Geriatric Clinic Research Articles

Prevalence and Type of Unmet Needs Experienced by People Living with Dementia.

Accurately identifying the unmet needs of community-dwelling people with dementia allows targeted support to be provided to assist these individuals to stay at home. We developed a self-report instrument to identify the unmet needs of community-dwelling people with dementia and used this to explore the prevalence and type of unmet needs present in this population. This was a cross-sectional survey of people with dementia living in the community in Australia. Participants were recruited from geriatric clinics, respite centers, aged care providers, and carers attending support groups. Eligible people with dementia were provided with a study information pack and survey which included the self-report Unmet Needs Instrument for Dementia (UNI-D), sociodemographic characteristics and survey acceptability. The UNI-D contained 26 items across 5 domains and demonstrated acceptable internal consistency, face and construct validity, and acceptability. Ninety-five eligible participants completed the survey (response rate 35%) with 85% identifying at least one unmet need (median = 4; IQR = 1-9). The items most frequently endorsed included needing more help with remembering things (64%), finding possible treatments for dementia (44%), understanding who to contact regarding a problem or concern related to dementia (36%), and to see friends and family more often (33%). The UNI-D is a promising tool to identify the self-reported needs of people with dementia. The development and rigorous testing of interventions targeting unmet needs related to health and wellbeing, dementia support, and meaningful activities appears warranted.

In veteran outpatients, antibiotics remain significant risk factor for community-acquired Clostridiodes difficile infection

Background: An estimated 30% of antibiotic prescriptions in outpatient settings may be inappropriate. Antibiotic exposure increases an individual’s risk of Clostridioides difficile infection (CDI). To assess the prevalence of community-acquired CDI (CA-CDI) among patients without recent hospitalization and to examine the influence of outpatient antibiotic exposure on the risk of acquiring CA-CDI in this population, we examined a 2-year cohort of patients seen in primary care clinics at VA community-based outpatient clinics (CBOCs) associated with a large VA medical center. Methods: All primary care visits and nonvisit antibiotic prescriptions were identified in calendar years 2018–2019 as encounters of interest. Encounters occurring Results: We identified 84,787 patients with visits meeting our criteria. In this cohort, 3,533 patients were prescribed antibiotics at their encounter of whom 5 (0.14%) developed CA-CDI. Among the 81,254 patients who were not prescribed antibiotics, 15 (0.02%) developed CA-CDI, yielding an unadjusted CA-CDI odds ratio of 7.68 (95% CI, 2.50–19.82). p Conclusions: Although CA-CDI episodes were infrequent among VA outpatients with a CBOC visit in 2018–2019, the odds of CA-CDI were 7-fold greater in outpatients with antibiotic exposure than outpatients without antibiotic exposure. Antibiotic stewardship interventions that emphasize adverse events as a result of care provided in the outpatient setting, rather than as events limited to acute-care settings, may mitigate CDI risk.Funding: This work was supported by the Merck Investigator Studies Program (MISP 59266 to F.P. and R.J.), and funds and facilities were provided by the Cleveland Geriatric Research Education and Clinical Center (GRECC) at the VA Northeast Ohio Healthcare System. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.Disclosures:. All authors report no conflicts of interest relevant to this article. R.J. has received research funding from Pfizer; she has also participated in advisory boards for Pfizer and Merck.

Relationship between Frailty and Depression in a Population from North-Eastern Romania.

(1) Background: In the older population, depression often affects people with chronic medical illnesses, cognitive impairment, or disability. Frailty is another important issue affecting older adults, being difficult to clinically distinguish from frailty in advanced old age. Well-designed interventional studies and clinical strategies targeting both frailty and depression are rare or nonexistent. (2) Methods: We realized a retrospective study in which we included a total of 411 patients that were admitted to the Geriatric Clinic from “Dr. C. I. Parhon” Hospital from Iasi for a period of 13 months. The aim of our study was to investigate the relationship between depression and frailty in a geriatric population due to the fact that the quality of life is negatively influenced by both frailty and depression. (3) Results: The prevalence of the depressive symptoms screened by the GDS-15 was 66.7%, with women being more depressed than men. Furthermore, an obvious relationship between depression and the dependence degree in performing daily activities has been observed. In addition, the mean MMSE score decreased with an increasing degree of depression. (4) Conclusions: Our study demonstrates the association between frailty and depression, one of them being a risk factor in the development of the other. A poor acknowledgment of the problem and an underdiagnosis of these conditions are important public health concerns due to the high healthcare costs. Thus, an active primary prevention would be imperiously needed in order to diagnose frailty and depression at an early stage, increasing the quality of life of the elderly and also their successful aging.

