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1.
Assessment of prevalence and clinical outcome of frailty in an elderly predialysis cohort using simple tools.
Ali, H, Abdelaziz, T, Abdelaal, F, Baharani, J
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 2018;(1):63-70
Abstract
The relationship between frailty and chronic kidney disease in elderly population has been recognized; however, studies concentrating on frailty in predialysis patients are limited. For nephrologists, the recognition of frailty is important as it has impact on decisions on the choice of dialysis modality and sometimes on whether dialysis is indeed in the patients' best interests. Many of the tools for routine assessment of frailty are not easily applicable to those clinicians not practicing elderly care medicine. A tool needs to be simple and applicable for daily routine practice. The aim of this study was to assess the prevalence and clinical outcome of frailty in an elderly predialysis population using simple tools. A nonrandomized prospective study was conducted in which, 104 patients aged 65 years or above with an estimated glomerular filtration rate of 25 mL or less were included. Data including age, sex, renal function, calcium, albumin, parathormone, and comorbidities were collected at baseline and at three months interval for one year. Functional performance was assessed using Karnofsky scale. The Charlson comorbidity index was used to assess comorbid status of each patient. Frailty was assessed using a combination of PRISMA questionnaire and Timed up and Go test. End points were death or start of dialysis at 20-month follow-up. A frail group (n = 58; males = 32, females = 26) and a nonfrail group (n = 46; males = 21, females = 25) were identified. Frailty was prevalent in 53.8% of the selected population. There was no significant difference between both groups in terms of age, gender, comorbidities, hemoglobin, inflammatory markers, or calcium hemostasis. Nine patients chose conservative management in the frail group and six in nonfrail group. Rate of death was significantly higher in the frail group (death = 14) compared to nonfrail group (death = 3; P = 0.01). There was no significant difference between both groups in terms of initiation of dialysis (P = 0.1). Frailty and Charlson comorbidity index were significantly associated with mortality (P = 0.023 and 0.032, respectively). Survival in frail patients who started peritoneal dialysis (PD) was slightly better than those started on hemodialysis (HD) with hazard ratio = 3.23 (P = 0.23). Our study shows that the prevalence of frailty and mortality rate is high among elderly predialysis patients. Frailty and Charlson comorbidity index are independent predictors of outcome in this population. PD might be a better option of dialysis modality compared to HD in the frail population.
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Nutritional screening and dietitian consultation rates in a geriatric evaluation and management unit.
Dent, E, Wright, O, Hoogendijk, EO, Hubbard, RE
Nutrition & dietetics: the journal of the Dietitians Association of Australia. 2018;(1):11-16
Abstract
AIM: Nutritional screening may not always lead to intervention. The present study aimed to determine: (i) the rate of nutritional screening in hospitalised older adults; (ii) whether nutritional screening led to dietitian consultation and (iii) factors associated with malnutrition. METHODS In this prospective study of patients aged ≥70 years admitted to a Geriatric Evaluation and Management Unit (GEMU), malnutrition was screened for using the Mini Nutritional Assessment Short Form (MNA-SF) and identified using the Mini Nutritional Assessment (MNA). RESULTS Of the 172 patients participating in the study, 53 (30.8%) patients were malnourished, and 84 (48.8%) were at risk of malnutrition. Mean (SD) age was 85.2 (6.4 years), with 131 patients (76.2%) female. Nutritional screening was performed for all patients; however, it was incomplete in 59 (34.3%) because of omission of the anthropometric measurement. Overall, 62 (36.0%) of the total number of patients were seen by the dietitian, which included 26 (49%) of malnourished patients, 27 (32%) of at-risk patients and 9 (26%) of the well-nourished patients. No patients lost >1% of body weight during GEMU stay. Malnourished patients were more likely to be frail, have poor appetite, depression, and have lower levels of: albumin, cognition, physical function, grip strength and quality of life. CONCLUSIONS The full benefits of nutritional screening by MNA-SF may not be realised if it does not result in malnourished patients receiving a dietitian consultation. However, it is possible that enrichment of the foodservice with high protein/high-energy options minimised patient weight loss in the GEMU.
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Relationship between the Functional Independence Measure and Mann Assessment of Swallowing Ability in hospitalized patients with pneumonia.
