Top Presentations at #AGS18 Address Barriers to Advance Care Planning, Osteoporosis Screening, Links Between Hypertension Treatment & Falls

Presentations at the prestigious Plenary Paper Session at the American Geriatrics Society (AGS) 2018 Annual Scientific Meeting (#AGS18) in Orlando, FL, this past May represented some of geriatrics’ most promising scholarship as assessed by peer experts and program planners from a pool of more than 1000 abstract submissions—the most in AGS history. This year’s highlights included the research noted below:

Correctional Clinicians’ Perspectives on Barriers to ACP

Prisoners are among our nation’s most rapidly aging vulnerable patient populations, but very little research has sought to understand their health care needs. The resulting lack of evidence extends to Advance Care Planning (ACP), or the process of engaging with health professionals, family, and friends to plan for future health care decisions. To address this knowledge gap, researchers investigated perspectives on barriers to ACP in prison among 24 correctional clinicians in different parts of the United States. The researchers found that many correctional clinicians voiced discomfort engaging in ACP in the prison setting and that misconceptions about ACP were common, including that it was only for patients at the very end of life or that it did not require patient participation. They also reported unique barriers to engaging in ACP, including profound patient mistrust and obstructive institutional policies. According to the researchers, their findings suggest that many correctional clinicians would benefit from additional training and that system-level changes are needed to adapt existing ACP programs to correctional settings.

Age Threshold for Primary Osteoporosis Screening in Men

Osteoporosis poses a significant but often silent threat to men, too few of whom recognize the disease or risk indicators. Clinical practice guidelines also vary regarding instructions for osteoporosis screenings. Researchers used data from the Centers for Medicare & Medicaid Services and the US Department of Veterans Affairs to look critically at osteoporosis screenings and bone fracture cases among men between ages 65 and 99. Of more than 183,000 men screened for osteoporosis, 18% were older than 80. For these individuals, screenings were associated with a 15% lower risk for fractures compared to the risk for the rest of the older male population. Findings not only support universal osteoporosis screenings for all men older than 85 but also suggest that men as young as 65 may benefit from diagnostic evaluation when certain risk factors are present.

Antihypertensive Drug De-Intensification and Recurrent Falls

An increased risk for falls is a concern for older adults who pursue “aggressive” targets for lowering high blood pressure. Little is known, however, about links between recurrent falls and less stringent blood pressure targets pursued through de-intensified blood pressure treatment. To explore that connection, researchers looked at data from American veterans older than 65 who had hypertension and were treated with 1 or more of 5 commonly-used classes of medication. The researchers looked specifically at veterans who fell 3 days or fewer after a systolic blood pressure (SBP) reading of 101 to 120 mm Hg or 80 to 100 mm Hg, suggesting aggressive blood pressure control. The researchers then looked at whether the person’s treatment had been de-intensified (ie, decreasing the dose or discontinuing a medication). The researchers then compared the 30-day risk for another fall among veterans who did and did not have their high blood pressure treatment de-intensified. The 30-day subsequent fall risk was lower in some but not all people with de-intensified blood pressure control. Among Virginia nursing home residents who had a fall and a low SBP, between 25% and 34% had their hypertension treatment de-intensified. Among these, individuals with the lower blood pressure levels had a significantly lower risk for falling again within 30 days of their first fall.

For more information on these and the more than 100 other events and presentations at #AGS18, visit:
Meeting.AmericanGeriatrics.org or GeriatricsCareOnline.org. 

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