Profiling of patients in aspecialized geriatric outpatient clinic

In Germany geriatric outpatient care is predominantly done by family doctors and general practitioners (GP). There are regionally different concepts for additional specialized geriatric outpatient care but they have not yet been validated and established. Still, it remains unclear whether ageriatric patient has to be diagnosed rather in aspecialized outpatient or inpatient setting. The aim of the present study is the profiling of geriatric outpatients to find key distinctions from geriatric patients that have to be admitted to hospital. Retrospective data analysis of patients sent to aspecialized geriatric outpatient clinic by their GP, compared with data of geriatric inpatients sent to hospital by their GP during the same time period. Study parameters comprised elements of the comprehensive geriatric assessment as well as results of routinely applied laboratory tests. Patients sent to the specialized geriatric outpatient clinic showed better results of functional assessments. Regression analysis: improvement of Barthel Index, GFR and total protein increased the chance of outpatient treatment. Early identification of geriatric patients who can be treated in aspecialized outpatient setting would ease the burden for GPs by interdisciplinary cooperation and prevent cost-intensive readmissions to hospital.

Nurse-led rabbit clinics

Nursing clinics are an excellent time to provide information to prospective and current owners about their pets. Rabbits are an often-overlooked pet and encouraging rabbit owners to attend nurse-led rabbit clinics can help to correct any underlying husbandry issues to prevent disease. Subtle signs of ill health can also be identified during nursing clinics, resulting in reduced morbidity. Of particular note, geriatric rabbit clinics should be performed frequently, as geriatric rabbits are more prone to developing disease compared with their younger counterparts.

Clinical trials in older people.

Randomised controlled trials (RCTs) usually provide the best evidence for treatments and management. Historically, older people have often been excluded from clinical medication trials due to age, multimorbidity and disabilities. The situation is improving, but still the external validity of many trials may be questioned. Individuals participating in trials are generally less complex than many patients seen in geriatric clinics.Recruitment and retention of older participants are particular challenges in clinical trials. Multiple channels are needed for successful recruitment, and especially individuals experiencing frailty, multimorbidity and disabilities require support to participate. Cognitive decline is common, and often proxies are needed to sign informed consent forms. Older people may fall ill or become tired during the trial, and therefore, special support and empathic study personnel are necessary for the successful retention of participants.Besides the risk of participants dropping out, several other pitfalls may result in underestimating or overestimating the intervention effects. In nonpharmacological trials, imperfect blinding is often unavoidable. Interventions must be designed intensively and be long enough to reveal differences between the intervention and control groups, as control participants must still receive the best normal care available. Outcome measures should be relevant to older people, sensitive to change and targeted to the specific population in the trial. Missing values in measurements are common and should be accounted for when designing the trial.Despite the obstacles, RCTs in geriatrics must be promoted. Reliable evidence is needed for the successful treatment, management and care of older people.

Malnutrition Prevalence Increased During the COVID-19 Pandemic in Patients with Dementia: A Retrospective Study from the Geriatric Outpatient Clinic

Objective: Individuals who are clinically vulnerable and older are more susceptible to severe consequences, either directly from the coronavirus disease 2019 (COVID-19) infection or indirectly from the rigorous social isolation policies. Increased frailty, reduced quality of life, high level of stress, and increased depressive symptoms were observed during the social isolation period. Patients with dementia are more vulnerable to the direct and indirect effects of COVID-19. In this study, we have explored the impact of the COVID-19 pandemic on nutrition in patients with dementia who were followed up in our outpatient clinic. Methods: Patients with a diagnosis of dementia who were followed up in the geriatric outpatient clinic at our university hospital were included in the study. The risk of malnutrition was evaluated using the Mini-Nutritional Assessment-Short Form (MNASF). An MNA-SF score between 8 and 11 was defined as risk of malnutrition, and scores < 8 were accepted as malnutrition. A retrospective study was performed using the identified electronic records of 121 patients who were admitted to the hospital between March 11, 2020, and March 31, 2021. Results: The mean age of the study population was 80.12 ± 7.12 years, and 60.3% of the patients were female. The MNA-SF scores decreased and malnutrition prevalence increased as the dementia worsened, and the difference before and during the pandemic was statistically significant (P < .05). Conclusion: For patients living with dementia, COVID-19 restrictions, particularly those related to social isolation like social distancing and lockdowns, might not only have mental and cognitive implications but also disturb their already vulnerable nutritional status.

