9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S81–S141 S107

Introduction.– Bisphosphonate therapy may have biological effectsbeyond bone health, including effects on cardiovascular, immuneand muscle function. We examined the association between bis-phosphonate use and functional outcomes in the rehabilitation ofolder people.Methods.– This was a retrospective cohort analysis of routinedata collected from the Dundee Medicine for the Elderly Servicebetween 1999 and 2011. Data on admission and discharge 20-pointBarthel score was combined with comorbid disease, biochem-istry, haematology and community prescribing data. The cohortwas split into four groups: current bisphosphonate users, pre-vious users (prescribed prior to admission); subsequent users(prescribed only after admission); and never users. Difference inBarthel between admission and discharge was analysed, adjustingfor baseline Barthel score, age, sex, comorbid disease, medicationburden, recent hip fracture, baseline albumin, calcium, renal func-tion and haemoglobin.Results.– Two thousand seven hundred and ninety-seven patientswere included in this analysis. Mean age was 84.1 (SD 7.5); 1153(41%) were male, and the mean baseline admission Barthel scorewas 10.5 (SD 3.8). After adjustment for the above covariates, currentbisphosphonate therapy was associated with a greater improve-ment in Barthel score (5.0 points, 95% CI 4.3 to 5.7) compared tothe never users (3.8 points, 95% CI 3.6 to 3.9, P < 0.001) and previ-ous users (3.4 points, 95% CI 2.8 to 4.0, P < 0.001) groups. However,there was no difference from those not taking bisphosphonates, butwho started use after discharge from rehabilitation (5.1 points, 95%CI 4.6 to 5.5, P = 0.82).Conclusion.– Bisphosphonate therapy is not causally associatedwith improved functional outcomes from inpatient rehabilitation.

http://dx.doi.org/10.1016/j.eurger.2013.07.349

P286Predictive factors for fear of fallingafter hip fractureJ. Visschedijk , M. Caljouw , R. van Balen ,W. AchterbergLeiden University Medical Center, Leiden, The Netherlands

Introduction.– Many factors are related to poor outcomes after ahip fracture, including age, gender, marital status, living situation,pre-morbid activities of daily living (ADL), physical performanceand cognition. In addition, psychological factors, such as fear offalling (FoF), are associated with these unwanted outcomes. Thepresent study aims to identify predictive factors for FoF and developa predictive model for FoF after a hip fracture.Methods.– Cross-sectional study in a total of 100 hip fracturepatients (aged ≥ 65) in 10 skilled nursing facilities (SNF). Partici-pants were divided into a low and high FoF group, based on medianFES-I score. Information on FoF was obtained by interviewing theparticipants. Possible predictive factors were collected, includingdemographic variables, aspects of functioning, psychological fac-tors, and co-morbidities. For every predictor a univariate logisticregression was conducted. For the multivariate regression modela backward procedure was used in which variables with P < 0.05were included.Results.– Walking ability and ADL before fracture, number ofcomplications, ADL after fracture, anxiety and self-efficacy wereunivariate predictors for FoF. Multivariate analysis showed thatwalking ability before fracture (odds ratio (OR) 0.34, 95% confi-dence interval (CI) 0.14–0.83), ADL after fracture (OR 0.89, 95%CI0.80–0.99), and anxiety (OR 1.22, 95%CI 1.05–1.42) were indepen-dent predictors for FoF.Key conclusions.– Impaired walking ability before fracture, impairedADL after fracture, and increased anxiety predict FoF after hip frac-ture. This information enables healthcare workers to identify olderpersons who are particularly prone to have FoF.

http://dx.doi.org/10.1016/j.eurger.2013.07.350

P287Hemoglobin level as a predictor ofrehabilitation outcome in olderChinese patientsJ.K.H. Luk a,b,c, P.K.C. Chiu a,b,c, L.W. Chu a,b,c

a Department of Medicine, Queen Mary Hospitalb Acute Geriatrics Unit, Grantham Hospitalc Department of Medicine and Geriatrics, Fung Yiu King Hospital,Hong Kong

Background.– The relationship between hemoglobin (Hb) level andrehabilitation outcome of older patients is still controversial. Thisstudy investigated the relationship between Hb and rehabilitationoutcomes of older patients.Methods.– It was a retrospective study performed in a step downhospital. Data of first Hb levels (1st-Hb) and last Hb levels (Last-Hb)during admission were collected. Change of Hb levels (= Last-Hbminus 1st-Hb) during hospitalization was determined. The Last-Hbwere segregated into: < 8.9 g/dl; 9 to < 11.9 g/dl; 12 to < 13.9 g/dl and≥ 14 g/dl. Absolute functional and motor gain were determined byBarthel Index (BI) and Elderly Mobility Scale (EMS), expressing asBI and EMS efficacy. BI and EMS efficiency were deduced by the effi-cacy divided by the length of hospital stay (LOS). Satisfactory motorand functional outcomes were discharge EMS ≥ 15 and BI ≥ 75.Results.– One thousand three hundred and ninety-seven patientsincluding 793 (57%) women and 604 (43%) men were studied.Their average age was (mean ± S.D) 82.3 ± 7.1. Significant improve-ment in EMS and BI across all 4 Last-Hb groups on discharge wasobserved. The EMS and BI efficacy and efficiency were the same in4 Last-Hb groups. 844 (60%) patients had Hb drop during admis-sion and they had significantly poorer discharge EMS and BI scorescompared with those without Hb drop (P < 0.001). Last-Hb was animportant positive predictor for satisfactory functional outcome(odds 1.13, CI = 1.02 to 1.25, P < = 0.023).Conclusion.– Maintaining a higher Hb level and preventing Hb dropduring rehabilitation may benefit rehabilitation of older patients.

http://dx.doi.org/10.1016/j.eurger.2013.07.351

P288“Fight like a ferret”: A novel approachof using art therapy (AT) in reducinganxiety in stroke patients undergoingrehabilitationK. Ali , D. Waller , T. Gammidge , J. Gaylard ,A. Howard , G. FaneaBrighton and Sussex Medical School, Brighton and Sussex UniversityHospitals NHS Trust, University of Brighton, Brighton, UnitedKingdom

Introduction.– Anxiety and depression are common post stroke.The holistic aspect of stroke rehabilitation to include psychologicalwell-being is currently neglected, with emphasis put on physicalrecovery. Creative strategies such as Art Therapy (AT) can be ben-eficial during rehabilitation in sharing of information, installationof hope, and reducing isolation amongst stroke patients.Methods.– Stroke patients in a hospital rehabilitation unit who areable to consent were invited to participate in 2 weekly AT sessions(50 minutes) for 6 weeks. The sessions were facilitated by an expe-rienced arts therapist using materials such as paints, crayons, clay,a camera and an Ipad. Hospital anxiety and depression scales (HAD)were measured at the beginning and end of the 6 weeks.Results.– Six male patients were recruited, average age 69 years(38–85). All patients attended at least 6 sessions. AT group dis-cussions allowed patients to express openly feelings of frustration,anger and despair as well as resilience and hope for good physicaland emotional recovery: “Fight like a Ferret” was an expressionused by an AT group member. The group produced several art