- Email: [email protected]
A pilot study comparing megestrol acetate concentrated suspension (MA-CS) and megestrol acetate oral suspension (MA-OS) on weight gain in patients with HIV-associated unintended weight loss (UWL)
Disclosures: All authors have stated that there are no disclosures to be made that are pertinent to this abstract.
End of life care for dementia patients
PALLIATIVE CARE & HOSPICE
Introduction/Objective: Caring for dementia patients and their families has particular challenges; grieving as the patient’s personality slips away, bizarre behaviors at times that can upset families, trying to understand how the end of life will look and what can done to best enhance quality of life. Design/Methodology: This is an outline to help providers and nursing staff help support and guide care of this challenging population. Results: 1 - Deciding Goals of Care - Best addressed when the individual is admitted to the facility. - Family meeting identifying ALL interested parties, including distant relatives. - Meeting can allow the primary caregiver not to be the solely responsible party. - What would the loved one want for themself if he/she could communicate? - What have they told you about their care with advanced dementia in the past? 2 - Educate the family on the natural progression of Dementia illness (below trimmed for type limits) 3 - Address issues of Hospital Care - Early on discuss the increased risks of distress and death in the hospital. - Medical Provider should, hopefully, give permission to family to address symptoms, not treat all diseases, if that would increase distress to the person with dementia (tricky area). “If the person is scared of the hospital, does not understand, and would be more distressed by being there; they should not have to go.” 4 - Hospice - Requirements to qualify for dementia are strict; must be at a FAST Level 7 5 - Comfort 6 - Positioning 7 - Bereavement - Starts early since loss of person they knew with dementia progression, variety of reactions; Guilt, Avoidance, Burn Out, Anger - Hospice Social Worker and Chaplain can support families Conclusion/Discussion: This approach has helped patients, facility staff and families enhance the quality of every day, focusing on what improves comfort and function today and not subjecting the loved one to interventions they fear and do not understand. Disclosures: Elizabeth A. Landsverk, MD is an employee and receives a salary from Vitas Hospice.
A pilot study comparing megestrol acetate concentrated suspension (MACS) and megestrol acetate oral suspension (MA-OS) on weight gain in patients with HIV-associated unintended weight loss (UWL) Presenting Author(s): Jodi L. Gutierrez, BA, Par Pharmaceutical, Inc. Author(s): Jodi L. Gutierrez, BA; Lynn D. Kramer, MD; Alan Kristensen, MS Introduction/Objective: Weight loss remains a common complication of HIV, especially in the developing world. MA-CS is a NanoCrystal® formulation of megestrol acetate that is bioavailable in the fasted state. Design/Methodology: 63 patients with HIV-associated UWL (90% of the lower limit of ideal body weight) from South Africa, India and the US were randomized to receive MA-CS (575 mg/5 mL) or MA-OS (800 mg/20 mL) qd po for 12 weeks in a randomized, open-label, multi-center, pilot study. Patients had weight, body composition, appetite (BACRI#5) and nutritional intake (24-hr recall) measured weekly. The sample size was determined empirically. Results: Demographics were comparable between the two groups. The mean weight change from baseline to Week 12 was 11.9 lbs (10% of baseline weight) and 7.7 lbs (6% of baseline weight) for MA-CS and MA–OS, respectively. Mean changes in weight relative to baseline (Wilcoxon Rank Sum) favoring MA-CS were observed as early as Day 3 (P ⫽ 0.024) and were present weekly thereafter. No increase in mean weight occurred until Week 2 for MA-OS. Lean body mass accounted for ⬃40% of the increase in both groups (MA-CS was 5% greater). Both groups showed comparable increases in mean triceps skin fold (⬃36%) at Week 12, suggesting an increase in subcutaneous fat. Appetite scores increased by ⬃30%, maximum caloric intake increased more for MA-CS (51%) than MA-OS (37%) and faster (Week 3 for MA-CS, Week 6 for MA-OS). Fat, protein, and carbohydrate intake increased; with protein intake greater in the MA-CS group (161% MA-CS vs. 115% MA-OS). The types and incidence rates of adverse events were similar between MA-CS and MA-OS. Conclusion/Discussion: Megestrol acetate is an effective intervention for HIV-associated weight loss, the new megestrol acetate concentrated suspension appears to produce favorable differences in regaining weight and lean body mass and improving caloric intake. Disclosures: Jodi L. Gutierrez, BA receives salary from, and is an employee of Par Pharmaceutical, Inc. Product(s) made by this company related to this talk: megestrol acetate, Megace ES. Ms. Gutierrez will discuss off-label use: megestrol acetate concentrated suspension (575mg/5mL) is a lower studied dose than the marketed product, Megace ES (625mg/5mL).
