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Bulcock A, Weatherburn A, Gbadebo A, De Sousa M. Improving access to Comprehensive Geriatric Assessment by improving flow through a Frailty Assessment Area-A QI project. Future Healthc J 2024; 11:100018. [PMID: 38646043 PMCID: PMC11025059 DOI: 10.1016/j.fhj.2024.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Early Comprehensive Geriatric Assessment is a key component of the assessment of older adults presenting to hospital with frailty syndromes, often this is facilitated through Acute Frailty Units. In this paper we describe how using QI methodology we improved access to our Frailty Unit using a digital solution. The impact of this improvement was demonstrated via the reduction in length of stay that these patients experienced compared to patients admitted to General Care of the Older Person wards.
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Wu X, Freeman S, Miyagi M, Park U, Nomura K, Ebihara S. Comprehensive Geriatric Assessment in the era of telemedicine. Geriatr Gerontol Int 2024; 24 Suppl 1:67-73. [PMID: 37846612 DOI: 10.1111/ggi.14705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
The aging global population poses significant medical and social challenges, necessitating efforts to promote healthy aging. Comprehensive Geriatric Assessment (CGA) is a multidimensional diagnostic approach for older adults that aims to improve overall health. Remote CGA, facilitated by technological advancements, offers convenience and other potential advantages. It enables early disease detection, monitors chronic disease progression, delivers personalized care, and optimizes healthcare resources for better health outcomes in older individuals. However, remote CGA also has limitations, including technological requirements, data security, and the need for comprehensive evaluation and simplicity. Collaborative efforts are essential to developing a digital home-based CGA platform that addresses accessibility issues and tailors the assessment process to meet the needs of older adults. Continuous optimization of remote CGA can become a pivotal tool for advancing geriatric care and ensuring the well-being of the aging population. Geriatr Gerontol Int 2024; 24: 67-73.
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Affiliation(s)
- Xinze Wu
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shannon Freeman
- School of Nursing, University of North British Columbia, Prince George, Canada
- Center for Technology Adoption for Aging in the North, Prince George, Canada
| | - Midori Miyagi
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Uijin Park
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Satoru Ebihara
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
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Bakas AT, Polinder-Bos HA, Streng F, Mattace-Raso FUS, Ziere G, de Jong RJB, Sewnaik A. Frailty in Non-geriatric Patients With Head and Neck cancer. Otolaryngol Head Neck Surg 2023; 169:1215-1224. [PMID: 37264978 DOI: 10.1002/ohn.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Patients with head and neck cancer (HNC) are characterized by a poor lifestyle and comorbidity. The Geriatric 8 (G8) is an established screening tool to identify frail older patients with cancer. However, studies evaluating frailty in younger HNC patients are lacking. The aim of this study is to evaluate if the G8 can identify frailty and if it is related to mortality in younger HNC patients. STUDY DESIGN Case-control study design. SETTING Tertiary cancer center. METHODS We studied patients <70 years with HNC. Patients with G8 ≤ 14 were considered frail. Patients were matched to nonfrail (G8 > 14) control patients. Patients were matched according to sex, age, smoking, tumor location, and period of first consultation. Baseline health characteristics were compared between frail patients and nonfrail controls. Second, the treatment plan and adverse outcomes were compared. RESULTS Forty-five patients with G8 ≤ 14 were included and matched to 90 nonfrail controls. The median follow-up time was 357 days. Frail patients had a significantly lower body mass index and level of education, a worse World Health Organization performance status, and reported lower experienced overall health. 28.9% of the frail patients died after 1 year versus 10% of the nonfrail control patients (hazard ratio: 3.87 [95% confidence interval: 1.32-11.36], p = 0.014). CONCLUSION The G8 is a valid screening tool to identify frail patients in younger HNC patients.
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Affiliation(s)
- Ajay T Bakas
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harmke A Polinder-Bos
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | - Fleur Streng
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | | | - Gijsbertus Ziere
- Department of Internal Medicine, Division of Geriatric Medicine, Rotterdam, The Netherlands
| | - Rob J Baatenburg de Jong
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Kapoor M, Pathania M, Dhar M. Serum sodium improvement: change in Comprehensive Geriatric Assessment parameters in geriatric patients with hyponatremia. BMC Geriatr 2023; 23:666. [PMID: 37848812 PMCID: PMC10580625 DOI: 10.1186/s12877-023-04299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/08/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Hyponatremia presents with symptoms considered age-associated in the elderly. We assess the change in Comprehensive Geriatric Assessment (CGA) parameters after hyponatremia improvement in hospitalized geriatric patients. METHODS We took 100 hyponatremic and same number of eunatremic geriatric patients (> 60 years) who were comorbidity, presenting-complaints, and age-matched. Four CGA parameters were utilized, the new Hindi Mental State Examination (HMSE), Barthel's index of activities of daily living (ADL), Timed up and go Test (TUG), and handgrip strength by hand dynamometer (HG). We analyzed these at admission and discharge, and their relationship with change in sodium levels. RESULTS Average age was 68.1 ± 5.8 years, with males constituting 75%. The CGA parameters demonstrated worse values amongst the hyponatremia than the normonatremia group. Severe hyponatremia group showed worse CGA scores in comparison with moderate and mild. With improvement in sodium level, the improvements in ADL, TUG, and HMSE scores were greater in the hyponatremia group (8.8 ± 10.1, 2.2 ± 2.5, and 1.7 ± 2.3 respectively) in comparison to the normonatremia reference group (4.7 ± 9.0, 1 ± 2.0, and 0.7 ± 1.3 respectively, P < 0.05). CONCLUSION Our study is the first utilizing HMSE to assess change in cognitive ability with improvement in serum sodium levels in the Indian elderly. Hyponatremic patients show worse baseline CGA parameters, and hyponatremia severity correlates with worse motor and cognitive function. Improvement in the serum sodium level improves the CGA parameters. Correction of hyponatremia in the geriatric age group significantly impacts life quality.
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Affiliation(s)
- M Kapoor
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, 249203, India.
| | - M Pathania
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, 249203, India
| | - M Dhar
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, 249203, India
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Safari R, Jackson J, Boole L. Comprehensive geriatric assessment delivered by advanced nursing practitioners within primary care setting: a mixed-methods pilot feasibility randomised controlled trial. BMC Geriatr 2023; 23:513. [PMID: 37620760 PMCID: PMC10463370 DOI: 10.1186/s12877-023-04218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Comprehensive Geriatric Assessment (CGA)is a widely accepted intervention for frailty and can be cost-effective within a primary care setting. OBJECTIVE To explore the feasibility of identifying older adults with frailty and assess the subsequent implementation of a tailored CGA with care and support plan by Advanced Nursing Practitioners (ANPs). METHODS A mixed-method parallel randomised controlled trial was conducted. Participants were recruited from two General Practice (GP) centres between January and June 2019. Older adults with confirmed frailty, as assessed by practice nurses, were randomised, using a web service, to the intervention or treatment-as-usual (TAU) groups for six months with an interim and a final review. Data were collected on feasibility, health service usage, function, quality of life, loneliness, and participants' experience and perception of the intervention. Non-parametric tests were used to analyse within and between-group differences. P-values were adjusted to account for type I error. Thematic analysis of qualitative data was conducted. RESULTS One hundred sixty four older adults were invited to participate, of which 44.5% (n = 72) were randomised to either the TAU (n = 37) or intervention (n = 35) groups. All participants in the intervention group were given the baseline, interim and final reviews. Eight participants in each group were lost to post-intervention outcome assessment. The health service use (i.e. hospital admissions, GP/emergency calls and GP/Accident Emergency attendance) was slightly higher in the TAU group; however, none of the outcome data showed statistical significance between-group differences. The TAU group showed a deterioration in the total functional independence and its motor and cognition components post-intervention (p < .05), though the role limitation due to physical function and pain outcomes improved (p < .05). The qualitative findings indicate that participants appreciated the consistency of care provided by ANPs, experienced positive therapeutic relationship and were connected to wider services. DISCUSSION Frailty identification and intervention delivery in the community by ANPs were feasible. The study shows that older adults with frailty living in the community might benefit from intervention delivered by ANPs. It is suggested to examine the cost-effectiveness of the intervention in sufficiently powered future research. TRIAL REGISTRATIONS The protocol is available at clinicaltirals.gov, ID: NCT03394534; 09/01/2018.
