. Another cause can also be acute disturbance of brain perfusion and oxygenation, which may be reversible by optimal resuscitation. We therefore assessed the relationship between vital signs, as a measure of acute hemodynamic changes and cognitive impairment in older ED patients. Methods: A prospective cohort study, performed in two tertiary care and two secondary care hospitals in The Netherlands. All consecutive ED patients aged 70-years and older were included. Vital signs were measured at the moment of ED arrival as part of routine clinical care. Cognition was measured using the Six-Item Cognitive Impairment Test ( Conclusion: Abnormal vital signs that associate with decreased brain perfusion and oxygenation also associate with cognitive impairment in older ED patients. Although this may partially reflect the association of disease severity with delirium, impaired cognition may also be caused by acute disturbance of brain perfusion and oxygenation. More research is needed to establish whether intervening and improving these vital signs will also acutely improve cognition. Prevalence of cognitive impairment in diabetics and associated factors Department of Geriatric Medicine, National University Hospital, Singapore, Singapore, 2 Department of Endocrinology, National University Hospital, Singapore, Singapore, 3 Yong Loo Lin School of Medicine, Singapore, Singapore Introduction: Type 2 diabetes (T2DM) is an established risk factor for cognitive impairment (CI). With increasing prevalence of T2DM, identifying patients with CI is important as it impacts disease management and quality of life. This study seeks to establish that T2DM is associated with early-onset CI and its associated risk factors. Methods: A cross-sectional study was conducted among patients (C 40 years) who attended General Medicine and Endocrine outpatient clinics over 10 months. Cognition was assessed using the Montreal Cognitive Assessment Scale, with cut-off score of 26 to determine CI. Data for diabetes control, complications and management, and cardiovascular co-morbidities was analyzed using chisquare and two-sample T-test. Results: A total of 210 diabetic and 97 non-diabetic subjects aged 40-88 years were enrolled. Prevalence of CI in diabetic vs non-diabetic patients was 41.0 vs 25.8% (P = 0.011) respectively, and 35.5 vs 16.9% (P = 0.013) in patients aged \ 60 years. In patients [ 60 years, the difference in prevalence of CI between the two groups was not significant (47.0% vs 39.5%, P = 0.450). In diabetics, CI was significantly associated with older age (61.8 vs 56.9 years), lower education levels (9.4 vs 12.1 years), longer T2DM duration (15.7 vs 12.6 years), higher glycated hemoglobin levels (8.4% vs 7.9%), insulin usage (49.5% vs 33.6%), presence of nephropathy (CrCl 73.0 vs 97.8 mL/min), retinopathy (52.1 vs 34.7%) and hypertension (44.8 vs 27.7%). Conclusion: Patients with T2DM have higher prevalence of CI at a younger age compared to non-diabetics. Active case finding in this group may enable better compliance and disease control. Prevalence of anticholinergic drug use in older adults with dementia in a large Tertiary Hospital in Singapore Kaysar Mamun 1 1 Singapore General Hospital, Singapore, Singapore Introduction: The use of anticholinergic drugs is controversial in patients diagnosed with dementia due to increased risk of cognitive impairment and psychosis in this population. Anticholinergic drugs are often involved in explicit criteria for inappropriate prescribing in older adults. However, the extent of anticholinergic drug use in Singapore General Hospital's patient population is unknown. This study aims to determine the prevalence of anticholinergic drug use in older patients with dementia and evaluate the association between its use with mortality and morbidity outcomes in these patients. Methods: This is a retrospective cross-sectional analysis of patients aged 65 or older with dementia and at least one hospital admission in 2013 (n = 460). Identified subjects were followed up prospectively for 1 year after first admission in 2013 for morbidity and mortality events. Data on exposure to anticholinergic drugs 3 months prior to admission were collected. Anticholinergic burden was determined using the Anticholinergic Risk Scale (ARS). Results: Most patients aged 75 years old and above (77.8%), with mean age, 80.8 ± 8.4 years. Majority were female (60.4%) and Chinese (84.1%). Overall proportion of patients prescribed with anticholinergic drug use based on ARS scale was 55.9% (n = 257). ARS level 1 drugs were most commonly prescribed (n = 86), followed by ARS level 3 drugs (n = 63) and ARS level 2 drugs (n = 41). The top three ARS level 1 drugs prescribed were mirtazapine (n = 36), quetiapine (n = 17) and risperidone (n = 12); ARS level 3 drugs were hydroxyzine (n = 20), chlorpheniramine (n = 11) and diphenhydramine (n = 9); followed by ARS level 2 drugs, loratadine (n = 21), tolterodine (n = 7) and prochlorpherazine (n = 4).Increased use of ARS level 3 drugs was associated with more hospitalizations, increased in length of stay and emergency visits. Use of drugs with significant anticholinergic activity (ARS level 2 or 3) was found to have a significant association with morbidity outcomes but not mortality. Conclusions: Anticholinergic drug use in patients with dementia is highly prevalent, especially in poly-medicated older adults. This may have contributed to increased morbidity for these patients. Efforts to increase awareness among health professionals regarding potential risks of anticholinergic drug usage may improve medication prescribing practice. Cardiovascular outcomes of cholinesterase inhibitors in patients with dementia: A meta-analysis and systematic review Methods: Two authors independently searched major electronic databases from inception until 06/17/2017 for longitudinal (without a control group) and cohort (with a control group) studies reporting cardiovascular (CV) outcomes in relation to AChEIs. Randomized controlled trials were excluded due to the inclusion of relatively healthy subjects. Changes in CV parameters were summarized through standardized mean differences (SMD) with 95% confidence intervals (CI). Event rate was used to assess the incidence of hypertension and bradycardia. The incidence of CV events vs. healthy controls were compared using hazard ratios (HRs). Results: Out of 4,588 initial hits, 31 studies including 258,540 patients with dementia and 2,246,592 controls were analyzed. Across longitudinal and open-label studies, AChEIs were associated with a significant higher incidence of hypertension (1573 patients; 4%; 95% CI 2-8%, I 2 = 47%) and bradycardia (13,703 participants; 2%; 95% CI 1-6%, I 2 = 98%). AChEIs were associated with a decrease in heart rate (SMD = -1.77; 95% CI -3.58 to 0.03, I 2 = 78%) and a prolongation of the PR interval (SMD = 0.10; 95% CI 0.008-0.19; I 2 = 3%) compared to baseline. During a median follow-up time of 116 weeks, AChEIs were associated with a significantly lower risk of CV events (i.e. stroke, acute coronary syndrome and CV mortality) (HR = 0.63; 95% CI 0.45-0.88; I 2 = 18%), without a significant increased risk of bradycardic events (HR 1.40; 95% CI 0.76-2.59; I 2 = 98%). Key conclusions: AChEIs therapy may be associated with negative chronotropic and hypertensive effects, whilst their use may be associated with a reduced risk for CV events. Falls among persons with Alzheimer disease: description, risk factors, and exercise interacting them Introduction: There is scarce of studies investigating fall-risk factors and especially their interaction with exercise among persons with dementia. The aim is to explore these features. Methods: FINALEX (randomized-controlled-trial) included 194 Alzheimer disease (AD) persons, of which two-thirds participated in exercise intervention 1 h twice weekly for 12 months. We investigated fall-risk factors (diseases, fall-related-drugs, physical functioning) and possible interaction between exercise and fall-related-drugs. Results: Of 355 falls (altogether) 123 led to injuries, 50 to Emergency Department visits, and 13 to fractures. Stumbling (n = 61) was the most common reason for falling. The persons with 1 (n = 34) or C 2 falls (n = 57) were older and had more severe dementia than those without falls (n = 103). Good nutritional status and physical functioning protected against falls whereas fall history, osteoarthritis, and diabetes increased fall-risk. We compared the fall-risk associated with fall-related-drugs between intervention and control groups: There was no difference in the number of falls among those without antihypertensives or psychotropics between intervention and control groups. In intervention group with antihypertensives, the IRR was 0.5 falls/ person-year (95% CI 0.4-0.6); among controls the IRR was 1.5 falls/ person-year (95% CI 1.2-1.8) (p \ 0.001 for group, p = 0.067 for medication, p \ 0.001 for interaction). Among participants using psychotropics the intervention group had an IRR of 0.7 falls/personyear (95% CI 0.6-0.9); the IRR for the control group was 2.0 falls/ person-year (95% CI 1.6-2.5) (p \ 0.001 for group, p = 0.071 for medication, p \ 0.001 for interaction). Key conclusions: We explored that exercise has a potential to decrease the risk for falls among people with AD using antihypertensives and psychotropics. Vaillant Ciszewicz Anne-Julie 1 , Quaderi André 2 , Robert Philippe 3 , Guerin Olivier 4 1 CHU EHPAD CIMIEZ, 2 NICE université, 3 CMRR NICE-COBTEK LAB-NICE, 4 CHU NICE More than 24 randomized controlled trials are evaluating the effect of EMDR therapy in traumatized patients. Alternate Bilateral Stimulations (ABS) induced by EMDR allow desensitization of traumatic information and reprocessing of associated memory. Currently, the EMDR does not have enough experimental data concerning the elderly person. Our research aims to establish a link between trauma symptomatology and behavioral symptomatology in neurocognitive pathologies. Verbal agitation and anxiety are found in both neurocognitive pathology [1] and also in PTSD. Amano et al. [2] are the pioneers of research in the field of EMDR and neurocognitive pathologies. According to the authors, behavioral disorders are directly related to past events that replay themselves here unless the psychic scene of the subject. Although the results are encouraging the study has only 3 subjects. We wish to demonstrate that it is possible to reduce verbal agitation by adapting the EMDR protocol. Method: 8 subjects in nusery home with verbal agitation (DSMV criteria for major cognitive impairment). At first we will assess primary needs (first source of verbal agitation). We have chosen 2 groups which are randomized (EMDR and Control). We will analyze intensity of verbalizatoons using a sound level meter (fréquence duration and intensity) on two repeated sessions. E use some evaluations like NPIES, CMAI, ALGOPLUS, PITTSBURGH, MMSE and statistical analysis of the results. Results: Current research indicates a reduction in verbal agitation for EMDR patients. Key conclusion: According to our first results, we can say that performing ABS in eldery people with cognitive disorders does not induce a healing phenomenon as in PTSD but a soothing of the limbic system and therefore of verbal agitation. Relationship of neuropsychiatric symptoms with falls in Alzheimer's disease: does exercise modify the risk? Secondary analysis of a randomized controlled trial Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 S233 Introduction: Alzheimer disease (AD) is associated with both neuropsychiatric symptoms (NPS) and falls. The aim of this study was to explore how NPS are associated with the number of falls and how exercise modifies the risk of falling among community-dwelling people with AD and NPS. Methods: This study is a secondary analysis of a 12 month randomized controlled trial (FINALEX) among people with AD. The original trial examined home-based and group-based exercise groups and compared them to the control group receiving normal community care. Both exercise interventions were supervised by physiotherapists and comprised 1 h sessions twice a week for 12 months. In this secondary analysis we merged the home-based and group-based exercise groups and compared them to the control group. NPS were measured with the Neuropsychiatric Inventory (NPI) at baseline and falls were recorded in daily fall diaries by spousal caregivers during a 1-year follow-up. Results: The number of falls increased linearly with NPI points. Fall rate was 1.48 (95% CI 1.26-1.73) per person/year in the intervention group whereas it was 2.87 (95% CI 2.43-3.35) in the control group. Adjusted for age, gender, MMSE, and SPPB, IRR was 0.48 (95% Cl 0.39-0.60) (p \ 0.001). Main effects for fall rate were significant for group (p \ 0.001) and NPI total (p \ 0.024); interaction effect was also significant (p = 0.009) (adjusted for gender, age, MMSE and SPPB, psychotropic medication use). Conclusions: Regular, long term exercise decreases significantly the risk of falling in community dwelling AD patients with NPS. Influence of the degree of dementia on the final parameters of static equilibrium in the female population over 80 years of age. Introduction: Dementia is a chronic and progressive syndrome that presents with deterioration of cognitive function. This syndrome affects the region of the brain that controls movements, so that balance, the most important capacities for self-valence, could be affected it. The aim of this study is to show how the degree of dementia influences the static balance in women over 80 years of age Background: The prevalence of cognitive impairment will continue to increase as society ages. Vascular dementia is the second most common type of dementia after Alzheimer's disease (AD) and is closely associated with stroke and cardiovascular disease. Detection of vascular cognitive impairment (VCI) is essential as controlling the risk factors may prevent progression. There is no consensus as to which cognitive screening instrument (CSI) is most suitable for VCI. Objectives: To systematically review the psychometric properties of brief CSIs across the spectrum of VCI from vascular mild cognitive impairment (VMCI) and vascular dementia (VaD). Method: A literature search for all available papers published from inception until 31st May 2018 was conducted using the scholarly databases. Bibliographies of all included studies were also screened for any related studies. The titles and abstract were screened and the studies that met the inclusion and exclusion criteria were thoroughly reviewed. Relevant data were extracted and summarised to produce clinically relevant inferences. Bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results: Fifteen papers were included in the final review. The data was reviewed in a narrative fashion as it was not possible to do a S234 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 meta-analysis with the data obtained. CSIs were grouped according to their properties of differentiating between (1) VaD and normal cognition, (2) MCI and normal cognition, and (3) VCI and AD. Conclusion: Not all studies reported the reliability and consistency measures for the CSIs. Of the ones that were reported, the Montreal Cognitive Assessment (MoCA) was most sensitive and accurate, both for differentiating VaD and VMCI from normal cognition. A classic presentation of an uncommon disease: Binswanger disease Rikitha Menezes 1 , Theresa Redling 1 1 Saint Barnabas Medical Center, Livingston, USA Introduction: Binswanger disease is a subtype of vascular dementia [1, 4] that was first described in 1894 [2, 3] . It affects men and women equally in the sixth to seventh decade of life with a 3-12% increasing incidence in elderly [1] . Case presentation: An 89 year-old woman with history of hypertension, hyperlipidemia, legal blindness, gait disturbances, urinary incontinence, presents with 1 year of short term memory impairment, suicidal ideations. On neuropsychiatric evaluation the patient demonstrated deficiencies in the following: executive: information processing speed, attention, working memory, learning, retention, orientation, semantic fluency, executive systems; MMSE 9/25; sensory: impaired visual acuity, bradykinesia, mild motor programming deficits, gait ataxia; psychiatric: generalized anxiety, depression. Discussion: Binswanger Disease is a subtype of vascular dementia which is an underrecognized gradually progressive demyelinating disease resulting in subcortical arteriosclerotic encephalopathy. It overlaps with other neuropathologies thus history and imaging is essential [1, 3, 6] . The disease is associated with hypertension (98% of cases) and lacunar infarctions [1] . CT brain demonstrates periventricular lucencies (hypodense); MRI brain shows hyperintense white matter abnormalities from fronto-temporal region to the centrum semiovale [1, 3] . Treatment is primarily supportive: discussions on advanced directives such as goals of care, social support and antidepressant therapy, etc. Management of hypertension and aspirin prophylaxis may help slow progression. Conclusion: Binswanger Disease is an underrecognized disease resulting in subcortical arteriosclerotic encephalopathy. It is important to recognize this entity as disease management will be different from other forms of neurodegenerative dementias. Keyword: Prevention in vulnerable population. Introduction: Data suggest that older adults with dementia are commonly prescribed potentially unsafe medications. Deprescribing refers to supervised tapering or cessation of drugs, aiming to minimize inappropriate polypharmacy and improve patient outcomes. This study reviews the literature about deprescribing in advanced dementia, its benefits, safety and barriers. Material and methods: Non-systematic review of literature using PubMed database using the following keywords: ''advanced dementia'', ''deprescribing'' and ''discontinuing medication''. Results: Most research on potentially inappropriate prescribing is focused on the elderly in general rather than dementia specifically. However, studies are increasingly focusing on prescribing for people with advanced dementia. The PEACE program, in particular, has produced criteria that show promise in identifying potentially inappropriate medications in advanced dementia, including anticholinesterase inhibitors and lipid-lowering agents. Potential benefits of deprescribing are widespread, including health and quality of life benefits to patients and cost benefits to the health care system. Challenges to successfully discontinuing medications include patient-, clinician-, and system-related barriers. Limited life expectancy and cognitive impairment appear to be the most important factors driving deprescribing. Being an essential issue, deprescribing should be part of the medical curriculum and throughout the career of senior clinicians. Key conclusions: Evidence supporting the benefits and safety of deprescribing in the elderly continues to grow, strengthening the cause for greater integration of regular deprescribing into medical culture. More evidence about deprescribing in advanced dementia is needed. Advance care planning is the cornerstone of high-quality palliative care in advance dementia and deprescribing should be part of that process. An Augmented Prescribed Exercise Programme (APEP) for frail older medical inpatients in the acute setting: a randomised controlled trial Aim: To measure the effects of an augmented prescribed exercise programme on physical performance, quality of life and healthcare utilisation for frail medical patients in the acute setting. Methods: Within 2 days of admission, older medical inpatients with an anticipated length of stay C 3 days, needing assistance/aid to walk, were blindly randomly allocated to the intervention or control group. Until discharge, both groups received twice daily, Monday-to-Friday half-hour assisted exercises. The intervention group completed tailored strengthening and balance exercises; the control group, stretching and relaxation exercises. Length of stay (primary outcome measure), readmissions, physical performance (Short Physical Performance Battery), and quality of life (EuroQOL-5D-5L) were measured at discharge and at 3 months. Time-to-event analysis was used for length of stay analysis, and linear regression models were used for physical performance and quality of life analysis. Results: Data from 190 patients (aged 80 ± 7.5 years) were analysed. Groups were comparable at baseline. Crude analysis showed no effect on length of stay Key conclusions: CI was found in 73% in elderly diabetic patients, which is more than three times the prevalence reported in the general population aged C 75 years. CI seems to be more common in DM patients compared to non-DM patients at the FSC. These findings suggest that CI may be underdiagnosed in elderly patients with DM. We recommend using the MoCA for screening CI in these patients. Atrial septal aneurysm as a rare cause of vascular dementia: a case report An atrial septal aneurysm (ASA) is a congenital malformation characterized by a localized bulging of the atrial septum into atrium. ASA is a poor known putative risk factor for cardioembolism. Its prevalence in the general population is 2.2%. We report a case of a 77 years old woman who came to our attention for progressive cognitive impairment. Symptoms were primarily loss of short-term memory and apathy, but was also reported an episode of walking disorder and one of misidentification of her husband. Medical history included only hypertension. Neurological examination was negative, while cardiac examination revealed a mesocardial heart murmur. Mini Mental State Examination score was 15.7/30. Basal and instrumental activities of daily living were also inadequate. Carotids ultrasonography and electrocardiogram were negative. The patient underwent to a cerebral tomography that founded chronic cerebrovascular disease with evidence of little ischemic strokes. A subsequent echocardiogram revealed the presence of an ASA. Our diagnosis was of vascular dementia as a result of repeated ischemic stroke caused by ASA presence. The patient is waiting to perform a transesophageal echocardiogram. To best of our knowledge this is the second case reported in literature of vascular dementia as result of ASA presence. This medical condition should be kept in mind for a possible cause of vascular dementia, particularly in the presence of multi-infartual strokes with negative carotids ultrasonography and normal electrocardiogram or in case of unknown cardiac murmur. The Methods: The questionnaire battery included the following questionnaires: QOL-AD, Geriatric Depression Scale, Mini-Mental State Examination, Patient Dignity Inventory, Short Physical Performance Battery, Bristol Activities of Daily Living Scale, and a set of sociodemographic data. Criteria for inclusion were: any type of dementia at an early stage; [ 60 years of age; living at home and having contact with a family caregiver at least once a week. EwESD were recruited from geriatric and neurologic outpatient departments of university hospitals in Hradec Králové and Ostrava in the Czech Republic. Pearson and Spearman correlation analysis, single-factor ANOVA, and multidimensional linear regression model were used for statistical processing. Results: The sample consisted of 272 patient-proxy pairs (mean EwESD age 79.8 ± 7.8 years; mean MMSE score 22.6 ± 1.7 points). The results show that QoL assessed by the EwESD is significantly associated with dignity (beta = -0.347), self-sufficiency (beta = 0.265), and depression (beta = -0.266). The QoL of the PwESD assessed by the caregivers correlated only with the level of self-sufficiency (beta = 0.571) and depression (beta = -0.138; P \ 0.001 in all cases). The results show that the elderly with early-stage dementia assess the quality of their life better when they suffer from less depression, are more self-sufficient in ADL, and have a greater sense of self-dignity. Study was supported by grant Nr. 16-28628A by Ministry of Health of the Czech Republic. Promoting activity, independence and stability in early dementia and mild cognitive impairment: feasibility trial RH Harwood 1 , V Van der Wardt 1 , SE Goldberg 1 , T Masud 1 , P Logan 1 , A Brand 2 , V Booth 1 , Clare Burgon 1 , RK Bajwa 1 1 Nottingham University, Nottingham, UK, 2 Bangor University, Bangor, UK Introduction: People with mild dementia and Mild Cognitive Impairment are at high risk functional deterioration. We developed an exercise-based therapy intervention aiming to promote safe activity and reduce risk of falling. Methods: We conducted a randomised feasibility trial, to test intervention delivery in practice and to prepare for a definitive trial. Sixty participants were recruited from Memory Clinics across two sites. Three randomisation arms compared intervention with high level supervision (50 professional visits), moderate supervision (nine visits), and control. We collected health status data at baseline and follow-up by interview with participants and family carers, and ascertained falls by diary. Results: Mean age was 76. Mini Mental State Examination scores were 20-30, mean 26. We followed up 49 (82%) after 12 months. One died, three moved to care homes. 81% of therapy sessions were delivered. 88% of diaries were returned. There were 19 reported adverse events, none related to the intervention. The Disability Assessment in Dementia primary outcome deteriorated over 12 months (mean -18 control, -17 moderate, -8 high). Berg Balance Score were better with active intervention (-6.8, -0.5 and + 0.1). Incidental and Planned Activity scores, pedometer step count and timed up and go test improved in the high intensity supervision group. Conclusions: We successfully recruited participants, delivered the intervention and collected data. The intervention resulted in improved balance, activities of daily living and physical activity, in underpowered comparisons, with greater benefits associated with higher levels of supervision. A full-scale multi-centred randomised controlled trial will commence in September 2018. High mortality in patients with dementia admitted to psychiatric care Results for 3-year and 5-year mortality were comparable. Being of Dutch ethnicity increased the 3 and 5-year mortality. There were no differences in mortality according to type of psychiatric comorbidity. Conclusion: Mortality of patients with dementia admitted to psychiatric care was high. The results of the present study should raise awareness in clinicians about the unfavourable prognosis of patients with dementia in psychiatric care, particularly older inpatient men with more somatic comorbidity. Caregiver burden in Alzheimer's disease Problematic: Alzheimer disease (AD) imposes a severe burden upon patients and their caregivers. Although there is substantial evidence of the adverse impact of burden, considerably less is known about its specific correlates and potential causes. Objectives: Assessment of the level of burden and frequency of depression among caregivers in AD, and identification of the main factors associated with the burden in these caregivers. Methods: We conducted a cross-sectional study at the psychiatric department. All caregivers who accompanied their relatives with AD to their appointments from 01 November 2016 to 15 January 2017 were invited to take part. We used the Zarit Burden Inventory to assess Beck's burden level in the caregiver. Results: The caregiver was a woman (74%) with a mean age of 46 and cohabiting with the patient in 68% of the cases. The mean score on the burden interview was 43. The burden was perceived as high by 48% of caregivers. A high caregiver burden was significantly associated with the absence of recreational activity (57% vs 83%), being the primary caregiver of the patient (50% vs 83%) and cohabiting with him/her (53% vs 83%). Regarding patient variables, only the level of dependence of the patient correlated with a high level of caregiver burden (38% vs. 79%). Conclusion: Dependency and patients' quality of life have stronger association with caregiver perception of burden than cognitive functioning. Combinations of pharmacological and family interventions targeting these two aspects of the disorder are likely to alleviate patient suffering but also mediate improved caregiver well-being. Antiepileptic drug use and the risk of stroke among communitydwelling persons with Alzheimer's disease: a matched cohort study Background: Persons with Alzheimer's disease (AD) are more predisposed to seizures than older people in general, and use of antiepileptic drugs (AEDs) is more frequent. AED use has been linked to higher risk of vascular events in general population, however, it is not evident whether the same association is in persons with AD. We assessed the risk of stroke associated with incident AED use among persons with AD. Methods: The MEDALZ cohort includes all Finnish persons who received a clinically verified AD diagnosis (N = 70,718) in 2005-2011. Persons with previous strokes were excluded. For each incident AED user (n = 5617) one non-user was matched according to sex, age and time since AD diagnosis. Analyses were conducted with Cox proportional hazards models and inverse probability of treatment weighting (IPTW). Results: Compared with non-use, AED use was associated with an increased risk of stroke (IPTW hazard ratio ( Introduction: Since underlying pathophysiology of physical frailty and cognitive frailty might be similar; therefore, finding any association could guide clinicians, to recognize effective strategies for each type of frailty resulting to preventive approach. Methods: This is a cross-sectional Bushehr elderly health survey in community setting. Frailty was assessed based on Fried's frailty phenotype criteria. Cognitive impairment was assessed by Mini Mental State Examination (MMSE), Mini Cog, Functional Assessment Staging Tool (FAST), and Category Fluency Test (CFT). The participants were categorized based on Fried's criteria and cognition tools. Multivariable logistic regression models were applied to determine association between frailty and cognitive impairment. Results: Among people C 60 years (N = 2392) women were 51.6%. Mean age of the participants were 69.3 years old. The prevalence of prefrailty and frailty was 42.9 and 8.1%, respectively and cognitive impairment was 21.7%. The odds ratio of association between frailty and cognitive impairment was 2.51 (CI 95%, 1.76-3.59) (adjusted for age, sex, and education levels). All components of Fried's frailty criteria, except unintentional weight loss were associated with cognitive impairment. Conclusion: We observed strong association between frailty criteria and cognitive impairment, that cognitive decline is determined as a crucial factor to define frailty. Further studies are needed to discover common causes of physical frailty and cognitive frailty to make a better geriatric management. Keywords: Physical frailty, Cognitive frailty, Cognitive impairment, Geriatric. The impact of activity-role participation on cognitive status in geriatric individuals P-608 What do healthcare professionals do when the patient with dementia says 'no' to a healthcare procedure? Background: Poor communication is a barrier to processes essential for good treatment and care. People with dementia and those who work with them can experience difficulties in communicating. Much healthcare involves a professional requesting an action from a patient). People with dementia often initially refuse these requests for action. We aimed to identify communication skills used by experienced professionals when a request for action is refused by a patient with dementia. Methods: We video-recorded 41 healthcare encounters between 26 professionals (eleven nurses, nine doctors and six therapists) and 26 people with dementia (16 women), comprising 378 min. We used a socio-linguistic research method, called conversation analysis, to study patterns in the communication encounters. Results: Twenty-eight (68%) of our recordings contained refusals, often repeated. Requests that were made explicitly and directly (imperatives), with high entitlement (authority to ask), and which lowered the perceived difficulties with the task ('contingencies') were more likely to succeed. Requests that referred to the person living with dementia's ability or willingness to comply ('can you…?') were often refused. Highly entitled requests could take the form of announcing future action, proposals, or statements of need. Contingencies were lowered by using words that minimised the size or duration of the task, asking the person 'to try', by offering help, or proposing joint action. Conclusion: How we frame requests to patients with dementia influences the likelihood of the patient granting that request. This study identified practical ways professionals can improve their communication with patients with dementia. Development of the promoting activity, independence and stability in early dementia and mild cognitive impairment (PrAISED) intervention Introduction: Older adults with dementia are at a high risk of falls. Standard interventions have not been shown to be effective. An intervention is required that addresses the particular needs of older people with dementia in a community setting. Methods: We followed guidelines for intervention development, which recommend a structured approach considering theory, evidence and practical issues. Data were included from literature reviews, clinician workshops, expert opinion meetings, patient and relative interviews, focus groups with people with dementia and clinicians, a cross-sectional survey of risk factors, a proof-of-concept intervention study, and case studies. Key findings from each source were synthesised using triangulation. A steering group comprising clinicians, researchers and patient carer and public involvement representatives reviewed and refined the triangulation matrix. Practical consideration of how an intervention could be delivered and implemented were considered from the outset. Results: A multicomponent intervention was designed. The focus is on promoting safe activity rather than risk or prevention of falls. Many information sources were consistent in their recommendations and influenced final intervention. Core elements of the intervention included individually-tailored, dementia-appropriate, balance, strength and dualtask exercises, functional training, and activities aimed at improving environmental access and risk enablement. Delivery of the intervention is through a motivational approach to support communication, adherence and longer term continuation of activity. Conclusion: We used a systematic process to develop a dementiaspecific intervention to promote activity and independence whilst reducing falls risk in older adults with mild dementia. The intervention is currently being feasibility tested. Factors associated with an improvement of quality of life (QoL) according to the Nottingham Health Profile (NHP) after a multicomponent cognitive stimulation program in a Geriatric Day Hospital (GDH) Introduction: The aim of this study was to identify which factors are associated with QoL improvement among the patients receiving a multicomponent cognitive stimulation program in a GDH. Methods: Longitudinal study including those patients that attended the GDH for a minimum of seven sessions between January 2007 and December 2011. We registered the following variables at baseline and at the end of the rehabilitation program: sociodemographic variables, NHP questionnaire (global score and subareas), Barthel Index and Lawton Index for activities of daily living, Timed Up and Go and Tinetti for mobility, and Mini-Mental Folstein and GDS-Yesavage for cognitive status and depression, respectively. We considered QoL improvement if a decrease of the NHP score occurred with an effect size of C 0.50. We performed bivariate and multivariate analyses. Results: Of the 107 patients included (mean age 78.5 ± 5.5, 60.7% women), thirty-five experienced QoL improvement. In the bivariate analysis, a lower baseline Yesavage score was associated with an improvement of all QoL subareas except for pain and physical mobility. In the multivariate analysis, a decrease in the Yesavage score of C Key conclusions: Baseline depression and improvement of symptoms of depression may play an important role in the QoL improvement among patients receiving a multicomponent cognitive stimulation program. Hospitalization after oral antibiotic initiation in Finnish community dwellers with and without Alzheimer's disease: retrospective register-based cohort study Register. Factors associated with hospitalization were estimated utilizing logistic regression models. Results: Risk of hospitalization following antibiotic initiation was higher among antibiotic initiators with AD than without AD (adjusted odds ratio, aOR, 1.37, 95% Cl 1.28-1.46). Strongest association with hospitalization was found for oral glucocorticoid use, aOR 1.41 (1.25-1.59); epilepsy, aOR 1.33 (1.10-1.63); active cancer, aOR 1.30 (1.14-1.49). Among initiators of cephalexin, pivmecillinam, amoxicillin/amoxicillin and enzyme inhibitor and doxycycline, persons with AD were more frequently hospitalized than persons without AD. A quarter of hospitalized antibiotic initiators had infection diagnosis in their hospital care records. Key conclusions: Persons with AD initiating an antibiotic had a higher risk for hospitalization than antibiotic initiators without AD. Further research is needed to determine whether infection-related hospitalization could be reduced. Hospital-treated pneumonia associated with opioid use among community dwellers with Alzheimer's disease: a nationwide matched retrospective cohort study Introduction: Pneumonia is a common cause for hospitalization and excess mortality among persons with Alzheimer's disease (AD), but there is little research to drug use as its risk factor. We aimed to investigate the association of opioid use and hospital-treated pneumonia among community-dwelling persons with AD. Methods: This study was part of the Medication use and Alzheimer's (MEDALZ) cohort. We included all community-dwelling persons newly diagnosed with AD during 2010-2011 in Finland with new prescription opioid use (n = 5623) and matched nonusers (n = 5623). Data on drug use, modelled from pharmacy dispensings, and hospitalization for pneumonia were retrieved from nationwide registers. Patients with active cancer treatment were excluded. Results: Use of opioids was associated with a higher risk of hospitalization for pneumonia compared to nonuse (adjusted HR, aHR 2.03 95% CI 1.53-2.69). The risk was observed only during the first 2 months of use (aHR 3.65, 95% CI 2.45-5.42) and became statistically non-significant after that. Compared to mild opioid use, buprenorphine use was associated with a higher risk of pneumonia (HR 1.47, 95% CI 1.01-2.15), as was strong opioid use (HR 2.20, 95% CI 1.38-3.51). Similarly, the risk was higher for those using C 50 morphine milligram equivalents (MME)/day, when compared to those using \ 50 MME/day (aHR 1.72, 95% CI 1.29-2.29). Key conclusions: Risk of pneumonia associated with opioid use needs to be considered in pharmacotherapy of pain among persons with AD, especially when opioid therapy is introduced. Do different medicine formulations and dysphagia effect the incidence of pneumonia amongst people with dementia? Introduction: Dysphagia is experienced by people with late stage dementia [1] and is associated with aspiration pneumonia (AP), which is a common cause of death in dementia [2, 3] .Although diet and liquid intake are modified to minimise the risk of AP, appropriateness of medicine formulation is often not considered. Aim: Determine whether medication formulation and dysphagia are associated with incident pneumonia among people living with dementia. Methods: A case-controlled study design nested within those with dementia was conducting using the Clinical Practice Research Datalink, which includes primary care data of over 20 million UK patients. Cases had a diagnosis of pneumonia whereas controls did not. There were no age restrictions and patients with pneumonia diagnosis \ 90 days after dementia diagnosis were excluded. Conditional logistic regression was used for data analysis. Results: The dataset contained 28,671 controls and 7259 cases. An increased risk of developing pneumonia was observed to be associated with dysphagia (odds ratios (OR) 3.57, 95% confidence interval (CI) 3.20-3.98, p \ 0.001) and liquid formulations (OR 2.37, CI 2.11-2.68, p \ 0.001). Patients with a dysphagia diagnosis as well as prescribed liquids were associated with ((adjusted) OR 4.49, , p \ 0.001). Conclusions: Patients with dysphagia or prescribed liquid medicines are associated with a greater risk of developing pneumonia. Whilst the relationship between dysphagia and pneumonia is predictable, the relationship with liquid medicines is less intuitive. They may be a proxy for severity of dysphagia. Further work to explore this relationship is warranted. Characterising the structural and functional architecture of falls risk and response to exercise therapy in people with dementia: feasibility using Magnetic Resonance Imaging (MRI) RH Harwood 1 , R Dineen 1 , P Wells 1 , V van der Wardt 1 , V Booth 1 , D Auer 1 1 Nottingham University, Nottingham, UK Introduction: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) programme has designed and implemented a high-intensity, exercise-based therapy programme to promote safe activity and reduce falls risk among people with early dementia. We plan to investigate if MRI allows quantification of exercise-induced structural and functional plasticity in motor and postural control networks, and if quantitative imaging markers of motor and postural network integrity on pre-intervention MRI predicts treatment response. Methods: We invited 23 people with diagnosed dementia who took part in the PrAISED study to undergo a battery of multi-modal MRI imaging on a 3.0 Tesla GE Discovery MR 750 scanner. We included functional imaging of a virtual reality-based, imagined, walking and obstacle avoidance tasks, and a novel postural instability experience (a stumble). Results: 21 people agreed to take part, and 20 tolerated scanning. Mean age was 76 (range 67-92) years, mean Mini-Mental State Examination was 26/30 (range 19-30). Participants agreed that tolerability was good, and all would be willing to be scanned again. We obtained structural T1-weighted, T2-weighted FLAIR, 3D ASL perfusion, neuromelanin-sensitive T1, Re-fMRI, Rs-fMRI and task fMRI images and diffusion tensor imaging to map white-matter tracts. Initial analysis included correlating fMRI images with MMSE, demonstrating positive correlations with deep brain structures, including those associated with memory, and negative correlations with visual association areas. Conclusion: Multi-modal research MRI scanning is feasible and well tolerated. Functional imaging for imagined walking and obstacle avoidance tasks, and brain responses to a loss of balance. Similar dementia risk in APOE-e4 carriers and non-carriers with high life-long cognitive reserve: a population-based cohort study Aspects of life experiences, such as education, occupational characteristics, or social activities have been linked with a reduced risk of dementia, potentially due to enhancing cognitive reserve. In this study, we collected four reserve-enhancing factors observed over the life course -education (early adulthood), substantive work complexity (midlife), size of the social network, and leisure activities (both late life) and considered their contribution to a latent indicator of cognitive reserve in a Structural Equation Modelling approach. Using data from the Swedish National Study on Aging and Care in Kungsholmen-a community-based longitudinal study of aging-we examined the association between the resulting latent indicator of cognitive reserve and clinically-ascertained incident dementia over a nine-year follow-up period, while also considering the interplay between latent reserve and APOE-e4 status. The best-fitting SEM model of cognitive reserve indicator based on four observed factors had a good fit (v 2 = 2.04, p = 0.153; RMSEA = 0.019; CFI = 0.99). Predicted latent reserve was entered into a Cox proportional hazard model and a reduced risk of dementia was found in those with moderate and high levels of a latent cognitive reserve indicator (HR 0.65 and 0.35, respectively; both p \ 0.01). A significant interaction on an additive scale was found between latent reserve and genetic risk of dementia. Dementia risk reduction was similar in both carriers and non-carriers of APOE-e4 allele with high cognitive reserve (HR: 0.26 and 0.24, respectively; p \ 0.01 for both). Not only is cognitive reserve protective of dementia, but it appears to override the detrimental effects of genetic risk. How to prepare from caregiver turn to surrogate decision maker for people with dementia: A integrative review patients that surrogate decision-making for loved ones is becoming more common, especially for dementia. However, it was unclear about how to prepare and support when family member from caregiver turn to surrogate decision maker for people with dementia. Method: An integrative review design was used based on Whittemore and Knafl's study [1] . A review of English and Japanese language publications before 2018 March was conducted. Searched electronic databases included MEDLINE, CINANL, EmBase, PubMed and ICHUSHI, CiNii. Critical appraisal was performed by researchers used MMAT. Results: 46 articles with 8 main types of surrogate decisions were included: Placement, Clinical treatment research, End-of-life, Feeding, Advance directive, Cardiac Implantable Electronic Devices, Hemodialysis and others. A total of 3486 surrogates were involved and more than half were women. 