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DETERMINING PREVALENCE OF SUBSTANCE USE DISORDER IN THE GERIATRIC POPULATION DURING CONSULT SERVICES
AAGP Annual Meeting 2019
Poster Number: LB - 14
A POST HOC ANALYSIS OF STUDY ACP-103-019 EVALUATING THE IMPACT OF A REDUCTION IN PSYCHOSIS ON THE SEVERITY OF AGITATION AND AGGRESSION IN PATIENTS WITH ALZHEIMER’S DISEASE Michael Guskey1; James Norton1; Bruce Coate1; Randy Owen1; Srdjan Stankovic1; Clive Ballard2 1
ACADIA Pharmaceuticals University of Exeter
2
Introduction: The objective of this post hoc analysis was to evaluate whether Alzheimer’s disease (AD) patients with psychosis who experience an improvement in their hallucinations and delusions with pimavanserin treatment also experience an improvement in agitation and aggression. Methods: ACP-103-019 was a 12 week, randomized, double-blind, placebo-controlled study that evaluated the efficacy of pimavanserin (PIM) 34mg once-daily in reducing the frequency and/or severity of hallucinations and delusions in patients with AD psychosis. The primary endpoint was change from baseline in the Neuropsychiatric Inventory Nursing Home Version Psychosis Score (NPI-NH PS) [domain A (delusions) + domain B (hallucinations)] at Week 6. A post hoc analysis was conducted to determine if there was a greater reduction in agitation and aggression, as measured by NPI-NH Domain C (agitation/aggression) and Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF), in patients who experienced a reduction in the frequency and/or severity of their hallucinations and delusions when compared with those who did not experience a reduction in hallucinations and delusions. Results: Overall in ACP-103-019, there were only minor differences between the placebo (n=91) and PIM (n=87) treatment arms when evaluating changes from baseline to Week 6 in Agitation/Aggression based on CMAI SF total score or NPI-NH Domain C score (0.30 [p=0.8031] and -0.66 [p=0.254], respectively). However, when subjects treated with PIM who responded to the treatment (n=48), defined as a 30% reduction in NPI-NH PS at Week 6, were compared with those who did not respond to PIM treatment (n=28), there was a greater reduction in both CMAI-SF and NPI-NH Domain C scores: -3.74 (p=0.0550) and -2.75 (p=0.0021), respectively. When response was defined as a 50% reduction in NPI-NH PS at Week 6, the greater improvement of agitation/aggression in responders (n=44) vs non-responders (n=32) was also observed for both CMAI-SF and NPI-NH Domain C: -3.714 (p=0.0483) and -3.64 (p<.0001), respectively. In addition, when patients with symptoms of agitation/aggression at baseline (defined as NPI-NH Domain C ≥6) were evaluated, there was also a greater improvement in agitation/aggression in patients who responded to PIM over those who did not. Conclusions: In this post-hoc analysis, some AD patients whose hallucinations and delusions responded to pimavanserin also experienced improvement in their symptoms of agitation and aggression. These results suggest a correlation between a reduction in hallucinations and delusions and a reduction in agitation/aggression in AD patients with psychosis. This research was funded by: Sponsored by ACADIA Pharmaceuticals Inc. (San Diego, CA, USA). Poster Number: LB - 15
DETERMINING PREVALENCE OF SUBSTANCE USE DISORDER IN THE GERIATRIC POPULATION DURING CONSULT SERVICES Sehba Husain-Krautter
Delaware Psychiatric Center
Am J Geriatr Psychiatry 27:3S, March 2019
S175
AAGP Annual Meeting 2019 Introduction: Objective: To determine the prevalence of substance use disorders (SUDs) in the geriatric population referred to the addiction consult and liaison services over a 6-month period, from July 2018 to December 2018. Methods: Method: All referrals during the 6-month will be reviewed and individuals aged ≥ 65 on the day of admission will be included in the study. Results: Preliminary results show that out of the 412 referral charts reviewed this far, the geriatric population makes up roughly 19% of the total referrals. Amongst that cohort, the most common substances being used are alcohol, benzodiazepines and opioids with a prevalence rate of 33.8 %, 13.9%, and 6.8% respectively. Conclusions: While alcohol remains the most common substance being used, the increasing number of elderly with opioid use disorder is following earlier trends in younger populations. Our results document the growing trend in this vulnerable population, and we hope that our data will aid towards increasing awareness of SUDs in older adults