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Affiliation(s)
- Reza Safari
- College of Health, Psychology and Social Care, University of Derby, Kedleston Rd, Derby, DE22 1GB, Derbyshire, UK.
| | - Jessica Jackson
- College of Health, Psychology and Social Care, University of Derby, Kedleston Rd, Derby, DE22 1GB, Derbyshire, UK
| | - Louise Boole
- College of Health, Psychology and Social Care, University of Derby, Kedleston Rd, Derby, DE22 1GB, Derbyshire, UK
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Lindner-Rabl S, Singler K, Polidori MC, Herzog C, Antoniadou E, Seinost G, Roller-Wirnsberger R. Effectiveness of multi-professional educational interventions to train Comprehensive Geriatric Assessment (CGA) - a Systematic Review. Int J Integr Care 2023; 23:9. [PMID: 37601034 PMCID: PMC10437136 DOI: 10.5334/ijic.7549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/01/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction As the world population ages, health and social care professionals are increasingly confronted with patients with chronic long-term conditions and multimorbidity, requiring an extensive assessment and integrated care management strategy. The aim of this paper was to systematically collect and assess evidence of interprofessional education and training strategies for Comprehensive Geriatric Assessment (CGA) to build a competent health workforce. Methods A systematic review was conducted according to PRISMA guidelines and the databases Medline, CINAHL, Cochrane and Embase were searched for studies illustrating effectiveness of educational interventions for teaching and training CGA in an interprofessional context. Results Based on 21 identified studies, a great variability and heterogeneity in duration, setting and design of the interventions was identified. Promising results were found in the domains analysed, ranging from knowledge and skills; practices and behaviour; patient health outcomes; attitudes and perceptions to collaboration and quality of care. Discussion Education and training of transversal skills within a continuous learning approach is key to equip the health care workforce for successful CGA performance in an interprofessional environment. Conclusion Further research in this field is recommended to strengthen the evidence-base towards development of a resilient and integrated health care workforce for an ageing population.
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Affiliation(s)
- Sonja Lindner-Rabl
- Medical University of Graz, Department of Internal Medicine, Graz, Austria
| | - Katrin Singler
- Institute for Biomedicine of Ageing, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
- Department of Geriatric Medicine, Klinikum Nürnberg, Paracelsus Private Medical University, Nürnberg, Nuremberg, Germany
| | - M. Cristina Polidori
- Faculty of Medicine and University Hospital Cologne, Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Carolin Herzog
- Medical University of Graz, Department of Internal Medicine, Graz, Austria
| | | | - Gerald Seinost
- Medical University of Graz, Department of Internal Medicine, Division of Angiology, Graz, Austria
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Pilotto A, Custodero C, Palmer K, Sanchez-Garcia EM, Topinkova E, Polidori MC. A multidimensional approach to older patients during COVID-19 pandemic: a position paper of the Special Interest Group on Comprehensive Geriatric Assessment of the European Geriatric Medicine Society (EuGMS). Eur Geriatr Med 2023; 14:33-41. [PMID: 36656486 PMCID: PMC9851592 DOI: 10.1007/s41999-022-00740-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/24/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The COVID-19 pandemic has been a dramatic trigger that has challenged the intrinsic capacity of older adults and of society. Due to the consequences for the older population worldwide, the Special Interest Group on Comprehensive Geriatric Assessment (CGA) of the European Geriatric Medicine Society (EuGMS) took the initiative of collecting evidence on the usefulness of the CGA-based multidimensional approach to older people during the COVID-19 pandemic. METHODS A narrative review of the most relevant articles published between January 2020 and November 2022 that focused on the multidimensional assessment of older adults during the COVID-19 pandemic. RESULTS Current evidence supports the critical role of the multidimensional approach to identify older adults hospitalized with COVID-19 at higher risk of longer hospitalization, functional decline, and short-term mortality. This approach appears to also be pivotal for the adequate stratification and management of the post-COVID condition as well as for the adoption of preventive measures (e.g., vaccinations, healthy lifestyle) among non-infected individuals. CONCLUSION Collecting information on multiple health domains (e.g., functional, cognitive, nutritional, social status, mobility, comorbidities, and polypharmacy) provides a better understanding of the intrinsic capacities and resilience of older adults affected by SARS-CoV-2 infection. The EuGMS SIG on CGA endorses the adoption of the multidimensional approach to guide the clinical management of older adults during the COVID-19 pandemic.
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Affiliation(s)
- Alberto Pilotto
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy.,Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, P.zza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Katie Palmer
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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Chen N, Farrell M, Kendall S, Levy L, Mehan R, Katz B. The Pain Clinic for Older People. Pain Med 2023; 24:182-187. [PMID: 35866999 DOI: 10.1093/pm/pnac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Multidisciplinary pain clinics have an established role in the management of persistent pain, but there is little evidence to support this approach in an older population. This study describes the characteristics and pain outcomes of patients attending a pain clinic designed exclusively for older people. METHODS A retrospective audit was performed of outcomes of the Pain Clinic for Older People (PCOP) in 2015-2019. Response to treatment was determined by change in Brief Pain Inventory (BPI) scores at initial attendance and after a treatment program. Clinically meaningful improvement was defined by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus criteria of ≥30% improvement in average pain and one-point improvement in pain interference. Results were compared with the national benchmark collated by the electronic Persistent Pain Outcomes Collaboration (ePPOC), which reports the combined results from 67 participating Australian and New Zealand pain services. RESULTS Patients attending the PCOP had a mean age of 80.5 years and had high rates of frailty (84%), cognitive impairment (30%), and multimorbidity. Significant reductions in BPI average pain and BPI pain interference scores were achieved. Clinically meaningful improvement in BPI average pain was achieved in 63% of patients attending the PCOP who were 65-74 years of age and in 46% of patients who were ≥75 years of age, which met the national benchmark set by ePPOC of 40% for both age groups. Clinically meaningful improvement in BPI pain interference was achieved in 69% of those attending the PCOP who were 65-74 years of age and in 66% of those who were ≥75 years of age, comparable to the ePPOC benchmark of 71% and 65% for the respective age groups. CONCLUSION PCOP clients achieved significant and meaningful improvements in their pain outcomes that satisfied the national benchmark. Advanced age, cognitive impairment, frailty and multimorbidity should not be regarded as barriers to benefit from a pain clinic specifically designed for older people.
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Affiliation(s)
- Nancy Chen
- Continuing Care, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Farrell
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
| | - Sarah Kendall
- Pain Clinic for Older People, Geriatric Medicine, St Vincent's Health Melbourne, Victoria, Australia
| | - Leah Levy
- Pain Clinic for Older People, Geriatric Medicine, St Vincent's Health Melbourne, Victoria, Australia
| | - Robert Mehan
- Pain Clinic for Older People, Geriatric Medicine, St Vincent's Health Melbourne, Victoria, Australia
| | - Benny Katz
- Pain Clinic for Older People, Geriatric Medicine, St Vincent's Health Melbourne, Victoria, Australia
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O'Shaughnessy Í, Robinson K, O'Connor M, Conneely M, Steed F, Ryan D, Carey L, Shchetkovsky D, Shanahan E, Leahy A, Quinn C, Sheikhi A, Galvin R. Comprehensive geriatric assessment in the emergency department: A protocol for a prospective cohort study. HRB Open Res 2022; 5:26. [PMID: 36313054 PMCID: PMC9582574 DOI: 10.12688/hrbopenres.13504.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 10/21/2023] Open
Abstract
Background: Comprehensive geriatric assessment (CGA) has been shown to improve outcomes in hospitalised older adults; however, there is currently no compelling evidence to support CGA interventions within the Emergency Department (ED). The aim of this study is to explore the clinical and process outcomes of older adults who receive ED-CGA over a period of six months after their initial ED attendance. Design: Prospective cohort study. Methods: The STrengthening the Reporting of the OBservational studies in Epidemiology (STROBE) standardised reporting guidelines will be adhered to. Older adults aged ≥65 years who score ≥2 on the Identification of Seniors at Risk (ISAR) tool and present to the ED with a medical complaint during the operational hours of the dedicated interdisciplinary team, will be considered eligible for recruitment. Demographic and health assessment information will be obtained at the ED index attendance followed by completion of an interdisciplinary CGA. A dedicated research nurse will complete follow-up telephone interviews with participants at 30 days and six months. The primary outcome will be incidence of hospital admission from the ED index attendance. Secondary outcomes will include functional decline, patient satisfaction with the ED index attendance, unscheduled ED reattendance(s), unscheduled hospital (re)admission(s), nursing home admission(s), healthcare utilisation, and death. Descriptive statistics will be used to profile the characteristics of the study participants and multivariate logistic and linear regression analysis will be used to analyse risk of adverse outcomes. Ethics and dissemination: Ethical approval was granted by the University of Limerick Hospital Group Research Ethics Committee (107/2021). The authors will disseminate study findings through publication in a peer-reviewed journal and presentation at national and international conferences. Patient and public involvement will be sought from a panel of older adults at the Ageing Research Centre in the University of Limerick. Clinicaltrials.gov Identifier: NCT05252182.