Non-Latinx Healthcare Provider’s Knowledge and Awareness of Latinx Geriatric Clinical Health Needs

ABSTRACT Objectives Due to the exponential growth in the Latinx older adult population, culturally responsive services are needed, especially since most healthcare providers are non-Latinx with limited Spanish or bilingual skills. One place to start is by drawing a formative assessment of the healthcare providers’ knowledge and awareness of the healthcare needs of Latinx older adults. Methods Focus groups were conducted to explore the healthcare providers’ knowledge and awareness of cultural and structural barriers and facilitators to accessing health care services for Latinx older adults. Results Results note that healthcare providers perceived the healthcare needs for Latinx older adults to be underutilized for healthcare services, preventive interventions for healthy diet/lifestyle, and healthcare knowledge. Providers reported Latinx family over-involvement, religiosity, immigration, and language/lack of interpreters as barriers to seeking timely healthcare. Finally, healthcare providers said that family support, the location of healthcare services, and community-based partnerships were all facilitators for seeking healthcare. Conclusions Findings suggest providers’ conflicting perspectives toward the Latinx communities. Clinical Implications Healthcare services can consider implementing trainings for non-Latinx providers to recognize conflicting perspectives and reduce implicit bias toward the Latinx communities.

Voice your values, a tailored advance care planning intervention in persons living with mild dementia: A pilot study.

In the early stage of dementia, persons living with dementia (PLwD) can identify their values and wishes for future care with a high degree of accuracy and reliability. However, there is a paucity of research to guide best practices on how best to incorporate advance care planning (ACP) in older adults diagnosed with mild dementia and therefore only a minority of these individuals participate in any ACP discussions. We developed an intervention called Voice Your Values (VYV) that healthcare professionals can implement to identify and document the values of PLwD and their trusted individuals such as friends or family. This single-group pre-test and post-test design aimed to determine the feasibility, acceptability, and preliminary efficacy of the VYV intervention. A convenience sample of 21 dyads of PLwD and their trusted individuals were recruited from five outpatient geriatric clinics. The tailored VYV intervention was delivered to the dyads over two sessions using videoconferencing. In terms of feasibility, the recruitment rate was lower (52%) than the expected 60%; the retention rate was high at 94%, and the intervention fidelity was high based on the audit of 20% of the sessions. In terms of preliminary efficacy, PLwD demonstrated improvement in ACP engagement (p = <0.01); trusted individuals showed improvements in decision-making confidence (p = 0.01) and psychological distress (p = 0.02); whereas a minimal change was noted in their dementia knowledge (p = 0.22). Most of the feasibility parameters were met. A larger sample along with a control group, as well as a longitudinal study, are requisite to rigorously evaluate the efficacy of the promising VYV intervention. There is emerging evidence that people living with mild dementia can effectively participate in identifying and expressing their values and wishes for future care.

Acceptability of the voice your values, an advance care planning intervention in persons living with mild dementia using videoconferencing technology.

