key: cord-0014449-m8s4upvo
authors: nan
title: Abstracts of the 16th International E-Congress of the European Geriatric Medicine Society: 7-9 October 2020
date: 2020-12-21
journal: Eur Geriatr Med
DOI: 10.1007/s41999-020-00428-6
sha: efd5e752a2da3dddd92249823faa4d31f27f0132
doc_id: 14449
cord_uid: m8s4upvo

nan

isolation measures. Infections are among the most common precipi-diffuse B-lines (24 patients), with bilateral involvement. A diagnosis 1 Barnet Hospital BH, 2 University College Hospital UCH The Coronavirus pandemic has changed all facets of our lives ranging from how we work, relax and travel. This includes an impact on the delivery medical training given the need for strict social distancing measures as lecture theatres can potentially become a medium for coronavirus spread. We aimed to explore hospital doctors experience of the delivery of training and new ways of working during this period. Hospital doctors at a UK NHS foundation trust were asked to complete a questionnaire on how they learnt about COVID19, their experience of the delivery of teaching and ways of working. 204 trainees took part; 39% were male with respondents being White (50%), Asian (25%) and black (3%). Trainees got updates and guidance about COVID19 from their employer (61%), TV news programmes (54%) and social media (45%). 73% of trainees indicated that the delivery of teaching had changed during COVID19. The commonest methods of delivery of teaching were through Microsoft teams (66%), webinars (27%) and zoom (25%). 17% reported face to face teaching with social distancing measures. 63% reported new ways of working including increased use of telephone and video consultations, zoom and Microsoft teams' multidisciplinary meetings and new rotas. The COVID19 pandemic has allowed the rapid transition from face to face teaching to using video collaborative tools for the delivery of teaching and healthcare. This allows trainees and trainers to access teaching sessions remotely thereby accessing training at a time of convenience and reducing travel time for the delivery of regional training days.

Older patients with urgent need for intensive care due to Covid19. Implementing geriatric aspects in triage decisions Heinrich Burkhardt 1 , Uwe Sperling 1 1

In expecting large scale need for intensive care unit at the beginning of the covid19 pandemic, a local conference in an urban metropolitan area in south-west Germany was held to find and consent possible triage criteria for allocation of intensive care unit capacities in case of severe shortage of these capacities. Among heads of intensive care units, emergency departments and local ethic experts the department of geriatrics was asked for possible support in refining decision criteria with special regard to identify geriatric vulnerability and translate this in expected prognosis for severe course of lung crisis in the covid19-disease. Beside the qSOFA-score, patient preferences, comorbidity with terminal diseases, aspects of frailty and cognitive impairment were implemented. Those clinical aspects were translated in short and easy to assess control questions. Hereby the identification of both older patients with preserved resources (fit) and older patients already-independent from covid19-in an end of live situation (palliative aspects first) should be possible. A short check-list and a comment explaining the use of the checklist were developed. The algorithm and the check-list were accepted by the local committee and will be evaluated by retrospective interviews and case analysis for usefulness in clinical practice.

Introduction: Agitation, aggression and wandering are responsive behaviours associated with dementia that are frequently treated with antipsychotic drugs, despite evidence of limited effectiveness and an increased risk of death. This research aims to understand how responsive behaviours are managed, using both pharmacological and non-pharmacological approaches, by nursing home staff in the Republic of Ireland during the Covid-19 pandemic. A further objective is to examine the impact of social isolation, due to Covid-19 restrictions, on responsive behaviour in residents with dementia. Methods: After receiving ethics approval from Lancaster University Faculty of Health and Medicine Research Ethics Committee (FHMREC) , an online questionnaire was distributed to nursing homes in Ireland (n = 443), to be completed during the period of Covid-19 restrictions, by care home managers, nurses and healthcare assistants. A sample of participants were invited to take part in an interview to explore their responses in greater depth. Concurrent analysis of qualitative data was informed by thematic analysis. Results: Preliminary findings indicate that during lockdown, the absence of family visits and social interaction, resulted in cognitive decline, low mood and an increase in responsive behaviours in some residents with dementia. Nursing home staff expressed concerns regarding inadequate external support during the Covid-19 pandemic and highlighted the need for well-trained staff, familiar with residents needs, to manage responsive behaviours effectively. Conclusions: The findings will inform policy and practice changes to support nursing homes and facilitate adoption of non-pharmacological approaches to manage responsive behaviours in residents with dementia.

Psychosocial and emotional impact of COVID-19 visitor restrictions to nursing homes on families of residents with cognitive impairment: A cross-sectional study as part of the Engaging Remotely in Care (ERiC) project Background: Northern Italy faced a severe outbreak of coronavirus-memory and physical assessments a safe distance away from the distancing are a particular challenge for their physical activity, mental health and social relations [3] , and can have a number of adverse effects through the progress of social isolation, loneliness and a sedentary lifestyle [9] . Social isolation leads to a wide range of psychological symptoms, including depression and anxiety, and negatively affects the quality of life [3] . The study evaluated the prevalence of depressive symptoms, activity and involvement in social life, as well as the quality of life before and after the outbreak. Methods: The study included 168 people over 60 years of age (125 females) who voluntarily completed an online survey. The presence of symptoms of depression was assessed using the Yesavage 15-point Geriatric Depression Rating Scale. On its basis, the subjects were divided into two groups (people without depressive symptoms-0-5 points and people with symptoms of depression [ 5 points). The quality of life was rated on a 10-point scale, where 0 points meant the worst possible, and 10-the best imaginable. Activity and involvement in social life were also assessed on a 10-point scale, where 0 said that the examined person was not able to get out of bed alone, and 10 points indicated the lack of any restrictions on activity. Both factors were assessed before and during the pandemic. Results: 31.5% of the respondents had depressive symptoms (among them, 94.3% were women). In people living alone, the symptoms of depression were significantly more frequent (p \ 0.001) than among married ones. Activity and involvement in social life deteriorated significantly as a result of COVID-19 in all subjects (p \ 0.001), among people with depressive symptoms (p \ 0.0001) and persons without depressive symptoms (p \ 0.0001). The mean scores before the outbreak of the pandemic in both groups were similar and amounted to 8.4 ± 2.1 points for subjects without depressive symptoms and 8.0 ± 2.1 points for those with symptoms of depression. As a consequence of the epidemic, people with symptoms of depression showed significantly worse activity and involvement in social life than people without depressive symptoms (6.2 ± 2.4; 7.4 ± 2.4 ; p \ 0.001, respectively).Similar results were obtained for the quality of life. The COVID-19 outbreak significantly affected the quality of life in all subjects (p \ 0.001), those with depressive symptoms (p \ 0.001) and no symptoms (p \ 0.001). People with depression indicated on average a significantly lower quality of life than people without depression, both before and during the pandemic (before the pandemic: 7.4 ± 1.7; 8.2 ± 1.6; p \ 0.001; during a pandemic: 5.4 ± 1.8; 6.6 ± 1.8; p \ 0.001, respectively). Conclusion: Social isolation associated with the COVID-19 pandemic has worsened the quality of life and has reduced the activity and involvement of older people in social life. Symptoms of depression among people over 60 years of age resulted in a significantly stronger deterioration in the quality of life and involvement in social life during the pandemic compared to subjects who did not have these symptoms.

The impact psychological resilience on development of coronavirus anxiety and sarcopenia in older adults during COVID-19 Pandemic Sumru Savas 1 , Asli Kilavuz 1 , Ö zlem Kuman Tunçel 2 , Zehra Kosuva Ö ztürk 1 , Fehmi Akçiçek 1 excluding an acute neurological event, the mydriatic effect of ipratropium anti-muscarinic action was considered to be a potential cause for the fixed dilated pupil, however this did not explain the unilateral involvement. The patient was observed while using the nebuliser and it was noticed that she could not tolerate the mask affixed to her face to form an adequate seal, rather, she was holding it aloft and favouring her right side, such that the mist dispersed more readily to the left; this explained the unilateral manifestations. The assumption was subsequently proven upon discontinuing the ipratropium, when the pupils size, symmetry and reactivity returned to normal after around 24 h, in keeping with timescales documented in previous case reports. Discussion: Ipratropium bromide, as an antagonist of muscarinic acetylcholine receptors, causes mydriasis due to unopposed action of the dilator pupillae muscle, and cycloplegia due to ciliary muscle relaxation. The ocular complications of ipratropium bromide are due to the local effect of the medication; i.e. when the aerosolised ipratropium comes into contact with the eyes. The incidence of ipratropium induced ocular complications is between 1% to \ 1 per 1000 patients. Whilst there have been some case reports of ipratropium causing mydriasis, it remains in practice, a poorly recognised adverse drug reaction (ADR). Patients must be instructed in the correct administration of ipratropium nebuliser to avoid its release into the eye. Clinicians need to be aware of the uncommon mydriatic side effect of ipratropium to avoid unnecessary imaging and other investigations.

Hip fracture and the urinary bladder Atef Michael 1 , Arlinda Lago 1 1 Russells Hall Hospital, Dudley, UK Introduction: Some older people have falls, resulting in hip fracture, while going to the bathroom to urinate, or coming back. The aim of this study is to analyse the ''phenomenon'' of hip fracture related to the urinary bladder. Methods: Prospective observational study of consecutive patients admitted to a UK teaching hospital with hip fracture in an 8 months period. Patients, notes and electronic records were reviewed; data were downloaded on excel sheet and analysed using descriptive statistics. Results: 377 hip fracture patients were admitted in the study period, of whom 51 patients (14%) had falls related to the bathroom. Of these 20% (10/51) male and 80% (41/51) female with average age of 81. 6 and 82 .8 years respectively. 51% (26/51) had urinary incontinence. 51% (26/51) had hypertension and 31% (16/51) had osteoarthritis. 67% (34/51) were on [ 4 drugs, 55% (28/51) were on antihypertensives, 22% (11/51) were on diuretics and 31% (16/51) were on an antidepressant. Falls were multifactorial; frailty in 41% (21/51) and postural hypotension in 24% (12/51) were considered the most contributing factors. Discussion: The number of patients who had fractures related to the urinary bladder could be underestimated as some older people with dementia were found on the floor with no reliable history; many of them could have been going to the bathroom. There are many reasons why elderly people might fall while going to the bathroom including postural hypotension, rushing to avoid urge incontinence, hypnotic or extrapyramidal side effects of medications, not using the mobility aids and poor lighting conditions.Conclusion: In this study 14% of falls resulting in hip fracture was attributed to the urinary bladder. Urinary bladder symptoms are a frequently forgotten risk factor for falls and fractures. To reduce the risk in this group of patients, urinary tract symptoms need to be explored, diagnosed and treated. Medications; specially antihypertensives and CNS active drugs should be rationalized and diuretics are to be avoided if possible.

Results: Of the total sample, 39 patients died, 52 were discharged and for all tests). They also had higher number of comorbidities, medi-and the patient was directed to the Urology Service. He was collected RT-PCR SARS CoV-2, in accordance with the rules of the pandemic context, certifying a negative result, with the opportunity of urological visa surgery. Postoperative, the patient was hospitalized in the ICU ward and the respiratory function deteriorated, with the tendency to desaturate, with the intensification of cough, requiring invasive mechanical ventilation. The culture of the tracheobronchial aspirate objectified a bacterial infection, corrected treated with antibiotic, but the patient develops intestinal symptoms, resulting in bacteriosis (Clostridium difficile). The aggravating spectrum of postoperative respiratory symptoms and the uncertain spectrum of intestinal symptoms led to the need for retesting for SARS CoV-2 pathology, with a positive result. We draw attention to the stereotypy in the manifestation and evolution of COVID-19 pathology in the senior and fragile patient. In the conditions of a previous negative result, only the symptomatic storm and the rapid degradation of the general condition claim the need for retesting. The insidious onset of respiratory phenomena and the false-negative or harvested test during the incubation period allowed surgery.

Covid-19 case series: Geriatric Giants presentations prevail. 

Introduction: As of the 4th of June, there have been 2, 211, 148 of those cases reported in Europe (1) . In Ireland, 18.39% of reported cases were 75 years of age or older, as of 2nd June (2) . The ECDC have described the case definition to include the following clinical criteria; cough, shortness of breath, fever, anosmia/ageusia/dysguesia (3) . However, we must be cognizant that the older population may present atypically. Studies have shown that confusion is a common feature (4). Methods: We present two cases of covid-19 presenting to a tertiary hospital under the care of a geriatric team. Results: Case 1 is an 84 year old gentleman who presented with acute onset confusion and pyrexia. He had no respiratory symptoms. Collateral history confirmed that he was premorbidly fully independent with ADLs and had normal cognitive function. His past medical history includes ischaemic heart disease and prostate cancer. His chest X-Ray demonstrated bibasal infiltrates and he was lymphopenic (0.6). Case 2 is a 78 year old gentleman who presented following a witnessed fall. This occurred following a three day history of rigors and diaphoresis with fluctuating confusion in the preceding 24 h. There were no respiratory symptoms. Past medical history includes hypertension and glaucoma. Chest X-Ray demonstrated bilateral infiltrates and lymphocyte was normal (1.7). Conclusions: Atypical disease presentations in this age population is a well-recognized phenomenon that has preceded this pandemic. Age over 60 and underlying cardiac co-morbidity are associated with higher mortality 5 . It is imperative that we remain vigilant of atypical presentations. References: 1. WHO. Coronavirus disease Situation report 136 [Internet] . World health organisation; 2020 Jun. Available from: https://www.who.int/docs/default-source/coronaviruse/situationreports/20200604-covid- 19-sitrep-136 

Introduction: Patients with COVID-19 infection can deteriorate rapidly, over h, with regards oxygen and care needs [1] . For those patients without medical reversibility from COVID-19, the terminal phase of their illness can be variable [2] . We describe the clinical course of the dying phase of three patients referred to palliative care services within a tertiary hospital to outline the heterogeneity within this cohort and the need to be vigilant for escalating symptoms at the end of life (EoL). Methods: Retrospective examination of clinical notes of three patients with COVID-19 referred to our specialist palliative care service to determine symptomatology and medication requirements at the EoL. Results: Our patients suffered predominantly from dyspnoea and agitation in their EoL phase. Medication requirements to achieve symptom control varied considerably despite the fact that all patients were opioid naive. Within the last 48 h of life our patients required a mean of 28 mg Morphine Sulphate sub-cutaneous (s/c), as-required (prn) (range 12.5-42.5 mg) for management of dyspnoea and a mean of 28 mg Midazolam (range 12.5-55 mg) s/c, prn for agitation. In contrast, secretions were less prominent in this cohort. Key conclusions: Dyspnoea and terminal agitation were key symptoms experienced by patients with COVD-19 at the EoL. Their symptoms tended to escalate quickly and required careful monitoring to ensure adequate administration of prn medication to maintain symptom control. Obstacles included the need for strict isolation with full Personal Protective Equipment (PPE) and the need for staff to minimise contact time as much as possible. The World Health Organization predicts an increase in the proportion of people over 60 by 2050. by 10% . Health problems are noncommunicable diseases. Also, depression caused by poverty and loneliness can aggravate the course of pathological processes.We examined 36 centenarians (people over 90 years old) using methods of prenosological diagnosis. The average age is 91.81 ± 0.26 years, of which 10 are women and 26 are men. All patients underwent the following studies:volumetric sphygmography to determine the stiffness of the vascular wall, peripheral vascular patency by volumetric sphygmography; determination of the adaptive capabilities of the body, vegetative and central regulation, assessment of the energy resources of the body, functional state state by assessing heart rate variability; determination of body weight, body composition in percentage terms, metabolic age using the bioimpedance method.The changes in the functional state and its reserves was identified before the COVID-19 pandemic in our study. Identified changes can be considered as processes, as a result of which regulatory systems are stressed in the absence of complaints and which can lead to a breakdown of adaptation, i.e. pathological process or exacerbation of existing diseases. We plan to conduct these studies again after the pandemic and the lifting of restrictive measures. An assessment will be given of the functional state of the organism, its adaptive capabilities.The data obtained can be useful in predicting measures to reduce epidemiological risks, taking into account the development of probabilistic psychoemotional conditions in the elderly population in territories exposed to adverse biological factors.

Case report: bedside lung ultrasound monitoring in a patient diagnosed with COVID 19 Maurizio Magri 1 , Cristiano Donadio 1 , Carmelo La Fuente 1 , Joël Belmin 1 1

Background: SRAS-nCoV-19 virus has become a worldwide pandemic since first being described at the end of 2019. Virus infection results in a distinctive inflammatory interstitial lung disease that may lead to severe acute respiratory syndrome, especially in older patients. Method: We performed lung ultrasound in a patient with diagnosis of COVID-19 at day 2, day 8 and day 10 to monitor the evolution of the lung lesions and to asses the feasibility of bedside ultrasound in the disease management. Lung scans were performed using a portable ultrasound (PHILIPS-LUMIFY) by two investigators trained in rapid lung ultrasound. Result: Ultrasound images demonstrated the hyperechoic vertical artifacts (B-lines) commonly present in lung interstitial involvement. In case of underlying pneumonia, when there are several B-lines, we can detect the presence of ''curtain sign''. The ultrasound features were often bilateral and the number of B waves has changed according to the progression of the disease. Conclusion: Pulmonary ultrasound is a safe and easy diagnostic instrument to detect unilateral, bilateral, diffuse (curtain sign) B-lines or focal consolidations. In this context, lung ultrasound at the bedside plays an important role.Recognize the typical lung features of SRAS-nCoV- 19 and quickly define the prognosis allows us to deploy the right resources for each patient; it becomes crucial when the available resources are not enough, as happened during this global pandemic.

Pancytopenia due to SARS-CoV-2

Patricia López Pardo 1 , Raquel Martín Pozuelo Ruiz de Pascual 1 , Pedro López-Dóriga Bonnardeaux 1 1 Geriatric Department. Hospital Universitario de Getafe 87-year-old woman referred from the emergency room for a four-day evening fever without another associated clinic. It was a patient with no history of interest, independent for the basic activities of daily life and without cognitive impairment. Physical examination revealed crackles in both lung bases, and chest X-rays revealed bilateral infiltrates compatible with COVID. Analytically, unknown pancytopenia stood out: 1730 leukocytes (neutropenia and lymphopenia of 760 in both series), 94, 000 platelets and hemoglobin of 11.5 g/dl. Hematology evaluation was requested, which carried out smears compatible with the infectious process: 45% of the segmented population with reinforced granulation and some hyposegmented forms with some crooks, 44% small lymphocytes and some activated lymphocyte, 11% monocytes with abundant vacuoles. Given these findings, a PCR was performed for SARS-CoV-2, which was positive and entered for respiratory surveillance and analytical control. The patient did not wish to receive compassionate use treatment for COVID-19. After 48 h, she presented a spontaneous analytical improvement with practical recovery of the parameters.

First case of COVID-19 in a local hospital Raquel Ortés Gómez 1 , Guadalupe Lozano Pino 1 , Estela Villalba Lancho 1 , Jean Carlo Heredia Pons 1 1 Virgen del Puerto Hospital. Plasencia (Cáceres, Spain) Introduction: We report the first case of COVID-19 at Virgen del Puerto Hospital, Plasencia (Cáceres, Spain). Methods: Mr. D., an 86-year-old man, had a history of hypertension, dyslipidemia, peripheral vertigo and osteoarthritis. He was independent for ADL, with a score of 5 on FAC scale and a score of 2 on Pfeiffer test. He lived alone at home. The patient was admitted to hospital on February 28, 2020, with a subcapital fragility hip fracture. He started with voiding discomfort on March 2 and with fever on March 3. He remains afebrile with antipyretics and he underwent surgery on March 4. Results: Mr. D. continued days after surgery with fever and he began with abdominal discomfort in relation to intestinal pseudoobstruction. On March 6 we started empirical antibiotic treatment. On March 9 we observed pancytopenia and it was described on abdominal computed tomography (CT) scan dolicosigma and incipient consolidations in lower lobes lung. We indicated airborne precautions and, after ruling out other viral infections, we request PCR SARS-CoV-2 on March 10 with positive result. In the following days Mr. D. worsened with respiratory symptoms despite he received treatment with antibiotics, Hydroxychloroquine, Lopinavir/Ritonavir, Interferon-b and oxygen therapy. Intensive support was dismissed and Mr. D. died on March 18. Key conclusions: COVID-19 is a life-threatening disease with different forms of presentation and that most frequently affects the elderly population. In the case we report fever was present from de beginning but respiratory symptoms were not present until the end.

Thoracic CT and COVID 19. Imaging and False negatives in COVID 19. Julia Castillo García 1 , Jorge Eduardo Corrales Cardenal 2 , Carmen Elias de Molins Peña 3 , Beatriz Gamboa Huarte 3 1 Hospital Nuestra Señora de Gracia de Zaragoza, 2 Hospital Nuestra señora de Gracia de Zaragoza, 3 Hospital Nuestra Señora de Gracia Introduction: 81 years old. Personal history: High blood pressure, moderate high pulmonary pressure, ischemic cardiopathy, diastolic heart failure, chronic renal failure. Treatment with: Adiro, furosemideGeriatric assessment: Institutionalized, widower. Moderate dependency for daily life activities, Barthels index: 45/100. Mild cognitive impairment. Case study: In march is admitted to the acute geriatric ward with a left inferior lobe pneumonia without changes in blood test and a negative swab test for COVID 19 . Chest X-Ray with an extensive left hemithorax condensation with no improvement despite broad spectrum antibiotic (ertapenem). During admission, no changes on imaging and two more swab test came back negative with negative serology for COVID 19 infection. Presented respiratory distress with bronchospasm that subsided with corticosteroid therapy. Given the poor evolution of the patient, a thoracic CT scan was performed; presenting bilateral patched and extensive alveolar occupation with a ground glass pattern compatible with COVID-19.Clinical worsening with low oxygen saturation, with a poor response to rescue treatment, presenting adult respiratory distress syndrome. Chest X-ray: bilateral multilobar condensations. Due to refractory syndrome and progressive worsening palliative care approach was used with end of life stage. Given the high suspicion of COVID 19 infection a post-mortem swab test was made with a positive result. Discussion: The sensitivity of Thoracic CT to diagnose COVID-19 has been reported as high and can predate a positive viral laboratory test, such as the case described. Considering this case at first as a false negative due to clinical and imaging findings with negative laboratory test.

Atypical clinical manifestations of COVID-19 infection in a family cluster: Facial nerve palsy and diarrhea Yaohua Chen 1 , Céline Derollez 2 , Tifanie Alberto 2 , Marie-Anne Mackowiak 2 1 Department of Geriatric, 2 Memory clinic Introduction: COVID-19 emerged as a viral infectious agent of severe respiratory syndrome with high contagiousness and ongoing global pandemic. Atypical manifestations, e.g. other than respiratory symptoms started to be reported. Methods: We reported of a family cluster of atypical clinical manifestations of COVID-19. Results: 84-year-old frail woman was admitted to our geriatric dedicated COVID-19 inpatient ward, due to intractable diarrhea and deconditioning. She was frail and had a long list of comorbidities, such as mild cognitive impairment, chronic skin sores, obesity, falls, arthritis and depression. Prior to the hospitalization, she remained in a rehabilitation center for 2 months, until discharge following a negative swab for SARS-Cov2. The diagnosis of COVID-19 was finally confirmed in the geriatric unit with her mother by naso-pharyngeal and feces RT-PCR assays. Her 57-years-old woman took care of her during the week interval between discharge from rehabilitation and admission in our unit. Her daughter was admitted in neurological inpatient ward 1 week later because of acute isolated left facial nerve palsy. Diagnosis of COVID-19 was confirmed in both cases while no major respiratory syndrome was reported. Conclusions: Clinicians should be aware of atypical manifestations due to COVID-19. Data remained poor regarding atypical presentation among older and frail patients. It seems that in a relatively large proportion of these patients, they only experienced minor symptoms. Preventive measures and social isolation of contact-cases are key strategies to arrest the pandemic. These cases will also be helpful for the understanding of pathophysiology of the virus.

Glucocorticoid treatment in COVID-19 bilateral pneumonia-a clinical case report Itxaso Marín-Epelde 1 , Agurne García-Baztán 1 , Isabel Rodríguez-Sánchez 2 , Belén González-Glaría 1 , María Gonzalo-Lázar 1 , César Cuevas-Lara 3 , Marina Sánchez-Latorre 1 , Nancy Jeanette Gonzales-Montalejo 1 , Á lvaro Casas-Herrero 1 , Fabricio Zambom-Ferraresi 3 1 Complejo Hospitalario de Navarra, Pamplona, Spain, 2 Hospital Clínico San Carlos, Madrid, Spain, 3 ''Complejo Hospitalario de Navarra (CHN)'', ''Universidad Pública de Navarra (UPNA)'', ''IdiSNA'', Pamplona, Navarre, Spain.

Glucocorticoids seem to be an effective treatment for cytokine storm activation in COVID-19 patients [1] . We present an 84 year-old male (Barthel Index 100/100) with a personal history of hypertension, type 2 diabetes mellitus, hypertensive cardiopathy with preserved ejection fraction, anticoagulated atrial fibrillation and obstructive sleep apnea syndrome who presented with cough, respiratory secretions, dyspnea and fever. He was admitted with bilateral COVID-19 pneumonia. Analytically, he presented with lymphopenia (600/L), thrombocytopenia (105, 000/L), elevated D-Dimer levels (2015 FEU/mL), elevated ferritin levels (721 microg/L), low sodium levels (132 mEq/ L), worsening of renal function (creatinine 2.14 mg/dL) and elevated CRP levels (134.7 mg/L) with no procalcitonin elevation. He was started on Hydroxicloroquine and antibiotics on admission. On day 11, he suffered a worsening of the respiratory situation, with increasing oxygen necessities. The chest X-Ray performed also showed a worsening of the bilateral reticular pneumonia, with the association of consolidations. Thus, glucocorticoids at high doses were initiated (125 mg/day for 3 days) and Tocilizumab (600 mg) was administered. After said treatment, he gradually improved, both subjectively (dyspnea) and objectively (as shown by Pa/FiO2 evolution and clearing of the bibasilar rales on auscultation). X-Ray improvement was seen on day 17, with resolution of the previously seen consolidations on the right side and a very slight persistence of reticular affectation on the left. Analytically, lymphopenia (900/L), elevated levels of D-Dimer (1563 FEU/mL), elevated ferritin levels (622 microg/L) and slightly elevated CRP levels (1 9mg/dL) persisted, but platelet count, renal function and LDH levels had normalized. 1 First Moscow State Medical University, 2 War Veterans Hospital N3

Introduction: According to some reports, older people are at highest risk from SARS-CoV-2, but Russian data on SARS-CoV-2 severity are not available. Methods: 155 patients were enrolled in this study. Patient's age varied from 26 to 94 years: 41.3% of patients were \ 60 years, 34.2%-60-74 years, 24.5%-C 75 years. 52.9% of patients were men. Results: Upon enrollment 47.4% of very elderly (C 75) and 21.9% of young (\60) patients had grade 3-4 clinical severity (p = 0.007). Most laboratory parameters in very elderly patients were worse than in young: hemoglobin levels were 121 b 135 g/l, respectively (p = 0.0001), leukocytes -10.4 and 6.5 (p = 0.00007), neutrophils-8. 5 and 4 .7 (p = 0.00005), total serum protein-60. 3 and 66 .0 (p = 0.00001), albumin-30. 2 and 35 .9 (p = 0.000001), urea-11.0 and 6.6 (p = 0.004), creatinine-132 and 98.0 (p = 0.0001), total bilirubin-16.8 and 10.2 (p = 0.0003), calcium-0.72 and 1.1 (p = 0.0001), D-dimer -1716. 6 and 1253.4 (p = 0.07) .There were significant differences in disease worsening during follow-up: 89.5% of patients 75-94 years and 51.6% of young patients have worsened (p = 0.0001). Follow-up computed tomography showed that 94.7% of patients 75-94 years old had severe lung damage (grade 3-4), while among young patients this indicator was 62.5% (p = 0.0002). 86.8% of patients 75-94 years old and 29.7% of young died during followup; discharged from hospital-70% of young and 13% of very elderly patients (p \ 0.00001). Key conclusions: In very elderly patients SARS-CoV-2 is more severe and is associated with clinical severity, CT progression and worsening of laboratory parameters and ultimately results in death of patients.

The role of Chest radiography on the management of COVID-19

Andreia Teles Ribeiro 1 , Gonçalo Freire 2 1 USF Descobertas, ACES Lisboa Ocidental e Oeiras, ARS Lisboa e Vale do Tejo, 2 Serviço Radiologia, Hospital Beatriz  ngelo, Loures, Lisboa Introduction: Amidst the COVID-19 pandemic, organization is essential to boost healthcare quality and reduce mortality rates, especially in the elderly. Typically, COVID-19 diagnosis is made through real-time reverse transcription polymerase chain reaction (RT-PCR), but results take about 6 h to be available. Methods: For this paperwork, a literature review was undertaken in PubMed and CENTRAL with the terms COVID-19 [MESH] and Radiography [MESH] . Furthermore, radiographic COVID-19 categorization by the British Society Thoracic Imaging is explained and illustrated. Results: Chest tomography is the gold-standard to study lung parenchyma abnormalities. However, it is expensive and timeconsuming. Although CXR is less sensitive, it can demonstrate findings suggestive of COVID-19 such as peripheral and bilateral ground glass opacities. It can also have an important role on risk stratification, distinguishing patients with increased risk for hospital admission and intubation. When the CXR is normal, patients can more confidently have medical release with isolation measures while waiting for the RT-PCR test results. Furthermore, in the geriatric population the differential diagnosis of COVID-19 is extensive. While it is essential to make a good clinical history and physical examination, CXR is able to diagnose other diseases such as cardiac insufficiency, pleural effusion or pneumothorax. Conclusion: Chest radiography is useful for both clinicians and patients, has it can detect findings suggestive of COVID-19 as well as other differential diagnosis. In addition, a normal CXR decreases the length of stay in the Emergency Department for those who have mild clinical disease, decreasing the risk of nosocomial infections.

Mortality factors in patients older than 80 years admitted for COVID-19 to an acute geriatric unit Javier Montero Muñoz 1 , Pablo Enrique Solla Suárez 1 , Cristina Guirola García-Prendes 1 , Francisco Jiménez Muela 1 , Laura Gómez Armas 1 , Marta Martínez Rivera 1 , Alberto Domínguez Bravo 1 , José Gutiérrez Rodríguez 1 1 Á rea de Gestión Clínica de Geriatría, Hospital Monte Naranco, Oviedo, Asturias, Spain Introduction: Several prognostic factors have been described in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, no studies analyze the impact of known factors associated with poor outcomes in older patients like functional dependence or cognitive impairment. The objective of this study is to identify factors associated with in-hospital mortality in patients older than 80 years admitted with diagnosis of coronavirus disease 2019 .

Methods: a retrospective observational study was carried out with data from patients older than 80 years admitted to an Acute Geriatric Unit with a laboratory-confirmed diagnosis of COVID-19. Sociodemographic, functional, cognitive, comorbidity and laboratory variables were collected. An univariate analysis to identify mortality associated factors was performed. Results: 58 patients were recruited. The median age was 89 (85-92), 69% were women, 65.5% had moderate-severe cognitive impairment and median previous Barthel Index was 35 (0-73.8) . 70.7% were institutionalized. The mortality rate was 41.4%. Factors associated with mortality were Barthel Index \ 40 (OR = 3.8 [1.2-12.2] ), cognitive impairment (OR = 5 [1-25.3] ), chronic kidney disease (OR = 3.2 [1.1-9 .7]), white blood cells count (p = 0.037), LDH (p = 0.019), procalcitonin [0.5 ng/mL (OR = 3.9 [1.03-15] ) and viral load [100.000 copies/1000 cells (OR = 5.5 [1.4-22.1] ). Key conclusions: Our results suggest that cognitive and functional impairment could be prognostic factors in COVID-19.This strengthens the value of comprehensive geriatric assessment in decision making given a new outbreak. Also, the association observed with bacterial superinfection markers or viral load and mortality could help identify those elderly patients with more potential to benefit from certain treatments like antibiotics or antiviral therapy.

Results: Before hospital admission, the 50 inpatients (median age: 88 years; 54% men; 46% living in nursing home) had cognitive impairment (54%), malnutrition (40%), major polymedication (C 10 daily drugs: 36%) and were severely/very severely frail (52%) according to the clinical frailty score [1] (median 7; range 4-8). In 36% of the patients, the first COVID-19 manifestation was atypical (severe fatigue, fall, diarrhoea, delirium-related symptoms) without fever or respiratory symptom. The IHM rate was 52% as 26 patients died in hospital and 24 patients were discharged alive. The risk of inhospital death was associated (p \ 0.05) with age (Hazard ratio (HR) = 1.10 per year), chronic respiratory disease (HR = 4.72), marked lung infiltrates (HR = 3.11) and cerebral apathy (HR = 2.47) upon COVID-19 diagnosis, but not associated (p[0.15) with male gender, nursing home residency, cognitive impairment, malnutrition and severe/very severe frailty. Conclusions: This is the first cohort study with complete follow-up until hospital discharge in geriatric inpatients with COVID-19. Further research is needed to determine the IHM and its predictors in these high risk inpatients. 

Background: Little is known at the end of spring 2020 about inhospital mortality (IHM) rates of older inpatients with COVID-19. Valid IHM rate calculations require a cohort study design with complete follow-up of all patients until hospital discharge. The aim of this study was to describe IHM rates in older patients (C 65 years) with COVID-19. Methods: Medical literature review from December 1, 2019 to June 17, 2020 of cohort studies including older patients (OP) with COVID-19. The outcome was the patient's vital status (death or alive) upon hospital discharge. Results: Twenty cohort studies selected and compared OP with the outcome at a certain hospital date (censoring bias). Four cohort studies completed the OP hospital follow-up, allowing calculation of the IHM rate. The IMH rate was 26.2% in 65 OP of the Pulmonary hospital in Wuhan [1] , 34.5% in 55 OP of the Zhongnan hospital in Wuhan [2] , 35.3% in 17 OP of the Dabieshan Medical Center in Huanggang [3] and 41 in Wuhan, China (2019) : a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci. 2020.

3. Yao Q, Wang P, Wang X, Qie G, Meng M, Tong X et al. A retrospective study of risk factors for severe acute respiratory syndrome coronavirus 2 infections in hospitalized adult patients. Pol

Introduction: COVID-19 created an unforeseen pandemic, mainly afflicting an older population. As an unknown disease, it lead to a high number of hospitalizations with scarce information on consequences on physical and mental health. The aim of this study was to compose and implement a short and feasible multi domain screening assessment to evaluate hospitalized COVID-19 patients to determine their further needs for adequate care and rehabilitation. Methods: A multidisciplinary expert panel agreed on a fixed combination of existing screening tools, taking into account the necessary hygienic aspects. It was gradually implemented with medical stable inpatients in the University Hospitals Leuven (Belgium) and data were analysed retrospectively. Results: Hand grip strength, timed chair stand test (TCS), Barthel index, swallowing screening, Nutritional Risk Screening 2002, HADS (Hospital Anxiety and Depression Scale) and MoCA (Montreal Cognitive Assessment) were agreed upon. Preliminary analysis showed that only 6% of the older ([ 70 year) patients were able to perform the TCS within 14 s. Around one third of patients showed significant anxiety or depressive symptoms. 75% had a score of 26 or less on the MoCA. 62% of older patients demonstrated severe functional impairment (Barthel \ 9). Conclusion: A large majority of hospitalized COVID-19 patients show problems or deficits in either physical, functional or mental domains, demanding adequate therapy and follow up after discharge. Especially the impact on older persons and their strength was striking, implying the need for a good discharge planning with adequate follow-up and evaluating the need for in-or outpatient rehabilitation programs.

Mortality rate and the factors associated to it due to COVID-19 infection in people aged 90 or more in a Spanish hospital Introduction: Mortality related to COVID-19 is higher in the elderly population. The purpose of this study was to compare the clinical features of elderly (EG) and young and middle-aged (YM) patients with COVID- 19 and analyze mortality predictors.Methods: Retrospective, single center study including patients hospitalized due to COVID-19 infection, from 13 March to 15 June 2020. Results: Of the 195 patients analyzed, 50.8% were female, 111 (56.9%) patients had C 65 years (EG) (median age 79 [65; 94]), of which 45% had C 80 years. 84 patients were YM (median age 50 [22; 54] ). EG had multimorbidity: hypertension, diabetes, heart failure and coronary disease (p \ 0.001). At admission Early Warning Score-2 (p \ 0.001), c-reactive protein (CRP), D-dimer, creatinine, anemia and lymphopenia were higher in EG. Median time of hospitalization was higher in EG (14 vs 10 days, p = 0.004). Complications were more common in EG, bacterial infection (56% vs 32%) and acute kidney injury (31 vs 19%) . There were no significant differences in admission to intensive care. There were 18 deaths (mortality 9, 23%), 16 in EG, 13 (81%) among patients aged C 80 years, 2 deaths in YM (p = 0.004). Modified Early Warning Score (MEWS) at admission (OR 1.60, 95% CI 1.07-1.37, p = 0.021) and CRP above 5 mg/dL (OR 2.12, 95% CI 1.13-26.26, p = 0.034) were independent predictors of mortality in EG. Conclusion: EG were at higher risk for complications and had higher mortality. Identification of specific scores of severity for this population, like MEWS at admission and CRP, is essential to ensure that best care is provided to these patients.

Introduction: Large volumes of recently published COVID-19 data makes it strenuous to effectively assess patterns in disease presentation and key clinical features in the older population. A concise qualitative summary of clinical characteristics, in light of most recently published data, allows for improved understanding, better clinical judgement, and guides efforts towards insufficiently researched aspects of disease. Methods: Qualitative systematic review was performed concerning all articles published from 1st of January to 1st of June 2020, using the keywords COVID-19 and SARS-CoV-2 followed by the generic terms elderly, older adults or older individuals. Following the extraction of data, summarized findings were then given confidence scores by an adaptation of the STROBE statement and CERQual approach. Results: In total, 1598 articles were screened, of which 20 studies were included in the final analysis, pertaining to 4965 older COVID-19 patients (C 60 years old). Fever, cough, dyspnea, fatigue, and sputum production were the most common symptoms observed. Changes in laboratory findings indicate lymphopenia, inflammation, and occasional organ damage. Renal injury was the most common complication. Roughly 70% of the older adults required supplementary oxygen, while invasive mechanical ventilation was required in almost a third of the patients. Patients with recorded outcome had a mortality rate of 20.0% (907/4531). Confidence in findings varied. Conclusion: Variety in symptom presentation is to be expected, and abnormalities in laboratory findings are present. Risk for mortality is evident, and attention to the need for supplementary oxygen and possible mechanical ventilation is advised. Presented literature may allow for the construction of better predictive models of COVID-19 in older populations. 1 

Introduction: Delirium is associated with poor outcomes. Early reports of covid-19 in older adults suggest delirium is common. Our primary aim was to assess the prevalence and outcomes of delirium in COVID-19. A recent national delirium audit suggested delirium may be under-diagnosed in frailer individuals. We also assessed the relationship between frailty and delirium recognition. Methods: This was a retrospective observational study of consecutive patients with community or hospital acquired COVID-19 in a Scottish geriatric unit. ''Recognised Delirium'' was identified if delirium or cognitive change was described in medical notes, 'Unrecognised Delirium' if delirium screening suggested delirium but there was no description of cognitive change. Frailty was assessed using the Clinical Frailty Score (CFS) and compared across the three groups: no delirium, recognised delirium, unrecognised delirium. Results: 158 individuals were studied. Average age was 82.5 ± 7.6 years, 61% were female. 67 (42%) had recognised delirium, 23 (15%) unrecognised delirium and 68 (24%) no delirium. Mortality was lower in those with delirium than those without, but the difference was not statistically significant (12 versus 22%, p = 0.099). People with unrecognised delirium had higher mortality than those with recognised delirium (30 versus 6%, p = 0.002). CFS (median, IQR) was 6 (6-7) without delirium, 6 (6-7) with recognised delirium and 7 (6-7) with unrecognised delirium. Conclusions: Delirium is common in COVID-19. The highest mortality was in people with unrecognised delirium. They had a slightly higher frailty score which may have impacted on delirium recognition. Screening for delirium at COVID-19 diagnosis may help improve care for this vulnerable group.

Multidimensional frailty, not chronological age, is associated to outcomes in respiratory diseases: Implications for the COVID- Background: Due to the current COVID-19 pandemic, medical professionals around the world are facing a variety of challenges. In some countries it has not been possible to provide all required ventilation therapy due to lack of resources. Difficult decisions had to be made with respect to triaging and chronological age was often used as a criterion. The aim of the present study was to retrospectively assess the clinical characteristics of older patients with respiratory diseases experiencing different outcomes from hospitalization to admission to intensive care unit (ICU), to treatment with non-invasive versus invasive ventilation, to death. Patients and Methods: The patient collective under investigation is based on four prospective studies conducted at the University Hospital of Cologne between 2016 and 2020. A total of 1.276 older multimorbid patients previously recruited in prospective studies in the emergency department (ED), the ICU and the internal acute care unit were screened for the presence of respiratory diseases as main diagnosis (acute or chronic pulmonary disease) as well the availability of data from a Comprehensive Geriatric Assessment (CGA) with prognosis calculation using the Multidimensional Prognostic Index (MPI) at admission. The MPI considers the functional, social, physical and psychological aspects of the patients and provides continuous values between 0 and 1, which can be subdivided into three risk groups for mortality and rehospitalization, MPI-1 (0.00-0.33), MPI-2 (0.34-0.66) and MPI-3 (0.67-1.00). Furthermore, acute respiratory stress syndromes (ARDS), tracheotomies, duration, frequency and cause of ventilation therapy, infections of the respiratory tract and antibiotics/ virustatics were recorded. Results: Of the patients' records screened, 237 (M 146, F 9178.1-5.9 years)met inclusion criteria. Ventilation therapy (V) was received by 46 (19.4% ) of the patients. The patients who received V tended to be chronological younger than non-ventilated patients (NV) (median 76.5 (70-82) vs. 78.0 (75-82) years; p-value 0.073). Patients in the V group were significantly more male than those in the NV group (73.9% vs. 26.1%; p-value 0.039). The mean MPI value at admission was 0.61 (± 0.20) in V patients and 0.50 (± 0.17) for NV patients (p \ 0.001). V patients belonged more often to the MPI-3 than NV patients (41.3% vs. 22 .0%) and less to the MPI-1 group than NV patients (10.9% vs. 20.4%; p = 0.020). V patients' length of hospital stay was significantly longer than in NV patients' (14.0 vs. 9.0 days; p = 0.006) and V patients had a significant higher heartbeat at admission -prior to being ventilated -than NV patients (92.0/min vs. 77.0/ min; p = 0.039). Thirty-seven% of V patients suffered from a hospital acquired pneumonia before they had to be ventilated (16.8% of NV patients; p = 0.003). Conclusion: Despite the retrospective nature of the data, a correlation between MPI and ventilation therapies could be observed in older patients affected by respiratory disease, suggesting that multidimensional frailty as a surrogate marker of biological age is a major determinant of patients trajectories for respiratory outcomes. As ventilated patients were younger than nonventilated patients, biological age appears more predictive than chronological age as far as poor outcomes are concerned in this patient population. Further research is needed to establish meaningful correlations between ventilation therapies and MPI, but multidimensional frailty should be systematically addressed in life-threatening conditions such as the COVID-19 disease in order to meet correct clinical and ethical decisions.

The show must go on: teaching geriatric medicine during Covid-19 lock-down bilateral pulmonary opacities predominantly peripheral and pneumonic in appearance associated with a diffuse prominence of the bronchovascular network. CURB65 scale: 3 points. Hydroxychloroquine treated. After this episode, in subsequent medical consultation, the patient described loss of appetite after having suffered Covid-19 with dysgeusia associated with anosmia. Weight loss of 15 kilos in 3 months. Endoscopy study was completed without significant alterations; Abdominal CT with a result of cholelithiasis; Brain CT without pathology; Chest CT scan shows extensive bilateral lung involvement with fibrosis in the lower lobes; Analytics without significant findings. Given the result of complementary tests, the patient is diagnosed with dysgeusia as a secondary complication of the covid-19 virus. The COVID-19 pandemic represents a new challenge for global health. In this clinical case, the importance of its secondary complications stands out. Coronoviruses not only affect the respiratory system, but also have deleterious effects on the central nervous system. CoV is reported to be found in the brain or cerebrospinal fluid. The pathobiology of these neuroinvasive viruses is fully known.The well-recognized symptoms of COVID-19 include fever, cough, dyspnea, sputum production, myalgia, arthralgia, headache, diarrhea, nausea/vomiting, and sore throat.There is growing evidence that olfactory dysfunction can occur in patients with Taste depends on the activity of specialized epithelial cells, the taste cells, which are found mainly in the mucosa of the tongue.The frequency of smell and taste disorders is high (49.8% (95% confidence interval, 8.2-91.5%, I 2 = 99.6%) as other symptoms, so recent Studies indicate that at least anosmia could be included in the symptom lists of COVID-19. Although there is promising evidence, it is premature to conclude that smell and taste disorders are strongly associated with the diagnosis of COVID-19. Multiple cross-sectional studies have shown that the incidence rate of olfactory dysfunction in COVID-19 patients ranges from 33.9 to 68% with a female predominance. The early olfactory recovery rate in recent studies is 44%.Recent findings could show that SARS-CoV-2 could enter taste cells through Angiotensin Converting Enzyme 2 and as a consequence, the normal functioning of these sensory cells would be disrupted. For its treatment, due to neuronal involvement, treatments such as pregabalin are recommended. 1 Pharmacy Service. Virgen del Rocio Universitary Hospital, 2 Pharmacy Service.Virgen del Rocio Universitary Hospital Objective: to analyze the characteristics of the patients treated with tocilizumab, as well as its effectiveness in the treatment of SARS-CoV-2 infection. Material and methods: Patients admitted to the intensive care unit (ICU) with severe SARS-CoV-2 infection, who received tocilizumab, according to the indications established by the Spanish Agency for Medicines and Health Products (AEMPS) during the months of March-May 2020 were included. The variables were collected: sex, age, weight, height, body mass index (BMI). As risk factors for cardiovascular disease, the presence of hypertension, diabetes and dyslipidemia was recorded. If the patient suffered from another underlying chronic disease (heart failure, chronic kidney failure, cirrhosis, liver transplantation, oncological disease, chronic obstructive pulmonary disease, asthma, bronchiectasis, neurological disease), it was classified as high-risk comorbidity. The date of onset of symptoms of SARS-CoV-2 infection and the date of administration of tocilizumab, the dose and the number of administrations were collected. As a primary objective, the variation of the acute phase reactants (CRP, fibrinogen, lymphocytes and D-dimers, before and 5 days after the first dose) were collected. The t-student test was applied for paired samples (p.05). The secondary objectives were the stay in the ICU (days) and the number of deaths. The data were analyzed with the SPSS statistical package. Results: 18 patients were included, 15 men. The mean age was 66.77 years (47-80). The mean BMI was 29.55Kg/m 2 , 27.77% of the patients were obese and 50% suffered from pre-obesity (BMI: 27-29.9). Regarding cardiovascular risk factors, 11 were hypertensive, 5 were diabetic and 10 were dyslipidemic. Six patients had highrisk comorbidity and 4 had no risk factors or comorbidity. The administration of tocilizumab with respect to the onset of symptoms presented a median of 9 days (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) . The mean dose received was 600 mg (4 received 3 doses, 5 patients 2 doses and 9 patients 1 dose.) At 5 days after the first dose, on average, CRP decreased 207.84 95% ], fibrinogen decreased 2.73 95% CI [1.52-3.93 ], and lymphocytes increased 0.311 95% CI [0.12-0.49], all reaching

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 statistical significance. The D-dimers increased on average 5254.66 95% CI [ (-4158.06 to 14667.40 )] (p \ 0.251). Finally, the mean stay in the ICU was 17.5 days . There were 6 deaths, of which 4 had high-risk comorbidity, 5 were hypertensive and dyslipidemic, and only 1 was diabetic.

Conclusions: A majority of the patients admitted to the ICU who received tocilizumab are obese or pre-obese older than 65 years, hypertensive and dyslipidemic. The use of tocilizumab is statistically significantly associated with an increase in lymphocytes and a decrease in fibrinogen and CRP at 5 days after the first dose, but not with D-dimers. The number of deaths was low. Hypertension and dyslipidemia stand out as prevalent risk factors among the deceased. More studies are needed to evaluate the efficacy of tocilizumab.

Introduction: Among COVID-19 cases, especially the (frail) elderly show a high number of severe infections, hospital admissions, complications, and death. The highest mortality is found between 80 and 89 years old. Why do these patients have a higher risk of severe In this review we address potential mechanisms regarding viral transmission, physical reserve and the immune system, increasing the severity of this infection in elderly patients. Observations: First, the spread of COVID-19 may be enhanced in elderly patients. Viral shedding may be increased, and early identification may be complicated due to a typical disease presentation and limited testing capacity. Applying hygiene and quarantine measures, especially in patients with cognitive disorders including dementia, can be challenging. Additionally, elderly patients have a decreased cardiorespiratory reserve and are more likely to have co-morbidity including atherosclerosis, rendering them more susceptible to complications. The aging innate and adaptive immune system is weakened, while there is a pro-inflammatory tendency. The effects of SARS-CoV-2 on the immune system on cytokine production and T-cells, further seem to aggravate this pro-inflammatory tendency, especially in patients with cardiovascular comorbidity, increasing disease severity.Conclusions: The combination of all factors mentioned above contribute to the disease severity of COVID-19 in the older patient. While larger studies of COVID-19 in elderly patients are needed, understanding the factors increasing disease severity may improve care and preventative measures to protect the elderly patient at risk for (severe) COVID-19 in the future.

First wave of COVID-19 in the oldest-old in the acute hospital in Belgium: a retrospective multicenter study describing clinical characteristics, treatment limitation decisions and in-hospital mortality related to frailty and respiratory failure observations were collected from their initial hospital electronic record and analysed.

Results: A total of 225 patients were included, of whom only 11.5% (n = 26) presented with the trio of cough, fever and breathlessness. However, 68 (30.2%) did not present with any of these symptoms (p \ 0.001). The most frequent atypical complaints were 'generally unwell' (n = 46, 20%), falls (n = 43, 19%) and confusion (n = 37, 16%). In comparison to patients presenting with a temperature C 37.6°C (n = 73, 32.4%), 81 (36.0%) recorded a normal temperature of 36.5-37.5°C (p[0.05) and 20.4% (n = 46) had a temperature\36. 4°C (p = 0.0003). Conclusion: A significant proportion of geriatric patients with COVID-19 presented with atypical symptoms and observations. The relatively high number of falls in this cohort highlights the need for thorough history-taking, as well as accurate rapid diagnostic testing for SARS-CoV-2 to allow effective infection control in the hospital setting.

Diagnostic utility of baseline chest radiography among older patients with Coronavirus Disease 2019 Patrick Crowley 1 , Elizabeth Moloney 1 , Ronan O. Caoimh 1 1

Introduction: While reverse-transcriptase polymerase chain reaction (RT-PCR) is the diagnostic reference standard for COVID-19, the test is limited by high false negative rates and delay in reporting results [1] . Radiology is an essential aid to diagnosis and prognostication [1] . Although computed tomography (CT) is the most sensitive and specific modality [1] , it is limited by increased radiation exposure and issues relating to availability and infection control [2] . While existing studies report relatively poor sensitivity for chest radiography [2, 3, 4] , older patients often present with more advanced lung involvement [1, 3, 4] . The purpose of this study is to evaluate the diagnostic utility of baseline chest radiography among older patients with Methods: This retrospective study involved patients over 70 years of age who were diagnosed with COVID-19 by RT-PCR between 27th February and 24th April 2020 at three hospitals in Cork, Ireland. Chest radiography findings were based on the initial radiology report. Results: 69 patients were diagnosed with COVID-19. 40 (58%) were male and 29 (42%) were female. The mean age was 80.65. Of the 62 patients who had baseline chest radiography, 9 (14.5%) were radiologically negative while 53 (85.5%) had reported abnormalities consistent with COVID-19. Males (89.2%) were more likely to have abnormal findings than females (80%). 51% had bilateral lung involvement. 24.5% had only right-sided involvement. 24.5% had only left-sided involvement. 75.5% had predominantly mid-lower zone involvement. 3.8% had only upper zone involvement. 20.7% involved both upper and lower zones. Key Conclusions: Baseline chest radiography is a useful tool for diagnosing COVID-19 among older patients. The recognition and characterization of the frail older adults is essential in Covid-19's fight strategies. They are critical to develop a special plan for geriatric care due to the high vulnerability and preexisting health conditions of this group. The ''shared decision making'' with the patient and family is particularly important in this context. Within a Project of integrated assistance to older people at risk of functional decline in the COVID-19 pandemic in Belo Horizonte, a cross-sectional this study was carried out with the aim of identifying fragile older people and broadening the understanding of preferences, care models in this group. In the quantitative step, the self-administered questionnaire with easy access and understanding made available on electronic means applied to 410 older adults was used. Three hundred eighty one was recruited to this study. In the qualitative step, 50 older adults participated in semi-structured interviews by videoconference, telephone call or presential encounters. Specialized care for the older adults involves appropriate communication strategies, shared decisions and prognosis definitions. Understanding the specificities of this group and anticipating advance directives can mitigate the overload in emergency care and intensive care units. Key words: frailty, screening, covid19, healthy policy, care planning.

Virtual (Telephone/video) clinics as an outpatient clinic alternative for older people in the COVID 19 pandemic Atef Michael 1 1 Russells Hall Hospital, Dudley, UK Introduction: During the COVID 19 pandemic, hospitals have had a heavy workload and obviously represent an environment with potential high COVID 19 antigen load. To reduce the risk of spread of infection many outpatient clinics in the NHS hospitals across the UK, have been cancelled/postponed, and a follow up alternative has to be found. An attractive alternative is telemedicine; a virtual clinic as a telephone or video consultations. The advantages and disadvantages of the virtual clinic and when it can and cannot be used in older people will be briefly discussed. The lists are not exhaustive, but represent general and broad outlines and consideration to guide practice and decision-making. Virtual clinics can be used to:

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

• Review the results of previously requested investigations and decide further action.

• Know the impact of newly started or reduced medications• Assess recovery following operative procedures.

• Triage and prioritize patients to identify those who need a face-toface consultation.

• Notice incompleteness, incorrectness and ambiguities of previous plans in the discharge summaries or clinic letters • Follow up of some previously diagnosed chronic diseases.

• Treat some acute minor conditions e.g. common cold Virtual clinics cannot be used in:

• First outpatient clinic consultation in many disease conditions . • Medical emergencies or markedly unwell patients.

• Patients with red flags.

• Patients with suspicion of malignancy.

• Assessment of patients with neurologic deficit Advantages of virtual clinics:

• To save older people, relatives and carers the time, transport expenditure and effort and may be travelling long distances.

• To provide more convenient care • To reduce the risk of exposure of older people to infection.

• To save physicians and health care professionals time and movement between hospital sites or clinics.

• To reduce unnecessary attendance at the hospital and increase the outpatient clinic capacity.

• To reduce carbon emissions Disadvantage of virtual clinics:

• There could be technological, societal or professional barriers.

• Not all older patients have access to video consultation facilities.

• It might not be a practical option for older people who are hard of hearing or with poor vision or who have some memory impairment or lack of dexterity.

• Inability to examine the patient and missing physical findings.

• Possibility of missing serious pathology; this can represent medico legal liability.

• Virtual clinics could be time consuming. And in case of telephone calls:

• Physicians are unable to use ''Looks well ''or ''looks unwell'' valuable summative clinical impression. .

• Inability to assess body language.

• Inability to observe crucial physical.

• Inability to objectively have evidence of improvement or otherwiseConclusions:

• The face-to-face medical consultation remains the gold standard however there could be situations when an alternative may be considered more appropriate.

• Virtual clinic is a viable option to be considered for follows up of older patients during the COVID 19 pandemic.

• Video consultations, compared to the telephone ones, allow more interaction with patients and have the advantage of more visual clues and would provide much more information. However many elderly may not be geared to use such technology.

• The decision to have a virtual clinic should be individualised.

• The physicians need to be aware of the limitations and the medico legal consequences.

• It is important to share a summary of the virtual consultation outcome with the patient, e.g. via a letter or an email.

• The virtual clinics will be refined, modified and improved with guidelines to identify indications and ''contraindications'' to ensure safe effective clinical care.

Lance-Adams syndrome in an octogenarian woman with SARS COV-2 pneumonia: case report Pamela Lisette Carrillo Garcia 1 , Blanca Garmendia Prieto 2 , Sagrario Pérez Delgado 3 , Jorge Artero Ortiz 4 , Javier Gómez Pavón 3 1 Hospital Central de La Cruz Roja. San José y Santa Adela, 2 Hospital Central dela Cruz Roja. San José y Santa Adela, 3 Hospital Central de la Cruz Roja. San José y Santa Adela, 4 Hospital Central de la Cruz Roja. San José y Santa Adela.

Introduction: Lance-Adams syndrome (LAS) is a condition characterized by development of chronic post-hypoxic action myoclonus due to a temporary lack of or inadequate brain oxygen supply 4. LAS is a rare complication 3.Clinical presentation is action myoclonus and problems in cognitive function 4, 5, 6.

Case report: An 82-year-old woman was admitted having presented SARS-CoV-2 pneumonia. After clinical, radiological and analytical worsening with signs of acute respiratory distress syndrome required admission to ICU, Orotracheal intubation was needed for 6 days. During her staying in the ICU, she had many complications: Pneumomediastinum and probable interstitial emphysema in possible relationship with barotrauma, acute renal failure, and bacterial superinfection .She received the following treatments: Lopinavir/Ritonavir, Hydroxychloroquine, Ceftriaxone, Azithromycin, Corticosteroids and Enoxaparin. After staying in the ICU, she presented tremor in right upper limb that radiated to the lower limb on the same side, which difficulted the ambulation. Brain MRI: oval areas of ischemia in protuberance, midbrain and semioval center. Metabolic disorders were ruled out.She was evaluated by t neurologist and was diagnosed Lance-Adams Syndrome. Treatment with clonazepam. The patient received physical rehabilitation treatment. Conclusions: Many cases of LAS are related to cardiac arrest and subsequent resuscitation; in this case myoclonus is described in a patient who presented hypoxemic state without cardiac arrest. Pharmacological treatment has not been established. In our patient clonazepam was sufficient to control the myoclonus.We emphasize that early diagnosis is necessary in order to start appropriate treatment: pharmacological and rehabilitation .

Early digital rehabilitation program for hospitalized Yael Adoni Tamir 1 , Ron Cialic 1 , Orly Barak 1 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Introduction: The COVID-19 pandemic presented us with unique challenges. COVID-19 patients are prone to develop severe respiratory failure and debilitating deconditioning. In addition, COVID-19 patients are physically and socially isolated. The care of these patients necessitate innovative approach.. We present a model, based on combined digital and hands-on tool, designed to provide early comprehensive rehabilitation for isolated patients. Methods: BitesÓ is a digital platform for sharing video-based interactive presentations. We used Bites to create a collection of education and training videos encompassing various biopsychosocial domains. These videos are sent to the patient via smart phone, enabling to deliver content tailored to the patient needs. A multidisciplinary based protocol directs the usage of this platform in an earlyrehabilitation program, comprised of digital and hands-on interventions.

Introduction: Karin Grech Hospital (KGH) is Malta's main rehabilitation hospital with over 300 in-patient beds, outpatients and multidisciplinary clinics. During the COVID-19 pandemic, KGH set up its own pandemic risk modification plan which met the hospital specific needs without deviating from the national practice guidelines stream.

Method: The management plan was designed in a triple axis fashion; Professional & Clinical: Staff received training and simulation for COVID-19 care and prevention. Admissions were suspended until a safe admission pathway was drafted. Outpatient clinics were stopped. Protocols for isolation, contact tracing and quarantining of inpatients were developed.Managerial: A task force was created to develop protocols. Rosters were adjusted and meetings conducted virtually to minimize staff contact.Infrastructural: A ward equipped for isolation of COVID-19 cases was added, and necessary personal protective equipment supplied. Staff was split into COVID- to prevent cross infection. Results: Staff felt prepared to confront the pandemic before the onset of the COVID-19 outbreak in Malta. Suspension of admissions until a safe pathway was created decreased the number of positive patients. The few cases of COVID-19 positive patients were quickly identified and isolated, without spread within wards. Staff shortages due to mandatory quarantine presented significant challenges which were overcome with good team-work and planning. Despite the staff shortages and restrictions patient rehabilitation was achieved. Conclusion: Thorough planning, safe practice, and a willingness to adapt to challenges lead to the successful management and containment on COVID-19 cases, while maintain a rehabilitation in-patient service.

Hospital trainees'' worries, percieved sufficiency of information and reported psychological health during the Covid19 pandemic Aria Khani 1 , Nikoo Aziminia 1 , Colette Smith 2 , Ameet Bakhai 1 , Clifford Lisk 1 1 Barnet Hospital BH, 2 University College Hospital UCH Introduction: During the A/H1N1 influenza pandemic, healthcare workers presented frequent concerns regarding their health, their families health as well as high levels of psychological distress. We assessed hospital trainees' concerns, perceived sufficiency of information, behaviour and reported psychological health during the COVID 19 pandemic. Method: Between May 1st and 23rd 2020, 204 trainees of an NHS Foundation trust completed a questionnaire regarding worries and concerns about the new COVID19 pandemic. Results: 92% looked after COVID19 patients. 92% were worried about COVID19; the most frequent concern was that of family and friends dying from COVID19 (75%). 22% reported infection with COVID19. 7% of trainees were so concerned about COVID19 infection that they would avoid going to work. Perceived sufficiency of information about COVID19 was moderately high. 26% reported that they were able to socially distance at work compared to 94% able to socially distance outside work. 42% reported that their psychological health had been affected by their work with the commonest being anxiety (57%), emotional distress (51%) and burnout (38%). 96% think it is important to have a service that provides psychological support during this pandemic; only 62% would consider its use at work. Conclusions: A significant proportion of hospital trainees are worried about the COVID19 pandemic with high levels of reported psychological distress. Given that almost a third would not use psychological support services at work, hospital leaders and liaison psychiatry need to explore the reasons for not wanting to use services at work and consider providing psychological services outside work.

Rationale: COVID-19 entered Belgium in the beginning of March 2020 and resulted in organization of hospital surge capacity to accommodate COVID-patients. Nursing homes (NH) in Belgium closed their doors for visitors on March 17th, 2020. With the focus on hospital COVID-management, the situation in nursing homes remained under the radar until COVID-outbreaks and deaths were increasingly reported from the end of March on. By the end of May more COVID-related deaths have occurred in nursing homes (n = 4742) than in hospitals (n = 4488).This Abstract reports the goals and results of the rapid response network for COVID-19 management in nursing homes (RRNWNH), initiated in the beginning of April 2020 in the Leuven region, Belgium. Methods: The RRNWNH consisted of 3 main partners: hospitals (n = 2), NH management (n = 58) and coordinating general practitioners (CGP's) of NH (n = 58). A steering committee of hospital nursing directors (n = 2), geriatricians (n = 3), CGP's (n = 4) and clinical process managers (n = 4) coordinated actions in the RRNWNH. These actions consisted of creating a website, monitoring tool and an intervention and follow-up log tool for the RRNWNH partners, a hotline for CGP's, an on demand outreach Nose Throat Ear physician swabteam, educational webinars and intervisions with NH, onsite medical and infection control advice, secondment of hospital nurses and PPE purchase/exchange. Results: Weekly online meetings were set up with the partners of the RRNWNH and the steering committee to discuss COVID-outbreaks and actions. The website offers NH all necessary contact information and links to educational material and network reports. The monitoring tool was used by 31 NH (1 -33 registrations per NH) depicting COVID-cases and mortality in residents and health care workers (HCW), HCW absence and personal protective equipment (PPE) needs. The intervention and follow-up log tool allowed to communicate and coordinate interventions in the different NH's. This allowed medical (geriatricians and CGPs) and infection control advice by advanced clinical practice nurses on site. CGP's contacted geriatricians, gerontopsychiatrists, palliative care physicians and hospital epidemiologists also via the hotline for specific urgent matters. The swabteam screened 1337 residents and 1534 HCW in 16 NH with COVID-outbreaks. Weekly infection control webinars were followed by ± 20 NH. 27 hospital nurses worked 118 shifts in 7 NH with HCW shortage due to COVID-outbreaks. FFP2 sterilization and apron purchase was centralized for several NH. Conclusion: Our RRNWNH was perceived as an urgent need and added value for a vulnerable sector in this COVID crisis. The network enabled the detection of COVID-related problems in NH, prioritization of and response to specific medical, infection control, educational, staffing and material needs. The RRNWNH forms the basis for a more preventive approach in the future and for the development of a long-lasting integrated care network between the partners involved.

Lessons learnt from COVID-19 related end of life care -a review of deaths from a london district general hospital Antony Zacharias 1 , Resham Arain 1 , Ku Shah 1 , Sheena Mitchell 1 1 The Whittington Hospital, London Introduction: In the United Kingdom in 2020, SARS-CoV-2 is the leading cause of death, and age is the most predictive factor [1, 2] . We present a review of such deaths from geriatric wards in a district general hospital between 15th March and 30th April 2020. Method: Structured judgement reviews were retrospectively completed for 18 patients using physical and electronic records. Avoidability of death and care quality were graded using the 'Avoidability of Death Judgement Score' and 'NCEPOD Classification of Care' [3, 4] . Results: The mortality rate was greater for patients with, compared to those without, . The mode avoidability score was 6 (range 5-6). All patients had an appropriate treatment escalation plan. Sixteen were recognised as 'end of life' (EoL) and received anticipatory medications. 37.5% were not referred to palliative care due to rapid deterioration. Those that were, received anticipatory medications more proactively (80% versus 62.5%), and fewer continued 'active management' (40% versus 75%). Next of kin were regularly updated in 15 cases (83.3%) with facilitated video calls. In six cases, ward moves led to reduced quality of care, namely miscommunication of target oxygen saturations and care shifting from comfort prioritisation. Deprivation of Liberty Safeguards were submitted for only 27.3% of patients that lacked capacity. Conclusions: Our review demonstrates a high standard of EoL care provided in uncertain times. Early involvement of the multidisciplinary team improved care, whereas inter-ward transfers tended to detract from this. Greater detail will be available in our final presentation. References: [1] Campbell A, Caul S. Deaths involving COVID-19, England and Wales. Office for National Statistics 2020. [2] The Economist. Tracking covid-19 excess deaths across countries. The Economist 2020. [3] Confidential Enquiry into Patient Outcome N, Death. NCEPOD grading system for use by case reviewers. NCEPOD 2020. [4] Hutchinson A. Using the structured judgement review method 2016.

Prognostic value of lung ultrasound in older nursing home residents affected by COVID-19

Nicola Veronese 1 , Luca Gino Sbrogiò 1 , Roberto Valle 1 , Laura Marin 1 , Elena Boscolo Fiore 2 , Andrea Tiozzo 1 1

Background: Lung ultrasound (LUS) imaging may play an important role in the management of patients with COVID-19-associated lung injury, particularly in some special populations, such as pregnant women. However data regarding the prognostic role of the LUS in nursing home residents, one of the most affected populations by COVID-19, are not still available. Methods: Nursing home residents were followed-up with a LUS from 08th April to 14th May 2020 in Chioggia, Venice. COVID-19 was diagnosed through a nasopharyngeal swab. LUS results were scored according to previous works on COVID-19 pneumonia using a 12-zone method, with a score from 0 to 12, higher scores reflecting more pneumonia severity. Mortality was assessed using administrative data. Data regarding accuracy (and related parameters) were then reported. Results: Over 175 nursing home residents, 48 (mean age: 84.1 years; 39 females) were affected by COVID-19, with 12 died during the follow-up period. The mean LUS score was 3. The area under the curve of LUS in predicting mortality was 0.603 (95% confidence intervals: 0.419-0.787). Taking score[4, the sensitivity in predicting mortality was 58.33%, specificity 63.89%, a positive likelihood ratio of 1.62 and a negative of 0.65. Conclusions: LUS is able to significantly predict mortality in nursing home residents affected by  indicating that this simple tool can be routinely used in this setting instead of more invasive techniques available only in hospital.

Hospital doctors perspectives of social distancing and solutions during The Covid19 pandemic Aria Khani 1 , Nikoo Aziminia 1 , Colette Smith 2 , Ameet Bakhai 1 , Clifford Lisk 1 1 Barnet Hospital BH, 2 University College Hospital UCH In response to the COVID19 pandemic, the UK government announced social distancing as part of measures designed to reduce the spread of coronavirus. We aimed to assess perspectives of hospital doctors in training on social distancing and solutions for their workplace in hospital.Between 1st and 23rd of May 2020, trainees at a UK NHS foundation trust were asked to complete a questionnaire regarding social distancing and perceived solutions for the workplace.204 trainees responded. 60% were female with 37% of respondents being Specialist Registrars. 26% reported that they socially distanced themselves at work compared to 94% socially distancing themselves outside work. The commonest reasons for not socially distancing at work were stated as ''unable to socially distance during ward rounds'' (72%) and ''unable to socially distance during board rounds due to the size of the room'' (68%). Options suggested to enable social distancing at work include larger offices (85%), more computers (76%), larger recreational spaces (62%), EPR access at home (49%) and remote ward rounds (38%).With the ongoing pandemic, social distancing measures are likely to be required for some time. It is therefore important that healthcare leaders consider potential solutions offered by their staff as part of measures at work to reduce the spread of coronavirus in healthcare settings.

Healthcare workers experience of the Covid19 pandemic: perspectives from the frontline Aria Khani 1 , Nikoo Aziminia 1 , Colette Smith 2 , Ameet Bakhai 1 , Clifford Lisk 1 1 Barnet Hospital BH, 2 University College Hospital UCH The COVID19 pandemic has seen a death toll of 360, 089 deaths globally. This raises concerns about the mental health and wellbeing of Healthcare workers (HCWs) caring for patients with COVID19. We aimed to assess HCWs concerns, perceived sufficiency of information and reported psychological health during COVID19. Between 1st and 31st May 2020; 410 HCWs of an NHS Trust completed a questionnaire regarding concerns, perceived sufficiency of information and reported psychological health during the COVID19 pandemic.There was a preponderance of females (307) with hospital doctors in training (HD) (204), nurses and health care assistants (NHCAs) (125) and Allied health professionals (AHPs) (81).The majority of HCWs had looked after COVID19 patients; HD 92%, NHCAs 79%, AHP 77%. The most frequent concerns across all HCW staff groups was that of family and friends dying from COVID19, family and friends being infected with COVID19 and being infected with COVID19 and transmitting it to family and friends. HCWs were less worried about themselves dying from COVID19; HD 22%, NHCAs 35%, AHP 25%.The most frequent reported psychological health concerns amongst the 3 staff groups were anxiety, emotional distress, burnout and depression.HCWs experienced high levels of anxiety about the pandemic with their degree of worry mainly pertaining to the health of their family and friends. It is therefore important for hospital leaders to focus on wellbeing programmes for HCWs, their families and friends to ensure that they can function at a high level in the workplace in times of extreme distress during pandemics.

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

The realization of a special cohort unit in the prevention of a general outbreak of SARS CoV2 in Flemish nursing homes Gillis Katrin 1 , Servotte Hilde 2 , Lievens Serge 2 , Cuvelier Henk 3 , Nieberding Philip 3 , Saegeman Veroniek 3 1 Odisee University College, 2 vzw Samen-Ouder, 3 

During the COVID-19 pandemic, the Flemish Agency for Care recognized two special cohort units for COVID-19 positive elderly people residing in nursing homes. The aim of the operationalization of special cohort units was fourfold: the protection of residents and caregivers in nursing homes, prevention of an overcapacity in regional hospitals, providing optimal and more specialized care for COVID-19 positive residents of whom the health status deteriorates and who declared having no willingness for hospital admission and reducing the workload and anxiety among caregivers in nursing homes.From the early stage on of the pandemic, residents from a consortium of six nursing homes (580 residents) who were diagnosed as COVID-19 positive were allocated to one special cohort ward at one location. On the other hand older COVID-19 positive hospitalized patients who could not return to the home setting, could be discharged towards this special cohort unit as long as isolation was required. To realize this approach, four essential conditions needed to be fulfilled: direct availability of the right infrastructure according to the principles of barrier nursing, featuring a source for protection materials, the presence of a competent team of experts and caregivers, and finally no-impact policy on other care departments in the nursing homes or the hospital. A strong collaboration between the consortium, the regional hospital and primary care practitioners made the implementation successful and prevented a further outbreak of COVID-19 in the nursing homes. Important insights and challenges for shared clinical primary and secondary care for older adults were gained.

Aim: The aim of this study was to gain in-depth knowledge and an increased understanding of how isolation from close relatives and carers, during the COVID-19 pandemic, impacted older patients during hospitalization in a Geriatric department. Method: The study was conducted as a qualitative study using qualitative explorative interviews and a phenomenologicalhermeneutic approach. The phenomenological-hermeneutic approach was chosen to get an understanding of the older participants' perspectives and lived experiences. Complete interviews were available for 11 patients -six men and five women, between 69 and 91 years of age.

Results: The analysis revealed five main themes: (1) COVID-19 creates fear and anxiety, (2) Relationships become strained, (3) The transformation from being ''a person'' to being ''a patient'', (4) Virtual contact can't replace the real world, and (5) The environment of care. All identified themes were connected to participants' narratives about being isolated with no contact to close relatives or carers. The co-creation during data collection, consisting of ongoing conversations and questioning of the older patients, was challenged several times because the interviews had to be interrupted or shortened due to ethical considerations regarding the individual person's needs and conditions. Conclusions: Our study provided in-depth knowledge about how older patients experienced hospitalization during the COVID-19 pandemic in a Danish hospital. The results emphasize that compassionate care includes a willingness to listen to patients' narratives and to imagine life as the older patient depicts it, which can lead to a better understanding of the individual person's needs, and increase compassionate caring.

Rekindling the spark Judith Ellis 1

Caring for elderly people recovering from Covid requires far more than addressing physical rehabilitation and waiting for that negative covid swab that is that vital ticket for discharge home or return to a care setting. As patients arrive on the Nightingale Manchester wards they are all exhausted, wary or indeed scared and for some it is even more upsetting. Staring into their eyes you observe a blankness that I have only witnessed before in those who have undergone prolonged cancer treatment or indeed in the eyes of those escaping war zones in low income countries. Still alive the spark of life has disappeared. The look has been described as 'soul death'. Soul death is allowing the sufferers to block out painful memories as a means of protection, allowing a perfusing numbness, an all consuming desire to sleep and be unaware of the world around.The scared, afraid and confused we can reassure, comfort and calm and indeed distract at times of added stress but for those with that scary and somehow inhuman blank stare or who just continuously appear asleep, the challenge for the caring team is how to rekindle that spark. The Family Liaison Team at the Manchester Nightingale covid hospital was established to facilitate communication between families and their medically isolated loved ones, but their role has become fundamental to the rehabilitation of elderly covid patients. Rehabilitation is dependent upon a desire to recover, a desire to re-engage with the world, a desire to live.

Mortality from COVID-19 in the elderly: a perspective from a care of the older person unit in a london hospital during the COVID-19 pandemic The Whittington Hospital, London

Introduction: Multiple ward moves increase the risk of hospitalacquired infection, length of stay (LOS) and mortality [1, 2] . Given the high transmissibility of SARS-CoV-2, we investigated the effects of ward moves on elderly patient outcomes during this pandemic. Methods: Data was collected from electronic records of all patients admitted onto the Care Of The Older Person (COOP) unit between 15/03 and 30/04 in 2019 and 2020 . All ward moves from the emergency department onwards were counted. We classified 1 to 2 moves as 'low', and 3 or more moves as 'high'. Admissions were classified as COVID-19 positive based on high clinical suspicion or swab result. Admissions resulting in death were excluded from LOS analysis. Results: Between 15/03 and 30/04/2020, there were 269 admissions of which 164/269 (61.0%) were COVID-19 positive. Mean LOS in COVID-19 positive admissions was longer than in negative admissions (12.5 vs. 8.0 days). In 2019 there were 219 admissions with a mean LOS of 9.0 days. 'High' ward moves correlated with increased mortality compared to 'low' ward moves in COVID-19 positive (28.6% vs. 21.3%), and negative admissions (18.8% vs. 11.2%). Comparatively, in 2019, 'high' ward moves correlated with increased mortality from 9.9% to 11.8%.Longer LOS also correlated with 'high' ward moves in both COVID-19 positive (10.7 vs. 14.5 days) and negative admissions (7.4 vs. 13.1 days). Conclusion: COVID-19 admissions had a longer average LOS and increased in-patient mortality than the same time period in 2019. Three or more ward moves correlated with increased LOS and mortality, regardless of COVID status. [1] Stowell A. et al. (2013) . Hospital out-lying through lack of beds and its impact on care and patient outcome. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21, 17 [2] Perimal-Lewis L, Li J.Y, Hakendorf P.H, Ben-Tovim D.I, Qin S. and Thompson C.H. (2013) . Relationship between in-hospital location and outcomes of care in patients of a large general medical service. Internal Medicine Journal, 43, 712-716

Abstract # 76

Observations from care home admissions to a care of the older person unit in a london hospital during the COVID-19 pandemic

Devesh Shah 1 , Rosanna Sasson 1 , Kristi Sun 1 , Phoebe Sharratt 1 , Motoko Otomo 1 , Naomi Head 1 , Oscar Lancaster 1 , Jamie Addlestone 1 , Antony Zacharias 1 , Johnny Swart 1 1 The Whittington Hospital, London

Introduction: In 2020, care homes reported a high burden of infection and mortality rates from COVID-19 [1] . We compared admissions from care homes to our Care of the Older Person (COOP) unit during the pandemic against an equivalent period in 2019.

Methods: Data was collected from electronic records of all patients admitted to our unit between 15/03 and 30/04 2019 and 2020. Admissions were classified as COVID- 19 Introduction: The COVID-19 pandemic has increased the need for reliable, real time data on the care of older people. We aimed to identify current data availability, challenges, and priorities for future research and innovations in Care Homes. Methods: Scoping fieldwork in six Lothian (Scotland) Care Homes included (a) 'audit' of all data items currently collected through paper or electronic care planning and (b) interviews with care home managers to discuss (i) availability /use of data; (ii) gaps; (iii) digital capabilities; and (iv) priorities for future research.

Results: All homes collected data routinely on dependency, nutrition, weight, falls, pressure sores and infections, and as required on wounds, frailty, bowels or fluid intake. Other data items are also recorded (e.g. pain, sleep, observations) that can identify changes in residents' condition in real time. There was significant variation between homes in recording processes and assessment tools. Data are often used as 'standalone' pieces of information rather than creating a holistic/longitudinal view of each resident. Priorities for future research included standardising documentation, recording non-care tasks, identifying change in residents' condition, and supporting staff.

Key conclusions: Care homes can be data heavy, but there is significant heterogeneity in the data, and it is mostly used to direct immediate resident care. There is an opportunity for a National Care Home Data Platform, with strong foundations. This is essential to: provide a robust data source for policy and planning; enable real time digital connectivity between care homes and health & social care providers; and inform future innovative technologies.

SARS-CoV-2 inpatient setting isolation: collateral damage among geriatric patients Victoria Garay-Airagui 1 , Maria Gebauer-Campos 2 , Carla Gàmez-Asunción 2 , Carlos Alfredo Colato-López 3 , Diego Sepúlveda-Moya 3 1 Medical Specialize in Geriatrics. University Hospital of Guadalajara (Guadalajara, Spain), 2 Internal Medicine Resident of Geriatrics. University Hospital of Guadalajara (Guadalajara, Spain), 3 Medical Specialize in Geriatrics. University Hospital of Guadalajara (Guadalajara, Spain)

Introduction: We present a male 85-years-old patient (hypertension, chronic plaquetopenia, prostatic adenocarcinoma, depressive mayor illness) who is admitted in acute-geriatrician unit with the diagnosis of no-consolidative SARS-Cov-2 respiratory infection. Geriatrician assessment: Barthel Index 50/100, moderate cognitive impairment, Global Deterioration Scale 6, nursery-home for 3 years. Polypharmacy was presented. Methods: The patient was treated following the in-hospital protocol for SARS-Cov-2 available in our hospital in April 2020 (hydroxychloroquine and azithromycin) and bacterial secondary infection suspicion was treated by cefalosporines. Fluidtherapy was needed for accute renal kidney. No other focus of infection.Hospitalization setting, acute stressful episode and disciplined isolation measures, trigger an intensive acute confusional syndrome. In this context, the patient suffers a craneo encefalic traumatism that requires a CT-Scan and neuroleptic management (Initially risperidone with extrapyramidal side effects). Benzondiazepines and antidepressants were retired. A diarly difficult assessment was performed despite the fluctuating nature of the vascular cognitive impairment established. Anticoagulation treatment according to SARS-Cov-2 prothrombic status was contraindicated because plaquetopenia and craneo encefalic traumatism.

Results: After 20-days of hospitalization, polypharmacy was reduced and optimized, reaching a controlled sleep-wake cycle with a combination of quetiapine and mirtazapine. Not aripripazole via intramuscular were needed at the time of discharge. Respiratory complications were not performed.Key conclusions:-Isolation protocol is not fixed to geriatric patients: They would suffer more inhospital complications, prolonged hospitalizations, loss of functionality, acute confusional syndrome, and lack of quality care.

Avoiding burnout of the care home workforce during the COVID-19 pandemic and beyond: sharing national learning and local initiatives Cari Malcolm 1 , Lucy Johnston 1 , Jo Hockley 2 , Susan D. Shenkin 3 1 ENU, 2 Usher Institute, University of Edinburgh, 3 

Introduction: COVID-19 in care homes has heightened the risk of staff burnout, undermining already problematic staff retention and low morale. There has been an associated proliferation of resources and online initiatives to support frontline workers, however, few of these are directly targeted at the care home workforce. Care home workers are highly skilled in caring for people with complex needs, but have very variable levels of formal training, and just over half of care homes in Scotland include registered nurses. This project will rapidly collate existing resources and identify, direct from care home workers, their best practice, initiatives, and resources used to support resilience and retention during this pandemic and moving forward. Methods: (1) Rapid review of care home specific evidence and resources (including published research and social media); (2) Online survey of Enabling Research in Care Homes (ENRICH) members across Scotland (n = 55); (3) Case studies within six care homes to identify what is working well and what is not in terms of promoting resilience and emotional support.

Results: The rapid review has identified a wide range of resources directed at supporting staff working in care homes; the survey and case studies will provide data on the key learning and resources that have supported staff, and outline the challenges identified. Key conclusions: This comprehensive review of resources and initiatives will make a valuable contribution to policy and practice designed to reduce burnout and foster retention not just in care homes but more widely across health and social care.

Inpatient management of the older adults with COVID-19 infections in a University Hospital in Kuala Lumpur-an observational study Introduction: Our knowledge on the treatment of older adults diagnosed with COVID-19 is evolving. In this study, we share our experience managing a cohort of older adults with COVID-19.

