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P OSTER
A BSTRACTS
B61
Losartan increases mitochondrial biogenesis in human fibroblast cells.
V. Cheng, 2,1 B. Manwani, 1 J. Walston, 1 P. Abadir. 1 1. Johns Hopkins
University, Baltimore, MD; 2. University of Kansas Medical Center,
Kansas City, KS.
Supported By: American Federation for Aging Research
Mitochondrial function declines with age and is thought to influence
chronic disease and frailty. The renin-angiotensin system (RAS)
acts through angiotensin (Ang) II type 1 (AT 1
R) and type 2 (AT 2
R)
receptors. We recently found a mitochondrial RAS, with AT 2
R located
in inner mitochondrial membranes that decrease with age and
increase with AT 1
R blocker losartan. Given these results, we hypothesized
that the RAS plays a key role in mitochondrial biogenesis.
Human fetal lung fibroblast cells (MRC-5) were grown in culture
and separated into a control and treatment groups with serially
increasing concentrations of losartan and Ang II. Cells given 100nM
Ang II were subjected to losartan (0.01nM to 100nM). After 48 hrs,
we measured mitochondrial gene ND6 and nuclear gene TK2 with
qPCR. A ratio to compare gene expression based on treatment was
generated.
Mitochondrial biogenesis increased with higher doses of losartan.
Cells given Ang II showed an increased ratio with Ang II up to
1nM and decreased fold change above 1nM. Cells with Ang II and
losartan displayed a reversal of AT 1
R effects and increased mitochondrial
biogenesis with losartan up to 10nM.
These results illustrate a potentially important role of the RAS
on mitochondrial biogenesis. While higher concentrations of losartan
increase fold change, our results suggest a level of losartan that maximizes
AT 1
R blocking efficacy. Optimizing mitochondrial biogenesis
via losartan is a novel approach that warrants further study in frail,
older adults.
ND6/TK2 ratio
Cells with higher doses of losartan showed a higher ratio. Cells
given Ang II show an increased ratio up to 1nM. Cells with 100nM
Ang II and losartan showed an initial increase in ratio.
B62
The Hospital to Home Program: A Window into Healthcare
Transitions for Older Adults.
A. Cornell, J. Speice, T. Caprio, R. McCann. University of Rochester,
Rochester, NY.
Supported By: Reynolds Foundation
HRSA GTPD Grant# HP08792
BACKGROUND: Hospital readmission rates and levels of patient
satisfaction have increasingly become a focus of attention as
federal reimbursement policies change. Although a few programs
have increased the efficiency of the discharge process, most hospitals
lack sufficient resources to support a comprehensive discharge planning
program outside the hospital. Data accumulated from the University
of Rochester’s medical resident education program provides
insight into the older adult patient’s perception of the discharge
process.
METHODS: A retrospective analysis from data collected from
20 patients, age >60 years old, who participated in Highland Hospital’s
“Hospital to Home Program” between September 2009 and September
2011. This program focuses on training medical residents to
identify discharge concerns during an inpatient bedside interview
which is videotaped. Residents follow up with the patient one week
after discharge in another videotaped encounter to gather information
about the patient’s discharge experience. Video footage was reviewed
by a clinical psychologist and the medical resident to identify
common themes that contributed to negative discharge experiences.
Learning points are highlighted in a video compilation that is presented
to a group of medical residents during a teaching noon conference
at the hospital to create a shared learning experience.
RESULTS: Five main themes were identified from the patient
feedback obtained during the program: difficulty accessing pain medicine
or medical equipment, unclear discharge instructions, failure to
have barriers to a safe return to home identified, inadequate follow
up from home health nursing services, and difficulty obtaining answers
to medical questions after discharge. One unique theme that
was also identified was an expressed wish by some patients for more
time to recover in the hospital due to preexisting caregiver responsibilities
at home.
CONCLUSION: The Hospital to Home program provides valuable
insight into the problems that older adult patients experience
after discharge from the hospital. Besides the educational value of this
program, the identified themes provide distinct areas of focus for institutions
striving to prevent unnecessary readmissions to the hospital.
B63
Enhancing Access to Palliative Care: An Initiative to Improve
Advance Care Planning Documentation.
A. Beyea, 1 H. Laura, 1,2 A. Caprio, 1,2 G. Winzelberg, 1,2 K. Wessell, 3
C. Rowe. 4 1. Division of Geriatric Medicine and Center for Aging and
Health, University of North Carolina, Chapel Hill, NC; 2. Palliative
Care Program, The University of North Carolina, Chapel Hill, NC; 3.
Cecil G. Sheps Center for Health Services Research, The University of
North Carolina, Chapel Hill, NC; 4. Division of Hematology and
Oncology, The University of North Carolina, Chapel Hill, NC.
Purpose: This prospective study focused on improving documentation
of advance care planning discussions for patients aged 65
and older admitted to an Acute Care for the Elderly (ACE) unit at a
university hospital. The primary aim was to increase utilization of an
Advance Care Planning (ACP) note, a hospital-specific documentation
tool in the electronic medical record (EMR).
Methods: A case-based education session was repeated nine
times from August 2010 to June 2011 to reach all physicians and medical
students providing care to patients admitted to an ACE unit. Education
covered communication and documentation about decisionmaking
and preferences for life-sustaining treatments (LST).
Following education sessions, participants received group performance
data feedback. A gift card incentive was also used to encourage
ACP discussions and documentation. Weekly chart review of patients
discharged was used to collect data on outcomes: frequency of documented
discussions about patient preferences for LST, and frequency
of documentation with the ACP note tool.
Results: Baseline chart review (N=88) showed 27% of patients
had documentation of LST preferences, while only 4% were documented
in the ACP note. Of the 204 charts reviewed during the intervention
phase, 49% had documentation of LST preferences and 14%
had an ACP note. For patients with dementia (N=64), 53% had documented
discussion of LST preferences in the EMR; 41% in an ACP
note. Among patients confused, sedated, or nonverbal (N=95), 56%
had documented LST preferences in the EMR; 32% in an ACP note.
Discussion: ACP note utilization facilitates effective communication
about changes in health status and patient preferences for LST
across a continuum of care. This quality improvement intervention
was associated with an overall increase in frequency of ACP note utilization.
Documentation practices among patients with dementia and
confusion suggest that providers engage in discussions about LST
preferences at least 50% of the time with patients at risk for progressive
decline, adverse outcomes, and death.
S94
AGS 2012 ANNUAL MEETING