S176 Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234

of the American Rehabilitation Counselling Association (ARCA)

amounts to1 FIM point per therapeutic day.

Conclusions: It is possible to obtain a sufficient functional

progress for all patients in stationary early geriatric rehabilitation

independently from which specialist department they were

overtaken from.

P299

Structured scoring of supporting nursing tasks in post-acute

care to enhance early supported discharge in geriatric

rehabilitation. The BACK-HOME study

M.A.A. Caljouw1, E. Bakkers2, M.S. Holstege1, R. van Balen1,

W.P. Achterberg1

1Leiden University Medical Center, Leiden, The Netherlands;2Zorginstellingen Pieter van Foreest, Delft, The Netherlands

Introduction: The aim of this study was to evaluate if the use of a

structured scoring of supporting nursing tasks in the evening and

night, leads to earlier discharge home in geriatric rehabilitation

patients.

Methods: A pre- and post-implementation cohort design was

followed. One cohort (n = 200) was assessed before and the

other (n = 283) after the implementation of the scorecard. The

implementation consisted of weekly filling out a validated

structured scorecard for identifying the supporting nursing tasks,

discussing them in the multidisciplinary team-meeting, in order to

establish if discharge home was possible with help in less than 3

nursing tasks within 2 weeks.

Results: Both cohorts were comparable in age, gender and

reasons for admission (mean age 80 years (SD:10); 69% females).

Reason for admission were stroke (23%), joint replacement (13%),

traumatic injuries (32%), and other (32%). Participants from the

post-implementation cohort were discharged home earlier, within

48 days (SD:26) compared with 56 days (SD:31) in the pre-

implementation cohort; P =0.044. 28% of the participants that were

able to be discharged home according to the supporting nursing

tasks, were discharged within 2 weeks. Reasons for discharge delay

were: no realized home adjustments (47%), diminished cognition

participant (29%) and impaired general condition participant or

informal caregiver (65%).

Conclusion: The use of a scorecard for discharge planning may lead

to earlier discharge home. After being indicated for discharge, this

is often not realised within 2 weeks. An early inventarisation of the

possibilities and barriers in the home situation is needed to avoid

discharge delay.

P300

Discharge destination after acute stroke; what determines

discharge in elderly stroke patients?

R.D. Dutrieux1, M. Spruit-van Eijk1, M.L. van Mierlo2,

C.M. van Heugten3, J.M.A. Visser-Meily4, W.P. Achterberg5

1Zonnehuisgroep Vlaardingen, Vlaardingen, The Netherlands;2Rehabilitation Centre de Hoogstraat, Utrecht, The Netherlands;3School for mental health and neuroscience Maastricht University,

Maastricht, The Netherlands; 4Rudolf Magnus Institute, University

Medical Center Utrecht, Utrecht, The Netherlands; 5Department of

public health and primary care LUMC, Leiden, The Netherlands

Introduction: The aim of the study is to identify determinants for

discharge destination of older stroke patients (≥70 years) after the

acute phase.

Methods: In this multicentre cohort study, six hospital stroke-units

included a total of 395 patients with a clinically evaluated stroke

within 7 days. The main outcome measure was discharge home

versus discharge to clinical rehabilitation for patients <70 years and

≥70 years. Collected data consisted of demographic factors, stroke

characteristics, functional impairments and disabilities, cognition,

co-morbidity and social participation. A logistic regression analysis

determined the independent contribution and overall explained

variance of discharge destination.

Results: Older patients were more dependent in activities of

daily living, had significantly more co-morbidity and were less

likely to have a partner. Cognitive functioning and pre-stroke

participation were also lower. Younger patients were usually

discharged home, while older patients were usually discharged

to a clinical rehabilitation setting. The majority of younger patients

that were discharged to clinical rehabilitation had a partner (71%),

while in the older group only 40% of the patients discharged to

clinical rehabilitation had a partner. Multivariate analyses showed

that having a partner was an important determinant in the older

age-group (Adj. OR 4.77, CI 2.01–11.31), but not in the younger age

group.

Conclusions: In older age the presence of a partner seems to be an

important factor for not entering clinical rehabilation after the acute

phase of stroke, more so than functional impairment or severity of

stroke.

P301

Outpatient geriatric rehabilitation in Parkinson’s disease

J. de Groot1, C.M.P.M. Hertogh1, A.M.A. Trumpi2

1VU Medisch Centrum, Hilversum, The Netherlands; 2VIVIUM

Naarderheem, Naarden, The Netherlands

Introduction: In advanced Parkinson’s disease (PD) motor-,

non motor- and neuropsychiatric symptoms exist. Patients with

multifaceted needs may benefit from a geriatric rehabilitation

program.

We developed a multidisciplinary outpatient program in a skilled

nursing facility, following national guidelines for PD. We studied

patient characteristics, functional parameters and the appreciation

of the program by patients and caregivers.

Methods: Patients with PD or parkinsonism and impairments in

several domains of daily life, were included. Participants with

MMSE <18/30 were excluded. Multidisciplinary assessment by a

dedicated team, goalsetting and a tailored eight week therapeutical

program were core elements of the intervention. All therapists

participated in the regional ParkinsonNet. We registered patients

characteristics, baseline comorbidity, cognition, stage of disease,

ADL, fatigue, quality of life, caregiver-burden and functional

parameters.

Results: We recruited 43 patients through referral by neurologists,

Parkinson-nurses or community health professionals. Three

patients didn’t participate. Mean age was 75 years; 22male,

11female; 35 PD, 8 parkinsonism; 11 living alone. Base line

characteristics were CCI 2,8/6; H&Y 3/5, MMSE 28/30; Screening

Parkinson symptoms & impairments: 20/39; We found non-

significant improvements in mobility; speechloudness significantly

improved. Satisfaction of participants (53/60) and their caretakers

(48/60) was high.

Conclusion: In this innovation we combined methods of geriatric

rehabilitation with specialised (allied) Parkinson care. Participants

were elderly patients with PD. The team experienced growing

expertise in PD and integrated multidisciplinary care. We had no

control group or follow up. Future research should focus also on

caregivers.

P302

Cognitive impairment as functional gain prognostic marker

in patients with hip fracture

N. Fernandez Gutierrez, I. Artaza Artabe, E. Elgezua Uriarte,

E. Aguirre Amantegui, M. Urkiza Abaunza, I. Arrinda Atutxa

IGURCO, Amorebieta-Etxano, Spain

Objective: to determine the influence of cognitive impairment in

functional gain at discharge for patients admitted to a unit of

functional recovery for convalescence of hip fracture.