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Affiliation(s)
- Íde O'Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Fiona Steed
- Medicine Directorate, University Hospital Limerick, Limerick, Ireland
| | - Damien Ryan
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Leonora Carey
- Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland
| | - Denys Shchetkovsky
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife Leahy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Colin Quinn
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Ali Sheikhi
- Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Chong E, Zhu B, Ng SHX, Tan H, Goh EF, Molina JDC, Pereira MJ, Kaur P, Baldevarona-Llego J, Chia JQ, Chong A, Cheong S, Foo CL, Chan M, Lim WS. Emergency department interventions for frailty (EDIFY): improving functional outcomes in older persons at the emergency department through a multicomponent frailty intervention. Age Ageing 2022; 51:6520521. [PMID: 35134848 DOI: 10.1093/ageing/afab251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES emergency department interventions for frailty (EDIFY) delivers frailty-centric interventions at the emergency department (ED). We evaluated the effectiveness of a multicomponent frailty intervention (MFI) in improving functional outcomes among older persons. DESIGN a quasi-experimental study. SETTING a 30-bed ED observation unit within a 1,700-bed acute tertiary hospital. PARTICIPANTS patients aged ≥65 years, categorised as Clinical Frailty Scale 4-6, and planned for discharge from the unit. METHODS we compared patients receiving the MFI versus usual-care. Data on demographics, function, frailty, sarcopenia, comorbidities and medications were gathered. Our primary outcome was functional status-Modified Barthel Index (MBI) and Lawton's iADL. Secondary outcomes include hospitalisation, ED re-attendance, mortality, frailty, sarcopenia, polypharmacy and falls. Follow-up assessments were at 3, 6 and 12 months. RESULTS we recruited 140 participants (mean age 79.7 ± 7.6 years; 47% frail and 73.6% completed the study). Baseline characteristics between groups were comparable (each n = 70). For the intervention group, MBI scores were significantly higher at 6 months (mean: 94.5 ± 11.2 versus 88.5 ± 19.5, P = 0.04), whereas Lawton's iADL scores experienced less decline (change-in-score: 0.0 ± 1.7 versus -1.1 ± 1.8, P = 0.001). Model-based analyses revealed greater odds of maintaining/improving MBI in the intervention group at 6 months [odds ratio (OR) 2.51, 95% confidence interval (CI) 1.04-6.03, P = 0.04] and 12 months (OR 2.98, 95% CI 1.18-7.54, P = 0.02). This was similar for Lawton's iADL at 12 months (OR 4.01, 95% CI 1.70-9.48, P = 0.002). ED re-attendances (rate ratio 0.35, 95% CI 0.13-0.90, P = 0.03) and progression to sarcopenia (OR 0.19, 95% CI 0.04-0.94, P = 0.04) were also lower at 6 months. CONCLUSIONS the MFI delivered to older persons at the ED can possibly improve functional outcomes and reduce ED re-attendances while attenuating sarcopenia progression.
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Affiliation(s)
- Edward Chong
- Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore
- Institute of Geriatrics and Active Ageing (IGA), TTSH, Singapore
| | - Birong Zhu
- Department of Nursing Services, TTSH, Singapore
| | - Sheryl Hui Xian Ng
- Health Services and Outcomes Research (HSOR), National Healthcare Group, Singapore
| | - Hongyun Tan
- Department of Nursing Services, Woodlands Health, Singapore
| | - Eileen Fabia Goh
- Institute of Geriatrics and Active Ageing (IGA), TTSH, Singapore
| | | | | | - Palvinder Kaur
- Health Services and Outcomes Research (HSOR), National Healthcare Group, Singapore
| | | | - Jia Qian Chia
- Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore
| | - Amanda Chong
- Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore
| | | | | | - Mark Chan
- Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore
- Institute of Geriatrics and Active Ageing (IGA), TTSH, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore
- Institute of Geriatrics and Active Ageing (IGA), TTSH, Singapore
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Ibrahim K, Mullee MA, Cox N, Russell C, Baxter M, Tilley S, Yao GL, Zhu S, Roberts HC. The feasibility and acceptability of assessing and managing sarcopenia and frailty among older people with upper limb fracture. Age Ageing 2022; 51:afab252. [PMID: 34977920 PMCID: PMC8753048 DOI: 10.1093/ageing/afab252] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND sarcopenia and frailty are associated with increased risk of falls and fractures. This study evaluated the feasibility of assessing sarcopenia and frailty among older people attending fracture clinics. METHODS patients aged 65+ years with an arm fracture attending fracture clinics in one UK city were recruited. Sarcopenia was assessed using gait speed, grip strength, skeletal muscle mass index SMI, SARC-F questionnaire and the European Working Group on Sarcopenia in Older People (EWGSOP) I and II criteria. Frailty was assessed using Fried Frailty Phenotype (FFP), FRAIL scale, PRISMA-7, electronic Frailty Index (e-FI), Clinical Frailty Score (CFS) and Study of Osteoporotic Fracture. The sensitivity and specificity of each tool was calculated against the EWGSOP II criteria (sarcopenia) and FFP (frailty). Patients identified to have either condition were referred for Comprehensive Geriatric Assessment (CGA). Interviews with 13 patients and nine staff explored the acceptability of this process. RESULTS hundred patients (Mean age 75 years) were recruited. Most sarcopenia and frailty assessments were quick with complete data collection and were acceptable to patients and staff. Sarcopenia was identified among 4-39% participants depending on the tool and frailty among 9-25%. Both conditions were more common among men than women with all tools. The SARC-F and PRISMA-7 had the best sensitivity (100 and 93%, respectively) and specificity (96 and 87%). CGA among 80% of referred participants led to three interventions per participant (e.g. medication changes and investigations). CONCLUSION SARC-F and PRISMA-7 are recommended for use in fracture clinics to screen for sarcopenia and frailty.
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Affiliation(s)
- Kinda Ibrahim
- Academic Geriatric Medicine and National Institute for Health Research Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Mark A Mullee
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Natalie Cox
- Academic Geriatric Medicine and the NIHR BRC Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Cynthia Russell
- Patient and Public Involvement, National Institute for Health Research Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
| | - Mark Baxter
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Simon Tilley
- Trauma and Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Guiqing Lily Yao
- Department of Health Sciences, College of Life Sciences, University of Leicester University, UK
| | - Shihua Zhu
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine and National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton
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Chen LJ, Nguyen TNM, Chang-Claude J, Hoffmeister M, Brenner H, Schöttker B. Association of Polypharmacy with Colorectal Cancer Survival Among Older Patients. Oncologist 2021; 26:e2170-e2180. [PMID: 34476870 PMCID: PMC8649018 DOI: 10.1002/onco.13961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/10/2021] [Indexed: 12/31/2022] Open
Abstract
Background In geriatric oncology, polypharmacy is often assessed during a comprehensive geriatric assessment. Previous studies about its association with survival among patients with colorectal cancer (CRC) were inconclusive and had high risk for indication bias. Patients and Methods A cohort study was conducted with 3,239 patients with CRC, aged ≥65 years, who were recruited in Germany between 2003 and 2016, while being hospitalized for CRC surgery. We defined polypharmacy as the concurrent use of five or more drugs, and excessive polypharmacy (EPP) as concurrent use of eight or more drugs. Cox proportional hazards regression models were performed to assess the associations of polypharmacy with 5‐year overall (OS), CRC‐specific (CSS), and non‐cancer‐specific survival (NCS) with rigorous adjustment for morbidity to minimize indication bias (e.g., for cancer stage, functional status, and 13 common diseases/conditions). Results The prevalence of polypharmacy was 54.7% and that of EPP was 24.2%. During up to 5 years of follow‐up, 1,070 participants died, among whom 615 died of CRC and 296 died of other causes than cancer. EPP was statistically significantly associated with poorer up‐to‐5‐year OS (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.02–1.47) and CSS (HR, 1.31; 95% CI, 1.03–1.68). HR point estimate for NCS was higher than 1 (1.22) but not statistically significant. Conclusion Polypharmacy was very common and EPP was a weak risk factor for mortality in this large cohort of older patients with CRC. Clinical trials are needed to address the causality of this relationship because older patients with CRC might benefit from deprescribing drugs without an indication. Implications for Practice The results of this study support the hypothesis that excessive polypharmacy, defined as use of eight or more concurrently used active substances, has a negative impact on the prognosis of older patients with colorectal cancer (CRC). This study suggests to oncologists that performing a medication review for older patients with CRC with eight drugs or more is indicated (especially when a broader comprehensive geriatric assessment is being performed). Such a medication review should not only focus on reducing the number of medications (by deprescribing drugs without an indication) but also check the appropriateness of indicated drugs for older patients with cancer. Excessive polypharmacy, defined as the concurrent use of eight or more drugs, is becoming more common, especially in the older population. This article evaluates the association of polypharmacy with overall survival in large cohort patients with colorectal cancer.
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Affiliation(s)
- Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Thi Ngoc Mai Nguyen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.,Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
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Yen KH, Hsu CC, Yu PC, Liu HY, Chen ZJ, Chen YW, Peng LN, Lin MH, Chen LK. Determinants of improved quality of life among older adults with multimorbidity receiving integrated outpatient services: A hospital-based retrospective cohort study. Arch Gerontol Geriatr 2021; 97:104475. [PMID: 34304112 DOI: 10.1016/j.archger.2021.104475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Older adults with multiple complex care needs tend to receive fragmented care that may jeopardize their quality of life (QoL) and health outcomes. This study evaluated the determinants of improved QoL among integrated outpatient service recipients with multimorbidity. METHODS We conducted a retrospective cohort study of integrated geriatric outpatient services (IGOS) at a tertiary medical center in Taiwan. Data from 2018 to 2019 were retrieved. All patients underwent comprehensive geriatric assessment, which included demographic information, serial functional assessments, and assessment for QoL. QoL was reassessed through a telephone survey 6 months after the patients' first visit to IGOS. Factors associated with the interval changes in QoL were identified using multivariate logistic regression. RESULTS Data from 995 patients receiving IGOS (mean age: 82.21 ± 7.96 years, 54.5% males) were analyzed. An overall mean improvement in QoL was noted (EQ-5D index: +0.055±0.26, p <0.001) while 747 recipients reported maintained or improved QoL. The results of the multivariate logistic regression showed that poorer nutritional status (OR = 1.56, 95% CI: 1.07-2.28), depressive symptoms (OR = 1.99, 95% CI: 1.38-2.86), and frailty (OR = 1.66, 95% CI: 1.10-2.52) were independent risk factors for poorer QoL after adjustment for baseline QoL. CONCLUSIONS Integrated outpatient services improved the quality of life of older adults with multimorbidity. Those with poorer nutritional status, depressive symptoms and frailty were less likely to show improvement in their QoL.