Methods: An observational study involved 25 patients aged C 60 years old diagnosed with COVID-19 who received treatment in a hospital in Kuala Lumpur. Data was traced from electronic medical records, and looked at inpatient management instituted. Results: 6 patients (24%) died. 11 patients (44%) received oxygen support, out of which 5 (20%) received positive pressure ventilation. 14 patients (56%) did not receive antiviral treatment: 9 of them had mild or no symptoms (all survived), and 5 received palliative care (all died). 11 patients (44%) received antiviral treatment: 9 patients received 1-9 days' course of Hydroxychloroquine (mode of 5 days). 5 patients received Lopinavir/Ritonavir for 2-7 days (mode of 2 days). 4 patients received a single dose of Toclizumab. All patients who were actively treated and required oxygen support were started on Lopinavir/Ritonavir and/or Toclizumab. 5 patients who received Hydroxychloroquine (55.5%) had prolonged QT intervals. 1 patient who received antiviral treatment died. 17 patients received Geriatric co-management, and 8 were transferred to the Geriatrics ward for further management. Key conclusions: There was no consistent management plan delivered to our patients. Prognostication is important in determining treatment goals and outcomes. Caution is advised in treating older adults with Hydroxychloroquine due to risk of prolonged QT intervals. There is a role for Geriatric co-management in dealing with complex care issues that may arise.

Introduction: Due to the COVID-19 outbreak in Poland nursing homes prohibited all visits since the 11th of March 2020. Significant lack of contact with families can increase feelings of loneliness and anxiety among nursing home residents. The aim of this study is to present methods of providing contact between residents and their relatives during this isolation. Methods: Our study took place in the polish nursing home for the elderly. 88 residents were constantly assessed by a geriatrician and a psychologist from the beginning of quarantine up to 30th of May. Based on its assessment we planned a therapeutic strategy for the time of expected lockdown. Results: Severely restricting family visits was the most painful effect of the quarantine reported by the residents. 45% of them reported an intense longing for relatives. 34% of all residents needed additional pharmacological intervention due to increased agitation, insomnia, or depressiveness. We implemented the following strategies to maintain the contact between residents and their relatives: smartphone/tablet videoconferences, meetings through the window, memory books prepared by the families, support lists from families, video wishes for relatives, 'hug-time' screen, and safe outdoor meeting space. We are still in the process of assessing the effectiveness of these methods. Key conclusions: There are multiple effective methods that can be used to provide contact between residents and their families even if visits in the nursing home are not allowed. Smartphone videoconferences and meeting through the window were not effective because of vision and hearing limitations.

Psychological evaluation of the healthcare workers in a Geriatric Unit during the Covid 19 Tatiana Zuinen 1 , Vanessa Willems 1 , Marie-Noëlle Geurt 1 , Sandra Higuet 1

Introduction: Since the outbreak of SARS-CoV-2 in 2020 in Belgium, healthcare workers have been in the frontline of the disease. They are the primary ressource that we need to fight this virus, but the psychological environnement in which they had evolved is full of stress factors. In order to anticipate a potential nervous breakdown, we have chosen to record their perception of the situation/state of mind.

Methods: On a voluntary based participation, two questionnaires were administrated to healthcare workers in geriatric non-covid unit of ISPPC of Charleroi. We have used the Perceived Stress Scale 14 (PSS) Questionnaire to evaluate the perceived stress within the month, and the Brief Resilent Coping Scale (BRCS-2004) to determine the presence of helpfull strategies in the health workers'psychological functionning.

Results: 31 healthcare workers have participated to our survey with 77.41% of women and the average age was 37.26 years old, 58% of nurses, 9.6% of physiotherapists, 6., 45% of physicians. Regarding PSS 14 score, with an average score of 27.65/56 we observed that the healthcare workers were not overstressed by the situation. We can observe that younger healthcare workers (\ 35 years old) perceived more stress (30.5/56) than the older one ([ 45 years old) with an average score of 21.4/56. They represent 41.9% of our sample. With a 13.84/20 of average score at the BRCS, the sample could be seen as medium resilient copers and neither coping strategies is more used one from another. Conclusion: This observational analyse tend to show that younger healthcare workers have perceived this situation as more stressfull than their older collegues and it therefore suggests that we should focus our future psychological interventions more on the youngest healthworker, especially in case of a second wave.

Supporting staff through the Covid-19 pandemic-a quality improvement initiative

Sherena Nair 1 , Shan Liung Liew 2 , Atif Nasrullah 1 , Muhammad Iqbal 1 1 Leeds Teaching Hospitals NHS Trust, 2 Calderdale and Huddersfield NHS Trust This quality improvement project was undertaken during the outset of Covid-19 to promptly identify the support needed for staff managing elderly patients with Covid-19 infections. Due to the nature of rotating medical teams and rapidly evolving guidance, this project enabled the team to work cohesively and optimally during such unprecedented times. A semi-structured survey was undertaken with feedback gathered from 20 members of staff on a designated covid ward including doctors, nurses, clinical support workers, and domestic staff. A 'Lessons Learned Log' was also created over a week to understand the pressures and issues faced by the team in order to put into place relevant support strategies swiftly. Responses from the survey were subsequently analysed into thematic headings. This initiative highlighted that communication about changes in Covid-19 guidance was crucial in allaying anxieties of the team. Notice about wards becoming designated covid areas despite rapid turnover of patients enabled staff to prepare themselves psychologically. Debrief sessions after deaths of patients also helped with the distress experienced by staff. Key strategies were discussed in the daily safety huddle with input from relevant specialties such as palliative care and liaison psychiatry to further enhance patient care. This project has led to a robust system in place to support staff on covid wards to care confidently and compassionately for elderly patients with covid-19.

A new barrier to COVID-19 transmission in nursing home residents: the successful experience of 17 facilities In France Introduction: The aim of this study was to review the impact of social isolation during COVID-19 pandemic on mental and physical health of older people and the recommendations for patients, caregivers and health professionals. Methods: A narrative review was performed including 20069 noninstitutionalized community-living people from ten descriptive crosssectional papers. Articles since 2019 to 2020 published on Pubmed, Scielo and Google Scholar databases with the following MeSh terms ('COVID-19', 'coronavirus', 'aging', 'older people', 'elderly', 'social isolation ' and 'quarantine') were included. The studies not including people over 60 were excluded. Guidelines, recommendations, and update documents from different international organizations related to mental and physical activity were also analyzed.

Results: Forty-one documents have been included in this narrative review, involving a total of 20.069 individuals, 58% women, from Asia, Europe and America. Thirty-one articles includedrecommendations and ten addressed the impact of social distancing on mental or physical health. Anxiety, depression, poor sleep quality and physical inactivity were the main outcomes reported during the isolation period. The main recommendations were centered in cognitive strategies and increasing physical activity levels using technology and apps, online videos and telehealth. Conclusion: Both mental and physical health in older people are negatively affected duringthe social distancing for COVID-19. A multicomponent program with exercise and psychological strategies is highly recommended for this population during the confinement. Future investigation in this area is needed.

The maiden voyage of the corrib ward: shining a spotlight on older adult care during a pandemic-an Irish perspective the elderly is identifying patients maximally benefiting from goal orientated multidisciplinary care (3) . Methods: We introduced a geriatric COVID 19 service.This team consisted of geriatric consultants, trainees, multi-disciplinary team and advanced nurse practitioners.We admitted, treated and rehabilitated all query and confirmed COVID 19 geriatric patients over a 12 weeks period in our tertiary referral centre. All patients were admitted and clinical frailty scale score assigned. An early and honest discussion around goals of care were conducted in collaboration with patients and their families.

Results: Initially, we analysed the first 100 patients through our service for this Abstract. Comprehensive geriatric assessments were completed on everyone. Seventy-five percent of patients were admitted from home, 21% from nursing homes and 4% from respite care.The average age of our patient cohort was 82 years. Average CFS was 5. Seven patients were palliated with end of life care implemented by our team, their average CFS was higher (8).

Conclusions: We feel our care positively impacted on the care of older patients during this pandemic.Fatality number were reduced in this cohort.Older adults care is optimized when treated by the physicians that have experience with their unique needs.

Would you trust a diagnostic procedure with 100% specificity and 96% sensitivity? Introduction: Nasopharyngeal swab (NPS) RT-PCR SARS-CoV-2 detection has 100% specificity and 70% sensitivity [1, 2] . We report a patient with four negative swabs. Methods: 94-year-old woman transferred for wrist-fracture rehabilitation on March 13th. Prior history: knee-prosthesis, osteoporosis, falls, cognitive deterioration. She took no medication. Examination revealed cognitive deficits and wrist plaster. WBC (neutrophils) were slightly increased, CRP normal. Six days later she developed dyspnoea and cough, but no fever, crackles or desaturation. NPS was negative. She remained clinically stable. Day 7 after symptom onset showed crackles over the left lung, T°37.6°C, 89%SaO 2 , normal WBC (lymphopenia). X-ray revealed lower left pneumonia. NPS was negative. Influenza, RSV, Mycoplasma, Chlamydia-pneumoniae were ruled out, blood cultures negative, sputum not obtained. Amoxicillin/clavulanate was initiated, shifted to piperacillin/tazobactam and clarithromycin added for persistent fever. NPS was negative (day 12). There was no clinical improvement, pneumonia worsened, and the patient was transferred for CT (day 19) , showing non-specific fivelobe-involvement. NPS was negative. She slowly recovered clinically and radiologically. SARS-CoV-2 antibody testing became available in Belgium revealing specific IgG.

Results: Serologically-confirmed COVID-19 in a patient with 4 negative RT-PCR results. Recently published timing-dependent sensitivity [3] indicates probabilities of negative RT-PCR in our patient of 0.4, 0.3, 0.5 and 0.7 respectively, resulting in a cumulative probability of 0.04, or cumulative sensitivity of 96%. Conclusions: Serial testing was unable to detect SARS-CoV-2 in our patient despite a cumulative sensitivity of 96%. While positive tests identify COVID-19 patients, negative testing is less conclusive. When suspicion is high, a negative test cannot rule out the disease. 

Introduction: Frailty is a predictor of multiple adverse inpatient outcomes. The aim of our study is to examine frailty, using Clinical Frailty Scale (CFS), its association with inpatient management and outcomes in Methods: This is a retrospective cohort study of older adults aged above 65, diagnosed with COVID-19 infection, treated in the UMMC, where we compared patients with CFS 1-5 (non-frail to mildly frail) (n = 14) against those with CFS 6-8 (moderate to severely frail) (n = 12). Results: As of April 2020, we have total 26 hospitalised older adults. The mean age was 82 6 in patients with CFS 6-8, which was significantly higher than those with ; p = 0.000]. Overall 58% of those with CFS 6-8 (n = 7) presented from institutional care setting. Almost half of those with increasing frailty presented with pneumonia requiring oxygen. Our data revealed that all of those with CFS 6-8 were co-managed by geriatric care (p = 0.001) and potentially managed to get their care planned in advanced (p = 007) with non-active resuscitation order issued in time (p = 0.00). Those with CFS 1-5 were more likely to receive critical care (p = 0.017) and antiviral therapy (p = 0.000). Inpatient mortality was higher with increasing frailty, with total 5 out of 6 death were reported in those with CFS 6-8. The median length of hospital stay was 27 , which was the same between the CFS categories, p = 0.695. Our data revealed worsening physical health status in both categories. Conclusion: Frailty is an important component of COVID-19 management. There are guidelines that guide management but adherence to it requires individualised decision making.

Frequency and intensity of medical interventions in a nursing home during COVID-19 PAndemic people to have rapid access to specialist advice. A telephone line was set up operating everyday 08:00-21:00. It was staffed by geriatricians and the focus was on advance care planning, admissions avoidance and delivering community-based treatment. Methods: Electronic patient records were reviewed from 21st April to 29th May 2020. Data was collected retrospectively from 28 weekdays including the timing and source of the call, details of advance care plans and outcomes for the patients. Results: Data was collected from 160 patients. The average age of patients was 85 years. 15% of those who were tested were positive for COVID-19. In terms of advanced care planning, 43% of all calls had preferred place of care (PPOC) and 27% had resuscitation status discussed. Whilst the majority of calls came from GPs, 11% of calls came from community matrons, 5% from paramedics and there were a variety of other users. Key conclusions: The data showed there was a need for supporting colleagues to help fulfil a person's wish to remain at home and to access the most appropriate hospital service when a decision was made to admit. This extended beyond patients with COVID-19. The data are being used to inform how this advice line can be implemented as a more permanent feature of our clinical service.

Investigating the impact of Covid-19 on hip fracture management in a Tertiary Referral Hospital Michael Curran 1 , Nur Atikah Mohd Asri 1 , Pamela Hickey 1 , Brian Lenehan 1 , Fibarr Condon 1 , Jude Ryan 1 1

Introduction: Covid-19 has caused unprecedented challenges the world over. On average 360 patients are treated for hip fractures in University Hospital Limerick (UHL) annually. Numerous improvements have been implemented in our service in recent years but Covid-19 has shifted this dynamic. Methods: Data was collected from the Irish Hip Fracture Database (IHFD) and UHL Patient Administration System from March 1st until May 1st 2020. It was compared with data from the same timeframe in 2019. Statistical analysis was performed using SPSS. Results: Demographic characteristics were comparable between both cohorts. The average length of stay (LOS) was 8 days compared to 15 days in 2019. This was primarily due to changes in hospital policy and an increased onus to discharge patients during the Covid-19 crisis. Strikingly the inpatient mortality rate at 30 days during the Covid-19 period was 13.4% (n = 7) compared to just 1.7% (n = 1) in 2019. Subsequent analysis from the 2019 data however unearthed a 60 day mortality rate of 25%. This would suggest that subsequent analysis of mortality rates from 2020 will increase further. Readmission rates are also higher during the current pandemic with 10.5% of patients requiring readmission within 30 days compared to 5% at 30 days in 2019. Interestingly 10 patients were admitted from nursing homes compared to just two patients in 2019. Conclusion: Increased demand for beds during Covid-19 crisis led to earlier discharge from our institution. Provisional analysis suggests this subsequently increased both readmission and mortality rates.

Eight nursing-home-specific, COVID lectures attended by mean 330 staff per session Tallaght University Hospital and Trinity College Dublin, 2 Tallaght  University Hospital, 3 All-Ireland Institute Hospice and Palliative  Care, 4 All-Ireland Institute of Hospice and Palliative Care, 5 Our  Lady's Hospice and Palliative Care Nursing homes, isolated from academic centres, have contended with rapidly-changing guidelines and modified clinical practice. An interactive, videoconference-facilitated education series was commenced to provide up-to-date guidance to nursing homes through a collaboration between Geriatrics Department, Tallaght University Hospital, Dublin and the All-Ireland Institute of Hospice and Palliative Care. The format was a brief didactic lecture but primarily focused on Q and A designed to address the COVID issues of the week. The first session, ''Anticipatory Prescribing'' was viewed by 300 nursing home healthcare workers and GPs. Attendances rose with COVID case rates to 550 mid-pandemic. At submission, eight COVID lectures were attended by a mean of 330 nursing homesrelated staff. Topics covered include a microbiologist's and then a respiratory consultant perspective on COVID, advance care planning, outbreak management and as the pandemic weaned; nutritional and swallow challenges in COVID, IT solutions to isolation/rehabilitation and then reopening nursing homes. Each week registrants were requested to input their ''burning issue'', which was addressed through Q and A. Using word-cloud software the primary issues in March, pre-pandemic, were end of life care, anticipatory medication stocks and syringe drivers. In April, mid-pandemic, the issues were PPE, managing COVID and Family. In late May, post-pandemic, focus changed to rehabilitation, isolation, re-accessing services. This lecture series was very well attended, provides a curriculum and highlights the success of videoconference lectures. Through question submission we provide a summary of the primary nursing home issues at differing time-points in a pandemic, albeit influenced by the lecture topic.

Vasculitis associated to SARS-COV2 infection Maria Jose Martin Legorburo 1 , Esther Espinosa Gimeno 1 , Carla Gamez Asunción 1 , Maria Gebauer Campos 1 , Viviana Oscullo Yepez 1 , Juan Rodriguez Solis 1 1 Hospital General Universitario de Guadalajara (Guadalajara).

Introduction: Different dermatological manifestations associated with COVID-19 infection have been published. Its frequency is variable (between 0. 2 and 20 .4% of infected patients), as well as the time to appear. The most frequent are: purpuric exanthema, vesicles, urticarial eruptions. 1 Clinical case: Here we present the case of a 90-year-old man with predominantly acral purpuric lesions in upper and lower limbs, 5 weeks after being hospitalized for Covid-19 pneumonia. Institutionalized patient with severe dependence for basic activities of daily living (ADLs) and mild cognitive impairment. Personal history: atrial fibrillation (AF), chronic renal disease. Admission to hospital for decompensated heart failure. After clinical improvement during admission, acral purpura and necrotic vascular lesions appear in 4 extremitiesEcoDoppler of both legs and echocardio, rules out other thromboembolism complications. We performed skin biopsy, small and medium vessel leukocytoclastic vasculitis, with isolated secondary intravascular fibrin thrombo. Coagulation tests to be highlighted are: D-Dimer elevation (7MG/L), antithrombin III deficiency (78%), C protein deficiency (71%), Factor VIII elevation (318%), Lupus anticoagulant: weak positive. The vasculitis study highlights: positive ANA, C3 complement low.Empirical treatment with high-dose corticotherapy was initiated and heparin was maintained at therapeutic doses due to suspected post SARS-COV2

Eur Geriatr Med (2020) to clinical trials if relevant. Some of the process were adopted by other younger inpatient wards, especially ethical concertation. As a tertiary center, we opened a hotline for LTCFs seven days a week and implemented ''screening on wheels''. Conclusion: Our team achieved an efficient way of organization of the whole geriatric sector during the pandemic. The department of Geriatrics has a crucial role to play in the referral and the organization of care in the entire region. The post-Covid world will need transdisciplinarities and collaboration.

Patterns of geographical distribution of COVID-19 infections and deaths-possible explanations 

Introduction: There is growing international evidence that people living in socio-health centers are especially vulnerable to severe SARS-CoV-2 infections and are experiencing high mortality rates. Due to its characteristics (advanced age, functional and mental difficulty, comorbidities ...), the consequences of both the disease and the problems derived from confinement itself secondary to social isolation, immobility and the anxiety generated are especially important. Multidisciplinary management is necessary to prevent these complitations. Methods: Narrative review of Management was performance by the authors in order to make recomendatios to the nursing home in our clinical area. Results: 16 recommendations were done by the groups. These are relative to medical follow-up (with analytics and radiography), anticoagulant and corticoids management, screening of functional and cognitive decline, malnutrition, delirium, anxiety, depression and polipharmafacy. For of all these problem, practical advice (based on exercise with Vivifrail, cognitivie stimulation, nutrition with suplement prescripcion, management polypharmacy with STOP-START criteria, management frecuent comorbilitis such hypertension, diabetes; reduccing risk of falling and coordination between primary care and geriatrics) were recommended in order to improve residents health status Conclusion: After the first wave of COVID pandemic, management of residents in nursing homes is still a big challenge. Practical recommendations are the base to improve residents management. (2) we are working on a ,,Guideline on Best Practice in geriatric rehabilitation''. In this presentation the audience will first get an overview about the content and status of all current SIG on GR projects, adaptions due to COVID-19 pandemic included. Additionally the first results of the working process on the ,,Guideline on Best Practice in Geriatric Rehabilitation'' will be presented. Nihon Fukushi University, 2 University College Dublin, 3 Tokyo Medical University 1. Introduction: The risk associated with COVID-19 infection is considered to be moderate to high among those interacting indoors, particularly older people. As a result, they refrain from accessing various services including nursing homes. In order to overcome this barrier to access and create a safer environment for care professionals, a nursing home in Tokyo adopted isolation measures to reduce the frequency of contact. In a nursing facility in Tokyo, a remotely controlled infrared monitoring system was introduced, and its impact and effectiveness were tested. 2. Methods: A monitoring system was set up for 38 older adults, and changes in the frequency of visiting the room and the workload of care professionals were compared before and after the introduction of the devices. 3. Results: The monitoring system decreased the frequency of room visits by care staff at night from 22.9 to 10.9 times, as it provided the visual information about the residents' status quo remotely. The system allowed the facility to welcome five potentially Covid19 infected residents as a result. The fatigue level of night-shift care staff also showed a decrease. A remarkable effect was found particularly towards the end of their shifts when fatigue levels reach the highest. 4. Key conclusions: The remote monitoring system decreased the physical and mental burden on care staff by reducing the frequency of their visit to residents' rooms at night. The system can be highly effective in tackling the challenge of Covid19 by mitigating the barrier to people's access to care home facilities. This study was in part supported by the Japan Keirin Autorace Foundation. We would like to acknowledge the support and dedication of care professionals.

The presentation of a COVID-19 positive patient in a 1000-bed long term care facility in Malta Introduction: This case report details the presentation and management of the only patient diagnosed with COVID-19 in a 1000-bed long term care facility which houses frail patients who require 24 h nursing and medical care and the measures undertaken in order to limit the spread of COVID-19. Case Presentation: The patient was an 88-year old lady who was a known case of diabetes mellitus, obesity, asthma, hypertension, hip fracture and congestive heart failure who experienced sore throat. All her parameters were normal and she was never febrile. A COVID-19 nasopharyngeal swab was positive. Management: The management of this patient required a holistic approach from all the teams within the facility in order to treat the patient as well as contain the spread of COVID-19 within a vulnerable population. The measures which were enacted in a timely fashion before the case of COVID-19 was registered in the facility were effective in containing the spread. These included the thermal screening of all staff entering the facility, all elective appointments outside the facility were postponed, contact tracing of staff and low threshold for swabbing for staff and patients. To date only one resident contracted COVID-19 from the entire facility. Immediate action was undertaken for medical isolation of the patient and was nursed in another ward catered for residents with COVID-19 within the facility and made an uneventful recovery.

Conclusions: Effective and timely measures in infection control were crucial in preventing COVID-19 spread to residents and in between residents.

Purpose: The United Kingdom (UK) care home population has experienced high mortality during the COVID-19 pandemic [1] . Atypical presentations of COVID-19 are being reported in older adults and may pose difficulties for early isolation and treatment, particularly in institutional care settings [2, 3] . We aimed to characterise the presenting symptoms and associated mortality of COVID-19 in older adults, with a focus on care home residents and older adults living in the community.

Methods: This was a retrospective cohort study of consecutive inpatients over 80 years old hospitalised with PCR confirmed COVID-19 between 10th March 2020 and 8th April 2020. Symptoms at presentation, including those associated with frailty, were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between-group comparisons and logistic regression. Background: Because of the Covid-19 lock down all teaching activities on campus were cancelled this spring. As a replacement, much of the planned courses were held using digital platforms. We launched a 1 week digital course in communication skills for 6th semester medical students.

The evaluation is based on the teacher comments and a structured student feedback form consisting of two qualitative questions (Q1: ''What was good with the communication course?'' and Q2: ''What could be better'') and three with a likert scale from 1-5 where 1 was ''bad' ' and 5 was ''best'' to rate the (Q3) course, (Q4) the lectures and (Q5) the group sessions respectively. The data from the qualitative questions are picked out non-systematically. Results: 54 of 80 students answered the questionnaire. On question 3 58% and 40% gave a score of 4 and 5 respectively. On question 456% and 36% rated the lectures as 4 and 5. And 70% rated the group session as ''best'' (Q5). The mix of class and group-sessions and video and live was evaluated as positive.

Conclusion: Launching the communication course on a digital platform was evaluated as a success. One of the most important factors seem to be a wells structured framework in the curriculum and information to the students. The biggest concerns before and during this course was information security and student care.

Survey of smart device use in hospitalised older adults to inform design of virtual outpatient clinics. Objectives: The COVID-19 pandemic has caused many nursing homes to prohibit resident visits to prevent viral spread. The perceptions of family members and friends of the nursing home residents is not clear if the potential detrimental effects of isolating residents outweigh the protective effects, and what does the social network view as important during and after the COVID-19 nursing home restrictions. The aim of this study was to capture these perspectives from the social network of nursing home residents. Methods: In this cross-sectional observational study, family members and friends of nursing home residents were asked to fill in an online survey about COVID-19 nursing home restrictions. A total of 1997 were included in data analyses. Results: Satisfaction of communication access to nursing home residents was highest when respondents had the opportunity to stay in touch with nursing home residents by nurses informing them via telephone, visits behind glass, and visits outside maintain physical distance. Respondents were concerned that nursing home residents had increased loneliness (76%), sadness (66%), and decreased QOL (62%) while study respondents reported personal sadness (73%) and fear (26%). Overall, 40% of the respondents found the adverse effects of the visiting restrictions outweighed the protective effect for nursing home residents. Respondents expressed the need for increased information, communication options, and better safety protocols. Conclusion: Both nursing home residents and relatives experienced adverse psychological effects because of COVID-19 visiting restrictions. The psychological symptoms and unmet needs of nursing home residents and informal caregivers should be addressed in health policy. 

Introduction: In geriatrics, where conditions such as delirium and dementia are common, collateral information can be vital. Covid-19 restrictions left families unable to visit, meaning telephone and video calling was essential, especially in those vulnerable to disorientation. We investigated whether contact between medical teams and families (updates) were established in Homerton University Hospital during the crisis, and whether this resulted in clinical or positive non-clinical outcomes. Methods: Electronic patient records (EPR) were searched for all patients [ 65 treated for covid-19 during the pandemic peak (16/03/ 2020-30/04/2020). EPR was searched for delirium at admission and/ or during stay, dementia diagnosis, number of updates, and any documented outcomes.

Results: Mean updates per day was greater in the dementia and delirium on admission populations, 0.61 and 0.58 respectively, than for the general population (0.53) but lower for those that developed delirium in hospital (0.41). 70% of patients received at least one update, of which 44% had a documented clinical outcome and 28% had a positive outcome. Key conclusions: Communication with families remained a priority during the crisis, and occurred more when patients were less able to do so themselves. Telephone conversations still yielded many clinical and positive outcomes. The familiarity and reorientation that families can provide to patients via video call may benefit both dementia and delirium patients, and a pilot of video calls with a dedicated communications team is ongoing.

Geriatric assessment in elderly patients with COVID-19 during admission to a Geriatric Unit in Teruel, Spain. Introduction: COVID-19 pandemia imposed restrictions in the visit routines of hospitalized older patients, which were though to negatively impact the psychological health of patients and their families. A Family Communication Service (FCS), facilitated by volunteer medical students, was implemented in the Geriatric Department of University Hospital in Nancy, France, to attenuate those consequences. We aimed to evaluate student's experience from their participation. Methods: Seventeen undergraduate medical students received dedicated training on their mission's outline and on Hygiene rules by both Faculty and Hospital and were equipped with the necessary infrastructure to organize calls and regulated personal objects exchanges between older patients and their families for 1 month (20/4-20/5/ 2020). Finally, an anonymized questionnaire was answered (M = 15). Results: In total, 258 actions took place: 119 students-family phonecalls (actions' organization), 94 patient-family video-calls, 24 patientfamily phone-calls and 22 objects' exchanges. Students reported an 8.8/10 satisfaction degree on the global functioning of the FCS and a 9/10 level of recommendation of the FCS to their peers. Predominant were positive reports on the amelioration of their communication skills with older vulnerable patients (with complex conditions), their families, the geriatric team and their peer students. Working in autonomy and experiencing the human aspect of the doctor-patient relationship, beyond medical conditions, discovering the patient's point of view and their family context were estimated as valuable experiences for their vision of the medical profession. Key conclusions: Active involvement of undergraduate medical students in activities beyond strict medical duties can be an enriching experience for themselves and their curricula. COVID), 94 patient-family video-calls (77 non-COVID; 17 COVID), 24 patient-family phone-calls (22 non-COVID; 2 COVID), 21 regulated personal objects exchanges (18 non-COVID; 3 COVID). Fifteen students answered the questionnaire (88.2%). There were strongly perceived important psychological benefits for the patients (psychological comfort, reassurance, joy, elimination of the feeling of abandonment, mood boosting, beneficial contact with young students) and their families (reassurance, serenity, joy, de-stress), who managed to maintain the affective connection and warmly expressed their gratitude. Geriatric teams welcomed being offloaded and reported facilitation to their care duties also by patients' mood amelioration. Visual contact by video-calls was considered an added value and it was suggested to be continued out of the crisis context, along with the recreational occupation for older patients. Key conclusions: The FCS resulted to be beneficial for older hospitalized patients, their families and the medical/paramedical stuff. Scaling up of some of its aspects merit consideration.

Safety patient circuit in a cardiology intensive care unit during the Covid-19 pandemic period Introduction: In a time of SARS-CoV-2 pandemic worldwide spread, patients who suffer from acute heart disease, must have a safe environment when admitted into a cardiology intensive care unit. Covid-19 pandemic brought mandatory changes into the healthcare institutions, where patients' safety circuits were organized. Methods: This is a descriptive-observational study of patients with heart conditions (heart failure and acute myocardial infarction), admitted in a cardiac ICU in a Portuguese University Hospital. All the patients were admitted to the emergency department (ED) due to a cardiac event. As SARS-CoV-2 tests were not always available at the ED, patients were transferred to a coronary ICU with six single bedrooms where patients were monitored and stabilized. In contrast, the SARS-CoV-2 test was meanwhile performed. If tests were negative, patients were transferred to a five-bed ICU or a cardiology ward. If tests were positive, patients were transferred to a cardiology ward or ICU in a dedicated Covid-19 building in another area. Results: Between April and June of 2020, among a total of 406 patients admitted in the ICU, only one asymptomatic patient tested positive to SARS-CoV-2, who was then transferred to Covid-19 coronary facility. Seventy-six (19%) patients were transferred to the five-bed ICU, 326 (80%) were transferred to the cardiology ward, and four patients died due to cardiac problems. During this period, none of the healthcare providers got infected by SARS-CoV-2. Key conclusion: The circuit organization implemented in our University Hospital allowed a safe care environment by healthcare professionals to our patients.

Rapid redesign of acute services for frail older people during the coronavirus pandemic Janice Bernardo 1 1 The Princess Alexandra Hospital NHS Trust Introduction: The coronavirus (Covid-19) pandemic presents particular risks for frail older people presenting for acute assessment in Emergency Departments or admitted to hospital. We responded by rapid service redesign to enhance capacity to assess and treat individuals whilst avoiding or minimising hospital exposure. This needed hospital, community and social care to share information, decisions and ongoing care and supervision without the patient moving about. Methods: Plan-Do-Study-Act method was used to rapidly test, refine and implement service redesign. Changes included procedures for accessing services, reducing duplication of assessments, changing the scope and routines for health professionals, and incorporating volunteer support. Results: Use of the new Clinical Frailty Scale App plus digital application were upskilled staff enabling each provider to preform and share expert assessments of frail people, improving quality and saving time. Primary care data interoperability and access to health and care system capacity report were authorised. A multiagency rapid access virtual clinic enabled quicker responses, sharing of these assessments and agreeing care plans without patients attending hospital. A Frailty Clinical Navigator was introduced in a COVID dedicated and non-COVID Emergency Department (ED). Discharge medications and equipment delivery were supported by voluntary sector. Key conclusion: Integrated working between health, social and voluntary services is imperative to deliver the right care at the right time. Frailty specific innovative roles need to be further explored creating more workforce flexibility and sustainability. Data interoperability must be prioritised.

Reconfiguration of Community Health Services Medicines Training due to COVID-19

John Introduction: Guy's and St. Thomas' NHS Foundation Trust Integrated Local Services (ILS) delivers home care to vulnerable patients; a large part of which involves support with medicines. At the onset of the COVID-19 Pandemic ILS rapidly reconfigured to relieve pressure on the acute hospitals. For ILS staff to safely support medicines use, training is usually delivered in small groups and competence assessed in patients' homes. To minimise patient and staff risk of potential exposure to COVID-19 new training and assessment were developed to up skill redeployed staff (nursing assistants and rehabilitation support workers), the outcomes of which are described. Methods: Two face to face training sessions were consolidated into one, and three simulated Objective Structured Clinical Examinations (OSCE) assessments of medicines administration were developed to replace two supervised medication administration competency assessments. Labelled medicines were obtained from King's College London's (KCL), and their facilities utilised to allow physical distancing. Results: Over two days, training was delivered to 33 staff, and OSCEs completed by 18 candidates; no candidate passed. 78% made a clinical decision outside of their scope of practice, 56% administered an incorrect dose, and 66% administered an expired medication. The majority of candidates followed the correct procedure when medication was refused (78%). Key conclusions: OSCEs were a useful educational tool where candidates can be objectively observed without intervention, and direct feedback on errors provided. Additional training on the handling and administration of medicines was required for all candidates. Training and OSCEs will be redesigned to meet the needs identified. Collaboration with academic partners is beneficial. patients during the pandemic in hospitalized elderly patients is an evolving challenge. Hospitalization often marks the beginning of a downward trajectory characterized by declining function, institutionalization and death. Functional status may be impacted by COVID-19. Methods: The sample includes all the geriatric patients admitted to the general wards of the Internal Medicine Department of Hospital Padre Américo, in Penafiel, Portugal, in April 2020. The sample is sequential and non-randomized. The functional status was evaluated using the Katz Index of Independence in Activities of Daily Living on admission and on discharge. All patients admitted were tested for COVID-19 using RT-PCR detection of SARS-CoV-2. The data was analyzed using SPSS analysed by SPSS version 26 for MacOS (SPSS Inc., Chicago, IL, USA). Means of 2 continuous normally distributed variables were com:pared by independent samples Student's t test. A value of P B 0.05 was considered significant. Results and key conclusions: 232 patients (54.5% female), with 80.2 (± 7.87) years old were admitted. 70 patients (30.2%) tested positive for SARS-CoV-2. 66 patients (28.4%) died, with 20 (8.62%) infected with COVID-19. The groups of patients with and without COVID-19 were comparable in terms of age, Charlson Index Score and main diagnosis (P[0.05). The mean Katz difference between the moments of discharge and admission was not significant (p = 0.447). COVID-19 does not seem to affect functionality in geriatric patients with mild forms of infection. Quality of care is assumed to have been similar in both groups.

Investigation of factors affecting death and survival in geriatric patients infected With COVID-19: a pandemic hospital experience Objective: We aimed to investigate the factors affecting the mortality of patients aged C 65 who were hospitalized with COVID-19. Method: From 11 March to 28 May 2020, patients who were hospitalized with COVID-19 are included. Demographic characteristics, comorbidities, number of drugs, laboratory datas and oxygen saturations were recorded at the time of application, 5th day of treatment and at discharge. CURB65 (Confusion, Urea, Respiratory rate, Blood pressure, Age C 65) scores were calculated. The hospitalized days numbers, ECG changes, presence of delirium and pressure ulcer, oxygen treatment types and drugs used for COVID-19 recorded. Results: 218 patients (112 men, 106 women) were included in the study. The patients were divided into 3 groups as 65-74 (n:107), 75-84 (n:86) and C 85 (n:25) years. 52 of patient (%24) were died (34 men, 18 women).While the mortality rate of men was higher than women (p:0.021), no significant relationship was found between age groups and death. Dispnea (p:0.002), polipharmacy (p:0.022), malignancy (p \ 0.001) and dementia (p:0.024) were associated with death. There was a relationship between hospitalized days numbers at intensive care (p \ 0.001), and clinics (p \ 0.001), intubated days (p:0.011), application oxygen saturation (p \ 0.001) and mortality. Neutrophil/lymphocyte ratio (p \ 0.001), lymphocyte (p:0.011) on admission and the highest values of procalcitonin (p:0.026), creatinin (p:0.006) and LDH (p \ 0.001) were associated with death. Highflow oxygen therapy was found to have a protective effect on mortality (p:0.012). Conclusion: Covid-19 is more mortal in older adults. It is important to be aware of the factors affecting mortality in order to prepare for a possible second wave.

Use of telephone consultations to avoid Hospital Admission-the COVID Frailty Hotline Mary Buckley 1 , Riaz Moola 1 , David Robinson 1 , Rory Nee 1 1 St. James's Hospital, Dublin, Ireland Introduction: St James Hospital is the largest hospital in Ireland with 1,000 inpatient beds. In 2017 there were 48,000 ED attendances and 23,550 inpatient discharges. COVID-19 was predicted to overwhelm our services with numerous contingency plans put in place across the hospital. Methods: With the aim of reducing crisis ED attendance, hospital admissions and facilitating ED avoidant medical admission of frail older adults in need of hospital care, a dedicated phone line to a consultant geriatrician was circulated to all GPs in the catchment area. The phoneline operated during working hour. Telephone advice was provided with urgent Day Hospital reviews as needed. Results: 19 GPs requested 31 consults during the months of April and May. The average age was 84 years. The average Clinical Frailty Scale was 6, indicating moderate frailty. Outcomes include ED avoidant medical admission (6), next day review via Day Hospital (7), domiciliary visit (3), or telephone advice 15 . The admission avoidance

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 rate was 80% and ED avoidance rate was 100%. 8 patients were nursing home residents and 5 were known COVID positive. Consultations included dementia with BPSD (14), delirium (3), severe anxiety (2) 

Seroprevalence of anti-SARS-CoV-2 antibodies in the Health Workers in Hospitals and in Nursing Homes in East France.

believed that they are at higher exposure risk to Covid-19 than the general population. In France, testing of HWs has so far been restricted to symptomatic individuals leading to underestimation of the real impact of the disease to the HWs. Here, we estimate the seroprevalence of anti-SARS-CoV-2 antibodies in the of HCWs working in hospitals and in nursing homes (NHs) of the Metz county in Lorraine region, one of the most affected regions in France.

Methods: During the epidemic, HWs, volunteers, symptomatic and asymptomatic, were screened for anti-SARS-Cov-2 antibodies using a rapid immunodiagnostic test. The results of this screening test as well as the information from self-administered, standardized questionnaires covering different topics were collected to perform a retrospective study on seroprevalence of anti-SARS-CoV-2 antibodies within this Covid-19 exposed population. were the groups at major risk. In Greece PHC was not engaged in the management of the pandemic to the same degree as hospitals. This study investigates the awareness and concerns of primary healthcare workers (PHCW) regarding the COVID-19 pandemic. Methods: A cross-sectional survey was conducted in public PHC units in Greece. A web-based 18-items questionnaire was administered, exploring HCWs' demographics, awareness level and knowledge of the pandemic preparedness plan and their work or nonwork related concerns.Results: 444 PHCWs participated in the study, most were female (67.1%) with a mean age of 44.4 (SD:9.2) years old and a mean working experience of 11.9 (SD:9.8) years. Participants being or living with high-risk individuals (e.g. elderly) showed less awareness (p = 0.006, 95% CI -0.95, -0.16). PHCWs in rural settings show more situation awareness, compared to PHCWs in urban areas (p = 0.008, 95% CI 0.28, 1.92). Older PHCWs have less concerns than younger PHCWs (p = 0.025, 95% CI -0.08, -0.005). Second line PHCWs are also less concerned than first line physicians (p = 0.028, 95% CI -1.49, -0.08). First line non-physicians PHCWs know less about the preparedness plan than their physician counterparts (p \ 0.001, 95% CI -0.97, -0.38). Same applies for participants being or living with high-risk individuals (p = 0.025, 95% CI -0.37, -0.03). Conclusions: In view of the second wave of the pandemic, PHC structures and PHCWs should be empowered to actively participate in treating and monitoring high risk and geriatric outpatients in PHC settings.

Admissions to Hospital from Local Care Homes During COVID-19 Pandemic Jennifer S. Pigott 1 , Celia Bielawski 1 1 Whittington Health NHS Trust, London UK Introduction: The COVID-19 global pandemic has disproportionately affected care home residents. Internationally reports range from 19 to 72% of COVID-19 deaths occurring in care homes [1] . Whittington Health NHS Trust, Care of Older People department provide an integrated ageing service which supports Islington Care Homes. Enhanced advanced care planning specifically to cover COVID-19 was undertaken in February 2020. Methods: Data was collected for patients admitted from Islington Care Homes to the Whittington Hospital during the peak of the UK pandemic (1/3/20-31/5/20) , and an equivalent time period from 2019. Demographics, clinical diagnoses, treatments, and outcomes were collected. Results: 19 Islington Care Homes admissions occurred, with two admitted twice. A further 4 were able to return home following treatment in the Emergency Department. All patients received treatment in hospital that could not have been provided in the community. 6 of the admissions tested positive for Sars-Cov-2 on PCR with another being diagnosed with COVID-19 based on imaging and clinical features but with a negative swab result. 2 of those with COVID- 

Eur Geriatr Med (2020) Introduction: During COVID19 pandemic, population of community-dwelling older adults was particularly isolated from the classic healthcare system. Undergraduate medical students served as a liaison with ambulatory network healthcare system. The aim of this action was to prevent and detect medical, social, or mental problems in this population of Nancy Metropole in Lorraine, allowing to order rapidly and relieve general practitioners'workload. Methods: The students had to phone frail people in order to provide them social contact according to a well-defined protocol written by the Territorial Platform of Support (PTA) of Grand Nancy, after receiving dedicated training to strategic, safe, smart, and resourceconscious way.They had to send a weekly report to the PTA physicians, and can contact them immediately (by phone or mail) as often as they needed. The PTA physicians can then take action accordingly, in conjunction with the general practitioner. Results: 145 students volunteered for 10 weeks, performed a telephone-based health survey. Each student called from 3 to 5 patients, from one to five times a week for each patient, so that the call duration was about 6 h/week per student. More than 700 patients were included in the action. Key Conclusions: This project certainly prevented many health issues from occurring among aged people and enabled undergraduate medical students to consolidate their plan of career development.

There is necessary an impact of COVID on medical education, and those students, who weren't in direct contact with patients, showed their collaborative spirit and enhance their medical skills in a completely new and innovative manner.

Use of monoclonal antibodies in octogenarian patients with COVID-19. About a case. Introduction: Tocilizumab is a monoclonal antibody indicated in patients with severe involvement of the T-CAR cell-induced cytokine release syndrome. Linked to this indication, it has been used against COVID-19 despite the lack of clinical trials. Methods: Analysis of the case of an 83-years-old man admitted in March 2020 due to COVID-19 infection. He presented a torpid evolution despite specific treatment, receiving treatment with tocilizumab, presenting clinical improvement with reduction of oxygen therapy and allowing the hospital discharge.

Results: 83-years-old man with a history of dyslipidemia, without toxic habits, independent for basic activities of daily living (Barthel index 100/100) who was admitted to hospital for fever, dry cough, myalgia and arthralgia for five days of evolution. COVID-19 infection was diagnosed by PCR and specific treatment was established with lopinavir/ritonavir, hydroxychloroquine and ceftriaxone. The patient presented torpid evolution, needing intravenous corticosteroid and oxygen therapy at high flows to maintain adequate saturations. Given the lack of improvement, tocilizumab was administered in a single dose, after 48 h of the same became a favorable evolution, being able to decrease the flows of oxygen therapy and improving auscultation. The patient discharged at home with oxygen therapy in 2-liter nasal glasses per minute. Conclusions: Tocilizumab may be a potential treatment in severe and critical cases of patients with COVID-19 due to its mechanism of action by interrupting the release of cytokines, however, it is necessary to carry out controlled clinical trials that evaluate the safety and efficacy of this drug for this indication. To address this problem, we aimed to explore the suitability and feasibility of telemedicine service for our community hospitalist group and understand its limitations in a pilot study. Methods: Four remote hospitalists performed ten telemedicine encounters each onadmitted patients (n = 40 total encounters). The patient population consisted of adult acute hospital admissions along with geriatric and adult psychiatry inpatients. Hospitalists situated themselves in our hospitalist office for the purposes of this pilot. Remote hospitalists partnered with a ''telepresenter'' who is also a hospitalist in our group. The telepresenter hospitalist mobilized the 2-way audio-visual telemedicine cart into the patient room and assisted with performing a physical exam. At completion, all 4 hospitalists were qualitatively interviewed individually and their interviews analyzed to evaluate their experience. Results: Remote hospitalists were satisfied with their ability to evaluate and communicate with patients using telemedicine. They felt confident knowing that the physical exam was performed by a hospitalist colleague, a ''telepresenter.'' The 2-way audio-visual experience was seamless. As noted by our remote hospitalists, patients found the encounter to be positive and enjoyed continuity of care. Limitations include the rapid response and late call workflow for which back-up systems will need to be implemented. A 5-h moonlighting telepresenter shift will need to be staffed. AimIt is apparent that the SARS-COV-2 virus disproportionately affects the older population and it has been anecdotally reported that COVID-19 presents atypically in this cohort. This can cause difficulty in identifying, treating, and appropriately isolating these patients. This project was therefore undertaken to describe and quantify clinical presentations of confirmed cases of COVID-19 in the older population. MethodThis was a retrospective cohort study of 50 patients who had PCR confirmed COVID-19 between April 1st 2020 and April 27th 2020 and were over the age of 80. 9 patients were excluded who had been tested routinely and did not have symptoms that triggered testing or who initially tested positive elsewhere. Symptoms at presentation were analysed and delirium during admission and clinical frailty scores were also assessed. ResultsOf the 41 patients, the majority did not present with symptoms consistent with WHO case definition of COVID-19. Although respiratory symptoms were the most common presenting complaint (29%), most patients presented atypically with a fall (20%), delirium (15%), GI symptoms (12%) or asymptomatically (12% Background: This study aimed to assess the contribution of asymptomatic and presymptomatic residents and staff in SARS-CoV-2 transmission during a large outbreak in a Dutch nursing home. Methods: Observational study in a 185-bed nursing home with two consecutive testing strategies: testing of symptomatic cases only, and weekly facility wide testing of staff and residents regardless of symptoms. Nasopharyngeal and oropharyngeal testing with RT PCR for SARs-CoV-2 was conducted with a standardized symptom assessment. Positive samples with a cycle threshold (CT) value below 32 were selected for sequencing. Results: 185 residents and 244 staff participated. Sequencing identified one cluster. In the symptom-based test strategy period 3/39 residents were presymptomatic compared to 38/74 residents in the period of weekly facility-wide testing (p-value\ 0.001). In total, 51/59 (91.1%) of SARS-CoV-2 positive staff was symptomatic, with no difference between the two testing strategies (p-value 0.763). Loss of smell and taste, a sore throat, headache or myalga was hardly reported in residents compared to staff (p-value \ 0.001). Median Ctvalue of presymptomatic residents was 21.3, which did not differ from symptomatic (20.8) or asymptomatic (20.5) residents (p-value 0.624).

Conclusions: The underreporting of symptoms in residents compared to staff suggests that a/presymptomatic residents could be unrecognized symptomatic cases. However, symptomatic and presymptomatic/unrecognized symptomatic residents both have the same potential for viral shedding. The high prevalence symptomatic staff found in facility wide testing suggests that staff has difficulty to attribute their symptoms to possible SARS-CoV-2 infection. Weekly testing was an effective strategy for early identification of SARS-Cov-2 cases, which resulted in fast isolation and mitigation of this outbreak.

Asymptomatic cases and limited transmission of SARS-CoV-2 in residents and healthcare workers in three Dutch nursing homes to answer the research question. We describe factors that may contribute to the prevention of transmission and argue that the necessity of large-scale preemptive testing in nursing homes may be dependent of the local situation regarding prevalence of cases in the surrounding community and infection control opportunities.

Symptom clusters in COVID-19: a potential clinical prediction tool from the COVID Symptom Study App

As no one symptom can predict disease severity or the need for dedicated medical support in COVID-19, we asked if documenting symptom time series over the first few days informs outcome. Unsupervised time series clustering of symptom development was performed on data collected from a training dataset of completed cases enlisted early from the COVID Symptom Study Smartphone application, yielding six distinct symptom presentations (n = 1653). Clustering was validated on an independent replication dataset (n = 1047). Individuals assigned to differing symptom clusters showed differences in the subsequent need for respiratory support in hospital, with risk escalating from 1.5% in cluster 1 ('flu like with no fever) to 19.8% in cluster 6 (Severe level 3: Abdominal and Respiratory). Moreover, older, frailer (PRISMA7) individuals and those with multimorbidities were more likely to exhibit the two most severe symptom clusters (Severe level 2: Confusion, and Severe level 3 Abdominal and Respiratory), distinguishable as early as day 3. Investigating prediction of subsequent need for respiratory support, we found that personal characteristics alone, including PRISMA7 frailty, were able to achieve a ROC-AUC of 69.5%. Adding data from the first 5 days of symptom logging after onset, the ROC-AUC of need for respiratory support was substantially improved at 78.8%. Such an approach could be used to monitor at-risk patients and predict medical resource requirements days before they are required, opening the doors for proactive interventions.

Eur Geriatr Med (2020) 

Background: Sars-CoV-2 is transmitted via droplet spread and can be carried in the nasal passages in asymptomatic or mildly symptomatic individuals. There is evidence that hypertonic saline nasal irrigation and gargling (HSNIG) can reduce the viral load of coronaviruses. We present a feasibility/pilot 1:1 cluster-randomised trial of hNIG in care home (CH) staff to protect CH residents from COVID-19.

Method: Staff in intervention CHs were asked to administer hNIG each shift. Nominated champions led the implementation. Baseline data, uptake of hNIG and outcomes were collected via self-reported online questionnaires. Barriers and facilitators to the intervention were explored via interview. Results: We contacted 30 CHs and randomised seven-four to intervention and three to usual practice. One dropped out on being allocated to usual practice and two did not complete data collection. Of these one CH felt overwhelmed during the pandemic and the other felt that the intervention was no longer needed. Four CHs (2 intervention, 2 control) completed the study. In the two intervention CHs adherence to the intervention was varied (100% and 40%) Facilitators to uptake of the hNIG included: highly motivated champions, strong leadership and integration into daily routines. Reported barriers were a lack of ownership by managers and champions and staff already feeling safe from COVID-19.

We demonstrate that self-administration of hNIG by CH staff is feasible. A future trial to test effectiveness should not rely solely on self-reported outcome data. Consideration should be given to a stepped-wedge design so all CHs participate in the intervention.

A real-world analysis of the value of repeated swabbing in COVID-19

Ealish Swift had a positive result on the first swab, and a further 7% later tested positive on repeated swabs. 18% were not reswabbed after an initial negative result but instead were treated clinically, and 25% never swabbed positive despite repeated attempts.

Key conclusions: Given that only 7% of suspected COVID patients become positive after an initial negative swab, and that a full 25% of suspected patients never swab positive, it may be pragmatic to use swabbing as more of a rule-in rather than rule-out measure, avoiding repeat sampling in those in whom this may cause distress. In addition, de-escalation and repatriation protocols requiring re-swabbing prior to discharge may need to be updated to consider the necessity of repeat swabbing in light of these findings.

Using WhatsApp messaging platform to facilitate rapid multiprofessional, multi-organisational support for care homes during the COVID-19 pandemic Università Cattolica del Sacro Cuore Roma, 6 Istituto Superiore di Sanità

Background: The prompt identification of patients affected by coronavirus disease 2019 (COVID-19) at higher risk of death represents a turning point in their clinical management and in the decisionmaking process. We aimed to evaluate whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age. Methods: We analysed data from 165 patients consecutively admitted to an acute geriatric medicine ward in Brescia, Northern Italy from March 8th to April 17th, 2020, with a suspected diagnosis of COVID-19. The infection was confirmed by reverse transcriptase-polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 RNA. Pre-disease frailty status was assessed with the 9-point Clinical Frailty Scale (CFS) and categorized as 'no to mild frailty' (\ 6 points), and 'moderate to severe frailty' (6+ points). Based on a predefined list of 60 chronic diseases, multimorbidity was defined as the co-occurrence of C 2 of these chronic diseases in the same patient. Cox regression models were used to evaluate the hazard (HR) of inhospital mortality as a function of frailty and multimorbidity in the whole population and in those aged 70+ years. The C-statistics of different Cox regression models were used to assess the increment in accuracy in the prediction of in-hospital mortality provided by adding information on the CFS and multimorbidity to chronological age. Results: The median length of stay of the whole sample population was 10 days (IQR 7-17). Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units and 42 died. Patients who died were older (81.0 years vs. 65.2 years, p \ 0.001), more frequently multimorbid (97.6% vs. 52.8%; p \ 0.001) and more likely to be frail (37.5% vs. 4.1%; p \ 0.001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only and 75% of those with both multimorbidity and frailty died during hospitalization. In survival analyses, adjusted for age, sex, and education, each unitary increment in the CFS score was associated with a significantly higher risk of in-hospital death in the whole sample (HR = 1.31; 95% CI 1.05-1.62) and in patients aged 70+ years (HR = 1.29; 95% CI 1.04-1.62), whereas each increment in the number of chronic diseases was not significantly associated with higher risk of death. The addition of the CFS to chronological age and sex increased in-hospital mortality prediction by 9.4% in those aged 70+ years. The highest positive predictive value was due to moderatesevere frailty (0.75 with a positive likelihood ratio of 9.15), whereas the highest negative predictive value was linked to multimorbidity (0.98 with a negative likelihood ratio of 0.05).

Conclusions: Frailty identifies patients with COVID-19 at risk of inhospital death independently of age. The significant prognostic value of frailty is maintained in persons aged 70 years and older. Multimorbidity also contributes to mortality risk stratification, especially because of the very low probability of death in its absence. Systematic screening for frailty and multimorbidity in patients with COVID-19 may help to identify high-risk individuals in need of early intervention and to develop and validate clinical decision support tools. 59000 Lille., 2 Département de recherche en éthique, Université Paris-Saclay.

Introduction: The end of the COVID-19 pandemic lockdown raised anxiety especially for aged people. To alleviate it, we created a score estimating the relative risk to be infected by SARS-COV2 and to die from it according to age, sex and body mass index (BMI). Methods: We used the cumulative number of deaths of the largest most severely affected French region, the Île de France (IDF) excluding people living in institutions, on April 22 2020, grouped by 10-year age classes. To approximate the impact of sex we calculated a standardized mortality ratio for men (1.49) and women (0.65). The influence of BMI was taken into account using data from an English cohort [1] .

Results: The COVID-SCORE applied to individuals without known comorbidities, and non-pregnant women. A publication [2] During telephone consultation the following variables were collected: age, type of heart disease, changes in management generated by the consultation, hospitalizations due to heart disease, mortality and causes, and COVID infections.

Results: N = 300, 55.3% women, mean age 83.07 ± 6.7. The most frequent reason for cardiology consultation was due to arrhythmias/conduction disorder (36%). 88% of the patients remained without medical changes, 6% required treatment adjustment and 2.3% were discharged by telephone. 90, 6% of the patients did not need to go to the emergency department, 4% came due to symptoms compatible with COVID, and only 1.7% came because of cardiological worsening. 5.6% of our patients suffered from COVID infection. 2.3% of patients died, out of which 0.3% (1) were due to cardiopathies, 0.7% (2) from COVID-19 and 1.3% (4) from other causes. Conclusion: Telemedicine is a useful tool to support the monitoring of patients with stable heart disease. Our patients suffered a low percentage of cardiac decompensations and mortality, as well as a low COVID-19 infection and mortality rate.

Ageism never gets old: preliminary results of an ongoing survey to understand prejudice and attitudes towards the elderly in the era of COVID-19 Introduction: Ageism against the elderly differs from other forms of discrimination in that every human being is inevitably a subject of it as they live long enough. In the era of COVID-19, as the older population is under the spotlight, ageism can be encountered in various aspects of life. To assess society's prejudice and attitudes toward the elderly during the pandemic and to understand whether ageism is related to nonfactual information spread, we designed an online survey. To the best of our knowledge, this is the first study addressing these questions based on responses to a survey. Methods: We designed a cross-sectional online survey consisting of 26 questions to assess/understand the perception and attitudes of Turkish population toward elderly during the pandemic. Among the questions, 5 of them were demographic, rest of them questioned false beliefs and community's source of information about COVID-19, attitudes to aged, and awareness of ageism.

Results: 550 participants enrolled in the study. 65.3% of them are women. 94.3% of participants are under 65 years old. 81.1% of participants never heard about ageism term. Surprisingly, 23% falsely believe that older people spread the virus more than young ones. There is a significant relation between not knowing ageism and false beliefs (p = 0.04). As can be expected, false information is more common at low education levels. On the other hand, 51% of respondents think that health services during the pandemic should be prioritized according to age with 35% thinking that\55 years should be favored. Finally, although almost everyone (%92.4) agrees that elderly experience psychological distress during the pandemic, only 50% of respondents take action to reduce anxiety of their elderly relatives.

Key conclusions: A society is measured by how it cares for its ''older'' citizens' says WHO. In this regard, we tried to understand how our society approaches the elderly and cares for them throughout COVID-19 pandemic. Our results suggest that educating the society about facts and prevention of misinformation may reduce ageism. Finally, we believe that increasing awareness is our duty as healthcare providers until the next pandemic.

Geriatric giants present in the suspected COVID-19 population in Galway University Hospital Introduction: Predictors of in-hospital mortality related to COVID-19 in the oldest old are unknown but probably different from the general population. Methods: Monocentric retrospective study of patients aged 65 years and older hospitalized in acute geriatric wards for COVID-19. Data from hospital admission was collected from the electronic medical records. Multiple logistic regression and Cox proportional-hazard models were used to predict mortality. Results: Of a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died during their hospital stay. Hypertension, cognitive impairment, heart failure, chronic kidney disease, and diabetes were the most prevalent comorbidities. Male sex was associated with mortality in this group but not differences in age. Non-survivors had a higher rate of heart failure (p = 0.044) and bilateral and peripheral infiltrates on chest radiographs (p = 0.001). A multivariable Cox regression model showed that male sex (HR 3.84, 95% CI 1.93-7.62, p = 0.0001), increased fraction of inspired oxygen (HR 1.06, 95% CI 1.03-1.09, p \ 0.0001) and the presence of crackles at clinical status performed at admission (HR 2.84, 95% CI 1.23-6.57, p = 0.0145) were the best predictors of mortality, while the absence of functional decline was protective (HR 0.98, 95% CI 0.97-0.99, p = 0.0003). Conclusions: In the oldest old hospitalized for COVID-19 male sex, crackles, a need for a higher fraction of inspired oxygen and functional decline at admission were independent risk factors of mortality. These routinely collected parameters, and not differences in age, should be taken into account to evaluate prognosis in the oldest old hospitalized for COVID-19.

Epidemiological aspects of COVID-19 in N. Macedonia-highest mortlity rate in elderly Introduction: First case of COVID-19 in N.Macedonia was registred on February 26th 2020-a female patient returning from Italy. Until June 7th 0, 14% of the population was infected or, in absolute number, 3025 people. Methods: statistical analysis of the official data from Ministry of health. Results: On population 2 083 379 people, total cases 3025, active 1226 (0, 05% of the population), deaths 153 (73 per 1M)-case fatality rate 5, 18% (global world case fatality rate 5, 76%). Recovered 1646. Total tests 36 325 (17 423 per 1M). Demographic data: total cases 3025: by gender-male 1453 (48%), female 1572 (52%); by age-0-9 148 (5%), 10-19 yrs 148 (5%), 20-29 yrs 393 (13%), 30-39 yrs 533 (17%), 40-49 yrs 540 (18%), 50-59 yrs 598 (20 %), 60+ yrs 665 (22%). Total deaths 153: by gender: 100 male (65.4%), 53 female (34.6%). By age: 20-29 yrs 2 (1 male, 1 female), 30-39 yrs 2 (2male), 40-49ysr 12 (10 male, 2 female), 50-59 yrs 33 (23 male, 10 female), 60-69 yrs 48 (33 male, 15 female), 70-79 yrs 39 (26 male, 13 female), 80-89 yrs 15 (11 male, 4 female), 90+ yrs 2 (2 male). Total deaths of patients 60+yrs -104 or 68% of all deaths. Key conclusion: Although only 22% of total cases of COVID-19 in N.Macedonia are at the age of 60 and above, which is similar to the younger age groups, they have the highest mortality -68% of total deaths. This imposes the necessity of strong preventive measures for this age group.

Higer mortality excess was found in younger departments in France during the COVID-19 pandemic Emmanuel Gonzalez-Bautista 1 , Claudia Lorena Vargas-Aleman 2 1 Gérontopôle, Toulouse University Hospital, France., 2 Independent Researcher Background: Surveillance for COVID-19 in France included the mortality excess (ME) at sub-national levels. The most significant proportion of fatalities occurred in older adults. However, there has been little evidence using an ecological (aggregate) approach. We aimed to test if the departments with a higher proportion of older adults reached a higher mortality excess in France and if they maintained a mortality excess for longer during the pandemic period. Methods: We used the data published by Geodes Public Health aggregated at the department level (n = 100 for Metropolitan France). Five levels of mortality excess in the French population were defined comparing expected versus observed mortality (EuroMomo model, 16-22 March to 11-17 May of 2020) . The departments were ordered based on their proportion of the population aged 60+. We obtained simple and complex absolute and relative measures of inequality of the maximum level of ME and the number of weeks with ME. Results: The maximum level of mortality excess of the youngest French departments was, on average, thrice that of the oldest departments. The youngest French departments reported mortality excess an average of 5 weeks longer than the oldest departments. Significant inequality was consistent using simple and complex, absolute and relative measures of inequality. Conclusion: Highest levels of mortality excess, and during a more extended period, were found in departments with a relatively younger population. A higher proportion of older adults in the population might be associated with a third socio-economical ''protective'' variable. Further multidisciplinary analyses are necessary to explain these health inequalities.

Clinical features in elderly patients with coronavirus disease Background: The coronavirus disease , caused by novel coronavirus (SARS-CoV-2) occurs in persons of all ages but has specially impacted the elderly people. Methods: Retrospective study of all patients older than 80 years with a diagnosis of SARS-COV-2 discharged from a University Hospital in Spain from March 1 to May 31, 2020.Results: 91 patients (100% analized). Median age 84, 5 (81, 2-89, 8) . Women 37, 8%. Institutionalized 32, 2%. Charlson median 2 (1) (2) . Independent 41, 8%, severe dependency 22%; no cognitive decline 70, 3%, moderate dementia 19, 7%. Pneumonia 75, 8%. Hidroxicloroquine + Azithromycin 66, 7%; Lopinavir/Ritonavir + Hidroxicloroquine + Azithromycin 12, 1%; steroids 42, 9%; support treatment 19, 8%, heparin (LWMH) 88, 9%; delirium 33, 9%; exitus 32, 2%.None association was found between mortality and age, gender, comorbidity, functional or mental condition. We only found relation with delirium and mortality (OR 1, 1: IC95% 1, 5; p = 0, 003) but the presence of pneumonia or coagulation complications didn't increase the mortality. Heparin dose, steroids or the treatment elected also were not related with mortality.The treatment was associated with Barthel index (p = 0, 001). Key conclussions: A third of the sample died during hospitalization. It is remarkable that we couldn't associate it with functional condition, only with presence of delirium. It could be consequence of the sample size. The treatment elected by the physician might be based on the previous condition and independence of the patient, with no differences in the prognosis.

Old frequent users in a tertiary hospital Portuguese reality at a glance Introduction: Expected death has no medical definition or consensus, but pertains to an acute or gradual clinical situation or condition that will not or cannot return or resume. The expected death and deterioration in the patient's health is often due to advanced disease, limitation of medical treatment and terminal illness, but the controversial emerges when some patients may prefer not to undergo lifesustaining treatments. The probability is associated with general indicators of decline and increasing needs, as the Gold Standard Framework Prognostic Indicator Guidance points. Methods: Prospective descriptive study of the patients admitted to a tertiary Hospital with COVID during the Pandemia from 11 March to 31 May. Patients who died were included and grouped according to admittance to Intensive Care Units (ICU) and compared according to demographic data, frailty scales, palliative Performance Scale version 2 comorbidities, used medication, admittance to hospital in the previous 6 month, and average length of stay. Results: There were 28 patients included, of those 16 were admitted to the ICU. The majority were between 75 and 85 y, none above 85 y. Average CFS was 2.6 vs 5.9, PPSV2 74.6 vs 44.7, PRISMA7 1.4 vs 4.2, Charlson index 1.6 vs 5.9, number of drugs 4.8 vs 8.7, recent admissions similar (2), lenght of stay 6.5 vs 7.2. Of these only 1 patient, was the cause of death not related to COVID infection. Discussion: In face of an unprecedented humanitarian crisis, research is important to evaluate and characterize the risk factors associated with the patients with expected death, and may contribute to better clinical decision and resource management. Our study showed that patients that died with higher disease burden were less likely to be admitted to the ICU.

Association between delirium, impaired consciousness, and adverse outcomes in hospitalized patients with COVID-19. 

Objectives: To investigate the occurrence of delirium and impaired consciousness in hospitalized patients with COVID-19 and explore their association with adverse outcomes.

Methods: Longitudinal observational study in a tertiary university hospital dedicated to the care of severe cases of COVID-19 in Sao Paulo, Brazil. We included 707 patients aged C 50 years consecutively admitted to the hospital between March and May 2020. We completed detailed reviews of electronic medical records to collect our data. We identified delirium using the Chart-based Delirium Identification Instrument (CHART-DEL) and defined delirium as prevalent when present on admission. We also classified patients according to level of consciousness on admission using the Richmond Agitation-Sedation Scale. Our outcomes of interest were in-hospital death, length of stay, admission to intensive care, and ventilator utilization. We estimated the associations of delirium and impaired consciousness with outcomes using regression models adjusted for sociodemographic factors, Charlson comorbidity index, antihypertensive drugs, signs, and symptoms related to COVID-19. Results: Overall, we identified delirium in 232 participants (33%). On admission, 86 (16%) were delirious, and 203 (29%) had impaired consciousness. We observed 263 deaths (37%) in our sample, and inhospital mortality reached 51% in patients who experienced delirium. Both prevalent delirium and overall delirium were associated with inhospital death, with an adjusted hazard ratio (aHR) of 1.81 (95% confidence interval [95% CI ] 1.25-2.62) and adjusted odds ratio (aOR) of 1.57 (95% CI 1.02-2.42), respectively. In-hospital mortality in hyperalert, lethargic/stuporous and comatose patients was respectively 74% (aHR = 2.63; 95% CI 1.34-5.17), 56% (aHR = 2.53; 95% CI 1.55-4.14), and 74% (aHR = 3.35; 95% CI 1.61-7.0). Delirium was also associated with increased length of stay, admission to intensive care, and ventilator utilization. Conclusion: Delirium and impaired consciousness were strongly associated with in-hospital death in adults aged C 50 years with COVID-19. Clinicians should include delirium and consciousness evaluations in their routine assessments of severity and prognosis in this population, despite the pandemic-related difficulties for patient care. Introduction: To contain the COVID-19 pandemic, governments around the world restricted social and physical contact by issuing lockdown and social-distancing measures. Older adults, being considered a risk group for COVID-19, often follow more strict rules. Yet, lockdown measures may induce mental health problems and increase the occurrence of domestic violence (DV). We examine the effects of lockdown measures on mental health and DV in older adults during the COVID-19 pandemic. Methods: In the first wave of this longitudinal cohort study, an online self-report questionnaire on mental health and aggression was administered to a non-probabilistic sample of participants living in Belgium, Germany and Portugal. Participants were sampled through national media, social media, and snowballing procedures. This Abstract reports on Belgian events that occurred between 13 March and 13 April 2020. The second wave of data-collection is currently ongoing.

Results: 358 participants aged 65 years and older were included in the analysis. 15% of respondents experienced DV with 14% experiencing psychological violence, 1% physical violence and 1% sexual violence. One respondent disclosed an (attempted) rape. Compared with non-victimized respondents, DV victims reported more stress (54% v 24%), more sedative use (35% v 13%) and showed more often symptoms of Acute Stress Disorder (33% v 8%). Key conclusions: DV in older adults appears to be common, linked with lockdown measures due to COVID-19, and associated with adverse mental health outcomes. These findings highlight the possible need for public health measures and sociocultural changes preventing DV and improving mental health during lockdown in older adults.

Compliance elderly to the directions to stay at home during the covid 19 lockdown in Greek province (17). The present study recorded the compliance, of elderly patients in two Xanthi's Municipalities, to the instructions of EODY (National Public Health Organization) for quarantine from March 15 to May 31.Methods: Using a structured questionnaire, we recorded age, gender, presence of partner and children, education, income, disease information, how to procure medicines and food, if they spent Easter/Bayram holiday alone and consent to the strict measures taken.Results: 265 elderly agreed to participate, of which 63.4% were women aged 73.4 ± 5.9 years, the majority were married (71.7%), compulsory educated (45.7%) with more than two children (78.4%) and income \ 15000 euros. Television was the main source of information (89.8%), while 85.7% spent Easter/Bayram alone. The supply of medicines (77, 8%) and food (40%) was made to order. There was a strong correlation between children's presence and elderly compliance (p = 0.019). Almost all of them agreed with the strict measures taken (99.2%). Key conclusions: We found a high rate of compliance of the elderly in the lockdown period which agrees with almost zero positive people in the region (3) in contrast to other Xanthi' s Municipalities. The elderly should be informed to comply with personal protective measures by their family physicians as there is a large viral load in the area.

Was COVID already spreading in Belgium on 25th of February?

Hilde Baeyens 1 , J. P. Baeyens 1 , Christine Balcaen 2 , Leen Derez 1 , Anne Piette 3 , Kyri Van Hecke 1 1 AZ Alma, Eeklo, 2 Bassevelde, 3 Az Alma, Eeklo On 3rd of February, the first Belgium COVID-patient arrived from Wuhan. On the 29 of February, a citizen returning from France was COVID-positive. On 13th of March, Belgium went in lock down. On 25th of February, a 90-year old lady was admitted to our geriatric ward. She had anorexia for 1 week and gait problems. She was known with bronchiëctasia and coughing. On admission (day 8 from beginning of symptoms) crp was 463 mg/dl, mild lymphopenia (1, 16 .10 3 / lL) was present, oxygen saturation 95 % (2-liter oxygen per minute). She was treated with beta-lactam antibiotics, moxifloxacin, and antithrombotic prophylaxis. On day 11, she developed bilateral pneumonic infiltrates with high oxygen demand. Droplet isolation was installed. Because of persistent fever on day 16, a naso-pharyngeal swab for PCR COVID and other respiratory pathogens (virus, bacteria, fungi) was negative. On day 26, her lymphopenia disappeared, and oxygen demand reduced. She went home on day 66, still needing oxygen and not able to walk due to severe sarcopenia. On day 86, she was referred to our geriatric day hospital. COVID-IgG antibodies were slightly positive: 7, 6 AU/ml. Refrigerated serum of day 32 (19/3) was strongly positive: 76, 6 AU/ml. Her grandson went skiing in Livigno (Lombardy) from 7th till 13th February and joined the football match in Rome on 18th of February (AA Gent -AS Roma). At home he got respiratory symptoms and on 17/3 he stayed at home in quarantine. Conclusion: On 25th of February, COVIDdisease was already in our hospital in Eeklo, Belgium. -19) has reached proportions to be declared a pandemic disease, particularly in older people. This pandemic created important issues in terms of prognostic evaluation. Multidimensional prognostic index (MPI) is widely used as prognostic tool in geriatric medicine. However, there are no studies yet regarding the use of MPI to predict prognosis in older COVID-19 patients. Methods: Older hospitalized patients (age [ 65 years) affected by COVID-19 across five Italian hospitals were included from 26th April to 19th June 2020. At baseline, a comprehensive geriatric assessment was made and the MPI calculated accordingly. Clinical, bio-humoral and instrumental information related to COVID-19 were also collected. A follow-up period was proposed. Results: 104 Italian participants hospitalized for COVID-19 (mean age: 81.1 ± 8.0; range: 65-95 years; females = 66.3%) were included. Their mean MPI value was 0.56 ± 0.25, with 21.4% in the MPI low risk, 28.2% in the moderate and the 45.6% in the high risk MPI category. Among clinical signs investigated, cough was significantly more common in the MPI 1 compared to the MPI 3 category (63.6 vs. 27.7%, p = 0.003). Regarding vaccination history, people in MPI presented a higher prevalence of anti-pneumococcal vaccination (22.7% vs. 4.3%, p = 0.02) than those in MPI 3. Finally, regarding therapeutically approach, people in MPI 1 were more frequently treated with anti-retroviral medications than their counterparts (p = 0.03) and were more frequently exposed to non-invasive ventilation (54.5 in MPI 1 vs. 10.6% in MPI 3, p = 0.003). Conclusions: Older people hospitalized for COVID-19 have a high prevalence of frailty making this condition of importance for clinical-decision making. Physicians had the propensity of using more frequently non-invasive ventilation and anti-retroviral medications in less frail patients. The prognostic role of anti-pneumococcal vaccination should be explored during the follow-up period.

Awareness of caregivers of elderly patients for COVİD-19 pandemia Guzin Cakmak 1 , Zeynel Abidin Ozturk 1 1 Gaziantep University, Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics Introduction: During the COVID-19 pandemic, the disease caused by the new coronavirus, older people are especially vulnerable to severe illness. Caregiving to elderly patients become harder than before, and being well-informed is more critical in this duration. Methods: This cross-sectional study was conducted for a period of 2 months, from March to May 2020. A questionnaire interrogated awareness and knowledge levels of caregivers. The questionnaire has consisted of general information about pandemic and demographic data. Participants answered the questions from the internet. SPSS-22 was used for data analysis. Results: The study population was composed of 79 women and 21 men. Sixty-nine percent of the patients were suffered from dementia. 30% of the participants were responsible for caregiving for more than 10 years. 76% of the caregivers were willing to take more information. 33% of the caregivers were taking the information from a single source. General knowledge status about pandemics were found to be correlated to education level (p \ 0.01, r = 0.397). Key conclusions: Caregiving to elderly patients is an essential responsibility in the pandemic. Education levels of caregivers could affect the health status of geriatric patients in this duration. Prospective studies will be better to explain the relationship between health outcomes for geriatric patients and the education levels of their caregivers. In the community of Castilla y León a diagnosis, surveillance and control strategy is being established in the transition phase of the COVID-19 pandemic, of the patients and their close contacts. In all Rural and urban health centers, they will have a Public Health manager who will guarantee that the epidemiological follow-up of cases of COVID19 and contacts Introduction: Despite the growing evidence on COVID-19, there are still many gaps in the understanding of this disease, especially concerning older people, who are the most affected by the pandemic.

The GeroCovid e-Registry is a European de-identified clinical data electronic registry of COVID-19 patients aged C 60 years, observed retrospectively or prospectively since March 1st, 2020. This study has been promoted by the Italian Society of Gerontology and Geriatrics and involves investigational sites across Italy, Spain and Norway. GeroCovid will explore the impact of COVID-19 in the following care settings: acute wards, nursing home, geriatric outpatient and home care, and dementia outpatient clinic. A common framework, adapted for the data collection in different settings, will evaluate: risk factors, clinical presentation and outcomes in COVID-19 inpatients; best strategies to prevent contagion in nursing home; impact of COVID-19 and social isolation on emotional, neuropsychological, functional and physical health; and, effects of telemedicine on health and management of dementia patients. Results: As of June 30th, 70 investigational sites have obtained their Ethical Committee approval and 477 cases (age 82.9 ± 11.0 years; 51% men) have been recorded in the e-registry. The current inclusion rate is 9-10 patients/day. The clinical follow-up of prospective cases and data collection will end on September 30th and preliminary results will be available in October 2020. Key conclusions: GeroCovid will explore relevant aspects of COVID-19 with high-quality and comprehensive data on older adults' health. This will help optimizing COVID-19 prevention and management, with practical implications for ongoing and possible future pandemics.

Covid-19 outbreak in a geriatric department. An observational Study Result: At total of 12 patients was tested SARS-CoV-2 positive during the period or on readmission within 7 days after discharge. The outbreak was located to 3 of the 9 hospital rooms, one single-occupancy room (SOR) and two quadruple-occupancy rooms (QOR). No detectable transmission from the patient in SOR was identified. In one QOR (Room A) a total of 6 patients were tested positive (5 being clinically probable index cases), and in the other QOR (Room B) a total of 5 patients were tested positive (1 being a probable index case).

Of the 12 patients 6 had been tested negative at admission, 5 of these were among probable index cases. Of the 12 patients 3 were found at the screening on April 21st. Of the 12 patients 6 had atypical/no symptoms of Covid-19 disease. Discussion: Prevention of disease spread depends on testing being accurate. The high number of probable false negative tests at admission in this geriatric population increases risk of transmission to other patients.

The -19) is an infectious disease caused by the newly discovered 2019 coronavirus. It was named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) due to its' capability to induce an extreme systemic inflammatory response, particularly in young adults. However, the geriatric population is particularly affected by this novel infection, given its' established fragility and high rate of comorbidities. This is a retrospective observational study protocol. We plan to include all the elderly adults ([ 65 years old) admitted in the COVID-19 dedicated ward of a district hospital, diagnosed with SARS-CoV-2 infection, from March to June 2020. We will analyse variables as continuous numerical or categorical values, as appropriate. All analyses will be presented with a 95% confidence interval. Parametric or non-parametric tests will be used according to population distribution. All quantitative data will be qualitatively interpreted. Statistical significance will be considered if Pearson \ 0.05. Subgroup and sensitivity analysis will be done as needed.We will compare Home-cared with Nursing Home geriatric patients and analyse all data on percentage of total COVID admissions, symptoms at arrival, lab analysis, oxygen needs, therapy, number of days of active and social admission, disease complications, final outcome, functional status, dependence in activities of daily living and frailty scores. We also plan to collect data on adverse events of therapy in both groups.We plan to interpret the impact this pandemic has produced in older populations, while also identifying the needs, differences and disease burden these patients have according to residence at admission.

Which parameters affected caregiver awareness in COVID-19 pandemic?

Guzin Cakmak The questionnaire consisted of general information about pandemic and demographic data. Participants were asked for this questionnaire on the internet and telephone conversation. We also evaluated the life quality of caregivers with EQ-5D. SPSS-22 was used for data analysis.

Results: The study population was composed of 79 women and 21 men. Caregivers aged between 25 and 39 were more adherent to social isolation measurement (p = 0.031) than others. The worst supporter of this measure was aged 18-24 (p = 0.001). The participants used more than one resource for being informed about the COVID-19 pandemic were more adapted to distance education than others (p = 0.022). They also supported the home office style working than others (p = 0.039). Caregivers that were willing to gain more information about pandemics were more adherent to social isolation (p \ 0.01 (2), friends (2) or from an unknown source (6) . Disabled older persons, not able to walk outside the home, got infected from family, including those banned together in quarantine (8), caregivers (2) , and in a palliative care facility (2) . Two older persons consequently avoided social contacts, however, they were infected by caregivers. These had been pointed out by some authors as one of the causes of crowding and included in the crowding input factors. Purpose: As part of a study that wanted to assess the impact of the CoViD pandemic on geriatric minor emergencies we evaluated the geriatric population that went to the ER for minor trauma.

We evaluated all patients aged 75 years and older who accessed our emergency room for minor traumas from February 22 to May 1, 2020 and during the same period of the previous year. Results and discussion: We enrolled 397 patients. There was a severe reduction in the total number of accesses for minor trauma: 120 in the CoViD period and 277 in the previous year. Gender, age and vital parameters were overlapping. Patients in the CoViD pandemic tended to be more frequently carried by ambulance and 118 compared to the reference period (67% vs 44%, the remaining half by independent means). The priority codes for medical examination were not different (94% minor emergencies, 4% non-urgencies in the pandemic period vs 95 and 3%). During the pandemic, the severity codes at discharge were higher (yellow and red) with a slightly higher frequency than in the reference period (9% vs 3%) and patients more frequently required hospitalization (21% vs 10%). Rarely this category of patients presents altered crowding indexes. Crowding input factors are however lower in the pandemic period: reduced attendants (120 vs 277) and reduced average waiting times (51 min vs 75 min). The percentage of patients who exceeded the waiting time target by priority code of medical examination is also reduced (3% vs 5%). Crowding throughput factors worsened only slightly: LOS (394 vs 248 min). Crowding output factors are also slightly worsened: the percentage of access block is higher during the pandemic (9% vs 5%). The Total Access Block Time is significantly higher in the CoViD period (6059 vs 2535 min). Crowding for patients who came for all causes of our ED was higher in the pandemic period compared to the reference period (OR = 3.95).

The epidemic led to a drastic reduction of accesses due to minor geriatric trauma, without any effect on overall ED crowding.

Patients have more frequently the need for hospitalization and more severe exit codes. Acknowledgements: we would like to thank all employees of the IRCCS Policlinico San Matteo Foundation for their extraordinary efforts during the pandemic.Keywords: COVID-19, minor trauma, ER, Triage, Emergency Department.

Analysis of the impact of the 2019 coronavirus epidemic (CoViD -19) on the presentation and crowding of patients for neurological disorders at a Lombardy ED.

Background: The coronavirus 2019 (CoViD -19) epidemic in Italy originated in the south-west of Lombardy, on February 21, 2020. The Fondazione IRCCS Policlinico San Matteo di Pavia has been involved in the management of the outbreak since its beginning. Crowding has been defined as a worldwide problem and is a cause of reduced quality of care and patient satisfaction. It is due and identified through three orders of factors: those at the access (input); those related to the patient's process (throughput); and those at the exit from the ED (output). The latter are considered the main responsible for Crowding. Purpose: As part of a study that wanted to assess the impact of the CoViD pandemic on time-dependent diseases in geriatric patients we evaluated the geriatric population that went to the ER for neurological disorders.

We evaluated all patients aged 75 years and older who were accessing our emergency room for neurological disorders from February 22 to May 1, 2020 and during the same period of the previous year.

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

Results and discussion: We enrolled 530 patients. There was only a slight reduction in the total number of accesses for acute neurological disorders: 243 in the CoViD period and 287 in the previous year. The vital parameters were overlapping without statistically significant differences. Patients in the CoViD pandemic tend to be more frequently carried by ambulance and 118 compared to the reference period (90% vs 64%, the remaining half autonomous). Patients in the CoViD pandemic have higher priority to medical examination and severity to discharge codes (yellow and red) more frequently than in the reference period (79% vs 65% respectively) and more frequently need hospitalization (67% vs 54% in Italy originated in the southwest of Lombardy, on February 21, 2020. The Fondazione IRCCS Policlinico San Matteo di Pavia has been involved in the management of the outbreak since its beginning. Crowding has been defined as a worldwide problem and is a cause of reduced quality of care and patient satisfaction. It is due and identified by three orders of factors: those at the access (input); those related to the patient's process (throughput); and those at the exit from the PS (output). The latter are considered the main responsible for Crowding.

Purpose: As part of a study that wanted to assess the impact of the CoViD pandemic on time dependent diseases we evaluated the geriatric population who went to the ER for chest pain.