9 studies focused on Clinical treatment research shown that who participated was mainly spouse as caregivers, adult children were contrasted. The review conducted the preference, influence, process of surrogates with variety of decision types that explored the evidence for caregivers to preparation and identified the advice for healthcare providers about support and intervention. Conclusions: Family members often care for people with dementia for several years, the more decision need the more burden with caregivers. However, many surrogates face the difficult decision with little professional support. Thus, it is urgently needing to support for caregiver turn to surrogate. The association between cognition and hearing is well known. With regard to the growing number of older persons and the incidence of demential illness the question arises whether hearing rehabilitation might counteract cognitive decline in aging. Since 2016 patients aged 50 or more suffering of severe to profound hearing loss and scheduled for cochlear implantation underwent a computer-based evaluation of neurocognitive functions prior to surgery. The multi modular computer-based test battery (ALAcog) composed of ten different subtests covering short-and long-term memory, processing speed, attention, working memory and inhibition. So far 80 patients (median: 67 yrs) were included. Out of these 33 patients were reassessed 6 months and 20 patients 12 months post implantation. After 6 months cognitive functions increased significantly regarding attention (p \ .001), delayed recall (p = .03), inhibition (p = .04) and working memory (2back p = .0041; OSPAN-test p = .0077). The benefit of the executive functions was the most remarkable. Results remained mostly stable after 12 months. Only working memory measured by the OSPAN additionally enhanced after one year (p \ .001). In contrast, long-term memory did not improve earlier than after 12 months (p = .021). In general, improvement was statistically better for subjects with poor baseline results. Cochlear implantation has a positive impact on cognitive abilities mostly on executive functions even in patients with lower preoperative performance. Further studies have to show whether hearing restoration through technical devices has a long-term effect on cognition and might even prevent demential illness. An assessment of cognitive screening in a population of geriatric patients at a local rehabilitation hospital in Malta Introduction: This retrospective study aims to: (1) establish whether cognitive screening is carried out with validated tools of assessment. (2) Assess role of radiological investigations for cognitive impairment and if underlying aetiology was identified. (3) Evaluate if treatment was initiated or reviewed following diagnosis. Method: Random selection of patients admitted to Karin Grech Hospital from different sources was carried out. Data was collected from patient files and electronic discharge summaries including: demographics; type of cognitive screening tools and documentation on discharge; brain imaging modality; attempts at diagnosis and review of treatment. Results: A total of 85 patients, with an average age of 81.5 years. While 43/85 (50.6%) patients had cognitive screening, this was only documented in the discharge summary of 23/85 (27.1%). AMT4 was performed in 29/85 (34.1%), MMSE in 21/85 (24.7%) and RUDAS in 5/85 (5.9%) with no patients having a MOCA or clock-drawing test. Cognitive impairment was detected in 8/29 (27.6%) on AMT4, 18/21 (85.7%) on MMSE and 4/5 (80%) on RUDAS. Only 3/8 (37.5%) patients with abnormal AMT4 scores were followed up by an MMSE. Computed tomography scan was the primary imagining modality used. Only 6/42 (14.3%) were scanned as part of their cognitive assessment and a formal diagnosis of cognitive impairment was documented in only one case. 10/85 (11.8%) patients were started on an acetylcholinesterase inhibitor (donepezil). Conclusions: This audit highlights lacunae in cognitive screening that still need to be addressed on a local level while also emphasizing its importance in the delivery of patient-centred care. Alzheimer's disease (AD) were included in this study. Patients with major depression were excluded. Those with dementia were selected from previously diagnosed patients according to the NINCDS-ADRDA and DSM-V diagnostic criteria. Patients with aMCI were diagnosed using Petersen criteria. The Qmci-TR, MMSE, and MoCA were administered sequentially and alternated by geriatricians experienced in the application of all three tests. Interrater reliability was determined in advance. The Reisberg FAST scale was used to stage cognitive status. Education and age-specific cut-offs were determined for all three screening tests for the normal cognition, aMCI and AD, and their discriminative values were compared. SPSS 18.0 and MedCalc programs were used for statistical analyses. Results: A total of 321 patients (133 with normal cognition, 88 aMCI, 100 AD) were included. Median (min-max) age was 75 (60-98) years. One-quarter (25.1%) had completed high school and above, 65% primary school or lower education levels. Half (51.1%) of the patients were aged 75 years old and over. The Qmci-TR was statistically significantly better than the MoCA in distinguishing between aMCI and AD in the whole sample and for those attaining high school or higher levels of education (AUC 0.833; 0.759 p = 0.004 and AUC 0.918; 0.752 p = 0.04, respectively). In addition, the Qmci-TR and MMSE were superior to the MoCA in discriminating normal cognition from cognitive impairment in the whole sample and in individuals over 75 years of age. Conclusion: This is the first study to compare the discriminative values of a broad selection of short cognitive screening tests in an older Turkish population. In distinguishing between MCI and AD, the Qmci-TR appears to be preferable to the MoCA; it is more sensitive for an older Turkish population and those with more education. Persistent depressive symptoms are independently associated with lower processing speed in healthy older adults A Clark 1 , N Pendleton 1 1 Introduction: Age-related deterioration in processing speed may drive decline in cognitive abilities in healthy older adults. We therefore need to understand factors that affect processing speed. Persistent depressive symptoms have previously been associated with processing speed decline -this may relate to confounding by a common cause, rather than an aetiological link. This study aimed to establish whether the relationship between depressive symptoms and processing speed is accounted for by cerebrovascular disease or neuroticism. Methods: Participants of the Manchester and Newcastle Study of Age and Cognitive Performance aged over 60 were included. Depressive symptoms were assessed on up to 4 occasions (using Beck Depression Inventory (BDI) and Geriatric Depression Scale). Processing speed was assessed using an alphabet coding task. Multiple linear regression was used to examine the relationship between depressive symptoms and processing speed adjusted for potential confounding factors. Results: 2919 participants were included (mean age 67.49 years). Low levels of depressive symptoms were reported (mean baseline BDI score 7.15). Average depressive symptoms over mean 8.6 years were significantly associated with processing speed (beta = -0.06, p = 0.02). Neither neuroticism (beta = 0.024, p = 0.415) nor cerebrovascular disease (beta = -0.03, p = 0.32) were associated with processing speed. Conclusion: Persistent low-level depressive symptoms in healthy older adults are associated with lower processing speed at follow-up over a mean 8.6-year period. This relationship is not accounted for by neuroticism or cerebrovascular disease. Subclinical depressive symptoms may therefore represent a modifiable target for interventions to promote healthy cognitive ageing. Correlations between dual-task performance and Alzheimer's disease cerebrospinal fluid biomarkers Introduction: Studies have indicated that gait disturbances occur early in the development of dementia and that dual-task performance including mobility may predict the progression from mild cognitive impairment (MCI) to dementia [1] . Amyloid-b-42 (Ab42), total tau (ttau) and phosphorylated tau (p-tau) in the cerebrospinal fluid (CSF) are acknowledged biomarkers for conversion from MCI to Alzheimer's disease (AD) [2] . Aim: To investigate correlations between CSF biomarkers and outcomes of I) the mobility test Timed Up-and-Go (TUG) combined with the verbal task of reciting animals (TUGdt), II) the Mini Mental State Examination (MMSE), and III) the Word Fluency Test (WFT). Methods: Eighty-three patients at two memory clinics who had undergone lumbar puncture were included with mean age 71 years (range 50-84). Thirty-one had a dementia diagnosis (22 AD) and 52 had MCI. The number of animals recited during the performance of TUGdt was counted. Spearman's rank correlations adjusted for age, gender and education were used. Results: Significant inverse (p.05) correlations were shown between CSF tau concentrations and I.I) the number of recited animals/10 s during TUGdt (t-tau: R = -0.25, p-tau: R = -0.25), I.II) the total number of animals recited during TUGdt (t-tau: R = -0.26, p-tau: R = -0.27), II) MMSE results (t-tau: R = -0.25, p-tau: R = -0.26), III) WFT results (t-tau: R = -0.24, p-tau: non-significant). CSF Ab42 did not correlate with any of the test results. Conclusions: Correlations between CSF tau and TUGdt performance were found at similar levels as between CSF tau and MMSE among patients with dementia or MCI. This may indicate that TUGdt results could be used as an aid in early identification of neurodegeneration. References: 1. Montero-Odasso MM et al (2017) Association of dual-task gait with incident dementia in mild cognitive impairment: results from the gait and brain study. JAMA Neurol 74 (7) Introduction: Current literature supports that cognitive function and physical performance are associated. Gait is more often evaluated on a straight walkway. F8WT, involving straight and curved walking to walk a figure-of-8 around two cones, might challenge cognitive function. Our aim was to assess the relationship between physical and cognitive function (specifically executive function) using different physical performance tests in community-dwelling older adults with cognitive impairment. Key conclusions: Our findings support an association between executive function and GS, but traditional linear physical performance measures appear superior to more challenging tasks. We hypothesize that F8WT might be more influenced by gait impairments because of the curved pathway. Hence, we need future research with larger study samples to better investigate this aspect. Reliability and validity of Rowland Universal Dementia Scale (RUDAS) in the diagnosis of mild dementia in Turkish population Background: Novel screening tests are needed to top up lacking parts of current tests. Aim of our study is, to validate the Turkish version Rowland Universal Dementia Scale (RUDAS). Methods: 140 patients over 65 years of age (70 control/70 mild dementia) were included. Power of cohort was over 80%. Diagnosis was supported by DSM V criteria in all patients. In 79 patients neuropsychometric tests were applied. RUDAS, was translated into Turkish, applied by the researcher. RUDAS was applied in 2 days to determine test-retest reliability. Results were compared with MMSE; reliability, validity, statistical values, factors affecting the results were determined. Results: Cohorts were distributed homogenously. Time validity was verified. MMSE was correlated wtih results of RUDAS with 45,3% in control, 73% in dementia group. Test was applied approximately in 5 min. Factor weights varied 0.44-0.81 and construct was verified as 6 item scoring system. When 25 was cut-off point, sensitivity, specificity, PPV, NPV were as follows respectively, 92.86%, 92.86%, 92.9%; 92.9%. Content validity index was determined by 7 specialists as 100%. Cronbach's alpha was 0.692, Test-retest reliability (ICC = 0.987) was determined. Results were not affected by educational, immigrant status, language used; however age, gender have significant effect. Conclusion: As a result of increased migration trend, screening tests became less reliable. Our study showed, Turkish version of RUDAS is valid, reliable that could be used in mild dementia patients from diverse populations while education, immigrant status, preferred language have no effect on results. Together with the diagnosis dementia, many things in daily life change or will change quickly. These changes might lead to issues you would like to discuss together to anticipate, but are sometimes difficult to discuss (e.g. cooking, personal hygiene, inheritance, and preferences for future care). In order to support people in having these conversations, the Dutch application Roodkapje (Little red riding hood) was developed. Roodkapje is a so called gamified application that is designed as a conversation facilitator for people with dementia and their informal carers. Grandmother comes across different topics, depicted in such a manner that players are encouraged to reflect and start the conversation on their own situation. Roodkapje was developed in collaboration with older persons and their relatives, both with and without dementia. The development process of applications as this is often complex, that is why we would like to share our learned lessons regarding content production, usability testing and app development. We used literature, surveys, and a focus group to collect the most important and difficult to discuss issues. During the development process older adults played prototypes of the game in order to provide us with feedback on user friendliness and use of the game as conversation facilitator. This feedback gave us insight on how to develop an application for older adults with dementia; we started the app as a serious game, but this did not fit the target audience. The current application is an interactive tool to facilitate conversations on changes due to dementia. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Helicobacter pylori infection is associated with an increased incidence of dementia in a cohort population study of old farmers Context: Alzheimer's disease (AD) is a chronic neurodegenerative disease and the first cause of dementia in developed countries. A new theory has emerged and concerns the possible impact of infectious agents on AD course. Helicobacter pylori, responsible for a lifelong gastritis, may be involved in the pathogenesis of AD. Objective: To determine whether H. pylori infection increases the risk of dementia (including AD), possibly by cerebrovascular lesions. Participants: Prospective community-based cohort AMI of 689 former farmers aged 65 and older, living in the southwest of France and followed from 2007 to 2017. Measurements: A descriptive and comparative analysis was performed at baseline according to H. pylori status (serology). Then Cox proportional hazard model was done to determine factors associated with dementia incidence during 10 years. Brain MRI was performed in order to investigate cerebrovascular burden regarding infectious status in a subsample of 260 volunteers. Results: At baseline, 200 (29.0%) subjects were infected by H. pylori. They were more cognitively impaired compared to non-infected ones. After 10 years of follow-up, 90 incidents cases of dementia were diagnosed. After controlling for age, sex, educational level, Apolipoprotein E4 status, wine and cardiovascular risks factors, H. pylori was associated with an increased incidence of dementia (HR = 1.70, P = 0.03). However, white matter hyperintensity (i.e. cerebrovascular burden) was not increased in case of infection. Conclusion: This study provides more evidence of an association between H. pylori and dementia, especially with AD. But our hypothesis that the underlying mechanism was based on brain vascular damages was not confirmed. Influence of memory disorders perceptions on quality of life in people with memory complaints Anaïck Besozzi 1 , Amélie Coquelet 1 , Adeline Dreyer 1 , Elisabeth Spitz 2 , Christine Perret-Guillaume 1 1 University Hospital of Nancy, Nancy, France, 2 EA4360 APEMAC, University of Lorraine, Lorraine, France The alteration of the quality of life (QoL) in people suffering from Alzheimer's disease is well documented in literature. It seems that QoL is also altered in mild cognitive impairment and subjective memory complaint. In the absence of loss of autonomy in these pathologies, the quality of life appears to be influenced by anxiety and depression. Little is known about QoL before diagnosis, at the beginning of care process. Our goal was to study the influence of memory problems perceptions on QoL in people expressing memory complaints before diagnosis (at the first visit at a Memory Clinic). We also control factors known to influence QoL: anxiety, depression and cognitive decline. One hundred fifty six persons expressing memory complaints were recruited at the Memory Clinic of the University Hospital of Nancy, France (mean age: 73 years; sex ratio: 99 female). Correlation Analysis, mean comparisons and regressions were carried out. Results show that, in a population expressing memory complaints without diagnosis, QoL does not seem to be influenced by anxiety, depression or cognitive decline. However, negative perceptions of memory disorders, such as a low personal control on memory loss, affect QoL, especially for social domains: if an individual thinks he cannot control his memory problems, then he will be less committed with his social life. Given the importance of social activities in maintaining cognitive abilities and quality of life, providing advises and mnemonic techniques in psychoeducational intervention could improve control on memory problems and reduce the risk of social withdrawal. Good outpatient services delay nursing home admission of people with dementia Introduction: The city of Zurich emphasizes outpatient services with diagnostics, treatment, medical and social care and counselling for patients with dementia and their formal or informal caregivers. There are three memory clinics, many day-care-centers offering respite care as well as increasing dementia specialisation of homecare services (Spitex). In 2008 the new service Home-visit SiL was launched. A team of specialised nurses provides a diagnostic assessment and specific counselling at the people's homes. They offer case-management and organize care for patients without a close social net. The goal of this service is to help people with dementia to stay longer at home. Appropriate outpatient services should delay the nursing home admission. This study measured the state of dementia and other data at patient's admission to two nursing homes in Zurich and compares it with data of RAI-NH Background: In Ireland, Persons living with dementia (PlwD) account for approximately 25% of acute hospital admissions. Acute care services are often fragmented with little integration between inhouse teams, ambulatory or community services, resulting in poorer care outcomes for PlwD, including deskilling and re-admissions. This project developed a person-centred integrated Dementia care pathway (IDCP) for PlwD availing of services. The pathway was developed over a 3-year period (2015-2017) and was governed by a consortium of key stakeholders. Method: Using Quality Improvement methodology and PDSA cycles, project activities were supported by the development of a Memory Assessment and Support Hub, accessed from various entry points on the pathway. Activity evaluation consisted of data capture and review, interviews, focus groups and clinical audit. Findings: Pathway activities focused on: dementia identification/diagnosis (n = 376 new diagnosis), (n = 1006 assessments/reviews), (n = 1250 signposting/post diagnostic supports), crisis intervention/ appropriate acute hospital avoidance (n = 181), enhanced inpatient care (n = 1013 assessment/reviews), (n = 73 Dementia/Delirium Care Bundle (DDCB)), supported discharge (n = 372), and targeted staff education (n = 902). Evaluation indicates improvements in personcentred inpatient care delivery, timely access to diagnostics, crisis management and post diagnostic supports and enhanced hospital/community integration. Conclusion: This flexible IDCP has different entry points for the PlwD depending on their individual needs at a given point in time. This acknowledges the complexity of person-centred care delivery for PlwD. Many challenges exist in sustaining the IDCP. Most importantly it requires a culture change at all levels of the organisation, for which educational initiatives and consortium governance is essential. Further targeted research is needed. Neuropsychological performance in elderly people with diabetes mellitus type 2. DIABDEM Project: preliminar results of a Chilean sample Agnieszka Bozanic Leal 1 , Francesc Formiga 2 , Pablo Toro 3 1 Introduction: There is a well known association between type 2 diabetes mellitus and cognitive disorders. Daily habits (diet, sleep, physical activities, etc.) may have a decisive role in this interaction. This study will assess the daily habits in elderly Chilean people with and without T2DM. Methods: The sample compared 33 subjects with T2DM with 67 control participants aged 65-80 years, community-dwelling, divided according years of education. The daily habits battery was designed to examine dietary, physical activity, perform in activities of daily living, sarcopenia, fragility, sleep, and depression. Results: Mean age was 71.2 ± 3.9 years, 66% women and a mean of 9.5 ± 4.1 years of education. T2DM subjects had significantly lower scores than subjects without T2DM in proper dietary habits (Questionnaire of Mediterranean Diet Adherence p \ 0.0072) and type of physical activities (Rapid Assessment of Physical Activities (RAPA) p \ 0.004). Key conclusions: In this sample, subjects with T2DM presented different daily habits in comparison to subjects without T2DM. This could increase the risk of developing a cognitive disorder in future. Alcohol use and abuse: old before your time Introduction: The over 65 people with high alcohol consumption show a worsening of short and long term cognitive skills; alcohol intake in the elderly is associated with more frequent memory and encephalopathy deficits compared to the general population. Methods: A comparative study was carried out by comparing the data related to over 65 inpatients of a alcohol rehab centre to patients admitted to a geriatric acute care unit at Fondazione Richiedei. We have considered scales related to cognitiveness (evaluating MMSE) and possible encephalopathies in the two patient clusters. Results: The data refer to patients admitted from 10/1/10 to 28/2/18. Out of 1145 patients admitted for alcoholism, 76 (6.63%) were over 65. Of these 46 (60.52%) had encephalopathy (6 vascular, 16 cortical atrophy, 24 mixed); 30 (39.47%) cognitive impairment patients, 20 (26.31%) cognitive impairment associated with encephalopathy. Of S246 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 these 1145 patients (of all ages) 86 (7.51%) had cognitive impairment. Out of 5149 patients admitted to the geriatric unit 65 (1.26%) needed alcohol-based detoxification. Of these 64 (98.46%) had cognitive deficits, 48 (73.84%) had encephalopathy. Keyconclusions: The data collected agree with the data of literature and show how the use of alcohol inflicts cognitive performance regardless of the personal abilities of each and levels the differences that, constitutionally, individuals can present. In alcoholics there is an anticipation of the reduced cognitive function that normally occurs with advancing age. Not only the elderly are more likely to develop cognitive deficiency or encephalopathies, but also non-over 65 alcoholics who will become the elderly of tomorrow. The kynurenine pathway and cognitive performance in community-dwelling older adults. The Hordaland Health Study Introduction: Tryptophan, its downstream metabolites in the kynurenine pathway and neopterin have been associated with inflammation and dementia. We aimed to study the associations between plasma levels of these metabolites and cognitive function in community-dwelling, older adults. Methods: This cross-sectional study included 2174 participants aged 70-72 years of the community-based Hordaland Health Study. Tryptophan, kynurenine, neopterin and eight downstream kynurenines were measured in plasma. Kendrick Object Learning Test (KOLT), Digit Symbol Test (DST) and the Controlled Oral Word Association Test (COWAT) were all outcomes in standardized Zellner's regression. The Wald test of a composite linear hypothesis of an association with each metabolite was adjusted by the Bonferroni method. Age, education, sex, glomerular filtration rate, smoking, diabetes, pyridoxal 5-phosphate, C-reactive protein and depressive symptoms were considered as potential confounders. Results: Higher levels of the kynurenine-to-tryptophan ratio (KTR) and neopterin were significantly associated with poorer, overall cognitive performance (p \ 0.002). Specifically, KTR was negatively associated with KOLT (b -0.09, p = 0.001) and COWAT (b -0.08, p = 0.024), but not with DST (b -0.03, p = 0.139). This pattern was also seen for neopterin (KOLT: b -0.08; p = 0.001; COWAT: b -0.06, p = 0.010; DST: b -0.01, p = 0.709). The associations were not confounded by the examined variables. No significant associations were found between the eight downstream kynurenines and cognition. Conclusion: Higher KTR and neopterin levels, biomarkers of monocyte activation, were associated with reduced cognitive performance, implying an association between the innate immune system, memory and language. Intracerebral infection with Streptococcus pneumoniae does not influence medium-term spatial memory and learning in a mouse model of Alzheimer's disease Introduction: In patients with Alzheimers disease (AD), bacterial infections are often associated with a cognitive decline. To elucidate the underlying mechanisms for this clinical phenomenon, we assessed the effect of an intracerebral (i.c.) infection with Streptococcus pneumoniae type 3 (SP3) in a mouse model of AD. Methods: Tg2576+/-mice (11-14 months) received an i.c. injection of either 1 9 104 CFU live SP3 (n = 47) or saline (n = 30), followed by antibiotic treatment with ceftriaxone starting 22 h post infection (p.i.) 29/day for 5 days. Mice were monitored for 4 weeks p.i. for clinical status, weight, motor functions (rotarod and tight rope test) and neuropsychological status including spatial memory and spatial learning using the Morris water maze. b-Amyloid (Ab) 1-40 and 1-42 loads in mouse brains were quantified by ELISA. Results: I.c. infection with SP3 followed by antibiotic treatment led to a high mortality of Tg2576+/-mice (53%), and a transient weight loss during the acute phase of the infection. Motor functions, spatial memory and learning as well as Ab loads of surviving Tg2576+/mice were not affected by i.c. SP3 infection during 4 weeks p.i. Key conclusions: In contrast to our previous study in Tg2576+/mice in which i.c. E. coli infection led to impaired spatial learning 4 weeks p.i., here, we did not detect any influence of i.c. SP3 infection on medium-term spatial memory and learning. This indicates that the disease-modulating effect of bacterial infections on cognition in AD is pathogen-specific and less pronounced when fast and adequate antibiotic treatment is performed. Prevalence of cognitive impairment among elderly patients with and without memory complaints Results: 83.4% of the examined patients pointed a decline in memory functioning or mental performance. However, based on the results of neuropsychological examination among patients without specific memory complaints only 6.6% (17) had no CI. 22% of patients without specific complaints were diagnosed with subtle CI, 35% had mild cognitive impairment (MCI) and 8% had dementia. In general, cognitive disorders without dementia were detected in 76% of patients who did not complain on memory and mental functions. Key conclusion: The study showed a rather high prevalence of CI among elderly patients. Specific memory complaints could be absent in a wide part of elderly population with no-dementia cognitive disorders, and therefore all elderly patients, especially at the age of 75+, should be routinely screened for CI. Prevalence of cognitive impairment in the elderlies in primary care settings Patients with cognitive decline and affective disorders had more pain days in the month and more pain duration. Conclusion: comorbidity of chronic pain syndromes and affective and cognitive disorders can be associated with common pathophysiologic mechanisms. Chronic pain have influence on cognitive and affective disorders in aged patients, so the prompt pain treatment is essential. Transferability and sustainability of effects of dual-task training in patients with dementia Klaus Hauer 1 , Nele C. Lemke 1 , Christian Werner 1 , Stefanie Wiloth 1 1 Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, Heidelberg, Germany Introduction: Transferability of trained to untrained dual task (DT) performances has not been studied in persons with dementia (PWD). Objective: The study objective was to evaluate immediate and longterm transferability of DT performances in PWD. Methods: Multi-morbid, older PWD (n = 105) were included in a 10-week randomized, controlled trial with the intervention group (IG) performing a DT-based training ('Walking and Counting') while the control group (CG) performed unspecific, low-intensity exercises. DT-performance was measured under 3 conditions: 'Walking and Counting' (trained), 'Walking and Verbal Fluency' (semi-trained) and 'Strength and Verbal Fluency' (untrained). Motor and cognitive performance was documented as single-task (ST) and DT at baseline (T1) after training (T2) and at follow up (T3). Results: The trained DT 'Walking and Counting' was significantly improved for motor performances (p \ 0.001-0.011, effect sizes as partial eta squared g 2 = 0.071-0.249) as well as cognitive performances (p \ 0.001-0.047, g 2 = 0.044-0.295). Significant transfer effects were found for the semi-trained DT 'Walking and Verbal Fluency' in motor (p \ 0.001-0.016, g 2 = 0.068-0.150) and partly cognitive performances (p = 0.026, g 2 = 0.059). No significant transfer effects were found for the completely untrained DT 'Strength and Verbal Fluency'. Effects sustained for the trained DT for most motor (p = 0.009-0.038, g 2 = 0.051-0.089) and partly cognitive outcomes (p \ 0.001, g 2 = 0.157). Transfer-effects could in parts be preserved for semi-trained DTs at follow up. Conclusion: Study results document for the first time a transfer from trained to untrained DTs which partly sustained after follow up in patients with moderate stage dementia. With increasing difference in task conditions and time lap to intervention, transfer effects were reduced. Evaluation of postural stability with clinical and laboratory tests in Alzheimer's disease patients Introduction: Gait and balance disturbances are seen more often in Alzheimer's disease patients, even in the early stage, than cognitively normal older people. We aimed to evaluate postural stability, gait and balance with clinical and laboratory balance tests in Global Deterioration Scale Stage 4 and 5 Alzheimer's disease patients and compare with cognitively normal patients. Methods: We recruited 37 patients with Alzheimer's disease (AD) and 21 cognitively normal older people. Individuals with advanced stage dementia, hearing problems, severe arthritis, history of surgery in previous month, Parkinson's disease, stroke sequel, and major depression were excluded. Comprehensive geriatric assessment, Berg Balance Scale and Timed Up&Go Test were performed to all participants. Fall history in previous year and blood tests results in the previous month were recorded. Walk across (WA), sit to stand (STS), tandem walk (TW) and step quick turn (SQT) tests were applied to all participants using computerized posturography, NeuroCom Balance Master (2011). SPSS 21.0 programme was used for statistical analysis. Results: Mean age was 76±5 vs. 73±4 years in AD and control groups, respectively. Twenty two of the AD patients and 12 of the controls were female. The walking speeds in WA and TW tests were slower in AD patients than the controls (p = 0.005 and \ 0.001). WA-step width increased (p = 0.034) and WA-step length decreased (p = 0.006) in the AD group. SQT-sway increased (p = 0.017) and SQT-time increased (p \ 0.001) in patients with AD. Regression analysis including age, vitamin B12, WA-step length, WA-step width, WA-speed, STS-sway velocity, SQT-turn sway, SQT-turn time, and TW-speed parameters showed that WA-step length (OR = 1.05, %95 CI 1.009-1.110, p = 0.02), SQT-turn sway (OR = 0.95, % 95 CI 0.910-0.998, p = 0.04), SQT-turn time (OR = 0.33, %95 CI 0.148-0.766, p = 0.01), STS-sway velocity (OR = 0.45, %95 CI 0.219-0.963, p = 0.04), and TW-speed (OR = 1.14, %95 CI 1.024-1.267, p = 0.01) were independently associated with Alzheimer's disease. Conclusion: Slower walking speed, higher turn sway and time show that patients with AD may have increased risk of falls risk even in early stages. The parameters associated with Alzheimer's disease independently from vitamin B12 levels and age may cause this outcome. Association between day to day blood pressure variability and cognitive impairment in memory clinic patients AL Meendering 1 , RAA de Heus 2 , LM van den Ingh 1 , JAHR Claassen 2 1 Radboudumc, Department of Geriatric Medicine, Nijmegen, The Netherlands, 2 Radboudumc, Department of Geriatric Medicine, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands Background: High blood pressure variability (BPV) might play a role in the association between hypertension and cognition. The main objective of this study is to gain more insight in the association between day-to-day BPV and cognitive impairment. Design and method: In this cross-sectional study, 213 memory-clinic patients were included. They performed a duplo measurement of their blood pressure (BP) twice a day for 1 week. After averaging duplo measurements and removing day 1 the mean BP and coefficient of variation (COV) were calculated. Patients were divided in three groups, based on clinical diagnosis by a geriatrician: group 1 = patients without suspicion of neurodegenerative disease, group 2 = mild cognitive impairment (MCI) or vascular cognitive impairment (VCI), group 3 = dementia (vascular or Alzheimer's disease). ANCOVA (p \ 0.05) was conducted to compare BPV (COV) between the 3 groups, with correction for age and mean BP. Results: COV was higher in patients with a diagnosis of dementia than in patients with MCI/VCI or without suspicion of neurodegenerative disease, F(2, 210) = 4198, p = 0.016. However, after adjusting for age and mean systolic BP, there was no significant difference in COV of systolic BP between the groups, F(2, 208) = 1755, p = 0.175. Conclusion: In the current study we did not found evidence for an association between BPV and cognitive impairment. Follow-up of this population is interesting to explore the longitudinal association of BPV and cognition. Tablet-based outpatient care for people with dementia: Guideline-based treatment planning, personalized disease management and network-based care and can contribute to the improvement of intra and intersectoral health care. The objectives of the presented project ''DemTab-Tablet-based outpatient care of people with dementia: guidelinebased treatment planning, individual health management and networking'' are the development and scientific evaluation of a tablet based intervention as an improvement of outpatient dementia care. Method: Within the framework of DemTab, a qualitative feasibility study will be carried out to test a tablet-based intervention in everyday outpatient care. The feasibility study takes into account the needs of patients with dementia and their caregivers as well as GPs in order to develop, document and systematically evaluate a tablet-based intervention (mixed methods approach). In a second step, the developed tablet-based intervention will be tested. In a cluster randomized control study, GPs (N = 20) and their patients with dementia together with their caregivers (N = 204) will be randomly assigned to an intervention (N = 102) and a control (N = 102) group. Clinical outcomes will be measured at baseline, after 9-months and after 12-months using standardized and validated measurements as well as continually using the tablet and medical records data. Results: The study design of DemTab and the first results of the feasibility study will be presented. Based on the feasibility study, first contents and applications of the tablet will be presented and discussed. Dietary intake of community-dwellers by cognitive performance cluster Introduction: Ageing is a critical issue worldwide. As one ages, several physiological changes take place, being cognitive decline one of the most meaningful for older adults. Once cognitive decline is influenced by dietary variables, we explored the patterns of dietary intake between poor and good cognitive performers. Methods: A group of 50 years or older community-dwellers from Northern Portugal were assessed in two moments (M1 and M2) 18 months apart. The dietary intake was evaluated through 24-h dietary recall, and nutrient density computed for macronutrients as percentage of total energy value and micronutrients as nutrient unit/ 1000 kcal. Cognitive performance clusters were derived from a principal component analysis (PCA) comprising scores of a battery of neuropsychological tests. Cross-sectional and longitudinal statistical analyses were carried out resorting to independent t-tests, Mann-Whitney U test, PCA, binomial logistic regressions, paired t-tests and Wilcoxon Signed Rank Test. Results: In the cross-sectional analysis, subjects whose total fat, monosaturated fat and saturated fat intakes were higher were more likely to be good performers (b = 0.62, p = 0.02). In the longitudinal analysis, despite energy intake has not changed over time, a significant decrease was recorded on carbohydrates and PUFA intake. At M2, poor performers reported a lower PUFA and Vit B9 intake, whereas good performers recorded a significative reduction in calcium, Vit E and several B vitamins intake. Overall, good performers stated a larger number of significant decreases. Conclusion: These findings suggest that food patterns might be a better predictive factor of the cognitive performance than a set of nutrients. Introduction: The use of benzodiazepines and related drugs (BZDRs) and opioids has been associated with serious risks in older persons, especially in individuals with Alzheimer's disease (AD). We investigated the prevalence and associated factors of concomitant use of these drugs among older people with or without AD. A shorter duration of concomitant use (1-89 days) revealed similar results, N = 3821; 15.6% and N = 3008; 10.6%, respectively. Prolonged concomitant use of BZDRs and opioids was associated with female sex, low socioeconomic position, most of the common comorbidities and history of substance abuse or long-term benzodiazepine use. The most commonly used combinations were Z-drug (31.7%) or benzodiazepine (29.9%) with a weak opioid. Key conclusions: Despite the recommendations and risks, the prevalence of concomitant BZDR and opioid use was common in older persons with or without AD. It is important to develop strategies to reduce unnecessary concomitant use of these drugs. Food intake and cognition in older adults: baseline findings in FlaSeCo-trial Introduction: The PrAISED intervention is a person-centred programme of exercise and daily activity aimed at maintaining independence and well-being for individuals with dementia. It was designed to be delivered by professionals in the UK National Health Service (NHS), but this approach is potentially expensive. This presentation focuses on a qualitative enquiry which considered if the intervention could be adopted in the voluntary or leisure industry sectors. Methods: The aim of the enquiry was to gain insights into whether factors linked to the 'inner setting' and 'individuals involved' sections of Damschroder's Consolidated Framework for Implementation Research (CFIR) might impact on delivering the PrAISED intervention outside the NHS. One-to-one interviews were conducted with three occupational therapists, two physiotherapists, a health care team manager and a local authority commissioning manager, all of whom had previous experience of working on projects involving the transition from service delivery in the NHS to the voluntary or leisure industry sectors. Results: Whilst informants raised no absolute objections to delivering the PrAISED intervention outside the NHS, they felt that the challenge would be to provide an individualised programme, based on an assessment and supported by motivational strategies. This was considered to contrast with the group exercise and activity classes currently delivered in the voluntary or leisure sectors for individuals with dementia. Key conclusions: The CFIR allowed the researchers to predict and plan for some of the issues which may surface when implementing PrAISED outside the constraints of the NHS or the requirements of a clinical trial. Time course of changes in motor-cognitive exergame performance during task-specific training in patients with dementia: identification and predictors of early training response Introduction: Few studies suggested positive effects of exergaming on physical, cognitive, and psychological outcomes in patients with dementia (PWD). However, little is known about the training volume required to produce such positive effects. The study aim was to analyze the time course of changes in motor-cognitive exergame performances during a task-specific training program and to identify independent predictors of early training response (ETR) in PwD. Methods: Fifty-six PwD participated in a 10-week, task-specific training program (29/week) on an exergame-based balance training system (Physiomat Ò ), combining postural control tasks with cognitive tasks of a modified Trail-Making-Test. Physiomat Ò performance was assessed at baseline (T1), at training session 7 (TS7) and 14 (TS14), and after 20 training sessions (T2) as the time required to complete different Physiomat Ò -Tasks (PT). Reliable change indices were used to identify early responders (T1-TS7). A multivariate logistic regression analysis was performed to determine predictors of ETR. Results: For all PT, significant improvements were already observed from T1 to TS7 (p B 0.001-0.006). Performance in most PT did not significantly improve from TS7 to TS14 and from TS14 to T2. Across all PT, significant improvements (p B 0.001-0.036) were found from TS7 to T2. Low baseline exergame performance, low performance in constructional abilities, and low dual-task performance predicted ETR. Conclusion: Substantial improvements in complex motor-cognitive exergame performances can be achieved within a surprisingly short task-specific intervention period in PwD. Patients with low baseline exergame performance and low visuospatial and divided attention abilities are more likely to improve early in the intervention. Occurrence of newly diagnosed cognitive disorders during a systematic two-year follow-up after hip fracture Introduction: Cognitive disorders are increasingly affecting the ageing populations with hip fractures another major concern. Cognitive disorders and dementia are common in hip fracture patients but little is known about the specific diagnoses of cognitive disorders emerging after hip fracture. Methods: Consecutive C 65-year-old patients sustaining their first hip fracture between January 2010 and August 2015 (n = 1165) in the Seinäjoki Central Hospital area (population 193,000) were systematically followed up for two years. Only patients without pre-fracture diagnosis of cognitive disorder were included (n = 831). The patients underwent a comprehensive geriatric outpatient assessment 4-6 months post-hip fracture with diagnostic investigations of cognitive disorders based on the 2010 update of the National Care Guideline including internationally accepted diagnostic criteria. Data on diagnostic investigations and diagnoses were extracted manually from the electronic patient files by the research physician (RJ). Results: Of the patients, 238 (28.6%) had died before diagnostic investigation. A cognitive disorder was diagnosed in 184 (22.1%) patients. Of these, Alzheimer's disease (AD, n = 79, 42.9%), vascular cognitive impairment (VCI, n = 23, 12.5%) and mixed type (AD + VCI, n = 73, 39.7%) were the most common diagnoses. Less common cases were also identified (Lewy body disease, dementia with Parkinson's disease, alcohol-induced dementia, Fahr's disease, ALS dementia; n = 9, 4.9%). At the two-year time-point diagnostic examinations were still ongoing in 52 patients (6.3%). Conclusions: Previously undiagnosed cognitive disorders are common among hip fracture patients. Specific diagnoses of cognitive disorders are important in planning the short-and long-term treatment scheme. A systematic follow-up is warranted to identify the new cases. Low cognitive test score predicts 30-day mortality in hospitalised patients without known dementia Background: Delirium and undiagnosed dementia are prevalent in older patients and are associated with poor outcomes but diagnosis may be challenging in the acute hospital setting. In contrast, a short cognitive screening test is quick, identifies objective cognitive deficits and can be done by non-specialist staff. We therefore determined the predictive value of low cognitive test score for mortality in patients without known dementia. Methods: Consecutive patients aged [ 65 years without known dementia admitted to a single acute medicine team over three 2-month periods (2010, 2012, 2015) had on-admission abbreviated mental test score (AMTS, low score \ 8) and delirium screen with follow-up to 2 years using electronic medical records. Hazard ratios (HRs) for death were calculated by low versus normal cognitive score adjusted for age, sex, illness severity, and pre-morbid function. Results: Among 495 patients (mean age/SD = 80.5/8.5 years, 237 (47.9%) male) 83 had pre-admission dementia diagnosis and 125 (25.2%) had delirium. Among the 412 without dementia, 92 (22.3%) had delirium and 106/286 (37.1%) tested patients had low cognitive score. Adjusted HR for 30-day mortality was 6.5 (95% confidence interval 1.3-13.4) for low cognitive score vs 3.0 (1.2-7.4) for delirium. Associations were non-significant thereafter on follow-up to 2 years after adjustment for confounders. Conclusions: Low cognitive score is prevalent in older patients without pre-admission dementia diagnosis and is an independent predictor of 30-day mortality. Simple cognitive testing is more straightforward than dementia/delirium diagnosis and should be routine at first assessment to identify co-morbid cognitive disorder. Evolution of oral-health and cognition in elderly patients with MCI Objectives: to investigate the relationship between oral status and the conversion from Mild Cognitive Impairment (MCI) to dementia and to assess the evolution of dental status and chewing efficiency, as well its association with cognitive function. Methods: prospective study with 5 years follow-up, amnestic MCI patients, C 70 years. Cognitive function was assessed using a standardized neuropsychological battery. Participants underwent an extensive clinical dental examination. Chewing efficiency was assessed using a two-color chewing gum mixing test; the results being expressed by the variance of hue. Outcomes were measured at baseline, and on an annual basis. Distribution was tested for normality; ANOVA and linear regression models with repeated measures adjusted for age and gender were used. Results: 89 MCI were included (men = 48, women = 41; age = 74.4 ± 6.6y) and underwent a total of 347 evaluations. The conversion rate from MCI to dementia was 12.4% in 5 years of followup. The initial mean number of 21 teeth decreased significantly between visits but not when adjusted for age (ANOVA: p = 0.0109, page adjusted = 0.0748), whereas chewing efficiency did not (p = 0.5503). MMSE scores remained stable throughout the years and were associated with oral-health. The number of teeth present at any point in time could explain 5.8% of the variance in MMSE (p = 0.0003, page adjusted = 0.0085). Each tooth present granted 0.07 additional MMSE point. The results confirm the association between number of teeth and cognitive function. The high number of natural teeth at baseline may have contributed to the rather stable cognitive and chewing function over time. Examination of the effectiveness of a specialised cognitive rehabilitation programme for adults with dementia in the community in the Irish context Introduction: Dementia is one of the three major diseases related to health care consumption [1] [2] [3] [4] [5] and it is a major cause of care burden and disability in the elderly. Therefore it is important to attempt to implement new effective and efficient health care interventions that increase independence and well-being of patients with dementia and decrease care giver burden resulting in a more efficient use of scarce health care resources (Baker et al. 2004) . In response, a cognitive rehabilitation programme was developed to potentially improve quality of life, cognitive ability and functional performance of meaningful occupations and activities for patients with dementia S252 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Nottingham University Hospitals, UK Introduction: Carer strain is associated with increased risk of carer depression and social isolation and institutionalisation of the care recipient. Activities of daily living (ADL) are impaired across all stages of dementia, and advanced ADL are argued to be impaired in MCI. People with greater ADL impairment may require more support, which could increase carer strain. This study aimed to assess the relationship between ADL and carer strain in people with dementia and MCI. Methods: Carers assessed caring-related strain and patient's ADL, as part of a baseline assessment of the Promoting Activity Independence and Stability in Dementia (PrAISED) study. The relationship between ADL and carer strain was explored using hierarchal linear regression. Carer gender and age, co-residency and spousal status, were entered in step 1, as evidence suggests these factors are associated with carer strain. ADL was entered in step 2. Results: 54 carers were recruited. 49 lived with the patient. 45 were spouses, and 9 were sons or daughters. Limitations in ADL was significantly associated with carer strain (r 2 = 26%, b = -0.448) when controlling for carer age and gender, co-residency, and spousal status. Introduction: Dementia and/or delirium are present in 30% of admissions of older people to hospital but there is widespread concern that neither syndrome is appropriately assessed or managed. We reviewed whether appropriate assessment procedures were carried out to evaluate cognitive impairment in older patients referred for specialist geriatric assessment so as to develop appropriate educational interventions. Method: An audit was carried out on consults with cognitive impairment to a geriatric medicine service in a university teaching hospital. The following data was collected from patients' records: (1) formal cognitive screen (2) collateral history (3) neuroimaging (4) screening for delirium (5) The results support that decline in MMSE both men and women could be predicted by functional profile at baseline. The impact of grip strength is predictive for both gender but of particular interest is the relevance of the endurance test for men while the physical performance score for women. We confirm the relevance of mobility measurements to detect cognitive decline over a long period of time. The role of standard physical exercise of moderate intensity in the management of depression in elderly female patients SD 11/6.6) . 15 (63%) wore the monitor for at least 20 h, all of whom achieved at least 21 measurements. In the remaining 9 participants the monitor was removed because of 'unsure/found off' 4 (44%), 'kept awake' 2 (22%), 'painful' 2 (22%), 'wanted to wash' 1 (11%). Key conclusions: ABPM was generally well tolerated in this group of people with dementia. However this group were only mildly cognitively impaired with a high Barthel Index. Further investigation into the tolerability of ABPM in people with more significant impairment is warranted. Infections and other clinical complications among institutionalized elderly patients with mild dementia in a one year follow-up (1974-present) and MEDLINE (1946-present) using: (diabet* OR glucose OR ''blood sugar'' OR HbA1c) AND (dementia OR (cognitive* AND (impair* OR decline))) AND ( (21 (13%)). The prevalence and severity of behavioural disturbances was higher on elderly care wards. 46 (29%) patients required nursing in continuous supervision bays, 6 (4%) required 1:1 supervision and 12 (7.5%) received pharmacological sedation. Nurses identified 23 (14.5%) patients with severe behavioural needs whose care would be enhanced in a Mental Health supported environment. Conclusions: The high prevalence of behavioural issues across all wards has implications on our ability to provide effective care. It is essential staff receive training on the recognition and management of delirium and dementia and adequate resources must be allocated to appropriately manage the behavioural needs of patients. Creating dementia-friendly environments and increasing Mental Health Team support represent potential solutions. In day-to-day clinical practice of Geriatric Medicine, the dilemma whether we are dealing with clinical depression or early dementia is becoming very common. Based on currently available literature there is evidence of complex correlation between Depression and Dementia. None of the cognitive assessments are designed to help this situation. Management of both these conditions by itself is not easy and needs clear approach plan to intervene at the right time and regular follow-ups. Untreated Depression can be catastrophic in older people and similar is true for early dementia, which needs intervention at the right time Questions that need to be answered: (1) Is this differentiation important to establish or important in clinical practice? (2) Are Neuropsychiatric assessment tools helpful in answering this dilemma? (3) Is combination of Neuropsychiatric assessment along with radiological imaging will assist in differentiation. (4) What should be the further management protocol if differentiation is established or not. Methods: (1) Review of available literature to find answers of above questions. (2) Analysis of available data from other relevant studies. (3) Designing a Cohort study to test the hypothesis. Results: There is evidence that Neuropsychological assessment may be helpful in differentiating early dementia from depression. Additional imaging studies may confirm the diagnosis though there is not many studies examining this approach. Key-findings of literature review will be presented. Wandering by acute akathisia in an old patient with severe dementia of Alzheimer's type Introduction: Acute akathisia is described as a state of subjective restlessness characterized by the impossibility of remaining still, with the need to move. It's usually induced by neuroleptics, in most cases after the first or second week or even more days after the start of treatment. It can also occur after a dose increase. A frequent accompanying clinical picture is insomnia. The treatment in the first instance consists of the withdrawal or reduction of the dose of the neuroleptic. The drugs more used for the treatment are propranolol and benzodiazepines. Method: We present the case of an 83-year-old patient diagnosed with Alzheimer's dementia GDS6 in treatment with memantine 20 mg: 1/24 h, pregabalin 25 mg: 1 / 12 h and quetiapine 100 mg: 1/8 h. His family reports that for several weeks and coinciding with a rise in the dose of quetiapine, the patient is more anxious and doesn't stop moving throughout the day. Clinical exploration highlights psychomotor restlessness, change of position and balance of both lower extremities. Given the medical, pharmacological and clinical examination history, the patient is diagnosed with acute akathisia due to neuroleptics. Quetiapine descent starts to take quetiapine 25 mg: 1/2 every 8 h, increase of pregabalin to take pregabalin 100 mg: 1/12 h. Propanolol is added to the treatment 10 mg: 1/2 every 8 h and clonazepam 0.5: 1/2 when he goes to sleep. Results: After one month, he attended the review accompanied by his family, who reported an important improvement in the clinical picture. The patient remains calm throughout the day and without disorders of the sleep. Key conclusions: The dose adjustment of the neuroleptic with the treatment with propranolol was shown to be effective in a patient with acute akathisia due to neuroleptics. This same conclusion has been revealed by other authors in similar clinical cases. A statement of the position for dental care and dental treatment guidelines for elderly people with dementia from The Japanese Society of Gerodontology (JSG) Hirohiko Hirano 1 , Ayako Edahiro 1 , Tetsuo Itikawa 2 1 Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan, 2 Guidelines Committee of The Japanese Society of Gerodontology, Tokyo, Japan The rapidly aging society and increase of people with dementia seen in Japan is unprecedented in the world. The Japanese society of Gerodontology (JSG) has been proactively working in pioneering research regarding the association between dementia and dental care in elderly people. In 2015, the Ministry of Health, Labour and Welfare of Japan adopted a ''Comprehensive Strategy to Accelerate Dementia Measures (called New Orange Plan)'' as a new strategy to bolster measures against dementia. This plan documents the implementation of improvements in training for dementia support among dentists. Based on the plan, JSG made ''A statement of position for dental care for the elderly peoples with dementia'', 2015. Our mission is to draft the guidelines for dental care for elderly peoples with dementia based on evidence and to promote the maintenance of dignity and quality of life in dementia patients. Based on the presented background, the previously stated mission statement for dental care for elderly people with dementia is representative of the current position of JSG. Furthermore, JSG started to create the dental treatment guidelines for elderly peoples with dementia from 2016. The contents of the guidelines will be in accordance with the existing ''Providing health care and long-term care services in a timely and appropriate manner as the stages of dementia progress'' shown in the Japanese Dementia Strategy (New Orange Plan). This presentation will include the assertions made above, as well as information on current dental care and oral function management in elderly patients with dementia in Japan. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Conclusion: This is the first study that evaluates the long-term effect of management of masked hypertension on cognitive functions in older adults. Blood pressure control in MH group was associated with improvement in cognitive functions. Masked hypertension should be kept in mind while assessing older people, and when detected, blood pressure must be controlled regarding the positive long-term effect on cognitive functions. Reference: 1. Esme M, Yavuz BB, Yavuz B, Asil S, Tuna Dogrul R, Sumer F, et al. (2017) .Masked Hypertension is associated with cognitive decline in geriatric age-geriatric masked hypertension and cognition (G-MASH-cog) study. J Gerontol Ser A 73 (2):248-254. Incorporating the A/T/N CSF biomarker pathological scheme into the diagnostic algorithm for Alzheimer's disease (AD) and neurodegeneration in an Irish Tertiary memory clinic setting Conclusions: Antipsychotic use was associated with increased risk of head traumas and TBIs among community-dwellings with AD. Therefore, use of antipsychotics should be carefully considered in this vulnerable population. Repetitive transcranial magnetic stimulation (rTMS): a potential therapy for cognitive disorders? Considering the limited effectiveness of drugs treatments in cognitive disorders, the emergence of non-invasive techniques could be of benefit to patients. Among these techniques, repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability and have therapeutic effects on cognition and behavior. These effects are due to physiological modifications in the stimulated cortical tissue and their associated circuits, depending on the stimulation parameters. The objective is to present the current knowledge and efficacy of rTMS in cognitive disorders to perform more studies and offer rTMS as a routine therapy for cognitive dysfunction [1, 2] . Previous studies found very encouraging results with significant improvement of higher brain functions. Some of rTMS are now associated with cognitive training exercises during the stimulation (NeuroAD Ò ). The rTMS effects last to 3 to 6 month and seem more to slowdown the symptoms of cognitive disorders after 15 consecutive daily sessions of stimulation. Limits have been found in studies like few patients enrolled, lack of brain imaging control of the stimulation, insufficiently formalized technique and cognitive tests. Despite the difficulties to realize them, studies are getting more and more accurate and controlled. Methods: 110 patients were included, C 60 years old, with diagnosis of mild and very mild cognitive impairment from the Centro de Deterioro Cognitivo in Madrid. The variables studied were the performance of any physical activity, which varied from exercise while sitting to running, its frequency and its duration. Sex, age and educational level were analyzed as confusing factors. Results: In relation to the duration of exercise, 85 (77%) patients exercised C 30 min and 74 (68%) did any type of physical activity on a daily basis. The mean days of physical exercise was 6. The majority of elders, 93 (84%), had a high SPPB score (10-12 points). Men had less physical adherence than women. Older patients did less days of physical exercise compared to younger patients, these results were statistical significant according to the logistic regression analysis. Conclusions: Most of the elders with mild cognitive impairment did any type of physical activity more than 30 min per day, 6 days a week. There was a statistical significant difference in exercise habits in men versus women and with the increasing aging. Evaluation of a multicomponent intervention in a group of patients with dementia and their principal caregivers through perception of psychological and behavioral symptoms of dementia The onset of dementia in patients aged \ 65 years (early-onset dementia-EOD) has dramatic consequences. While the burden of EOD is likely to grow due to the ageing of the baby boomer generation, its epidemiology remains poorly characterized. We estimated prevalence and incidence rates of EOD in France. Using the French national health data system, we identified all dementia cases aged 40-64 years, affiliated to the main health insurance fund, and alive at the end of December 2016. Due to the low sensitivity of administrative data to identify EOD, criteria (anti-dementia drugs consumption, hospitalization or benefits for chronic diseases with an ICD10 dementia code) were searched over 5 years (2012-2016) . Incident cases were those identified in 2016 but not in 2015. Age-and sex-specific prevalence and incidence rates of EOD were estimated; we compared age-adjusted rates by sex using Poisson regression. A total of 26,874 prevalent (prevalence = 159/100,000) and 6521 incident (incidence = 38.6/100,000 person-years) cases of EOD were identified. Both prevalence and incidence rates sharply increased with age between 40 and 65 years. Age-adjusted prevalence and incidence rates were lower in women than men (prevalence rate ratio = 0.70, 95% CI 0.68-0.72; incidence rate ratio = 0.65, 95% CI 0.6-0.68).Our findings are consistent with those from a small number of studies that provided data on EOD frequency in the general population. Previous work shows that the underestimation of dementia frequency using administrative databases is likely to be less important for EOD. Based on these figures, we extrapolate that there were about 37,000 cases of EOD in France in 2016, including 9000 incident cases. A novel technique to collect cerebrospinal fluid in the freely behaving mice as a preclinical model for biomarker research With the emergence of disease-modifying therapies for neurodegenerative disorders like Alzheimer's disease, there is an urgent need for the development of better biomarkers detecting early stage of neurodegeneration and predicting rate of progression. Cerebrospinal fluid (CSF) provides direct representation of pathophysiological changes occurring in the central nervous system, and CSF biomarkers have proven to be useful for the diagnosis and prognosis of neurodegenerative disorders. Preclinical work using mouse models would be useful to explore novel CSF biomarkers; however, detailed characterization of CSF proteins has been challenging due to the difficulty in collecting large amount of CSF from mice. Here, we developed a novel technique that allows consistent recovery of CSF in the awake, freely behaving mouse. A small incision was made on the posterior atlantooccipital membrane and a collecting tube was placed and fixed on the surface of the posterior atlantooccipital membrane that CSF can be drawn via the small hole. We were able to collect large volume of high-quality CSF from the same animal over time. Contamination of brain tissue or blood, which could potentially affect biomarker measurement, was carefully assessed using sensitive methods. This technique would provide the opportunity to identify novel CSF biomarkers using mouse models. The impact of mental health liaisons services on the health care of elderly ward Amy Hillarious 1 , Jagdish Sharma 2 , Nisha Sunwar 1 , Monique Patel 1 1 United Hospitals of Lincolnshire, Lincolnshire, UK, 2 United Hosptials of Lincolnshire, Lincolnshire, UK Cognitive Impairment is the primary or contributing cause of admissions for elderly patients presenting either as behavioural changes of acute delirium or BPSD. Mental Health Liaison services (MHLS) services provide psychogeriatric support for inpatients with complex needs. Our aim is to audit the value of the input of MHLS into patient management and assess the follow up arranged by MHLS on discharge. 24 Patients who had been referred and reviewed by the mental health team were randomly selected over a fourth month period. Referral outcomes were graded as per the Framework for the routine outcome measurement in Liaison Psychiatry using the IRAC scale. Of those referred 66% were seen within 24 h, reasons for referral were Behavioural issues (62%) suspected cognitive impairment (25%) and medication review (13%). A diagnosis was made in 50% of patients, majority of these made by a doctor (60%) vs specialist nurse. For behavioural issues pharmacological management was advised in 46%. Community follow up was not arranged in any of the patients with suspected dementia. The MHLS achieved an IRAC score of fully achieved in 25%. Training of the MHLS staff will ensure a diagnosis and management plan in each patient, with remote support from Consultants. Education of the doctors working on geriatric wards in the guidelines of managing delirium will minimise inappropriate referrals with the expectation that MHLS will advise appropriate pharmacological interventions when referred. All those with suspected dementia inpatient have to be referred to outpatient memory clinics to ensure continuity of care. Art and music therapy We noted an improvement in the MOCA results performed on the first and sixth month (p = 0.07). There was also a significant positive trend in some items such as orientation in MMSE (p = 0.03), and abstraction (p = 0.001) and orientation (p = 0.014) in MOCA. Although TAVI is associated with more ischemic cerebral lesions, most studies show that cognitive function was preserved in the great majority of patients throughout the first 2 years after implantation. A cognitive improvement after TAVI had already been shown in patients with very severe aortic stenosis, related to hemodynamic improvements [1] . Conclusion: While it would be interesting to perform a global cognitive functions assessment and functional magnetic resonance imaging, our study already confirms cognitive function stability using both MMSE and MOCA. Is dual task combined switching training an effective tool to improve cognitive functions? Although 70% of People with YOD had an indication for an ACP (i.e. one or more markers of limited life expectancy), only 11% had any ACP recorded. 37% of patients had died, most commonly due to a complication of advanced dementia (e.g. aspiration pneumonia) rather than comorbid illness. Conclusion: There were notable differences between this sample of people with YOD and LOD populations, regarding their diagnosis, comorbidities, diagnosing physician, etc, which has implications for multidisciplinary team input and post-diagnostic support. People with YOD most commonly die from complications of dementia, as opposed to people with LOD who often die with dementia. Advanced care planning appears to be suboptimal in people with YOD. More research is essential to inform future policies and services for this often neglected population. Many elderly patients with COPD have psychological problems such as anxiety and depression as an effect of the disease and represent the two least-treated comorbidities in the chapter of this pathology. The aim of the present study is to verify a possible correlation between COPD and depression in elderly outpatients. Materials: To all patients suffering from COPD who came for specialized assessment with spirometry examination at the Pneumology Clinic of Cuggiono Hospital of ASST WEST Milanese in the period October 2016 -December 2017 self-administered the Geriatric Depression Scale-J. Yesavage (GDS, score used in the geriatric field to highlight the mood tone deflection).The group consisted of nr. 162 subjects M: 98 F: 64 with a mean age 76, 2. The indices considered in this study were: FEV1-FEV1/fvc and GDS. We therefore wanted to verify a possible correlation between the above mentioned indices. The results were as follows: correlating the indices among them of all the subjects studied we obtained: FEV1 versus GDS 0.05524, FEV1/ fvc versus GDS 0.019986. We then divided the subjects in relation to the severity of the GDS in three groups. A first group consisting of 100 subjects with GDS less than 10, a second group composed of 39 subjects with GDS between 11-15 and a third group composed of 21 subjects with GDS greater than 15. By evaluating the possible correlations we obtained the following data: Introduction: The inability to express pain in unconscious, chronically ventilated geriatric patients is a significant barrier to assess pain intensity. This puts this population at risk for inappropriate pain management. BPS has been evaluated and validated as a tool for assessing pain among ventilated patients in intensive care units, but has not been tested among chronically unconscious ventilated patients. The aim of this study was to examine the reliability and validity of the BPS in this population. Methods: This observational study enrolled chronically ventilated old patients, at two different geriatric long-term care facilities. Each patient was assessed for pain by two assessors using the BPS score. Pain was evaluated during repositioning, venous puncture and tracheal suction. Each assessor, independently, assessed the BPS score in three time points: before, during and after each one of the aforementioned procedures. Data regarding background morbidity, demography, cause and duration of ventilation, laboratory parameters and usage of analgesics was collected. Results: 864 observations were conducted among 48 patients recruited. The mean (± SD) age of the patients was 75.9 ± 9.8 years. 24 patients (50.0%) were men. Total BPS score showed a good internal reliability for repositioning, venous puncture and tracheal suctioning (Cronbach a = 0.885, 0.868 and 0.693 respectively). Validity was attained by demonstrating significant increase from baseline to painful levels of BPS score and significant decrease from painful levels to the post-procedure levels during all three procedures (P \ 0.001). Conclusion: BPS is a valid and reliable pain assessment tool for chronically, unconscious ventilated old patients. Thirty-six (50%) patients died. CCI was ranged from 4 to 11 (median 6, IQR 5-7) points. Kaplan-Meier analysis didn't confirm that comorbidity (CCI C 6 points) influence 5-years total mortality (Chi square 1.2; p = 0.27). Also Kaplan-Meier analysis identified only one chronic disease which was associated with 5-years mortality: atrial fibrillation (Chi square 27.0; p \ 0.001). Cox regression with age and sex adjustment showed that atrial fibrillation increases the 5-years mortality risk in 5, 6 times (HR 5.59; 95% CI 2.72-11.49; p \ 0.001) in very old patients. Conclusions: Comorbidity (CCI C 6 points) is not associated with increase of 5-years total mortality risk in the very old Moscow population. Atrial fibrillation not included into the CCI is an independent predictor of 5-years total mortality in these patients and should also be considered for evaluation of life prognosis. Analysis of white blood cell values in older patients: results of a cross sectional study on hematologic laboratory parameters among outpatients aged ‡ 60 years study group has now laid the focus on the analysis of normal values for white blood cell counts in aged persons C 60 years [3] . Methods: Cross sectional study of outpatient laboratory data of 2015 from a German countrywide working laboratory company; inclusion criteria were age C 60 years, normal CRP, transferrin saturation, reticulocytes, LDH, haptoglobin and soluble transferrin receptor; exclusion criteria: GFR \ 60 ml/min, lack of inclusion criteria; primary objective was the assessment of the mean leucocyte count, secondary objectives were the assessments of the mean counts of lymphocytes, eosinophil, neutrophil and basophil leucocytes as well as platelets in hematologic healthy persons aged C 60 years. Necrotizing pneumonia is a rare complication of bacterial pneumonia that occurs on chronic and immunocompromised patients. There are inflammation and lung necrosis with formation of small cavitations. Streptococcus pneumoniae, Staphilococcus aureus and Klebsiella pneumoniae are the most frequent etiological agents. Desfavorable course to antibiotic therapy and CT-scan images make the diagnosis. However, pulmonary tuberculosis must be excluded. The elder patient has an atypical presentation. A 92-years-old institutionalized and dependent woman presented with fever, dyspnea, dry cough and anorexia at 3 days. She had dementia, cachexia, ischemic cardiopathy, and past-history of aspiration pneumonia 1-year before, and genital tuberculous 40-years before. She was diagnosed with rightbase pneumonia and started empiric antibiotherapy. Microbial studies were negative as well as interferon-c release assay. Due to persistence of symptoms the antibiotherapy was escalated without improvement. After naproxen fever resolved and sustained with linezolid/metronidazol. 25-days after she underwent thoracic computed tomography that was suggestive of necrotizing pneumonia. Bronchoscopy didn't aid morphologic information but the direct examination of bronchoalveolar lavage fluid shows mycobacterium tuberculosis. Done the diagnostic of pulmonary tuberculous (PT) she died 1 week after tuberculostatics onset. The incidence of tuberculosis in nursing home residents is three to four times higher than that of those living in the community. Comorbidities, immunosenescence, malnutrition, immunosuppressive therapy and unfavourable socioeconomic conditions, all contribute to the higher incidence of tuberculosis in the elderly patient. Advanced age is associated with PT atypical clinical presentations leading to delayed diagnosis and an increased rate of postmortem diagnosis. Results: Patients with PKM achieved only a minor functional improvement after geriatric intervention (stagnant Barthel Index at discharge \ 35: 59% vs. 36%). Patients with PKM were more likely to receive a first time or higher degree of care certificate (68% vs. 50%). The main complications in the PKM group were Delirium (64%) and Dysphagia (50%). Pre-existing cognitive impairment was equally common in both groups. Discussion and conclusions: Delirium is known to be associated with an increased need of long-term care. Our data indicated this correlation also for dysphagia. Delirium and Dysphagia are associated with malnutrition and often cause a prolonged hospitalisation. Thus, it appears necessary to extend the geriatric basic assessment for patients with comprehensive need of care, in order to allow targeted indications for specific interventions, eg drug or nutritional therapy, in order to reduce the incidence of complications and inpatient readmissions, which would show positive effects on treatment costs and quality of life. Home medicine today: the high prevalence of heart failure with preserved systolic function among home-bound residents Background: In the coming years, home medicine will comprise an increasing share of patient encounters, due to the unprecedented and continuing demographic changes. The primary aim of the study was to identify the diagnosis of the cohort to prepare training for in house providers. Methods: We analyzed data of consecutive patients visited at home due to mobility problems, vision problems, cognitive decline and in some cases, mental health issue in 2017. ICD-10 codes were extracted on all the primary encounter diagnosis from all the visits. Results: There were a total of 3.408 patient home encounters during the study period. There were 2345 ICD codes extracted. Mean age is 81.9 years, The ICD by organ system are cardiovascular (I) = 1085, endocrine (E) = 232, Malignancy C = 30, Respiratory = 179, M-179, Renal N = 63. The top 10 ICD classification includes: I11.9: Hypertension heart disease without heart failure (N = 288)I5032: Chronic diastolic heart failure (n = 239)E11.xx: Type 2 diabetes mellitus (all types) (n = 153)I110: Hypertensive heart disease with heart failure (n = 149)I48.xx atrial fibrillation (n = 137)J44.x: Chronic obstructive pulmonary disease (n = 90)I2510: Athscl heart disease of native coronary artery (n = 88)K21.x: Gastro-esophageal reflux disease (n = 52)M179: Osteoarthritis (n = 47)J209: Acute bronchitis (n = 42). Conclusions: Most home bound medical encounters of older adults were due to cardiovascular causes mostly from diastolic heart failure. The present findings clearly emphasize focus on specialized training in heart failure to providers dedicated to practicing home medicine. Anemia in elderly patients is associated with high rather than low serum vitamin B12 Introduction: Evidence of an association between subnormal vitamin B12 and anemia is limited and inconclusive in older patients. To get more knowledge of this, blood tests and geriatric assessment were carried out in 829 home-dwelling older patients, who were transferred to nursing home after acute hospitalization. Methods: Different parameters, including serum folate, plasma homocysteine, anemia (Hb \13 in men, \ 12 in women), renal insufficiency (eGFR \ 60 mL/min/1.73m2), Mini-Mental Status Examination, sex and age were compared in patients with low (\ 250 pmol/L), normal (250-650 pmol/L) and high ([ 650 pmol/L) serum vitamin B12. In addition, iron deficiency (Transferrin receptor [ 4.5 mg/L or Ferritin \ 35ug/L) was included in multiple regression analysis to examine the odds ratio for anemia. Results: Mean age was 84 years, 396 (52%) had anemia. Seventyeight (9%) had low, 465 (56%) had normal and 286 (35%) had high serum B12. Comparing patients with low and high versus normal serum B12, a significant lower Hb and higher incidence of anemia was demonstrated in patients with high serum B12, n = 162 (57%), Hb 11.9 g/dL, (p \ 0.001), while no higher incidence of anemia was demonstrated in patients with low serum vitamin B12, n = 36 (46%), Hb 12.5 g/dL. No decrease in cognitive function was demonstrated in the patients with low B12. In multiple regression analysis, male sex (p \ 0.001), renal failure (p = 0.001), and high serum B12 (p = 0.02) gave higher odds for anemia. Key conclusions: B12 deficiency was uncommon and not associated with anemia, while high B12 were more common and associated with anemia. Ictus in patient with endocarditis related to ICD catheter Background: The management of complex patients affected by Atrial fibrillation and Heart Failure could lead difficulties in the choice of strategy therapy, due to the concomitant presence of implantable device. Case: Man 69 years old diabetic, hypercholesterolemic, former smokers, affected by ischemic dilated cardiomyopathy (EF 20%, ICD implant in 2016) due to inferior infarction (1996) and anterior ones (2007), both undergoing PCI and atrial fibrillation on rivaroxaban therapy, was hospitalized in Geriatric ICU because of septic shock and exacerbation of heart failure (pro-BNP: 19824 pg/mL). Results: Hospitalization was complicated by acute hepatic failure (ALT: 1042 U/L; INR: 15.1), that required subsequent modification of anticoagulant therapy with edoxaban. During the hospitalization surgery check of pacemaker was performed because of inflammation sign elevation, positive blood cultures and daptomicina was started, continued for 4 weeks. One month later, he was hospitalized due to recurrence of sepsis, therefore PET was performed with evidence of hypermetabolism in correspondence with PM and the removal of device was programmed. Three days later, Edoxaban was stopped, reintroduced for 24 h and stopped again to permit implantation of subcutaneous ICD. Discharge test with sinus rhythm restoration was performed. At the release, fall due to left hemiplegia occurred (NIHSS18). At the Angio-Tc evidences of occlusion of media cerebral artery appeared, therefore he underwent endarterectomy procedure with progressive full recovery. Finally we released him with anticoagulant therapy with dabigatran 150 mg/bid. Conclusion: In patient with comorbidity, personalized medicine could be no sufficient to avoid serious but inevitable complications. Hospital management of a complex case of geriatric cardiology (2000), paroxysmal AF in OAC. Polypharmacy (15 drugs). In charge at Syncope Unit where he goes for a control. We found left conduction delay associated with ST segment alteration in the precordials (V1-V6) and overlap in aVR. The patient was asymptomatic. He then enters our Geriatric-ICU where we decided to perform a coronary angiography, preceded by CRRT, and PTCA (multiple DES implanted). The subsequent hospitalization was complicated by delirium episode requiring dexmedetomidine, substituted by midazolam for SAE (hypotension and bradycardia). IOT was required for ARF (inhalation following vomiting). The course was further complicated by the onset of ACS (NSTEMI) requiring PTCA with post-procedural hemodynamic instability treated with inotropes and AF. Once stabilized, the patient was transferred to an internal medicine department then to a cardiological rehabilitation center. At discharge OAC was not confirmed, to be reassessed in the follow-up on ischemic/hemorrhagic risk ratio. Three months after the acute event, the Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 patient is again at home, independent in BADL and partly in the instrumental ones (he does not drive the car anymore). Conclusions: Clinical trials published in the literature often do not include complex patients such as the case reported above, which instead represent daily life in our hospitals. The intra-hospital management of these patients must therefore take into account the relationship between the risks to which the patient is subjected and the benefit that is expected to be obtained. Breast cancer in elderly Background: The most common geriatric psychiatric disorder is depression. The role of family systems in depression among the elderly has not been studied extensively. We conducted this study in Monastir City, to determine the relationship between the type of family system and depression as well as correlation of depression with other important sociodemographic variables. Methods: A community based sample of 598 non-institutionalized elderly (age C 65 years), was selected using probabilistic multistage cluster sampling. Questionnaire based interviews were conducted among the elderly people. Depression was assessed using the mini-Geriatric Depression Scale. Results: There was a predominance of female (66%) and mean age was 72.3 years (± 7.4) .Of all the subjects, 40% were unmarried (single, divorced, widowed or separated) at the time of study and only 11% were educated. A large proportion (59.9%) of males were unemployed or retired. Eight percent of the subjects were living alone. Out of the 598 subjects, 22.7% of thesubjects screened positive for depression on the mini-GDS. The elderly living in a nuclear family system were 2.5 times more likely to suffer from depression than those living in a joint family system (OR = 2.5 [95% CI = 1. 3-4.5] ). Conclusion: Residing in a nuclear family system is a strongIndependent predictor of depression. The prevalence of depression in the elderlypopulation was moderately high and a cause of concern. The transition in familysystems towards nucleation may have a major deleterious effect on the physical and mental health of the elderly. Gynecologic problems in geriatric-aged women Introduction: Gynecologic concerns in postmenopausal women are common. Although various conditions may affect all women in this age group, the prevalence of certain disorders, and also diagnostic approaches and treatment options, may vary significantly when considering elderly women. Objective: The focus of this study is to address several commonly gynecologic issues in postmenopausal women. Methods: This is a retrospective descriptive study carried out at the Monastir Maternity Center over a period of 9 years. This study involved 269 women aged over 65. Results: The average age of our patients was 70.6 ± 5.6 years. The average duration of hospitalization for elderly women was 17.2 days. Comorbidities were found in 72.5% of women, Cardiovascular disease, including hypertension, and diabetes mellitus were the most common associated medical problems. In our patients, the gynecological pathology of the elderly women was dominated by cancers (46.1%) followed by benign conditions (27.1%) and pelvic static disorders (26.8%). Breast cancer was the most common, followed by those of the cervix and the body of the uterus. For the benign pathology, that of the uterus was the most frequent followed by that of the breast and ovaries. Conclusion: In Tunisia the interest in gynecological pathology has been centered more on the active women than on the elderly. This population requires significant health care and services. It is important to be aware of common gynecologic concerns and give a particular attention to aspects that must be considered when caring for women in the geriatric age group. Loss of autonomy and comorbidity in the elderly living in nursing homes A positive correlation has been found between AGGIR and KATZ-ADL. The global average of CIRS-G scale was 9.91. Multiple logistic regression analysis revealed that the following were significant: living alone (OR = 4.5), osteoarticular disorders (OR = 8.5) and neuropsychiatric disorders (OR = 12.7). A negative correlation has been found between AGGIR and CIRS-G scales. Conclusion: An adequate screening of the loss of autonomy and the management of comorbidities constitute the best prevention against the loss of autonomy in old age. Predictors of mortality in elderly patients admitted to an acute geriatric ward Background: Common characteristics of patients admitted to an acute geriatric ward are frailty and older age. The goal of this study was to assess the association between patient, health and functional characteristics and 12 month mortality after discharge. Knowledge of these predictors of mortality can support medical decision making. Methods: Retrospective study conducted between December 2014 and September 2015 acute geriatric wards of a Dutch teaching hospital. Included were patients admitted for at least one overnight stay. Demographic characteristics and health-related patient factors, including frailty and disability were collected. Results: 290 patients with a mean age of 84 years were included. The majority were women (60%). Mortality 12 months after discharge was 40.3%. Prevalence of disability, impaired mobility and cognitive decline were 81, 84 and 67% respectively. Significant predictors of mortality after 12 months were occurrence of delirium (Odds ratio (OD) 2.4), Charlson Comorbidity Index C 3 (OR 2.1) and low BMI (OR 0.9) in the multivariate analyses. The occurrence of all these predictors simultaneously raised the risk of mortality 17 fold. Frailty characteristics were not associated with higher mortality. Conclusion: in predominantly frail elderly patients 1 year mortality is associated with incident delirium, low body weight and concurrent comorbidity and not so much frailty features. Furthermore, the high mortality rate in these patients emphasizes the need for timely consultation of the patient and/or his family about the goal(s) of medical treatment in order to prevent interventions during hospital stay that are not beneficial for the patient. Vitamin D and comorbidity in hospitalized very older persons Introduction: The medical complexity of hip fracture patients still exist and may increase after surgical hip repair, and despite recent improvement in care the mortality is still 30% within 1 year. Many medical aspects should be addressed as in-or outpatient. We aimed to identify the reasons and indications of postoperative medical follow up after discharge. Methods: Analysis of 30 consecutive hip fracture patients' electronic records (retrospectively) and 12 patients' clinical notes and electronic records (prospectively). Detection of possible chronic neuropathic pain among elderly using DN4 Questionnaire Geriatric Outpatient Clinic Med-All, Cracow, Poland Introduction: Prevalence of neuropathic pain in general population is estimated to be around 6.5-11.5%, but its exact frequency in geriatric population is poorly investigated. We tried to assess the prevalence of neuropathic pain symptoms among elderly using DN4 (Douleur Neuropathique 4) Questionnaire. Methods: 145 subjects older than 60 years (nursing home residents, or geriatric outpatient clinic patients) scored C 7 points in the AMTS (Abbreviated Mental Test Score) were included. Chronic pain was defined as lasting[ 3 months, possible neuropathic pain was assessed using DN4 Questionnaire. Results: The mean age of patients equaled 76 ± 9.68 years, 78% reported chronic pain and 32% possible chronic neuropathic pain (DN4 score C 4 points). The most common complaints were: numbness, tingling, electric shocks, burning, hypoesthesia to touch and hypoesthesia to prick. Usually patients reported 4/10 complaints in DN4 questionaire. The most common localizations of possible neuropathic pain were feet, hands and lower limbs. It has been shown that chronic pain and possible neuropathic pain were more common among patients suffering from endocrine, nutritional and metabolic diseases, than with other diseases (p = 0.01). There was a higher prevalence of type 2 diabetes in patients with possible neuropathic pain (p = 0.08). Conclusions: The prevalence of chronic neuropathic pain in the elderly population seems to be higher than previously expected. Diabetes was the most common cause of possible neuropathic pain's symptoms. The problem requires further research and dissemination of knowledge on the diagnosis of neuropathic pain in the elderly among medical practitioners. A paradigm shift in home medicine: the high prevalence of heart failure with preserved ejection fraction among home-bound residents Jun R. Chiong 1 1 MedEx Health Network, Inc, North York, Canada Background: The volume of patient encounters in home-bound individuals has recently shown unprecedented growth. The reasons for this are multifactorial but one aspect is the increasing age of these patients. Consequently it is important to identify disease mechanisms in this cohort in order to develop appropriate training for medical providers. Methods: We analyzed data of consecutive patients visited at home due to mobility problems, vision problems, cognitive decline and in some cases, mental health issue in 2017. ICD-10 codes were extracted on all the primary encounter diagnosis from all the visits. Results: There were a total of 3.408 patient home encounters during the study period. There were 2345 ICD-10 codes extracted. Mean age is 81.9 years, The top ICD by organ system are cardiovascular (n = 1085), endocrine (n = 232), respiratory (n = 179), renal (n = 63), malignancy (n = 30).The top 10 ICD classification includes:ICD-10: description1. Heart Failure with preserved systolic function. I5032: Chronic diastolic heart failure. n = 239. I11.0: hypertensive heart disease with heart failure. n = 149. Total n = 3882. I11.9: Hypertensive heart disease without heart failure. n = 2883. E11.xx: type 2 diabetes mellitus (all types). n = 1534. I48.xx atrial fibrillation. n = 1375. J44.x: chronic obstructive pulmonary disease. n = 906. I2510: atherosclerotic heart disease of native coronary artery. n = 887. K21.x: gastro-esophageal reflux disease. n = 528. M179: osteoarthritis. n = 479. J209: acute bronchitis. n = 4210. R29.6: falls. N = 30 Conclusions: Most home bound medical encounters of older adults were due to cardiovascular related causes mostly from heart failure with preserved ejection fraction. With heart failure being one of the most common causes of hospitalization and readmission in the elderly population today. The present findings clearly emphasize focus on specialized training in heart failure to providers dedicated to practicing home medicine. Orthostatic hypotension and overall mortality in 1050 elderly patients of the outpatient comprehensive geriatric assessment unit Introduction: Orthostatic hypotension (OH) is a common problem in the elderly population, with prevalence between 6.9% and 55%. In some studies, an association between OH and negative medical conditions, including falls, cardiac events, heart failure and stroke, have been shown. The association of OH with mortality is not clearcut. In our previous retrospective study of 571 frail elderly who underwent a comprehensive geriatric assessment (CGA) over the years 2005-2013 we did not find any association between OH and mortality. The aim of the present study was to assess possible associations between OH and mortality in a broader sample that included not only patients who underwent CGA, but also those who underwent a geriatric consultation (GC) in the same unit. Methods: Individuals who were evaluated in the Outpatient Comprehensive Geriatric Assessment Unit between January 2005 and December 2015 and who had data on orthostatic hypotension were included in the study. The database included socio-demographic characteristics, body-mass index, functional and cognitive state, geriatric syndromes, co-morbidity and mortality data. Results: The study sample included 1050 people of who 626 underwent comprehensive geriatric assessment and 424 underwent geriatric consultation. The mean age was 77.3 ± 5.4 years and 35.7% were males. Orthostatic hypotension was diagnosed in 294 patients (28.0%). In univariate analysis orthostatic hypotension was associated with overall mortality only in patients aged 65-75 years old (hazard ratio = 1.5; 95% CI 1.07-2.2), but in the multivariate model this association disappeared. Conclusions: In elderly frail patients orthostatic hypotension was not an independent risk factor for overall mortality. Accurate detection of arterial hypotension in elder were included in the high mortality risk group (MPI-3). In-hospital mortality was 13%.79% received anticoagulation therapy at admission (57.1% coumadin, 36.7% NOACs and 6.1% low molecular weight heparin (excluded from the analysis). Apixaban was the most used NOAC (44.4%). 100% had CHA2DS2-VASc score C 2 and 58% HAS-BLED score C 3. No significant differences were found in sociodemographic, functional, nutritional, cognitive, comorbidity, number of medicines, MPI and in-hospital mortality between groups (coumadin vs NOACs). However, the coumadin group had a higher bleeding risk (HAS-BLED C 3) than those with NOACs (78% vs 44%, p = 0.018). Conclusion: Older patients with AF treated with coumadin do not differ in baseline characteristics or mortality risk from those on NOACs, but have a higher bleeding risk. The The diagnostic evaluation of syncope in the elderly with transient loss of consciousness is often complex: more causes can coexist and sometimes there is an overlapping between pseudo syncope and syncope. It is necessary to follow an individualized and targeted diagnostic pathway to avoid unnecessary tests. Multimorbidity and functional dependency in elderly who are assisted by home health care teams: a cross-sectional study region, from Portugal. After sample size calculation (n = 228, 5% error, 92% prevalence and two design effect), cluster sampling was used. The analysis was completed via the generalised estimation equations using the IBM SPSS-v24.0 tool. Results: The 230 seniors, distributed across 23 home health care teams, were divided almost equally by gender (54% women) and had a mean age of 84. The average conditions per person were 9.5 and the Charlson index was 8.48; males scored higher on both of these measures. Multimorbidity was present in all participants. The Barthel's score average was higher in men (younger and less ADL dependent than women). Dementia (OR = 10.873) and cerebrovascular disease (OR = 3.013) are the medical conditions most associated with dependence. Obesity (OR = 0.522) and arterial hypertension (OR = 0.186) appear to be protective. Mobility activity dependency is associated with multimorbidity severity (Charlson C 9), but not with multimorbidity magnitude (counted conditions). Discussion: Elderly dependence was only related to multimorbidity severity, not magnitude. The results confirm the neuropsychiatric pattern of dependency. The protective obesity effect highlights the obesity paradox. In the elderly, longitudinal studies are needed to understand the relationship between multimorbidity and dependence. Diagnostic delay is longer in elderly patients with Amyotrophic Lateral Sclerosis We also investigated a relationship between use of antibiotics and the CRP value. Method:This is an exploratory location-clustered intervention study in Dutch LTCF. The intervention group consists of the patients staying in the main location in both facilities, the control group consists of the other patients. Included are patients suspected of an AI where the physician has doubts about prescribing antibiotics. Excluded are patients suffering dementia. The intervention is the addition of CRP POCT to regular best common practice.Primary endpoint is the difference in direct and total (after 7 days) antibiotic use between the groups. A secondary endpoint is to determine if there is a relationship between CRP values and direct and total antibiotic use. Results:In this study, 19 included cases were analysed, of which eleven in the intervention group. No significant difference between use of antibiotics is found. Key conclusion:In this study, not enough patients were included to find a significant difference in anbiotic use between intervention and control groups or in CRP categories. However, there are clues that the use of CRP POCT in suspected AI will help the physician start appropriate therapy earlier. More research in larger patientgroups in more LTCF is needed to conform this hypothesis. Introduction: A gap exists between evidence-based recommendations for post-fracture care and actual clinical practice. Our purpose is to evaluate the effectiveness of an outpatient ortho-geriatric service in the prevention of re-fractures. Materials and methods: 271 hip fracture older patients were assessed within 40 days from hip fracture surgery. Patients underwent clinical assessment and standardized questionnaires by a multidisciplinary team. They receive pharmacological and non-pharmacological indications for falls and fracture prevention. All participants receive follow-up evaluation at 6 and 12 months for adverse events, including falls and re-fractures. Results: 79% women and 21% male with a mean age of 84 years, which preserved a good level of functional autonomy before the fracture, despite previous falls and fractures. More than half presents substantially preserved cognitive functions and received FKT program privately. Furthermore, patients receive a recommendation to change drug therapy, to promote the prevention and the appropriate management of ulcers from pressure. The anti-fracture treatment has been initiated in the 97% of cases with supplements of vitamin D and diet integration of calcium, while in the 66% of cases with most suitable drugs. Conclusions: The ortho-geriatric outpatient service has the potential to identify and manage certain clinical and care needs of frail elderly who are at a high risk of falls, fractures, and adverse events. Identifying loneliness and its predictors in the inpatient setting admitted to the acute general wards at the John Radcliffe Hospital, Oxford, were assessed for loneliness and its predictors using a questionnaire measuring self-reported perceived loneliness, and the UCLA 3-item loneliness scale. Inclusion criteria required consenting patients aged C 75 years old, who were not confused, and had been an inpatient for C 3 days.Answers were converted into numerical scores for statistical analyses. Results: 20.2% of participants were lonely according to the UCLA score; 30.6% perceived themselves to be lonely at least some of the time in hospital. Perceived loneliness was significantly correlated to loneliness measured by the UCLA score (r = 0.41, p \ 1e-8).Statistically-significant predictive factors of inpatient loneliness were: loneliness pre-admission (r = 0.72, r = 0.48), depression (r = 0.52, r = 0.43) and anxiety (r = 0.48, 0.37).Those with better self-reported general health were less likely to feel lonely during inpatient admission (r = -0.25, r = -0.18).Interestingly, a patient's social network did not predict loneliness.Perceived loneliness, living alone, and anxiety, were correlated with willingness to accept intervention. Conclusion: The predictive factors for loneliness in older inpatients are easily ascertained by both self-reporting questionnaires and the UCLA score. The inpatient setting could be an opportunity to recognise those who are feeling lonely both in and out of hospital, and offer intervention. Functional decline, mortality and institutionalization, and associated factors in patients with multimorbidity at 18 months of follow-up: the FUNCIPLUR longitudinal study and 26 (12.6%) of the patients were using at least one antiaggregant and anticoagulant medication respectively. Acetyl salicylic acid (38.8%) was the most common antiaggregant while warfarin (5.3%) was the most common anticoagulant. Hypertension, diabetes mellitus, and hyperlipidemia were the most frequent comorbidities, and at least 4 comorbidities were found in 70 (33.38%) patients. Iron deficiency, megaloblastic, chronic illness and indeterminate anemia were found in patients as follows; 106 (51.2%), 27 (13%) 49 (23.7%), 25 (12.1%) respectively. By the age increases, the hemoglobin levels were found to be decreased (r = -0.208, p = 0.003). The frequency of patients on antiagregant treatment was higher in the unexplained anemia group (p \ 0.001). Conclusion: The use of antiaggregant and anticoagulant drugs in geriatric patient population is quite frequent. This entity requires to be considered in the etiology of anemia. It should be remembered that the use of antiaggregant and anticoagulant drugs in the unexplained anemia may be a major risk factor for etiology, especially in elderly patients. Diabetes mellitus is associated with vitamin D deficiency in older people . Most patients were dependent on at least one activity of daily living (61.1%) and had several comorbidities (Charlson comorbidity index mean 6.0). One hundred (79.3%) were hospitalized with a mean length of stay of 10.6 days, and three were admitted in intensive care unit. Respiratory failure was the leading cause of admission (51.6%); other complications as pneumonia (23.8%); acute heart failure (24.6%); chronic obstructive pulmonary disease exacerbation (18.2%); acute kidney injury (11.1%); delirium (6.3%); and asthma exacerbation (5.6%) were also prevalent. The treatment strategy included: nebulized bronchodilators (81.0%), antibiotics (75.4%), corticosteroids (65.9%), oxygen therapy (81.7%), noninvasive ventilation (9.5%), and invasive mechanical ventilation (1.6%). All-cause mortality was 10.3%. Conclusions: The impact of RSV on morbimortality among elderly was significant. Further studies are needed to evaluate the future importance of RSV screening in the elderly patient with respiratory infection, and the development of new therapeutic approaches. Subclinical thyroid disease and cardiovascular, metabolic and cognitive comorbility in elderly admitted in long term care .1% (50.0% F and 50.0% M); 9.4% had already been diagnosed and 12.5% were on Tiamazole therapy. We found a positive association between IPO Sub and diabetes (q = 0.008), hypertension (q = 0.011), stroke (q = 0.024) and between IPER Sub and heart failure (q = 0.036). No significant correlation was found between IPO Sub or IPER Sub and cognitive impairment and depressive symptoms. Conclusion: This study highlights a close association between subclinical thyroid dysfunction, cardiovascular comorbidity and diabetes but not with cognitive impairment. Do current clinical guidelines in Germany and the US address geriatric issues properly? Franziska Scherr 1 , Heinrich Burkhardt 1 1 Universitätsmedizin Mannheim-Geriatrisches Zentrum, Mannheim, germany Background: Guidelines are significant tools in medicine. However, as risk-benefit ratios may often differ in the elderly and specific geriatric issues have to be taken in consideration, there is still some discussion about missing geriatric aspects in those guidelines, concerning properly clinical decision-making in the elderly. Methods: A previously committed search strategy identified german guidelines (AWMF) and corresponding US-guidelines (National Guideline Clearing House) according to guideline titles. There was a wide range of clinical topics included in search strategy. These were chosen in advance either by an increasing prevalence in the elderly (e.g. diabetes, stroke, syncope, dementia, incontinentia) or by the topic itself if representing a specific geriatric issue. If possible pairs of guidelines (US and Germany) were analyzed. A previously built scoring matrix was applied to evaluate the guidelines (range 0-38). Within this matrix following issues were evaluated: mentioning elderly patients in general, locomotion problems, cognition, polypharmacia, multimorbidity. Results: 30 guidelines were analyzed (13 german, 17 US). Only the US-guideline concerning diabetes (ADA) reached the highest category (75% and more of maximum possible score). 13 guidelines were placed in category II (50-75% of maximum possible score), 11 in category III (25-50% of maximum possible score) and 5 guidelines remained in the lowest category (below 25% of maximum possible score). Out of the 5 issues applied polypharmacia was least addressed (0% of the possible maximum score in 41.1% of guidelines). Discussion: There is a remarkable heterogeneity how geriatric issues are addressed in current clinical guidelines. Only few guidelines mention geriatric issues properly with a remarkable lack in the case of polypharmacia. On the other hand in most guidelines at least some geriatric aspects are mentioned. To improve this further a comprehensive effort is recommended in the guideline consenting process to address geriatric issues and provide special comments to clinical situations where those may influence recommendations. Comorbidity and multimorbidity in older adults living in rural northern Greece Vaitsa Giannouli 1 , Nikolaos Syrmos 1 1 School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece Introduction: Comorbidity and multimorbidity in older adults is generally accepted as having a major impact on healthcare resources and costs. The aim of this study is to examine comorbidity and multicomorbidity, by assessing which are the most prevalent health problems in a representative sample of older adults living in rural northern Greece. Methods: Eighty-seven older adults from Northern Greece (52 females) participated voluntarily in this door-to-door study. The data were collected during 2017. The cognitive function of the participants was assessed with the MMSE, and their daily functioning with FRSSD and FUCAS. The participants with severe cognitive deficits were excluded from the study. The existence of chronic conditions was examined with a written closed-ended questionnaire. The mean age of the participants was 74.65 years (SD = 6.75, range 66-89), their level of education 8.60 years (SD = 3.92), and their mean MMSE score was 26.50 (SD = 3.99). Results: Results revealed that 21% did not experience comorbid health conditions, 22% of respondents reported simple comorbidity, and 57% reported three or more chronic conditions. The frequency of the 8 most reported conditions is in descending order: vision problems, hearing loss, high blood pressure, heart trouble, diabetes, arthritis-rheumatism, stroke, and lung diseases. Conclusions: These preliminary findings support that older adults, coming from a little investigated geographical area, experience two or more chronic health conditions. Future research in larger samples should elucidate the factors that influence the initiation and progression of comorbidity and multicomorbidity. Strong association between malnutrition, inflammation and depression in elderly patients, novel geriatric complex based on malnutrition; MID Complex? Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Conclusion: Geriatric syndromes, polypharmacy and functional loss, as well as the analytical parameters of our study, low values of hemoglobin and albumin, showed to be predictive factors of mortality at one year. The diagnostic and therapeutic adequacy is today the biggest challenge of a geriatrician. We have varied information on several factors that contribute to mortality, but we still don't have a gold standard. The challenge of recruiting multimorbid elderly patients to a randomised controlled trial Introduction: Research involving the multimorbid elderly is gaining momentum. However, little is known about how to plan a randomised controlled trial (RCT) involving this group of patients. Having an evidence based approach could guide researchers designing RCTs and prevent underpowered trials. Method: We used baseline data from the GerMoT trial, a RCT comparing proactive outpatient care based on Comprehensive Geriatric Assessment (CGA) with usual care. Multimorbid elderly patients with high healthcare utilisation were recruited to the trial. We define the number of patients that need to be identified and the number of eligible patients that need to be invited in order to achieve the desired recruitment number. Results: Of 1122 patients identified in a database as meeting inclusion criteria only 770 could be invited to participate in the trial. The rest had to be excluded or could not be reached for a variety of reasons despite considerable efforts made by our team of researchers. 420 of the invited patients agreed to participate with younger patients being more inclined to consent. Key conclusions: When planning a RCT involving this cohort of patients one can anticipate that less than 70% of patients identified as meeting inclusion criteria can be invited. We have also established that of those that can be invited the consent rate for such a trial is 54% and it varies slightly with age. We believe this information is generalizable beyond RCTs and can be used to plan recruitment to new proactive healthcare interventions involving this vulnerable group of patients. A New geriatric syndrome; hyperkyphosis? determining the frequency of hyperkyphosis and comparison of three methods Aim: Age-related hyperkyphosis (ARH) is an exaggerated anterior curvature of the thoracic spine. Though the prevalence of hyperkyphosis in older individuals is not clear, existing studies show that the prevalence is between 20 and 40%. This study aimed to determine the frequency of ARH and to compare three methods used to evaluate hyperkyphosis in patients. Method: Patients who applied to geriatric outpatient clinic were included in this study. Participants were evaluated by using the Cobb's angle, the kyphotic index, and the block method. Patients who have Cobb's angle of 40°and above, the kyphotic index of 12 and above, or the block of one and above were considered as hyperkyphosis. Results: The study included 161 participants comprised of 121 women (75.2%) and 40 men (24.8%), with an average age of 72.5 ± 6.90. 66 (41.0%) patients were hyperkyphotic by the Cobb's angle. In the kyphotic index measurements, 65 (40.4%) patients were hyperkyphotic. According to the block method, 81 (50.3%) patients were hyperkyphotic. There is a significant correlation between the Cobb's angle and the kyphotic index (rs = 0.30, p: 0.002) and the kyphotic index and the block method (rs = 0.32, p: .001) while the Cobb's angle and the block method is not significantly correlated (rs = 0.15, p: 0.13). Conclusion: Hyperkyphosis is one of the deformities that occur in musculoskeletal system with ageing. This is the first study that used three different methods concurrently to evaluate hyperkyphosis that is a clinical manifestation which would be discussed as a new geriatric syndrome imminently. Fracture risk is under-recognised and under-treated in memory clinic attendees Introduction: People with cognitive impairment are more likely to sustain a fracture than their cognitively intact peers. Those referred to the memory clinic with suspected dementia therefore represent a group where fracture risk assessment and risk factor modification should be prioritised. This project set out to evaluate the management of fracture risk in memory clinic attendees. Methods: Memory clinic attendees from the 1st of February until the 12th of March 2018 had their fracture risk calculated by FRAX Ò as part of their routine appointment. Their 10-year-risk of fracture was calculated and the UK National Osteoporosis Guideline Group (NOGG) recommendations were documented. Treatment and use of DEXA scans were compared to that recommended. Results: Data were available from 79 attendees with a mean age of 83 (SD5.9), 47 (59%) female, 54 (68%) with dementia, MMSE 21 (SD 4.7). 22 (28%) reported falling at least once in the last year and sustained a total of 57 falls. Those reporting a fall fell a median of 2 (IQR 1-3) times. 26 (33%) were taking calcium/vitamin D supplementation while 10 (13%) were taking an antiresorptive. 9 (32%) of those recommended to be treated were on treatment, while 4 (13%) of those recommended a DEXA had had one. Key conclusions: Despite being at high risk of fracture, this memory clinic population was under-treated compared to national guidelines. These findings highlight an important deficit in fracture risk assessment which will inform future interventions to help improve treatment rates. Loneliness as geriatric syndrome Kiryl Prashchayeu 1 1 Belarusian Republican Gerontological Public Association, Navapolatsk, Belarus Introduction: Loneliness is one of the common psychological conditions in elderly which is experienced according to different sources 20% of all people in age 65 plus. The aim of the study was to reveal medical effects of loneliness and to consider it as a socio-medical geriatric syndrome. Materials and methods: Study was performed in three stages, including the revealing of elders with acute feeling of loneliness (n = 340) by D. Russel, M. Ferguson Questionary, comprehensive geriatric assessment of elders with acute feeling of loneliness (n = 69), working out the ways of overcoming of loneliness (n = 69). Results: In lonely elders were observed the decreasing of general nutritional status, loss of appetite and psychological problems which with unregular including of fruits and vegetables into the diet, decreased level of protein intake were correlated with decreasing of grip strength without changing of muscle mass. Elders with loneliness had the worst indicators of general health, mental health and physical functioning, more adherence to the pain, p,05. To overcome loneliness the special educational programmes for volunteers were worked consisted in 36 academic hours, after education volunteers had 6-months working with lonely elders, including visits, control of food consumption, creation of positive emotional environment, cognitive training. After such intervention we observed the positive dynamics of loneliness and increasing of functional ability, p \ 0.05. Conclusion: Loneliness may be the factor of decreasing of intrinsic capacity and important geriatric syndrome with the decreasing of nutritional status as causative element of complex medical changes. Patterns of multimorbidity in older medical patients ( ‡ 65 years): and how they relate to mobility the first year after an acute admission Introduction: Multimorbidity is common among older people and may contribute to adverse health effects, such as functional decline. Identification of differences in mobility after an acute hospitalization among multimorbidity patterns may help stratify treatment and provide the basis for including patients in randomized controlled trials to study the effect of evidence-based multi-disciplinary rehabilitation strategies. Aim: To describe older patients' mobility in relation to patterns of multimorbidity the first year after an acute medical hospitalization. Methods: Prospective cohort study of 369 medical patients (77.9 years, 62% women) acutely admitted to the emergency department. During the first 24 h of admission, 30 days and one year after discharge we assessed mobility level using the de Morton Mobility Index. Information about chronic conditions was collected by national registers. We used Latent Class Analysis to determine differences among patterns of multimorbidity based on 24 chronic conditions. Results: We identified five different patterns of multimorbidity: (1) acutely hospitalized without chronic conditions (prevalence 37%, expected number of chronic conditions 1.77); (2) sensory organs and osteoporosis (19%, 4.25) ; (3) cardiovascular (26%, 4.31); 4) Lifestyle diseases (8%, 6.75); and (5) degenerative and metal disorders (9%, 6.98). Low mobility was associated with membership of pattern 4 (lifestyle diseases) and 5 (degenerative and metal disorders) at all time points. No differences were found in mobility change between the patterns after admission. Key conclusions: The results support that chronic conditions cluster together and that these patterns differ in mobility, which suggests a differentiated approach towards treatment and rehabilitation is needed. Patterns of multimorbidity in older medical patients ( ‡ 65 years): and how they relate to mobility the first year after an acute admission Introduction: Multimorbidity is common among older people and may contribute to adverse health effects, such as functional decline. Identification of differences in mobility after an acute hospitalization among multimorbidity patterns may help stratify treatment and provide the basis for including patients in randomized controlled trials to study the effect of evidence-based multi-disciplinary rehabilitation strategies. Aim: To describe older patients' mobility in relation to patterns of multimorbidity the first year after an acute medical hospitalization. Methods: Prospective cohort study of 369 medical patients (77.9 years, 62% women) acutely admitted to the emergency department. During the first 24 h of admission, 30 days and one year after discharge we assessed mobility level using the de Morton Mobility Index. Information about chronic conditions was collected by national registers. We used Latent Class Analysis to determine differences among patterns of multimorbidity based on 24 chronic conditions. Results: We identified five different patterns of multimorbidity: (1) acutely hospitalized without chronic conditions (prevalence 37%, expected number of chronic conditions 1.77); (2) sensory organs and osteoporosis (19%, 4.25) ; (3) cardio vascular (26%, 4.31); (4) lifestyle diseases (8%, 6.75); and (5) degenerative and metal disorders (9%, 6.98). Low mobility was associated with membership of pattern 4 (lifestyle diseases) and 5 (degenerative and metal disorders) at all time points. No differences were found in mobility change between the patterns after admission. Key conclusions: The results support that chronic conditions cluster together and that these patterns differ in mobility, which suggests a differentiated approach towards treatment and rehabilitation is needed. Rehabilitation geriatric day care in French Hospital The management of patients in geriatric day care hospitals (DCH) is an addition to short-stay units with a predominant diagnostic activity: rehabilitation units are organized around weekly or multi-weekly rehabilitation interventions. The purpose of this study, was to draw up an inventory of the contents of stays among 50 rehabilitation day care hospitals in France. The method used was a multicenter retrospective study. The main items collected were:-data about the center (professionals, team, organization…)-goals of care; duration; number of acts performed; presence of an initial assessment, a therapeutic objective and a final assessment. The results showed an average duration of stay of 25-45 days, with 2 interventions per day; by at least 2 different professionals. The care team was different from one center to the other. The main pathologies found, motivating this care were dementia and falls, with improvement of these after care. In conclusion, this study gave us the opportunity to show that with objective care goals and experienced professionals, we now have a better knowledge of the place of day care hospital in the geriatric sector. Factors determining self-rated health status and global quality of life perception in older adults The demographic transition in Tunisia is characterized by an increase in the prevalence of the elderly population and its related socioeconomic and health problems. Materials and methods: Our study aimed at providing reliable information to assess quantitatively and qualitatively the health status, the actual needs in healthcare and social assistance among the elderly population (65 years and more) living at home in the governorate of Monastir. Results: The study concern 598 people, the mean age is 72,3 years, with a predominance of women (66% VS 34%). Education shows that 77% have a lowest level of education. Most of our population are still married (60%) and 60% are inactive. Widowhood concern more frequently women 53.5% than men 6.9% .Subjects without occupation or having never worked represent 60% of cases. The perception of the state of health is good in 35% of the cases, moderate in 40% of the cases. The assessment of autonomy and quality of life revealed a dependency in 10%. The most common morbidities are arterial Hypertension (52%), diabetes (22%) and polypharmacy [ 3 medications in 60%. The prevalence of psychological disorders is 29% for depression according to mini GDS score and 3% in cognitive impairment according to MMSE adapted to Tunisian population. Conclusion: The demographic transition in Tunisia is causing an increase in the prevalence of the elderly population, an increase in the chronic diseases and an impairment of the quality of life. Psychotropes is too much! Belgium is the European country that consumes the most psychotropic drugs, mainly benzodiazepines The side effects of these drugs are well known, including cognitive disorders and balance disorders favoring falls, with the cascade of multiple consequences, complications often resulting in prolonged hospitalization, loss of autonomy and institutionalization. Withdrawal these medication requires first the collaboration of the patient, his entourage and all the professionals of the first line: attending physician, nursing home staff, etc. This is what the RGH Mons Hainaut geriatrics team proposes: in the context of day hospitalization, one of the planned actions concerns cognitive revalidation and resocialization, which includes support for medicated withdrawal. In practice, after consultation with the patient, the family and the attending physician and the home help services, a care plan is drawn up by the multidisciplinary team. Than a program is set up, providing a day hospitalization and then, two to three times per week the patient is welcomed into the institution. During these days, workshops and group activities are organized (speech spaces, workshops led by occupational therapists, speech therapists and physiotherapists) and individual interviews with the psychologist and dietitian. The average duration of weaning is of the order of 3 months with 2-3 sessions per week with about 40 sessions. After a period of 6 months, the first results can be presented: improvement of the multidisciplinary evaluation (cognition, risk of falling, activities of the daily life and instrumental activities, etc.) Antihypertensive therapy effects on functional status markers in patients with frailty Introduction: Frailty is a reversible condition of vulnerability towards disability and other outcomes in older adults. Goal. To assess the effect of antihypertensive therapy (AGT) on functional status markers in patients with frailty. Materials and methods: We examined 200 patients with frailty, aged 60 to 91, both sexes suffering from arterial hypertension (AH) who underwent AGT for 6 months (month) with an assessment of the functional status markers on the 180th day of the study. The evaluation of the effectiveness, safety of the AGT, as well as its impact on the functional status markers was carried out. Results: Based on the results of the study, the clinical efficacy and safety of AGT has been assessed. In patients with achieved target levels of arterial pressure (BP) 140/80-90 mmHg. improvement in the functional status markers was observed. Against the backdrop of AHT cases of falls and orthostatic hypotension was not recorded. In assessing the baseline daily activity index (Barthel Index), an easy 98.6 ± 3.9 score was observed initially and a significant increase in baseline activity on the 180th day was 99.1 ± 2.86 points. The decrease in instrumental activity assessed by the IADL scale was stable throughout the study and was 26.3 ± 2.1 and 26.4 ± 2.13 on the initial and on the 180th day, respectively. An improvement in walking markers, as measured by the ''Stand Up and Go'' test, was noted. Conclusion: The results of the study proved clinical efficacy and safety of AGT, its beneficial effect on functional status markers. Body composition of long-liver patients with coronary artery disease The study purpose was investigation of body composition in longliver patients with coronary artery disease (CAD). Methods: 190 patients with CAD (females-69.3%, males-30.7%) aged 90-106 years were enrolled in this study. Body composition were assessed by dual-energy X-ray absorptiometry. Results: 70.4% of patients were overweight or obese. Mean body mass index was 27.6 kg/m 2 . Women had more fat mass then men (p \ 0.0001). Overall bone mineral density (BMD) was 1005.9 mg/cm 3 , mean T-score: -1.75 SD. The greatest BMD was in lower extremities (1058.6 mg/cm 3 ), the lowest BMD-in ribs (626.2 mg/cm 3 ). Female patients had lower BMD (p \ 0.0001). Significant correlation between fat and BMD was observed; the greatest significance-for correlation between trunk BMD and trunk fat (r = 0.61; p.0001). Significant positive correlation between BMD and learn mass was revealed; the greatest significance-for upper extremities (r = 0.65; p.0001). Positive correlation between BMD and handgrip strength was registered (r = 0.48; p \ 0.0001). BMD positively correlated with distance covered in the 6-min walk test (r = 0.35; p = 0.002). Positive correlation between lean mass and handgrip strength was registered (r = 0.53; p.0001) as well as with distance in the 6-MWT test (r = 0.22; p = 0.007). Negative correlation between BMD and frailty scale scores was observed (r = -0.45; p.0001) as well as between lean mass and frailty scale score (r = -0.22, p = 0.003). Conclusion: Study results demonstrated some features of body composition in patients with CAD aged 90 years or older. Significant associations between bone, fat and lean tissue as well as between BMD, muscle strength and functional capacities were observed in the study population. Implementation of a geriatric program as support for primary care The main diagnosis was dementia and heart failure (23.5 and 18.8%). The most performed actions were family intervention, therapeutic adjustment and polypharmacy control in 95.1%, 42.7% and 30.5%. Conclusions: The start-up of a unit represents a possible assistance challenge thanks to the support of the entire service. We are faced with a profile of a female patient, multi-pathological with moderate frailty. PC demands support in dementia and heart failure. The interventions are based on family orientation, polypharmacy control and therapeutic adjustment. Impact of a complex intervention on the appropriateness of prescribing for nursing home residents (come-on study): results of a cluster-randomized controlled trial Goedele Strauven 1 , Pauline Anrys 2 , Eline Vandael 1,3 , Séverine Henrard 2,4 , Jan De Lepeleire 5 , Anne Spinewine 2,6 , Veerle Foulon 1 falls of hospitalized patients have been reported through a specific tool that collects information about the patient, hospitalization, risk factors for fall, applied prevention strategies, consequences of the fall and treatments. ODDS Ratios (95%) coefficients, multivariate analysis and logistic regression were performed. Results: A total of 607 falls have been reported (2014: 77; 2017: 182; ?136,6%); 76,9% of patients were over 65 years of age; 92% of falls occurred during ordinary hospitalization; 64,7% falls occurred in patients considered being at risk for falls. Multivariate analysis highlights that patients with a history of accidental falls and gait instability have a greater risk of fall with injury compared with patients without those risk factors (OR = 5.61, 95% CI (1.06-29.8); patients with gait instability have a minor risk of fall with injury compared to patients without previous history of fall and gait instability (OR = 0,46, 95% CI (0.25-0.84). The results of the study show an increased sensibility of healthcare workers in reporting falls. The risk for fall with injury is higher in patients with a previous history of fall and gait instability: this confirms the results of other published studies. Those risk factors must be carefully considered by healthcare workers in order to identify the most effective prevention strategy, the lack of which can have health and legal consequences; for these reasons it is extremely important to sensitize and train healthcare workers. Risk factors of iatrogenic disease in elderly Background: Drug iatrogenic disease has a very high human and economic cost in elderly. It is often serious and may be responsible for more than 10% of hospitalizations in this population. Our objectives were to describe iatrogenic disease features in elderly and to determine risk factors for iatrogenic disease in these patients. Methods: We conducted a retrospective, descriptive and analytical study including patients aged of 65 years or older, who developed at least an iatrogenic drug effect. We compared demographic, clinical, paraclinical, therapeutic characteristics and outcome of elderly and non-elderly subjects. Results: Fifty-eight elderly subjects presented an iatrogenic event. The sex-ratio (M/W) was 1.07. Mean age of our patients was 72.2 ± 7.3 years. Polypathology was present in 58.6% of patients and was statistically more common among older people. Arterial hypertension was the most common medical history in our patients (51.7%), followed by thromboembolic disease (41.4%). Arterial hypertension, stroke, rhythm disturbances and moderate renal failure were significantly more frequent in elderly. Cardiovascular drugs were significantly more prescribed in elderly, particularly anti-vitamin K (AVK). AVK overdose was the most noted iatrogenic drug effect in our series (29.3%), followed by hematological impairment found in 17.2%. AVK Overdose, renal failure and rhabdomyolysis were significantly more common in elderly. Incriminated drug was discontinued in 39 patients (67.2%) and doses was decreased in ? patients. Improvement was noted in 74.1%. No differences were noted between elderly and younger patients. Older people had more polypathology and cardiovascular drugs. AVK Overdose, rhabdomyolysis and renal failure were the most common side effects in this group of patients. Prevalence of vitamin D deficiency in elderly patients with osteoporosis and cardiovascular diseases Introduction: Vitamin D deficiency is defined as a decrease in the level of 25 hydroxy vitamin D \ 20 ng/ml. Meta-analysis studies have shown an association between vitamin D deficiency and the prognosis of patients with osteoporosis and cardiovascular diseases. Methods: Transversal study on 100 patients, 99 women, mean age 83.71 ± 7.6 years with cardiovascular risk factors. Vitamin D was analyzed in all patients and comparative data were obtained. Vitamin D deficiency\20 ng/ml, insufficient = 20-30 ng/ml and optimal = 30-80 ng/ml was recorded. The presence of vertebral/ nonvertebral fractures, some biochemical data (glycemia, cholesterol, LDL, triglycerides), bone density by dual x-ray absorptiometry were observed. Descriptive analysis by SPSS statistical tools. Results: 73 patients had Vitamin D insufficiency (15.85 ± 5.34, p.001), mean age 77.99 ± 11.62 years. 70-79 years age group has the highest prevalence of osteoporosis (42%). The high prevalence of comorbidities in the case of insufficient Vitamin D was: diabetes mellitus (15.06%), high blood pressure (69.86%) and ischemic heart disease(30.13%). Mean cholesterol levels (p.572) and triglycerides (p.134) are elevated regardless of the vitamin D level and may suspect a correlation between dyslipidemia and osteoporosis. In patients with normal vitamin D were found low densitometry parameters: T-score hip-2.3 ± 0.9 and T-score spine-3.27 ± 0.85. Nonvertebral fracture is more common (15.08%) than vertebral (6.8%) in patients with insufficient vitamin D. Key conclusions: Chronic cardiovascular diseases are associated with vitamin D insufficiency in the elderly population. Although vitamin D is within the normal range, T scores are low, showing the importance of screening for osteoporosis and early initiation of treatment. A follow of this study is to analyze in comparison vitamin D level after osteoporosis treatment. Evaluation of life and sleep quality in elderly with metabolic syndrome Introduction: Tunisia is in advanced stage of demographic transition; as a result, the country is facing great socio-economic challenges, including health concerns. The aim of our study is to update health indicators specific to the Tunisian elderly. Materials and methods: Data were obtained from the household National Health Examination Survey (THES 2016), target population was aged 15 years and over. Data collection was performed using questionnaires and biological, functional and anthropometric measurements. The data analysis concerned elderly aged 65 and more, via the software R. version 3.3.2. Results: People aged 65 and over represented 16.9% of the included population (n = 1552), with a slight male predominance. Illiteracy rate was 68.5%, with a female significant superiority (84.1%). Subjects without occupation or having never worked represented 47.1% of subjects. Slightly more than one-quarter belonged to the lowest socio-economic quintile. Perceived health status was good in 30.7% of the cases, moderate in 42.7% and bad in 26.6% of the cases. Measurements revealed that most common morbidity was arterial Hypertension (72.2%), followed by abdominal obesity (51.9%), dyslipidemia (49.8%), anemia (45.5%), impaired vision (42.6%), diabetes (36.9%) and finally obesity (30.2%). More than 15% of subjects combined hypertension, dyslipidemia and diabetes while 14% combined anemia and overweight, with a significant difference by gender. Conclusion: The prevalence of a number of chronic conditions pose a significant and particular threats for elderly Tunisians. It is essential and urgent that health system make effective response to these current challenges, in addition to promoting universal prevention and healthy lifestyle for a healthy aging within future generations. Prevalence of Comorbidities in a Large Representative Sample of Swiss Older Adults FR Herrmann 1 , C Luthy 1 , C Ludwig 1 , AF Allaz 1 , C Cedraschi 1 , D Zekry 1 1 Geneva University Hospitals and University of Geneva, Geneva, Switzerland Introduction: In older adults, comorbidities, the presence of concomitant diseases, largely contribute to individual differences in risks of frailty and reduced well-being. This paper quantifies the prevalence of comorbidities in an older community-dwelling population. . Multivariate ordered logistic regression was used to predict the severity of GIC classification with sex, age group, linguistic region and education level as predictors. Results: Increasing age (ORage 65-69 = 1.0; ORage 70-74 = 1.3, 95% CI 1.1-1.6; ORage 90 = 2.1, 95% CI 1.6-2.7) and being a women (OR = 1.3, 95% CI 1.2-1.5) is associated with a higher GIC class. German speaking and participants with more years of education were less likely to belong to a higher GIC class. Conclusions: Comorbidity is associated with increased adverse outcomes. Its study is essential for a comprehensive appraisal of health in the aged population. Objectives: To evaluate chronic lung disease comorbidity in nonagenarians and centenarians admitted to hospital and to analyse morbidity profiles of COPD patients. Methods: Prospective nested case-control study. All the centenarian admissions to our hospital from 2006 to 2016 were recorded and, for each one, 3 nonagenarian controls were included. Chronic lung disease history was retrospectively reviewed in detail. Lifetime diagnoses of COPD where classified in morbidity profiles: ''survivors'' (diagnosed \ 80 years), delayers (80-100 years and scapers ([ 100 years or diagnosed at admission). Results: We recruited 602 admissions, 74.75% female. The APACHE was 10.85 ± 4.14, Charlson Index 1.6 ± 1.35. Main reasons for admission: respiratory infections in 22.9%, decompensated heart failure 14.5%, urinary infection 5.1%, stroke 3.3%, and hip fracture 2.6%. In 73 patients (12.1%) chronic lung disease was recorded: 44 COPD (60.3%), 13 asthma (17.8%), 2 tuberculosis sequels (2.7%), 2 repeated pulmonary aspiration (2.7%), 2 bronchiectasis (2.7%), 1 pulmonary fibrosis (1,4%) and 1 obesity-hypoventilation syndrome (1.4%). COPD patients were 94 ± 3.24 years and 65% males. The APACHE was 11.4 ± 4.2, Charlson Index 2.4 ± 1.2. According to the COPD diagnosis, 28 were delayers (63.6%) and 16 survivors (36.4%). Pulmonary function tests were recorded in 19 COPD patients (43.2%): VEMS(%) 60 ± 12.1, CVF(%) 71.9 ± 13.3, and VEMS/CVF(%) 56.1 ± 10.7. Key conclusions: Although almost a quarter of very elderly patients were admitted because of lower respiratory tract infection, only 12% had chronic lung disease, being COPD the most frequent diagnosis. Patients were mainly delayers for COPD diagnosis and pulmonary function tests were recorded in less than half, showing moderate airflow obstruction. Challenges associated with usage of BMI as an adiposity index in a typical African elderly population cohort: the need for better approaches Background: Sub-Saharan Africa is recording a surge in population with excess adiposity with time. However, population based screening programmes hardly assess utility of variables included in measurements during screening procedures. Objective: To assess the compare the association between different non-invasive adiposity indices among the elderly cohort in the CRISTA-programme. Methods: A cross-sectional community based screening exercise was conducted at Mikocheni ward of Dar es Salaam, Tanzania during the national diabetes week (Nov 2017). Sitting systolic & diastolic BP, fasting glycaemia, electrocardiographic screening, weight, height, hip circumference, waist circumference as well as neck circumference formed the non-invasive data. Continuous & categorical data were summarized using median (IQR) and frequency (proportions) respectively. Main analysis employed generalized linear model after appropriate validation of model assumptions. Data analysis was done using SAS version 9.4. All participants were verbally consented to participate prior to inclusion into the screening process. Results: We screened 227 self-reported healthy participants during the 2 days screening exercise. Median age was 67 (IQR 60-75.2) years. Out of 227 participants, 124 (54.6%) had hyperglycaemia (FBG [ 7 mmol/L), 168 (74%) had systolic BP [ 130 mmHg, 183 (80.6%) had diastolic BP [ 85 mmHg, 121 (53.3%) were obese (BMI C 30 kg/m 2 ). There was marginal but significant correlation between waist-to-hip ratio and Framingham cardiometabolic risk score (g = 0.421, P \ 0.01). Neck circumference (g = 0.65, P \ 0.01), waist-to-hip ratio (g = 0.73, P = 0.002) was strongly and significantly associated with mean arterial BP. Conclusion: BMI was found to be a weak predictor of adiposity in this study population. Dysphagia Frequency of elderly residents in an institution with different tools Aim: The Eating Assessment Tool-10 (EAT-10) is a self-administered questionnaire for dysphagia screening. Whether the EAT-10 is a suitable tool for assessment of swallowing for residents in institutions is debatable. Yale Swallow Protocol (YSP) is an easily administered, reliable, and validated swallow screening protocol. The purpose of this study was to assess dysphagia with EAT-10 in elderly individuals living in an institution and to compare the results with Yale Swallow Protocol (YSP). Materials and methods: Elderly (C 65 years) residents without eating and cognitive problems were enrolled. EAT-10, YSP, Mini-Nutritional Assessment-Short Form (MNA-SF), body mass index (BMI), diet type (normal food, oral nutrition supplement, soft food), calf circumference (CC), comorbidities were noted, C 3 points pointed out the risk of dysphagia with EAT-10. For YSP; the results were recorded as successful and unsuccessful. Results: Ninety-nine residents were enrolled. The mean age, BMI, CC, and current comorbidity number of patients were 76.2 ± 7.7 years, 27.1 ± 4.9 kg/m 2 , 34.9 ± 4.1 cm, and 1.2 ± 0.9. The mean scores of MNA-SF and EAT-10 score were 10.9 ± 2.0 and 2.47 ± 3.8. The risk of dysphagia was 31.3% with EAT-10 and 18.2% with YSP (p = 0.023). There was an agreement between EAT-10 and YSP (j = 0.231, p \ 0.014). Conclusion: The risk of dysphagia in the elderly residents of the institution was high and variable with different tools. There was a weak agreement between EAT-10 and YSP. PS: Presented in Academic Geriatrics Congress. Improving Hypoglycemia management by using a standard protocol at a Longterm Facility -A Quality Improvement Project Introduction: Long-term Care Facility in Qatar has residents with multiple co-morbidities. Approximately a third of residents have Diabetes Mellitus. Complications such as hypoglycemia can infrequently occur amongst them. Sub-standard management may lead to increased glucose variability which in turn increases the risk of mortality. An audit revealed only 12% of the staff followed hypoglycemia management as per a standard protocol. Aim was to increase the percentage of staff at the long-term care facility using a standard protocol from 12% to 100% over 12 months. Methods: This is a Quality Improvement project which was carried out between January 2017 and March 2018. A multidisciplinary team was formed who used ''Dartmouth Microsystem Quality Improvement Model''. Baseline Process map with cause and effect diagram identified likely reasons for not using the standard protocol. Various interventions were carried out including simplifying a previously established protocol (First Intervention), educational training events (Second Intervention) for all the primary front-liners was provided, posters at the nursing stations and presentations at the television units at the nursing stations. Establishing Clinical Practice Guideline (CPG) on Hypoglycemia in Long-term Care Facility (Third Intervention). Results: A run-chart was used to monitor the response following aforementioned interventions. First Intervention showed significant improvement in the use of protocol to 60% within 2 months and subsequently increased to 100%. After establishing the CPG it remained at 100%. Conclusion: Dedicated multidisciplinary team utilizing a standard model of Quality Improvement produced significant change in the care provided during hypoglycemia management in a Long-term Care Facility in Qatar. Objective: To identify the disease characteristics of diabetes that are related to geriatric syndromes (GS) in older adults. Methods: A cross sectional study was conducted in 198 individuals with diabetes, using clinical interviews and common GS's screening scales. Syndromes investigated were the presence of falls in the last year by questionnaire, depressive symptoms by the Geriatric Depression Scale, disability by the Global Disability Scale, physical function by the Timed Up and Go (TUG) test and cognitive function by the Mini Mental State Examination. Results: Several geriatric syndromes like diminished physical function (TUG) (p = 0.038), falls (p = 0.021), disability (p = 0.001) and depressive symptoms (p = 0.028) were related to diabetes macrovascular complications (presence of coronary, and/or carotid and/or lower limb artery disease), even though people with and without complications did not differ in terms of age or sex. Diabetes duration only showed a tendency for more prevalent disability (p = 0.076) and worst TUG performance (p = 0.095). Type of diabetes treatment, incidence of hypoglycemia and HbA1c were not correlated to any of the GS investigated. By contrast, disability (both p \ 0.001), TUG (both p \ 0.05), cognitive function (both p \ 0.05) and depression (both p \ 0.001) were related to self-rated health status and quality of life respectively. Key conclusions: The prevalence of GS in older adults with diabetes is mostly related to macrovascular complications, irrespectively of age or sex, and correlates to health status and quality of life subjective perception. Casuistics of a project in the field of geriatrics in a medical ward: a one year results Pedro Marques 1 , Rita Martins 1 , Eduardo Doutel Haghighi 1 , José Barata 1 1 Hospital de Vila franca de Xira, Vila Franca de Xira, Portugal Introduction: The Portuguese population is becoming increasingly older and multiple geriatric syndromes are becoming more common in the hospital wards. A project in the field of Geriatrics was created and implemented in an internal medicine department in order to prove the benefits of a differential geriatrics approach. Objectives: Compare the data and outcomes of the patients included in the project with the remaining patients admitted in the same ward. Methods: Comparing age, gender, admission provenience, mortality, discharge destination, length of stay and mean number of diagnosis per patient during 1 year (April 2017 to April 2018) between the 2 groups. Results: During that period, there were 92 patients included in the project versus (vs) 5269 not included; characteristics of both groups were similar, with exception of mortality, which was lower in the project group (4.35% vs 13% in the rest of the population), medium age (83.5 years vs 73.65 years) and number of total diagnosis (13.79 vs 11.41). Average length of stay was slightly higher in the project. The patients on the project group were also more frequently sent to a hospital consultation for reevaluation. Discussion: Geriatric patients are very complex (older and with more comorbidities) and need a particular approach when admitted on a hospital ward in order to reduce morbidity, mortality and length of stay. With a geriatric approach, we were able to reduce mortality in an older population with more comorbidities, with only a slight increase in stay length. A rare complication of Paget's disease Introduction: Sarcomatous degeneration is the major complication of Paget's disease of bone (PDB). Its diagnosis is usually easy but the prognosis is quickly fatal. We report a case of sarcomatous degeneration of a PDB. Observation: Mr. KA, a 69-year-old high-smoking men (40 PA), with a history of dyslipidemia and ischemic coronary artery disease, had consulted for hip and left thigh inflammatory pain (EVA 8/10) since two months with impaired general condition not improved by symptomatic treatment. The physical examination showed a painful mobilization of the left hip with flexion limitation at 75°. The biology had shown a biological inflammatory syndrome (ESR = 80 in H1), a normal phospho-calcium balance except increased alkaline phosphatase at 284 IU / L. Pelvic X-ray radiography showed hypertrophy, cortical thickening and heterogeneous lytic lesion of the left iliac wing. A pelvic CT scan showed significant reshaping of the left iliac wing with multiple osteolytic areas and erasure of the cortex. A bone scintigraphy showed heterogeneous hyperfixation of the left hemipelvis with a discrete hyperfixation of the left scapula. A pelvic MRI showed bone lysis of the left iliac bone with bilobed tissue mass at the expense of ipsilateral psoas and gluteal muscles enhancing after Gadolinium injection. A bone biopsy was performed showing a pagetoid appearance with undifferentiated sarcoma of the bone. Thoracic CT was performed as part of an extension assessment showing pulmonary metastasis. The patient had been infused with zoledronic acid (Aclasta 5 mg) and was referred for chemotherapy. Conclusion: Although PDB appears nowadays less active and less severe, sarcomatous degeneration may be inaugural. It would be useful to start a multicentre study comparing the different treatments for sarcomatous degeneration in order to increase the median survival of patients. Oto-rhino-laryngological manifestations of rheumatoid arthritis over 65 years old Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder that can damage a wide variety of body systems. Ear, nose and throat (ENT) involvement is frequent but not often reported. Objectives of our work are to determine the prevalence of ENT involvement during RA over 65 years old and to evaluate its correlation with RA disease activity. Methods: This is a cross-sectional study of 21 consecutive RA over 65 years old, followed at the Rheumatology department of Monastir Teaching Hospital in Tunisia, during 06 months (November 2016 to April 2017) and 46 matched volunteers. ENT clinical examination with tonal audiometry and thyroid tests (TSH, T4, anti-Thyroperoxidase Ab (Anti TPO Ab) and Anti-Thyroglobulin Ab(Ab anti Tg) were performed. Results: ENT involvement prevalence was 62%. The most frequent functional signs were intermittent dysphonia in 52% and dysphagia in 47% of cases. The neck examination revealed painful larynx mobilization in 47% cases and cervical lymph nodes in 5% of cases. Indirect laryngoscopy, performed in the 57% of symptomatic patients, noted inflammatory mucosa in 33% of cases anddecrease in vocal cord mobility in 19% of cases. Fifty two percent of patients had temporomandibular Joint (TMJ) involvement. Tonal audiometry revealed 52% of cases of deafness: 33% sensorineural deafness, 23% conductive deafness and 2% cases mixed hearing loss. The ENT manifestations significantly associated to RA compared to the witness group (p \ 0.01) were intermittent dysphonia, dysphagia, painful larynx mobilization, inflammatory nasal mucosa, painful TMJ and deafness. Active disease (DAS 28 [ 3.2) is statistically associated with deafness (p B 0.048) and TMJ involvement (p B 0.009). The ENT manifestations significantly associated to RA over 65 years old against RA under 65 years old were compared to the witness group (p \ 0.01) were intermittent dysphonia, painful TMJ and deafness. Logistic regression study shows that RA duration over 10 years was associated to laryngeal dyspnea (OR = 4.4, p B 0.012, IC (95%) [1.377, 14.134] ) and deafness (OR = 3.8, p B 0.03, IC (95%) [1.142, 12.882] ). In the other hand, age over 65 years old is associated with ENT involvement (OR = 0.123, p B 0.016, IC (95%) [0.076, 0.772]) and deafness (OR = 7.8, p B 0.017, IC(95%) [1.431,43.175] ). Conclusions: ENT involvement is a very common, usually asymptomatic extraarticular manifestation during RA. It is, mainly, TMJ involvement, deafness and dysphonia. The main relevant determinants are age over 65 years old, RA disease activity and duration. Coronary calcification and its relationship to cardiovascular risk factors in asymptomatic community-dwelling men Objectives: We evaluated coronary artery calcification (CAC) and its association with cardiovascular risk factors in asymptomatic community-dwelling men. Methods: The sample consisted of 150 asymptomatic men aged 50-70 years, who underwent multidetector computed tomography examinations. We evaluated CAC using the Agatston score, classifying results as B 10 (no evidence and low CAC) and [ 10 (moderate and severe CAC). A multivariate Modified Poisson regression model was used to identify risk factors associated independently with moderate/severe CAC. Results: We identified the presence of CAC (calcium score [ 0) in 59.3% of participants. Bivariate analysis revealed significant associations between moderate/severe CAC and \ 150 min/week physical activity (p = 0.041), family history (FH) of coronary artery disease (CAD; p = 0.033), hypertension (p = 0.014), and elevated blood glucose level higher p = 0.023). In the multivariate analysis, moderate/severe CAC remained independently associated with FH of premature CAD (PR = 1.39; 95% confidence interval [CI], 1.03-1.88, p = 0.029) and \ 150 min/week physical activity (PR = 1.40; 95% CI, 1.01-1.93; p = 0.045). Conclusion: Cardiovascular risk factors such as FH of premature CAD and low physical activity were associated independently with moderate/severe CAC. Our results suggest that these risk factors should be considered more fully when evaluating global cardiovascular risk. Keywords: Coronary artery calcification, Risk factor, Family history, Physical activity. Subclinical hypothyroidism and cardio-cerebro-vascular risk in older people Introduction: Prevalence of subclinical hypothyroidism increases with age. It increases the risk of myocardial infarction two-to threefold in older women. Often is under-diagnosed since its clinical picture is silent and atypical. Aim of the study was to identify the effects of this disorder on cardiovascular conditions in older people as compared to adults. Materials and methods: A retrospective study performed on 120 randomly selected patients previously diagnosed with subclinical hypothyroidism, divided into 2 equal groups: adults (50-64 years), elderly (C 75 years), with equal number of women and men. Results: Prevalence of patients from rural area was 19.17%. Obesity was more prevalent in adults (54%). Hashimoto thyroiditis in past medical history was almost four times more prevalent in women in the general sample, and mostly in adults. Arrhythmias were more prevalent in older men (23%), but atrial fibrillation was significantly more prevalent in older women (p \ 0.01). Atherosclerosis had a high prevalence in both age-groups ([ 70%), but significantly more prevalent in older group (p \ 0.01) suggesting the long-term effects of subclinical hypothyroidism. Ischemic heart disease was significantly more prevalent in older men (p \ 0.01), nearly twice as adult men. Stroke was twice as prevalent in older age group as compared to adults, and significantly more prevalent in men (0.001). Heart failure was significantly more prevalent in older women as compared to men of the same age group (p \ 0.05) and to adult group (p \ 0.001). Conclusions: Subclinical hypothyroidism increases the prevalence of cardio-cerebro-vascular conditions in older people most probably by being an additional risk factor. Introduction: Despite a preventive policy, the incidence of the « FNF» still reaches 8/1000 after 80 years old with a hospital mortality of 2 to 14% and a mortality at 1 year of 20 to 30%. The opening of the ortho-geriatrics' concept allowed to improve the life and functional prognosis of the elderly patients. The goal of our study was to define the predictive factors of the mortality at 30 days, 6 months and the overall mortality after an operated «FNF». Methods: In 2016, the physicians of the «MOBILE GERIATRIC TEAM» (EMG) from the University Hospital of Nice opened an ortho-geriatrics department (daily visit at the trauma services). Accompanied by a social worker, they interviewed and examined the elderly patients over 75 years old who usually living at home and receiving surgical treatment for an «FNF». An unicentric prospective cohort was created as well as a collection of pre-, per-, and postoperative data. A phone calling to the caregivers and/or the general practitioner in charge allowed to complete the collected data and each was call back beyond the 6 months of post-operation in order to collect the judgment criteria. Results: During one year, 252 patients (median: 88,1 years old, 76,2% of women) were included. Being a man or having a chronic respiratory disorder were predictive factors for the mortality postoperation after 30 days (respectively OR 2.9 (1.05-8.12) and OR 3.8 (1.32-10.5) ). Regarding the mortality at 6 months, the postoperative confusion syndrome was a predictive factor of the mortality (OR 4.6 (1.75-12.87)), as well as the atrial fibrillation or the cancer as comorbidities (respectively OR 3.75 (1.25-11.34 ) and OR 1.4 (1.36-10.21) ). Regarding the overall mortality, the predictive factors were the postoperative confusion syndrome (OR 3.5 (1.62-8.07)), the age, the cancer or the chronic respiratory disorder as comorbidities (respectively OR 1.1 (1.03-1.17), OR 3.9 (1.65-9.52) and OR 2.7 (1.01-7.20) ). Conclusion: Despite that the FNF is an independent risk factor for death for elderly patients, this study has highlighted the predictive factors of death which are changeable or unchangeable. Having identified these risk factors, the geriatricians have to pay special attention to these elderly patients with death risk. be undervalued and as such diagnostic exams and antiosteoporosis drugs are not used. Objective: Compare hospitalized elderly patients with and without previous osteoporosis-related fracture. Methods: Retrospective study comparing elderly patients admitted during 2017 to an Internal Medicine Ward of a Tertiary Hospital with (wOF) and without (nOF) osteoporotic related fracture. Patients were characterized by age, gender, Katz score, FRAX evaluation, MUST score, modified Charlson score, average number of medication used, and use of antiosteoporotic treatment. Outcomes evaluated were average length of stay and mortality. Results: The study included 50 wOF patients and 253 nOF patients. Comparing the two groups the patients wOF had an average age of 83.2 vs 80.9 years; female gender 29(58%) vs 132(52%) patients; Katz \ 3 of 6(12%) vs 116 (45%) patients; nutritional risk according to MUST 18 (36%) vs 69 (27.3%); average FRAX score of 13.7 vs 7,68; average Charlson score 3.72 vs 3.27; average number of medications used 7,51 VS 6,77; of which calcium, D vitamin and, bisphosphonates only in 6 vs 13 patients; and concerning realization of DEXA 14 vs 29 patients. Fractures were mostly hip 18, lumbar spine 10 and Colles fracture 6. Concerning the outcomes average length of stay 14.72 vs 10.1 days and mortality 20% VS 12.6%. Discussion: Despite of a high FRAX score, in these elderly hospitalized population, only a small number had done a DEXA exam and an even smaller number was taking antiosteoporosis drugs. In the sample, of the patients had a previous osteoporosis-related fracture they had a tendency for older age, female gender, higher nutritional risk, Charlson score and a higher average number of medications. They were less dependent, but had a higher average length of stay and mortality. Effectiveness of an innovative kinesio-taping-based treatment in fourth-stage pressure ulcers. A pilot study Introduction: Over 90% of stage III and IV pressure ulcers take longer than 2 months to heal. As reduced tissue vascularity is one of the mechanisms preventing skin ulcer healing, treatments able to improve local circulation could accelerate their clinical resolution. Given that Kinesio taping (KT), which is used in various painful musculoskeletal conditions, can improve local blood circulation and lymphatic drainage, this study aims to determine whether the application of KT near serious pressure sores can improve their healing. Methods: Ten unselected elderly poly-pathological patients (4 men, 6 women) with non-infected fourth-stage sacral bed sores were treated at home by our home-care service team. KT was applied close to a portion of the ulcer, while the contralateral portion was treated according to the standard protocol ('control', C). The surface reduction of both portions was measured every 4 days after KT application (5 follow-up visits: V1-V5). Results: On each visit, the mean percentage reduction was significantly greater in the KT-treated areas (KT-A) than in C: V1 = 21.9% vs 8.3%, p \ 0.001; V2 = 38.3% vs. 17%, p \ 0.001; V3 = 58.1% vs 25.8%, p \ 0.001; V4 = 70.3% vs 36.9%, p \ 0.001; V5 = 81.1% vs 46.3%, p \ 0.001, respectively (paired-sample t-test). Furthermore, starting from V2, the number of ulcers that halved their extension was significantly higher in KT-A, with the maximum difference on V4 (8 ulcers halved in KT-A vs 2 in C, p = 0.007; Chi squared test). Key conclusions: KT can be an effective, rapid and low-cost therapy in fourth-stage pressure ulcers in elderly patients. Royal Gwent Hospital, Newport, UK The gold standard for the management of all older people accessing the urgent care should be routine assessment for frailty syndromes and the presence of one or more should trigger a comprehensive geriatric assessment (CGA). Acute care of the elderly unit (ACE) was set up with the aim to provide to frail older patients the best quality of care involving a daily, holistic and interdisciplinary assessment to coordinate safe, clinical efficient and cost-effective early discharges. All patients admitted under acute care of the elderly were included. The LOS was collected from IT Data, CWS (Clinical Work Station) and the readmissions were collected from GRAPE and CWS during the period between January 2016 and December 2016. A total of 622 elderly patients were admitted to ACE in 2016 of which 437 patients were discharged as ACE. The average length of stay (LOS) in ACE during the period analysed was 3.7 days, compared with the national average of 9 days for patients over 65 years. Patient readmission rate was 7.9% within 30 days, compared with the national average of 15.5% (age over 75) indicating that a more rapid decision making does not pose a higher readmission risk if patients are assessed by a multidisciplinary team through a comprehensive evaluation. The pressure for hospital beds in the elderly continues to grow. A rapid population ageing needs changes in our current models of care assessing frail older people admitted with urgent care needs. It is proven that a comprehensive geriatric assessment of older people leads to better outcomes and units focuses on those patients likely to be able to return home within the first 24-72 h to admission are proving being efficient and effective. Evaluation of caregiver burden of geriatric homecare patients Background: Home care is a providing health care to the patients in process of care in their home environments, after the diagnosis and treatment. Ones who need home care are mostly the patients aged over 65. This care is generally run by the relatives of the patients. Often one person is in charge of caring the patient and that one may be in difficulty most of the time. This research aim is to determine the difficulty experienced by the one who provides home care for the patients aged over 65 by using ''Zarit Burden Interview''. Material-method: In this descriptive research, the ones who provide home care for the patients traced by Marmara University during the period of February-March 2016 were included. After taking approval of participants, Zarit Burden Interview of 22 questions, put into practice by asking the questions face to face. The result from Zarit Burden Interview can be minimum 0, maximum 88. Higher result shows higher experienced difficulty. 