Day 2 :
Keynote Forum
Sakura Kinjo
University of California, USA
Keynote: Postoperative pain management and delirium
Time : 09:30-10:15
Biography:
Sakura Kinjo is an anesthesiologist and pain management physician at University of California, San Francisco. She is graduated from the Ryukyu University, Faculty of Medicine, Nishihara Cho and Okinawa, Japan in 1994. Kinjo is affiliated with UCSF Medical Center Parnassus. Her research interests are acute pain management, postoperative cognition and regional anesthesia.
Abstract:
Postoperative delirium (POD) is a common postoperative complication in older patients and may increase morbidity and mortality. The etiology of POD is multifactorial and suggested to be the result of interactions between patient vulnerability (predisposing factors) and exposure to precipitating factors. Poorly controlled postoperative pain has been identified as a precipitating risk factor for POD. However, effective pain management strategies to reduce incidence of POD are still far from being elucidated. Postoperative pain management techniques in older patients have changed substantially in recent years; for example, peripheral nerve blocks and multimodal analgesia have become common adjunctive techniques. It is unclear; however, whether these pain control management techniques can change the incidence of POD. I will review opioid analgesics, which are the most commonly used postoperative pain medications for major surgery. In addition, pain management techniques will be discussed; intravenous patient-controlled analgesia, epidural analgesia, peripheral nerve blocks, multimodal analgesia, and structured pain management protocols in multi-component delirium intervention.
Keynote Forum
Nagy A. Youssef
Augusta University, USA
Keynote: Bipolar depression: Predictors and implications for treatment and prognosis in elderly
Time : 10:15-11:00
Biography:
Nagy A. Youssef is an Associate Professor at the Medical College of Georgia, AU. His primary academic interest include clinical, education and research in treatment-resistant psychiatric disorders especially mood disorders and PTSD and suicide prevention. He is interested in the mechanistic understanding at the environment-genomic interface and brain stimulation interventions of these disorders. He did medical school at Cairo University (Egypt); psychiatry residency and postgraduate fellowship at the University of South Alabama and Yale University; and a research fellowship at both Durham VA and Duke University. He was on the faculty at Duke University before moving to Augusta.
Abstract:
Depression is one of the leading causes of premature death especially in the geriatric population, and one of the highest burdens of overall disability. Depression also can be a precursor to suicide. Highest rates of suicide occur in the geriatric population. Thus proper diagnosis of depression (unipolar vs. bipolar) and aggressive treatment are very important.
Depressive episodes are still underdiagnosed and undertreated. Several factors contribute to underdiagnosis and treatment, including lack of detailed knowledge of the condition, lack of confidence in treatments, etc. Improving knowledge and confidence in diagnosing depression types in order to improve either treatment (based on proper diagnosis of unipolar vs bipolar depression) both in psychiatry and primary care clinics would improve patient’s mental and physical outcomes, morbidity, mortality, and quality of life.
Despite all available education avenues, there are still high rates of underrecognition of depression and misdiagnosis of bipolar depression among psychiatrists as well as primary care physicians. A meta-analysis of several studies comparing several western countries found that clinicians in Australia and the US were the worst in identifying depression.
Moreover, bipolar depression can be difficult to distinguish from unipolar depression and can be underdiagnosed. Delays can lead to further worsening of the disease with additional burden. This presentation will review the studies and the evidence-based medical approach to early detection, proper diagnoses, and how bipolar and unipolar depression are treated differently, especially when it comes to different pharmacotherapeutics. Recent updated evidence-based interventions with pharmacotherapy and brain stimulation interventions will be discussed.
Keynote Forum
Merete Gregersen
Aarhus University, Denmark
Keynote: Overall quality of life in frail elderly with hip fracture
Time : 11:20-12:05
Biography:
Merete Gregersen is master of health science and has completed her PhD in 2015 from Aarhus University, Denmark. She is a researcher at the Department of Geriatrics, Aarhus University Hospital and involved in many clinical areas in the department’s research unit e.g. orthogeriatrics, oncogeriatrics, and organizational improvements in the acute older medical patients. She has published 16 papers in scientific journals and has reviewed several journal submissions.