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Meerkerk CDA, Chargi N, de Jong PA, van den Bos F, de Bree R. Low skeletal muscle mass predicts frailty in elderly head and neck cancer patients. Eur Arch Otorhinolaryngol 2021. [PMID: 33956205 DOI: 10.1007/s00405-021-06835-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/19/2021] [Indexed: 12/22/2022]
Abstract
Purpose Treatment of head and neck cancer (HNC) carries a high risk of adverse outcomes in patients, especially in frail elderly. Therefore, it is important to identify patients in which treatment benefits outweigh the risk of any adverse outcome. Although the comprehensive geriatric assessment (CGA) identifies frailty, it is a time-consuming tool. Instead, measurement of skeletal muscle mass and strength (sarcopenia) may be a promising and time-efficient biomarker for frailty. The aim of this study was to examine the association between sarcopenia and frailty assessment tools, such as the CGA, Fried criteria and the Groningen Frailty Indicator (GFI). Methods A retrospective study was performed in elderly patients (≥ 70-years) with HNC. Sarcopenia was defined as the combination of reduced handgrip strength (HGS) and low skeletal muscle mass (SMM), according to the EWGSOP-2 criteria. SMM was measured on routinely available diagnostic imaging and corrected height: skeletal muscle index (SMI). A CGA was performed by a geriatrician. Frailty screening was performed using the GFI and the Fried criteria. Results In total, 73 patients were included of which 33 were men (45.2%) and 40 women (54.8%). Frail patients diagnosed by CGA were more likely to have low SMI, sarcopenia, more comorbidities and were at high risk for malnutrition (all p < 0.05). In multivariate regression analysis, the only significant predictor for frailty diagnosed by CGA was SMI (OR 0.9, p < 0.01) independent of comorbidity and muscle strength. Conclusion Low SMI and sarcopenia are associated with frailty in elderly HNC patients. Low SMI predicts frailty and is a promising time-efficient and routinely available tool for clinical practice.
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Kennedy F, Galvin R, Horgan NF. Managing frailty in an Irish primary care setting: A qualitative study of perspectives of healthcare professionals and frail older patients. J Frailty Sarcopenia Falls 2021; 6:1-8. [PMID: 33817445 PMCID: PMC8017349 DOI: 10.22540/jfsf-06-001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Little is known about the views of key stakeholders on frailty in Primary Care in Ireland. The aim of this study was to explore the views of Irish healthcare professionals and patients on frailty and its management in Primary Care. METHODS A qualitative descriptive design was used. Seventeen healthcare professionals and three patients were recruited using purposive sampling. Data were collected using semi-structured interviews which were analysed thematically. RESULTS Three themes were identified: (i) Perceptions of Frailty (ii) Current Management of Frailty and (iii) Comprehensive Geriatric Assessment in Primary Care. The results demonstrated variability in perspectives on frailty. Healthcare professionals described a fragmented service often delivering substandard care to frail older patients. The general consensus was that frailty management required an adequately resourced Primary Care service. Support for frailty screening and Comprehensive Geriatric Assessment was evident while the suitability of the current pathway for patients requiring assessment was questioned. CONCLUSION This study highlights an absence of a shared and complete understanding of frailty among healthcare professionals and a fragmented model of care for community-dwelling frail older patients. Based on these findings, inter-professional training, investment in Primary Care, the development of a frailty pathway and an interface service is recommended.
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Affiliation(s)
- Fiona Kennedy
- Meath Primary Care Services, Community Health Organisation (CHO) 8, Health Service Executive (HSE), Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick (UL), Ireland
| | - N. Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), Ireland
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Kroc Ł, Fife E, Piechocka-Wochniak E, Sołtysik B, Kostka T. Comparison of Nutrition Risk Screening 2002 and Subjective Global Assessment Form as Short Nutrition Assessment Tools in Older Hospitalized Adults. Nutrients 2021; 13:225. [PMID: 33466724 DOI: 10.3390/nu13010225] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to compare two widely recommended short nutrition assessment tools—Nutrition Risk Screening 2002 (NRS-2002) and Subjective Global Assessment Form (SGA)—with other Comprehensive Geriatric Assessment (CGA) measurements. The study included 622 consecutively hospitalized older subjects, aged 81.7 ± 7.8 years. The criteria to participate were the ability to communicate and given consent. Both NRS-2002 and SGA were inversely related to anthropometric measurements, functional assessment tests, Mini-Mental State Examination (MMSE) and positively associated with the Vulnerable Elders Survey-13 (VES-13) score. Results of SGA and NRS-2002 were not related to sex and 15-item Geriatric Depression Scale (GDS) score. Comparison of well-nourished subjects and patients with suggested problems with nutrition according to NRS-2002 (0–2 vs. 3–7) and SGA (A vs. B + C) gave comparable results. Both nutritional scales at given cut-off points similarly discriminated anthropometric data and other CGA tools in the populations of well-nourished vs. malnourished hospitalized older subjects. In conclusion, we can recommend using both NRS-2002 and SGA to detect malnutrition or risk of malnutrition in a routine clinical practice of the geriatric department ward.
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O'Donovan A, Morris L. Palliative Radiation Therapy in Older Adults With Cancer: Age-Related Considerations. Clin Oncol (R Coll Radiol) 2020; 32:766-774. [PMID: 32641244 DOI: 10.1016/j.clon.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
There are many additional considerations when treating older adults with cancer, especially in the context of palliative care. Currently, radiation therapy is underutilised in some countries and disease sites, but there is also evidence of unnecessary treatment in other contexts. Making rational treatment decisions for older adults necessitates an underlying appraisal of the person's physiological reserve capacity. This is termed 'frailty', and there is considerable heterogeneity in its clinical presentation, from patients who are relatively robust and suitable for standard treatment, to those who are frail and perhaps require a different approach. Frailty assessment also presents an important opportunity for intervention, when followed by Comprehensive Geriatric Assessment (CGA) in those who require it. Generally, a two-step approach, with a short initial screening, followed by CGA, is advocated in geriatric oncology guidelines. This has the potential to optimise care of the older person, and may also reverse or slow the development of frailty. It therefore has an important impact on the patient's quality of life, which is especially valued in the context of palliative care. Frailty assessment also allows a more informed discussion of treatment outcomes and a shared decision-making approach. With regards to the radiotherapy regimen itself, there are many adaptations that can better facilitate the older person, from positioning and immobilisation, to treatment prescriptions. Treatment courses should be as short as possible and take into account the older person's unique circumstances. The additional burden of travel to treatment for the patient, caregiver or family/support network should also be considered. Reducing treatments to single fractions may be appropriate, or alternatively, hypofractionated regimens. In order to enhance care and meet the demands of a rapidly ageing population, future radiation oncology professionals require education on the basic principles of geriatric medicine, as many aspects remain poorly understood.
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Affiliation(s)
- A O'Donovan
- Applied Radiation Therapy Trinity (ARTT) research group, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin, Ireland.
| | - L Morris
- Department of Radiation Oncology, St George Hospital, Sydney, NSW 2217, Australia
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Lee JY, Kim KJ, Kim CO, Lee KH. Relationship of the pre-operative comprehensive geriatric assessment to length of stay in Korean older adults undergoing spinal surgery. Aging Clin Exp Res 2020; 32:1137-1143. [PMID: 31429002 DOI: 10.1007/s40520-019-01300-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although pre-operative, Comprehensive Geriatric Assessment has been used widely, its impact on the health status of older adults has not been fully examined. AIMS This study aimed to investigate the relationships between subcomponents of a Comprehensive Geriatric Assessment and length of hospital stay in older adults undergoing spinal surgery. METHODS Participants were 133 older adults in neurosurgical department. The Comprehensive Geriatric Assessment included nutrition, physical activity, functional status, cognition, depression, the Timed Up and Go test, self-rated health, and frailty. Length of stay was replaced by excessive number of days, because expected length of stay varied depending on the type of surgery. RESULTS Excessive lengths of stay were associated with pre-frailty (p = 0.02), frailty (p = 0.02), risk of depression (p < 0.01), and post-operative complications (p < 0.01). More specifically, frailty and risk of depression played as moderators as interacting post-operative complications. The effect of interaction was greatest in the older adults who were frail and depressed (p < 0.001). DISCUSSION Among the subcomponent of Comprehensive Geriatric Assessment, frailty and depression were significant predictors of excessive length of stay. The interrelationship between frailty and depression better explained excessive length of stay rather than considered as individual variable. CONCLUSIONS Clinicians are encouraged to pay attention to depression and frailty, and its interaction to improve the health status of surgical elderly patients.
