Potentially inappropriate medications, the future of Advance Care Planning (ACP), and improved emergency care for older adults are among headline presentations anchoring the American Geriatrics Society (AGS) 2017 Annual Scientific Meeting (#AGS17), to be held May 18-20 in San Antonio, Texas.
Presentations at the prestigious Plenary Paper Session at #AGS17 (May 18 from 10-11am Central Time) represent some of geriatrics' most promising scholarship as assessed by peer experts and program planners from a pool of more than 800 abstract submissions. This year's highlights include:
D-PRESCRIBE Overtakes EMPOWER in Patient-Centered Deprescribing of Benzodiazepines: Preliminary Results from a Pragmatic Cluster-Randomized Community-Based Trial in Canada (presented by Phillipe Martin, MSc)
As we age, more and more of us are living with multiple chronic conditions and using multiple medications as part of our treatment plans. But changes in our bodies over time can increase the likelihood that we will experience side effects or adverse reactions. "Potentially inappropriate medications" are those that may come with higher risks with age, warranting careful consideration because of the unique risks they may pose for older adults. Efforts to reduce reliance on potentially inappropriate medications rank high on the list of priorities for geriatrics healthcare professionals. In this study, researchers from Canada report on an innovative approach to deprescribing that combined tools for healthcare providers as well as education for older adults to help discontinue chronic use of benzodiazepine, a type of medication sometimes used to treat insomnia, agitation, or delirium. In the "D-PRESCRIBE" clinical trial, pharmacists in Montreal provided an evidence-based pharmaceutical opinion discouraging benzodiazepine use to physicians who prescribed benzodiazepines to older adults (older adults also were provided with an educational brochure). D-PRESCRIBE results were then compared to those from an existing program (known as "EMPOWER") that involved educating older adults using a brochure. More than 80 percent of participants in the D-PRESCRIBE group (versus just 62 percent of older adults in EMPOWER) initiated a conversation about discontinuing their benzodiazepine prescription. Over the course of the study, the D-PRESCRIBE intervention was twice as likely to result in the discontinuation of benzodiazepine compared to an intervention that relied on public education alone.
A Patient-Facing Advance Care Planning (ACP) Website Called PREPARE Increases ACP Documentation and Engagement in a Randomized Trial of Diverse Older Primary Care Patients (presented by Rebecca Sudore, MD)
ACP is a comprehensive, ongoing, person-centered approach to communication about future healthcare choices. After years of advocacy, the service was first recognized as a benefit for older adults using Medicare beginning in 2017. ACP has a proven track record for improving the quality and respectfulness of care, but experts still need to learn more about best practices for working with older adults and caregivers when it comes to medical decision-making. In this study, researcher from the University of California, San Francisco, and the San Francisco VA Medical Center report on promising results from a randomized trial of an interactive, video-based ACP website and an easy-to-use advance directives. Both PREPARE and the easy-to-read advance directive increased ACP documentation in the medical record at 6 months. However, the PREPARE group had significantly greater documentation as well as self-reported engagement in ACP by older adults.
Telephone Follow-Up for Older Adults Discharged to Home from the Emergency Department: A Randomized Controlled Trial (presented by Kevin Biese, MD, MAT)
The Emergency Department (ED) is often referred to as the "front porch" of healthcare since many of us–including older adults — now enter the health system beginning with a visit to the ED. Reducing the need to return to the ED is a key goal when caring for older adults, and follow-up telephone calls have been one approach. In this study, researchers in North Carolina worked to pin-point the effectiveness of these calls by assessing how well a scripted phone call with a registered nurse reduced the likelihood for readmission among older adults recently discharged from the ED. From a study sample of more than 11,800 older adults, 2,000 individuals who had been cared for in an ED received a phone call that addressed everything from orders for medication to following post-discharge instructions and addressing follow-up issues. Interestingly, these phone calls did not reduce readmission rates or mortality within 30 days. The study suggests that more work must be done to identify effective solutions for improving ED care.
With more and more of us living longer, providing high-quality, cost-effective health care now and in the future will be imperative. #AGS17 stands at the crossroads between a growing demand for expert health professionals and the need for innovation supporting the health, safety, and independence of us all as we age. More information on the #AGS17 program and registration (free to members of the media) is available at AmericanGeriatrics.org.
About the American Geriatrics Society
Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has — for 75 years — worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.
About the AGS Annual Scientific Meeting
The AGS Annual Scientific Meeting is the premier educational event in geriatrics, providing the latest information on clinical care, research on aging, and innovative models of care delivery. More than 2,500 nurses, pharmacists, physicians, physician assistants, social workers, long-term care and managed care providers, healthcare administrators, and others will convene May 18-20, 2017 (pre-conference program on May 17), at the Henry B. Gonzalez Convention Center in San Antonio, Texas, to advance geriatrics knowledge and skills through state-of-the-art educational sessions and research presentations. For more information, visit AmericanGeriatrics.org.
Daniel E. Trucil