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Journal of Clinical Oncology : Official... Aug 2014To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. (Review)
Review
PURPOSE
To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer.
METHODS
SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care.
RESULTS
GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another.
CONCLUSION
There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.
Topics: Age Factors; Aged; Aged, 80 and over; Consensus; Geriatric Assessment; Geriatrics; Humans; Neoplasms
PubMed: 25071125
DOI: 10.1200/JCO.2013.54.8347 -
Annals of Oncology : Official Journal... Aug 2012Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment (CGA). We develop...
BACKGROUND
Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment (CGA). We develop and evaluate the G-8 screening tool against various reference tests.
PATIENTS AND METHODS
Analyses were based on 364 cancer patients aged>70 years scheduled to receive first-line chemotherapy included in a multicenter prospective study. The G-8 consists of seven items from the Mini Nutritional Assessment (MNA) questionnaire and age. Our primary reference test is based on a set of seven CGA scales: Activities Daily Living (ADL), Instrumental ADL, MNA, Mini-Mental State Exam, Geriatric Depression Scale, Cumulative Illness Rating Scale-Geriatrics, and Timed Get Up and Go. We considered the presence of at least one questionnaire with an impaired score as an abnormal reference exam. Additional reference exams are also discussed.
RESULTS
The prevalence of being at risk varied from 60% to 94% according to the various definitions of the reference test. When considering the primary reference test, a cut-off value of 14 for the G-8 tool provided a good sensitivity estimate (85%) without deteriorating the specificity excessively (65%).
CONCLUSION
The G-8 shows good screening properties for identifying elderly cancer patients who could benefit from CGA.
Topics: Age Factors; Aged; Aged, 80 and over; Early Detection of Cancer; Female; Geriatric Assessment; Humans; Male; Neoplasms
PubMed: 22250183
DOI: 10.1093/annonc/mdr587 -
PloS One 2020The geriatric syndromes of frailty, sarcopenia, weight loss, and dementia are highly prevalent in elderly individuals across all care continuums. Despite their...
INTRODUCTION
The geriatric syndromes of frailty, sarcopenia, weight loss, and dementia are highly prevalent in elderly individuals across all care continuums. Despite their deleterious impact on quality of life, disability, and mortality in older adults, they are frequently under-recognized. At Saint Louis University, the Rapid Geriatric Assessment (RGA) was developed as a brief screening tool to identify these four geriatric syndromes.
MATERIALS AND METHODS
From 2015-2019, the RGA, comprised of the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS) tools and a question on Advance Directives, was administered to 11,344 individuals ≥ 65 years of age across Missouri in community, office-based, hospital, Programs of All-Inclusive Care for the Elderly (PACE), and nursing home care settings. Standard statistical methods were used to calculate the prevalence of frailty, sarcopenia, weight loss, and dementia across the sample.
RESULTS
Among the 11,344 individuals screened by the RGA, 41.0% and 30.4% met the screening criteria for pre-frailty and frailty respectively, 42.9% met the screening criteria for sarcopenia, 29.3% were anorectic and at risk for weight loss, and 28.1% screened positive for dementia. The prevalence of frailty, risk for weight loss, sarcopenia, and dementia increased with age and decreased when hospitalized patients and those in the PACE program or nursing home were excluded.
CONCLUSIONS
Using the RGA as a valid screening tool, the prevalence of one or more of the geriatric syndromes of frailty, sarcopenia, weight loss, and dementia in older adults across all care continuums is quite high. Management approaches exist for each of these syndromes that can improve outcomes. It is suggested that the brief RGA screening tool be administered to persons 65 and older yearly as part of the Medicare Annual Wellness Visit.