24 is considered to be cut-off score. Information including socio-demographic characteristics of caring ones and patients were recorded. Results were analysed by using SPSS Statistics 23.0 program and Mann Whitney U and Kruskal-Wallis tests. For the research ethical committee approval was received from Marmara University. Results: Totally 119 care givers (100 females, 19 males) participated in this study. In the study Zarit Burden Interview score was found out to be 49. 5 ± 14.73 (12-79) . One hundred and eight (%90) care giver's score was higher than 24. The associations between the burden of care giver were; the period of caring the patient, care giver's age, gender, education level, relationship to the patient and working condition. Between care giver's burden score and his or her relationship with the patient (p = 0.038), patient's education level (p = 0.008), and caring period of the patient (p = 0.008) were found statistically significant. Conclusion: Evaluation of care giver's burden and determining the problems might help to increase living qualities of both the care givers and the patients. This awareness might provide more beneficial caring for the patient. The elderly in the middle-East are growing rapidly. Most government in the region are ignoring the need of the elderly assuming that the family are still enough to handle their problem. Middle Eastern countries have certain cultural, social and economic characteristics in common with similar aspiration. The percentage of elderly in the Middle East is expected to increase with improvement of the health care delivery in the area. The region, like other developing countries, needs to define the policies and programs that will reduce the burden of aging populations on the society and its economy. The number of Alzheimer patient in the region is increasing rapidly. A number of studies were done using InterRai instrument (community Health Assessment)-CHA to determine the prevalence in the community. Initial report from the study in Lebanon will be presented.CHA, Community, Dementia. A community study on the elderly in Dubai/UAE to plan for future geriatric services The percentage of elderly in the Middle East is expected to increase as the youthful masses work their way up the population pyramid due to the improvements in health care. According to the WHO Department of Aging 2000 report, most Middle Eastern countries will be entering the window of opportunity during this decade, and the window is expected to last until midcentury. It is during this lucrative period that the groundwork for future geriatric services should be firmly established and nurtured. Therefore, this cross sectional study aims to assess the health needs of the elderly in order to deliver solid data for providing future geriatric services that can improve the quality of life of the elderly in the region. Information was gathered from elderly attending many health care and elderly facilities in Dubai, UAE. People who lived in the UAE and were 65 years old or above were included whilst those who were only visiting the UAE were not included. Overall, the total elderly population in Dubai is estimated to be 32,000 people. With a margin of error of 5% and a confidence level of 90%, the recommended sample size turned out to be 269 people. The sample size included in the study consisted of 300 individuals. The interRAI organization's community health assessment instrument (interRAI CHA) was used as a tool for gathering information. After filling in all the questionnaires, the data was entered into the SPSS Statistics program for analysis. The results obtained delineated which diseases need our support and improved prevention or management. By filling the gaps in elderly health care and by recognizing which aspects of care need our attention, we can ensure a better quality of life. This research is part of Middle East effort to propagate InterRAI instrument in the region. It will help as promoting the research in the field of aging in the region. In addition to comparing the data between countries in the Middle East. CHA, Community, Assessment. The impact of depressive symptoms on social participation in older adults: a Turkish sample Nesrin Yagci 1 , Ugur Cavlak 1 , Emre Baskan 2 , Mucahit Oztop 3 1 Prof, 2 Assist Prof., 3 Introduction: Social participation in the elderly is positively or negatively affected by personal, environmental and economic factors. Emotional factors play a decisive role in social participation. The aim of this study was to investigate the effect of depressive symptoms on social participation in Turkish older adults. Methods: Five hundred thirty seven older adults (279 females; 258 males; mean age: 72.33 ± 6.56 years) included in the study. Depressive symptoms were evaluated using by Short Form of the Geriatric Depression Scale (GDS). The participants were divided into four groups according to the GDS scores: Group 1 (n = 263); no symptoms, 0-4 points from GDS, Group 2 (n = 165); mild depressive, 5-8 points from GDS, Group 3 (n = 58); moderate depressive, 9-11 points from GDS, Group 4 (n = 51); severe depressive, 12-15 points from GDS. Social participation was evaluated with a total of five open-ended questions. Results: 54.1% of the participants reported that they participated in leisure activities. 53.4% of these participants reported that they performed housekeeping and gardening. 60% of older adults participated in social activities. 48.4% of the elderly participating in outdoor social activities stated that they participated with their children or relatives. As the level of depressive symptoms increased in the older adults, their leisure activities (p = 0.0001), housekeeping and gardening (p = 0.0001) has been found to decrease their indoor activity participation. Also, increased depressive symptoms affected outdoor social participation of the older adults negatively (p = 0.0001). Key conclusions: The findings indicate that indoor and outdoor social participation of the elderly negatively affected by increased depressive symptoms. Medicine and Gerontology, Collegium Medicum, Jagiellonian Universit Introduction: The prevalence of chronic pain as well as depression among older adults is high and may adversely impact their everyday functioning, although it is often unrecognized. We tried to assess the relationship between chronic pain presence, depression and functioning level. Methods: 145 subjects older than 60 years (nursing home residents, or patients of outpatient geriatric clinic) were included. Information of pain presence, functional and mental status was obtained using a questionnaire. Chronic pain was defined as lasting [ 3 months, severity of pain was assessed using Numeric Rating Scale (NRS), functional ability using Activities of Daily Living tool (ADL) and mood/possible depression using Geriatric Depression Scale (GDS). Results: The mean age of patients equaled 76 ± 9.68 years, 78% reported chronic pain. Patients with chronic pain more often presented low mood, lower satisfaction with life, with no differences according to ADL. Unlike in case of pain, suspected depression was connected with poor functional status, with the lowest mood among bed-bounded people. Answer for question: 'what is your biggest health problem?' surprisingly was not pain, even among people with high intensity of pain (49 patients with [ 4 points in NRS), but inability to move/walk. Conclusions: Chronic pain in the elderly population is common, but even for patients with severe pain the biggest health problem and cause of depression is not pain, but lack of independence. That shows the continuum pain -depression -disability requires more holistic approach to improve quality of life of elderly patients on a daily basis. Relationship between mean platelet volume and depression Introduction: Depression with high rates of morbidity and a risk for mortality is a common mood disorder in the elderly; associated with a chronic low-grade inflammation, but the underlying mechanism remains unclear. Mean platelet volume (MPV) is widely used as a measure of platelet size and it is known to be a marker of platelet activity. Clinical trials have proven that MPV could be used as a biomarkers of inflammation in various diseases. The aim of this study is to show a correlation between depression status and MPV in elderly population. Methods: 266 patients aged 65 years or above, followed in outpatient geriatric clinic in Ege University Hospital from November 2015 to December 2017 are included in this observational, cross-sectional, retrospective study. The study included patients aged 65 years and nondiabetic, non-malignant, normal cardiac and renal function. Patients were divided into 4 groups according to short form geriatric depression scale; normal: 0-4, mild depression: 5-8, moderate depression: 9-11; severe depression: 12-15. The data was transferred to SPSS 17 (Statistical Package for Social Science) program. Values are given as mean ± standard deviation. The Mann Whitney U test was used to compare values between groups, and the Kruskal-Wallis H test was used to analyze multiple group values. Results: The study involved 266 patients (178 female, 88 male); mean age, platelet(PLT) and MPV of all patients were 78.2 ± 7.5, 253,000 ± 63,000 and 10.6 ± 0.9, respectively. There was no significant difference between the mean age of patients, PLT number and MPV values according to sex (F: age 78.2 ± 7.7, Plt 260,000 ± 62,000, MPV 10.6 ± 0.96, M: age 78.0 ± 7.0, PLT 258,000 ± 65,000, MPV 10.6 ± 1.0). According to geriatric depression score, 62% (n: 166) of the patients were normal, 22% (n: 59) mild, 8.6% (n: 23), middle and 7.5% Statistically significant differences were found between the MPV and PLT numbers among the patients with moderate to severe depression (10.2 ± 1.1 / 11 ± 1 P value: 0.041, 292,000 ± 66,000 236,000 ± 53,000, P value: 0.024). Conclusions: In this study we found a significant increase MPV in patients with severe depression in compared to patients with moderate depression. There was a significant decrease in PLT count in moderate and severe depression group. Further investigations from different centers are needed whether the deterioration in the MPV induces depression or if it changes due to neurohumoral changes in the depression. Results: The mean MMT scores were 12.1±7.5 and GDS scores were 23.5±5.4. As a result of CDC HRQOL-4 scores, the mean physically (PUD) and mental unhealthy days (MUD) were 10.35±10.03 and 6.84±9.04 days, respectively. Besides the mean of activity limited days (ALD) were 6.84±9.04 days. While GDS, PUD, MUD and ALD scores were significantly greater in female gender geriatrics (p = 0.0001), the MMT scores was greater in male gender (p = 0.0001). Key conclusion: The results of the study indicated that cognitive, psychological status and health related quality of life is more affected in female geriatrics, negatively. IGRIMUP: development of the Turkish inappropriate medication use (TIME) criteria: a methodological report the influence of art therapy on physical and cognitive function as well as the well-being in patients of an acute geriatric day clinic. Methods: PAINT is a monocentric, randomised long-term study (09/ 2017-08/2019). Included are patients C 70 years with either mild dementia, depression or chronic pain syndrome as principal diagnosis or comorbidity. In the intervention group patients take part in a standardized art therapy for 60 min twice a week. All patients receive a comprehensive geriatric assessment including scores for QoL and well-being. Three months after discharge all patients receive a followup by telephone in order to evaluate the sustainability of the project. Results: So far 84 patients are included in the study. The mean age was 82.5 years. The mean number of art intervention sessions during the hospital stay was 5 times. Patients feedback on the intervention is very positive. Although exact preliminary results will be evaluated in summer 2018 there is evidence towards a positive influence of art therapy on emotion and well-being of the patients (5-WHO Well being Index), but no significant changes in function and cognition compared with patients in the control group of the study. Key conclusion: Art therapy is very well accepted by geriatric patients. Preliminary results suggest a measurable positive effect on emotion and well-being in patients of a geriatric day clinic. Segmental mesenteric ischemia: multidisciplinary action in the face of acute abdomen in an elderly patient Introduction: Abdominal pain is a frequent reason for consultation in a surgical emergency service. A multidisciplinary action with a geriatric doctor will facilitate the adequacy of the therapeutic effort. Methods and results: We present the clinical case of 87-year-old patient with a personal history of hypertension, insulin-dependent type II diabetes mellitus, stage IIIa chronic kidney disease, permanent atrial fibrillation anticoagulated with Apixaban. A comprehensive geriatric assessment is performed to know their baseline situation in which a good cognitive state stands out, maintaining orientation in the three spheres (space, time and person) without amnestic failures in recent memory. Performs walking with a cane, being independent for the basic activities of daily life. She reported abdominal pain located in the left iliac fossa of three days of evolution and without referring other accompanying symptoms, is afebrile, hemodynamically stable and in the abdominal exploration she underlines pain with deep palpation in the left lower quadrant with signs of peritoneal irritation. The patient evolves with increased pain and analytical worsening, metabolic acidosis, leukocytosis and increase of lactic acid dehydrogenase (LDH).The CT scan suggestive of mesenteric ischemia. After the evaluation of the multidisciplinary team composed of geriatrics, surgery and anesthesia, and once commenting with the family, surgical treatment was decided with previous infusion of fresh frozen plasma. Under general anesthesia, diagnostic laparoscopy is peritonitis without massive mesenteric ischemia. The patient evolved favorably. Conclusions: Comprehensive geriatric assessment is the best tool to personalize the appropriate treatment for the elderly patient. A comparative study of models of geriatric assessment and the implementation of recommendations by primary care physicians Yan Press 1 , Tamar Freud 2 , Roni Peleg 2 , Ella Kagan 1 , Boris Punchik 1 , Alex Barzak 1 1 Unit for Community Geriatrics, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 2 Sial Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel Introduction: The effectiveness of outpatient geriatric assessment has been the subject of many studies that had inconsistent outcomes. In addition to the classic model of the comprehensive geriatric assessment unite (CGAU) there are other models in which the geriatrician comes to the patient's clinic without the multidisciplinary team. These models require fewer resources, but their effectiveness is not clear. In the present study we compared the rate of implementation of geriatric recommendations by different assessment models. The patients in Model ''OCGAU'' were older (mean age 83.2 ± 6.2 years) than in ''Clinic'' models (mean age was 79.7 ± 6.5, 81.5 ± 6.1, and 80.7 ± 6.5, P.001). More recommendations were given per patient (6.4) in the Model OCGAU than in the ''Clinic'' models (range 1.9-3.9, P \ 0.05), but the implementation of recommendations by PCP was lower in Model OCGAU (48.9%) than in ''Clinic'' models (range 56.9-71.8%, P \ 0.005). Conclusions: Although more recommendations were made in the ''OCGAU'' unit, the implementation rate was lower. This indicates the need for organizational changes, in particular improving communication between the geriatric staff and PCP. Which factors affect the implementation of geriatric recommendations by primary care physicians? Yan Press 1 , Boris Punchik 1 , Ella Kagan 1 , Alex Barzak 2 , Tamar Freud 3 1 Unit for Community Geriatrics, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 2 Unit for Community Geriatrics, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 3 Sial Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev, Beer-Sheva, Israel Introduction: The overall implementation rate for outpatient comprehensive geriatric assessment unit (OCGAU) recommendations ranges from 48.6 to 71%. The purpose of the study was to identify factors that reduce the implementation rate of geriatric recommendations. Methods: The medical records of patients who were assessed in the OCGAU over an 8-year study period were surveyed. The data included patient's characteristics (socio-demographic, functional, cognitive, and affective condition, co-morbidity), number of recommendations, the identity of the geriatrician, and data related to the primary physician (age, sex, seniority, number of patients referred for geriatric assessment). Results: Three thousand four hundred thirty-four recommendations were made for 488 patients (mean age 83.6 ± 0.6 years) of which 1634 (47.6%) were implemented by their primary physician. In univariate analyses patients with an implementation rate \ 25%, compared to patients with implementation rate C 75%, had a higher Charlson Comorbidity Index Total Score (CCITS) (2.5 ± 1.9 vs. 1.8 ± 1.7, P \ 0.05), a lower Barthel Index (82.8 ± 16.2 vs. 87.0 ± 15.3, P \ 0.05), and a lower Instrumental Activity of Daily Living score (7.2 ± 3.5 vs. 8.2 ± 3.7, P \ 0.05). In the multivariate analysis only higher CCITS was associated with a lower rate of recommendation implementation by primary physicians. Conclusions: There is a need to increase the implementation rate by primary physicians by increasing and strengthening the link with them and by further training in the field of geriatrics medicine. A novel oxidative stress marker in contrast induced nephropathy; can dynamic thiol/disulphide homeostasis be predictive marker for elderly patients? Aim: The aim of this study was to investigate a novel oxidative stress marker (thiol/disulphide homeostasis) in patients with contrast induced nephropathy in elderly patients for the first time in literature. Methods: A total of 39 patients who administered contrast media for any reason were included in the study; 9 developed contrast induced nephropathy after intervention and other 30 not developed; matched for age, gender and baseline-48 h creatinine and native thiol, total thiol, disulphide values were recorded. Additionally, antioxidant parameters were compared with other routinely performed clinical parameters within comprehensive geriatric assessment. Results: In contrast induced nephropathy group native and total thiol levels decreased and disulphide level increased at 48 h but it was not statistically significant. Patients with contrast induced nephropathy had significantly higher level of neutrophil-to-lymphocyte ratio (p \ 0.005) than non-contrast induced nephropathy patients. Serum albumin, folic asit, Katz Activities of Daily Living score and Mini Nutritional Assessment score levels correlated with serum native thiol values in all patients and a significant inverse correlation was found between native thiol and C-reactive protein and ferritin. Conclusion: This study demonstrated that antioxidant reserve is reducing with acute inflammation and inducing with nutrition and functionality in elderly patients. In the light of this study correlation between antioxidant status and fraility can be examined in the elderly in further studies. Bilateral vestibulopathy; an underdiagnosed condition in elderly with gait unsteadiness and dizziness: cases from a Danish geriatric fall clinic Mette Lindhardt 1 , Hanne Elkjaer Andersen 1 1 Geriatric Section, Medical Department, Glostrup, University Hospital Hvidovre, Hvidovre, Denmark Introduction: Bilateral vestibulopathy may be an underdiagnosed condition in elderly with falls, gait unsteadiness and dizziness. Previously it has been difficult to examine the vestibular system and there has been no tradition of including this examination in fall assessment in the elderly. The video head impulse test (vHIT) is a new, easy and cheap way to examine the vestibular system and thereby possibly diagnose vestibulopathy. Cases: An 84-year-old woman, previously no medical history overall. Complained about slowly progressing unsteadiness of gait and dizziness. Worsening of symptoms in the dark or on uneven ground. No symptoms at rest. No episodes of falls or syncope. Multifactorial fall assessment identified risk factors in form of vision impairment and impairment of balance due to peripheral neuropathy. Supplementary vHIT showed bilateral vestibulopathy with pathological gain with subsequent saccades on both right and left side (Gain: 0.37 and 0.56 respectively). An 89-year-old woman, complained about unsteadiness and oscillopsia, emerging after abdominal surgery where she had received aminoglycosides. Multifactorial fall assessment identified risk factors in form of impairment of balance and muscle strength. Caloric test showed bilateral canal paresis with no nystagmus at all on both sides. Supplementary vHIT confirmed markedly bilateral vestibulopathy with pathological gain (Gain: 0.05 and 0.09). Conclusion: Gait unsteadiness and dizziness are often multifactorial in origin. Bilateral vestibulopathy may be an underestimated condition in elderly with gait unsteadiness and dizziness. vHIT may be suggested as a part of falls screening guidelines in elderly. Nevertheless further research on the subject is recommended. Role of neurogeriatric assessment in a candidate for percutaneous aortic valve replacement: case report Introduction: Greater availability of less invasive methods, such as percutaneous valve replacement techniques, offers the opportunity of treating a growing number of elderly people affected by valvulopathy. A multi-dimensional evaluation including neuro-geriatric skills can be valuable to select candidates undergoing these procedures. Methods: A 70-year-old woman with a non-clear functional impairment was observed at the Cognitive Disorders Center of Geriatrics (Florence) for preliminary evaluation of percutaneous aortic valve replacement (TAVI) for severe aortic stenosis. Results: Presence of mild cognitive impairment, bradykinesia and postural instability determining a rapidly progressive functional impairment were reported since 2 years: preserved BADL (Basic Activities of Daily Living) 2/6. Multiple deficits emerged in a global cognitive assessment, especially in executive functions. Neurological examination showed ideomotor apraxia of left upper limb and left emineglect. A magnetic resonance showed right parieto-occipital hyperintensity. On suspicion of neurodegenerative disease as corticobasal degeneration, a Positron Emission Tomography was performed showing right hemisphere cortical hypometabolism and metabolic reduction in the right caudate and thalamus. Considering the modest cardiological symptomatology limited to the effort, reduced functional capacity and prognosis of the neurodegenerative disease, indication to TAVI was excluded. After 6 months the patient remained stable on cardiovascular level, while a further deterioration of the cognitive-motor pattern with progression of functional dependence (BADL 0/6) emerged. Key conclusions: Identifying the pathogenesis of the disorders in the present case allowed to formulate a prognosis and to modify the interventional approach to heart disease. Neurogeriatric evaluation can be useful for the Heart Team to schedule intervention strategies. Introduction: Gold standard guidance on management of Parkinson's disease (PD) by NICE was updated in 2017 [1] . This audit compared current outpatient management in the Geratology Department at John Radcliffe Hospital against this guidance. Methods: Ninety-two closed questions were designed to enable paper and electronic clinic notes to be audited against the NICE guidance. After exclusion of new referrals, seven cases were randomly selected from Geratology PD clinics. Results: Areas of good practice included communication with patients and carers (accessible point of contact and advice about driving given in 100% cases), clinical diagnosis based on UKPDS Brain Bank Criteria (100%) and offering levodopa early when quality of life was impacted (100%). However, our analysis suggested a need for better provision of oral and written information about side effects of dopaminergic therapy (impulse control disorder 33%; psychotic symptoms 17% cases). Other areas for improvement included offering a cholinesterase inhibitor in mild-moderate PD dementia (33%), early multidisciplinary team (MDT) involvement (physiotherapy 43%; occupational therapy 29%) and provision of information regarding palliative care (advance care planning 14%). Key conclusions: Recommendations were made in the departmental audit meeting across three key areas: documentation, pharmacological and MDT. We suggested using a specialist nurse proforma to both prompt and document the provision of key information to patients and carers. We also recommended offering a cholinesterase inhibitor in mild-moderate PD dementia and early assessment by PD-experienced MDT specialists. Limitations of our analysis include the small sample size and focus on Geratology clinics (Neurology PD clinics were not audited). [1] . 50% of which are preventable and 70% of these are in patients over 65 years of age and on 5 or more medicines [1] . Methods: A new multidisciplinary team review was carried out for a 76 year old Buckinghamshire nursing home resident 3 days post hospital discharge. Clinical Commissioning group pharmacist, general practitioner, geriatrician and care home nurse reviewed the patient. Medical complexity of resident included complex epilepsy with seizures occurring three times a week, brittle asthma, ischaemic heart disease, old strokes, type 2 diabetes mellitus on background of congenital tetraplegia and impaired immune system. The resident was able to use an electric wheelchair to mobilise and on occasions presented to staff with drowsiness and confusion. Prescribed 35 medications. Results: 11 medications were stopped. Phenytoin dose was optimised, Fentanyl dose reduced. Total cost savings on medicines stopped was £2 677. On follow up at 4 and 12 weeks seizures reduced from 12 to 1 per month. Patient was alert and referred for physiotherapy on request. Conclusion: A holistic multidisciplinary review ensures patient treatment is optimised to achieve their preferred outcome with reduction in medication burden and risk of harm. Introduction: Measuring health status of elderly is essential for the prediction of their health care needs. Health research usually considers objective outcome measure; however there is a need to increase self-reported measures of health. The aim of our study was to assess the psychometric properties of the SF-36 among a group of Lebanese elderly. Methods: It was a cross-sectional observational study. A systematic sample of elderly people aged 60 years and more was selected from dispensary, private and governmental hospitals randomly selected in Beirut city. Data were collected using face-to-face interview. The first part of the questionnaire consisted of sociodemographic characteristics. The second part consisted of the Arabic version of the SF-36. The third part consisted of Activity of Daily Living (ADL) scale, number and type of health problems and number of medications consumed per day. Results: A total of 251 elderly people were included. The mean age was 70.69 ± 7.70 years. Cronbach alphas for all SF-36 scales exceeded 0.798. The intra-Class correlation coefficient varied between 0.675 (item 2) and 0.980 (items 14, 16 and 18) indicating good reliability. SF-36 was able to discriminate participants according to their sociodemographic characteristics and health problems: The quality of life (QoL) of women was poorer than men (p value \ 0.001). It was significantly lesser when the number of health problems (p value \ 0.001) and medications (p value \ 0.001) increased, and the ADL score (p value \ 0.05) decreased. Conclusions: SF-36 is a valid and reliable instrument for measuring QoL among Lebanese elderly and could be used for monitoring the QoL of this population. Introduction: Up to 26% residents in Nursing Home (NH) have cancer, and their care represents a challenge. The aim of this study is to establish the prevalence of older adults with cancer in Europe to better understand its impact. Methods: Longitudinal multi-centre cohort study based on data from the Services and Health for Elderly in Long TERm care (SHELTER) study. Participants were assessed through the interRAI-LTCF tool including cancer assessment. Results: Among 3698 residents, 428 (10.7%) had cancer (mean age 86.4±7.2; 62.8% women). France was the country having the highest number of reported cancer cases (17.6%) and Italy the fewest (6.6%). The most frequent kind of cancer were pancreas, breast, colon, skin and lung. The most common cancer patients were white women older than 85 years. Excessive polypharmacy (C 10 drugs) was higher in residents with cancer (30.1% vs. 23.6% P \ 0.001). Cognitive impairment was more prevalent among cancer patients (47.4-38.7% P \ 0.001). Threw up, falls, dyspnea and pain had a higher prevalence in residents with cancer (p \ 0.05 for all). 20.8% cancer residents experienced daily pain in last 3 days, and the 5.8% experienced breakthrough pain despite large use of painkillers (p \ 0.05). Conclusions: Cancer patients are prevalent in NH but supportive seems to be poorly provided, especially in terms of pain management. Introduction: The visual complaints of elderly patients are not always easily understood primarily; sometimes, on the first view, they might not harmonize with the doctor's findings. Methods: From the experience collated in a private practice for ophthalmology low vision caused by age related macular degeneration (AMD), visual field defects caused by glaucoma or stroke and hallucinations in Charles Bonnet Syndrome (CBS) were chosen as important topics, the clock-test as an important tool for understanding elderly patients with visual handicaps: patients' complaints and clinical findings were analyzed and compared with each other. Results: The understanding of a patient's visual disability and perception is the first step. Second, in AMD magnifying low vision aids and reading strategies, in visual field defects, especially hemianopic field defects, reading strategies and training of explorative saccades into the hemianopic field can support the coping with everyday tasks, in CBS especially behaviorial strategies. The clock test was found to be a very important tool to differentiate visual impairment caused by diseases of the eye or optic pathways up to the primary visual cortex from neglect or visual impairment caused by beginning dementia. Key conclusions: Understanding of the variety of visual impairment in different diseases of elderly patients, basically, is very beneficial not only for ophthalmologists but also for geriatricians in everyday work, especially when performing the geriatric assessment. Shortness of breath and sarcopenic obesity: are they connected? Case presentation Introduction: Shortness of breath is usually related to cardiovascular, respiratory or metabolic disease. In elderly patients with multiple comorbidities one should take into account other rather rare causes. Methods: We present the case of a 62-year-old obese woman, with personal history of angina, hypertension and diabetes who was admitted for persistent shortness of breath. Investigations revealed that she had no cardiovascular, respiratory, metabolic causes, or electrolyte imbalance to justify the symptoms. Widening the search for etiology, we found that the patient is, despite stage 2 obese, at high risk of malnutrition, sarcopenic and depressed. Nutritional status was Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 evaluated by mini nutritional assessment questionnaire, Prognostic nutritional Index, Geriatric Nutritional Risk Index, muscle strengthdetermined by dynamometer, and muscle and fat mass by bioimpedance. Results: We considered that the shortness of breath is due to sarcopenic obesity (SO), a well-known risk factor for negative progression of cardiovascular and metabolic diseases. The management of SO in such a patient requires a multidisciplinary team whose purpose is improving muscle mass and muscle strength with physical exercise, nutritional intervention to reduce fat tissue and also maintaining a normal glycemic status and applying no strain on the cardiovascular system. Conclusion: Malnutrition is not limited to cachectic or anorexic patients but is also related to obesity. Preventing progression of the chronic diseases, maintaining high quality of life and high level of independence is directly connected to reversing the SO by a tailormade medical, nutritional and exercise plan for these patients. Factors affecting fall of fear in community-dwelling elderly Introduction: Valvular heart disease (VHD) is frequent in older persons, but largely underdiagnosed because of decreased physical activity, presence of limiting comorbidities or reduced access to care. Methods: The higher aim of the study is to assess the prevalence of VHD in nursing home residents and examine associations with comprehensive geriatric assessment (CGA) and the prognostic impact of both. The recruitment phase of a prospective study in two nursing homes in Cologne begun in April 2018. MD and PhD students underwent structured cardiac auscultation training and subsequent examination of nursing home residents willing and able to consent was planned which additionally included assessment of the performance of a structured CGA. Based upon the functional, psychosocial and clinical CGA domains, a Multidimensional Prognostic Index (MPI) is calculated which allows the classification of patients according to low-(MPI-1, 0-0.33), middle-(MPI-2, 0.34-0.66) and high-(MPI-3, 0.67-1) risk of mortality. Using a stepwise approach, based on auscultatory suspicion of valve disease, patients will undergo confirmatory transthoracic echocardiography. MPI values will be compared from patients with confirmed versus those without valve disease and clinical decision making will be evaluated accordingly. Preliminary Observations and research outlook. Despite the careful ethical and logistic improvement process which led to a patient-friendly, uncomplicated study design, the response rate of both nursing homes and nursing home residents/caregivers was low. Strategies are currently implemented to improve the recruitment process in this study, which has a high potential of providing important information on the impact of VHD in nursing home residents. Profile of treatments prescribed in base of a multidimensional protocol in the follow-up of hip fracture patients included in a Geriatric Fracture Liaison Service (G-FLS) Chronic kidney disease (CKD) affects more than one third of people aged 65 and older. Many patients have renal impairment as one of the multiple deficits influencing their frailty status and prognosis. The routine assessment of frailty can be useful as prognostic marker as well as an instrument for designing personalized care interventions. We evaluated 115 nephrologic outpatients aged between 65 and 94 years with CKD (stage IV or V, but not yet undergoing dialytic procedures). Patients unable to collaborate and those with life expectancy \ 6 months were excluded. A 38-item Frailty index (FI) using the cumulative deficit model was computed taking advantage of clinical and biological information. During the 12-month follow-up, hospitalisations, cardiovascular events, initiation of dialysis and death were recorded. The mean age of the sample was 80.2 years (standard deviation, SD 6.3); 30.3% were women. The mean FI was 0.29 (SD 0.10); men 0.27, SD 0.09; women 0.35, SD 0.10). The FI increased with age for both sexes (Spearman r = 0.22), consistently with the literature. It was also significantly higher in patients who experienced a hospitalisation (p = 0.02), a cardiovascular event (p = 0.02) or death (p = 0.003), independently of age and sex. The decision to start dialysis was predicted by the participant's glomerular filtration rate (p = 0.008), but not by the FI.FI is a strong predictor of negative outcomes in nephrology patients. Its use in the nephrological setting may support the identification of frail patients (independently of age), and promote the allocation of adapted care. The risk of dysphagia is associated with malnutrition and poor functional outcomes in a large population of community-dwelling older individuals Introduction: Oropharyngeal dysphagia (OD) is a widespread clinical condition among elderly. Although it represents a risk factor for metabolic and respiratory outcomes, its assessment and contribution to functional decline appears ignored. Our aim was to estimate the prevalence of OD in a large population of community-dwelling older people and to evaluate its relationship with malnutrition and physical function. Methods: 10-item Eating Assessment Tool (EAT-10) and Mini Nutritional Assessment Short Form (MNA-SF) were used to identify the risk of dysphagia and malnutrition. Short Physical Performance Battery (SPPB) and handgrip strength were used as functional endpoints. The relationship between risk of dysphagia and functional outcomes was tested in a multivariate regression analysis adjusted for age and sex (Model 1) and for other confounders including Mini Mental State Examination (MMSE) and polypharmacy (Model 2). Results: Mean age of 773 subjects (61.3% females) was 81.97 years. 30.1% of participants was at risk of dysphagia (EAT C 3), 37.8% was malnourished (MNA-SF \ 8), 46.2% was at risk of malnutrition (8 \ MNA-SF \ 11). EAT-10 was significantly and negatively associated to MNA-SF, SPBB and handgrip in both univariate and multivariate models (b = -0.28±0.07, p.0001; b = -0.25 ± 0.05, p \ 0.0001; b = -0.07 ± 0.03, p \ 0.0001, respectively). After categorization of risk of dysphagia in at risk and not risk groups, MNA-SF, SPPB and handgrip were independently associated with higher risk of dysphagia (OR = 0.91, 95% CI = 0.83-0.99, p = 0.03; OR = 0.83, 95% CI = 0.77-0.89, p \ 0.0001; OR = 0.96, 95% CI = 0.92-0.99, p = 0.02, respectively). Conclusion: In a large group of community-dwelling older individuals, we observed a significant negative association between risk of dysphagia and nutritional and physical performance, suggesting that the screening of OD, possibly supported by its assessment, should be implemented in the geriatric setting to potentially prevent the functional decline. Does the Fried phenotype of frailty reflect muscle strength of the lower extremities? Consequences for mobility rehabilitation and fall prevention Laura Schmidt 1 , Thea Laurentius 1 , L. Cornelius Bollheimer 1 , Joao P. Batista Jr 1 1 Department of Geriatric Medicine, RWTH Aachen University Hospital, Aachen, Germany Introduction: Handgrip strength is used as an overall surrogate for decreased muscle strength and is one criterion for physical phenotype of frailty according to Fried. Frailty is well reported as a predictor of falls but handgrip strength as well as gait velocity deliver only limited and indirect information about the muscle strength of the lower limbs which is very important in renowned tests to detect fall and functional mobility, such as the chair-rise(CR) and the timed up&go test (TUG). Aim: To compare isometric knee extension strength in frail versus non-frail subjects with propensity to fall. Methods: Geriatric patients (C 70 years) will be included and divided into two sub-groups: Frail and non-frail subjects. To evaluate the propensity to fall the TUG and CR will be evaluated. Isometric knee extension strength will be investigated by a handheld dynamometer positioned at the front of the ankle with patient seated on bed with knee at 70°flexion (0°= max. extension). Participants will be instructed to push the dynamometer as strong as possible for three times. Frailty will be measured based on the physical phenotype criteria provided by Fried. Expected results and clinical relevance: We expect to find lower muscle strength of frail geriatric patients for upper and lower limbs as well as some relationships between Frailty scores and knee extension strength. Although handgrip is regarded to be accurate to measure muscle strength in frailty patients, little attention has been given to other muscle groups that would reflect closer dependency of the mobile capacity and fall prevention related tests. Health for elderly: a physiotherapy assessment tool to assess physical and psychosocial skills and pain Introduction: The assessment of physical and psychosocial skills and pain is central to support the medical and physiotherapy treatment with the aim to enhance autonomy and social participation in active life for elderly. Falls and physical inactivity prevention are the cornerstones of building a good perception on safety and promoting health and well-being of older people with disability or frailty. Ability to adapt, empowerment and reliability must be increased by an integrated socio-sanitary team, privileged point of connection and support. Methods: A physiotherapy assessment tool (Svft_02) was used to assess physical and psychosocial skills and pain of elders who were patients and former patients of the physiotherapy Primary care unit in Genoa. This study aims at assessing physical and psychosocial skills linked to a physiotherapy treatment and to estimate correlations with pain. Results: We investigated N = 2.271 elders. Pain correlates significantly and positively with balance (r: 0.125; p \ 0.001), movement skills (r: 0.162; p \ 0.001), and posture changes (r: 0.157; p \ 0.001). A linear regression analysis show that posture changes (b: 0.157; p \ 0.001), motivation b: 0.263; p \ 0.001), and self-efficacy (b: -0.130; p \ 0.001), were pain predictors. We are processing some socio-sanitary dimensions and we are monitoring the outcomes. The indications received allow us to enjoy with the elderly, the rehabilitation team and the social support context, the best solution for appropriateness, effectiveness and sustainability. Key conclusions: Assessing physical and psychosocial skills linked to physiotherapy treatment is useful to predict pain and to support functional autonomy for elders. Does preoperative comprehensive geriatric assessment and frailty predict postoperative morbidity, mortality and delirium?: a prospective study Background: The evidence for the fact that comprehensive geriatric assessment is part of the preoperative evaluation is rather limited. In this study, the influence of preoperative CGA and frailty on postoperative morbidity, mortality, and delirium was examined. Methods: 108 geriatric patients for whom elective operation planned were evaluated. CGA and Freid Criteria were performed to patients. We used the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity score(POSSUM), the American Society of Anesthesiologists Score(ASA), the British United Provident Association Score(BUPA) and the Charlson Comorbidity İndex (CCI) to determine the risk of postoperative morbidity and mortality. Confusion Assessment Method (CAM) and Assessment Test for Delirium (4AT) were applied for detection of delirium. Patients were followed for postoperative delirium, morbidity and mortality. Results: The median age was 71 years, 25% of the patients were frail. The mortality and morbidity rate were 0.9% and 28.7% respectively. The Instrumental Activities of Daily Living Scale(IADL) (p: 0.032), the Mini-Nutrition Assessment(MNA) (p: 0.01) and the Mini Mental State Examination(MMSE) score (p: 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p: 0.005), operative score (p: 0.015) and CCI (p: 0.029) were significantly higher in the patients with morbidity. Patients who developed morbidity were found to be more frail (p .001). Delirium developed in 3.7% of the patients. Patients who developed delirium were older (p: 0.039), all of them were frail, and 50% had dementia. The patients with delirium were found to have lower IADL score (p: 0,049) and MMSE score (p: 0,004) and higher POSSUM physiology score (p: 0.005). As a result of multivariate analysis, it was found that frailty, POSSUM operative score and preoperative systolic blood pressure were found to be independently related factors in developing postoperative morbidity. Conclusion: In our study, comprehensive geriatric assessment and frailty in the preoperative period indicated postoperative morbidity and delirium. Introduction: The National Institute for Health and Care Excellence recommends home hazard assessment and intervention in falls prevention in community dwelling older people. There are no specific recommendations in prevention of falls outside of home. We conducted a service evaluation project in a district hospital looking at falls presentation in older people attending the emergency department assessing the location of the fall and the immediate consequences. Methods: We collected data of people aged 70 and above who had fallen and presented to the emergency department (ED) in the year 2017. We randomly selected 200 patients using simple randomisation methods of 1 in every 10 patients and exempted patients from care homes. Results: The total number of visits to the ED of our district hospital was 105,116 for the year 2016-2017 across all age groups of which 21,243 were adults aged 70 years and above. A total of 2097 (9.9%) patients aged 70 and above presented with a history of fall to the ED in the year 2017. Of the 200 (9.5%) patients evaluated, the average age is 84 years, females 137 (68.5%) and males 63 (31.5%). 173 (87%) had fallen indoors at home, 20 (10%) outdoors and 7 (3%) not stated. 134 (67%) in total were admitted, out of which 120 (69%) had fallen indoors and 10 (50%) outdoors. 43 (21.5%) had significant injuries, consisting of 23 (16.5%) fracture neck of femur, 18 (9%) other fractures, and 5 (2.5%) traumatic brain injury. Of these 43 patients, 42 (98%) of them were admitted and 4 (2%) of them had fallen outdoors. 4 (2%) deaths were recorded. Conclusion: Majority of the older people attending emergency department had fallen at home. While home based interventions are important in prevention of falls in older people, fall prevention advice outside of home should also be considered. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Introduction: The Older Person Assessment and Liaison (OPAL) team was integrated on the Acute Medical Unit (AMU) in September 2015. This involves 14 beds on the 54-bedded AMU being ringfenced for frail elderly patients with complex needs with a seven-day service including multidisciplinary consultant geriatrician led ward rounds, frailty nurse input and close liaison with pharmacy and therapy staff. Initial impact: The impact of the service on patient outcomes has been positive, with a 55% increase in discharges on Saturdays as well as a 95% increase in discharges of these patients on Sundays [1] . In addition to this, we have achieved double the amount of discharges in the morning [1] .With regard to the over 90 s, we have noted a 22% increase in discharges from the AMU rather than being admitted into the hospital as well as a reduction in 30-day readmission rates of 7.5% [1. Staff survey: We undertook a written questionnaire survey of 20 Allied Health Professionals in 2018 including nursing staff, care support workers and junior doctors that demonstrated OPAL increased the confidence of these staff in working with complex elderly patients as well as the positive impact the service has had on patient care. It was also noted that those questioned would recommend the care received by patients to their family members and friends. Conclusions: Embedding services on an Acute Medical Unit improves both outcomes with regard to patient flow as well as improving the understanding and confidence of healthcare professionals in undertaking comprehensive geriatric assessment. brain imaging, to add professional caregivers support and to modify inappropriate anti-hypertensive and psychotropic drugs. Conclusion: The availability of a geriatric consultation in a hemodialysis center allows to identify frequent and multiple geriatric syndromes in older patients, especially those with a history of hypertension or an hypoalbuminemia, and to propose geriatric interventions. Relation between hand grip strength and body composition in the elderly This study aims to verify the relation between the Manual Hold Force (MHF) and the body composition. Methods: The FPM of the right/left hand was evaluated by hand grip (Jamar, dynamometer). Dual Energy X-Ray Absorptiometry (DEXA, Lunar iDXA, General Electrics) was performed to elderly individuals to evaluate: total mass, fat mass, lean mass. Descriptive, correlational and inferential statistical analysis was performed. Results: The sample was constituted by 100 individuals with balance body mass index (BMI): 67 women and 33 men, with a mean age of 69 and 71, respectively. Right and left MHF was higher in men than in women. Significant differences were founded between right and left MHF. Significant correlation was found for hands, total mass, and lean mass; and also for MHF and the arm, trunk; total right/left lean mass. No correlation was founded between fat mass and MHF of the dominant hand. For gynoid fat mass distribution the correlation was negative and non-existent for android fat distribution. Key conclusions: The lack of correlation between fat mass and right/ left FPM refers to the reflection of sarcopenic obesity in individuals with android obesity. Considering these results a reflection about the negative correlation in gynoid obesity must be also made. Bone mineral density and manual grip strength comparison in elderly Introduction: Anemia is a risk factor for functional decline and mortality among older adults. Since mild anemia is often under-diagnosed and ignored, its prevalence needs precise determination and recognition of predisposing factors. Our study identified the influence of socio-economic factors on the prevalence of anemia in the representative elderly population. Method: PolSenior was a cross-sectional population-based study performed on the representative sample of Polish seniors. Complete blood count was assessed in 4003 respondents aged 65 years or above (1910 women) divided into six five-year cohorts and a reference group of 622 people aged 55-59 years (333 women). Anemia was defined based on WHO criteria: Hb \ 12.0 g/dL in women and Hb \ 13.0 g/dL in men. The following socio-economic factors were evaluated through the multiple logistic regression analysis: education level, marital status, place of residence, living arrangements and self-reported poverty. Results: The prevalence of anemia in older persons standardized for the population was 10.8% (17.4% of the study group) and was more frequent in men than in women (20.8% vs 13.6%). The frequency of anemia progressed with age from 5.3% in the youngest to 37.7% in the oldest cohort, with stronger progression in men. We found the link between anemia and age in both genders, along with unmarried status and urban dwelling in men. When age was omitted, logistic regression showed the link between anemia and unmarried status, urban place of residence (both genders), and poor education (women only). Conclusion: Oldest, poorly educated, unmarried and urbanites require intense screening for anemia. Validity of a set of smartphone-based measures to assess mobility in the elderly Introduction: The study of human functional capacity requires a controlled environment and proper measurement systems which are usually expensive and time consuming. The use of smartphones in clinical research is progressively increasing with the availability of low cost/ freely available ''apps'' that could be used for functional assessment, and yet their clinical validity is unproven or unclear. The aim of this study is to verify the agreement between mobility measures derived from inertial sensors embedded into a smartphone and the measures obtained in a clinical movement analysis lab (gold standard). Four tests have been included: postural sway with different feet positions (stabilometric platform, Bertec), gait characteristics over a distance of 400 m (GAI-Trite-sensorised walkway), the TUG test, and the Five Times Sit-to-Stand Test (3D motion capture system, BTS). Methods: We enrolled 96 healthy volunteers (age 20-80 years, 8 subjects for decade, 50% female). We adopted the InCHIANTI mobility assessment protocol. The SP was worn in a case waist belt placed on L5 in agreement with the FARSEEING project set up. A set of features is derived from both the smartphone and the gold standards. Expected results: We expect to be able to select a subset of features with a good statistical agreement with those obtained in the movement analysis lab. Conclusions: The identification of clinically valid smartphone-based mobility measures, along with a set of normative values, would allow the development of fast, affordable, and objective screening/assessment tests that can be administered in both supervised setting and in ecological settings. Introduction: Older patients with head and neck cancer (HNC) are at higher risk for adverse health outcomes after treatment, compared to younger patients. Careful selection could aid in optimizing treatment for individual patients. The aim is to describe the association of functional capacity and cognitive functioning with one-year mortality in older patients with cancer in the head and neck region. We performed a cohort study in which all patients aged 70 years and older, or younger but with multiple comorbidities, diagnosed with stage III-IV HNC, or diagnosed with a lower stage but needing invasive treatment, received a geriatric screening prior to their treatment. Baseline assessment included patient characteristics, tumor staging and geriatric assessment in social, physical functioning and cognition domains. Background: Sarcopenia, defined as the loss of muscle mass and function, is a geriatric syndrome potentially reversible and often leading to frailty. Multiple factors positively influence and are affected by sarcopenia, including cardiac function. However, no study has fully addressed the relationship between skeletal muscle and cardiac muscle in older patients with sarcopenia and physical frailty. Methods: 100 sarcopenic and physical frail outpatients, 32 men (M), 68 women (F), (mean age 79.8±5.1 M, 78.6 ± 5.3 F; aLM 21.4 ± 3.0 M, 15.3 ± 2.1 F) with data available on appendicular lean mass (aLM) and left ventricular mass (LVM) were evaluated. 70% had hypertension. Each participant underwent cardiologic assessment and echocardiography to estimate LVM. Sarcopenia was evaluated with Dual X-ray absorptiometry basing on the values of aLM and was defined according to FNIH criteria. Physical frailty was defined on SPPB score between 3 and 9. Results: We found a positive and statistically significant correlation between aLM and LVM (r = 0.56; p \ 0.001) but also with other structural left ventricular parameters such as end-diastolic (r = 0.53; p \ 0.001) and end-systolic volumes (r = 0.47; p \ 0.001), end-diastolic (r = 0.49; p \ 0.001) and end-systolic diameters (r = 0.46; p \ 0.001), septal (r = 0.35; p \ 0.001) and posterior wall thicknesses (r = 0.34; p \ 0.001) but not with functional left ventricular parameters. Conclusions: In older people low skeletal muscle mass is associated with low LVM. The mechanisms underlying this relationship remain unclear; however physical activity, insulin resistance, inflammation may mediate this association. Using gait speed as screening tool for frailty in elderly with severe aortic stenosis Background: The increasing use of Transcatheter Aortic Valve Implantation (TAVI) in elderly and the usefulness of comprehensive geriatric assessment (CGA) warrant continued research to develop an accurate screening tool to identify older patients with severe aortic stenosis (AS) who would benefit the most from geriatric evaluation. Aim of this study was to assess the diagnostic performance of a tool combining short form of Mini Nutritional Assessment (MNA-SF) and gait speed. Methods: Consecutive patients C 75 years referred for TAVI in Poitiers hospital between March 2013 and September 2017 were included. Geriatric evaluation and 6-minutes walking test (6MWT) were performed before the procedure. Gait speed was based on 6MWT. CGA was established as the reference test and included information on functional, cognitive and nutritional status; comorbidity; and medication. Two cohorts were established to develop and validate the tools. Results: We included 280 patients (46% women, mean age 85.5 ± 4.2 years), 139 in developmental cohort and 141 in validation cohort. CGA was impaired in 221 (79%) patients. The screening tool combining MNA-SF and gait speed (cutoff, 0.83 m/s) showed good sensitivity (83 and 88%, respectively) and specificity (71 and 77%, respectively) in both cohorts. Positive likelihood ratio (LR) and negative LR were respectively 3.0 and 0.2 in first cohort and 3.6 and 0.2 in second cohort. The area under the curve was 0.8 in both cohorts. Key conclusions: An easily performed screening tool that combines gait speed and MNA-SF could facilitate identification of elderly patients who should require evaluation by geriatrician before valvular therapy. Introduction: The G8 screening tool was developed to identify older cancer patients who could benefit from comprehensive geriatric assessment (CGA). Our aim was to provide a systematic overview of the characteristics and results of primary studies using the G8 in cancer patients. Methods: A systematic literature search was conducted in 4 databases and 3 study registries. Based on inclusion criteria (primary study with cancer patients, use of G8), titles/abstracts and full-texts were screened and data was extracted by 2 reviewers independently. Conflicts were resolved through discussion or a third person. Results: Of 4683 identified references, 36 studies reported the use of G8 in cancer patients. Mean patients age ranged from 72-83 years. Studies varied with regard to cancer type (e.g. specific types, mixed samples) and treatment modality (e.g. chemotherapy, surgery). Impairments in G8 (B 14 of max. 17 points) were examined in 33 studies ranging from 26-91%. In 28 studies, the G8 was compared with other (frailty) instruments (e.g. Vulnerable Elders Survey) or CGAs. The latter differed with regard to included instruments (e.g. Mini-Nutritional Assessment) and cut-offs for defining impairment. Prognostic relevance (e.g. mortality, functional decline) of G8 was investigated in 15 studies with varying results depending on outcome and cancer type. Key conclusions: Since its development in 2012, G8 was used in numerous studies varying in purpose, patient groups, methods and results. More work in well-defined patient groups is needed to demonstrate the benefits of this tool. Conflict of interest: The project was financially enabled by Nestec S.A. There are no data about geriatric fracture liaison services. Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Methods: Observational single-center study. Individuals aged C 60 years, with VES-13 scale score C 3, hospitalized between December 2016 and December 2017 were included. Socio-demographic and medical data were collected at the baseline. The evaluation of functional status was performed by a geriatric team after initial treatment. Standardized functional assessment scales were used including ADL, IADL, Barthel and Tinetti scales. Results were analyzed in terms of planned and acute hospitalizations. Results: 359 older adults were included, 59% women. Mean age was 79 (± 8) years (range: 60-98). Mean BMI was 27.5. Most admissions were due to cardiovascular causes, 59% were acute and the majority of patients had multimorbidities and polypharmacy. Mean hospitalization time was 8±7 days (range: 1-42 days). The percentage of independent patients was 62% according to ADL (score 5-6) and 56% according to Barthel scale (score C 85), patients with severe functional impairment comprised 25% (ADL score B 2) and 18% (Barthel B 20), respectively. Differences in functional scores among patients admitted in acute and planned setting were observed, including risk of falls and a need for 24-hour care after discharge. Conclusions: Incorporating functional assessment to general medical examination in internal medicine wards, especially in acute setting, may help to choose adequate treatment and disability prevention strategies. Introduction: Eyesight and hearing disorders are one of the main causes of disability in Poland. The aim of the study was to present data on sensory organ dysfunctions as well as ophthalmic diseases in older people. Methods: The cross-sectional, population-based survey PolSenior (2007) (2008) (2009) (2010) (2011) was performed on random sample of older people to assess medical and non-medical aspects of aging in Polish elderly. Finally 4979 subjects aged 65 years and more was included to the study. Based on standardized interview with respondents, the history of glaucoma, cataracts and macular degeneration were reported. Vision assessment involved examination using the Snellen tables, reading distance, watching television, counting fingers and assessing the sense of light. Hearing assessment was established during the interview and using whisper test. Results: Mean age (±SD) of the subjects was 78.8 ± 8.4 years, 51% were women. Visual impairment was found in nearly 50% of subjects-moderate visual impairment was most common, blindness was diagnosed in 2% of subjects. Hearing impairment was observed in 30% of respondents-total deafness or significant impairment of hearing was recognized in 1.3% of respondents. Overall, the prevalence of cataract, glaucoma and macular degeneration was respectively: 29%, 7% and 2%. In subjects with history of hypertension or heart failure the hearing impairment occurred significantly often. Furthermore, in these patients ophthalmic disorders were more common. The vision and hearing assessment should be routine procedure in geriatric evaluation of older patients, especially with coexisted cardiovascular diseases, for preserve the better functionality in the later life. Comparison of the active standing test and head-up tilt test for orthostatic hypotension diagnosis in older adults Orthostatic changes were assessed separately for 3rd minutes. HUT is used as the gold standard test. Results: The prevalence of OH during HUT and AST was 19% and 15%, respectively. In patients with OH during HUT, the frequency of balance disorder and the presence of symptoms during the test were higher (P \ 0.05). Comparison of the groups according to CGA measurements revealed significant differences in terms of balance function and up-go test in patients with OH only during HUT (P \ 0.05), but not during AST (P [ 0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of AST were 32.5%, 89.5%, 41.9%, and 85.1% respectively, according to HUT. Conclusion: It was demonstrated that the accuracy of evaluating orthostatic BP changes by AST has never reached that of HUT, and that manual auscultatory measurements have overdiagnosed the OH during both AST and HUT. Furthermore, the results suggested that orthostatic BP changes during HUT were higher clinical significance than that of AST. Therefore, it is important that HUT should be included in daily geriatric practice, to avoid overdiagnosis of OH in older adults. Evolution of functional status in older patients after transcatheter aortic valve implantation (TAVI) Conclusions: To our knowledge, this is the first large cohort study to report on long-term follow-up of functional status in TAVI patients. Geriatric assessment parameters, but not conventional cardiac risk factors, predicted functional status course 1 year after TAVI. Early identification of at-risk patients may help to target interventions aimed at the prevention of functional status decline in these patients. Comprehensive geriatric assessment in older patients undergoing cardiac surgery Leeds Teaching Hospitals NHS Trust, Leeds, UK Introduction: The rapid growing elderly population and the demand for cardiac surgery in this group of patients is a medical challenge. Objective: to describe the population of patients over 70 years old undergoing cardiac surgery at a tertiary hospital by using a comprehensive geriatric assessment (CGA) and evaluate the impact of frailty on their outcomes. Methods: We performed a prospective analysis of data including 115 patients evaluated in the preoperative clinic for cardiac surgery from 10/2017-05/2018. All patients were assessed by a geriatrician. Avoiding unplanned admission after hospital stay by a phone call Peter Johnson 1 , Annica Rosenborg 1 1 Södertälje sjukhus, Södertälje, Sweden Background: A large proportion of the healthcare resources in Stockholm County Council (SLL) are dedicated to emergency, unscheduled care 1 . Likewise, it is known that the risk of recurrent emergency hospital stays increases with increasing age. Older people have, to a greater extent, more hospital stays classified as avoidable than other patient groups. Good coordination and continuity is a prerequisite for these patients and their relatives to feel safe and involved. Research in the field shows that safe patients feel to a lesser extent that they are in urgent need. At the same time, statistics from 2015 show that 1 in 7 patients were unplanned admitted to hospital within 30 days, of which half occurred within 1 week. 30% had not had a care contact between discharge and readmission (2) . Statistics also showed that Södertälje Hospital had a higher proportion of readmission than other emergency hospitals in SLL 2015. Within the geriatric sector, the proportion of readmissions fell within 30 days at 12.9%. In the fall of 2015, therefore, the geriatrics of STS, including three emergency care services with a total of 53 hospital beds, were decided to seek project funding to actively work to reduce the proportion of readmission through prevention work through the SVEA project, Combined Care through Uniform Work, initiated by Health and Safety health care administration within the Stockholm City Council. Purpose: Through targeted phone follow-up to patients who are printed from geriatric hospital care, follow up on care and solve problems, thus optimizing the patient's situation and preventing readmission to hospital. In the healthcare team, visualize ''the fragile patient'' and increase knowledge and communication about factors that cause avoidable readmission, but not caught by our established trials estimates. Method: Statistics from previous projects in the geriatrics show that it is neither meaningful nor workable to call all patients discharged from the geriatric care. Therefore, it was decided that all patients during their stay would be assessed according to a form developed at Brommageriatriken ''Risk assessment for readmission''. In the assessment form, the team answers yes or no whether the patient has the following; heart failure, COPD, pain, fall hazard or previous cases, more than two hospital stays in the past year, polypharmacy, anxiety and / or depression, cognitive impairment and risk medicines, such as Warfarin, NSAIDs, sedatives and / or neuroleptics. assessment is done by the entire care team to simultaneously visualize the fragile patient and increase knowledge about these. The patients who were considered to be fragile (C 4 points) were booked for a telephone call with a doctor within 3-5 days after printing. The idea of the conversation is that it will focus on completing the planning done at the time before discharge and that the patient can handle his health condition as planned at home. Results: The result shows that we have lowered the percentage of readmission from 12.9% to 10.1% between 2015 and 2016. This represents a decrease of about 22%. Statistics show that all patients booked for follow-up call are called up of wich about 85% are dialed within 5 days of discharge. Approximately 39% of all patients who treated at hospital ward are called up, which corresponds to approximately 3-4 calls per department and doctor per week. A very small percentage of patients who are not followed up with telephone calls are reinstated, indicating that we capture the most fragile elderly in our assessment form. However, statistics show that our patients with dementia are to a small extent followed up by telephone calls, as they rarely reach up to 4 points, but at the same time have a higher readmission rate than other patients. Unfortunately, despite good results, the knowledge and communication in the healthcare team has not increased around these patients. The assessment is usually done by the doctor himself, without any remaining members of the team and the knowledge exchange and communication has not improved. Conclusions: By simple assessment, we can catch the ''fragile elderly'' patient group and with a follow-up phone call after discharge prevent readmission. On the other hand, we can see that the demented patient is not caught in the estimation and is still reintroduced to a greater extent. The challenge is to find a way to capture this patient group as well, and reduce the readmission rate. The assessment of the patient in connection with the round in the ward did not become the team-friendly task the project group hoped for. Because the doctor is the one who calls the patient after discharge, it also became the one who usually performed the assessment alone. In order to visualize ''the fragile patients'' in the care team and to increase knowledge and communication, the team probably needs support and resources in the introduction of new working methods.Application and dissemination of results. The result of the project has resulted in the fact that we now have telephone follow-up after geriatric end-care as a routine for our three geriatric care departments. Introduction: Polypharmacy is also defined as the use of multiple medications and generally ranges from 5 to 10 medications.When older people compared with younger individuals,they tend to have more chronic diseases and more precriptions for these conditions.We aimed to assess the relationship between polypharmacy and other factors. Methods: 1107 individuals C 60 years of age admitted to Istanbul Medical School Geriatrics outpatient clinic for the first time the period between 2013-2016 were enrolled to study. We used The International Association of Nutrition and Aging's FRAIL scale. Polypharmacy was defined as the use of five and more medications. Patients were asked about their falls, urinary incontinence, chronic pain, activities of daily living (ADL), instrumental activities of daily living (IADL),and assessed about their nutritional status by Mini Nutritional Assessment (MNA). Results: 1107 patients were analyzed with a comprehensive geriatric assessment. The sample was composed of women (66.8%) and men (33.2%) with mean age of 78.5 ± 5.7 years. Prevalence of polypharmacy was 16% (n = 179).Univariate and multivariate regression analysis were performed to investigate the association between polypharmacy and other factors. In multivariate analysis polypharmacy was found independently associated with urinary incontinence (p = 0.022) and malnutrition (p = 0.028). Conclusions: Polypharmacy is a common problem among older adults; which is an independent risk factor for inappropriate medication use and adverse events. In our study malnutrition and urinary incontinence were found independently associated with polypharmacy. Clinicians should be aware of polypharmacy and prevent patients from poor outcomes associated with this condition. Area: Delirium P-836 The delirium recovery programme (DRP): evaluation of an innovative service providing cognitive enablement at home following hospital admission Tammy Angel 1 , Gemma Holland 1 , Adriana Vyse 1 , Adriana Jakupaj 1 , Mark Mandell 2 1 West Hertfordshire Hospitals NHS Trust, 2 Hertfordshire Partnership University NHS Foundation Trust Introduction: Delirium in acute hospitals can affect up to 60% of elderly in-patients. We have learnt from many studies how to reduce risk of delirium and yet this acute confusional state is common among s older adults in hospital. This study designed a 21 day pathway to provide cognitive enablement at home to support rapid recovery from delirium in a familiar home setting. Patients with delirium were identified and treated by consultant physician and psychiatrist. An individual care plan was produced after discussion with patient and family. Patients were discharged onto a daily virtual ward round, with a 24-hour live in carer and reviewed at day 4 by Occupational Therapist (OT) and day 7 by OT and social worker. Day 10 patients attended ambulatory care for joint review of physical and mental health. Patients received a financial assessment on discharge from the DRP. Objective: Delirium is a frequent problem among older patients in the Emergency Department (ED) and early detection is important to prevent its associated adverse outcomes. Several screening tools for delirium have been proposed for the ED, such as the Confusion Assessment Method-Intensive Care Unit (CAM-ICU). Previous validation of this tool for use in the ED showed varying results, possibly because they were administered at different or unknown time points. The aim was to study incidence of delirium in older (C 70 years) ED patients using the CAM-ICU. Methods: Prospective cohort study, in one tertiary care and one secondary care hospital in The Netherlands. Patients aged 70-years and older attending the ED were included. Delirium screening was performed within 1 h after ED registration using the CAM-ICU. The 6-Item Cognitive Impairment Test (6-CIT) was determined for comparison, using a cut-off point of C 14 points indicating possible delirium, which has previously associated with the presence of delirium using gold standard assessment. Results: A total of 997 patients were included in the study, with a median age of 78 years (interquartile range 74-84). Delirium as assessed with CAM-ICU was positive in only 13 (1.3%) patients. 95 (9.5%) patients had 6-CIT C 14. Conclusions: We found a delirium incidence of 1.3% using the CAM-ICU, which was much lower than the expected incidence of around 10% as been frequently reported in literature and what we find when using the 6-CIT. Based on these results, caution is warranted to use the CAM-ICU for early screening in the ED. The effect of the anticholinergic burden on duration and severity of delirium in older hip-surgery patients with and without haloperidol prophylaxis: a post-hoc analysis Introduction: This post-hoc analysis was performed to assess the effect of the anticholinergic burden (ACB) on the duration and severity of delirium in older hip-surgery patients with or without haloperidol prophylaxis. Methods: Older patients with a postoperative delirium following hipsurgery from a randomized controlled trial investigating the effects of haloperidol prophylaxis on delirium incidence were included in this study [1] . The ACB was quantified using two different tools, the Anticholinergic Drug Scale and an Expert Panel. Using linear regression, the association between the anticholinergic burden and delirium duration and severity was analyzed. Results: Overall delirium duration and severity were not significantly associated with the ACB. Also, no statistical significant differences were found in delirium duration or severity between the placebo and haloperidol treatment groups for the anticholinergic burden groups. The protective effect of haloperidol on delirium duration and severity however tended to be present in the patients with no or a low ACB but not or to a lesser extent in patients with an intermediate to high ACB. Conclusions: The ACB was not significantly associated with delirium duration or severity. The use of haloperidol however tended to shorten delirium duration and decrease delirium severity in patients with no or a low ACB. Additional research with a larger study population and ACB quantification taking drug exposure into account is warranted to further assess the influence of anticholinergic drugs on delirium duration and severity and the effect of concomitant haloperidol use. Background: Delirium is a common neurocognitive disorder in hospitalized older patients. It has been shown to correlate with increased length of hospital stay, mortality, and admission to nursing home (Inouye, Westendorp, & Saczynski, 2014; Siddiqi, House, & Holmes, 2006; Vida et al., 2006) . The purpose of this study was to develop an evidence-based practice guideline for delirium management in hospitalized older patients. Method: A multidisciplinary task group at a medical center in southern Taiwan was established. Team members reviewed current delirium practice guidelines. An adapted practice guideline was developed by constructing foreground questions of key issues, systematical search, appraisal and synthesizing evidences. After a new draft of guidelines was established, the Delphi method was used to reach consensus among expert. Finally, the developed guideline was applied in a geriatric ward of a medical center to evaluate its applicability. Results: The developed delirium guideline address 3 issues with 35 recommendations. The panel of clinical and methodological experts recommended that delirium guideline can be applied in practice. Most nurses in geriatric ward indicated that delirium guideline was feasible and easy to implement. However, few procedures difficult to be implemented were ''provide a therapeutic environment'', ''promote good sleep patterns and sleep hygiene'', and ''consider psychotropic medication as a last resort for agitation''. (Bimatoprost) . He went to the Emergency Department for presenting visual hallucinations at night for a month. He refers that in the night, he usually sees two men with cardboard masks. They disappear when he's trying to approach. Today, he has seen a gentleman who is into the closet. He knows that those objects don't exist but it generates quite anxiety. He doesn't hear any sounds. No infectious symptoms. Physical exploration: A lucid exploration, calm and approachable, oriented, not depressive symptoms, no psychotic symptoms, no self or heterolesive ideas. Complementary tests: PC: Attached laterCRANIAL-CT: Normalresults: Given the antecedents and ophthalmological exploration, the characteristics of the symptoms and the cognitive exploration, the patient was diagnosed of Charles-Bonnet syndrome. He has follow-up by Ophthalmology and Psychogeriatrics. His treatment was sertraline 100 mg/24 h and Risperdal Solution: 0.25 cc/24 h. Conclusions: Charles-Bonnet syndrome is a common condition in the elderly patients with visual impairment. It's imperative that the health workers know this entity to be able to reach an adequate diagnosis. It's essential to carry out a multidisciplinary approach of the patient to be able to treat it adequately and thus improve the quality of life of these patients, which they are usually very distressed with the clinic and with the confusion that they may be developing a dementia. Non-pharmacological, multicomponent delirium interventions: Team-based approaches for the acute geriatric setting Objective: Delirium is an often undiscovered and serious syndrome that often occurs in the geriatrics, and therefore requires delirium detection, prevention and management. Among these, non-pharmacological, multicomponent interventions have proven effective, which has been demonstrated primarily by selected, low-threshold and voluntarily provided prevention components. However, there are hardly any findings with regard to the service provision of the entire spectrum, which, as expected, requires the expertise and close cooperation of health care professionals. Therefore, the question of which team-based interventions are available was pursued. Methods: A scoping review was performed; research strategies were generated based on predefined inclusion and exclusion criteria, followed by a systematic database search. Title, abstract and full text screening (3.809/77) by two independent reviewers led to the inclusion of 24 studies. The narrative presentation of the results was adapted from the PRISMA statement; the critical appraisal was made by means of the CReDECI 2 checklist and specific teamwork criteria. Results: 45.83% of intervention programs address detection/prevention; one management, while 50% address the entire spectrum. The number of identified intervention components varies from three to 18, of which mobilisation and training (83.33%) are most represented. Duration, frequency and type of interventions are described in different qualities; processes, procedures and areas of responsibility are hardly comprehensibly depicted. Patient outcomes (e.g. prevalence/ incidence) are usually reported in the studies, in contrast to teamassociated endpoints (e.g. adherence, education). Conclusion: To date, few delirium intervention programs available cover the spectrum of detection/prevention/management for acute geriatric clients and adequately describe team-based approaches. Background: Delirium is a common neurocognitive disorder in hospitalized older patients. It has been shown to correlate with increased length of hospital stay, mortality, and admission to nursing home (Inouye, Westendorp, & Saczynski, 2014; Siddiqi, House, & Holmes, 2006; Vida et al., 2006) . The purpose of this study was to develop an evidence-based practice guideline for delirium management in hospitalized older patients. Method: A multidisciplinary task group at a medical center in southern Taiwan was established. Team members reviewed current delirium practice guidelines. An adapted practice guideline was developed by constructing foreground questions of key issues, systematical search, appraisal and synthesizing evidences. After a new draft of guidelines was established, the Delphi method was used to reach consensus among expert. Finally, the developed guideline was applied in a geriatric ward of a medical center to evaluate its applicability. Results: The developed delirium guideline address 3 issues with 35 recommendations. The panel of clinical and methodological experts recommended that delirium guideline can be applied in practice. Most nurses in geriatric ward indicated that delirium guideline was feasible and easy to implement. However, few procedures difficult to be implemented were ''provide a therapeutic environment'', ''promote good sleep patterns and sleep hygiene'', and ''consider psychotropic medication as a last resort for agitation''. Conclusion: The evidence-based delirium management guidelines for hospitalized older patients integrated recommendations from the best available evidence and obtained a high consensus among clinical experts. Thus, these guidelines are recommended for clinical application.Key words: Hospitalized Older Patients, Delirium, Clinical Practice Guidelines. Prevalence of delirium in patients 75 years or older admitted to ten Norwegian hospitals Introduction: Our objective was to determine the incidence of delirium, describing its associated factors and impact on mortality in patients who were admitted in a post-acute convalescence unit between January 1 to April 1 of 2018. Methods: Prospective study. Patients [ 65 years were recruited and followed until their hospital discharge. We studied probable predisposing and precipitating factors, demographic data, comorbidity, preexisting cognitive impairment and physical function. Additionally, date and reasons for hospital discharge were collected. Subjects with advanced dementia, diagnosis of any organic encephalopathy or evidence of delirium at the time of the admission were excluded. Delirium was defined according the Confusion Assessment Method. Results: A number of 180 patients were recruited (mean 82.1 years). A total of 44 cases were registered as first episode of delirium. Incidence was 66.8 per 1000 person-days (95% CI 48. 5-89.6) . Meantime for development of delirium was 15 days and the average time for hospital discharge was 37.5 days. Adjusted by age, the factors associated with delirium were: Pre-existing cognitive impairment OR = 3.9(95% CI 1.9-8.3) (p.001), previous delirium history OR = 3.1 (95% CI 1.4-6.7) (p = 0.006), total errors according Pfeiffer's Test OR = 1.4 (95% CI 1.2-1.6) (p.001) use of anticholinesterase agents OR = 2.8 (95% CI 1.3-6.2) (p = 0.011) and Charlson comorbidity score OR = 1.2 (95% CI 1.0-1.5) (p = 0.03). According survival analysis, delirium was strongly associated with mortality HR = 5.2 (95% CI 1.3-21.1) (p = 0.02). Risk adjustment was made for patient age and Charlson score. Key conclusions: Conditions related to cognitive impairment are strongly associated with delirium. Additionally, adjusted by age and comorbidity, delirium is associated with mortality in convalescence units. Response to rivastigmine in elderly patients with delirium post stroke P-849 Introduction: Delirium is a serious and distressing medical condition in which a person suffers a severe and acute decline in memory. It is often caused by infections, acute illnesses or side-effects of prescription drugs. People with dementia are highly prone to delirium. Delirium is common, but it is under-diagnosed. It is known that 20 per cent of older people in hospital have delirium. Two-thirds of hospital patients with delirium also have dementia. In these cases the delirium seems to have 'unmasked' the dementia. At Barking Havering and Redbridge Trust provide an out patient follow up clinic. Patient assessed by geriatrician and psychiatrist of old age. Methods: Retrospective study of one year carried out to confirm that delirium clinic adds the national initiative of improving early diagnosis of dementia, as delirium proven association with cognitive impairment. Results: 82 patients reviewed by geriatrician in clinic over one year were analysed, median age 82.5, male and female ratio 35:47. Main source of referrals were from community followed by post hospital discharge. In clinic most people had investigations in keeping with national standards, patient's medication assessed particularly those with anticholinergic side effects, risk factors for vascular disease also identified, formal screening test for cognitive assessment carried out .During follow up delirium resolved in 44 patients, 18 patients were newly diagnosed with dementia and 10 with mild cognitive impairment. Conclusions: Delirium is a common first presentation of an underlying dementing process, cognitive function periodically can be assessed in out-patient clinic even if delirium has resolved. Delirium clinic: an outpatient follow up clinic to unmasked dementia Introduction: Delirium is a serious and distressing medical condition in which a person suffers a severe and acute decline in memory. It is often caused by infections, acute illnesses or side-effects of prescription drugs. People with dementia are highly prone to delirium. Delirium is common, but it is under-diagnosed. It is known that 20 per cent of older people in hospital have delirium. Two-thirds of hospital patients with delirium also have dementia. In these cases the delirium seems to have 'unmasked' the dementia. At Barking Havering and Redbridge Trust provide an out patient follow up clinic. Patient assessed by geriatrician and psychiatrist of old age. Methods: Retrospective study of 1 year carried out to confirm that delirium clinic adds the national initiative of improving early diagnosis of dementia, as delirium proven association with cognitive impairment. Results: 82 patients reviewed by geriatrician in clinic over 1 year were analysed, median age 82.5, male and female ratio 35:47. Main source of referrals were from community followed by post hospital discharge. In clinic most people had investigations in keeping with national standards, patient's medication assessed particularly those with anticholinergic side effects, risk factors for vascular disease also identified, formal screening test for cognitive assessment carried out. During follow up delirium resolved in 44 patients, 18 patients were newly diagnosed with dementia and 10 with mild cognitive impairment. Conclusions: Delirium is a common first presentation of an underlying dementing process, cognitive function periodically can be assessed in out-patient clinic even if delirium has resolved. Preventing delirium in the elderly population K. Alattar 1 , V. Amin 1 , B. Vijayakumar 1 Background: Delirium is seen in 15-30% of secondary-care admissions [1] . It is associated with longer hospital stays, higher mortality and morbidity. Many causes of delirium are reversible; early recognition and correction can prevent adverse outcomes in vulnerable populations and ease cost arising from late diagnosis [2] . In 2017, the National Institute for Health and Care Excellence (NICE) [1] * published recommendations on the management of delirium, including screening of vulnerable groups. Despite this, local uptake has been poor. We investigated the feasibility of an educational intervention** as a means of improving uptake rate. Method: Patients were identified using their Emergency Department [ 75 proforma at University Hospital Lewisham. Inclusion criteria: age [ 65, admitted due to acute or worsening confusion/delirium. Exclusion criteria: incomplete notes. Adherence to the NICE guidelines prior to and following our intervention was assessed. Results: Despite some positive trends, no significant improvements were observed. Following our intervention, an increase in percentage of completed abbreviated mental test score (pre = 61%; post = 95%), mid-stream urine and imaging*** (pre = 47%; post = 59%) was observed. There was no improvement in completion of full confusion blood screen (pre = 50%; post = 35%). Overall, there was no change in percentage of patients receiving a complete confusion screen (pre = 17%; post = 17%). Discussion/conclusion: Education improved understanding of NICErecommendations for confusion screening, but alone was not successful in improving uptake. A multi-intervention approach aimed at adherence and engagement of the healthcare team may be more effective than education alone. This is imperative as the population of elderly patients increases, as will the need for elderly-focused care. Footnotes/references: *NICE is the UK's national guidance which we audited against. **Education intervention implemented involved an informative presentation followed by question and answer session. ***Imaging = chest x-ray and CT head 1. Nice.org.uk. (2017) . Delirium in adults | Guidance and guidelines | NICE. [online] https://www.nice.org.uk/guidance/qs63. Accessed 18 Jan 2018. Introduction: Delirium is reported in 30% of older patients admitted to hospital medical wards. National Institute for Health and Care Excellence guidelines recommend tailored multi-component intervention in treating delirium. We conducted a service evaluation project to assess the prevalence and progress of various behavioural symptoms of delirium after admission and outcomes at discharge and 1 year following discharge from hospital. Methods: We reviewed electronic case notes of patients coded with a diagnosis of delirium between August to December 2016. Data collected included age, sex, behavioural manifestations of delirium like agitation, aggression, hallucinations, and sleep disturbance at presentation and their progress and discharge outcomes following admission and 1 year after admission. Results: A total of 49 patients were diagnosed with delirium during the period, 27 females and 22 males. Age range was 48 to 95 years, mean 82 years. Length of stay ranged from 1 to 86 days with a mean of 21 days. The most common symptoms of delirium in hospital stay were activity disturbance seen in 45 (92%) patients, sleep disturbance in 41 (84%) patients, affect in 36 (73%) patients and paranoid/delusions in 33 (63%) patients. The behavioural symptoms worsened in 25 (51%) patients during the admission. 14 (29%) had at least one recorded fall. The outcomes at discharge were 9 (18%) deaths, 12 (24%) patients to care home and 22 (45%) patients returned to their own home. The outcomes at 1 year following discharge are 19 deaths (39%) and 18 patients living in their own home (37%). Conclusions: Sleep and activity disturbances are common behavioural symptoms observed in adults admitted with delirium to the hospital. These behavioural symptoms show a worsening following admission resulting in possible increased risk of falls. Interventions aimed at improving sleep in patients admitted with delirium should be considered at admission. Multidimensional prognostic index (MPI) predicts delirium in older patients with hip fracture who underwent surgical intervention Introduction: Hip fractures precipitate several acute adverse outcomes in elderly people, thus leading to acute adverse outcomes. The aim of this study is to evaluate whether the multidimentional prognostic index (MPI) may predict delirium in older individuals admitted to the hospital for hip fracture who underwent a surgical intervention. Methods: This was a retrospective observational cohort study on older patients, admitted to the OrthoGeriatrics Unit for hip fracture. At baseline the MPI was calculated. According to previous cut-off analyses, MPI was expressed in three grades, i.e. MPI-1 (low-risk), MPI-2 (moderate-risk) and MPI-3 (high risk of mortality) Delirium was assessed by nurses and physicians during the hospitalization by means of 4 AT test. Covariates included age, sex, baseline mobility and functional status, preoperative cognitive impairment, and post operative complications were also assessed. Results: 247 older patients (mean age 85 ± 6.9 years; Females = 208, 84,2%) who underwent surgery for a hip fracture were included. 104 subjects (41%) received a diagnosis of delirium. Patients with delirium showed higher pre-operative cognitive impairment (p = 0.0001), lower baseline functional status (p = 0.001) and were older than patients who did not experience delirium. Logistic regression analysis demonstrated a significant association between MPI grade and delirium (p = 0.04). MPI score demonstrated a significant association with delirium (p \ 0.0001). Overall, the incidence of delirium during hospitalization was significantly higher in patients with more severe MPI score. Conclusion: MPI predicts delirium in older patients with hip fractures who underwent surgical intervention. Calf circumference as a correlate of delirium in hospitalized older people: data from the Italian delirium day 2017 Background and objectives: Extended visiting time (VT) was suggested as a protective factor for delirium in intensive care units, but its role in general acute hospital is still unclear. We performed an exploratory analysis on the association between VT and delirium in a national multi-centre point prevalence study. Methods: A total of 2609 patients [ 65 years admitted to Medicine, Surgery, Geriatrics, Neurology and post-acute Rehabilitation wards during the Italian Delirium Day 2016 were included in the present analysis. Disability, history of dementia, multimorbidity (Charlson Comorbidity Index) and nutritional status were assessed. Delirium was defined with the 4-AT. Daily VT allowed in each ward was recorded. Results: Delirium was detected in 22% (N = 566) of patients. Patients with delirium were significantly older and had a higher prevalence of dementia, malnutrition, multimorbidity and disability. Daily VT was longer in wards hosting patients who experienced delirium (8.8 vs 7.7 h per day, p \ 0.001) and was overall longest in Geriatric wards (11 h). However, the association between VT and delirium was not statistically significant after adjustment for age, dementia, disability, multimorbidity and malnutrition. Conclusions: Older patients, with worse clinical and functional profile and higher prevalence of delirium, are more often admitted to wards with longer VT, often Geriatrics wards, in Italian hospitals. Whether longer VT mirrors the need to care for an already complex patient or if it can be an effective strategy to reduce incident delirium should be assessed in future longitudinal, intervention studies. Delirium, frailty, and fast-track surgery in oncogeriatrics: is there a link? Introduction: Postoperative delirium (POD) is more frequent in elderly patients undergoing major cancer surgery. The interplay between individual clinical vulnerability and a series of perioperative factors seems to play a relevant role. Surgery is the first-line treatment option for cancer, and fast-track surgery (FTS) has been documented to decrease postoperative complications. The study sought to assess, after comprehensive geriatric assessment (CGA) and frailty stratification (Rockwood 40 items index), which perioperative parameters were predictive of POD development in elderly patients undergoing FTS for colorectal cancer. Methods: A total of 107 consecutive subjects admitted for elective colorectal FTS were enrolled. All patients underwent CGA, frailly stratification, Timed up & go (TUG) test, 4AT test for delirium screening, anesthesiologists physical status classification, and Dindo-Clavien classification. Results: The incidence of POD was 12.3%. Patients' prevalent clinical phenotype was pre-frail. The multivariate analysis indicated physical performance (TUG in seconds) as the most significant predictor of POD for each second of increase. Conclusions: Only few procedure-specific studies have examined the impact of FTS for colorectal cancer on POD. This is the first study to investigate the risk factors for POD, in a vulnerable octogenarian oncogeriatric population submitted to FTS surgery and frailty stratification. Nocturnal hypoxemia and delirium in hospitalized postoperative orthogeriatric patients with hip fracture surgery Fella Tahmi 1 , Lucie Dourthe 1 , Lorraine Zerah 1,2 , Helane Vallet 1 , Alice Gioanni 1,2 , Anthony Meziere 3 , Rebecca Haddad 1 , Mohamed Doulazmi 4 , Judith Cohen-Bittan 1 , Jacques Boddaert 1,2 , Kiyoka Kinugawa 2, 4, 5 Introduction: Delirium is a common complication following hip fracture surgery (HFS) in older people. Our preliminary study of postoperative nocturnal hypoxia and intra-hospital complications including 46 patients, showed a significant association between the presence of nocturnal hypoxia and the occurrence of delirium (abstract 2017). To complete these results, the study's methodology was modified to control nocturnal oxymetry recording heterogeneity and also to collect daytime SpO 2 with the hypothesis that the post-operative nocturnal hypoxia in patients with HSF is associated with the occurrence of delirium. Methods: Patients hospitalized in orthogeriatric unit after HFS were monitored for nocturnal SpO2 with a pulse oximeter continuously up to 15 h, covering from one to three night(s). In-hospital complications were recorded in all patients, especially the occurrence of delirium with the CAM scale. Results: Interim analyzes are done on 38 additional patients included, with a mean age of 89,7 years, and a mean oxymetry recording of 601,73 min/night (10 h). The hypoxia vs non-hypoxia (time spent with SpO 2 \ 90% more than 20%) groups will be analyzed for clinical characteristics, comorbidities and medication use. We will look for statistical association between severe post-operative nocturnal hypoxemia and occurrence of delirium, and if its association is independent from daytime SpO 2 . Conclusion: The potential confirmation of an association between post-operative nocturnal hypoxemia in patients with HFS and the occurrence of delirium will lead us to reflect on a clinical trial testing the benefit of oxygen therapy in the prevention of post-operative delirium, to improve the medical care of orthogeriatric patients. Prescription and administration of haloperidol in hospital admitted patients with an geriatrical approach Pedro Marques 1 , Rita Martins 1 , Eduardo Doutel Haghighi 1 , Mariana Carvalho 1 1 Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal Introduction: The frequency of delirium in the hospital admitted patient is very high in Portugal. Haloperidol is still used as first line therapy in these patients, unfortunately often in inadequate doses and routes of administration. Objectives: To demonstrate that, when using a differentiated approach to elderly patients, that there is less need to use Haloperidol. Methods: In an internal medicine ward, 455 old patients ([ 65) were admitted from January to September 2017; to 132 of them haloperidol was prescribed; the authors compared a 4 months period where no geriatric approach (GAP) was implemented with a 4 months period where selected patients (cognitive and/or recent functional impairment and/or falls) were submitted to a GAP, regarding to haloperidol prescription and administration. Results: On the period where no GAP was implemented, from a total of 253 old patients, 71 were prescribed haloperidol whereas only 23 (from a total of 202) had haloperidol prescribed when GAP was performed. In the first group, 44 patients had haloperidol administered; in the second group, 12 patients had haloperidol administered. The patients with GAP also received lower doses and different routes (intramuscular or oral) comparing to others (mainly intravenous). Discussion: -In the group where GAP was performed, haloperidol was less prescribed, less administered, in lower doses and different routes. The authors pretend to extend both groups to a bigger period to see if the results remain consistent. This work points out the crucial need of implementing a comprehensive geriatric assessment to old patients admitted in the hospital. Association between anticholinergic load and delirium after hip fracture surgery in patients over 75 years Introduction: Delirium is common after hip fracture surgery(HFS), which could be explained by several factors, including drug utilization with anticholinergic effects. No study has evaluated the association between delirium and anticholinergic load (AL) after HFS. The objective of this study was to evaluate the association of AL measured by all existing scales with delirium in this population. Methods: All patients admitted after HFS in the Geriatric Perioperative Unit (UPOG) were included. Delirium was diagnosed by a validated tool, the Confusion Assessment Method. AL was measured based on patients' computerized prescriptions and considered all treatments received during hospitalization. AL was evaluated by several scales: Drug Burden Index(DBI-Ach), Anticholinergic Drug Scale(ADS), Anticholinergic Risk Scale(ARS), Anticholinergic Cognitive Burden Scale(ACB), Chew's scale(Chew), Anticholinergic Activity Scale(AAS), Anticholinergic Load Scale(ALS), Clinician-Rated Anticholinergic Scale(CrAS), Duran's scale(Duran) and Anticholinergic Burden Classification(ABC). Results: On the 53 patients included (mean age 86.9 ± 5.4 years; 81.1% female), there was 39.6% of delirium. The mean ± SD AL(scale) was: 0.72 ± 0.40(DBI-Ach), 1.39 ± 0.95 (ACB), 0.28 ± 1.26 (ARS), 0.55 ± 0.89 (ADS), 0.73 ± 1.30(ABC), 0.79 ± 1.12 (Chew), 1.39 ± 0.74 (Duran), 0.38 ± 0.86 (AAS), 0.72 ± 0.95 (ALS) and 1.45 ± 1.08 (CrAS). No significant association was found between AL and delirium. Key conclusions: In patients after HFS managed in UPOG, no association between delirium and AL measured by the 10 existing scales was found. These preliminary results will be verified in a cohort of 764 patients. Cognition and delirium screening in older adults admitted acutely to hospital Background: Delirium or acute confusional stare is a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course. Delirium can be associated with poorer outcomes for older patients [1] . The purpose of this study was to examine what, if any methods were used to assess cognition in older adults admitted acutely to an Irish hospital. Methods: We conducted a retrospective review of a sample of acute medical admissions in patients over 75, between 25th February 2018-16th March 18 at Cork University Hospital. The type of cognitive assessment or delirium screening tools used were recorded. Results: Among the 35 charts reviewed, 17 (49%) had some form of cognitive screening or delirium assessment documented within 24 h of admission. 