Presenting Author(s): Elizabeth A. Landsverk, MD, Vitas Hospice Author(s): Elizabeth A. Landsverk, MD
Evaluation of a staff support group on death and dying issues in the long term care setting
Causes of death in elderly nursing home residents
Presenting Author(s): Hadijatou J. Jarra, MD, Family and Community Medicine, Thomas Jefferson, Philadelphia, PA Author(s): Hadijatou J. Jarra, MD; Susan M. Parks, MD, CMD
Presenting Author(s): Todd H. Goldberg, MD, CMD, Albert Einstein Medical Center, Philadelphia, PA Author(s): Todd H. Goldberg, MD, CMD; Andres Botero, MD Alzheimer’s/dementia in 10 cases (37%), 7 cardiac/cerebrovascular, 4 hematologic/malignancies, 3 pulmonary, 1 ESRD, and 2 indeterminate/ miscellaneous causes in 66% of patients were on hospice and 92% had advance directives usually including a DNR/DNH order. None received resuscitation in the nursing home, and none had autopsies. Conclusion/Discussion: The single most common cause of death occurring within in the nursing home was advanced dementia. Most patients who die in the nursing home are appropriately on hospice care. Most patients with other diagnoses were sent out to the hospital when acutely ill or dying. However the true cause of death is often difficult to specify when patients have little workup and no autopsies. Disclosures: All authors have stated that there are no disclosures to be made that are pertinent to this abstract.
Introduction/Objective: Previous research has shown that jobs dealing with end of life care, such as hospice nursing, can be highly stressful resulting in burnout and emotional distress. Chandler Hall is non profit long term care facility that provides an array of programs to the elderly population including: assisted living, skilled nursing care, adult day health, and hospice care. A prior focus group study was completed at Chandler Hall, which identified key themes that would be used to improve cultural aspects in an existing end of life care program. Five constructs identified from the prior focus group were: view of elders; how dying people are cared for; description of dying experience; family experiences; and improving the end of life experience. Chandler Hall is now developing a staff centered support group focusing on death and dying including the five constructs identified in the previous focus groups. This study will aim to evaluate the effectiveness of the support groups by comparing pre-support group and post-support group questionnaires. The research study questions are: Can a staff centered support group focusing on death and dying improve staff comfort level around death and dying; Does a
B16
JAMDA – March 2007
End of life care for dementia patients
PALLIATIVE CARE & HOSPICE
Introduction/Objective: Caring for dementia patients and their families has particular challenges; grieving as the patient’s personality slips away, bizarre behaviors at times that can upset families, trying to understand how the end of life will look and what can done to best enhance quality of life. Design/Methodology: This is an outline to help providers and nursing staff help support and guide care of this challenging population. Results: 1 - Deciding Goals of Care - Best addressed when the individual is admitted to the facility. - Family meeting identifying ALL interested parties, including distant relatives. - Meeting can allow the primary caregiver not to be the solely responsible party. - What would the loved one want for themself if he/she could communicate? - What have they told you about their care with advanced dementia in the past? 2 - Educate the family on the natural progression of Dementia illness (below trimmed for type limits) 3 - Address issues of Hospital Care - Early on discuss the increased risks of distress and death in the hospital. - Medical Provider should, hopefully, give permission to family to address symptoms, not treat all diseases, if that would increase distress to the person with dementia (tricky area). “If the person is scared of the hospital, does not understand, and would be more distressed by being there; they should not have to go.” 4 - Hospice - Requirements to qualify for dementia are strict; must be at a FAST Level 7 5 - Comfort 6 - Positioning 7 - Bereavement - Starts early since loss of person they knew with dementia progression, variety of reactions; Guilt, Avoidance, Burn Out, Anger - Hospice Social Worker and Chaplain can support families Conclusion/Discussion: This approach has helped patients, facility staff and families enhance the quality of every day, focusing on what improves comfort and function today and not subjecting the loved one to interventions they fear and do not understand. Disclosures: Elizabeth A. Landsverk, MD is an employee and receives a salary from Vitas Hospice.
