Here - American Geriatrics Society

P OSTER
A BSTRACTS
This study’s purpose was to understand the association between
process- and outcome-based quality of care measurement in elderly
surgical patients. Process measures describe the care that patients receive.
Outcome measures are the result of care.
Methods:
This was a retrospective review of 143 patients over the age of
65, who underwent elective general surgery between November 2009
and July 2010. Adherence to 9 surgical Quality Indicators (QIs) (antibiotic
and anti-thrombotic prophylaxis, euglycemia, early withdrawal
of urinary catheter, central line inspection, early mobilization,
malnutrition screening, medication list, surgical safety checklist) and
6 geriatric QIs (delirium screening, standard delirium work-up, cognitive
assessment, complete discharge planning, level of care documentation,
pressure ulcer prevention) was abstracted from medical
records. Surgical and Geriatric Quality Scores were calculated for
each patient (#QIs passed / #QIs eligible x100). The primary outcome
was 1 or more postoperative complications, recorded by NSQIP. The
association between the Quality Score and complications was determined
using logistic regression analysis.
Results:
The median Surgical Quality Score was 66.7%; the median Geriatric
Quality Score was 20.0%. Descriptive statistics of the Low and
High Quality Groups, stratified by the median Quality Score, are
summarized in Table 1. Multivariate logistic regression analysis, adjusting
for age, gender, comorbidities and functional status, revealed a
higher risk of complications in the High Geriatric Quality Group,
compared to the Low Geriatric Quality Group (OR=2.99,
95%CI=1.21-7.33, p=0.017).
Conclusions:
We have assessed quality of surgical care in elderly patients
using a novel, process-based approach. Better geriatric care was associated
with a higher likelihood of developing complications, although
the latter probably drives the former.
Comparison of Patient Characteristics and Outcome in High and
Low Quality Groups
A110
Depressive symptoms and high levels of stress significantly lower
PSA screening rates in men with long life-expectancies in a
nationally-representative sample.
A. A. Kotwal, 1 S. G. Mohile, 2 W. Dale. 1 1. Department of Medicine,
Section of Geriatrics & Palliative Medicine, University of Chicago,
Chicago, IL; 2. Department of Medicine, James Wilmot Cancer Center,
University of Rochester, Rochester, NY.
Supported By: The National Social Life, Health, and Aging Project
(NSHAP) is supported by grants from the National Institutes of
Health, including the National Institute on Aging, the Office of
Research on Women’s Health, the Office of AIDS Research, and the
Office of Behavioral and Social Sciences Research (5R01 AG021487),
and by NORC, which was responsible for the data collection.
Background: Guidelines recommend informed decision-making
regarding prostate specific antigen (PSA) screening for men having
10 years of remaining life expectancy (RLE), but there remains a high
rate of non-RLE-based PSA screening. Few studies have specifically
examined the relationship of psychological health to cancer screening
behaviors in men. We therefore assessed whether RLE-based screening
is related to men’s psychological health.
Methods: A nationally-representative sample of men over 57
without prostate cancer (N=1,032) was selected from the National
Social life, Health and Aging Project (NSHAP) and stratified into
two RLE categories: 0-9 years (inappropriate to screen) and 10+
years (appropriate to screen). The relationship of PSA screening
rates within these RLE categories with psychological health variables
anxiety, depression, and stress was assessed using multivariable logistic
regression analyses to control for various potential confounders.
Results: Men with 10+ year RLE with moderate/severe depressive
symptoms had a significantly decreased odds of having PSA
screening (OR=0.55 p=0.02). Men with 10+ year RLE with high stress
levels also had decreased odds of receiving PSA screening (OR=0.37
p=0.02). There was no significant difference in PSA screening rates by
psychological variables in the 0-9 year RLE.
Conclusions: Depression and stress significantly lower PSA
screening rates in men with long life-expectancies for whom an informed
decision on screening would be appropriate. Psychological
morbidity may therefore be a barrier to appropriate informed decision
making on PSA screening in healthy men with long life expectancies.
A111
Elder Self-Neglect and Hospitalization: Findings from the Chicago
Health and Aging Project.
X. Dong. Rush University, Chicago, IL.
Supported By: NIH
Objective: The objective of this study is to quantify the relation
between reported elder self-neglect and rate of hospitalization in a
community population of older adults.
Design: Prospective population-based study
Setting: Geographically-defined community in Chicago.
Participants: Community-dwelling older adults who participated
in the Chicago Health and Aging Project. Of the 6,864 participants
in the Chicago Health and Aging Project, a subset of 1,165 participants
was reported to social services agency for suspected elder
self-neglect.
Measurements: The primary predictor was elder self-neglect reported
to social services agency. Outcome of interest was the annual
rate of hospitalization obtained from the Center for Medicare and
Medicaid System. Poisson regression models were used to assess
these longitudinal relationships.
Results: The average annual rate of hospitalization for those
without elder self-neglect was 0.6 (1.3) and for those with reported
elder self-neglect was 1.8 (3.2). After adjusting for sociodemographic,
socioeconomic, medical commorbidities, cognitive function and physical
function, elders who self-neglect had significantly higher rate of
hospital utilization (RR, 1.47, 95% CI, 1.39-1.55). Greater self-neglect
severity (Mild: PE=0.24, SE=0.05, p