Abstract:
Hip fracture substantially reduces quality of life (QoL) in older people. This reduction is highly correlated with physical ability measurements. Also, before the hip fracture institutionalized older patients are less mobile and more dependent on assistance in the activities of daily living (ADL) than those living in their own homes. Further, institutionalized patients generally suffer from some degree of cognitive impairment. The questionnaire “Depression List” is validated as a qualified measure of Overall Quality of Life (OQoL) in nursing home residents with a Mini Mental State Examination score between 5 and 30 (from severe impairment to normal state).
We have examined the reproducibility of the questionnaire and found that it is able to detect clinically relevant changes over time. Using the “Depression List” questionnaire in institutionalized older patients 30 days after the hip fracture and one year later, we found that the OQoL was very low postoperatively, but improved with time. Likewise, we found that ADL recovery, measured by the Modified Barthel Index, improved within the period from 30 days to one year after hip fracture. We may conclude that progress in OQoL and ADL seems to be correlated.
- Geriatric Medicine and Aging
Geriatric Medicine and Emergency Medicine
Geriatric Medicine and Disorders
Geriatric Medicine and Elder Abuse
Location: Chattahoochee A
Chair
Agnieszka Batko-Szwaczka
Medical University of Silesia, Poland
Co-Chair
Barun Mukhopadhyay
Indian Statistical Institute, India
Session Introduction
Mary R Mulcare
NewYork-Presbyterian Hospital, USA
Title: A novel clinical protocol for placement and management of indwelling urinary catheters in older adults in the emergency department
Time : 12:05-12:35
Biography:
Mary R Mulcare completed her medical degree at Columbia University College of Physicians and Surgeons, followed by an Emergency Medicine residency at NewYork-Presbyterian Hospital. She subsequently did a fellowship at Weill Cornell Medicine in Geriatric Emergency Medicine. She is the Assistant Program Director of the NYPH Emergency Medicine Residency and Assistant Director of the Geriatric Emergency Medicine Fellowship at Weill Cornell. Her research has focused on creating and testing an effective pathway for protocol development for improved care of older adults in emergency departments.
Abstract:
Indwelling Urinary Catheters (IUCs) are placed frequently in older adults (aged 65) in the Emergency Department (ED) and carry significant risks. We developed, implemented, and assessed a novel clinical protocol to assist ED providers with appropriate indications for placement, reassessment, and removal of IUCs in this population. This evidence-based clinical protocol was built from an extensive literature review and ED provider focus groups, then implemented by 20-minute scripted slide presentations to providers. Written surveys administered before, after, and at 6-months assessed providers baseline practice and the protocol’s impact. A quantitative analysis compared rates of IUC placement and catheter-associated urinary tract infections (CAUTIs) in the 6 months before and after protocol implementation. 111 EM providers participated in the all three surveys. Participants anticipated that this intervention would reduce rates of IUC use and increase patient safety. At 6-month follow-up, 81% felt the protocol had changed their practice. ED providers correctly identified the appropriate approach for IUC placement in 63% of cases at baseline with an increase of 22% (95% CI: 19, 25%) post-intervention and a maintained increase of 8% (95% CI: 6, 12%) at 6-months. With protocol implementation, an absolute reduction in the use of IUCs of 3.5% (P<0.001) for older adults admitted to the hospital, with 3 CAUTIs reduced to 0 attributable to the ED. Overall, this comprehensive, evidence-based clinical protocol was well received by participants, and was associated with a sustained change in self-reported practice, providing a template for future protocol development and implementation.
Nagy A. Youssef
Augusta University, USA
Title: Does acute treatment with benzodiazepines affect suicide risk in elderly?
