Review

Authors: Hans Wildiers, Pieter Heeren, Martine Puts...

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

Authors: C A Bellera, M Rainfray, S Mathoulin-Pélissier...

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

Review

Authors: Martine Extermann, Mohammed Al-Jumayli, Christine Sam...

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

Authors: Birgitta Langhammer, Johan K Stanghelle

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

Meta-Analysis Review

Authors: Zi Chen, Wei-Ying Li, Mandy Ho...

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

Authors: Yitshal Berner

Topics: Aged; Frailty; Geriatric Assessment; Humans; Syndrome

PubMed: 28471582
DOI: No ID Found

Authors: Anne Hendry, Ruth Law

Many providers aspire to scale up proactive care that prevents escalation of health and care needs, delays onset of disability, and reduces demand for emergency department attendance or admission to hospital or care home. NHS England offers guidance on personalised and coordinated multi-professional support and interventions for people with moderate or severe frailty. This article reflects on the growing international evidence for an integrated proactive approach for older people with frailty and why investing in high-quality, joined-up care for older people across the whole system improves outcomes for people, reduces demand for services, increases system resilience, and delivers economic and societal benefits. Facing up to frailty requires creative whole system workforce planning and development that will be challenging to deliver in the current financial and recruitment context yet all the more worthwhile as scaling up proactive care has the potential to be a game changer.

Topics: Humans; Aged; Frailty; Frail Elderly; State Medicine; England; Health Services for the Aged; Geriatric Assessment

PubMed: 38815964
DOI: 10.12968/hmed.2024.0018

Authors: Dae Hyun Kim, Sebastian Schneeweiss, Robert J Glynn...

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

Authors: Hyuntae Park, Fimiharu Togo, Masashi Miyashita...

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

Authors: Ertugrul Erken

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