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P OSTER
A BSTRACTS
interval. Results are limited to published articles and articles with at
least an abstract published in English.
Conclusions: This review identified that few barriers to medication
adherence have been addressed in the cognitively impaired population.
Future interventions should better address reported barriers
to medication adherence, as well as evaluate the impact on disease
markers and cognitive function as clinical endpoints.
A89 Encore Presentation
Atypical presentation is common in Late Onset Rheumatoid
Arthritis.
P. Chatterjee, A. B. Dey. Geriatrics, AIIMS, New delhi, India.
Background-Presentation of rheumatoid arthritis (onset after
60 years of age) is varied and atypical, posing diagnostic uncertainties.
Objective- To examine the mode of presentation of late onset
rheumatoid arthritis (LORA) and to identify baseline clinical and
laboratory features that would contribute to diagnosis and prognostication.
Methodology- 31 cases of inflammatory arthritis were diagnosed
as RA among the patients attending Geriatric OPD of AIIMS,
using revised American Rheumatology Association criteria for RA
or with clinical (atypical presentation), laboratory and radiologic evidence
of RA. Patients were followed 2 weeks, 3 months then 6
months to see the response to DMARDs by Disease activity score
and development of disability using Stanford Health Assessment
Questionnaire disability index (HAQ DI).
Result- Mean age of presentation 66.32 ± 4.24 years, mean duration
of presentation 20.74 ±30.23 months. Female to male ratio was
1.8. 51.61% had both large and small joint involvement, 29.35% had
exclusive small joint involvement, 19.35% had exclusive large joint
disease, 58.6% had peri-arthritis of shoulder joint and 51.6% had
polymyalgic symptoms on presentation. 67.7% has bilaterally symmetrical
presentation. 74.2% had RA factor positivity; 41.9% had x-
ray features suggestive of RA; 25.8% had anti-CCP antibody positivity;
and 61.3% had ADL impairment on diagnosis. 61.3% of the
LORA patients had more than 3 co-morbidities. 80.6% patient responded
to methotrexate and 19.4% developed deformity during follow-up.
ADL impairment was significantly (p=0.001) associated with
large joint involvement and RA factor positive group had significant
XRAY changes (p=0.02) and ADL impairement(p=0.03)
Conclusion- LORA is associated with female predominance as
in young age. But due to late and atypical presentations, ADL impairment
is common. Response to DMARD is satisfactory. Multiple comorbidities
and early disability compromises the quality of life.
Larger scale prospective studies are required to provide better diagnostic
criteria and treatment recommendations.
A90 Encore Presentation
Factors Associated with Geriatric Syndromes in Older Homeless
Adults.
R. T. Brown, 1,2 D. K. Kiely, 3 M. Bharel, 4 S. L. Mitchell. 3,5 1. Division
of Geriatrics, University of California, San Francisco, San Francisco,
CA; 2. San Francisco Veterans Affairs Medical Center, San Francisco,
CA; 3. Hebrew SeniorLife Institute for Aging Research, Boston, MA;
4. Boston Healthcare for the Homeless Program, Boston, MA; 5.
Division of Gerontology, Beth Israel Deaconess Medical Center,
Boston, MA.
Supported By: 1. NIH-NIA T32 AG000212
2. NIH-NIA K24 AG033640
Background: Although older homeless adults have high rates of
geriatric syndromes, little is known about the risk factors for these
syndromes. We sought to identify factors associated with geriatric
syndromes in 250 homeless adults ≥50 years old recruited from eight
homeless shelters in Boston, Massachusetts.
Methods: Multivariate regression models were used to estimate
the association of subject characteristics with the following outcomes:
1) total number of geriatric syndromes; 2) cognitive impairment
(Mini-Mental State Examination (MMSE) score and Trail Making
Test Part B (TMT-B) duration); 3) fall in the past year; 4) frailty; and
5) major depression.
Results: Total number of geriatric syndromes was associated
with < high school education, diabetes, binge-drinking, drug use problem,
and impairment in Activities of Daily Living (ADL). Lower
MMSE score (worse cognition) was associated with older age, < high
school education, non-English primary language, binge-drinking, and
longer duration of homelessness. Longer TMT-B duration (worse executive
function) was associated with older age, non-White race, <
high school education, non-English primary language and stroke.
Falling was associated with arthritis, binge-drinking, ADL impairment
and depression. Frailty was associated with diabetes and depression.
Finally, depression was associated with younger age, < high
school education, drug use problem, traumatic brain injury, and ADL
impairment.
Conclusions: This study identifies modifiable factors associated
with geriatric syndromes in older homeless adults. This knowledge
can help health care providers identify and assess homeless patients
who may have geriatric syndromes, and may provide targets for interventions
to improve the health of older homeless adults.
A91
A Mystery of Vision & Thrombosis.
S. Hodroge, R. Lands, B. Pearman. Internal Medicine, University of
Tennessee Medical Center, Knoxville, TN.
Introduction:
Unilateral orbital pain, swelling, limitations in ocular motion
and diplopia, are concerning in any patient. This usually signals the
presence of pathology within the orbit or paranasal sinuses. We present
a patient with these symptoms who was found to have a right
spontaneous superior ophthalmic vein thrombosis (SOVT) and a
lupus anticoagulant.
Case Report:
A 56-year-old white female presented to University of Tennessee
Medical Center with a 2-month history of progressive right
sided periorbital redness, swelling, pain and finally opthalmoplegia.
CT scanning revealed periorbital cellulitis. She was treated with several
rounds of antibiotics, steroids, and NSAIDs without improvement.
Upon presentation to our hospital, she had noted worsening of
right-sided headache, photophobia, and vision deterioration with decreased
red color discrimination. She reported no purulent nasal discharge
or fever. She fell three months prior to admission, but denied
loss of consciousness or neurologic symptoms. Risk factors for thrombosis
included the use of estradiol. She had no family history of
thrombophilia. Physical exam revealed right periorbital swelling with
erythema, proptosis, ptosis and a lateral rectus palsy of the right eye.
Dilated fundoscopic exam showed 1+ disc edema as well as abnormally
engorged retinal veins. Pupils were reactive to light but the
right pupil was smaller than the left. Right intraocular pressure was
mildly elevated at 25mm Hg. Lab findings included a normal white
blood cell count and ESR. Magnetic resonance angiography demonstrated
a right superior ophthalmic vein thrombosis. The patient was
anticoagulated with heparin and treated with IV antibiotics pending
return of negative blood cultures. After ruling out carotid cavernous
fistula, arteriovenous malformation, and intracranial aneurysm, she
had a cerebrovascular angiogram that was normal. The patient’s
symptoms improved after the angiogram. Evaluation for acquired hypercoagulable
states demonstrated the presence of a lupus anticoagulant,
which was still present three months later. She remains on Warfarin
and will require anticoagulation indefinitely.
Discussion:
SOVT is a rare condition usually related to inflammation of the
orbit or paranasal sinuses, clinically similar to periorbital cellulitis.
AGS 2012 ANNUAL MEETING
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