We evaluated all geriatric patients accessing our PS for chest pain from February 22 to May 1, 2020 and during the same period of the previous year. Results and discussion: We enrolled 405 patients. There was a severe reduction in the total number of accesses for chest pain: 144 in the CoViD period and 261 in 2019. The vital parameters were overlapping without statistically significant differences. In both periods there was no gender prevalence (M 50% in 2019 and 55% in 2020) or age difference (average 82 in 2019 and 83 in 2020) . Patients in the CoViD pandemic tend to be more frequently carried by ambulance and 118 compared to the reference period (74% vs 55%, the remaining half by independent means). Priority codes for medical examination were not different. CoViD pandemic patients have higher discharge severity codes (yellow and red), more frequently than in the reference period (40% vs 30%) and they also more frequently need hospitalization (39% vs 31%). Crowding input factors are lower in the pandemic period: both the patients (144 vs 261) and average waiting times (62 min vs 79 min) are reduced. Also the percentage of patients who exceeded the waiting time target by priority code is lower during the pandemic (31% vs 45%). The Crowding throughput factors have instead worsened: LOS (720 vs 501 min). The Crowding output factors also worsened: the percentage of access block is higher during the pandemic (17% vs 8%). The Total Access Block Time is significantly higher in the CoViD period both for the Visiting Rooms (25,185 vs 12,014 min) and for the Holding Area (13,341 vs 1975 min) . The interpretation of the data must also take into account the increased incidence of late heart attacks highlighted by the literature in the period of the epidemic and also published by a group of our clinic. Conclusion: the epidemic has led to a reduction of accesses for chest pain, especially self-reported. Patients had more frequently the need for hospitalization and more severe exit codes. The pandemic period presented a worse Crowding for these patients due to the Access Block. Acknowledgements: We would like to thank all employees of the IRCCS Policlinico San Matteo Foundation for their extraordinary efforts during the pandemic. Keywords: COVID-19, Chest Pain, Time Dependent Pathologies, First Aid, Triage, Emergency Department, crowding.

Analysis of the impact of the 2019 coronavirus epidemic within the elderly patient population on the presentation mode and crowding at a Lombardy ED.

waiting times, percentage of waiting times longer than expected. Factors related to the patient's process usually analyzed through the total length of stay in ED (Length of Stay). The factors at the exit from the ED (output) are the main ones responsible for Crowding. They are usually measured with the exit block. This is defined by the length of stay in PS more than 8 h before admission. The exit block can be expressed as a percentage of patients who suffer it or the total time of exit block in each time frame. Purpose: As part of a study to assess the impact of the CoViD pandemic on time-dependent diseases, we evaluated the population who went to the Emergency Room for acute neurological disorders during the period of the CoViD pandemic from 23 February to 1 May 2020 and compared it with the population accessing our Emergency Room during the same period of the previous year. Materials and Methods: We evaluated all patients over 75 years of age who needed access to our emergency room from February 22 to May 1, 2020. We then compared this population with those over 75 years of age who were accessing our emergency room during the same period of the previous year. Results and discussion: We enrolled 4891 patients. There was a severe reduction in the total number of elderly accesses: 1910 in the CoViD period and 2981 in the previous year. However, this decrease (-36%) was lower than that of the general population (about -50%). The vital parameters were overlapping without statistically significant differences. In both periods a slight female prevalence was confirmed (about 55%). The average age (84 years) was superimposable. Patients in the CoViD pandemic tend to appear more frequently accompanied by ambulance and 118 compared to the reference period (78% vs 38%, the remaining half by independent means). Patients in the CoViD pandemic have high (yellow and red) priority and discharge severity codes with only slightly higher frequency compared to the reference period (50% vs 44% and 43% vs 25% respectively) and more frequently need hospitalization (54% vs 31%). The Crowding input factors are lower in the pandemic period: reduced patients (1910 vs 2981) and reduced average waiting times (62 min vs 92 min). Reduced also the percentage of patients who exceeded the waiting time target by code of priority to the medical examination (16% vs 26%). Crowding throughput factors worsened: LOS (853 vs 485 min). Crowding output factors also worsened: the percentage of access block is higher during the pandemic (30% vs 10%). The Total Access Block Time is significantly higher in the CoViD period both for the Visiting Rooms (632,738 vs 199,073 min) and for the Holding Area (80,253 vs 38,420 min). Conclusion: the epidemic has led to a reduction in the access of elderly patients, although to a lesser extent than the general population, Especially self-reported patients. Patients have more frequent hospitalization needs and more severe exit codes. The period of the pandemic presented a worse crowding for these patients due to the Exit Block resulting in a prolonged stay in the ER.

Background: The 2019 coronavirus epidemic of Italy originated from Codogno, an Italian municipality of 15,978 inhabitants in the province of Lodi, in the south-west of Lombardy, on February 21, 2020. Codogno is about 50 km from Pavia, home of one of the largest educational hospitals in the region, the IRCCS Policlinic San Matteo Foundation. The hospital has been involved in the management of the outbreak since its beginning. The elderly is a fragile subject and represents the population with the highest mortality within the pandemic. Due to its fragile condition and the coexistence of chronic diseases, it is also one of the populations with the highest access to emergency departments (ED The vital parameters were superimposable without statistically significant difference. The main cause of access during the pandemic was the dyspneic symptomatology followed by fever. The period of comparison coincides with the flu peak of 2019.

The reasons for access that have suffered the greatest reduction were those for minor medical symptoms and specialist visits. The other reasons for access showed a modest and less marked reduction than that suffered by other age groups. Conclusion: the epidemic has led to a reduction in access for elderly patients, although less than the general population. The most frequent reasons for access were compatible with CoViD symptoms in more than a third of the accesses. However, the elderly still had to access EDs frequently due to the exacerbation of their chronic pathologies. Method: All information pertaining to patients referred to the Social Prescribing Co-ordinator is recorded on a PSPP database. The information collected includes demographic details, sources of referral, reason for referral, home circumstances, health care packages where relevant. The results of an analyses of data on the first 40 patients referred to the social prescribing program between May 1st 2020 and July 31st 2020 when COVID-19 restrictions were in place are as follows.

Results: The mean age of the group is 79.8 yrs (Std dev ± 6.3), In total 28 patients (69%) were female and 12 (31%) were male. A total of 28 patients (69%) were living alone, a further 7 patients (17%) were living with a partner and the remaining 6 (14%) were living with a son or daughter. In total 24 patients (59%) were referred due to social isolation and loneliness, a further 7% with anxiety depression and low mood as a result of isolating. Introduction: During the COVID 19 pandemic social prescribing link co-ordinators are moulding their role to find alternative ways of supporting the person referred to their service. With many community based services for older people closed at present it is more challenging to discharge people from the SP service which may result in prioritising consultations and waiting lists.

Method: A review of the first 40 patients referred to the Care of the Older People SP programme at St James's Hospital was carried out. Preliminary results would indicate that referrals may be need to be prioritised in the following order.

Results: (Taking into consideration the presence or not of a home care package (HCP) and the number of hours included in the HCP) 1.

Person with a diagnosis of dementia, living alone with co-morbidities and no family support 2. Person without a diagnosis of dementia, living alone with co-morbidities and no family support3. Person with a diagnosis of dementia, living alone with co-morbidities and family support (not live in) 4. Person without a diagnosis of dementia, living alone with co-morbidities and family support (not live in) 5. Person with a dementia, living with a carer (partner or son/daughter) with comorbidities 6. Person without a diagnosis of dementia, living with a carer (partner or son/daughter) with co-morbidities. Conclusion: When prioritising the urgency of addressing referrals to the social prescribing program it is useful to have indicators but also important to recognise that each case needs to be assessed on an individual basis 

Background: Although older adults constitute most hospitalizations and deaths from COVID-19, conventional triage tools in acute care settings ignore key aspects of geriatric vulnerability. Objective: To estimate the usefulness of adding a rapid geriatric vulnerability screening to an illness acuity tool to predict mortality in hospitalized COVID-19 patients.

Methods: This is a cohort study comprising 1565 patients aged C 50 years consecutively admitted to a large university hospital dedicated to COVID-19 care in Sao Paulo, Brazil, between March 30 and June 30, 2020. We assessed geriatric vulnerability using the PRO-AGE scoring system (0-7; higher = worse), a validated and easy-to-administer screening tool that rates physical impairment, recent hospitalization, acute mental change, weight loss, and fatigue. Baseline covariates included age, sex, Charlson comorbidity score, and the National Early Warning Score (NEWS), a well-known illness acuity tool based on physiological parameters. Our outcome was time-todeath within 60 days from admission.Results: Patients had a median age of 66 years, and 57% were male. The cumulative incidence of 60-day mortality ranged from 20 to 69% across quartiles of PRO-AGE. In Cox proportional-hazards models, compared with PRO-AGE scores 0-1 (lowest quartile), the adjusted hazard ratios (95% CI) for 60-day mortality for PRO-AGE scores 2-3, 4, and 5-7, were 1.7 (1.3-2.2); 2.1 (1.6-2.8); and 3.1 (2.3-4.0), respectively. The PRO-AGE predicted different mortality risk levels within each stratum of NEWS and markedly improved the discrimination of predictive models including demographics, Charlson comorbidity score, and the NEWS.

Conclusions: In this large sample of patients admitted to the hospital with COVID-19, measuring geriatric vulnerability in addition to illness acuity improved accuracy to predict mortality. Providers in fastpaced acute care settings should be aware that combining practical tools like PRO-AGE and NEWS may help stratify the risk of death from COVID-19 better than using illness acuity alone.

The frail elderly population as the principal focus of the NHS Nightingale North West COVID-19 Field Hospital Introduction: COVID-19 field hospitals have been established in the UK to support the surge capacity of the National Health Service while protecting the community from onward infection. We investigated the impact of frailty on such a hospital over time.

Methods: We described the patient population of the NHS Nightingale North West (NNW) field hospital in April-June 2020 from medical records including clinical frailty score (CFS). We analysed predictors of mortality using logistic regression and admission duration using Cox's regression, and described trends in frailty prevalence over time using linear regression.

Results: 104 COVID-19 patients were admitted from hospitals in North West England, 74% with moderate-to-severe frailty (CFS [ 5). 84 were discharged, 14 transferred to other hospitals, and six died on site. High C-reactive protein (CRP) [ 50 mg/dl predicted 30-day mortality (aOR 11.3, 95% CI 3.1-41.4, P \ 0.001), with diabetes and admission Early Warning Score retained in the final explanatory model. Patients with CFS [ 5 had a 10-day median admission, vs. 7-day for CFS B 5 and half the likelihood of discharge on a given day (HR 0.53; 95% CI 0.32-0.88, P = 0.015). CRP [ 50 mg/dl and nosocomially acquired COVID-19 also predicted admission duration. Consequently, while frailty on admission was steady over time, rate of discharge was lower, so prevalence of CFS [ 5 increased from 64% initially to 90% in the final week (non-zero slope P \ 0.001). Conclusions:The NNW population was characterized by high levels of frailty, which increased over time, with operational implications.

Adapting to the needs of this population will improve NNW if it is needed again.

Assessing the impact of covid- 19 Higher CCI and CFS scores were correlated with increased mortality. Older males experienced a higher death rate (53%). There is a greater degree of dependency following COVID-19 in frail patients, often requiring transfer to non-acute hospital settings linked to our Trust for discharge planning and rehabilitation. Conclusion: COVID-19 leads to higher mortality and morbidity in older adults. Frailty is important in predicting outcomes, with higher CCI/CFS scores, and male gender, all associated with increased mortality. Frail older survivors were more likely to have increased dependency levels, requiring complex discharge planning and social support. Using non-acute hospitals was crucial in ensuring capacity for acute admissions.

Age and frailty are associated with adverse outcomes in patients with COVID-19: results of a multi-centre international cohort study

Introduction: Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear.

Methods: Multi-centre cohort study involving patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used multinomial logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Introduction: We aimed at examining the impacts of COVID-19 pandemic on older adults' daily living and the burden of geropsychiatric care issues in Turkey. We also proposed several solutions to ease the period of social isolation. Methods: To examine the available information on geropsychiatric care in Turkey, we performed a literature search in local databases and PubMed starting from March through June 2020 and examined the local media releases.

Results: The national budget explicitly covered the entire costs of screening, hospital admissions, and treatment for COVID-19. To provide maintenance medication, the governor's emergency order provided access to a 30-day refill of prescription medications for chronic conditions from the local pharmacies. Outpatient appointments were mostly suspended. As for nursing home care, the Turkish Ministry of Health released and updated a guideline to reduce the impact of the outbreak on these settings. The outbreak led to an increased demand for home health care, especially in some nonhomebound older adults avoiding hospital admissions. Concerning the engagement with novel preventive measures, many older individuals have initially failed to engage in home stay and attempted to go out for various reasons such as exercising, meeting friends, dog walking, and shopping. Key conclusions: This latest outbreak has shown the lack of adequate, human-centered management plans in the context of elderly care during a pandemic. Extraordinary measures taken by the authorities should cover the physical, mental, and social needs of older people, as well as the involvement of elderly organizations during decision making.

Are older people adequately profiled in COVID-19 training?

Introduction: Older people represent the key demographic affected by mortality and morbidity of COVID-19 but there are concerns that this vulnerability has not been accorded due prominence by international health bodies such as the WHO. This may reflect a wider failure by the profession in general: we assessed the relative prominence and timeliness of focused presentations on older people by four postgraduate medical colleges in the UK and Ireland. Method: We analysed schedules and content clinical update teaching presentations and videocasts to calculate proportion of topics specifically addressing older people, and their scheduling over a 14-week period spanning the beginning and evolution of the pandemic. Results: Of 80 talks given by the 4 colleges, only seven (9%) directly related to older people. A specific focus on older people appeared on the seventh week of weekly clinical updates in one college, and on the second week for another, no clear dates were attached to talks given by the third college, and no presentation featured on the COVID-19 presentations of the fourth college. Key conclusions: Adequate and timely education for physicians in the UK and Ireland is not proportionate in timing or content to the burden of morbidity and mortality of older people from COVID-19 .

A learning outcome of this pandemic should be to encourage stronger joint working with geriatric medicine and a closer proportionality between the populations most affected in the content and scheduling of medical postgraduate educational initiatives for emergent crises, disaster and pandemic planning.

The importance of trace COVID-19: the Portuguese surveillance platform -19) spreads from person-to-person through droplet and contact transmission. In Portugal, Public Health has created a platform called Trace COVID-19 to monitor and follow patients with confirmed disease, with suspected symptoms or who have been exposed in closed contact to other patients with the disease. Methods: We provide a description of the Trace COVID-19 platform and its function. We also report the results of our unit in terms of number of patients followed, referrals to the emergency service, patients with confirmed disease and number of recoveries. Results: It's considered a suspected case of COVID-19 when a person has symptoms, and exposed when we find contact with a positive case. In both cases, the patient is inserted in the platform Trace-COVID-19 to be followed up. In exposed patients they are considered in active surveillance and monitored daily by Public Health professionals to re-assure of the quarantine measures and do contact tracing. In suspected cases, is required an overactive surveillance made by General Practitioners, and a diagnostic test is prescribed. In this case, each person is contacted daily to monitor their symptoms, if there is a necessity for observation (either in the community or in the hospital) and to answer to the needs of the patients. Key conclusions: This platform enabled clinicians to follow the patients at home, saving resources in hospitals and primary care centers, prioritizing the patients who need to be evaluated, and giving patients a regular contact to answer their needs.

Age, ageing and age-itation in the Age of COVID-19: the necessary combination of the geriatric medicine and public health approaches

Ben-Gurion University of the Negev, Beersheva, Israel S90 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 COVID-19, the illness caused by the SARS-CoV-2 virus, has reached pandemic proportions and is greatly affecting countries around the world. Although the virus can cause disease in anyone, it is particularly dangerous for those with various ''co-morbidities'' such as heart disease, hypertension, diabetes, obesity and others. Furthermore, advancing age (from about 60 on) even in those older persons without any accompanying illnesses, is a strong and independent risk factor for pneumonia, need for an ICU bed and death from COVID-19.

Although intuitively it makes sense that older persons would be more at risk from such viral threats, this is not always the case. For example, the 1918-19 influenza pandemic spared older persons and the SARS-CoV-2 does not seem to affect children. Obviously we still have much to learn about this new virus and its age-related predilections. However, given the clear danger of this virus to older persons it is essential to find ways to protect at-risk persons from the virus while at the same time not harming, more than absolutely necessary, their essential freedoms. Furthermore we must at the same time take into account their social/psychological needs. Even in the absence of physical disease societal measures taken to protect society in general can wreak psychological havoc on isolated seniors. In our approach we must keep in mind that the older population is extremely heterogeneous -ranging chronologically anywhere from about 60 up until the very outer ranges of the maximum life span (122). On average, each age cohort from ''young-old'' (60-79) to ''old-old (80 +) is different and within each group there are also huge variations relating to SES, illness exposure and burden. Furthermore, the situation of almost older persons in high income countries (HICs) differs significantly from almost every elder in the poorer regions of the world, ie those which are low income (LICs). One example re COVID-19: a much higher proportion of older persons in the LICs live in multi-generational households making the idea of ''social distancing'' far less feasible than in HICs. But working in the opposite direction, disadvantaging older person in HICs, a much higher proportion live in long-term institutions which for obvious reasons constitute a very large proportion of COVID-19 related deaths in these countries. As well, for those elders in the community, lockdown policies of HICs which are effective in ''flattening the curve'' can also flatten the ability of older persons to cope with the resultant social isolation which for the most part does is not seen in LICs As such, our approach to the risks to older persons during this pandemic must take many factors into account: biology, clinical medicine, epidemiology and public health. The blanket is indeed not large enough for all but we must place it as judiciously as possible in order to protect, cover and keep warm as much as possible of the body politic. Until the successful advent of a vaccine effective in older persons, there is much to be done. An approach which will combine the expertise of geriatric medicine with time honoured field of public health is essential to knitting this protective cloth.

Frailty status is not associated with unawareness of protective measures against COVID19: the Mexican experience .5 years) to maintain their geriatric status. Online counselling was carried out by geriatricians and ergotherapists to create medical, social, physical, psychological programs of rehabilitation and adaptation. They created special complexes of adaptive physical training which were posted on the websites of territorial social service centers. Each territorial center was assigned a specialist in physical rehabilitation which made daily online group classes on Viber, Skype or Phone. Printed materials were also produced and send by post. Respiratory gymnastics was a mandatory element of all programs. At the request of older persons, adapted complexes were also prepared individually.

Results: Online training with active movement was more popular among women. Men preferred the online game of checkers or chess, which were passive but improved the level of cognition. During 14-days training we observed not improving, but maintenance of the levels of cognition, mobility, prevention of falls. The level of depression and moral status statistically improved, p \ 0, 05. Results: The mean age of the sample was 71.88 years (SD ± 5.92) and 80% were women. The mean value of their self-perceived health on a ten-point scale where 10 stood for ''best possible'' was 7.24 (SD ± 1.53). Respectively, the mean value of their self-perceived emotional state was 7.18 (SD ± 1.73), the mean value of their perceptions regarding the extent to which coronavirus changed their life was 8.62 (SD ± 1.22) and their average compliance with the State's guidelines was 9.59 (SD ± 0.26). Depression was negatively correlated with self-perceived health (r = -0.438, p = 0.001), emotional state (r = -0.588, p = 0.000) and positively correlated with change in life (r = 0.377, p = 0.005). Finally, the participants reported activities they missed during the lockdown, highlighting the ''absence of a sense of freedom and walks'', ''activities in Open Care Centre'' and ''contact with family''. Conclusions: The research pointed out the negative emotional impact of the lockdown in elderly people and the need of community care services.

Interest in meta-research in geriatric medicine: a survey of members of the European Geriatric Medicine Society Purpose: There has been an exponential increase in meta-research, especially in the branch dealing with systematic reviews [SRs] and meta-analyses [MAs] . However, the knowledge regarding these topics in geriatric medicine is still poorly explored. We therefore undertook a survey of the current knowledge and needs in meta-research in geriatrics.

Methods: A short survey (taking approximately 5 min to complete) was freely available on the European Geriatric Medicine Society (EuGMS) website and disseminated via social networks by the EuGMS and the authors of the survey. The questionnaire was available during the whole year of 2019. The questionnaire specifically addressed demographic information, previous research activities and the knowledge of the participants on meta-research in geriatric medicine.

Results: The survey was completed by 291 participants from 36 different countries of about 3, 000 EuGMS members (age 55-64 years; 51.5% female; mainly from Italy and Germany). Most respondents (65.6%) reported reading more than 20 articles in the past year, but few (36.4%) read more than 10 SRs/MAs. Participants reported that SRs and/or MAs are important in clinical practice: 83.8% giving a score of [ 6/10, and 23.0% reporting 10. The large majority of the participants asked for more education in meta-research. In particular, there is need for educational courses for metaresearch in geriatric medicine, online or in person, organized by the EuGMS.Conclusion: Our survey shows that interest in SRs/MAs is high, and there is a demand for education on these topics in relation to geriatric medicine.

Psychological consequences on Geriatric patients hospitalized in a non-Covid Unit during the containment period linked to the SARS-CoV-2 pandemic: observational study.

Bérengère Covens 1 , Tatiana Zuinen 2 , Vanessa Willems 1 , Marie-Noelle Geurts 1 , Sandra Higuet 1

Introduction: During this period of the SARS-CoV-2 pandemic, each country has adopted measures such as containment. However, strict application of such measures has not been without risk for our vulnerable population, already affected by a context of loneliness. The goal of this approach is the search for rapid screening of people at risk of developing signs of anxiety or depression. an eGFR \ 20 mL/min/1,73 m 2 from October 2018 onward, to assess the feasibility of implementing a nephrology-tailored geriatric assessment. Before the COVID-19 outbreak, baseline data was collected on health-related quality of life (HRQoL), symptoms, optimism, and depression. In May 2020, we sent additional questionnaire to participants who were still alive and not lost to follow-up (n = 106). Response allows prospective comparison with baseline measurement on measures of HRQoL (using Short Form 12), symptoms (Dialysis Symptom Index), optimism (Life Orientation Test Revised), and depression (Geriatric Depression Scale 2/-15). In addition, fear (Hospital Anxiety Depression Scale) and stress (Perceived Stress Scale 10) during the COVID-19 pandemic will be assessed cross-sectionally.Results: First results are expected in July 2020.

Key conclusions: This study provides insights on the influence of the COVID-19 pandemic on the psychological wellbeing of older patients approaching end-stage renal disease.

Effect of quarantine of COVID-19 pandemic on sleep quality, in elderly persons. Mater Dei is the acute general hospital in Malta with the only fully equipped emergency department (ED) in the country. ED Physiotherapy services were established since 2016 and among the many conditions seen, falls in the elderly are a common occurrence. To facilitate management of the devastating consequences of this serious health problem, mechanisms of assessment and referral have been put in place to identify and treat frailty and frequent falls in Malta's aging population.With the onset of the Covid-19 pandemic with Malta registering its first case on March 7th 2020, a higher number of referrals to Physiotherapy of elderly frail patients sustaining falls in their homes was registered. The reasons for this rise may be multiple including possible social isolation due to the social distancing restrictions imposed that may have created a general disruption in elderly people's routine and support network and may have also accentuated any medical problems. It was also noted that falls were frequently missed during this crisis due to medical staff being concentration on the Covid-19 emergency.The Physiotherapist operating in the ED helped to raise this awareness with medical and nursing staff and to flag these falls patients by referring them to community teams to prevent further incidents.

Influence of requests to refrain from going out and the suspension of exercise classes to prevent the spread of COVID-19 infection on participants in exercise classes. Introduction: In order to prevent the spread of COVID-19 infection, a state of emergency was declared by the Japanese government on 16 April 2020 for all of Japan. Japanese people has required to refrain from nonessential outings. They were also required to suspend exercise facilities. The purpose of this study was to investigate the physical and mental effects of a state of emergency among participants of municipal exercise classes. Methods: A questionnaire survey was conducted on 683 people (average 69.3 years old) who participated in a municipal exercise class in Mitsuke City, Niigata Prefecture. The participants were asked how refraining from going out and suspended exercise class affected their exercise habits, social participation and mental health. Results: 72.2% of the participants felt that they were not getting enough exercise, and 63.4% reported that their communication with others had decreased. 11.4% of the participants reported that forgetfulness was a concern for them. Five-fold increase in the proportion of participants who reported that they felt their health had deteriorated compared to before the state of emergency was declared. Participants who reported reduced communication with others reported significantly lower mood, motivation, and interest in daily life compared to those who did not. Key conclusions: The municipalities surveyed were in areas where there were no COVID-19 cases. Nevertheless, it was suggested that requests to refrain from going out or to suspend exercise facilities may affect motor function, mental health and cognitive function.

Use of telemedicine in dementia drugs prescription: need and opportunity in the COVID-era Introduction: In March 2020, the Italian government adopted lockdown as a measure to contain the spread of COVID-19. Access to hospitals, including outpatient clinics, was limited to urgent cases, forcing health professionals to apply innovative approaches to managing patients with a variety of chronic diseases, including persons with dementia (PWDs). Methods: A phone assessment of PWDs previously referred to the geriatric memory clinic of Careggi Hospital, Florence, Italy, was designed, mainly based on the application of checklists for prescription of cholinesterase inhibitors, memantine, and antipsychotics (APs). The tool was included in the national GeroCovid observational study. In selected cases, the caregiver was required to shoot and send via internet videos of the patient during daily life.

Results: From March 9 to April 30, 2020, 345 phone interviews and 222 checklists of drug prescription were completed. Videos were requested for 16 patients, mainly because of behavioural disorders and/or motor impairment, to evaluate the possibility of introducing or modulating the dosage of APs. A new AP was introduced, or the dose was up-titrated, in 8 out of 16 cases, whereas the drug was withdrew or witheld in 5 cases due to evidence of bradykinesia. Two cases of new-onset dyskinesias were detected. Conclusion: Telemedicine may be an efficient way to monitor specific drug prescriptions in dementia care. This approach, which was mandatory during the epidemic period, might also be useful in the future for clinical monitoring of PWDs. Appropriate informatic platforms should be developed to improve data transmission and protection of personal data.

Ramifications of COVID-19 Awareness: Psychology of Indian Geriatric population during nationwide lockdown. Conclusions: Awareness about COVID deaths and cases renders the geriatric population anxious and, a smaller proportion phobic. Both these factors might influence the immune response of the participant and thus make him/her more susceptible to adverse outcomes in case of infection. Awareness is necessary but it's effects must be monitored by regular mental health follow ups to avoid its repercussions. Low sample size was a limitation due to avoidance of android devices but Indians geriatric population.

Physical and psychological wellbeing during the COVID-19 Movement Restriction Order period among cognitively frail older persons with prior engagement in community-based multidomain intervention. Methods: Both CBMDI (n = 21; 67.74 ± 4.43 years) and UC (n = 21; 70.79 ± 7.03 years) groups were interviewed via phone call. Cognitive frailty was identified using Clinical Dementia Rating Scale and Fried Frailty Index during previous study assessments. Physical and psychological wellness were assessed using International Physical Activity (IPAQ), Functional Activity (FAQ), General Health (GHQ) and Brief COPE Scale questionnaires. Data was compared using independent t-test. Results: CBMDI group had significantly higher levels of estimated resting energy expenditure (MET) for 'walking' (CBMDI:l = 1723 ± 780; UC:l = 537 ± 581) (p.01), 'moderate intensity' (l = 1422 ± 1215; UC:l = 405 ± 746) (p \ 0.01) and lower 'sedentary' (CMDPI:l = 1723 ± 780; UC:l = 2130 ± 697) (p \ 0.05). activities compared to UC group. CBMDI group was also significantly more independent in functional activity (l = 1.76 ± 1.73) compared to UC group (l = 5.57 ± 8.31) (p \ 0.05). Regarding coping behaviour, CBMDI group relied significantly on the domains of religion (CBMDI:l = 6.43 ± 0.99; UC:l = 6.09 ± 1.09) (p \ 0.05) and planning (CBMDI:l = 4.81 ± 0.75; UC:l = 4.04 ± 1.28) (p \ 0.05).

In contrast, UC group relied on humour (UC:l = 3.14 ± 1.19; CBMDI:l = 2.38 ± 0.74) (p \ 0.05). However, there was no significant difference for GHQ scores between both groups (CBMDI:l = 1.57 ± 3.36; UC: l = 1.24 ± 3.28) (p [ 0.05), indicating similar psychological wellbeing status.

Conclusion: Older persons with prior engagement in communitybased multi-domain intervention were more physically active, functionally independent and resorted to positive coping behavior using religion and planning strategies throughout the MCO. Communitybased multi-domain interventions should be advocated to promote resilience among older persons.

Preferences of older adults for Covid-19 Tracking and Tracing apps

Annemiek Linn 1 , Fam te Poel 1 , Susanne Baumgartner 1 , Eline Smit 1 , Hande Sungur 1 , Liset van Dijk 2 1 Amsterdam School of Communication Research, 2 Netherlands Institute for Health Services Research Introduction: The COVID-19 pandemic is impacting the global population and especially older adults are facing the most serious threats. Governments are looking at tracking and tracing apps as a means to slow the spread of the virus. These apps have raised privacy concerns, as some of these apps need to store user data. Given these concerns, it is unclear if older adults are willing to use these. The aim of this study is to explore older adults' preferences for using Covid-19 tracking and tracing apps. Methods: An online survey was distributed among panel members of a panel company in the Netherlands. The data were collected in April. A total of 1068 respondents completed the questionnaire. For this study, we only focus on participants aged 65 and older (N = 259). The questionnaire included questions regarding media use and information needs during the Covid-19 pandemic. Preliminary results: Most older adults (96.5%) indicated that they heard of Covid-19 tracking and tracing apps. Just under a third indicated that they are willing to use such an app, while more than 40% of the respondents are not sure. Many of them believe that their privacy cannot be guaranteed (59.4%). Besides, 20% mistakenly believes that the app will protect them against infection. Key conclusions: If health organizations decide to start using a tracking and tracing app this app should be developed in collaboration with the users and based on existing guidelines for mHealth. Introduction: Older adults as the higher risk group for COVID-19 infection were known to face psychological and coping difficulties during this pandemic. Therefore, this study aimed to assess the general psychological health and coping strategies among Malaysian older adults during this pandemic crisis. Method: A total of 340 of individuals aged above 60 years (men = 159, women = 181), from the earlier cohort (LRGS TUA) and interventional studies from four selected states in Peninsular Malaysia were followed up during the lock-down period (MCO) due to COVID-19 outbreak (April-June 2020). Telephone interviews were conducted by trained interviewers from health sciences background to obtain participants' socio-demographic information, general psychological health, and coping strategies using Malay version of 12-items General Health (GHQ-12) and Brief COPE questionnaire. The analysis was performed using SPSS Statistics version 25.0 and presented as mean ± SD. Result: The result revealed that the participants have a low mean score of GHQ-12 (0.32 ± 1.44). After adjusting for age, gender, ethnicity, years of education, household income, and smoking status, participants living with their family significantly have a greater impact on their psychological health (R 2 = 0.326, p \ 0.05). Besides, the participants used adaptive coping strategies, in which the highest mean score was religion (4.28 ± 2.73), followed by positive reinterpretation (3.59 ± 2.09), acceptance (3.42 ± 1.90), planning (3.25 ± 1.84), active coping (3.20 ± 1.72), use of instrumental (2.63 ± 1.04) and emotional support (2.56 ± 1.02). Conclusion: This finding indicated that the Malaysian older adults had good psychological health status, especially when they are living together with their family and adapted positive coping mechanisms during this pandemic crisis.

Investigation of leisure time activities and anxiety in elderly of Non-Covid living at home during COVID-19 period Sebahat Yaprak Cetin 1 , Alime Buyuk 1 , Gokce Yagmur Gunes Gencer 1 1

Introduction: The COVID-19 are affected the elderly negatively around worldwide. In COVID-19 period in Turkey had a curfew for the elderly. The aim of our study was to examine leisure time activities (LTA) and anxiety levels in the elderly living at home. Methods: 73 elderly adults (37 women, 36 men) with an average age of 67.41 ± 5.60 years living at home in a region of Antalya city participated in the study. LTA were determined by the elderly, such as reading, watching TV, and doing exercise, and the frequency and duration of activities were recorded. Geriatric Anxiety Inventory (GAI) was used for anxiety assessment. Results: It was found that the elderly attended LTA such as watching TV (78.1%), meeting by phone (69.9%), praying, cooking and reading respectively, at home for all day. GAI score was 10.41 ± 5.23. It was found that 97.3% of the elderly did not exercise at all. In addition, a positive correlation was found between GAI score and praying (r: 0.580, p: 0.01). Key conclusions: According to the results of this study, it was observed that the elderly do activities that they were not active during the period of COVID-19. In addition, the elderly had moderate anxiety. Also, as anxiety increases, the rate of praying increases. The results of the study support that LTA should be organized by health and community professionals in order to reduce the level of anxiety, ensure that they are more active and productive during the periods of obligation to stay at home.

Impact of Covid19 restrictions on older patients attending an outpatient geriatric medicine service Introduction: During the Covid19 pandemic older adults ([ 70 years) in Ireland were advised to stay at home and avoid unnecessary physical contact-termed 'cocooning'. During this time hospital outpatient appointments were conducted virtually (via telephone). This project aimed to assess patient's experience of Covid19 cocooning and the virtual outpatient service. Methods: Patients attending an outpatient geriatric medicine service were invited to participate in this project following their routine virtual assessment. A proforma questionnaire was administered to participants contacted virtually within 1 week of consent. Data was anonymised, imported into excel and analysed using SPSS (chisquared test). Results: 31 patients were included, median age was 83. 52% were male, 25% lived alone and 52% had cognitive impairment. 75% had heard of 'cocooning', of which 67% correctly understood the term. Three-quarters stated that cocooning had negatively impacted their quality of life (QoL); anxiety, loneliness and depression were reported in 49%, 36% and 29% respectively. 39% strongly feared getting Covid19. Cognition and living status did not correlate significantly with the psychological impact of Covid19. 61% did not use modern social media, its use did not impact QoL scores. 45% experienced a reduction in support services. 87% found the outpatient telephone service useful and 77% reported their needs were addressed. Threequarters favoured future virtual assessments. Conclusion: One third of patients poorly understood 'cocooning'. Necessary Covid19 restrictions impacted negatively psychologically on this older cohort. Novel virtual clinics proved a positive experience and a useful future outpatient resource even amongst our oldest patients with dementia.

What is the opinion of Brazilian and Portuguese elderly people about Covid19?

Manuel Barbosa 1 , Anna Fernandes 2 , Glaucia Martins 2 1 Universidade de Aveiro -Departamento de Educação e Psicologia, 2 Escola de Artes, Ciências e Humanidades, EACH -USP Introduction: The first case of a new coronavirus was identified in Wuhan, China, on December 1, 2019 [1, 2] and was declared by the World Health Organization's World Pandemic on March 11, 2020. During this pandemic, the world has adopted measures of isolation and social distance. Methods: This is a cross-sectional, quantitative and exploratory study, which included a sample collected online through social networks composed of 159 seniors aged between 60 and 65 years old, residing in Portugal and Brazil. According to the exclusion criteria described above, for the analysis of the results it was necessary to exclude 11 participants, 6 Portuguese and 5 Brazilian. The final sample included 96 Brazilian seniors and 52 Portuguese seniors who answered the questionnaire online, through Google Forms. Results and main conclusions: Categorizing the responses of the participants, the results indicate that the majority of the elderly interviewed have feelings of fear and concern about the Coronavirus associating it with death. It is noticed that these manifestations are due to the condition of isolation necessary to contain the virus, in addition to the lack of general knowledge about the consequences of the same. It is necessary, however, in view of the reduced sample; expansion of the study, to better deepen the social issues that guide the opinions presented about the coronavirus.Keywords: COVID-19; Seniors; Brazilian and PortugueseBibliographic reference [1] H. Lu, C.W. Stratton, Y.W. Tang Introduction: In the twenty-first century, the epidemics are spreading more rapidly than ever affecting ever-larger numbers of people [1] .

The global pandemic of coronavirus seems to introduce a new crisis in different levels with severe consequences affecting the psychological condition of the older adults by raising degrees of stress, uncertainty or anxiety [2] . In the context of this new reality, the adoption of a productive and beneficial routine might be crucial for older adults. This study describes a (social care) initiative taken within the coronavirus outbreak and examines the potential benefits in older adults' quality of life. Methods: For this purpose, the Integrated Healthcare System Long Lasting Memories Care (LLM Care) [3] was exploited, and more specifically the web-based cognitive training software [4] was used for 2 months. An online questionnaire, including consent form and assessments (SAST, IES-R-Gr, WHO-5, SUS) [5] [6] [7] [8] , was distributed to 20 older adults (mean age 69.54 years ± 4,61) before and after the exploitation of cognitive training software aiming at evaluating the potential positive effect and usability of cognitive training software. Results: Overall, the study demonstrates interesting findings with regards to the degree of stress and anxiety, the quality of older adults' life, as well as the usability of the web-based cognitive training system. Key conclusions: Consequently, the use of web-based applications is considered to play a significant role during this severe situation in improving older adults' health well-being. Acknowledgements: This research is supported by the business exploitation scheme of the ICT-PSP funded project LLM, namely, LLM Care which is a self-funded initiative at the Aristotle University of Thessaloniki (www.llmcare.gr). References: [1] World Health Organization. (2018). Managing epidemics: key facts about major deadly diseases. World Health Organization. [2] World Health Organization. (2020) . Mental health and COVID-19. Retrieved from http://www.euro.who.int/en/health-topics/ health-emergencies/coronavirus-covid-19/technical-guidance/mentalhealth-and-covid-19 [3] Long Lasting Memories Care. (2020) . Retrieved from www.llmcare.gr [4] BrainHQ. (2020) . Retrieved from gr.brainhq.com Introduction: Social isolation has been found to increase the risk of poor health and death, and the risk has been said to be as high as cigarette smoking. Yet during the COVID-19 pandemic, governments internationally have to resort to social distancing. This study aims to overcome psychosocial repercussion of social distancing by determining the effects of virtual exercises for older persons on mental well-being and factors which influence their adherence to the physical exercises during the COVID-19 pandemic. Methods: This is a quasi-experimental study involving participants of the Promoting Independence in Seniors with Arthritis (PISA) study which was carried out between 2015 and 2019. Mental well-being is measured using the Hospital Anxiety and Depression Scale (HADS) pre-intervention and post-intervention. HADS scores were also available from annual visits conducted during the study. The 4-week virtual exercise was tailor-designed for older persons. Daily 30 min exercise on Google Meet as the virtual platform is led by health care professionals. Participants are required to keep a diary of when they exercised to promote adherence. Results: The original 251 PISA participants were approached using an online bulk text messaging application (Whatsapp) and 46 agreed to participate by replying to the text message. The results of their 4-week scores at baseline and 4-week follow-up will be available to report by mid of July. Conclusions: Older persons are considered a vulnerable group during the COVID-19 pandemic. By conducting virtual exercises, the risk of COVID-19 through physical contact could be removed while maintaining social contact using modern telecommunications.

Impact of the Covid-19 Pandemic on Physical Capacity and Activity of People over 60 Jessica Koschate 1 , Sandra Lau 1 , Michel Hackbarth 1 , Tania Zieschang 1 1

Introduction: The measures taken to flatten the infection rate during the Covid-19 pandemic were accompanied by enormous restrictions in social life and organized sports activities. Especially older people, a high-risk group for a severe course of the disease, severely restricted their range of action. However, especially in older adults, reduced physical activity (PA) can quickly lead to reductions in muscle mass. The aim of the study is to determine the extent to which seniors used alternative ways of maintaining physical fitness and to evaluate their efficacy. Methods: Persons (60+) who trained in a standardized fitness circle which records individual training data, are examined. The participants are asked about their PA and mobility in daily life before, during, and after the pandemic-related restrictions. The primary endpoint of the study is the difference in the product of training weight and number of repetitions at the circle's leg extension compared between the three last trainings before and the first trainings after the restrictions. Results: The training data are evaluated by means of analysis of variance. Level of significance will be set to a = 5%. Discussion: Based on the results of the data collection, the effects of the pandemic-related restrictions on the physical capacities of older people can be assessed. Based on these results, measures can be identified to maintain physical fitness of older adults when organized sports activities are not available and give recommendations for PA during a potential second wave of the pandemic.

Athina Greka 1 1

Abstract: In the context of the innovations required due to the unprecedented situation we experienced in Greece and worldwide, Medecins du monde, Greece, implemented a pilot for 4 months, a new application entitled ''Internet companionship''. Introduction: Participants: Lonely elderly people of both sexes, over 65 years . The aim was to create virtual groups, in order to break the isolation of the lonely elderly people, for communication, under the guidance of a team of experts: Internist-Gerontologist, Nurse, Psychologist, Social worker . Program Coordinator Team members could interact with each other through simple activities. The functionality of new applications was tested, in relation to the perception and compliance of the elderly in them, in order to establish inventive communication solutions of this age group, which could be useful even after the end of the alert period due to the corona . Method: The technology used was simple and suitable for the elderly. It was software built into a tablet with a simple and understandable form of use. At a predetermined time, the group as a whole participated in the online company. Results: 1. Initially the elderly, presented fears and difficulties in understanding the new communication technology. 2. But finally they were looking forward to each meeting, in order to communicate with each other, but also with the program coordinator. 3. They also actively participated in their interactive activities on their screens (eg gymnastic exercises). 4. At the end of the program they were more familiar with the new communication. Introduction: Older people are a group at risk for a severe course of Covid-19 disease. The current measures to protect from infection are likely to cause adverse effects by reducing older peoples' physical activity. Currently, many older patients avoid attending physiotherapy although it can prevent a deterioration of functional abilities, especially in multimorbid patients. Real time video-based physiotherapy sessions could be a useful supplement to standard physiotherapy. Since this therapy option was introduced in Germany due to Covid-19 pandemic for the first time, physiotherapy practices are not equipped and empirical data do not exist, yet.This study aims to investigate the feasibility of video-based physiotherapy as an alternative therapy option for older patients (C 60 years) and its influencing factors. Method: Patients have been equipped with hardware and corresponding software for six weeks. Physiotherapy practices receive technical support. The number of video-based physiotherapy sessions are documented and individual experiences of physiotherapists and patients are reported via questionnaires. Therapists briefly document important aspects after each therapy session and for the whole treatment. Telephone interviews are used to collect demographic data, acceptance of technology and the use of technical communication devices from patients at the beginning and end of the study.

Results: Nine participants have been included so far (mean age 73.0 (± 5.5) years). Video-based physiotherapy proves to be technically feasible. Acceptance and appraisal vary between individuals. Conclusion: Barriers regarding the technical application of videobased physiotherapy exist on patients' side, but to a considerable extent also on the side of the physiotherapists.

Nursing approaches and their effect on the health of the elderly with Covid-19

Fatimatüzzehra Genç 1 , Arzu Uslu 1 1

Fatımatüzzehra GENÇ 1, Arzu USLU2 1, 2 Necmettin Erbakan University Faculty of Nursing, İnstructor, PhD student. İntroduction: Elderly individuals, considered as a part of the highrisk group, can be affected more severely by Coronavirus disease. This review aims to discuss the protection and appropriate nursing methods for managing COVID-19 in elderly. Methods: This is a narrative review study. Results: The increase in the elderly population worldwide and the higher prevalence of comorbid diseases in this group, the elderly are particularly at a high risk during this pandemic. Nurses are involved in follow-ups and care as well as in primary, secondary and tertiary health services for the elderly. The disease has adverse effects on the physical health of elder individuals who have a weak immune system, limited activity, and difficulty in taking adequate nutrition. Conditions such as an inability to cope with stress, weakness, and hopelessness adversely affect psychological health. Furthermore, conditions such as loneliness, being away from loved ones, stigmatization, and abuse adversely affect social health as well. Nursing theorists such as Nightingale, Orem, Rogers, Neuman, Roy, and Watson, who have significantly contributed to this discipline, have explained the relationship between the elderly and the environment, self-care, energy field, stress-coping methods, adaptation process, and spiritual care during a pandemic. Conclusion: Nurses have a significant role and responsibility in preventing the transmission of the virus, treating and caring for the infected elderly, and providing post-discharge rehabilitation. Keywords: COVID-19, elderly, nursing, theory, protection Introduction: Opioid-induced delirium is very common amongst hip fracture patients. Introduction of Femoral Nerve Blocks (FNBs) offers a safe and effective method for improving pain in the setting of hip fractures leading to reduced opioid need. It is typically initiated in the emergency department in our institution prior to the COVID-19 pandemic. Due to the reconfiguration of services secondary to COVID-19, the majority of hip fracture patients are no longer receiving FNB which consequently leads to poor pain control and

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 higher opioid needs. This paper aims to look at the relationship between delirium and FNB. Method: Retrospective analysis was performed on all patients over 60 admitted with hip fracture (n = 359) in our hospital from June 2018 to June 2019. The data was collected from the Irish Hip Fracture Database (IHFD) and was correlated with the orthogeriatric database from the Electronic Patient Medical System (EPMS). Delirium was assessed using the 4AT tool. Data were analysed using SPSS for statistical analysis.

Result: Demographic information was obtained. The percentage of patients receiving FNB decreased during pandemic from 89.6% (69/ 77) to 52.5% (31/59) pre-pandemic. Delirium prevalence increased from 16.8% (13/77) pre-pandemic to 35.6% (21/59) during the pandemic. There is 111% increase in delirium incidence between the two-time points. Conclusion: The number of patients not receiving FNB has a direct correlation with the incidence of delirium. Early FNB to control pain results in less opioid use and subsequently less incidence of delirium in hip fracture patients.

Interstitial pneumonia in the elderly in the coronavirus era: covid-like or covid-free?

Alessandra Pitocco 1 , Nelson Anzoletti 2 , Claudia Falcone 1 , Franco

An 81-year-old patient arrived in hospital on 4 May 2020 at the Geeiatric department with the diagnosis of interstitial pneumonia in a likely Sars-Cov2 infection. The patient went to the emergency room in the May 3 data for the reported persistence of fever for about three days complicated on the last day by acute dyspnea. She was a patient with advanced Alzheimer's disease complicated by lodging syndrome, Parkinson's disease, high blood pressure, severe dysphagia and hypothyroidism in replacement treatment. The patient takes the following drug therapy: cardioaspirin, lercadipine, levothyroxine, valsartan. In the emergency room, the patient had performed blood chemistry tests with detection of neutrophilic leukocytosis with partial lymphopenia, elevation of RCP, alteration of D-dimer and LDH, with substantial normality of the other laboratory indices, including procalcitonin. Gold-pharyngeal and nasopharyngeal swab negative for Sars-Cov2 research. The blood gas analysis documented acute hypoxemic-hypocapnic respiratory insufficience, mixed alkalosis with normale anion-gap and P/f ratio equal to 169. At the thorax the radiologist reported a ''ground-glass'' interstitial commitment framework compatible with a CO-RADS 4/5 classification (high probability of Sars-Cov2 infection). In light of the clinical, laboratory and instrumental picture, the infectious disease colleague placed the indication for hospitalization in the covid-area by our hospital. During the hospitalization, in consideration of the positive blood culture for Staphylococcus epidermidis, the patient was treated with antibiotics with a wide range and oxygen therapy, first with Venturi mask and FiO2 31% passerà on the fifth day with nasal cannulas with low parameters . During hospitalization, the radiological checks documented a slow and incomplete resolution of the interstitial lung picture with constant negativity of the Sars-Cov2 research both on swab and on serological investigation. After 24 days of hospitalization, the patient was discharged with a complete resolution of the respiratory insufficiency and of the radiological and laboratory framework. In conclusion, the low sensitivity of the diagnostic means for COVID-19 in our possession, together with the great phenotypic variability of the clinical, laboratory and instrumental framework made the diagnosis of certainty and the subsequent therapeutic and management process of the elderly patient complex. Although federal restrictions aimed to protect this vulnerable group, the measures may also reduce physical activity and thus accelerate functional decline. Due to the pandemic, regulations were changed so that video-based physiotherapy can now be conducted in Germany. As this is a novel approach, we will investigate health related patient experiences regarding video-therapy. Methods: Patients aged over 60 years and technically unequipped who had been prescribed physiotherapy were given the opportunity to attend video-therapy sessions. A semi-structured telephone interview was held at the beginning of the study and after 6 weeks questioning health status, physical activity, quality of life, participation, and evaluation of the video-based physiotherapy they received.

Results: Participants' age ranged from 64 to 82 years. Each subject received a maximum of twelve sessions of video-therapy. Patient reported outcomes and experiences are presented qualitatively.

Patients' appraisal of video-therapy compared to conventional therapy varied. Further results will be presented in October.

Conclusion: Prospectively, video-therapy could be established during future pandemics, in patients in medically indicated isolation (e.g. in cancer with immunomodulating therapies), or in rural areas.

Regarding the ongoing digitalization of the health care system, there is an urgent need to implement and evaluate alternatives to conventional therapy. Further research is needed on the effectiveness, identification of specific target groups, and clinical relevance of video-therapy.

Gabriel New coronavirus infection labelled COVID-19 generated a significant pandemic despite various measures that have been implemented in order to reduce or stop the spread of this virus. One epidemiologic characteristic was that people with significant comorbidities presented the most severe forms of disease and the highest death rates. Since older people in general have a higher prevalence of chronic conditions they seemed to be at highest risk. Consequently, several measures for isolating this category of population have been implemented in many countries, including in Romania. This is a normal approach since so little was known about the specific behavior of this coronavirus infection. Nevertheless, not all older people are the same, they are a highly heterogenous group, as it is well known. Maybe for the future these protective measures need to be different when addressing robust older people and frail older people, tailored to their degree of frailty. This is important since strict home isolation of all older people, irrespective of their comorbid status, could have some consequences. These aspects, including psychological and pathological effects, are evaluated for two regions in Romania to help identify the impact of social isolation and strict home isolation of older people, especially those with little social support, including family support, comparing rural to urban communities.

Teledermatology services for elderly people during COVID-19 pandemic 

Introduction: The emergence and spread of COVID-19 have brought great challenges to public health services worldwide. In Hungary, like in many other countries, the amount of direct contact between doctors and patients was reduced according to the existing Hungarian legislation. In this extraordinary time at the Department of Dermatology, Venerology, and Dermatooncology of Semmelweis University, dermatologists have provided successful telemedicinal dermatology care with a store-and-forward system. Teledermatology allows dermatologists to evaluate, diagnose, and treat patients at a distance using telecommunication technology. Furthermore, teledermatology opened up the possibility in the healthcare system to provide remote dermatology care for a special group of elderly people (frailty, bedridden, disabled, etc.) as an alternative to traditional face-to-face visits.

Methods: We started the teledermatology healthcare service with a store-and-forward system on 28. March 2020. Patients or caregivers had to submit some personal data (name, date of birth, etc.), a short medical history, a list of the symptoms, a list of the regular medications, and upload at least five photos of the affected areas through a smartphone. Patients' pictures and medical data were stored on a secure platform. If further information was needed we performed a phone call. Every patient received a report and a treatment plan from a certified dermatologist. Nonemergency skin conditions were reviewed within three days, emergency conditions were reviewed within 24 h. Results: In 1 month, we have performed 3487 teledermatology consultation. The great majority of patients (91%) were aged under 65. The number of patients aged over 65 was 286 (8,2%), consisting of 147 men (4,2%), and 139 women (3.9%), the mean age of men was 74.21 years, the mean age of women was 73.46 years. Only 56 patients aged over 65 took photos of themselves, 162 patients needed help in taking photos because of the localization of the skin conditions, and 68 patients were unable to take photos for various reasons (e.g., general condition, dementia, or insufficient technical skills). Further in-person examinations were needed in 55 cases. Only 11 patients had to be hospitalized. The majority of dermatological indications for telemedical consultations included various kinds of skin diseases, skin cancers, and wounds. The most common disorders in the elderly population were different forms of eczema (n = 62), including venous eczema (n = 19), psoriasis vulgaris (n = 10), leg ulcer (n = 7). The most frequent infectious skin conditions were herpes zoster (n = 6), and scabies (n = 5). Among the findings, there were some rare skin conditions such as bullous pemphigoid (n = 1), mycosis fungoides (n = 1), carcinoma erysipeloides (n = 1). Surgical procedures were needed in 11 cases. DiscussionNowadays telemedicine has become an important element of health care. Due to the visual character of the dermatological specialty, teledermatology may become a major tool in dermatological consultations, particularly for the elderly population. Teledermatology could be extremely useful for patients living with severe cognitive or physical disabilities, and for whom traveling even short distances can pose considerable practical and economical difficulties. Although our institute started teledermatology service in an emergency, it could be useful in normal circumstances to determine the emergency of a skin condition, establish obvious diagnoses, and perform follow-up visits for this fragile population. However, our data have higlighted an important aspect of teledermetology related to the underrepresentation of older patients among the cases which could be due to the little confidence of the elderly population in using electronic devices needed for a telemedical consultation. Therefore, caregivers may play an important role in teledermatology services for the elderly patients in the future.

Influence the COVID-19 pandemic on the profile of patients in a palliative care unit.

Yanira Aranda-Rubio 1 , Concepción Jiménez Rojas 1 , Javier Gómez Pavón 1 1 Hospital Central de la Cruz Roja, San José y Santa Adela.

The palliative care unit of Cruz Roja Hospital was inaugurated last December in 2019. In its first months of opening, the unit has 7 hospital beds. During the acute phase of the covid19 pandemic (March-May 2020), the unit continued to receive non-covid palliative patients. Through a descriptive observational study, we analyzed whether the pandemic influenced the profile and admission of the patients attended.

Demographic characteristics: Since the opening of the unit, a total of 90 patients (36 women) were admitted. Regarding age, 60% were older than 80 years (54 patients), most were referred from home by Home Care Support Teams. Clinical features: 83.3% (75 patients) were cancer patients and the rest (16.7%) were non-cancer. Of the latter group, most had degenerative neurological diseases (6 advanced mixed-profile dementias and one amyotrophic lateral sclerosis).The most common reason for admission was poor symptomatic control requiring continued hospital care. Hospital income trajectory: After the start of the COVID pandemic in March, the average stay on the floor was significantly reduced: prior to it, the average stay was less than 4 days in 37% of patients, between 5 and 10 days in 34.2 % and above ten days in 28.7%.In patients admitted for advanced neurological disease, the average stay was 7 days. After the onset of the covid pandemic, the number of patients who died in a period of less than 48 h increased, and income from home was 100% of income. S100 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

Hallucination as a ''porcupine'' in the ''stay at home'' period because of the Covid-19 pandemic in a patient with Alzheimer's disease Sumru Savas 1 1 Geriatrics Section, Internal Medicine Department, School of Medicine, Ege University, Izmir, Turkey

We are facing a pandemic caused by severe acute respiratory syndrome Corona virus 2 (SARS-CoV-2) widespread infection all around the world. During the pandemic, older patients represent an age group which is vulnerable to physical, psychological deteriorations because of the ''lock down'', loneliness, bad news coming from all over the world from social media and television which they were almost condemned to watch and read all they long with no other occupation, and communication. I report a patient in Izmir with Alzheimer's disease (AD) dementia and hallucination as ''porcupine'' (the shape explained by the patient resembles SARS-CoV-2) which started 1 month after the first case of SARS-CoV-2 in Turkey on 10th March. The patient was 86 years old, hypertensive, diabetic, and had also coronary artery disease. He was a university graduate. AD diagnosis was present for 2 years, but no medication was able to be started because of intervening hypo-hyperglycemic, hypertensive attacks, and the unwillingness of his wife and the patient. Telephone calls and online video meetings were made with the patient and the caregiverwife, separately. The issue was not discussed with the patient, because the wife had mentioned that he did not want this situation to be shared with anybody. No medication was prescribed, and the caregiver's understanding and acceptance of the symptom was established by explaining. The hallucinations are fewer 2 weeks after moving to the ''summer house'' on 5th June, still following the precautions, but gardening, and taking little walks as lock down is over.

How do older adults react to coronavirus disease 2019?

Ahmet Cigiloglu 1 , Zeynel Abidin Ozturk 1 , Eyyup Murat Efendioglu 1 1

Aim: Outbreaks have a wide spectrum of psychosocial impact on individuals. This study aimed to investigate the impact of the novel coronavirus disease on older adults in Turkey. Methods: A survey was conducted on 104 adults who had to stay at home during the epidemic. Depressive symptoms, anxiety symptoms, nutrition status, health-related quality of life, and sleep quality of the participants were assessed. Results: 37.5% of the older individuals had symptoms of depression and 29.8% anxiety. The frequency of depression was higher in women, aged 85 and over individuals and in those with lower education and monthly income. Anxiety disorders frequency was also higher in women and in those with lower education and monthly income. Quality of life and sleep were poorer in those with anxiety disorders and depression.

Conclusions: In our knowledge this is the first study in the medical literature investigating the effect of epidemic on mood, anxiety symptoms, nutrition status, quality of life and sleep of older adults during the epidemic period. Our findings indicate the importance of psychosocial support in older individuals during and after the epidemic period. Introduction: The covid-19 pandemic caused increased concern, anxiety, and mood changes amongst vulnerable groups, such as older adults [1] . The literature suggests that symptoms of mood disturbance tend to be more prevalent in hospitalized patients [2] . 

The COVID-19 pandemic has brought inevitable change in all institutions including SVPR which is a longterm facility in Malta. The aim of this study is to establish whether there was a change in fall frequency in people suffering from dementia at SVPR between COVID-19 and non COVID-19 periods. Method: An observational study including patients with dementia residing in closed wards at SVPR. Collected data included: number of patients who fell, total number of falls, mechanism and consequence of fall and physical restraints' use. We compared results of April 2019 (pre Covid-19) with April 2020 (COVID-19 era). Only patients residing in these wards during both years were included. Data was collected from patients' files. Results: A total of 75 patients were included. 11 patients (14.7%) sustained a fall in both April 2019 and April 2020. The total number of falls in 2019 was 13 compared with 16 falls in 2020. One patient had physical restraints in April 2019 compared to 3 patients in April 2020. The most common mechanism of injury was an unwitnessed fall in both years. No serious fall-related injuries occurred in 2019 but one patient sustained a hip fracture in 2020. Conclusion: There was no significant change in number of patients who fell and total number of falls in COVID-19 era. Study Limitations: small population size, short time-period and data collected from patient's notes is influenced by quality of documentation. The process of dementia itself has deteriorating consequences on gait and balance which might also affect falls' risk over 1 year.

Feasibility, acceptability and usefulness of a telemedicine (TM) program in older people with dementia during COVID-19 pandemic Barbara Senesi 1 , Camilla Prete 1 , Ekaterini Zigoura 1 , Alessandra Pinna 1 , Giacomo Siri 1 , Sabrina Zora 1 , Cristina Novello 1 , Vincenzo Solfrizzi 2 , Carlo Custodero 2 , Alberto Cella 1 , Alberto Pilotto 1 1 Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genova, Italy, 2 2) Department of Interdisciplinary Medicine, University of Bari, Italy Aim: To investigate the feasibility, acceptability and usefulness of a telemedicine (TM) program in older people with dementia and their caregivers, during the COVID-19 pandemic isolation rules. Methods: From March 9 to May 11, 2020, 140 older patients and their caregivers, followed-up by our Center for Cognitive Decline (CDCD), were contacted by telephone and interviewed by using a telephone-based survey. Of the 131 respondents, 119 participants accepted to receive a TM visit by using a dedicated connection (jiitsi meet/Galliera), including only the dyads with access to PC, tablet or smart phone for 2 way video interaction. Results: Of the 131 respondents (mean age 80.6 ± 6.1 years; males = 20%), 85 (69.4%) lived accompanied, 40 (30, 5%) lived alone with caregiver supervision. During the lockdown period, the isolation measures forced 20/131 respondents (15, 2%) to change their living arrangements. Grocery and pharmacy outings were performed by family members in 111/131 participants (84,7%). Health status was found to be stable in 79/131 respondents (60,3%), with no COVID-19 symptoms; 1 patient/131 deceased for COVID-19 and 13 patients (9,1%) were hospitalized for other health problems. 53 patients out of 131 (41,9%) reported Behavioural and Psychological Symptoms of Dementia (BPSD) including sleep disorders (26,7%), anxiety symptoms (15,6%), delirium superimposted on dementia (7%) with an increased burden of caregivers. 10 caregivers out of 131 (7,6%) started a psychological support remote programme. Moreover, 63 patients (48%) reported pain. Finally, in 39 patients (29,7%) the COVID 19 emergency insight was present and 44 patients (33,6%) without disease insight reported difficulties to respect the COVID-19 restrictive and confinement measures. Conclusion: This TM program showed to be feasible and well accepted in most of patients (93, 6%). Monitoring BPSD and pain, tailoring actual therapies and delivering information and psychological care to patients and their caregivers were the most useful interventions in older patients with dementia and their caregivers. perceived stress and the self-report mental efficiency of individuals with mild cognitive impairment (MCI) and mild dementia, during and after the lockdown. Methods: A total of 40 individuals, of which a deep neuropsychological evaluation was available immediately before the pandemic, were recruited. Participants answered to questionnaires investigating their perceived stress, and self-reported mental efficiency, by telephone. This evaluation was repeated three times, every 2 weeks, to monitor over time possible changes. A post-pandemic neuropsychological evaluation is currently ongoing. Results: Although cognitive data are still lacking, data about perceived stress and self-reported mental efficiency suggest that people with MCI and mild dementia seem to not perceive stress related to Covid-19 and a detrimental effect of it on their cognitive functioning. Key conclusions: In people with MCI and mild dementia, the effects of a world-wide pandemic emergency seem to not affect their routine life, as well as their psychological and cognitive well-being. Data about neuropsychological actual status will be available, and will show if consistency between patients' self evaluation and objective consequences of Covid-19 on cognition exists.

Mary Buckley 1 , Riaz Moola 1 , David Robinson 1 , Rory Nee 1 1 St. James's Hospital, Dublin, Ireland Introduction: St James's is the largest hospital in Ireland with 6, 500 Geriatric Medicine outpatient attendances annually. COVID 19 resulted in transformation of the service necessitating a new way of working. This crisis has encouraged embracing telemedicine as an appropriate means of assessing our patient cohort. 79% of the 65-74 year-old age group lack digital skills, therefore telephone consultations were chosen for our cohort. Methods: St James's benefits from an Electronic Patient Record system. A remote working team was established including doctors in isolation and those redeployed from other services, who were given remote access. Secretarial staff informed patients of appointment cancellations and upcoming telephone consults. Telephone contact was made with both patient and next of kin, if required. Records were kept of consultations, and correspondence sent to the primary care physician. Results: Contact was made with 277/321 (86%) patients. 24 (16%) were discharged, 43 (9%) warranted urgent reviews and 75% (210) were given further appointments. The reviews were facilitated in our day hospital on a next day basis. These reviews included -dementia with BPSD (7), Parkinson's disease review (3), medically unwell (3), falls (3), CCF (2), general decline (2), stroke (1), medication review (1), no details (2) . Two of these were admitted. Feedback has been positive and evaluation is currently underway. Conclusion: Telemedicine, despite substantial research undertaken in the late 1990s, has not gained mainstream support. It enabled rapid triage and further assessment in those who were perhaps avoiding hospitals otherwise. Feedback has been positive with formal evaluation underway. We often fear what is unknown, which appears uncertain and obscure, as can happen with the threat of a pandemic. Generally, we experience a state of anguish when we lose our stable references, there is uncertainty about the future, we foresee a condition of forced solitude and isolation, when our lives or those of our loved ones are affected by a challenging chronic or disabling disease, which are already the prevailing fears of the elderly. The most fragile among us, such as those who suffer from cancer, feel more exposed to events that can threaten their precarious state of health. The recent and current pandemic situation caused by Covid-19 can generate a particular state of anxiety, especially in elderly cancer patients. They are very frightened that they will be neglected, that they will be unable to complete the necessary treatment, the planned therapies, the periodic checks already scheduled for their cancer. Given their precarious health condition, cancer patients also fear that covid-19 may be more aggressive and dangerous for them than for other people. There is also the fear of being an easier source of contagion for their relatives. Fears tend to become more pronounced in the elderly men, most affected by the covid-19 infection.In this delicate period, elderly cancer patients, perhaps more than others, require specific psychological intervention, even more so if they are alone.In a medical service of North Italy, we examined several elderly cancer patients by a semi-structured interview, a specific questionnaire and DASS-21 scale.

The impact of SARS-CoV-2 pandemic on older persons in Poland -a protocol and first progress report To present the baseline data. Methods: A prospective study of older who had a medical appointment cancelled due to the pandemic in Poland. The endpoints assessed 1 and 6 months after lifting the lockdown will include the self-reported: anxiety and depressiveness, cognitive impairment and emotional, perceptual and behavioural disturbances, malnutrition, sarcopenia, functional dependence, impaired physical performance, falls, incontinence, polypharmacy, impaired well-being. The comprehensive geriatric assessment will be done in the framework of regular care for older outpatients; the PTSD will be diagnosed according to the DSM-V criteria. Results: The mean (SD) age of 138, COVID19-free, unquarantined participants (68.8% women) was 78.4 (6.3), range 64-90 years. At baseline 39.0% lived alone, of them 56.6% received help from children, 11.3% from other relatives, and 5.7% from institutional caregivers. COVID19-related anxiety was reported by 65.9%, including severe anxiety by 12.1% and depressive symptoms by 54.4%. We found decreased every-day physical and mental activity in 43. 5% and 27 .5% participants, respectively. Falls since the beginning of the pandemic were reported by 8.7%. The median (Q1; Q3) quality of life scored 69.5 (50; 80) points, with the well-being and physical deterioration reported by 44.2% and 28.3% participants, respectively. Key conclusions: At the beginning of the pandemic, the majority of older subjects felt anxiety and were depressed, with large numbers perceiving physical and cognitive deterioration. This is setting a stage for the post-pandemic recovery strategies to be centred on reassurance and physical exercise.

Internet-telephone consultation services-a ''Learning by Doing'' project held for consultations of elderly during COVID-19 pandemic and healthcare lockdown Background: Limited access to healthcare services during pandemic lockdown jeopardized controlling of chronic conditions in geriatric patients since numerous healthcare establishments remained closed or were turned monomial and were designated to tackle Coronavirus Disease 2019 pandemic. Due to global university closure and lack of clinical rotations most of university classes were conducted online. Method: In response to pandemic lockdown, medical and pharmacy students based in Poznań University of Medical Sciences in Poland have established remote consultation services under substantive supervision and guidance of tutors specialized in geriatrics and pharmacy. Data derived from consultations along with follow-up interviews of senior participants and consultants were collected and subjected to analysis. Objective: The aim of this article is to present potential benefits of interdisciplinary, cooperative, ''learning by doing'' educational undertaking with the use of remote communication means towards improvement of care of elderly patients during pandemic lockdown.ResultsProper interventions were assigned to each of healthand pharmacotherapy-related problems reported by project's participants. Positive feedback results have shown that students' remote consultations proved to be beneficial for both elderly patients and medical and pharmacy students during pandemic lockdown and university closure. Conclusions: Students and elderly participants can both benefit from remote consultations. Remote means are considered efficient in detection and counselling of health-and pharmacotherapy-related problems of Elderly (especially, during pandemic lockdown in regard to social distancing measures). ''Learning by Doing'' project has proved to be favourable method of learning during COVID-19 pandemic lockdown.

Ensuring good quality care of elderly patients in LTC facilities during COVID19 pandemic: results of an interdisciplinary online consensus conference Methods: In June 2020 we held a consensus online conference on the care of elderly patients in LTC facilities during COVID19 pandemic. The composition of the panel is diverse (MD geriatrics&psychiatry, clinical psychologist, architect, researcher on dependent elderly care). We listed the problems related to care of elderly patients, then we discussed consequences of these problems on patients' QOL, finally we addressed solutions for increasing QOL of patients. Ideas were generated by brainstorming and were kept if all participants agreed upon.

Results: According to participants, physical and social distancing represent important factors that determine decrease in QOL of elderly patients. The major consequences are lack of activities and limitation of physical activity for patients, decrease in the degree of communication between residents and family members, staff members stress. These problems have impact on all dimensions of QOL. The solutions that the groups agreed upon are: using guidelines for safety measures against infections; implementing telehealth services; supporting physical activity for patients; finding alternatives for leisure activities for patients; ensuring communication of patients with family members; preserving as much as possible daily routine of residents; counseling and relaxation spaces for staff; public financing for LTC settings during pandemics. Conclusions: COVID19 pandemic represents a new challenge for LTC settings. Ensuring good QOL of elderly residents requires the adoption of appropriate measures to serve the needs of elderly persons and staff.

Pharmaceutical care service-remote consultations for elderly with polypharmacy during COVID-19 pandemic-the first service of its kind In Poland Background: Limited access to healthcare services during pandemic lockdown underlined the urgent need for pharmaceutical care service especially for elderly with multimorbidity and major polypharmacy since numerous healthcare establishments remained closed. Method: The service is the first of its kind in Poland. It includes the detailed medical and pharmaceutical interviews of the pharmacological treatment undertaken by pharmacists trained in geriatrics. Thereafter recommendations are given for the elderly patients and-if necessary-also for their general practicioners. Objective: The aim is to present the algorithm of the innovative Pharmaceutical Care Service financed by the Poznan City Hall. It is an effective, validated model of pharmaceutical care in geriatrics with the main beneficiary being the elderly with major polypharmacy. Results: Remote consultations of seniors with major polypharmacy resulted in the improvement of the appropriateness of their pharmacotherapy, especially when over the counter drugs and herbal remedies were used in self-treatment. Additionally, the elderly could seek pharmaceutical advice in the time of health care system lockdown resulting in the improvement of their compliance to drug regimen.

Conclusions: This innovative project allows specially trained pharmacists to use validated, effective model of Pharmaceutical Care in geriatrics to detect, resolve and prevent medication-related problems in seniors also in the time of COVID-19 pandemic. Pharmaceutical Care Service is recommended to be included in a healthcare system in Poland.

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

Background: The coronavirus 2019 epidemic in Italy originated in the south-west of Lombardy, on February 21, 2020. The Fondazione IRCCS Policlinico San Matteo di Pavia has been involved in the management of the outbreak since its beginning. All the hospitals involved have experienced a huge increase in crowding, while witnessing a reduction in the presentation of minor emergencies. These had been pointed out by some authors as one of the causes of crowding and included in the crowding input factors.Purpose: As part of a study that wanted to assess the impact of the CoViD pandemic on geriatric minor emergencies, we evaluated the geriatric population that went to the ER for minor signs and symptoms.

We evaluated all patients aged 75 years and older who were accessing our emergency room for minor medical emergencies from February 22 to May 1, 2020 and during the same period of the previous year. Results and discussion: We enrolled 663 patients. There was a severe reduction in the total number of accesses for minor injuries: 208 in the CoViD period and 455 in the previous year. Age and vital parameters were overlapping. Patients in the CoViD pandemic tended to be more frequently carried by ambulance and 118 compared to the reference period (75% vs 53%, the remaining half independent). The priority codes for the medical examination were not different (71% minor emergencies, 7% non-urgency in the pandemic period vs 78 and 5%). During the pandemic, they patient presented with higher discharge severity codes (yellow and red) with a slightly higher frequency compared to the reference period (25% vs 13%) and more frequently need hospitalization (46% vs 28%). Rarely this category of patients presents altered crowding indexes; Crowding input factors are however lower in the pandemic period: reduced patients (208 vs 455) and reduced average waiting times (86 min vs 118 min). The percentage of patients who exceeded the waiting time target by priority code of medical examination was also reduced (13% vs 19%). Crowding throughput factors worsened only slightly: LOS (580 vs 425 min). Crowding output factors also slightly worsened: the percentage of access block is higher during the pandemic (19% vs 9%). The Total Access Block Time is significantly higher during the CoViD period (36, 104 min vs 29, 159 min). The crowding for patients who came for all causes of our ED was higher during the pandemic period compared to the reference period (OR = 3.95).

The epidemic led to a drastic reduction in access for minor signs and symptoms, with no effect on overall ED crowding. However, patients were more frequently in need of hospitalization and had more severe exit codes. Acknowledgements: we would like to thank all employees of the IRCCS Policlinico San Matteo Foundation for their extraordinary efforts during the pandemic.Keywords: COVID-19, minor emergencies, crowding, Time Dependent Pathologies, First Aid, Triage, Emergency Department.

Lending ears to the patient can make a huge difference 2020) .His renal, liver and thyroid functions were intact. Albumin creatinine ratio 12.23 mg/g (0-30). Nerve conduction study-consistent with mixed polyneuropathy.He continued to follow-up physically even during the Covid crisis as he was very much concerned about the elevated SMBG and BP values. In June, 2020, the patient & and his daughter were educated about the Libre (CGM) usage.His Gliclazide dose was optimized and Inj.Glargine, 10 units daily was started.The antihypertensives were also adjusted. On patient's follow-up in August, 2020, his time in range had improved to 80% (33% in June, 2020), average glucose was 147 mg/dl (200 before), glucose variability was 27.8% (28.9), hypoglycemia (54-79 mg/dl) was 1% (0).

Key conclusions: *Physicians should always pay heed to the patients' complaints, which can help in solving their problems.*Continuous blood glucose monitoring can be a more efficient method than glycosylated hemoglobin and self-monitoring of blood glucose, for detecting the correct glycemic status.

Rehabilitation intervention for active elderly with balance disturbance after traumatic brain injury: a case report

Abstract: Background: Gait and balance disturbance in older adults may lead to dysfunction and loss of independence, thereby reducing their quality of life. The aim of this case report is to describe the benefit of the rehabilitation program as an intervention for elderly patient with gait and balance disturbance after traumatic brain injury. Case presentation: This was a case report of a 75 years old woman with a balance disorder after a traumatic brain injury. The patient also fulfill the hakim's triad (gait disturbance, urinary frequency, mild cognitive impairment) for early stage of Normal Pressure Hydrocephalus (NPH). Eventhogh, Ventriculomegaly, multiple lacunar infarction on paraventricle and cerebral atrophy was found in CT scan of the head, these findings can not rule out the NPH for sure.

Rehabilitation program that given to this patient include balance training, cardiopulmonary training, and family meeting to support environment modification.

Conclusion: This case showed the importance of rehabilitation program for gait and balance disturbance in elderly with instability.

Rehabilitation medicine assessment and program should be conducted to elderly patients after traumatic brain injury to prevent falls and improve functional ability. Keywords: balance, elderly, gait, traumatic brain injury Introduction: a state of alarm was declared in Spain to tackle the covid-19 pandemic. The population had permission to leave their homes only for essential activities. The objective of this study was to examine the health status and lifestyle habits of vulnerable, community-dwelling older adult during the confinement. Methods: a social worker and a nurse performed a telephone interview at the end of confinement to a sample of people aged[70 years, living in Gipuzkoa (Spain), with a Barthel index score of C 85 points and frail or with high risk of falls. Besides, this assessment data was compared to a previous face-to-face interview carried out 9 months earlier.

Results: a total of 38 individuals were included (71% women). During the confinement, a 63% showed difficulties in walking up 10 steps, 42% reported poor self-perceived health, 66% had sleep problems and 74% experienced pain. They were not anxious/depressed (71%) and did not feel loneliness (60%). Considering the previous assessment, a deterioration of basic and instrumental activities of daily living was observed. The body mass index decreased and a higher proportion of people at risk of malnutrition or malnourished was identified. Family support increased.

Key conclusions: in a group of vulnerable older individuals, health status and lifestyle habits deteriorated during the covid-19 confinement. As the epidemic is still ongoing and new confinements are possible, it is necessary to be aware of the implications of this situation and implement specific measures to control these potential negative impacts.

Utilisation of remote consultations significantly reduces exposure during the COVID-19 pandemic

Ealish Swift 1 1

Introduction: Exposure to the clinical environment during the COVID-19 pandemic has become a great source of anxiety and apprehension for the elderly and/or at-risk populations. However, many elderly patients are also poorly equipped to adapt to the technological advances designed to minimize risk, such as video consultations in GP practice. Proportion of remote consultations requiring 'conversion' (subsequent face-to-face consultation) was measured to determine if telephone and video consultations are sufficient to reduce footfall in the practice. Methods: 2938 consultations were reviewed, comparing 'conversion' rates (CR) for the first 2 weeks of lockdown (March 2020) to the preceding 2 unrestricted weeks as a baseline. Footfall was calculated as 'converted' remote consultations plus primary face-to-face consultations.

Results: CR dropped from 20% at baseline to 2% in week 2 of lockdown, despite remote appointments being expanded in scope from minor triaged issues pre-lockdown, to any and all problems as remote consultation became the default. This decrease correlated with increasingly creative uses of technology, such as asking patients to email in photographs of skin lesions. There was also increased efficacy in stratifying patients to either self-help at home or referral to secondary care. Overall, footfall in the practice dropped by 91% as a result of these changes. Key conclusions: Footfall and exposure to the clinical environment in a GP setting can be successfully reduced by creative and pragmatic utilization of video consultation technology. This is essential to protect the elderly and/or at-risk population during the COVID-19 pandemic.

Orthogeriatrics service in COVIDemia Results There was a significant decrease in stroke admissions, across all presentation time frames, throughout the United Kingdom (UK), chi squared (4, N = 39228) = 14.07, p \ 0.01, with stroke admissions more than halving. In Bolton, stroke patients presented later in the months of April and May, than pre-lockdown. Patients were more likely to be initially managed in a tertiary centre pre-lockdown than during lockdown, chi squared (2, N = 126) = 11.98, p \ 0.01. The overall length of stay of stroke patients did not differ significantly during lockdown (Mann-Whitney U = 1913, Z = -1.0526, not significant at p \ 0.5). Key conclusions: Less stroke patients have presented to hospital during the COVID-19 lockdown in the UK. In Bolton there was a delay in presentations of a significant number of stroke patients, although this appears to be recovering since July. Proportionally less patients were transferred for initial management at a tertiary stroke centre, however no effect was seen on overall LOS in hospital.

Effects of the home confinement due to the Covid-19 outbreak on wellbeing of former active elders During the lockdown period (about 10 weeks) they exercised at their home using video, leaflets, etc. Different scales were administered after the home confinement to measure PA, well-being, feelings, diet and sleep quality changes. In addition, several tests were performed to evaluate BMI, balance, strength and flexibility at the end of the S108 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 lockdown and compared with the same measures collected before the home confinement.

Results: PA decreased during the home confinement, and well-being, feelings and sleep quality were affected significantly. BMI, balance, strength and flexibility do not change significantly between before and after home confinement.Key conclusions. Our data confirmed that a certain amount of PA in a safe home environment reduces the impact of prolonged quarantine functional abilities while it seems unable to avoid changes in well-being, feelings and sleep quality that were probably more related to psycho-social dimensions of exercise.

References:

[1] Chen, P., Mao, L., Nassis, G.P., Harmer, P., Ainsworth, B.E., & Li, F. (2020) . Coronavirus disease : The need to maintain regular physical activity while taking precautions. Journal of Sport and Health Science, 9, 103-104.

Ageism in times of pandemic: exploring age discrimination among health professionals Agnieszka Bozanic 1 , Francisca Ortiz-Ruiz 2 , Andrés Aranda Ortega 3 1 Barcelona University, 2 The University of Manchester, 3 University of Chile

The main objective of this presentation is to evaluate the level of ageism between health professionals, considering the presence of a Pandemic as the COVID-19. The data used has been produced in Chile by May of 2020, using a constructed survey to measure it. These are the first results about it applied in Chile, South America, and in the context of a pandemic . The analytical design used is the scale proposed by Becca Levy and Ellen Langer (1994) , which explores the negative stereotypes of older people. It is tested and validated this scale in a context of two different aspects as the standard applications had been made: during a Pandemic and in a South American country. Until now, the survey has been applied during the entire month of May 2020, getting a total of 357 answers.

In general, the results show that the image of older people has been associated with advice, family-oriented, capable, active, positive outlook, well-groomed, and walks slowly, wise and sick. Accordingly, the presentation gives some useful information about how to measure in a better way the level of ageism in a Spanish speaking country as Chile. It is concluded that there are some indicators of ageism between health professionals, which also depended on different attributes of the responder people. Identifying the ageist attitudes of healthcare professionals can help in the creation of a series of strategies oriented to reverse the trend of ageism and improve the quality of life of older people, especially in an unusual context as COVID pandemic.

Pre-admission anti-coagulation does not improve all-cause mortality in geriatric COVID-19 patients Introduction: COVID-19 pandemic is having a global impact on healthcare system around the world. Everyone is susceptible to COVID-19, but older adults aged 60 years and above due to physiological changes that come with ageing and possible underlying medical disorders are more susceptible [1] . The need to ensure access to healthcare services by the elderly during this pandemic is paramount. Nonetheless, it is essential that stakeholders continue to prioritize access to healthcare services and medicines among the older adults amid the fight against this global public health, especially in Africa where little attention is paid to geriatric care. Methods: This is a descriptive recommendation Abstract for countries in Africa based on tailored strategies to improve access to healthcare among the geriatric population during this pandemic and in the post-pandemic era. Discussion and key conclusion: When implementing interventions to reduce the spread of disease, such as partial or total lockdown, exceptional attention must be offered to older people. Remote consultations such as telemedicine have the potential to protect healthcare workers and older adults from unnecessary exposure to disease, while ensuring continuity in the delivery of care, and in addition, decreases resource utilization across the already stressed health-care infrastructure [2] . COVID-19 is a call to accelerate improved geriatrics differentiated healthcare services in Africa by leveraging on telemedicine and technology without necessarily exposing older adults to the risk of contracting diseases by visiting healthcare settings. During COVID-19 pandemic and post-pandemic telemedicine would have unlimited potential to provide effective, appropriate, and secure care in the context of highly transmissible disease epidemics, both for management, and for regular follow-up of chronic disease among older adults. The implementation of this technology should ensure that the future policy on telemedicine includes the end-users in the planning and implementation. 2) admitted to our hospital (average-stay 16.9 ± 5.4 days) with severe bilateral COVID-19 pneumonia who received high-dose glucocorticoid therapy when they developed mild-to-moderate ARDS and their clinical evolutions (temperature) and radiological changes. We analyzed analytic parameters (D-Dimer). Furthermore, we compare glucocorticoids alone versus associated with Tocilizumab and we looked at differences between early or late administration of treatment in disease-evolution. They all received therapeutic-dose heparin. Results and discussion After therapy, D-Dimer tended to go down, as did body temperature, and lymphocyte count went up. Patients who received glucocorticoid therapy in an early phase of disease evolution (50%) presented a less severe D-Dimer elevation compared with those who received it in later phases. Combination therapy with glucocorticoids and Tocilizumab (60%) was used when ARDS presented quicker and more severely, which coincides with a higher elevation of D-Dimer.

Conclusions: Although cause-effect relationships cannot be established due to the data being observational, there is a seemingly chronological relationship between glucocorticoid treatment and clinical, analytical and radiological improvement. These findings also point to the possibility of early anti-inflammatory treatment being justified in patients with early hypoxemia. Randomized Controlled Trials are urgently needed on this topic.

Therapeutic exercise in adult post-COVID-19 patients in postacute care Introduction: COVID-19 has been declared a global pandemic by WHO. Currently we have lacking therapeutic options. Some observational studies have suggested benefits of hydroxychloroquine (HCQ) for the treatment of Covid-19, whereas other treatment reports have described mixed results. As a result, these treatments are increasingly used off-label for patients with COVID-19. Tisdale et al found a valid method to quantify the risk of drug-induced QTc interval prolongation. In a retrospective study we assessed the usefulness of this method for the management of HCQ in relation to the prolongation of the QTc. Methods: 58 hospitalized patients, positive for SARS-CoV-2 (PCR) treated with HCQ were examined. We calculated the risk score of prolongation of the QTc interval and examined its possible progression on the basal ECG (T0) and after 7 days from the insertion of the drug (T1). Results: Of 58 patients (M = 36,20%) 44, 82% were[65 years of age (average age 76,10 ± 8, 70 years). The QTc interval was prolonged from 434,22 ± 26,08 ms (T0) to a value of 462,22 ± 37,24 ms (T1) (p .000). The QTc were significantly prolungation in high risk group (n = 23; score Tisdale C 11 points) as compare to low-moderate risk group (n = 35; Tisdale\10 points) (477, 33 ± 39, 7 vs. 452, 4 ± 36, 6 ms; p \ 0, 017). Key conclusions: In our opinion the use of Hydroxychlorochinic in COVID -19 must be assessed case by case, by using QTc Interval S112

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Prolongation Risk Score, and paying attention to interaction with other drugs associated with QTc prolongation.

