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A BSTRACTS
difference between groups. We have demonstrated the feasibility of
the PEACE intervention with respect to enrollment rate, appropriateness
of the inclusion/exclusion criteria, ability of CMs to implement
the intervention and willingness of PCPs to participate. Elements
requiring revision in larger RCT include selection of different
outcome measures, the use of dedicated palliative care CMs and incorporation
of in-home evaluations by pharmacists, pastoral care and
palliative care RN team members.
Discussion: The outcome measures used in this pilot appeared
to be more appropriate for a population at the end of life. More appropriate
outcomes for our population would include medication appropriateness,
goal attainment, completion/honoring of ADs, quality
of life and symptom assessment tools with less focus on end of life.
D105
Prevalence of Very Low Bed Use to Prevent Bed-Related Fall-
Injury in Hospitals: Preliminary Findings.
L. C. Mion, 1 R. I. Shorr, 2 A. F. Minnick, 1 M. Dietrich, 1 G. Hunt, 1
B. Donaghey. 1 1. Vanderbilt University, Nashville, TN; 2. University of
Florida, Gainesville, FL.
Background: Annually 1 million hospital patients fall with a
10% injury rate. Hospital fall prevention has been only modestly effective
despite >20 years effort. Very Low Beds (VLB) have been
used in long term care settings and expert panels suggest VLBs to
prevent fall injury for hospitals. Only one study exists of VLBs in hospitals
and found no impact on fall-injury rates. Further, a growing
number of reports indicate adverse events for patients, staff and families.
Objective: To determine prevalence of VLB use in NICHE hospitals
(Nurses Improving Care of Hospitalized Elders), impact on
fall-injury rates, and adverse events to patients, families and staff.
Methods: A web-based survey was distributed to 288 NICHE Coordinators
in November 2011. Survey items determined VLB prevalence,
criteria for use, types of units deployed, effect on fall-injury rates, and
adverse events as a direct result of VLB. Descriptive analyses were
performed using SPSS.
Results: To date, there have been 131 responses (45%). Of these,
29 sites (22%) used VLBs; 17 (59%) with padded floor mats. 41%
own and 59% rent VLBs. Most (74%) do not track patient use or
number of bed-days of use (88%). Only 19% track effectiveness of
VLB. General medical and surgical units were the most frequent
users (56%); 31% used in ICUs. Most (60%) have used VLBs for 3+
years. Most (63%) have no policy or procedure for use. 52% of sites
reported at least one patient VLB-event with falls (21%). Staff events
included: injury (10%), falling/tripping (20%), and difficulty maneuvering
equipment (24%). 35% of the sites noted family VLB-events.
52% believe VLB benefits outweigh VLB risks for adults 65. Fall rates ranged from 1 to 4.5 and fall-injury
rates ranged from 0.5 to 1.5/1000 patient-days. Added comments expressed
concerns over costs and staff consistent use of the beds because
of ‘hassles’ for nurses in procurement and transfers.
Conclusions: Less than 1/4 of NICHE respondents use VLBs.
No consistent criteria or procedure was evident. Few track use or effectiveness.
However, most believe the benefits outweigh the risks for
older patients. Adverse events occurred in up to 52% of the sites. Similar
to studies on hip pads, staff adherence was a concern. Carefully
designed studies are necessary prior to policy changes to incorporate
VLBs in acute care settings.
D106
Geriatric Home Care Reduces Hospitalizations in Very Frail Elderly
in Toledo, Spain.
C. Castillo, C. Rodriguez, C. García, A. Bartolomé, M. Diaz de Cerio,
C. Gómez, M. Cuadrado, M. Gomez, B. Aguirre, A. Carbonell.
Geriatrics, Hospital Virgen del Valle, Toledo, Toledo, Spain.
