Abstract Session A2: Aging/Geriatrics/End of Life Moderator: Daniel Matlock, MD, MPH Discussant: Catherine Sarkisian, MD, MSPH, SGIM 2014 Distinguished Professor in Geriatrics LOOKING BEYOND THE PROSTATE: DETERMINANTS AND IMPACT OF NOCTURIA IN MIDDLE-AGED AND OLDER WOMEN Amy Hsu 1 ; Sanae Nakagawa 2 ; Louise Walter 1 ; Stephen K. Van Den Eeden 3 ; Jeanette S. Brown 2 ; David Thom 2 ; Sei Lee 1 ; Alison J. Huang 2 . 1 San Francisco VA Medical Center, San Francisco, CA; 2 University of California San Francisco, San, CA; 3 Kaiser Permanente Division of Research, San, CA. (Tracking ID #1926776) BACKGROUND: Nocturia is a common complaint in middle-aged and older adults presenting to primary care, and is linked to poor sleep quality, decreased mental and somatic health, falls and fractures. Among older men, nocturia is widely considered to be a consequence of prostate-related outflow obstruction. In contrast, the determinants of nocturia in older women are poorly understood and little is known about why some women suffer from nocturia but not others. METHODS: We conducted a cross-sectional study of 2016 community-dwelling women, aged 41 to 83 years, from four racial/ethnic groups (White, Black, Asian and Latina), and enrolled in a group health delivery plan in Northern California. During home-based study visits, interviewers asked women about nocturnal voiding frequency, as well as bother and interference associated with this symptom. Other participant characteristics were examined by questionnaire, medical record abstraction, or physical examination and performance testing. Multivariable models were developed to assess for factors associated with nocturia, defined as waking two or more times to void at night. Potential predictors included demographics, gynecologic history, chronic medical conditions, medication use, and physical and mental functional status. RESULTS: Of the 2016 participants, mean (SD) age was 56 (9) years, and over half were racial or ethnic minorities (22% Black, 20% Asian, 23% Latina). Thirty-four percent reported waking to urinate at least two times per night, and 15% reported waking to urinate at least four times per night. Of those with nocturia, 39% reported being at least "moderately" bothered by this symptom, and 15% reported that nocturia affected their day-to-day activities. Factors associated with nocturia in multivariable analysis included older age (OR 1.18, CI: 1.10-1.27 per 5 year increase), Black race (OR 1.86, CI: 1.39-2.50), Latina ethnicity (OR 1.36, CI: 1.02- 1.83), hysterectomy (OR 1.85, CI: 1.13-3.05), vaginal estrogen use (OR 1.48, CI: 1.02-2.14), decreased mobility (OR 1.29, CI: 1.05-1.58 per 5-second increase in the Timed Up and Go test), and depression (OR 1.09, CI: 1.05-1.13 per 1-point increase on the Hospital Anxiety and Depression Scale score). The strongest predictor of being bothered by nocturia was greater frequency of nocturia (OR 2.63, CI: 2.08-3.31 per each additional nocturnal voiding episode), although 26% of women who voided 4 or more times per night were only "slightly" or not at all bothered by this symptom. CONCLUSIONS: Over a third of middle-aged and older community-dwelling women experience nocturia, and nearly 40% of those with nocturia are significantly distressed by it. A variety of demographic, gynecologic, and geriatric factors are associated with nocturia in women, which suggests that a comprehensive evaluation of the patient is necessary to evaluate the risk for nocturia and tailor management to the individual.
