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Allopurinol use is associated with greater functional gains in older rehabilitation patients – a retrospective cohort study L. Beveridge a,∗ , M. Mcmurdo b , J. George c , M. Witham b Dept Of Medicine For The Elderly, NHS Tayside, Dundee, United Kingdom b Ageing And Health, University of Dundee, Dundee, United Kingdom c Clinical Pharmacology, University of Dundee, Dundee, United Kingdom ∗ Corresponding author.
Introduction.– Oxidative stress may contribute to muscle weakness in older people via mitochondrial dysfunction. Allopurinol reduces oxidative stress, improves endothelial function (and therefore muscle perfusion) and may result in ATP sparing. We therefore examined the association between allopurinol use and functional outcomes after rehabilitation in a cohort of older people. Methods.– Retrospective cohort study. Patients admitted to Royal Victoria Hospital, Dundee between 1999 and 2008 for rehabilitation were identiﬁed from a clinical database of routinely collected data. Data were collected on allopurinol use, antiplatelet therapy as a marker of vascular disease, sex, age, admission and discharge 20-point Barthel scores, and co-morbid disease. Patients without baseline or discharge Barthel scores and individuals who died during admission were excluded. Multivariate analyses were performed to examine difference between admission and discharge Barthel score, adjusting for age, sex, admission Barthel score, antiplatelet use and comorbid disease. Results.– Three thousand one hundred and ninety-ﬁve patients were included in the analysis. Mean age was 81.4 years (SD 7.6); 1288/3195 (40.3%) were male. Ninety-seven out of 3195 (3%) were taking allopurinol on admission. Improvement in Barthel scores was higher in the allopurinol group than the non-allopurinol group (4.73 vs. 3.62 points, P = 0.002). When adjusted for age, sex, admission Barthel, number of drugs and comorbid disease, adjusted improvement in Barthel score was still greater in the allopurinol group than non-allopurinol group (4.76 vs. 3.80 points, mean difference 0.94, 95% CI 0.27 to 1.61, P = 0.006). Conclusion.– Allopurinol use was associated with improved functional outcomes in older rehabilitation patients. Disclosure.– No signiﬁcant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.438 O075
A randomized, double-blind, placebo-controlled trial of Nintendo Wii training on balance impaired older adults M. Gronbech Jorgensen a,∗ , U. Laessoe b , C. Hendriksen c , O. Nielsen a , P. Aagaard d a Department Of Geriatrics, Aalborg University Hospital, Aalborg, Denmark b Physiotherapy Department, UCN, Aalborg, Denmark c Department Of Integrated Health Care, Bispebjerg University Hospital, København, Denmark d Institute Of Sports Science And Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ∗ Corresponding author. Introduction.– Older adults show increased risk of falling and major risk factors include impaired lower extremity muscle strength and postural balance. However, the efﬁciency of biofeedback based Nintendo Wii training on maximal muscle strength (MVC) and postural balance in balance impaired older adults is unknown. Methods.– This randomized, double-blinded, placebo-controlled trial examined postural balance and MVC in balance impaired old adults (n = 58; 75 ± 6 yrs) pre and post 10 weeks of biofeedback
Nintendo Wii training (WII) or daily use of Ethylene Vinyl Acetate Copolymer insoles (controls, CON). Primary endpoints were MVC and Center of Pressure velocity-moment (CoP-VM) during bilateral static stance (postural balance). Results.– MVC increased from pre-to-post intervention (+249.6N; +17.0%) in WII subjects with no change in CON (–19.9N; –1.3%), yielding a between-group difference of 269.5N (95% conﬁdence interval, 126.2 to 412.8; P < 0.001). Pre-to-post changes in CoP-VM were –1.6 mm2 /s (–7.8%) in WII and –1.6 mm2 /s (–8.3%) in CON (between-group difference 0.002 mm2 ; 95% conﬁdence interval, –4.8 to 4.8; ns.). Pre-to-post changes in all secondary endpoints (functional performance) were greater in WII than CON (P < 0.05). Participants rated WII highly motivating at 5 and 10 weeks of intervention. Conclusion.– Biofeedback-based Nintendo Wii training led to marked improvements in mechanical leg muscle strength and overall functional performance in balance impaired old adults. Despite the reduction in fall risk factors, static bilateral postural balance remained unaltered. The high level of subject-motivation suggests that Nintendo Wii training may ensure a high degree of compliance to home and/or community-based training. Disclosure.– No signiﬁcant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.439 O076
Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers – a randomized controlled trial M. Laakkonen a,∗ , E. Hölttä b , N. Savikko c , R. Tilvis d , T. Strandberg e , M. Suominen f , K. Pitkälä c a Laakso Hospital, Helsinki Health Centre, Helsinki, Finland b Geriatric Psychiatric Clinic, Helsinki Health Centre, Helsinki, Finland c Department Of General Practice, University of Helsinki, University of Helsinki, Helsinki, Finland d Department Of General Internal Medicine And Geriatrics, University of Helsinki, Hus, Finland e Institute Of Health Sciences/geriatrics, Oulu University/Oulu City Hospital, Helsinki, Finland f Society For Memory Disorders Expertise In Finland, Helsinki, Finland ∗ Corresponding author. Text.– Introduction.– After dementia diagnosis poor mastery of issues related to disease leads to decreased quality of life (QOL) of the family. Support for self-management interventions have not yet been studied in dementia. Therefore, we examine in an objective-oriented group intervention the efﬁcacy of selfmanagement support program (SMP) on the QOL of dementia patients and their spousal caregivers. Method.– During 2011–12, 132 dementia patients and their spouses have been randomized into two arms: 66 patients for group-based SMP sessions including topics preferred by the participants, 66 patients serve as controls in for usual community care. Sessions aim to empower couples and improve self-efﬁcacy and mastery of families by giving information and skills preferred by couples. Results.– The mean age of patients is 76.8 years, 37% are females and 72% are at mild stage of dementia. Cognitive status is poorer in the intervention group compared with the control group when measured with CDR, MMSE (mean 19.8 vs 21.7) or verbal ﬂuency. There were no differences in mean age, number of comorbidites or MNA score between the groups. There mean age of caregivers was 75 years. There were no differences in mean, QOL, and general health quality scores among caregivers between the groups. The sense of competence among caregivers in the intervention group was higher (98.8) than among controls (93.2). Conclusion.– This is a “proof-of-concept” study to explore the efﬁcacy of group support for self-management skills among dementia
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S1–S32
families. It will also provide data on cost-effectiveness of the intervention. Disclosure.– No signiﬁcant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.440 O077
Impact of galantamine on weight of patients with Alzheimer’s dementia E. Droogsma a,∗ , D. Van Asselt b , C. Schölzel-Dorenbos c , E. Huinink b , C. Van Der Hooft b a Geriatric Medicine, Leeuwarden, Netherlands b Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, Netherlands c Geriatric Medicine, Slingeland Ziekenhuiis, Doetinchem, Netherlands ∗ Corresponding author. Introduction.– There is discussion about the impact of cholinesteraseinhibitors (CERs) on weight of patients with Alzheimer’s disease (AD). Given the negative effects of weight loss in AD patients and the fact that an increasing number is treated with CERs, it is important to establish the impact of CERs on weight. Text.– This was a retrospective observational study at our memory clinic. AD patients aged 65 years or older who started with galantamine and lived at home or in residential care were included. Various data were recorded at the time the diagnosis AD was made and at subsequent outpatient clinic visits. The Generalized Estimating Equations model was used to determine the impact of galantamine of 16 mg and 24 mg on weight. Three hundred and three patients were enrolled (mean age ± sd = 79.4 ± 5.5 yrs; mean MMSE ± sd = 22.3 ± 3.8; median follow-up in months between the moment the diagnosis AD was made and: 1st visit: 6 (n = 302); 2nd visit: 13 (n = 215); 3rd visit: 25 (n = 118); 4th visit: 37 (n = 58)). Galantamine corrected for age, gender, social status, informal care, professional care, co-morbidity, number of medications, cognition, behavior and appetite, had no effect on weight (P > 0.05). Patients with an informal caregiver (P = 0.01, B = –3.7) or partner (P = 0.04, B = –3.2) had a higher average weight compared with patients who did not had an informal caregiver or partner. Weight loss in AD patients should not be attributed to galantamine. This is in accordance with advice of Belmin in 2007. If AD patients are losing weight, other causes, such as insufﬁcient care, should be investigated. Disclosure.– No signiﬁcant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.441 O078
Parathyroid hormone, vitamin D, and cognitive decline in older people with a history of vascular diseases M. Björkman a,∗ , K. Pitkälä b , T. Strandberg c , R. Tilvis d Internal Medicine And Geriatrics, Helsinki University Central Hospital, Hus, Finland b Department Of General Practice, University of Helsinki, University of Helsinki, Helsinki, Finland c Institute Of Health Sciences/geriatrics, Oulu University/Oulu City Hospital, Helsinki, Finland d Internal Medicine And Geriatrics, University of Helsinki, University of Helsinki, Helsinki, Finland ∗ Corresponding author.
