Here - American Geriatrics Society

P OSTER
A BSTRACTS
Conclusions: Nurses in SNFs identify multiple quality deficiencies
in hospital-to-SNF transitions, which they feel impact care. Future
qualitative work with SNF nurses will assist in designing interventions
to improve hospital-to-SNF care transitions.
C104
Primary Care Providers’ Experiences of Assessing and Minimizing
Treatment Burden of Multimorbid Older Adults.
B. Limm, 1 T. B. Hughes, 2 C. Boyd, 2 C. Rand. 2 1. John A. Burns
School of Medicine, University of Hawaii, Honolulu, HI; 2.
Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD.
Supported By: The Robert Wood Johnson Foundation Physician
Faculty Scholars Program, and the Paul Beeson Career
Development Award Program (NIA K23 AG032910, AFAR, The
John A. Hartford Foundation, The Atlantic Philanthropies, The Starr
Foundation and an anonymous donor).
Purpose: Comorbidity is associated with poor outcomes including
worse quality of life, mortality, disability, and complications from
treatment. Older patients with multiple chronic conditions present
substantial challenges to delivering medical care that is both patientcentered
and guideline-based. Patients are often overwhelmed by the
aggregate weight of all the actions and resources that they must devote
to maintain their health. To gain insight into the experience of
managing and treating multimorbid older adults, focus groups were
conducted with 20 primary care physicians. Methods: Participants
were asked to discuss how treatment burden affected the treatment
plans and adherence of older adults with multiple chronic conditions,
and how they made decisions with these patients. Focus group sessions
lasted one to two hours in duration, were audio-taped and transcribed.
Content analysis of data was performed for emergent themes
by two independent investigators utilizing Atlas.ti 5.2. Results: Nearly
all respondents reported challenges in the treatment of patients with
multiple chronic conditions, particularly among patients with complex
medication regimens, financial constraints, inadequate social
support, and those in need of prolonged visits. Findings revealed the
following emergent themes: physicians prioritized treatment decisions
based on patient preferences, level of motivation, finances, disease
severity, and level of social support; system regulations were barriers
to the provision of comprehensive care; and non-physician office
staff was a link to better patient care. Conclusions: Treatment burden
presented challenges by affecting decision-making, actual treatment
plans, and adherence among primary care providers. Research findings
will contribute to the development of a screening tool for health
care providers to assess the burden of prescribed treatments and recommendations
among patients, promote communication between patients
and physicians, and guide medical decision-making regarding
treatment regimens.
C105
For a seat at the table, bring the table: A transdisciplinary model for
aging-related advocacy in non-health policy.
B. Williams, 1 C. Ahalt, 1 D. Faigman. 2 1. UCSF, San Francisco, CA; 2.
UC Hastings, San Francisco, CA.
Supported By: The Langeloth Foundation and The UCSF Program
for the Aging Century
Background: Policy decisions that are not health-specific may
increasingly cause unintended health consequences for older adults.
As a result, broader reaching geriatrics advocacy is needed. Health
Impact Assessment (HIA) is an emerging conceptual model for identifying
the health consequences of policies and communicating that
information to policymakers. Using the HIA transdisciplinary approach,
we convened a roundtable of national experts in geriatrics,
correctional health, and the law to assess “Realignment,” a new criminal
justice policy in California that will redistribute thousands of
older adults from prisons to jails and community corrections. We explored
HIA as a platform for geriatrics advocacy to develop recommendations
to minimize the adverse consequences of Realignment
for older adults.
Methods: The 26 Roundtable participants received a short crossdisciplinary
lecture to convey basic knowledge in 3 areas: geriatrics,
older prisoner health, and Realignment. Next, transdiscipline working
groups brainstormed critical issues to address.Facilitators grouped highpriority
issues into 4 “topic areas” and assigned each to a transdisciplinary
group to develop recommendations. Each group then presented
their policy recommendations to the Roundtable to achieve consensus.
Results: 26 of 32 (81%) invitees participated: Correctional physical
or mental health providers (4), Law professors (4), Public Defenders
or District Attorneys (3), Pre-Trial Diversion or Probation officials
(2), Community service providers for the formerly incarcerated (2),
Criminal justice experts (4), and Academic physicians/geriatricians
(7). Consensus was reached on 6 recommendations: Collect age-stratified
data; Improve access to incarceration alternatives; Develop geriatric
assessments for arrest and incarceration; Expand peer-mentoring
for older inmates; Improve transitions of care; Expand geriatric training
for professionals in contact with older correctional populations.
Each recommendation incorporated the expertise of multiple disciplines.
95% of participants would participate in a similar future event.
Conclusion: While many policy changes could affect older
adults’ health, policymakers in non-health related fields rarely reserve
a “seat at the table” for geriatricians. Our findings show that the
HIA approach works as a mechanism for achieving transdiciplinary
geriatrics advocacy in non-health-specific policy.
C106
Knowledge of and perceived need for evidence-based educational
materials about antipsychotic medication safety by nursing home staff.
C. Lemay, S. Foy, K. Mazor, L. R. Harrold, J. Donovan, A. Kanaan,
B. A. Briesacher, J. Gurwitz, J. Tjia. Geriatrics, University of
Massachusetts Medical School, Worcester, MA.
Supported By: This study was funded by the Agency for Healthcare
Quality and Research.
Background: Given the widespread overuse of antipsychotic
medications among US nursing home (NH) residents, we sought to
identify knowledge of and perceived need for the AHRQ Comparative
Effectiveness Research Summary Guide (CERSG) “Off-Label
Use of Atypical Antipsychotic Drugs”.
Methods: We conducted a baseline needs assessment with 12
NHs participating in a randomized controlled trial evaluating evidence
dissemination strategies. Using a mixed-methods approach, we
conducted in-depth assessments of knowledge, attitudes, and practice
behavior using telephone interviews with NH leadership (administrators,
directors of nursing [DONs], and medical directors), and questionnaires
with NH leadership, consultant pharmacists and direct care
staff. Interviews were transcribed and verbatim responses were coded
independently by 2 project staff. The coding scheme was revised after
each round until substantial agreement (85%) was reached.
Results: Interviews revealed that 70% of medical directors and
46% of DONs & administrators believed that antipsychotics decreased
agitation and controlled harmful behavior; 50% of medical
directors and 7% of DONs & administrators reported knowledge of
the increased risk of morbidity amd mortality due to atypical antipsychotics.
Half of administrators and DONs expressed interest in receiving
information for NH staff pertaining to understanding dementia
and dementia-related behaviors, and 42% believed families would
benefit from information about antipsychotic use for dementia-related
behaviors. Questionnaire results were similar. When leaders
were asked to list any risks associated with antipsychotic use for residents
with dementia, only 17% reported death as a possible adverse
event; licensed nursing staff (RN and LPNs) reported death 5% of
the time. Over half of consultant pharmacists reported that their
biggest barrier to improving medication use in challenging NHs was
AGS 2012 ANNUAL MEETING
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