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P OSTER A BSTRACTS PROGRAM STRUCTURE AND PROCESS: The Fracture Care and Prevention Program is a model of care designed to intervene when the first minimal trauma fracture occurs. A nurse coordinator (attached to a geriatrics department) identifies patients with minimal trauma fractures in hospital wards, rehab department, emergency department and local health centres. This coordinator provides patients with educational materials about osteoporosis and fractures, provides recommendations for vitamin D and calcium supplementation, encourages exercise and explains the specific treatment for osteoporosis. Patients are also referred to bone density testing. The patients’ family doctor is informed of the assessment to reiterate the recommendations provided to the patient, and for referral to a specialist at the Falls and Fractures Clinic. PROGRAM OUTCOMES: From January to August 2011, 82 patients were registered with the Fracture Care and Prevention Program. At follow-up post-discharge from hospital (8 weeks), 51% of patients were referred to the Falls and Fractures Clinic (13% attended), 32% started gentle exercise, and 40% read the educational materials provided. The number of patients taking vitamin D increased from 12% to 40%. The number of BMD tests increased 25%. In addition, 28% had a discussion with their physician about osteoporosis and treatments. Finally, the number of prescription for osteoporosis treatment increased in 32%. CONCLUSIONS: The Fracture Care and Prevention program is an effective model of intervention to increase awareness of the importance of falls and fractures prevention in older persons, not only to the patients but also to their physicians. This model, run by a nurse coordinator, is cost effective and easily implemented in a geriatric setting. C130 Profiles and Characteristics Associated with Rehospitalization of Patients in a Sub-Acute Rehabilitation Facility. H. Guzik, 1 N. Sharma, 1 A. Gupta, 1 N. Arif, 1 C. Nouryan, 1 R. Pekmezaris, 1 M. Lesser, 2 G. Wolf-Klein. 1 1. North Shore-LIJ Health System, New Hyde Park, NY; 2. Feinstein Institute for Medical Research, Manhasset, NY. Background: Reduction of unnecessary rehospitalization of patients has been identified as an important goal in geriatric medicine. We studied hospital readmission patterns of patients receiving care at a 258-bed sub acute rehabilitation facility. Methods: Retrospective chart review of 100 patients (50 rehospitalized [RH] and 50 not rehospitalized [NRH] within 60 days of admission), randomly selected between 1/2011 and 9/2011. Results: When comparing RH and NRH, demographic analysis revealed a significant difference with regard to age (80.6 vs 75.7 respectively, p
P OSTER A BSTRACTS medical assistant. We work closely with all community agencies to help maintain the patient in the community as long as possible. Methods: Home visit patients (N=590) were identified by a log maintained by home visit staff. The patients were linked to hospital information system data by medical record number to obtain demographic and hospital encounter information (N=539). Only patients with identifiable hospital admissions prior to or post 180 days to the program entry were included in the before and after comparison (N=387). A comparison group (N=1273) was defined as Medicare patients with 3 or more inpatient admissions in calendar year 2008 who were not enrolled in HV program. Primary outcome measures were ED visits, hospital admissions, and length of stay at 30 and 180 days pre- and post-home visit enrollment. Secondary measures were patient days in the HV program and discharge disposition. Results: Approximately 55% of the HV patients had death as their primary reason for discharge from our program. Average number of patient days in the HV program was 285 days. Patients had worse primary outcome measures prior to enrolling in the HV program. After entering the HV program, 30 day ED visits and inpatient admissions were reduced by 26% and 34% respectively. At the 180 day interval, this effect was still sustained with ED visits reduced by 9% and inpatient admissions by 28%. When compared to the non-HV comparison group, the HV outcomes were favorable as the comparison group had a 55% 180 day readmission rate. Of note, our case mix index (1.74) was higher than the comparison group (1.66). Length of stay for our cohort of patients prior to the HV program was 8.0 days. After enrollment, LOS was 6.2 days which again compares favorably to the non-HV comparison group with a LOS of 7.5 days. Conclusion: A HV program is an effective model of care that reduces ED visits, readmission rates, and length of stay. Hospital systems looking to improve their transitions of care process should look to partner with HV programs to improve similar outcome measures. The average length of time a patient stays in our program is roughly 9.5 months. By serving such a frail population, a HV program can and should be viewed as an outpatient palliative care program. C133 The Effect of Medication on Brain Size: Polypharmacy is Associated with Gray Matter Atrophy. A. Toussi, 1 O. V. Meulenbroek, 2 S. A. Studenski, 1 M. G. Olde Rikkert. 