Credit: (C) 2019, American Geriatrics Society
Data on the chronic use of opioids following spinal surgery, intensified treatment of high blood pressure after hospital discharge, and assessments of which frailty measures best predict poor outcomes following aortic heart valve replacement are among headline presentations at the American Geriatrics Society (AGS) 2019 Annual Scientific Meeting (#AGS19), held May 2-4 in Portland, Ore. Research reviewed at the prestigious #AGS19 Plenary Paper Session (Thurs., May 2, 9:30-10:15am PT) represents some of geriatrics’ most promising scholarship drawn from a pool of more than 1,000 submissions. This year’s highlights include:
* Spinal Surgery for Degenerative Spine Disease–Opioid Prescription Filing Patterns in Geriatric Patients (presented by Anthony V. Nguyen)
Degenerative spine disease (DSD), the medical term for a gradual deteriorating of the spine, is a common and often painful condition for older adults. Older people living with DSD often receive long-term prescriptions for opioids to help manage pain, but evidence suggests that chronic opioid use may play a considerable role in a range of health concerns. Nguyen and colleagues from the University of Texas Medical Branch in Galveston sought to describe patterns and predictors of opioid use among older adults undergoing spinal surgery for DSD. Assessing surgery and prescription pain management among more than 14,000 older adults who received opioid prescriptions following spinal surgery for DSD, the research team found that more than 7 percent of the study population continued filling their prescriptions one year after surgery. People who used benzodiazepines within the year prior to surgery, people eligible for Medicaid, people previously prescribed opioids pre-surgery, and patients undergoing multiple same-day procedures were among those most likely to use opioids for a prolonged period. Understanding the factors associated with chronic opioid use could aid in patient selection when considering spinal surgery, the researchers observed. They added that these findings underscore the urgent need to develop safer and more effective pain management approaches that improve quality of life and function for older adults living with degenerative spine disease.
* Clinical Outcomes of Intensifying Older Adults’ Antihypertensives at Hospital Discharge (presented by Timothy S. Anderson, MD, MAS, MA)
Temporarily elevated blood pressure can be common during hospitalization, even in people whose blood pressure is usually well-controlled. This condition may lead doctors to discharge older adults on “intensified” blood pressure medications. However, the safety of this practice is unknown and may risk unnecessary or overly intense treatment (sometimes called “overtreatment”). In their study, Dr. Anderson and colleagues from the University of California San Francisco and the San Francisco VA used national VA and Medicare data to examine the clinical outcomes of veterans who were discharged home from the hospital on intensified hypertension treatment. Thirty days after being discharged from the hospital, patients receiving intensified hypertension treatment had a significantly higher risk for readmission to the hospital and a significantly higher risk of experiencing medication-related “serious adverse events,” which include falls, syncope (fainting), and acute kidney injury. Interestingly given high blood pressure’s link to cardiovascular health, there was no reduction in patient’s blood pressure or readmission to the hospital for heart-related concerns one year after discharge among patients who received intensified antihypertensives at hospital discharge. According to the researchers, findings indicate that intensifying treatment for hypertension at hospital discharge may pose a greater risk with fewer benefits than previously imagined.
* Development of a Practical Two-Stage Frailty Assessment for Older Adults Undergoing Aortic Valve Replacement (presented by Anthony Maltagliati, MS)
Frailty, the medical term for the increasing weakness we may experience with age, is often linked to death and/or declines in function for older adults undergoing heart surgery. Maltagliati and colleagues committed to exploring a practical strategy to assess frailty for older adults undergoing procedures to replace aortic valves (one of the valves in your heart that plays a critical role in proper blood flow). Evaluating two types of procedures–surgical and transcatheter aortic valve replacement–among 246 patients, the researchers looked at how well several simple frailty tests (all administered in less than 3 minutes) helped accurately predict poor outcomes (defined as death or a declining ability to perform specific activities common to daily life) six months after aortic valve replacement. The researchers also explored whether a two-stage strategy that involved administering a more comprehensive geriatric assessment to those who tested positive for frailty with the simpler measure might also lead to improved care and treatment. Among the assessments evaluated, a “chair rise test” (a measure of frailty based on your ability to rise from a seated position) was particularly useful in evaluating patients irrespective of their aortic valve replacement procedure. Patients who tested positive for frailty with the chair rise test and also scored poorly on a more comprehensive follow-up assessment also exhibited poor health outcomes, suggesting the two-step strategy was sensitive both to identifying patients at risk for poor outcomes following aortic valve replacement and reliably predicting their functional trajectories. Maltagliati and colleagues hope their work will help identify patients at high risk for death or poor functional recovery following medical procedures like aortic valve replacement. They also hope their research will provide actionable data that geriatricians, as members of a heart team, can use to facilitate patient-centered decision making and individualized perioperative care.
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 more than 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 2-4, 2019 (pre-conference program on May 1), at the Oregon Convention Center in Portland, Ore., to advance geriatrics knowledge and skills through state-of-the-art educational sessions and research presentations. For more information, visit Meeting.AmericanGeriatrics.org.
Daniel E Trucil