Advance care planning (ACP) can improve outcomes for persons living with dementia (PLwD). Clinicians see the lack of acceptability of these conversations as a barrier to ACP in individuals with mild dementia. COVID-19 pandemic has magnified the need for ACP discussions in older adults, particularly for those living with dementia. In light of the pandemic, much of the healthcare is provided virtually, but little evidence exists on how to best implement ACP virtually. We designed Voice Your Values (VYV), a tailored ACP intervention for persons living with mild dementia and their trusted individuals such as friends or family. Purpose Determine the acceptability of the VYV intervention, in terms of its content and the potential utility of videoconferencing to deliver it. Methods For this pilot study, we recruited 21 dyads of older adults with mild dementia and their trusted individuals from five geriatric clinics in Ontario, Canada. The tailored VYV intervention was delivered to dyads over two sessions over videoconferencing. Acceptability was assessed using scores on a modified Treatment Evaluation Inventory. The interventionist diary and Researcher Virtual Experience Questionnaire were used to examine facilitators and barriers, whereas Participant Virtual Experience Questionnaire was used to understand their experience. Qualitative data was analyzed using inductive content analysis. Results 100% of the participants rated VYV as acceptable. Participants and researcher rated video and sound quality highly. PLwD who lived with their trusted individuals were more likely to find the intervention acceptable (t = 3.559, p = 0.001, β = 0.323). Five interrelated themes were established that describe the acceptability of the virtually delivered VYV intervention. All PLwD were able to articulate their values and wishes related to being in a terminal and vegetative states and had them documented. Conclusion The virtual VYV intervention was an acceptable approach to ACP in older adults with mild dementia and their trusted individuals.

The ability of eight frailty instruments to identify adverse outcomes across different settings: the FRAILTOOLS project.

BackgroundTo compare the performance of eight frailty instruments to identify relevant adverse outcomes for older people across different settings over a 12 month follow‐up.MethodsObservational longitudinal prospective study of people aged 75 + years enrolled in different settings (acute geriatric wards, geriatric clinic, primary care clinics, and nursing homes) across five European cities. Frailty was assessed using the following: Frailty Phenotype, SHARE‐FI, 5‐item Frailty Trait Scale (FTS‐5), 3‐item FTS (FTS‐3), FRAIL scale, 35‐item Frailty Index (FI‐35), Gérontopôle Frailty Screening Tool, and Clinical Frailty Scale. Adverse outcomes ascertained at follow‐up were as follows: falls, hospitalization, increase in limitation in basic (BADL) and instrumental activities of daily living (IADL), and mortality. Sensitivity, specificity, and capacity to predict adverse outcomes in logistic regressions by each instrument above age, gender, and multimorbidity were calculated.ResultsA total of 996 individuals were followed (mean age 82.2 SD 5.5 years, 61.3% female). In geriatric wards, the FI‐35 (69.1%) and the FTS‐5 (67.9%) showed good sensitivity to predict death and good specificity to predict BADL worsening (70.3% and 69.8%, respectively). The FI‐35 also showed good sensitivity to predict BADL worsening (74.6%). In nursing homes, the FI‐35 and the FTSs predicted mortality and BADL worsening with a sensitivity > 73.9%. In geriatric clinic, the FI‐35, the FTS‐5, and the FRAIL scale obtained specificities > 85% to predict BADL worsening. No instrument achieved high enough sensitivity nor specificity in primary care. All the instruments predict the risk for all the outcomes in the whole sample after adjusting for age, gender, and multimorbidity. The associations of these instruments that remained significant by setting were for BADL worsening in geriatric wards [FI‐35 OR = 5.94 (2.69–13.14), FTS‐3 = 3.87 (1.76–8.48)], nursing homes [FI‐35 = 4.88 (1.54–15.44), FTS‐5 = 3.20 (1.61–6.38), FTS‐3 = 2.31 (1.27–4.21), FRAIL scale = 1.91 (1.05–3.48)], and geriatric clinic [FRAIL scale = 4.48 (1.73–11.58), FI‐35 = 3.30 (1.55–7.00)]; for IADL worsening in primary care [FTS‐5 = 3.99 (1.14–13.89)] and geriatric clinic [FI‐35 = 3.42 (1.56–7.49), FRAIL scale = 3.27 (1.21–8.86)]; for hospitalizations in primary care [FI‐35 = 3.04 (1.25–7.39)]; and for falls in geriatric clinic [FI‐35 = 2.21 (1.01–4.84)].ConclusionsNo single assessment instrument performs the best for all settings and outcomes. While in inpatients several commonly used frailty instruments showed good sensitivities (mainly for mortality and BADL worsening) but usually poor specificities, the contrary happened in geriatric clinic. None of the instruments showed a good performance in primary care. The FI‐35 and the FTS‐5 showed the best profile among the instruments assessed.

Addressing Barriers to COVID-19 Vaccination Among Older U.S. Veterans.

