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P OSTER
A BSTRACTS
BMI=28.4, mean PSQI=8.7 and mean PHQ-9=4.6. Previously unrecognized
SA was common, with a mean AHI=19.5; 49.3% of participants
had AHI ≥15 (suggesting moderate-severe SA). 14.2% of all
participants were prescribed BzRAs, and 11.5% reported using the
BzRA during the study period. Among participants with moderatesevere
SA, 9.6% were prescribed BzRAs and 8.2% actually used the
medication. There were no significant differences between participants
with or without moderate-severe SA in BzRA prescription
(Chi-square=2.504, p=.157) or BzRA use (Chi-square=1.513, p=.303).
CONCLUSIONS: We found that half of community-dwelling
older Veterans meeting diagnostic criteria for insomnia had objective
evidence of unrecognized moderate-severe SA. Nearly 10% of these
individuals were prescribed BzRAs, some of which may worsen SA
and increase risk for adverse health outcomes. Further research is
needed to address the recognition and management of coexisting insomnia
and SA in older adults.
B90
Pyridostigmine Improves Orthostatic Tolerance and Symptoms in
Patients with Orthostatic Hypotension and Supine Hypertension:
The Faint and Fall Clinic Experience.
N. Sanders, 1 T. Jetter, 2 S. Wasmund, 2 C. Pacchia, 2 M. Hamdan. 2 1.
Geriatrics Division, University of Utah, Salt Lake City, UT; 2.
Cardiology Division, University of Utah, Salt Lake City, UT.
Background: Orthostatic Hypotension (OH) is a common problem
in the elderly. While midodrine helps OH, its use is often limited
by the presence of supine hypertension (HTN). Pyridostigmine is an
acetylcholinesterase inhibitor that increases sympathetic tone by improving
cholinergic neurotransmission. Its efficacy in patients with
OH remains uncertain.
Methods: All patients with symptomatic OH and supine HTN
were included. Supine, 1-min and 3-min orthostatic BP measurements
were obtained at baseline and following 30 days of pyridostigmine at
60 mg PO TID. The decreases in SBP and DBP at 1 and 3 minutes
were assessed at baseline and compared to the 30-day follow-up values.
Clinical symptoms were also assessed and categorized as worsening,
no change or improving.
Results: A total of 10 patients were enrolled with 2 patients not
tolerating the drug (Mean age=75). At baseline, the supine BP and
HR were 139/82 mmHg and 74 bpm. The mean decrease in SBP/DBP
at 1 minute and 3 minutes were 28/12 mmHg and 31/10 mmHg respectively.
After 30 days of drug therapy, the baseline supine BP and
HR were 132/78 and 73 bpm. The mean decrease in SBP/DBP at 1
minute and 3 minutes were 16/7 mmHg (p=0.055 for SBP; p=NS for
DBP when compared to baseline) and 13/9 mmHg (p=0.05 for SBP;
p=NS for DBP when compared to baseline) respectively (see Figure).
All patients reported improvement in their symptoms.
Conclusion: Pyridostigmine improves orthostatic tolerance and
symptoms in patients with OH and supine HTN at 30 days. Its longterm
efficacy awaits additional studies.
B91
Cancer, Functional Decline, and the Vulnerable Elders Survey
(VES-13) in Older Medicare Beneficiaries.
P. Wroe, 1 A. Naeim, 2 W. Dale, 1 L. Fan, 3 S. Mohile. 3 1. University of
Chicago, Chicago, IL; 2. University of California, Los Angeles, Los
Angeles, CA; 3. University of Rochester, Rochester, NY.
Supported By: The Medical Student Training in Aging Research
Program, the National Institute on Aging (T35AG026736), the John
A. Hartford Foundation, the MetLife Foundation, and the Lillian R.
Gleitsman Foundation.
University of Rochester John Hartford Foundation Center of
Excellence Grant (to Mohile).
Background: The US population is aging rapidly, cancer is more
prevalent among older adults, and older adults account for a large
and growing percentage of cancer cases and deaths. The longitudinal
association between a cancer history and functional decline has not
been determined, nor has the use of the Vulnerable Elders Survey
(VES-13) as a screening tool for predicting decline or death in older
cancer survivors.
Methods: Using data from the 2003 and 2004 Medicare Current
Beneficiary Survey, we compared older adults with and without a cancer
history on functional status (Activities and Instrumental Activities
of Daily Living, I/ADLs), geriatric syndromes, and vulnerability
(VES-13 score 3 or higher) with chi-squared tests of proportion. We
used receiver operating characteristic (ROC) curves to assess the
ability of the VES-13 survey instrument (VES-13 score 3 or higher) to
predict functional decline or death one year after baseline.We defined
functional decline as one of the following: a one-year increase of 2 or
more functional deficits, one or more functional deficits after one year
if zero functional deficits at baseline, or a nursing home admission.
Results: Older Medicare beneficiaries with a cancer history
(n=1,210) were significantly more likely than those without a cancer
history (n=5,278) to have functional limitations (56.2% vs. 49.3%,
p