long term care providers should realize that hospitals appear to rely on nursing

home protocols to provide routine Pneumovax� 23 vaccination. Thus, the

responsibility of pneumonia prevention rests on the diligence and expertise

of the interdisciplinary gerontology team within the long term care setting.

Disclosures: All authors have stated there are no disclosures to be made that

are pertinent to this abstract.

Effects of a Continence NP Specialist in LTC

Diane A. Smith, MSN, CRNP, OnSight Senior Care

Author(s): Diane A. Smith, MSN, CRNP; Alis Panzera, MSN, CRNP

Introduction/Objective: Purpose of this descriptive study is to show the af-

fects of the advanced practice Nurse Practitioner’s assessment and treatment

of urinary incontinence in long term care residents.

Design/Methodology: Services at this Pennsylvania facility were initiated in

April of 2007. The continence Nurse Practitioner was consulted by the facil-

ity to evaluate and manage the UI residents who flagged on the quality indi-

cator reports as having low risk incontinence and incontinence with no

toileting plan. Residents were evaluated by standard methods including his-

tory and physical exam, and selected bladder studies including post void re-

sidual. An individualized plan of care is developed, and the resident is

followed on a monthly basis. The plan of care may include toileting programs,

pelvic muscle rehabilitation, constipation management, medication inter-

vention for urge UI and vaginal atrophy, and management of prolapse with

pessaries. Facility staff and primary care providers were also given extensive

education by the specialists on UI before the service is initiated. Quality in-

dicator reports were reviewed in April and September of 2007 as well as in

January of 2008. Number of patients and percent of patients with low risk in-

continence and with no toileting plan were recorded and compared.

Results: During the 9 months of services in the facility both the number of

patients and the percent of residence with low risk incontinence and incon-

tinent with no toileting plan decreased. See table for exact data.

Conclusion/Discussion: Recently the role of the Nurse Practitioner as a con-

tinence specialist in long term care has become more prevalent. This spe-

cialty practice can have a positive impact on the reduction of UI in these

facilities. Following simple strategies of evaluation and management, a conti-

nence specialist Nurse Practitioner is a useful addition to the care of long term

care patients and may reduce the prevalence of incontinence in long term

care as well as reduce the amount of monies spent on treating the sequela

of incontinence by CMS.

Disclosures: Diane A. Smith, MSN, CRNP has received a speaker honorar-

ium from Watson Pharmaceuticals, Inc. Product(s) made by this company re-

lated to this topic: Oxytrol. Alis Panzera, MSN, CRNP has no disclosures to

be made that are pertinent to this abstract.

Empowering the Brain/Person through Computer Training in NursingHome Residents

Jaspinder S. Dhillon, MD, MetroHealth Medical Center

Author(s): Jaspinder S. Dhillon, MD; Mary V. Corrigan, MD

Introduction/Objective: To enhance NH residents’ brain fitness and general

well being through the use of computer technology. Does the use of computer

software by group of elderly residents improve their cognitive abilities, hear-

ing, confidence, and quality of life? Background: Brain fitness is a science of

maintaining and training cognitive abilities. Cognitive abilities like atten-

tion, motor coordination, and executive functions like planning and problem

solving can diminish over time unless used regularly. Brain plasticity is its

ability to rewire itself at any age. The use of computers by the elderly is small

but growing.

Design/Methodology: Prospective pilot cohort study. Involve voluntary par-

ticipation in computer training of independent and assisted living residents in

a CCRC. Provide orientation of the computer, mouse, verbal and written de-

scription of six computer exercises. Computer exercises divided into 6 sec-

tions: high or low, tell us apart, match it, sound replay, listen and do, and

story teller. Computer exercises performed 1-3 hours per setting, on average

3-5 times a week over the period of 8-12 weeks for the total of 40 hours. Pace

set individually. Patients queried before commencement of the exercises, at

the half way point, and upon completion of the forty hours. Data gathered

from pre, mid-cycle and post class questionnaire.

