Here - American Geriatrics Society

P OSTER
A BSTRACTS
Conclusion: In this analysis of palliative care inpatients, we
found that escalating ARS increases the odds of delirium. In an effort
to minimize delirium, anticholinergic medications should be added
with caution in this vulnerable cohort. Further prospective studies are
needed to establish a directly causal relationship.
B84
Screening for osteoporosis in elderly patients admitted to post-acute
rehabilitation.
K. Major, 1 S. Monod, 1 C. Bula, 1 S. Rochat, 1 O. Lamy, 2 D. Hans, 2
A. Laszlo, 3 M. Krieg. 2 1. Service of Geriatrics medicine and geriatric
rehabilitation, University of Lausanne Medical center, Lausanne,
Switzerland; 2. Center of Bone Diseases, Lausanne University
Hospital, Lausanne, Switzerland; 3. Service of Geriatric medicine,
Hospital of Fribourg, Fribourg, Switzerland.
Background: Screening for osteoporosis is important in older
patients admitted to post-acute rehabilitation. However, DXA measurement
is sometimes difficult to perform because of difficulties in
positioning the patient and artefacts (osteoarthritis, prosthesis). The
objectives were to determine the prevalence of unknown clinical osteoporosis
in rehab patients and to determine new strategies for identifying
clinical osteoporosis in this population.
Method: Over a 9-months period, patients consecutively admitted
to post-acute rehabilitation were included in th stdy. Patients with
osteoporosis diagnosis, and those with terminal illness or severe physical
limitations were excluded. Patients underwent Bone Mineral
Density (BMD) by DXA and Vertebral Fracture Assessment (VFA).
Clinical osteoporosis was defined as BMD ≤-2.5 SD at any site (lumbar
spine, femoral neck, total hip or distal radius), ≥1 vertebral fracture,
≥1 hip fracture, or another fragility fracture and BMD ≤-2 SD.
Results: Overall, 102 (17.0%) of the 600 patients admitted to
rehab refused to participate in the study or were unable to consent.
Among the 498 remaining patients, 99 (19.9%) were excluded because
of already known diagnosis of osteoporosis, 101 (20.3%) were
excluded because of terminal illness, severe physical limitations, and
45 (9.0%) because of inability to perform DXA during the stay
(death, hospital transfer). Overall, 253 patients were assessed with
DXA and VFA (166 women, mean age 83±7 years, mean BMI 27±6
kg/m2, and 87 men, mean age 82±6 yrs, mean BMI 27±5 kg/m2). Of
these, 70% had history of fall during the last 6 months and 9.1% had
hip fracture history. Prevalence of osteoporotic vertebral fracture was
36% in women and 32% in men. Overall, 152 (60.1%) patients had
clinical osteoporosis (women: 67%; men: 46%) according to above
criteria. Hip fracture history and vertebral fracture assessment identified
correctly 105 (69.1%) of these 152 patients.
Conclusion: A high prevalence of osteoporosis was observed in
this population of rehab patients. Osteoporosis status should be systematically
assessed in these patients at high fall risk, at least with
careful history of hip fracture and an assessment for vertebral fractures
with spine X-ray.
B85
Reasons for not prescribing guideline-recommended medications to
veterans with heart failure.
L. Dimaano, 1 C. Peterson, 2 M.A. Steinman. 2 1. University of California,
San Francisco, CA; 2.VA Medical Center, San Francisco, CA.
Supported By: MSTAR Program Grant 2 T35 AG026736-06
Department of Veteran Affairs Grant 06-080-02
Background:
ACE inhibitors and beta blockers reduce mortality among patients
with heart failure, yet some patients are not prescribed these
medications. While general barriers to prescribing have been previously
described, little is known about the reasons for foregoing treatment
in individual patients, and whether this represents appropriate
or inappropriate care. In this study, we described the distribution of
reasons for not prescribing guideline-recommended drugs to older
adults with heart failure.
Methods:
We conducted a chart review of patients from 4 VA health care
systems who had systolic heart failure but were not prescribed ACE
inhibitors (or ARBs) or beta blockers. For each patient, we used a
standardized chart abstraction tool to identify the clinician’s reasons
for not prescribing these drugs. Because chart review may not fully
capture reasons for non-prescribing, we interviewed 61 clinicians who
cared for patients in our cohort and compared the reasons they cited
in the interview with reasons found in chart review.
Results:
Among 2846 patients screened, 301 were included in the study.
Mean age of subjects was 75 +/- 10 years and 98% were male. 70%
were not prescribed ACE inhibitors or ARBs, 18% were not prescribed
beta blockers, and 11% were not prescribed both drugs. Using
chart review, we identified reasons for non-prescribing in 65% of patients.
The most common reason was clinical contraindications (58%).
We identified at least one non-biomedical reason in 18% of patients,
including patient attitude, adherence, and misuse of drugs (10%), and
co-management with another clinician (6%). Interviews with clinicians
yielded substantially more reasons than chart review (1.6 vs 0.9
reasons per patient, P < .001). While clinical contraindications remained
the most common reason for non-prescribing (70%), clinicians
described other reasons in 66% of patients. These included patient attitude,
adherence and misuse; co-management with other clinicians;
and believing that the drug was not indicated (21-27% each).
Conclusion:
Clinical contraindications are the most common reason for not
prescribing guideline-recommended drugs to heart failure patients.
While chart review indicates that clinical contraindication eclipses all
other reasons in importance, clinician interviews suggest that nonbiomedical
factors figure equally in the decision not to prescribe
these medicines.
B86
Tai Chi training increases the complexity of standing postural
control in frail older adults.
M. Lough, 1 B. Manor, 2 M. Gagnon, 1 I. Iloputaife, 1 P. Wayne, 3
L. Lipsitz. 1,2 1. Institute for Aging Research, Boston, MA; 2. Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston,
MA; 3. Osher Center for Integrative Medicine, Boston, MA.
Background: The development of frailty in old age is accompanied
by a loss in the dynamic “complexity” of standing postural control.
In this case, complexity refers to the multi-scale structure contained
within postural sway fluctuations, which is believed to arise
from the numerous processes that regulate the body’s movements
over time. Tai Chi is a mind-body exercise with goals of targeting multiple
physiological processes and integrating their dynamics. We
therefore hypothesized that Tai Chi training would increase postural
sway complexity in frail older adults.
Methods: Subjects were recruited from supportive housing facilities
and randomized into a Tai Chi group (11 women and 3 men;
age=83±6yrs) or educational control group (12 women and 3 men;
age=84±8yrs). Tai Chi and education interventions consisted of two,
60min instructor-led group sessions per week for 12 weeks. To assess
postural sway, center-of-pressure dynamics were recorded during
standing with eyes-open and eyes-closed. Postural sway complexity
was estimated by multi-scale entropy analysis. Average sway speed
and area were also computed. Cognition (i.e., Trail Making Test,
TMT) and physical function (i.e., gait speed, timed up-and-go, TUG)
were evaluated.
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AGS 2012 ANNUAL MEETING