Poster Number: LB - 16
POISONING DEATHS AMONG LATE-MIDDLE AGED AND OLDER ADULTS: COMPARISON BETWEEN SUICIDES AND DEATHS OF UNDETERMINED INTENT Namkee Choi1; Diana DiNitto1; C. Nathan Marti1; Bryan Choi2 1
University of Texas at Austin Brown University
2
Introduction: In violent deaths, forensic autopsy is often regarded as the means for making the final medical diagnosis of the cause and manner of death; however, without other corroborative evidence (e.g., suicide note, prior history of suicide attempt/ intent disclosure), drug intoxication and other poisoning deaths, especially among individuals with pre-existing substance use and/or mental health problems, pose challenges in determining the intent/manner of death. Given the rapid increase in prescription and illicit drug poisoning deaths in the 50+ age group, we examined precipitating/risk factors and toxicology results associated with poisoning deaths classified as suicides compared to intent-undetermined death (UnD) among decedents aged 50+. Methods: The National Violent Death Reporting System, 2005-2015, provided data. The 2005-2015 NVDRS contained 56,118 suicide decedents and 7,752 UnDs aged 50+. Of these 50+-year olds’ deaths, poisoning deaths were 18.5% (N=10,363) of suicides and 65.7% (N=5,090) of UnDs. The present study focused on these 15,453 poisoning decedents and stratified them into three groups—suicide decedents who left a suicide note, suicide decedents who did not leave a note, and decedents classified as UnD. Following descriptive statistics using x2 tests, multinomial logistic regression models were used to test study hypotheses (associations of intent/manner of death with precipitating/risk factors and positive toxicologies) controlling for incident year (time), state, and demographic variables. We chose suicide decedents who did not leave a suicide note as the baseline comparison group to better examine potential differences and similarities between them and UnDs. Results: Of all poisoning deaths, 29.4% were classified as suicide decedents who left a note, 37.7% as suicides without a note, and 32.9% as UnDs. Of all NVDRS participating states, Maryland and Utah had the highest proportions of all poisoning deaths (82.8% and 58.9%, respectively) and the highest numbers of UnDs (52.5% of all UnDs in this study). We also found that of all states, Maryland had the highest proportion of Black decedents (34.6% of both poisoning suicides and UnDs). Analysis of time trend showed that the proportions of UnD cases in 2005 and 2015 were 36.5% and 30.0%, respectively, with a generally declining trend over the 11-year period. Multinomial logistic regression analysis showed that compared to suicide decedents without a note, those with a note were more likely to have been depressed and had physical health problems and other life stressors, while UnD cases were less likely to have had mental health problems and other life stressors but more likely to have had substance use and health problems. UnD cases were also more likely to be opioid (RRR=2.65, 95% CI=2.42-2.90) and cocaine (RRR=2.59, 95% CI=2.09-3.21) positive but less likely to be antidepressant positive (RRR=0.79, 95% CI=0.72-0.87). Those who left a note were older and more likely to be non-Hispanic White, but Blacks were more than twice as likely as nonHispanic Whites to be UnDs. Gender was not a significant factor. Results from separate regression models in the highest UnD states (Maryland and Utah) and in states other than Maryland/Utah were similar. Conclusions: The finding that UnDs had a higher likelihood of substance use problems and positive opioid and cocaine toxicology results suggests that their substance use/abuse was largely and directly responsible for their death. We could not compare UnDs to accidental overdose deaths, as the NVDRS does not include the latter, but such research among middle-aged and older adults is needed as many UnDs may be more correctly classified as unintentional overdose deaths. The extremely high UnD rates in Maryland and Utah are also likely reflections of the opioid epidemic that has raged in these two states. The study limitations were that as data on precipitating circumstances were largely collected from decedents’ informal support systems, the validity of these proxy-derived data is a concern as is incomplete/unknown data, and substantial numbers of toxicology-tested decedents had missing test results. However, the findings show that along with more accurate determination processes for intent/