Topics: Aged; Aged, 80 and over; Dementia; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Male; Medicare; Missouri; Prevalence; Sarcopenia; Syndrome; United States; Weight Loss
PubMed: 32502177
DOI: 10.1371/journal.pone.0233857 -
Gerontology 2023Cancer is a disease of aging and is rapidly becoming the number one cause of mortality in older people. Over their lifetime, one in two men and one in three women will... (Review)
Review
Cancer is a disease of aging and is rapidly becoming the number one cause of mortality in older people. Over their lifetime, one in two men and one in three women will develop a cancer, with half of the risk being beyond the age of seventy. Therefore, cancer is a problem frequently encountered by geriatricians. In this article, we review a few recent progresses that will be of interest to the geriatric community. First, we now have robust evidence that a comprehensive geriatric assessment and management change outcomes in older cancer patients, notably allowing decreased treatment toxicity, better treatment completion, and increased functional outcomes. In gastrointestinal cancers and breast cancer, several recent studies have addressed when treatment intensity can be decreased, and when it cannot. New treatments for acute myeloid leukemia are finally beginning to improve outcomes for older patients and such patients should be referred to oncologists for management. In prostate cancer, new imaging techniques (e.g., PSMA scan) and treatment options can allow better treatment targeting and spare some hormonal and chemotherapy toxicity. Finally, we review recent public policy efforts to address the epidemiologic wave of cancer in older patients on a global scale.
Topics: Male; Aged; Humans; Female; Breast Neoplasms; Geriatric Assessment; Aging
PubMed: 37321185
DOI: 10.1159/000531559 -
Journal of Physiotherapy Jul 2015
Topics: Aged; Aged, 80 and over; Exercise Test; Geriatric Assessment; Humans; Middle Aged; Physical Fitness
PubMed: 26044346
DOI: 10.1016/j.jphys.2015.04.001 -
Nutrients Apr 2021Sarcopenia, with risk factors such as poor nutrition and physical inactivity, is becoming prevalent among the older population. The aims of this study were (i) to... (Meta-Analysis)
Meta-Analysis Review
Sarcopenia, with risk factors such as poor nutrition and physical inactivity, is becoming prevalent among the older population. The aims of this study were (i) to systematically review the existing data on sarcopenia prevalence in the older Chinese population, (ii) to generate pooled estimates of the sex-specific prevalence among different populations, and (iii) to identify the factors associated with the heterogeneity in the estimates across studies. A search was conducted in seven databases for studies that reported the prevalence of sarcopenia in Chinese older adults, aged 60 years and over, published through April 2020. We then performed a meta-analysis to estimate the pooled prevalence, and investigated the factors associated with the variation in the prevalence across the studies using meta-regression. A total of 58 studies were included in this review. Compared with community-dwelling Chinese older adults (men: 12.9%, 95% CI: 10.7-15.1%; women: 11.2%, 95% CI: 8.9-13.4%), the pooled prevalence of sarcopenia in older adults from hospitals (men: 29.7%, 95% CI:18.4-41.1%; women: 23.0%, 95% CI:17.1-28.8%) and nursing homes (men: 26.3%, 95% CI: 19.1 to 33.4%; women: 33.7%, 95% CI: 27.2 to 40.1%) was higher. The multivariable meta-regression quantified the difference of the prevalence estimates in different populations, muscle mass assessments, and areas. This study yielded pooled estimates of sarcopenia prevalence in Chinese older adults not only from communities, but also from clinical settings and nursing homes. This study added knowledge to the current epidemiology literature about sarcopenia in older Chinese populations, and could provide background information for future preventive strategies, such as nutrition and physical activity interventions, tailored to the growing older population.
Topics: Aged; Aged, 80 and over; China; Female; Geriatric Assessment; Humans; Male; Middle Aged; Prevalence; Sarcopenia
PubMed: 33923252
DOI: 10.3390/nu13051441 -
Medicine Jul 2021Researchers have repeatedly examined the relationship between a previous experience of a fall and subsequent fear of falling (FOF); however, few studies have...
