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P OSTER
A BSTRACTS
pigeon serum antibody. Inpatient pulmonary function test showed a
restrictive pattern with significant reduction in her lung diffusing capacity.
Patient was initiated on intravenous methylprednisolone for
five days. Repeat CT scan of her chest 6 days from admission showed
a significant improvement of her lung parenchymal disease and lymphadenopathy.
There are limitations to several proposed diagnostic criteria especially
in the setting of sub-acute or chronic disease. Misdiagnosis
and delays occur in the absence of a comprehensive review of environmental
exposure. This provides a diagnostic challenge in the elderly
and psychiatric population. Serum precipitins have poor sensitivity
and specificity. The risks of invasive diagnostic workup including
bronchoscopic lavage and lung biopsy may outweigh its benefits in
advanced disease. The treatment involves removal of the offending
agent and glucocorticoids.
A31
Lipedema, a frequently misdiagnosed problem in elderly patient.
Y. Ye, U. T. Efeovbokhan, R. W. Parker. UTHSCSA, San Antonio, TX.
Background: Lipedema was first described in 1940 as a bilateral,
gradual accumulation of fatty deposition in the lower extremities and
buttocks. The feet are usually spared which is difference from lymphedema.
This condition is found exclusively in females. It develops
insidiously after puberty and progresses gradually. This condition is
frequently misdiagnosed as lymphedema which is due to accumulation
of protein-rich interstitial fluid with the skin and subcutaneous
tissue caused by lymphatic dysfunction. We describe an elderly patient
with gradually enlargement of bilateral lower extremities for
five years complicated with recurrent skin infection and ulcers.
Methods: This case report describes the presentation of lipedema
in a 68 yr old female patient in which the lipedema is complicated
with lymphedema and skin infection.
Results: Case Presentation: A 68 yr old Caucasian female was
admitted for pain and smelling in bilateral lower extremities. The patient
noticed her both legs gradually becoming swelling for five years.
The swelling becomes worse when sitting for a long time and alleviated
when both legs are elevated. This condition made her confined
to wheelchair. One month ago, patient felt the swelling was getting
worse and she has severe pain in both calves. One course of clindamycin
did not improve the symptom. Physical examination revealed
massive bilateral lower extremity non-pitting edema. There
were firm subcutaneous, cobblestone like nodules and papules with
hyperpigmentation on both legs, especially in the lower one third of
the legs. There was noticeable bilateral erythema up to knees. The
skin was warm to touch. There is a 5x3cm open, foul smelling ulcer on
the left lower extremity. Bilateral ankles and feet were spared. Stemmer’s
sign was negative. Skin biopsy revealed benign polypoid skin
with dermal myxedematous-like change.
Conclusion: Although lipedema is not a rare condition, it is frequently
missed because clinicians lack familiarity with lipedema. Patient’s
history and physical examination are usually sufficient to differentiate
lipedema from lymphedema. However, patient with long
–standing lipedema may eventually develop mechanical insufficiency
of the lymphatic system, producing “lipolymphedema”. The discoloration
and epidermal change of the legs, as well as the skin infection
in this patient is probably due to the dysfunction of lymphatic system.
A32
“We need an interpreter!”
Y. Ang, S. Lee, M. Brennan. Internal Medicine, Baystate Medical
Center/ Tufts University School of Medicine, Springfield, MA.
Intro:
A growing number of immigrant elders in the US are at risk of
poorer health due to cultural and language barriers that limit access
to care.
Case:
A 65 year old Somali man (Mr. K) with dementia presented for
geriatric evaluation after years of cognitive decline. He was disoriented,
disinhibited, impulsive and had decreased speech and repetitive
vocalization. He responded “ I don’t know” to most queries. History
was difficult as the Somali interpreter did not arrive and family
members’ English was limited. Mr. K. was diagnosed with frontotemporal
dementia. Organizing medical care was complex. The language
barrier, poor health literacy and cultural beliefs (e.g. a reluctance to
allow “outsiders” into the home, views about the appropriate role of
women in the family and fears of “official paperwork”) presented
challenges. Medication adherence was frequently problematic as
even simple instructions were “lost in translation”. Appropriate documentation
for exemption from a citizenship interview exam required
significant time and a multidisciplinary effort.
Discussion:
37 million foreign-born immigrants lived in the US in 2006; 12-
15% were aged 65 or older. By 2050, elders will be 61% non-Hispanic
whites, 18% Hispanic, 12% black, 8% Asian, and 2.7%
“other”(1). Geriatric immigrants receive much less health care than
native-born seniors and are far more likely to be uninsured (33.2%
vs 12.7% in 2007)(2). Reasons include a dearth of culturally competent
services along with geographic and economic factors. However,
low English proficiency remains the major risk for poor access to
care. Communication is critical for effective and equitable health
care for ethnic elders.
Conclusion:
Care of older immigrants is challenging given current limitations
in culturally and linguistically sensitive services. Physicians must
consider potential obstacles to care for older immigrants and pay attention
to communication barriers and cultural values as well as clinical
symptoms. It is crucial for institutions to develop system wide
policies and practices that welcoming the diversity of our patient
populations.
References:
1. McBride M. (2010). Ethnogeriatrics and Cultural Competence
for Nursing Practice. Hartford Instutute for Geriatric Nursing
2010. Retrieved Nov 25, 2011, from http://consultgerirn.org.
2. Steven A. (2009, Aug). Facts on Immigration and Health Insurance.
Center for Immigration Studies. Retrieved Nov 25, 2011,
from http://www.cis.org/HealthCare-Immigration
A33
Heart failure in hospitalized elderly subjects in geriatric department:
poor and unusual clinical signs.
Y. Wolmark, 1 M. Gaubert-Dahan, 1 F. Tubach, 2,3 T. Zerah. 1 1. Hôpital
Bretonneau, Paris, France; 2. Hôpital Bichat, Paris, France; 3.
Université Paris Diderot, Paris, France.
Background: Heart failure is a frequent and serious disease in
the elderly. The purpose of the present study was to analyse the characteristics
of the patients with acute heart failure and to compare the
frequency of these characteristics between systolic heart failure (left
ventricular ejection fraction ≤ 50%) and diastolic heart failure. Methods:
The present study was an observational and prospective study
about the clinical features and the radiology, biology and echocardiography
results of 53 patients (mean age 87.8 years) hospitalized in
geriatric care units at Bretonneau hospital in Paris. The Fisher’s exact
test was used to compare 2 nominal variables and the Mann-Whitney
test to compare 2 ordinal variables. Results: The majority of the patients
had hypertension (83%), malnutrition (81%) and anaemia
(62%). Thirty eight percents experienced a first episode of heart failure.
Before the current episode of acute heart failure, 55% of patients
were treated with diuretic agents, 55 % with angiotensin-converting
enzyme inhibitors or angiotensin receptor blockers and 51% with
beta-blockers. The patients had 3 clinical signs or symptoms of heart
failure on average. The most frequent were: pulmonary rales (68%),
dyspnea (60%), crepitant rales (55%), weight gain (64%), peripheral
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