Antiplatelet therapy in patients with Covid-19: a retrospective observational study

Josef Banik 1 , Christian Köhler 1 , Marco Schmidtmann 1 1 Department of Internal Medicine, Klinikum Fichtelgebirge, Selb, Germany

Introduction: Covid-19 is associated with a high risk of venous thromboembolism. In addition, cases of arterial thromboembolism were also reported. We investigated the effect of antiplatelet therapy on the disease course. Methods: We evaluated a cohort of inpatients with Covid-19 (n = 152). We recorded the patient's demographic data, their comorbidities, medication use including the use of antiplatelets and anticoagulants, laboratory findings and data about ventilation. We then separated the patient's outcomes into either being ,,bad'' (dead or referral to higher level of care) or ,,good'' (discharge). Then we evaluated the factors that contributed to the patient needing ventilatory support and to showing typical radiological findings.

Results: In our cohort, 21 patients received ventilatory support whereas 131 did not require the use of ventilators. 127 patients had good outcomes and 25 had bad outcomes. By using multivariate analysis, we found that the need for ventilatory support was the strongest predictor of a bad outcome. All patients who were on ventilators displayed typical radiological findings. The factors predicting the need for ventilatory support were LDH and CRP levels, the presence of cardiac conduction abnormalities as well as chronic lung conditions. Cardiac conduction abnormalities, LDH and CRP levels, and the use of antiplatelets, were factors that predicted typical radiological findings.

Conclusions: There was a higher incidence of typical radiological findings in patients on antiplatelet medication. However, it did not translate into changes in the ventilation requirement or in the outcome. The need for ventilation was the strongest predictor of a bad outcome.

Elderly patients dying with Covid-19: lessons learned Shan Liung Liew 1 , Muhammad Iqbal 2 , Atif Nasrullah 2 , Sherena Nair 2 1 Calderdale and Huddersfield NHS Trust, 2 Leeds Teaching Hospitals NHS Trust

The start of the pandemic in the United Kingdom resulted in many elderly patients with Covid-19 dying in hospitals as rapid guidelines were being drafted to support the care of such patients with compassion and dignity [1] . Experience from caring for patients with Covid-19 found that the course of illness differed from diseases familiar to geriatricians which prompted further evaluation. A snapshot audit of 30 patients was conducted over a 2 week period on a geriatric medicine ward to assess the nature and progression of Covid-19 and the challenges around care at the end of life. The unusual features found in these patients included a prolonged hypoactive delirium stage in 50% of patients with a mean time of 4 days from starting end-of-life care to death. Also, 30% of patients required increased doses of midazolam compared to average doses, prompting support from the specialist palliative care team to manage symptoms of agitation and breathlessness. In about 40% of patients, it was felt that death was caused by a slow deterioration in renal function due to hypoactive delirium and minimal oral intake, rather than a rapid progression of multi-organ failure; death seemed to be protracted in this group of patients. In conclusion, the progression of Covid-19 in older people represents an atypical trajectory to death. Hypoactive delirium seems to be a prominent feature and terminal agitation from presumed 'air hunger' described in Covid-19 patients seems to require higher doses of palliative drug doses towards the end of life Introduction: Short leukocyte telomere length (LTL) is associated with atherosclerotic cardiovascular disease (ASCVD). Mendelian Randomization Studies, using single nucleotide polymorphisms (SNPs) associated with short LTL, infer a causal role of LTL in ASCVD. Recent results, using the blood-and-muscle model, indicate that higher early life LTL attrition, as estimated by the ratio between LTL and skeletal muscle telomere length (MTL), rather than short LTL at conception, as estimated by MTL, should be responsible of the ASCVD-LTL connection. Methods: We combined LTL and MTL measurements by Southern blotting and SNPs profiling in 402 individuals to determine if 15 SNPs classically described as associated with short LTL at adult age were rather responsible for higher LTL attrition during early life than for shorter LTL at birth.Results: Two of these SNPs (rs12696304 and rs10936599) were associated with LTL in our cohort (p = 0.027 and p = 0.025 respectively). These SNPs, both located on the TERC gene, were associated with the LTL/MTL ratio (p = 0.007 and p = 0.037 respectively) but not with MTL (p = 0.78 and p = 0.32 respectively). Key conclusions: These results suggest that SNPs located on genes coding for telomere maintenance proteins may contribute to a higher LTL attrition during the highly replicative first years of life and have an impact later on the development of ASCVD.

Eur Geriatr Med (2020) Key conclusions: The 4AT is now supported by a substantial evidence base comparable to other well-studied tools such as the Confusion Assessment Method (CAM). The strong pooled sensitivity and specificity findings for the 4AT in this meta-analysis along with its brevity and lack of need for specific training provide support for its use as an assessment tool for delirium.

Palliative Care Training In Long-Term Settings To Improve residents' QOL and quality-of-dying Methods: AS patterns were generated based on three sequential binary systolic blood pressure features: drop C 40 mmHg within 10 s post-stand (''immediate deficit''), failure to return to within 20 mmHg of supine level at 40 after standing (''stabilisation deficit''), and drop C 20mmHg at any time between [ 40 and 120 s post-stand (''late deficit''). Eight AS groups resulted from combining the presence/ absence of the three sequential features. The groups were cross-sectionally characterised, and their ability to independently predict orthostatic intolerance (OI) during AS, and falls or syncope in the past year, was evaluated using multivariate logistic regression models.

Results: 4899 participants were included (mean age 61), of which 3312 (68%) had no deficits. There were significant differences in age, sex, co-morbidities and medication usage across groups. Regression models identified independent associations between OI and three immediate-deficit groups; those associations seemed stronger as more deficits were present. There was a significant association between falls history and the three-deficit group (OR Introduction: Osteoporosis and associated fractures are a public health concern worldwide due to high societal and economic burden. The study assesses trends in incidence rates of hip and distal femoral fractures and in the use of anti-osteoporosis drugs in Italy between 2007 and 2017 Introduction: Although frailty can arise in middle age (i.e. before 65), very few studies have investigated frailty in this age group. Our objectives were to assess the prevalence of frailty parameters in middle-aged individuals (aged 50-65) and probe the association with future adverse events. Methods: We performed cross-sectional and longitudinal analyses of asymptomatic, community-dwelling individuals aged 50-65 (n = 411, median age: 59.0) having undergone a multidomain geriatric assessment (2010) (2011) (2012) (2013) (2014) (2015) in an outpatient clinic in the greater Paris area of France (SUCCEED cohort). The primary outcome was a composite measure of adverse health events (non-accidental falls, fractures, unplanned hospitalizations, and death), recorded in 2016/2017. Multivariable logistic regression models were built to identify independent predictors, using multiple imputation for missing data. A sensitivity analysis in complete cases was performed. [1, 2] . However, few observational studies have examined how these different trajectories could have different effects on mortality risk and none of them have use the tool FTS5 [3] . Data driven methods allow us to group subjects according to similar FTS5 trajectories along baseline and follow-up score using the Toledo Study of Healthy Aging (TSHA) sample, a longitudinal cohort study. Our hypothesis is that decreasing frailty score could show lower death risk than those subjects that increase or maintain higher FTS5 scores.

Methods: Participants data were taken from the TSHA. Frailty was determined using FTS5, being 0 the lower (the most frail) and 50 the highest (the most robust) score. FTS5 score at baseline and follow-up at 5.04 median years later were used to construct frailty trajectories according growth mixture modelling. Deaths were ascertained through the Spanish National Death Index. Factors independently associated with poor performance included positive responses to SARC-F questions, physical inactivity, impaired cognition and multimorbidity. In a multivariable model, those with multimorbidity had a 23% (95% CI 8-40%) higher relative odds of slow 5-CST compared to those without, and a 26% (95% CI 6-49%) higher relative odds of being unable to perform the 5-CST. The majority of those with poor performance had slow gait speed or were unable to complete the gait test.

Key conclusions: Poor performance in the 5-CST is increasingly common with age and is associated with several risk factors. We recommend a low threshold for performing the 5-CST in clinical settings.

Abstract # 1

One-year mortality of hospitalized adult patients 

Introduction: There is increased demand and intense pressure on NHS secondary care beds and the government has invested in primary care and community teams to avoid unnecessary hospital admissions. Subsequently patients who are admitted are markedly unwell with sever acute or acute on chronic illness. The mortality of these patients would be expected to be high. Many clinicians may be unaware of the prognosis and limited life expectancy of some patients, depriving them from planning and organizing end of life care. The aim of this work is to study the 1-year mortality of inpatients in different wards/ specialties and to explore the potential to plan end of life care for patients in their last year of life.

Methods: A prospective observational study; all adult inpatients in a certain day, in a UK teaching hospital, were identified. They were followed up 1 year later to see whether they were still alive. Results: In total there were 716 inpatients on the specified day. A year later, 224 died (31%). The risk is higher in elderly patients (61%), oncology patients (55%), High Dependency Unit patients (50%), respiratory patients (48%), rehabilitation patients (43%), renal patients (41%) and hip fracture patients (41%). Conclusions: Three in ten of adult inpatients would be expected to die within the subsequent 12 months of admissions. Early identification and recognition of those who are in the last 12 months of life will be helpful to deliver proactive care, advance care planning, better symptom control and prevention of unnecessary and avoidable admissions.

Elevated NT-proBNP levels shows low correlation with heart failure presence in elderly hospitalised patients with suspected diagnosis of heart failure Background: The diagnosis of congestive heart failure (CHF) is often difficult and underestimated in geriatric population, especially when an echocardiographic evaluation is not available or feasible. NT-proBNP assay is promoted as a key tool for the diferential diagnosis of CHF. But the diagnostic utility of NT-proBNP for systolic HF identification has been questioned in elderly, as NT-proBNP levels are influenced by age and several age-related comorbidities, such as anaemia, renal dysfunction, malnutrition. This study aimed to evaluate the diagnostic and prognostic value of NT-proBNP levels and its correlation with echocardiography in the group of elderly hospitalized patients initially not admitted with the diagnosis of HF. Methods: We enrolled 517 consecutive elderly patients (age [ 65 years) admitted to the Geriatric Clinic during the year 2019 (1.1.-31.12.2019) . Admissions due to worsening of known HF were excluded. Patients with at least one sign or symptom compatible with CHF were tested for NT-proBNP (fatigue, exercise dyspnea at most). NT-proBNP values \ 300 pg/ml were considered as an age-independent exclusion criterion for HF (high negative predictive value), while values above 1500 pg/ml were considered as a highly suspected diagnostic criterion for CHF. Main comorbidities and laboratory parameters were considered to adjust correlation analyses between NT-proBNP and LV systolic function. LV function was measured echocardiographically as ejection fraction (EF) in all subjects with increased NT-proBNP values and correlation was calculated.Results:Mean age of the cohort was 81 years, mean NT-proBNP 2254.7pg/ml and median value of 1659 pg/ml. Circulating levels higher than 1000pg/ml were reported in 45 % of studied patients, 36% showed values [ 1500 pg/ml. Only 25% of all seniors admitted to hospital with non-cardiac symptoms presented NT-proBNP levels \ 300pg/ml. Only 11% of patients with elevated values higher than 1500 pg/ml proved echocardiographically low EF \ 40%. When performed univariate analysis, NT-proBNP values showed no significant correlation with EF, haemoglobin concentration, CRP, uricaemia and surprisingly age. Weak correlation was identified between NT-proBNP levels and value of eGFF and creatinaemia. No correlation with the LV ejection fraction was observed, even after considering of other parameters in multivariable regression analyses. ConclusionHighly elevated NT-proBNP values were present in most of the admitted non-cardiac studied seniors. Diseases different from CHF have appeared to affect NT-proBNP plasma levels significantly in the elderly population of patients and can falsely mislead to CHF diagnosis when relying the diagnostic process only on the biomarker assay. In contrast to younger Abstract # 3

Age is an important clinical predictor of unsuccessful electric cardioversion for atrial fibrillation-5 years experience Background: Electric cardioversion is highly efficient therapy for patients with persistent atrial fibrillation and atrial flutter (AF). Despite its efficacy, there is still a group of patients, where even repeated application of electric energy does not lead to conversion to sinus rhythm (SR). Aim: We aimed investigate retrospectively the incidence and predictive value of several clinical and echocardiographic parameters for an unsuccessful electric conversion to SR and short-term AF recurrence in patients who have experienced the electric cardioversion (ECV) for an episode of persistent AF. Methods: We have examined data from 1380 patients who underwent ECV between Jun 2015 and Feb 2020 in our institution. Only those patients with failure to restore SR after an elective ECV or who experienced short -term recurrence of AF within 6 h after ECV were analyzed further. We assessed the predictive power of several potentially risk factors: senior age above 60 y., sex, obesity (BMI [ 30 kg/m 2 ), presence of diabetes mellitus, clinically significant mitral regurgitation or form of coronary heart disease in the history of patient, echocardikographic parameters (LV ejection fraction, dilated left atrium (LA[4, 2cm) , value of energy of the biphasic shock used for ECV, repeated ECV performed in past, type of antiarrhythmic medication and statins or ACE-inhibitors in the medication of the individual.

Results: The group of patients with unsuccessful ECV consisted of 53 individuals, 80% men. Mean age of the study group was 66 (median 66) years. Presence of recorded risk factors was reported in percentage. We could identify following markers of ECV failure: masculine gender (80% incidence), age [ 60y. (70%), severe obesity (68%), dilated LA (82%). No pre-treatment with type I or III antiarrhythmics prior to ECV was indentified as powerfull risk factor for ECV failure (67%) too. On the other side, presence of diabetes mellitus or CAD (only 12%/15% incidence), no ACEi (30%), mitral regurgitation of II.grade and higher (58%), low EF\40% (10%), ''low'' energy shock used \ 150J (10%), even the history of repeated ECV previously (40%) were not identified as a significant risk factors for ECV failure in our group of patients. Amiodarone (60%), but not propaphenone (40%) when addeded to the therapy before repeated have increased the efficacy of the repeated ECV with the success rate 76% vs. 25%. ConclussionThe combination of senior age, obesity, male gender, LA dilatation and no antiarrhythmic treatment (group I and III) could identify subjects with low success rate of ECV. Weight loss and adding amiodarone to medication prior ECV can significantly increrase the success rate of elective ECV of these high risk patients. Further data on larger populations of AF patients could prove pre presented concept.

Seamless transition from hospital to home (H2H) in Singapore: a quality improvement activity (QIA) ) ; 404 under 75y, (73% male). In our population, the presence of haemodynamic instability as defined by American College of Surgeons is greater in the elder population, being 26, 5% against 9, 2% in the younger population. Also mortality rate is greater in the elder patients (4% vs 1, 3%). Evaluating the coagulopathy presence, it is similar in the two subpopulations (36.2% in the younger and 38% in the elder patients), whilst the haemotrasfusion need results greater in the younger patients (3.8% against 2%), in a statistically significant way with p \ 0.05. Acid pH, precipitating factor of trauma coagulopathy, results to be more elevated in the younger patients (8.6%) and never present in our elderly case study.

Conclusions: Elderly, inside the same catchment area (aroun 400,000 inhabitants) of a second level italian trauma center, present less haemotransfusional need and the same coagulopathy rate compared to the younger population; although they present a greater mortality rate. Elderly's mortality could therefore be linked to other factors rather than bleeding.

Introduction: Elderly, due to many co-factors (unstable walking, reduced sight, blance and reflexes), are exposed to a greater risk of falling and head trauma. We therefore analyzed if this statement is also valid in our Major Trauma (MT) population and if this could lead to worse outcomes. Methods: We made a prospectic monocentric observational study of all the patients who accessed in our Emergency and Acceptance Department for MT in 12 months. Results: We enrolled 501 patients in total; 51 over 75 years old (64% male). Regarding the body districts affected, in the elder population head trauma is the most frequently affected (in 62% of cases), followed by chest (52%), lower limb (24%), abdominal (22%), upper limb (14%), pelvis (26%), spine (36%). In the younger population chest is the most affected district (in 45% of cases), followed, in order of frequency, by head trauma (44%), spine trauma (34%), lower limb trauma (26%), upper limb trauma (25%), abdominal trauma (15%), pelvis trauma (13%). Head trauma is more frequent in the elderly in a statistially significant way (p = 0.016). This is further confirmed by the fact that in the elder population there is a greater request for maxillo-facial surgeon advice (10% against 2% in younger patients) and neurosurgeon advice (38% against 26%). Consequently also GCS is more impaired in elder subjects, in fact 12% of them had CGS \ 9 against 3% in the younger population.Key Conclusions: Elderly with MT present more frequently head trauma compared to the younger population, needing more specialistic surgeon visits (maxillofacial and neurosurgical) and presenting more severe sensorial impairment.

Aim: Describe and typify the population that accesses our emergency room for signs or symptoms that then lead to the diagnosis of pneumonia.

We retrospectively analyzed all patients who received pneumonia diagnosis in our emergency room in 10 consecutive months (1 January 2018 -31 October 2018 . Results: of the 565 patients with pneumonia, 443 were elderly. Among elderly 33% received low priority codes of medical examination and allocation at the low intensity of care, 67% instead a code of high priority to medical examination, of this 5% was attributed to the low intensity of care wing and the remaining 95% to the medium-high intensity care wing.. The medical severity code at discharge was green in 53% of cases, 43% yellow and 4% of cases red. 53% required access to the intensive brief observation for stabilization of the clinical picture.66% of patients were hospitalized, 6% transferred to a lower-care facility and only the remaining 28% discharged. Key conclusions: patients who come to the emergency room for pneumonia are more frequently elderly. These are complex patients, in large part they require a medium-high intensity of care for the administration of aerosol, oxygen and trp cadenced, multiparametric monitoring and oximetry. An intensive care organization with short intensive observation with a dedicated team therefore allowed immediate allocation to the most correct treatment area and excellent waiting and process issues.

Hospitalisation rate and length of hospital stay in case of major trauma: a comparison between older and younger population Introduction: Elderly have been, in the last few decades, more and more exposed to Major Trauma (MT) and the rate of elderly who reported a MT has been progressively raising. The old patient is universally considered a frail subject and therefore present the risk of worse outcomes. Methods: AWe did a prospectic monocentric observational study of all the patients who accessed to the Emergency and Acceptance Department of Fondazione Policlinico IRCCS S. Matteo in Pavia for MT in 12 months: from 1st january 2018 to 31 december 2018. Results: We enrolled 501 patients in total. Between the patients over 75, we enrolled 51 patients, 64% of which were male. 449 were, instead, under 75, and 73% of them were male. Hospitalisation rate resulted comparable in the two subpopulation, being 72% in the elder patients and 74% in the younger ones. The ICU hospitalisation rate was 16% in the elder subjects and 12% in younger subjects, a non statistically significant difference (p 0, 3736). Although the mean duration of the ICU stay was greater in older patients (18.75 days against 9.45 in younger patients), it does not reach statistical significativity. The latter statement is valid also for the need of operation theatre during hospitalisation (18% against 12.88%).

Conclusions: Elderly with MT do not present a greater rate of hospitalisation, or ICU stay. They do not present a statistically significant increase in the duration of ICU stay neither in the operation theater need. This, in the face of a greater statistically significant mortality that emerged in our population.

Introduction: Elderly, due to many co-factors (unstable walking, reduced sight, blance and reflexes), are exposed to greater risk of falling and trauma. Often falling are victims of major trauma. We want to find out if Major Trauma (MT) is more often underestimated.

Methods: prospectic monocentric observational study of all patients who accessed Emergency Department for MT in 12 months: from 1st january 2018 to 31 december 2018. Results: We enrolled 450 patients in total. 45 over 75 years. in older subpopulation, only 76% of the population received high priority code wait for the visit (red code), compared to 85% in younger. Also Trauma Team activation was lower (48% against 56%) in the elderly. The elder population presented more often haemodynamic instability (26% in the elderly vs 9% in the younger partients); they also present a more often impaired anatomic severity index like ISS [ 15 (44% of the elder population against 32% of the younger population). Undertriage, calculated by using modified Cribari formula is 35% in the elder population and in 23% of the younger population. Overtriage was greatere in ounger patients (45%) compared to older patients (34%).

Conclusions: Elderly present a more elevated underestimation. This is due to many causes: vital signs in elderly are often indipendently more compromised, so their impairment is sometimes attributed to preexisting causes. Furthermore, elderly more often present MT causes usually wrongly identified as low-risk like domesic accidents and other-s violence (in our elderly 26% and 2% compared to 6% and 0.2% in younger Results: Elderly patients diagnosed with strokes in our emergency room and subjected to thrombolysis for a total of 49 patients were analyzed. This population has a high incidence of risk factors: 94% had at least one risk factor, 63% of the study population had at least two risk factors, and 30% had 3 or more. By far the most represented risk factor in this population is high blood pressure in 73.5% of cases. The prevalence of atheromasia superortic trunks present in 32.6% of patients, ischemic heart disease 26.5%, atrial fibrillation 26.5% and diabetes mellitus 20.4% follow with substantially overlapping prevalence. with slightly lower percentage of ical disease 22.4%; while cigarette smoking habit has a lower incidence in this population (4%). We then divided the population of thrombolysis patients into clinical syndromes: motor, sensory, language and nonspecific symptoms. Conclusions: in elderly patients who are candidates for thrombolysis, high blood pressure is the widely represented risk factor, while cigarette smoking is poorly represented. Particular attention should be given to all the other risk factors under consideration. Patients with atypical symptomatic cadres, on the other hand, have a lower prevalence of FA, suggesting that in these cases the rate of heart disease pathogenic stroke is reduced Abstract # 15 Invisibily cloak: recognition delay of atypical stroke symptoms in patients with more than 75 years Introduction: According to different symptomatological spectrum at presentation, the purpose of this study is to ana-lyze times needed for recognition and management of patients over 75 years affected by stroke. Methods: We conducted a prospective and monocentric observational study of all patients with acute stroke referred to the Department of Emergency and Acceptance in Pavia from May 1, 2017 to May 1, 2018. Results: We enrolled a total of 430 patients with more than 75 years who received diagnosis of stroke at our Emer-gency Department from May 1st 2017 to May 1st 2018. The average age was 83.8 y and women were in slight majority (female 60%). At presentation, symptomatological spectrum was so divided: 56.7% motor symptoms, 15.7% sensory symptoms, 46.8% speech disorder and 36.5% atypical symptoms (including dizziness, confusion and syncope). While the first three groups with typical symptoms accurately presented an high priority code for medical examination (about 90% had yellow code or higher), only 74% of patients belonging to the forth group (atypical symptoms) had a high pri-ority code. This resulted in different waiting times: average of 38 min (min) for the first three categories, average of 55 min for patients with atypical symptoms. This time delay in the fourth group was primarily dependent on recogni-tion at door, while subsequent times (request for imaging, neurological consultation and process time) were normalized. Conclusions As our results demonstrated, patients presenting atypical symptoms of stroke were more difficult to recognize at door as neurological acuities, leading to increased waiting times.

Toc toc: who is it? elderly with acute stroke knocks on the door of the emergency room. the characterization of the elderly population with acute stroke in real life 83 y) . 85% of patients are given a priority code for high visit with a yellow or red code. More than 90% needed hospitalization. 77% were admitted to our DEA and 14% transferred to a low-intensity neurological institution. 75% of patients had high process-term severity code. 52 patients were proven to be candidates for thrombolysis, systemic or mechanical or both. Looking at risk factors such as diabetes mellitus, high blood pressure, cigarette smoking habit, previous ictal disease, ischemic heart disease, superortic athemtic athesia and atrial fibrillation is seen as 64% of the study population had at least two risk factors, and 35% 3 or more. Only 9% did not take drugs at home. The most represented drugs were antipertensive, anticlusters, anticoagulants, polypomizers, beta blockers, oral antidiabetics, PPPs, antidepressants. 41% were already in antiaggregating trp and 16% were already anticoagulant trp. Conclusions: elderly who report acute stroke are highly complex population as demonstrated by high prevalence of risk factors and other concomitant pathologies, high percentage of hospitalization, complexity of home therapy and from high percentage of high severity codes to discharge. They have high cardiovascular risk and home drug polytherapy. It is often already antiaggregated or anticoagulated. It has high hospitalization rates.

Waiting time and fibrinolysis in the elderly with acute stroke in the emergency room in real life: the time machine neurological examinations were 31 min; those requiring CT scan (execution and reporting) with intracranial and extracranial circulation evaluation had median of 1 h and 32 min. All of the patients were admitted to the stroke unit after an initial observation in the emergency room. Population that underwent thrombolysis was taking multiple medications at home. 83% was taking at least one prescription medication, 67% was taking at least 348.98% was taking at least 516.4% at least 8. 36.7% was taking antiplatelet therapy and 20.5% taking anticoagulants. Conclusion: Elderly population who underwent thrombolysis is represented by patients with many pathologies, at high cardiovascular risk and taking cardiovascular medications at home.

Introduction: We analyze the risk factors in a large cohort of patients who have been diagnosed with acute stroke in our emergency room. In particular: diabetes mellitus, arterial hypertension, smoking, previous stroke, ischemic cardiopathy, atheroma of supra-aortic vessels and atrial fibrillation in various patients over 75 years of age. Materials and Methods: We conducted a prospective and monocentric observational study of all patients with acute stroke from May 1, 2017 to May 1, 2018. Results: 430 patients were enrolled in the study. These patients presented the average age of 83.8 Y.O. with a predominance for the female sex (60% F). The general population evaluated demonstrated a high incidence of risk factors: over 91.3% presented at least one risk factor, 63.7% of the study population presented at least two risk factors, and 34.6% presented three or more. The most common risk factor represented was arterial hypertension, which was present in 73% of the cases. Following: Smoking in 5.1 %, previous stroke in 27.6%, ischemic cardiopathy in 23.8%, atheroma of supra-aortic vessels in 30%, atrial fibrillation in 25.5% and diabetes mellitus in 23. Conclusions: It can be deduced from the careful analysis of the risk factors together with the collection of signs and symptoms that an improvement in early recognition can be brought to the attention to patients with acute neurological problems and as a consequence the entire diagnosis and treatment process in elderly patients can be facilitated when recent medical history can be correctly be collect.

Risk factors in various clinical frameworks of acute stroke within aging populations Introduction: we analyze the risk factors in a large cohort of patients over 75 years who have been diagnosed with acute stroke. We have therefore divided the population according to the presentation of the following symptoms: motor, sensory, language deficit and atypical (dizziness, confusion and syncope). Methods: prospective and monocentric observational study of all patients with acute stroke from May 1, 2017 to May 1, 2018. Results: 430 patients were enrolled in the study. The 4 symptom based groups are results are superimposable for age, distribution of sex and outcome o the hospitalization. The symptom based group with motor disturbances, language deficit and non-specific have been substantially demonstrated to be superimposable for the number and distribution of risk factors. In particular: arterial hypertension 71-74% with a peak in 83% of patients with sensory symptoms; cigarette smoking in 5-6%, previous stroke in 23-27%, ischemic cardiopathy in 22-29%, atheroma of supra-aortic vessels in 29-33%, atrial fibrillation in 23-27% and diabetes mellitus in 15-20% with a peak in 26% in patients with atypical symptomatology. Conclusions: It can be deduced from the careful analysis of the risk factors together with the collection of signs and symptoms that an improvement in early recognition can be brought to the attention to patients with acute neurological problems and as a consequence the entire diagnosis and treatment process in elderly patients can be facilitated when recent medical history can be correctly be collect. Purpose: Describe and analize signs and syntoms of population who go our Emergency Department with the aim to identify early the sepsis. Methods: Survey is on all inpatients of the ED that are received the sepsis diagnosis in 10 months (from 1st of January to the 31th of October of 2018). Results: 336 inpatients are enrolled in study, of which 275 are elderly, with male prevalence (55%).The average age is 79. Only 22% of the elderly went spontaneously to the ED, the 79% was accompanied by the ambulance. 20 % of the elderly inpatients received a high gravity level after the medical visit, 25% was assigned to the minor intensity care area and the last 75% to the medium-high intensity level of care. The average waiting time to the medical examination was 29 min. 22% of these inpatients needed to recover in Short Observation Intensity for an average time of 18 h to stabilize the clinic state. Nearly all ED inpatient were recovered in and only the 1.1% were transferred to an hospital with a minor intensity level of care. Conclusions: The ED inpatients with sepsis belongs to the elderly population. They are vulnerable and they need a medium-high level of intensity of care to take the drugs, to be monitored and to be subject of invasive procedures. A dedicated team and a care organization of S130

Eur Geriatr Med (2020) . Despite this data, the patients with atypical symptomatology were underestimated at the Triage and more often it was given them a low priority code for the medical visit (35% vs 23%). Concerning outcomes, the patients with atypical symptomatology presented a moderate increase of prevalence of an augmented short-term mortality risk, calculated with sPESI index (47% vs 44%), while no differences are present amongst the two groups for the length of stay and the need of hospitalization in the Intensive Care unit.

Conclusions: the results show that the subpopulation of patients with atypical symptoms is not negligible (21%) and is often underrecognized at the Triage, while it doesn't differ in a significative way for the severity of pulmonary embolism and for its outcomes.

Impact in the elderly of severity of pulmonary embolism as massive pulmonary embolism on the early recognition in the emergency department for a minimal female prevalence (58% vs 54%).Concerning assignment of priority code for the medical examination, the patients with massive pulmonary embolism presented a slight increase in the rate of high priority codes, however without reaching statistical significance. In particular, they had a rate of white codes of 0%; green codes 25%; yellow codes-low intensity care of 0%; yellow codes-high intensity care of 75%; red codes of 0%. Patients presenting with peripheral pulmonary embolism presented a rate of white codes of 4%; green codes of 33%; yellow codes-low intensity care of 4%; yellow codeshigh intensity care of 55%; red codes of 4%. Concerning allocation towards the medium intensity care unit, there is a higher allocation of patient with massive pulmonary embolism compared to patients with peripheral (75% vs 59%). The rate of under-triage is superior in patients with peripheral pulmonary embolism (25% massive vs 41% peripheral).

Conclusions: subpopulation with peripheral pulmonary embolism more frequently undergoes to under-triage.

Impact on elderly population of the presence of organ damage in pulmonary embolism on the early recognition in the emergency department from the admission age is an important risk factor for intracranial haemorrhage. In particular the age of 70 entails an increase in the risk of bleeding by 180%. While age represents a risk factor for ICH, on the other hand the elder is a fragile subject more prone to falls, resulting in increased risk of MHI. Elder is also at risk for changes in his homeostasis and for taking more drugs. Elderly is more exposed to falls with MHI. Outcomes are worse in terms of ICH, hospitalization and returns.

Experiences with and attitudes towards screening for geriatric vulnerability among older Emergency Department patients: a qualitative study Laura C. Blomaard 1 , Mareline E. Olthof 1 , Yvette Meuleman 1 , Bas de Groot 1 , Jacobijn Gussekloo 1 , Simon P. Mooijaart 1 1

Background: Screening tools assessing geriatric vulnerability in older Emergency Department (ED) patients are seldom put to use in routine care. This study explores experiences with and attitudes towards routine screening for geriatric vulnerability among older ED patients.

Methods: Individual face-to-face semi-structured interviews were conducted at home in older patients (C 70 years) within one month after they completed the 'Acutely Presenting Older Patient' (APOP) screener at the ED of Leiden University Medical Center. Purposive convenience sampling was used to select a heterogeneous sample of participants regarding age, disease severity and APOP-screening result. Interviews were audio recorded and transcribed verbatim. Transcriptions were analyzed inductively using thematic analysis with Atlas.ti software. (Preliminary) results. After 13 interviews (6 men, 7 women, median age 81 years), data saturation was reached. Most participants considered the vulnerability screening to be part of routine care and could not remember the particular screening questions, except for the cognition test. Their overall attitude towards the concept of screening was positive. Participants believed that vulnerability screening could help to identify the patient as a whole and adapt care to the patient's needs, which they considered important for all patients, regardless of age. Participants who did not consider themselves to be vulnerable, did not personally experience an added value of the screening but they did believed in the added value for others. Conclusion: From an ED-patients' perspective, screening for geriatric vulnerability was experienced as a part of routine ED care and was considered to be of added value for optimal ED care. Hospital-acquired skin injury (HAPI) is described as preventable events, but in many instances prevention is relative to knowledge deficit. HAPI is not ole the responsibility of the nurse, but inclusive of the entire healthcare team. Acute care facilities continue to see an increase in the number of HAPI resulting in increased mortality rates annually. In order to preserve and reduce the current rates, development of education specific to the clinical technician (CT) will promote a comprehensive approach for this level of care provider. Prevention of HAPI is of great concern, therefore ensuring that the knowledge deficit is not the cause, a proactive approach to education for the CT is vital.

Importance of previous hospital stays on the risk of hospital readmission in older adults: a real-life analysis of the PAERPA study population Background: Consideration of the first hospital readmission only, and failure to take account of previous hospital stays, are two significant limitations when studying risk factors for hospital readmission.The objective of the study was to use appropriate S134

Eur Geriatr Med (2020) Objectives: To assess the effectiveness of game-based interventions on health-related outcomes in acutely hospitalized older patients. Materials and methods: Randomized controlled trials (RCT) and non-randomized trials for assessing the impact of games interventions on health-related outcomes (i.e. functional capacity, quality of life) in older adults (aged 65 years or older) admitted to an Acute Care for Elderly unit were selected. Results: 4 RCTs were included in the review. The interventions were based on the implementation of serious games programs using Nintendo Wii in acute medical patients. Across the included studies, no significant differences were observed between groups on functional capacity and health-related quality of life. Significant differences were found between groups on the adherence to treatment (in favor of the control group), but no differences were obtained in other outcomes such as enjoyment and motivation.

Conclusions: The findings suggest that the existing evidence is very limited and insufficient to state that game-based interventions are effective for improving health-related outcomes in acutely hospitalized older adults.

Are patients having their capacity to agree to remain in hospital assessed and a deprivation of liberty safeguard put in place? 

Older people are among the most affected by the COVID-19 epidemic. However, little specific attention has been paid to the management of the epidemic and the scientific literature is scarcely dedicated to older persons. Through an online questionnaire, we collected the experience of Belgian geriatricians and their hospital teams in the management of the geriatric COVID-19 patients.The survey started on 18/5/2020 and includes 40 questions on geriatric practice, on the multidisciplinary approach, on consultation on the intensity of care, on collaboration with nursing homes, and the impact on standard geriatric care. The subjective perception of the geriatricians was also noted.The survey has not yet been completed; we currently have 57 responses, on approximately 300 active Belgian geriatricians. The first results show an involvement of geriatricians in all CoviD units, whether geriatric or not. Ambulatory activities have ceased. Geriatricians have often been involved in the triage of patients in the emergency and intensive care units (ICU), but the age limit rarely appears to be a hindrance, except in cases of saturation of ICU beds, where the age limit of 80 years is the most frequent. A sense of value, recognition and solidarity are the positive elements; stress, isolation, and the media's misinterpretation of the involvement of gerritricians in COVID-management in nursing homes are the negative elements.The COVID pandemic has profoundly changed geriatric practices, but the involvement of geriatricians has been important at all levels. Sharing the Belgian experience is an initiative of the Belgian Society of Gerontology and Geriatrics to recognize and value this involvement.

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Introduction: Physical frailty is an identified risk factor for in-hospital mortality. In the Greek health system, due to lack of specialty of geriatrics, older people are hospitalized in Internal Medicine Departments with no recordings of frailty status or the interplay between functional status and clinical outcomes. Methods: Patients aged C 65, admitted to the general medical ward of a tertiary hospital due to acute infection were recorded over a 1-year period (2019). Pre-admission and discharge frailty and functional status were evaluated using the Clinical Frailty Scale (CFS) and the modified Rankin Scale (mRS). Results: Among 322 eligible patients, 314 were included (51% females, median age 82 years). Urinary (48%) and low respiratory tract (43%) were the most common sites of infection, combined in 7% of patients. Mean pre-admission mRS score was 3.5 (± 1.44): 55% of patients had loss of autonomy (mRS C 4). Mean CFS was 5.6 (± 1.99): 21% with CFS1-3 (non-frail). Discharge mRS increased into 35% of patients and CFS into 29%. Among patients with initially preserved autonomy (mRS0-3), 20% lost autonomy (mRS4-6). Among patients characterized initially as non-frail (CFS1-3), 31% became frail (CFS4-9). In-hospital mortality was 16%: patients with preadmission mRS4-6 had a 6-fold increased risk than those with mRS0-3 (95% CI 2.78-14.71, p-value \ 0.05).

Greek older general medical ward inpatients and functional dependence, as evaluated by the mRS, is strongly associated with inhospital mortality. Additional measures are required to prevent further loss of function during hospitalization, both among frail and non-frail inpatients.

Investigation of opposition to diagnostic or therapeutic procedures in older people hospitalised in acute geriatric services: the OPTAH study.

Thomas Tannou 1 , Hélène Trimaille 1 , Florence Mathieu-Nicot 1 , Séverine Koeberle 1 , Régis Aubry 1 , Aurélie Godard-Marceau 1

Introduction: Opposition and refusal of care are key concepts in geriatric research. Even if these concepts are frequently used, they are not yet well understood in the medical literature, and there is a lack of consensus on their definition. We therefore explored those concepts by defining opposition to diagnostic or therapeutic proposals in geriatrics acute care in a reproducible framework. Method: Our study is based on a mixed methodology (epidemiological and qualitative research). Opposition and refusal as defined were quantified, and semi-structured interviews were conducted with patients, their relatives and referring carers to explore their core elements. Multidisciplinary meetings that were associated with these situations were also analysed.

Results: Thirty-three situations were included in the epidemiological component, of which 5 situations were included in the exploratory qualitative component leading to 15 interviews. Of the 33 situations, only 6 corresponded to an informed rejection of the proposed acute medical management. After multidisciplinary meetings, 12 situations were actively managed despite opposition. Persistent opposition situations usually occurred on the 9th day of hospitalization Interviews show that good symptom control and anosognosia modify the patient's adherence to medical strategies that he does not understand because he no longer feels sick. This favours the rupture of therapeutics before their term or etiological investigations and preventive strategies.

Conclusion: The consequences of these situations are major in terms of public health with, in addition to the increase in the length of hospital stays, excess mortality and early re-hospitalisation. They also have consequences on the daily management of care.

Developing an integrated comprehensive geriatric unit Conclusion: By blurring boundaries between the acute and community, allowed a frictionless pathway for patients. This has led to improvement in patient care and outcomes for the patient and system as a whole.

Gastrointestinal bleeding in the elderly and contribution of the ultrasound diagnosis of gastrointestinal bleeding, melena, hematemesis, enterorrhagia, rectorrhagia, bleeding from esophageal varices or from hemorrhoids, if the ultrasound (US) performed before the endoscopy allows to modify the diagnostic procedure, increasing the appropriateness of the diagnostic and therapeutic prescriptions. Materials and methods: 300 patients were included in the study, over the age of 65 (170 women, 130 men, from 65 to 95 years) hospitalized in Geriatrics. All patients underwent US. Subsequently, in all cases, an esophagogastroduodenoscopy (EGDS) and/or colonoscopy and/or rectoscopy was performed as an emergency. US diagnoses were correlated with clinical data and endoscopic diagnosis.

Results: The diseases detected with US were: 95 liver cirrhosis, 35 hepatocarcinomas, 20 pancreatic neoplasms, 10 gallbladder neoplasms, 22 suspected abdominal neoplastic pathologies, 30 abdominal ascites, 10 masses from gastroduodenal neoplasia, 10 masses from colon cancer, 18 pelvic masses from likely uteroovaric neoplasia. In 50 patients the US was normal. Endoscopic diagnoses were then analyzed in these 300 patients. Esophageal, gastric or duodenal or rectal bleeding was present in 60 cases of cirrhosis and in 20 HCC. In all other cases, it was necessary to prescribe CT or angioCT or arteriography, which showed bleeding of varying amounts in correspondence with the neoplastic masses suspected by the US. In all cases, at the same time as the request for second level diagnostic tests, specialist advice (surgical, urological, gynecological, etc.) was requested in relation to the clinical situation and the diagnostic suspicion formulated by the US. In addition, the urgent therapeutic decisions, always completed by the request for blood transfusion, were set up taking into account the US reports and endoscopy, pending the report of the second level investigations required for further investigation.

Conclusions: In conclusion, the US, even in the presence of gastrointestinal bleeding, can be considered as the most appropriate method to be performed in emergency, before endoscopy. The US abdominal examination in fact in most cases allows to detect unknow diseases of the elderly patient, to prescribe appropriated diagnostic procedures and the therapy. In the elderly patient with numerous chronic diseases, in fact, often gastrointestinal bleeding can be caused by drugs or other pre-existing diseases that are associated with neoplastic pathologies that endoscopy alone cannot detected. Therefore, before prescribing invasive investigations, the US allows easily to study the abdomen and often the unknown neoplastic pathologies that are the cause of progressive increase of anemia in the elderly, especially if associated with iatrogenic causes, can be quickly detected. 

Introduction: Polypharmacy is a growing problem among older adults. More than one-fifth of all adults aged 80 years or over are prescribed ten or more medications in the United Kingdom (UK) [1] . Polypharmacy is associated with negative clinical outcomes, including increased risk of falls and adverse drug reactions [2] and reduced cognitive and physical capability [3] . Acute hospital admissions via specialist geriatric medicine services provide opportunities for medication review and de-prescribing. We evaluated the impact of daily geriatrician input on polypharmacy in older adults admitted to the acute Clinical Decisions Unit (CDU) of Barnet Hospital, a UK district general hospital. Method: Daily geriatrician reviews were introduced for older adults admitted to CDU in November 2019. Prior to this, reviews were performed by general medicine consultants. Data on polypharmacy were retrospectively collected using electronic records from patients aged over 70 years who were referred to medicine over 2-week periods pre (October 2019, n = 40) and post (November 2019, n = 44) intervention.

Results: Following introduction of daily geriatrician review, more patients had one or more medications deprescribed during their admission (38.6% versus 15%, p \ 0.05). Of those who had medications deprescribed, there was an increased total number of medications stopped (l 2.4 versus 1.5). There was also increased documented recognition of polypharmacy (21% versus 10%). Introduction: Nursing home(NH) residents are vulnerable population,often with multi-morbidity and advanced frailty. Their use of acute hospital services is more than twice that of community dwellers. Hospital admissions have been found to be protracted with detrimental outcomes for these residents. To improve care provided to NH residents in the acute hospital, a dedicated geriatrician-led team was introduced.

Methods: A pre/post intervention study was conducted to analyse outcomes for NH residents in Connolly hospital,a teaching hospital in Dublin. The intervention was a geriatrician-led team managing the care and early supported discharge of these residents,with community follow-up. The aim was to assess the benefits of this initiative to NH residents. Data was collected from the hospital electronic patient record with comparison for six months pre and post commencement of the initiative in July 2019,with a focus on length of stay (LOS) and total bed-days.

Results: There were 381 NH residents admitted to Connolly hospital 6 months pre-intervention compared with 368 admissions in the six months post. The average LOS was 9.25 days pre-intervention,compared with 6.6 days post (p value 0.014). There was a decrease in total bed -days from 3449 to 2416, a saving of 1033 days (p value 0.04). Key conclusions: The study proved the effectiveness of a dedicated geriatric team in reducing hospital LOS for NH residents,due to specialist care and follow-up. With the saving of 1033 bed-days over six months,patient flow within the hospital was significantly improved.This small study highlights the big potential improvements for this frail cohort with specialist care.

Potential efficacy of pragmatic exercise program (sprint) during hospitalization in older adults on health care and physical performance: a pilot study Intracerebral haemorrhage was the cause of 14% of all strokes presenting to Royal Cornwall Hospital in 2017 and was associated with poor outcome. In-hospital mortality was 39%, 30 day mortality was 41% and 39% were left with significant disability (Rankin 3+). We audited the management of blood pressure control, anticoagulant reversal, treatment escalation plans, involvement of neurosurgery and intensive care and compared the mortality of haemorrhagic stroke of 2017 to that of 2018. We have seen a reduction in mortality for haemorrhagic stroke in comparison to last year's audit (33% vs 39%).

Patients who were discharged with no to minimal symptoms received appropriate BP management, anticoagulant reversal and discharged within 2 weeks. Better BP control, timely anticoagulant reversal and full resus status was associated with lower mortality. Neurosurgery was lifesaving, but did not improve the quality of life.

Determinants of discharge at home: a proposal. Introduction: Portugal is the third country with the oldest population in the world, but still with only few geriatricians. We face a huge challenge especially in the Emergency Departments (ER) where the elderly are prevalent and account for the largest group of frequent users (defined as more than 4 visits a year). It is essential to evaluate these patients in order to create policies directed to avoid extensive and unnecessary use of the available health resources and on the other hand to create adequate health offers to meet the needs. Methods: Retrospective descriptive study of patients older than 75 years admitted to the ER of a tertiary hospital, during 2018. The analyzed data were obtained from the electronic file namely demographic data (gender and age), priority score determined in the triage (red-immediate resuscitation, orange-very urgent, yellow-emergent, green-non urgent, blue), admittance with an ambulance that meant that there was probably a previous telephonic contact with the National Institute of Emergency Medicine (INEM), diagnostic tests ordered, medical specialties that evaluated the patient, time spent in the ER and destination. Results: There were 1913 patients included, with an average age of 81,29 (of which 639 had over 85years), 1115 (58,3%) females. There were 406 patients with more than 6 visits and 116 with more than 9 visits, accounting for a total of 10705 episodes.A sample of 2082 episodes was evaluated, the priority score showed 11 (0,5%) red, 196 (11,4%) were orange and the majority 1104 (53%) were considered yellow patients, there were 771 (37.7%) of non-emergent episodes.

Patients arrived with an ambulance in 579 (27,8%) episodes. The average length of stay was 9:12 hours (0:13 minutes to 10 days). Concerning diagnostic tests, blood test was performed in 1303 (62,58%), ECG in 767 (36,9%), radiographs in 1046 (50,24%) and CT-scans in 290 (13,8%). The patients admitted to the medical and S146 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 chirurgical wards were 357(17,2%), discharged to the health care center or outpatient clinic or home were 1371 (65,9%), only 1 died. Discussion: Elders are more vulnerable due to multi morbidities and polypharmacy and the clinical presentation of acute disease tends to differ from the young adult, being frequently vague, this assumes importance in the ED that is at the core of the healthcare for acutely ill . There is a tendency and a necessity for the use and abuse of diagnostic tests and medical specialties, that increases both human and monetary costs.

Infectious diseases and its characteristic features in a geriatrics service Conclusions: Infectious diseases have specific characteristics in a Geriatrics Service. The Geriatrics Service accounted for most of the hospital's bacteriemias. Infections due to multiresistant bacteria belonged mostly from nursing homes. In our service the use of quinolones was reduced, although the use of wide spectrum antibiotics rose slightly.

Call me maybe? Differences in ''next of kin'' and ''contact in emergency'' contacts in the acute hospital setting 

Background: A large number of hospitals in Ireland use the same patient information management system. This interface gives patients the option of inputting both ''next of kin'' (NOK) and ''contact in emergency'' contact options. This can regularly lead to confusion when communicating with families, and there is often misunderstanding among staff and patients about the significance of these terms. Methods: We conducted a cross sectional observational cohort study of all hospitalised inpatients to examine how many patients have the same designated NOK and ''contact in emergency'' person.

Results: 152 patients were included. 103 patients (67.8%) had a different person nominated as NOK and contact in emergency. 35 patients (23%) had the same designated person for each, and 13 (8.6%) had only of these two options filled in. The most common discrepancy was where a spouse was listed as NOK, and a child listed as contact in emergency, followed by two separate children in each role, and then two separate siblings. Subgroup analysis showed no significant difference in mean age (72.8 vs 74 years, p = 0.36) or mean length of stay in days (11.6 vs 7.9, p 0.11) in patients who designated a different contact person for NOK and contact in emergency versus those who did not. There was no difference in gender (p = 0.23) between the two groups. Discussion: We found large discrepancies in the contact details for NOK and contact in emergency. False beliefs exist that the NOK term confers additional powers to those nominated to that role, and we would recommend a re-organisation of the IT administration systems to consolidate these two confusing labels into one emergency contact.

Clinical semiology of anemia in patients over 75 years: a prospective study conducted in France by the SiFMI group (1) sensitivity for factors (interaction term with sex) and (2) in exposure to factors (percentage change of the sex difference) associated with gait speed. Results: Older women had a lower gait speed compared to men (-0.047 m/s 95% CI -0.064 to -0.029, height and age adjusted). Women had a stronger association of higher BMI, higher waist circumference, pain and lower physical activity with lower gait speed (i.e. sensitivity), where higher BMI and especially pain were also more prevalent among women (i.e. exposure). In addition, low education and chronic diseases were also more prevalent among women. In contrast, two factors associated with higher gait speed were more often found among women: larger personal network size and higher physical activity. Key conclusions: The female disadvantage in gait speed represents a combination of (1) a higher exposure to most risk factors and (2) a higher sensitivity to some risk factors, of older women compared to men. From a prevention point of view, the female disadvantage could be bridged by intervening at the modifiable factors pain, BMI, and physical activity.

Short telomeres length in leukocytes is the key risk factor of both the atherosclerosis and arteriosclerosis Introduction: Increased arterial stiffness, atherosclerotic plaques presence are important aspects of vascular aging, which may be considered as morphological and functional basis for cardiovascular diseases (CVD). These two processes can occur in isolation or simultaneously in the arterial wall. Peripferal blood leukocytes telomeres length (TL) is cellular senescence and vascular aging biomarker, which has been proposed as an independent predictor of cardiovascular diseases. But presently there is no detailed information regarding the interactions of TL and conventional cardiovascular risk factors (CVRF) in vascular aging. The aim of this study was to determine the role of TL in their interaction with CVRF in vascular aging process. Conclusions: TL shows more stable relationship with increased stiffness of arteries than with atherosclerosis. TL \9.25 is risk factor of increased arterial stiffness in both age groups, and is a risk factor of atherosclerosis only in the ''younger'' age group. The relationship of TL with arterial stiffness is stronger in the ''younger'' group.

Clinical implication of obesity in esophageal cancer in the elderly: a nationwide population-based cohort study of South Korea There is an important vascular dimension to age-related frailty, including associations with increased cardiovascular morbidity and mortality and vascular cognitive impairment. Vascular biomarkers offer the potential to monitor response to treatment in frail populations, with respect to the vascular risk element of the condition. CD3+ T cells expressing the CD31 adhesion molecule (PECAM-1), have been shown to play a role in vascular homeostasis and repair and are termed angiogenic T cells (TANG). T cells that no longer express CD28 (CD28NULL) are regarded as senescent T cells and have a proinflammatory phenotype. These T cell subsets are appealing biomarkers for the vascular dimensions of frailty due to their biological associations with vascular repair, inflammation, and immunosenescence. Using flow cytometry, we have quantified TANG and CD28NULL T cell subsets in young adults (n = 21), non-frail (n = 16) and frail (n = 12) older adults. The % frequency of TANG in the young, non-frail older and frail older groups were 44.2 ± 2.4%, 20.8 ± 2.4% and 27.3 ± 2.2% respectively with the frequency lower (p \ 0.001) in both older cohorts compared to young and the difference between frail and non-frail approaching significance (p = 0.068). The % frequency of CD28NULL T cells in the respective groups were 13.3 ± 3.3%, 15.3 ± 3.4% and 30.6 ± 6.1% with the frequency lower (p \ 0.05) in the young and non-frail compared to the frail and no difference between the young and the non-frail (p = 0.691). There is some evidence in our preliminary data that T cell subsets with biological associations to vascular health can distinguish frail and nonfrail older adult groups.

Restrictive cardiomyopathy due to cardiac amyloidosis . None antitrombotics were used in 20 (10%) vs. 10 (3%). Based on ESC guidelines, both groups were divided into two subgroups according to the guideline adherence to proper anticoagulation therapy. The quality of medical treatment increased significantly from 2012 to 2017. 61% of patients were on guidelineadherent thromboprophylaxis, 39% were undertreated in 2012, while in 2017 the guidelines were followed much better -14% were undertreated vs. 86% treated properly. We examined statistically the importance of age, frailty, history of ischaemic stroke, minor heamorhage, and values of CHADS2 and HASBLED indexes for the nonadherence to Guideline aproved antitrombotic management. Series of binary logistic analyses showed that increasing age (p = 0.05), and concomitant history of minor bleeding (p = 0.003) were associated with undertreatment in 2012, while in 2017 HASBLED score (p \ 0.051), nor other studied factor led to non-adherence to Guideline aproved therapy. AF patients who were guideline adherent had a lower rate of all-cause death (p = 0.007) compared to those nonadherent. Binary logistic regresion analysis showed that guidelinenonadherent patients had a higher risk for all-cause mortality (p = 0.003).

Conclusions: Non-adherence to guidelines is currently less prevalent among elderly AF patients compared to clinical treatment in previous years. Proper Guideline-adherent treatment is being independently associated with lower risk of all-cause mortality. Efforts to improve guideline adherence would lead to better outcomes for elderly and frail AF patients.

Interest of ambulatory management of patients with chronic heart failure by protocolized follow-up and therapeutic education: results of the USICAR experiment. Introduction: The objective of this study is to determine whether the implementation of regular and structured follow-up of patients with chronic heart failure, combined with therapeutic education, led to better management of these patients.

This was a monocentric, retrospective study on a cohort of patients with a proven chronic heart failure, followed in the Mulhouse region (France), between January 2016 and December 2017, by the Unit for Monitoring Heart Failure Patients (USICAR). These patients benefited from a regular protocolized follow-up and a therapeutic education program for a period of 2 years. The main criterion of this study was: the number of days of hospitalization for Heart Failure per year and per patient. The secondary endpoints were: the number of days of hospitalization for cardiac causes other than Heart Failure and the number of hospital stays for Heart Failure per patient. These criteria were collected over the one-year period before inclusion, at one year follow-up, and at two years follow-up. Results: 159 patients with a mean age of 72.9 years were included in this study. They all had a chronic heart failure, mainly stage I-II NYHA (88.7%), of predominantly ischemic origin (50.9%), with altered left ventricular ejection fraction in 69.2% of cases. The primary endpoint averaged 8.33 days (6.84-10.13) in the year prior to inclusion, 2. Conclusion: This study demonstrates the value of a protocolized follow-up associated with a therapeutic education program to improve the management of ambulatory chronic heart failure patients, particularly for moderate chronic heart failure.

The quality of life in elderly patients with metabolic syndrome and chronic heart failure with intermediate ejection fraction

Elena Gosteva (1), Olga Osipova (2) 1

Introduction: In recent years, the number of elderly patients with metabolic syndrome (MS) and heart failure with intermediate ejection S150

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 fraction (HFmrEF) had a tendency to increase. Hyperstimulation of the hypothalamic-pituitary-adrenal system in insulin resistance, which leads to increased cortisol excretion, is considered to be one of the possible reasons for the decline of their quality of life, and may be associated with the development of depression as geriatric syndrome. 

The cut-off value of serum homocysteine in relation to increase of coronary artery calcification Nam-Seok Joo 1 , Susie Jung 2 1 Ajou University School of Medicine, 2 Ajou University Hospital

Purpose: Recent study reported that coronary artery calcification and serum homocysteine were well associated, however, no report is available for the cut-off value of serum homocysteine according to increase of coronary artery calcification volume score.

The data of 469 subjects out of 777 subjects in one health promotion center located in Seoul were selected after exclusion of the missing data of serum homocysteine and coronary artery calcification volume score (CVS Introduction: Pulmonary hypertension (PH) is a serious medical condition subsequently complicating many other common diseases. PH seems to be increasing in the elderly; however, it has been poorly studied in this group. The aim of this study was to determine the diagnostic and prognosis features as well as management of precapillary PH in the elderly compared to young subjects. Methods: We performed a single center retrospective study in the Introduction: In nursing home (NH) residents, hypotension may predispose to adverse events including falls, fractures and mortality. Yet, evidence on hypotension detected by ambulatory blood pressure monitoring (ABPM) is scarce in this setting. This study aimed to determine the prevalence and the clinical predictors of ambulatory hypotension in NH residents and to analyze its related ABPM profile. Methods: We retrospectively analysed data from a sample of 100 NH residents undergoing a comprehensive geriatric assessment and ABPM. Ambulatory hypotension was defined as a systolic blood pressure (SBP) drop C20 mmHg between two consecutive measurements to a minimum SBP \100 mmHg. Participants with nocturnal hypotension were excluded from the analysis. Predictors of ambulatory hypotension were investigated using multivariate logistic regression adjusted for comorbidities, functional status and hypotensive medications. Results: Among 91 residents (mean age 83, 56% female), 50 showed ambulatory hypotension. They had a higher prevalence of heart failure (p = 0.02) and atrial fibrillation (p = 0.007) and more commonly received digoxin (p = 0.001) and benzodiazepines (p = 0.015). At ABPM they had lower 24h, daytime and nighttime SBP (p \ 0.001) and more frequently showed a white coat effect (p \ 0.001) and a reverse-dipping profile (p = 0.013 Results: Elevated IL-6 levels were found in 49% of patients. Mean IL-6 concentration was 7.96 + 5.1 (1.5-30.6) pg/ml (N \ 7.0). In patients aged\90 years mean IL-6 level was 6.7 + 3.2 pg/ml, in longlivers-9.1 + 6.2 pg/ml (p = 0.09). In patients with CAD mean IL-6 concentration reached 10.9 pg/ml, in control group -5.9 pg/ml (p = 0.02). Higher IL-6 levels were found in patients with heart failure (13.3 and 7.6 pg/ml, p = 0.04). Relative risk of high IL-6 levels in patients with heart failure was increased by 4.4. times (RR = 4.4; p = 0.02). Among patients with hyperuricemia mean IL-6 values were 10.5+3.1 pg/ml, with normal uric acid -7.1+3.1 pg/ml (p = 0.001).

Relative risk of high IL-6 levels in patients with hyperuricemia was increased by 9.7 times (RR = 9.7; p = 0.003). Positive correlations were found between IL-6 and tumor necrosis factor-a (R = 0.34; p = 0.01), creatinine (R = 0.35; p = 0.01) and urea (R = 0.28; p = 0.05) concentrations. Regression analysis demonstrated that the most important factor influencing IL-6 levels was hyperuricemia (b = 0.7, p = 0.00003).

Key conclusions: Study results demonstrated frequent IL-6 increase in very elderly patients with CAD along with relationships between IL-6, heart failure and hyperuricemia.

Tumor necrosis factor-alfa in very elderly patients with coronary artery disease Results: Mean TNF-a concentration was 9.2+4.7 (3.9-31.9) pg/ml. Increased TNF-a levels were found in 54.6% of patients. In patients with CAD mean TNF-a concentration reached 10.0+4.9 pg/ml, in control group -6.1+1.8 pg/ml (h = 0.000001). TNF-a levels were higher in patients with heart failure (h = 0.002). Hopital Charles-Foix, 2 

Background: Heart failure is responsible for around 100,000 hospitalizations per year in France and it is the main cause of hospitalization for people over 65 years old. The re-hospitalization rate is particularly high after a first hospitalization for heart failure, around 40% within 1 year. The ''PRADO'' program was launched by national health system in 2013 to help and anticipate the needs of patients after hospitalization for heart failure, improve their quality of life and to strengthen the quality of care for the generalist, by seeking to reduce the rate of re-hospitalization. Methods: The aim of this study was to collect testimonials (through a questionnaire) from elderly patients ([ or = 75 years) after hospitalization for heart failure in order to evaluate their satisfaction and their possible improvement in quality of life in a follow-up with the PRADO program.

Results: They feel more secure and protected (20 out of 32 patients have positive feedback on the PRADO program).

Conclusions: Thanks to the follow-up with PRADO program (visiting nurses at home and organized appointments), patients suffering from heart failure get to know their illness and recognize the main symptoms of a worsening of their health. Identifying early warning signs can positively affect the percentage of readmissions. The impact of PRADO program could therefore be significant because the patients in this study declare that they have learned more about heart failure.

Periprocedural edoxaban management in routine clinical practice in the elderly is associated with low bleeding risk: Outcomes from the EMIT AF/VTE and the ETNA Korea/Taiwan studies Conclusions: This is the first case report of cardiac syncope during concomitant pulmonary embolism, Tako Tsubo Syndrome and complete AV block. The relationship between these ree entities in unclear. Syncope is likely a consequence of third degree AV block, but it is not clear if Tako Tsubo syndrome has been triggered by pulmonary embolism or by complete AV block; both mechanism are described in literature.

Premature aging assessment in patients with arterial hypertension and subclinical hypothyroidism Introduction: Biological age (BA) assessment can predict deterioration rates of human health better than chronological age (CA). The study aimed to examine the relationship between premature aging and routine biomarkers in patients with arterial hypertension (AH) and subclinical hypothyroidism (SH). Methods: 87 patients (55% female; mean age 43.9 years, SD = 10.4, range 25-59) were included in the study and divided into group 1 (controls, n = 22) and group 2 (n = 65) composed of patients with grade 1 AH and SH. Standard clinical and laboratory parameters were S154 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 evaluated in all patients. BA was estimated using CA and laboratory parameters according to the method of M. Levine et al. (2018) . Results: The difference between BA and CA was less in group 2 compared to controls (-1.38 vs 0.3 years). In controls, significant associations with BA were observed between monocytes (p = 0.000), granulocytes (p = 0.001), triglycerides (p=0.003), total cholesterol (p = 0.001), LDL-cholesterol (p = 0.031), VLDL-cholesterol (p=0.002) and glomerular filtration rate (p = 0.03). Whereas in group 2 such associations were not detected and BA correlated with hemoglobin (p=0.007), platelet count (p=0.000), erythrocyte sedimentation rate (p=0.000), all bilirubin fractions (p B 0.005), urea (p = 0.000), as well as with waist circumference (p = 0.023) and BMI (p = 0.01).

Conclusions: Premature aging rates are slowed down in patients with AH and SH compared to controls and associated with blood rheological properties, liver tests and anthropological parameters rather than with lipid profile and renal function. One of the probable reason for this may be standard drug therapy of AH, which may reduce the rate of the underlying aging mechanisms.

Characterization of a home-bound population with heart failure Cloie June Chiong 1 , Alan Miller 2 , Cassidy June Chiong 3 1 University of North Carolina, Chapel Hill, 2 University of Florida-Shands Jacksonville, 3 MedEx Health Network, Inc.

Introduction: Home-bound patients are characterized as those seen at home or at a non-medical facility. These patients have a multitude of comorbidities associated with aging, with heart failure being the leading diagnosis. Therefore, it is important to examine this group to evaluate the correlations between demographics and comorbidities, as well as potential interactions of guideline-directed treatments for their conditions. Methods: A total of 471 home-bound, heart failure patients seen from January 2016-March were reviewed for age, sex, Body Mass Index (BMI), race, blood pressure, diagnoses, and outcomes. Data was extracted via electronic medical record.

Results: Among the home-bound cohort, the mean age was 78.9±11.6 and the mean BMI was 26.5 ± 6.3 (overweight). A majority of the group consisted of females (60.3%) and the most prominent race was White (79.2%), followed by Asian (11.3%), then Black (8.7% Objective: A controversial systematic review in 2016* revealed that in 68,094 individuals [ 60 years from 19 cohort studies, LDL-C levels were inversely associated with overall and with cardiovascular mortality or had no association. Conversely, 2019 European guidelines on dyslipidemia management in the elderly recommend statin use in primary prevention based on a reduction in major vascular events in clinical trials. Therefore, our aim was to revisit the association between LDL-C and mortality in the general geriatric population in light of the latest cohort studies. Methods: The authors independently searched PubMed for cohort studies with the following keywords: lipoprotein AND (old OR elderly) AND mortality NOT animal NOT trial. We excluded non-English reports, studies in high cardiovascular risk groups, and papers with electronic publication date before 18/12/2015 or after 1/5/2020. Results: We identified 5 papers including 72,036 elderly individuals from 6 cohorts where all-cause mortality was recorded, two of which also analysed cardiovascular mortality (N = 70,132). Statistically significant inverse association between all-cause mortality and LDL-C was seen in 4 cohorts representing 98% of the total number of participants. In 2 cohorts, no association was found. Regarding cardiovascular mortality, females with the lowest LDL-C quartile had significantly higher cardiovascular mortality in one cohort (no association found in males), while in the second cohort no association was found Conclusions: Recent cohort studies reinforce the LDL reverse epidemiology in the elderly. Even though statins appear to be safe, in older people higher LDL levels may be protective for non-cardiovascular diseases such as cancer, respiratory/digestive disease, and injuries. patients with increased Body Mass Index (BMI). An extensive literature indicates that heart failure (HF)-related cardiac denervation, measured through iodine-123 metaiodobenzylguanidine (123I-mIBG) imaging, constitutes an independent predictor of cardiovascular outcomes and mortality. Moreover, it has been also demonstrated that aging independently affects cardiac sympathetic innervation, which is also influenced by BMI in HF patients. However, the impact of BMI on cardiac 123I-mIBG uptake in elderly HF patients has not been specifically investigated. Methods: We studied 161 patients with systolic HF aged 65 years or older, collecting demographic, clinical, echocardiographic data and 123I-mIBG imaging parameters. The propose of the study was to assess the impact of BMI on cardiac adrenergic derangement, measured by 123I-mIBG, in elderly HF patients. 

Real world data from a small outpatient registry on tolerability and titration of Sacubitril/Valsartan in elderly affected from heart failure with reduced ejection fraction. Background: Assessing the prognosis of elderly patients with acute myocardial infarction (AMI) is particularly challenging since clinical evolution and prognosis of these patients is the result of a complex combination of functional, biological, environmental and psychological factors. The Multidimentional Prognostic Index (MPI) is a prognostic tool able to predict the outcome in different clinical settings. However, the prognostic role of MPI in elderly patients with acute myocardial infarction has not yet been explored. Therefore, the aim of the present study was to evaluate the role of MPI on short term survival in elderly patients with AMI. Methods: 302 elderly patients hospitalized with a diagnosis of IMA and undergoing coronary angiography and angioplasty have been studied. A comprehensive geriatric assessment was performed after the clinical stabilization of the patient through the MPI. It was also calculated the predictive index Grace Score. Results: The study population presented a mean age of 73.0 ± 6.8 years. During a 6-month follow-up, 29 non-survivors were registered. The logistic regression analysis revealed the GRACE Score and the MPI to be significantly and independently predictive for mortality: OR 1.04 (95% CI 1.02-1.07) and 12.55 (95% CI 4.68-33.62), respectively. From the analysis of ROC curves, it emerged that a predictive model including both Grace Score and MPI is better than the ones taking the two score separately (AUC 0.91). Conclusions: MPI is an independent predictor of short-term outcome in elderly patients with AMI. MPI predictive value is comparable to Grace Score and application of both models together improves the efficacy of model.

Cardiovascular regulation as an indicator of aerobic fitness: comparison between healthy older people and patients with type 2 diabetes Jessica Koschate 1 , Tania Zieschang 1 , Uwe Hoffmann 2 1 Carl von Ossietzky University Oldenburg, Geriatric Medicine, 2 German Sport University, Exercise Physiology Introduction: The kinetics of the cardiovascular system (CVS) describe the dynamic adaptation to work rate (WR) changes and is, unlike the gold standard for assessing aerobic fitness (maximum oxygen uptake [V'O2max]), measurable in moderate WR intensities. This offers advantages, especially for vulnerable patient groups. The aim is therefore to describe potential differences in aerobic fitness in the moderate and maximum WR range in healthy, physically inactive older adults (HPIOA) and type 2 diabetes patients (T2D). Methods: 27 HPIOA (73 ± 3 years) and 27 inactive T2D patients (60 ± 8 years) were tested on a cycle ergometer with pseudo-randomized WR changes of 30W and 80W, followed by the assessment of V'O2max. Heart rate (HR) and oxygen uptake (V'O2) data were measured and kinetics information was calculated using cross-correlation-functions (CCF) between WR and the respective parameter. Higher maxima of CCFs indicate faster adjustments in the CVS. V'O2max was determined over the last 30s of the test. Results: V'O2max did not differ significantly (P = 0.675) between the groups (HPIOA: 22.7 ± 5.2 ml•min-1•kg-1 vs. T2D: 22.1 ± 5.8 ml•min-1•kg-1). The CCFmax(HR) of T2D (0.25±0.05) was significantly (P = 0.018) lower than that of HPIOA (0.30 ± 0.09), but not the CCFmax(V'O2) (T2D: 0.31 ± 0.04 vs. HPIOA: 0.31 ± 0.07; P = 0.684). Discussion: Despite their younger age, HR regulation in T2D patients seems to be slower. This was not evident by the exclusive analysis of V'O2max. HR regulation is of great importance for the adaptation to changes in WR in everyday life and should be assessed in different patient groups for early identification of changes in the CVS.

Age-related differences in association between telomere length and cardiovascular risk Introduction: Available data allow us to judge the relationship of shortened telomere length (TL) with cardiovascular risk (CVR), early vascular ageing, atherosclerosis. Aim: to determine age differences in the association between TL and CVR. Methods: 60 patients aged 31-75 years with moderate CVR without clinical symptoms were included in the main group and 63 control individuals aged 30-75 years -in the control group. Study subjects were categorized into 3 groups: 30-44 years (young group, n = 20), 45-60 years (middle group, n = 20) and over 60 years (older group, n = 20). There were no significant differences in the sex between the groups. Results: According to the data of correlation analysis we did not find relationship TL and Telomerase Activity (TA) with any factors in control groups of young and mild ages. Though there was an association between TA and TL (r = 0.71, p \ 0.05) in the old control group. Analyses the data of the young CVR group indicated, that TL was associated with age (r = 0.67, p \ 0.05), TA with blood pressure (BP) (r = 0.79, p \ 0.05). The data of mild CVR group did not indicate the association of TA and TL with any factors, but was a significant relationship between body mass index (BMI) and BP (r = 0.62, p.05), HOMA index (r = 0.68, p.05). TA in the old main group was strongly associated with HOMA (r = 0.79, p \ 0.05), creatinine (r = 0.77, p \ 0.05). Conclusions: The established relationship TA and TL with factors cardiovascular disease may indicate the important role of TA/TL in the cardiovascular changes in patients with CVR.

Eur Geriatr Med (2020) 

Results: Age-and sex-adjusted LTL was the shortest in Group 1 (6.51 ± 0.13 kb), longer in Group 2 (6.69 ± 0.13 kb) and the longest in Group 3 (6.78 ± 0.09 kb; p \ 0.05). In group 3, ECFC-TL was associated with the number of generated clones (p \ 0.01). ECFC-TL was strongly correlated with LTL (r = 0.82; p \ 0.0001) but was always longer (7.98 ± 0.13 kb vs. 6.74 ± 0.12 kb; p\ 0.0001).

Conclusions: Blood samples with a longer LTL yield a higher number of self-renewing ECFCs. These results suggest that individuals with a longer LTL might have a better endothelial repair capacity. 

Acute-on-chronic heart failure secondary to severe mitral valve regurgitation due to chordae tendineae rupture: a case report Mitral regurgitation (MR) is an abnormal backflow of blood into the left atrium during cardiac systole, caused by an apparatus dysfunction with potential for hemodynamic compromise. MR is a strong predictor of cardiac outcome in patients with ischemic heart disease and is associated with higher mortality. A 85-year-old man with chronic heart failure with preserved ejection fraction of multiple-factor aetiology, previously submitted to coronary artery bypass grafting and coronary angiography with stent placement, maintaining severe two vessel disease, mild mitral and tricuspid regurgitation, permanent atrial fibrillation, essential hypertension, type 2 diabetes and chronic kidney disease, admitted due to progressive worsening of dyspnoea and bilateral oedema of the lower limbs. Physical examination: jugular vein distension, pansystolic murmur best heard over the apex, abolish murmur in the lower half of the right hemithorax and bilateral oedema of the lower limbs until the inguinal zone. Laboratory investigation: elevated Nt-proBNP. X-ray: increased cardiothoracic ratio, right pleural effusion. EKG: atrial fibrillation, nonspecific ST-T wave abnormalities. Transthoracic and transoesophageal echocardiograms: dilated left atrium and ventricle with preserved ejection fraction, severe MR due to chordal rupture with A2 flail and annulus dilatation, severe tricuspid regurgitation and high probability of pulmonary hypertension. After multidisciplinary discussion percutaneous mitral valve repair (PMVR) was performed with improvement of symptomatology. PMVR is an important procedure for patients at high risk of surgical repair, which has successfully reduced patient symptoms, disease morbidity, improved quality of life, and facilitated reverse remodelling with potential for a survival advantage.

Eur Geriatr Med (2020) Introduction: Impaired insulin signalling and insulin resistance in the brain cells has been found to be of importance for AD pathogenesis [1, 2] . However, it seems that not only insulin resistance but also other factors can link neurodegenerative diseases with metabolic ones [3] . (2020) 11 (Suppl 1):S1-S309 S161 often due to lack of adequate assessment or prescribing errors. This is important since studies have shown a positive correlation between use of antipsychotics in patients with dementia and increased risk of stroke, as high as 9 folds, in just four weeks from initiation of antipsychotic drugs [1] . The aim of this quality improvement project was to establish whether current practice in prescription of antipsychotics meets national guidance on this topic provided by NICE in a UK GP surgery and improve any substandard domain in this topic.A retrospective database search was conducted with inclusion criterias of ''dementia and ''antipsychotics'', after which 30 patients were identified and their documentation and drug chart were audited against current standards. Followed by a prospective search of same inclusion criterias 3 months after introduction of interventions to improve standards.There was a 50% improvement in documentation regarding discussion between prescribing healthcare professional and patient/carer about the risk/benefits of antipsychotic medication. There was 40 % increase in use of non pharmacological interventions prior to initiating antipsychotics. There were marked improvements in all set standards and overall an increased awareness regarding prescribing in dementia related Method: We treated two couples which one of the partners has Alzheimer's disease and and living together at home. The two couples took part in weekly sessions together at home over a course of 8 weeks. Interviews, led before and after the intervention, were analysed and provided access to the couple's subjective experience in terms of the emotions they feel, the quality of the relationship and the benefits of the treatment.

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

Results: Hypnotic intervention appeared to ameliorate both psycho-Introduction: Curcumin is suggested for the treatment of Alzheimer's Disease (AD) because of its' protein modifying and antioxidative features. In this study, anti-dementia effects of curcumin on scopolamine-induced AD rat models were evaluated.

Methods: Twenty-one male Wistar Albino rats of 300 ± 25grams, 1-year-old were introduced to study. They were divided into 3 groups (n:7 in each group); untreated control, exposed to scopolamine and treated by curcumin, and then exposed to scopolamine. Animals were evaluated for behavioral tasks with the Morris Water Maze test. After behavioral tests; interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were measured in hippocampal tissues. SPSS version 26.0 was used for data analysis.

Results: In this study, we found that distance to reach the escape platform (DTZ) was highest in the scopolamine group, lowest in the curcumin group (p = 0.004). Time to reach the platform was longest in the scopolamine group, shortest in the curcumin group (p = 0.025). Spatial learning seemed to be conserved in the curcumin group. DTZ was highest in the scopolamine group, lowest in the control group in the probe test (p = 0.035). Reference memory seemed to be deteriorated in the scopolamine group. IL-6 levels were higher in the scopolamine group than the curcumin group (p = 0.017) and the control group (p = 0.005). TNF-alpha levels were highest in the scopolamine group, there was no statistical significance. Key conclusions: We revealed that curcumin provides a protective effect on scopolamine-induced dementia. The anti-inflammatory feature of curcumin was shown too. Curcumin could be neuroprotective for people at risk of becoming AD.

Comparative study of stigma and burnout among professional and family caregivers in dementia care Family caregivers presented lower depersonalization levels (U = 10599.5, p = 0.003) and higher levels of personal achievements (U = 8866.5, p = 0.001) possibly due to their close familial relationship and emotional involvement while nurses may often experience a sense of low status and social recognition of their profession. Key conclusions: Conclusions drawn with regard to the contribution of stigma towards burnout of professional and family caregivers, can contribute to a better educational preparation of geriatric nurses as well as carefully planned strategies to increase public awareness and destigmatize dementia.

The influence of neuropsychiatric symptoms of elderly with dementia, on stigma and burnout of family caregivers Results: The patients' most aggravating symptoms for family caregivers were found to be (a) apathy/indifference, (b) depression, (c) agitation/aggression and (d) anxiety. The multivariate linear regression analysis showed that family caregivers who feel the greatest psychological stress from their patient's neuropsychiatric symptoms stigmatize him more intensely and feel more emotionally exhausted. It was also found that the higher the number, severity and frequency of patients' neuropsychiatric symptoms, the greater the stigma that, according to caregivers, people in society place on their relatives (rs = 0,267, p = 0,001) as well the stigma they deposit on their relatives (rs = 0,320, p = 0,001) and the sense of shame and pity for the patients (rs = 0,214, p = 0,008). The sense of personal achievement of the family caregiverr decreased (rs=-0.203, p=0.012) and depersonalization increased (rs = 0.278, p = 0.001) as the severity of patients' neuropsychiatric symptoms increased. Key conclusion: Positive correlations found between severity of neuropsychiatric symptoms, stigma and burnout of family caregivers call for development of educational programs that will help caregivers manage the symptoms of their relatives and reduce the stigma surrounding the disease.

Hypercog: cognitive screening in older adults with hypertension: a pilot study The aim of this Cochrane review is to assess the efficacy and safety of aromatherapy for people with dementia. Methods: We searched electronic databases on 5 May 2020. We included randomised controlled trials which compared an aromatherapy intervention for dementia with placebo aromatherapy or with usual care. We conducted no meta-analyses because of heterogeneity between studies, but presented a narrative synthesis of results. Results: We included 13 studies involving 708 participants with dementia, all resident in care homes. Our primary outcomes were agitation, overall behavioural and psychological symptoms (BPSD), and adverse events. Ten studies assessed agitation and eight assessed BPSD. Five and three studies respectively reported no usable data or we had very low confidence in their results. We had moderate or low confidence in the results of the remaining studies. For agitation, four of these studies reported no significant effect of aromatherapy on agitation, one study reported a significant benefit. For BPSD, four studies reported a significant benefit from aromatherapy, one study reported no significant effect. Adverse events were poorly reported or not reported in most studies. Key conclusions: We found no convincing evidence that aromatherapy is beneficial for people with dementia although there are many limitations to the data. In order for clear conclusions to be drawn, better design and reporting and consistent outcome measurement would be needed in future trials.

A phase II, randomized, double-blind, placebo-controlled trial to investigate the efficacy and safety of avidekel oil for the treatment of patients with agitation related to dementia Vered Hermush 1 1

Introduction: The treatment options for patients with severe dementia are limited and lead to severe side effects. Clinical studies on adults show that cannabinoids (CBD) could have a beneficial effect on behavioral disorders in general, and in dementia-related disorders in particular. The aim of this randomized clinical trial (RCT) was to evaluate the safety and efficacy of CBD rich oil for the treatment of subjects with agitation related to dementia. Methods: 64 patients were randomly assigned in a 2:1 ratio to receive drops of Avidekel Oil or placebo respectively. Over the course of sixteen weeks, ten visits were conducted. In each visit data on vital signs, behavioral disorders (based on the Cohen-Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory (NPI-NH), Clinical Global Impression Severity-Agitation/Aggression), Mini-Mental State Examination (MMSE), concomitant medications, adverse events, and safety tests were collected. Results: 64 eligible patients were screened and recruited. Their average age was 79 with 37.5% men. Four patients withdrew before randomization, 60 patients began cannabis/placebo treatment, 40 in the active treatment group and 20 in the control group. Baseline CMAI scores in the treatment and the placebo groups were 57. 28 and 58.5, respectively (p [ 0.83) . About 72% of the patients in the treatment group achieved the primary outcome of CMAI reduction of 4 points, versus 30% in the control group (p \ 0.003), with a mean change of 13. 3 and 2.3 in the treatment and placebo groups, respectively (p.002). No differences were found in the baseline NPI-NH agitation/aggression sub score between the two groups (p [ 0.95). However, the mean change in NPI-NH was 3.3 and 1.1 points in the treatment and the placebo groups, respectively (p \ 0.02).

Conclusions: Neuropsychiatric symptoms are very common among patients with dementia. CBD rich oil can reduce agitation and improve the behavioral symptoms in dementia.

The risk and incidence of neurocognitive disorders in patients with chronic kidney disease and diabetes in the North Wales Denbighshire cohort, United Kingdom.

Peter Hobson 1 1 Dr Background and aims: Cognitive impairment is commonly reported in chronic kidney disease (CKD). This study will calculate the risk S164 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 and the incidence for neurocognitive disorders (NCD) in a CKD cohort with diabetes. Method: Cognitive function was assessed in 92 CKD patients (mean age 75.8 + 9.1; 49 males: 43 female), at baseline and at 36-months. Cognitive impairment diagnosis was based upon patient, informant, case note review, neuropsychological assessment and application of Diagnostic and Statistical Manual of Mental disorders version 5 (DSM-5) for an NCD. An age and gender matched sample of 143 subjects without CKD, diabetes, or cognitive impairment acted as a control group.

Results: Follow-up neuropsychological assessment and application of DSM-5 criteria revealed that 25/92 (27%) of the CDK cohort had developed an NCD (mild n = 19; dementia n = 6). The CKD patients had a twofold increased for the development of an NCD compared to the controls adjusted for age and sex. The incidence rate for an NCD in the CKD cohort was 10.5 and 5.1 in the controls. No association was observed with the stage of CKD and cognitive function. The strongest neuropsychological predictors for developing an NCD were impairments in memory, fluency and executive function.

Conclusion: This study found that CKD patients are at a twofold increased risk for the development of an NCD compared to those without the condition. The higher risk and incidence for cognitive function reported here suggest that routine neuropsychological assessment should be incorporated and screened in this population as part of normal clinical practice.

Unrecognized cognitive impairment in cardiac rehabilitation patients Introduction: To determine the prevalence of unrecognized brain dysfunction accompaning chronic severe cardiac disease, we examined 20 clinically stable consecutive admissions to a cardiac rehabilitation service who were free of known stroke or dementia. Methods: Age range was 65-85 years,thre were 50% male and 50% female.They suffered from different types of Cardiomyopatihies (50% ishaemic, 30% dilatative). They also had arterial hypertension 70%, lung disease 30%, gastritis 30% and different anemias 20%. Results: Multiple cognitive deficits including significant memory impairment and disorientation were present in eight patients (40%), seven of this eight patients were unable to administer their own medications reliably.An additional six patients (30%) showed milder impairments.One patient was found to be normal after neurological examination ,four showed evidence of a single brain lesion and 15 of 20 (75%) had multipleneurological abnormalities suggesting multifocal brain disease. Conclusion: The mechanism of cognitive deficits in cardiac patients is unclear and it may be related to multiple infarcts or acute or chronic hypoxic damage secondary to arrhythmias,cardiac failure or small vessel disease of the brain.Patients with cardiac disease should unergo cognitive screening , as early identification of patients at risk of progressive intelectual loss may allow early use of peventive therapy.