Researchers have repeatedly examined the relationship between a previous experience of a fall and subsequent fear of falling (FOF); however, few studies have investigated the effects of falling along various timelines among older adults. The objective of this study was to determine whether experiencing a fall in the previous month or the previous year led to FOF among the elderly.The National Health and Aging Trends Study (NHATS) in the U.S. collected information indicative of basic trends in the behavior of individuals aged 65 years and older. In the current study, we applied multiple logistic regression analysis of results from round 7 of the NHATS with the aim of identifying the risk factors associated with FOF among 5559 participants aged 65 years or older.FOF was reported by 48.8% of those who experienced a fall in the previous year and 46.8% experienced a fall in the previous month. The results of regression analysis revealed that after adjusting for sex, age, related chronic disease, activities of daily living, and instrumental activities of daily living, FOF was significantly associated with experiencing a fall during the previous month (OR = 2.29, 95% CI: 1.78-2.95) or during the previous year (OR = 2.60, 95% CI: 2.16-3.14).Our results indicate that experiences of falling during the previous month or the previous year were both significantly associated with a fear of falling, and caregivers should keep this in mind when dealing with community-living elderly individuals.
Topics: Accidental Falls; Activities of Daily Living; Adaptation, Psychological; Aged; Aged, 80 and over; Aging; Fear; Female; Functional Status; Geriatric Assessment; Humans; Independent Living; Life Change Events; Male; Qualitative Research; Risk Factors; Taiwan
PubMed: 34190176
DOI: 10.1097/MD.0000000000026492 -
Computational and Mathematical Methods... 2018
Topics: Aged; Aging; Blood Chemical Analysis; Computational Biology; Diagnosis, Computer-Assisted; Early Diagnosis; Electroencephalography; Geriatric Assessment; Humans; Mass Screening; Syndrome; Wearable Electronic Devices
PubMed: 30498518
DOI: 10.1155/2018/7830584 -
The Journals of Gerontology. Series A,... Jun 2018Frailty is a key determinant of health status and outcomes of health care interventions in older adults that is not readily measured in Medicare data. This study aimed...
BACKGROUND
Frailty is a key determinant of health status and outcomes of health care interventions in older adults that is not readily measured in Medicare data. This study aimed to develop and validate a claims-based frailty index (CFI).
METHODS
We used data from Medicare Current Beneficiary Survey 2006 (development sample: n = 5,593) and 2011 (validation sample: n = 4,424). A CFI was developed using the 2006 claims data to approximate a survey-based frailty index (SFI) calculated from the 2006 survey data as a reference standard. We compared CFI to combined comorbidity index (CCI) in the ability to predict death, disability, recurrent falls, and health care utilization in 2007. As validation, we calculated a CFI using the 2011 claims data to predict these outcomes in 2012.
RESULTS
The CFI was correlated with SFI (correlation coefficient: 0.60). In the development sample, CFI was similar to CCI in predicting mortality (C statistic: 0.77 vs. 0.78), but better than CCI for disability, mobility impairment, and recurrent falls (C statistic: 0.62-0.66 vs. 0.56-0.60). Although both indices similarly explained the variation in hospital days, CFI outperformed CCI in explaining the variation in skilled nursing facility days. Adding CFI to age, sex, and CCI improved prediction. In the validation sample, CFI and CCI performed similarly for mortality (C statistic: 0.71 vs. 0.72). Other results were comparable to those from the development sample.
CONCLUSION
A novel frailty index can measure the risk for adverse health outcomes that is not otherwise quantified using demographic characteristics and traditional comorbidity measures in Medicare data.
Topics: Aged; Aged, 80 and over; Comorbidity; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Insurance Claim Review; Male; Medicare; Surveys and Questionnaires; United States
PubMed: 29244057
DOI: 10.1093/gerona/glx229 -
Jornal Brasileiro de Nefrologia Aug 2019
Topics: Aged; Aged, 80 and over; Cognitive Dysfunction; Frailty; Geriatric Assessment; Humans; Kidney Failure, Chronic; Mental Status and Dementia Tests; Quality of Life; Renal Dialysis
PubMed: 31419277
DOI: 10.1590/2175-8239-JBN-2019-0098