Here - American Geriatrics Society

P OSTER
A BSTRACTS
C61
New Non-Invasive Technique to Assess Arterial Stiffness.
F. M. Felice, A. K. Reddy, J. D. Taffet, C. J. Hartley, G. E. Taffet.
Baylor College of Medicine, Houston, TX.
Supported By: AFAR,NHLBI,Huffington Center on Aging
Large arteries stiffen with age increasing the risk of cardiovascular
disease. The stiffening causes increased systolic blood pressure,
decreased diastolic blood pressure, and increased pulse wave velocity(PWV).
Yet current techniques only measure PWV at diastolic
pressure when the pulse wave velocity is lowest because the artery is
not fully distended.
Methods: We developed a new technique to measure stiffness
looking at reversals in flow in the radial artery. Using 20 mHz
Doppler probes to assess blood flow velocity in the proximal and distal
radial arteries, sampling at both sites simultaneously to avoid beat
to beat variations. Probes were custom made and interfaced with a
multichannel Doppler Signal processing workstation (Indus Instrument).
Pulse wave velocity was calculated at the start of flow and
when forward flow started after each reversal.
Results: We attempted to assess radial artery flow non-invasively
in 8 subjects ranging in age from 18 to 64. We found that reversals
in blood flow happened in all our subjects, providing timing signals
for calculation. The quality of the signals needed to determine
the second wave PWV was very high so we could not get interpretable
data from 5 out of 8 subjects. We found within the range of
diastolic to systolic blood pressure, PWV increases by 40-80% as
blood pressure increased by 20 to 30 mmHg. Obtaining adequate signals
required significant attention to detail, however with good data,
it was then feasible to create a pressure versus PWV relationship.
Conclusion: With this strategy, the slope of the pressure PWV
relationship more directly defines stiffening and provides novel information
to assess arterial stiffening with aging and perhaps direct risk
reduction for cardiovascular disease for the elderly.
C62
Positive Effect of Restorative Sleep on IL6 and Fibrinogen in
Post-Midlife.
S. Song, 1 F. J. Prerost, 2 M. Sanders, 2 M. Barash, 2 A. Valone. 2 1.
Biomedical Sciences, Midwestern University, Downers Grove, IL; 2.
Family Medicine, Midwestern University, Downers Grove, IL.
BACKGROUND: Treatment of medical illnesses that emphasizes
hereditary and lifestyle etiological factors is often associated
with diverse health outcomes. The research identifying converging
bio-psychosocial pathways reflects this emphasis on disease risk. Proinflammatory
markers are understood as indicative of chronic conditions
including metabolic, autoimmune, and hematologic disorders.
The objective of the current study is to examine the positive effect of
restorative sleep on IL6 and fibrinogen as a protective factor that
might mitigate the onset of aging related decline.
METHODS/DESIGN: Longitudinal, secondary data
SETTING: Midlife in the United States (MIDUS) national sample
of independently dwelling middle-aged and older adults living in
the United States
PARTICIPANTS: Phase II of the MIDUS study comprised the
biomarkers project; a subsample (n = 398) of the original group of
participants between the ages of 35 and 84 underwent biological assessments
over a two-day period
MEASUREMENTS: Actiwatch sleep data collection and fasting
blood specimens of IL6 and fibrinogen biomarkers
RESULTS: Restorative sleep, measured as sleep efficiency, was
inversely related to serum IL6 (r = -.14, p < .001) and blood fibrinogen
(r = -.12, p = .01). Sleep efficiency was not significantly diminished
by the presence of diabetes (84% of participants did not have
diabetes) or physician diagnosed arthritis (F = .102, p >.05), blood
clots (F = .056, p > .05), or bleeding diseases (F = .031, p > .05).
CONCLUSIONS: Participants who exhibited higher amounts
of restorative sleep had lower levels of inflammation measured by
serum IL6 and blood fibrinogen. It was not the case that sleep efficiency
was adversely affected by pre-existing illnesses typically associated
with less healthy markers and subsequent disruptions to circadian
rhythm. Researchers have found that chronic and acute stressors
(i.e. childhood traumas, parental neglect, difficulties in adulthood,
etc.) have generated profiles similar to those of older and oldest
adults. Identifying possible mitigating factors of aged proinflammatory
markers will contribute to the literature and broaden treatment
options.
C63
Attitudes and Knowledge about Resuscitation Discussion in a
Community Hospital: A Survey of Physicians and Nurses.
C. X. Pan, 1 D. A. Acquista, 1 A. Bushan, 1 S. M. Constantine, 1
I. Kariolis, 1 S. Sunday. 2 1. New York Hospital Queens, Flushing, NY; 2.
North Shore- LIJ Health System, Manhasset, NY.
Background: For patients with a serious illness, discussions with
healthcare staff often include resuscitation preference or “code status”
including DNR/DNI (do not resuscitate/do not intubate). This
study assesses health care professionals’ attitudes and knowledge
about resuscitation discussions at a community hospital. The objective
is to examine if health care discipline and level of experience affect
attitudes and knowledge about discussion about resuscitation decisions.
Methods: A 34-question self administered survey was distributed
to attending physicians, nurses and internal medicine residents.
Questions included demographic information, religious beliefs, clinical
vignettes with management options, scales assessing
comfort/competency levels regarding treatment of symptoms in patients
who are full code vs DNR, knowledge of hospice appropriateness,
and perceived need for education about resuscitation discussions.
Results: There were 135 respondents: 30 attendings, 50 nurses
and 55 residents (M=37%; F=63%). Respondents were diverse in
ethnic/racial background. One respondent reported having a religious
reason that prevented discussing DNR/DNI. 83% of attendings,
49% of residents and 52% of nurses felt it was the attendings’
responsibility to discuss code status. When managing symptoms,
>85% of nurses, >75% of attendings and >63% of residents felt “very
comfortable,” while >89%, >63%, and >49% of nurses, attendings,
and residents felt “very competent,” respectively; (p-value for “comfort
level” NS; and “competence” p=0.0002). Attendings correctly
identified hospice appropriate patients in different case scenarios;
nurse and resident responses varied. Both nurses and residents
(>84%) felt they would benefit from more training about resuscitation
discussion. Conclusion: This study found differences in attitudes
and knowledge about resuscitation decisions among health care disciplines
with various levels of experience. Nurses felt more comfortable
and competent in managing symptoms compared to attendings
and residents; and only attendings consistently identified hospice appropriate
patients. Next steps may include: 1) residents and nurses receive
more education regarding resuscitation discussion and hospice
appropriateness, and 2) attendings and residents may benefit from
more training in symptom management.
C64
Weaving Aging Education Into The Surgery Clerkship: an
opportunity to increase future physician awareness of unique issues
in surgical care for the elderly.
A. Macnow, 1 R. Kelz, 1,3 A. Corcoran. 1,2 1. Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA; 2. Internal
Medicine, University of Pennsylvania, Philadelphia, PA; 3. Surgery,
University of Pennsylvania, Philadelphia, PA.
Supported By: Donald W. Reynolds Foundation
Background: Successful outcomes for geriatric surgical patients
are dependent on a team well versed in the unique issues of the aging
AGS 2012 ANNUAL MEETING
S153