ANTIBIOTIC SUSCEPTIBILITIES OF URINARY ISOLATES IN OLDER ADULTS Theresa A. Rowe; Lee Lindquist; Abel Kho. Northwestern University Feinberg School of Medicine, Chicago, IL. (Tracking ID #1927517) BACKGROUND: Background: Older adults are at an increased risk for development of multi-drug resistant organisms because of compounded exposure to antibiotics. Clinicians empirically treat suspected urinary tract infections (UTI) in older adults, selecting antibiotics based on guidelines intended for younger patients. No prior studies have examined whether there are age-related differences in UTI antibiotic susceptibility. We sought to identify antibiotic susceptibility patterns of urinary isolates in outpatient older adults and compare them to younger patients over a 3-year period. METHODS: Retrospective analysis of all adult outpatients with a positive urine culture who received antibiotic treatment for UTI within 3 days. The most common organisms Escherichia Coli (E. Coli) and Klebsiella spp. were tested for resistance to commonly prescribed antibiotics. We compared resistance patterns of adults over the age of 65 to younger adults under the age of 65 using descriptive statistics and chi square analysis. RESULTS: Urine cultures from 8,659 patients were reviewed. For E.Coli the percentage of resistance for adults ≥ 65, compared to adults < 65 were: Ciprofloxacin (31.97% in 65 years and older patients vs. 16.85% in under 65 year old patients; p <0.01), Trimethoprim/Sulfamethoxazole (30.12% vs 25.19%; p <0.01), Ampicillin/Sulbactam (19.47% vs 19.36%), Cefuroxime (5.27% vs 4.23%; p<0.05), Nitrofurantoin (1.80% vs 1.47%). For the second most common organism, Klebsiella species: Ciprofloxacin (5.28% vs 4.99%), Trimethroprim/Sulfamethoxazole (12.61% vs 13.59%), Ampicillin/Sulbactam (6.88% vs 12.85%; p<0.01), Cefuroxime (6.39% vs 7.91%), Nitrofurantoin (26.28% vs 24.36%) CONCLUSIONS: Older adults with UTIs have different resistance patterns to microorganisms when compared to younger patients. Current clinical guidelines for treatment may not reflect these differences. Clinicians need to be aware of the resistance patterns unique to older adults so that they can be appropriately treated
IS STRENGTH TRAINING ASSOCIATED WITH MORTALITY BENEFITS? A 15 YEAR COHORT STUDY OF US OLDER ADULTS. Christopher Sciamanna; Jennifer Kraschnewski; Liza S. Rovniak; Erik B. Lehman. Penn State Hershey, Hershey, PA. (Tracking ID #1936358) BACKGROUND: Guideline-concordant aerobic activity has consistent and powerful relationships with future mortality. Specific recommendations regarding strength training have come only more recently; in 2007 the American Heart Association (AHA) and American College of Sports Medicine (ACSM) recommended all adults participate in such activities at least twice each week. Although several smaller clinical studies have observed that greater amounts of muscle strength are associated with lower risks of death, few have studied the relationship between strength training behavior and mortality in a large national sample over an extended time period. We undertook this investigation to understand the association between meeting strength training guidelines and future mortality. METHODS: Data from the 1997-2001 National Health Interview Survey (NHIS), linked to death certificate data found in the National Death Index, were analyzed. The main independent variable, guideline-concordant strength training, was assessed using the following question: "How often do you do leisure-time physical activities specifically designed to strengthen your muscles, such as lifting weight or doing calisthenics?" Responses were categorized to signify whether the individual performed these activities at least twice each week, consistent with guidelines. Covariates included demographics variables, past medical history (i.e. diabetes, hypertension, coronary artery disease, and non-skin cancer), and other health behaviors (i.e. body mass index, physical activity, alcohol use and smoking status), consistent with variables shown to be associated with strength training in other studies. Analysis was limited to adults of 65 years or older. Mutlitivariate analysis was conducted using multiple logistic regression analysis, with the dependent variable being all-cause mortality. RESULTS: Overall, 9.6% of NHIS adults age 65 and older (N=30,162) reported doing strength training consistent with guidelines and 31.6% died during the follow-up period. After adjusting for demographic covariates, those who reported guideline-concordant strength training had 46% lower odds of all-cause mortality than those who did not (adjusted odds ratio: 0.64; 95% CI: 0.57, 0.70; p<0.001). This association remained when adjusting for past medical history and health behaviors. CONCLUSIONS: Guideline-concordant strength training is significantly associated with decreased overall mortality in older US adults. Unfortunately, only a minority of adults currently meet recommendations of strength training at least twice each week. This suggests we are far from engaging patients in the "Exercise is Medicine" campaign launched by the AHA/ACSM, where doctors are encouraged to recommend physical activity to patients as they would any other effective treatment. Identifying interventions to successfully engage older adults in guideline-concordant strength training has the potential to significantly reduce all-cause mortality in this population.
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