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P OSTER
A BSTRACTS
SES, adiposity and memory and executive function factor scores were
assessed with multiple regression analyses (with age, sex, and race as
covariates).
Results: Higher levels of education and income were associated
with higher memory (high vs. low education B = .41*** and income B
= .28***) and executive function scores (high vs. low education B =
.82*** and income B = .51***), and lower levels of adiposity. Small, but
significant negative associations were found between adiposity indicators
and cognitive function scores. However, coefficients for SES predictors
remained relatively unchanged with the inclusion of adiposity
indicators into analytic models, suggesting that adiposity indicators did
not mediate observed SES variations in levels of cognitive functioning.
Conclusion: Both lower SES and greater adiposity are associated
with lower levels of cognitive functioning. Those of lower SES
also have significantly greater levels of adiposity. However, results do
not support adiposity as a mediator of SES variations in cognitive
function. An important objective for future research is the identification
of other biomedical and behavioral variables that may underlie
SES disparities in cognitive function.
B33
Prediction of 5-Year Risk of Becoming Dependent in Activities of
Daily Living in Community-Dwelling Older Adults.
D. H. Kim, 1,3 E. Newton, 2 L. A. Lipsitz. 1,2 1. Gerontology, Beth Israel
Deaconess Medical Center, Boston, MA; 2. Institute for Aging
Research, Hebrew SeniorLife, Boston, MA; 3. Epidemiology, Harvard
School of Public Health, Boston, MA.
Supported By: Dr. Kim is supported by John A. Hartford Center of
Excellence Award.
Background: Several risk factors have been identified for activity
of daily living (ADL) dependence, but it remains unclear how to
optimally combine them into a simple clinical prediction model.
Methods: Using data from the Established Populations for Epidemiologic
Studies of the Elderly, a prospective cohort of community-dwelling
older adults, we developed and validated a prediction
model of ADL dependence, based on self-reported information and
brief examination. In the derivation set (n=7,982), we used Cox proportional
hazards regression to develop a risk score that predicted
the 5-year risk of becoming dependent in 3 or more ADLs for at least
2 consecutive years, or at 1 year followed by death in the subsequent
year. We tested the score in the validation set (n=3,993), and examined
its relations to hospitalizations and mortality within 5 years.
Results: During 5 years, the incidence rate of ADL dependence
was 2% in both derivation set (663/34,382 person-years) and validation
set (359/17,128 person-years). A risk score calculated using age,
income, visual impairment, self-rated health, diabetes mellitus, stroke,
cognitive function, and self-reported upper and lower extremity function,
showed good agreement between expected and observed absolute
risks and excellent discrimination (C statistic, 0.80 in the derivation
set and 0.77 in the validation set). The score predicted
mortality as well as recurrent hospitalizations for myocardial infarction,
stroke, cancer, and fracture within 5 years.
Conclusions: A simple risk score based on self-reported information
and brief cognitive assessment can accurately predict a persistent,
severe form of disability within 5 years.
B34
The Utilization of HEDIS High-Risk Medications in Veteran’s
Administration Nursing Homes.
D. M. Dosa, 2,1 O. Intrator, 2,1 S. Hyde. 2 1. Research Enhancement
Award Program, Providence VA Medical Center, Providence, RI; 2.
Medicine, Brown University, Providence, RI.
Supported By: Veteran’s Administration-(Dosa-Career
Development Award)
Background: Nursing homes (or Community Living Centers as
they are referred to within the Veteran’s Administration) have been
identified by the Institute of Medicine (2000) as the most common
site for Adverse Drug Events (ADE) with over 800,000 estimated
prescription related errors annually. Such errors in the long term care
environment have been associated with a high degree of morbidity
and mortality. A common error described in the literature is the utilization
of high risk medications in the elderly—a population most
likely to experience morbidity relative to ADEs. The purpose of this
study was therefore to evaluate the use of prescriptions classified by
the Healthcare Effectiveness Data Information Set (HEDIS) as high
risk medications over time in VA Community Living Centers (CLCs)
and assess variability by region and institution.
Methods: Nursing home Minimum Data Set records from calendar
year 2004-2009 were merged with VA Decision Support System
Pharmacy Data to identify residents of Community Living Centers
who received at least one medication on the HEDIS high risk list for
the elderly.
Results: Between 2004 and 2009, a total of 25,105 out of 186,986
(Average=13.81%, SD=5.93%) veterans admitted to a CLC received
at least one HEDIS high risk medication. Annual proportion of CLC
veterans using HEDIS medications varied among CLCs from 3.6%
to 44.2% and among VISNs from 7.2% (VISN22) to 22.6%
(VISN10). Steady reduction in the use of high risk medications was
noted, however, between 2004 and 2009. In 2004, the average proportion
of veterans using HEDIS medications in any CLC was 15.0%
(SD=7.2, Min= 2.9%, Max=47.1%); by 2009 the average rate was
6.4% (SD=4.6; Min= 0.3%, Max=30.6%).
Conclusions: The utilization of high risk medications at VA
CLCs has improved over time but significant variation exists between
homes. More work needs to be conducted to determine if patient specific
and/or facility factors predict utilization of HEDIS medications
amongst elderly nursing home veterans at high risk for ADEs.
B35
Risk Factors for Readmissions in Patients 65 or Older Admitted For
Pneumonia.
H. Rahbar, 1,2 O. Abreu-Lanfrranco, 1,2 A. Singh, 2,4 M. Tims, 2
B. Ramasamy, 2 C. Biedron, 1,2 L. Mody, 3 K. S. Kaye. 1,2 1. Wayne State
Medical School, Detroit, MI; 2. Detroit Medical Center, Detroit, MI; 3.
University Of Michigan, Ann Arbor, MI; 4. Fuqua School of Business,
Duke University, Durham, NC.
Supported By: MSTAR Grant
Background: Pneumonia is one of the most common infections
leading to inpatient visits and is an important cause of morbidity and
mortality, particularly in older adults. Recently Medicare began decreasing
coverage for all-cause readmissions within the 30-day discharge
period for patients who were admitted with a primary diagnosis
of pneumonia. This study aimed to identify risk factors for hospital
readmission within a 30-day period following hospitalization for
pneumonia in adults > 65 years of age.
Methods: This study was conducted at Detroit Medical Center,
an 8-hosital tertiary care health system. Retrospective chart review
was conducted for patients > 65 years old with primary diagnosis of
pneumonia from January 2010 to March 2011, and data pertaining to
demographics, comorbid conditions, functional status and medications
were abstracted. “Cases” who experienced readmission within
30 days of discharge for any reason were identified; and were compared
to “controls” who were matched to cases by hospital and calendar
time of initial admission.
Results: Eighty cases who were readmitted within 30 days were
compared to 80 controls that were readmitted after an initial pneumonia
diagnosis, after matching a total of 160 patients were analyzed.
Cases and controls had similar demographics (Mean Age of 77.7 +8.2,
54.4% were female; and 55% were African American) and functional
status. Cases were more likely to have diabetes than controls (50%
and 30%, p=.015) and a were more likely to have a Braden Score < 16
(36% and 20%, p=.013). Cases also had a greater severity of illness as
S84
AGS 2012 ANNUAL MEETING