Systematic review and without meta-analysis of clinical practice guidelines (CPGs) relating to cognition testing in older patients Clayton Micallef 1 , Terry Quinn 1 1

Introduction: Most people with dementia admitted to hospital will have a primary medical diagnosis(es) and the importance of their dementia is overlooked despite a growing number of over 65s presenting as unscheduled care. We set out to analyze current CPGs relating to cognitive assessment in these patients. Methods: We generated a robust search strategy on the 12/02/2019 encompassing the Medline, Embase, and Cinahl and PsycInfo databases concerning dementia and delirium. This was developed in an iterative process to further refine and improve the search of the relevant databases.

Results: In all 8 eligible CPGs were found, with 5 rated as high quality covering both dementia and delirium. 2 were of moderate quality, and 1 of low quality. There is a paucity of primary evidence for most recommendations. SIGN uniquely recommends the 4AT tool for delirium, although they almost unanimously recommend an informant history to aid diagnosis. A normal cognitive screen doesn't rule out dementia, and changes in presentation should prompt a further cognitive screen. All dementia guidelines recommend a cognitive and functional assessment as workup.

Conclusions: Primary gold standard studies are lacking, and most CPG recommendations are based on expert consensus. Both delirium and dementia CPGs almost unanimously recognize the importance of taking an informant history to assess a patient's baseline, and the utility of assessing for delirium at the initial presentation. The use of validated tools to detect delirium and performing an initial screen on presentation agreed upon by half delirium CPGs. All dementia guidelines recommend a cognitive and functional assessment as part of diagnostic workup.

Does late-life depression counteract the beneficial effect of physical activity on cognitive decline? Results from the NESDO study Marieke Henstra 1 , Erik Giltay 2 , Roos van der Mast 2 , Didi Rhebergen 2 , Nathalie van der Velde 1 , Nathaly Rius Ottenheim 2 1 Amsterdam UMC, location AMC, 2 LUMC Objectives: Physical activity (PA) may postpone cognitive decline in older persons. It is unknown whether depression, which affects both PA and cognitive functioning, counteracts this association. We therefore investigated the association between baseline PA and cognitive functioning over time, stratified for depression. Design: Longitudinal. Setting and participants: We used data of the Netherlands Study of Depression in Older persons (NESDO), a multi-site cohort study with 6-years follow-up. 297 depressed and 97 non-depressed older participants with complete data on baseline PA and cognitive functioning were included. Measures: Linear mixed models, stratified for depression, were used to assess the association of self-reported baseline PA with five standardized outcomes of cognitive functioning (Mini Mental State Examination, interference-control, verbal memory, working memory, and their compound-score) at baseline, and after 2 and 6 years. We also assessed the association between time and cognitive functioning stratified for depression.

Results: Mean age was 70.1 years (SD 7.1), and 63 % were women. No significant associations between baseline PA and decline of any cognitive outcome were found, irrespective of the presence of depression. In both groups, also no significant interactions of PA with time were found, indicating that the extent of the rate of cognitive decline over time was largely unaffected by PA. Only decline of working memory was significantly worse in the depressed group compared to the non-depressed group. Conclusions and implications: At older age, the level of PA may not impact long-term cognitive functioning, irrespective of the presence of depression. Depression appeared to worsen age-related decline of working memory only. However, selective attrition may have biased our results. As a higher PA-level at older age has a positive effect on a multitude of other health outcomes, PA should still be encouraged in this population.

Sedative load in community-dwelling older adults with mildmoderate Alzheimer's disease: longitudinal relationships with adverse events, delirium and falls Background: Antipsychotics are frequently used in older adults with Alzheimer's disease (AD) and are associated with numerous adverse events and increased mortality. Whilst frequently listed as causing Orthostatic Hypotension (OH), the relationship between antipsychotic use and OH has never been explored in mild-to-moderate AD, a group who may be particularly vulnerable to their adverse effects. Methods: We analysed longitudinal data from community-dwelling older adults with mild-to-moderate AD in 9 European Countries. We assessed the effect of antipsychotic use on orthostatic blood pressure (BP) measured on eight occasions over 18-months, in addition to the association between antipsychotic use and incident falls. Results: Of 509 older adults (aged 72.9 ± 8.3 years, 61.9% female) with mild-to-moderate AD, 10.6% (n = 54) were prescribed a longterm antipsychotic. Ongoing antipsychotic use was associated with a greater likelihood of developing sit-to-stand OH at both 1 minute (OR Between 2018 and 2050, the proportion of people over 65 years of age will increase about 10% in the EU-28. Thus, the promotion of cognitive health among older people will gain further importance in the EU countries in the coming years. The present small-scale, exploratory study focuses on the perception of cognitive health amongst health care providers and older people. We conducted semi-structured interviews with two physicians, and two persons without cognitive impairment aged 65 and 68 years. The interviews were analysed using thematic analysis. The results show two types of knowledge of cognitive health: a scientific one, held by physicians, socially and culturally transmitted and disseminated; and a reified one, popularised, and specifically anchored among older adults. Additionally, our results suggest several perceived barriers and levers regarding the promotion of cognitive health. Lack of motivation can be one of these barriers. Furthermore, barriers include public policies and the health care system (e.g., lack of provision, or unsuitable settings), or can be linked to communication. Several levers directly related to these barriers have been identified. We found the need for better communication between health care providers and older adults related to the promotion of cognitive health. Our results also suggest using economic levers, such as insurance coverage or vouchers to improve the participation in the promotion of cognitive health amongst older adults. Our findings provide foundation for refining and expanding the offerings dedicated to the promotion of cognitive health among older people in Luxembourg.

Introduction: Patients suffering from dementia may need advanced care planning when affected by acute illness and hospitalization, and prognostic assessment tools are relevant. We aimed at studying the association between basic activities of daily living at hospital admission and mortality among older patients with dementia. Methods: All patients aged C 65 years with diagnosed dementia in the population-based National Danish Geriatric Database from 2005 to 2014 were included and followed until death, emigration, or study termination (31.12.2015) . Data on Barthel-Index-100 (BI) was used to assess ADL. Patients were categorized into four predefined standard BI subcategories according to the national Danish version of the statistical classification of diseases (BI = 0-24 (very low ADL), BI = 25-49 (low ADL), BI = 50-79 (moderate reduced ADL), and BI = 80-100 (independent ADL)). Association with mortality was assessed using multivariable Cox regression analysis adjusting for age, marital status, Charlson Comorbidity Index, BMI, prior hospitalizations, year of admission and polypharmacy. Results: In total, 6,543 patients (women 62%) were included, median (IQR) age 84 (79-88) . Mortality increased significantly with decreasing BI in both the crude and multivariable analysis. In subcategories BI = (80-100) and BI = (0-24) survival time (median(95%)) was 3.6 (3.4-3.9) years and 0.8 (0.7-0.9) years, respectively. Also, in patients with BI = (0-24), the overall mortality risk (HR (95%CI)) was 2.4 (2.2-2.7), 30-day risk 11.8 (5.8-23.9), and 1-year risk 4.4 (3.5-5.5) when using BI = (80-100) as reference.

Conclusion: BI is independently associated with all-cause mortality among older patients with dementia admitted to hospital. BI may be helpful when discussing future advanced care planning with patients and their families prior to discharge from hospital.

Physical activity and exercise in dementia: an umbrella review of intervention and observational studies Background: Dementia is a common condition in older people. Among the potential risk factors, increasing attention has been focused on sedentary behaviour. However, synthesizing literature exploring whether physical activity/exercise can affect health outcomes in people with dementia or with mild cognitive impairment (MCI) is still limited. Therefore, the aim of this umbrella review, promoted by the European Geriatric Medicine Society (EuGMS), is to understand the importance of physical activity/exercise for improving cognitive and non-cognitive outcomes in people with dementia/MCI. Methods: Umbrella review of systematic reviews (SR) (with or without meta-analyses) of randomized controlled trials (RCTs) and observational (prospective and case-control in people with MCI) studies based on a systematic literature search in several databases. The certainty of evidence of statistically significant outcomes attributable to physical activity/exercise interventions was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Among 1,160 articles initially evaluated, 27 systematic reviews (4 without meta-analysis) for a total of 28,205 participants with dementia/MCI were included. No observational study on physical activity/exercise in MCI for preventing dementia was included. In SRs with MAs, physical activity/exercise was effective in improving global cognition in Alzheimer's disease and in all types of dementia (very low/low certainty of evidence). Moreover, physical activity/ exercise significantly improved global cognition, attention, executive function, and memory in MCI, with a certainty of evidence varying from low to moderate. Finally, physical activity/exercise improved non-cognitive outcomes in people with dementia including falls and neuropsychiatric symptoms. SRs, without meta-analysis, corroborated these results.

Conclusions: Supported by very low to moderate certainty of evi-Introduction: We study dual-task test performance with Timed Upand-Go (TUG) [1] combined with naming animals (TUG dual-task, TUGdt) [2] [3] [4] , where number of animals/10s can discriminate between patients with dementia, mild cognitive impairment, subjective cognitive impairment, and healthy controls [4] . For TUGdt, reference values and reliability estimates have not previously been presented. Aim: To present reference values for TUGdt and to establish testretest reliability in healthy controls. Methods Study population: 166 healthy controls (age 50-91 years) for reference values and 43 (age 50-91 years) for reliability. Test procedures: One movement sequence starting from sitting position, standing up and walking three meters, turning, walking back and sitting down, combined with the simultaneous task of naming animals. For reliability, tests were repeated in 10±3 days. Statistical analyses: Reference values were calculated with quantile regression [5] in age and gender groups. Intra-class correlation coefficients (ICC) were used for reliability analyses. Results: For men in age groups 50-59, 60-69, 70-79, and 80-years, reference values (2.5th percentile) were 5. 2, 4.0, 2.8 and 1.8, and for women 5.4, 4.7, 3. 

Dual-task tests improve capacity of models for predicting dementia incidence: a prospective cohort study Introduction: Identifying dementia disorders at early stages is essential for initiating interventions. At such stages, patients may present with either subjective cognitive impairment (SCI) or mild cognitive impairment (MCI). Methods: Participants: In total 172 patients (age range 39-91 years, 78 women) with SCI or MCI were included, of whom 51 developed dementia within 2.5 years. Data collection: A dual-task test involving Timed Up-and-Go [1] simultaneous with naming animals (TUGdt) [2] was performed at baseline. Time score, number of animals named, and number of animals/10s [3, 4] were calculated. Data on demographic characteristics and results of the cognitive tests Mini-Mental State Examination (MMSE) and Clock Drawing were collected. Diagnoses were identified after 2.5 years. Statistical analyses: Logistic regression was used to predict dementia incidence. C-statistics were calculated for predictive capacity. Analyses were stratified by age.ResultsThe TUGdt variable ''animals/10s'' showed the highest association with dementia incidence in the total sample (OR per 1 std decrease 4.06, 95% CI 2.28-7.23, p \ 0.001). Among younger patients (under median age, 72 years), the corresponding OR was 19.4, 95% CI 3.53-106.17, p \ 0.001, and ''animals/10 s'' added predictive capacity to a model with age, gender, educational level, MMSE, and Clock Drawing test, with an increase of c-statistics from 0.88 to 0.94. In the total sample, the increase in c-statistics was negligible (0.85 to 0.86).Key conclu-sionsAmong younger patients with SCI or MCI, ''animals/10s'' adds value to demographic characteristics and standard cognitive tests regarding predicting dementia disorders. Hence, TUGdt may become Introduction: Acetylcholinesterase inhibitors (AChEI) and Cognitive Training (CT) are the gold-standard pharmacological and non-pharmacological treatments for mild to moderate dementia [1] . The present study aims to investigate the effect of each treatment, alone or combined, on neuropsychological profile of patients with mild dementia. Methods: Forty participants, enrolled on clinical (geriatric assessment) and morphological (CT/RMN) assessments, were assigned to three groups receiving, respectively, only the pharmacological treatment (AChEI, n = 14), both the treatments (AChEI + CT, n = 15), or only the cognitive training (CT, n = 11). Cognitive profile was evaluated, at the baseline and after three months, by the MMSE [3] , and an extended neuropsychological battery of tests, the Brief Neuropsychological Examination-2 [4]. To evidence differences among the treatments, in terms of changes in the patients' neuropsychological profile, linear mixed models were conducted. Results: A general improvement at the MMSE emerged only in patients which received AChEI + CT, and CT, compared to the group that received only AChEI. Interestingly, after the intervention, individuals receiving the CT showed a significant improvement in immediate memory recall with respect to the AChEI group. In addition, only the group receiving both the treatments (AChEI + CT) showed an improvement in delayed recall after the intervention, compared to the other groups. Key conclusions: The combination of AChEI and CT seems to bring the greatest benefit for persons with mild dementia. More interestingly, CT is more effective than AChEI alone even in improving memory, which classically is considered as the ''lost'' cognitive domain. References: [1] Calabria, M., Geroldi, C., Lussignoli, G., Sabbatini, F., & Zanetti, O. (2009) . Efficacy of acetyl-cholinesterase-inhibitor (ACHEI) treatment in Alzheimer's disease: A 21-month follow-up

The aging society with age-related pathologies, in particular dementia, challenges the traditional healthcare paradigms. Both aging and age-related cognitive decline are heterogeneous, multifactorial processes with a high demand for studies aimed at better characterizing the interface between dementia and Alzheimer's disease (AD). In this study, the ATN classification system was applied to the records of 223 patients with a diagnosis of mild cognitive impairment (MCI) and dementia admitted to the Memory Clinic of the University Hospital of Cologne. Patients were divided into two age groups: \ 70 years (n = 98, 44%) and C 70 years (n = 125, 56%). In the 223 participants with full data sets including cerebrospinal fluid, neuropsychological testing, diagnosis and age, A+T+N+ was the most common group (52%). Significant differences were found between the two age groups in AD continuum groups (ie. all groups with pathological amyloid) and non-AD continuum groups (p = 0.018), whereby the older group belongs to AD groups to a larger extent compared with the younger one. A relationship between amyloid pathology and cognition (Mini-Mental State Examination) was found (p = 0.003), but only the younger participants showed significant differences of cognition in amyloid stages (p \ 0.001) and not the older ones (p = 0.639). The latter observation is in agreement with recent studies from other groups. Our results show that the overlap between aging and dementia needs to be considered in every interpretation of diagnostics. Age-related cut-off values might be a better fit. Aging and pathologies other than amyloid may play a substantial role in cognitive decline of older patients. Diagnostic examinations of oldest-old patients might have to be considered more comprehensively than those of young-old persons. Introduction: With the evolving knowledge on hearing as a mid-life risk factor for dementia, identification of patients who are at risk becomes increasingly important. Our memory clinic is based in a tertiary referral centre and refers patients with mild cognitive impairment (MCI) for audiological evaluation based on cognitive diagnosis, rather than self-reported hearing deficits. This study sought to examine the patient experience and understanding of this process. Methods: All patients with MCI who were referred for audiology review were contacted. A patient survey was delivered over the phone. Outpatient letters and the memory clinic database were reviewed. Results: 30 patients were contacted, 9 (30%) could not recall their audiology assessment. 20 patients were surveyed. 8 (40%) had selfreported hearing loss. 9 (45%) had mild-moderate hearing loss and 8 (40%) had moderate-severe. 6 patients (30%) could recall having the rationale behind having a hearing test as part of their memory assessment explained to them. The majority (75%) felt a hearing test was an important part of their memory assessment, but just 7 patients (35%) identified a link between hearing loss and memory problems. All patients who provided feedback on the service itself made positive S170

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 comments, although 20% felt they did not get adequate information 

Long distance cognitive rehabilitation during COVID19 pandemic: a study report Romania, 4 ''Carol Davila'' University of Medicine and Pharmacy, Bucharest, Romania Introduction: Due to limited access at healthcare services for elderly patients during COVID19 pandemic, significant disruptions occurred regarding long term therapeutic interventions. Considering the absolutely necessary social distancing measures, reorganizing and finding the proper working techniques, equipment and materials to be applied in cognitive rehabilitation programs represent a challenge for the rehabilitation clinician.

Methods: We present a study report of a 78 years old male with minor cognitive deficit and minor aphasia due to stroke (Nov.2019) .

In order to evaluate the efficiency of remote approach, we proceeded to following the therapeutic protocol that involves evaluation, initiation of therapy and post-intervention evaluation. We applied MMSE for cognitive screening and Speech Therapy Evaluation Sheet to assess the language indices. Results: We identified communication platforms able to ensure the continuity of therapeutic process and we got access to the digital instruments compatible with the remote mode. We used the Wordwall software to create our own interactive resources, using custom templates, accessible on any web device. We also used cognitive training computerized applications. The intervention was performed for 8 weeks, 2 times/week, 60 minutes/session. We noticed increase in cognitive performance indices and improvement of language indices. The patient described good adherence to the sessions.

Conclusions: The use of communication platforms and of digital tools to provide optimal cognitive training in remote mode has an essential role in situations requiring social distancing. This type of approach is a valuable alternative solution in COVID19 pandemic to ensure patient safety and also the quality health care.

Evaluation of quality of life in patients with major neurocognitive disorder 

Introduction: Dementia is a syndrome in which there is an increase in dependency and a decrease in quality and life expectancy. Quality of life is a multidimensional concept whose evaluation is complex, but very useful in the therapeutic approach. The objective was to assess the quality of life in institutionalized elderly diagnosed with dementia. Material and methods: Descriptive cross-sectional observational study carried out on institutionalized patients in Lanzarote (Spain) during February 2020. The variables recorded were: sociodemographic (age and sex), baseline situation (Barthel index -IB-, global deterioration scale-functional assessment staging -GDS-FAST-and social resources scale -OARS-) and quality of life determined by the specific QUALID scale (Quality of life in late-stage dementia), whose score ranges from 11-55 points (inversely proportional results). The statistical analysis was carried out in the statistical program SPSS-V26.

Results: 35 patients were included, with a mean age of 83.91 ± 7.66 years. In relation to the comprehensive geriatric assessment: 97.14% had severe functional dependence (mean IB 12.71 ± 15.69), the mean GDS-FAST was 6.00 ± 1.08 and the mean OARS was 2.51 ± 0.74. The mean score obtained in the scale was 26.09 ± 11.14. If we analyze the items separately, smiling and physical contact obtain the highest scores (3.03 ± 1.72 and 2.97 ± 1.10, respectively). In

Background: Neurologic symptoms, cognitive impairment, motor dysfunction, disorders of mood and behaviour, chronic pain occur frequently in older adults. These conditions not only have a strong negative impact on intrinsic capacity and mantainance of autonomy; they also increasingly coexist, with advancing age, with non-neurologic comorbidities and geriatric syndromes as well as their therapeutic management. In this complex figure, the ability to properly address presence, severity and treatment of an underlying or concomitant neurologic condition is essential to prevent disability and/or enhance recovery after an acute illness. If on one hand the Comprehensive Geriatric Assessment (CGA) is the tool of choice to uncover neurocognitive and neuropsychiatric deficits among others, there is a paucity of data on the method and degree of implementation of neurological know-how systematically used by or to be integrated in geriatric medicine to improve the management of neurogeriatric patients.

Methods: To fill this gap of knowledge, recently a Task Force for Neurogeriatrics was established in Germany. Physicians specialized both in neurology and geriatrics as well as geriatricians with expertise in cognitive impairment compose the group. Results: The Task Force is currently (1) conducting a nation-wide survey to retrieve information on assessments, performance and functions tests conducted in geriatric units to examine neurologic status; (2) completing ethical issues clearance to prospectively collect data on assessments, performance and functions tests harmonized across German geriatric units to examine homogeneously neurologic status in the near future. Additionally, one of the main priorities of the Task Force is to foster neurogeriatric research and training concepts as well as to provide innovative care strategies for geriatric patients with leading neurological conditions and disabilities.

Benjamin Blackburn 1 , James Ferryman 1 1

Introduction: Venous thromboembolism is estimated to cause between 24000 and 32000 deaths annually in hospital inpatients with a proportionally large incidence in the elderly population (approximately 8 per 1000 in the population over the age of 85). Appropriate use of thromboprophylaxis is shown to reduce the incidence of VTE and death from PE. The rationale for its use is both scientifically plausible and evidence based. Conclusions: Implementation of ward round checklists and posters resulted in a tenfold increase in proportions of patients being appropriately re-assessed within 24 h of admission. This improvement following the provision of easily accessible information on the Trust guidelines may reflect a lack of awareness of this particular guideline amongst junior staff.

Importance given by elderly people to the components of a Comprehensive Geriatric Assessment in terms of the influence on health: VALINTAN tool. Kharkiv National University named after V.N. Karasin'', 3 Kharkiv National Medical University

The combination of non-alcoholic fatty liver disease (NAFLD) and subclinical hypothyroidism (SH) attracts attention due to general metabolic changes that can make an independent contribution to the formation of cardiovascular diseases (CVD) depending on age.The purpose of the study was evaluation of the cardiometabolic changes formation features in patients with NAFLD in combination with SH depending on age. Conclusion: In patients with NAFLD in combination with SH under the age of 50 years old, the early formation of cardiometabolic changes create the prerequisites for premature vascular aging.

Design of a consensus-based geriatric assessment tailored for older patients approaching end stage kidney disease Introduction: Routine geriatric evaluation in older patients approaching end stage kidney disease (ESKD), benefits disclosure of highly prevalent unidentified functional and cognitive impairments. Although recommended in guidelines, a suitable standardized geriatric test set is lacking. We aim to propose a consensus-based test set for geriatric assessment useful in both routine care and research in older (C 65 year) patients approaching ESKD. Methods: A multidisciplinary expert panel of physicians, nurses and supportive disciplines with clinical and/or scientific experience in geriatric nephrology was assembled. Preconditions and selectioncriteria for the selection of potential measures resulted from general geriatric principles, critical appraisal of literature, inventory of conventional instruments, and focus group meetings with patients, carers and health professionals. Older patients (aged C 65 years) approaching ESKD (eGFR \ 20 ml/min/1.73m 2 ) were selected as the target population. An expert panel meeting and subsequent online round of comments led to agreement on the best suitable test set.

Results: The final consensus set contains instruments in functional, cognitive, phycological, and somatic domains, and patient preferences, nutritional status and fall risk. The set comprises a patient questionnaire (six instruments) and a professional-administered test set (including ten instruments). Estimated time for administration in pilot testing was 20 and 40 minutes respectively. Key conclusions: We propose a consensus-based nephrology-tailored geriatric assessment, to benefit clinical care for older (pre-)ESKD patients and enhance research comparability. Future research should investigate effectiveness, feasibility of implementation, patients satisfaction and the value for treatment decision making and outcome improvement.

The SELFY-MPI short-form: a self-administered frailty screening tool in primary care [1] , and delayed discharges of complex older adults are increasing in frequency [2] . Early comprehensive geriatric assessment (CGA) has been shown to increase older patients' likelihood of being alive and in their own homes after acute admission [3] . We evaluated the impact of the CGA via daily geriatrician input on an acute Clinical Decisions Unit (CDU) on outcomes for older inpatients in Barnet District General Hospital in the UK. Method: We collected data for patients aged 70 or over admitted to CDU over two 2-week periods in October 2019 (n = 40), and November 2019 (n = 44). Between these time periods, we implemented daily geriatrician review, and introduced a multidisciplinary board round. Results: Our intervention reduced mean length of stay on CDU (2.15 versus 6.4 days, p \ 0.05) and increased referrals to outpatient services (25% versus 7.5%, p \ 0.05). We noted improvements in numbers of discharges directly from CDU (56.8% versus 42.5%), total length of hospital stay (5.8 versus 6.7 days) and discharges within five-days (66% versus 50%) or to patients' own homes (85% versus 71%); however data from a larger sample is required to confirm these trends. Thirty-day mortality and readmission rates were unaffected.

Key conclusions: Geriatrician led-care in the acute setting improved length of stay on CDU, and use of specialist outpatient facilities. This could potentially enhance patient satisfaction and reduce costs associated with prolonged inpatient care, supporting the role of a dedicated front-door geriatrician. Background: Geriatric syndromes (GS) are very common in older patients and are disclosed through the Comprehensive Geriatric Assessment (CGA). The grouping of complexes geriatric multifactorial conditions under the conceptual framing of GS allows the standardization and thus simplification of the clinical treatment of older patients. Geriatric resources (GR), on the other hand, represent a similar construct in terms of patients' capacities. Neither GS nor GR, however, are currently collected as a standard in everyday clinical practice. Therefore, the actual prevalence of these two entities is largely unknown across settings. Patients and methods: All patients in this study were prospectively enrolled in 4 different studies and received a CGA at admission and discharge, as well as GS and GR recording at admission. Patients were all over 65 years of age and had at least two chronic conditions. The studies were performed at an internal medicine ward (IM, 499 patients), in the emergency room (A&E, 270 patients), at a general practice (GP, 125 patients), and in the intensive care unit (ICU, 56 patients). The GS recorded were polypharmacy, instability, incontinence, inanition, immobility, irritability/depression, cognitive impairment, insomnia, impoverishment, swallowing disorder, chronic pain, sensorial impairment, irritable colon, iatrogenic disease, social isolation, fluid/electrolyte problems, incoherence/delirium. The GR recorded were physical, good living conditions, social, economic, competence-related, intellectual, spiritual, motivational, emotional and mnestic resources. The syndromes and resources were collected S178 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 either by direct questioning the patient or relatives, by researching the medical history or by CGA. Results: The mean age of the patients was 77.7 (± 5.8, IM), 80.7 (± 4.7, A&E), 79.2 (± 6.5, GP) and 74.8 (± 6.5, ICU) years (p.001), the median length of hospital stay was 9 (5-17, IM), 4 (1-10, A&E), zero (GP) and 18 (8-36, ICU) days (p \ 0.001). The most frequent admission diagnoses were kidney failure (38.7%, IM), cardiovascular diseases (23.7% at A&E and 17 .6% at GP) and acute infections (19.6%, ICU; p \ 0.001). Both the number of GS per setting and the number of GR per setting were statistically significant (p \ 0.001). The highest number of GS were in patients admitted to IM with a median of 6 GS (4-7), while GR were mostly present in patients admitted to the A&E and the ICU, with a median of 7 (6-8 and 5-8) .

Conversely, GP patients displayed the lowest GS number (median 4, , patients at the A&E had a median amount of 4 (IQR 3-6) GS and at the ICU a median amount of 5 (IQR 3-8) was counted. The lowest amount of GR occurred in patients admitted to IM and at the GP (median for both 6, IQR 4-7). The distribution of the various GS and GR was, with a few exceptions (for GS ''impoverishment' ' and for GR ''living conditions'', ''social'' ''motivational'' and ''competence-related'' were not significant), also statistically significant. Discussion: It is possible to collect GS and GR in many different settings where older, multimorbid patients are typically managed and treated. Additionally, there is a different distribution of GS and GR between these settings, which is likely to play an important role in patients' trajectories but has not been adequately addressed yet. How these findings can influence clinical decision making and what conclusions can be drawn for physicians and nurses needs to be investigated in further studies. Introduction: Frailty is common in older, multimorbid patients and has a negative impact on physical activity. Walking as a main functional ability to participate in activities of daily living is of key importance. Established questionnaires assessing physical activity are based on self-report and are strongly biased. In this study, we focused on GPS data to detect and compare real time walks and individual mobility characteristics in frail older persons. Methods: Community-dwelling adults C 70 years with (pre-)frailty received a GPS Logger for 10 months. Walking speed and distances were analyzed by customized software. In parallel, Short Physical Performance Battery (SPPB) including gait speed (GS) and Timedup-and-Go Test (TUG) were conducted monthly. Results: GPS data of 20 participants (84.5(± 5.2) years, 85% women, mean frailty index 1.9 (70% C 2) points) were analyzed and revealed three types of walkers: Type A presented only a few, short walks nearby the home with significantly reduced means in GS (0.45 (± 0.1) m/s), SPPB (3.8 (± 0.8) points) and TUG performance (23.4s (± 4.9)). Type B showed the largest activity space, exceeding walking distances and highest mobility scores (0.82 (± 0.1) m/s (GS), 7.0 (± 1.3) points (SPPB), 13.2(± 1.4)s (TUG)). Type C performed constantly high numbers, durations and distances of walks with an average of 0.63 (±0.2) m/s (GS), 6.5 (±2.4) points (SPPB), 17.1(±4.4)s (TUG). Conclusion: Walks and individual activity spaces can be mapped via GPS. Heterogeneous walking behaviors and a wide range of functional performance were observed. GPS data can make a valuable contribution to the assessment of physical activity under everyday conditions in frail older people. Background: Policies related to older people include interventions directed towards health, independence, activity, social and economic participation. Assessment of quality of life (QoL) is an endpoint used to evaluate the efficacy of these. The OPOQOL 35 questionnaire addresses gaps from previous questionnaires. Methods: Cross-sectional study in the Geriatric Clinic outpatients. Patients fulfilled the OPQOL-brief questionnaire with the nurse, as well as the EQ-5D-3L questionnaire. Clinical data was collected. Statistical analysis was performed using STATA, a p value \ 5 was considered significant. Results: A total of 40 patients were included, 28 (70%) female, the median age of 80 (76-88). Considering global geriatric evaluation, a median of 5 (4-7) on the Lawton & Brody scale, 6 on the Katz scale, and 2 (2-3, 5) on PRISMA7. The OPQOL-brief questionnaire answers had a median score of 56 (48, 5-59), the visual analogue scale (VAS) of quality of life had a median 60 (50-75), and QALYs median was 0,44 (0, 35-0, 55). OPQOL-brief correlated with QALYs (correlation coefficient 0,57, p-value = 0,0001), and with geriatric scores: Lawton&Brody (correlation coefficient 0,5, p-value = 0,002), Katz (correlation coefficient 0,48, p-value = 0,005) and PRISMA7 (correlation coefficient -0,5, p-value = 0,006). Discussion/conclusion: OPQOL-brief varies between 13 and 65, with higher scores standing for better QoL. Our sample had a median of 56, which reveals an overall good QoL. Most importantly, it seemed that the quality of life was tightly related to the geriatric scores associated with dependency and frailty, and there was no relation to demographic factors.

Clinical relevance of jump parameters in older adults systematic review is to summarize and evaluate different jump testing approaches and their clinical relevance in the field of geriatric medicine. Methods: To determine existing technical and non-technical approaches to assess and measure vertical jumps in an older adult cohort including 60-year-old persons up to the oldest old, multiple databases are screened independently by two authors. We will include all published trials regardless of study design. We aim not to restrict study eligibility by publication status, but we will exclude studies that are not published in German or English. If applicable, we will also report on jumping procedures, normative values and main findings associated with jumps. All findings of the data search will be provided and presented according to the high-quality standards for systematic reviews. The review will be registered in PROSPERO. Results: Basic information will be collected and described qualitatively for each study concerning methods (e.g. study design, sample size), participants (e.g. selection criteria and diagnoses, age, gender), type of jump test and used technical devices for measurement. Calculated parameters and additional outcome variables will be provided additionally. Results will be available by October.

The relation between delirium and frailty in hospitalized geriatric patients : delirium day datas Asli Tufan Ç inçin 1 , Rabia Gökçen Umurca 2 1 Marmara University Medical Faculty, 2 Marmara University Medical Faculty Introduction and objective: As a result of aging world population, health problems of the elderly are encountered more frequently in daily practice. Delirium which is an acute confusional state with fluctuating course during the day is frequently observed in elderly patients experiencing acute stress such as hospitalization. Various strategies are being developed to detect and prevent this syndrome which causes serious morbidity and mortality worldwide. In our study, which we conducted on the delirium awareness day, we determined the point prevalence of delirium in geriatric inpatients in our country by using the Confusion Assessment Method (CAM), and revealed its relationship with frailty, a geriatric syndrome which is a common cause of serious morbidity. Materials and method: Sixty-two patients aged 60 years or older who were hospitalized in the Internal Medicine Clinic of Marmara University Pendik Training and Research Hospital on March 13, 2019 were included in the study. The demographic information, comorbidities and medical history of the patients were obtained from the patient or first degree relatives, and patients' medications were obtained from the patient files. Mini Nutritional Assessment (MNA) to assess nutritional status of patients, FRAIL frailty scale (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) to assess frailty status, Katz Index of Independence Activities of Daily Living (ADL), Lawton-Brody Instrumental Activities of Daily Living (IADL) to assess functional status, delirium risk factors and delirium evaluation test (CAM) were applied. If there was mortality during follow up, the date was stated. Results: The mean age of the patients was 71,9 + 8,21. Twenty six patients (41.9%) were female and 36 (58.1%) were male. According to CAM, delirium was detected in 18 (29%) of the patients. According to the FRAIL scale, 21 (33.9%) patients were prefrail and 41 (66.1%) were frail. All 18 (100%) cases developing delirium were found to be frail. In multivariate logistic regression analysis, being older than 70 years, low Katz ADL score and low MNA score were found to be independent risk factors for delirium development.

Conclusion: Delirium and frailty are common in hospitalized elderly patients, and frailty is a risk factor for delirium. Health care workers should be aware of these geriatric syndromes, recognize them early, and develop delirium prevention strategies.

Delirium is associated with increased mortality in older COVID-19 patients The COVID-19 outbreak is a worldwide pandemic that has severely affected patients aged[65 years. This study investigates the outcomes of 104 older COVID-19 positive patients (mean age 84) diagnosed with delirium on admission to Homerton University Hospital, London, UK. It was conducted as a retrospective analysis of electronic patient records of patients admitted during the peak of the coronavirus outbreak. The aims of the study are twofold: To assess how delirium is diagnosed in COVID-19 patients. To evaluate the outcomes of older COVID-19 patients diagnosed with delirium. Methods: Data was collected from electronic patient records to determine, firstly, how delirium was diagnosed. Confusion was diagnosed by 2 methods: History documented in the notes, or formal use of an assessment tool-the Abbreviated Mental Test Score (AMTS).Outcomes of these patients were subcategorised: Still an inpatient, discharged from hospital, deceased. Results: 243 older COVID-19 positive patients were admitted during the study period, 104 were diagnosed with delirium. 45 were diagnosed using the AMTS. 52 were diagnosed based upon clinical history. Of the 104 diagnosed with delirium 36 were discharged from hospital. 64 patients died. 4 remained as an inpatient. Conclusion: Delirium is a common presentation of COVID-19 in older adults. It is a poor prognostic indicator, associated with high mortality. The results of this study demonstrate that older adults often present atypically, with acute delirium rather than cough and fever. Recognition of this association and the risk of increased mortality will help inform clinical decision making and improve patient care.

Multidimensional Prognostic Index (MPI) predicts delirium in older patients with hip fracture who underwent surgical intervention Unfortunately, no tools have been yet validated to identify the patients at risk of delirium in the acute hospital setting. Aim: In this retrospective observational cohort study, we evaluated whether the Multidimensional Prognostic Index (MPI) could predict the delirium onset in older individuals admitted to the hospital for hip fracture who underwent surgical intervention. Methods: Consecutive older patients admitted to the hospital for hip fracture underwent a comprehensive geriatric assessment (CGA) to calculate the Multidimensional Prognostic Index (MPI) from information on functional, cognitive, mobility and nutritional status, comorbidity, number of medications and co-habitation. According to previous cut-off, MPI was expressed in three grades, i.e. MPI-1 (lowrisk), MPI-2 (moderate-risk) and MPI-3 (high risk of mortality). Delirium was assessed during hospitalization using 4 AT test. Results: 244 older patients (mean age 85 ± 6.9 years; females = 84.2%) who underwent surgery for hip fracture were included. 104 subjects (43%) 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 MPI score and the onset of delirium during hospitalization (p \ 0.05 and p \ 0.0001, respectively). Overall, the incidence of delirium during hospitalization was significantly higher in patients with more severe MPI score. Conclusions: MPI may be an useful tool to identify older patients at risk of delirium when admitted to hospital for hip fractures and have to undergo surgical intervention.

Training improves identification of delirium for primary care providers'

João Tavares Introduction: The evaluation of delirium is a central domain in caring for older adults. Studies on delirium evaluation focus mainly on the hospital context. However, the identification of delirium in primary health care is essential, especially because of complaints of changes in mental status [1] . This study aims to assess the effects of a short educational intervention on the knowledge of health care clinicians (HCC) in primary care (HCC-PC) to identify delirium in older adults in the community. Methods: The pretest-posttest design followed a single group of HCC-PC. To assess knowledge, a standardised case vignette of delirium was used [2] . Two hours of education and training were provided in a single session. The data were analysed with a Wilcoxon test, accepting a p-value \ 0.05 as statistically significant. Results: Fourteen clinicians participated in the training (nine nurses and five physicians). Eleven of the participants were female. The average age was 46.3 ± 15.5 years; the average professional time was 27.8 ± 11.2 years. Eleven reported no previous education or training in delirium. In the pretest, eight did not recognize the acute change in mental state and twelve did not recognise delirium and the subtype. In the posttest, twelve and eleven recognised the acute change in mental state and delirium, respectively; all participants identified the subtype. Posttest recognition of acute mental status (p = 0.014), recognition of delirium (p \ 0.01) and identification of subtype (p \ 0.01) significantly improved from the pretest. Introduction: Delirium is common, particularly in hospitalized elderly patients (up to 30%) (1) . The identification of underlying causes is crucial to avoid adverse outcomes. Case report: An 80-year-old-woman was admitted to the emergency department with a convulsive crisis. She presented a Glasgow coma scale of 9, little reactive isochoric pupils, febrile (38,5 8C) and normotensive. There were no other symptoms suggesting infection, the remaining physical examination was normal and glycaemia was 508 mg/dL. She had clinical record of incipient dementia, diabetes, hypertension, epilepsy and nonadherence to medication. She had no previous hospitalizations or genitourinary tract manipulation. The lab results demonstrated leukocytosis (15.19 9 103) with neutrophilia and normal Reactive Protein C. Urine analyse was normal, with no drugs identified; Sars-Cov2 and influenza swabs were negative. Cranio-encephalic computed tomography (CT) had no signs of ischemic or haemorrhagic events. Abdominal ultrasound and cerebrospinal fluid had no signs of infection. The hyperglycaemia was corrected and was medicated with valproate bolus and ceftriaxone, without improvement during hospitalization. Endocarditis, HIV, Hepatitis B or Hepatitis C were excluded and Thoraco-abdominalpelvic CT was normal. The blood cultures were negative and the urine culture identified a Candida tropicalis; she started fluoconazole, presenting gradual improvement of consciousness and resolution of fever. Conclusion: Candiduria by Candida tropicallis is rare (12,7%) (2), especially without risk factors such as genito-urinary tract manipulation, immunosuppression, surgery or recent antibiotherapy. In this case, the only risk factors identified were uncontrolled diabetes and age. As candiduria may present only as delirium in elderly, it is pivotal an early detection and treatment. Introduction: There are multiple delirium assessment tools. Yet validation data have mostly been generated under study conditions. There are few studies providing information in full clinical populations on (a) tool completion rates and (b) proportions of scores positive for delirium. The 4AT (www.the4AT.com) is a globally-used clinical tool for delirium detection. We examined completion and detection rates of the 4AT as implemented in two university hospitals. Methods: We analysed electronic records on all consecutive patients aged C 5 0 years admitted to acute medical wards between Apr 2016 and May 2019. The 4AT is scored from 0 to 12. Scoring: 0, negative; 1-3, cognitive impairment but no delirium; 4-12, possible delirium. We assessed completion rates, percentages with scores in the three scoring bands, and length of stay. Results: Of the 69,462 consecutive admissions aged C 50 years old, 51,238 (74%) had a completed 4AT. 77% of patients aged C 65 had a completed 4AT. In the 51,238 with completed 4AT, 33,028 (64%) had a score of 0, 9,499 (19%) had a score of 1-3, and 8,711 (17%) had a score of 4-12. Median length of stay in days in relation to scoring categories was 0: 3.6 days (IQR 1.3-8.6); 1-3: 8.9 days (IQR 2.8-26.1); 4-12: 9.2 (IQR 3.3-26.8).

Key conclusions: These findings suggest that the 4AT is (a) implementable in clinical practice, and that (b) when performed it detects clinically realistic levels of delirium. Further studies in full clinical populations will enhance knowledge of the implementability of delirium detection tools.

Potential risk predictor in type 2 diabetes mellitus patients Introduction: Basal insulin is widely used in older patients with Type 2 Diabetes (T2D). Long-acting insulin analogues (LIA) induce less nocturnal hypoglycemia than NPH insulin because of their flat action. However, older patients with diabetes have rarely insulin resistance : their risk of nocturnal hypoglycemia may be higher.Aim : to assess the number of hypoglycemia episodes (HE) according to basal insulin type, cognitive and nutritional status in frail older people with T2D. Methods: Prospective, exploratory single center study. Inclusions stratified on type of insulin: NPH/LIA. Frail or dependent patients ([ 75 years) with T2D treated only with basal insulin in geriatric wards or nursing homes used a continuous glucose monitoring system during 120 hours. Results: 25 patients were enrolled: 9 treated with NPH, 16 with LIA. Four HE were found: 1 nocturnal in NPH-group (11%); 3 in LIAgroup (19%), 2 nocturnal, 1 diurnal.Among 12 patients with MMS [ = 21 no HE was noted, while 3 of 10 patients with MMS 11-20 and 1 of 2 patients with MMS \= 10 had HE. No HE was noted among 6 patients with normal nutritional status according MNA. Diurnal HE was noted in 1 of 9 malnourished patients, also obese. Nocturnal HE were found in 2 of 9 malnourished patients and 1 at risk of malnutrition. Their BMI were in normal range or overweight. Key conclusions: HE was frequent in patients with MMS \ 20 or with malnutrition or a risk of malnutrition according to MNA. HE also occurred in obese patients. 

The aim of this study was to assess the effectiveness of the Diabetic and Oral Care Program for Seniors (DOCS) in terms of improving oral health perception, behaviours, oral hygiene and reduced glycaemic status in older patients with type 2 diabetes mellitus (T2DM). A double-blind randomised controlled study was conducted in the two health centres located in Muang district, Nakhon Ratchasima province, between July 2019 and January 2020. Control and intervention groups were created and thirty-five T2DM older patients with chronic periodontitis who attended the centres were randomly recruited into each group. The intervention group received an oral health education program based on the Health Belief Model (HBM), individual oral hygiene instruction, scaling and root planning at one month, and individual oral hygiene instruction at three months. The patients in the control group received the routine program. Outcomes were assessed using a questionnaire, a simplified oral hygiene index, and glycaemic status (HbA1c). These measures were applied at baseline, three months and six months. Data were analysed using a Chi-square test, a t-test, and repeated measure ANOVA at p-value = 0.05. The results at three and six months showed that the intervention group significantly improved their HBM and oral health behaviour scores. Furthermore, their OHI-S scores and HbA1c levels (p \ 0.05) decreased, while there was no significant difference in the control group. The findings suggested that the proposed program was effective among diabetic older people who have periodontitis in terms of improving oral health S182

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 perception, behaviours, oral hygiene, and glycaemic status as indicated in evaluations occurring three and six months after the initiation of the study.

Effect of antidiabetic medications on major adverse cardiovascular events in the elderly: meta-analysis of cardiovascular outcome trials [2,6; 3,7] , 8 [5, 6 ; 6, 1] . In 59% of the patients HbA1c was below 6%; 33% had concentrations between 6% and 6,4%, and only in 8% we found HbA1c higher than 6,5%. None of the patients received any sugar-lowering therapy and only 2 (3,2%) were previously diagnosed with diabetes. No correlation was also found between HbA1c values and lipids profile. After dividing patients into subgroups depending on stage of carbohydrate metabolism disorders we did not notice any statistically significant differences in lipid profile in them (p = 0,005). Comparing survivors and non-survivors groups we did not find any significant differences in total cholesterol, LDL, HDL and HbA1c (p , 005) . While comparing functional status and QoL with metabolic profile we discovered positive correlation (r = 0.834) between total cholesterol and index of instrumental activity, and between LDL and IADL as well as MNA score (r =0.732 and 0.634 respectively). Conclusion: In centenarians usual prognostic factors such as HbA1c and lipids do not have any impact on survival but they influence functional status and QoL. Further investigations of metabolic status in super old persons are needed to personalize their lifestyle and treatment goals.

Foot care knowledge and practices amongst Maltese individuals with diabetes: trends and determinants. King Saud University

The autoimmune polyglandular syndromes(APS),(Types1-4),are the most common polyendocrine adenopathies.These occur as a consequence of autoimmune destruction of self-antigens in endocrine glands and other tissues. Methodology: A case of polyglandular syndrome,most likely PGA-3,is being described. mIU/l, FT4 19.1 pmol/l). Rest WNL. Other Investigations: CT scan brain-normal, Short Synecthen Test negative (ACTH 4.8pmol/l), Anti-gastric parietal cell and Anti-Intrinsic factor Antibodies strongly positive(Anti-parietal ;47.4 units-normal: 020),Anti-Intrinsic factor Abs-69.2 units-normal 0-1.1 units). ECG & CXR-unremarkable. Anti-Islet cell Abs-Negative,Anti-GAD-65 Abs Highly Positive-5504.1 U/ml (0.0-5.0), S.Gastrin-30 pg/ml (0115). Anti-thyroid Abs: Anti TPO-1761 units (0-100),Anti . Elective surveillance upper GI endoscopy: unremarkable apart from the finding of a 3mms,whitish nodule in the gastric antrum. Gastric histopathology: (4 specimens).Specimen from the gastric nodule revealed mild to moderate inactive gastritis, gastric atrophy and intestinal metaplasia. Antral Bx-positive for H.pylori like organisms. Otherwise biopsies from incisura & body of stomach showed mild to moderate inactive gastritis. Gastroenterology followup was still awaited. Conclusion: Autoimmune disorders can co-exist and can present in close succession.With Type 1 diabetes and Hashimoto's thyroiditis, other autoimmune diseases e.g. adrenal insufficiency,vitiligo,hypoparathyroidism,candidiasis,pernicious anemia etc. can appear later on,as part of one of the polyglandular syndromes. Method design: Screening test based on teleophthalmology. The patient is recruited in primary care consultations and is included in the detection program with a procedure based on the capture of images by non-medical personnel, the images are sent electronically to the reading center, where they are evaluated by a team of opticians and ophthalmologists who are responsible for checking if there is any pathology; and if so, its severity, the frequency of its follow-up or, if necessary, the referral to the ophthalmologist at your hospital for a more complete study or the establishment of treatment are established.Setting: Urban health area, en Castilla y León (Spain) Population and Sample:Diabetic patients (n = 3738).Time period: From November 2, 2017 to October 31, 2019. Results: Patients with diabetic retinopathy (DR) lesions: 471 (12,60%) Patients with other pathologies: 361 (9,65%)Patients referred to the Ophthalmology Service of the Hospital for DR: 63 (1,7%)Patients urgently referred to the Hospital Ophthalmology Service for other pathologies: 2 (0,05%) Conclusions: Teleophthalmology allows the early detection of one of the most important and frequent complications of diabetes: retinopathy associated with poor glycemic control. Examining patients remotely makes it possible to optimize the work of professionals as a result of better coordination between the different levels of care.In addition, it allows reducing referrals to the specialist's office and, consequently, reducing waiting lists, avoiding unnecessary trips for patients residing in rural areas.

Introduction: Diabetes mellitus (type II) is an expected to be the seventh leading cause of death in the world by 2030. Evidence have shown that fluctuations on glucose levels may not significantly influenced by increasing age, but mostly due to obesity and lack of physical activity. Therefore, the aim of this review is to present an overview of the effect of physical exercise on older people with type II diabetes. Methods: A literature review was conducted in biomedical database (PubMed) using MeSH terms such as ''insulin resistance'', ''exercise'', ''aerobic exercise'' etc, related to physical activity improvement. Articles in language other than English were excluded. Results: Evidence has shown that Well-designed progressively increasing intense of exercise programs improves cardiorespiratory function and consequently blood glucose levels. Also improves body composition, reduces fat mass, cholesterol and triglycerides and can reduce medication and insulin administration and even inhibit it. Resistance exercise is even more effective when it is combined with diet in overweight individuals. Conclusion: A physical activity of any kind can significantly improve the quality of life of older people with type II diabetes. Therefore, it is necessary for people with diabetes type II to include exercise and all forms of physical activity in daily living.

Impact of SGLT2 inhibitors on renal function in elderly with type 2 diabetes in the first-year treatment Introduction: SGLT2 inhibitors(iSGLT2) treatment was associated with a decrease in albuminuria and has reno-protective effect in diabetic kidney disease. This study aims to evaluate the effect of iSGLT2 on glomerular filtration rate(eGFR) and albuminuria in elderly inpatients during the first year of treatment. Methods: Retrospective cross-sectional study including elderly patients([ 65 years) with type 2 diabetes treated with iSGLT2. Data were collected at the iSGLT2 introduction and 3, 6, 9 and 12 months of treatment. Results: Were Included 115 elderly, 48.7% male, mean age 72.4 ± 5,2 years, median HbA1c 8.4±1,7% and median DM2 duration of 17 ± 12 years. Dapagliflozin was initiated in 60. 9% and empagliflozin in 39. 1%.An eGFR of 30-60 ml/min/1.73m 2 was observed in 21.7% with moderate albuminuria in 12.2% and severe albuminuria in 4.3%. Throughout the first year, there was a significant reduction in HbA1c (p \ 0.038). Regarding eGFR, no significant differences at the beginning and after 1 year were observed, nonetheless, a non-significant reduction was observed in the first semester, followed by a significant increase in eGFR (71.37-84.93 ml/min/1.73m 2 ; p.006) in the second semester. As to the variation of eGFR yearlong, there were no significant differences between dapagliflozin and empagliflozin, although in the first semester, empagliflozin presented a greater variation in eGFR (p = 0.021). There was no significant reduction in albuminuria.

Conclusion: In our sample of elderly patients, there was no variation in eGFR after 1-year treatment with iSGLT2, although it reduced in the first semester, particularly with empagliflozin, followed by an improvement in the next semester. Against evidence, Albuminuria did not ameliorate during the first year of treatment.

Evaluation of the estimated glomerular filtration rate with CKD-EPI equation of older adults aged 90 years and over with diabetes Liudmila Merkusheva 1 , Nadezda Runichina 1 , Sergey Lysenkov 2 , Irina Strazhesko 1 , Yulia Kotovskaya 1 , Anastasia Shvedko 1 , Natalia Sharashkina 1 , Olga Tkacheva 1 1 Results: Patients were 453 (mean 92,5 ± 2,5SD years), 79.2% were female. The main group included 64 (14,1%) patients with diabetes and 359 (79.2%) control group without diabetes. Main group didn't differ from the control one in age (92.0 ± 2.3 vs 92.5 ± 2.4, p = 0.12) and percent of women (85.9% vs 78.2%, p = 0.18).All patients demonstrated low levels of eGFR. Values of eGFR in main group vs control group by formulas: CKD-EPI Creatinine: 57,2 ± 12,8 vs 57,7 ± 13,1 ml/min/1.73m 2 (p = 0.79), CKD-EPI CystatinC: 31,4 ± 7,5 vs 32,6 ± 8,4 ml/min/1.73m 2 (p = 0.31),CKD-EPI Creatinine-Cystat-inC: 41,7 ± 9,6 vs 42,7 ± 9,9 ml/min/1.73m 2 (p = 0.47) respectively. Differences between values were decreasing along with the diabetes in means of eGFR, however, even using minimal values, one of the equation overestimates values versus another equation. It was found, that eGFR in older adults aged 90 years and over varied depending on the method of calculation with up to two-fold difference. Introduction: Diabetes is a growing public health concern, with a prevalence two times higher among elderly people compared to middle and younger ages and an estimate of 1/3 of geriatric population affected [1] . Complications of diabetes develop rapidly or over time and are the result of microvasulopathy affecting several systems and leading to events such as heart attack, stroke, kidney and ocular damage [2] . Methods: A PubMed search was conducted in English language for the last 6 years, in order to investigate and highlight various ocular complications associated with Diabetes in elderly population. Results: The hallmark of diabetes regarding the eye is diabetic retinopathy (DR). Loss of pericytes leads to capillary damage and eventual break in the inner blood-retinal barrier. DR may be proliferative or non-proliferative and the main risk factors are longer duration of diabetes and poor metabolic control. Concomitant diseases, commonly encountered in elder patients such as hypertension, hyperlipidemia, smoking and obesity may have an adverse effect on DR. Macular edema, ischemic maculopathy, vitreous hemorrhage and retinal detachment are the main sequelae of DR [2] . Visual impairment in the diabetic patient may also be attributed to corneal pathology such as punctate or neurotrophic keratitis, tear film abnormalities and endothelial changes. Finally, glaucoma risk is higher in diabetic patients as they are more susceptible to the development of Primary Open Angle Glaucoma and its progression or they can develop neovascular glaucoma secondary to proliferative DR [3] . Key conclusions: Untreated diabetes can result in visual impairment which can further negatively impact the quality of life. Routine eye examination is essential, since 90% of vision loss from diabetes can be prevented. National University of Ireland Galway, 2 University Hospital Galway Introduction: Management of type 2 diabetes mellitus (T2DM) in the geriatric population is both complex and nuanced. The American Diabetic Association has dedicated recommendations in this area. Without a systematic approach, and within the time restraints of a busy clinic, areas considered in these guidelines are not always addressed. We sought to audit our practice in Galway University Hospital (GUH) in relation to these guidelines. Method: Consecutive entries in the diabetic electronic patient record were reviewed. Entries were considered for inclusion in the audit, if the patient was born between January 1934 and January 1944, was community dwelling, and had been reviewed in the previous year for T2DM. Areas reviewed were: Assessment of geriatric domains, meeting HbA1C targets, seeking hypoglycaemic episodes and considering deintensification of treatment if a patient meets criteria. Results: 200 records were reviewed. The mean patient age was 79.7 years (SD = 2.7). 56% were male (n = 111). Assessment of geriatric domains was considered in only 22% of cases (n = 44). The mean HbA1c was 61.8 mmol/mol (SD = 15), with 67.5% (n = 135) either at or below target. Hypoglycaemia was sought in 75% of cases (n = 150), but regime deintensification was considered in only 17.4% of cases (n = 32). Conclusion: Certain areas that may impact quality of life and outcomes appear to be neglected in our current model of busy undifferentiated T2DM clinics. Exploring education, a dedicated diabetic geriatric assessment form, or dedicated diabetic geriatric clinics may be options to explore. Background: Vitamin D deficiency is increasing worldwide. Despite high ultraviolet irradiation in southern European countries, vitamin D levels were found to be low in older adults. Doctors are a crucial source of information to their patients and therefore this study attempts to assess knowledge and attitudes of Maltese doctors on sunlight exposure with regard to vitamin D deficiency. Methods: A cross-sectional survey of all Maltese doctors was carried out, excluding doctors that do not come into frequent contact with older adults and doctors who were not currently practicing/residing in Malta. In order to reach a 95% confidence interval with a margin of error of 5% a total of 847 medical practitioners were included. The survey was disseminated via an online link sent by e-mail and a hard copy via post. Descriptive statistics were used for data analysis. Results: The final population included 138 participants. 82.6% believe that exposure to outdoor sunlight is the main source of vitamin D in Malta. 44.2% managed vitamin D deficiency by giving advice to receive more natural sunlight. In summer 73.9% advice their patients to use sun protection at all times during the peak UV index. During the winter, 25.4% still suggest to use sun protection at all times during peak UV index, with 19.6% either giving the advice to use sun protection most of the time during peak UV index, but to S186

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 receive some direct sunlight, or to not use sun protection outside peak UV times and receive direct sunlight during this time.

Conclusions: A national clinical guidance on sun exposure with regard to vitamin D deficiency is recommended to be available for all Maltese doctors.

How to successfully promote adherence to geriatric interventions in socialization

Pascale Dinan 1 , Sylvie Bonin-Guillaume 2 , Helene Petit-Bhoyroo 3 1 Geriatrician, Member of EAMA and SFGG, Mauritian Republic, 2 Geriatrician, Marseilles CHU, France, 3 Rheumatologist, Member Of Mauritian And French Rheumatologist Society and the GRIO Loneliness is a prevalent problem for adult populations and yields negative feelings of depression, psychological stress and pain (1). Is is also linked with multiple chronic conditions such as metabolic and cardiovascular disease, overall morbidity and mortality. It is important to create social connectedness through which one has constructive relationships with individuals and groups. Many systematic reviews confirm that the most effective interventions are group interventions aimed at increasing skills, strengthening social support, increasing social interactions and socio cognitive training. They are more effective when their programs are individualised, adapted culturally to the participants, when they aim to promote a healthy active lifestyle and when done on a regular routinely basis (2, 3) . As an example we can refer to the multi-ethnic and multi-cultural ageing society of the Mauritian Republic, ranked highest in the African region (42th position) in the Global Age Watch Index 2015 measuring social and economic wellbeing of elderly (4, 5). The seniors can become engaged in geriatric interventions through free service non governmental associations (International Federation of Associations for elderly FIAPA and Alzheimer Association Mauritius, Third Age Mauritius University) and parastatal bodies (Senior Citizen Council of Mauritius comprising of 850 senior groups working for their well-being). The geriatric interventions in socialization include recreational and physical activites, various activities in retirement homes, life long learning and education, geriatric talks, cognitive stimulation in day care centers for Alzheimer patients. By promoting adherence to socialization a society of geriatrics and gerontology is thus emerging in the Indian Ocean region where health care professionals can share knowledge, organise congresses. Hence, it has a facilitating role on geriatric interventions in terms of training of care partners and continuous medical education, in raising awareness on geriatric topics towards different sectors of the community and in ensuring that government policy is on the right track (6).

A cross-professional qualification tool to optimized pharmaceutical care for geriatric patients (OAV) Introduction: The progress of modern medicine makes a longer life possible. At the same time, the combination of drugs can trigger serious diseases, so called adverse drug events (ADEs). Especially in the case of elderly patients with multiple morbidities and correspondingly extensive medication plans the dimensions of these events are greatly underestimated. In nursing care, 60 to 80 percent of these events are due to a lack of monitoring of therapy among other things [1] . The aim of the project OAV is to prevent or reduce ADEs through interprofessional team-partnership. Through interprofessional collaboration it is possible to increase medication safety in the long term [2] . This means that the various disciplines must expand their usual action patterns and cooperate. For this purpose, a cross-professional qualification tool was developed that builds on the previous experiences and resources of all actors involved (nursing staff, physicians and pharmacists) and sustainably increases the competence of the actors to guarantee treatment safety. Method: To determine the contents of the qualification tool, a document analysis was carried out. Existing curricula and corresponding professional articles/books served as a basis. The results were evaluated in several discussion rounds and finally condensed into a curriculum. The qualification tool is finally composed of six modules. One module comprises four chapters in which the technical and social competences are built up step by step.

Results: It is expected that the qualification tool will improve attention to drug therapy safety and thus reduce drug-induced risk situations for elderly patients. Recently, LUMC-researchers found that in undergraduate medical students, intrinsic motivation influences research involvement. The aim of our study is to examine perception and motivation of residents in elderly care medicine to conduct research and to evaluate attitudes around the mandatory WLO study. Methods: An educational ethics committee approved this mixedmethods study (NVMO: 2009.7.7). Residents of three groups that started March 2018, March 2019, and September 2019 were asked to participate. A questionnaire included validated perception and motivation scales with response options ranging 1 to 7. Qualitative interviews which also examined attitude regarding the WLO study were underpinned by interpretative phenomenological analysis. Results: Of 38 residents, 23 questionnaires were obtained (15 from female residents). The mean score on perceptions of research was 4.1 (SD 0.8), intrinsic motivation 4.8 (SD 1.0), and extrinsic motivation 4.3 with a higher SD of 1.4. There was also diversity in attitudes concerning research and the WLO study, related to any previous experiences in conducting research. Eight interviews indicated that doing research was experienced as difficult, in particular statistical analyses of the WLO data. Key conclusions: Residents show diversity of attitudes, and we found low motivation to conduct medical research compared with undergraduate students. This knowledge will be used to improve the mandatory WLO study. Abstract # 196 Educational policies and legislation at European level for LGBT+ inclusive education: building a MOOC Antonio López-Villegas 1 , Remedios López-Liria 2 , Patricia Rocamora-Pérez 2 , Alfonso Pezzella 3 1 CTS-609 Research Team, Poniente Hospital, El Ejido, Spain., 2 Hum-498 Research Team, Health Research Centre, University of Almería, Almería, Spain., 3 Research Centre for Transcultural Studies in Health, Middlesex University, London, United Kingdom Introduction: The European project IENE9 ''Developing a culturally competent and compassionate LGBT+ curriculum in health and social care education'' :aims to enhance the skills regarding LGBT+ issues and develop teaching tools to support their inclusion. Methods: Internet mapping and systematic documentation to develop a list of policy recommendations towards improving and safeguarding LGBT+ people. Seven countries (UK, Spain, Italy, Cyprus, Romania, Denmark, Germany) co-work to create an easy to navigate resource with information about legislations/guidance/policies. Finally, development of the training courses with tools and methodologies to strengthen theoretical and practical knowledge and skills on LGBT+ issues, and to affect attitudes and prejudices in the relationship with LGBT+ patients/users who ask for psychological support or health care. Results: There is a growing awareness of the need for LGBT+ competency training to ensure that the health and social care services offered to LGBT+ people are suitable and gender sensitive. Emerging lines of inquiry to improve health include populations such as LGBT+ veterans, reproductive health and parenting, intimate partner violence, sexual minority persons living with chronic illness, disability, etc. Key conclusions: In some cases, healthcare professionals do not know how to approach and provide treatment to LGBT+ persons and admit their need for specific training. The program aims to improve this environment, with observance of human rights and free from all forms of discrimination and violence. A new culturally competent and compassionate LGBT+ curriculum will be developed and delivered through a MOOC for health and social care teachers/workers and learners worldwide. Introduction: To know the prevalence of functional decline in hospitalized elderly patients and implement an early mobilization strategy, with the participation of patients, caregivers and health workers. Method: Interdisciplinary team intervention. The prospective study enrolled patients admitted to the acute geriatric unit, between April and June 2018. Patients excluded: those in palliative care, with severe dementia and with Barthel Index: \ 20. Patients were divided into three levels: Level A: able to walk, B: able to transfer to a chair, C: not able to stand. A complete evaluation of mobility was conducted, during admission, hospitalization and discharge. Clinical and epidemiological characteristics were collected. Results: Creation of posters to identify mobility level, multicomponent exercise protocols and mobilization activities for each level, design of mobility promotion posters and brochures. 32 patients out of 102 admitted to the study period were included. Average age 86.6. Average length of stay: 9.8 days, Barthel index median at the admission: 62.2 and at the discharge: 57.6, Mini Nutritional Assessment Short Form: 9.22. Mobility Level Registration: 90%. Patients and/or family members who received brochure:80%. Functional decline associated with hospitalization: 31.2% (70% male, 50% older than 90 years old, 70% institutionalized, 50% moderate dependence, 80% dementia, 60% malnourished, 90% delirium) Conclusions: The establishment of an early mobilization strategy is possible with the involvement of the health workers, patients, and caregivers.• Functional decline among hospitalized elderly patients is common but with an early intervention, this can be reduced. Objective: Being active and history of physical activity (PA) habits are nowadays recognized as important predictor to prevent physical aging. However, it is unclear if sex or age influence this relationship and if a sub-type of voluntary PA is more efficient to maintain healthy aging. Thus, we aim to assess the impact of the last 5-years of PA level and functional capacities and body composition among elderly people. Material and methods: Functional capacities using different validated tests (i.e. grip strength, Timed Up and Go, sit-to-stand, muscle power, alternate step test, leg extension, VO2 max), body composition (fat & fat-free masses) using DXA were assessed. Last 5-years of global (total) and specific (aerobic, resistance or body and mind) PA levels (duration) were obtained through a questionnaire. Multiple regressions, adjusted on age, sex and BMI, were performed to assess the relationship between past PA level and body composition or functional capacities. Sub-group analysis, according to the sex and age (\ 65 year vs. C 65 year) were also performed using Pearson Correlations. Results: 525 subjects (61.7 ± 8.1 year; women: 68.9%; BMI = 26.4 ± 4.8 kg/m 2 ) were enrolled. After adjustment on confounding factors, past level of PA has no impact on functional capacities and body composition, regardless of sex. Among people under 65 years, there is no relationship between time spent on total physical activity and functional capacities or body composition. However, our study found a significant correlation between total physical activity and balance (r = 0.19; P = 0.01), alternate-step test (r = 0.24; P = 0.02) and VO2 max (r = 0.19; P = 0.02) in people aged 65 and over. More precisely, the time spent on cardio and resistance activities influence balance (r = 0.16; P = 0.03 and r = 0.15; P = 0.04, respectively) in this age category. Conclusion: Our results highlights that PA history has little or no influence on functional capacities and body composition in healthy aging population.

Eur Geriatr Med (2020) Introduction: The implementation of evidence-based practice (EBP) has tremendous benefits in health care systems including the quality improvement, reliability, and patients' best outcomes [1] . As nurses' play a crucial role in the delivery of health care, they need to embrace new and innovative techniques to provide effective and best possible treatment to their patient. Nevertheless, it was found that several institutional and personal barriers were hindering nurses' for adopting EBP [2] . Methods: The authors carried out a bibliographic search using Medline database for scientific papers published over the last decade. Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings).

Results: The international literature highlights that the majority of nursing personnel holds a positive attitude towards EBP, but individual and organizational barriers can hamper the implementation of EBP [3] . According to experts, the top barrier is the lack of nursing competencies toward EBP in terms of knowledge, skills and attitude. Furthermore, lack of time, low self-confidence, absence of EBP mentors and limited leadership can influence the quality of nursing practice [4] . Research has found that other common barriers to EBP embracement in the clinical setting are the lack of informational resources, poor understanding of research findings, appraising and synthesizing the evidence and resistance to change [4] . M. Predictors of evidence-based practice knowledge, skills, and

Introduction: The aim of the study was to develop an innovative model for the holistic interdisciplinary approach of elderly over 65 who had a fragility fracture in order to improve their quality of life. Method: Through literature review, good practices abroad were studied, as well as Greek efforts made to deal with fragility fractures. It was found that most programs are based on patient mobilization with a focus on exercise, nutrition and pharmaceutical interventions, in a dual effort for the treatment of polypharmacy and osteoporosis.

A key finding for the Greek reality was that the main problem in supporting efforts for elderly patients with fragility fractures outside the hospital was the low compliance to the guidelines. Based on this finding, the idea of a Community model of care was developed with the aim of empowering elderly patients with fractures and improving the level of their compliance, in order to avoid a second fracture. A six-month multilevel, digital intervention program, entitled ''School of Healthy Aging'', was designed, including: Individual physical exercise, Nutritional education, Falls Prevention Training, Search of spirituality, Development of an experiential relationship with interdisciplinary team members. Conclusions: This model is in the process of implementation, as it will be applied to a group of twenty (20) elderly patients in the second semester of 2020 and its results will be published.

Overview of Junior geriatricians' profile: training, activities and risk of burnout: results of a French national survey Introduction: Geriatrics is a professional field that has evolved rapidly throughout the world, particularly in recent years. Thus, the individual profiles leading to the practice of our speciality are varied. The French Association of Young Geriatricians aimed, , through its 2020 national survey, to provide a picture of the profile and training of geriatricians in their early carreer (specialist geriatricians with less than 8 years experience).

The survey was carried out in the form of an online questionnaire sent to members throughout France. It consisted of a three-part structured form:(1) description of academic training, (2) description of the mode of practice and (3) description of personal background. Finally, the wishes for future practice and the feeling of burnout risk were collected. Results: One hundred and fifteen participants responded to the survey. Their responses confirm the eclecticism of geriatrician profiles. Nevertheless, certain trends emerge. In particular, it can be noted that initial training is mainly a qualification in general medicine. Most of the practice is full-time, with multiple activities (predominance of regular activity in acute care combined with consultation activity) and participation in permanent care. The practice assignments are mainly fixed-term contracts. More than half of those surveyed feel that they are or have been in an episode of potential burnout. Finally, most respondents are female, in relationships, having young children.

Conclusions: This first national survey describing the profiles of geriatric practices could serve as a support to support the evolution of our profession.

Geriatric ultrasound training program for general practitioners Vito Carrieri 1 , Antonella Bray 1 , Giovanni Argentieri 1 , Vincenzo Paternò 1 , Gloria Mazelli 1 , Luca Di Lena 1 1

Introduction: The professional activity of General Practitioners(GPs)is prevalent with commitment of time and resources for patients over 65 years. Objectives of the work are to illustrate a Geriatric Ultrasound training program for GPs,according to practical clinical ultrasound objectives and starting from real clinical cases,and to evaluate the impact on the approach of GPs to the problems of elderly patients. Materials and methods: A 5 day Geriatric Ultrasound traininig program was carried out addressed to the Gps,with theoretical and practical activities in the department of Geriatrics.10 groups of GPs were set up each of 3 people,10 tutors were used,who carried out teaching activities. Each of the 30 GPs has personally run at least 30 US. Every day 2 hours of interactive lessons with presentation of clinical cases and 3 hours of practical activity were performed. Some clinical situations have been examined,both from an ultrasound and from a clinical point of view:chronic heart failure, liver cirrhosis, chronic renal failure, urinary retention, acute renal failure, jaundice, weight loss, lymphadenomegaly and fever, severe anemia, digestive haemorrhage, abdominal pain, intestinal obstruction, digestive haemorrhage, hematuria, abdominal volume increase, pulsating abdominal mass, neck mass, pelvic mass, rectorrhagia, metrorrhagia, hydrocele. Results: After the 5 day training program,all GPs were much more motivated in dealing with acute and chronic practical problems of geriatric patients.The US performed in selected patients in relation to the clinical problem and symptoms frequently encountered in clinical practice, has allowed the correlation of symptoms,diagnostic hypotheses and ultrasound findings. The Gps easily formulated diagnostic conclusions,prescribed the further diagnostic procedure or subsequent therapy with high appropriateness. A questionnaire proposed to GPs 6 months after the ultrasound training program, allows to confirm that the approach to the clinical problems of the elderly patient, examined with ultrasound in the training program,allows to observe a better outpatient management.The numbers of specialist consultations and of hospitalizations were reduced by 30% compared to the usual management methods before attending the Geriatric Ultrasound training program.

The results obtained demonstrated the usefulness of ultrasound competence for GPs in patients over 65 years.The ultrasound examination also has allowed to detected unknown diseases of the elderly patients. The Gps can learn the easy management of the S190 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 elderly patient , without invasive diagnostic methods.The increase in the prescribing appropriateness of GPs confirms that ultrasound is an indispensable method for daily clinical practice of Gps in the management of geriatric patients.

How clinically vulnerable doctors can contribute during a pandemic -lessons from COVID-19

Marianne Phillips 1 , Catriona Davidson 1 , Harriet Mark 1 , Parth Patel 1 , Stefanos Kateroglou 1 1 Addenbrookes, Cambridge University Hospital

Introduction: In March 2020, in response to the COVID-19 pandemic, the UK Government classified approximately 1.5 million individuals as extremely vulnerable and advised them to ''shield'' [1] . Shielding comprised advice to stay indoors and avoid contact with the general population. This included a minority of UK healthcare workers who faced a complete change in working, at a time when the pressure upon both hospitals and colleagues was set to increase. The feeling of responsibility permeates all aspects of a doctor's life and hence doctors cannot simply leave their working identity at the hospital [2] . We describe our experience as a small cohort of ''shielded'' doctors from a large Teaching Hospital. Whilst working from home, under the supervision of a Consultant Geriatrician, we instigated a number of projects to support patients and colleagues.

Methods: A policy on remote working for self-isolating medical staff was ratified in April 2020. The team comprised of 1 Consultant Geriatrician and 5 trainees. Clinicians undertook three strands of working practice: clinical work, education and research. Results: Clinical work: a telemedicine service was established to proactively manage patients with COVID-19 at home. Educational work: a medical emergencies handbook was developed and disseminated throughout the region to support re-deployed clinicians. In addition, online lectures for medical students and doctors were provided to replace face-to-face teaching. Research: involvement in a number of projects including data collection for a multi-centre study.

Conclusion: Despite being confined to home we feel that we have made a significant contribution to the efforts in tackling COVID-19.

References: (1) Guidance on shielding and protecting extremely vulnerable persons from COVID-19: https://www.gov.uk/ government/publications/guidance-on-shielding-and-protectingextremely-vulnerable-persons-from-covid-19/guidance-on-shieldingand-protecting-extremely-vulnerable-persons-from-covid- 19 [23/05/ 2020] . (2) Wessely, A. & Gerada, C. When doctors need treatment: an anthropological approach to why doctors make bad patients. BMJ 347, (2013).

What does COVID-19 mean for inter-professional education?

Louise Thornhill 1 , Gillian Shepherd 1 , Sanja Thompson 1 1

Geriatric medicine could be considered the epitome of multidisciplinary patient management. It requires the co-operative input of physicians, nurses, speech and language therapists, physiotherapists, occupational therapists and more. Their effective collaboration is vital to improve overall health outcomes in the geriatric population. The underlying concept of inter-professional education (IPE) is that a workforce trained in an inter-professional environment will be better equipped to work within the multidisciplinary team (MDT), leading to improved outcomes and care of older patients. During recent years, the Geratology department of Oxford University Hospital, in conjunction with the Oxford Medical School, and Oxford Brooks University have been establishing a curriculum of IPE and teaching using case-based discussions involving students from a multitude of training programs. The COVID-19 pandemic and its social distancing requirements have significantly disrupted student teaching. With little hope of resuming normal face-to-face teaching programs in the near future, we have been evaluating how to safely deliver IPE in the current climate. Methods of distanced IPE teaching used by other institutions include online seminars, presentations, teaching modules, discussion forums for case studies, virtual clinic and video conferencing and live grand rounds. In the upcoming months we aim to restart Geratology IPE teaching using a modified teaching curriculum. We intend to use strategies such as prerecorded communication skills scenarios with professional actors and online presentations, with live student participation. This is with the understanding that flexibility in plans will be required. The outcome of our socially distanced teaching will be evaluated by students and educators.

Reduction of family caregivers' burden by an innovative videobased remote coaching system with a multimodal comprehensive care methodology for dementia: a feasibility study

Masaki Kobayashi 1 , Saki Une 1 , Sumio Yasutake 2 , Miwako Honda 1 1

Background: Family caregivers experience psychological, physical, and social burdens in caring for patients with dementia. This study was conducted to assess the feasibility of a video-based remote coaching system with multimodal comprehensive care methodology training to reduce the care burden of family caregivers of people with dementia at home. Methods: A pre-post prospective study was designed. The participants were six family caregivers. First, they received on-site training for a multimodal comprehensive care methodology. Subsequently, participants recorded their care at home on an iPad and sent to the coach online. The video was evaluated by the innovative system which recorded the comments of the coach, and simultaneously drew recommended movements of caregivers with arrows which was recorded on the same video. The participants reviewed the video and practised at home. The duration of coaching was three months. Feasibility was analysed using the Zarit Burden Interview (ZBI) score, semistructured interviews, and questionnaires. Results: Four participants completed the three-months follow-up. The reason for the dropout was a difficulty in using an iPad. The ZBIscore decreased (41.3-40 .0, P = 0.95), but was not statistically significant. The four participants were satisfied with the programme as revealed in interviews.

Conclusions: This feasibility study of an innovative remote coaching system with multimodal care methodology can reduce family caregiver burden for patients with dementia. An expanded study needs to be followed.

Analysis of sedentary behaviour patterns in nursing home residents 

Introduction: The Covid 19 pandemic led to the cessation of face to face teaching at the University of Oxford Medical School as it did amongst many universities globally. The use of online teaching in undergraduate medical education (including online lectures) has been shown to achieve similar outcomes compared with face to face delivery [1] . In response, the geratology department delivered its series of 4th year undergraduate teaching sessions online through prerecorded lectures via the software Canvas for individual student use.

Here we evaluate the novel use of online material to deliver the undergraduate geratology curriculum at Oxford University Medical School.

Method: Feedback for face to face and online lectures was evaluated and compared using feedback forms recording learner comments and multi-domain learner rated scores. A focus group consisting of lecturers and students was also conducted. Comments were evaluated using thematic analysis and feedback scores compared.

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

Results: Online delivery enabled more content to be taught and also encouraged individual learning styles through self directed student exploration of lecture resources whilst maintaining social distancing. 

Objectives: The aim was to review evidence from all randomized, controlled trials using palliative care education or staff training as an intervention to improve nursing home residents' quality-of-life (QOL) or quality of dying (QOD) or to reduce burdensome hospitalizations. Design: A systematic review with a narrative summary.Setting and participants: Residents in nursing homes and other long-term care facilities. Methods: We searched PubMed, CINAHL, PsycINFO, Cochrane, Scopus, and Google Scholar, references of known articles, previous reviews and recent volumes of key journals. Randomized controlled trials (RCT) were included for the review. Methodological quality was assessed. Results: The search yielded 932 articles after removing the duplicates. Of them, 16 cluster RCTs fulfilled inclusion criteria for analyses. There was a great variety in the interventions in respect to learning methods, intensity, complexity and length of staff training. Most interventions featured other elements besides staff training. In the six high quality trials only one showed reduction in hospitalizations, whereas among six moderate quality trials two suggested reduction in hospitalizations. None of the high quality trials showed effects on residents' QOL or QOD. Staff reported improved QOD in one moderate quality trial. Conclusion and implications: Irrespective of means of staff training, there were surprisingly little effects of education on residents' QOL, QOD or burdensome hospitalizations. Further studies are needed to explore the reasons behind these findings Introduction: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has impacted healthcare institutions worldwide leading to uncertainty and disruption among medical schools for students on clinical placement. Many universities, including our institution, paused all clerkships for several reasons; for safety of students and hospital patients given the contagious nature of SARS-CoV-2, cancellation of procedures, active transition to telehealth services and limited stocks of personal protective equipment (PPE). In lieu of the clinical geriatric placement model, all teaching was transitioned to case-based collaborative, online sessions. Our aim was to determine the efficacy of this model and its acceptability to students when compared with the traditional model.

Methods: All third-year medical students attending the online collaborative sessions were invited to anonymously complete an electronic feedback survey. Results: 60/200 students completed the survey. Of these, 65% found the online format straightforward to navigate and 96% found it easy to ask questions with 80% finding it easier to ask questions than in person setting. 43% had completed a clinical geriatric medicine placement. Themes which emerged from students' reflections on the new model included lack of face to face communication with older persons, the reality of managing multi-morbidity and polypharmacy in the hospital setting, practising gait and delirium assessments and missing on-site interaction with the multidisciplinary team. Key conclusions: Students demonstrated insight into core principles of management of the complex older person often learned during clinical immersion. Medical educators must be cognisant to incorporate these competencies in adapted curricula such as hi-fidelity simulation.

Converting a traditional undergraduate geratology course in year 5 into an online learning module in the COVID-19 era Christopher Horton 1 , Ellen Brunet 2 , Charlotte Willis 2 , Sanja Thompson 1 1 University of Oxford, Oxford University Hospitals NHS Trust, 2 Oxford University Hospitals NHS Trust Geratology teaching for University of Oxford fifth year medical students is delivered using traditional formats, including lectures, tutorials and quiz-based consolidation sessions. Following the COVID-19 outbreak, traditional face-to-face geratology teaching was halted. Lecturers were therefore required to develop and deliver remote teaching sessions through alternative methods. We aimed to compare students' opinions on the novel, online geratology teaching provision with existing traditional teaching methods. Prior to COVID-19, feedback on geratology teaching was collected using both paper and online forms. Following the cessation of face-to-face teaching, sessions were converted to virtual formats: lectures were recorded, small group teaching transferred to online platforms and quizzes adapted into online assessments. Feedback was collected using online forms and mixed method comparisons were made. The comparison will include student attendance and the ability to achieve the desired learning outcomes. We know from the students that, although they appreciated the flexibility allowed by online learning, some reported reduced ability to maintain attention to topic matters in comparison to in-class lectures. We will also analyse the impact on the students' ability to ask questions and for teachers to provide immediate feedback, which may not be easily replicated using pre-recorded, online platforms.We now aim to incorporate a combination of pre-recorded and live online teaching sessions to meet all desired learning outcomes, as well as to ensure students can engage in thoughtful discussions and critically assess their academic progress. We also aim to provide pre-recorded sessions with geratology patients in place of face-to-face bedside teaching sessions. Introduction: Educational opportunities on practical aspects of management of frailty are scarce in countries where geriatric medicine is under development. We aimed to evaluate the feasibility and efficiency of a short educational program for primary health care (PHC) professionals on the detection, assessment and management of frailty.

Methods: A single-day workshop on frailty was organized by the Aristotle University of Thessaloniki PHC Research Network, in November 2019 in Thessaloniki, Greece, facilitated by three physicians trained in geriatrics abroad. Self-administered anonymous questionnaires were delivered before, upon completion and 3 months after the workshop to evaluate attitudes, knowledge and everyday practices regarding frailty, using Likert-type scales. Results: Out of 31 participants (17 physicians, 12 nurses, 2 health visitors), 31 (100%) filled in the first, 30 (97%) the second, and 25 (81%) the third questionnaire. Significant improvements were reported in familiarization with the frailty syndrome (p = 0.041) and in self-perception of knowledge and skills to detect (p \ 0.001) and manage (p \ 0.001) frailty, that were also sustained 3 months afterwards (p = 0.001 and p = 0.003 respectively). Significant change was observed in the attitude that frailty is an inevitable consequence of aging (p = 0.007) and in the reported frequency of application of screening (but not management) strategies, 3 months following the workshop compared to baseline (p = 0.014). Level of agreement that systematic screening for frailty was unfeasible in their daily practice was 2.4/5 three months after versus 1.6/5 before the workshop (p = 0.006). Conclusions: A short skill-oriented educational program can significantly and sustainably improve PHC professionals' attitudes and practices regarding frailty.

of Medicine, ,,Carol Davila'' University of Medicine and Pharmacy, Bucharest, Romania Introduction: According to ICD11, burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. Our research aims to identify the qualities of an anti-burn-out space within the elderly care institutions. Methods: We used focus group method, 4 participants working in elderly care institutions (MD geriatrician & psychiatrist, psychologist, scientific researcher biologist & physical therapy assistant, physical therapist) and one facilitator (architect). During 1 hour 17 relevant questions were asked on the issue of burn-out which concerned: work volume, needs of breaks/relaxation for each professional, preferences in terms of relaxation activities and the architectural qualities of a relaxation space at work. Results: The professionals responded that they work between 5 and 12 hours per day and fatigue occurs from 7 hours onwards. All professionals considered that activity with the patient is greatly influenced by the quality of the space in which it takes place. Professionals have opted for both passive and active relaxation. At none of participants' workplaces exist spaces dedicated to staff relaxation. Natural light, colours, natural soundcapes are preferred. A relaxation space is intended to be different from the one professionals work in, sometimes tonic, cheerful, sometimes quiet and comfortable, with areas of interaction but also with the possibility of being alone, connected to internet or practising mindfulness techniques on individual basis. Key conclusions: The research clearly revealed the need for spaces specifically dedicated for staff relaxation although the claims proved to be quite small. These suggest insufficient education about space potential in preventing burn-out among healthcare professionals.