B8

Results: Pre-cycle questionnaire: N 5 23; Gender F 5 83%, Age range 68-

94, median age 83. Education level, high school to graduate school. Median

education is college level. Comfort level with computer use on a likert scale of

1-5, 1 5 not comfortable at all, 5 5 very comfortable, results ranged 1-4, me-

dian 3. Current computer use: 39% no use. All purposes: 39% word process-

ing, 43% games, 39% bills, 48% internet surfing, and 26% shopping.

Perception of computer use in enhancing memory: 78% yes, 9% no, and

13% unsure. Current involvement in other memory enhancing activities

96% yes, 4% blank. Choice of activities to enhance memory, 96% read,

52% crossword puzzles, 87% watch TV, 52% play cards, and 48% other

games.

Conclusion/Discussion: Ongoing study, mid-cycle data, N 5 6 suggest

trending towards some improvement in focus, listening, memory and process-

ing speed. We anticipate favorable results, increased computer use correlated

with improved cognition, confidence, and enhanced quality of life.

Disclosures: All authors have stated there are no disclosures to be made that

are pertinent to this abstract.

Endogenous Serum Testosterone and Estradiol and All-Cause Mortalityin Older Men: The Honolulu-Asia Aging Study

Suteevan Cholitkul, MD, The John A. Hartford Center of Excellence in

Geriatrics, John A. Burns School of Medicine, University of Hawaii, Kuakini

Medical Center

Author(s): Suteevan Cholitkul, MD; Lenore Launer, PhD;

Suwitda Cholitkul, MD; Christina Bell, MD; Randi Chen, MS;

Robert Abbott, PhD; Helen Petrovitch, MD; G. Webster Ross, MD;

Patricia Blanchette, MD; Lon White, MD; Kamal Masaki, MD

Introduction/Objective: Serum testosterone gradually declines with age in

men. Low endogenous testosterone has been associated with cardiovascular

events, whereas high endogenous estrogen has been linked to risk of stroke

and coronary heart disease in elderly men. We studied the associations be-

tween endogenous serum testosterone and estradiol and mortality in elderly

men.

Design/Methodology: The Honolulu-Asia Aging Study is a longitudinal co-

hort study of elderly Japanese-American men in Hawaii, a continuation of

the Honolulu Heart Program that began in 1965. At examinations that

were conducted between 1991 and 1993, serum testosterone and estradiol

levels were measured in 3,168 men aged 71 to 93 years. Subjects were divided

into quintiles based on levels of bioavailable testosterone and estradiol. Data

on all-cause mortality were available through December 2007, providing 16

years of follow-up.

Results: Men in the lowest quintile of bioavailable testosterone were signif-

icantly more likely to die during follow-up compared to those in the highest

quintile (84.7% vs 69.7%, p \ 0.0001). Using Cox proportional hazards

models adjusting for age, BMI, hypertension, diabetes, pack-years smoking,

physical activity index, cholesterol, alcohol consumption, and prevalent cor-

onary heart disease, stroke, cancer and dementia at baseline, men in the low-

est quintile of bioavailable testosterone levels had a significantly higher risk

of all-cause mortality compared to those in the highest quintile (RR 5 1.29,

95% CI 5 1.12-1.48, p \0.001). Conversely, men in the highest quintile of

bioavailable estradiol levels had a significantly higher risk of all-cause mortal-

ity compared to those in the lowest quintile (RR 5 1.19, 95% CI 5 1.04-1.37,

p 5 0.012) adjusting for the above factors.

Conclusion/Discussion: Low endogenous testosterone and high endogenous

estradiol levels were associated with an increased risk of all-cause 16-year

mortality in elderly Japanese-American. These findings should be confirmed

by other prospective studies.

Disclosures: Kamal Masaki, MD received a speaker honorarium from Pfizer

Inc. As of submission, Patricia Blanchette, MD and Lon White, MD have

not provided disclosures. All other authors have stated there are no disclo-

sures to be made that are pertinent to this abstract.

Fournier’s Gangrene in an 80 y.o. Patient

Ekaterina Zilberfayn, MD, Albert Einstein College of Medicine, Montefiore

Medical Center

Author(s): Ekaterina Zilberfayn, MD; Louis A. Kaplan, PA-C;

Rubina Malik, MD

JAMDA – March 2009