2 1. University of Pittsburgh School of Medicine, Pittsburgh, PA; 2. Alzheimer Centre Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. Supported By: NIH Grant 5 T32 AG 021885-09 Background: Cognitive decline is a frequent problem encountered in the geriatric population and it is associated with the use of polypharmacy. In addition, the elderly are more susceptible to adverse drug reactions, especially neuropsychiatric effects (e.g. delirium) due to aging changes in the neurochemistry of the brain, pharmacodynamics, and pharmacokinetics. The combined effect of aging and polypharmacy may be detrimental to the brain function and structure. We investigated the burden of polypharmacy on the structure of the brain, specifically on the amount of gray and white matter, in a population of patients who were referred to our memory clinic. Methods: We selected consecutive patients who visited the Radboud University Nijmegen Medical Centre memory clinic from 2007 to 2010 database. Baseline variables included demographics, medication list, and information on relevant co-morbidities. The level of education was scored by the system of Verhage. The structural MRI scans were segmented into gray matter (GM), white matter (WM) and CSF using the VBM toolbox in SPM5, and volumes were extracted. We calculated the GM and WM fraction by dividing the GM or WM volume by the intracranial volume (GM+ WM+CSF). The number of current, regularly-taken medication with a known systemic effect was counted. Topical, “as needed”, and supplemental medications (vitamins, minerals, and herbals) were excluded. We used a linear regression model to investigate the correlation between GM fraction, WM fraction and amount of medication, while controlling for age, sex, education and diagnosis. Results: We found a significant correlation between polypharmacy and GM (Pearson r = -0.149, p=0.002). These effects were independent of sex, age, education and diagnosis. For WM fraction, there was no correlation. Discussion: Our results indicate that the more medications a patient is taking, the more GM atrophy is present. However, further investigation of the effects of medications on brain atrophy is warranted. Physicians already should be cognizant of this association when treating elderly patients. C134 MOCA & MMSE Comparison in Detection of Cognitive Impairment & Change in Very Old Age. A. Mohammed, 1 S. Kabsoun, 1 B. Leonard, 2 W. Nieri. 1,2 1. Geriatric, Banner Geriatric Fellowship Program, Sun city, AZ; 2. Banner Health Research Institute, Sun City, AZ. Background The Mini Mental State Exam (MMSE) is the most widely used screening test for dementia. However, research shows that it can underestimate cognitive impairment, varies within the population by age & education, and probably has limitations in assessing progressive cognitive decline. The Montreal Cognitive Assessment (MOCA) test may be superior to the MMSE in early detection of Alzheimer’s disease (AD), but little research has been done with it using very old subjects. We determined the efficacy of the MMSE and MOCA in detecting early signs of cognitive impairment and change in healthy subjects 70-105 years old. We also determined whether level of physical activity was related to cognitive performance. Methods Subjects were in the longevity project at the Center for Healthy Aging, BSHRI. They were 70 years old or older with no dementia at enrollment, and had completed baseline, 2nd and 3rd annual assessments in cognitive, medical, and psychosocial domains. One hundred and forty-eight subjects met these criteria and were stratified by age decade. To assess relative efficacy, MMSE & MOCA scores were plotted for each subject, and the proportion performing at, below, or above standard cutoff scores was determined. To assess decline over 1-year, difference scores were calculated separately for the MMSE & MoCA. Level of activity was measured with the Rapid Assessment of Physical Activity (RAPA), and scores were correlated with MoCA performance. Results A fair number of healthy 70, 80, 90 and 100 year-old subjects performed above the cutoffs on both the MMSE & MoCA. With increasing age, however, an increasing proportion performed below the MoCA cutoff while scoring above the cutoff for the MMSE, supporting previous findings of superiority of the MoCA over the MMSE in the younger old. In the same groups, 1-year change was negligible for the MMSE, while for the MoCA, scores were on average 1.3 points lower. Subjects who were more physically active scored higher on the MoCA, but only for 90- and 100-year olds. Conclusion This study suggests that the MoCA is a better instrument for detecting cognitive impairment compared to MMSE, even in the oldest old. The MoCA can be a good tool for monitoring cognitive changes over time, and thus can aid care planning in early dementia. Finally, increased physical activity may mitigate cognitive decline often associated with aging. AGS 2012 ANNUAL MEETING S177
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Dear Annual Meeting Attendee: The A
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P APER A BSTRACTS the National Deat
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P APER A BSTRACTS management in col
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P OSTER A BSTRACTS been ruled out.