Efforts are being made to ensure that COVID-19 vaccination among older adults is as complete as possible. Dialogue-based interventions tailored to patients’ specific concerns have shown potential for effectiveness in promoting vaccination. We implemented a quality improvement project intended to help patients in an outpatient geriatrics clinic overcome barriers to COVID-19 vaccination. We offered tailored conversations by telephone in which we discussed the barriers to vaccination that the patients were facing and offered to provide relevant information and/or logistical assistance. Of the 184 patients reached by phone, 125 (68%) endorsed having already been vaccinated and 59 (32%) did not. About one third of the unvaccinated patients were willing to participate in tailored conversations (20 patients = 34% of the unvaccinated). In follow-up calls 30 days after the intervention we found that four of these 20 patients had received COVID-19 vaccination, one patient was scheduled for vaccination, 10 continued to be deciding about vaccination, four had decided against it and one could not be reached. Dialogue-based interventions that are conducted by telephone and are tailored to the specific barriers to vaccination being faced by older adults may have some effectiveness in encouraging vaccination against COVID-19. The effectiveness of such interventions may be decreased in populations that already have high vaccination rates and in which many patients have already formed strong opinions regarding vaccination against COVID-19. Completion of Plan-Do-Study-Act cycles is a feasible way to design, implement and work to optimize quality improvement efforts related to COVID-19 vaccination.

The prevalence of cognitive impairment in older Indian persons with cancer and brain metastases.

BackgroundOlder patients with cancer are more vulnerable to the effects of cognitive impairment affecting their functional status, quality of life, compliance to treatment and ultimately survival. Cancer-related cognitive impairment may be due to the cancer itself or due to the treatment of cancer. There are no data regarding the prevalence of cognitive impairment in older persons with cancer and brain metastasis.MethodsThis retrospective analysis was conducted on a prospectively collected data set of patients who attended the geriatric oncology clinic at a tertiary care comprehensive cancer centre in India from June 2018 to July 2021. Patients aged 60 years and above with malignancy were included. Cognition was assessed with the mini-mental status examination (MMSE); the Hindi MMSE was used for illiterate patients. A score of ≤23 on the MMSE was considered abnormal. Correlation between the presence of cognitive impairment and brain metastasis was tested using the chi-square test.ResultsA total of 597 patients were included, of which 462 (77.4%) were male. The median age was 69 years (range: 60–100 years). All patients had solid tumours; 244 (40.9%) had lung, 189 (31.7%) had gastrointestinal and 75 (12.6%) had head and neck malignancies. Forty-one (6.9%) patients had brain metastases, of which 10 (24.4%) had solitary, 30 (73.2%) had multiple lesions and 1 (2.4%) had leptomeningeal metastases. Cognitive impairment was noted in 11 (26.8%) of the 41 patients with brain metastases and 91 (16.4%) of the 556 patients without brain metastases. There was no significant correlation between the presence of brain metastases and cognitive impairment, p = 0.086.ConclusionOlder persons with cancer and brain metastases were not found to have a higher occurrence of cognitive impairment than those without brain metastases in this study. The next step is to understand whether older persons with brain metastases are at a higher risk for cognitive decline as a result of therapeutic interventions such as cranial radiotherapy and chemotherapy.

Preventive Steps Implemented on Geriatric Services in the Primary Health Care Centers during Covid-19 Pandemic

Background: The emergence of the COVID-19 pandemic has changed the delivery of medical care across the world. The objective of the study is to understand and document the preventive steps implemented on geriatric services in the primary health care centers during COVID-19 pandemic.Design and methods: This is a retrospective study carried on geriatric services utilization (Geriatric Clinic, Osteoporosis Clinic, Memory and Dementia Clinic) in primary health care centers in Dubai Health Authority in 2020.Results: The study showed that the overall in person visits for all geriatric service in 2020 declined by almost 70%. The total number of telephone consultations in geriatric clinics, osteoporosis clinics and memory clinics were 1479, 1149 and 104 respectively. The COVID-19 pandemic had led to a reduction in most of the geriatric services including outpatient clinics, screening and referral. Telephone consultation provided a foundation for delivery of the service.Conclusions: This study reflected the potential for telehealth services to bring benefits and convenience to the geriatric population, even after the end of the pandemic. Significance for public health COVID-19 pandemic has resulted in drastic public health measures in most countries of the world. Researches on the impact of COVID19 on different health specialties including geriatric services will help tailoring public polices and health polices to be more prepared to deal with emergencies such as the one created by the COVID-19 pandemic.

