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P OSTER
A BSTRACTS
physicians. Implementation of strategies to improve recognition of
cognitive impairment may improve care of these patients, particularly
at the time of hospital discharge.
D141
Arizona Alzheimer’s Registry: Strategy and Outcomes.
K. T. Saunders, 1 C. Holt, 2 J. B. Langbaum, 2 W. Chen, 2 N. High, 2
C. Langlois, 2 M. Sabbagh, 3 P. N. Tariot. 2 1. College of Medicine,
University of Arizona, Phoenix, AZ; 2. Banner Alzheimer’s Institute,
Phoenix, AZ; 3. Banner Sun Health Research Institute, Sun City, AZ.
Supported By: NIA ADCC P30 AG19610, State of Arizona
Medical Student Training in Aging Research (MSTAR) Program
Background: The Arizona Alzheimer’s Consortium (AAC) is a
statewide Alzheimer’s disease (AD) research consortium funded by
NIA and the state of Arizona. In 2007 the AAC created a screening
and referral process for people interested in participating in AD related
research, as well as a relational database called the Arizona
Alzheimer’s Registry (AAR). The goals of the AAR were to increase
awareness of AD research and accelerate enrollment into AAC clinical
research projects. The AAR matched Registrants to AAC research
according to interest, location, and eligibility.
Methods: Enrollment was by open invitation to volunteers age
50 and older. Registrants were recruited by community outreach,
mass mailings, earned and paid media, and the Internet. Those interested
received a welcome packet, consent, and questionnaire, which
were reviewed by trained staff via telephone prior to brief cognitive
screening. Evaluation of medical history, cognitive status, and interests
resulted in the Registrant being referred to existing AAC studies
or being held for future referral.
Results: 2263 people contacted the AAR; all but 231 were given
a welcome packet. 1257 consented and 1182 underwent an initial cognitive
screening. Earned media was the most effective recruitment
strategy. Participants had a mean age of 68.1 (SD 10.6), 97% were
Caucasian, had 15.2 (SD 2.7) mean years of education, and 60% were
female. 30% reported a family history of dementia, 20% reported a
diagnosis of cognitive impairment or dementia, and 70% subjectively
reported normal cognition. The initial telephone assessment revealed
681 with no impairment, 269 with possible cognitive impairment, and
234 with possible dementia. 301 were referred to AAC sites.
Conclusion: The AAR exceeded its goals of increasing awareness,
Registry recruitment and research referral. This model was well
received by the community and served as a mechanism for volunteers
to explore their own cognitive status while making a contribution to
the scientific community. The established infrastructure and experiences
gained from the AAR will serve as the prototype for the webbased
Alzheimer’s Prevention Registry, a national registry focusing
on AD prevention research.
D142
Prevalence of Disruptive Behaviors Among PACE Participants.
K. Kwak, 1 M.Trahan, 2 M. McNabney. 2 1. Stony Brook University
School of Medicine, Stony Brook, NY; 2. Division of Geriatric
Medicine and Gerontology, Johns Hopkins University, Baltimore, MD.
Supported By: Johns Hopkins University; MSTAR Program
Background: Disruptive behaviors occur in approximately 63%
of adult day center participants. The Program for the All-inclusive
Care of the Elderly (PACE) is a capitated and comprehensive service
delivery system for older adults. PACE participants attend an adult
day center where all care is coordinated and provided in order for
participants to continue living in the community. The rate of disruptive
behaviors among a PACE population is unknown.
Objective: To study the frequency and type of disruptive behaviors
typically displayed among PACE participants.
Methods: This study took place at one PACE location in Maryland.
To measure disruptive behaviors in PACE participants, we used
the Cohen-Mansfield Agitation Inventory-Community (CMAI-C),
consisting of 36 agitation items.
Results: One hundred forty-two PACE participants (79% female)
were included in the study. Dementia was present in 67
(47%) participants. Among all the participants attending the PACE
day center, 35.9% (45% with dementia and 28% without dementia)
displayed at least one disruptive behavior once a week. The
most frequently rated disruptive behavior was verbally non-aggressive
behaviors (e.g., constant, unwarranted requests for attention,
restless).
Conclusions: PACE dementia participants display less disruptive
behavior than seniors attending traditional day centers and residents
living in nursing homes. From a psychosocial perspective, these
results suggest that PACE might be better equipped to meet the physical,
emotion, or social needs of participants when compared to traditional
models of care.
D143
Guideline quandary in VTE prophylaxis management in elective
joint replacement.
J. Prager. Geriatrics, Mount Sinai Hospital, New York, NY.
Introduction:
Managing VTE prophylaxis from an evidence based approach,
guidelines have been created from within both the American College
of Chest Physicians (ACCP) and the American Academy of Orthopedic
Surgeons (AAOS). Elective joint replacement epitomizes multidisciplinary
care between orthopedics and internists to manage VTE prophylaxis
concurrently while following conflicting recommendations.
Case:
An 85 year old female with a history of osteoarthritis presented
to a tertiary care center for a scheduled left total hip arthroplasty for
worsening symptoms of osteoarthritis. Patient was admitted to the orthopedic
service. Post-operative day 0, patient was started on aspirin
325mg BID for 35 days for VTE prophylaxis. On post-operative day
9, patient’s hemoglobin had steadily decreased to 8.3 g/dl from a
baseline of 12.7 g/dl. Patient was transfused 1 unit of packed red
blood cells. Patient was discharged home with instructions to follow
up with primary physician. Prior to patient’s appointment, patient
called the primary physician’s office on a Saturday reaching the on
call provider describing asymmetric leg swelling of post-operative
leg. The on-call physician recommended for the patient to go to emergency
room for evaluation for VTE, which was negative on ultrasound.
Discussion:
The ACCP recently updated VTE prophylaxis in 2008 categorizing
elective joint replacement as a high risk procedure necessitating
low molecular weight heparin i.e. enoxaparin, fondaparinux, or warfarin
with an INR goal of 2.5. ACCP recommends against aspirin as
VTE prophylaxis for elective joint replacement. Orthopedic concerns
rest heavily on the underestimation of bleeding complications with
evidence showing a 9% bleeding risk with 10 day course of ACCP
recommended VTE prophylaxis coupled with 4.7% readmission rate
in a study of 290 patients. AAOS recommendations are founded on
evaluating patient’s risk of VTE combined with risk of bleeding. Aspirin
remains as a treatment despite randomized controlled trials
demonstrating superiority of low molecular weight heparin in secondary
outcomes. Who should manage VTE prophylaxis? The longstanding
internist or the current orthopedic surgeon? With the advent
of newer agents i.e. rivaroxaban, the interest of patient safety is paramount
to arrive at a unifying management protocol to decrease VTE
post elective joint replacement while minimizing peri-operative
bleeding.
AGS 2012 ANNUAL MEETING
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