Teaching communication skills: feedback from students and actors

David Molinas Zocche 1 , Sanja Thompson 1 1 Oxford University Hospitals NHS Introduction: Many healthcare professionals lack confidence and skills in communicating with patients suffering from dementia, especially if patients also suffer with behaviours that challenge. The communication skills course for medical students addresses these issues. Methods: The course was delivered with the help of professional actors and focused on non-verbal communication; managing a triadic interview with a patient, relative/carer, and clinician; and managing behaviour that challenges. 89 students attended the course in January and February 2020. Both students and actors evaluated the course via anonymous written feedback. Quantitative and qualitative data were analysed. Results: All students provided feedback. Average response regarding usefulness was 4.78/5. 78% of students ranked 5 points considering the session very useful. As for ''how well was teaching conducted'', the average score was 4.87/5 with 86% students scoring 5 points. Students indicated addressing carers' concerns and learning deescalating techniques as main learning points. Students gave no negative comments and suggested more time for scenarios, individual feedback and debriefing. The actors identified more areas for improvement. They were concerned about responsibility allocated to them when working with less experienced facilitators, about short time allocation for each scenario and for reflection after scenarios. Actors suggested encouraging students to express their thoughts in between role-plays and querying about previous experience with dementia. The lack of discussion of broad range of approaches being discussed was also identified. Conclusion: Although feedback in education usually focuses on students and facilitators, exploring actors' perspective may highlight further areas for improvement of future teaching sessions.

Strategies supporting residential homes in the geriatric palliative care: close cooperation between acute geriatric care in hospital and residential homes Introduction: A lot of geriatric patients admitted to the hospital suffer from one or more chronic progredient diseases (oncological and also non-oncological) and need except for treatment also some palliative care (early, middle or late). Approximately fourth part of admitted geriatric patients is from residential homes. Especially in Czech residential homes is not the palliative care fully developped. We were searching for strategies how to support residential homes in the palliative care. Methods: Geriatric patients admitted to the hospital especially from residential homes are examined not only with Comprehensive geriatric assessment, but also with NECPAL CCOMS-ICO 2 tool, Palliative Prognostic Score (PPS) and Palliative Prognostic Index (PPI). Patients with the need of palliative care and their relatives are discussed on diagnosis, prognosis, advance care planing and their needs. Results: We started close cooperation with 14 residential homes and prepared for them individual palliative care plans for their residents who were admitted to the hospital. We started educate nurses and general practitioners in these residential homes in the palliative care. As a first result of our work was significant decrease of readmission of dying patients because of better terminal care in residential homes. Key conclusion: Close cooperation between acute geriatric care in hospital and residential homes in the field of geriatric palliative care and education could be the way of increasing the quality of life of the palliative geriatric patients.

Paramedics' perceptions on advance care plans and end-of-life in the community: results of a survey Alvin Shrestha 1 1

Introduction: Advance care plans (ACP) establish what treatments patients may or may not want and form an important part of care patients with frailty and co-morbidity. Paramedics are often the frontline staff encountering such patients at a time of crisis and must decide what treatment to offer and ultimately whether to convey to hospital or not. This study was designed to find out their perceptions in managing such patients, including at end of life, through advance care plans. Method: A survey was created and copies left in Croydon University Hospital's Emergency Department for paramedics to voluntarily fill, with a total of 52 completed surveys collected. Results: Paramedics find ACPs helpful but only if they are detailed enough-only 27% of paramedics thought they were good enough ''most of the time''. Paramedics value, specifically, advice on how to manage expected symptoms, baseline observations, baseline behaviour, prognosis and contact details of services involved in patients' care. Hospice advice in-hours and community rapid response were favoured as the best services in managing end of life at home, whilst hospice out-of-hours and General Practice (GP) out-of-hours ranked the worst. This was reflected in which services required the most improvement, with hospice out-of-hours and GP out-of-hours coming out as the highest in need for improvement. Conclusion: ACPs need to be detailed and specific to be of most use. There may be a need for improvement to both hospice and GP out-ofhours services to help end-of-life care in the community.

Palliative thoracentesis and pleurodesis at home Introduction: Malignant pleural effusion (MPE) is a very distressing condition for the patient, generally requiring symptomatic relief. However, most of these patients are long-suffering, at a terminal stage of their disease and negative to any transportation outside home. Ultrasound-guided thoracentesis could be a key palliative intervention for the management of this vulnerable population at home. Methods: Two patients (69 and 79 years old) with metastatic breast cancer, suffering from severe, recurrent, symptomatic MPEs, required thoracentesis, but refused to leave their house. After written consent, an indwelling pulmonary catheter (IPC) (Pleuracan-B. Braun) was inserted at home under portable ultrasound guidance (Chison ECO 5). Results: In one patient the IPC remained for 10 days and chemical pleurodesis with sterile talc powder (4 grams of graded talc) was attempted. Subsequently, she remained free of respiratory symptoms (dyspnea, chest discomfort or heaviness, cough) for the last 2 months of her life. In the second patient, the IPC remained for 15 days. After removal of the IPC, no new thoracentesis was required thereafter, probably due to autopleurodesis. The patient did not experience any severe respiratory distress until the end of her life 70 days later. In both patients, after IPC removal, lung sliding could not be detected with thoracic ultrasonography. Conclusion: Palliative thoracentesis and pleurodesis under ultrasound guidance could be safely and successfully performed at home from a skilled staff without need for transportation of the patient.

Is secure mailing communication possible for elderly patients hospitalized in a French teaching hospital?

Durand Amaury 1 , Chenailler Catherine 1 , Varin Rémi 1 1

Introduction: In France, the General Data Protection Regulation (GDPR) established in 2018 strengthens the patients' rights and empowers actors dealing with critical data such as health data. The hospital report and associated documents should be provided at discharge to community professionals by secure messaging. We wanted to know whether this approach was feasible for patients leaving acute geriatrics or rehabilitation care from our French teaching hospital. Methods: During a 5 months period (November 2019-March 2020), for each patient who benefited from a medication reconciliation, were recorded the general practitioner and community pharmacist identities and the existence of a secure messaging. Then, we were able to calculate the percentage of professionals who could benefit from a secure information transmission at discharge. Results: 493 patients benefited from a medication reconciliation. The general practitioner and community pharmacist identities were filled respectively for 414 (83.9%) and 366 (74.2%) patients. 267 (64.5%) general practitioners and 222 (60.7%) pharmacists had secure messaging. Key conclusions: According to an extraction from ASIP Health data, 12.2% of French physicians and 52.1% of French pharmacists, all specialties combined, had secure messaging in December 2019. The results of our study testify that the secure messaging deployment is good in our region, in particular through the training sessions organization with hospital and community health managers since 2017. However, it remains perfectible in order to allow secure and fast transmission of information at discharge. Introduction: Advance care planning (ACP) allows people to plan for their future care needs. It is important but underutilised in noncancer conditions, such as Parkinson's disease. We aimed to explore the experiences of ACP for people with Parkinson's disease, atypical Parkinsonian disorders, their family carers and healthcare professionals. Methods: We conducted a systematic search of online databases in April 2019; using a narrative synthesis approach, thematic analysis and tabulation to synthesise the findings. Results: We identified 507 articles and 27 were included. There were five themes: (1) What is involved in ACP discussions? Discussions included a wide range of topics, but coverage was patchy. (2) When and how are ACP discussions initiated? It was unclear when it should be initiated, some patients wanted early discussions, but others did not. It depends on patients' readiness and professional's willingness to discuss the topic; which often resulted in discussions first taking place in response to a crisis, such as a hospital admission. (3) Barriers to ACP. This included a lack of information and knowledge related to palliative care by both patients and professionals, and practical barriers such as time in consultations. (4) The role of healthcare professionals. Access and collaboration with palliative care services and multi-disciplinary teams led to clear plans. (5) The role of the family carer. Carers were a facilitator but could be a barrier if emotionally burdened. Key conclusions: This evidence was used to highlight eight effective components to support optimal ACP in Parkinsonian disorders, which can inform best practice.

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 Introduction: Palliative care is multi and interdisciplinary, specialized care focused on improving quality of life for patients with serious illness(both oncologic and non-oncologic) and their families, since the diagnosis to the bereavement. The PalliativSe Care Team (PCT) is a multidisciplinary team that has many possibilities of evaluating the patients-outpatient clinic, inpatient evaluation, home consultation and telephonic follow-up. Conclusion: Although the preferred place of death is at home, it is often not possible for this wish to be fulfilled, whether due to the impossibility of the patient's management by the caregivers or due to the current insufficient response by the PCT (community and hospital). This close follow-up, promoting dignity and comfort is well received with gratitude.

Performance of the socio-health assessment unit in traumatology Conclusions: The profile of the patient with a hip fracture is similar to that of other territories, being an elderly patient with a right intracapsular fracture, whose stay does not generally exceed 6 days.

Elderly-femoral fractures-prevention In the geriatric field, a large chapter is dedicated to falls in elderly subjects, also great interest is aimed at fractures of the femur deriving from these falls. Today we are increasingly talking about prevention, but perhaps we are not talking about health education in the home.We know that most femoral fractures occur in the home environment (inadequate slippers, slipping, stumbling block, rapid movements etc ...) and that most individuals are female.In light of the above, from 1 November 2019 Twenty-six fell exactly in the domestic environment, two down the outside steps, one on the sidewalk, one, car accident. The data confirmed what previously stated and also demonstrate that the patients in this study still show good functional activity and memory, considering their average age. In conclusion, we believe that a good disclosure could prevent acute events thus avoiding the loss of daily functional and instrumental activities

Comprehensive hospitalist care for elderly patients with vertebral compression fracture Takahiko Tsutsumi 1   1 Takatsuki General Hospital

Introduction: Vertebral compression fracture (VCF) is traditionally seen only by orthopedic physicians in Japan. Although common in geriatric patients, it requires specific care; as well as acute management of VCFs, maintenance of quality of life may also require comprehensive geriatric assessment and prevention of additional fractures. Currently, such a multi-faceted approach to VCF in the elderly is thought to be uncommon in Japan. We investigate the impact of co-management of VCF by hospitalists compared with orthopedic treatment alone. Methods: In a retrospective single-center Japanese observational study, we assessed patients over 65 years old who were admitted with VCF. Usual orthopedic care (UOC) was provided between January and August in 2017 and 2018, and between January and August in 2019, patients received comprehensive hospitalist care (CHC). We compared patients in CHC group with patients in UOC group. Variability of functional independence measure (FIM) was evaluated with FIM on the admission day as covariate. We also evaluated cost, length of stay, initiation rate of treatments for osteoporosis during hospi- 

Introduction: Falls are a major source of harm in older adults in Ireland and internationally. Patients admitted to hospital have defined pathways of care. However, we have noted gaps in services for those discharged in our hospital's catchment area. Method: We retrospectively reviewed ED notes of patients aged C 65 discharged from ED with a fall in November 2019 in a university teaching hospital. Results: Of 123 older patients discharged after a fall, 27 (21.9 %) were seen by FITT (Frailty Intervention Team); 18 patients (14.6%) were referred to community falls services. There were 52 patients (42%) discharged out of hours. Patients discharged out of hours are not seen by FITT. Fractures were sustained in 29 patients (23.6%). Only 3 patients with fractures (10.3%) were referred to services. Services for early identification and intervention in patients suffering osteoporotic fractures are lacking. Community falls services are urban centric with 44% being outside the catchment area. Conclusion: FITT functions as the cornerstone of multidisciplinary integrated care in our hospital. We believe this is an effective model of care. However, services and staffing must be commensurate with the needs of the increasing number of patients with falls. Patients discharged out of hours and patients living outside of catchment areas need improved services. Falls pathways must employ early identification and community intervention for patients suffering osteoporotic fractures. As the population in Ireland and in Europe ages, such effective pathways of integrated care become even more important.

Fracture of the left proximal humerus, after accidentally falling from its own height. 85-year-old woman, who presented pain and functional impotence in the left shoulder after accidentally falling from her own height forward. It denies the loss of sensitivity in said member. No traumatic brain injury or previous dizziness. Physical exam: conscious and oriented, good general condition, normohydrated, eupneic. Left shoulder: hematoma and pain in the left shoulder, in the lateral anterior and lateral zone, mobility limited by pain, good mobility of the elbow, good pulse and distal perfusion. Shoulder X-ray: Left proximal humerus fracture.Therapeutic plan: arm with the position of immobilization in a sling (placed outside the clothing). Local ice. Mobilization of the elbow and fingers. Paracetamol 1 g every 8 hours.Evolution: revision at 17 days, immobilized with a sling. She is now a caregiver dependent for activities of daily living, previously the fracture was independent. You have performed scheduled exercises. RX control: no bone displacement. Physical examination: normal flexion, abduction of 808, internal rotation of 458. Therapeutic plan, immobilization with a sling for one more week. It is included in an early mobilization protocol and is referred to your family doctor for control.Final comment: The importance of this case for Primary Care is the mechanism of fracture production: from the patient's own height, who apparently does not suffer from underlying pathologies that make her vulnerable. However, he has already presented a fracture due to a mechanism that should not cause it, so bone fragility should be suspected. At this point, it is essential to confirm the existence of osteoporosis in this patient, and to establish preventive and therapeutic measures to improve bone status and prevent future fractures or other complications.

Complicated hip fracture

Iker Introduction: Hip fracture is a frequent process in the elderly population in which it is necessary to make an early diagnosis and adequate and coordinated treatment between orthopedists, rehabilitators, geriatricians and specialists in primary care. Description of the case: 70-year-old patient who goes to the emergency department after suffering a fall at home. He reports pain in the lower right limb at the level of the upper femur. He was admitted with the diagnosis of right pertrochanteric fragility fracture to perform surgery.

Personal history: allergy to pyrazolones and NSAIDs, surgery for a hysterectomy with double adnexectomy, high blood pressure, repeated psychotic episodes, mild mental retardation, generalized tonic crisis a year ago. He underwent surgery, performing reduction and osteosynthesis with an endomedullary nail of the proximal femur. In the review of the four-month consultation, it was observed that the nail had broken, so the operation was performed again, the anterior nail was extracted, grafting to the femoral head and reosteosynthesis with an endomedullary nail. long. With evolution without incident.

Recommendations: A hip fracture and/or an endomedullary nail fracture complication is a serious injury with life-threatening complications. It is important that before all the patients with osteoporosis and/or multiple pathologies in the follow-up in the primary care consultation, an evaluation of the risk of falls is carried out, through a physical and emotional evaluation, which allows us to individualize a prevention and implantation. intervention with each patient in the care plan to reduce their incidence and complications.

Hip fracture and the urinary bladder 

Introduction: Some older people have falls, resulting in hip fracture, while going to the bathroom to urinate, or coming back. The aim of this study is to analyse the ''phenomenon'' of hip fracture related to the urinary bladder.

Methods: Prospective observational study of consecutive patients admitted to a UK teaching hospital with hip fracture in an eight months period. Patients, notes and electronic records were reviewed; data were downloaded on excel sheet and analysed using descriptive statistics.

Results: 377 hip fracture patients were admitted in the study period, of whom 51 patients (14%) had falls related to the bathroom. Of these 20% (10/51) male and 80% (41/51) female with average age of 81. 6 and 82 .8 years respectively. 51% (26/51) had urinary incontinence. 51% (26/51) had hypertension and 31% (16/51) had osteoarthritis. 67% (34/51) were on [ 4 drugs, 55% (28/51) were on antihypertensives, 22% (11/51) were on diuretics and 31% (16/51) were on an antidepressant. Falls were multifactorial; frailty in 41% (21/51) and postural hypotension in 24% (12/51) were considered the most contributing factors. Discussion: The number of patients who had fractures related to the urinary bladder could be underestimated as some older people with dementia were found on the floor with no reliable history; many of them could have been going to the bathroom. There are many reasons why elderly people might fall while going to the bathroom including postural hypotension, rushing to avoid urge incontinent, hypnotic or extrapyramidal side effects of medications, not using the mobility aids and poor lighting conditions. Conclusion: In this study 14% of falls resulting in hip fracture was attributed to the urinary bladder. Urinary bladder symptoms are a frequently forgotten risk factor for falls and fractures. To reduce the risk in this group of patients, urinary tract symptoms need to be explored, diagnosed and treated. Medications; specially antihypertensives and CNS active drugs should be rationalized and diuretics are to be avoided if possible.

Influence of the frailty in patients with hip fracture treated with blood transfusion and/or intravenous iron infusion, measuring haemoglobin levels pre and post-surgical intervention Objectives: to describe the impact of the frailty on hip fracture patients following blood transfusion and/or intravenous iron infusion treatments, during the hospitalization period and three months after the surgery. Methods: Descriptive study conducted in the Orthogeriatrics Unit from the University Hospital Ramon y Cajal, February-April 2019. Demographic and preinjury characteristics of the patients in each of the FRAIL categories were described. Results: In a cohort of 127 patients (mean 87 ± 6 years), 73% were females and 78% lived in dwelling houses. The pertrochanteric was the most frequent fracture. Evaluation of the patient using FRAIL Questionnaire showed that 50% were frail and 37% were prefrail. Most of the frail patients were dependent; showed malnutrition, major comorbidities, polypharmacy and frequent alterations in the iron kinetics profile. Blood transfusion was used in 35% of these patients, and the haemoglobin levels were comparable between the admission and after three months (12,4 ± 1,8 to 12,6 ± 1,5 g/dL). Alternatively, intravenous iron infusion was the prevalent treatment given to 30% of the prefrail patients. Similarly, haemoglobin levels did not change significantly (12,6 ± 1,8 to 12,3 ± 2,2 g/dL). Linear regression models adjusted by frailty category, were used to examine the association between the chosen treatment and the haemoglobin levels, measured during the study. Conclusion: in this particular cohort of patients, the prevalence of frailty is high and blood transfusion were preferably prescribed. However, intravenous iron infusion was frequently used in the prefrail group. The analysis performed concludes that haemoglobin levels do not change regardless the frailty status, independently of the chosen treatment.

Disruption of proprioception increases the risk of falling in elderly patients undergoing hemodialysis

Ozkan Ulutas 1 1 Inonu University Faculty of Medicine, Department of Nephrology

Backround: Patients undergoing HD experience more accidental falls compared to the senior population not on HD, causing increased morbidity and mortality in this patient group. In the present study, we hypothesized that ankle proprioceptive sensation may have been impaired in HD patients with a history of falling. Materials and methods: Sixty-three patients on hemodialysis aged 65 or more included to the present study. Patients who have experienced 1or more falls last year considered as fallers and others as nonfallers. Demographic data, laboratory values, timed up and go test duratians and inclinometric deviation of ankle joint were compared between two groups. Proprioceptive sensation of the ankle was measured using a simple digital inclinometer instrument on the dominant side. While the patients were in supine position, and their eyes were closed, their ankles were brought to 10 degrees of dorsiflexion by the help of study nurse. Afterwards, the patients were asked to come back to the starting point, and actively return to the set angle 3 times without help. All attempts of the patients measured and the error angle deviated from the set angle was used as the result value. The average of 3 results was accepted as the test result.

Results: Of 63 patients 25 (39.7%) were fallers. Mean inclinometric deviation of the study population was 4.1 ± 1.9 degrees, which was significantly higher (5.5 ± 1.9, p = 0.000) among patients in the faller group when compared with patients in the non-faller (3.1 ± 1.2) group. Age, serum albumin levels, PTH, TUG test duration, inclinometric deviation of patients have been included in the logistic regression analysis. Of these parameters, only inclinometric deviation (OR = 0.393, p = 0.004) was determined as an independent predictor of falls. Conclusion: Falls are common in elderly hemodialysis patients, and disruption of ankle proprioception is evident in HD patients who fell.

Trauma of the hand, fracture of the proximal phalanx Introduction: The initial care of the patient with the traumatized hand largely determines the final result. It is the doctor who attends the urgent demand who has the most difficult and responsible mission because he is the one who determines the orientation to arrive at an accurate diagnosis and treatment. Description of the case: 69-year-old male patient who comes to the consultation after falling from his height 24 hours ago with inflammation and pain in the right hand. Physical examination: Great inflammation of the right hand, great hematoma, pain on palpation of the proximal phalanx of the 3rd and 4th fingers. Good mobility and sensitivity of the fingers. Neuro-vascular distal preserved.X-ray:nondisplaced fracture of the proximal phalanx 3rd and 4th fingers of the right hand. He was referred to Traumatology for urgent evaluation, immobilization with a plaster dorsal splint. Plan:-Raised hand-Local ice-Paracetamol 1g/8h if pain.-Follow-up in the hand unit of the trauma service.

Recommendations: Hand injuries are a common presentation problem in urgent demand in Primary Care. It is important to assess, diagnose, and treat quickly and accurately to prevent short or long term dysfunction. In the event of any suspicion of fracture or dislocation of elements of the hand, radiographs (always at least two projections) should be made centered on the suspicious area (to try to obtain maximum detail) and not of the entire complete hand in a systematic way, taking Keep in mind that the most important thing is the previous exploration of the hand.

Bone mineral density in long-living patients with coronary artery disease Introduction: Limited data are available on osteoporosis in longliving patients. Therefore, we evaluated bone mineral density in longliving patients with coronary artery disease (CAD). Methods: 202 patients hospitalized with CAD were enrolled in this cross-sectional study. The patients' age ranged from 90 to 101 years. The majority of study participants (64.4%) were women. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry.

Results: Normal lumbar spine BMD was observed in 40.9%, osteoporosis-in 26.9%, osteopenia-in 32.2% of patients. Normal proximal femur BMD values was observed in 21.3%, osteoporosisin 39.9%, and osteopenia-in 38.8% of patients. Normal femoral neck BMD was registered only in 10.4% of patients, osteoporosis was observed in 60.4%, osteopenia-in 29.2%. Significant positive correlation was found between all BMD values and body mass index of patients (h \ 0.001). Positive correlation was registered between BMD values and serum uric acid (p = 0.0005). Positive correlation between triglycerides levels and T-score was revealed (h = 0.02). Negative correlation between frailty severity and BMD values (h = 0.01) was found. Positive correlation was found between BMD values and functional abilities of patients assessed using Barthel index (p = 0.000002) and IADL scale (p = 0.00008). Fractures in history were observed in 27.6% of patients. Key conclusions: The study results indicate some features of BMD in long-livers. In the study group significant relationships were found between bone mineral density on the one hand and patients' functional abilities on the other. It is advisable to further study the state of bone tissue in long-livers involving a large sample of patients.

Falls in patients with and without diabetes: a consequence of neuropathy? Falls Background-objective: Falls are a common reason for hospitalization. However, limited data exists regarding differences in people with and without diabetes mellitus (DM) with falls. The aim of this study was to examine for differences in demographic, clinical, and biochemical characteristics in subjects with and without DM who were hospitalized after falls.

Methods: This is a retrospective non-interventional study that examined all falls hospitalized in two teaching hospital from June 2017 until December 2019. Data of 458 patients (with DM: n = 109; age 75.8 ± 9.6; 22 men and 87 women; and non-DM: n = 349; mean age 76.0 ± 8.9 years; 72 men and 277 women and) who were admitted after falls were reported and analyzed.

Results: In the total cohort, falls were much more common in women than in men (79.5 vs 20.5%, respectively), while no gender differences were found between patients with and without DM (p = 0.569).

Neuropathy was more common in the DM than the non-DM group (30.3 vs 15.2%, respectively, p=0.001). No significant differences were found between DM and non-DM patients regarding prevalence of foot deformities, amputations, and those wearing or not shoes during falls. 14 .6%, p = 0.341), head trauma (11.9 vs 12.0%, p = 0.968), neck pain (11.0 vs 9.2%, p = 0.569), chronic obstructive pulmonary disease (9.2 vs 11.7%, p = 0.456), hemorrhage (10.1 vs 8.0%, p = 0.499), muscle weakness (11.9 vs 10.3%, p = 0.635), alcohol consumption (10.1 vs 6.3%, p = 0.182) and reduced consciousness (7.3 vs 6.9%, p = 0.869).

Low back pain was more in patients with than in those without DM (33.9 vs 23.2%, p = 0.025). There was a trend of stroke to be more common in DM vs non-DM group (17.4 vs 10.6, p = 0.057). The values of pulse rate, hemoglobin, serum glucose, sodium, potassium, triglycerides, urea and creatinine at admission were not different between patients with and without DM. Significantly more patients with DM used b-blockers in comparison with those without DM (50.5 vs 15.2%, p \ 0.001), while no differences were found in the use of calcium channel blockers, diuretics, non-steroidal anti-inflammatory medications, antipsychotics or proton pump inhibitors. The median value (interquartile range) of hospital stay was similar between patients with [8 (6.25-9.0)] and without DM [8 (6.0-9.0) days, p = 0.938). Conclusion: In the total cohort, falls were almost four times more common in women than in men. Neuropathy was more frequently found in patients with DM hospitalized for falls. No differences were found in other comorbidities, clinical, demographic and biochemical characteristics between patients with and without DM. Common comorbidities reported by patients who fell were hypertension, visual impairment, chronic kidney disease, heart diseases, dizziness and fatigue.

Hip fracture and the urinary bladder Atef Michael 1 , Arlinda Lago 1 1

Introduction: Some older people have falls, resulting in hip fracture, while going to the bathroom to urinate, or coming back. The aim of this study is to analyse the ''phenomenon'' of hip fracture related to the urinary bladder.

Methods: Prospective observational study of consecutive patients admitted to a UK teaching hospital with hip fracture in an eight months period. Patients, notes and electronic records were reviewed; data were downloaded on excel sheet and analysed using descriptive statistics. Results: 377 hip fracture patients were admitted in the study period, of whom 51 patients (14%) had falls related to the bathroom. Of these 20% (10/51) male and 80% (41/51) female with average age of 81. 6 and 82 .8 years respectively. 51% (26/51) had urinary incontinence. 51% (26/51) had hypertension and 31% (16/51) had osteoarthritis. 67% (34/51) were on [ 4 drugs, 55% (28/51) were on antihypertensives, 22% (11/51) were on diuretics and 31% (16/51) were on an antidepressant. Falls were multifactorial; frailty in 41% (21/51) and postural hypotension in 24% (12/51) were considered the most contributing factors. Discussion: The number of patients who had fractures related to the urinary bladder could be underestimated as some older people with dementia were found on the floor with no reliable history; many of them could have been going to the bathroom. There are many reasons why elderly people might fall while going to the bathroom including postural hypotension, rushing to avoid urge incontinence, hypnotic or extrapyramidal side effects of medications, not using the mobility aids and poor lighting conditions. Conclusion: In this study 14% of falls resulting in hip fracture was attributed to the urinary bladder. Urinary bladder symptoms are a frequently forgotten risk factor for falls and fractures. To reduce the risk in this group of patients, urinary tract symptoms need to be explored, diagnosed and treated. Medications; specially antihypertensives and CNS active drugs should be rationalized and diuretics are to be avoided if possible.

Gait, balance and fall risk in the elderly Introduction: Reduced gait velocity and poor balance are associated with higher risk of falls in the elderly. Objective: The aim of this study was to evaluate relationship between gait, balance and risk of falls in the elderly.

In this cross-sectional study 60 years and older man and women participated. Sociodemographic data, Mini-Mental State Examination, Berg Balance scale (BERG), Dynamic Gait Index (DGI) and Tinetti test were performed. Gait parameters such as gait velocity and time were analysed using 6 inertial sensors. Subjects were divided to age groups: 60-69 years. consisted of 28 participants, 70-79 years.-56 subjects, and 80+ years. -29 participants.

Results: The data of 113 subjects (32 men and 81 women) which average age was 74.9±8.33, were analysed. In 80+ age group BERG balance score (37.79 ± 8.00) was statistically significant lower compared to 60-69 (45.68 ± 6.70) and 70-79 (42.66 ± 7.15) groups (respectively, p = 0.000 and p = 0.013). DGI result was higher in 60-69 (18.36 ± 3.05) compared to 80+ (14.59 ± 4.33) group (p = 0.001). It was found that increasing age was related with higher risk of falls. Age correlated with gait velocity (r = -0.299, p = 0.001), gait time (r = 0.320, p = 0.001), BERG score (r = -0.353, p = 0.000), DGI score (r = -0.323, p = 0.000) and Tinetti test score (r = -0.270, p = 0.004).

The study results revealed that gait and balance were statistically significant different between age groups. It was found negative relationship between different age groups and Tinetti score, BERG scale, DGI and gait velocity. Gait time showed a positive relationship with age groups.

Snapshot of a pioneer swiss orthogeriatric unit

Coutaz Martial 1 , Weiss Lucien 1 1

Introduction: Proximal femur fractures are a frequent and lifechanging event among elderly patients. In order to optimize care, the Valais Hospital in Switzerland created a pilot orthogeriatric unit in 2018. This innovative unit, managed by a geriatrician who functions within the orthopedic department, allows timely, standardized management of geriatric syndromes. Methods: Prospective cohort study from January 1, 2018 through March 1, 2020. Inclusion criteria were hip fracture among patients C 70 years, or any elective orthopedic surgery C 75 years. Primary outcome measures were postoperative complications and mortality. Results: We enrolled 356 patients, mean age 84 years, 77% female. The majority were classified as ''vulnerable'' health status, and 1/3 were ''fit''. Forty percent had cognitive impairment. Twenty-six percent had osteoporosis, only 1/5 of whom were treated. Malnutrition was prevalent (NRS 5: 22%). We treated 287 hip fractures (45% neck, 48% intertrochanteric, 7% periprosthetic). Mean time to operation was 33.5 hours. The most common orthopedic complication was screw displacement (8.8%). The most frequent geriatric complications were delirium (17.7%), urinary retention (13.3%) and obstipation (6.6%), along with medical complications that included acute renal failure (23%), urinary and pulmonary infections (21.9%) and heart failure (13.7%). Postoperative mortality rate was 5.9% (17/287). Key conclusions: In a vulnerable population, our approach showed a low postoperative mortality rate (5.9%) and a short pre-operative time (33.5 hours). Perioperative complications are frequent, and are often due to non-orthopedic problems, thereby justifying early geriatrician involvement.

Acceptance and effectiveness of the recurrent use of a fall prevention app Background: A fall prevention app was developed to support care takers in performing a multifactorial fall risk assessment according to required standards [1] . The app generates an individual fall risk score (FRS) [2] with recommendations for fall prevention. The study aimed to evaluate the acceptance of the app as well as its effectiveness in reducing individual FRSs.

Methods: To address these questions, we investigated data from 113 (83.7 ± 9.9 years, 79.5% female) care recipients participating in a pilot project supported by the AOK Nordost who had completed the fall risk assessment twice (73 ± 43 days between assessments). Effectiveness of fall risk prevention was evaluated by comparing the S202 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

FRS at baseline and follow-up assessment. Acceptance was analysed through a standardized questionnaire that was completed by 42 geriartric nurses that had used the app. Results: Mean FRS decreased significantly from 27.2 points at baseline to 24.3 points at follow-up (p = 0.002). Regarding acceptance, 81% of nurses indicated that the use of the app supports them in planning prevention measures, 71% stated that the use of the application simplifies documentation and 74% perceived an ease-of-use of the app.

Conclusions: Results showed that the recurrent use of the fall prevention app was associated with a significant decrease in FRS. High acceptance among nurses was reported. The fall risk assessment app has the potential to support care takers in implementing required fall prevention measures. Furthermore, it enables nurses to measure the effectiveness of fall prevention.

Introduction: The aim of the study was to compare the fear of falls and relevant characteristics between elderly people who had a fracture and those who had a reported fall. Method: The cross-sectional study was conducted in March 2020, with random sampling from the list of members of an Open Protection Centre for the Elderly of Patras (194 active members). The sample size was 64 people over 65 years (50 women). The Falls Efficacy Scale International (FES-I) Greek questionnaire was used to investigate the fear of falls, while the Cronbach's Alpha reliability test showed very high reliability (a =0.952).

Results: The mean age of the sample was 72.15 years (± 6.04). 32.8% of the sample reported a fall (during 2019) and 37.5% reported a fracture in the last 3 years. The Kruskal-Wallis non-parametric test showed a statistically significant difference between men and women concerning fractures (X2 = 9.585, DF = 1, p = 0.002 \ 0.01). The non-parametric Mann-Whitney test showed a statistical difference in FES-I, indicating that women are more afraid of a possible fall (U = 227.00, p = 0.045, _ X = 29.90, SD = ± 11.15). Finally, the Spearman's non-parametric r control showed a positive correlation between FES-I with sex (r = 0.252, p \ 0.05) and number of falls (r = 0.306, p \ 0.05), while a negative correlation was found with self-perception of health (r = -0.300, p \ 0.05), falls(r = -0.270), p \ 0.05) and vision problems(r = -0.419, p \ 0.01). Conclusions: The study found important risk factors of fear of falls, indicating the need of the systematic education of the elderly to prevent it. Introduction: There is concern regarding adverse effects of antihypertensive treatment, including falls and subsequent fractures, especially hip fractures. As frailty is increasingly recognised as an important risk factor for adverse outcomes, we examined its relationship to fracture rates in older patients after starting antihypertensives. Methods: Using the Clinical Practice Research Datalink (CPRD), we identified participants over 65-years old starting a first-line antihypertensive medication. Using deficits identified in CPRD we classified patient-level frailty as 'Fit', 'Mild', 'Moderate' or 'Severe' using the Electronic Frailty Index. We calculated the rate of fractures by frailty level and fracture site, and determined the rate ratio (RR) of first fracture by frailty level, adjusting for confounding. We conducted sensitivity analyses to additionally adjust for ethnicity, deprivation, and bisphosphonate use. Results: 44% of participants were classified as mildly frail or greater , but frail participants experienced 58% of all fractures, and 63% of hip fractures. The whole cohort showed a crude rate of 14.1 fractures/ 1000 person-years , with 4.5 hip fractures/1000 person-years. In severe frailty, this rises to 51.0 fractures/1000 person-years, and 17.7 hip fractures/1000 person-years. After adjustment for confounding, increasing frailty was associated with greater rate of any fracture, reaching RR 2.85 (95% confidence interval 2.43-3.33) for severe frailty versus fit. Results were unchanged in sensitivity analyses. Key conclusions: Frailty and fracture are both common in older participants who start antihypertensive medications. Increasing frailty was positively associated with increased rates of fracture. Clinicians need awareness of this relationship to consider fracture risk assessment and prevention in these patients.

The effect of vitamins Cyanocobalamin (B12) and 25-OH-vitamin D3 (D3) and anticholinergic drugs on balance and falls. Results from a geriatric patients sample in the clinic for fall prevention, osteoporosis and sarcopenia (C.F.P.O.S) of the General Univer was also recorded and the ANTICHOLINERGIC-COGNITIVE-BURDEN Scale score (ACBscore) was calculated. The balance was evaluated with the Mini-Balance-Evaluation-Systems-Test (Mini-BESTest). Results: Linear Bivariate Correlation did not indicate a statistical strong relationship between vitamin B12 level, Mini BESTest score and the number of falls and fractures. A statistical negative correlation was found between blood level of vitamin D3 and the number of falls and fractures (rs (93) = -0.274, p = 0.008 \ 0.05). Multiple Linear Regression analysis, using the Enter method, indicate that from the studied factors, vitamin D3 can predict with statistical significance the number of falls and fractures(p = 0.028 \ 0.05) and that ACBscore can predict with statistical significance the Hand Grip values levels (p = 0.022 \ 0.05). Conclusion: In the present study vitamin D3 appears to influence falls and fractures in contrast to vitamin B12. The use of anticholinergic drugs affects muscle strength negatively, but not falls and fractures. A larger sample of participants and further studies are needed to confirm our findings.

Verbal working memory is associated with bone mineral density in women assessed for bone fragility Introduction: Bone loss and related fractures have been previously associated with cognitive and psychological features. The aim of our study was to explore the association between executive functions with fracture risk in a cohort of postmenopausal women. Methods: We performed cognitive tests assessing executive functions (Trial Making Test-B, Digit Span Backward, Digit Span Forward), questionnaires measuring psychological features (Hamilton Anxiety Scale and Back Depression Inventory), physical performance evaluation (Short Physical Performance Battery and handgrip strength), evaluation of 10-year probability of major and hip fractures (Fracture Risk Assessment tool -FRAX), bone mineral density (BMD) measurement (Dual-Energy X-ray Absorptiometry at lumbar spine and femoral neck). Results: Participants (n = 60, mean age 66 ± 7.99 year) showed a Mini Mental State Examination (MMSE) score C 24. Trial Making Test B score (r = -0.25) and Digit Span Backward (r = -0.34) were associated with FRAX score for major fractures; the FRAX score for hip fracture was associated with handgrip strength (r = -0.39). BMD at lumbar spine was associated with Digit Span Backward (r = -0.32) and with depression (r = -0.33). After adjustment for age, BMI, MMSE score, handgrip strength, Digit Span Forward score, Verbal Fluency score, Trial Making Test-B score, a multiple regression analysis showed BMI (ß = 0.09, SE 0.03, p = 0.013), Beck Depression Inventory score (ß = -0.09, SE 0.06, p = 0.04) and Digit Span Backward score (ß = 0.55, SE 0.17, p = 0.002) independently predicted lumbar BMD. Key conclusions: Verbal working memory, as assessed by Digit Span Test, was associated with BMD and could contribute to fracture risk prediction in postmenopausal women.

Factors associated with blood transfusion during hospital treatment of hip fractures Noelia CC Salazar 1 , Luana Sandoval Castillo 2 , Julie Braüner Christensen 3 , Martin Aasbrenn 3 , Anette Addy Ekmann 2 , Thomas Giver Jensen 4 , Troels Haxholdt Lunn 5 , Henrik Palm 4 , Charlotte Suetta 2 1 Hospital General de Zona #2, Instituto Mexicano del Seguro Social, Hermosillo, Mexico, 2 Department of Geriatric Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark, 3 CopenAge, Copenhagen University, Denmark, 4 Department of Orthopedic surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark, 5 Department of Anesthesia, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark Introduction: The purpose of the present study was to investigate the factors associated with perioperative blood transfusions in patients with hip fractures. Methods: Patients above 65 years admitted to the department of orthopedic surgery at Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark with a hip fracture in 2018 were included in the study. Characteristics of the surgery and the anesthesia, demographics, comorbidities, medication, blood pressure values and blood tests were registered. A multivariable analysis was used to determine risk factors, data are presented as odds ratios (OR) with 95% confidence intervals (CI). Results: In total, 300 patients with a mean age of 83 ± 9 years were included. 27% were men. 54% had femoral neck fractures, 42% pertrochanteric fractures and 4% subtrochanteric fractures. 31% of the patients had at least one blood transfusion. The mean preoperative haemoglobin (Hb) was 12.4 ± 1.9 g/dL, the mean postoperative Hb was 10.3 ± 1.8 mmol/L. Predictors for transfusion included cardiac failure (OR 1.9, 95% CI 1.1-3.5), operation with intramedullary hip screw (IMHS) (OR 4.8, 95% CI 2.7-8.7), lowest intraoperative diastolic blood pressure under 50 mmHg (OR 10.6, 95% CI 1.8-62.7), subtrochanteric fracture (OR 9.3, 95% CI 1.1-79.8) and surgical bleeding above 300 ml (OR 3.2, 95% CI 1.5-6.7). Conclusions: In the present cohort, cardiac failure, subtrochanteric fractures, IMHS surgery, intraoperative diastolic blood pressure under 50 mmHg and surgical bleeding above 300 ml were factors associated with blood transfusion. Careful preoperative planning and multidisciplinary management efforts are crucial to reduce the use of postoperative transfusions. Results: After screening 3005 studies for eligibility, 220 studies with 104,638 participants were included. NMA (N = 190 studies) revealed a reduction in number of fallers, compared to usual care, for single interventions exercise (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.77-0.90) and quality improvement strategies (RR 0.90; 95% CI 0.83-0.99). Most effective multiple interventions were assistive technology in combination with basic falls risk assessment (RR 0.52; 95% CI 0.30-0.90) and assistive technology in combination with quality improvement strategies (RR 0.58; 95% CI 0.41-0.81). Relatively few studies (N = 14) were available specifically for multimorbid participants and the NMA revealed no statistically significant changes in number of fallers compared to usual care. The number of fall-related fractures was reduced by the single interventions basic falls risk assessment (RR 0.60;95%CI 0.39-0.94) and exercise (RR 0.62; 95% CI 0.42-0.90). Conclusion: Several single and multiple fall prevention interventions lead to fewer falls. Basic falls risk assessment and exercise lead to fewer fall-related fractures. Few studies have investigated the effect of fall prevention interventions in multimorbid older people, a topic which is of high importance for future research.

Association of nonselective beta-blocker eyedrops and injurious falls: a Danish nationwide active comparator, new user propensity score matched cohort study Background: Non-selective beta-blocking eye drops such as timolol potentially increase the risk of falls due to systemic absorption. Our aim was to investigate the association between initiation of timolol eye drops and injurious falls in older patients. Methods: We conducted an active comparator, new user cohort study using information on redeemed prescriptions and hospital discharge diagnoses from the Danish nationwide registries. We identified all patients aged C 65 years, who initiated timolol eye drops or topical prostaglandin analogues and matched them in a 1:1 ratio, based on a high-dimensional propensity score. Primary outcome was injurious falls (contusion, wounds, fractures other than hand/feet), within 90 days of first prescription. Secondary outcome was fall-related fractures. We obtained incidence rate ratios (IRR) and incidence rate differences (IRD). Results: We identified 40,420 users of timolol and 55,754 users of prostaglandin analogues; 43% were male and age (median [IQR]) was 75 [70] [71] [72] [73] [74] [75] [76] [77] [78] [79] [80] years. For the unmatched cohort, the IRR of injurious falls was 1.20 (95% CI 0.98-1.49) and IRD was 4 (95% CI 0-8) cases/ 1000 person years for treatment with timolol compared to prostaglandin analogues. In the propensity score matched cohort, we included 28,431 users of timolol and prostaglandin analogues, respectively. The IRR of injurious falls was 0.96 (95% CI 0.73-1.27) and IRD was-1 (95% CI -6 to 5) cases/1000 person years. For fallrelated fractures, the IRR was 1.30 (95% CI 0.96-1.76) and IRD was 4.0 (95%CI -0.5 to 8.4) cases/1000 person years. Conclusions: We found no association between initiation of timolol eye drop treatment and injuries falls in older people. Introduction: Falls and the frailty are geriatric syndromes having common risk factors and adverse health outcomes. Falls weigh the course of the frailty, which leads to an increase in the human dependence on others. To maintain the existing level of autonomy, early detection of risk factors and prevention of falls in the group of the elderly patients with the frailty is necessary. Aim: To evaluate the incidence of falls, their characteristics and functional status in patients with the frailty. Materials and methods: 170 patients with the frailty (78.6 ± 7.8 years, 136 women, 80%) were divided into 2 groups: 1 group -117 (68.8%) patients with falls, 2 group -53 (31.2%) patients without falls. All patients underwent a general clinical examination and a comprehensive geriatric assessment. Charlson Comorbidity Index did not differ significantly in both groups. Results: The incidence of falls was 68.8%. The number of falls is 2.29 ± 1.9; 2 or more falls occurred in 65 (55.6%) people. 97 (82.9%) people had falls earlier, 54.7% of them developed a fear of falls. Fractures were diagnosed in 13.7%. Common risk factors for falls in patients with the frailty were: vitamin D deficiency (86.1%), chronic pain (84.7%), sensory deficiency (69.9%), imbalance (60.2%), inactivity (56.1%) and cognitive impairment (44.9%). In patients with falls, compared with patients without them, the following were lower: muscle strength (16.04 ± 7.5 and 22.4 ± 6.1, p \ 0.05), walking speed (0.44 ± 0.34 and 0.52 ± 0.22, p \ 0.05) and SPPB score (3.98 ± 2.1 and 4.9 ± 2.12, p.05). Patients in 1 group were 2 times more likely to have a pronounced dependence (Bartel index). The number of geriatric syndromes was higher in patients of 1 group (8.4 ± 2.4 and 6.2 ± 3.5, p \ 0.05). Conclusion: Every second patient with the frailty has a fall, which worsens the functional status of the patient and leads to a decrease in autonomy. Falls are prevented in most cases by screening for risk factors and correcting them.

Cross-country comparison between asian and caucasian older adults on the association between obesity and falls Introduction: Previous studies on obesity or increased BMI and falls in older adults have not evaluated potential regional references. This study, therefore, aimed to identify potential differences in the relationship between increased body mass index (BMI) and falls between an Asian and two Caucasian populations. Methods: Baseline screening data from the MELoR (Malaysia), FoRMOSA (Germany) and EPIC-NORFOLK (UK) studies were utilized. Basic demographic characteristics, medical history, anthropometric parameters, physical assessments and 12-month falls history were extracted from the existing datasets. Only data for women aged 65 years and over and women aged 70 years and above from the MELoR and EPIC-NORFOLK to allow for direct comparisons with FORMOSA. Comparisons were conducted using logistic regression with MELoR as the reference group. Results: Data from 3536 (1751 EPIC-NORFOLK, 1319 FoRMOSA and 466 MELoR) older women were included. A significant association was observed between BMI and falls in the previous 12 months for both FoRMOSA and MELoR study but not EPIC-NORFOLK. The relationship between BMI and falls was attenuated for MELoR

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 women after additional adjustment for %body fat (aOR = 1.03, 95%CI = 0.98-1.10), but the relationship remained unchanged for FoRMOSA. Conclusion: Notable differences in country patterns for the relationship between BMI and falls were identified, which could be attributed to body composition and lifestyle differences observed between the populations. Our findings will inform cross-cultural translation of existing evidence for fall prevention in older persons with increased adiposity, while increased body fat could be a modifiable risk factor for falls in the Malaysian, but not German or UK settings.

Potentially inappropriate prescribing (PIP) in a real-world falls registry

Rosalind Chiam 1 , Tan Maw Pin 1 1

Introduction: Polypharmacy is common in older adults, with increased risk of adverse events, which increases with potentially inappropriate prescribing (PIP). This study applied the STOPP-START criteria to a real-world registry and to determine the burden of PIP among older adults attending a falls and syncope clinic. Methods: The falls and syncope registry at the University of Malaya Medical Centre comprised a dataset containing individuals C 65 years evaluated for dizziness, syncope and falls since it was started in 2014. Information on symptoms, medical history, medications and diagnoses were recorded. The STOPP-START criteria were applied to individual prescriptions by one researcher and cross-checked by a second researcher.

Results: At least one PIP was identified in 275 (65.6%) accounting for 85% of the prescriptions. Patients with two or more comorbidities were more likely to be exposed to two or C 2 PIP. Of those with polypharmacy (C 5 medications), 144 (81.4%) were exposed to C 2 PIMs. 361 (54.8%) PIP were within the STOPP K criteria which were ''drugs that predictably increase the risk of falls in older adults''. Conclusions: Vasodilators were the PIP identified in the real-world falls registry. The STOPP & START criteria is a useful medication review tool for PIP in older patients within a fall and syncope clinic setting and identifies potential omissions as well as inclusion.

Hospital falls and implicated drugs in older patients

Ana Andrade Oliveira 1 , Sílvia Oliveira 1 , Paulo Gouveia 1 1

Introduction: Hospital falls are prevalent among the elderly and connected to increased morbidity and mortality. Several drugs are associated with increased risk of falls, mainly the ones working on brain and circulation. We analyzed the high-risk drugs administered 24 hours before the falls among hospitalized patients older than 74 years old. Methods: We performed a retrospective study covering the hospital falls recorded in 2018. Data were collected through clinical files. Statistical analysis was executed with SPSS. Results: In 2018 were recorded 270 hospital falls, in 246 patients; 48% of them happened in patients older than 74 years old. In the 24 hours before the fall, each patient received a medium of 8.8 ± 3.1 drugs. The most prescribed medicines were psychotropic drugs (68%), being benzodiazepines the most prescribed psychotropics (70%). The second most prescribed drugs were anti-hypertensives (42%), with a preference for angiotensin-converting-enzyme inhibitors (ACE inhibitors) (71%). Opiate analgesics were administered in 26% of the patients. Discussion: The risk of falls rises with the number of drugs prescribed, nevertheless older patients continue under an excessive number of drugs during hospitalization, as we demonstrate. Although psychotropic drugs are known to increase falls risk, with literature advising against their use in the elderly, we continue to see more than half of these patients under them. Drugs are a modifiable risk factor for falls, a periodical drug review on high-risk medications should be made in elderly patients.

Sarcopenia evaluation with computed tomography in trauma patients 

Aim: Sarcopenia is characterized by a decline in muscle mass, muscle strength, and physical activity (1) . Recent studies have shown that sarcopenia is associated with impaired physical capability, poor quality of life, adverse metabolic effects, falls, disability, mortality, and hospitalization (2). The sectional area of skeletal muscle taken from the abdomen is strongly related to the whole body muscle distribution, and it is known that the cross-sectional skeletal muscle index (SMI, cm 2 ) at L4 level is highly associated with the total body skeletal muscle mass (2) . It also provides the ability to detect muscle radiation attenuation (SMRA, Hounsfield Units (HU)), a measure of muscle quality that is inversely related to muscle fat content (3) . In this study, we aimed to show the change of muscle area and density measured by cross-sectional CT by age.

Methods: In January-March 2020, 265 patients who were admitted to the emergency room of our hospital due to trauma, who had underwentabdominal computed tomography (CT) scan including L3 and umbilical levels for measuring SMI and transverse psoas muscle thickness, respectively, were included. Sarcopenia was defined as a L3 skeletal muscle index of 49 cm 2 /m 2 for men and 31 cm 2 /m 2 for women using Korean-specific cutoffs (4). Results: 265 patients were included. The average age was 62.8±12.4 years, and 133 patients (50.2%) were men. One hundred seven (40.4%) patients met the criteria for SMI-sarcopenia. The mean SMRA level was significantly lower in the sarcopenia group than the non-sarcopenia group (p = 0.008). There was a statistically significant negative correlation between age and SMI, SMRA (p = 0.005, p = 0.008, respectively).

The high diagnosis of sarcopenia with CT taken in patients admitted to the hospital after trauma indicates that sarcopenic individuals are more susceptible to trauma.Therefore, early diagnosis and treatment of sarcopenia in older people will be effective in reducing hospital applications. 

Introduction: We aimed to examine the characteristics of patients admitted to hospital for more than 10 days following a wrist fracture versus those not admitted or briefly admitted for surgery (\ 3 days).

We also aimed to assess for differences in clinical outcomes in both patient groups in the 12 month period post their fracture.

Methods: Patients aged [ 50 who had a new X-ray diagnosis of low trauma wrist fracture were recruited between January and October 2018. Patient assessments were completed at the time of the fracture and at 6 and 12 months. Outcome data included mortality, re-admission to hospital, falls, further fractures and disability as assessed by patient self report using the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Results: 134 patients were recruited and 113 attended follow up. Two patients were inpatients at the time of fracture. Overall, 27 (20.1%) patients were admitted for \ 3 days for surgery. 18 (13.4%) were admitted for [ 10 days and had a median length of stay of 48 days . Those admitted for [ 10 days were older (80.7 vs 67.6, p \ 0.001) and frailer (p \ 0.001), had a higher Charlson comorbidity index (p = 0.001) and were pre-morbidly more likely to require help with ADLs (50% v 11.4%, p = 0.000) and take more medications (p \ 0.001). They were also more likely to have a lower BMD at the femoral neck (p = 0.013), total hip (p = 0.007) and forearm (p = 0.026) and have a previous vertebral fracture (p = 0.042) though had higher 25(OH)D (p = 0.001). Comparing outcomes, they had a higher readmission rate (31.3% vs 10.9%, p=0.025) and worse performance on DASH at the time of fracture (p = 0.021) and at 6 months (p \ 0.001) and 12 months (p = 0.026) There was no difference in mortality with one death in each group. Conclusion: Wrist fracture in older, frail adults is associated with much longer hospital admissions, three times the readmission rate and greater disability over a one year follow up period. Findings highlight the importance of identifying these at risk patients and ensuring robust pathways to optimise care for this vulnerable group.

Introduction: Hyperparathyroidism is a risk factor of osteoporosis. Excess parathyroid hormone (PTH) accelerates bone loss via bone reabsorption and increases the risk of fragility fracture. Fragility fractures are associated with serious consequences in older patients [1] . This study aimed to look at the prevalence of hyperparathyroidism and vitamin D deficiency in older patients (age [ 60) who presented with hip fractures in an Irish tertiary hospital. Methods: Data was collected from Irish Hip Fracture Database (IHFD) and the Ortho-geriatric Electronic Patient Medical System (EPMS) between July April 2020 (n = 207) . Demographic data and bone health profile (PTH, Vitamin D, and Calcium) were analysed using SPSS for statistical analysis.

Results: The median age of patients was 81 years (SD 8.7), and 68.3% of patients were female. Median 10-year probability of major osteoporotic and hip fracture risk was 22. 5% and 12.2%, respectively. 29 .9% were diagnosed with hyperparathyroidism with prevalence rates of primary and secondary hyperparathyroidism of 6.7% and 23.1%, respectively. The majority of these (87.3%) were normocalcaemic hyperparathyroidism. 50.7% were vitamin D deficient, with 11.5% being severely deficient (Vitamin D \ 20nmol/L). Conclusion: The prevalence of hyperparathyroidism is higher in the hip fracture group than in the general population [2] . Vitamin D deficiency is also prevalent in this group. FRAX score indicated significant proportion of patients had high major osteoporosis and hip fracture risks. Routine bone health profile checks in this high-risk group allow early identification and management of hyperparathyroidism and vitamin D depletion, which can potentially reduce the risk of future fracture Conclusion: Awareness of the patient characteristics described in this study allows design of targeted fracture prevention strategies. We describe the significance, in particular, of age, gender and BMI in predicting lower BMD and therefore future fracture risk. We explore the difference between the profile of male versus female patients sustaining the fracture highlighting the importance of being aware of the risk of this fracture in younger men with relatively higher BMD as well as the lower rate of prescribing of osteoporosis treatment in this group.

Prescription review in frail patients with femur fracture Introduction: Femur fracture is considered a potentially serious entity for the frail patients for its high morbidity and mortality. Anticholinergic drugs are frequently used, increasing the risk of adverse reactions, such as falls [1] . Aim: to review the prescription in frail patients with femur fracture.

Methods: Retrospective and observational study. Analyzing patients C 85-years-old or younger than 85 years-old with cognitive impairment with femur fracture admitted to Geriatric Acute Unit shared with Traumatology Unit between April to October 2019. Variables: Sociodemographic, cognitive, functional, pharmacological (polypharmacy (global: C 5 drugs and severe: C 10 drugs), preventive drugs for osteoporosis, inappropriate prescription (IP) identified through the application of patient-centered prescription model [2] , and prescription optimization, falls and anticholinergic burden with Drug Burden Index (DBI) 0: null, \ 1: low, 1-2: moderate, Introduction: Femur fractures are common in elderly patients. Several factors have been identified as fall-risk increasing such as pharmacological treatment. Aim: to analyze the association between polypharmacy, inappropriate prescription (IP), anticholinergic burden and falls, comparing patients with and without femur fracture. Methods: A case-control study in patients older than 85-years or younger with cognitive impairment admitted to Geriatric Acute Unit with femur fracture and history of falls compared with control group. Variables: Sociodemographic, cognitive, functional, pharmacological (polypharmacy (global: C 5 drugs), IP using patient-centered prescription model [1] and prescription optimization and anticholinergic burden with Drug Burden Index (DBI): 0: null, \1: low, Introduction: Frailty is considered often as a physical impairment in the elderly and its characteristics are weakness, weight loss, exhaustion, a decrease of the physical activity accumulating also co morbidity. It is considered the geriatric syndrome related to the aging process, declining of biological reserve that results in an increase of vulnerability for negative results including disability, hospitalization, and death. Frailty was defined as ''a state of increased vulnerability on the stress factors due to the decline of the intramuscular, metabolic, physiologic reserve and immune systems. Conclusion: Regular studies came to the same conclusion that physical activity has preventive effects in frail elderly even though uncertainty exists in optimal exercise programs regarding the frequency, kind of nutrition and duration. To prevent the fragility, necessary measurements need to be taken with nutrition e proteins, vitamin D and other alimentary, but this information is not yet public domain. The benefits of physical exercises in frailty elderly include increased movement, increased performance in activities of daily living, improved walk, elimination of falls, improvement of mineral bone density and the increase of overall health. However, systems of health care actually are not organized to offer integrated care on daily life, but to identify and treat acute diseases. Recommendation: Physical activity and adequate nutrition, especially regarding vitamin D, calcium and proteins are fundamental in improving at the same time bones, muscles, and the functional results in elder population, if they are individually adapted and determined. Preventive methods through physical activity in frailty elder should be described with an individual progressive plan as in the other medical treatments. Keywords: Physical activity, frailty, elder, prevention, nutrition.

The minimal clinically important difference of six-minute walk in Asian older adults 

Introduction: Rehabilitation interventions promote functional recovery among frail older adults and little is known about the clinical significance of physical outcome measure changes. The purpose of our study is to examine the minimal clinically important difference (MCID) for the 6-minute walk distance (6MWD) among frail Asian older adults. Methods: Data from the ''Evaluation of the Frails' Fall Efficacy by Comparing Treatments'' study were analyzed. Distribution-based and anchor-based methods were used to estimate the MCID of the 6MWD. Participants who completed the trial rated their perceived change of overall health on the Global Rating of Change (GROC) scale. The receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of the cut-off values of 6MWD (in meters) for GROC rating of ''a little bit better'' (?2), based on feedback from participants. Results: The mean (SD) change in 6MWD was 37.3(46.2) m among those who perceived a change (GROC C 2), while those who did not was 9.3(18.2) m post-intervention (P = 0.011). From the anchor-based method, the MCID value for the 6MWD was 17.8 m (sensitivity 56.7% and specificity 83.3%) while distribution-based method estimated 12.9 m. Key conclusion: The MCID estimate for 6MWD was 17.8 m in the moderately frail Asian older adults with a fear of falling. The results will aid the clinicians in goal setting for this patient population.

The results of complex geriatric assessment in frail elderly patients from the Republic of Moldova (2) to compare this screening tool with other scales such as the Fried Scale, Gerontopole Frailty Screening Tool (GFST), Short Emergency Geriatric Assessment (SEGA) Grid A, and the standardized gerontological evaluation.

Results: One hundred two patients were included, with a mean age of 82, 65 ± 4, 79; 55 were women and 47 were men. The proportion was 74.5% for our scale, 69% the SEGA (Short Emergency Geriatric Assessment) grid A scale, 75.5% for the GFST (Gerontopole Frailty Scale Tool) scale, 60.8% for the FRIED scale. After a comprehensive geriatric assessment, frailty syndrome was found for 57 patients (55.9%). In general, both scales showed good performance and differences between them in the sample is minimal. Because the EGS showed a prevalence of frailty of 55.9%, a similar prevalence threshold for the ZFS, i.e. 64% at the threshold C 3 could be assessed.

The completion time of our scale was less than 2 minutes and staff required no training beforehand. Its sensitivity was 83.9% and its specificity was 67.5%. Its positive predictive value was 80%, and its negative predictive value was 73%. The Pearson correlations between the geriatric scores were all strong and roughly equivalent to each other.

Screening of frailty in elderly subjects admitted to an emergency department: an exploratory investigation Introduction: It is currently considered that screening for frailty in elderly subjects is a major public health issue. Methods: a cross sectional study involving elderly subjects (over 75 years of age) admitted at the Emergency Department of the hospital of Troyes in the period August 24th to August 30th , 2017 was conducted. Patients were screened for frailty using the SEGAm (part A) grid, correlated with the subjective opinion of the triage nurse and the senior physician/interns. This study was aiming at evaluating the screening of frailty at the emergency department.

Results: 100 patients were included during the study period, mean age was 84.34 years (range 75-97), 56 patients (56%) were female, the average CHARLSON score was 4.28 (range 0-11). The patient's previous medical history was remarkable for cardiovascular diseases. The main reason of hospital admission was fall (26 subjects, 26%). Hospitalization was suitable in 52 subjects (52%). The average SEGAm score was 6.3 ± 3.59. The completion time for the SEGAm (part A) score was about 5 minutes. According to Cohen's kappa, the concordance between the subjective opinion of the triage nurse and the SEGA grid was average, while the concordance between the subjective opinions of the senior physicians/interns was good.

The SEGAm score appears to be well-suited and useful in the Emergency Department. It is easy to use, allows an overall evaluation of the patient and is not time-consuming.

Frailty changes predict mortality in four longitudinal studies of aging Key conclusions: In this study, we revealed that frailty was related to polypharmacy. Our study is the first that the relationship between polypharmacy and frailty was assessed with SOF criteria. We designated that only Fried criteria influenced polypharmacy independently. That made us thought that Fried criteria were more useful to define the relationship between frailty and polypharmacy. Prospective studies to evaluate the effect of decreasing the number of used drugs on frailty could be useful.

The role of frailty and social support in hospitalized older patients Introduction: The shoulder is the most mobile joint in the human body, it is also the one with the most injuries it can have. Rotator cuff injuries can occur primarily due to two causes, trauma or sudden falls in the arm and degeneration of the arm. Description of the case: A 69-year-old male patient came to the clinic for presenting sudden onset pain in his left shoulder after an accidental fall due to stumbling over the extension arm.Examination: inability to actively abduct, positive fall sign, abducts the upper limb up to 90 degrees and when it stops holding it, it falls abruptly and positive painful arc. X-ray and ultrasound: confirms the rupture of the supraspinatus muscle tendon. Treatment: rest and Aines and is referred to the trauma service. They indicate surgery to repair the tendon. After arthroscopic surgery, the process evolved favorably.

The painful shoulder is a very frequent pathology of the locomotor system. The time factor and the levels of uncertainty in Primary Care consultations make it essential to follow a clear differential etiopathogenic scheme if we want to carry out a correct approach for its diagnosis and treatment. This scheme includes multiple pathologies, frequent, to always take into account in our clinical reasoning and others that, due to their lower frequency, are not always part of the first diagnostic hypothesis, but which should not be forgotten when the former do not explain the clinical picture.

Introducing an exercise intervention to reverse frailty and build resilience in primary care consultations Introduction: Resistance exercises have been shown to reverse frailty yet common practice appears low. GPs are in a unique position to discuss frailty and resilience and offer interventions. We wished to assess uptake of an exercise regime; rating of its ease and subjective health after participation; and how a follow-up telephone-call might affect compliance. Methods: Patients aged 65?, meeting inclusion criteria, who presented to a GP over 4 months, were invited to participate. They were offered a pictorial leaflet with 11 resistance-based exercises and informative discussion. Demographics, health indicators, SHARE-FI and Rockwood frailty scores were recorded. Half the randomised participants were telephoned after 1 month and all after two. Results: 57 of 63 eligible patients (90%) participated (average age 75, 36 female (63%)). All females enrolled while 19% males declined. Only 18% had previously considered resistance exercises. At one month, 60% called were exercising regularly (67% of females, 50% of males). At two months, compliance among those previously called was higher: 74% (77% of females, 67% of males). 35% described exercises as 'very easy', 35% 'somewhat easy', 6% 'neither easy nor hard', 24% 'somewhat hard', 0% 'very hard'. 6% felt 'much better', 50% 'slightly better', 44% 'about the same', 0% 'slightly worse'/ 'much worse'. Many described how the home-based exercises helped with staying active and reducing anxiety while housebound during the Covid-19 pandemic.

Conclusions: There was positive engagement in discussion on frailty and resilience and exercise uptake was high. A single telephone call appeared to help increase participation by [20%.

Frailty index changes in late-life: acceleration in health deficit accumulation rate indicates the presence of frailty 2020 and 30 April 2020 based on the outcome at discharge (alive or deceased). We investigated the risk factors that were associated with mortality using binary logistic regression analysis. Kaplan-Meir (KM) charts were generated by following the outcome in all patients until 12 May 2020. Introduction: Frailty is a prevalent and critical geriatric syndrome among older adults often associated with adverse outcomes [1] . This study examines the prevalence of frailty among older adults in the community using a Frailty Index (FI). Methods: A cross-sectional study was performed from June to September 2019, with older adults who were users of primary care. EASYcare was used for data collection. The FI construction was based on data provided from EASYcare and 44 variables were scored '1' if the value fell outside the normal range and '0' otherwise. For example, an individual with 20 of a possible 44 deficits would have an FI score of 20/44 = 0.45. The cut-off point of C 0.25 indicates frailty [2] . Results: 100 older adults have participated (mean age: 77.99 ± 7.24 years; 61% female) Most of the participants had lower levels of education (one to three years) (67%). The EASYcare summarising indexes showed: the independence score (0-100) was 17.28 ± 18.2; the risk of a breakdown in care (0-7) was 2.6 ± 1.9; the risk of falls (C 3 in total of 8) was 41%. The mean FI was 0.29 ± 0.13. More than half (55%) of the participants were frail. Key conclusions: In this study, the prevalence of frailty was high among older adults in the community; however, these results could be affected by the FI construction. These data show the importance of implementing frailty prevention intervention in the community. (2) showed high levels of dependency (average score -6). High levels of acuity were noted. There were marked levels of both delirium (31%) and incontinence (50%). Implementation of the Covid Geriatric service posed a unique set of challenges. There were barriers to communication due to wearing of personal protective equipment and the reduced duration and frequency of patient interactions. There was delayed time to presentation to the acute setting which necessitated liaison with palliative care services. Patients were more vulnerable to prolonged and complicated delerium. Constraints on availability of investigations and delayed swab results led to increased patient deconditioning and length of stay. Interventions were wide ranging and included nurse education, management of delerium and the use of a multi-disciplinary approach. Methods: The aim of this study was to evaluate the impact of the Homesafe project on length of stay from the patient being recorded as safe for discharge, future hospital attendances and admissions, comparing data from 2 months before and after implementation. Results: Following implementation there were no requests for Telecare on the AMU.The median number of admissions prior to implementation was 1, and post was 0. The median length of stay was 2 days after being deemed medically safe for discharge. Service User and NOK feedback was positive. Conclusion: The homesafe project has been shown to reduce length of stay on AMU with subsequent reduction in reattendance and admission rates with good service user feedback. It demonstrates the importance of collaborative working across sectors to support those patients who are socially isolated and vulnerable. It should be considered across other AMUs to support patient flow and patient experience.

Frail older adults report high approval for an exercise programme integrated within a sports centre for young and elite athletes hour-long session prioritising resistance exercise in a sports centre affiliated with a local higher education institution three times per week for 8 weeks. This allowed frail older adults to integrate with a community of young and elite athletes. They also consumed 500mL of a protein-enriched milk beverage each day. The purpose of this study was to evaluate participants' views of the integrated environment.

Methods: A telephone survey was administered to 21 out of 28 subjects who participated in the intervention and results were recorded anonymously via an online survey application.

Results: Of the participants surveyed, 19 out of 21 disagreed with the statement ''The sports centre is only suitable for younger generations''. Participants were also asked about previous involvement in sports in their youth. 10 considered themselves to be active participants in sport in their youth while 8 did not. Conclusion: Our findings indicate that frail older adults can successfully complete a dedicated exercise programme in an integrated environment with younger and elite athletes. Their perception of the integrated environment was not biased by their past sporting participation. This suggests that exercise programmes in the frail older adult should not be restricted to geriatric day ward/rehabilitation settings but should be promoted in community sports centres and gymnasia. This integrated environment offers numerous societal benefits to all involved.

Evaluation of the estimated Glomerular Filtration Rate with CKD-EPI equation of older adults aged 90 years and over with frailty Together with an inconsistency in care responsibility and clinical decision making between the cardiothoracic surgeons and anaesthetists impacted on post-operative care planning. Illustrated by a near-complete absence of resuscitation decisions and a prolonged length of stay.A significant proportion of patients suffered episodes of delirium with subsequent new prescriptions of antipsychotics which are known to worsen existing cognitive impact and negatively impact recovery.

Key conclusions: More extensive anticipatory frailty assessment is due, including objective assessments (see Essential Frailty Toolset) and supplementary testing of cognitive function. Assessment should be done before decision-to-treat, by a frailty in-reach service such as those already established and proven successful in ortho-geriatrics, oncology and general surgery.Ultimately, further research into length of stay and surgical outcomes in this frail patient group, and the impact of a frailty in-reach service on this, is necessary to facilitate patients to make more informed decisions regarding whether to undertake such invasive cardiothoracic procedures.

Prevalence of frailty among hospitalized patients in geriatric unit and correlation with several commonly used serum biomarkers Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

Introduction: Frailty is a common syndrome in older people that carries an increased risk for poor health outcomes including mortality. Two main models previously described frailty as a loss of physical functions or as accumulation of multiple deficits. Recently, a novel conceptual model of multidimensional frailty has emerged based on the loss of harmonic interaction between multiple domains (biological, functional, cognitive, psycho-social and economic) that ultimately lead to homeostatic instability. Aim of our study was to compare the physical frailty index developed in the Cardiovascular Health Study (CHS) with a multidimensional frailty tool, the Multidimensional Prognostic Index (MPI), in predicting death in community-dwelling older subjects. Methods: In this observational longitudinal cohort study, 407 community-dwelling older subjects were enrolled. Each subject underwent a comprehensive geriatric assessment (CGA) with the calculation of the MPI and CHS. Mortality was then recorded over the following 5 years. Cox-PH models were used to assess the effect of CHS and MPI, respectively: the difference between the observed C-indexes were adopted to compare the performance of mortality risk prediction.

Results: In the sample as a whole (mean age 77.5 ± 4.5 years; 51.6% female), at the baseline the prevalence of physical frailty, according to the CHS index, was 9.3%, and of pre-frailty 26.5%. According to the MPI score, 2% of subjects were in the high-risk category (MPI-3) and 18% in the moderate risk category (MPI-2). During the 5-year follow-up period 53 subjects (13%) died. Both MPI and CHS index were able to predict mortality. However, the MPI was significantly more accurate than CHS to predict mortality (C-index = 0. 69 and 0.59, respectively) , with a statistically significant difference of 10% (95% CI 0.02-0.18, p = 0.013).

Conclusions: Multidimensional frailty, assessed by MPI, predicts five-year mortality in community-dwelling older people better than physical frailty, as assessed by the CHS index.

Neuroleptic malignant-like syndrome in Parkinson's disease; combination of antipsychotic drugs and withdrawal of dopaminergic medications is a potential precipitant Sophie Wallace (1) (1) Russells Hall Hospital, Dudley, UK

Case report: A 76-year-old woman was hospitalised because she gradually became unresponsive. Her medical history included Parkinson's disease and PD related dementia. She was refusing her co-careldopa (25/100 mg TDS) in the days prior to becoming unresponsive. She was also on rivastigmine 1.5 mg BD and quetiapine 2 5mg OD On examination her Glasgow Coma Scale (GCS) was 7 and she was mildly hypertensive. Heart, chest and abdominal exam was normal. She had cogwheel rigidity bilaterally. FBC and CRP were normal. Urea and Creatinine were elevated at 13.9 mmol/L and 114 lmol/L respectively. Creatine kinase (CK) was elevated at 2444 IU/L. Chest X-ray and CT head showed no acute pathology. Neuroleptic malignant-like syndrome was diagnosed. The patient was started on a rotigotine patch 8 mg/24 h and intravenous fluids. A nasogastric tube was inserted but pulled by the patient on several occasions. She remained afebrile, initially renal function improved, however level of consciousness continued to fluctuate reaching a maximum GCS of 12 and rigidity persisted. Subsequently the patient developed acute kidney injury (AKI) stage 3, deteriorated and was managed palliatively. Discussion: Neuroleptic malignant syndrome (NMS) is a rare lifethreatening disorder, which is most often due to an adverse reaction to an anti-psychotic drug. First generation anti-psychotics were the usual culprits but every class has been implicated in reported cases. NMS can also occur in PD patients if their dopaminergic drug therapy is abruptly stopped or reduced, as in this case, and has been referred to in the literature as neuroleptic malignant-like syndrome or malignant syndrome in PD. NMS is defined by the tetrad of hyperthermia, mental status change, muscle rigidity and autonomic dysfunction. Elevated CK levels, usually [ 1000 IU, increase the suspicion of NMS; the level of elevation correlates with disease severity and prognosis. Leucocytosis, elevation of liver transaminases, hypocalcaemia, hypomagnesaemia and hyperkalaemia are common but not specific. Our patient remained afebrile throughout hospitalisation. Although hyperthermia is a classic feature of NMS, there have been reported cases where fever has not been present. The exact pathogenesis of NMS is unknown. Central blockade of the hypothalamic and nigrostriatal dopamine receptors interferes with dopamine's role. If NMS is suspected, the precipitating drug should be discontinued. In PD patients, if dopaminergic therapy had been abruptly stopped, it should be re-started. Temperature and blood pressure should be monitored. Dehydration is a known precipitant of NMS and hydration is vital. Rhabdomyolysis and AKI are the two most common complications in NMS and AKI is a significant predicator of mortality. In this case, despite the patient being adequately fluid resuscitated she developed profound AKI, which proved fatal. NMS mortality could be as high as 50%The best treatment is prevention. Dantrolene, Bromocriptine, or amantadine have been tried in NMS; however, the evidence supporting their use is limited. Conclusion: Physicians need to be aware of the potential of developing NMS in PD patients when a dopaminergic medication is suddenly withdrawn or reduced especially if the patient was on an antipsychotic or an antipsychotic was started. In this case, withdrawal of L Dopa on a background of use of an antipsychotic drug precipitated NMS, and age, development of AKI and rhabdomyolysis and having a single kidney contributed to the poor outcome.

Integrating a front door frailty service in the emergency department: results of a pilot study

Liam Dunnell 1 , Alvin Shrestha 1 , Elaine Li 1 , Zahra Khan 1 , Nima Hashemi 1 1 Croydon University Hospital

Introduction: Increasing old age and frailty is putting pressure on health services with 5-10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week.

Methodology: A 2-week pilot (Monday-Friday 8am-5pm) was undertaken, with a ''Front Door Frailty Team'' comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward -opposed to the usual pathway of referral from the ED team to medical team. Data was captured using ''Cerner'' electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions.

Results: 95 patients were seen over two weeks. In the over 65s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%).

The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients.

The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.

High caregiver burden among acutely presenting older patients in the emergency department Background: In many developed countries, the number of older individuals that live independently at home is on the rise. These older individuals often rely on caregivers who typically have a similar age and health status. Therefore, caregivers may experience a high burden. The aim of this study was to determine the caregiver burden, to investigate potential risk factors and to assess the burden persisted four weeks after ED presentation.

Methods: Prospective observational cohort study of 200 primary caregivers of patients aged C 70 years visiting the ED. Caregiver burden was measured by the caregiver strain index (CSI). Additionally, data form medical records were used. Univariate and multivariate regression analyses were performed to identify independent determinants for burden. Results: The mean age of patients was 82 (SD 6.7) years, 50.5% was female. The mean age of a caregiver was 66 (SD 12.4) years, 67.7% was female. Seventy-eight caregivers (39%) experienced a high burden. Multivariate analysis showed a significant association between high caregiver burden and patients with cognitive impairment or dependency for instrumental activities of daily living (IADL) and a higher number of self-reported hours caring per day.

Conclusion: Almost 40% of caregivers of acutely presenting older patients experience a high burden. This burden is significantly associated with cognitive impairment and IADL dependency of the patient as well as a high number of self-reported hours caring per day by the caregiver. Clinicians should be aware of this problem and address possible burden when communicating with caregivers in the ED.

The ''GERI-toolbox''. Initial outcomes of an e-Health instrument for the prevention of acute hospital admission of frail older adults.

Karen Phytobezoars constitute conglomerates of indigestable food materials which may cause pathological conditions in the digestive system. They may appear in any part of the gastrointestinal tract, although more frequently in the stomach.

Methods: This study included geriatric patients with phytobezoars surgically treated for ileus in the last decade in our hospital. The analysis involved demographic characteristics, pre-and postoperative findings, imaging findings, surgical or endoscopic treatment and the postoperative course. Results: 7 patients were studied, from 68 to 83 years old. They all visited the Emergency Department (ED) with abdominal pain and vomiting and underwent an abdominal CT scan. One patient had a double phytobezoar in the stomach and small intestine, while the others had intestinal masses. Three had a gastric operation in the past, one had neurological disease and three had mastication problems due to artificial dentures. They all were subjected to an exploratory laparotomy and the intestinal phytobezoars were removed through enterotomy. In the case with a double mass, the gastric one caused a temporary jaundice due to duodenal blockage and was removed endoscopically. All patients had an uneventful postoperative course.

Conclusions: Phytobezoars may usually cause obstruction of the stomach or small bowel. The double mass and jaundice are extremely rare. The disease should be suspected in patients with mastication problems, high fiber consumption, past gastric surgery or neurological disease that affects gastric emptying.

Intestinal obstruction in a spigelian hernia with a concomitant jejunal diverticulum

Konstantinos Paschos 1 , Michalis Kirmanidis 1 , Anestis Chatzigeorgiadis 1 1 General Surgery, Hospital of Drama, Greece

The spigelian hernia (SH) is a rare type of hernia, usually of limited diameter, which commonly presents complications, including incarceration and strangulation of the major omentum or/and the small or large bowel. Case presentation: a 70 year-old woman was admitted at the Emergency Department (ED) due to abdominal pain in the right side of the abdomen and vomiting. Her medical history included hypertension and atrial fibrillation. At the ED she presented normal arterial pressure and pulses, while her blood tests were within normal limits. She underwent an ultrasound tomography and a computerized tomography (CT) scan, which revealed small bowel obstruction within the sac of a SH in the right abdominal wall. The patient underwent a surgical operation where the SH sac was removed, while the incarcerated intestinal part was viable and was returned in the abdomen. The abdominal control also revealed a jejunal diverticulum which was removed through a wedge resection. The postoperative course was normal; the patient had no problems 1 year postoperatively.

Conclusions: Although rare, SH may cause complications and emergency surgery in more than 2% of the patients with hernia. The medical personnel should know the special features of this hernia and ask for the proper imaging exams when someone presents pain and a palpable mass in the lower abdomen.

Intro: The safety of telephone triage (TT) services for delivering outof-hours (OOH) care to older persons has been widely debated. However, few efforts have been made to establish clear criteria for managing calls addressing unplanned needs of older persons. Currently, there are no standardized methods outlining how to obtain group consensus regarding such issues. We therefore aim to establish a clear protocol for a Delphi process seeking to establish expert consensus on the management of TT calls related to older persons (over 65 years of age) seeking OOH unplanned care.

Methods: As part of the TRANS-SENIOR international training and research network, a three-part Delphi consensus will be conducted. A sample of 12-15 experts with at least 2 years of prior professional experience relevant to unplanned care for older persons, and/or telephone triage will be recruited. The first two parts of the study will consist of online surveys where experts will rate and provide feedback regarding the use of current TT protocols for managing calls related to older persons. During the third part of the study, a face-to-face round table meeting will be held to achieve further agreement on unresolved protocol details. Data analyses: Descriptive and thematic analyses will be used to aggregate responses. All responses will be quantitively and qualitatively analyzed over several rounds for a maximum of two additional rounds per survey. Final consensus of protocol details will be attained during the planned meeting.

Conclusion: A clear protocol describing our planned study will ensure scientific transparency and may potentially guide best practice methods for implementing a Delphi process.

Age-related in-hospital mortality in patients aged ‡ 65 years admitted to the emergency department with suspected sepsis Introduction: Hip fractures are a major cause of morbidity and mortality in older adults. Orthopaedic ward admission within 4 hours is an important target to improve clinical outcome. In our hospital most patients do not meet this target. This audit aimed to quantify the burden (within this cohort) of coexisting acute medical issues on presentation, as possible obstacles to safely fast-track to the ward. Methods: All patients presenting with hip fracture over six months were included. A data collection proforma was used to record medical, laboratory and radiological details. Data was anonymised, imported into excel and analysed using SPSS.

Results: 108 patients were included, 63% were female, median age was 79y. 49% were prescribed [ 5 medications. 27% had [ 4 comorbidities. 10% had a coexistent fracture. Airspace or interstitial abnormalities were seen on only 8% of chest radiographs. 18% had brain imaging, acute haemorrhage seen in one. Altered mental status, syncope/seizure or acute coronary syndrome was documented in only 5.5%, 2% and 0% respectively. 11% required review (but not admission) by the medical team. Documented heart rate, oxygen saturations, blood pressure and temperature were normal in 79%, 93%, 76% and 98% respectively. Laboratory results were significantly abnormal in less than 10%. Conclusion: Despite multi-morbidity, most of our hip fracture cohort did not present with acute coexisting medical issues. Radiological and laboratory investigations and vital signs were normal for most patients and did not impact on acute management. Fast-tracking to the ward is safe and should remain the focus in these patients.

Deep venous thrombosis associated with Plummer-Vinson syndrome in elderly : a case report

Mrouki Maroua 1 , Derbal Samar 1 , Ben Dahmen Fatma 1 , Abdallah Maya 1 1

Introduction: Plummer-Vinson syndrome refers to the association of iron-deficiency anemia with dysphagia secondary to a post-cricoid web. We report a case of deep venous thrombosis (DVT) revealing Plummer-Vinson syndrome.

Case report: A 75-year-old woman was admitted in our department of Internal Medicine with edema of the left lower limb, poor appetite, weight loss and dysphagia. Microcytic anaemia were identified. An ultrasound duplex showed a deep venous thrombosis of the left superficial femoral vein. On presentation, she had a smooth tongue, angular cheilitis and koilonychia. Investigations revealed an anaemia with a haemoglobin level of 9 g/dl, mean cell volume 71.2 fl and irondeficiency. A barium swallow revealed a post-cricoid web. It was thereafter ascertained on pharyngo-esophageal endoscopy. Then, our patient was diagnosed of Plummer-Vinson syndrome associated with DVT. However, no biopsy was taken. Given that our patient was elderly and DVT may be paraneoplastic, a thoraco-abdominal scan, gastric endoscopy and colonoscopy did no show any abnormality. She was treated with iron therapy and anti-coagulant drugs. She has been followed up for a period of 24 months with improvement in her dysphagia and general nutritional status with no recurrence of DVT. Conclusion: Plummer-Vinson syndrome is very rare and usually diagnosed in young adults. This case highlights that, although rare, Plummer-Vinson syndrome can occur in elderly. When it is associated with DVT, a neoplasia must be searched. Thereby, early diagnosis, treatment and close follow-up is of paramount importance in elderly.

Comparison of the variable indicative of placement risk to short frailty screens in the emergency department Abstract: The value of maintaining social connections through the life is important for mental health and well-being of older adults [3] . The isolation regime during coronavirus disease 2019 (COVID-19) showed that it can exacerbate the negative health decline associated with loneliness in older adults, which is closely linked to the increased morbidity [1] and mortality [2] . In this regard, the focus of health specialists was placed on implementation of effective health strategies of delivering physical activity to decrease loneliness in older adults [4] .

