Here - American Geriatrics Society

P OSTER
A BSTRACTS
NTM infection was started in 8/11 patients. 2/8 patients had recurrence
of the infection. 3/11 patients died, with no death directly related
to NTM infection.
Conclusions: This is the first study to describe the natural history
of NTM infections in an older rheumatologic disease patient cohort.
As in the general population with NTM infection, patients tended to
be female with pre-existing bronchiectasis. The infection could often
be successfully treated, but there appeared to be some risk of recurrence
in patients who are continued on immunosuppressive therapy.
Such cases will likely continue to be identified and more studies on
the optimal management is needed.
A146
Lack of Effort Towards Removal of Foley Catheters Before
Transferring Patients For Rehabilitation (Rehab).
M. S. Ashraf, 1 N. Sheikh, 1 V. Kinzie, 2 K. Cochran, 2 C. Faulk, 1
K. Ramsey. 1,2 1. East Carolina University, Greenville, NC; 2. Pitt
County Memorial Hospital, Greenville, NC.
Supported By: Study was supported in part by Centers for Disease
Control and Prevention
Background: Geriatricians commonly admit patients who are
discharged with indwelling foley catheters from the hospitals to subacute
care settings, and often these foleys are no longer indicated. We
designed a study to review the effort of various health care providers
towards removing foleys before discharging patients for rehab.
Methods: A retrospective chart review of hospital and rehab admissions
was performed on all adult patients admitted with an indwelling
foley to a 75 bed rehab facility over a period of 1 year (9/09 to
10/10). Data analysis was primarily descriptive to obtain the frequency
of appropriate documentation for presence of the foley, plan for its
discontinuation, timing of its removal and demographic information.
Results: Total of 114 patients (Median age 65 year, 51% Male)
were admitted in the facility with indwelling foleys and 103 hospital
charts were available for review. A majority (n=61) of them were discharged
by surgical teams as opposed to medical teams (n=42) and all
were evaluated by the rehab service. Rehab providers mentioned
presence of foley in their exams only 30% of the time. Similarly surgery
and medical teams recognized the presence of foleys in less than
half of the cases within 2 days before the discharge (38% & 31% respectively).
In many cases (n=64, 62%) rehab service did not make
recommendation to remove foley during hospitalization. Interestingly,
a third of these patients (n=24, 37.5%) had their foley removed
within 2 days of rehab admission. Even though the rehab providers
recommended removing foleys in 39 (38%) cases, the primary team
did not respond. Eventually 60% (n=23) of these foleys were also removed
within 2 days of rehab admission. Surgical and Medical teams
provided reasons for continuing foley in their final notes in only a
third of cases (34% & 33% respectively).
Conclusions: 1) We have identified that health care providers
frequently under-recognize the presence of foleys in patients who are
being transferred for rehab. 2) When they do identify, efforts are lacking
to remove it in a timely fashion. 3) There is a need for improved
communication among consulting rehab service, primary inpatient
teams and physicians at accepting facilities to promote timely removal
of foleys which should reduce the incidence of subsequent
catheter associated urinary tract infections in this patient population.
A147
Hyponatremia and falls in the elderly in hospital setting Neychelle
Fernandes MD,Mary Musuku MD, Arnold Eiser Md,FACP.
N. Fernandes. Internal Medicine, Mercy Catholic Medical
Center,Drexel university, Darby, PA.
Background:Falls are the most frequently reported adverse
events in inpatient settings.Mild chronic hyponatremia may appear to
be asymptomatic and remain unnoticed by both physician and patient
but has been associated with gait unsteadiness and attention deficits
in the elderly
Methods: The study objective was to determine the incidence of
hyponatremia in patients above 65 years who experienced a fall and
associated risk factors for falls
During a twelve month period from Sept 2009- Sept2010 serum
sodium levels were evaluated in 60 cases of falls in patients aged
65years and older and in 60 randomly selected non fall patients aged
65years and older seen in acute inpatient setting. The following data
were extracted for all patients: age, gender, medical morbidities, and
number of medications, details of medications, serum sodium level
and length of hospital stay. Initial blood chemistry on day of fall was
used for evaluation of hyponatremia. Non-fall group blood chemistry
on day of admission was used. Hyponatremia was classified as Serum
Na level less then 136mmol/l. Fall/nonfall groups who had a glucose
level on chemistry above 200 mg/dl were excluded from study. Use of
medication including drugs potentially associated with hyponatremia
- SSRI, diuretics, antihypertensive, benzodiazepines,psycholeptics
was also analyzed in both groups.
Results:Majority of fallers were female (75%) and mean age of
fall and non-fall groups were 78±8 and 79±7 respectively. Hyponatremia
was detected in 18 (30%) of fall group, compared to 5(18%) in
nonfall group (P value 0.0004). Mean sodium level was 131±3meq/l
and lowest level of serum sodium was 124meql/l in fall group. In fall
group when controlling for other independent risk factors hyponatremic
patients were four times more likely to fall (Pvalue0.004). .
Those in the fall group had a longer length of stay and were more
likely to be nursing home residents. A greater proportion of fallers
had multiple medical co-morbidities (HTN, CHF, AF) and were on
more likely to be on four or more medications at presentation than
non-fallers.
Conclusion:Hyponatremia is an independent risk factor for falls
in elderly acute inpatient setting and should be added to the list of
common conditions causing falls. Screening for low serum sodium
level,finding the etiology and treating it when present may be a step
forward to prevent falls and related injuries.
A148
Osteoporosis awareness in men at risk for fragility fracture and
osteoporosis.
S. Kashan, N. Lecea, G. Bachuwa. Hurley Medical Center, Flint, MI.
Supported By: No author received funding related to this research
project.
Background: Osteoporosis is a major public health problem. Its
hallmark is fragility fractures and increased risk of morbidity and
mortality which are known to be higher in men than in women. In
2001, the direct cost of osteoporosis was $17 billion for Americans
and $3.4 billion of which was related to the care for men. The number
of men age 50 and older with osteoporosis (and osteopenia) in the US
was predicted to increase from greater than 14 million in 2002, to over
17 million in 2010, and to well over 20 million in 2020.
Aim: Evaluate the awareness and knowledge of osteoporosis in
men. Estimate the proportion of men at risk for osteoporosis who received
appropriate screening. Estimate the proportion of men at high
risk for osteoporosis who received appropriate Calcium and Vitamin
D supplements.
Method: Our participants in this study were recruited by consecutive
sampling from the Hurley Medical Center Senior Ambulatory
Clinic. We included only Males who are greater than or equal to 54
years old. Participants were asked to fill a self-administered survey.
The questionnaire included questions about demographic data, Osteoporosis
awareness, diagnosis and treatment, Co-morbid medical
conditions and medications list including OTC and supplements. This
study was approved by the Hurley Medical Center Institutional Review
Board.
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AGS 2012 ANNUAL MEETING