S176
Am J Geriatr Psychiatry 27:3S, March 2019
Poster Number: LB - 14
A POST HOC ANALYSIS OF STUDY ACP-103-019 EVALUATING THE IMPACT OF A REDUCTION IN PSYCHOSIS ON THE SEVERITY OF AGITATION AND AGGRESSION IN PATIENTS WITH ALZHEIMER’S DISEASE Michael Guskey1; James Norton1; Bruce Coate1; Randy Owen1; Srdjan Stankovic1; Clive Ballard2 1
ACADIA Pharmaceuticals University of Exeter
2
Introduction: The objective of this post hoc analysis was to evaluate whether Alzheimer’s disease (AD) patients with psychosis who experience an improvement in their hallucinations and delusions with pimavanserin treatment also experience an improvement in agitation and aggression. Methods: ACP-103-019 was a 12 week, randomized, double-blind, placebo-controlled study that evaluated the efficacy of pimavanserin (PIM) 34mg once-daily in reducing the frequency and/or severity of hallucinations and delusions in patients with AD psychosis. The primary endpoint was change from baseline in the Neuropsychiatric Inventory Nursing Home Version Psychosis Score (NPI-NH PS) [domain A (delusions) + domain B (hallucinations)] at Week 6. A post hoc analysis was conducted to determine if there was a greater reduction in agitation and aggression, as measured by NPI-NH Domain C (agitation/aggression) and Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF), in patients who experienced a reduction in the frequency and/or severity of their hallucinations and delusions when compared with those who did not experience a reduction in hallucinations and delusions. Results: Overall in ACP-103-019, there were only minor differences between the placebo (n=91) and PIM (n=87) treatment arms when evaluating changes from baseline to Week 6 in Agitation/Aggression based on CMAI SF total score or NPI-NH Domain C score (0.30 [p=0.8031] and -0.66 [p=0.254], respectively). However, when subjects treated with PIM who responded to the treatment (n=48), defined as a 30% reduction in NPI-NH PS at Week 6, were compared with those who did not respond to PIM treatment (n=28), there was a greater reduction in both CMAI-SF and NPI-NH Domain C scores: -3.74 (p=0.0550) and -2.75 (p=0.0021), respectively. When response was defined as a 50% reduction in NPI-NH PS at Week 6, the greater improvement of agitation/aggression in responders (n=44) vs non-responders (n=32) was also observed for both CMAI-SF and NPI-NH Domain C: -3.714 (p=0.0483) and -3.64 (p<.0001), respectively. In addition, when patients with symptoms of agitation/aggression at baseline (defined as NPI-NH Domain C ≥6) were evaluated, there was also a greater improvement in agitation/aggression in patients who responded to PIM over those who did not. Conclusions: In this post-hoc analysis, some AD patients whose hallucinations and delusions responded to pimavanserin also experienced improvement in their symptoms of agitation and aggression. These results suggest a correlation between a reduction in hallucinations and delusions and a reduction in agitation/aggression in AD patients with psychosis. This research was funded by: Sponsored by ACADIA Pharmaceuticals Inc. (San Diego, CA, USA). Poster Number: LB - 15
DETERMINING PREVALENCE OF SUBSTANCE USE DISORDER IN THE GERIATRIC POPULATION DURING CONSULT SERVICES Sehba Husain-Krautter
Delaware Psychiatric Center
Am J Geriatr Psychiatry 27:3S, March 2019
S175
AAGP Annual Meeting 2019 Introduction: Objective: To determine the prevalence of substance use disorders (SUDs) in the geriatric population referred to the addiction consult and liaison services over a 6-month period, from July 2018 to December 2018. Methods: Method: All referrals during the 6-month will be reviewed and individuals aged ≥ 65 on the day of admission will be included in the study. Results: Preliminary results show that out of the 412 referral charts reviewed this far, the geriatric population makes up roughly 19% of the total referrals. Amongst that cohort, the most common substances being used are alcohol, benzodiazepines and opioids with a prevalence rate of 33.8 %, 13.9%, and 6.8% respectively. Conclusions: While alcohol remains the most common substance being used, the increasing number of elderly with opioid use disorder is following earlier trends in younger populations. Our results document the growing trend in this vulnerable population, and we hope that our data will aid towards increasing awareness of SUDs in older adults
Poster Number: LB - 16