Engaging the Wisdom of Older Veterans to Enhance VA Healthcare, Research, and Services

BackgroundStakeholder engagement helps ensure that research is relevant, clinical innovations are responsive, and healthcare services are patient-centered.ObjectiveEstablish and sustain a Veteran engagement board involving older Veterans and caregivers to provide input on aging-related research and clinical demonstration projects.Design and ParticipantsThe Older Veteran Engagement Team (OVET)—a group of eight Veterans and one caregiver who range in age from 62 to 92—was formed in November 2017 and has met monthly since January 2018. The OVET provides feedback on topics that reflect the foci of the VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC) (e.g., physical functioning, hearing health, and emotional wellness/mental health). Ongoing evaluation documents the return on investment of Veteran engagement.Main MeasuresThe OVET member and provider/investigator meeting evaluations with longitudinal follow-up at 6 and 12 months.ResultsReturn on investment of Veteran engagement is multi-faceted. For OVET, ROI ranges from grant support to improved healthcare quality/efficiency to social-emotional benefits. To date, funding awards total over $2.3 M for NIH and VA-funded projects to which OVET provided substantive feedback. Documented impacts on healthcare services include reductions in patient wait times, more appropriate utilization of services and increased patient satisfaction. Social-emotional benefits include generativity, as OVET members contribute to improving clinical and community-based supports for other Veterans. The OVET provides an opportunity for older Veterans to share their lived experience with trainees and early career investigators who are preparing for careers serving Veterans.ConclusionThe OVET is similar to other established stakeholder engagement groups; team members offer their individual viewpoints at any stage of research, clinical demonstration, or quality improvement projects. The OVET provides a mechanism for the voice of older Veterans and caregivers to shape aspects of individual projects. Importantly, these projects support patient-centered care and promote the characteristics of an age-friendly healthcare system.

SORL1 Polymorphisms in Mexican Patients with Alzheimer's Disease.

The present study evaluated the risk effect of 12 Single Nucleotide Polymorphisms in the SORL1 gene in the Mexican population using Late-Onset Alzheimer’s Disease (LOAD) and control subjects. Considering APOE as the strongest genetic risk factor for LOAD, we conducted interaction analyses between single nucleotide polymorphisms (SNPs) and the APOE genotype. Methods: Patients were interviewed during their scheduled visits at neurologic and geriatric clinics from different institutions. The LOAD diagnosis included neurological, geriatric, and psychiatric examinations, as well as the medical history and neuroimaging. Polymorphisms in SORL1 were genotyped by real-time PCR in 156 subjects with LOAD and 221 controls. APOE genotype was determined in each study subject. Allelic, genotypic, and haplotypic frequencies were analyzed; an ancestry analysis was also performed. Results: The A/A genotype in rs1784933 might be associated with an increased LOAD risk. Two blocks with high degree linkage disequilibrium (LD) were identified. The first block composed by the genetic variants rs668387, rs689021 and rs641120 showed a positive interaction (mainly the rs689021) with rs1784933 polymorphism. Moreover, we found a significant association between the APOE ε4 allele carriers and the variant rs2070045 located in the second LD block. Conclusion: The rs1784933 polymorphism is associated with LOAD in Mexican patients. In addition, the presence of APOE ε4 allele and SORL1 variants could represent a genetic interaction effect that favors LOAD risk in the Mexican population. SNPs have been proposed as genetic markers associated with the development of LOAD that can support the clinical diagnosis. Future molecular studies could help understand sporadic Alzheimer’s Disease (AD) among the Mexican population, where currently there is a sub-estimate number in terms of disease frequency and incidence.

Validation of the five-item version of the Geriatric Depression Scale (GDS-5) in a Turkish elderly population.

