DECREASING PAIN, ANXIETY, AND CONFUSION IN TERMINALLY ILL VETERANS

Abstract Terminally ill patients often receive medications for pain and anxiety that result in sedation that may inhibit communication with their loved ones. Balancing comfort while maintaining meaningful communications is a common dilemma for patients, staff, and families. Many patients report confusion and a decreased ability to communicate with families and health care providers, resulting in fear, anger, and frustration. Additionally, family members (25 to 33%) also feel frustrated and angry not being able to communicate with their loved ones needs and wishes. Delirium, a distressing syndrome characterized by disturbed consciousness, reduced ability to focus attention, altered cognition is experienced by 62–88% of terminally ill patients. Unfortunately, it is often underdiagnosed and undertreated. While not all delirium can be prevented it is estimated that 50% of terminal delirium may be ameliorated. This project was designed to proactively identify terminally ill veteran preferences for nonpharmacological interventions to reduce pain, anxiety, and prevent delirium. In the sample of Veterans from an inpatient VAMC Hospice (n=31) the mean age was 79.46 (sd=10.69); 60.7% were Black and 39.3% were white; 60.9% had cancer and 27.6% had heart failure. The most common patient delirium related behaviors were verbal agitation, physical agitations, physical aggression, anxiety, and confusion. Veterans identified the following comfort priorities: decreased noise (82.6%) and lighting (82.6%), warm blankets (78.3%), music (65.2%), emotional support (73.9%), increased family involvement (43.5%) and (20.8%) going outdoors. Preventative individualized nonpharmacological interventions decreased disruptive delirium related behaviors over 95% of the time and should be incorporated into routine hospice care.

control for observed differences in baseline characteristics. Regression models were used to compare group differences in outcomes. Although in analyses without PSM, older adults with HF were more likely to have higher 90-day readmission, and 30-, 90-, and 365-day mortality, this association was not significant after controlling for selection bias. However, the associations between having HF with 30-day readmission and longer length of stay were significant before and after PSM. Additionally, if patients did not receive hip fracture surgery procedures within two days of admission, they had a 3.6-day longer inpatient stay (P-value < 0.0001) and were 47.8 times more likely to die during hospitalization (95%CI 4.9-482.0, P-value < 0.001). Being non-white was significantly associated with higher 90-and 365-day mortality. Future research should consider PSM approach on national representative datasets to rigorously evaluate the effects of HF on mortality and readmission following hip fracture surgery in older adults.

DECREASING THE USE OF BENZODIAZEPINES AND SEDATIVE HYPNOTICS IN POST OPERATIVE OLDER ADULTS Amaka Opute, UTSW Medical Center Dallas, Dallas, Texas, United States
Purpose: The purpose of this project was to decrease the prescribing of benzodiazepines and sedative hypnotics in post-operative older adults Background: Routine prescribing of benzodiazepines and sedative hypnotics as first line choices for sleep medication is a known contributor to prolonged hospital stays, increased fall rates, increased development of delirium, higher health care costs, and long-term cognitive decline. Methodology: Practice changes included monthly provider and nursing staff education inservices, coupled with transparent monitoring of provider prescribing practices. The outcomes measure was to decrease the prescribing of benzodiazepines and sedative hypnotics by 5% within 90 days and increase the prescribing of melatonin by 10%. Results: When comparing six months of data pre and post implementation on the unit, there was a 33% decrease in the prescribing of benzodiazepines/sedative hypnotics and a 12% increase in the prescribing of Melatonin. There was also a 28% decrease in the hours of patient safety sitter use, a marker for delirium. Implications: This quality improvement project decreased the number of benzodiazepines and sedative-hypnotics prescribed by expanding provider and nursing knowledge, which ultimately led to fewer hours spent utilizing patient safety sitters, thereby lowering healthcare costs, while concurrently improving the quality of care delivered