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P OSTER A BSTRACTS Discussion: Angi
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P OSTER A BSTRACTS calcitriol via 1
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P OSTER A BSTRACTS ii J Clin Micrbi
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P OSTER A BSTRACTS is on the rise.
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P OSTER A BSTRACTS edema (60%), and
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P OSTER A BSTRACTS categories based
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P OSTER A BSTRACTS Methods: A longi
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P OSTER A BSTRACTS Design. CaMos is
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P OSTER A BSTRACTS incidents (64%)
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P OSTER A BSTRACTS TNF-R1 levels we
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P OSTER A BSTRACTS curriculum betwe
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P OSTER A BSTRACTS A75 Geriatrics a
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P OSTER A BSTRACTS Design: Based on
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P OSTER A BSTRACTS medicine fellows
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P OSTER A BSTRACTS While we were no
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P OSTER A BSTRACTS and its sum of b
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P OSTER A BSTRACTS NTM infection wa
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P OSTER A BSTRACTS death because
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P OSTER A BSTRACTS A158 Curved Path
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P OSTER A BSTRACTS compared to pati
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P OSTER A BSTRACTS Methods: We are
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P OSTER A BSTRACTS with only about
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P OSTER A BSTRACTS with typical ris
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P OSTER A BSTRACTS The aim of this
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P OSTER A BSTRACTS B27 Shared Decis
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P OSTER A BSTRACTS SES, adiposity a
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P OSTER A BSTRACTS care (OR 1.93, 9
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P OSTER A BSTRACTS B49 Prevalence a
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P OSTER A BSTRACTS Conclusions: The
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P OSTER A BSTRACTS B61 Losartan inc
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P OSTER A BSTRACTS Significant incr
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P OSTER A BSTRACTS frailty have inc
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P OSTER A BSTRACTS Conclusion: In t
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P OSTER A BSTRACTS BMI=28.4, mean P
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P OSTER A BSTRACTS Each subject’s
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P OSTER A BSTRACTS There is growing
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P OSTER A BSTRACTS variation in uti
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P OSTER A BSTRACTS complex elders s
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P OSTER A BSTRACTS satisfaction wit
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P OSTER A BSTRACTS Methods: The Hon
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P OSTER A BSTRACTS B130 Early Disco
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P OSTER A BSTRACTS IgE antibodies i
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P OSTER A BSTRACTS contribution by
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P OSTER A BSTRACTS The oldest old (
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P OSTER A BSTRACTS D114 Fall Reduct
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P OSTER A BSTRACTS D120 Geropsychia
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P OSTER A BSTRACTS In addition to 7
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P OSTER A BSTRACTS D132 Encore Pres
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P OSTER A BSTRACTS Conclusions: The
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P OSTER A BSTRACTS D144 The Use of
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P OSTER A BSTRACTS Methods: Cross-s
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P OSTER A BSTRACTS CONCLUSIONS: The
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P OSTER A BSTRACTS Aggressive treat
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A UTHOR I NDEX Azhar, G . . . . . .
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A UTHOR I NDEX Ceimo, J . . . . . .
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A UTHOR I NDEX Dunn, C M . . . . .
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A UTHOR I NDEX Griebling, T L . . .
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A UTHOR I NDEX Johnson, K . . . . .
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A UTHOR I NDEX Levine, M . . . . .
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A UTHOR I NDEX Mulsant, B . . . . .
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A UTHOR I NDEX Pschirer, J P . . .
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A UTHOR I NDEX Sheppard, K D . . .
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A UTHOR I NDEX Ukritchon, S . . . .
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K EYWORD 25-hydroxyvitamin D . . .
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K EYWORD I NDEX Colorectal cancer s
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K EYWORD I NDEX Geriatric curriculu
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K EYWORD I NDEX Medication discrepa
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K EYWORD I NDEX Race . . . . . . .
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