Late-life depression is a geriatric syndrome which should be taken seriously. Many clinical scales have been developed for the screening of geriatric depression. Most of these have been validated at different times and in diverse populations. A five-question version of the Geriatric Depression Scale (GDS-5) was developed in 1997. This test has been validated and used in different populations. In the present study, we plan to validate the GDS-5 for the Turkish elderly population. Patients aged 60 years and older who applied to the Geriatrics Clinic of our hospital between November 2018 and November 2019 were included in the study. We compared the effectiveness of Yesavage Geriatric Depression Scale-30 (YGDS-30) and GDS-5 in screening depression, based on Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) depression criteria. Four hundred participants were included in the study. A significant positive correlation was found between the DSM-5 scale and the GDS-5 scale (rho=0.726, P <0.001). According to DSM-5, YGDS-30 and GDS-5, 112 participants (28%), 154 patients (%38.5) and 199 patients (%49.8) were diagnosed with depression respectively. When the cut-off value was taken as ≥2, the sensitivity, specificity, positive predictive and negative predictive values for the GDS-5 scale were determined as 96%, 68%, 54%, and 98%, respectively. We obtained these diagnostic measures with 95% confidence intervals. This study demonstrated the validity and reliability of the GDS-5 for Turkish elderly populations. This five-question scale will be significant in daily use to screen for depression in elderly individuals with multiple problems.

Development of an Electronic Frailty Index for Hospitalized Older Adults in Sweden.

Frailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its association with adverse outcomes in hospitalized older adults. EHRs were extracted for 18 225 patients with unplanned admissions between 1 March 2020 and 17 June 2021 from 9 geriatric clinics in Stockholm, Sweden. A 48-item eFI was constructed using diagnostic codes, functioning and other health indicators, and laboratory data. The CFS, Hospital Frailty Risk Score, and Charlson Comorbidity Index were used for comparative assessment of the eFI. We modeled in-hospital mortality and 30-day readmission using logistic regression; 30-day and 6-month mortality using Cox regression; and length of stay using linear regression. Thirteen thousand one hundred and eighty-eight patients were included in analyses (mean age 83.1 years). A 0.03 increment in the eFI was associated with higher risks of in-hospital (odds ratio: 1.65; 95% confidence interval: 1.54-1.78), 30-day (hazard ratio [HR]: 1.43; 1.38-1.48), and 6-month mortality (HR: 1.34; 1.31-1.37) adjusted for age and sex. Of the frailty and comorbidity measures, the eFI had the highest area under receiver operating characteristic curve for in-hospital mortality of 0.813. Higher eFI was associated with longer length of stay, but had a rather poor discrimination for 30-day readmission. An EHR-based eFI has robust associations with adverse outcomes, suggesting that it can be used in risk stratification in hospitalized older adults.

MAINTAINING ROBUST SERVICE UTILIZATION IN GERIATRIC PSYCHIATRY DURING THE PANDEMIC: SUPPORT FOR THE FEASIBILITY OF TELEMEDICINE

<h3>Introduction</h3> Background: Since the beginning of the COVID-19 pandemic, telemedicine became ubiquitous. Telemedicine is defined as the use of information technology to provide the delivery of health care from a distance [1]. The World Health Organization (WHO) has defined it as critical to the delivery of health care services, including when distance is a limiting factor to obtain care [2], and there is evidence that telemedicine in a geriatric population is equivalent to in-person care [3]. Since COVID-19, HIPAA approved telemedicine platforms have provided a viable alternative to traditional face to face appointments. In particular, with the growing elderly population especially affected by the virus, there has been an increase in the use of telemedicine, which is a critical adaption for a geriatric population. For example, telemedicine removes barriers related to transportation (geriatric patients are more likely than general adult patients to rely on caregivers for transportation) and more easily facilitates caregiver reporting of collateral information (geriatric patients are more likely to have loved ones involved in their care and care decisions). Importantly, there has been a misconception that elderly patients would find the technology itself to be a barrier to care [4] – though in this new era of COVID-19, most patients, including geriatric patients, are now "Zoom" competent. Aims/Objectives: To examine the feasibility and potential sustainability of a geriatric telemedicine psychiatry practice, it is important to compare the rates of utilization before and after this surge in telemedicine in March 2020. This comparison is an important first step, as decreased rates of utilization subsequent to the ubiquity of telemedicine would be suggestive of systemic barriers to care (e.g., technology). If, on the other hand rates are comparable, then this would begin to shed light on telemedicine services sustaining beyond the pandemic. Therefore, we compare the number of clinical service encounters provided in a Geriatric Psychiatry Fellows' Clinic, specifically comparing the total number of visits in the year prior to the pandemic, and the total number of visits in the same timeframe that includes the onset of the pandemic. <h3>Methods</h3> The Emory productivity dashboard was utilized to determine the number of geriatric patients that arrived in the Geriatric psychiatry fellow's clinic in the academic periods before and during the pandemic for outpatient medication management and follow up visits. <h3>Results</h3> The geriatric clinic maintained a robust outpatient service. Review of the data showed that during the pre-pandemic months of February 2019 to January 2020, the number of patients that visited the geriatric psychiatry clinic in-person was 247. Consistently, during the pandemic year from February 2020 to January 2021, the number of patients that arrived in the same clinic and saw the same providers as the transition to telemedicine was in progress, was 297. <h3>Conclusions</h3> Our geriatric service continued to deliver services via telemedicine during the pandemic despite the assumed challenges, particularly related to technology, among elderly patients. Future research can continue to examine rates of utilization into 2021 and 2022 and incorporate patient ratings of satisfaction, to continue to examine if the benefits of a geriatric telemedicine practice are at least equivalent, if not potentially superior to, traditional in-person medicine. <h3>This research was funded by</h3> There are no funding to report