Methods: Participants were healthy, inactive, community-dwelling older adults at risk for loneliness, aged 60-92 years. The intervention included: once weekly group walking and health education workshops with a wait listed control group. The feasibility outcomes were to estimate recruitment, retention and adherence rates. Secondary outcome measures (not blinded assessment) were body mass index, blood pressure, physical activity, and psychosocial variables.

Results: Forty-eight participants were recruited over 4 months with a recruitment rate of 25% (48/195); 52% (25/48) met the inclusion criteria and 100% (25/25) were randomised into the intervention (N = 12) and WL control groups (N = 13). Participants were 25 older adults (mean (SD) 68.5(8.05) years), 14 (56%) female, and 18 (72%) white. At 12 weeks, 10/12 (83.3%) intervention and 10/13 (76.9%) control participants completed the final assessments. The average attendance rate was 58.3% for the intervention group (range 33.0-75.0%) and 42.3% (range 23.1-69.2%) among controls. The a priori recruitment and retention criteria for progression were not met. No serious adverse events occurred.

Conclusion: Research showed that physical activity can be effective for loneliness reduction in older adults, however there is a need for improvement of adherence, which is likely to decrease over time. 

Objectives: Short-term residential care facilities (STRC) were recently implemented in the Netherlands for community-dwelling older adults with low complex health problems with the aim to provide short-term care and return home. In practice 40% is discharged to long-term care. The objective of this study is to identify the needs of patients admitted to an STRC and to describe their care pathway using interviews with STRC staff. Design: Qualitative research using semi-structured focus groups Setting and Participants: Eight nursing homes and three hospitals providing STRC. In total 28 participants working in an STRC were interviewed.

Analysis: Thematic analysis of semi-structured group interviews. Pseudonymized patient cases of 39 discharged patients were discussed from admission to discharge. Results: The patients were admitted with multiple complex problems that were not identified in the handover by the GP or hospital. These problems made returning to home difficult. Main themes contained: (1) the policy of low complex problems and returning home does not fit with practice; which results in STRC in a (2) mismatch between patient needs and care delivered by short-term residential care facilities. Therefore (3) planning appropriate care before and after discharge are important, such as advance care planning, social care and home adaptations are important. Conclusions and implications: Short-term residential care is used by a patient population with an increasing complexity of health problems and often a longer existing functional decline. The provision of better targeted and evidence-based care is warranted. Adequate staffing and resources is necessary. Also, the problems of STRC should be seen in the larger context: a the environmental context of the patient need to be addressed to enable older adults to live longer independently at home.

Socio-demographic and clinical associated factors of healthcare services utilisation in older persons with knee osteoarthritis: a retrospective study. 

Introduction: The first aim of the study was to investigation of the effect of pelvic floor muscle (PFMT) and behavioral training (BT) on incontinence and constipation in elderly. The second aim was to examine whether PFMT were superior to BT. Methods: 84 elderly adults with an average age of 66.34 ± 6.88 (66 women,18 men) years participated in the study. The elderly were randomly divided into two groups. Pelvic floor muscle training (PFMT) group and behavioral training (BT) group received 1 hour of training 2 days a week for 8 week. International Consultation Incontinence Questionnaire-Short form (ICIQ-SF), Urogenital Distress Inventory (UDI -6), Incontinence Impact Questionnaire (IIQ-7) was used for incontinence assessment, Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) and Constipation Severity Instrument (CSI) was used for constipation assessment.

Results: There was a significant difference in all parameters of incontinence and constipation after PFMT (except of pain sub-parameter, Z: -4.20--1.27, p: 0.04-0.00) and BT (except of CSI score, Z:-4.87--2.23, p:0.04-0.01). After training, PFMT group was found to be superior in ICIQ-SF, UDI-6 and IIQ-7 scores compared to the BT group (Z: -2.68--1.28, p:0.01-0.00). Key conclusions: According to the results of the study, both PFMT and BT had a positive effect on incontinence and constipation in the elderly. In addition, PFMT had more positive effects in terms of incontinence than BT. These results support that both exercise and training should be given in order to increase the quality of life in terms of incontinence and constipation in the elderly.

History of falls in the previous year, physical function, and dualtasks tests in older patients of the hospital ward Łukasz Magnuszewski (1), Zyta Beata Wojszel (1), Agnieszka Kasiukiewicz (1) (1) Medical University of Bialystok

Introduction: Falls are a major public health concern with at least one-third of people aged 65 years and over falling at least once per year. This study aimed to verify if recurrent falls reported over the past year correlated with physical function and motor-cognitive dualtask tests in older people. Material and methods: A cross-sectional study of 250 patients consecutively admitted to the geriatric ward at the turn of 2019 and 2020 Conclusions: As we expected, comparing to non-fallers, patients who reported falls in the previous year had significantly reduced functional efficiency in SPPB test and gait speed but they did not differ in other dual tasks and BI functional status characteristics.

Epidemiological analysis of COVID-19 at short-term rehabilitation facility for elderly in Ö rebro Municipality, Sweden Only the dual task training group showed an improvement in cognitive parameters (p \ 0.05). When the mean changes between groups were compared, dual task training group was superior to single task training group in all parameters except in the SLBT scores (p[0.05).

No side effects were observed during the exercises.

The current study concluded that standardized individual-based dual task training is more useful than single task training to improve the balance of healthy elderly individuals and to improve their functional mobility.

Introduction: Significant rehabilitation provision is necessary following infection with COVID-19 but no data exists on impact of intercurrent COVID-19 infection on current rehabilitation processes. This study profiled older rehabilitation patients during the pandemic, including interventions required and discharge outcomes in a specialist geriatric rehabilitation unit. Method: Observational cohort study of current inpatients who contracted COVID-19 during their stay via healthcare record review including rehabilitation input and outcomes.

Results: The mean age (± SD) of 16 patients (57% women) who acquired COVID-19 was 78.4 (± 7.7) years: four died, two were discharged home and three transferred to acute hospital. The 7 patients included in this study had a planned discharge date (PDD) prior to COVID19 diagnosis. There was a mean delay of 15.6 (± 1.7) days in receiving active rehabilitation post diagnosis, reducing to 3 (?1.4) days 2 weeks post initial diagnosis, with 57% newly oxygen dependent, 57% experiencing swallow function deterioration and 86% experiencing a mean weight loss of 3.3 ± 0.9%. Mean modified Barthel deteriorated from 42.9 (?26.9) to 25.2 (?20.8). Two months post initial COVID19 diagnosis, it was not possible to calculate any PDD and mean length of stay was 91.9 (±52.4) days.

Key conclusions: COVID-19 has not only a significant mortality among older rehabilitation patients but also a major impact on the rehabilitation journey, resulting in transfers to the acute hospital and altered therapy schedules, culminating in poorer functional outcomes and delayed discharge. Rehabilitation strategies must be adapted to the altered and more complex needs of older people infected with COVID-19.

Age-dependent differences in reactive balance control during perturbation-treadmill walking 

Introduction: Despite its high relevance in everyday life, reactive balance is not focused on as a fall risk factor in clinical practice. Mediolateral contralateral perturbations lead to particularly pronounced instability in the gait pattern. The aim of this study is to compare reactive balance between younger and older people with and without a history of falls at individually adjusted walking speed and perturbation intensity and to simultaneously conduct an in-depth gait analysis.

Methodology: The reactive balance of healthy young adults (18-30 years), healthy robust older people, as well as older people with a history of falls (C 70 years) is tested on a perturbation-treadmill (BalanceTutorÒ). Fall history and functional performance (Mini-Balance-Evaluation-Systems-Test) are assessed. The intensities of the perturbations are initially determined in a static position in each individual and carried out dynamically at habitual walking speed. Gait parameters are recorded during the dynamic test using coupled inertial-sensors and depth-cameras with bodytracking-capabilities.

We will be able to present data on changes in gait parameters, such as stride-length, track-width and their variability, as well as step-threshold in comparison of the groups. Discussion: This is the first study comparing younger people with older healthy people and older people with a history of falls using an individually tolerated perturbation intensity protocol. Furthermore, a gait analysis with inertial sensors validated by camera visualization is applied during perturbations. The results may provide new starting points for targeted interventions to prevent falls in people at risk of falling.

Rehabilitation programs for the elderly in the pre-operative period after spine surgery: scoping review protocol Introduction: After spine surgery, the elderly are, consistently subject to numerous critical moments of stress and vulnerability. Nursing rehabilitation plays an essential role in the capacitation of the elderly before and after surgery. First stage interventions of the rehabilitation nurse require education/training with the purpose of maximizing the elderly's autonomy and independence in the activities of daily living.

Objective: Map the rehabilitation programs for the elderly submitted to spine surgery. Method: A scoping review, based on JBI's recommendations will be carried out, using the following databases: CINAHL Complete; MEDLINE Complete; Medline, Cochrane, and PEDro. Studies focused on the elderly submitted to spine surgery (Population), subject to a motor and respiratory rehabilitation program (Concept) in the pre-operative period (Context). No time frame will be considered, with studies published in English and Portuguese to be included. Results: Extraction tables will allow for the mapping of the characteristics of the rehabilitation programs, allowing for a better understanding of the settings requirements and potential adherence of these patients to these programs. Also, the knowledge that arises, will help develop a nursing rehabilitation intervention in a reference spine center in Portugal. Key conclusions: Nursing rehabilitation plays an important role in the adaption of the elderly to the implications of spine surgery. This scoping review will allow us to develop a better approach in the preoperative period.

Mapping the knowledge centered on the proprioceptive rehabilitation programs in the institutionalized elderly Introduction: The aging process brings serious physiological changes in the human being. Balance, muscle strength, and articular movement are some of the functions that may suffer some type of impairment because of this process. The decline in the neurological components that are responsible for these functions will lead to a decrease in autonomy and independence, particularly in the performance of daily-living activities, increasing the rate of falls, with an impact on the well-being and health experience of the elderly.

Objective: Map the proprioceptive rehabilitation programs for the institutionalized elderly with balance impairment.Method: A scoping review, based on JBI's recommendations will be carried out, using the following databases: CINAHL Complete; MEDLINE Complete; Medline, Cochrane, and PEDro. Studies focused on the elderly with balance impairment (Population), subjected to a proprioceptive rehabilitation program (Concept) in nursing homes (Context). No time frame will be considered, with studies published in English and Portuguese to be included. Results: Extraction tables will allow for the mapping of the characteristics of proprioceptive rehabilitation programs, allowing for a better understanding of which programs have a better potential to adapt to the Portuguese reality. Also, the knowledge that arises will help develop a nursing rehabilitation intervention in a nursing home in central Portugal, that will be assessed for dissemination.

Conclusions: This research will help develop evidence-based proprioceptive programs to the institutionalized elderly potentially reducing the rate of falls, demonstrating the importance of the rehabilitation nurse in these contexts.

Effectiveness of the diabetic and oral care program for senior in older people with type 2 diabetes mellitus in Muang District, Nakhon Ratchasima Province, Thailand

Namon Phetnin 1 1 Mahidol University

The aim of this study was to assess the effectiveness of the Diabetic and Oral Care Program in terms of improving oral health perception, behaviours, oral hygiene and reduced glycaemic status in type 2 diabetes mellitus older patients. A double-blind randomised controlled study was conducted in the two health centres between July 2019 and January 2020. Control and intervention groups were created and thirtyfive T2DM older patients with chronic periodontitis who attended the centres were randomly recruited into each group. The intervention group received an oral health education program based on the Health Belief Model (HBM), individual oral hygiene instruction, scaling and root planning at one month, and individual oral hygiene instruction at three months. The patients in the control group received the routine program. Outcomes were assessed using a questionnaire, a simplified oral hygiene index, and glycaemic status. These measures were applied at baseline, three months and six months. Data were analysed using a Chi-square test, a t-test, and repeated measure ANOVA at p-value = 0.05. The results at three and six months showed that the intervention group significantly improved their HBM and oral health behaviour scores. Furthermore, their OHI-S scores and HbA1c levels (p \ 0.05) decreased, while there was no significant difference in the control group. The findings suggested that the program was effective among diabetic older people who have periodontitis in terms of improving oral health perception, behaviours, oral hygiene, and glycaemic status as indicated in evaluations occurring three and six months. Introduction: Lung cancer is a major health problem. It is the leading cause of death from cancer in the world. It is the second neoplasm in men and the third in women. The median age of diagnosis is 65 years. Case summary: 69-year-old patient who went to the emergency department after an accidental fall 8 days ago, hitting himself in the right rib region. After the examination, an X-ray of the right rib and chest is requested. On the rib radiograph there are no acute bone lesions and on the chest radiograph there is condensation in the left hemitorax (we have no previous radiographs). After performing an anamnesis again, she comments on two episodes of colds in the last months, without fever, without expectoration, or chest pain, without dysthermia or thermometric fever. pak yeer (27), units of alcohol per day (4). The patient does not report weight loss. The patient is referred to Pneumology to complete the study of the pulmonary mass of accidental findings. Lung cancer is diagnosed and evaluated in oncology, where appropriate treatment is started.

Recommendations: Tobacco causes 90% of lung cancers, the cessation of this habit is vital to decrease their mortality. It is important to promote comprehensive care for the smoker from the health system. And do not forget that before a smoker with the most frequent presenting symptoms are cough, dyspnea, pain and weight loss. The appearance of persistent cough in a smoker should make us suspicious. The first on-demand imaging test is a chest x-ray.

Pathologic fracture by metastasis in adenocarcinoma of straight Introduction: The high incidence of bone metastases secondary to carcinoma and the serious functional repercussion they cause are reasons for studying evaluation, diagnosis and treatment methods. Pain is the most frequent presenting symptom, although sometimes the beginning is a pathological fracture. Description of the case: A 67-year-old female patient with a history of hypertension, nephrectomy for nephrocalcinosis, adenocarcinoma of the rectum at an advanced stage for which she had a discharge colostomy, and also presented bone metastases at the level of the right hip. The patient without previous trauma presents intense pain at the level of the right inguinal region, with total inability to wander. Therefore, he was admitted to the hospital with the diagnosis of a subcapital fracture of the right femur. She undergoes surgery by performing a partial hip arthroplasty. It presents good evolution, reason why it is discharged from the hospital with indication of control by the family doctor and the oncologist.

Recommendations: Colorectal cancer (CRC) bone metastases are rare. When present, they generally correspond to a late manifestation of the disease. CRC meets the necessary conditions to consider it as a neoplasm capable of primary, secondary and tertiary prevention. In the field of primary prophylaxis, the intervention of the family doctor is very important, through education, aimed at promoting diet modifications and genetic counseling. On the other hand, the detection of preneoplastic lesions are the basis of the screening programs carried out in Primary Care for an early diagnosis and to avoid metastasis.

Not only a matter of breast surgery: geriatrician can have its say for endometrial and ovarian cancer surgery too! Results from a pilot study Social Welfare Corporation Tokyo Seishin-kai, 5 Universal Accessibility Evaluation Organization Japan, 6 Tokyo Medical University

Introduction: It has been reported that monitoring of older people's safety can improve the quality of their life in nursing homes and reduce the burden on care professionals at nighttime. The aim of this paper is to report the progress in our efforts to develop a bedside robot which functions as an Input/Output device between a monitoring system and older people. Methods: Development of the robot was based on the PDCA cycle, which is a method of continuous improvement. The research team, composed of system developers, software engineers, care professionals and researchers, followed four processes in parallel: basic design (definition and design of functions including shape and system); user interface A (design) and B (system improvement); and detailed system design, including design of the communication function for the robot.

Results: Improvements were observed in each PDCA cycle, with a shape and sound quality that is easy for older people to use at the bedside (size: 33cm x 27cm x 26cm, 285g). The communication robot can hold basic conversations, respond to signals from the infrared monitoring device and vital sensors, and send alerts to staff and older

Introduction: health-related quality of life (HRQoL) and functional capacity values at short and medium term after pacemaker implantation have been analized previously; however, not much has been known about its long-term effects. The main objective of this study was to compare the health-related quality of life at long-term of users with remote monitoring of pacemakers (RM) versus conventional monitoring (CM) at hospital. Methods: this is a single-centre, controlled, non-randomised, nonblinded clinical trial. Data were collected pre-implantation and after 60 months. The patients in the PONIENTE study were assigned to two different groups: RM and CM. The EuroQol-5D (EQ-5D) questionnaire was used to assess HRQoL and Duke Activity Status Index was used to assess the functional capacity. Results: After 5 years, 55 patients completed the study (RM = 21; CM = 34). EuroQol-5D and functional capacity values were improved; however, significant differences were observed only in the EQ5D visual analogue scale (p \ 0.001).

Conclusions: remote monitoring was equally feasible, reliable, safe, and clinically useful as CM. The frequencies of rehospitalisations and emergency visits did not differ between the groups. RM was found to be safe and effective in early detection and treatment of medical-and device-related events and in reducing hospital visits. Improved HRQoL was described not only immediately after PM implantation but also extended over a long time.

Single Market; empowering citizens and building a healthier society.

[4] SHAPES H2020. (2020) . Retrieved from https://shapes2020.eu.

[5] Long Lasting Memories Care. (2020) . Retrieved from www.llmcare.gr. [6] Methods: A mixed methodology was used, with a sample for convenience, of 50 seniors 29 were men and 21 women, aged between 65 and 80 years old (M = 70.80; SD = 4.70) residing in nine parishes in the municipality of Viseu, in Portugal, a pilot study was carried out with 12 seniors in order to validate the data collection instrument used in this study. Results and key conclusions: Through the identification of obstacles that senior citizens encounter in using the service, and also in assessing the usability of the service, it is clear that the 'e-faturas' service of the Portuguese Finance Portal is not a senior friendly service reinforcing results of other investigations (Macedo, Veloso, A. & Costa, 2019) . Although three usage patterns have been identified according to the degree of independence with which each senior performs each task, the usability problems related to the 'e-faturas' service are highlighted, which are related to the lack of contrast between the background and the various graphic and textual elements. Keyword: Senior citizen; Digital inclusion; 'e-faturas' service [einvoice service];

Introduction: Virtual reality (VR) tasks for cognitive assessment are increasingly being developed. VR can provide different levels of immersion and fully immersive tasks are said to be the more promising as they allow more ecologically valid measures. The aim of this study was to conduct a systematic literature review of immersive VR tasks for cognitive evaluation in the elderly in order to assess the scope of existing research in this field. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the published literature on immersive VR tasks used on the elderly for cognitive assessment was conducted.

Results: A total of 22 studies were included in this review out of 2838 screened articles. Immersive VR tasks provided measures for assessing memory (n=4), navigation and neglect (n=7), executive functions and daily activities (n=6), and global cognitive efficiency (n=5), which were mostly correlated with existing pencil and paper tasks. Furthermore, immersive VR tasks did not raise any major concern on feasibility aspects as subjects were able to go through them without any evidence of significant anxiety, cybersickness or usability difficulty. Conclusions: Immersive VR tasks are promising cognitive assessment tools for the elderly as they can serve both a classical diagnostic purpose and provide more ecological data. Further studies are needed in order to confirm these results as current literature suffers from methodological limitations.

Wearable-sensors based personalized assessment (WeSPA) of frailty: preliminary findings Introduction: Wearable sensors allow monitoring older subject's physical activity in daily life and, therefore, are particularly appealing in the evaluation of older persons in their environment, to capture early signs of frailty-and mobility-related problems. Aim of the WeSPA study is to explore the use of body-worn accelerometers for automated frailty assessment. Methods: After screening by geriatricians for the presence of frailty (Fried's criteria), 34 persons aged 70? years were asked to walk 20 m at their preferred speed while wearing two accelerometers, one positioned on the lower back and the other on the wrist. Sensorderived signals were then analyzed independently to compare the ability of the two signals (wrist vs back) in the identification of frailty status. A gait-cycle detection technique was applied to divide each signal into segments made of four gait cycles, which were then used S240 Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 as input to a feature-extraction phase. Features in the time domain and the time-frequency domain (i.e., Wavelet Transform) were computed on these segments, and eventually a subset of 18 features was selected. Finally, different machine learning models were trained to classify subjects as robust or non-robust (prefrail/frail). Results: The wrist sensor identified non-robust subjects with 100% sensitivity and 73% specificity, compared to only 87% sensitivity and 73% specificity of the back sensor.

Conclusions: A wrist-worn accelerometer signal provides valuable information for the recognition of frail and pre-frail older subjects and could be a valid tool for an automated assessment of frailty in the elderly.

Acute hospital in-reach service Conclusions: It has been possible to implement a joint consultation of trauamtology and geriatrics, obtaining that a minimum of 80% of the patients go to revision consultations and be assessed in a multidisciplinary way. The user satisfaction survey gives a score higher than 9 in this query.

IoT-based home monitoring: supporting practitioners' assessment by behavioral analysis The DS-RER approach aims at empowering care professional with additional information that is not commonly provided in current care practice, namely their behavioral routines. Such information can not be directly mapped to conventional clinical markers, for which telemedicine solutions already exist and are commonly used (e.g., blood pressure monitors, pulse oximeters and weight scales, among others); nonetheless, changes in behavioral habits may reflect changes in overall wellbeing of a person (e.g., sleep routines, toilet usage changes).

Abstract introduction: Although the use of central venous catheters (CVC) is widespread and contributes to patient survival, hematogenous infections associated with their application are a major cause of morbidity and mortality. The treatment of these infections varies depending on the type of catheter and the micro-organism [1] [2] [3] . The contribution of nursing care is catalytic at all stages of the implementation of the CVC. Risk minimization is linked with the prevention of hematogenous infections through the implementation of evidence-based best practices promoting in this way the quality of care and patients' safety [3] [4] [5] . Introduction: Most of people with dementia in nursing homes show one or more symptoms of behavioural and psychological symptoms of dementia (BPSD). Two consecutive Dutch Health inspectorates in nursing homes showed a late, inadequate or incorrect response to BPSD. Three proven effective approaches have joined forces to develop one combined intervention, the STIP method: the personalised integrated stepped care approach to BPSD (Dutch guideline 2018). We are implementing STIP, supported with the BPSD Care web application in two nursing homes (N= 200) with the aim to investigate facilitators and barriers to perform STIP. Methods: The implementation of STIP is executed by means of sounding board groups including informal carers, care professionals and managers. Qualitative data on facilitators and barriers were extracted from 24 transcripts. Quantitative data about the extent of implementation were extracted from patient records (n= 40). Results (preliminary): Qualitative analysis points towards the following facilitators: acknowledgement of difficulties in dealing with and treating of BPSD; acknowledgement for the need of a more integrated approach; leadership; ownership and collaboration. Barriers include a lack of notion about the costs and benefits of STIP; insufficient support from managers and a less-methodological workflow. Quantitative analysis shows multiple deficits in clinical reasoning e.g. the absence of an integral interdisciplinary goal attainment plan. Key conclusions: Both qualitative and quantitative data underline specific difficulties in the implementation of STIP in nursing homes. Insight in barriers and facilitators is a prerequisite for nursing homes to pinpoint the bottlenecks and subsequently to effectively counteract them.

Demand and development of multifunctional intelligent bed for the elderly patients Introduction: Traditionally, elderly patients with long-term care must stay in bed for a long time, in order to avoid long-term lying and pressure sores, nursing staff need to turn over for those patients for two to four hours, which may cause occupational injuries to nursing staff and affect medical quality. Furthermore, in clinical practice, the choice of the bed frame of the hospital bed has a structure that can raise the head of the bed and the end of the bed, but in order to clean and avoid those patients from developing bed sores due to prolonged lying, those patients still needs to turn over. The bed frame is still unable to meet the needs of making those patients easy to turn over. Therefore, Dayeh University established the Long-Term Care and Intelligent Assistive Device Laboratory in 2017 to design and develop multifunctional intelligent bed, and expected it can meet with the demands for elderly patients. Objectives: The demands of the multifunctional intelligent bed will be established and analyzed by the reference for the future revisions.MethodsThis creation was jointly developed by Taichung Veterans General Hospital and Daye University to carry out creative research and development, adding the function of bed end assisted getting out of bed, left and right turning functions, the bed posture control adds eye tracker and mobile phone APP control methods, and the patient can look at the eye tracker screen or mobile phone operation to adjust the posture through the eyeball, to avoid the problem of bedsores, so this smart bed expects to be able to reduce the stress and physical load of care providers. Results: The multifunctional intelligent bed was designed and developed with the Taiwan patent certificate (No 1652055) at the current stage. This study assumes that the demand of multifunctional intelligent bed for the elderly is to help those patients turn over, thereby reducing the burden of the patients' families and reducing the chance of nursing staff working hours and occupational injuries, and the research is still processing as well. Conclusions: The research results will provide medical supplies development of the Long-Term Care and Intelligent Assistive Device Laboratory in the future and to understand the demands of the elderly for multifunctional intelligent bed, and to avoid the problem of bedsores, then therefore to reduce the stress and physical load of care providers.

Feeding practices among people with dementia in residential care facilities: an exploratory study Introduction: In advanced stages of dementia, people with this condition may have feeding difficulties, usually manifested by oropharyngeal dysphagia and/or refusal to eat. More than a nutritional act, mealtimes play a social, religious, biological, and symbolic role in most cultures. It has been increasingly recommended that feeding difficulties can be reduced by applying a social-ecological approach to care, such as the C3P Model -Change the Person, Change the People, Change the Place [1] . This study aimed to explore feeding practices in institutionalized people with dementia (PwD) according to the dimensions of the C3P Model. Methods: Twenty-three nursing assistants (NA) were included in this exploratory-descriptive study. Their skills while offering lunch to institutionalized PwD were assessed through the Feeding Skills Checklist [2] . Results: All participants were female, with an average age of 44.73 years (SD = 10.42) and with 10.28 years of professional practice. Of the 41 meals observed, only 37.7% of good practices were observed. The worst performance was in the PwD dimension, which had only 21.2% of good practices performed. There is not a meal routine and no oral hygiene after the meal was performed. A significant positive correlation was found for time of profession practice and the FSC environment dimension (rs = 0.435, p = 0.038). Key conclusions: There is a weakness in the interpersonal relationship between NA and PwD, and better performance in the environmental (and institutional) Introduction: Medication non-adherence is a complex behavior with multidimensional causes. WHO refers to financial strain as one of the most important factors for it. This literature review describes the factors associated with cost-related medication non-adherence (CRMN). Methodology: A literature review was conducted at PubMed database using the keywords ''adherence'', ''compliance'', ''financial strain'', ''older adults'', ''cost-related medication nonadherence'' and ''community nurse''. Results: In developed countries, CRMN rated 60% for people over 60 years old, which was commonly expressed as unfilled or delayed prescriptions and decreased frequency and doses. Elderlies have multiple chronic conditions and multiple medication use is needed. Frequently, they cannot afford them due to out-of-pocket payments and inadequate coverage by insurance. Evidence has shown that socioeconomic characteristics such as female sex, being uninsured, and living in poverty are associated with a higher likelihood of CRMN. There are also health-related factors (multimorbidity, mental disease, functional limitations and poor health) and other factors such as older people's relationship with healthcare providers and healthcare system which are associated with a higher likelihood of CRMN. Heterogeneity exists between disease groups and cultural backgrounds. The consequences of that behavior are complications in patient's condition and consequently higher costs for healthcare systems. Key conclusions: Community nurses encounter and manage first these types of patients' behaviors and should be appropriately prepared to manage them. On the other hand, reliable healthcare systems and political decisions must guarantee equity and equality of healthcare provisions for all.

General practitioners' appreciation of the return home program of elderly patients hospitalized for heart failure PRADO health system in 2013 to reduce the risk of re-hospitalization after a decompensating heart failure in older people. Methods: Our aim was to understand the degree of satisfaction, the difficulties and expectations of general practitioners concerning the PRADO-IC programme through self-administered questionnaires, carried out from March 2019 to October 2019 to 60 GPs following patients hospitalised between 01/01/17 and 03/03/19 aged 70 or over and included at the hospital discharge in this program. A descriptive analysis of the sample and a statistical analysis according to age and department of work of the practitioners have been performed. Results: The response rate was 41.1%. This survey showed us that the program is well appreciated overall, especially by older doctors. General practitioners believe in the use of the program and think it can improve the treatment of heart failure in elderly patients. However, some complain of poor involvement in scheduling appointments. Conclusion: The PRADO-IC allows an efficient organization of the return home with a link between several care actors. Our study shows fairly positive feedback from general practitioners, but highlights some problems, such as the need for greater participation by the general practitioner in organizing patient follow-up.

Correlation between number of visits and Lubben Scale to evaluate the social network in Nursing Home Residents Introduction: Most Nursing Home (NH) residents have difficulties in responding to questionnaires due to cognitive impairment. Assessing their social network through a health professional (proxy) may be useful. We aimed to analyze the correlation between the number of visits (by proxy respondents) and the Lubben Social Network Scale of 6 items (LSNS-6, by older people) to evaluate the social network of NH residents. Methods: Cross-sectional study in 4 NH from Osona (Barcelona), between January and March 2020. The Spearman test was used for bivariate analysis between LSNS-6 and number of visits (''how many visits per month does the resident receive?'', with a confidence level of 95%. Results: Among the recruited 145 subjects, 33 (22.7%) were excluded due to individuals or their legal guardians refused to participate, 5 (3.4%) were less than 65 years old, 4 (2.7%) were hospitalized or other reason, 64 (62.1%) for cognitive impairment and 6 (5.8%) presented incomplete data on the two main variables. Final sample was 33 (22.7%), mean age of 82 years (±8.05), being 23 (69.7%) women. Mean number of monthly visits was 12.5±10.99; 13 (39.4%) had low risk of social isolation and 20 (60.6%) high risk. A significative negative correlation (-0.50, p=0.003) between LSNS-6 and number of visits was found. Conclusions: Number of monthly visits are significatively and negatively correlated with high risk of social isolation. It is necessary to achieve a larger sample to elucidate if the number of visits is a reliable measure to assess social network in NH residents. 19 and 15/1/ 20 . It involved collecting data which are recorded routinely and are available on the computer system.The parameters studied include the NEWS score, Pain score, duration of admission into the service, source of admission and place of discharge. Results: The total number of patients admitted into the service was sixty. Out of this, there were 36.67 percent of males and 66.33 percent females.Patients were referred into it from different sources. Half of them were referred by the GPS.Eight patients were referred from the Hospitals.One fifth of the referrals came from the social services and another one fifth came from district nurses.Ambulance service referrals were 5 in number which accounted for a sixth of the referrals.6.67% of referrals came from the IV team.In the review, 46 out of 55 patients who had NEWS done had either had better NEWS scores or remained the same. Seventeen patients had better final NEWS scores in comparison with initial NEWS scores. Also nine patients had worse NEWS scores on the final score in comparison to the first NEWS score.Pain score is measured with numerical rating scale. This is based on patient's self assessment (Childs et al, 2005) . Twelve patients were better with the pain scores on the final discharge when compared with eight who had worse scores. Among the places of discharge, forty four patients were in their normal places of residence. One patient who was palliative ,died at home. Fifteen patients were admitted in hospital. The total number of days the patients were under the service was 716 days. This divided by the total number of patients which is 60 gives a mean stay of 11.93 days. Conclusions: The results of the review were positive overall with good outcomes reached for patients. This is reflected in the NEWS scores and the pain scales. Also the number of days the patient is within the service is within the parameters of the National Institute of Clinical Excellence.

Case presentation: A 73 y/o male who is a resident at a long-term care facility and a known case of advanced dementia, diabetes mellitus and hypertension presented with a 1-week history of multiple rapidly enlarging pressure sores and reduced oral intake. Due to the rapidly progressive nature of the pressure sores, a potential dermatological cause was sought. The patient was reviewed and noted to have had multiple oral ulcerating lesions and on the patient's arms he was noted to have multiple small (few mms in size) ulcerating lesions and healed excoriation marks. A collateral history was obtained from the patient's wife which yielded that he was previously diagnosed with a dermatological condition years prior. On the national database of investigations, he was noted to have been tested for Prickle Cell Desmosome Antibodies and the results showed [1:40. A provisional diagnosis of Pemphigus Vulgaris induced pressure sores was made. After treatment with high dose intravenous steroids the patient's pressure sores have started to resolve and the treatment has proved to be promising. Learning points: This case illustrates the fact that pressure sores may have complex aetiological factors involved, apart from the classical causes of decreased nutrition, frailty and decreased mobility. Due to the Covid-19 crisis, this patient was not able to undergo a skin biopsy due to reduction into dermatological services offered. This case also shows the importance of making clinical decisions with the tools available to the geriatrician at the time. Poster to Include Images of Lesions and Discussion Section.

Positive anti-smooth muscle antibodies and interstitial pneumonitis in an old patient with multiple system atrophy Derbal Samar 1 , Ben Dahmen Fatma 1 , Abdallah Maya 1 1 Regional hospital of Ben Arous Introduction: Multiple system atrophy (MSA) is a progressive neurodegenerative disorder among synucleinopathies. The aetiology of MSA remains unknown, but it can involve the extrapyramidal and pyramidal system, the autonomic nerves and the cerebellum. The main clinical manifestations are Parkinson's symptoms, cerebellar ataxia, pyramidal tract signs and autonomic nervous system disorders. Several conditions can be associated. We report a case of MSA associated with interstitial pneumonitis and positive anti-muscle antibodies. Case report: A 79-year-old patient with a medical history of arterial hypertension was followed in the our department of internal medicine for progressive balance disorders, diffuse myalgia, frequent falls, orthostatic hypotension and parkinsonism. The patient was diagnosed with probable MSA and a cerebral and spinal magnetic resonance imaging was not consistent with Parkinson's disease.The clinical examination showed a cerebellar syndrome, a pyramidal syndrome, a parkinsonian syndrome and autonomic dysfunction: urinary incontinence and constipation. Pulmonary auscultation revealed crackling rales. The thoracoabdominal CT objectified lesions of nonspecific interstitial pneumonitis. Hepatic, renal, metabolic and inflammatory assessments were normal. Hepatitis B, C and HIV serologies were negative. The immunoassay revealed positive anti-smooth muscle antibodies. Anti-nuclear antibodies, anti-extractable nuclear antigens and anti-neuronal antibodies were negative. The patient was treated with levodopa 500 mg per day combined with corticosteroid therapy 0.5 mg/kg/day, motor rehabilitation and education of his family. Corticosteroids were tapered gradually. The patient is currently followed the the outpatient department with no further signs. Conclusion: MSA is a rare but serious condition. Its atypical clinical presentation can lead to other diagnosis in elderly. We found no previous reports in literature, of coexistence of MSA and positive anti-smooth muscle antibodies and interstitial pneumonitis.

Toxic megacolon by clostridium as a cause of death in oncohematological patient Yanira Aranda 1 , Cristina Carrasco 2 , Beatriz Neira 3 , Arís Somoano 3 , Carmen Alcaraz-L 4 1 Hospital Central de la Cruz Roja., 2 Hospital Gregorio Marañón, 3 Hospital Central de la Cruz Roja, 4 Hospital Virgen del Rosell A male (85-year-old) with myelodysplastic syndrome type AREB-1 diagnosed in 2016.In 2019, the patient went to the emergency department for extreme malaise with diarrhea. We showed hemoglobin 7.5 g/dL, severe thrombopenia and worsening renal function. Coproculture was collected and the result was Clostridium difficile toxin positive, so antibiotic treatment with metronidazole was started with torpid evolution due to persistence of fever and diarrhoeal stools, with the need to associate vancomycin. Despite the prescribed

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 treatment, the patient presented fever of 38.78, hypotension and intense abdominal pain with distension. Abdominal radiography revealing a dilation at the level of the colon of 8.19 cm: diagnosis of toxic megacolon. Due to the terminal condition after the progression of his hematological disease, it was decided to prioritize comfort and symptomatic control, and the patient died after 48 hours.Toxic megacolon is a rare and potentially fatal complication. It is a nonobstructive dilation of the colon, which is usually associated with systemic toxicity. SIt is often associated with inflammatory bowel disease, especially ulcerative colitis, however, any condition that causes inflammation of the colon may be its etiology. In recent times, epidemiology has shifted towards infectious causes, specifically due to an increase in Clostridium difficile-associated colitis, possibly due to the extensive use of broad-spectrum antibiotics. As responsible physicians, we must justify as much as possible any initiation of antibiotic treatment and initiate sequential therapy with antibiotics oriented to compatible antibiograms, reserving broad-spectrum treatments to selected cases and not in a generalized way.

Quality of life of the elderly patients with chronic cardiac pathologies and associated co-morbidities In the 200 elderly patients without gallbladder's diseases US revealed liver steatosis in 50 % of patients and the prevalence was of the 90% in the groups with obesity. Discussion and conclusions: Metabolic Syndrome in the elderly patients is often associated with gallbladder's diseases. The diabetes with neuropathy causes gallbladder hypotonia with biliary stasis and often in the elderly patients with gallbladder sludge we observe dyspeptic syndrome and reduced gastric motility. In the elderly patients with diabetes and obesity, US detected early and easily gallblader's diseases and the prevalence was very high. In patients with the association between diabetes and dyslipidemia or hypertension was observed a low prevalence of gallbladder's disease. In conclusion, the data of our study show that in the elderly patients with metabolic syndrome is the obesity the most important risk factor for gallbladder's diseases, while the diabetes plays a fundamental role , also related to neuropathy. The high blood pressure is not a risk factor for gallbladder's disease. The dyslipidemia slightly increases the prevalence of gallbladder's diseases. The early U S in elderly patients is very important to detect the serious inflammatory complications of gallbladder: in fact cholecystitis , associated with fever and abdominal pain is often observed in diabetic elderly patients. We suggest that US should be performed in all elderly patients with metabolic syndrome, also without symptoms of gsllbladder's diseases. US allows to apply very quickly the appropriate diagnostic and therapeutic program and increases the effectiveness and efficiency of care in geriatrics.

Demographic and clinical characteristics of home bound patients with chronic heart failure 

Introduction: Parkinson's disease (PD) is a neurodegenerative condition that involves motor and non-motor symptoms such as autonomic dysfunction which include cardiac system. Neurogenic orthostatic hypotension is the most common cardiac manifestation. Another cardiac effect in PD, however, is changing in heart rate.

Case report: A 55-year-old woman with high blood pressure, diabetes and kidney failure related to diabetic kidney disease was admitted for hyperglycemia. She reported a deep fatigue. At the electrocardiography, she had sinus tachycardia at 120 beats per minute without any other abnormalities. The cardiovascular examination was normal. Moreover, she had a motor slowness (bradykinesia), a stiffness of the two wrists and tremors of the distal extremities. The biological tests, including the cardiac enzymes were normal. The cerebral computed tomography didn't show any abnormalities. After having ruled out all the cardiac and extra-cardiac causes of sinus tachycardia, the diagnosis of PD with autonomic dysfunction was retained. Conclusion: In PD the autonomic control of the cardiac system is impaired affecting even heart rate. Heart rate variability is more pronounces in patients who developed PD than those who did not. Cardiac autonomic dysfunction can be an early non-motor symptom of PD.

Benefits of computed tomography of the thorax, abdomen and pelvis in inflammatory syndromes of unknown origin in older people 

Introduction: Amyloid light chain (AL) amyloidosis due to deposition of monoclonal immunoglobulin light chains, is a rare and heterogeneous hematologic disease. We report a case of chronic polyradiculoneuropathy revealing AL amyloidosis in an old patient.

Case report: A 65-year-old man admitted for edema of the lower limbs, weight loss, and progressive motor slowdown affecting the 4 limbs evolving for 3 months. Physical examination showed a proximal and distal symmetrical sensory and motor deficiency with abolished ankle reflexes. The rest of the examination was normal apart from an infiltrated purpura of the 2 lower limbs. Viral serologies were negative. The bioassay eliminates a phosphocalcic disorder, a hemostasis disorder, diabetes and vitamin deficiency. Brain CT was normal. The first electromyography (EMG) demonstrated a severe sensory and motor neuropathy. Negative serology for hepatitis B, hepatitis C, rheumatoid factor, anti-CCP antibodies, and antinuclear, anti-dsDNA, anti-neuronal, and anti-neutrophil cytoplasmic antibodies confirmed the absence of underlying auto-immune diseases. Skin biopsy confirmed amyloidosis. The immunohistochemical investigation was positive for AL deposits. Serum protein electrophoresis did not show a monoclonal component. Immunofixation of serum proteins revealed normal kappa/lambda ratio. The bone marrow cytology showed 5% plasma cell infiltration with no other signs multiple myeloma. There were no bone lesions on radiographs of the complete skeleton. The patient was diagnosed with peripheral neuropathy revealing AL amyloidosis. There was also no evidence of cardiac or renal involvement. He was treated with high-dose corticosteroids with no improvement of the motor deficiency after 48 months. Conclusion: Peripheral neuropathy is described in 15-20% of cases of AL amyloidosis. This involvement may mark the beginning of the disease and may present with progressive sensorimotor polyneuropathy, focal neuropathy, autonomic neuropathy, as well as other unusual clinical presentations. Diagnosis is often delayed. It is prudent that physicians consider the diagnosis of AL amyloidosis in patients with neuropathy, so that these patients may be treated earlier.

Telephone support for complex chronic patients Medical activity in geriatric units extends beyond mere routine clinical practice and it is essential for a real, easy and direct healthcare continuity. However, in the XXI century access to medical specialists in hospitals remain a Penrose Stair for geriatric patients. The particularities of this population require that accessibility to medical resources become more fluid and direct. At this point, why something so basic and cheap as a phone consultation in the age of telecommunications is something so unusual? Perhaps by the overloading of clinicians, lack of time and support that allows registration or because its has been doing in an informal way for long without any registration. The benefits of continuity of care in this population are well documented today. Phone support reduce hospitalizations and emergency departments conultations 1, 3, 6, premature readmissions, improve the health status of chronic patients 2, 3 , improves prognosis of patients with heart failure 5, and terapeutic adherence 7. It has also been incorporated into the comprehensive managment in palliative care services with improvements in quality of care perceived by patients 10 . Within the framework of state programs chronicity justifies the need to develop and document this innate care activity in most geriatric units since its inception and is now extrapolating and incorporating other services. The aim of our study is to enhance the recording of telephone consultations in the geriatric unit which for years has been carrying out this activity and analyze the user profile to provide an efficient, actual non-contact continuous and specialist care and focused on the particularities of our population (1) (1) University of Helsinki, Department of General Practice and Primary Health Care

Introduction: The aim of this study was to explore the changes in nutrition, especially energy and protein intake between 2007-2017 in two cross-sectional cohorts of older long-term care residents in Helsinki. We also studied how the residents' disability and stage of dementia modifies the association between cohort year and protein intake (g/kg). Methods: In this cross-sectional study residents' nutrient intake was determined by one-or two days food record in 2007 (n=350) and 2017 (n=476). Residents' disability was determined by Clinical Dementia Rating (CDR) scale ''personal care'' question and stage of dementia was determined by CDR.

Results: There was no significant difference in energy intake between the cohort years. Carbohydrate, total protein and protein g/kg intakes were significantly lower in 2017 than in 2007. Fat intake was higher in 2017 than in 2007. In 2017 the intake of some vitamins and minerals was reduced (tiamin, calcium), but some increased (vit. A, D, C, E) compared to 2007. Residents' disability (p=0.049) and cohort year (p=0.037) were significantly associated with protein intake (g/kg) , but the interaction was not significant (p=0.35). Stage of dementia was not associated with protein intake (p=0.22), but the cohort year was (p.001). The interaction was not significant (p=0.30).

Conclusions: There have been some improvements in long-term care residents' nutrition during the decade. However, the intake of energy, protein and some vitamins are even lower. As long-term care residents become more disabled in the future, more attention should be paid to nutrition.

Assessing nutritional status in geriatric patients Introduction: Drugs with anticholinergic properties use are common in the elderly despite growing evidence of their adverse outcomes.

Information is scarce concerning the impact of anticholinergic exposure on nutritional status in this population. Therefore, we evaluated the association between anticholinergic burden and the malnutrition risk in community-dwelling older adults. Methods: We enrolled a total of 470 subjects who had undergone comprehensive geriatric assessment (CGA) between 2017 and 2019 years in this cross-sectional study. Nutritional status was checked by the Mini Nutritional Assessment-Short Form (MNA-SF) (The malnutrition risk: a score of 11/14 or lower) [1] . Each participant's anticholinergic burden was evaluated using the Anticholinergic Cognitive Burden (ACB) scale [2] . 

Background: Appetite loss in older people is common and associated with malnutrition, sarcopenia, frailty and mortality. Effective management of appetite loss may prevent these major health burdens, but no current guidance exists. This is in part due to a lack of understanding of how older individuals experience appetite loss.Aim: To understand older individual's perceptions of appetite and appetite loss.

Methods: Qualitative research with men and women aged C 65 years, in their own home. Semi-structured interviews were audiorecorded and transcribed. Reflexive thematic analysis, with inductive coding, generated themes with data examples. Results: 13 participants (8 female, 4 living alone). Perceptions of appetite and appetite loss were described in two ways and valued differently by individuals. 'Appetite as an experience' encompassed escalating positive thoughts and feelings, driving a desire to eat. Then, appetite loss as struggling to initiate eating due to negative thoughts and feelings. 'Appetite as a physical function' encompassed physical descriptions of bodily need, without thought or feeling. Then, appetite loss as a continued ability to initiate eating but with reduced capacity from fullness.Perceptions of appetite and appetite loss shaped individual's adaptations to poor appetite. Either seeking out desirable food (appetite as an experience) or having smaller meals (appetite as a physical function).

Conclusions: Appetite and appetite loss are perceived by older individuals in distinct ways. Importantly these viewpoints affect individuals' adaptation to poor appetite. This highlights a need for novel person-centred interventions for appetite loss, based on understanding of the individual's experience.

Post-stroke dysphagia: swallowing and nutritional status after hospital discharge Eirini Stratidaki 1 1 Causes against NI in 36 malnourished residents were: awaiting further weight trends 10x, satisfactory weight 6x, adequate BMI 6x, not judged as malnourished 5x, a living will 5x, refusal by legal guardian 1x, sufficient appetite 1x, terminal situation 1x, awaiting results of dietary records 1x. 29 residents without malnutrition were given enriched meals 23x, ONS 1x, or both 5x for the following reasons: unsatisfactory intake 15x, BMI[20\23 5x, WL 4x, no explanation 3x, tumour 2x. Conclusion: A huge discrepancy between residents being malnourished and those receiving NI was revealed, which can partially -but not always -be explained by valid reasons.

The association between nutritional status and functional status of community-dwelling older adults Conclusion: Our results support the use of SNAQ to screen for anorexia amongst non-frail community-dwelling older adults. Using a higher cutoff improves detection and is associated with relevant outcomes.

Correlation between minerals and weight change in patients older than 65

Athina Greka 1 1 EEMEG Abstract: In the present study, the weight loss ratio of people over 65 years of age was studied in relation to their muscle mass.Screening test: laboratory profiles a targeted diet exercise program in conjunction with their medication. Introduction: Over a three months period, 30 patients aged over 65 were examined. (None with pacemaker) All the patients followed. Background: The Global Leadership Initiative on Malnutrition (GLIM) proposed in 2019 a consensus for diagnosing malnutrition in adults in clinical settings. First screening ''at risk'' status using a validated screening tool, second diagnosing and assessing the severity of malnutrition. The new consensus was used to assess the impact of malnutrition in length of stay, readmission and mortality in an acute medicine ward.

Methods: Prospective study of elderly patients admitted to an internal medicine ward, for 6 months, willing to participate (signed informed consent). Demographic and clinical data were obtained from the electronic file, and antropometric data (height, weight, midarm diameter and nutritional history) from the patient. Nutritional data were analyzed with the GLIM Consensus and MUST for ''at risk'' screening, and patients divided by diagnosis of malnutrition. The assessed outcomes were length of stay, readmission at 1 month and mortality. Statistical analysis was performed using STATA (Stata-Corp. Stata statistical software: release 14. College Station, TX:

StataCorp LP). A p value of .05 was considered significant. Parametric data were expressed as mean (standard error of the mean, SEM), non-parametric data as median (interquartile range, IQR). Statistical tests for univariate analysis were T-student and chi square and for multivariate analysis logistic regression.

Results: A total of 30 patients were included, of whom 10 (33%), had a diagnosis of malnutrition using the GLIM criteria. Age (79±8,5 vs 82±7,3, p-value=0,35) and female gender predominance (50%, p-value=1) was similar in both groups. Malnourished patients exhibited a slight tendency to infection as diagnosis at admission (40 vs 15%, p-value=0.07), not statistically significant due to similarity in other diagnosis. Both groups had similar levels of comorbidity burden by the Charlson index (4±2,4 vs 5, 3±3,8, p-value=0.3) , dependence by the Lawton&Brody scale (4,7±2,3 vs 4.3±3,3, p-value=0.6) and frailty by PRISMA7 (3,2±1,8 vs 2,8±2, p-value=0,6) . Considering the outcomes, there was only a difference in mortality at 6 months (10 vs 40% for the malnourished, p-value=0.05), with similar length of stay (10,7±5,7 vs 29±85, p-value=0.09), readmission (40 vs 20%, p-value=0.2) and in-admission mortality (10 vs 20%, p-value=0.4). Discussion: Despite the small size sample, we observed 1/3 of malnourished patients, that did not seem to differ from the other in terms of demographic and geriatric features. The higher impact appears to be on medium-term mortality. Background: Malnutrition is an often unrecognized and untreated cause and consequence of disease in adults. It has a substantial impact on health across all care settings, including the Hospital setting.The Global Leadership Initiative on Malnutrition (GLIM) recently proposed a consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale. It is a two-step approach, first screening to identify ''at risk'' status using a validated screening tool, and second, assessment for diagnosis and grading of the severity of malnutrition. Our aim is to use this new consensus to estimate the prevalence of malnutrition in the elderly in an acute medicine ward. Methods: Cross sectional study performed at an internal medicine ward, throughout 4 months, to patients willing to participate following signed informed consent. Demographic and clinical data gathered from the electronic file, and antropometric data (height, weight, midarm diameter and nutritional history) collected from the patient. Nutritional data was analysed according to the GLIM consensus together with MUST for at risk screening. Patients were divided into 2 age groups (\65 and[65 years old). The outcome was prevalence of malnutrition. Statistical analysis was performed using STATA (Sta-taCorp. Stata statistical software: release 14. College Station, TX: StataCorp LP). A p value of .05 was considered significant. Parametric data were expressed as mean (standard error of the mean, SEM), non-parametric data as median (interquartile range, IQR). Statistical tests for univariate analysis were T-student and chi square and for multivariate analysis logistic regression.

Results: A total of 44 patients were included, of those 30 (68%) were elderly, with a prevalence of the female gender (64 and 50%, under and over 65 respectively). The main causes for admission were similar between young and elderly: cardiovascular (29 vs 39%), infectious (14 vs 23%) and respiratory (21 vs 7%). As expected, elderly patients had a higher comorbidity burden, with a higher Charlson index (2,4±1,4 vs 4,5±2,9, p-value=0 .01), were more dependent according to Lawton&Brody scale (6,3±1,8 vs 4,5±2, p-value=0 .007), and were more frail by PRISMA7 (1,4±1,7 vs 3 ±1,8, p-value=0.008). All patients were on an oral diet, and a majority was not taking any multivitamin supplements (100% vs 90%). Concerning nutritional status, average BMI was similar, although slightly lower in the elderly (29±8,5 vs 26±7, p-value=0.2). Using MUST as a screening tool, 46% of the young and 40% of the elderly were at risk for malnutrition (p-value=0.7). Using the GLIM criteria, this number decreased slightly to 43% in the young and 33% in the elderly (p-value=0.5). Discussion: We observed a high percentage of patients at risk for malnutrition and with a diagnosis of malnutrition using MUST as a screening tool and the GLIM criteria as diagnostic. This was observed both in patients under and over 65. Surprisingly, despite increased comorbidity burden, dependence and frailty, the elderly patients exhibited a lower percentage of malnutrition, despite not statistically significant.

EuGMS-2020: gait speed predicts depression in mild cognitive impairment Objective: Slowed gait speed, an established measure of reduced functional performance, is considered a sensitive predictor of worsening cognitive status. Depression symptoms are known to influence gait speed in cognitively healthy adults. In this study, we determined the relationship between slow gait speed and depression symptoms in a sample of patients with mild cognitive impairment. Method: We measured 15-feet gait speed and depression symptoms in community-dwelling older people (C 65 years) with mild cognitive impairment recruited from an outpatient setting of a tertiary geriatric care unit. The subjects were classified as slow and normal gait speed based on the Fried criteria. Introduction: Shared decision making (SDM) describes the process by which clinicians and patients jointly consider the best available evidence and the patient's personal values in order to make judgements about healthcare. This is advocated by a number of organisations including NICE. Perioperative Care of Older People undergoing Surgery (POPS) is an assessment and management service for multi-morbid and frail patients within which SDM should be routinely practiced. This quality improvement project aims to evaluate satisfaction in SDM amongst clinicians and patients in the POPS preoperative clinic.

Methods: POPS preoperative clinics in September/October 2019 (first cycle) and November 2019 (second cycle) were selected for analysis. Following each consultation, clinicians and patients completed paired SDM-Q9 questionnaires to evaluate SDM satisfaction. This tool has been previously validated in this population. Results were standardised and compared using paired t-tests. Group discussions were used to identify strategies for improvement.

Results: 68 (52%) questionnaires were initially returned completed. SDM satisfaction was 89.2% for patients and 78.9% for clinicians (p.001) and further analysis suggested that junior clinicians found SDM particularly challenging. Following this, a teaching programme led by senior clinicians was instigated. In the second cycle, 31 (57%) questionnaires were returned completed and there was a significant increase in patient satisfaction in SDM in the junior doctors group (p=0.045).

Conclusions: Although SDM is of generally high quality in the POPS preoperative clinic, junior clinicians found this more challenging. Patient satisfaction in SDM was significantly improved following the commencement of a dedicated teaching programme.

Enhanced recovery after surgery in patients ‡ 70 years undergoing elective colorectal surgery Background: Enhanced recovery programs (ERPs) in colorectal surgery have demonstrated beneficial effects on postoperative complications, return of bowel function, length of stay, and costs, without increasing readmissions or mortality. However, ERPs were not specifically designed for older patients and feasibility in older patients has been questioned. Aim: The aim of this study was to assess ERP adherence and outcomes in older patients and to identify risk factors for postoperative complications and prolonged length of stay.

Method: Retrospective analysis of consecutive patients (C 70 years) undergoing elective colorectal resection in a tertiary referral hospital in 2017.

Results: Ninety-six patients were included. Adherence rates were above 80% in 18 of 21 ERP interventions considered. The lowest adherence rates were noted for preoperative carbohydrate loading and cessation of intravenous fluids. Postoperative complications (Clavien-Dindo C2) and prolonged postoperative length of stay ([75th percentile) were observed in 39. 6% and 26 .3%, respectively. Median length of stay was 7 days. The 30-day mortality, readmission and reoperation rates were 2.1%, 12.6% and 8.3%, respectively. Multivariable analysis indicated that polypharmacy and site of surgery were independent risk factors for postoperative complications, while higher age, American Society of Anesthesiologists class and preoperative radiotherapy were independent risk factors for prolonged postoperative length of stay. Conclusion: ERP adherence in older patients undergoing colorectal resection is high and ERP is therefore considered feasible. Postoperative complications and prolonged postoperative length of stay are common, so at risk patients should be targeted with tailored geriatric interventions.

Perioperative management of antithrombotic therapy in hip fracture patients Abstract # 418 The association between frailty and severity of cognitive impairment in older inpatients with postoperative delirium 

Introduction: Frailty and cognitive impairment are risk factors for postoperative delirium and predictors of negative health outcomes. The objective of the study is to determine the association of frailty and severity of cognitive impairment in older inpatients with postoperative delirium. Methods: Consecutive patients aged C65 years old admitted to a tertiary teaching hospital for semi-urgent and elective surgery were recruited over 6 months period. Frailty status was identified using Fried Frailty Index. All patients had cognitive assessment using Montreal Cognitive Assessment(MOCA) and delirium was diagnosed using the Cognitive Assessment Method and 4AT. Patients were then divided into category A(dementia with frailty), category B(dementia alone), category C (mild cognitive impairment(MCI) with frailty, also termed cognitive frailty), category D(MCI alone), category E (frailty alone) and category F (normal cognition with no frailty Background: According to Orem's Self-Care Deficit Nursing Theory, nurses assume an essential role in preventing complications in the postoperative neurosurgical period in the elderly, specifically concerning the focus of attention of positioning. Objective: Map the elderly's postures/positions that enhance security and reduce complications in the postoperative neurosurgical period. Methods: A scoping review based on Joanna Briggs Institute's recommendations was carried out through the following databases: Medline (PubMed) and CINAHL (EBSCO). Studies in English, Spanish and Portuguese, with no time limitation, were included in the search. Two independent reviewers assessed studies for title and abstract in the first stage, and full text in the second stage, with a third reviewer assessing in case of discordance.

Results: A total of thirteen articles were included in the analysis. From these studies, eight evidenced reduction of Intracranial Pressure (ICP) by raising the head-of-bed by 30 degrees, while keeping Cerebral Perfusion Pressure (CPP) stable (p.05). When raising head-of-bed to 45 degrees, a slight increase in ICP and a decrease in CPP was observed (p.05). Regarding Chronic Subdural Hematoma (CSDH), although not significant, three articles evidenced the presence of complications when raising head-of-bed (p.05), with another article evidencing a positive impact in the length of stay. Conclusion: Raising the head-of-bed by 308 degrees in the postoperative period contributes to a quicker recovery, through optimization of ICP and CPP, with subsequent improvement of venous return. Incorporating this evidence into nursing care will help reduce complications and length of stay in the elderly submitted to a neurosurgical procedure.

Neuroprotective effect of rapalogs in a pharmacological model of Parkinson's disease María José Hormazábal 1 1

Introduction: Parkinson's Disease (PD) is a neurodegenerative disorder characterized by a progressive loss of dopaminergic neurons into substantia nigra (SN). Rapamycin, used in transplanted patients as immunosuppresor, has shown a therapeutic potential in pre-clinical model of PD through the neuroprotection of dopaminergic neurons in SN. Moreover Rapamycin has been associated to glucose metabolic disorders. Previous studies suggested that analogs of Rapamycin (Rapalogs) have similar neuroprotective effects by signaling for mTOR pathway. We investigated if Rapalogs called TAM-1 and TAM-3 has a neuroprotective effect and avoids metabolic alterations in a pharmacological PD model in comparison with Rapamycin effects (performance). Material and methods: Adult male C57BL/6 mice were injected unilaterally into the SN with the neurotoxin 6-OHDA, validated PD model. Animals were pretreated with Rapamycin, TAM-1, TAM-3 or vehicle (2 injections administered intraperitoneally). After 7 days, we evaluated the motor performance by Cylinder test and determine neurodegeneration process by histopathological analysis using antityrosine hydrolase antibody. Moreover, we determine metabolic parameters as glucose, insulin, and leptin levels in serum samples of these mice. Results: Rapamycin, TAM-1 and TAM-3 prevent the loss of dopaminergic neurons of the nigrostriatal pathway. Additionally, TAM-3 ameliorate the motor impartment and TAM-1 did not trigger glucose resistance in PD model. Discussion: These results suggest that TAM-1 and TAM-3 exert neuroprotective effect of nigrostriatal circuits and alleviate the motor impairment, similar to Rapamycin in the pharmacological model of PD by signaling the mTOR pathway.

Chronic kidney disease and appropriate prescribing in hospitalized older adults: an observational study 

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

Introduction: Chronic kidney disease (CKD) is highly prevalent in older adults, but is frequently omitted in medical records, which may lead to inappropriate prescriptions.This study aimed to assess the under-reporting of CKD in discharge summaries of older hospitalized patients and to evaluate appropriate prescribing according to renal function. Methods: Patients aged 65? were enrolled in a geriatric acute care setting between January and May 2018, if creatinine was available within 3 days before discharge. Renal function was assessed according to the following formulas: Cockroft-Gault (CG), Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD), Berlin Initiative Study 1 (BIS1) and Full Age Spectrum (FAS). Prescriptions were evaluated according to the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) 2013 criteria.

Results: 192 patients were enrolled (mean age 85). In discharge summaries, CKD was omitted in the 54% of patients, 25% of whom showing severe CKD. According to the CG formula, STOPP criteria were not applied in the majority of patients taking thrombin inhibitors (50%), Xa inhibitors (64%) and colchicine (100%), since patients' weight was missing. These prescriptions were instead appropriate according to CKD-EPI. None of the patients with CKD showing Hb B 11 mg/dl were prescribed erythropoietin. Conclusions: CKD is frequently omitted in discharge summaries. The under-reporting of CKD and difficulties in the use of CG formula limit the use of STOPP and START criteria. Accurate reporting of CKD in medical records may favor appropriate prescribing in these patients.

Prevalence of crushing medication in people aged 65 years or more, living at home in Martinique Cécilia Cofais 1 , Lidvine Godaert 2 , Moustapha Drame 3 1 CHU Rennes, 2 CH Valenciennes, 3 

Introduction: The safety of medicine management is a public health issue. Crushingmedication (defined as modifications of the solid oral drug products (chewing,splitting, crushing...) has been identified as a common medical error. Several studiesconducted in long-term care facilities for the elderly have shown that the frequency ofcrushing medication varies between 7 % and 35 %. To the best of our knowledge, nodata exists about how often community-dwelling older people crush drugs to facilitateingestion. The aim of this study was to estimate the prevalence of crushingmedication in people aged 65 years or older living at home. Method: A cross-sectional, observational, epidemiological study was carried out. Inclusion criteria were: age 65 years or more, living at home, and to have taken atleast one oral medication for two weeks or more. The subjects included wererecruited from different geriatric departments in Martinique. The primary outcome ofthis study was the prevalence of crushing medication. Results: In total, 209 patients were included; 17.7 % were found to crush theirmedication. We observed that family carers were more likely to crush medicationthan nurses or the patients themselves.

There was no significant difference betweennurses and patients in the frequency of crushing medication. Discussion: Our findings show that crushing medication is frequent amongcommunity-dwelling older people. The iatrogenic risk incurred by this practice isunknown to caregivers, carers, and patients. Campaigns are warranted to raiseawareness among the general population and caregivers of the risk of this practice. Background: As the number of older people with dementia (PWD) increases, safe pharmacotherapy in this population has attracted attention in recent years. Aim: The aim of this study was to clarify the prescribing patterns in older patients who were prescribed anti-dementia drugs and to investigate the association of potentially inappropriate medications (PIMs) with the use of anti-dementia drugs. Methods: Adults aged C65 years, who were prescribed anti-dementia drugs at 585 pharmacies across Japan (N = 7953), were surveyed. The percentage of prescriptions for anti-dementia drugs and the effect of those prescriptions on PIMs were investigated. Results: Prescriptions for anti-dementia drugs were found in 4.4% of the entire study population. A logistic regression analysis revealed that the use of anti-dementia drugs reduced the risk of prescribing psychotropic drugs, which represented PIMs, and that a combination of anti-dementia drugs (e.g., choline esterase inhibitor with memantine) may reduce the risk of prescribing PIMs compared with monotherapy.

Conclusions: Anti-dementia drugs were under-prescribed relative to the possible prevalence of dementia, and the use of anti-dementia drugs or the combination of available drugs may reduce the risk of prescribing PIMs.

Relationship between polypharmacy, anticholinergic burden, therapeutic complexity and inappropriate prescription with frailty

Núria Case report: A 79-year-old lady was admitted with shortness of breath. The patient had a diagnosis of adenocarcinoma of the lung on a background of COPD. She was started on nebulised salbutamol 2.5mg and ipratropium bromide 500mcg. On Day 5, it was observed that the patient had a fixed 6 mm dilated left pupils and the right pupil was 3 mm. In the previous day the pupils were non-dilated, equal and reactive bilaterally. The patient was not on mydriatic eye drops . On examination there were no other lateralising neurological signs; cranial nerves as well as motor exam of the upper and lower limbs were normal, apart from the dilated fixed left pupil. After clinically excluding an acute neurological event, the mydriatic effect of ipratropium anti-muscarinic action was considered to be a potential cause for the fixed dilated pupil, however this did not explain the unilateral involvement. The patient was observed while using the nebuliser and it was noticed that she could not tolerate the mask affixed to her face to form an adequate seal, rather, she was holding it aloft and favouring her right side, such that the mist dispersed more readily to the left; this explained the unilateral manifestations. The assumption was subsequently proven upon discontinuing the ipratropium, when the pupils size, symmetry and reactivity returned to normal after around 24 hours, in keeping with timescales documented in previous case reports.

Discussion: Ipratropium bromide, as an antagonist of muscarinic acetylcholine receptors, causes mydriasis due to unopposed action of the dilator pupillae muscle, and cycloplegia due to ciliary muscle relaxation. The ocular complications of ipratropium bromide are due to the local effect of the medication; i.e. when the aerosolised ipratropium comes into contact with the eyes. The incidence of ipratropium induced ocular complications is between 1% to \ 1 per 1000 patients. Whilst there have been some case reports of ipratropium causing mydriasis, it remains in practice, a poorly recognised adverse drug reaction (ADR). Patients must be instructed in the correct administration of ipratropium nebuliser to avoid its release into the eye. Clinicians need to be aware of the uncommon mydriatic side effect of ipratropium to avoid unnecessary imaging and other investigations.

Massive weight loss from rivastigmine patch in an older patient: a rare case Here, we report a case of an older woman with a history of AD who lost weight unintentionally due to the rivastigmine patch. ''Ms. G'' was a 75-year-old woman presented to the outpatient service of geriatrics clinic in September 2018 with a history of loss of appetite, fatigue, a feeling of hopelessness, and loss of interest in daily activities. She lost 42-lb (19 kg) gradually during this period. She started the rivastigmine patch prescribed by her neurologist for AD since November 2017, and the dosage increased to 13.3 mg/d (15 cm 2 ) in March 2018. Also, her relatives reported that she was brought to an emergency room for nausea and fatigue a couple of times after the dosage raise of rivastigmine patch to 13.3 mg/d (15 cm 2 ). Her baseline weight and body mass index obtained from medical records were 137 lb (62 kg) and 27.9 kg/cm 2 . Her relatives shared information on emesis and anorexia occurred at one month of donepezil use. The detailed physical examination and laboratory studies did not consider a malignancy or malabsorption. Massive weight loss was attributed to the rivastigmine patch and associated exacerbated depression. The rivastigmine patch was discontinued, and the nutrition counseling recommendations were received by the dietitian who was involved in the multidisciplinary geriatric team. Two months later, we saw a marked improvement in mood and cognition, and her weight increased to 112 lb (51 kg). Nutritional status and weight of patients should be closely monitored after initiating therapy and each dose increment.

Conclusion: The use of FQ represents a low percentage in comparison other antibiotics, however, there are alternatives, for non-severe infections and absence of BL allergy. Its used more in respiratory diseases (presence of bronchiectasis and pseudomonas superinfection) with BL allergy and less in urinary tract infection (high resistance rate). In general, are well tolerated, even though in our patients (high comorbidities and polypharmacy) its hard to attribute some adverse effects.

Trends in benzodiazepine receptor agonists use and associated factors in belgian older adults: analysis of the belgian health interview survey data Introduction: Benzodiazepine receptor agonists (BZRA), that include benzodiazepines and z-drugs, are commonly prescribed for insomnia and anxiety in older adults and often used long-term. Yet, due to an unfavorable benefit-risk ratio, recommendations suggest avoidance or a maximal treatment duration of 4 weeks. We aimed to describe trends of BZRA use in older adults (C 65 years) over a 10-year period and associated factors in Belgium. Methods: BZRA use prevalence rates, standardized for age, sex and region, were calculated using Belgian Health Interview Survey data in 2004, 2008 and 2013 . Multivariable logistic regression was performed to assess factors associated with BZRA use in 2013 (N=1286) and included socio-demographic factors, geriatric factors, comorbidities, medication use, healthcare services use, and subjective, mental and social health indicators. Results: Overall, standardized prevalence rate of BZRA use decreased significantly from 22% to 18% between 2004 and 2013 (rate difference (95% CI): -4.0% (-6.8; -1 1.3)). However, no decline was observed in z-drugs use nor in multiple BZRA users. In multivariable analysis, sleeping disorder was associated with BZRA use (OR (95% CI)=1.86 (1.31; 2.64)) but not with anxiety disorder. Other variables significantly associated to BZRA use included female gender, poor mental health, polypharmacy, trazodone and other antidepressant use. Key conclusions: An encouraging decline in BZRA use was observed from 2004 to 2013, but it remained highly prevalent in Belgian older adults. Promotion of alternatives to BZRA for sleeping problems remains essential. High-risk subgroups such as multiple BZRA users or concomitant users of BZRA and antidepressant should be targeted in deprescribing interventions.

Deprescribing tool for STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk) items

Background: Health care professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, a deprescribing tool was developed by a European expert group for STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) items. Methods: STOPPFall was created using an expert Delphi consensus process in 2019 and in 2020, 24 panellists from EuGMS SIG on Pharmacology and Task and Finish on FRIDs completed deprescribing tool questionnaire. To develop the questionnaire, a MedlineÒ literature search was performed. The panellists were asked to indicate for every medication class a possible need for stepwise withdrawal and strategy for withdrawal. They were asked in which situations withdrawal should be performed. Furthermore, panellists were requested to indicate those symptoms patients should be monitored for after deprescribing and a possible need for follow-ups. Results: Practical deprescribing guidance was developed for STOPPFall medication classes. For each medication class, a decision tree algorithm was developed including steps from medication review to symptom monitoring after medication withdrawal. Conclusion: STOPPFall was combined with a practical deprescribing tool designed to optimize medication review. This practical guide can help overcome current reluctance towards deprescribing in clinical practice by providing an up-to-date and straightforward source of expert knowledge.

Objective: To assess the effectiveness of medication review interventions for preventing hospital readmissions in older adults.Design: Systematic review, network meta-analysis (NMA). Case report: 80-year-old. Personal history: Type 2 diabetes, high blood pressure, atrial fibrillation, bladder cancer. Starts with sudden lumbago, treated in 3 occasions with nonsteroidal anti-inflammatory drugs without recovery, associates fever and its referred to emergency room. Its diagnosed with urinary sepsis and is admitted in the geriatric ward. Starts with broad spectrum antibiotic (imipenem). Due to persistency of abdominal and back pain is performed an abdominal CT that show L1-L2 and L3-L4 spondylodiscitis ? bilateral psoas muscle abscess. Blood and urine culture were negative. Abscess puncture is not performed. Conservative treatment with broad-spectrum antibiotic is initiated empirically with vancomycin, tigecycline and gentamicin. Periodic blood work is done without abnormalities. After 2 weeks of parenteral treatment, oral treatment is initiated with linezolid, fosfomycin and doxycycline and is discharged. Re-admitted a few days later with sickness, vomiting and atrial fibrillation. Blood analysis: anemia ? thrombocytopenia ? hyperlactatemia. Blood tests show an evolution towards a non-regenerative pancytopenia. Antibiotic treatment is suspended due to suspicion of a serious adverse reaction to linezolid. Ruling out the presence of deficiency factors. Is treated with support measures and analytical follow-up control. The symptoms disappear without sequels one month later.

Conclusions: Pancytopenia is one of the most serious adverse reactions associated with the use of Linezolid and usually results in treatment termination. Routine analytical monitoring is considered advisable in the use of linezolid in geriatric patients.

Potentially inappropriate medication use in older adults with mild-moderate Alzheimer's disease: prevalence and associations with adverse events 

Ivabradine is a selective inhibitor of the sinus node I(f) channel often prescribed in patients with heart failure, but also in patients with chronic coronary disease. This medication is documented to be well tolerated by the older patients. It is one of the few cardiac medications without orthostatic hypotension as side effect. Syncope is a frequent emergency in the old adult. To emphasis a less common side effect of the ivabradine, we present a clinical case of an 84-year-old patient, addressed for a syncope. He associated other symptoms such as severe vertigo, physical asthenia and fatigue. Emergency cranial CT scan ruled out a possible neurological etiology. His personal hystory included: chronic coronary syndrome, orthostatic hypotension and benign prostatic hyperplasia. Its chronic treatment included: ivabradine due to its intolerance to beta-blocker, nitrates and calciumblockers, aspirine and tamsulosin. Clinical examination revealed orthostatic hypotension, considered secondary to dehydration, chronic venous insufficiency, and tamsulosine side effects. The ECG Holter revealed intermittent second-degree atrioventricular block. We considered the second-degree atrioventricular block as iatrogenic, secondary to ivabradine treatment. The ivabradine treatment was stopped and after the proper wash-out period another ECG Holter mounted. The ECG Holter was normal during all monitored period. The patient did not experience another syncope or associated symptomatology. Atrioventricular block of second degree is a very rare, less than 0.01%, side effect of ivabradine. In an older patient, ivabradine treatment is well tolerated, despite his multiple co-morbidities and polypharmacy. The occurrence of atrioventricular block and syncope in patients treated with ivabradine is relatively low in the older patients, nevertheless we must consider it.

From simple painkiller to an TNF-alpha inhibitor and back again or Doing less is always more in geriatrics

Leners Jean-Claude 1 \ 1 LTCF A male patient aged 81 years now, is known to us for years with a primary diagnosis of learning disability. (LD) Over years he complained on back-pain due to osteopenia and cervico-dorsolombarthrosis and treated by simple pain-killers.During a break in our medical follow-up (longer humanitarian mission) , the patient was addressed to a rheumatologist and treated for rheumatoid disease with prednisone and TNF alpha inhibitor . Pain level never changed (Eular:2 pts) but patient's communication was poor and probably the major reason for medical misunderstanding .After 6 months appeared: aphthous lesions, high temperature, herpetic vesicles , diarrhoea and pneumonia. The blood sample showed a pancytopenia with leukopenia 1.3 giga/l; neutrophils at 0.38 giga/l; Hb at 9.8 g/dl and thrombopenia at 39 giga/lDouble antibiotic treatment , isolation and immediate stop of etanercept cured the patient and even changed to a thrombocytosis (600 giga/l). We excluded a possible myeloproliferative syndrome (search for mutation in gene Jak2 : negative).Since one year now, blood analysis are normal , few symptoms present and Rx of the vertebra still shows simple degenerative signs and a diffuse idiopathic skeletal hyperostosis ( DISH) .In conclusion, we faced severe side-effects of TNF alpha inhibitor (mostly rare), which fortunately regressed after stopping the drug. The most important message from this case study is: (1) make a clear and plain communication to elderly with LD ; (2) trust in simple and standardized evaluation tools and (3) go slowly in the introduction of new biotherapeutics.

data on an individual level extracting data on medications, and hospital diseases. Patients were followed to the end of study (31.12.2015) , death, or emigration, which ever occurred first. Kaplan-Meier survival curves were used to estimate crude survival proportions. Univariable and multivariable analyses were performed using Cox regression. The multivariable analysis adjusted for age, marital status, period of hospital admission, BMI, and BI (model 1), and further adding either number of diseases (model 2) or Charlson comorbidity index (model 3). Results: We included 74603 patients (62.8% women), with a median age of 83 (interquartile range [IQR] 77-88) years. Patients used a median of 6 (IQR 4-9) medications. Increasing number of medications was associated with increased overall, 30-days, and 1-year mortality in all 3 multivariable models for both men and women. For each extra medication the mortality increased by 3% in women and 4% in men in the fully adjusted model. Conclusion: Increasing number of medications was associated with mortality in this nationwide cohort of geriatric inpatients. Our findings highlight the importance of polypharmacy in older patients with comorbidities.

Prevalence and predictors of adverse drug reactions in older hypertensive adults Introduction: Polipharmacy is common in older people, thus increasing the risk of adverse drug reactions. This study aimed to analyse prevalence and predictors of the most relevant adverse drug reactions in older hypertensive adults. Methods: We retrospectively analysed data on antihypertensive-and statin-related adverse drug reactions in adults aged 65 or older evaluated at the Hypertension Clinic of Careggi Hospital, Florence, Italy, between January 2018 and December 2019. Predictors were investigated using multivariate logistic regression. Results: Of 262 participants (mean age 75.9 years, 55.3% female), the 19% of the patients taking ACE-inhibitors reported cough while 33.6% of the patients taking calcium channel blockers (CCB) reported peripheral edema, occuring more frequently of amlodipine. The prevalence of statin-related myalgia was 23.5%. At multivariate analysis SNRI antidepressants and gastroesophageal reflux disease (GERD) were predictive of ACE-inhibitors induced cough (OR 16.220, 95% CI 1.243 -211.621; OR 4.207, 95% CI 1.249 -4.171, respectively) and angiotensin-receptor blockers were associated with an increased risk of peripheral edema on CCB (OR 2.500, 95% CI 1.095 -5.710). GERD was predictive for statin-induced myalgia (OR 6.737, 95% CI 1.530 -29.662). Conclusion: ACE inhibitor-induced cough, CCB-related peripheral edema and statin-induced myalgia are common in older hypertensive adults. SNRI antidepressants and GERD are independently associated with ACE inhibitor-induced cough, while angiotensin-receptor blockers are predictive of CCB-related peripheral edema. GERD is also associated with statin myalgia. Background: Whilst statin use is recommended for secondary prevention of cardiovascular disease, increasing attention has been paid the potential benefits of these drugs in delaying the onset or course of dementia. Whilst some reports have generated concerns over statin safety in vulnerable groups, there is a paucity of data assessing their potential benefit and harm in older adults with dementia. Method: We analysed data from NILVAD, a randomised control trial of Nilvadapine in mild-moderate Alzheimer's Dementia (AD). We analysed the effect of statin use on cognitive function and dementia severity on three validated tools over 18 months using mixed-effects linear models in addition to the association between statin use and adverse events using poisson regression. Conclusion: Whilst statin use was not associated with attenuated cognitive decline or dementia progression in AD, they were not associated with any increase risk of adverse events or unscheduled healthcare utilisation. Our findings support the safety of statin use in older adults with AD for the ongoing prevention of cardiovascular disease.

Improving documentation of direct oral anticoagulant prescribing in stroke patients (2020) 11 (Suppl 1):S1-S309 30%. 60% of patients received verbal information but none were documented to have received written information. 80% of discharge letters documented new prescription of a DOAC, 10% documented all the recommendations outlined in the ESC guidelines.

Conclusions: This project highlighted potential areas for improvement. Group discussion following audit presentation led to a design of a DOAC sticker to meet ESC guidelines. The sticker includes prompts for correct prescribing, education of patients and details to highlight in the discharge letter. Due to COVID 19 the introduction of this sticker was delayed until June 2020 but this sticker approach could help other centres improve DOAC documentation.

Prevalence of potentially inappropriate prescriptions (STOPPfrail criteria) in patients with end-stage dementia Introduction: Benzodiazepine receptor agonists (BZRA) are associated with several adverse events (AE) such as falls, fractures, or cognitive decline, especially in older multimorbid patients and in association with other psychotropic drugs. However, the prevalence of BZRA use is high in this population. Hospitalizations in geriatric wards can be an opportunity for deprescription. We aimed to describe BZRA use among a cohort of older multimorbid patients receiving usual care during their hospital stay in a geriatric ward and to analyze factors associated with BZRA deprescription during their hospitalization.

Methods: A retrospective study within 3 Belgian geriatric wards between January and December 2018. Data were collected from medical records of 1277 consecutively admitted patients discharged alive. BZRA load was measured by converting dosages into equivalent-lorazepam and deprescription was defined as cessation or dose decrease for BZRA users at admission. Descriptive statistics and univariate analyses were performed. Results: BZRA use was highly prevalent (49.7% at admission and 48.6% at discharge, P=0.240) and often associated with at least another psychotropic drug use (71.1% and 69.2%, respectively). Global BZRA load was significantly reduced (0.92 equivalent-lorazepam and 0.76 respectively, P.001. Among BZRA users at admission, the deprescription rate was 38.6%. Factors associated with a higher deprescription rate were depression (P=0.035) and delirium (P=0.044).

Conclusions: Prevalence of BZRA use was high at admission and discharge, often associated with other psychotropic drugs. Usual geriatric management significantly reduced BZRA load. Further research is needed to better understand factors related to long-term adherence and to improve deprescription rate during hospitalization.

Deprescription of benzodiazepines and benzodiazepine-like drugs in orthogeriatric patients Introduction: It is established that benzodiazepines and benzodiazepine-like drugs (BZD) are associated with a higher risk of cognitive decline, falls and fractures in geriatric patients. However, they are still overprescribed. Our objective was to determine the percentage of patients admitted to our Orthogeriatric Unit (OGU) with proximal femur fracture that were chronically taking BZD, and how many underwent deprescription after comprehensive geriatric assessment. Methods: Retrospective study of patients discharged from the OGU during a 2-year period through electronic clinical record analysis. We Compared the preadmission and discharge chronic medication according to the discharge report. Patients taking BZD before the hospital admission were classified into 5 categories according to the intervention at discharge: maintenance of the previous prescription; switching to lower risk BZD; dosage reduction; tapering schedule; discontinuation. Results: We included 384 patients, 68.92% women, average age 84 years-old, Barthel score 81.29, Lawton score 4.01, Global deterioration scale 3.10, ''Cumulative Illness Rating Scale-Geriatric'' 8.9. 38.54% (N=148) were taking BZD before hospitalization. 88.51% were taking one BZD, 11.49% were taking more than one. The most prescribed were: bromazepam (20.86%), lorazepam (19.63%), alprazolam (18.40%), zolpidem (12.27%), diazepam (6.75%). At discharge 58.12% were submitted to deprescription either by drug discontinuation (37.84%), dosage reduction (10.14%), tapering plan (4.73%) or switching from a long acting to an intermediate or short acting benzodiazepine (5.41%). Conclusion: A significant percentage of patients were submitted to the deprescription of BZD, increasing the chronic medication safety profile, reducing the risk of adverse events and potentially improving older patients quality of life.

Proton pump inhibitors: when will the paradigm shift? Introduction: The transition from secondary to primary care is a critical process, often accompanied by information loss and insufficient communication, especially in geriatric patients with accumulated comorbidities resulting in polypharmacy. In these patients, discharge medication might be discontinued or changed by the general practitioner (GP) or a rehabilitation clinic (RC) with possible negative effects.

Methods: The objective of this first part's evaluation of the AGI-TATE study (clinicaltrials NCT03412903) was to determine if a negative GP's or RC's medication evaluation upon discharge from a specialized geriatric clinic has an impact on the number of rehospitalisations and days spent at home as well as the time until rehospitalisation, documented at 1, 3 and 6 months after discharge and adjusted for comorbidity and functional status. Negative medication evaluation was defined as changes in the hospital medication during rehabilitation or GP's first contact with the patient, resulting in two groups based on a positive or negative evaluation. Results: 85 patients participated in the first phase and the results of 74 probands can be used in the still ongoing analysis. Key conclusions: The results of this study could give insight into the question if immediately changing the specialized geriatric clinic's discharge medication has a negative impact on the patient. This is part of the discussion if a hospital admission in geriatric patients should be seen as an isolated event or rather as a part of the process of functional impairment requiring long-term adjustments in pharmacotherapy.

