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 <strong>American</strong>) 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
P OSTER A BSTRACTS measured by CURB65, Pneumonia Severity Index [PSI] and Charlson’s Comorbid Index. Cases also had significantly more discharge medications than controls (median of 12.36 and 10.53, p=. 009) and were more likely to have received influenza vaccination in the year prior to initial hospital admission (59% and 41%, p=.009). Discussion: Among older adults, Braden Score was an objective, strong predictor of readmission following pneumonia hospitalization. The association between prior receipt of influenza vaccination and increased likelihood of readmission was unexpected and warrants further investigation. B36 IS LENS TRANSPARENCY ASSOCIATED WITH CARDIOVASCULAR OR METABOLIC DISEASE OR COGNITIVE FUNCTION IN OLDER WOMEN? DEFINING A NEW BIOMARKER OF AGING. J. Sanders, A. Nau, Y. Conley, R. Boudreau, L. Niedernhofer, L. Kuller, A. Newman. University of Pittsburgh, Pittsburgh, PA. Background: Few primary markers of aging are validated in human population studies. The lens is of interest because transparency can be measured accurately, noninvasively, and repeatedly throughout life. To evaluate the lens as a biomarker of aging we tested the association of lens transparency and cataract surgery to markers of aging and disease including risk factors for coronary atherosclerosis, coronary artery calcium (CAC), fasting plasma glucose or insulin, cognitive function and ApoE genotype. Methods: We measured lens transparency with Scheimpflug photography (N=136) and cataract surgery with self-report (N=231) in participants of the Healthy Women Study (mean (SD) age 73.3 (1.7) years). Atherosclerosis risk factors (age, smoking, waist circumference, BMI, lipids, blood pressure, fasting glucose and insulin, medication use) were measured concurrently with lens transparency and 13 years previously. CAC was measured with electron beam tomography at the time of lens measurements and ~7, 10, and 13 years previously. Cognitive indicators included the Modified Mini Mental Status Exam and ApoE genotype. Results: Cross-sectionally, cataract surgery was associated with larger waist circumference and diabetes (P
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