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Cruz-Jentoft AJ, Daragjati J, Fratiglioni L, Maggi S, Mangoni AA, Mattace-Raso F, Paccalin M, Polidori MC, Topinkova E, Ferrucci L, Pilotto A. Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons: results and final recommendations from the MPI_AGE European Project. Aging Clin Exp Res 2020; 32:861-868. [PMID: 32180170 DOI: 10.1007/s40520-020-01516-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
MPI_AGE is a European Union co-funded research project aimed to use the Multidimensional Prognostic Index (MPI), a validated Comprehensive Geriatric Assessment (CGA)-based prognostic tool, to develop predictive rules that guide clinical and management decisions in older people in different European countries. A series of international studies performed in different settings have shown that the MPI is useful to predict mortality and risk of hospitalization in community-dwelling older subjects at population level. Furthermore, studies performed in older people who underwent a CGA before admission to a nursing home or receiving homecare services showed that the MPI successfully identified groups of persons who could benefit, in terms of reduced mortality, of specific therapies such as statins in diabetes mellitus and coronary artery disease, anticoagulants in atrial fibrillation and antidementia drugs in cognitive decline. A prospective trial carried out in nine hospitals in Europe and Australia demonstrated that the MPI was able to predict not only in-hospital and long-term mortality, but also institutionalization, re-hospitalization and receiving homecare services during the one-year follow-up after hospital discharge. The project also explored the association between MPI and mortality in hospitalized older patients in need of complex procedures such as transcatheter aortic valve implantation or enteral tube feeding. Evidence from these studies has prompted the MPI_AGE Investigators to formulate recommendations for healthcare providers, policy makers and the general population which may help to improve the cost-effectiveness of appropriate health care interventions for older patients.
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Abstract
Frailty is defined as a reduced physiologic reserve vulnerable to external stressors. For older individuals, frailty plays a decisive role in increasing adverse health outcomes in most clinical situations. Many tools or criteria have been introduced to define frailty in recent years, and the definition of frailty has gradually converged into several consensuses. Frail older adults often have multi-domain risk factors in terms of physical, psychological, and social health. Comprehensive geriatric assessment (CGA) is the process of identifying and quantifying frailty by examining various risky domains and body functions, which is the basis for geriatric medicine and research. CGA provides physicians with information on the reversible area of frailty and the leading cause of deterioration in frail older adults. Therefore frailty assessment based on understanding CGA and its relationship with frailty, can help establish treatment strategies and intervention in frail older adults. This review article summarizes the recent consensus and evidence of frailty and CGA.
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Affiliation(s)
- Heayon Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Karpa K, Graveno M, Brightbill M, Fox G, Kelly S, Lehman E, Salvadia A, Shaw T, Smith D, Walko M, Sherwood L. Geriatric Assessment in a Primary Care Environment: A Standardized Patient Case Activity for Interprofessional Students. MedEdPORTAL 2019; 15:10844. [PMID: 31911935 PMCID: PMC6944254 DOI: 10.15766/mep_2374-8265.10844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Given the aging population and the benefits of comprehensive geriatric assessment to this subset of patients, an interprofessional education training approach may be advantageous for learners from a number of different health professions. METHODS Through intercollegiate collaborations involving seven different colleges, an interprofessional simulation using standardized patients was developed and instituted for learners in medicine, nursing, pharmacy, occupational therapy, physical therapy, dental hygiene, and dietitian programs. Herein, we describe the design of the simulation experience and examine its impact on students, as assessed primarily via written reflective comments provided via exit slips at the conclusion of the activity. RESULTS Of the 340 student participants, 83% submitted exit slips describing something gained from the interprofessional session that would not have occurred if students had completed the activity with only students from their own discipline. Three key themes were identified from these reflections: new understanding of roles and responsibilities of other disciplines, new knowledge or skills pertaining to geriatric assessments, and the value of teamwork. DISCUSSION Reflective comments from students regarding the interprofessional experience are evidence of this initiative's benefits, which include increasing knowledge of geriatric medical and allied health-provided care and attainment of interprofessional competencies.
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Affiliation(s)
- Kelly Karpa
- Professor, Department of Pharmacology, Pennsylvania State University College of Medicine
- Assistant Dean for Interprofessional Education, Pennsylvania State University College of Medicine
| | - Molly Graveno
- PharmD Candidate, Duquesne University School of Pharmacy
| | - Megan Brightbill
- Campus Associate Dean, Academic Affairs, Harrisburg Area Community College
| | - Gina Fox
- Lecturer, Occupational Therapy, Elizabethtown College
| | - Shawnee Kelly
- Assistant Teaching Professor, Department of Nutritional Sciences, Pennsylvania State University College of Health and Human Development
- Coordinator of Master of Professional Studies in Nutritional Sciences, Department of Nutritional Sciences, Pennsylvania State University College of Health and Human Development
| | - Erik Lehman
- Biostatistician, Department of Public Health Sciences, Pennsylvania State University College of Medicine
| | | | - Tanya Shaw
- Education Program Assistant, Pennsylvania State University College of Medicine
| | - Dylan Smith
- PharmD Candidate, Nesbitt School of Pharmacy, Wilkes University
| | - Matthew Walko
- Clinical Assistant Professor, Physical Therapy, Lebanon Valley College
| | - Lisa Sherwood
- Assistant Professor, Department of Medicine, Pennsylvania State University College of Medicine
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Mazya AL, Garvin P, Ekdahl AW. Outpatient comprehensive geriatric assessment: effects on frailty and mortality in old people with multimorbidity and high health care utilization. Aging Clin Exp Res 2019; 31:519-525. [PMID: 30039453 PMCID: PMC6439176 DOI: 10.1007/s40520-018-1004-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/06/2018] [Indexed: 10/31/2022]
Abstract
BACKGROUND Multimorbidity and frailty are often associated and Comprehensive Geriatric Assessment (CGA) is considered the gold standard of care for these patients. AIMS This study aimed to evaluate the effect of outpatient Comprehensive Geriatric Assessment (CGA) on frailty in community-dwelling older people with multimorbidity and high health care utilization. METHODS The Ambulatory Geriatric Assessment-Frailty Intervention Trial (AGe-FIT) was a randomized controlled trial (intervention group, n = 208, control group n = 174) with a follow-up period of 24 months. Frailty was a secondary outcome. Inclusion criteria were: age ≥ 75 years, ≥ 3 current diagnoses per ICD-10, and ≥ 3 inpatient admissions during 12 months prior to study inclusion. The intervention group received CGA-based care and tailored interventions by a multidisciplinary team in an Ambulatory Geriatric Unit, in addition to usual care. The control group received usual care. Frailty was measured with the Cardiovascular Health Study (CHS) criteria. At 24 months, frail and deceased participants were combined in the analysis. RESULTS Ninety percent of the population were frail or pre-frail at baseline. After 24 months, there was a significant smaller proportion of frail and deceased (p = 0.002) and a significant higher proportion of pre-frail patients in the intervention group (p = 0.004). Mortality was high, 18% in the intervention group and 26% in the control group. CONCLUSION Outpatient CGA may delay the progression of frailty and may contribute to the improvement of frail patients in older persons with multimorbidity.
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O'Brien K, McKoy JM, Penedo F. Cancer Comorbidity: Implications for Drug Safety. Cancer Treat Res 2019; 171:21-35. [PMID: 30552654 DOI: 10.1007/978-3-319-43896-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer is primarily a disease of aging. This chapter discusses relevant aspect of the physiology of aging, medication use and toxicity, comorbidities, and specific challenges in treating older adults with cancer.
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Affiliation(s)
| | - June M McKoy
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Frank Penedo
- Department of Medicine, Northwestern University, Chicago, IL, USA
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Isik AT, Soysal P. Dementia-Related Results of "Costs of Medication in Older Patients: Before and After Comprehensive Geriatric Assessment". Am J Alzheimers Dis Other Demen 2018; 33:497-499. [PMID: 30249114 PMCID: PMC10852474 DOI: 10.1177/1533317518802434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Changes in the pharmacokinetics and pharmacodynamics of drugs in the presence of certain comorbidities and geriatric syndromes and reduced tolerability of potential drug side effects due to physiological changes with aging lead to difficulties in planning treatments in elderly adults, especially patients with dementia. The Comprehensive Geriatric Assessment has an important role in assessing polypharmacy and optimizing potentially inappropriate medications and potentially prescribing omissions in these patients. For this reason, we intend to reexamine our new study titled " Costs of medication in older patients: before and after comprehensive geriatric assessment," because most of these results are also very important for dementia practice.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Meyer AM, Becker I, Siri G, Brinkkötter PT, Benzing T, Pilotto A, Polidori MC. New associations of the Multidimensional Prognostic Index. Z Gerontol Geriatr 2018; 52:460-467. [PMID: 30406302 DOI: 10.1007/s00391-018-01471-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The multidimensional prognostic index (MPI) is a validated, sensitive, and specific prognosis estimation tool based on a comprehensive geriatric assessment (CGA). The MPI accurately predicts mortality after 1 month and 1 year in older, multimorbid patients with acute disease or relapse of chronic conditions. OBJECTIVE To evaluate whether the MPI predicts indicators of healthcare resources, i.e. grade of care (GC), length of hospital stay (LHS) and destination after hospital discharge in older patients in an acute medical setting. MATERIAL AND METHODS In this study 135 hospitalized patients aged 70 years and older underwent a CGA evaluation to calculate the MPI on admission and discharge. Accordingly, patients were subdivided in low (MPI‑1, score 0-0.33), moderate (MPI-2, score 0.34-0.66) and high (MPI-3, score 0.67-1) risk of mortality. The GC, LHS and the discharge allocation were also recorded. RESULTS The MPI score was significantly related to LHS (p = 0.011) and to GC (p < 0.001). In addition, MPI-3 patients were significantly more often transferred from other hospital settings (p = 0.007) as well as significantly less likely to be discharged home (p = 0.04) than other groups. CONCLUSION The CGA-based MPI values are significantly associated with use of indicators of healthcare resources, including GC, LHS and discharge allocation. These findings suggest that the MPI may be useful for resource planning in the care of older multimorbid patients admitted to hospital.