Time : 12:35-13:05
Biography:
Nagy A. Youssef is an Associate Professor at the Medical College of Georgia, AU. His primary academic interest include clinical, education and research in treatmentresistant psychiatric disorders especially mood disorders and PTSD and suicide prevention. He is interested in the mechanistic understanding at the environment-genomic interface and brain stimulation interventions of these disorders. He did medical school at Cairo University (Egypt); psychiatry residency and postgraduate fellowship at the University of South Alabama and Yale University; and a research fellowship at both Durham VA and Duke University. He was on the faculty at Duke University before moving to Augusta.
Abstract:
Anxiety (among several other symptoms) has been identified in one prospective study as associated with suicide risk in depressed patients early in treatment. It has been suggested that treatment of anxiety in depression with sedative/hypnotic agents, especially benzodiazepines, may decrease suicide risk. Sedative/hypnotic agents (S/H) including benzodiazepines also have depression and disinhibitory properties which might increase suicide risk. This review addresses these potential risks (and weigh it with any benefits) with regard to suicide.
Pertinent medical literature will be reviewed in depth. The review did not reveal any evidence that using benzodiazepines (or S/H) as an early adjunct to antidepressant treatment of anxious, depressed patients (or otherwise) decreases their suicide risk. There is considerable evidence that S/H produce depressant and/or disinhibitory effects in a small proportion (perhaps 5%) of people who take them. Toxicological data on suicides indicate that a majority of people who commit suicide are under the influence of S/H chemicals (including alcohol) at the time of suicide. Alternatives to sedative/hypnotics should be used if early adjunctive treatment for anxiety in depressed patients is thought to be indicated.
Tiffany Clack
Baylor Scott & White Health Transitional Care, USA
Title: 5 factors that impact hospital readmissions in the aging population & what we are doing about it
Time : 14:00-14:30
Biography:
Tiffany Clack is a passionate person pursing her childhood dream career in nursing. She’s dedicated to providing care to the older adult population. She obtained a Master
of Science in Nursing degree from University of Texas for Adult & Gerontological Nurse Practitioner and board certified by American Nurse Credentialing Center
Abstract:
The interdisciplinary Transitional Care team at Baylor Scott & White in Dallas, Texas is focused on readmission reduction of patients aged 65 and beyond with a primary inpatient diagnosis of Heart Failure, COPD or Pneumonia. All patients are followed by the registered nurse, licensed masters social worker (LMSW), pharmacist, medical assistant, and advanced practice registered nurse (APRN) for 30 days post hospitalization. Through our remote tele monitoring system, daily health checks are completed and reviewed by the team. High risk patients also receive APRN home visits. Several categories were identified detailing the reoccurring reasons for hospital readmissions. Reasons included patient and system level factors, sociodemographics, as well as communication challenges. Evaluating patients for the development of post-acute care risks was conducted via APRN inpatient geriatric assessment. Second, a post hospitalization telephonic assessment was completed by the team’s LMSW. From October 2015 to May 2016, 162 readmissions were reviewed. The most prevalent reasons contributing to the readmission were:
- Patient declined services (31%)
- Insufficient patient and caregiver education (31%)
- Unpredicted medical emergency (10%)
- Medication mismanagement (7%)
- Provider initiated readmission (7%)
Our team developed an action plan that enhances communication with acute & post-acute care providers. This created a more cohesive partnership to combat readmission. In addition to reinforcing the importance of patient adherence, our team educated patients in lifestyle behavior changes. We found this to be relevant to their healthcare treatment plan which resulted in improved quality of life.
Phyllis Wright
Nell Hodgson Woodruff School of Nursing, USA
Title: Why successful transitions in care are more than 30 day readmissions
Time : 14:30-15:00
Biography:
Phyllis Wright is an assistant professor in the Nell Hodgson Woodruff School of Nursing. An Adult Gerontological Nurse Practitioner, she is the program director for primary care education and the PI on a 5 year grant to develop practitioners experienced in Veteran’s Health Care. Her area of research is 30 day readmission prevention, fiscal policy, and financial education for clinical providers to maximize population health and improve efficient delivery of care.