DECREASING PAIN, ANXIETY, AND CONFUSION IN TERMINALLY ILL VETERANS
communication with their loved ones. Balancing comfort while maintaining meaningful communications is a common dilemma for patients, staff, and families. Many patients report confusion and a decreased ability to communicate with families and health care providers, resulting in fear, anger, and frustration. Additionally, family members (25 to 33%) also feel frustrated and angry not being able to communicate with their loved ones needs and wishes. Delirium, a distressing syndrome characterized by disturbed consciousness, reduced ability to focus attention, altered cognition is experienced by 62-88% of terminally ill patients. Unfortunately, it is often underdiagnosed and undertreated. While not all delirium can be prevented it is estimated that 50% of terminal delirium may be ameliorated. This project was designed to proactively identify terminally ill veteran preferences for nonpharmacological interventions to reduce pain, anxiety, and prevent delirium. In the sample of Veterans from an inpatient VAMC Hospice (n=31) the mean age was 79.46 (sd=10.69); 60.7% were Black and 39.3% were white; 60.9% had cancer and 27.6% had heart failure. The most common patient delirium related behaviors were verbal agitation, physical agitations, physical aggression, anxiety, and confusion. Veterans identified the following comfort priorities: decreased noise (82.6%) and lighting (82.6%), warm blankets (78.3%), music (65.2%), emotional support (73.9%), increased family involvement (43.5%) and (20.8%) going outdoors. Preventative individualized nonpharmacological interventions decreased disruptive delirium related behaviors over 95% of the time and should be incorporated into routine hospice care.

. University of Massachusetts Boston, Boston, Massachusetts, United States
Adults and older adults with intellectual and developmental disabilities (I/DD) often experience medical complexity, accelerated aging, and shortened life expectancy. This project explores health service utilization (HSU) of adults with I/DD receiving state services in the U.S. over the adult lifespan before and after the implementation of the Affordable Care Act (ACA). Three waves of cross-sectional data (2008-2019) from the National Core Indicators-In Person Survey were analyzed using multilevel mixed effects logistic regression (n=46,284). Older adults with I/DD were more likely to receive a physical exam, flu vaccine, eye exam, hearing test, and a dental exam compared to younger individuals, although these differences were small. Compared to non-Hispanic whites, non-Hispanic blacks were less likely to receive physical exams, flu vaccines, and dental exams; non-Hispanic other were less likely to receive eye exams and dental exams; and Hispanic persons were less likely to receive eye exams, flu vaccines, and dental exams. Individuals with I/DD living in states that expanded Medicaid were at 68% greater odds of receiving a physical exam than those who did not. Our research indicates that overall adults with I/DD are not yet reaching HSU of pre-ACA times, perhaps due to the oversaturation of existing providers. National and state policies, along with individual case management each play a role in ensuring healthy aging of individuals with I/DD. A call to action to better understand and integrate these three entities may help improve the potential for healthy aging of this group.

LOVE AMONG OLDER AFRICAN AMERICAN COUPLES: AN ACTOR PARTNER INTERDEPENDENCE MODEL ANALYSIS
Kadija Mussa, 1 and Chalandra Bryant 2 , 1. University of Minnestoa,Falcon Heights,Minnesota,United States,2. University of Minnesota,Minneapolis,Minnesota,United States Older women are often described as being asexual and uninterested in sex or intimacy (McHugh & Interligi, 2015). Thus, most research examining older couples describes those couples as primarily enjoying companionate or compassionate love -a type of love reflecting care and concern for another person (Allen et al., 2018). Unlike companionate or compassionate love, passionate love refers to a "state of intense longing for union with another" (Hatfield & Rapson, 1993, p. 67). Relatively little is known about passionate love and older couples (Hatfield & Rapson, 1993); moreover, far less is known about passionate love among African American older couples. Using data collected from African American couples (332 couples aged 20 to 39 and 90 couples aged 40 to 79), Actor-Partner Interdependence Models were used. For both age groups, 20 to 39 and 40 to 79, husbands' and wives' reports of marital quality were significantly associated with each other at Time 1. Husbands' and wives' reports of passionate love (assessed at Time 2) were not significantly associated with each other -for either age group under study. Cross paths (partner effects) were not significant for either of the two age groups; wives' marital quality (Time 1) did not significantly predict husbands' passionate love (Time 2), nor did husbands' marital quality (Time 1) predict wives passionate love (Time 2). It is important to note that the older and younger age groups exhibited a similar pattern of results, suggesting that passion and physical intimacy may operate in similar ways for both.