Medication Patterns in a Geriatric Psychiatry Outpatient Clinic

<h3>Introduction</h3> To date, little has been published about the specific pharmacological prescribing patterns in a geriatric psychiatry outpatient clinic. This retrospective chart review was conducted as part of a QI/PI project intended to examine prescribing patterns and more granular details of psychotropic drug initiation and discontinuation among geriatric psychiatry outpatients. The study intended to identify clinical patterns, unmet patient needs, trends, and opportunities to optimize clinical care and improve patient outcomes. The poster is a preliminary summary of identified trends. <h3>Methods</h3> As part of a quality improvement chart review project examining pharmacological treatments and clinical outcomes at two teaching geriatric psychiatry clinics, we set out to review the electronic medical records of one hundred patients seen in a geriatric psychiatry teaching service. Patients were selected if they were 65 years of age or older and had a minimum of six documented outpatient visits or visits spanning a minimum of six months. Data was collected for a maximum duration of twelve months. Data from any inpatient stays was excluded. Our dataset included basic demographic data such as age, sex, and marital status, as well as diagnoses, MMSE scores, and medications extracted from chart documentation at each clinic visit. <h3>Results</h3> At the point of this interim analysis, our population was 75.1 years old (+/- 8.6 years SD), 69% female, 41% widowed, 31% married, 28% single, 90% Caucasian, and had 14.1 ys of education (+/- 2.9 yrs SD). Common medical comorbidities included hypertension (72%), hyperlipidemia (62%), arrhythmias (24%), and 38% were being treated with an anticoagulant. The top three most commonly prescribed medication classes at baseline were: 1) Antidepressants (43%), followed by 2) Benzodiazepines (16%), 3) shared by two classes Antiepileptics/Lithium and Antipsychotics (13% each). The top three most commonly prescribed medications at baseline were: 1) mirtazapine (10%), 2) shared by two drugs, bupropion and quetiapine (7% each), and 3) escitalopram (6%). The reviewed patients had an average of 9 visits over an average 9 month long review period. When first seen at the clinic, patients were already taking an average of 2.6 psychotropic drugs. That number was 2.9 at the end of the followup period. Over the course of the review period, patients on average discontinued 1 drug and started 2 new ones, generating an average of 7.4 orders for medication initiation, discontinuation, or dose adjustments. <h3>Conclusions</h3> These preliminary chart review results reflect the challenges posed by the psychopharmacological management of elderly patients. Patients frequently arrive at our clinic following treatment failures or complications, and often on psychotropic polypharmacy. Due to fluctuations in patients' conditions and the need to titrate medications slowly, patients require numerous medications changes and dose adjustments, necessitating frequent visits. The clinic advises to minimize benzodiazepine use. Our data suggests that a significant proportion of patients (15%) come to our clinic while being treated with benzodiazepines, and our review suggests that in the short term efforts to wean them off their benzodiazepines are not successful. <h3>Secondary Rationale</h3> N/A <h3>This research was funded by</h3> No funding was obtained for this study.