Here - American Geriatrics Society

P OSTER
A BSTRACTS
Conclusions: Conclusions: The results indicate that there may be
a single factor underlying the responses to OHIP-14 questions in
these older adults. The ohip-14 seems not to represent seven separate
dimensions of oral health as originally devised.
C47
Mexican-American Elder Post Hip Fracture Survival Study.
D. V. Espino, 1,2 R. C. Wood, 1,2 C. C. Moore. 2,1 1. Family and
Community Medicine, University of Texas Health Science Center at
San Antonio, San Antonio, TX; 2. School of Medicine, University of
Texas Health Science Center at San Antonio, San Antonio, TX.
Supported By: National Institute of Health (NIH)
American Federation for Aging Research (AFAR)
University of Texas Health Science Center at San Antonio
(UTHSCSA)
As the world’s population is shifting to an older age due to advances
in medical care, increased numbers of hospital visits, especially
for geriatric hip fractures, are being documented. Despite the
vast research conducted on hip fractures in general, little emphasis
has been made on the effects of hip fractures on Mexican-Americans.
The Hispanic Established Populations for the Epidemiologic
Study of the Elderly (H-EPESE) compiled data on risk factors for
morbidity and mortality in Mexican-Americans used to create a
community-based survival analysis of geriatric hip fractures. The H-
EPESE began in 1993 with a contingent of 3050 individuals and is
currently on the seventh wave of the study. Using a Cox Model Regression
Survival Analysis program, significance (p65), gender and presence or
absence of Type II Diabetes Mellitus creating a drastic influence on
mortality rates. Over a 7 year span after sustaining a hip fracture, a
patient meeting the appropriate risk factors noted above had an approximate
fifteen percent increased risk for mortality than a patient
not meeting the criteria. Factors influencing the comorbidities,such
as: osteoporosis in the elderly, post-menopausal hormone imbalances
in women and peripheral neuropathy associated with Type II
Diabetes Mellitus were investigated as contributors to the increased
mortality rates. While this study does not cover the entire spectrum
of comorbidities associated with increased geriatric hip fractures in
the Mexican-American population, it does attempt to bridge the literature
gap associated with the Mexican-American minority and
create interest for expanding the literature for this subset of the
population.
C48
Lifetime Manic Spectrum Syndromes and All-Cause Mortality: A
26-year Follow-Up of the US National Epidemiological Catchment
Area Study.
C. Ramsey, 1 A. P. Spira, 1 W. W. Eaton, 1 H. B. Lee. 2,1 1. Mental Health,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
2. Psychiatry, Yale University, New Haven, CT.
Background: Increasing evidence suggests a high prevalence of
bipolar spectrum disorders, associated morbidity and mortality.While
research supports the association between depression and mortality,
the role of mania has received less attention. This analysis evaluated
the association between manic spectrum syndromes and risk of mortality
in the community. Methods: Participants in the prospective US
National Epidemiological Catchment Area Study were classified into
mutually exclusive groups based on their responses to the Diagnostic
Interview Schedule items assessing mania in 1981. Those with manic
spectrum syndromes (n=133; mean age: 33.8 +/- 12.6; female: 29.2%)
met one of the following criteria: mania (met DSM-III criteria for a
manic episode; n=36), hypomania (met all DSM-III criteria for a
manic episode except the severity requirement of causing impairment
or help seeking; n=42) and subsyndromal mania (had a euphoric
or irritable mood for a week or more and at least one other
symptom, but did not meet criteria for mania or hypomania; n=55).
Participants without manic spectrum syndromes (n=13,784; mean
age: 48.6 +/- 20.2; female: 53.8%) comprised the control group. Vital
status through the end of follow-up in 2007 was ascertained by
matching individual identifying information with the National Death
Index. Manic spectrum and control groups were compared in terms
of demographics, depressive symptoms, and self-rated health in 1981
using independent samples t-tests and chi-squared tests. To account
for the age difference between groups, a propensity score was used.
Risk of mortality was assessed using a Cox-proportional hazards
model with age in 1981 as the time of entry and age at death or follow-up
as the time of exit. Results: Estimated lifetime prevalence of
manic spectrum syndromes was 0.98%. This group was older than the
controls, had more symptoms of depression, was more likely to be
married and to be Caucasian. After adjusting for these covariates in
the hazard model, manic spectrum syndromes were not a significant
risk factor for all-cause mortality (HR=1.3, p=0.270). Conclusions:
History of manic spectrum syndromes did not increase risk of allcause
mortality. Future studies should evaluate specific causes of
mortality.
C49
Asymptomatic Bacteriuria and Antibiotic Use in Nursing Homes.
D. R. Mehr, 1 C. D. Phillips, 2 L. Adepoju, 2 D. K. Moudouni, 2 N. Stone, 4
O. Nwaiwu, 2 E. Frentzel, 3 S. Garfinkel. 3 1. Family and Community
Medicine, University of Missouri, Columbia, MO; 2. Texas A&M
Health Sciences Center, College Station, TX; 3. American Institutes for
Research, Chapel Hill, NC; 4. Centers for Disease Control and
Prevention, Atlanta, GA.
Supported By: Supported by the Agency for Healthcare Research
and Quality
Background: Overuse of antibiotics is a longstanding concern in
nursing homes. As part of a project on antibiotic stewardship, we investigated
the use of antibiotics to treat asymptomatic bacteriuria
(ASB) among nursing home residents with a suspected urinary tract
infection (UTI).
Methods: In 4 central Texas nursing homes, episodes of treatment
for suspected UTI were identified from facility logs. Symptoms
and resident characteristics were abstracted from residents’ records.
Using a multi-level multivariate model, we evaluated resident and facility
characteristics associated with antibiotic use despite the absence
of symptoms and signs suggesting need to treat a UTI (criteria from
Loeb, et al. Infect Control Hosp Epidemiol 2001).
Results: Over 6 months, clinicians ordered antibiotics for suspected
UTI 227 times among 167 residents; 89% had urine studies.
Half (114) of the antibiotic prescriptions occurred in the absence of
any symptoms or signs. In multivariate analyses, resident characteristics
did not differentiate between treated residents with or without
symptoms or signs; however, in the same model, 2 of the 4 facilities
exhibited less treatment of asymptomatic residents (odd ratios and
95% confidence intervals, 0.28 [0.09,0.88] and 0.34 [0.15,0.74]).
Conclusions: This research confirms frequent use of antibiotics
for ASB in nursing homes. Antibiotic stewardship in nursing homes
must address treatment that seems to be based solely on urine findings.
Clinicians’ prescribing behavior was clearly associated with the
S148
AGS 2012 ANNUAL MEETING