Here - American Geriatrics Society

P OSTER
A BSTRACTS
PARTICIPANT: 57-year-old female with a hemorrhage in the
basal ganglia.
INTERVENTION: Interventions were aimed at addressing balance
and gait. CMI was addressed during functional activities that required
multitasking. Dual task challenges include carrying objects in
her hands, carrying a tray with various items, and talking or answering
questions while ambulating. Dual task challenges progressed along
with gait interventions by utilizing different surfaces and environments.
MEASUREMENTS: Timed Up and Go (TUG), TUG manual,
TUG cognitive, Dynamic Gait Index (DGI).
RESULTS: TUG improved from 14 to 10 seconds, TUG manual
from 15 to 10 seconds, TUG cognitive from 21 to 13 seconds. Dynamic
Gait Index increased from 14 to 21.
CONCLUSION: After using the dual task paradigm to create
interventions focused on decreasing the extent of CMI without deterioration
of either motor or cognitive task, the patient showed improvements
in independence and safety during ambulation and transfers
and decreased risk of falls.
C164 Encore Presentation
Functional Trajectories of Elderly Patients admitted in a Geriatric
Rehabilitation Unit after discharge of acute hospitalization.
E. Martínez, 1,2 J. Sánchez Rodríguez, 1 N. Albiol Tomàs, 1 R. Audi
Ferrer, 1 J. García Navarro. 2 1. Geriatric Department, Hospital de la
Santa Creu, Tortosa, Tarragona, Spain; 2. Grup Sagessa, Reus,
Tarragona, Spain.
Background:The aim of this study is to analyze which factors
evaluated during the Comprehensive Geriatric Assessment(CGA),
performed at acute care by a geriatric team, predict functional trajectories
in elderly patients transferred to a Geriatric Rehabilitation
Unit(GRU).
Methods: Prospective study. All acute hospitalized patients evaluated
(June - December 2010) and transferred to our GRU were included
and followed-up till discharge. Collected data: age, sex, diagnostic
groups (orthopedics, stroke, others); functional status –
activities of daily living (ADLs) previous to acute hospitalization,in
acute care and at discharge (Barthel index,BI). Comorbidity (modified
Charlson Index),dementia,delirium in acute care, length of stay
in acute and rehabilitation units,laboratory data (Hematocrit,Albumin,Total
Proteins, ESR,CRP),polipharmacy and if patient lives
alone.
Statistical Analysis: Characteristics of ability in ADLs patients
groups were compared using t-test to evaluate differences in means
and chi-square test to evaluate differences in percentages; and multivariate
analysis by logistic regression.SPSS v.17 software.
Results: 174 patients evaluated; 12.6 % died; Mean age: 77 years
(±17.5); 48.3% male. Length stay in acute care:12.3 days (± 10.4),
length in GRU: 56 days (± 51.9). Previous BI mean 78.6 (± 22.3);BI in
acute care mean 27.2 (±26.2);BI at discharge 49.2 (± 36.3). Independent
ability to walk: previous: 70.7%, in acute care: 3.4%, at discharge:
37.9%. Patients with dementia: 25.3%,delirium: 25.9%; polipharmacy:
71.3%,living alone 35.6%. Diagnosis groups: Orthopedic
33.5%, stroke 22.9%, cardiovascular and others 32.9%. Modified
Charlson Index: mean 1.8 (±1.2).
In multivariate analysis, factors related to walk independent
were absence of dementia and short lengths of stay in GRU. Dementia,Cardiopathy
and long length of stay in acute care were associated
with poor functional prognosis. The functional decline in acute care
should explain 15% of functional trajectory (Pearson coeff. correlation
0.38).
Conclusions: The probability to walk independent was low in
demented patients with long length of stay in the GRU. The best ability
in ADLs was achieved in patients with a short length of stay in
acute care, with orthopedic diagnosis on admission and no comorbidity
as dementia, delirium and heart disease.
C165
Factors associated with acute care readmissions from a skilled
nursing facility.
R. Y. Blake, K. Fairfield, H. Wierman, R. Marino. Geriatrics, Maine
Medical Center, Portland, ME.
Background:
Readmission from skilled nursing facilities (SNF) to acute care
hospitals is costly, disruptive, and may serve as a marker of poor quality
care. This study was designed to investigate risk factors for readmission
in a single small, suburban skilled nursing facility.
Methods:
We conducted a retrospective chart review of all admissions to a
SNF in Maine within a one year period (N=130). We excluded four
patients with incomplete data (final N=126). Data collected included
patient age, gender, day and month of admission, days from SNF admission
to first physician contact, and admitting primary and secondary
diagnoses. For patients who were readmitted to an acute care facility
within 30 days, we reviewed hospital admission records to
determine primary readmission diagnosis. We used descriptive statistics
(chi square, t-test) for data analyses.
Results:
The mean age of the population was 82 years, with a range of 50-
99. The majority were women (79/126, 63%). The overall 30-day readmission
rate was 13% (17/126). A significantly higher proportion of
men were readmitted vs. women (21% vs. 9%, p=0.05). 63% (12/17)
of readmissions were attributable to patients admitted during the
months of December, January, and March. There was a mean of 1.8
+/- 1.7 days from SNF admission to initial physician contact, and this
was similar for readmitted vs. non-readmitted patients (2.3 +/-1.8 vs.
1.8 +/- 1.7, p=0.35). Specific primary diagnoses associated with the
highest readmission rates included GI bleed (2/5, 40%), pneumonia
(3/9, 33%), CAD (1/3, 33%), UTI (3/10, 30%), and CHF (2/9, 22%).
At the time of acute hospital readmission, top diagnoses were similar,
also including pneumonia (4/17, 24%), CHF (2/17, 12%), and GI
bleed (12%), with the addition of multifactorial delirium (12%). Patients
who were ultimately readmitted had significantly more active
comorbidities (8.0 +/- 2.7) than those were not readmitted (6.3 +/-
2.3), p=0.02.
Conclusions:
In this population, patients at higher risk for readmission include
males, those with a higher number of active comorbidities, and
patients with a primary diagnosis of GI bleed, infection (UTI, pneumonia),
or cardiovascular disorder (CAD, CHF). Closer attention to
these higher risk patients, in conjunction with strict adherence to established
guidelines and standards of care, may help to minimize unnecessary
acute care hospital readmissions in the future.
Poster Session D
Friday, May 4
3:00 pm – 4:30 pm
D1
Amiodarone-induced Rhabdomyolysis.
E. C. Ong, 1 N. Maheshwari, 1 A. Sy, 1 E. Roffe, 2 S. Chaudhari, 1,2
D. Kumari, 2 S. Mushiyev. 1 1. Internal Medicine, Metropolitan Hospital
Center, New York, NY; 2. Geriatric Medicine, Metropolitan Hospital
Center, New York, NY.
Introduction: Rhabdomyolysis is a condition characterized by
muscle necrosis causing release of muscle enzymes into the circulation,
resulting in elevated serum creatinine kinase (CK) levels. It is
rarely caused by Amiodarone. We present a case of an elderly male
with amiodarone-induced rhabdomyolysis.
AGS 2012 ANNUAL MEETING
S187