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P OSTER
A BSTRACTS
Conclusion: Aging women are heterogeneous in terms of positive
aging indicators over time. Somatic experiences (i.e., pain, symptoms)
and number of chronic conditions were the strongest predictors
of membership in non-robust trajectories for Physical-Social
Functioning and depression was the strongest predictor of Emotional
Functioning.
B45
Patterns of Comorbid Chronic Diseases and Geriatric Conditions
Associated with Greater Severity of Chronic Obstructive Pulmonary
Disease in Older Adults.
S. S. Chang, T. M. Gill. Geriatrics/Internal Medicine, Yale School of
Medicine, New Haven, CT.
Supported By: This research was funded in part by the John A.
Hartford Foundation for Excellence in Geriatric Medicine at Yale
University (Grant 2007-0009), the Yale Claude D. Pepper Older
Americans Independence Center (National Institute on Aging P30
AG021342), and Clinical Translational Science Award (Grant UL1
RR024139/ KL2 RR024138) from the National Center for Research
Resources (NCRR), a component of the National Institutes of
Health (NIH), and NIH roadmap for Medical Research.
Background:
Chronic obstructive pulmonary disease (COPD) is the third
leading cause of death in the U.S. and increases in prevalence with
advancing age. Extrapulmonary diseases, which occur throughout all
stages of COPD, can complicate its management and negatively impact
long-term prognosis, especially as COPD worsens. Geriatric
conditions, which confer high risk of adverse health outcomes, add to
the complexity of effectively managing COPD in older adults. Identifying
patterns of comorbid chronic diseases and geriatric conditions
which are associated with greater COPD severity will provide
insight into enhanced approaches to optimize outcomes in older
adults with COPD.
Methods:
Data were drawn from the Cardiovascular Health Study, a
prospective multi-center cohort of U.S. community-dwelling adults
aged 65-80 who completed baseline spirometry (N=3583). COPD was
established by spirometric criteria for airflow limitation, using the
Lambda-Mu-Sigma (LMS) method, an approach which accounts for
age-related changes in lung function. We performed ordinal logistic
regression to evaluate the relationships between patterns of comorbidities
and COPD severity, staged according to LMS-derived spirometric
Z scores (mild, moderate, and severe) and the American Thoracic
Society (ATS-DLD-78) dyspnea scale (grades 1-5). Models
were adjusted for age, gender, education, and smoking.
Results:
Of the participants with COPD (13.8%), comorbid hypertension
(HTN) and arthritis (28.0%), atherosclerotic vascular disease
(AVD) and HTN (24.3%), and HTN and polypharmacy (11.1%)
were among the most frequent comorbidity patterns. Individuals with
COPD who had comorbid HTN and arthritis (adjusted OR=1.60,
95%CI=1.08-2.38), AVD and HTN (1.55, 1.03-2.32), and HTN and
polypharmacy (1.95, 1.09-3.46) were more likely than those without
these respective comorbidities to have greater COPD severity, assessed
by spirometry. Similarly, having comorbid HTN and arthritis
(adjusted OR=1.63, 95%CI=1.11-2.39), AVD and HTN (1.65, 1.11-
2.44), and HTN and polypharmacy (2.70, 1.57-4.63) was significantly
associated with worsening dyspnea.
Conclusions:
Specific patterns of comorbid chronic diseases and geriatric conditions
are associated with worsening COPD. These findings could inform
the design of interventions to improve outcomes in older adults
with COPD.
B46
Cognitive Status and Care-seeking Behavior in Elderly Patients with
Acute Heart Failure.
S. N. Levin, 1 A. Hajduk, 2 D. M. Lessard, 2 F. A. Spencer, 3
J. H. Gurwitz, 1,2 R. J. Goldberg, 1 J. S. Saczynski. 1,2 1. Meyers Primary
Care Institute and Division of Geriatric Medicine, UMASS Medical
School, Worcester, MA; 2. Department of Quantitative Health
Sciences, UMASS Medical School, Worcester, MA; 3. Department of
Medicine, McMaster University, Hamilton, ON, Canada.
Background: Heart failure (HF) is a chronic disease characterized
by acute exacerbations and high rates of rehospitalization.
In response to worsening symptoms, patients are advised to
promptly seek medical care. Cognitive impairment (CI) is highly
prevalent in patients with HF and may impact their decision or
ability to seek treatment for an acute exacerbation. We examined
the association of impairment in specific cognitive domains and
time to emergency department (ED) presentation following acute
HF symptom onset.
Methods: The sample included 564 patients hospitalized with
acute HF (mean age = 72 years, 45% female) between 2007 and 2010
at several tertiary care and community medical centers. CI was assessed
in 3 domains (memory, processing speed, executive function)
using standardized measures. Time to ED presentation was collected
from a structured interview during hospitalization. The time interval
between the patient’s latest reported symptoms of HF and ED presentation
was assessed.
Results: More than three quarters (78.2%) of patients were impaired
in at least one cognitive domain. The average pre-hospital
delay for patients who experienced acute symptoms of decompensated
HF was 4.2 days (100 ± 12 hr) while their median delay time
was 14 hours. Over two fifths (43%) of all participants waited at
least one day before presenting to the ED. Compared to patients
with intact cognitive function, those with CI had a longer delay to
ED presentation following symptom onset (median delays: 15.0 hr
vs. 8.6 hr; p = 0.03). Pre-hospital delay times varied according to specific
cognitive domains. Patients with deficits in memory or processing
speed had longer median delay times than unimpaired patients
(memory: 23.2 hr vs. 11.4 hr, p = 0.02; Speed: 19.4 hr vs. 11.3 hr, p =
0.05). Executive function was not associated with duration of prehospital
delay.
Conclusion: Cognitive impairment is common among patients
hospitalized for HF and is associated with delays in seeking emergency
care. Interventions to enhance the care of patients with acute
heart failure should take into consideration the important impact of
cognitive status.
S88
AGS 2012 ANNUAL MEETING