Here - American Geriatrics Society

P OSTER
A BSTRACTS
We monitor the template’s use and encourage physicians not
using it to do so. Performance on quality measures such as HEDIS,
which include topics addressed in the template, is measured annually
and has improved. For example, glaucoma screening increased from
54.84% in 2010 to 60.88% in 2011. For a sub-group of our population,
metrics include annual discussion of advance directives, medication
review, assessment of functional status and comprehensive pain
screening. Along with other initiatives, template implementation was
associated with improvements between 2010 and 2011: Advance Care
Planning increased from 22.14% to 70.07%; Medication Review
74.94% to 98.30%; Functional Status Assessment 13.63% to 91.48%;
and Pain Screening from 39.42% to 95.13%. Referrals to our Geriatrics
team increased with template use, from 21 to 35 per month. Issues
identified for referral included previously unrecognized cognitive
disorder/dementia and gait problems/falls.
Because our physicians are now familiar with the need to address
these topics, we recently modified the template and developed
and refined workflows to enable nursing staff to ask many of the
screening questions. This will increase efficiency and better enable
physicians to focus on evaluating and treating the problems identified.
Overall, implementation of the tool appears to be an effective
means of improving primary care physicians’ awareness of, attention
to, and appropriate referral for, issues important in older patients.
C124
Care of the Older Adult Continuing at Home (COACH):
Optimizing Medical Resident Understanding of the patient at home.
D. C. Hayley, 1,2 J. Kalender-Rich, 1,2 B. Lowry, 1 M. Brimacombe. 3 1.
Internal Medicine, University of Kansas, Kansas City, KS; 2. Landon
Center on Aging, University of Kansas School of Medicine, Kansas
City, KS; 3. Biostatistics, University of Kansas School of Medicine,
Kansas City, KS.
Supported By: Landon Center on Aging
Purpose-To determine differences between what Internal Medicine
residents expect to find and what they actually observe on posthospitalization
home visits of frail elderly.
Methods—Internal Medicine Residents on their month of Geriatrics
rotation make a home visit through COACH (Care of the
Older Adult Continuing at Home) on an elderly patient discharged
from the hospital in the last month. After chart review, the resident
completes a pre-visit questionnaire with questions on discharge diagnosis,
predicted functional status, number of medications and support
at home. After the home visit and primary data collection in these
same domains, a post-visit questionnaire is completed including
quantitative and qualitative differences between what was expected
and what was found.
Results—Of the 12 residents who have completed this study
thus far, 10 reported that there was NO difference between diagnosis
on the hospital discharge summary and the patient/family report. In
all cases, the patients had someone with them at all times and 4 residents
reported that this was more supervision than expected. Patient
functional status was different than expected in 5 of 12 cases. There
were from 0 to 16 differences in number of medications at home as
compared to expected and in only one case was it reported that there
were no discrepancies. 10 of 12 residents reported the experience was
superior. Qualitative responses regarding suggestions on discharge of
elderly patients to home include attending to patient’s social support,
functional status and medications. There were repeated requests for
more of this experience in residency.
Conclusions—Residents did a fair job of predicting discharged
patient’s supervision and functional status but still missed many important
issues at home, especially medications the patient is actually
taking. Most residents acknowledged the importance of these aspects
in elderly patients and request more of this geriatrics and home visit
experience in residency. They found this was useful for their learning
and improving optimal discharge practices in the frail elderly.
C125
Safety profile of high dose statin therapy in geriatric patients with
stroke.
D. Manocha, N. Bansal, Z. El Zammar, S. Brangman. SUNY Upstate
Medical University, Syracuse, NY.
Introduction: Use of high dose statins in patients with stroke has
become a standard clinical practice after the SPARCL study in 2006.
Although the mean age of population in SPARCL study was around
63 years, scientific evidence derived from the same has been extrapolated
to much older patients in clinical practice. Very little data is
available on the magnitude of adverse effects of high dose statin therapy
in geriatric patients. Methods: This single-center retrospective
study was conducted at Upstate Medical University, Syracuse, NY.
The goal was to define the magnitude of side effects of high dose
statins in our selected geriatric study population. We reviewed
records of 120 patients between the ages of 65-89 years to collect demographic,
clinical, laboratory & adverse drug reaction data. Data
were compared between patients on high dose statin therapy (cases)
vs. those on regular doses (controls) using Chi square, Fisher exact
test & Student T test. P value