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Affiliation(s)
- Anna Maria Meyer
- Ageing Clinical Research, Dpt. II for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Giacomo Siri
- Scientific Directorate - Biostatistics, E.O. Galliera Hospital, Genova, Italy
| | - Paul Thomas Brinkkötter
- Nephrology, Rheumatology, Diabetology and Internal Medicine, Dpt. II for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Thomas Benzing
- Nephrology, Rheumatology, Diabetology and Internal Medicine, Dpt. II for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - M Cristina Polidori
- Ageing Clinical Research, Dpt. II for Internal Medicine, University Hospital of Cologne, Cologne, Germany.
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Mäkelä P, Godfrey M, Cradduck-Bamford A, Ellis G, Shepperd S. A protocol for the process evaluation of a multi-centre randomised trial to compare the effectiveness of geriatrician-led admission avoidance hospital at home versus inpatient admission. Trials 2018; 19:569. [PMID: 30340618 PMCID: PMC6194629 DOI: 10.1186/s13063-018-2929-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/21/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Attempts to design services to support the delivery of healthcare closer to home have taken various forms as countries respond to an increase in hospital admission rates for older people, who are at risk of hospital-acquired morbidity, prolonged lengths of stay and readmission. Evidence to support the development of these services is limited. We are conducting a process evaluation, alongside a UK multi-site randomised trial, to understand the contexts and practices of implementing geriatrician-led admission avoidance hospital at home services and to explore ways that the intervention might be effective, under what conditions, for whom, and how it differs from inpatient care. METHODS We are interviewing patients and their caregivers, from sites that are purposively sampled from participating National Health Service (NHS) trusts across the UK. We are also visiting sites to observe local processes and discuss the establishment and running of services with a range of multidisciplinary staff, managers, commissioners, primary care and social services representatives. We aim to interview approximately 36 patients and their caregivers with experience of hospital at home or inpatient services; 12 at each of three sites. We will use a content analysis approach to explore data across participants, services and sites. DISCUSSION This process evaluation will enable evaluation of implementation processes prior to knowing trial outcomes. We encompass domains of reach, delivery, change, context and response to the intervention by patients, their carers, health professionals and the health system. TRIAL REGISTRATION ISRCTN60477865 . Registered on 10 March 2014. Trial sponsor: University of Oxford. Version 3.1, registered on 14 June 2016.
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Affiliation(s)
- Petra Mäkelä
- Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Mary Godfrey
- Institute of Health Sciences, University of Leeds, Leeds, LS2 9LJ UK
| | - Andrea Cradduck-Bamford
- Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| | - Graham Ellis
- Monklands Hospital, Monkscourt Avenue, Airdrie, ML6 0JS UK
| | - Sasha Shepperd
- Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Ekdahl AW, Axmon A, Sandberg M, Steen Carlsson K. Is care based on comprehensive geriatric assessment with mobile teams better than usual care? A study protocol of a randomised controlled trial (The GerMoT study). BMJ Open 2018; 8:e023969. [PMID: 30309994 PMCID: PMC6252639 DOI: 10.1136/bmjopen-2018-023969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process used to determine the medical, psychological and functional capabilities of frail older people. The primary aim of our current study is to confirm whether CGA-based outpatient care is superior than usual care in terms of health-related outcomes, resource use and costs. METHODS AND ANALYSIS The Geriatric Mobile Team trial is designed as a single-centre randomised, controlled, assessor-blinded (at baseline) trial. All participants will be identified via local healthcare registries with the following inclusion criteria: age ≥75 years, ≥3 different diagnoses and ≥3 visits to the emergency care unit (with or without admittance to hospital) during the past 18 months. Nursing home residency will be an exclusion criterion. Baseline assessments will be done before the 1:1 randomisation. Participants in the intervention group will, after an initial CGA, have access to care given by a geriatric team in addition to usual care. The control group receives usual care only. The primary outcome is the total number of inpatient days during the follow-up period. Assessments of the outcomes: mortality, quality of life, health care use, physical functional level, frailty, dependence and cognition will be performed 12 and 24 months after inclusion. Both descriptive and analytical statistics will be used, in order to compare groups and for analyses of outcomes over time including changes therein. The primary outcome will be analysed using analysis of variance, including in-transformed values if needed to achieve normal distribution of the residuals. ETHICS AND DISSEMINATION Ethical approval has been obtained and the results will be disseminated in national and international journals and to health care leaders and stakeholders. Protocol amendments will be published in ClinicalTrials.gov as amendments to the initial registration NCT02923843. In case of success, the study will promote the implementation of CGA in outpatient care settings and thereby contribute to an improved care of older people with multimorbidity through dissemination of the results through scientific articles, information to politicians and to the public. TRIAL REGISTRATION NUMBER NCT02923843; Pre-results.
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Affiliation(s)
- Anne Wissendorff Ekdahl
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute (KI), Stockholm, Sweden
- Department of Clinical Sciences Helsingborg, Geriatric Medicine, Lund University, Helsingborg Hospital, Stockholm, Sweden
| | - Anna Axmon
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lunds University, Lund, Sweden
| | - Magnus Sandberg
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
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Boscart VM, Heckman G, Davey M, Heyer M, Hirdes JP. Impact of the applied simulated and integrated learning approach on nursing assistants' knowledge and confidence caring for frail seniors in nursing homes. Pilot Feasibility Stud 2018; 4:77. [PMID: 29785281 PMCID: PMC5950201 DOI: 10.1186/s40814-018-0272-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Increasing importance is being placed on optimizing the role of Nursing Aides (NAs) in improving quality of care for nursing home (NH) residents. One approach to do so is to have NAs participate in assessments embedded within the Minimum Data Set (MDS). This pilot study aimed to design and evaluate the Applied Simulated and Integrated Learning Approach (ASILA) program, a novel innovative training program for NAs employed in NHs to enhance their ability to assess residents within an inter-professional framework. Methods A mixed quantitative and qualitative repeated measures design was used to assess changes in NAs' knowledge and perception of assessments and resident clinical outcomes. Additionally, focus groups were conducted with NAs upon completion of the ASILA program. A total of 23 NAs and nurses in NHs in two Canadian provinces participated. The ASILA pilot program consisted of three selected modules; each module including an evidence-informed case-scenario, assessments, the use of appropriate MDS tools and documentation, care planing and reporting systems. ASILA was delivered over the course of two days per home. The primary outcome measure focused on the impact of ASILA on NA knowledge and confidence in assessing residents and understanding the relevance and use of elements if the MDS tools. Secondary outcomes included NAs' satisfaction with ASILA and the impact of ASILA on resident clinical outcomes. Data were collected one week prior, immediately after, and three months after the ASILA program. Results Following ASILA, NAs reported increased knowledge test scores and confidence in assessing residents by using MDS tools, although this did not reach significance after multiple testing (p = 0.0256 and p = 0.1541 respectively). NAs reported more confidence in providing care to residents (77.8%) and felt that the care provided was more resident-centered (83.3%) than before the ASILA program. There were no significant trends in improved resident outcomes following ASILA. Conclusion Pilot findings indicate that the ASILA program could be a successful approach to support NAs to enhance their ability to assess residents in an inter-professional framework.
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Affiliation(s)
- Veronique M Boscart
- 1CIHR/Schlegel Industrial Research Chair for Colleges in Seniors Care, Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada
| | - George Heckman
- 2Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Canada
| | - Meaghan Davey
- 3Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada
| | - Michelle Heyer
- 4Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada
| | - John P Hirdes
- 5School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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O'Caoimh R, Kennelly S, O'Shea D. Can the Geriatric Day Hospital Act As a Hub for Services for Older People across the Spectrum of Ageing from Active Ageing to Advanced Frailty? Front Med (Lausanne) 2018; 5:23. [PMID: 29552560 PMCID: PMC5840151 DOI: 10.3389/fmed.2018.00023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/23/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland, Galway, Galway, Ireland.,National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Siobhán Kennelly
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, Ireland.,Department of Medicine for the Elderly, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Diamuid O'Shea
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, Ireland.,Department of Geriatric Medicine, St Vincent's University Hospital, Dublin, Ireland
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Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K, Kennedy S, Roberts H, Conroy S. What is Comprehensive Geriatric Assessment (CGA)? An umbrella review. Age Ageing 2018; 47:149-155. [PMID: 29206906 DOI: 10.1093/ageing/afx166] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Indexed: 12/24/2022] Open
Abstract
Background Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most. Objectives our objectives were to describe the key elements, principal measures of outcome and the characteristics of the main beneficiaries of inpatient CGA. Methods we used the Joanna Briggs Institute umbrella review method. We searched for systematic reviews and meta-analyses describing CGA services for hospital inpatients in the Cochrane Database of Systematic Reviews, Database of Reviews of Effectiveness (DARE), MEDLINE and EMBASE and a range of other sources. Results we screened 1,010 titles and evaluated 419 abstracts for eligibility, 143 full articles for relevance and included 24 in a final quality and relevance check. Thirteen reviews, reported in 15 papers, were selected for review. The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency. The main beneficiaries were people ≥55 years in receipt of acute care. Frailty in CGA recipients and patient related outcomes were not usually reported. Conclusions we confirm a widely used definition of CGA. Key outcomes are death, disability and institutionalisation. The main beneficiaries in hospital are older people with acute illness. The presence of frailty has not been widely examined as a determinant of CGA outcome.