Mitani, Y, Oki, Y, Fujimoto, Y, Yamaguchi, T, Yamada, Y, Yamada, K, Ito, T, Shiotani, H, Ishikawa, A
Geriatrics & gerontology international. 2018;(12):1620-1624
Abstract
AIM: Pneumonia ranks high among the causes of death worldwide. However, the predictive values of activities of daily living, the nutrition index and the aspiration index measured objectively remain unclear. The present study aimed to examine the associations of activity, nutrition and dysphagia with pneumonia. METHODS We assessed 992 hospitalized patients. Logistic regression analysis was used to examine the predictors of pneumonia. Receiver operating characteristic curve analysis was used to determine the cut-off values of variables. Kaplan-Meier and Cox hazards regression analyses were used to examine the incidence of pneumonia and the factors associated with pneumonia. RESULTS We finally enrolled 393 inpatients. Of the 393 patients, 102 (26.0%) had pneumonia. On logistic regression analysis, age, Functional Independence Measure (FIM)-motor score and Mann Assessment of Swallowing Ability (MASA) score were independent predictors of pneumonia. The FIM-motor and MASA cut-off values were 19.5 (area under the curve 0.83, P < 0.01) and 170.5 (area under the curve 0.82, P < 0.01), respectively. Kaplan-Meier analysis showed that the no pneumonia rate was significantly lower among patients with FIM-motor scores <20 than among those with FIM-motor scores ≥20 (log-rank test, P < 0.01), and was significantly lower among patients with MASA scores <171 than among those with MASA scores ≥171 (log-rank test, P < 0.01). Cox regression analysis showed that FIM-motor (hazard ratio 0.97, P = 0.009) and MASA scores (hazard ratio 0.99, P < 0.01) were significantly associated with pneumonia. CONCLUSIONS In addition to the infectious risk, the FIM-motor and MASA scales are useful tools to predict the development of pneumonia in older adults. Geriatr Gerontol Int 2018; 18: 1620-1624.
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The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients - A systematic review.
Hamaker, ME, Te Molder, M, Thielen, N, van Munster, BC, Schiphorst, AH, van Huis, LH
Journal of geriatric oncology. 2018;(5):430-440
Abstract
AIM: The aim of this systematic review is to summarise all available data on the effect of a geriatric evaluation on the multidisciplinary treatment of older cancer patients, focussing on oncologic treatment decisions, the implementation of non-oncologic interventions and the impact on treatment outcome. METHODS A systematic search in MEDLINE and EMBASE for studies on the effect of a geriatric evaluation on oncologic and non-oncologic treatment decisions and outcome for older cancer patients. RESULTS 36 publications from 35 studies were included. After a geriatric evaluation, the oncologic treatment plan was altered in a median of 28% of patients (range 8-54%), primarily to a less intensive treatment option. Non-oncologic interventions were recommended in a median of 72% of patients (range 26-100%), most commonly involving social issues (39%), nutritional status (32%) and polypharmacy (31%). Effect on treatment outcome was varying, with a trend towards a positive effect on treatment completion (positive effect in 75% of studies) and treatment-related toxicity/ complications (55% of studies). CONCLUSION A geriatric evaluation affects oncologic and non-oncologic treatment and appears to improve treatment tolerance and completion for older cancer patients. Fine-tuning the decision-making process for this growing patient population will require more specific and robust data on the effect of a geriatric evaluation on relevant oncologic and non-oncologic outcomes such as survival and quality of life.
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Frailty Screening (FRAIL-NH) and Mortality in French Nursing Homes: Results From the Incidence of Pneumonia and Related Consequences in Nursing Home Residents Study.
De Silva, TR, Theou, O, Vellas, B, Cesari, M, Visvanathan, R
Journal of the American Medical Directors Association. 2018;(5):411-414
Abstract
OBJECTIVES To investigate the ability of the fatigue, resistance, ambulation, incontinence or illness, loss of weight, nutritional approach, and help with dressing (FRAIL-NH) tool to predict mortality. DESIGN The Incidence of Pneumonia and Related Consequences in Nursing Home Residents (INCUR) study database was used. This was an observational cohort study in French nursing homes conducted over 12 months in 2012. PARTICIPANTS A total of 788 residents aged 60 years or older, from 13 randomly selected French nursing homes. MEASUREMENTS FRAIL-NH was generated from the available variables at baseline. FRAIL-NH scores ranged from 0 to 14 and people were categorized as nonfrail (0‒1), frail (2‒5), and most frail (6‒14). Mortality data were obtained from medical charts and confirmed by the nursing home administrative documentation. RESULTS Mean age of the participants was 86.2 ± 7.5 years, and 74.5% were women. The prevalence of persons with FRAIL-NH score greater than 1 was 88.8%, with 54.2% and 34.6% of residents identified as most frail and frail, respectively. The mean FRAIL-NH score was 6.0 ± 3.4. Women (N = 583) were frailer (6.1 ± 3.4) than men (N = 200, 5.5 ± 3.4; P = .027). Overall, 136 residents died over the 1-year follow-up period. The FRAIL-NH score was a predictor of mortality (adjusted hazard ratios: for frail group 1.15, 95% confidence interval 0.55‒2.41; for most frail group 2.14, 95% confidence interval 1.07‒ 4.27). CONCLUSIONS FRAIL-NH is a predictor of mortality in nursing home residents and the score could assist with guiding appropriate care planning.
