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P OSTER
A BSTRACTS
older adults are needed to better understand its trajectory, associated
factors, and outcomes.
B150
Factors associated with enrollment in a randomized controlled trial
of oxycodone vs acetaminophen for moderate or greater noncancer
pain.
J. Shega, C. Ogbevire, W. Dale. Medicine, University of Chicago,
Chicago, IL.
Supported By: NIA
Background: Studies document the under-identification and
treatment of non-cancer pain among older persons. In addition optimal
pharmacologic management remains unclear.
An obstacle of analgesic use in this setting is lack of high-quality
comparative effectiveness data comparing acetaminophen to opioids
in community-based populations, particularly African Americans
(AA). We sought to identify factors associated with the likelihood of
older adults enrolling in a randomized control trial (RCT) of these
therapies.
Methods: A face-to-face screening questionnaire was completed
for all referred older adults who were eligible for an analgesic intervention
conducted in a predominantly AA, community-based geriatrics
clinic. Information elicited from the screening questionnaire included
basic demographics, pain intensity (verbal descriptor scale: 0
[no pain] to 5 [excruciating pain], frequency of pain in the past week,
number of painful sites, mobility difficulty, and presence of adequate
social support.
Results: Among the first 50 participants (46/50, 96%, AA) referred,
15 (30%) elected to enroll in the RCT. The most commonly
cited reasons for not enrolling were: 1) infrequency of pain (6%) and
2) fear of opioid-related side effects (8%). Age was not associated
with likelihood of enrollment, 82.2 ( SD=6.78) years versus 82.0
(SD=6.72) years, p=0.94. Gender (female) 31% vs 69%, p=0.55, pain
severity 2.87 ( SD=1.1) versus 3.18 ( SD=1.2), p=0.40, number of
painful sites 2.6 (SD=1.6) versus 2.1 (SD=1.4), p=.53, mobility difficulty
60% versus 40%, p=0.31, and availability of social support 93%
versus 97%, p=1.00 were also not associated with study enrollment.
Those who reported pain everyday, compared with those reporting
pain 1-3 times per week were more likely to enroll, 100% versus
31%., p=0.065.
Conclusion: In this preliminary analysis, the number of older,
primarily AA adults in a community setting enrolled in a RCT that
included an opioid mirrored the rates from cancer clinical trials.
Common stated reasons for not enrolling were concern for side effects
and pain considered insufficient for treatment. The experience
of pain everyday was positively associated with enrollment, while age,
gender, pain intensity, number of pain sites, mobility difficulty, and social
support were not associated with study enrollment. This is unique
information on AA enrollment in RCT for pain management.
B151
Experiences of informal caregivers of older adults discharged from
nursing homes to the community through the Money Follows the
Person Demonstration Program.
L. Kristof, C. Butler, J. Robison, R. Fortinsky. Center on Aging,
University of Connecticut, Farmington, CT.
Background: The multi-state Money Follows the Person (MFP)
Demonstration Program enables Medicaid recipients residing in
nursing homes to move back to their communities. Little is known
about how family and other informal caregivers are affected by older
adults returning to the community after what was considered longterm
nursing home residence. We examined caregiver burden and the
positive aspects of caregiving in caregivers of older adults (age >65)
enrolled in Connecticut’s MFP who were discharged to the community
after a nursing home stay of more than 3 months. Secondary outcomes
evaluated were depressive symptoms and anxiety in caregivers.
Methods: In this cross-sectional study, caregivers completed a
self-administered questionnaire 6 months after their family members
returned to the community. We asked caregivers about stress levels
compared to previous time points. Caregiver burden was measured
using the Modified Zarit Burden Interview. Positive aspects of caregiving
were evaluated using the COPE index. We evaluated for symptoms
of depression using the 2 question PRIME-MD screen. Statistical
analysis was done using SPSS.
Results: Preliminary results from 21 caregivers were analyzed
(M age = 57, range 30-77; 81% female; 48% live with the MFP participant;
32% work full time, 53% do not work). The mean Burden
Index score was 5.38 (M=5.38, Range 0-12); mean score for the
COPE index was 8.85 (M=8.85, Range 0-10). Compared to the time
when the older adults resided in nursing homes, 75% of caregivers
felt less stressed, 10% felt the same stress, and 15 % felt more
stressed. Compared to the period before nursing home admission,
61.1% of the caregivers felt less stress, 27.8% felt the same stress, 11.1
% felt more stressed. Burden scores and COPE index scores were not
significantly different whether caregiver lived with the MPF participant
or not (Burden M=4.2 vs. M=6.45, p=0.081; COPE M=9.6 vs. M=
8.18, p=0.234).
Conclusions: Preliminary results suggest a decrease in caregiver
stress and, compared to other studies of community-based caregivers,
lower levels of caregiver burden and higher levels of positive aspects
of caregiving for caregivers of older MFP participants in CT.
B152
FUNCTIONAL OUTCOMES AND HEALTH RELATED
QUALITY OF LIFE AFTER TRANSCATHETER AORTIC
VALVE IMPLANTATION IN ELDERLY PATIENTS WITH
SEVERE AORTIC STENOSIS.
M. G. Mendieta F., 1 N. F. Pereyra, 1 E. Sánchez G., 1 E. Gutierrez, 2
F. Fernández Aviles, 2 H. Bueno, 2 M. Vidán A.. 1 1. Geriatry, Gregorio
Marañón Hospital, Madrid, Madrid, Spain; 2. Cardiology Service,
Gregorio Marañon Hospital, Madrid, Madrid, Spain.
Background: Transcatheter aortic valve implantation (TAVI)
improves survival in patients with aortic stenosis unelegible for surgery.
The changes in patients functional performance and quality of
life (QoL) after TAVI are not well known.
Methods: The change in health related quality of life (SF-12
questionnaire), autonomy for activities of daily living (ADL), mobility
and social help was prospectively evaluated in a cohort of consecutive
patients one month after TAVI. Demographic and clinical characteristics,
in-hospital complications and clinical evolution were also
evaluated.
Results: Between January 2009 and November 2011, 57 patients
were enrolled in the Cardiology Department, with a mean age of 82.2
± 5.7 years. Thirty-day mortality was 12,2%. Among survivors, 58%
improved cardiac symptoms, 26% improved mobility, and 15% improved
autonomy for ADL but 30% increased dependency for ADL.
In addition, 41% needed new social or private help for daily living.
Baseline SF-12 physical summary was 36.3± 10 and baseline mental
summary was 43±9.2. Both scores showed modest improvements
after one month: 2.9±9.6 (p=0.04) and 2.7±11.6 (p=0.02), for physical
and mental scores, respectively. The proportion of patients with relevant
improvement (>2points) in physical health was 47.7%, and
59.1% in mental health. No significant association between cardiac
symptoms improvement and changes in quality of life was found.
Conclusions: Most inoperable patients with severe aortic stenosis
show improvements in symptoms and quality of life one month
after TAVI but the changes are modest in absolute terms and not always
associated with functional improvement. Longer-term follow-up
is ongoing.
AGS 2012 ANNUAL MEETING
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