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Affiliation(s)
- S G Parker
- Newcastle University, Institute for Health and Society, Newcastle upon Tyne, Tyne and Wear, UK
| | - P McCue
- Newcastle University, Institute for Health and Society, Newcastle upon Tyne, Tyne and Wear, UK
| | - K Phelps
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, UK
| | - A McCleod
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Arora
- Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, UK
| | - K Nockels
- University of Leicester Library, Leicester, UK
| | - S Kennedy
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - H Roberts
- University of Southampton, Academic Geriatric Medicine, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - S Conroy
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, UK
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Cui Y, Gong D, Yang B, Chen H, Tu MH, Zhang C, Li H, Liang N, Jiang L, Chang P. Making the CARE Comprehensive Geriatric Assessment as the Core of a Total Mobile Long Term Care Support System in China. Stud Health Technol Inform 2018; 247:770-774. [PMID: 29678065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Comprehensive Geriatric Assessments (CGAs) have been recommended to be used for better monitoring the health status of elder residents and providing quality care. This study reported how our nurses perceived the usability of CGA component of a mobile integrated-care long term care support system developed in China. We used the Continuity Assessment Record and Evaluation (CARE), developed in the US, as the core CGA component of our Android-based support system, in which apps were designed for all key stakeholders for delivering quality long term care. A convenience sample of 18 subjects from local long term care facilities in Shanghai, China were invited to assess the CGA assessment component in terms of Technology Acceptance Model for Mobile based on real field trial assessment. All (100%) were satisfied with the mobile CGA component. 88.9% perceived the system was easy to learn and use. 99.4% showed their willingness to use for their work. We concluded it is technically feasible to implement a CGA-based mobile integrated care support system in China.
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Affiliation(s)
- Yanyan Cui
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | | | - Bo Yang
- Yangpu Kongjiang Hospital, Shanghai, China
| | - Hua Chen
- Yangpu Kongjiang Hospital, Shanghai, China
| | - Ming-Hsiang Tu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Chaonan Zhang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan Li
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naiwen Liang
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Liping Jiang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Polun Chang
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
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Mas MÀ, Inzitari M, Sabaté S, Santaeugènia SJ, Miralles R. Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care. Age Ageing 2017; 46:925-931. [PMID: 28655169 DOI: 10.1093/ageing/afx099] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/08/2017] [Indexed: 11/12/2022] Open
Abstract
Objective to analyse the clinical impact of a home-based Intermediate Care model in the Catalan health system, comparing it with usual bed-based care. Design quasi-experimental longitudinal study. Setting hospital Municipal de Badalona and El Carme Intermediate Care Hospital, Badalona, Catalonia, Spain. Participants we included older patients with medical and orthopaedic disabling health crises in need of Comprehensive Geriatric Assessment (CGA) and rehabilitation. Methods a CGA-based hospital-at-home Integrated Care Programme (acute care and rehabilitation) was compared with a propensity score matched cohort of contemporary patients attended by usual inpatient hospital care (acute care plus intermediate care hospitalisation), for the management of medical and orthopaedics processes. Main outcomes measures were: (a) Health crisis resolution (referral to primary care at the end of the intervention); (b) functional resolution: relative functional gain (functional gain/functional loss) ≥ 0.35; and (c) favourable crisis resolution (health + functional) = a + b. We compared between-groups outcomes using uni/multivariable logistic regression models. Results clinical characteristics were similar between home-based and bed-based groups. Acute stay was shorter in home group: 6.1 (5.3-6.9) versus 11.2 (10.5-11.9) days, P < 0.001. The home-based scheme showed better results on functional resolution 79.1% (versus 75.2%), OR 1.62 (1.09-2.41) and on favourable crisis resolution 73.8% (versus 69.6%), OR 1.54 (1.06-2.22), with shorter length of intervention, with a reduction of -5.72 (-9.75 and -1.69) days. Conclusions in our study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system.
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Affiliation(s)
- Miquel À Mas
- Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Marco Inzitari
- Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
- Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain
| | - Sergi Sabaté
- Fundació Puigvert (IUNA), Barcelona, Catalonia, Spain
| | | | - Ramón Miralles
- Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
- Department of Geriatrics, Consorci Parc de Salut Mar, Barcelona, Catalonia, Spain
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Abstract
In this article, we discuss the emergence of new models for delivery of comprehensive geriatric assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home and institutionalisation. Traditionally It is delivered by specialised multidisciplinary teams, often in dedicated wards, but in recent years has begun to be taken up and developed quite early in the admission process (at the 'front door'), across traditional ward boundaries and in specialty settings such as surgical and pre-operative care, and oncology. We have scanned recent literature, including observational studies of service evaluations, and service descriptions presented as abstracts of conference presentations to provide an overview of an emerging landscape of innovation and development in CGA services for hospital inpatients.
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Affiliation(s)
- S G Parker
- Newcastle University, Institute for Health and Society, Newcastle upon Tyne, UK
| | - A McLeod
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
| | - P McCue
- Newcastle University, Institute for Health and Society, Newcastle upon Tyne, UK
| | - K Phelps
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, Leicester LE1 7RH, UK
| | | | - H C Roberts
- University of Southampton, Academic Geriatric Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - S P Conroy
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, Leicester LE1 7RH, UK
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Ethun CG, Bilen MA, Jani AB, Maithel SK, Ogan K, Master VA. Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA Cancer J Clin 2017; 67:362-377. [PMID: 28731537 DOI: 10.3322/caac.21406] [Citation(s) in RCA: 313] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Answer questions and earn CME/CNE The concept of frailty has become increasingly recognized as one of the most important issues in health care and health outcomes and is of particular importance in patients with cancer who are receiving treatment with surgery, chemotherapy, and radiotherapy. Because both cancer itself, as well as the therapies offered, can be significant additional stressors that challenge a patient's physiologic reserve, the incidence of frailty in older patients with cancer is especially high-it is estimated that over one-half of older patients with cancer have frailty or prefrailty. Defining frailty can be challenging, however. Put simply, frailty is a state of extreme vulnerability to stressors that leads to adverse health outcomes. In reality, frailty is a complex, multidimensional, and cyclical state of diminished physiologic reserve that results in decreased resiliency and adaptive capacity and increased vulnerability to stressors. In addition, over 70 different measures of frailty have been proposed. Still, it has been demonstrated that frail patients are at increased risk of postoperative complications, chemotherapy intolerance, disease progression, and death. Although international standardization of frailty cutoff points are needed, continued efforts by oncology physicians and surgeons to identify frailty and promote multidisciplinary decision making will help to develop more individualized management strategies and optimize care for patients with cancer. CA Cancer J Clin 2017;67:362-377. © 2017 American Cancer Society.
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Affiliation(s)
- Cecilia G Ethun
- General Surgery Resident, Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mehmet A Bilen
- Assistant Professor, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Ashesh B Jani
- Professor, Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K Maithel
- Associate Professor, Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kenneth Ogan
- Professor of Urology, Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Viraj A Master
- Professor, Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA
- Director of Clinical Research, Department of Urology, Winship Cancer Institute, Emory University, Atlanta, GA
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Abstract
Urgent care for older people is a major public health issue and attracts much policy attention. Despite many efforts to curb demand, many older people with frailty and urgent care needs to access acute hospital services. The predominant model of care delivered in acute hospitals tends to be medically focussed, yet the evidence-based approaches that appear to be effective invoke a holistic model of care, delivered by interdisciplinary teams embedding geriatric competencies into their service. This article reviews the role for holistic care-termed Comprehensive Geriatric Assessment in the research literature-and how it can be used as an organising framework to guide future iterations of acute services to be better able to meet the multifaceted needs of older people.