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Integrating geriatric assessment in the first line chemotherapy treatment in older patients with metastatic colorectal cancer: Results of a prospective observational cohort study (AVAPLUS).
Decoster, L, Kenis, C, Naessens, B, Houbier, G, De Man, M, Lambrecht, G, Monsaert, E, Moons, V, Vergauwe, P, Prenen, H, et al
Journal of geriatric oncology. 2018;(2):93-101
Abstract
OBJECTIVES This study aims to investigate the use of chemotherapy with or without bevacizumab in older patients with metastatic colorectal cancer (mCRC) in current daily practice and to identify predictive parameters for treatment-related outcomes. PATIENTS AND METHODS This is a Belgian multi-centre, observational cohort study. Patients≥70years old with mCRC considered suitable for first-line chemotherapy were eligible for inclusion. At baseline geriatric screening and assessment was performed. Treatment choice was at the discretion of the investigator. Treatment duration, Progression Free Survival (PFS) and safety were recorded. RESULTS Between August 2011 and July 2013, 252 patients with mCRC were included of which 50.8% were treated with bevacizumab. Median treatment duration was 5.5months and median PFS was 8.9months. Approximately 50% of patients experienced severe adverse events, most frequently diarrhea. In multivariate analysis, baseline Eastern Cooperative Oncology Group (ECOG)-performance status (PS) was predictive for treatment duration (p=0.0047), PFS (p<0.0001) and severe toxicity and baseline nutritional status for PFS (p=0.0007). In patients with a good ECOG-PS, nutritional status was predictive for PFS. CONCLUSIONS In current daily practice in Belgium, half of older patients with colorectal cancer treated with chemotherapy also receive bevacizumab. Nearly half of older patients presented with severe toxicity during treatment. Baseline nutritional status is a predictive marker for PFS. Patients with a baseline ECOG-PS≥2 have shorter PFS and higher risk of severe toxicity and should therefore be treated with caution.
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Predicting early death in older adults with cancer.
Boulahssass, R, Gonfrier, S, Ferrero, JM, Sanchez, M, Mari, V, Moranne, O, Rambaud, C, Auben, F, Hannoun Levi, JM, Bereder, JM, et al
European journal of cancer (Oxford, England : 1990). 2018;:65-74
Abstract
BACKGROUND Predicting early death after a comprehensive geriatric assessment (CGA) is very difficult in clinical practice. The aim of this study was to develop a scoring system to estimate risk of death at 100 days in elderly cancer patients to assist the therapeutic decision. METHODS This was a multicentric, prospective cohort study approved by an ethics committee. Elderly cancer patients aged older than 70 years were enrolled before the final therapeutic decision. A standardised CGA was made before the treatment decision at baseline. Within 100 days, event (death), oncologic and geriatric data were collected. Multivariate logistic regression was used to select the risk factors for the overall population. Score points were assigned to each risk factor using the β coefficient. Internal validation was performed by a bootstrap method. Calibration was assessed with the Hosmer-Lemeshow goodness of fit test and accuracy with the mean c-statistic. FINDINGS One thousand fifty patients (mean age: 82 years) joined the study from April 2012 to December 2014. The independent predictors were metastatic cancers (odds ratio [OR] 2.5; 95% confidence interval [CI], [1.7-3.5] p<0 .001); gait speed<0.8 m/s (OR 2.1; 95% CI [1.3-3.3] p=0.001); Mini Nutritional Assessment (MNA) < 17 (OR 8; 95% CI; [3.7-17.3] p<0.001), MNA ≤23.5 and ≥ 17 (OR 4.4; 95% CI, [2.1-9.1) p<0.001); performance status (PS) > 2 (OR 1.7; 95% CI, [1.1-2.6)] p=0.015) and cancers other than breast cancer (OR 4; 95% CI, [2.1-7.9] p<0.001). We attributed 4 points for MNA<17, 3 points for MNA between ≤23.5 and ≥ 17, 2 points for metastatic cancers, 1 point for gait speed <0.8 m/s, 1 point for PS > 2 and 3 points for cancers other than breast cancer. The risk of death at 100 days was 4% for 0 to 6 points, 24% for 7 to 8 points, 39% for 9 to 10 points and 67% for 11 points. INTERPRETATION To our knowledge, this is the first score which estimates early death in elderly cancer patients. The system could assist in the treatment decision for elderly cancer patients.