Authors: C.Castillo, C.Rodriguez, C.García,A.Bartolomé, M.Diaz
de Cerio, C.Gómez, M.Cuadrado, M.Gomez, B.Aguirre,A. Carbonell
Institution: Hospital Virgen del Valle, Spain
Introduction: The goal in Geriatric Home Care (GHC) is to improve
quality of life for patients and their families when they face a
non-curable life threatening disease. It is not easy to keep patients
with multiple chronic diseases at home because of their complex
treatments and the difficulty determining terminality; therefore, patients
are frequently hospitalized and very often die in the hospital.
We studied the functional status and the number of hospitalizations
of non-oncologic patients admitted in our GHC Unit.
Methods: We reviewed the charts of 519 patients. We excluded
oncologic patients. In the analysis we included main diagnosis, reason
for admission in our GHC Unit, the New York Heart Association
scale (NYHA), use of home oxygen, the Global Deterioration Scale
(GDS), the Barthel index, the number of hospitalizations 12 months
before and 12 months after admission in GHC, the presence of
anorexia and/or disfagia, and the Charlson Index.
Results: 238 patients were non-oncologic. 32% were admitted as
non-oncologic palliative patients. Mean age was 85.53 (SD 5.6) mean
time of stay in GHC was 5.2 months (SD 5.5). 20% of the 238 patients
had a NYHA of III-IV. 24% of the patients were on home oxygen. Severe
dementia was present in 18% of the patients. Severe dependency
was found in 52%. Anorexia and/or disfagia were present in 25% of
the patients. Charlson index above three was found in 31% of individuals.
Before admission in GHC mean number of hospitalizations
was 1.94 (SD 1.84; 95% CI 1.61-2.07) and after GHC it was 0.8 (SD
1.4; 95% CI 0.7-1.075), therefore we achieved a 55% reduction in the
number of hospital admissions. 52% of patients died during their stay
in GHC, of which 32% died at home.
Conclusions: In our GHC Unit Geriatricians manage very old
patients with severe advanced chronic diseases who are hospitalized
very often. After being evaluated by GHC the number of hospitalizations
is reduced and an important percentage of patients die at home,
reducing inadequate use of health system resources. In the future, we
should potentiate care giver support at home in order to improve our
goal of reducing hospital use by this population.
D107
Palliative Oncologic Patients Die at Home and Palliative Nononcologic
Patients Die in the Hospital.
C. Castillo, C. Rodriguez, C. García, A. Bartolomé, M. Diaz de Cerio,
C. Gómez, M. Cuadrado, M. Gómez, B. Aguirre, A. Carbonell.
Geriatrics, Hospital Virgen del Valle, Toledo, Toledo, Spain.
Background: It is relatively easy to determine terminality in an
oncologic disease, but it is difficult with non-oncologic diseases, therefore
patients are frequently hospitalized and very often die in the
hospital. In our Geriatric Home Care Unit (GHC) our goal is to improve
the quality of life of our patients, and prevent inadequate use of
health care resources. We studied the number of hospitalizations of
oncologic and non-oncologic patients admitted in our GHC.
Methods: We reviewed the charts of oncologic and non-oncologic
patients followed in our GHC between 2008 and 2010 and collected
demographic data such as age and sex, time followed by GHC,
the number of hospitalizations 12 months before and 12 months after
admission in GHC, the number of deaths and where the patients died.
Results: We studied 519 patients of which 281 were oncologic
and 238 were non-oncologic. Of the oncologic patients, mean age was
83 (SD 5.2), 64% were men and their mean time in GHC was 4
months (SD 4.2). Mean number of hospitalizations 12 months before
admission in GHC was 1.34 (SD 1.32; 95% CI 1.16-1.46) and 12
months after admission was 0.5 (SD 0.9; 95% CI 0.44-0.65); this result
represented a 60% reduction in the number of hospitalizations. 90%
of patients died, and 76% of deaths were at home. Of the non-oncologic
patients, mean age was 85.5 (SD 5.6), 56% were women and
mean time in GHC was 5.25 months (SD 5.5). Mean number of hospitalizations
12 months before GHC was 1.94 (SD 1.84; 95% CI 1.61-
2.07) and 12 months after GHC it was 0.8 (SD 1.4; 95% CI 0.7-1.075);
AGS 2012 ANNUAL MEETING
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