Annals of Long Term Care

Excellent Early and Late Outcomes of Aortic Valve Replacement in People Aged 80 and Older

Farzan Filsoufi, MD, Parwis B. Rahmanian, MD, Javier G. Castillo, MD, Joanna Chikwe, MD, George Silvay, MD, PhD, and David H. Adams, MD

OBJECTIVES: To investigate early and late outcome of aortic valve replacement (AVR) in a large cohort of patients aged 80 and older.

DESIGN: Retrospective study of consecutive patients undergoing AVR using a computerized database based on the New York State Department of Health registry. Data collection was performed prospectively.

SETTING: University hospital (single institution).

PARTICIPANTS: One thousand three hundred eight patients undergoing AVR (231 (17.6%) aged ≥80, 1,077 (82.4%) <80).

MEASUREMENTS: Patient characteristics, hospital mortality, morbidity, length of stay and long-term survival were analyzed.

RESULTS: Subjects aged 80 and older were more likely to be female, had a lower body mass index, and presented significantly more often with comorbidities such as heart failure, renal failure, and extensive aortic calcification. Crude hospital mortality was 5.2% (n=12) in subjects age 80 and older, compared with 4.5% (n=48) in those younger than 80 (P=.37). Respiratory failure occurred more frequently in those aged 80 and older. In multivariate logistic regression analysis, age of 80 and older was not a predictor of hospital mortality. The median length of stay was significantly higher in those aged 80 and older than in those younger than 80 (10 days vs 7 days, P=.01). Five-year survival was 64±5% in those aged 80 and older, which was similar to that of the age- and sex-matched general U.S. population.

CONCLUSION: Excellent results after AVR can be expected in patients aged 80 and older, with minimal increase in postoperative mortality and acceptable postoperative morbidity. Respiratory failure is the main postoperative complication in patients aged 80 and older. Recent advances in operative techniques and perioperative management have contributed to better surgical outcomes in these patients than found in historical reports. J Am Geriatr Soc 2008;56(2):255-261.

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Efficacy of a Geriatrics Team Intervention for Residents in Dementia-Specific Assisted Living Facilities: Effect on Unanticipated Transitions

Sandra Bellantonio, MD, Anne M. Kenny, MD, Richard H. Fortinsky, PhD, Alison Kleppinger, MS, Julie Robison, PhD, Cynthia Gruman, PhD, Martin Kulldorff, PhD, and Patricia M. Trella, MS

OBJECTIVES: To determine whether a multidisciplinary team intervention minimizes unanticipated transitions from assisted living for persons with dementia.

DESIGN: Randomized trial.

SETTING: Two dementia-specific assisted living facilities in Connecticut owned and managed by the same corporation.

PARTICIPANTS: One hundred older adults with dementia who relocated to assisted living.

INTERVENTION: Four systematic multidisciplinary assessments by a geriatrician, geriatrics advanced practice nurse, physical therapist, dietitian, and social worker during the first 9 months of relocation to assisted living.

MEASUREMENTS: Permanent relocation to a nursing facility, emergency department (ED) visits, hospitalization, and death.

RESULTS: Fifty-five residents experienced any unanticipated transition out of assisted living, on average 84 ± 74 days after relocation; falls were the primary reason for transition. The intervention reduced the risk of any unanticipated transitions (13%), permanent relocation to a nursing facility (11%), ED visits (12%), hospitalization (45%), and death (63%), but the results did not meet statistical significance.