11 patients (31%) were documented as ''orientated to time, place, person'', while 3 (9%) had an Abbreviated Mental Test Score (AMTS), 1 patient had a 4AT, 1 patient was documented as ''orientated'' and 1 patient was assessed using the Mini Mental State Examination. Conclusions: In our study only 49% of sampled patients had documentation of cognitive assessment within 24 h of admission. Our results suggest a need for improved documentation of cognitive status using a standardised approach to aid in identifying delirium and managing its risk factors. Background: Delirium is a common condition yet it is poorly diagnosed within the Emergency Department. The Emergency Department introduced the 4 at tool to its admission document to Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 S319 increase the rate of screening. Clinicians were prompted to screen both those who are confused and all patients over 65. Several initiatives have also been introduced to the department yet the screening rate of those over 65 remains below the target levels. Aims: This study aims to identify the reasons for the lack of screening. Methods: Surveys were conducted within the emergency department with nurses, advanced practitioners and doctors who were identified as the clinicians who should be screening. Surveys were also conducted with health care assistants and porters to establish wider opinions around delirium. Screening rates were compared with the 4 h wait target and the number of patients attending to establish if departmental pressures were a factor. Results: There is still a deficit in knowledge about delirium despite teaching on the subject. Clinicians also admitted to not screening all those over 65 due to doubts around the efficacy of screening over clinical judgement. Departmental pressures did not have a significant impact on screening rates. Conclusion: Though it is clear that the new pathway for delirium and the teaching has increased screening it is apparent that this is not enough to sustain a high screening rate. Changing attitudes of clinicians may require new approaches to teaching. Introduction: The findings of the IAGG/IAGG GARN survey on end-of-life (EOL) care in nursing homes of 18 long-term care (LTC) experts across 15 countries will be presented [1] . Although recommendations are that palliative care (PC) should be available to everyone with advanced illness, including those in nursing homes (NH), 10 of the 15 countries (67%) reported not having access for NH residents. Methods: The experts were chosen as a convenience-based sample of known LTC experts in each country. The survey had both open-ended responses for defining hospice care, PC, and EOL care, as well as a series of questions related to attitudes toward EOL care, current practices and EOL interventions, structure of care, and routine barriers. Results: Overall, experts strongly agreed that hospice and PC should be available in NHs and that both are defined by holistic, interdisciplinary approaches using measures of comfort across domains. However, experts felt that in most countries the reality fell short of ideal care, as exemplified by the lower use of emotional and spiritual support, higher rates of antipsychotics, and ongoing use of restraints as an intervention. As a result, experts called for increased training, communication, and access to specialized EOL services within the NH. Discussion: This survey further demonstrated ongoing inconsistency in access to EOL care in NHs worldwide, as well as the great variation of services in NHs in any given country, including prevalent barriers and inconsistent standards. Yet, attitudes about the importance of hospice and PC are overwhelmingly positive. Introduction: The gold standards framework (GSF) is a national protocol which helps clinicians to recognise when a patient is approaching the end of life. The primary aim is to ensure that patients receive the best care at the end of life. Aims: The aims of this closed loop audit and quality improvement project were to improve awareness of the GSF to elderly care department. Methods: This was a closed loop audit and QIP. Two cycles were performed focused on patients from care homes from elderly wards. The data source was from patients' medical notes and SystemONE. The first cycle included 27 patients and the second loop had 53 patients. Results: The results from the first loop showed that the patients who should have been on the GSF (20/27) only 5 25% of these patients were actually on GSF. The changes implements from the first cycle included; juniors teaching and posters advertised in elderly wards. The results showed that the patients who should have been on the GSF (33/53) now (11/33) 33% were on it. Conclusion: There has been an improvement in the number of patients on the GSF increased from 25% to 33%. We have successfully achieved our audit aims and the changes implemented have aided positive correlation. For further improvement we have suggested; further teaching via coloured posters are put up on the acute and elderly wards. We also suggested discussion with palliative care for further improvement and to possibly generate a popup system on SystemONE so patients are not missed. End of life program can benefit dying older patients in a geriatric step-down hospital In recent decades technological advances in treatment and clinical propaedeutic brought dysthanasia as a side effect. It raised bioethical discussions on solving dilemmas. In this context, the advance directives are a proposal to ensure legal support to patients' rights. The objective of the present study is to analyze the statements of Federal Council of Medicine in Brazil concerning this subject. A review of articles published in Bioethics Journal of the Brazilian Federal Council of Medicine and it latest resolutions in the last ten years was carried out. It were identified nine articles and three key resolutions. The nine articles deal with the perception not only of the health professional but also of the patient on this matter, besides the legal reflexions in question. The three resolutions were published in 2006, 2009 and 2012, respectively. Resolution 1.805 deals with ethical aspects and the dignity of death. Then the new Code of Medical Ethics was created. And finally, the resolution 1.995/12 regulated the living will. It was observed that, in Brazil, advance directives have normative character among the medical class. Currently, its validity is directed through the current constitutional norms, among the principles of human dignity, autonomy, and the prohibition of inhumane treatment guaranteed in the Brazilian Federal Constitution of 1988. However, there is no specific bill about this subject in National Congress and the information consulted does not demonstrate the existence of specific laws on the subject. Nurses' experiences of being confronted with tiredness of life in older persons: a qualitative study (1) definition of, (2) attitude(s) towards, and 3 ways of dealing with ToL. Methods: A qualitative interview design, based on the principles of the Grounded Theory approach (Charmaz, 2014), was adopted. Both home care nurses (self-employed or working in an organization) and nursing home nurses were purposefully recruited. Interviewers (MM and EHP) had no previous relationship with the participants. The interview guide consisted of reflective and open-ended questions. To achieve credibility and confirmability, investigator triangulation was realized. Results: A careful consideration indicative of an oscillation between three levels (e.g. behavioural, cognitive, and affective) is present. The nurse's actions created a continuum ranging from not discussing ToL to its open acknowledgment. This communicative behaviour is underpinned by a delicate deliberation on a cognitive and an emotional level, resulting in an attitude ranging from understanding to incomprehension. The cognitive component grounds the nurses' assessment of the validity of the presence of ToL. On the emotional plane, the participants stress the importance of being able to understand the patient's ToL or empathize with the ToL. Conclusions: Present study shows the challenge to establish communication about ToL in both home care and nursing homes. Our findings indicate that nurses aim to provide good care, sensitive to the older person's needs when experiencing ToL, but this process is not without ambiguity. Doctors' knowledge and attitudes regarding eating problems and enteral feeding in advanced dementia In the question about their preferences relating to insertion of a FT one hundred thirty-nine physicians (69.2%) answered that they would prefer not to agree to FT if they would suffer from advanced dementia with eating problems. Only 7% would like that their close family members reach the decision and 15.4% would agree that the medical team decide. Conclusion: In the present study there were large gaps in knowledge among physicians on the use of FTs and their consequences in patients with advanced dementia. Development of a Japanese version of the 9-item shared decisionmaking questionnaire-physician version to visualize the quality of decision-making in a primary care setting Yuko Goto 1 , Hisayuki Miura 1 , Kazuyoshi Senda 1 1 National Center for Geriatrics and Gerontology, Japan Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 S321 Introduction: In Japan, the number of elderly patients who need important medical decision-making is increasing every year. However, there is no scale to visualize the decision support in Japan. Shared Decision-Making Questionnaire-Physician Version (SDM-Q-Doc) can measure and visualize the degree of shared decision-making through a medical interview between patients and doctors. We aimed to develop a Japanese version of SDM-Q-Doc thorough Japanese translation and psychometric testing. Methods: After obtaining approval from the copyright holder, we translated and back-translated between the original and Japanese versions of SDM-Q-Doc twice with the help of Japanese doctors. Participants were adult outpatients and their treating physicians who practiced family medicine. In total, 23 physicians rated their consultations with patients (n = 142) using SDM-Q-Doc at the first visit of each patient. Reliability and construct validity [exploratory and confirmatory factor analysis (EFA and CFA, respectively)] were assessed. For convergent validity, the Physicians' Confidence in the Medical Interview measure (PCMI) was used. Results: Reliability was evaluated with internal consistency. The overall Cronbach's alpha was 0.87, and the I-T correlation was high (0.84-0.87). EFA showed a one-component model similar to the original version. CFA yielded a good index of fit for the one-factor model. The total SDM-Q-Doc scores correlated with PCMI (r = 0.53), as expected. Key conclusion: The Japanese version of SDM-Q-Doc showed adequate reliability and acceptable clinical efficacy and may help visualize decision support and increase its quality in various settings, such as homes, where elderly patients desire to receive medical care in Japan. identifying aims of advance care planning: a systematic literature review Introduction: Since the introduction of the concept of advance care planning (ACP), many studies have been conducted exploring beneficial effects. However, the endpoints of those studies vary considerably, as do the goals that are pursued with ACP in clinical practice. Whilst originally introduced as a means of preserving patients' individual autonomy once they become incapacitated, nowadays ACP is also used for improving patient-clinician communication and preparing patients and their surrogates for future healthcare decision making. Aim: To clarify which goals are pursued with ACP. Methods: Systematic literature search in PubMed, EMBASE, Psy-chInfo, CINAHL and Cochrane Library, using various search terms for 'ACP' and 'ethics'. Articles on normative aspects of ACP were included, based on title and abstract. Due to the quantity of inclusions, of which many had similar content, purposive sampling was used to select articles for full-text analysis. Analysis stopped once saturation was reached. Sensitivity analysis was performed to guarantee that unfrequently mentioned goals were found as well. Results: In total, 6497 unique articles were found of which 183 were included. Analysis of the purposive sample revealed a wide range of goals of ACP, either orientated at the patient, family, clinician or healthcare system. Group 2, n = 192) . We studied whether the resident had a living will, a do-not-resuscitate order (DNR), an order to forego parenteral antibiotics or any antimicrobial therapy, an order to withdraw an artificial hydration or nutrition (ANH), a do-not-hospitalize order (DNH) and whether the treatment orders were discussed with the resident or proxy. Comparisons between proportions were performed using Pearson's Chi square test. Results: Practically all residents had a DNR order (group 1 98.1% vs group 2 100%). Residents who died earlier were less likely to have advance directive to forego life-sustaining antibiotic therapy (38.1% vs 64.6%; p \ 0.001, withdraw ANH (40.0% vs 81.3%; p \ 0.001) and have a DNH order (28.1% vs 69.6%; p \ 0.001) compared to those who died later. Key conclusions: Residents with advanced dementia who died between 2010-2013 were significantly more likely to have advance directives limiting aggressive care than those who died earlier. Preferences for surrogate designation and decision-making process in older versus younger adults with cancer: a comparative cross-sectional study Claudia Martinez- The majority of patients want conversations to be initiated opportunistically. Yet, a running theme throughout the literature is the degree of individual and cultural differences that need to be taken into account leading to differences in a patient's preferred timing of conversations and level of shared-decision making. Conclusion: The level of shared decision-making that individuals personally want and the degree to which they would like relatives or carers to be involved should be established. Open and honest conversations should then be initiated at the earliest opportunity. However, research into an elderly, frail outpatient population is limited and this could guide future studies. Early implementation and evaluation of a charter to improve medicines management and reduce inappropriate covert administration in care homes for older people Background: Evidence in the UK suggests that residents with dysphagia in care homes for older people are more likely to experience medication errors and medicines are frequently covertly administered to residents without capacity in contravention of the Human Rights Act. Aim: To pilot a charter to improve medicines administration to care home residents and develop strategies to enhance its implementation. Aim: To pilot a charter to improve medicines administration to care home residents and develop strategies to enhance its implementation. Methods: Expert working party developed a nine-point charter for care home staff and residents (http://www.carehomecharter.org). Care homes from England, Wales and Northern Ireland were recruited to pilot charter implementation. Centrally located evening workshops introduced the charter to senior and junior care home staff. Feedback was obtained one-month post workshop via an on-line survey. Results: Twenty-two care homes attended the workshops. Eighteen respondents from 13 care homes completed the survey. Implementation was via staff bulletins, through care home meetings, provision of copies to staff and displaying in prominent locations. Sixteen (88.9%) respondents were positive regarding the charter. All believed that the charter would improve detection and reporting of dysphagia, medicines administration, improve the quality of staff training and adherence by staff to the law when covertly administering medicines. Recommendations were to incorporate the charter into staff training and to involve the mutli-disciplinary team in the process. Key conclusion: A staff-training package was developed for implementation within the home and an on-line assessment added to the website providing a certificate of commitment for those individuals who successfully completed it. Work is ongoing to assess the impact of the changes following piloting. The palliative care patient (Z51.5): in a geriatric acute care unit The main demand for palliative care comes from chronic diseases, not from oncological processes. Our patients is an octogenarian women, severe cognitive impairment and clinical deterioration, who is admitted trough an emergency service in a GACU with an infectious disease of different etiology and an unfavorable prognostic index. There is a high tendency to desprescription. This could mean an adecuacy of treatment on this kind of patients. Palliative and end-of-life care conversations in chronic obstructive pulmonary disease in Croatia Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality, estimated by 2020 to be the third cause of death worldwide. Despite the progressive nature of the disease and association of high morbidity and mortality with severe COPD, many older patients receive inadequate palliative care, not having timely end-of-life care (EOLC) discussions with healthcare professionals. Methods: The aim of this study is evaluation of the practice of Croatian Pulmonologists in EOLC communication/palliative care in older COPD patients, as such data are unknown. We looked into the reasons behind the poor communication about EOLC. The study is designed as a cross-sectional research. Two groups of examinees, COPD patients [ 65 years and healthcare professionals were interviewed through an anonymous survey. Results: Our analysis shows that in the majority of cases, there is no advance care planning, including any kind of patient-clinician communication about EOLC. Current care practices do not facilitate satisfactory conversation about palliative care in the older patients with severe COPD and healthcare professionals. Almost all patients reported that they have not had EOLC discussions with healthcare professionals, while many patients would like these conversations. Conclusions: Due to the progressive nature of the disease, EOLC discussion with the older patients suffering from advanced COPD should improve quality of life, by timely anticipating patients' likely future needs, and also providing proactive support in accordance to patients' preferences. We identified patients and clinicians attitude and obstacles towards such discussions, as well as present practice. Methods/design: Five regions, each consisting of one hospital and multiple primary care organisations, will participate in this pragmatic stepped-wedge clustered randomised controlled trial. 600 patients aged C65 years, acutely hospitalised and positive scores on vulnerability scales will participate. The intervention starts when patients are identified with palliative care needs using the Surprise Question and SPICT TM . Advance care planning and a comprehensive palliative assessment is performed by a newly-formed transitional palliative care team (TPCT). Patients are discussed in an interdisciplinary team meeting, with both primary and secondary care professionals. A personalised palliative care plan is formalised and handed over. After discharge the TCPT can be consulted and visit patients at home. The control group will receive 'care as usual'. The primary outcome is unplanned hospitalisation within 6 months after discharge. Secondary outcomes are death at the place of patient's preference, quality of life, symptom burden, caregivers' burden and health care utilisation. Furthermore, a process-evaluation and cost-effectiveness analysis will be performed. Discussion: This study will provide knowledge on the effectiveness of a transitional care pathway for older patient with palliative care needs. Survival in patients aged 70 years and older with and without cognitive disorders following PEG placement, ethical concerns and considerations Introduction: In this study we investigated survival in patients with and without cognitive disorders, who received a PEG-tube, in four different hospitals in The Netherlands. Furthermore, we conducted a literature search, exploring the ethical concerns and considerations that might play in role in the decision whether or not to insert a PEG tube in a patient with severe dementia. Results: 303 patients were included, mean age of 77.4 years. 42 patients had cognitive disorders. In analyses adjusted for age and sex, patients with cognitive disorders had a 49% increase on risk of mortality (HR 1.49, 95% CI 1.01-2.19). A statistically significant difference was found for survival after PEG placement between the groups with and without cognitive disorders, there was no statistical difference in short-term complications. Discussion: We found higher mortality rates after PEG placement in patients with cognitive disorders when compared with patients without cognitive disorders. There are several possible mechanisms to explain this difference: the incurable nature of dementia, the increase of long term complications such as pressure ulcers and the increased need to use restraints to keep the tube in place. Ethical concerns and considerations: In the studied literature, it is shown that multiple ethical concerns and considerations play a role, both medical and nonmedical, such as: beliefs regarding the benefits of a PEG tube, a lack of knowledge about the natural course of dementia in both professionals and family of patients, and a fear of letting the patient die hungry. Discussion: We found higher mortality rates after PEG placement in patients with cognitive disorders when compared with patients without cognitive disorders. There are several possible mechanisms to explain this difference: the incurable nature of dementia, the increase of long term complications such as pressure ulcers and the increased need to use restraints to keep the tube in place. Ethical concerns and considerations: In the studied literature, it is shown that multiple ethical concerns and considerations play a role, both medical and nonmedical, such as: beliefs regarding the benefits of a PEG tube, a lack of knowledge about the natural course of dementia in both professionals and family of patients, and a fear of letting the patient die hungry. Organ donation after euthanasia, morally acceptable under strict procedural safeguards Rozemarijn van Bruchem-Visser 1 , Gert van Dijk 1 , Inez de Beaufort 1 1 Erasmus Medical Center, Rotterdam, The Netherlands In this presentation, we will present a case of organ donation after active euthanasia (ODE) in The Netherlands from a patient who had his life ended at his explicit and voluntary request. The form of ODE we describe here concerns patients who are not unconscious and on life support, but who are conscious and want to have their life ended because of their hopeless and unbearable suffering, for instance due to a terminal illness such as Amyotrophic Lateral Sclerosis (ALS) or Multiple Sclerosis (MS). This form of ODE is of course only possible in jurisdictions where euthanasia is allowed. In these jurisdictions, organ donation after euthanasia is an option that may be considered. We believe ODE is worthwhile to pursue, as it can strengthen patient autonomy, can give meaning to the inevitable death of the patient, and be an extra source of much needed donor organs. To ensure voluntariness of both euthanasia and organ donation and avoid conflict of interest by physicians, ODE does need strict procedural safeguards however. The most important safeguard is a strict separation between the two procedures. The paper on whitch this abstract is based discusses several ethical issues such as who should broach the subject of organ donation and who should perform the euthanasia, and how a conflict of interest can be avoided. Ethical reflections in hospice care: a new validated tool applicable to requests for sedation and/or euthanasia by senior patients! Leners Jean-Claude 1 1 OMEGA; LTCF Introduction: The unique hospice in our country has 15 beds . The average of admissions is around 130 persons per year; mean age 76,5 years and mean length of stay 44 days. Regularly our senior patients are requesting either sedation (in a temporary or terminal way) or as well euthanasia (the national law exists since 2009). Method: In these specific situations we always meet us with the whole team (nurses, psychologists, supervisor) in order to evaluate ethical aspects of the requests. We have opted for a new standardized instrument in order to have an equal assessment. This validated tool is called: Ethical reasoning in difficult situations for Elderly. The method will be explained in details: aspects include the patient in first, the relatives, the team's view and societal aspects for equity. Results: As we meet us monthly for evaluation of difficult situations, these sessions are used for ethical debate and in urgent situations we meet within 24 h. The conclusions or consensus drawn out of this reflections are transmitted to the patient by the physician. Euthanasia requests are still rare: 15 for 2017, whereas the wish for sedation are nearly a weekly decision. Two examples will illustrate the values, the consequences and the consensus. Key conclusions: As our senior patients should have access to the highest quality of end-of-life care, we need standardized assessment methods for our ethical reflections. This tool, in use regularly in another country, allows us to take into consideration all relevant aspects concerning autonomy, beneficience and equity for difficult clinical situations and the focus is specifically put on elder patients. Electronic communication tool to support, record, share process of advance care planning (ACP) with adopting frailty evaluation axis in inter-disciplinary transitional care at the view of the patient in Japan Conclusion: ECT to share process of communication for ACP is fundamental for high-quality TC system at local communities to provide sense of secure. We promote Japanese inter-disciplinary TC with our ECT to share process of communication for ACP with frailty evaluation axis, which enables true person-centered care. The terminology of 'risk feeding': a help or hindrance? Dharinee Hansjee 1 , David G Smithard 1 1 Introduction: For individuals with advanced dementia who have swallowing impairments, the preferred option to maintain nutrition is to continue eating and drinking despite the risk of developing aspiration pneumonia [1; 2] . This choice is referred to as 'risk feeding'. Although addressing end of life care, the terminology has wider application within a diverse caseload which has led to an ongoing debate on the appropriateness of the term. Conformity in language will aid communication and understanding between professionals and individuals/family members. This study was undertaken to ascertain professionals' views on the terminology of 'risk feeding'. Methods: In October 2017, a multidisciplinary consultation regarding the term 'risk feeding' was undertaken via Survey Monkey. The survey was cascaded to speech and language therapists (SLTs), consultant geriatricians, physiotherapists, dietitians, nurses and GPs. Results: The survey yielded 367 responses, of which 91% were SLTs. 'Risk feeding 'was used as a consistent term by 39% of the participants. Of all the respondents, 43% were positive about the term whilst 29% were negative and 28% remained neutral. The results raised key factors which influenced opinion on the term 'risk feeding'. These included the service setting, the use of the word 'risk', the impact of the term on the individual and family, the ambiguity of the term. Conclusion: The survey has highlighted both enablers and barriers to the term risk feeding. Locally agreed terminology with an emphasis on a model of care to support discussions should be the way forward until national consensus is agreed. References: [1] RCP (2010) Guidelines on oral feeding difficulties and dilemmas. Available at:https://www.rcplondon.ac.uk/projects/outputs/oralfeeding-difficulties-and-dilemmas Accessed on 05/02/18]. Introduction: At the end of life, deep and continuous sedation practice require improvement in the monitoring of sedation and pain, in order to avoid the burden of unethical awake phases. Developed in anesthesiology, portable pupillometry is a nociception monitoring technique based on sympathetic and parasympathetic balance through pupil dynamic recording. It has never been used or evaluated in the palliative care complex framework near the end-of-life. We aimed to report clinical examples to provide primary evidence of the possible range of usefulness in end-of-life and palliative care practice. Methods: Case series using narrative clinical aspects and descriptive statistics. Results: We report 11 patients from a french palliative care unit. Age ranges from 22 to 97 years old. There are suffering complex health conditions and are exposed to multiple drugs to help symptom management. Light reflex might be progressively altered during sedation. Pain assessment might be possible using pupil dilatation recording during specific procedure. We observed a progressive alteration of light reflex until death. Intracerebral pathology might influence pupil size and dynamic (eg. vascular injury, septic embols for endocarditis, grade 4 glioblastoma). Instead of traditional scopolamine, butylbromure-scopolamine might not alter light reflex. Low dose infusion of ketamine might not influence pupil dynamic. Conclusion: Pupillometry seems to provide useful information about awakeness state, pain experience and pharmacological mecanism. It might be an effective technique to monitor pain and sedation in palliative care practice. However, our cases illustrate the need to properly define variability of pupil dynamic among palliative care patients in regards to complexity of physiological aspects of end-oflife, progressive organ failure and pharmacological influence. Functioning, quality of life, and end of life care of patients with huntington's disease living in long-term care facilities: the advanced HD study design Methods: This study consists of a cross-sectional, descriptive study, and a qualitative study. Results: Data of the cross-sectional study are collected from September 2017 until May 2019. We aim to include 250 HD patients living in 9 specialized LTCFs in The Netherlands. The data will be obtained using observation scales and questionnaires. Data of the qualitative study are obtained by conducting multiple in-depth interviews every 6 months for the period of 2-2.5 years with 10-15 HD patients, and one in-depth interview with elderly care physicians. Results are expected in 2021. Key conclusions: This study will provide valuable information on the functional status, quality of life and end-of-life care of HD patients living in LTCFs. Results may provide an evidence base to develop specific guidelines for care of institutionalized HD patients. The 4-dimensional model applied to palliative care in nursing home, a cost-effective example of geriatric comprehensive assessment Background: Nursing Care Homes for will become the place of death of the elderly and fragile people. According to the study by A. Bone by 2040.Our Nursing home has developed a specific protocol of Palliative Care in Patient with advanced dementia. We Integrated the 4-Dimensions Model developed by Prof. Murray a multidimensional approach divided into 4-Dimensions: (1) Physical (2) Results: In process of elaboration. Preliminary data show a significant increase in the ACP and increase of early palliative care, the care project failures were extremely rare. Equipe AUDIT following every critical case.Very low rate of Artificial Nutrition. Conclusions: Preliminary data confirm that almost all the formalized end-of-life projects were concluded in Nursing home setting. Good feedback from family members with verbal and written acknowledgments. We involved students and other visiting professionals to enhance our palliative care experience in the elderly care. Increases in agreement on opinion regarding ''good death'' between in-training physicians and older patients, trend of changes toward aging society in Thailand Manchumad Manjavong 1 , Varalak Srinonprasert 1 1 Division of Geriatric medicine, Siriraj hospital, Mahidol University, Thailand Background: In order to carry out qualitative care for older patients toward end-of-life (EOL), understanding of their wishes regarding good death is crucial. Some differences between physicians and older adults in component of good-death were apparent from previous study in Thailand. An educational programs have been implemented over few years. We explored the differences opinions between physicians and older people and the trend of change over 7-year period. Methods: We conduct a cross sectional study using 13-situationbased questionnaire which developed from literature reviews to explore perspectives on 'good-death'. Participants were older patients and physicians at a university hospital. The results were compared between 2 groups and to previous study and also compared the physicians' preferences for their EOL and what they would do for patients. Results: Three hundred fifty-two patients and 293 physicians were recruited. General concepts such as wishing to know the truth regarding prognosis, to treat suffering symptoms were important for most participants. Compared to previous study, higher proportion of physicians wished to tell all the truths about illnesses to patient (96.9% vs 88.1%, p.001) and agreed with patients regarding not to prolong suffering (83.2% vs 71.0%, p.001). When elicited opinion for their own EOL, higher proportion of physicians agree for most components in the questionnaire, particularly on not prolong suffering. Conclusions: Some difference in opinions regarding good death between patients and physicians remains. Nevertheless, the gap has been narrow over the past 7 year. Current scheme to promote knowledge regarding palliative care appears to be successful. Background: Advance chronic diseases and cancers are major causes of death among older patients. Appropriate palliative and end of life care would enhance death without suffering and reduce healthcare cost. Study that compared between cancer and non-cancer Thai patients regarding care for them are limited. Methods: A retrospective cohort of patients at least 60 years old admitted and discharged alive in 2013 was investigated. They were classified into cancer and non-cancer group, according to the study criteria. Healthcare utilization and advance directives were collected. Results were analyzed. Results: There were 306 older patients (130 of metastatic cancer and 176 of advance stage of non-cancer cases). Non-cancer patients were older and had more comorbidities than those in cancer group. Advance directives before admission were conducted in 38.6% of non-cancer and 10.5% of cancer patients (p.001). The median length of hospitalization of non-cancer group and the other group were 11 and 7 days, respectively (p \ 0.001). In non-cancer patients, rate of invasive procedures such as endotracheal intubation were higher (p \ 0.001). Health care cost (USD/patient/year) were 6790 and 3900 in non-cancer and cancer, respectively, p \ 0.001). Time interval to dead from last discharge date in 2013 was significantly longer in the non-cancer group (476.9 VS 180.3 days, p \ 0.001). Conclusion: In non-cancer group, health care utilization was higher than the other one. Palliative and end of life care should be considered in routine practice for caring of older patients with advance stage of illnesses, for the benefits of peaceful death and reduction in healthcare utilization. Keywords: palliative care, advance care planning, end of life care, cancer and non-cancer, older patients The 4-dimensional model applied to palliative care in nursing home, a cost-effective example of geriatric comprehensive assessment Background: Many elderly patients present to the emergency department (ED) complaining of deliberate self-poisoning (DSP). The aim of this study was to determine some characteristics of elderly patients who committed DSP. Methods: A retrospective review was performed on 1329 patients ([ 15 years) who were treated with poisoning in two EDs between January 2010 and December 2016. Of these patients, we classified into two groups depending on age (elderly group C 65, adult group). Information regarding age, gender, cause, time of ingestion, type of drug, history of attempting suicide, and outcome, among other characteristics, was collected. Results: The 242 (18.2%) patients were included in elderly group. The 211(86.9%) patients in the elderly group were first suicide attempt (p \ 0.001). 186(77.2%) patients of elderly group visited in ED by 119 EMS Ambulances (p \ 0.001). Regarding GCS \ 13 in visiting of ED, 95(39.7%) of elderly group and 211(19.6%) of adult group showed (p \ 0.001). In elderly group, admission to the ICU (43.8% vs 25.5%) and endotracheal intubation (16.1% vs 4.9%) was found more frequently than adult group (p \ 0.001). The distribution of poisoning severity score showed more poor outcomes (score [3] [4] in elderly (p \ 0.001). There were no differences in past psychiatric history between elderly and adult patients. Conclusion: In elderly poisoning patients who visited in ED, first suicide attempt was found more frequently. Decreased mental status and poor outcome is a more common in elderly poisoning patients. Emergency physicians should be consider poor progression of elderly poisoning patients in ED. Relationship between sleep duration and coronary heart disease in older adults Background and aim: Insomnia, a frequent geriatric syndrome, is thought to be linked with coronary artery disease and increased mortality. The aim of our study was to examine the relationship between sleep duration and coronary heart disease (CHD) and cardiovascular risk factors. Patients and method: In this study, patients who applied to geriatric medicine outpatient clinic for comprehensive geriatric assessment were retrospectively studied. Optimal sleep duration was assumed to be 6 h and patients were divided into two groups; sleeping under 6 h and sleeping 6 h or more. Results: Total number of 2255 patients (age 72 ± 6 years, 63.3% female) were included in this study. Patients who were sleeping less than 6 h were older (14.4% vs. 10.3%; p = 0.005) and female sex was higher (69.5% vs. 60.2%; p).The frequency of CHD (31.9% vs. 25.9%; p = 0.003), falls (31.8% vs. 25.3%; p = 0.002), and depression (25.7% vs. 21.3%; p = 0.022) were higher, hypertension (68.5% vs. 72.5%; p = 0.049) was lower in the short sleep duration group. In the regression analysis, independent from other parameters, CHD (OR: 1.39; 95% CI: 1.14-1.7; p = 0.001), age (OR: 1.02; 95% CI: 1.01-1.04; p = 0.001), male gender (OR: 0.63; 95% CI: 0.51-0.76; p.001), hypertension (OR: 0.74; %95 CI: 0.6-0.9; p = 0.003), and falls history (OR: 1.25; 95% CI: 1.02-1.5; p = 0.026) were found to be associated with short sleep duration. Conclusion: Similar to the literature in our study, CHD was frequently observed in patients who had less than 6 h of sleep. Considering this relationship between short sleep duration and CHD, it is important to question sleep duration in comprehensive geriatric assessment. Cross-sectional observational study of prevalence and factors associated with depression in patients admitted to a convalescence unit Eva Martinez Suarez 1 , Elisabet Palomeras Fanegas 1 , Jose Antonio Martos Gutierrez 1 , Ramon Cristofol Allue 1 1 Introduction: Depression is frequent psychiatric disorder and leads to serious consequences [1] . They could developed in previous stages and persist or develop late. It's associated with comorbidities, functional deterioration, use of healthcare resources and increased mortality [2, 3] . Depression in the geriatric patient is underdiagnosed and treated incorrectly [5, 6, 7] . Methods: Cross-sectional observational study took place in Hospital Sant Jaume (Barcelona), patients recruited from February-2017 until February-2018. Patients included were attended in the convalescent service who have signed informed consent. Patients excluded were: not accept assessment, not understand test questions, have dementia, Mini-mental state examination (MMSE)\24 points. Results: 100 patients were analyzed, 62 women and 38 men, between 58-99 years (y) and an average age of 78.60y(?/-10.95).Origin of the patients 47% of community(alone),47% community(living with relative),3% community(living with family worker) and 3% institutionalized. Diagnosis: 45% functional deterioration in relation to new diagnosis, 7% of which to acute cerebrovascular accident; 25% femur fracture; 16% exacerbation of chronic disease; 6% acute arterial ischemia with amputation; 4% due to ulcer healing; 1% due to insufficient social support. The prevalence of depression according to the clinical history was 31%. When screening: two question screener positive 82%, Yesavage scale positive 57%. Diagnosis with Hamilton scale it positive 61%. Use of psychotropic drugs present in 44% patients: 31% 1 drug, 19% 2 drugs, 3% 3 drugs and 1% 4 drugs. Type of psychotropic drugs used 31% antidepressants, 28% benzodiazepines, 6% antipsychotics, 7% antiepileptic. Key conclusions: Elderly patients have high prevalence of depression detected at screening or diagnostic and more frequently associated with greater social risk. Introduction: Sleep is a normal, transient, periodic and psychophysiological status that is caused by the decline in nervous sensation and voluntary muscle movements of organic activities. Sleep problems are highly prevalent in those over the age of 65, with up to 50-70% in some studies. In elderly population sleep disorders have been related with poor quality of health, falls, inappropriate medication use and higher rates of morbidity and mortality. In our study, we aimed to evaluate the frequency of sleep problems and their relationship between the possible factors in our outpatient clinic. Material and method: A retrospective review of medical reports of 295 patients, admitted (November 2013-November 2016) was conducted and the relationen sleep problems and age, gender, falls, fraility, restless leg syndrome (RLS) were evaluated. Results: 295 geriatric patients were included in the study. 66% (n = 196) of the patients was female and, remaining 34% (n = 99) male. Mean age was 75.6 ± 6.8. Prevalence of sleep problems was 47.8%. In bivariate analysis, the relation between insomina and age, polypharmacy, RLS was significant. There was no statistically significant difference between both genders. In regression analysis, the association between sleep problems and age, polypharmacy and RLS was found independent. Conclusions: Sleep disorders in elderly is a major health problem affecting quality of life negatively and should be questioned during polyclinic visits. It should be kept in mind that the sleep problems may be related with important geriatric syndromes as polypharmacy. Depression In later life is associated with blood pressure dependent frontal lobe hypoperfusion. Data from TILDA Robert Briggs 1 , Daniel Carey 1 , Sean Kennelly 1 , Rose Anne Kenny 1 1 The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland Background: Frontal lobe white matter disease has been implicated in late life depression (LLD) and hypoperfusion has been suggested as a potential mechanism for this. The aim of this study is to examine the association between depression and frontal lobe perfusion during orthostasis in a large cohort of community-dwelling older people. Methods: Over 2500 participants aged C50 years were included and underwent measurement of orthostatic blood pressure (BP) by finometry and frontal lobe perfusion by near-infrared spectroscopy (NIRS). Depression was assessed by the 8-item CES-D. Real-time frontal lobe cerebral oxygenation was measured by the Portalite System, detecting changes in frontal lobe perfusion and reporting a % Tissue Saturation Index (TSI). Results: Almost 8% (209/2616) met criteria for depression. Multilevel models demonstrated significantly lower TSI in participants with depression compared to the non-depressed group at both 60 and 90 s post-stand with coefficients of -0.43 (95% CI -0.63 to -0.22) and -0.37 (95% CI -0.57 to -0.16) respectively. Controlling for covariates, such as cardiovascular disease, stroke, antidepressant/antihypertensive use, did not significantly attenuate these associations. After addition of systolic BP this association was no longer significant however, suggesting lower BP may modify this relationship. Conclusion: This study demonstrates that depression is associated with lower frontal lobe perfusion after standing in a cohort of community-dwelling older people and that this association is BP dependent. This finding is important because, given the established longitudinal association between hypotension and incident LLD, cerebral hypoperfusion may represent an underlying mechanism for a causative relationship and therefore a potential therapeutic target. How does knowledge in diagnosis and management of insomnia differ between an acute medical hospital and a mental health hospital? Introduction: Insomnia is a common complaint, particularly amongst elderly inpatients. It causes a significant negative impact on quality of life and daily functioning. Despite this, it is often poorly managed. The inappropriate first line prescription of sedating medication leads to adverse secondary consequences. To manage patients with insomnia effectively, it is key that healthcare professionals across all specialities have knowledge and understanding of insomnia diagnosis and management. Method: We surveyed staff on their knowledge in diagnosis and management of insomnia within an acute medical hospital (AMH) and a mental health hospital (MHH). The wards included: Geriatrics, Stroke, Diabetes, Orthopaedics, Elderly Frailty Unit within Emergency Department, Old Age and Adult Mental Health. The results between the two hospitals were compared. Results: 72 Questionnaires in total (39 at the AMH and 33 at the MHH). 93% had not received any training in insomnia. All the staff lacked knowledge in diagnosis and pharmacological management. 