Here - American Geriatrics Society

P OSTER
A BSTRACTS
ing decisions when patients develop dementia. The purpose of this
study was to describe the perspectives of family caregivers toward
forgoing or continuing cancer screening.
We audio-taped and transcribed focus group sessions with a
convenience sample of caregivers of patients with dementia attending
4 local Alzheimer’s Association support groups. Session topics included
recent experiences with screening decisions and preferences
for patient-clinician communication. The interviews were coded independently
by all investigators to identify key themes using methods
of grounded theory.
We conducted 4 focus group sessions with 32 caregivers of patients
with dementia. Mean age was 65.5 (range 49-85), 25 were
women, 7 were African American, 24 white, and 1 African American/Indian.
Caregivers were 14 daughters, 13 were spouse, and 5
other. The most important factor in making decisions about screening
tests preserving the patient’s Quality of Life. One said, “I was concerned
about her quality of life and making sure that she was very,
very comfortable, and I think that means more than putting people
through a lot of unnecessary, uncomfortable…procedures.” The second
theme involved the Increasing Burdens and Decreasing Benefits
of continued screening as dementia worsened. Specifically, the inability
to understand procedures and patient agitation increased the test
burdens. Caregivers noted their own Pivotal Role in Decision Making,
often stepping in to stop invasive tests and deciding when to take
over decision making from the patient. Caregivers noted variable levels
of Physician Knowledge/Expertise, with some having limited
knowledge of the course or challenges of dementia.
Caregivers of patients with dementia consider cancer screening
tests in light of their impact on quality of life. Given their perceptions
of the changing balance of burdens and benefits as dementia worsens,
many caregivers choose to forgo screening. The perspective of caregivers
contrasts with prior research on patient perspectives, which
finds that many patients plan to continue screening for themselves
despite possible future declines in health.
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Older Adult Opinions of “Advanced Driving Directives”
M. E. Betz, 1 S. Lowenstein, 1 R. Schwartz. 2 1. Emergency Medicine,
University of Colorado School of Medicine, Aurora, CO; 2. Division
of Geriatrics, University of Colorado School of Medicine, Aurora, CO.
Supported By: Emergency Medicine Foundation and John A
Hartford University of Colorado Denver Center of Excellence.
BACKGROUND: Discussions and decisions about driving retirement
are difficult. “Advanced driving directives” [ADDs], similar
to advanced directives for end-of-life care, would allow drivers to designate
a person to help make decisions about driving cessation when
their driving skills decline. It is not known if older drivers support the
idea of ADDs; we sought to describe older adults’ experiences and
opinions about driving discussions and ADDs”.
METHODS: A convenience sample of English-speaking adults
(55+ years) at two independent living facilities and two community
centers were invited to complete an anonymous survey.
RESULTS: Of the 168 participants, 133 (80%) were female and
the median age was 76.5 (range: 56-93) years. Most reported driving a
motor vehicle at least occasionally (96%; 95%CI:92-98) and only
29% (95CI:22-37) found driving somewhat or very stressful. Seven
percent (95CI:4-12) reported a crash in the past year. Most participants
(73%; 95CI:66-80) supported mandatory age-based driver testing;
of these, half (50%; 95CI:40-59) though testing should begin at
age 80 or higher. More thought that the driver (71%; 95CI65-78),
family (61%; 95CI:53-68) or physician (59%; 95CI:51-66) should determine
license revocation for an unsafe driver rather than the department
of motor vehicles (32%; 95CI:25-39). A minority had spoken
with someone about driving safety (5%; 95CI:2-10) or wishes
when driving skills decline (21%; 95CI:15-28); of these, 83%
(95CI:67-94) had spoken with a family member but only 17%
(95CI:6-33) with a healthcare provider. However, older adults were
open to discussions (table) and 54% (95CI:46-62) said they would
complete an ADD if recommended. Of these, 79% (95CI:69-87) said
it was likely or very likely they would follow the ADD in the future.
CONCLUSION: Older drivers are open to driving discussions
with physicians, supporting the important physician role in counseling
and coordinating conversations about driving. Advanced planning
with ADDs may facilitate future decisions about driving retirement.
B146
Walking Ability is Associated with Pain, Depression, and
Overweight among Community Dwelling Older Adults.
N. Satchidanand , 1 C. Fox, 1 K. Brunton, 2 G. S. Cherr . 2 1. Family
Medicine, State University of New York at Buffalo, Buffalo, NY; 2.
Surgery, State University of New York at Buffalo, Buffalo, NY.
Supported By: American Geriatrics Society: Dennis W. Jahnigen
Career Development Scholars Awards Program.
BACKGROUND: Maintenance of mobility is an important goal
for the elderly. Impaired physical function limits the ability of older
adults to live independently and is strongly associated with declining
health. The association between physical comorbidities and disability
is well studied. However, less is known about the influence of modifiable
factors on physical function. The study purpose was to examine
the influence that select treatable factors have on walking ability
among older adults.
METHODS: A total of 200 subjects, age ≥65 were included
(62.5% female). Depressive symptoms, psycho-social stress and
chronic pain were assessed using literature validated questionnaires.
Body mass index (BMI) was calculated. Physical function was assessed
using the Six Minute Walk Test. Pre-existing medical conditions
which may impact walking ability (i.e. PAD, COPD, CHF) were
also assessed. Path analysis was performed to characterize the contribution
of each predictor variable (depression, stress, chronic pain,
BMI) on distance walked and to derive path coefficients, R 2 -values
and probability values.
RESULTS: The predictor variables demonstrated low to moderate
correlations with one another, (0.27 to 0.54). Depressive symptoms,
pain and BMI (but not psychosocial stress) were significant predictors
of distance walked.The overall causal model accounted for about 30%
of the variance in distance walked among all patients. After adjusting
for pre-existing medical conditions, the proposed model still accounted
for about 30% of the variance in distance walked.The strongest association
with distance walked was with chronic pain for both the overall
model (β = -.296, p < .01) and adjusted model (β = -.250, p < .01).
CONCLUSIONS: Among community dwelling older adults,
three treatable factors were significantly associated with impaired
walking ability. These associations remained after adjusting for medical
conditions that are also associated with impaired physical function.
Further research is needed to determine the most efficacious interventions
to treat depression, ameliorate chronic pain, and prevent weight
gain in aging in order to preserve physical function and quality of life.
B147
“SERIOUSLY ILL OCTOGENARIANS &
NONAGENARIANS”– ROLE OF PALLIATIVE CARE
CONSULTS IN INITIATING “DO NOT ESCALATE CARE”
PATHWAY AND DISCHARGE TO HOSPICE IN SERIOUSLY
ILL OLDEST OLD PATIENTS ADMITTED TO A TERTIARY
ACADEMIC MEDICAL CENTER.
F. Kawai, V. Periyakoil. Stanford University School of Medicine,
Stanford, CA.
Supported By: Stanford University School of Medicine
Background:
AGS 2012 ANNUAL MEETING
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