Here - American Geriatrics Society

P OSTER
A BSTRACTS
More than ½ of all older patients treated and released from the
emergency department(ED) receive one or more prescriptions. The
goals of this study were to describe medication prescribing and continuity
of care for older patients treated and released from the ED.
Methods
We examined health system records of 308 patients ≥ 65 years old
treated and released from an urban academic ED with 77,000 annual
visits. Patients were excluded if they did not have at least one PCP visit
in the 12 months preceding the index ED visit. Data were collected
using a standardized chart abstraction tool. Medications were categorized
according to the VA Medication Classification System, and continuity
measures (1) ED contact with PCP; (2) ED visit acknowledgement
by PCP; and (3) discharge drug documentation by PCP were
based on Acute Care of the Elderly (ACOVE) Quality Indicators.
Results
Of 308 patients, 163 (53%) were prescribed at least one medication
(total 260 drugs); 23.3% were prescribed 2 medications and 8%
were prescribed ≥ 3. Overall, 89.2% of prescriptions were new medications
for the patient. The most commonly prescribed drug class
was central nervous system (CNS) medications (32.3%); 86.9% of
these were opioid containing. Other commonly prescribed drug
classes were antimicrobials (21.9%) and gastrointestinal medications
(11.9%). Common indications for medications included non-urinary
infections (17.3%), musculoskeletal pain (17.3%) and trauma
(16.5%). The majority of prescriptions were written for a time limited
course (91.1%); 46.6% had a specified schedule and 53.4% were as
needed (prn). Of the scheduled drugs, the median days supply was 7
(mode 7). Among prn drugs, the median days supply was 5 (mode 3).
The ED provider note documented communication with patients’
outpatient provider in 14.5% of visits (2.2% PCP; 12.3% specialist).
Overall, 72.4% of patients had a PCP follow-up within 90 days of
their ED visit. The PCP note acknowledged the ED visit in 46.1% of
patients. Among patients prescribed medications in the ED (n=163),
the PCP note acknowledged the new medications in 25.4% of cases.
Conclusions
ED providers frequently prescribe new CNS and antimicrobial
medications for older patients treated and released from the ED.
Lack of communication between providers in the care for this patient
population was common. Further research is needed to determine
how best to improve communication between the ED and PCPs.
D36
Vitamin D deficiency is associated with fall-related risk factors in
home-bound older adults.
J. L. Demons, 1 J. A. Tooze, 1 B. R. Davis, 1 R. Shertzer-Skinner, 1
L. Kearsley, 2 R. Gottlieb, 2 J. D. Williamson, 1 D. K. Houston. 1 1. Sticht
Center on Aging, Wake Forest University School of Medicine,
Winston-Salem, NC; 2. Senior Services, Inc, Winston-Salem, NC.
Supported By: Supported by the Wake Forest Translational
Science Institute, Center for Integrative Medicine and Pepper
Center (P30-AG21332)
Background: Falls in the elderly are known to be costly to both
the function of seniors and the medical system. Risk factors for falls
that can be intervened upon, such as vitamin D deficiency, are sought
by physicians. Older home-bound persons eligible to receive meals
from a home meal delivery program (Meals on Wheels (MOW)) are
at high risk for vitamin D deficiency due to the very nature of being
home-bound and inability to provide their own nutrition. They are
likely also at higher risk for falls considering their inability to move
about in the community. We assessed several aspects of falls and fallrelated
risk factors to determine if they were associated with vitamin
D levels in MOW participants.
Methods: 25-hydroxyvitamin D levels were assessed in seventytwo
seniors being served by MOW in Forsyth Co, NC as part of baseline
assessments for a vitamin D intervention study (mean age 77.3
yrs; 76% women, 76% black). History of falls in the prior year and the
seriousness of any fall that occurred were obtained by recall. Fear of
falling and the Pepper Assessment Tool for Disability (PAT-D) were
also obtained.
Results: Vitamin D insufficiency (10-