85% of the staff at the MHH were aware that non-pharmacological measures (for instance lifestyle and diet) are the first line management versus 54% at the AMH. Key conclusions: There is insufficient knowledge across both hospitals in diagnosis and pharmacological management. The increased knowledge of non-pharmacological management aspects within the MHH can be explained by increased awareness and emphasis of insomnia management as a factor in mental wellbeing and the part it plays in psychiatric illnesses. The overall gap in knowledge highlights the need for education and guidelines on insomnia to deliver the best appropriate care for our patients. Psychogenic falls in an elderly patient Atef Michael 1 , George Tadros 2 1 Russells Hall Hospital, Dudley, UK, 2 Birmingham Heartlands Hospital, UK An 86 years male attended the falls clinic with recurrent falls for more than 15 years and many ''stumbles''. Past medical history included hypertension, permanent pacemaker, Meniere's disease and anxiety. He was on Amlodipine, Citalopram and Betahistine. He was mobile with a stick and independent for ADLs.The nurse during preparation commented that while taking his observations he fell ''strangely''. Heart, chest, abdominal and full neurological exam was normal. After the consultation he stood and collapsed slowly in the chair, then he stood again steadily, walked outside the room without support. Approaching a chair he staggered, walked a step backwards and supported himself onto the wall until help came. Haematological and biochemical profile was normal. ECG showed paced rhythm and tilt table test revealed normal response. He had physiotherapy for 12 weeks. The therapist observed that he had an exaggerated response when balancing. For the subsequent 8 months he continued to fall three to four times daily but mostly managed to land safely on a near seat or against a wall. In the follow up clinics he displayed the same findings on standing and walking. His mild vestibular hypofunction did not explain the severity and extent of his symptomology. The pattern of falls, the frequency and duration without soft tissue or bone injury, with lack of signs or investigation result that can explain the falls supported a ''psychogenic ''cause. This was sensitively discussed with the patient but initially he resisted the concept. After reflection, 4 month later, he accepted the diagnosis. He was referred to and had eighteen sessions with a psychologist. When reviewed 10 months later he was definite that the frequency of falls had become less since the intervention. He had no falls during the next 15 months; but continued to stagger. In the clinics he was still observed to have staggering following standing or starting to walk, and if not supported he would adjust himself immediately or support himself against a wall. In one of the clinics he staggered on standing, a nurse ran to help him. His partner commented '' the less people there are the more steady he will be''. Then the patient started to fall again. Over the subsequent 3 years he was admitted seven times for a total of 63 days; with several investigations, courses of physiotherapy and addition of medications. When he was 92 years, he fell and fractured his neck of femur. It was difficult to diagnose the cause of his recurrent falls. Fear of falling is a well-known disabling consequence of falling. In our case there was another psychogenic element as well. The patient's falls were most likely due to conversion disorder; a functional neurological disorder. The patient was unlikely to be malingerer or factitious. The case demonstrated a rare cause for falls in older people; a conversion disorder. It showed how a psychogenic cause of falls could be difficult to diagnose, resistant to treat, protracted and costly with a serious devastating outcome. It is essential to consider and address the psychological element. Fear of falling and activity avoidance is associated with life space in geriatric patients with cognitive impairment Klaus Hauer 1 , Phoebe Ulrich 1 , Martin Bongartz 1 , Tobias Eckert 1 1 Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, Heidelberg, Germany Background: Analysis of fear of falling (FOF)-related determinants for life space (LS) in vulnerable, multi-morbid patients with cognitive impairment (CI) and acute motor impairment following discharge from geriatric rehabilitation are lacking. Objective: To identify association between LS and fall-related selfefficacy, activity avoidance and LS. Objective: To identify association between LS and fall-related selfefficacy, activity avoidance and LS. Methods: All relevant parameters were assessed by established validated methods: Fall-related self-efficacy (Falls Efficacy Scale-International, FES-I), activity avoidance (Fear of Falling Avoidance Behavior Questionnaire, FFABQ) and LS (Life-space Assessment in Persons with Cognitive Impairment, LSA-CI), while associations were analyzed by Spearman correlation in 117 home-dwelling patients with CI following discharge from geriatric rehabilitation. Results: FES-I and FFABQ were significantly associated (all p \ 0.01) with LSA-CI total-score (FES-I: (rho): -0.024, FFABQ:-.38) but also with LSA sub-scores documenting impact of personal as well as technical support: (FES-I: LSA-CI-I: -0.25; FFABQ: LSA-CI-E: -0.35; LSA-CI-I: -0.44). Conclusion: Fall related self-efficacy as well as fall-related activity avoidance was significantly associated with LS in a vulnerable, high risk group for FOF and activity restriction, highly relevant for quality of life in old age. Depressive symptom profiles and survival in older patients with cancer: latent class analysis of the ELCAPA cohort study Canouï-Poitrine Florence 1 , Gouraud Clément 2 , Martinez-Tapia Claudia 3 , Segaux Lauriane 2 , Reinald Nicoleta 2 , Hoertel Nicolas 4 , Gisselbrecht Mathilde 4 , Mercadier Elise 4 , Boudou-Rouquette Pascaline 5 , Chahwakilian Anne 5 , Bastuji-G 1 Hôpital Henri-Mondor, 2 APHP-Hôpital Henri-Mondor, 3 Université Paris Est Creteil, 4 APHP-HEGP, 5 APHP-Cochin, 6 APHP-Henri-Mondor, 7 Introduction: The objective was to identify depressive symptoms profiles in older patients with cancer, describe the associated factors and assess the prognostic value of the profiles regarding survival. Methods: Patients C 70 years old referred to geriatric oncology clinics were prospectively included. Depressive symptoms were used as indicators in a latent class analysis. Multinomial multivariable logistic regression and Cox models examined the association of each class with baseline characteristics and mortality. Results: For the 847 complete-case patients included (median age 79 years; women, 47.9%), we identified 5 depressive-symptom classes: ''somatic only'' (38.8%), ''pauci-symptomatic'' (26.4%), ''severe depression'' (20%), ''mild depression'' (11.8%) and ''demoralization'' (3%). Compared to the ''pauci-symptomatic'' class, the ''somatic only'' and ''severe depression'' classes were characterized by more frequent comorbidities with poorer functional status and higher levels of inflammation. ''Severe'' and ''mild'' depression also featured poorer nutritional status, more medications and more frequent falls. ''Severe depression'' was associated with poor social support, inpatient status and increased risk of mortality at 1 year (adjusted hazard ratio 1.62, 95% confidence interval 1.06-2.48) and 3 years (1.49; 1.06-2.10). Conclusions: A data-driven approach based on depressive symptoms identified 5 different depressive symptom profiles, including demoralization, in older patients with cancer. Major depression was independently and substantially associated with poor survival. ''I knew they were not there'', a case of Charles Bonnet syndrome This case report describes a case of Charles Bonnet syndrome. A 71-year-old gentleman who is a known case of Parkinson's disease, diabetes mellitus and depression was admitted to a long-term facility as his son could not keep up with his increasing need of care due to his deteriorating mobility. His main complaints were decreased mobility and nocturnal hallucinations for which he was recently started on olanzapine after a psychiatric review. History revealed full insight with hallucinations consisting of small animals and children playing which the patient did not believe to be true . They only happened at night in poor lighting. Examination revealed rigidity with resting tremor and difficulty mobilising. Both MMSE and Addenbrooke's cognitive assessment were done and failed to indicate any significant cognitive impairment. Formal ophthalmology review was done in view of longstanding diabetes which revealed background diabetic retinopathy in both eyes. Olanzapine was tailed down as diagnosis of psychosis was reconsidered and rigidity improved with no further instances of hallucinations experienced during his stay at the admission ward. The patient continued to improve in terms of mobility and independence as olanzapine was eventually stopped. At this point, several diagnoses were entertained including worsening of parkinsonian symptoms due to antipsychotic use in addition to release hallucinations. A formal psychiatric review was done which revealed a probable mixed aetiology for the hallucinations including Charles Bonnet syndrome, hypnopompic hallucinations and organic hallucinations. It was advised by the psychiatrist to keep off olanzapine and consider stopping nortriptyline. Patient was reassured.Patient continued to improve and eventually started walking independently, playing cards and fully independent in basic ADLs. Profile of depressive symptoms in community dwelling older adults in Poland Introduction: Mood and anxiety disorders are major psychological health disturbances in older individuals. Profile of depressive symptoms in older age is multidementional, may be less specific than in younger generations, and usually is complicated by multimorbidity. The aim of the study was to analyze profile of depressive symptoms in relation to their severity in community dwelling older adults, participants of the PolSenior project -the largest cross-sectional study of the aging population conducted between 2007 and 2011 in Poland. Materials and methods: The study group consisted of 4001 people aged C 65 years. Depressive symptoms were assessed with the 15-Item Geriatric Depression Scale (GDS-15) administered by trained nurses. Individuals with moderate or severe dementia were excluded on the basis of Mini-Mental State Examination Test. Results: No depression (GDS score \5) was diagnosed in 69.6%, moderate depressive symptoms (GDS score 6-10) in 25% and severe depressive symptoms (GDS score [ 10) in 5.4%. Depressive symptoms were more prevalent in women than men (36.9% vs 25.1%), and augmented with age. The least specific symptoms for depression were decline of activities, anxiety and preference to stay home, while the most specific symptoms for severe depression was: ''Do you think it is wonderful to be alive now?''. Conclusions: The profile of depressive symptoms may indicate severity of depression and may be useful in the assessment of older adults living in the community. Area: Urology and continence management P-904 Antibiotic prescribing and non-prescribing in nursing home residents with signs and symptoms ascribed to urinary tract infection (ANNA) Jeanine Rutten 1 , Laura van Buul 1 , Martin Smalbrugge 1 , Suzanne Geerlings 2 , Debby Gerritsen 3 , Stephanie Natsch 3 , Ruth Veenhuizen 1 , Hans van der Wouden 1 , Cees Hertogh 1 , Philip Sloane 4 1 VUmc, 2 AMC, 3 Radboudumc, 4 UNC Introduction: lmost 60% of antibiotic (AB) prescriptions in Dutch nursing homes (NHs) are for treatment of suspected urinary tract infections (UTI). A third of these AB prescriptions for UTI are not (yet) required. Inadequate AB use is associated with an increased risk of exposure to side-effects and drug interactions and plays an important role in the development of AB resistance. Recently, a UTI treatment decision tool for frail elderly was developed with the aim to reduce inadequate AB prescriptions in nursing NHs. Objectives: (1) to evaluate whether the use of the UTI treatment decision tool results in an increase in appropriate AB prescriptions for NH residents with suspected UTI (2) to investigate the degree, quality, facilitators and barriers of the use and implementation of the UTI treatment decision tool (process evaluation) Methods: Study design: 18-month pretest-posttest cluster randomized controlled trial (cRCT) with NHs as the unit of randomization Setting: 16 NHs in The Netherlands. Study population: NH residents with a new diagnosis 'suspected UTI'. Exclusion criteria: -Recent antibiotic use (past 7 days) for a different type of infection;-A treatment policy indicating that the resident wishes not to be treated with AB in case of a UTIIntervention: UTI treatment decision toolControl: care as usual Main outcomes: (1) Inadequate AB prescribing for suspected UTI at index consultation (yes/no). (2) Facilitators and barriers for implementing and using the UTI treatment decision tool. Results/conclusions: Expected in 2020. Constipation affects 14% of the global population. Older people are prone to constipation due to poor fluid intake, immobility, over use of laxatives and medication. Constipation may present as delirium, anorexia, food refusal, vomiting, faecal incontinence and urinary retention. The usual management is to prescribe oral laxatives, suppositories or enemas. Guidelines are available for the management of chronic constipation, but there appears to be little advice/ guidance on management in the acute setting. Methods: The medical records of 81 people admitted to an acute frailty ward were reviewed. Information regarding prescribing of laxatives (prior to admission or on admission), whether there was a duration of prescription documented, diagnosis of constipation (rectal examination or abdominal radiograph) and type of stool at the time for review. Results: 34 were male and 47 female; median age 87 years (50-95 years). On admission, 19 were taking previously prescribed laxatives. 66 were prescribed laxatives at the time of admission, 60/66 (90.9%) did not have an abdominal X-ray and 61/66 (92.4%) did not have a rectal examination (v 2 = 14.07, p \ 0.01). There was no difference between age, nor stool Bristol stool type and laxative prescription. Only 7 (10.6%) had a review date for the prescription documented. Conclusions: The management of constipation is a common clinical problem. This study has found that prescription of laxative medication is often undertaken with no documented indication nor duration of treatment. Prescription of laxatives is not without potential consequences (e.g. electrolyte imbalance, dehydration) and prescription should be time limited and indication documented. Tabish Zaidi, Syed P-3 Tadros, George P-899 Tagliaferri, Sara P-183, P-218, P-805, P-811, P-819 Taglini, Alessandra P-885, P-888 Taha, Hind P-381, P-383 Tahmi, Fella P-857 Taipale, Heidi O-112, P-29, P-74, P-604, P-611, P-612, P-642, P-665 Tait, Z. Fulden P-344 Takada, Shuko P-206 Takahashi, Kyo P-159 Takahashi, Paul P-113 Takahashi, Takami, Youichi P-675 Takanashi, Sanae P-881 Takasou, Marin P-889 Takeda, Shuko P-675 Takeya, Miyuki P-206 Takeya, Yasushi P-206, P-675 Takx Richard, RAP P-402 Talme, Toomas P-345 Tamburini, Paola P-816 Tamulaitiene, Marija P-224, P-337, P-339 Eur Geriatr Med (2018) 9 (Suppl 1):S1-S367 Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective Oral and perioral herpes simplex virus type 1 (HSV-1) infection: Review of its management Epidemiology of multiple herpes viremia in previously immunocompetent patients with septic shock Herpes Simplex virus type 1 infection: overview on relevant clinico-pathological features Preventing cognitive decline in healthy older adults Consequences of age-related cognitive declines Mechanisms of age-related cognitive change and targets for intervention: social interactions and stress Leisure time activities and cognitive functioning in middle European population-based study Intake of DHA in groups accordingly was 325 mg (SD 437), 1172 mg (1307), 3231 mg (2337) p \ 0.001 and EPA 868 mg (2905), 2716 mg (5246), 5956 mg (5712) p \ 0.001. TMT B times in groups I, II and III were 100.9 (47.8), 96.1 (45.2), 82.8 (32.1), (p = 0.062) when adjusted for age, gender and education years. Conclusions: There was positive association in fish consumption and cognition among healthy older adults with overall good quality of diet. Background: Infections due to extraintestinal pathogenic Escherichia coli (ExPEC) result in many hospitalizations and deaths 000 associated deaths in the EU. Key conclusion: IED is associated with considerable morbidity and mortality Preventive measures are sorely needed Antibiotic Use and Resistance in Long Term Care Facilities Variability in Antibiotic Use Across Nursing Homes and the Risk of Antibiotic-Related Adverse Outcomes for Individual Residents Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial Variable: VIDA questionnaire, with 10 items (AIVD) and a Likert scale, and a maximum of 38 points. Result event: functional decline in BADL (Barthel \ 60), institutionalization, or death. Analysis. ROC curve and cut-off point with better sensitivity/specificity. Using IBM SPSS 23 software. Results: Considering the 185 patients, 57 (30.8%) had the result event (32 died, 19 had functional decline, 6 institutionalized). Median of the questionnaire 27 (IQR 19.5-33) in those with event vs. 34 (30-36) patients without it (p \ 0.001).AUC 0.76, B 29 being the best cut-off point (sensitivity 61 Sup 1):S32-S156 Introduction: Despite the beneficial impact of comprehensive geriatric assessment (CGA) for older patients in the hospital, it is not clear to what extent these models have been implemented in European hospitals. Methods: A cross-sectional survey study was conducted in autumn 2017 to map the implementation status of CGA-based care models in general hospitals in Belgium (n = 69 Multidisciplinary geriatric consultation teams are widely implemented in Belgium (100%), Ireland (72.7%) and Denmark (59.1%), but are rare in Malta, Iceland, Estonia and Greece. Geriatric co-management teams are most often implemented in Malta (100%), Denmark (63.6%) and Belgium (40.6%). Transitional care programs to ensure continuity of care after discharge are present in 59.8% of all hospitals. The intention to implement any of the care models in the next 5 years ranges from 10.3% to 25.2% and is the highest for co-management (36.2%), systematic screening of ED patients (35.9%) and transitional care programs (29.2%). Conclusion: CGA-based care models are widely Sara Gabriele 1 , Carlos Labat 2 , Marina Kotsani 2 , Sylvie Gautier 2 , Francesco Fantin 1 Sitting hypotension (SitHypo) or hypertension (SitHyper) were defined respectively as a decrease or increase of C 20 mmHg in systolic BP (SBP) from supine to the sitting position. A similar classification was used for defining orthostatic hypotension (OrthHypo) or hypertension (OrthHyper) i.e. differences in SBP between sitting and upright position of C 20 mmHg. Results: Among these patients, 27.1% showed significant changes between supine and sitting positions. The prevalence of SitHypo was 17.8% and of SitHyper 9.3%. SitHyper increases proportionally to the frailty status: 0, 9.4 and 16.9% respectively (age-and sex-adjusted values; p \ 0.02). The frailty status did not influence the SitHypo. OrthHypo was more frequent than OrthHyper (19.6 and 2.8% respectively) and was more prevalent in frail patients. Conclusions: In older adults, especially those with pronounced frailty, sitting and supine SBP present major differences Methods: The study included 622 (431 women) consecutive older people, aged 81.7 ± 7.8 years, who were hospitalized in the acute care Geriatric University Clinic, Central Veterans' Hospital in Lodz (Poland), and had complete data with all the assessment tools. Results: The mean NRS score for this group was 1.6±1.2, 85% had A (well-nourished) category of SGA Bringing a multidimensional approach to geriatric patients in different clinical settings: essential consonances of the multidimensional prognostic index Frailty Area, Galliera Hospital sensorial impairment (p.0001), incontinence (p.0001), type 2 diabetes (p = 0.001), hospitalization and falls in the last 12 months (p \ 0.0001), years of education (p = 0.027) and level of educational requirements (p = 0.001) as well as GC (p \ 0.0001). Conclusions: The CGA-based MPI values are highly significantly associated with healthcare indicators including GC, LHS and discharge destination independent of the medical settings 9% at admission and dropped to 11.3% at the follow-up. In-bed, seated and stand-up specific exercises were performed in 98.7% of patients during hospitalization and maintained after discharge. Conclusions: Few HF patients in the community have a previous anti-osteoporotic treatment. The treatment in a G-FLS include not only the adjustment of anti-osteoporotic drugs but also nutritional support and the performance of specific exercises Geriatric Fracture Liaison Service (G-FLS) after a fragility hip fracture D. Moral-Cuesta 1,2 , P. Matovelle 1 , T. Alarcón 1,2 , R. Menéndez-Colino 1,2 , A. Gutiérrez Misis 2,3 , I. Martín-Maestre 1 Instituto de Investigacioen del Hospital La Paz IdiPAZ The aims of the study were to evaluate the concordance between different SMIs and DXA in identification of sarcopenia and to examine the relationship between different sarcopenia criteria, in frail, community-dwelling older individuals. Methods: DXA was the reference method [5] used to extrapolate appendicular lean mass (ALMcrude and ALM/BMI) and to identify sarcopenic subjects 2. SMI kg/m 2 = SMM/body height and cut-offs ), respectively. Key conclusions: Our data showed good concordance between BIA (SMI) and DXA in muscle mass estimate of community-dwelling older individuals. Sensitivity and specificity varied along with different SMIs, indicating Janssen (2004), supported by EWGSOP, as the best estimate of sarcopenia at least in European population Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women Prevalence of sarcopenia estimated using a bioelectrical impedance analysis prediction equation in community-dwelling elderly people in Taiwan The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates Suheyla Coteli 1 , Olgun Deniz 1 , Rana Tuna Dogrul 1 , Cagatay Cavusoglu 1 , Ali Oncul 1 The Wong-Baker FACES Pain Rating Scale (WBS) and Visual Analog Scale for Pain(VAS Pain) were used for the evaluation of pain intensity. Assessment of quality of life was performed by using the three-level version of the EuroQol-5 Dimension (EQ-5D-3L) and the Nottingham Health Profile (NHP) questionnaires. Results: The median age of the patients was 71(min-max: 65-87) years and 56.5% of the patients was female. Chronic pain was observed in 63% of the patients. Katz Activities of Daily Living, Mini Mental State Examination, the Geriatric Depression scale-short form (GDS-SF), EQ-5D-3L and NHP scores in patients with chronic pain were worse than those without(p \ 0.05 for all parameters) Relationship between common geriatric syndromes and inappropriate medication use among older adults Pinar Kucukdagli 1 , Gulistan Bahat 1 , Ilker Bay 2 , Ozlem Yilmaz 1 , Meryem Merve Oren 3 , Cihan Kilic 1 Methods: Older patients(aged C 65 years) admitted to the outpatient clinic of a university hospital were retrospectively evaluated for PIM with Beers 2012. Age, sex, chronic diseases and number of drugs; functional, cognitive and nutritional statuses, presence of chronic pain, depression, falls, constipation, polypharmacy, urinary and fecal incontinence were studied with regression analysis as possible factors related to PIM. Results: The study included 667 participants (63.1% women, mean age 77.6 ± 6.3 years). The mean number of drugs was 6.1 ± 3.4. PIM prevalence was 33.3% detected by Beers 2012 criteria. There was no statistically significant difference in terms of sex Association between the impaired nutritional status and frailty in acute hospitalised elderly patients MNA-SF was used to assess malnutrition (\ 7 points) and patients at risk of malnutrition (8 to 11 points). By using FRIED, subjects were classified as frail, pre-frail or robust. A factor analysis was applied to identify overlaps between the MNA Ò -SF and Fried items. Internal consistency of different dimensions was assessed by using Chi square test and logistic regression. Results: Of the total sample 21.4% were malnourished, whereas the 49% were at risk of malnutrition. In regard to frailty assessment, 74.12% and 25.87% of the total sample were found to be frail and prefrail, respectively. Among patients at risk of malnutrition 79.6% were frail and the 20 Geriatric assessment in decision-making process in older patients with breast cancer: the ELCAPA cohort study Centre Hospitalier Intercommunal Créteil, 8 Institut Curie, France Introduction: Our objective was to assess the change of cancer treatment plan after geriatric assessment in older patient with breast cancer and factors associated Female sex, AF and NYHA were associated to frailty: p(0.001),p(0.003) and p(0.01). 8.2% had malnutrition, 25.6% depression, 98% were independent by Katz scale, mean Lawton scale was 6 ± 1.45 points, mean Montreal Cognitive Assessment (MOCA) 20.4 ± 4.47. The 56.53% of patients have undergone surgery. 30-day mortality is 5.7%. ESII p(0.003), vitamin D p(0.03), serum albumin p(0.04), tricuspid valve replacement p(0.000), Fried p(0.03) and extracorporeal circulation time p(0.04) were mortality predictors. 50% of the frail patients who underwent surgery showed an improvement in their frailty status at follow-up Time to surgery and multidimensional prognostic index (MPI) in older patients with hip fracture C. Musacchio Comorbidity (CIRS), drugs and cohabitation and were divided in MPI class. The mean waiting time to surgery was 3 days. We adopted linear regression analysis using time to surgery (log-transformed) as dependent variable and MPI as predictor, adjusting for age, gender, delirium, anemia and infections. Results: 247 hospitalized patients were recruited (mean age 85 ± 6.9 years, females = 84%) and classified according to the MPI at admission: MPI-2 (moderate risk of mortality) = 103 patients (42%) and MPI-3 (severe risk of mortality) = 144 patients (58%). A 20% (95% CI: 1.0-1.44) longer waiting time to surgery was detected in patients with severe MPI 3 vs Conclusion: This study suggests that MPI is an independent and significant predictor of the waiting time to surgery in older patients with hip fracture Baerum Hospital, Vestre Viken Hospital Trust Methods: On World Delirium Awareness Day March 14th 2018, all patients aged C 75 years admitted to the Emergency Departments of ten Norwegian Hospitals between 8.00 a.m. and 10.00 p.m. were screened for delirium with 4AT by geriatricians. Delirium Motor Subtype was assessed using the Delirium Motor Subtype Scale. Age, sex and hospital department affiliation were registered. Informed written consents were obtained from the patients or close relatives. Results: In total, 140 patients aged C 75 years (mean age 85.5 years, 54% women) were admitted during the study period, and 118 (84%) of these were included. Delirium was diagnosed in 16 (14%) of the patients. In addition, 37 patients (31%) had signs of cognitive impairment. Hypoactive (50%) was the most common delirium motor subtype, while 6% had hyperactive and 13% had mixed motor subtype. Patients with delirium or cognitive impairment were admitted to all hospitals and departments. Conclusions: Cognitive impairment was prevalent in the Emergency Departments of all hospitals in the study Prevalence of delirium and associated factors in convalescence units Using a questionnaire, we studied probable predisposing factors (visual and hearing impairment, psychoactive drugs) and precipitating factors (bladder catheter, fever, poor control of pain and sleep disturbances). Additionally, demographic data, comorbidity, pre-existing cognitive impairment and physical function were recorded. Subjects with advanced dementia, diagnosis of any organic encephalopathy or evidence of delirium at the time of the admission were excluded. Delirium was defined according the Confusion Assessment Method. Results: A total of 224 patients were recruited (mean 82.1 years old) Città della Salute e della Scienza -Molinette 11 Italian Society of Hospital s and Community Geriatrics (SIGOT), Italy, 12 Gerontology Unit 15 Federazione Italiana delle Associazioni Dirigenti Ospedalieri Internisti (FADOI) End of life (EoL) discussion. PRN therapies Special write consent to avoid unnecessary hospitalization (2) Psychological: explain the trajectories of the disease were introduced and the SPIKES in family conference. were offered for mourning, addressed to local support groups. Psychological support discussion with Palliative Care Mobile Unit. (3) Social Extended visit times. Environment Intervention. (4) Spiritual Dimension: In the ACP of the end of life the spiritual dimension is explored and part of the assessment, pastoral support is available. Results: In process of elaboration. Preliminary data show a significant increase in the ACP and increase of early palliative care, the care project failures were extremely rare. Equipe AUDIT following every critical case. Very low rate of Artificial Nutrition. Conclusions: Preliminary data confirm that almost all the formalized end-of-life projects were concluded in Nursing home setting Improving rational prescribing for UTI in frail elderly (ImpresU) Alternative technics were offered in 63.6% (n = 63) of patients, including 30 catheter withdrawals, 15 urethral stents, 17 photovaporizations of the prostate (PVP) and 1 prostatic artery embolizations. Overall, the success rate was 88.9% at 7 days and 92.1% at 1, 3, 6 and 12-month follow-up. The IUC group patients were significantly older (89.3 vs 85.2y, p = 0.001), very dependent (ADL \2, 72.2% vs 39.7%, p = 0.002) and with neurologic comorbidities (77.8% vs 50.8%, p = 0.007). The global rate of death of Conclusion: Our type of decision analysis model may be a useful consensus building to offer a better chance to deal with IUC in elderly people with a global success rate of 92.1% catheter withdrawals at 12 months. The elevated rate of death in IUC group highlights the frailty of dependent patients and data is needed to report the relation with IUC Mehmet P-35, P-147, P-157, P-158, P-468 O-105, P-48, P-127 Mahtab P-151 Natalia Vázquez P-549 Á lvarez-Gómez S336 Lamer P-497 Emine P-792 Teslime P-505 P-279 Sylvie O-107, O-58 Giulia O-78, P-559, P-563 Filipa O-115, P-331 S338 O-73, P-521, P-522, P-579, P-585 Capova Pavlina P-375 Cengiz Isik, Mehmet P-232 C_ epla Riffard P-60, P-61, P-62, P-63 Sergio P-437, P-456 Ć orić, Tanja P-271, P-272, P-273 Cristiane França P-594 Umran P-459, P-473 Funda P-728, P-729 O-105, P-48, P-127 Yolanda Parada P-102 P-454 de Groot, Lisette P-25 O-82, P-639 de Jaegere S342 Fabiana O-24 de van der Schueren, Marian P-454 de Vet Ilaria P-502 Vieri O-28 Arzu P-638 den Boeft Marija P-19 do Desterro Soares Brandão S344 André O-115, P-331 Inês Miguéis O-115 P-90, P-96 Balea-Fernandez P-171 O-74, P-60, P-61, P-62, P-63 Elisa P-661, P-841 P-90, P-96 S346 P-205, P-214, P-655, P-705, P-772 Olof P-209, P-406 S348 Beuscart P-225, P-497 P-737, P-738 Satu O-30, O-32 P-218, P-805, P-811 Lesauskait_ e, Vita P-426, P-478 Leskauskait_ e, Daiva P-426 Aldo O-78, P-559 P-90, P-96 O-73, P-521 S352 O-28, P-122 Anna P-502, P-570, P-798 Maider O-100 Rocío P-227, P-230, P-577, P-578 Meryem P-157, P-158 P-90, P-96 P-634, P-635 S354 Irimia P-287 Alireza P-151 Haissa P-116 82 On behalf of Frailtools Team S356 Cemile P-217, P-390, P-638, P-667, P-808 Ö zsürekci O-51 Ö ztürk Zeynel Abidin P-178, P-180, P-265, P-452, P-725, P-728, P-729 Palomeras Fanegas, Elisabet P-895 P-90, P-96 Nikesh O-103, O-105, P-48, P-127 O-44, P-179 P-90, P-96 O-90, O-96, P-564, P-647, P-656 Christine P-493, P-626 Carmichael O-45, P-53 Bedouch P-491, P-60, P-61, P-62 Kaisu O-6, O-32, O-118, P-589 PolSenior Study Group P-825 O-124, P-357, P-358 O-124, P-357, P-358 Gibert P-491, P-60, P-61, P-62 Monika O-97 O-105, P-48, P-127 Maria Fernanda P-15 S358 Roubaud Baudron, Claire P-625 P-90, P-96 P-41, P-167, P-170, P-391 Kezban Ulku P-638 Ş ahin O-124, P-357, P-358 P-232, P-443, P-505 S360 Gozde P-390, P-619 Gözde P-663, P-720 P-205, P-825 Š karić-Jurić P-388 Š koloudík Rabia Bag P-447 P-90, P-96 Timo O-6, O-30, O-32 Enrique Solla P-66, P-281 Sumer, Fatih P-216, P-217, P-390, P-638 Pelin P-638, P-667 Ü nsal, Pelin P-663 Annele O-6, O-30, O-32 USAREL Anne-Julie P-590 Van den Noortgate, Nele O-119, P-156 Tischa O-103, P-407 Lorenz P-21, P-22 van der Putten, Gert-Jan P-324 van der Roest P-317 van der Steen, Jenny O-87 van der Velde, Marije P-569 van der Velde, N. P-404 van der Velde, Nathalie P-25 van der Velden Liesbeth O-119, P-866 van Iersel S364 P-554 P-90, P-96, P-97, P-336, P-507 Villain, Cedric O-13 María Piar López P-99 Katarzyna O-122, P-510 Burcu Balam O-41, P-216, P-217, P-390, P-663 P-505, P-623 S366 Introduction: In recent years the quality of care and additional interventions applied in nursing homes moves into focus. Using effects as quality indicators we have to struggle with three main difficulties: (1) Cognitive impairment reduces the reliability of information given by residents. (2). The view of the staff may be biased. (3) Residents in nursing homes are very vulnerable and the staff always under stress, so assessment has to be quick, easy and safe. Methods: By means of continuous practice research the Research Group Geriatrics Lübeck develops a multimodal program (''Lübeck Model Worlds of Movement'') offered to seniors in need of long-term care. Evaluation of the effects must be based on profound knowledge about the situation in nursing homes. After modification of the target group by elimination of lack of walking ability as exclusion criterion we checked in what way we had to adapt the assessment battery. Results: We found that ceiling effects occurred seldom, floor effects often. For some target parameters we could not find an instrument already established, so we modified existing tests or even developed new ones. In interviews simple language enhances cooperation-not only with the main target group but also with the staff. Key conclusions: Monitoring effects via assessment calls for different instruments according to the functional level of the participants. We share our experiences with typical problems in assessment in nursing homes, show videos of those instruments that are yet unknown to most of the spectators and explain why we chose them. Introduction: Cervical spinal fractures are common in the elderly with an incidence of approximately 2 in 10,000 yearly at the level of C2 alone [1] . These can have a devastating impact with some studies quoting mortality rates of 35.1% at 1-year post injury [1] . Method: We examined case notes for patients admitted over the age of sixty with suspected cervical or upper thoracic vertebral fractures over the course of 2017. Results: 12 sets of notes were reviewed for the purposes of this audit. 6 males and 6 females were studied with a mean age of 79.3 (ranging from 60-94 years-old) As well as outcome data based on NICE guidelines, we found practicalities involving discussion with tertiary services to be time consuming and that 33% of our patients had a decline in their previous level of function. This emphasises the devastating impact of these injuries on an elderly cohort of patients, and the length of stay would corroborate this further being almost 3 weeks on average which leads to huge costs for the National Health Service at a time when it is under more pressure than ever. Conclusion: These results demonstrate that even for spinal column injuries with no cord involvement there can be significant input on patient morbidity and functional baseline, with 5 (42%) of our patients declining in their level of function to the point where 2 required 24-h care on discharge from hospital and 3 required intermediate care. This can also impact on National Health Service in general. Acute heart failure un the elderly: which is the treatment of choice at discharge? Real world data from the ATHENA registry Aldo Lo Forte 1 , Francesco Orso 1 , Alessandra Pratesi 1 , Andrea Herbst 1 , Silvia Parlapiano 1 , Giulia Biagioni 1 , F. Fedeli 1 , Camilla Ghiara 1 , Anna Chiara Baroncini 1 , F. Bacci 2 , G. Ciuti 2 , Mauro Di Bari 1 , Niccolò Marchionni 1 Department of medicine and geriatrics, Careggi University Hospital (AOUC), Florence, Italy, 2 Department of emergency and Internal Medicine, Careggi University Hospital (AOUC), Florence, Italy, 3 Careggi University Hospital (AOUC), Cardiothoracova, Florence, Italy Introduction: The prognosis of patients with HF with reduced EF has improved in recent years thanks to the availability of evidence based treatments. Currently, equally effective treatments are not available for patients with HFpEF (preserved) and for those with HFmrEF (mid-range), the new category of patients with HF. Methods: Data derived from the ATHENA (AcuTe Heart failurE in advaNced Age) retrospective observational study which included elderly patients (C 65 years) admitted with diagnosis of AHF (worsening or de novo) to the Emergency Department (ED) of a tertiary University teaching-hospital in the period 01.12.2014-01.12.2015 . Inclusion criteria were: mean age of three group of patients was respectively 84. 2, 84.3 and 80.3 years, p \ 0.001 . Pharmacological treatments at discharge in the three HF groups are shown in the attached table. BBs and MRAs were the only two classes of drugs that had a statistically different prescription rate across the three HF groups: patients with HFmrEF received BBs in similar percentage to patients with HFrEF. Instead MRAs prescription rate in HFmrEF was more similar to the one of patients with HFpEF. Key conclusion: Elderly patients with AHF differ in terms of clinical characteristics and in-hospital prognosis according to the different settings of care. In this population in-hospital mortality seems to be correlated with clinical variables already known to impact prognosis, but also with geriatric variables such as functional status and cognitive impairment and with setting of care of assignment after the Emergency Department, with a protective effect of management in cardiological settings.Aim: Hyperkyphosis commonly affects elderly people and closely related to morbidity and mortality. On the other hand, depression is an important disorder which is also prevalent among geriatric population. The relation between depression and physical illness is apparent and disturbs life quality of patients and their relatives. This study aims to investigate the relation between hyperkyphosis and depression. Methods: The study included 142 participants who applied to our university's geriatric outstanding clinic. The kyphosis grade was measured using the block method. The participants were told to lie in a supine position on a radiology Introduction: The COME-ON study (Collaborative approach to Optimize Medication use for Older people in Nursing homes) aimed to investigate the impact of a complex intervention on the appropriateness of prescribing for Belgian nursing home residents (NHRs) [1] . Methods: A multicenter, cluster-randomized controlled trial was set up. The complex intervention consisted of blended training, local concertation (discussion on the appropriate use of specific medication classes on the nursing home (NH) level) and repeated interdisciplinary case conferences (ICC) (involving the GP, the pharmacist and the nurse) to perform medication review for each NHR. Control NHs delivered usual care. The primary outcome measure was an improvement in appropriateness of prescribing from baseline to end of study, defined as solving at least one potentially inappropriate medication (PIM) or potentially prescribing omission (PPO) from baseline at end of study, and without a new PIM or PPO at end of study. Detection of PIM and PPO occurred via an automatic algorithm based on explicit tools (STOPP/START v2 and BEERS 2015) [2] . Methods: The first draft of the TIME-criteria will be based on combination of STOPP/START version 2 and CRIME-tools. We will ask the panelist consisting of more than 40 experts from geriatrics and various specialties to review the Draft 1 in light of current guidelines, expert opinions, and their practice in terms of importance and accuracy. Then we will ask them to send back with additional recommendations to improve the structure and content of the existing criteria in Phase 1. Draft 2 will be set according to the panelists comments in terms of additional criteria, revision of current criteria and removal of the criteria in Phase 2. The evidence will be sought for the proposed criteria and comments in Draft 2 by the authors and at least 1 relevant panelist for every criterion face-to-face in Phase 3. Then Draft 3 will be set in terms of revisions and removals in Phase 4. Phase 5 and following phases will consist of Delphi rounds. Draft 3 TIME-criteria will be sent panelists by e-mail for assessing clinical relevance. We will ask the panelists to rate how appropriate they found inclusion of each criterion for the final TIMEcriteria by rounds of Delphi. A Likert scale (between 0 and 5)will be used in terms of ''Criteria should be included in the list of TIME-1''for scoring. Median value and 75th percentile value for each criterion will be calculated. Items with both median value of 4-5 and 75th percentile value C 4 will be included in the in the final ''TIMEcriteria-Set''. Conclusion: TIME-criteria will be the first national PIP list in Turkey. We presented the planned methodology of the TIME-criteria on development process. This report may a methodological reference for developing new tools. Relationship between IL-1beta and cardiovascular disease in elderly patients Introduction: Cardiovascular disease (CVD) is a major cause of mortality at elderly age, and are mainly caused by atherosclerosis, a complicated process governed by several risk factors. The basis of atherosclerosis is the chronic vascular inflammation. Proinflammatory cytokines secreted by adipose tissue and other tissues play an important role in this process. Interleukin-1beta (IL-1b), a major proinflammatory cytokine, play an integral role in increased migration of inflammatory cells and through proinflammatory, procoagulant nature in developing atherosclerotic plaques.Methods: The aim of this study was to determine changes in serum levels of IL-1b in elderly patients (aged 69 ± 7 years) with cardiovascular disease compared to a control group. Quantitative determination of IL-1b was performed by an ELISA method. Results: Our results showed an increase of IL-1b levels at group of patients with CVD compared with a control group (9.412 ± 16.86 vs 4.672 ± 10.89 pg/ml serum). Key conclusion: In conclusion, serum IL-1b levels are elevated in individuals with CVD, indicating that IL-1b, as a proinflammatory cytokine, plays an important role in the progression of atherosclerotic plaques and in the pathophysiology of cardiovascular disease. Introduction: Four wheeled walkers (FWW) are primary used by geriatric patients for walking but also for other functional activities, such as rising up from a chair. There are evidence in the literature about the biomechanics of chair rising, but the movement strategies of this task using a FWW have not yet been quantified. Aim: To analyze the biomechanical characteristics of rising up from a chair of geriatric patients using four wheeled walker. Methods: Frail geriatric inpatients (C 70 years) will be included in this study and divided into two sub-groups: FWW-Users and Non-FWW-Users. The motion will be captured by ten infrared cameras with 42 reflective markers. Ground reaction forces will be measured with an integrated force plate. Non-FWW-Users rise up with the hands on the thighs. FWW-Users stand up with the hands on the FWW handles. All subjects have to place their feet in a pre-defined position on the force plate and will be instructed to stand up five times. Frailty will be assessed according to the phenotype of Fried. Expected results and clinical relevance: Considering the results of a pilot study with four young healthy women (age ± 27 years), we expect less trunk movement and acceleration, as well as decreased hip and knee joint angles by using a FWW during chair rising. Further, we expect less displacement of the center of pressure by FWW-Users. Our results might improve the recommendations and safety of standing up from a chair using a four wheeled walker. Use of the Frailty Index in older persons with chronic kidney disease Introduction: The presence of delirium after a stroke is a frequent clinical picture in elderly patients. The deficit of acetylcholine according to the different studies, would be involved in its etiopathogenesis. Based on studies conducted by some authors using acetylcholinesterase inhibitors in patients with cerebral vascular pathology, we describe the response to rivastigmine in 6 patients who present delirium. Methods: We present 6 patients who are between 83 and 91 years, all of them with cardiovascular risk factors (HTA, DM, DL) who are admitted to the geriatric hospital with a recent diagnosis of stroke. All of them presented a hyperactive delirium with bad response to neuroleptics. After performing EKG, a treatment with rivastigmine patches of 4.6 mg per day is started. Results: After 3 and 6 days from the beginning of rivastigmine, the symptoms presented by the patients were re-evaluated. In 4 of the 6 cases, the symptoms were resolved after 3 days and the remaining 2 were resolved in the 4th and 6th days. All cases were resolved after 6 days. Key conclusions: According to the authors, the treatment with rivastigmine could be useful in the delirium of elderly patients who have suffered a stroke as well as to reduce the duration of symptoms. Studies with a larger number of patients are needed to support these results. Delirium in older adults ''ergo'' dementia, but if it was a brain tumor? Methods: Semi-structured interviews were held with ten nurses and 18 physicians working in seven hospitals. The interviews were taperecorded, transcribed verbatim and analysed using thematic analysis. HCPs feel insecure about how to define the palliative phase and identification is not something respondents reported doing structured or actively. A variety of ways to identify the palliative phase were described: (1) Prognostication, (2) Treatment trade-off and (3) Patients' needs. Within prognostication great variation existed in what was considered a limited life expectancy and was thought to be more difficult in non-cancer patients. When the benefits of treatment no longer outweighed the negatives, this was thought to be a transition point to the palliative phase. However, this was thought to result in late identification. Patients' needs and preferences were also important in identification. Some respondents wait for patients to vocalize preferences themselves, but many actively start these discussions themselves, but found this difficult. Conclusion: Identification seems to be a non-structured process. Difficulties in identification occurred because of variance in definitions, unpredictability of non-oncological diseases, focus on treatment and difficulties in communication. These results contribute to the development of a training for HCPs to timely identify patients in the palliative phase. The PalliSupport care pathway, a transitional care pathway for older patients in the last year of life: study protocol of a pragmatic stepped-wedge clustered randomised controlled trial Results: The deceased more than 65 years old were 132 people (70 men average 56.1 years, 62 females average 57.5 years). 67 people were died due to diseases; 50 were heart disease, 11 were pneumonia and three were cerebral infarction, liver cirrhosis, malignant tumor respectively. In suicide, the average age were about 10 year younger than the deceased due to disease. The breakdown of the suicide were nine hanging, five jumping. In extrinsic death, ten deceased were accidental ingestion/asphyxia. We thought the result was associated with pica and side effect of drugs. Key conclusions: We showed case reports which couldn't be decided whether suicide or not in case of drug intoxication and drowning.Background: Religion may have an important role as a resource for coping with the negative emotional reaction to the cancer experience. The aim of this study is to examine the relation between self-declared levels of religiosity (religious, traditional and secular) and depression / distress symptomatology among community-dwelling elderly persons with cancer. Methods: The current study included 243 cancer patients, aged 65-97 years old who have active cancer disease. Patients who had cognitive impairment, had hospice care or needed help in basic ADL activity were excluded from the study. Depressive symptomatology is measured using the 5-item GDS (Geriatric Depressive Scale) and distress by the Distress Thermometer. The findings indicate that the highest levels of depressive symptoms and distress were seen among cancer patients in the traditional group (2.24 ± 1.82 and 5.01 ± 3.50, respectively), among patients in the secular group lower levels of depressive and distress symptoms were reported (1.78 ± 1.87 and 4.36 ± 3.36, respectively), while patients in the religious group had the lowest level of depression and distress (1.26 ± 1.45 and 3.34 ± 3.14, respectively).ConclusionThe association between religion and depressive symptoms and distress in elderly adults with cancer is not linear. Understanding the complex mechanisms whereby religion may affect depressive symptoms and distress among elderly cancer patients remains an important research priority. Conclusion: The association between religion and depressive symptoms and distress in elderly adults with cancer is not linear. Understanding the complex mechanisms whereby religion may affect depressive symptoms and distress among elderly cancer patients remains an important research priority. The evaluation and design of a short depression screening tool in Turkish older adults Introduction: Depression is a common and serious health care problem for older adults. This study aimed to determine validity and reliability of GDS-4 and GDS-5 in Turkish, and to establish a new short-form geriatric depression scale for our population, and also determine the superiority of each short scale to another. Methods: A total of 437 outpatients were enrolled in the study. A researcher evaluated all cases according to the DSM-5 diagnostic criteria, and then another researcher applied GDS-15 to all cases. We obtained the answers of short GDS forms, examined in this study, from GDS-15 forms. After Cohen's kappa analysis, we compared the diagnostic value of each question for geriatric depression according to their kappa values and, developed three (TGDS-3), four (TGDS-4), five (TGDS-5) and, six (TGDS-6) question-scales to screen geriatric depression in the Turkish population.Results: A total of 437 participants were assessed. The mean age (SD) of the patients was 72.95 (7.37 ). Cronbach's alpha values of GDS-4 and GDS-5 were .70. TGDS-3, TGDS-4, TGDS-5, TGDS-6's Cronbach's alpha values were [ 0.70. The best cuf-off values were C 5 for GDS-15, GDS-5, and C 1 for others. Discussion: GDS-15 is the most powerful screening scale for geriatric depression. GDS-4 and GDS-5 are not eligible for depression screening in Turkish older adults. All new short scales are valid and reliable, and the TGDS-4 is a practical, less time-consuming option for daily practice. Mental health inequalities among older adults in Iran: Findings from a population-based study (Urban HEART-2) Background: Antimicrobial resistance is a growing problem in long term care which calls for antibiotic stewardship interventions (ASI) in home care and institutional care settings for frail elderly. The study in this European project aims to reduce antibiotic (AB) overuse for urinary tract infections (UTI) through implementation of a new algorithm to support clinical decision making.Objectives:1) To design a tailored intervention to reduce inappropriate AB prescribing and usage of AB for UTI by implementing an algorithm that encourages 'watchful waiting' in case of non-specific S&S, combined with a bundle of actions selected on the basis of a conceptual model of factors that influence prescription decisions and with use of a toolbox of interventions to support rational and restrictive prescribing of AB in UTI.2) To conduct and evaluate a RCT of this multifaceted intervention in frail elderly in institutional and community care settings in the four participating countries.Objectives: (1) To design a tailored intervention to reduce inappropriate AB prescribing and usage of AB for UTI by implementing an algorithm that encourages 'watchful waiting' in case of non-specific S&S, combined with a bundle of actions selected on the basis of a conceptual model of factors that influence prescription decisions and with use of a toolbox of interventions to support rational and restrictive prescribing of AB in UTI. (2) Results: In studies aiming in the world-wide of elderly people living in the community, UI prevalence ranging from 8% to 34% have been reported, this ratio reaches up to 70% in the elderly nursing home residents. In the study of Ateskan et al. (2000) , the prevalence of urinary incontinence in the Turkish population was 44.2%. In the study of Leiros et al. (2017) , the prevalence of urinary incontinence in the Spanish population was found to be 15% in women and 11.6% in men.Key conclusions: The incontinence problem should be identified for elderly people living in hospital and at residents or nursing homes. Various evaluation forms can be used for this. The incontinence problems experienced by elderly individuals should be detected; it is thought that the living problems can be reduced and the quality of life can be increased. Experiencing and managing urinary incontinence: a qualitative study Urinary incontinence is a complex problem from which millions of people are affected worldwide. How the affected persons experience and organize their day-to-day lives has hardly been studied. It is important to understand that the people who are involved in the process of business, In Strauss and Corbin (NOC), the conceptual framework and thirty-two problem-centered interviews were conducted with 18 women and 14 men, which were then analyzed using the grounded theory method, after Strauss and Corbin. The experience of urinary incontinence is dependent on the incontinence and on the episode of incontinence. Incontinence itself influences social, cultural, and partner relationships. The results show that persons with incontinence use different strategies that are prepared for the next episode of episode of incontinence and searching for possible therapiesto regain control. If the experiences of the incontinence with elderly, public health nurses can help them by using NIC and NOC methods. To increase the success of removing the urinary catheter in elderly patients with recurrent urinary retention