A pilot study comparing megestrol acetate concentrated suspension (MACS) and megestrol acetate oral suspension (MA-OS) on weight gain in patients with HIV-associated unintended weight loss (UWL) Presenting Author(s): Jodi L. Gutierrez, BA, Par Pharmaceutical, Inc. Author(s): Jodi L. Gutierrez, BA; Lynn D. Kramer, MD; Alan Kristensen, MS Introduction/Objective: Weight loss remains a common complication of HIV, especially in the developing world. MA-CS is a NanoCrystal® formulation of megestrol acetate that is bioavailable in the fasted state. Design/Methodology: 63 patients with HIV-associated UWL (90% of the lower limit of ideal body weight) from South Africa, India and the US were randomized to receive MA-CS (575 mg/5 mL) or MA-OS (800 mg/20 mL) qd po for 12 weeks in a randomized, open-label, multi-center, pilot study. Patients had weight, body composition, appetite (BACRI#5) and nutritional intake (24-hr recall) measured weekly. The sample size was determined empirically. Results: Demographics were comparable between the two groups. The mean weight change from baseline to Week 12 was 11.9 lbs (10% of baseline weight) and 7.7 lbs (6% of baseline weight) for MA-CS and MA–OS, respectively. Mean changes in weight relative to baseline (Wilcoxon Rank Sum) favoring MA-CS were observed as early as Day 3 (P ⫽ 0.024) and were present weekly thereafter. No increase in mean weight occurred until Week 2 for MA-OS. Lean body mass accounted for ⬃40% of the increase in both groups (MA-CS was 5% greater). Both groups showed comparable increases in mean triceps skin fold (⬃36%) at Week 12, suggesting an increase in subcutaneous fat. Appetite scores increased by ⬃30%, maximum caloric intake increased more for MA-CS (51%) than MA-OS (37%) and faster (Week 3 for MA-CS, Week 6 for MA-OS). Fat, protein, and carbohydrate intake increased; with protein intake greater in the MA-CS group (161% MA-CS vs. 115% MA-OS). The types and incidence rates of adverse events were similar between MA-CS and MA-OS. Conclusion/Discussion: Megestrol acetate is an effective intervention for HIV-associated weight loss, the new megestrol acetate concentrated suspension appears to produce favorable differences in regaining weight and lean body mass and improving caloric intake. Disclosures: Jodi L. Gutierrez, BA receives salary from, and is an employee of Par Pharmaceutical, Inc. Product(s) made by this company related to this talk: megestrol acetate, Megace ES. Ms. Gutierrez will discuss off-label use: megestrol acetate concentrated suspension (575mg/5mL) is a lower studied dose than the marketed product, Megace ES (625mg/5mL).
Presenting Author(s): Elizabeth A. Landsverk, MD, Vitas Hospice Author(s): Elizabeth A. Landsverk, MD
Evaluation of a staff support group on death and dying issues in the long term care setting
Causes of death in elderly nursing home residents
Presenting Author(s): Hadijatou J. Jarra, MD, Family and Community Medicine, Thomas Jefferson, Philadelphia, PA Author(s): Hadijatou J. Jarra, MD; Susan M. Parks, MD, CMD
Presenting Author(s): Todd H. Goldberg, MD, CMD, Albert Einstein Medical Center, Philadelphia, PA Author(s): Todd H. Goldberg, MD, CMD; Andres Botero, MD Alzheimer’s/dementia in 10 cases (37%), 7 cardiac/cerebrovascular, 4 hematologic/malignancies, 3 pulmonary, 1 ESRD, and 2 indeterminate/ miscellaneous causes in 66% of patients were on hospice and 92% had advance directives usually including a DNR/DNH order. None received resuscitation in the nursing home, and none had autopsies. Conclusion/Discussion: The single most common cause of death occurring within in the nursing home was advanced dementia. Most patients who die in the nursing home are appropriately on hospice care. Most patients with other diagnoses were sent out to the hospital when acutely ill or dying. However the true cause of death is often difficult to specify when patients have little workup and no autopsies. Disclosures: All authors have stated that there are no disclosures to be made that are pertinent to this abstract.
Introduction/Objective: Previous research has shown that jobs dealing with end of life care, such as hospice nursing, can be highly stressful resulting in burnout and emotional distress. Chandler Hall is non profit long term care facility that provides an array of programs to the elderly population including: assisted living, skilled nursing care, adult day health, and hospice care. A prior focus group study was completed at Chandler Hall, which identified key themes that would be used to improve cultural aspects in an existing end of life care program. Five constructs identified from the prior focus group were: view of elders; how dying people are cared for; description of dying experience; family experiences; and improving the end of life experience. Chandler Hall is now developing a staff centered support group focusing on death and dying including the five constructs identified in the previous focus groups. This study will aim to evaluate the effectiveness of the support groups by comparing pre-support group and post-support group questionnaires. The research study questions are: Can a staff centered support group focusing on death and dying improve staff comfort level around death and dying; Does a
B16
JAMDA – March 2007