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P OSTER A BSTRACTS rate was 21.9% for community dwellers and 34.4% for nursing home residents. Readmission rates for specific diagnoses among community-dwelling and nursing home patients were, respectively: 19% and 43% for CHF, 12.8% and 22.5% for pneumonia, 13.6% and 35% for UTI, and 23.5% and 28% for GI bleed. Conclusions: Nursing home patients have a higher rate of readmission and in-hospital mortality than community-dwelling patients. Readmission rates for major diagnoses were uniformly higher for nursing home patients than for community dwellers. D44 Encore Presentation High Blood Pressure is Associated with Mortality only in Faster Walking Elderly Adults. M. Odden, 1,2 C. A. Peralta, 2 M. Haan, 3 K. Covinsky. 2 1. Public Health, Oregon State University, Corvallis, OR; 2. Medicine, University of California, San Francisco, San Francisco, CA; 3. Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA. Supported By: Dr. Odden was supported by a Ruth L. Kirschstein National Research Service Award (T32HP19025). Background: The association between high blood pressure (BP) and risk of death varies by age and appears to be attenuated in some elderly adults. Walking speed is an excellent measure of functional status and may identify which elders may be most at risk for the adverse consequences of hypertension. We aimed to determine if the association between BP and mortality differed by walking speed in elderly adults. Methods: The study population included 2,340 persons ≥ 65 years, with measured BP, in the National Health and Nutrition Examination Survey (NHANES) waves 1999-2000 and 2001-2002. Mortality data was linked to death certificate data in the National Death Index. Walking speed was measured over a 20-foot walk; 243 (8%) did not complete the walk for various safety and logistical reasons. Participants with walking speed above the mean (2.7 ft/sec) were classified as faster walkers. Potential confounders included age, sex, race, survey year, lifestyle and physiologic factors, chronic health conditions, and antihypertensive use. Results: There were 589 deaths recorded through December 31st, 2006. Among faster walkers, those with elevated systolic BP (≥140 mmHg) had a higher mortality rate compared to those with systolic BP
P OSTER A BSTRACTS pare; (3) to get a sense of patient’s goals of care. Common reasons not to discuss included: (1) respect for patient’s cultural values; (2) patient’s lack of mental capacity to understand implications of prognosis; (3) difficulty estimating prognosis with non-specific disease/comorbidity. 11 clinicians were not willing to discuss 5-year prognosis because they felt that they could not accurately prognosticate on that time frame and they did not think it would be useful for patients to receive uncertain information. All clinicians were willing to discuss prognosis with patients who have less than 1 year to live because it helps patients make critical decisions about their end of life care. CONCLUSIONS: Clinicians balance individual patient factors when deciding to discuss prognosis with their frail older patients. Clinicians identified a lack of accurate prognostic information as a barrier to discussing long-term prognosis with frail elders. D47 Assessment of Advanced Care Planning Documentation for Patients Discharged to Hospice Care. M. E. Young, 1 E. Hurwitz, 2 S. H. Chao, 1 V. Parker, 1 W. Suen. 1 1. <strong>Geriatrics</strong>, Boston University, Boston, MA; 2. Internal Medicine, Boston University, Boston, MA. Background: Three components of advanced care planning (ACP) include choosing a health care agent, determining resuscitation wishes and delineating goals of care. During transitions of care, these three wishes should be documented in one place where the receiving providers can easily access the information. Methods: We performed an assessment of ACP documentation at our hospital. From 2005-2010, 289 patients, 65 years of age and older, were discharged from Boston Medical Center to hospice care. Of these patients, fifty randomly selected discharge summaries were reviewed to look for the presence of the three defined components of ACP. If the ACP elements were not documented in the discharge summary, we searched the entire medical record for the location of documentation. Results: The majority (n=43) of the charts we reviewed did not include all three components of ACP in the discharge summary. When examining the entire medical record, we found at least one ACP element missing in 42% (n=21) of the charts. The discharge summary author most commonly missed documenting the health care agent. Patients with a documented palliative care consultation had more complete documentation of ACP than those without a palliative care consultation. Conclusions: Documentation of ACP is poor at the time of discharge. A palliative care consultation is associated with more complete documentation of ACP. We plan to implement an educational and technological intervention to encourage clearer and more complete documentation of ACP. D48 Assessing the wish to die in elderly people. S. Monod, 1 E. Rochat, 2,1 C. Bula, 1 A. Durst, 1 B. Spencer. 3 1. Service of geriatric medicine, University of Lausanne Medical Center, Epalinges, Switzerland; 2. Chaplaincy Service, University of Lausanne Medical Center, Lausanne, Switzerland; 3. Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland. Background: The wish to die has mainly been studied in terminally-ill young adults. In elderly persons, factors associated with the wish to die are likely to differ from those observed in younger people. Since the most frequently used scale -“The Schedule of Attitudes Toward Hastened Death” (SAHD, Rosenfeld et al., 2000)- was previously used in terminally ill cancer or AIDS patients, its use in elderly people suffering from multiple comorbidities is problematic. The objectives of this study were 1) to adapt the SAHD for use in elderly people, 2) to develop a new instrument to assess patients’ attitudes towards death 3) to test the relevance/acceptability of these instruments. Methods:An adapted version of the SAHD to the elderly population (SAHD-OLD) was obtained by analyzing all items of the instrument in an interdisciplinary group of experts in geriatric care. Items were modified according to their relevance in elderly population. An instrument to assess patients’ attitudes towards death was built on previous qualitative work performed by Schroepfer. These 2 instruments were subjected to cognitive testing in a convenience sample of 11 community-dwelling people (median age = 82 years; range 76-91). Results: The SAHD-OLD was obtained by modifying those items addressing palliative care issues (eg. irreversible consequences of stopping treatment) and systematically replacing “illness/disease” by “health problems”. We expressed in statements the 6 categories identified by Schroepfer, and created instructions asking respondents to describe their current attitude towards death (Adapted Schroepfer). During cognitive testing, our sample assessed the SAHD-OLD and the Adapted Schroepfer as relevant for elderly people. Respondents judged these 2 instruments acceptable and appreciated the direct manner in which they addressed end of life issues. The opportunity to speak openly on this topic was welcomed. Conclusions: The SAHD-OLD and the Adapted Schroepfer seem promising instruments to assess the wish to die in elderly people suffering from multiple comorbidities. Preliminary results show good comprehension, high relevance and acceptability. Psychometric properties of the SAHD-OLD are currently being tested in a large sample of patients. D49 ROS-Induced NADPH Oxidase Changes and the Aging Heart. M. E. DuMond. 1,2 1. Pathology, University of Washington, Seattle, WA; 2. Stony Brook University, Stony Brook, NY. Supported By: MSTAR The aim of this work was to investigate the effects of increased Reactive Oxygen Species (ROS) on the levels of NADPH Oxidase 4 (Nox4) and Nox4D in heart tissue. Nox4 is expressed in cardiomyocyte mitochondria, and its splice variant Nox4D localizes to the nucleus. Both are ROS generators suspected to be involved in redox signaling. Cellular damage incurred by chronic ROS overproduction is the causative agent of an alarming number of diseases and is the underlying culprit of aging. Understanding the redox signaling that mediates cellular changes induced by ROS is an important step in intervening in disease and aging. Potential mechanisms for the antioxidant effects of the mitochondrial-acting SS31 peptide (Szeto, H, 2006) were also investigated in this study. SS31 peptide has been shown to reduce the damaging effects of ROS in mitochondria and elsewhere in the cell, but its mechanism of action in mitochondria is currently unknown. In this study, wildtype mice were treated with Angiotensin II (AngII) using osmotic minipumps for drug delivery. AngII simulates aging and heart failure by inducing ROS-mediated tissue changes. Animals were treated with AngII, AngII + SS31 peptide, or saline. The heart tissue was collected at three timepoints: 3 day, 1 week, and 4 weeks. The results were then evaluated by Western Blot and protein quantification, comparing treatment to saline controls. Nox4 was shown to be transiently decreased in AngII + SS31 peptidetreated mice early in treatment, but after 4 weeks of treatment, Nox4 levels were elevated in both the AngII and AngII + SS31 peptide mice, suggesting that the rescuing antioxidant effects of SS31 peptide are eventually overcome by continuous ROS stimulation in response to AngII. These data suggest that there may be a critical window where the effects of increased ROS production are reversible, but over-induction of redox signaling for a prolonged period of time may result in a state of cellular immunity to the effects of SS31 peptide and intervening antioxidants. The roles of Nox4 and Nox4D in redox signaling are obfuscated by the apparent opposing early and late effects. However, one hypothesis to be further investigated is that a shift from one Nox4 splice variant to the other in response to increased ROS is a modulator of redox signaling, and this may be interrupted by SS31 peptide action. AGS 2012 ANNUAL MEETING S203
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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 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 A75 Geriatrics a
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P OSTER A BSTRACTS A158 Curved Path
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P OSTER A BSTRACTS B49 Prevalence a
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P OSTER A BSTRACTS BMI=28.4, mean P
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P OSTER A BSTRACTS complex elders s
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P OSTER A BSTRACTS B130 Early Disco
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P OSTER A BSTRACTS B159 Accuracy of
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P OSTER A BSTRACTS GDS and GDS apat
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P OSTER A BSTRACTS In this case it
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P OSTER A BSTRACTS the episodes of
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P OSTER A BSTRACTS Discussion/Concl
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P OSTER A BSTRACTS Results: Of 1401
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P OSTER A BSTRACTS Results: Regiona
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P OSTER A BSTRACTS Conclusions: Con
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P OSTER A BSTRACTS 2.47-25.96), and
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Page 250 and 251: A UTHOR I NDEX Azhar, G . . . . . .
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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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