Abstract:
30 day readmission rates specific to heart failure have barely moved inspite of the million of dollars and energies expended for reduction in rates. The most successful programs have demonstrated a strong palliation component often instituted in acute care setting. However, recommendations for initiating palliative care in stage III and stage IV heart failure in primary care are largely ignored due to provider’s lack of time, reimbursement and metrics that families and patients understand. Developing risk stratification for families to actively complete, such that they can understand the likelihood of a 30 day readmission could be a foundation for informed decision making by provider and patient for transitions not only in care but applied to those in overall decline.
The policy makers and legislative decision makers must have activist providers at all levels to match patient interest, provider expertise, and fiscal reality in care transitions. Active studies that prove consultation services in all patient transition periods saves money in Medicare, enhances patient satisfaction and improves quality of life are needed to justify increasing reimbursement for phone, email, video and face to face services for those who engage in the decision making of the 65+ age group.
Li Yang
Harbin Medical University, China
Title: Effect of a comprehensive health education program on pre-hospital delay in high-risk stroke population and caregivers
Time : 14:30-15:00
Biography:
Li Yang has been graduated from Harbin Medical University. She is a teacher of nursing with the specialties including internal medicine, nursing, social and community nursing and master’s degree in nursing from the Harbin Medical University in China. Later on she obtained her Medical degree in social medicine from Harbin Medical University with subjects “chronic disease management” and then started working in the school of nursing where she has continued his research. Presently she is working at the harbin city in china.
Abstract:
Many factors influence pre-hospital delays in the event of a stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015 and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay, behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. There were significant differences between before and after the intervention (P < 0.01). SPDBI, PSSCT, and SPSAT scores were significantly different between the groups (P < 0.01). The interaction between time and intervention method was significant (P < 0.01). According to multivariate repeated-measures analysis of variance, SPDBI, PSSCT, and SPSAT scores were significantly different at each time after intervention (P < 0.05). The comprehensive educational program was significantly effective in decreasing SPDBI, improving knowledge, enhancing stroke pre-symptoms alert, and reducing the possibility of pre-hospital delays.
Beyhan Cengiz Ozyurt
Celal Bayar University, Turkey
Title: Physical and financial abuse in the elderly population in Manisa, Turkey
Time : 15:00-15:30
Biography:
Beyhan Cengiz Ozyurt is currently a PhD student in Ege University department of Geriatrics and concurrently working in Celal Bayar University dept. of Public Health. She has published more than 15 papers in reputed journals.
Abstract:
This study investigated physical and financial abuse in an elderly population of age 65 and older, residing in two different settlement regions (rural and urban) of Manisa Province. The population of this cross-sectional study was 3163 elderly individuals who were living in the region of two randomly selected primary medical services (one at rural area, other at urban area) in April 2015. The sample size was calculated using the software of Epi info 7.0; thereby, 480 elderly individuals were enrolled. Each individual was randomly selected from his/her registration at the Manisa Public Health Department. All data were collected by face-to-face interview and a standardized questionnaire form, that involved sociodemographic characteristics, health and social status, Katz index was used. The rate of participation was 88.9% (n=427). All data were evaluated using descriptive analysis and chi square test. Logistic regression was used for multivariate analysis.
The mean age of the study group was 72.9±6.7. The majority of individuals (86.4%) had a chronic disease for which continuous drug administration was required, 49.6% was women, 35.1% was graduated from elementary school and 23.4% was living alone. More than 79.4% of elderly could have done daily living activities easily, less than 5% were dependant in one or more basic activities of their daily life. Elderly abuse was determined 11.3% of the study group (urban 13.0%, rural 9.6%, p>0.05). Verbal abuse was more common (10.3%). Physical abuse was 5.4% and financial abuse was 2.7%. The risk factors of elderly abuse were being 85 years of age and over, having worse perceived health status, social isolation, insufficient income and lack of accessibility in health care. In conclusion, low rates of physical and financial abuse were found in Manisa.