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Affiliation(s)
- Simon P Conroy
- University of Leicester School of Medicine, Department of Health Sciences, Room 3.37, Centre for Medicine, University of Leicester, Lancaster Road, Leicester LE1 7HA, UK
| | - Sarah Turpin
- Fellow in Geriatric Emergency Medicine, Leicester Royal Infirmary , Leicester, UK
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Rajasekaran T, Tan T, Ong WS, Koo KN, Chan L, Poon D, Roy Chowdhury A, Krishna L, Kanesvaran R. Comprehensive Geriatric Assessment (CGA) based risk factors for increased caregiver burden among elderly Asian patients with cancer. J Geriatr Oncol 2016; 7:211-8. [PMID: 27067580 DOI: 10.1016/j.jgo.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/21/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aims to identify Comprehensive Geriatric Assessment (CGA) based risk factors to help predict caregiver burden among elderly patients with cancer. MATERIALS AND METHOD The study evaluated 249 patients newly diagnosed with cancer, aged 70years and above, who attended the geriatric oncology clinic at the National Cancer Centre Singapore between 2007 and 2010. RESULTS Out of 249 patients, 244 patients had information available on family caregiver burden and were analysed. On univariate analysis, ADL dependence, lower IADL scores, ECOG performance status of 3-4, higher fall risk, lower scores in dominant hand grip strength test and mini mental state examination, polypharmacy, higher nutritional risk, haemoglobin <12g/dL and presence of geriatric syndromes were significantly associated with mild to severe caregiver burden. On multivariate analysis, only ECOG performance status of 3-4 (odds ratio [OR], 4.47; 95% confidence interval [CI], 2.27-8.80) and haemoglobin <12g/dL (OR, 2.38; 95% CI, 1.14-4.99) were associated with an increased probability of mild to severe caregiver burden. The model achieved a good fit (Hosmer-Lemeshow's p=0.196) and discrimination (area under the curve [AUC]=0.742; bias-corrected AUC=0.737). Based on this, patients were stratified into 3 risk groups with different proportion of patients with increased caregiver burden (low risk: 3.9% vs intermediate risk: 18.8% vs high risk: 39.6%; p<0.001). CONCLUSION ECOG performance status and haemoglobin were associated with increased caregiver burden among elderly patients with cancer. Using these two factors in the clinic may help clinicians identify caregivers at risk and take preventive action to mitigate that.
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Affiliation(s)
| | - Tira Tan
- Department of Medical Oncology, National Cancer Centre, Singapore
| | - Whee Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore
| | - Khai Nee Koo
- Perdana University Graduate School of Medicine, Serdang, Malaysia
| | - Lili Chan
- Department of Medical Oncology, National Cancer Centre, Singapore
| | - Donald Poon
- Raffles Cancer Centre, Singapore; Duke-NUS Graduate Medical School, Singapore
| | | | - Lalit Krishna
- Department of Medical Oncology, National Cancer Centre, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Ravindran Kanesvaran
- Department of Medical Oncology, National Cancer Centre, Singapore; Duke-NUS Graduate Medical School, Singapore.
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Ekdahl AW, Alwin J, Eckerblad J, Husberg M, Jaarsma T, Mazya AL, Milberg A, Krevers B, Unosson M, Wiklund R, Carlsson P. Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months. J Am Med Dir Assoc 2016; 17:263-8. [PMID: 26805750 DOI: 10.1016/j.jamda.2015.12.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/27/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion. DESIGN Randomized, controlled, assessor-blinded, single-center trial. SETTING A geriatric ambulatory unit in a municipality in the southeast of Sweden. PARTICIPANTS Community-dwelling individuals aged ≥ 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG). INTERVENTION Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care. OUTCOME MEASURES Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months. RESULTS Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P = .026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P = .01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P = .43). CONCLUSIONS CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGA's superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs.
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Affiliation(s)
- Anne W Ekdahl
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Department of Research and Education, Helsingborg Hospital, Helsingborg, Skåne Region, Sweden.
| | - Jenny Alwin
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Jeanette Eckerblad
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Magnus Husberg
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Amelie Lindh Mazya
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Department of Geriatric Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Anna Milberg
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Advanced Home Care and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Barbro Krevers
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Mitra Unosson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Rolf Wiklund
- Department of Analysis of Health Care, Östergötland Region, Linköping, Sweden
| | - Per Carlsson
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
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Maekawa Y, Sugimoto K, Yamasaki M, Takeya Y, Yamamoto K, Ohishi M, Ogihara T, Shintani A, Doki Y, Mori M, Rakugi H. Comprehensive Geriatric Assessment is a useful predictive tool for postoperative delirium after gastrointestinal surgery in old-old adults. Geriatr Gerontol Int 2015; 16:1036-42. [PMID: 26311242 DOI: 10.1111/ggi.12587] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2015] [Indexed: 11/29/2022]
Abstract
AIM To determine whether carrying out the Comprehensive Geriatric Assessment before operations would be useful for predicting complications, particularly postoperative delirium (POD), in old-old patients. METHODS A total of 517 patients aged 75 years and older, who underwent radical surgery for gastrointestinal cancer at Osaka University Hospital, were recruited for this observational study. The Comprehensive Geriatric Assessment components and assessment of performance status were carried out before surgery, and a record of postoperative complications including POD was made prospectively until discharge from hospital. The following morphological and clinical measurements were also obtained from the medical records: age, sex, disease type, previous history, comorbid lifestyle-related diseases, POD, postoperative complications, operative method, duration of operation, hemorrhage volume, blood transfusion volume, method of anesthesia, body mass index and blood tests. RESULTS POD appeared in 24.0% of the 517 patients who underwent surgery. Barthel Index, Mini-Mental State Examination, instrumental activities of daily living and Geriatric Depression Scale results were associated with the incidence of POD, and the Barthel Index, Mini-Mental State Examination and Instrumental Activities of Daily Living results were extracted as independent factors associated with the development of POD after adjusting for traditional risk factors for postoperative complications and performance status. CONCLUSIONS The Comprehensive Geriatric Assessment before gastrointestinal surgery can be a useful tool for predicting the development of POD in old-old patients. Geriatr Gerontol Int 2016; 16: 1036-1042.
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Affiliation(s)
- Yoshihiro Maekawa
- Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ken Sugimoto
- Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Yamasaki
- Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Takeya
- Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koichi Yamamoto
- Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Mitsuru Ohishi
- Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Toshio Ogihara
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Ayumi Shintani
- Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Mori
- Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiromi Rakugi
- Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Flores Ruano T, Cruz Jentoft AJ, González Montalvo JI, López Soto A, Abizanda Soler P. [Geriatric assessment tools in Spanish Geriatric Departments]. Rev Esp Geriatr Gerontol 2014; 49:235-242. [PMID: 24953247 DOI: 10.1016/j.regg.2014.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/06/2014] [Accepted: 05/08/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Comprehensive Geriatric Assessment (CGA) is the main measurement tool used by Geriatricians. A 2000 survey demonstrated great variability in the tools used for CGA among Spanish Geriatric Departments. A new survey to detect 13-year trends in the use of CGA tools in our country is presented. MATERIAL AND METHODS Descriptive study using a structured questionnaire on the use of CGA tools in different levels of care sent to the Heads of 39 Spanish Geriatric Departments or Services (27 with postgraduate teaching in Geriatrics) during the first three months of 2013. RESULTS The response rate was 97.4%. It was found that 78.4% (29 centers) used different tools depending on the level of care. Barthel and Lawton index were the most used functional assessment tools in all Departments and across all geriatric levels, although gait speed and Tinetti scale were frequently used in Day Hospital and Outpatient clinics. The Mini Mental State Exam and its Spanish version Mini Examen Cognoscitivo were the most used mental scales (97.4%), followed by tools for assessing depression-behavior (86.8%) and severity of cognitive impairment tools (84.2%). CGA tools were used in 43.2% of the emergency departments of the hospitals surveyed, being the most frequent. More than two-thirds (69.4%) of the Departments reported that their affiliated Primary Care centers used CGA tools, with the Barthel and Lawton again being indexes the most used. Most of the responding Departments considered that the main domains of CGA are functional, mental and social status. Nutrition, comorbidity, falls and pressure ulcers are other important domains. CONCLUSIONS There is still a great variability in the CGA tools being used in Spanish Geriatric Departments, although there is a trend towards a greater use of Barthel index, greater adaptation of tools to each level of care, and increasing assessment of new domains like frailty, nutrition or comorbidity.
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Affiliation(s)
- Teresa Flores Ruano
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | | | | | - Pedro Abizanda Soler
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España.
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Kanesvaran R, Wang W, Yang Y, Wei Z, Jia L, Li F, Wu S, Bai C, Xie H, Zhang H, Yang G, Sloane R, Li P, Cohen HJ. Characteristics and treatment options of elderly Chinese patients with cancer as determined by Comprehensive Geriatric Assessment (CGA). J Geriatr Oncol 2014; 5:171-8. [PMID: 24486112 DOI: 10.1016/j.jgo.2014.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 10/15/2013] [Accepted: 01/08/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE China is experiencing a rapid increase in cancer incidence in elderly patients. In order to better understand this group, a large study of patients from multiple tertiary centers in the Beijing area was designed. This study was designed to provide insight into their unique treatment preferences, including the use of traditional Chinese medicine (TCM). MATERIALS AND METHODS 803 patients from nine hospitals in the Beijing area were enrolled into this study. The inclusion criteria were patients who were 65 years or older and had a diagnosis of cancer at any stage. The CGA questionnaire used with these patients included the Chinese translation of the Gero-Oncology Health and Quality of Life Assessment tool. The questionnaire was provided to patients by a research nurse and was administered in Mandarin. RESULTS The mean age of the patients was 72 years (range 65-94). The patients were mainly male (59.8%) and of Han ethnicity (95.4%). About 45% of these patients also had concurrent TCM in addition to their other cancer treatments. About 70% were able to manage their activities of daily living without assistance. Patients on TCM were more likely to have higher number of co-morbidities compared to their counterparts. CONCLUSION This is the largest prospective study of CGA assessments done on elderly patients with cancer in Asia. The study demonstrates that CGA provides insights into understanding the needs of elderly Chinese patients with cancer. TCM is used frequently in China, and its impact on quality of life needs further investigation.
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