Here - American Geriatrics Society

P OSTER
A BSTRACTS
Femur neck bone mineral density (FNBMD) is the cornerstone
of hip fracture risk stratification in current clinical practice. Other
risk stratification tools use FNBMD with other selected risk factors.
It is unknown whether electronically derived available patient information
is useful in predicting hip fracture. The goal of this study was
to demonstrate the use of electronic medical records to create an
index which is able to risk-stratify heterogeneous older population.
METHODS
This was a retrospective cohort study. All community-dwelling
patients over 60 years in a primary care panel in Olmsted County,
MN on January 1st, 2005 were enrolled (N=12,650).
Subjects were randomly assigned to two groups, a development
cohort (N=8,387) and a validation cohort (N=4,263).
Using the development cohort’s electronic medical records
(EMR), risk factors over the previous two years including demographic
characteristics and comorbidities were evaluated for significance
in univariate and multivariate logistic regression. The primary
outcome was incident hip fracture in the subsequent four years. Risk
factors were assigned a score based on their regression coefficient estimate
and a total risk score was created. We used EMR of the validation
cohort to evaluate the total risk score for sensitivity and specificity
and create a receiver-operating curve.
RESULTS
288 (3.43%) subjects in the development cohort sustained a new
hip fracture. The final model included age ≥75 (odds ratio (OR) 10,
95% CI 4.4, 23), age 70-74 (OR 7.7, 95% CI 3.3, 18.1), age 65-70 (OR
3.8, 95% CI 1.6, 9.4), white race (OR 2.5, 95% CI 1.2, 5.5), female gender
(OR 1.5, 95% CI 1.1, 1.9), prior hip fracture (OR 5.3, 95% CI 3.8,
7.4), liver cirrhosis (OR 2.7, 95% CI 1, 7.6), malnutrition (OR 2.6,
95% CI 1.6, 4.5), peripheral arterial disease (OR 1.7, 95% CI 1.2, 2.3),
Parkinson’s disease (OR 1.6, 95% CI 1.2, 2.1), prior nursing home
stay (OR 1.7, 95% CI 1.2, 2.3), and prior hospitalization (OR 1.4, 95%
CI 1.1, 1.8). Area under receiver-operating curve (AUC) was 0.818,
SE 0.017. Subjects with the highest 10% of the total risk score had
(OR 9.1, 95% CI 6.5,12.6); thus a 9 fold increased risk for acquired
hip fracture versus the rest of the cohort.
CONCLUSION
Electronically obtained, readily available patient information
can be utilized for hip fracture risk stratification, without the need for
further patient evaluation or FNBMD testing.
B25
Comparative impact of continence promotion interventions
targeting older women reluctant to seek care for urinary
incontinence.
R. Agnew, 1,2 E. van den Heuvel, 2 C. Tannenbaum. 1 1. Université de
Montreal, Montreal, QC, Canada; 2. Brunel University, Uxbridge,
United Kingdom.
Supported By: This work was funded by a partnership grant between
the Canadian Institutes of Health Research and the United
Kingdom New Dynamics on Aging Program.
Surveys suggest that only 13% to 50% of older women with urinary
incontinence (UI) talk to a health care practitioner about their
condition or implement evidence-based treatment. Continence
awareness programs exist, but their effectiveness remains unknown.
We sought to determine the comparative impact of a constructivist
learning workshop on UI, an evidence-based self-management tool
for UI, or both, compared to the effects of a sham workshop, on incontinent
women’s perceived improvement in their UI condition.
Methods: a 2x2 factorial open-label cluster randomized controlled
trial testing is currently being conducted in the United Kingdom.
The cluster (unit of randomization) is at the level of each local
community senior’s group, from whence participants are recruited for
the workshops. One of four interventions (3 experimental and 1 sham
intervention) is randomly assigned to each community group, with
randomization achieved by computer-generated random digits, balanced
in block groups of four. Eligible participants are communitydwelling
women 60 years of age or older, who have not sought medical
advice for incontinence symptoms in the last 5 years, and who experience
urinary incontinence with a frequency no less than twice
weekly. One outcome for the trial is an improvement in UI at three
months post-intervention, measured by a rating of improvement on
the Patient’s Global Impression of Improvement questionnaire.
Results: Five-hundred and twenty-four women attended the
workshops and 200 (mean age 70 + 7 years) met eligibility criteria
and were recruited to the trial. At 3-month follow-up, 47% of women
in the combined group reported that their UI condition was very
much or much better, compared to 35% of the constructivist workshop
group alone, 28% of the self-management group, and 14% of
the sham control group (p=0.013). Less than 5% of participants were
lost to follow-up.
Conclusion: Results of this interim analysis suggest that a continence
promotion intervention combining constructivist learning theory
debunking myths about UI being a normal part of aging and use
of a self-management tool has the greatest impact on improvements
in UI in older women with incontinence.
B26
The effects of life review writing on depressive symptoms: A
randomized control trial.
T. Chippendale. Occupational Therapy, Tufts University,
Somerville, MA.
Supported By: American Occupational Therapy Foundation
Background:The purpose of this RCT was to evaluate the effectiveness
of life review through writing with respect to decreasing depressive
symptoms in older adults residing in senior residences. Life
review is an important developmental task and therapeutic intervention.
When executed through writing, the benefits may be multiplied.
This study sought to provide support for this psychosocial intervention
for older adults. Although meta-analysis reveals a number of
studies that have examined the effectiveness of life review as an intervention
for decreasing depressive symptoms (1), some have called for
a refinement and validation of intervention protocols. The intervention
used in this study, the “Share you Life Story” Workshop (2), includes
the added therapeutic benefits of writing. Life review through
writing, as opposed to life review through the oral method, has not
been well studied (3) and may be a more beneficial approach (4).
Methods: Participants: 45 older adults 65 years and older, who
spoke English and who had a negative screen for probable dementia
on the Mini-Cog.Setting:4 senior residences in NYC. Design: A randomized
control trial with participants assigned to the treatment or
wait list control group. Randomized was within each site using randomization
with forced equal sample size. Data was analyzed using
an RMANOVA and SPSS version 17 with a .05 significance level. The
Geriatric Depression Scale was the primary outcome measure. Results:
A statistically significant decrease in depressive symptoms was
found for the treatment group as compared to the control group
(N=45, p=.03, effect size d=.7). Conclusions: The results support the
“Share your life story” writing workshop as an effective intervention
for addressing depressive symptoms in older adults.
(1)Bohlmeijer, E., Smit, F. & Cuijpers, P. (2003). Effects of life review
on late life depression: A meta-analysis. International Journal of
Geriatric Psychiatry, 18(12), 1088-1094.
(2)Sierpina, M. (2002). Share your life story workshops. Galveston:
University of Texas Medical Branch.
(3)Richeson, N. & Thorson, J. A. (2002). The effect of autobiographical
writing on the subjective well-being of older adults. North
American Journal of Psychology, 4, 395-404.
(4)Sherman, E. (1995). Differential effects of oral and written
reminiscence in the elderly. In B. H. Haight, & Webster, J. D. (Eds.),
The art and science of reminiscing (pp. 255-264). Washington: Taylor
& Francis.
AGS 2012 ANNUAL MEETING
S81