Here - American Geriatrics Society

P OSTER
A BSTRACTS
ratory failure become chronically critically ill, requiring prolonged
mechanical ventilation (PMV). Older adults who are ventilator dependent
and admitted to long-term care hospitals (LTCH) have a
~50% mortality rate at 1 year, are at high risk for hospital and ICU
readmission. But there is scant data about older adults who receive
care at long-term care skilled nursing facilities (LTC-SNF). This study
examines outcomes of adults on PMV, who were not able to be
weaned, 1 year after their admission to a LTC-SNF.
Methods: A retrospective chart review of mechanically ventilated
adults, admitted to a 60-bed ventilator unit at Silvercrest Center
for Nursing and Rehabilitation (SCNR) from 1/1/2009 to 12/31/2009
and their outcomes at 1 year follow up. Demographic and clinical
data were collected at the time of admission. At 1 year follow up, possible
outcomes included: 1) Alive, 2) Dead, and 3) Lost to follow up.
Also examined was number of readmissions.
Results: During the 1 year time frame, there were a total of 167
subjects on PMV. Of these, 98 were excluded (38 were ventilator liberated
and 60 were admitted prior to 1/1/2009); 69 were admitted for
the first time in 2009 and were included in this study. For these 69 subjects,
the average age was 75 (19-104), with 39 female and 30 male.
The ethnic composition was 37.7% White, 23.2% Black, 24.6% Hispanic,
10% Asian and 4% other. The primary reasons for respiratory
failure were: pneumonia (23.2%), CVA (20.3%), sepsis (15.9%),
COPD (14.5%), anoxic brain injury (10%) and other (16%). At 1
year follow up, 40 (58%) subjects died on the ventilator; 16 (23%)
were alive with 15 in SNF and 1 in the hospital; and 13 (19%) were
lost to follow up due to readmission. On average, subjects experienced
3.3 readmissions (range 0-11). For subjects who were alive at 1
year, readmission rate was 4.7 (range 1-8).
Conclusions: Older adults who require prolonged mechanical
ventilation have a high risk of mortality at 1 year and experience multiple
transitions of care, with many resulting in loss to follow up. Subjects
who survive at 1 year follow up have a higher readmission rate
and none were able to go home.
A119
Improving Transitions to Home in Older Veterans after
Hospitalization.
M. Mather, 1,2 T. Patel, 1,2 S. Espinoza. 1,2 1. GRECC, South Texas
Veterans Healthcare System, San Antonio, TX; 2. UT Health Science
Center, San Antonio, TX.
Supported By: GRECC, Veterans Administration
Background: Approximately 20% of Medicare beneficiaries experience
readmission after hospital discharge (DC). Follow-up (FU)
is usually scheduled 7-10 days after DC, although the high risk time
for post-DC complications, such as falls, is 24-72 hrs after DC. The
goal of this quality improvement project was to improve transitions
to home by contacting patients during this time window in order to
increase safety awareness, improve medication compliance, and prevent
readmission.
Methods: Patients were outpatients enrolled in the Geriatric
Evaluation and Management (GEM) clinic at Audie Murphy VA
Hospital. Scripted follow up calls were made 24-72 hrs post-DC over
a 15-month period by a clinical nurse leader (CNL), who asked about
new disability, new medications, social work (SW) concerns, capacity
for self-care, and whether FU was scheduled. All actions resulting
from the call made by the GEM interdisciplinary team (CNL, MD,
SW, clinical pharmacist) were documented. A standardized retrospective
chart review was performed for data collection, and the information
was summarized using descriptive statistics.
Results: 96 patients were called: mean age was 77.3 ±11.5 yrs,
93.8% were male, 53.1% were Non-Hispanic White, and 30.2% were
Hispanic. Medical comorbidity was common: 65.4% had 2 or more of
diabetes, congestive heart failure, chronic obstructive pulmonary disease,
and hypertension. 73.9% had received new medications upon
DC, and 16.7% had a new disability. While most (88.1%) were taking
medications appropriately, 4.8% were taking the wrong medication
or dose, and required medication reconciliation. 12.1% of calls lead to
intervention by the MD, and readmission was prompted by the call in
15.3% of patients. 4.8% experienced a fall after DC and 15.3% were
readmitted within 30 days. Neither falls nor readmission were associated
with any specific chronic disease.
Conclusion: The GEM team identified the need for post DC FU
calls to improve communication with patients and address unmet
needs. Anecdotally, patients reported increased satisfaction and reduced
anxiety transitioning to home post DC as a result of this intervention,
although this was not formally evaluated. Patients and their
families should receive disease and safety education, particularly with
regard to falls, at every encounter.
A120
Improving Care of the Geriatric Trauma Patient.
S. Hobgood, L. Scheider, P. Boling. Geriatrics/Internal Medicine,
Virginia Commonwealth University, Richmond, VA.
Background: Trauma from falls, motor vehicle crashes, and other
mechanisms causes much morbidity, hospital use and mortality. Patients
over age 65 now account for 12% of trauma admissions, rising
to 40% by 2050. While studies have shown benefit from linking Geriatrics
and Orthopedic Surgery services, little evidence exists regarding
outcome impacts by Geriatrics in other surgical areas. VCU Medical
Center admits hundreds of trauma patients aged 65 and older
each year. Every weekday, the Geriatric Consult Service (GCS) sees
and follows Trauma patients on request. We assert that the VCU GCS
intervention benefits trauma patients.
Methods: We conducted a detailed structured electronic record
review of all patients age 65 or older, seen by the GCS at VCU Medical
Center in 2010, including 73 of 251 (29%) geriatric Trauma Surgery
admissions. We studied patient characteristics, financial data, disposition,
and mortality.
Results: The table shows the main results. There were no differences
in sex, race, zip code, or other demographic characteristics.
Conclusions: Trauma patients seen by GCS were older, and were
sicker than other elderly trauma patients based on a significant difference
in DRG weights, and ICU days. GCS patients more often
went to nursing homes which may reflect acuity or GCS intervention
effects, and though the sicker GCS patients stayed longer and cost
more, they had a better financial outcome for the hospital. Despite
the acuity, in-hospital mortality was lower although not statistically
significant in this small sample, an encouraging finding that we continue
to study.
Geriatric trauma patients seen by GCS versus those not seen by GCS
A121
Transition Coaching to Reduce Hospitalization and Emergency
Department Use.
S. Pandey, 1,2 D. Ifon, 2 L. Williams, 2 K. Blackstone, 1,2 E. L. Cobbs. 1,2 1.
Medicine, George Washington University, Washington, DC; 2.
Geriatrics, Extended Care and Palliative Care, Washington DC VA
Medical Center, Washington DC, DC.
Background: Transition Coaching (TC) is a short term program
to help patients with functional decline. TC provides short term case
management using home visits and person- and family-centered care.
TC comprehensively assesses the patient and caregiver situation, provides
meaningful education, improves medication management, and
identifies needed resources. Goals are to achieve a comprehensive assessment,
improve patient and family understanding of the disease,
AGS 2012 ANNUAL MEETING
S57