Here - American Geriatrics Society

P OSTER
A BSTRACTS
articulate goals of care, reduce inefficiencies of care, and reduce caregiver
burden.
Methods: The TC program started in 10/10 and was fully operational
in 2/11. Two nurse practitioners (NP) deliver short term transition
coaching in response to consultation requests. Outcome measures
include patient and family satisfaction, referring provider
satisfaction, hospital and emergency department utilization, advance
care planning documentation (ACP) and additional resources accessed.
Initial funding was obtained with grant support for two NP
salaries. NPs were embedded into an existing geriatric clinic team.
Revenues from the home visits will sustain the TC program.
Results: 63 patients were served by the TC program from 10/10
to 10/11. 52 completed the program. The most common reasons for
TC consult were medication use, averting functional decline, and alleviating
caregiver burden. The mean age was 83, and all were men.
Most were living with a caregiver. The two most common diagnoses
were heart failure and dementia. 100% underwent comprehensive
assessment, 96% had patient-centered medication management, and
83% had ACP documentation. 37% were linked to new resources,
38% received social worker consultation, 75% received durable
medical equipment, 15% enrolled in home hospice, and 13% enrolled
in home-based primary care. To date, hospital and emergency
department use have been reduced by half, when compared with the
year prior to TC. Patient, family and provider satisfaction has been
excellent.
Conclusion: TC appears to add an important piece to the array
of interventions to help patients remain at home. TC helps optimize
medical management, document ACP, and access resources to decrease
hospital and emergency department use.
A122
Use of the Frailty Index to evaluate the risk of death in older
patients presenting to hospital.
S. Evans, 1 A. Mitnitski, 2 K. Rockwood. 2 1. Medicine, Mercy Hospital
of Buffalo, Buffalo, NY; 2. Medicine, Dalhousie University, Halifax,
NS, Canada.
Supported By: Mercy Hospital of Buffalo, NY
Community Health Foundation of Western and Central New York
Dalhousie Medical Research Foundation
QEII Fountain Innovation Fund
Background: The frailty index can identify groups at increased
risk of deathy in older adults, as reported by ours and other groups. In
hospitals, a Frailty Index (FI) based on a Comprehsnive Geriatric assessment
(CGA) can be built from routinely collected data. The objectives
of our study were: 1. To test the predictive validity of the FI-
CGA in relation to length of stay (LOS) and mortality. 2. To compare
the impact of change in health status over a two week period on outcomes.
Methods: This is a prospective cohort study of 754 patients age ≥
75 admitted to a medical unit at Mercy Hospital, Buffalo NY.. Main
outcome measures were mortality and hospital LOS. Kaplan-Meier
survival analysis was performed separately in men and women.The logrank
test was used to assess differences between survival curves. Cox
proportional hazard regression model was applied to analyse the association
of the FI-CGA with mortality, adjusted for age and sex. Multivariate
logistic regression was used to analyse the association of the FI-
CGA with 30-day and 90-day mortality.A generalized linear model was
usedtoanalyseLOSinrelationtotheFI-CGAandotherfactors.
Results: 754 older adults were enrolled, of whom complete data
are available on 751. These patients were older (mean age 84.0
(SD=5.5) and most (480; 60.7%) were women. Their mean length of
stay in hospital was 5.2 (SD=5.1) days. 30-day mortality rate was
11.5% (91/751) which increased to 16.4% (130/751) by 90 days. On
average, patients were moderately frail at baseline (median FI-
CGA=0.35), but their health status had worsened significantly in the
two weeks prior to admission, at which time their median FI-CGA
was 0.46. In Cox regression analysis, age, sex and the FI-CGA score
were significantly associated with mortality (e.g., for the FI-CGA, the
HR=1.04 (95%CI=1.03, 1.05) for each 1% FI-CGA increment. Multivariate
logistic regression also showed the age and sex adjusted risk
of death was highly associated with the FI-CGA (OR=1.06 (1.04,
1.08) for 30-day mortality and OR=1.05 (1.03, 1.07) for 90-day mortality..
Likewise, a higher FI-CGA was significantly associated with
LOS (R2=0.3).
Conclusion: Here, the FI-CGA stratified the risk of death and
long LOS in older adults admitted to hospital.
A123
GHEST-3D: Greenwich Hospital Executive Screening Tool for
Delirium, Depression and Executive Dysfunction. Report on an
observational quality improvement study.
S. Buslovich, 1 G. J. Kennedy. 2 1. Internal Medicine, Greenwich
Hospital-Yale New Haven Health, Greenwich, CT; 2. Geriatric
Psychiatry, Einstein-Montefiore Medical Center, Bronx, NY.
Supported By: Greenwich Hospital funded the part time salary of a
geriatric screening nurse to administer the survey instruments.
Cognitive decline is omnipresent in the geriatric patient population.
The risk of cognitive impairment increases with age and is further
enhanced after hospitalization as supported in the literature.
Screening patients for cognitive impairment during hospital admission
could be the first step in early identification of cognitive impairment,
allowing for implementation of appropriate interventions. Several
conditions that significantly impact functionality and
independence may be subtle and undiagnosed.
We evaluated patients considered to be at high-risk for hospital
re-admissions, such as patients admitted with CHF exacerbations,
acute myocardial infarctions, pneumonia and COPD exacerbations
for delirium, depression and executive dysfunction. A screening tool
was designed utilizing evidence based tools, such as, the Confusion
Assessment Method (CAM), Patient Health Questionnaire (PHQ-9),
Controlled Oral Word Association Test (COWAT), and Oral Trail
Making Test (OTMT) to conduct an oral interview and identify patients
with delirium, depression and executive dysfunction.
The original sample size consisted of 43 case patients and 27 control
patients. Control patients were age, and sex matched surgical floor
patients without history of the high-risk diagnoses. 91.3% (21) of the
23 readmitted (within one year) case patients tested positive for executive
dysfunction; 50% (3/6) original study subjects that tested positive
for depression were readmitted with one year; 75% (3/4) original study
subjects tested positive for delirium were readmitted in the same time
period. The subject pool was inadequate to identify a reliable time to
readmission for each specific diagnosis in this observational study.
This study illustrates the potential value of systemic screening for
cognitive impairment in acute stay hospitalized elderly patients and possible
implications of all-cause readmission rates. Further cohort studies
are needed to evaluate whether recognition and targeted interventions
could contribute to positive outcomes, specifically, follow through with
the discharge plan of care, medication regimen adherence, reduction in
nursing home admissions, depressive symptom remission, hospital readmissions,
mortality and improvements in the patients’ quality of life.
A124
Safety in Transitions of Care; Identifying Needs Among Key
Providers in an Urban Academic Hospital.
U. K. Ohuabunwa, 1,2 S. Shah, 1 Q. Jordan, 2 K. Johnson, 1 C.Tai, 1
J. Flacker. 1 1. Division of Geriatrics, Dept of Medicine, Emory
University,Atlanta, GA; 2. Senior Services, Grady Hospital,Atlanta, GA.
Supported By: HRSA - Geriatric Academic Career Award
Hartford Center of Excellence Clinician Educator Award
Background: Medication errors, poor communication, and poor
coordination between providers are major contributory factors to
failure in transitions of care.
S58
AGS 2012 ANNUAL MEETING