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The impact of exercise and vitamin D supplementation on physical function in community-dwelling elderly individuals: A randomized trial.
Aoki, K, Sakuma, M, Endo, N
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. 2018;(4):682-687
Abstract
BACKGROUND We investigated the impact of exercise and vitamin D supplementation on physical function and locomotor dysfunction in community-dwelling elderly individuals. METHODS In total, 148 community-dwelling elderly individuals (aged ≥60 years) who were not taking osteoporosis medications participated in a 24-week intervention. The participants were randomly divided into an exercise group, vitamin D group, and exercise and vitamin D group. The participants and outcome-assessing staff were not blinded to group assignment. Exercise comprised three daily sets each of single-leg standing (1 min/leg/set) and squatting (5-6 repetitions/set); vitamin D supplementation was 1000 IU/day. Participants were contacted every 2 weeks to check on their condition and encourage continued participation. The primary outcome was lower limb muscle strength and mass; secondary outcomes were several physical function measurements, serum 25-hydroxyvitamin D levels, and results of a self-assessment questionnaire completed pre- and post-intervention. RESULTS We analyzed data from 45, 42, and 43 participants in the exercise, vitamin D, and exercise and vitamin D groups, respectively, who completed the intervention. Locomotive syndrome, which involves reduced mobility due to locomotive organ impairment, was diagnosed in 99 participants (76.2%). Many physical function measurements improved in all groups. Lower limb muscle mass increased significantly in all three groups, with no significant differences between the groups in the degree of change. The average serum 25-hydroxyvitamin D of all vitamin D-supplemented participants increased from 28.1 ng/ml to 47.3 ng/ml after vitamin D supplementation. CONCLUSIONS Both exercise and vitamin D supplementation independently improved physical function and increased muscle mass in community-dwelling elderly individuals. Moreover, the combination of exercise and vitamin D supplementation might further enhance these positive effects. CLINICAL TRIAL REGISTRY UMIN Clinical Trial, UMIN000028229.
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Preoperative Management of the Geriatric Patient: Frailty and Cognitive Impairment Assessment.
Dalton, A, Zafirova, Z
Anesthesiology clinics. 2018;(4):599-614
Abstract
As the population ages, more geriatric patients will be presenting for surgical procedures. Preoperative evaluation seeks to assess patients for geriatric syndromes: frailty, sarcopenia, functional dependence, and malnutrition. Age-related changes in physiology increase risk for central nervous system, cardiovascular, pulmonary, renal, hepatic, and endocrine morbidity and mortality. Identification of various comorbidities allows for preoperative optimization and for opportunities for intervention including nutritional supplementation and prehabilitation, which may improve postoperative outcomes.
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Self-Reported Physical Function As a Predictor of Hospitalization in the Lifestyle Interventions and Independence for Elders Study.
Callahan, KE, Lovato, L, Miller, ME, Marsh, AP, Fielding, RA, Gill, TM, Groessl, EJ, Guralnik, J, King, AC, Kritchevsky, SB, et al
Journal of the American Geriatrics Society. 2018;(10):1927-1933
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Abstract
OBJECTIVES To explore whether baseline scores on the Mobility Assessment Tool-short form (MAT-sf), a brief, animated, computer-based means of assessing mobility that predicts mobility disability, are associated with number of hospitalizations and time to first hospitalization over a median follow-up of 2.7 years. DESIGN Post hoc analysis of prospectively gathered data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a randomized clinical trial of lifestyle interventions to preserve mobility in older adults. SETTING Eight U.S. academic medical centers. PARTICIPANTS Of 1,635 sedentary community-dwelling older adults enrolled in LIFE, 1,574 completed baseline physical function screening including the MAT-sf, with baseline scores ranging from 30.2 (low function) to 69.8 (high function) on a scale from 30 to 80. MEASUREMENTS Number of hospitalizations and time to first hospitalization, adjusted for age, sex, race, living alone, clinical site, baseline comorbidities, number of prescription medications, and cognition. RESULTS Of the 1,557 participants with data regarding hospitalization status, 726 (47%) had at least 1 hospitalization; 78% of these had 1 or 2 hospitalizations. For every 10-point lower MAT-sf score, the rate of all hospitalizations was 19% higher in those with lower scores (adjusted rate ratio=1.20, 95% confidence interval (CI)=1.08-1.32, p<.001). Lower baseline MAT-sf scores were also associated with greater risk of first hospitalization (adjusted hazard ratio=1.20, 95% CI=1.09-1.32, p<.01, per 10-point lower MAT-sf score). CONCLUSION Low MAT-sf scores identify older adults at risk of hospitalization; further study is needed to test interventions to reduce hospitalizations in these individuals.