Portuguese older patients' attitudes toward deprescribing Anabela Pereira 1 , Ó scar Ribeiro 2 , Manuel Veríissimo 3 1 University of Aveiro, CINTESIS, Portugal, 2 University of Aveiro, AgeingC CINTESIS,Portugal, 3 University of Coimbra, faculty of medicine, Portugal Introduction: Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional to manage polypharmacy and improve outcomes. It is a complex process influenced by multiple factors, facing several barriers to its implementation. Patients' attitudes and perspectives towards deprescribing is one of the most common obstacles encountered. In Portugal, polypharmacy prevalence in the elderly is among the highest in Europe (36.9%). Successful deprescribing strategy implementation needs to know the Portuguese reality in this area. Methods: Translation and cultural validation to Portugal of the revised version of the Patients Attitudes Toward Deprescribing questionnaire (rPATD). Quantitative cross-sectional study, with patients aged 65 or older with at least one medication, using the rPATD Portuguese version, sociodemographic characteristics and clinical data collection. The main outcome is older patients' willingness to deprescribe inappropriate medications. The cross-sectional study is in progress. Results (preliminary): 25 older patients, 16 females (64%) and nine males (36%) completed the study. The majority (80%) are overall satisfied with their current medicines. Still, at the same time, they would be willing to stop one or more of the regular medication if their doctor said it was possible (11.1 % strongly agreed, 62.9 % agreed.) Key conclusion: These are preliminary results, but they aligned with other studies using this instrument. The rPATD helps to identify if patients willing to have medicines deprescribed, which can guide Portuguese doctors in their clinical practice selecting patients most likely to succeed in this process. Introduction: Intervention studies have shown that adequate protein intake combined with resistance exercise (RE) can counteract declines in muscle mass and function (sarcopenia). However, the role of whole foods rich in protein, such as milk, in sarcopenia in older adults is less understood. We aimed to examine the feasibility and acceptability of milk?RE as an intervention for sarcopenia in communitydwelling older adults, and to collect exploratory pilot data for future substantive research. Methods: Thirty community-dwelling older adults (71.7±3.6 years; 40% women) were randomised into three groups: WM (whole milk 3.6% fat)?RE, SM (skimmed milk 0.3% fat)?RE, and C (control (isocaloric carbohydrate drink)?RE. A 6-week intervention was delivered in a local gym twice weekly. After a structured RE programme for upper-and lower-body strength exercises (2-3 sets, 8-10 repetitions), participants consumed 500ml of milk (*20g protein) or control drink within 45 minutes post-exercise and another 500ml within the following 5-6 hours. Results: The groups had similar sociodemographic, health and lifestyle characteristics. Twenty-nine participants completed the intervention with an overall attendance of 97.1%; 89.7% rated their overall study experience as 'excellent'/'very good'. Drinking compliance was 97.1% (WM), 98.3% (SM), and 95% (C); 93.1% rated their drink intake as 'easy'/'very easy'. RE compliance was 97.5% (WM), 98.3% (SM), and 95.8% (C) with overall resistance training intensity rated as 'somewhat hard ' and 'hard' . No adverse effects were reported. Collection of exploratory pilot data was successful. Conclusion: The milk?RE intervention conducted in a community gym setting was feasible and acceptable to older adults.

Milk Intervention Muscle AgeiNg (MIlkMAN) pilot study: a content analysis of motivators and barriers to engagement Lorelle Dismore 1 , Christopher Hurst 1 , Avan A Sayer 1 , Emma Stevenson 2 , Terry Aspray 1 , Antoneta Granic 1 1 AGE Research Group, Translational and Clinical Research Institute, Newcastle University, UK, 2 Population Health Sciences Institute, Newcastle University, UK Introduction: Resistance training (RT) combined with adequate protein intake are recognised as preventative measures of sarcopenia, yet few older adults meet recommended levels. Additionally, limited number of studies have investigated the role of whole foods rich in protein in combination with RT in sarcopenia. To promote healthier lifestyles in older adults, an understanding of the acceptability of interventions and motivations and barriers to continued engagement is needed. Methods: Thirty community-dwelling older adults (aged 65.8-80.1 years) took part in a 6-week intervention consuming either whole milk, skimmed milk or an isocaloric control drink, in combination with RT. A health psychologist conducted interviews with 29 participants using standardised open-ended questions about their experiences in the study, acceptability of the intervention, and motivations and barriers to continued engagement. Data were analysed using content analysis. Results: The analysis revealed positive experiences and outcomes of taking part in the intervention, including: self-perceived improved health and physical fitness; knowledge acquisition in nutrition and exercise; positive reported outcomes (healthier lifestyle choices, increased energy and reduced pain), and social wellbeing. Social bonds and peer encouragement were motivations to continued engagement in widowed women. Having a personal instructor and being in a fun environment were highly valued by most. Drink consumption was viewed as a reward without negative effects on appetite. Barriers included affordability, environmental factors and concerns over negative health outcomes. Conclusion: To increase engagement, muscle health promoting strategies should focus on education and interventions should be enjoyable and offer social opportunities to promote and maintain health behaviours.

The prevalence of sarcopenia in older people north-west region of the Russian Federation Eugeniy Zotkin 1 1

Objectives: assessment of functional status and analysis of the prevalence of sarcopenia in people over 65 living in community. Material and methods: 230 people were included in the cross-sectional study (average age 74 ± 6.5 years; 96.5% women). EWGSOP2 criteria were adopted. Skeletal muscle strength was determined by grip strength and Chair stand test (5-times sit-to-stand). Skeletal muscle mass was calculated by Appendicular skeletal muscle mass (ASMM) by Dual-energy X-ray absorptiometry (DXA). Muscle function was evaluated by Short physical performance battery (SPPB). Results: Muscle strength in sarcopenics is lower than in non-sarcopenics (p .001). The overall score for SPPB tests was reduced in both groups, but the sarcopenic level was lower than the non-sarcopenic level (p = 0.035). The prevalence of sarcopenia is 30% for older people living in the community, aged 65-74 years at 21.4%, 85? years at 52.9%. Men have a risk factor for sarcopenia of 2.64 (95% CI: 1.68-4.15, p .0001). Sarcopenia was statistically significantly less in patients with obesity 3.0% (95% CI: 0.4-10.4, p .0001) and metabolic syndrome 7.0% (95% CI: 2.6-14, 6, p .0001). Sarcopenia is greater in patients with chronic anemia (95% CI: 2.3-14.6, p = 0.015). The risk of sarcopenia is 14.30 (95% CI: 6.39-31.98) times higher in patients with a body mass index (BMI) of less than 25 kg/m 2 . Conclusions: Sarcopenia is a common problem in older people, especially men. Low BMI, chronic anemia increased the risk of sarcopenia Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309

HIIT intervention can counter 2 years aging process effects in previously sedentary older adults.

Methods: Older ([ 65 years old: 21 men ? 23 women) sedentary (steps \7500/d) adults who completed a 12 week HIIT intervention were reevaluated 2 years later (T2) (unplanned follow-up). Body composition (DXA), muscle function (upper and lower muscle strength, power and muscle quality), functional capacities (TUG, sitto-stand and 6min walking tests) and physical activity (PA) level were compared between baseline and T2 (SPSS; p .05: significant). Results: Through time, PA level did not changed. We observed a decrease in total lean body mass ([ 5%) whereas muscle strength and quality are maintained. Finally, muscle power and functional capacities such gait speed (TUG) still improved. Key conclusion: A sporadic HIIT Intervention seems to slow down the aging physical process over the time. These results could have a clinical impact but need to be confirmed by comparison with a control population (e.g. active or frail) or with other type of PA training.

Relationship between sarcopenia and ACTN3 R577X gene in older adults Introduction: Computed tomography (CT) is considered as gold standard for evaluation of total skeletal muscle quantity. Skeletal muscle assessments at L3 vertebra level were revealed to be significantly correlated with whole body muscle measurements. Herein, we aimed to provide gender specific cutoff sfor psoas muscle mass index (PMI) and skeletal muscle mass index (SMI) at the third lumbar vertebra level in Turkish population. Material and method: Preoperative plain CT images of living adult liver donors admitted our hospital transplantation center between June 2010-April 2018 were evaluated to determine PMI, skeletal muscle area (SMA) and SMI at the level of the third lumbar vertebra. Cutoff values using both 5th percentile and two standard deviations were considered to define low muscle mass in total study population, and in younger population aged 18-40. Results: 601 patients (age 18-59; 326 male, 275 female) were evaluated; 482 (%80) were young (age 18-40; 268 male, 214 female). In patients aged 20-40 gender specific SMI by using 5th percentile were calculated as 41.42 cm 2 /m 2 for males and 30.7 cm 2 /m 2 for females respectively. In the same age group, gender specific SMI by using two standard deviations were estimated as 38.67 cm 2 /m 2 for males and 27.8 cm 2 /m 2 for females respectively. In whole study population, gender specific SMI by using 5th percentile were calculated as 41.33 cm 2 /m 2 for males and 31.4 cm 2 /m 2 for females respectively. In the same age group, gender specific SMI by using two standard deviations were estimated as 37.84 cm 2 /m 2 for males and 27.82 cm 2 /m 2 for females respectively. In our study, cutoff values for SMI were comparable with the other cutoffs reported in so far studied populations. Conclusions: The prevalence of UI in institutionalized older people was found high (77.9%) with the most common type being functional incontinence (80.8%) due to cognitive deterioration (48.1%) or walking difficulties (32.7%). Most individuals (77%) who followed scheduled toileting improved their incontinence of whom some (29%) achieved continence.

Discussing the rational use of diapers and bladder catheters to preserve urinary continence in hospitalized elderly 

Introduction: Devices such as diapers and bladder catheters, when installed, represent a change in the usual urination strategies, which may affect the state of continence. This study aimed to identify reasons for the indiscriminate use of diapers and bladder catheters in hospitalized elderly. Method: Qualitative study carried out with ten professionals from the nursing team of a Hospital in northeastern Brazil, using the focus group as the collection technique. Situations related to the investigated outcome were discussed in the focus group workshops, which were recorded, transcribed and had the content of the statements analyzed.

Results: Many situations related to the indiscriminate use of diapers have been reported, especially in elderly women with impaired mobility, despite the possibility of using the urinal. Factors such as shame (modesty), fear of getting wet and the greater need for help from the team for support at this time, influenced this practice. The majority of the team doesn't observe previous states of continence when it is not related to the reason for the admission of the elderly. There was little association of the participants related to the use of the bladder catheter and the risk of urinary incontinence. Main conclusions: The nursing team routinely uses diapers and a bladder catheter in hospitalized elderly people, even if they have maintained continence status, mainly with impaired mobility as a justification. It warns of the need for instruments to guide this care practice, establishing criteria for the use of diapers and bladder catheters, in order to manage the risk of urinary incontinence.

Urinary incontinence and quality of life: a systematic review and meta-analysis Background: Urinary incontinence (UI) and low quality of life (QoL) are two common conditions in older adults. Some recent literature proposed that these two entities can be associated. However, no attempt has been made to collate this literature. Therefore, the aim of this study was to conduct a systematic review and meta-analysis of existing data to estimate the strength of the association between UI and QoL.

Methods: An electronic search of major databases up to 18th April 2020 was carried out. Meta-analysis of cross-sectional and casecontrol studies comparing QoL tools between patients with UI and controls was performed, reporting random-effects standardized mean differences (SMDs) ±95% confidence intervals (CIs) as the effect size. Heterogeneity was assessed with the I2. Results: Out of 7,981 articles initially screened, 23 were finally included for a total of 24,983 participants (8,723 with UI; 16,260 controls), mainly women. UI was significantly associated with poor QoL as assessed by the short form 36 (SF-36) total score, (n= 6 studies; UI: 473 vs. 2971 controls; SMD= -0.89; 95% CI: -1.3 to -0.42; I 2 = 93.5) and by the sub-scales of SF-36 and 5/8 of the domains included in the SF-36. Similar results were found using other QoL tools. The risk of bias of the studies included was generally high. Conclusions: UI is associated with a poor QoL, with a strong level of certainty. This work, however, mainly based on cross-sectional and case-control studies, highlights the necessity of future longitudinal studies for better understanding the importance of UI on QoL.

The awareness of medical specialists about severe complications of Herpes zoster in Lithuania questionnaire. Statistical analysis was performed using IBM SPSS Statistics 24.0 software. Results: 26.6% of respondents were family medicine physicians, 53.8% -specific physicians/residents, 12.7% -medical students. The majority of medical professionals (63.5%) confirmed that they very rarely treat patients for PHN. We asked medical specialists ''What is the most common complication of HZ?''. The vast majority of respondents (96.4%) chose the correct answer of PHN. But when we asked ''When is PHN diagnosed?'', the opinions differed. Only 41.7% of respondents chose the correct answer -''pain lasts over 90 days''. What concerns rare but serious HZ complication, 77.9% of physicians picked the correct answer ''granulomatous arteritis''.

Conclusions: The medical professionals of Lithuania rarely consult patients with PHN. Most physicians know that the main complication of HZ is PHN but there is still a lack of knowledge, when this complication is detected. Only part of the doctors know that the pain must last over 90 days, then it is a typical neuropathic postherpetic pain. It is also noteworthy that not all physicians are aware that a rare but very complicated complication is granulomatous arteritis. We consider that medical professionals facing AHZ should always collect the anamnesis of pain and follow patients for serious complications. References: 1. Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014 Jun 10;4(6):e004833.

Associations between pneumococcal vaccination and reduction in mortality and hospital admissions among nursing home residents: an observational study Introduction: Immunosenescence and high risk of complicated COVID-19 infection in older persons mandates intensification of efforts to prevent co-infections, by improving compliance with existing preventive strategies of public health via immunization [1] [2] [3] [4] .

Our aim was to evaluate influenza and pneumococcal vaccination rates among older primary care outpatients in the period immediately preceding the outbreak of 2019 novel coronavirus infection. Methods: A cross-sectional study including people C 65 was conducted in February 2020 in a primary health care unit of rural Greece. Vaccination status of each participant was recorded according to self report and Greece's electronic universal prescribing system. Results: The study sample included 104 participants (median age=78 years, 49.1% women) from a population base of approximately 300 older adults in the community. The majority of the population was vaccinated with quadrivalent influenza vaccine for the current and previous influenza season (59.6%), whereas only 40.4% had been immunized against pneumococcus with either conjugate or polysaccharide vaccines after turning 65 years old. In total, 37.5% of the participants had not been immunized for either infection. In more detail, among 65 participants with inadequate vaccinations 61.8% lacked both vaccines, 30.9% lacked only pneumococcal immunization and 7.4% lacked only influenza immunization. Conclusions: Our findings highlight the unmet need for adequate influenza and pneumococcus immunization in rural communitydwelling older adults in the context of the evolving COVID-19 pandemic. Background: Flu is one of the most prevalent winter-season infection, leading to poor prognosis in older populations (mortality, complex morbidity and functional decline). Vaccines is variably be efficient to prevent influenza but the question of a potential role of vaccines on severity of influenza episode is not well addressed. We aim to study this role using a cohort study of Older populations with influenza admitted to Hospital and performed in winter 2017. Materials/methods: We achieved a comparative analysis of vaccinated and non vaccinated patients who experimented a flu episode ([ 80 years) included in a national retrospective cohort over the 2016-2017 influenza outbreak in France (15 12 2016 to 30 03 2017). Demographic and baseline Data , all type of acute and middle complications (Mortality and functional status after 3 months) according use of antibiotic and oseltamivir have been analysed. Results: out of 515 patients with positive PCR, vaccine status wasn't known for 272 (52,3%), 159 (30.8%) were vaccinated and 84 (16.3%) non vaccinated. Mean Charlson index was the only variable statisically different between both goups at baseline. Mortality rate, acute organ failures, nosocomial influenza, length of stay, nursing home admissions were not different but functional decline at 3 month was lower in the vaccine group. Conclusions: Proven influenza hospitalized patients who were previously vaccinated exhibit a higher rate of comorbidities, but have a better functional outcome 3 months after a flu episode as compared with whose who were not vaccinated. No other outcome differences have been found. A prospective study measuring the the impact of influenza vaccine on influenza associated functional decline is warranted.

Eur Geriatr Med (2020) 11 (Suppl 1):S1-S309 

Acute kidney injury in the elderly: Only the tip of the iceberg

Casanueva Felipe F. 7 , Slowikowska-Hilczer ''real world'' study. Archives of gerontology and geriatrics

disability and frailty in later life: mid-life approaches to delay or prevent onset. Guidance and guidelines

The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing

A critical evaluation of body composition modalities used to assess adipose and skeletal muscle tissue in cancer

Edmonton's Frailty Scale (EFS) and data for routinely performed biochemical parameters: Hemoglobin (g/dL), Albumin (g/L) and HbA1c (%) and cGFR (ml/ min/1,73m 2 ), were used. Results: 133 patients age 65? were enrolled, 63 male, 70 female

Hyper/ hypoglycaemia and hospital admissions within 6 months of the 1st dose of chemotherapy were evaluated. Data analysed with SPSS. Results: 336 patients received chemotherapy. Mean age 75.4?/-4.3 years (range 70-89). 15.2% (51/336) had pre-existing diabetes. 45/336 (13.4%) of patients and 22/51 (43.1%) of people with diabetes had a baseline HbA1C. Random capillary blood glucose (CBG) was measured in 103/336 (30.7%). CBG[11.1 mmol/l occurred in 21.4% of patients. Hyperglycaemia occurred in 100% of those already on insulin or with baseline HbA1CC 60mmol/mol. Hospital admission C1 occurred in 41.4% (139/336). This was associated with raised CBG (p=0.025) but not with a pre-existing diabetes diagnosis (p=0.370). Conclusion: Most patients do not have measures of glycaemia during chemotherapy

4 Department of Communication Studies

Estudo exploratório da usabilidade do serviço «efatura» com o cidadão sénior

Using immersive virtual reality as a cognitive assessment tool for the elderly: a systematic literature review

Development of the World Health Organization WHOQOL-BREF quality of life assessment

Hsu CY. The effects of Tai Chi on Quality of Life of Older People Living in the Long-Term Care and Using Wheelchairs for Mobility: A Randomized Controlled Trial. Doctoral dissertation

Responsiveness of the numeric pain rating scale in patients with low back pain

Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis

Glaucoma patient-provider communication about vision quality-of-life

Advanced age results in a rise of its prevalence, especially in post-menopausal woman. Typically categorized into aqueous deficient and evaporative type, the main mechanism is tear film instability and subsequent ocular surface inflammation, resulting S248

Dry Eye Disease: Consideration for Women's Health

Introduction: It is widely recognized that malnutrition is one of the most common complications in stroke survivals post-stroke dysphagia due to dysphagia

The National Institutes of Health Stroke Scale (NIHSS) was used to assess the neurological status of patients and, the Mann Assessment of Swallowing Ability-MASA (Mann) scale for the assessment of dysphagia. Also, the Eating Assessment Tool (EAT-10) was used to assess their ability to eat and drink for 1 month. Results: We studied 60 stroke patients (61,7% female). Between baseline measure and a month later (follow-up) it was observed significant improvements in neurological status -NIHSS (1st 10,6±8,1 vs. 2nd 6,3±8,1, p,001)

Post-stroke dysphagia: swallowing and nutritional status after hospital discharge Eirini Stratidaki 1 , Stefania Schetaki 1

Theodula Adamakidou (1)

Athina Patelarou1, Christos Kleisiaris1,1 Department of Nursing, Faculty of Health Sciences

On the contrary, stroke patients were presented with significantly decreased homebound status during their rehabilitation (1st 2,2±1,3 vs. 2nd 1,0±1,2, p,001post-acute rehabilitation. References: 1

Mini Nutritional Assessment (MNAÒ), body mass index (BMI), and

Conclusions: The results suggest that survivors after moderate-tosevere COVID-19 pneumonia potentially need further psychological rehabilitation and psychiatric assessment. Background: Early operative management of fragility hip fractures improves outcomes, hence surgery within 48 hours of presentation remains an important metric in standard of care. One reason for delay to surgery is anti-thrombotic medication use. University Hospital Waterford (UHW), a busy Irish trauma unit (c. 450 hip fractures per year) has local guidance on peri-operative anti-thrombotic management. We aimed to assess application of these guidelines to hip fracture patients, and explore the contribution of anti-thrombotic medication use to delays to surgery. Methods: A convenience sample of 50 charts were reviewed

Pharmacy Department -Consortium Vic Hospital / Santa Cre's Vic Hospital -Central Catalonia

Pharmacological outcomes were recorded: polypharmacy, medication complexity (by MRCI) and anticholinergic burden (by DBI). Fisher-test, Wilcoxon-test or McNemar-Bowker-test were used to compare both periods. Results: We included 157 patients (mean age 83.4, SD 7.94; 66.4% female; 58.4% nursing home; median Index Barthel 50/100; 73.7% cognitive impairment 12.7%; mortality at 3 months).Pre-intervention mean drug use per patient was 9

Scientific societies have evaluated said impact and alerted about its rational use; so as not to compromise the therapeutic value, it should be preserved and not used as a first line of treatment. Objectives: -Prevalence. -Prescription adequacy according to the established criteria.-Record of adverse effects.Method:Prospective, descriptive study

A. Cherubini 26 , N. van der Velde 27 training. Methods: Twenty-five HIV-positive men

Intervention (12-weeks, 3-times/week): High Intensity Interval Training (15 min/session; cycle: 30s at Borg [17 ? 1 min 30 of Borg: 12-15) on elliptical device ? Mixed Power Training (25min/session; 2 sets; 12 repetitions; workload: 80%; tempo:1-0-2-1) in major muscles

Fat-free masses; DXA), muscle composition (qPCT), performance on 4-m (normal and fast speed) and 6-min (distance) walking tests were assessed pre and post intervention

1±8.1, p=0.039) and leg power (S: 169±65 vs. L: 239±93, p=0.04) but also higher appendicular (S: 53±19 vs. L: 35±22, p=0.038) and gynoid

SPPB were used for determination of physical, functional and nutritional status, while muscle mass and fat mass were measured by DXA-scans

Mechanism of action of the specific nutrient combination of actisyn to support muscle building in sarcopenia Janneke van Wijngaarden 1 , Francina Dijk 1 , Miriam van Dijk 1 , Lisette de Groot 2

Introduction: Sarcopenia is the loss of muscle, accumulating across the lifespan. Multiple factors cause or exacerbate sarcopenia, with aging as the primary factor and malnutrition, inactivity and diseases as secondary factors. We aimed to design a nutritional strategy to manage sarcopenia. Methods: Our research program investigated: nutrient deficiencies in sarcopenic older adults, muscle protein synthesis (MPS) response in preclinical models, and effects of a specific nutrient combination (whey protein, leucine and vitamin D -ActiSyn), present in the medical nutrition product FortiFit, on MPS in older adults. Results: We observed lower protein and vitamin D intake in sarcopenic versus healthy older adults

Intake of a leucine-enriched whey supplement in healthy older adults resulted in higher blood levels of leucine and EAA compared with casein-based supplements (p.001) [3,4]. vitamin D supplementation activated MPS in vitamin D deprived C2C12 myotubes [5], as did leucine-enriched whey protein in aged mice (p.05) [6]. Intake of a leucine-enriched whey supplement stimulated MPS in healthy

Conclusion: The specific combination of whey, leucine and vitamin D (ActiSyn) provides the right strategy for muscle building in sarcopenia, an environment where these nutrients are often deficient

Amsterdam, the Netherlands Introduction: The medical nutrition product FortiFit, containing ActiSyn (whey protein, leucine and vitamin D), is designed to support

Prevalence, severity, and symptom bother of lower urinary tract symptoms among men in the EPIC study: impact of ove-ractive bladder

Department of Collective Health, Graduate Programme in Collective Health, Natal, Brazil Introduction: There is no evidence supporting the relationship between sedentary behaviour (SB) and urinary incontinence (UI) in nursing homes (NH) residents. This study aims to determine this potential association. Methods: A cross-sectional observational study (Clinical Trials NCT04297904) in 4 NH was conducted in the Osona county (Barcelona, Spain). Dependent variable was UI presence (by Minimum Data Set 3.0 version), and independent variables were % of SB in daytime hours (%SB) and total upright time (TUT) in hours (standing and walking) by ActivPAL3 device (AP) during 7 consecutive days. Exclusion criteria were \65 years, transient NH residence, refusal to participate, hospitalization and palliative care. Data was analysed with a confidence level of 95% through the Mann-Whitney U test with the mean ± standard deviation. Results: The final sample consisted of 67 subjects, 53 (79.1%) women and 15 (10.3%) men, mean age 85.3±8.0. Mean %SB was 69.6%±12.7% and mean TUT 2.8h±1

The clinical characteristics of pneumonia patients co-infected with 2019 novel coronavirus and influenza virus in Wuhan

Susana PM384 Sánchez-García, Elisabet PM452 Sánchez-Latorre, Marina OCM7 Sánchez-Martínez, Vanessa PM337 Sánchez-Sánchez

Lasse Lybecker

Philip PM159 Sciberras, Nicole PM159 Sciutti

Shelina P134 Seers, Tim P41 Seers, Timothy P212 Seiffert

Dvorah PM69 Sharashkina, Nataliya PM76 Sharashkina

Adir OC46 Shavit, Linda PM35 Shchetkovsky, Denys PM229 Sheldrake

Annemieke P54 Smorzhevskaya, Marina P31 Smyrnakis

Sofía PM405 Somoano, Arís PM373 Sonja, Rebel P88 Sonnenblick, Moshe PM35 Soric, Gabriela PM374 Souliotis

Anne PM434 Staekenborg, Salka PM88 Stangherlin, Vanni P158 Stanley, Eve P52 Starkel, Peter P34 Starkovait_ e

Konstantinos P223, P227, P273

Older patients' perspectives and experience of hospitalization during the COVID-19 pandemic-a qualitative explorative study Introduction: Geriatric nutritional risk index (GNRI) is an easy-applied tool to assess nutrition. In this study, we aimed to evaluate the efficiency of GNRI for predicting sarcopenia and sarcopenic obesity. We also proposed a new index to predict nutritional and muscle status. Methods: Patients admitted to polyclinic between January 2018 and January 2019 were evaluated retrospectively. Patients who had a creatinine clearance of less than 60 ml/min/1.73 m2 were excluded. EWGSOP 2 criteria were used to diagnose sarcopenia. Malnutrition was evaluated by GNRI [(1.489 9 serum albumin (g/L)) ? (41.7 9 (current body weight/ideal weight). We designed a new index, ''creatinine x1000/GNRI''. We analyzed the correlation of these indices with sarcopenia and sarcopenic obesity. Data analysis was done SPSS version 22. Results: The study population was composed of 97 women and 80 men, of mean age 70.3 ± 6.7 years. GNRI was negatively correlated with skeletal muscle mass index (SMMI). The new index was positively correlated with handgrip strength, SMM, and SMMI. Fat-mass, fat percent, hip and waist circumference, and body mass index were correlated positively with GNRI, negatively with the new index. In linear regression analysis, GNRI was related to fat-mass, fat percent, Introduction: Anorexia is commonly reported by older people and portends malnutrition and adverse outcomes. The 4-item Simplified Nutritional Appetite Questionnaire (SNAQ) predicted weight loss and adverse outcomes in outpatient and inpatient settings at cutoff of B14. We aimed to establish optimal cutoff of SNAQ and association with outcomes in non-frail community-dwelling older adults. Methods: This is a cross-sectional study of 230 participants (mean age 67.2 years; 72.6% females) who were non-frail by FRAIL criteria. We performed receiver operating characteristic curve analysis for optimal cutoff of malnutrition risk via Mini-Nutritional Assessment. Using linear regression adjusted for age and gender, we determined the association of anorexia with International Physical Activity Questionnaire (IPAQ) and Frenchay Activities Index (FAI); Life Space Assessment (LSA); 15-item Geriatric Depression Scale (GDS); Social Frailty Scale (SFS-8); and modified Fried criteria for physical frailty. Results: The optimal cutoff for malnutrition risk was 15 (Area under curve=0.71, 95% CI: 0.56-0.85, Sensitivity=69.2%, Speci-ficity=61.8%). SNAQ cutoffs of B15 and B14 identified 93 (40.4%) and 42 (18.3%) participants respectively with anorexia. SNAQ cutoff B15 was associated with physical activity measured using IPAQ Results: Were admitted 114 patients, 58.8%(n=67) submitted to a nutritional evaluation.The majority were female, 77.6%(n=52), with an average age of 84 years. The FS more prevalent at admission was 6 (34.3% n=23) and KATZ level was A, 31.3%(n=21). The mean length of stay was 19.7 days.The BMI adjusted to age\20.5 prevalence was 22.4%(n=15) and 46.3%(n=31) had a NRS [3. In patients with FS B5 the prevalence of NRS [3 was 40% compare to 55.5% in FS[5. Key conclusions: This study reveals that almost half of the patients are at risk of malnutrition, should initiate a personalized diet and nutrition supplements. The FS and malnutrition seem to be correlated and could lead to a worst outcome. If we miss a nutritional assessment, it could mean that a significant number of patients will lose treatment strategies and have a higher risk of worst outcome. [1,[5] [6] References : 

Using GLIM to compare the impact of malnutrition in an Internal Medicine Ward by age group (2) evaluate the content validity index (CVI). Methods: The principles of good practice for the translation and cultural adaptation were used [1]. The content validity criteria were CVI, probability of a chance occurrence (pc) and modified Kappa (MK) [2]. In this procedure, we appealed to nine experts with doctoral degrees related to gerontology.Results: At the end of the translation process, a preliminary version of the Social Isolation Scale -PT (14 items) was obtained. After the first round, six items showed a CVI .8. After review, the second evaluation had seven items that showed a CVIC0.89 and the remaining items had a CVI=1. The average value of the CVI was 0.95, the universal agreement of the CVI was 0.5 and the pc values ranged between 0. 018 Purpose: To explore the association between the number of medications and mortality in geriatric inpatients taking activities of daily living and comorbidities into account. Methods: A nationwide population-based cohort study was performed including all patients aged C65 years admitted to geriatric departments in Denmark during 2005-2014. The outcome of interest was mortality. Activities of daily living using Barthel-Index (BI) were measured at admission. National health registers were used to link 

Abstract # 144 Abstract # 186 The role of oxidative stress in type 2 diabetes to older patients G.I. Constantin 1 , C.M. Pena 1 , S. Opris 1 1 National Institute of Gerontology and Geriatrics ''Ana Aslan'', Bucharest, Romania Introduction: Diabetes mellitus has been recognized as a chronic metabolic disease which includes a variety of syndromes with different etiologies characterized mainly by hyperglycemia. Most of the studies have suggested that oxidative stress plays a key role in the pathogenesis of diabetes and its complications. The mechanisms by which oxidative stress interfere in the appearance of vascular lesions in diabetic patients are: intensification of low density lipoproteins oxidation (oxLDL), endothelial dysfunction, vascular inflammation, activation of thrombosis processes. Methods: The purpose of this study was to assess the LDL susceptibility to lipid peroxidation in two study groups of older patients (aged 72 ± 6 years): a control group and a group with type 2 diabetes mellitus (NIDDM). The LDL susceptibility to ''in vitro'' induced lipid peroxidation was evaluated following its incubation with a prooxidant system. Results: The results obtained in patients with NIDDM showed a significant increase in the susceptibility of LDL to lipid peroxidation Introduction: Frailty has the potential to be delayed or reversed by appropriate interventions, however these are often not available in countries lacking formal geriatric education/infrastructure. The aim of this study was to: (a) explore ideas, perceptions and attitudes of primary health care (PHC) professionals towards frailty in a country where geriatrics is not recognised as a specialty; (b) explore PHC professionals' training needs in frailty; and (c) define components of a frailty educational programme in PHC. Methods: Qualitative study. Two focus groups with PHC professionals were conducted in Thessaloniki, Greece in November 2019. Focus groups were audio recorded, transcribed, and data was thematically analysed. Results: 31 PHC professionals participated in the study (17 physicians, 12 nurses, and 2 health visitors). Four main themes were identified: (1) Perceptions and understanding of frailty; (2) Facilitators and barriers to frailty identification and management; (3) Motivation to participate in a frailty training programme; (4) Education and training. The main barriers for the identification and management of frailty were associated with the healthcare system (e.g. duration of appointments, focus on prescribing, staffing of allied health professionals, multidisciplinary team not available). A gap in education on frailty was highlighted, with scarce training opportunities, based on personal incentive. Professionals were receptive to training in frailty with a focus on peer learning and practical skills with direct clinical application.Background: An Integrated Falls Prevention Pathway was established in 2015 in our Community Health Organisation. The services included in the pathway are the specialist falls clinics, community rehabilitation teams and community-based multifactorial falls risk assessment clinics (FRACs). We examined the demographics and risk factor profiles of those attending the FRACs over a 3-month period. Methods: Those who attended the five FRACs between January and March 2018 were identified from the falls service administrative database. Information on 11 risk factors for falls were extracted from QuickscreenÒ summary reports. QuickscreenÒ involves taking a falls history, medication review,, and it assesses vision, cognition, sensation, strength, balance and reaction time using formal screening tools. Fracture risk was assessed with the Fracture Risk Assessment Tool (FRAXÒ).Results: Overall 82 people attended the FRACs during the study period. The average age was 78 years (range 54-95) and 65 (79%) were female. The average number of falls risk factors was 6 (range [1] [2] [3] [4] [5] [6] [7] [8] [9] . 74 (90%) attendees had a history of falls, 69 (84%) were on four? medications. Visual impairment was present in 47 (58%) of attendees and 61 (74%) had impairments of strength, reaction times or balance. 2 Waterford Institute of Technology, 3 

Introduction: Resistance exercise and protein supplementation can delay or reverse frailty in older adults. However, they have not yet been widely implemented, due to challenges with translation into practice and limited capacity within health services. Methods: The DEFRAIL (Diet and Exercise for Frailty) intervention was developed by consensus using a modified Delphi process. It involves an eight-week multicomponent group exercise program, suitable for community delivery, with protein supplementation. Participants recruited from Geriatric Medicine clinics were assessed at baseline, after eight weeks of regular activity (Control period), and following the eight-week program (Intervention period). The primary outcome measure was the Fried frailty score. Secondary outcome measures included measures of physical performance, body composition, cognition, mood, pain and frailty biomarkers. Results: 28 participants (22 female, 6 male) commenced the program, of which 22 (16 female, 6 male) completed follow-up assessments. There were no significant changes in outcome measures during the 8-week control period. However, the median Fried frailty score improved from 4 (IQR 3-4) to 2 (IQR 1 to2) (Z = -4.102, p.001) over the eight-week intervention, while the median ''Timed Up & Go'' improved from 18.09 seconds to 15.56 seconds ) (Z = -2.45, p = 0.014), and the median 30-second sit-to-stand improved from 6 (IQR 4.5-8.0) to 8 (IQR 3.75-10) (Z = -2.58, p = 0.010). Key conclusions: The DEFRAIL intervention may provide an effective community-based means of reversing frailty and its associated adverse outcomes. To demonstrate this, a larger longitudinal study is required.

Cost analysis of a community-based exercise and nutritional intervention in frail older adults Joseph Walsh 1 , Padraig Bambrick 1 , Michael Harrison 2 , Thomas Byrne 3 , George Pope 1 , Niamh O'Regan 1 , Riona Mulcahy 4 , John Cooke 4 1 UHW, Waterford, Ireland, 2 WIT, Waterford, Ireland, 3 PMBRC, WIT, Ireland, 4 

Introduction: Diet and Exercise in FRAILty (DEFRAIL) was a study performed to evaluate the effect of exercise and protein supplementation on frailty. The aim of this cost analysis is to use published data to estimate a potential monetary saving that the DEFRAIL intervention could provide to the Irish healthcare system. Methods: DEFRAIL uses the Fried Frailty Index (FFI) to identify and track changes in frailty. A total of 22 patients completed the 8 week intervention. Median FFI pre-intervention and post intervention were 4 and 2 respectively. Components of the service costs required to deliver DEFRAIL were the exercise facility, dietary supplementation, instructors and equipment. The cost of these components were evaluated retrospectively. Potential cost savings due to DEFRAIL were calculated for each patient individually using data from a prospective 3 month analysis on the association of FFI with healthcare costs in Germany.Results: The cost of DEFRAIL was €341.62 per participant and €7,515.66 in total. At baseline prior to DEFRAIL the total projected 3 month healthcare cost of all 22 patients corresponding to their FFI was €29,911.41. After DEFRAIL, projected 3 month healthcare costs aligned to the re-calculated FFI, had significantly reduced to €4,650.02 potentially saving an average of €1148.25 per patient or €25,261.39 in total anticipated healthcare related costs. Conclusion: This analysis using published data indicates that there may be a significant cost saving in terms of healthcare resource use post DEFRAIL. It warrants further cost-effectiveness analysis using a definitive intervention trial.

Frailty in the elderly patient with symptomatic severe aortic stenosis: prevalence and associated risk factors Pablo Enrique Solla Suárez 1 , Javier Montero Muñoz 2 , Jorge Eduardo Herrera Parra 2 , Marta Fernández Fernández 2 , Eva María López Á lvarez 2 , José Gutiérrez Rodríguez 1 1 Á rea de Gestión Clínica de Geriatría Hospital Monte Naranco, Oviedo, Asturias, Spain. Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain, 2 Á rea de Gestión Clínica de Geriatría Hospital Monte Naranco, Oviedo, Asturias, Spain Introduction: Frailty is associated with adverse health outcomes in older patients with symptomatic severe aortic stenosis (SAS) undergoing valve replacement, making its determination of great relevance in clinical practice. Objectives: This study aims to determine its prevalence and analyze its association with demographic, clinical, cardiological, laboratory, nutritional, functional and mental variables. Material and methods: Prospective longitudinal epidemiological study that included all subjects over the age of 75 with symptomatic SAS who could benefit from undergoing valve replacement, attended by the Heart Team between May 2018 and February 2020. Results: 286 patients with a mean age of 83.99 ± 4.01 years, most of them women (61.2%) without high associated comorbidity (abbreviated Charlson 1.44 ± 1.29) were included in the study; with good nutritional (MNA 11.61 ± 1.80), functional (Lawton males 4.09 ± Background: Balance disorder due to age-related progressive loss of functioning are considered a global epidemic according to the World Health Organization. Generally, balance disorders contribute to a falling rate of approximately 40% in the older population ([ 65 years). An evidence-based prevention-and rehabilitation strategy of falling should include balance training. However, for clinical routine, no standardized exercise procedures exist, even if practice guidelines provide recommendations for the management of older adults at risk for falls. As part of the EU-project HoloBalance, a systematic review of the previous guidelines on balance physiotherapy was carried out Abstract # 332 Introduction: Growing evidences support safety and feasibility of elective breast surgery in elderly patients, while surgical treatment of other gynecological cancers seems to be a neglected issue. Methods: All over 65 y.o. patients referred for CGA before endometrial or ovarian cancer surgery from 02/15 to 02/20 at Bologna University Hospital were prospectively included. For each patient we recorded: oncological and surgical variables, G8 score, CGA test results, 30-day postoperative complications and hospital length of stay. Logistic regression identified predictive variables for complications.Results: 65 patients were included (median age 73); 53,7% had a FIGO stage C 3 cancer. Although 60.3% was ASA C 3, the majority were independent for ADL and IADL, had no cognitive impairement, no CIRS severe comorbidities, good physical performance and normal nutritional status. At least one complication was recorded for 26 patients (40%), but only 5 (7.7%) were Clavien Dindo C 3. Independent predictors of complications are number of CIRS-G categories endorsed (OR = 1,488; P=0.019) and the G8 (OR = 0.785; P = 0.048), which is the only independent predictor for major complications (OR = 0.560; P = 0.012); surgical variables do not reach statistical significance. Exclusive laparoscopy (p \ 0.001) and SLNB (P = 0.012) seem to be associated with a shorter length of stay, robotic surgery with longer operating time (P = 0.009), without changes in outcome. Key conclusions: In this setting, surgery could be safe, CGA can be more complex and appropriate than anesthesiologist's judgement, G8 could be a complication predictor and minimally invasive techniques may be feasible, but further studies are needed to assess their real benefit Introduction: Prostate cancer is common in older men. Androgen Deprivation Therapy (ADT) is an effective treatment but is associated with long-term medical complications including osteoporosis, hypertension, type 2 diabetes, hypercholesterolaemia, obesity and ischaemic heart disease. Despite this, there are no national/international guidelines on how to systematically monitor and manage these risks in patients receiving ADT. We evaluate current clinical practice in formally assessing relevant comorbidities at the start of ADT with a view to developing a clinical pathway to improve care.Methods: Consecutive patients attending the oncology first hormone injection clinic between 07/08/2018 and 23/04/2019 are included. Data was retrospectively collected from patients notes accessed via electronic patient records. Results: 190 patients were included. Median age was 70 (age range 53-94). Most common pre-existing comorbidities were hypertension (60.5%), hypercholesterolaemia (38.3%) and diabetes (19.2%) . Although parameters such as BP were often taken, explicit baseline assessment of comorbidity control was low. 22.1% had an explicit baseline assessment of blood pressure control, 20.6% diabetes control, cholesterol 4.2%, DEXA 11.1% and vitamin D 20.0%. This was not more likely even if the comorbidity was already present. The need for monitoring these comorbidities was not often explicitly communicated to the general practitioner (GP). As a result, a new protocolised baseline comorbidities assessment and communication plan was developed. Key conclusion: Relevant comorbidities are not systematically assessed at the start of ADT suggesting the urgent need for national guidelines. A new protocolised assessment and communication aid will be evaluated.

Preoperative risk factors for non-surgical postoperative complications in older colorectal cancer patients stratified by prehabilitation H.C. van der Hulst 1 , E. Bastiaannet 2 , J.E.A. Portielje 3 , J.M. van der Bol 4 , J.W.T. Dekker 1 1 Introduction: Postoperative complications in older colorectal cancer (CRC) patients are common and associated with worse outcome. Prehabilitation might improve the outcome. The aim is to evaluate postoperative non-surgical complications and determine risk factors in older CRC patients, stratified by prehabilitation. Methods: This observational cohort included C 70 years non-metastatic CRC patients who had elective surgery from 2014-2019 in Reinier de Graaf Hospital, Delft. Patients were divided into prehabilitation and non-prehabilitation group. The primary outcome was non-surgical complications and the secondary outcome surgical complications. Results: In total, we included 357 patients. The 86 patients (24.0%) in the prehabilitation group presented with higher comorbidity scores and walking-aid use than the non-prehabilitation group. In the prehabilitation group 26.7% experienced non-surgical and 23.3% surgical complications. In the non-prehabilitation group 21.8% had non-surgical and 13.7% surgical complications (p-value 0. 339 and 0.034, respectively) . Multivariate analyses showed that C2 comorbidities (OR 3.1 95% CI 1.6-5.7), ASA score CIII (OR 2.7 95% CI 1.5-4.9), walking-aid use (OR 2.2 95% CI 1.1-4.4) and positive Geriatric-8 score (OR 2.7 95% CI 1.1-6.9) were associated with nonsurgical complications in all patients. These risk factors remained significant in the non-prehabilitation group, but had no association in the prehabilitation group. Conclusions: Despite differences in baseline characteristics, we observed similar non-surgical complication rates between prehabilitation and non-prehabilitation group. Furthermore, risk factors for non-surgical complications had no association in the prehabilitation group. This suggests that prehabilitation might compensate Introduction: Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term costutility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of patients with pacemakers, 5 years after implant. Methods: This is a controlled, not randomized nor masked clinical trial. Initially, 82 patients with pacemakers were selected (CM=52; RM=30). Patients were monitored during 5 years, after what a total 34 for CM in hospital and 21 for RM finalised the study. It was performed a cost-utility analysis to assess the RM of patients with pacemakers in terms of costs per gained quality-adjusted life years (QALYs). Costs from National Health Service (NHS) and patient perspectives were considered. Results: After follow-up period, total costs per patient were 23.02% higher in the CM than in the RM group, corresponding to a €82.10 cost saving per patient (p=0.033). However, the reduction of in-hospital visits derived from RM does not impact significantly costs from the NHS perspective, although there was a cost saving of 15.04% per patient (p=0.144). Patients in the CM group showed a slightly better QALY at the end of the study (3.579) than RM group (3.306) . Costs/ QALYs obtained by the CM group were lower than the RM group (p=0.773). The incremental cost-effectiveness ratio of CM in comparison to RM becomes positive (€301.16).Conclusions: This study confirms that total costs per patient were 23.02% higher in the CM than in the RM group (p=0.033).

Digital versus conventional rehabilitation after total knee arthroplasty: a long-term follow-up Older population has increased in the last decade linked with an increase of chronic diseases, as Osteoarthritis. Arthroplasty is a properly-established solution to this pathology witch Total Knee Arthroplasty (TKA) is one of the most common in the world. Concurrently, technological advancement improved in many areas, including digital rehabilitation. Most of the studies assess rehabilitation outcomes only in a short time period, and when compared in a long-time, it does not include a digital rehabilitation program. This study aimed to present follow-up results comparing two different home-based programs after TKA in older people: (1) conventional face-to-face sessions (CRT; n=15) and (2) digital intervention (DRT; n=16) performed through an artificial intelligence-powered biofeedback system under remote clinical monitoring (Sword Health); and verify if DRT it is a good possibility to this population after a longterm follow up. Patients were assessed in baseline and follow up (22.6 ± 3.4 months after TKA) through Timed Up and Go test (TUG) and Knee Injury and Osteoarthritis Outcome Score (KOOS). The results showed that both groups attained clinically relevant improvements from baseline to long-term follow-up (p.05). KOOS subscale scores and TUG were similar in both groups (p [ 0.05). Therefore, this study demonstrated that digital intervention rehabilitation after TKA is feasible and engaging. Furthermore, it is a promising alternative by demanding fewer human resources in the current paradigm imposed by the pandemic situation through Covid-19.

Older adult engagement in user-centered, innovative digital solutions for active and healthy ageing Introduction: Health is considered to be a major determinant of quality of life, well-being, social participation and accessibility to healthcare [1] . Assistive technology (AT) is promoted as a means of retaining autonomy and quality of life for older adults [2] . Thus, the evolution of digitisation of services and eHealth technologies will be key to the restructuring of care delivery and help to personalise and customise individual care [3] . In this context, the SHAPES project [4] aims to create the first European open Ecosystem enabling the largescale deployment of a broad range of digital solutions for supporting and extending healthy and independent living for older adults who are facing permanently or temporarily reduced functionality and capabilities. Methods: The SHAPES Pan-European Pilot Campaign aims at engaging ?2000 older adults across 11 European countries and bringing forward technology to improve their health, well-being and autonomy. A user-centered interoperable SHAPES Technological Platform will be developed, including smart digital solutions tailored to health and care delivery. Among others, the Integrated Healthcare System Long Lasting Memories Care (LLM Care) [5], a web-based platform that combines state-of-the-art mental exercises against cognitive deterioration with physical activity [6] [7] [8] , will be exploited by older adults with or without neurodegenerative diseases. Key conclusions: This venture will lay the ground for the expansion of LLM Care's Ecosystem and its wider deployment across Europe aiming at improving health, well-being and autonomy of older adults. Acknowledgements: This project has received funding from the European Union's Horizon 2020 research 

Introduction: The proportion of the Taiwanese older people who living in long-term care (LTC) facilities has increased as the population rapidly, however, it is also resulted to this population using wheelchair increasingly [1] . The purpose of this study is to understand the mood states of the older people in wheelchairs living in LTC. Methods: This study uses a cross-section survey for research, based on the population of the LTC facilities in Changhua and using a convenient access to the study sample, expected to have the number of samples 150. This study uses a structured questionnaire; data collection includes demographic information and Profile of Mood States Short Form (POMS) [2] . Data analysis will use SPSS 12.0 for Window 2000, frequency distribution table, percentage, chi-square test, t test, and ANOVA analysis to answer questions. Results: The study found that the basic information of older people in wheelchairs who was different between male and female, such as: ''age'', ''education'', ''marriage'' and '' Mini-Mental State Examination; MMSE '' were all significantly different (P.05). Those people were no significant difference in the overall mood states (Total Mood Disturbances, TMD), which showed that the male and female were in the same mood states (POMS). Those people have significant differences in their positive mood state with ''vigor-activity'' and ''time period of living in long-term care institutions'' (P \ 0.05). Key conclusion: The results will enable to the nursing staff to understand the mood states of the older people in wheelchairs living in LTC, and to expecting by this study provides the research outcomes for nursing staff to have a real knowledge, to pay attention for those people on the mental health promotion program in the future, and resulted to improving the mental health and well-being for older people in wheelchairs. 

Self-reliance care mode to support elderly in the physical health Chen-Yuan Hsu 1 1

Introduction: The percentage of the Taiwanese elderly is increasing and related to living in the long-term care, and also losing the physical activities of self-reliance due to the care mode of the facility, therefore, a health preservation for those people is an important. Methods: This study was based on the population of a long-term care in the middle of Taiwan. There was a following research on the self-reliance care mode of daily life self-ability with the number of samples 40 collected by this study, comparing the self-reliance care mode group (n=20) and general care mode group (n=20) and used a structured questionnaire as the Physical Health Dimension of Quality of Life [1] , as data collection included demographic information and the dimensions of physical health. Data analysis used SPSS 22.0 for Window 2000, frequency distribution table, percentage and t-test to answer questions. Results: The results of this study, which examined the Physical Health Dimension of Quality of Life for Taiwanese elderly. A Chinese version of the Physical Health Dimension of Quality of Life including 7 items, has been used for elderly from the long term-care in Taiwan with good reliability, Cronbach's alpha 0.77 [2] [3] . For the sex distribution, there were 22 males (55%) and 18 female subjects (45%); there were 35 subjects aged 65-85 years and five subjects aged above 85 years; there were 25 subjects speaking both Mandarin and Taiwanese languages, 12 subjects speaking Taiwanese language, and 3 subjects speaking Mandarin. Finding shows the result of t-test analysis. Increasing physical health mostly showed a positive correlation with quality of life, the result suggested that there was a higher level of physical health dimension of quality of life on the self-reliance care mode group (25.5±3.62) comparing with the general care mode group (18.45±4.16). Finding shows the comparison of physical health dimension of quality of life significant differences with two groups p=.000 (p \ 0.05). Key conclusion: This study indicates that Taiwanese elderly living in the long-term care, suggesting a trend, that choosing the self-reliance care mode group was higher than that general care mode group on the physical health dimension of quality of life. The results can also provide the reference for community, to encourage Taiwanese elderly living in the long-term care to participate in self-reliance care mode for daily life self-ability in the future, and therefore improving their physical health dimension of quality of life.

Risk factors associated with dialysis catheter-related bloodstream infections (DCRBI): a retrospective analysis in a regional dialysis unit Introduction: Caring for people with Alzheimer's disease causes physical and psychological problems in caregivers and diminished quality of life (QoL). This study aimed to assess of caregivers of Alzheimer's disease patients and determine factors affecting it. Method: A descriptive cross-sectional survey was carried out with 70 patients and their family caregivers in Athens, Greece between May and July 2019. The SF-36 General Health Questionnaire and a sociodemographic and relevant medical conditions questionnaire were used for data collection. Results: The mean age of the caregivers was 61.4 ± 12.9. Of them 61.4% were women, 84,3% were first degree relatives and for 48.6% of them their relation were spouse. The average number of years caring for the patient was 4.7 ± 3.0 and the mean daily time care was 10.9 ±7.9 hours. The ''physical composite score'' was 52,1 ±8,2 and the ''mental composite score'' 37,7 ±10,3, which were significantly lower from the normative means of the general population. It was found that in caregivers of unable to walk patients, there was a significant correlation with lower scores in ''physical functioning'' (p=0,031), ''general health'' (p=0,001) ''vitality'' (p=0,028) and ''mental health'' (p=0,04). Duration of caregiving and the age of caregivers were correlated with lower scores in ''role-emotional'' (p=0,024) and ''physical health composite'' (p=0,021) respectively.

Nursing personnel in the era of precision health and geriatric care Abstract introduction: Elderly's people health status is characterized by changes in physiology as well as, multimorbidity due to the presence of chronic diseases and frailty. Moreover, they represent a special population group that receive the largest number of drug prescriptions and excessive needs for healthcare [1] . Methods: The authors carried out a bibliographic search using Medline database for the last decade. Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Results: Personalized nursing care (PNC) for elder, in the context of precision health, involves the interpretation and clinical use of -omics information as they derive from system medicine approaches (biology, pharmacology) towards patient advocacy and support throughout testing, treatment adherence and compliance as well as, ongoing chronic monitoring and support for patient decision making [2] . Nurses, representing the largest group of professionals in healthcare, should adopt in the challenges posed from this new era that shifts medicine from the reactive or one-size-fits-all scenario towards participatory, preventive, predictive and personalized healthcare (P4 medicine) [3] . PNC, entailing the uniqueness of an elder individual, not only should be able to adopt this knowledge but also consider the special characteristics of elder population such as polypharmacy or pathophysiological changes that result in different pharmacological response and clinical outcome [4] . Key conclusions: It is essential for nursing profession to stay up to date with the changes generated from the realization in clinical practice of precision medicine and integrate relative content for continuous education [5] . This will allow them to utilize state-of-theart approaches to the bedside, making contributions in the areas of symptom assessment, prevention, management, and treatment towards optimal healthcare in elder patients [4] . References: 1. Yarnall AJ, Sayer AA, Clegg A, Rockwood K, Parker S, Hindle JV. New horizons in multimorbidity in older adults. Age Ageing. 2017;46 (6) Introduction: Glaucoma is a major cause of irreversible blindness worldwide which appears mainly in people over the age of 60 and results in progressive damage to the optic nerve [1] . Nowadays, more than 64 million people are supposed to have glaucoma, with this estimate increasing over the years [1, 2] . Vision impairment is an important public health issue that influences the quality of life of elderly people [3, 4] . Methods: We carried out a bibliographic search using Medline database (English language) for the last decade, in order to investigate the effects of glaucoma on social and emotional wellbeing. Results: Because of the relatively strong association with older age, patients may suffer from multiple co morbidities. Advanced age, family history, race, ocular pathologies and injury and other pathologies such as diabetes and hypertension represent major risks for developing glaucoma.According to the current literature, there are various instruments available to measure quality of life. Many studies are carried out by the developed two instruments for measuring quality of life by WHO, revealing that several aspects of the disease may impair quality of life for glaucoma patients.Visual impairment is the major determining factor for a worse quality of life in such cases and may disturb the patient's daily habits such as reading, walking, driving and recognizing people and objects. Furthermore, fear of going blind and social isolation, side effects of conservative therapy and treatment costs may result in psychological disturbance such as anxiety, fear and depression. Key conclusions: Close monitoring and trusting healthcare providerpatient relationship remain essential for such patients, in order to maintain and improve their quality of life by using appropriate and individualized medical therapy.

Choosing wisely in geriatrics: results of the first French national campaign Tannou Thomas 1 , Menand Emilie 2 , Laigle Francine 3 , Berthou Julie 4 , Daucourt Valentin 5 , Jarno Pascal 6 , Somme Dominique 7 , Corvol Aline 7 1 CHU de Besançon -FRANCE, 2 Geriatrie -CHU Rennes -FRANCE, 3 France Assos Santé -Rennes, 4 CHU Besançon -FRANCE, 5 REQUA -Besançon -FRANCE, 6 CAPPS Bretagne -Rennes -FRANCE, 7 Geriatrie -CHU de Rennes -FRANCE Introduction: International Choosing Wisely campaign aims to improve the appropriateness of care, by raising awareness among physicians and end-users of the risks in over-medicalisation. In France, the Société Française de Gériatrie et Gérontologie (SFGG) join by implementing recommendation to improve the appropriateness of care provided to older inpatients or those living in nursing homes. Method: The recommendations were drawn up according to an iterative model of co-construction with end-users and physicians with preliminary experiment in one region. Analysis and feedback of endusers lead to 5 final recommendations. These refer to the use of antibiotics in urinary tract infections, anxiolytics for a extended period of time, neuroleptics in psycho-behavioural disorders, statins for primary prevention and, finally, the proper collection of preferences concerning level of care of the end-users. The professional practice assessment was carried out using a one day data collection approach on medical records. Results: A total of 5428 practice screenings were conducted among patient-residents, and 1139 patients were included in the practice assessment. These revealed a total of 280 patient-resident situations corresponding to acknowledged practices (i.e. 25%) versus 859 situations (i.e. 75%) whose practice is questionable considering the literature. These situations of practices to be optimised mainly concerned the use of benzodiazepines, neuroleptics and antibiotics in case of urinary colonisation. Conclusion: The Choosing Wisely campaign in geriatrics in France shows a strong involvement of health actors in this type of evaluation, and very heterogeneous practices, particularly in the field of deprescription practices related to psychotropic drug, which must be specifically supported.

Gallbladder disease's in elderly patients with metabolic syndrome:role of ultrasonography Abstract # 391

Olof Gudny Geirsdottir 1 , Alfons Ramel 1 , Milan Chang 1 , Palmi V Jonsson 1 , Inga Thorsdottir 1 1

The World Health Organization defines a healthy body weight range for adults as a body mass index (BMI) between 18.5 and 24.9. Healthy body weight rage is based primarily on studies in younger adults, for the risks of non-communicable diseases and mortality associated with increased body weight. Examine association in BMI and geriatric health parameters in the Age, Gene/Environment Susceptibility-Reykjavik study (AGES-Reykjavík study) participants.Population of 5696 participants with mean age of 77y in AGES-Reykjavik study in the years of 2002-2006. Geriatric health parameters and mortality were analysed according to BMI tenth tiles.BMI was divided in tenth tiles with lowest tenth tiles with mean BMI 20.0 ± 1.5 and highest tenth tiles with mean BMI 35.8 ± 3.0, the mean BMI of the population was 27.0 ± 4.4. Cox-regression showed significant higher risk of hip-fractur in lowest BMI tenth tiles (P \ 0.001) and logistic regression showed significant higher mortality rate (p \ 0.001) in lowest BMI tenth tiles corrected for age and gender. Higher BMI was not associated with worse geriatric health parameters in general like serum cholesterol or blood pressure. Low BMI within the healthy range of BMI (18.5-24.9) is associated with higher frequency of hip-fracture and higher mortality rate in Icelandic old adults.

Is prognostic nutritional index useful for evaluation of the nutritional status in elderly patients?Guzin Cakmak 1 , Ahmet Cigiloglu 1 , Zeynel Abidin Ozturk 1 1 Gaziantep University, Faculty of Medicine, Department of Interal Medicine, Division of Geriatrics Introduction: Malnutrition is an important geriatric syndrome that can be prevented and reversed. In this study we aimed to evaluate the efficacy of prognostic nutritional index (PNI) in the elderly. We compared PNI with geriatric nutritional risk index (GNRI) according to their relationship with other nutritional tests and frailty indices. Methods: This cross-sectional study was conducted between September 2019 and December 2019. Malnutrition was assessed by mini nutritional assessment short-form (MNA-SF), long-form (MNA-LF), Global Leadership Initiative on Malnutrition criteria (GLIM), PNI, and GNRI. Frailty was assessed by using Fried and SOF (Study of Osteoporotic Fractures) criteria. Data analysis was done by SPSS version 22. Results: The study population was composed of 43 women and 35 men, of mean age 72.6 ± 7.4 years. According to PNI 8 of them were severely malnourished and 11 of them mildly malnourished. According to GNRI 6 of them had high risk, 6 of them had moderate risk and 5 of them had a low risk for malnutrition. PNI and GNRI were related to each other (p.001, r = 0.714). PNI and GNRI were positively related to MNA-SF, MNA-LF, and negatively related to GLIM. SOF scores were negatively related to PNI and GNRI. Fried scores were only related to GNRI. In linear regression analysis, only GNRI were independently related to MNA-SF and MNA-LF (r 2 = 0.214, p = 0.007; r 2 = 0.121, p = 0.018). Key conclusions: The results of this study made us thought that PNI was not as useful as GNRI in the geriatric population. More studies in larger populations could be better.

Which malnutrition test is more useful in polypharmacy studies?Guzin Cakmak 1 , Zeynel Abidin Ozturk 1 1 Gaziantep University Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics Introduction: Malnutrition is prevalent among older adults and associated with morbidity and mortality. The aim of this study was to investigate the relationship between malnutrition and polypharmacy in the elderly. Methods: This cross-sectional study was conducted for a period of 4 months between September 2019 and January 2020. Malnutrition was assessed by mini nutritional assessment short-form (MNA-SF), longform (MNA-LF), Global Leadership Initiative on Malnutrition criteria (GLIM), and geriatric nutrition risk index (GNRI). Patients were evaluated for inappropriate medication use by TIME (Turkish Inappropriate Medication Use in the Elderly) criteria. Data analysis was done by SPSS version 22. Results: The study population was composed of 57 women and 43 men, of mean age 72.8 ?/-7.4 years. Polypharmacy was seen in 14% of the study population. MNA-SF, MNA-LF and GLIM were correlated with polypharmacy (p=0.05; 0.023; 0.047). MNA-LF was associated with polypharmacy in linear regression analysis (r 2 =0.079, p=0.005). We demonstrated a cut-off value of 5.5 of drug numbers for carrying the risk of malnutrition according to MNA in the ROC curve (sensitivity 76%; specificity 52%; CI=95%, p=0.031). The frequency of inappropriate medicine use was 38%. Key conclusions: In this study, we revealed that malnutrition was related to polypharmacy. Our study is the first that the relationship between polypharmacy and malnutrition was assessed by GLIM criteria. We designated that MNA-LF influenced polypharmacy independently. That made us thought that MNA-LF was more useful for polypharmacy studies. Prospective studies for evaluating the effect of the number of drugs used on malnutrition could be useful.

New nutritional index for sarcopenia and sarcopenic obesity Introduction: Electrolites disturbances are often observed in older people. The aim of this study was to recognize the prevalence of combined low serum concentrations of calcium, magnesium and potassium in the real life. Methods: This retrospective study was based on admission data from out-patients and in-patients whose serum levels of magnesium, calcium and potassium were simultaneously measured from a single centralized laboratory at the University Hospital of Messina, Messina (Italy), between January 1, 2015 and December 31, 2017, according to standard methods. Age and gender as well as estimated kidney function calculated by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula were considered. Results: Out of 8,108 patients, hypocalcemia, hypomagnesemia and hypokalemia accounted in 377, 305 and 108 subjects, respectively. Combined deficits raged from 0.29 to 0.65%. Hypomagnesemia and hypocalcemia simultaneously appeared in n=53 patients; of these, n=18 (n=9 males, n=9 females) were under 65-year-old and n=35 (n=13 males; n=22 females, p=0.05) over 65-year-old (p=0.001). Hypomagnesemia and hypokalemia were found simultaneously in n=24 patients; of these, n=11 (n=9 males, n=2 females; p=0.008) were under 65-year-old, while n=13 (n=5 male; n=8 females) over 65-yearold. Association between hypocalcemia and hypokalemia was found in n=51 patients, of which n=20 (n=9 males; n=11 females) were under 65-year-old and n=31 (n=16 males; n=15 females) over 65-year-old (p=0.04), Kidney failure has been found in most cases of multiple electrolyte deficiencies. Key conclusions: Low concentrations of serum electrolytes are more often combined in the elderly. Kidney failure is a condition associated with multiple electrolyte deficiency.

No nutritional intervention despite malnutrition; no malnutrition and yet nutritional intervention? An exploration in the nursing home setting Franz Großhauser 1 , Eva Kiesswetter 1 , Gabriel Torbahn 1 , Cornel C. Sieber 1 , Dorothee Volkert 1 1 Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany Rationale: Little is known about the selection of nursing home residents receiving nutritional interventions (NI). This study investigated the use of NI and corresponding main reasons in residents with or without malnutrition.Methods: 246 residents from 7 German nursing homes were examined within the framework of nutrition Day. Malnutrition was defined as BMI \ 20 kg/m 2 or weight loss C 5% in last three months or low dietary intake (plate diagram \ 1/2). The use of NI (enriched meals and/or oral nutritional supplements [ONS]) and corresponding reasons (open questions) were elicited in interviews with caregivers. Results: Of 80 malnourished residents 44 received NI. Enriched meals were offered for the following reasons: low intake 14x, weight loss (WL) 5x, low BMI 4x, poor nutritional status 2x, tumour 2x. ONS were provided due to low intake 1x, poor nutritional status 1x. Both NI were offered on account of low intake 7x, WL 7x, tumour 1x.

Assessment of disease related malnutricion(drm) in geriatric patients: GLIM criteria.Rocio Onieva 1 , Julia Castillo 1 , Carmen Cánovas 1 , Sofía Solsona 1 , Beatriz Monterde 1 , Genoveva Labari 1 , Eduina Pérez 1 1 Hospital Nuestra Señora de Gracia, Zaragoza Introduction: Hospital malnutrition in geriatric patients is a prevalent problem that needs to be approached in a priority manner. In this assessment, the new GLIM criteria have been acknowledged, endorsed for the general population. Objectives: To know the prevalence of malnutrition in our patients. To identify whether GLIM criteria are an effective tool in our patients.METHODOLOGY: Cross-sectional descriptive study in hospitalized patients in two days in January/February 2020. Personal history, biochemical, anthropometric data, intake, MNA and GLIM were collected. SPSS. Results: 73 patients, 73.2% women, average age: 88 years (SD 6.15). Barthel.I\20: 29.7%. Cholesterol\150:45.5%. Albumin\3:18.5%. According to GLIM criteria, 58.6% malnourished. According to MNA, 43.37% malnourished and at risk 42%. 52.4% suffered chronic disease malnutrition. Phenotypic criteria: 52% did not know their usual weight. For this reason, only the involuntary weight loss could be calculated. BMI\22: 31.5%. Size/Length elbow-wrist: 69.86%. Brachial circumference (BC) \21cm: 15%, calf circumference (CC) \31 cm: 64.38%. Etiological criteria: Possible reduction of the usual intake: 33.8%. Inflammatory load in the hospital little appraisable: 56%. Key conclusions: GLIM is a less useful tool in the dependent geriatric patient, taking into account the absence of real recording of criteria. Biochemical markers are not valid as nutritional parameters during hospitalization as they are known to be modified in acute processes. BC in postmenopausal women underestimates the loss of muscle mass by greater accumulation of adipose tissue. The use of CC is prefered. MNA provides our patients a better evaluation and more complete nutritional, functional, dietetic and anthropometric information.

Simplified Nutritional Assessment Questionnaire to screen for anorexia: optimal cutoff and association with outcomes in non-frail community dwelling older adults 

Introduction: Medication reconciliation and pharmaceutical analysis of prescriptions helps to avoid potentially inappropriate medications and drug-related problems. In an acute geriatrics unit, pharmacy students do not analyse prescriptions during medication reconciliation at admission. For training purposes, they have been asked to do so. Methods: Between November 2018 and March 2019, pharmacy students were instructed to obtain a medication history, reconcile this list with the medical chart and identify drug related problems. These pharmaceutical interventions were then exposed to a pharmacy resident and to the prescriber to assess the appropriateness of these interventions. At the end of the training period, the students were asked to give their opinion on this practice in an open manner. Results: Pharmacy students identified 600 discrepancies in 88 patients, 11.5% of which were rated as unintentional. Geriatricians confirmed 93.8% of the discrepancies and admitted that 8.3% of the discrepancies were unintentional. Moreover, students performed 30 pharmaceutical interventions, 60% of which were accepted by prescribers. Students appreciated this mission, which enabled them to better integrate into the unit and to understand the comprehensive geriatric assessment. Key conclusions: The acceptance rate of pharmaceutical interventions performed by students was not significantly different from the acceptance rate of those performed by the resident during this period, although this is partly related to the low number of pharmaceutical interventions completed. Pharmacy students provided a valuable service, improved the quality of patient care by identifying drugrelated problems.

Efficiency of the pharmacist in geriatrics: should we favored acute or rehabilitation units? 

Introduction: Within a teaching hospital, a pharmacist and a pharmacy resident analyze prescriptions and make medication reconciliation among two acute geriatric units (60 beds) and four geriatric rehabilitation wards (140 beds). Objectives were to assess the percentage of medication related hospital admission (MRA), to highlight the number of pharmaceutical interventions (PIs) performed and to observe 7-day re-admission is these units. Methods: Drug assessment in patients admitted between November 2019 and March 2020 was determined by Kempen's tool, based on hospitalization report. All PIs performed were recorded to assess the targeted drugs, the clinical impact and the acceptance rate. Sevendays re-admission was audited on the computerized patient record. Results: 493 patients received a medication reconciliation. Hospitalization was possibly related to an adverse drug reaction (ADR) in 19.7% of cases (97 patients). 19 patients (19.6%) benefited from a reconciliation at discharge. A PI was performed upon entry for 28 patients (28.9%), during the stay for 37 patients (38.1%) and at discharge for 7 patients (36.8%). A total of 147 PIs were performed, involving mainly ATC classes N (43 PIs, 29.3%) and A (37 PIs, 25.2%), had a major clinical impact in 21.8% of cases (32 PIs) and were accepted in 81.0% of cases (119 PIs). One patient was re-hospitalized less than 7 days after discharge, for the same ADR. Key conclusion: Pharmacists can improve the drug management in geriatrics wards where medication-related hospital admission is frequent, up to 40% in a recent study even though very few patients are readmitted soon. Results: 789 PI were performed for 929 patients mainly for ATC classes: digestive tract and metabolism A (29%), blood and hematopoietic organs B (21%), cardiovascular system C (13%) and nervous system N (13%). The most frequent inappropriate prescriptions were therapeutic absence for validated medical indication (18%), supra-therapeutic dosage (14%) and non-prescribed posttransfer drug (14%). The clinical impact was major in 24% of cases. At admission and at discharge, 493 and 107 MR were performed for 507 patients, respectively; 235 and 62 UD were found, respectively and concerned ATC classes N (22%), C (18%) and A (17%). The most frequent UD was non-prescribed post-transfer drug (57%). The clinical impact was major for 13% of UD. Key conclusion: The pharmaceutical presence in the unit allowed to correct many inappropriate prescriptions and reduce the risk of adverse drug events 

Relationship between pneumonia and sarcopenia in old people-a cross-sectional study Takae Ebihara 1 , Tatsuma Okazaki 2 , Kumiko Nagai 3 , Shinichi Izumi 2 , Koichi Kozaki 1 1 Kyorin Univ. School of Med., 2 Tohoku Univ.School of Med., 3 Kyorin Univ.School of Med.Background: Respiratory muscle (RM) strength plays important roles in coughing and ventilating. Whereas sarcopenia is an aging related loss of muscle mass and function (strength or performance) whose worsening is associated with malnutrition. Nobody has investigated the relationship between RM weakness and malnutrition on pneumonia in old people. Objective: Determine effects of RM weakness in correlation with malnutrition on incidence of pneumonia.Design A cross-sectional study Setting Geriatric ward at 2 hospitals in Japan Participants Inpatients with incidence of pneumonia (n = 47) and controls without pneumonia (n = 35) aged 70 years and older between April 2018 to March 2019. Measurements RM strength (maximal inspiratory pressure (PIMAX) and maximal expiratory pressure), the tongue muscle (TM) strength and sarcopenia, according to the European Working Group on Sarcopenia in Older People were evaluated. Serum-albumin levels at admission and somatic-fat volume were determined as index of malnutrition of the study. All parameters excluding serum-albumin were measured at the time of recovery from pneumonia or other disease. Results: The RM and the TM strengths, body-trunk muscle mass, serum-albumin level, and somatic-fat were significantly lower in pneumonia patients than in controls. A logistic analysis rendered the depressed PIMAX strengths, the low body-trunk muscle mass and the low serum-albumin level in patients with healthcare-associated pneumonia (odds Ratio: 6.85, 6.86 and 5.46, respectively). Conclusion: Functional and quantitative decrease in RM in patients with pneumonia may force old people susceptible to develop pneumonia and intractable to be cured. Furthermore, malnutrition may involve it. Introduction: Sarcopenia is a progressive and generalized disorder of skeletal muscle morphology and function. Its associated with an increased risk of adverse health outcomes and impaired quality of life (QoL). In 2015, a questionnaire intended to measure the QoL in patients with sarcopenia, SarQoLÒ, was developed and validated in French. Objectives: Translation, cultural adaptation and validation of the psychometric properties of the original version of SarQoLÒ into Spanish. Material and methods: cross-sectional study, 86 participants. Two direct translations, a synthesized version of the direct translations, two reverse translations, a pre-final version, pre-test and final version were developed. Discrimination power, construct validity, internal consistency, test-retest reliability and ceiling/floor effects were analyzed and compared with the original psychometric properties.

The Spanish version showed no discriminating power between sarcopenic and non-sarcopenic subjects (EWGSOP and FNIH diagnostic criteria of sarcopenia). It did show discriminating power between patients with decreased vs normal muscle strength (54.9 vs. 62.6, p=0.009) and low vs. normal physical performance (57.3 vs. 70.2; p=0.005). The Spanish questionnaire presented a good construct validity (high correlation with comparable domains of the SF-36: physical function, limitation by physical problems, vitality, mobility and ADLs), high internal consistency (Cronbach's alpha coefficient:0.84 ) and excellent test-retest reliability (intraclass correlation coefficient:0.967, 95% CI 0.950-0.967). No ceiling or floor effect was found. Conclusions: the Spanish version of SarQoLÒ does not discriminate between sarcopenic and non-sarcopenic patients according to the EWGSOP or FNIH criteria although it does with subjects with low muscle strength and low physical performance. The rest of the psychometric properties are similar to those of the original instrument.

Milk Intervention Muscle AgeiNg (MIlkMAN) pilot study: quantifying the internal training response to resistance exercise in older adults at risk of sarcopenia Introduction: Resistance exercise (RE) represents an effective strategy for counteracting age-associated declines in muscle strength and physical performance. However, as exercise induced adaptation is primarily driven by the physiological stress imposed (i.e. the internal training response), eliciting a consistent and standardised training dose is necessary to evaluate potential intervention effects. Methods: Thirty community-dwelling older adults (71.7 ± 3.6 years; 12 female) naïve to RE, performed 6 weeks of twice weekly, machine-based progressive RE involving a combination of upper-and lower-body exercises. Internal training response was quantified using ratings of perceived exertion (RPE). Following each RE session, participants provided an overall rating of perceived exertion (sRPE) and differential ratings of perceived exertion for upper-body muscle exertion (sRPE-U) and lower-body muscle exertion (sRPE-L) using the CR100 scale (range 0-100 arbitrary units [AU]; 12, easy; 22, moderate; 35, somewhat hard; 50, hard; 100, maximal). Results: Twenty-nine participants completed the intervention (97% attendance) with mean RE session intensity rated as between 'somewhat hard ' and 'hard' (sRPE: 38 ± 19, . There was no change in mean RPE throughout the intervention (sRPE, mean slope: -2; 95% confidence interval [CI] -9 to 4, sRPE-U: -2 [-9, 5], sRPE-L: -3 [-10, 3]), despite substantial variability between participants (sRPE, slope SD: 15; 95% CI [10, 21], sRPE-U 14 [9, 21], sRPE-L 15 [11, 21] ). Introduction: Given the need to establish new criteria, the EWG-SOP2 defines the sarcopenia as the loss of strength and muscle mass and determines the parameters by diagnosis. The objective was to identify the prevalence of sarcopenia in institutionalised older people who live in Catalonian nursing homes (NH), according to the new criteria of the EWGSOP2. Methods: A cross-sectional study in 4 NH of the Osona region (Barcelona) was conducted from January to March 2020. Residents with sarcopenia were identified using the algorithm developed and suggested by the EWGSOP2 for sarcopenia case finding and screening in practice. The main variables in the diagnosis of sarcopenia were strength, assessed by a hand grip dynamometer, muscle mass, measured by bioelectrical impedance analysis and physical performance, evaluated by the Four Meter Walking Test. Results: 145 individuals were initially included, of which 64 were excluded to no fulfil criteria of the main study (Clinical Trials register number NCT04297904) or for not being able to perform the three assessments. 81 participants (55.8 %), mean age of 84.6 years (SD=± 7.8), 67 (82.7%) women, were finally included. 6 (7.4%) had no sarcopenia, 55 (67.9%) were diagnosed of probable sarcopenia, 12 (14.81%) of confirmed sarcopenia and 8 (9.87%) of severe sarcopenia.

The study indicates that the 92.6% of the institutionalised older people in Central Catalonia is suffering of probable, confirmed or severe sarcopenia, according to the new criteria of the EWGSOP2.

Myostatin as a biomarker of muscle wasting and other pathologies: state of the art and knowledge gaps Jan Bączek 1 , Marta Silkiewicz 2 , Zyta Beata Wojszel 3 1 Doctoral School, Medical University of Bialystok, 2 Medical University of Białystok, 3 Department of Geriatrics, Medical University of Białystok Sarcopenia is a geriatric syndrome with significant impact on older patients' quality of life, morbidity and mortality. Despite the available new criteria of sarcopenia developed by European Working Group on Sarcopenia in Older People (EWGSOP2 algorithm), its early diagnosis remains difficult, highlighting the necessity of looking for a valid muscle wasting biomarker. Myostatin, a muscle mass negative regulator, is one of the potential candidates.The aim of this work is to point out various factors affecting the potential of myostatin as a biomarker of muscle wasting. Based on the literature review, we can say that although myostatin raised high hopes as a candidate for sarcopenia biomarker, recent studies produced conflicting results and revealed numerous potential confounding factors influencing its use in sarcopenia diagnosing. These factors include physiological variables affecting serum myostatin abundance (such as age, sex, physical exercise and activity of various agents inhibiting and promoting myostatin pathway), as well as a variety of disorders (including heart failure, obesity and insulin resistance, kidney failure, chronic obstructive pulmonary disease and inflammatory diseases) and differences in laboratory measurement methodology.Our final conclusion is that although serum myostatin alone might not prove to be a feasible singular biomarker, it could become an important part of a recently proposed panel of muscle wasting biomarkers. However, a thorough understanding of the interrelationship of these markers for muscle mass and function, as well as establishing valid measurement methodology for myostatin and revising current research data in the light of new criteria of sarcopenia is needed.

Impact of sporadic high intensity interval training on muscle and functional capacities in healthy older adults: an unplan 24 month follow up study Introduction: Aging is characterized by a decline in functional capacities and muscle function (i.e. muscle mass, strength and quality) as well by an increase in fat mass (around 1-5%/year). A sedentary lifestyle is associated with accelerated aging while physical activity (PA) improves or maintain general health, even in elders. However, it is unknow if sporadic supervised intervention, and more specifically High Intensity Interval Training (HIIT); can counter the effects of aging over time. Thus, we aimed to evaluate if a sporadic Abstract # 467 Correlation between muscle mass and weight change in patients older than 65Athina Greka 1 1 EEMEG Abstract: In the present study, the weight loss ratio of people over 65 years of age was studied in relation to their muscle mass.Screening test: laboratory profiles a targeted diet exercise program in conjunction with their medication. Introduction: Over a three months period, 30 patients aged over 65 were examined. (None with pacemaker) All the patients followed • Diet based: mix 50% carbohydrates, 30% protein and 20% fat • Proper hydration: more than 2 liters of water daily • A light exercise program for torso and main body and walking for a period of 40 minutes/ daily • Solar exposure for more than 20 minutes per day in average Method: BIA body consistency analysis DSM-BIA Method (Direct Segmental Multi-frequency -Bioelectrical Impedance Analysis)Afterwards the patient's situation was reassessed monthly and the progress was put down on progress reports which included the measurement according to date for height, weight, body mass and fat percentage. 

Introduction: Urinary tract infections (UTI) are among the most prevailing infectious diseases with considerable morbidity and mortality with a substantial financial burden on society. The elderly persons are the most susceptible to UTI that frequently requires successive hospitalization. Methods: We conducted a one-year retrospective study (2019) in Hospital Sf. Luca, on 1791 patients with a mean-age73 ± 6,23 years. Data for the study were Urinalysis and antibiograms performed by AutomatMicroscan. We analyzed the demographic profile, the incidence of the favoring factors and the frequency of the symptoms encountered. Isolated microorganisms and their sensitivity to antibiotics were the basis of a comparative analysis using SPSS software. Results: There were 221 Urinalysis 23 of which were asymptomatic bacteria. 82.32% of patients are women; 51% are from rural areas; age group (75-84y) are the most numerous (46.6%). Constipation and insufficient hydration are the most frequent favoring factors (50%); drug abuse is very rare in Romanian elderly (0.5%). The most common symptoms (67%) are pollakiuria and dysuria.The distribution of Urine culture showed growth of Escherichia Colli(58.4%), Klebsiella(17.7%); Enterococcus and Pseudomonas in approx. equal to (4.52%). Escherichia Coli were sensitive to quinolones (73%), cephalosporins(54%) and carbapenem(90.9%). The most effective antibiotics were Amikacinum (80% sensitivity) for Proteus and Pseudomonas; Carbapenem(90%sensitivity) for Escherichia Coli and Proteus. The uropathogens that were the most resistant to antibiotics: Klebsiella (60%); Enterococcus(62%), Staphylococcus Aureus(68%). Key conclusions: Our outcomes show that isolated uropathogens have a low sensitivity to antibiotics. This increasing resistance to broad-spectrum antibiotics is particularly troublesome at elderly, a frail populational group.

Misuse of treatments for benign prostatic hyperplasia in the elderly population Renoncourt Thomas 1 , Bloch Frederic 2 , Saint Fabien 2 1 Chu Amiens Picardie, 2 Chu Amiens Picardie Introduction: The benign prostatic hyperplasia (BPH) is one of the most frequent pathology in elderly patients, with a prevalence of 80.7% at 60 years old [1] . the main complications are renal insufficiency, urinary retention (acute or chronic) [2] , and repeated falls. This study aims to define the misuse of drugs for HBP and to assess if this misuse is associated with significant side effects. Methods: A 14 days cross-sectional study was realized between February 25th -March 3rd, and March 25th -March 31th, from a request on the prescriptions of all treatments for BPH on our hospital. It included117 male patients aged 75 or more and treated either by aadrenergic blockers or by 5a-reductase inhibitors.

A single-centered prospective study to investigate effect of fesoterodin treatment of urinary incontinence on quality of life, anxiety and depression Introduction: Urinary incontinence (UI) is an important health problem of elderly women. UI is thought to be related with depression and quality of life (QOL). In this study, we aimed to evaluate effect of UI treatment on QOL, depression, anxiety, and disability. Methods: This prospective study was conducted for a period of 6 months from August 2019 to February 2020. Women applied to outpatient clinic with urge incontinence were included to the study. Patients were evaluated for QOL, anxiety, depression, disability and geriatric syndromes before and after treatment. QOL was assessed by International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Incontinence of Quality of Life Questionnaire (I-QOL). Anxiety and depression was assessed by Hospital Anxiety and Depression scale (HADs). SPSS versiyon 22 was used for data analysis. Results: The study population was composed of 42 women; aged 69.7 ± 4.3 years. QOL, anxiety and depression symptoms, and daily activities of living (ADL) were revealed to be improved after treatment. ADL and I-QOL scores were positively, ICIQ-SF and HAD scores were negatively correlated to treatment. ICIQ-SF, I-QOL and HADs scores were associated with UI treatment when evaluated with one-way MANOVA (F [4, 79] =3.25, p=0.00, Wilk's K=0.859, partial g 2 =0.14). Key conclusions: This study revealed that fesoterodin improved QOL and psychological symptoms. Those findings demonstrated that proper treatment of UI is critical for healty ageing. Our study is unique because there was no previous study about the effect of anticholinergic treatment on life quality, anxiety and depression in patients with UI.