Introduction.– Cross-sectional and prospective follow-up studies have suggested serum 25-hydroxyvitamin D (25-OHD) to associate with cognitive decline. However, other regulators of calcium homeostasis, such as parathyroid hormone (PTH), may confound this
association. In this prospective three-year follow-up study the predictive value of both 25-OHD and PTH for cognitive decline were investigated. Methods.– Older community-dwelling people (n = 400, age = 80 ± 5 years) with a history of vascular diseases were included. In addition to thorough clinical examination cognition was assessed by Consortium to Establish a Registry for Alzheimer Disease neuropsychological assessment battery total score (CERAD) at baseline and after three-year follow-up. Baseline serum 25-OHD, PTH, total calcium, creatinine and apolipoprotein E4 genotype were determined. Results.– The mean baseline MMSE score was 26 ± 3 and that of total CERAD score 69 ± 12. A weak inverse association was observed between baseline PTH levels and CERAD total scores (r = –0.120, P = 0.023). The highest PTH quartile (≥ 83.1 ng/l) compared with lower quartiles was associated with 2.4-fold risk (95%CIs = 1.05–5.35) for at least 10-point decline in CERAD total score within three years. The risk remained signiﬁcant after controlling for age, gender, education, apolipoprotein E4, baseline CERAD score, body mass index, creatinine, total calcium, and 25hydrovitamin D. No signiﬁcant associations were found between 25-OHD and cognition at baseline or after follow-up. Conclusion.– High levels of PTH are associated independently of vitamin D status with clinically signiﬁcant cognitive decline in older community-dwelling people with a history of vascular diseases. Further studies are warranted to address the role of PTH and its regulators in the etiology cognitive impairment. Disclosure.– No signiﬁcant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.442 O079
Systematic postoperative geriatric care in orthopedic wards reduces incidence of delirium in old frail patients, a comparative study P. Le Squere a , A. Gentric b,∗ , M. Andro b , E. Comps a Geriatric Unit, CHU de Brest, Brest, France b Service de médecine interne gériatrique, CHU de Brest, Brest, France ∗ Corresponding author.
Introduction.– Delirium is a common complication in old frail patients after acute orthopedic surgery. Predisposing factors are well known, but preoperative assessment is usually not possible, and we have to consider that such patients are all at risk. The aim of our study was to compare the incidence of postoperative delirium in two traumatologic departments, one with a systematic postoperative geriatric care (intervention unit in Brest hospital), another with usual care (control unit in Quimper hospital). Methods.– All the patients over 75 hospitalized for an acute orthopedic surgery between 31/10/2012 and 1/03/2011 were included. Sociodemographic data, comorbidities (CIRS-G), polymedication, activities of daily living, type of fracture were recorded. In the intervention unit, a geriatrician present three days a week has educated the ward staff to geriatric care: orientation, adapted communication, presence of visual and hearing aids, avoiding contention. Usual postoperative measures, ﬂuid and electrolytes balance, pain treatment. . . were similar in the two units. The primary outcome was the incidence of delirium in the three postoperative ﬁrst days (Confusion Assessment Method). The secondary outcome was the duration of delirium. Chi2 and Student tests were used for statistical analysis. Results.– Eighty three patients were included in Brest, 85 in Quimper. The two populations were comparable (age, CIRS-G, polymedication, ADL). The incidence of delirium was respectively of 28.6% and of 51.8% in the intervention and the control unit (OR: 0.38 IC [0.19; 0.75]). The duration of delirium was lower in the intervention unit (2.46 days versus 6.23 days, P = 0.001).