POISONING DEATHS AMONG LATE-MIDDLE AGED AND OLDER ADULTS: COMPARISON BETWEEN SUICIDES AND DEATHS OF UNDETERMINED INTENT Namkee Choi1; Diana DiNitto1; C. Nathan Marti1; Bryan Choi2 1
University of Texas at Austin Brown University
2
Introduction: In violent deaths, forensic autopsy is often regarded as the means for making the final medical diagnosis of the cause and manner of death; however, without other corroborative evidence (e.g., suicide note, prior history of suicide attempt/ intent disclosure), drug intoxication and other poisoning deaths, especially among individuals with pre-existing substance use and/or mental health problems, pose challenges in determining the intent/manner of death. Given the rapid increase in prescription and illicit drug poisoning deaths in the 50+ age group, we examined precipitating/risk factors and toxicology results associated with poisoning deaths classified as suicides compared to intent-undetermined death (UnD) among decedents aged 50+. Methods: The National Violent Death Reporting System, 2005-2015, provided data. The 2005-2015 NVDRS contained 56,118 suicide decedents and 7,752 UnDs aged 50+. Of these 50+-year olds’ deaths, poisoning deaths were 18.5% (N=10,363) of suicides and 65.7% (N=5,090) of UnDs. The present study focused on these 15,453 poisoning decedents and stratified them into three groups—suicide decedents who left a suicide note, suicide decedents who did not leave a note, and decedents classified as UnD. Following descriptive statistics using x2 tests, multinomial logistic regression models were used to test study hypotheses (associations of intent/manner of death with precipitating/risk factors and positive toxicologies) controlling for incident year (time), state, and demographic variables. We chose suicide decedents who did not leave a suicide note as the baseline comparison group to better examine potential differences and similarities between them and UnDs. Results: Of all poisoning deaths, 29.4% were classified as suicide decedents who left a note, 37.7% as suicides without a note, and 32.9% as UnDs. Of all NVDRS participating states, Maryland and Utah had the highest proportions of all poisoning deaths (82.8% and 58.9%, respectively) and the highest numbers of UnDs (52.5% of all UnDs in this study). We also found that of all states, Maryland had the highest proportion of Black decedents (34.6% of both poisoning suicides and UnDs). Analysis of time trend showed that the proportions of UnD cases in 2005 and 2015 were 36.5% and 30.0%, respectively, with a generally declining trend over the 11-year period. Multinomial logistic regression analysis showed that compared to suicide decedents without a note, those with a note were more likely to have been depressed and had physical health problems and other life stressors, while UnD cases were less likely to have had mental health problems and other life stressors but more likely to have had substance use and health problems. UnD cases were also more likely to be opioid (RRR=2.65, 95% CI=2.42-2.90) and cocaine (RRR=2.59, 95% CI=2.09-3.21) positive but less likely to be antidepressant positive (RRR=0.79, 95% CI=0.72-0.87). Those who left a note were older and more likely to be non-Hispanic White, but Blacks were more than twice as likely as nonHispanic Whites to be UnDs. Gender was not a significant factor. Results from separate regression models in the highest UnD states (Maryland and Utah) and in states other than Maryland/Utah were similar. Conclusions: The finding that UnDs had a higher likelihood of substance use problems and positive opioid and cocaine toxicology results suggests that their substance use/abuse was largely and directly responsible for their death. We could not compare UnDs to accidental overdose deaths, as the NVDRS does not include the latter, but such research among middle-aged and older adults is needed as many UnDs may be more correctly classified as unintentional overdose deaths. The extremely high UnD rates in Maryland and Utah are also likely reflections of the opioid epidemic that has raged in these two states. The study limitations were that as data on precipitating circumstances were largely collected from decedents’ informal support systems, the validity of these proxy-derived data is a concern as is incomplete/unknown data, and substantial numbers of toxicology-tested decedents had missing test results. However, the findings show that along with more accurate determination processes for intent/
S176
Am J Geriatr Psychiatry 27:3S, March 2019