Mark Yassa
Augusta University, USA
Title: Assessing medical students knowledge in diagnosis and initial treatment of depression
Time : 15:30-16:00
Biography:
Mark Yassa is a Pre-Medical student at Augusta University, GA. He majors in Medicinal Chemistry in his senior year. His research interests include Clinical Psychiatry and treatment resistant psychiatric disorders. He is a Research Assistant for Dr. Nagy Youssef at the Department of Psychiatry at the Medical College of Georgia. He assists in several studies and in the recently submitted paper entitled “Low Amplitude Seizure Therapy: Proof of Concept study in Humans” as well as in the recently published paper “Racial/Ethnic Differences in the Association of Childhood Adversities with Depression and the Role of Resilience.” Journal of Affective Disorders.”
Abstract:
Depression is one of the leading causes of premature death in the geriatric population, and one of the highest burdens of overall disability. Depression rates are around 13% in primary care settings.
Depressive episodes are still underdiagnosed and undertreated, in the primary care settings. Several factors contribute to this, including lack of detailed knowledge, lack of confidence in treatments, etc. Improving knowledge and confidence in diagnosing depression types in order to improve either treatment or referring patients to psychiatric care would help address this gap, and improve patients’ care and quality of life.
Moreover, bipolar depression can be difficult to distinguish from unipolar. Delays in recognition and referral can lead to further worsening of the disease. Bipolar depression is treated differently than unipolar depression. Improving education of future physicians in the formative years in these areas would consequently impact and improve care for patients.
Aims: 1) To assess student’s level of confidence and knowledge in diagnosing and treating depression before and after a psychiatry clerkship, and any barriers to gaps in knowledge
2) To assess students’ knowledge in differentiating unipolar versus bipolar depression and any barriers to gaps in knowledge.
We are assessing these by an online survey on a website used by Medical College of Georgia for student questionnaires, which is sent to all third year medical students after internal medicine rotation. The survey will be sent through the academic affairs office and students will be notified by email of the availability of the survey if they wish to participate.
Nadezhda Korsakova
Russian People Friendship University, Russia
Title: The type of age-related cataract as an available marker of socially significant diseases
Time : 16:20-16:50
Biography:
Nadezhda Korsakova has been graduated as Dr. Med. from Russian People Friendship University (2011), with the specialties including Neurobiology, Ophthalmology, Gerontology. She is the Laureate of State Prize of Chuvash Republic in the field of natural sciences in ophthalmology (2012). She has published more than 31 papers in reputed journals, 4 monography. She has been 7 Patents for the Russian Federation’s invention and were awarded by The Medal after name of Alfred Nobel for the contribution in inventions’ development (2012). As a result of the I All-Russian Competition she was awarded the honorary title ‘The best young Doctor of Science – 2013’
Abstract:
The aim of this study was to investigate the general somatic status and carry on a comparative analysis of the functional activity of the sympathetic and parasympathetic parts of the autonomic nervous system of a patient information of certain types of age-related cataracts. By methods of functional general clinical and ophthalmology diagnostics (P<0.05) it was found for the first time that the predominance of sympathetic effects of the autonomic nervous system and associated with it peculiarities of systemic degenerative changes in the tissues were typical for patients with age-related cortical cataract; in patients with nuclear type of age-related cataract the predominance of parasympathetic effects, triggering the emergence of degenerative changes of dissimilar nature, was revealed. Consequently, the type of forming age-related cataract can be proposed as an available clinical marker of the neurodystrophic process nature, which takes place in the patient’s organism.