Here - American Geriatrics Society

P APER
A BSTRACTS
management in collaboration with primary care (PCP) improved care
quality and reduced acute care utilization for seniors at high risk of
hospitalization.
Objective: To assess the impact of GRACE Team Care on hospital
readmissions in older veterans at a Veterans Affairs Medical Center
(VAMC).
Methods: Veterans 65 or older with PCPs from 4 of 5 VAMC
clinics were enrolled following discharge home from an acute hospitalization
on the medicine service from April 2010 to June 2011. After
an initial home-based transition visit, a nurse practitioner and social
worker (GRACE Team) returned to conduct a geriatric assessment
visit. Guided by 12 geriatric protocols and input from the GRACE
geriatrician, pharmacist, and psychologist, the GRACE Team developed
a veteran-centric care plan and collaborated with the PCP to
implement that plan. Hospitalized veterans with PCPs from the fifth
VAMC clinic that did not get GRACE but who otherwise met enrollment
criteria served as a comparison group. Data on demographics,
comorbidity, hospital utilization, and mortality were drawn from VA
databases.
Results: 174 veterans (mean age 78 years, range 65-97; 97%
male) were enrolled in GRACE and followed for an average of 8.5
months (range 0.4-15.5), and 77 veterans (mean age 77 years, range
65-93; 94% male) in the comparison group were followed for an average
of 8.6 months (range 0.4-16.0). Charlson Comorbidity Index
scores were similar between groups: GRACE mean 2.40 (range 0-13)
vs. comparison mean 2.17 (range 0-10). GRACE veterans vs. comparison
had lower readmission rates at 7 days (2/174 [1.1%] vs. 5/77
[6.5%], p=0.03); 14 days (8/174 [4.6%] vs. 7/77 [9.1%], p=0.25); 30
days (17/174 [9.8%] vs. 13/77 [16.9%], p=0.11); and 60 days (26/164
[15.9%] vs. 17/73 [23.3%], p=0.17). Over the follow-up period,
GRACE veterans had a lower mortality rate than the comparison
group (17/174 [10%] vs. 13/77 [17%], p=0.11).
Conclusion: GRACE Team Care, which provided in-home, veteran-centric,
geriatric care management while supporting VA primary
care, had a positive impact on reducing hospital readmissions.
GRACE may offer an opportunity for better care at lower costs in
high risk older veterans.
P15
The Falls and Fractures Clinic: Testing an Integrated Model of
Secondary Prevention in a High-Risk Older Population.
G. Duque, 1,2 P. Suriyaarachchi, 1,2 D. Boersma, 1,2 O. Demontiero, 1,2
G. Loza-Diaz, 1 A. Sharma. 2 1. Ageing Bone Research Program, The
University of Sydney, Penrith, NSW, Australia; 2. Geriatric Medicine,
Nepean Hospital, Penrith, NSW, Australia.
Supported By: Nepean Medical Research Foundation
INTRODUCTION: Although falls and fractures are highly
prevalent in older persons, there is still a fragmentation in terms of
falls being assessed by geriatricians and fractures remaining within
the scope of other specialties. Therefore, an integrated model of secondary
prevention for falls and fractures run by geriatricians is highly
needed.
OBJECTIVE: To evaluate the effectiveness of a multidisciplinary
Falls and Fractures Clinic as an optimal integrated model to assess
risk and to prevent new events in a high-risk older population.
METHODS: Four hundred and thirty subjects (mean age=82,
65% female) were assessed between January 2009-June 2011 at the
Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia).
Assessment included fear of falling (SAFFE), risk factors for
falls and fractures, physical examination, nutrition, depression, grip
strength (dynamometer), densitometry, posturography (Medicaa,
Uruguay), gait parameters (GaitRITE®), and blood tests for secondary
causes of osteoporosis including vitamin D and parathyroid hormone
(PTH). An integrated plan was then designed according to the
subject’s risk factors. Subjects were surveyed by phone (month 3) and
fully re-assessed at the clinic nine months later.
RESULTS: 77% had suffered a fall and 38% had suffered a fracture
before the assessment. An average of 6.5+/-2.8 falls and 3.5+/-1.8
fracture risk factors were identified per subject. At the time of the
second assessment, the incidence of falls was reduced in -
65%(p