Age-specific Problems Research Articles

“Aiming at a moving target”—The daily life experiences of adolescents and young adults with a low-grade glioma

Abstract Background Low-grade gliomas (LGG) are among the most frequently occurring tumors in adolescent and young adult (AYA) patients (aged 18–39 years old at primary diagnosis). These tumors have a variable prognosis, presenting challenges for patients in shaping their future. This study aimed to identify the age-specific experiences and needs of AYA patients with LGG in their daily lives. Methods In-depth interviews were conducted with AYA patients diagnosed with LGG. Thematic analysis was performed to derive the age-specific codes, looking for overarching themes and sub-themes. Results Sixteen patients participated in this study. The cognitive symptoms of the disease (including difficulty concentrating, memory issues, and speech problems) are invisible to others but caused significant disruptions in many domains that were particularly important to AYA patients (eg, employment, family life, and autonomy). Additionally, the uncertainty regarding their life expectancy led to difficulties in making decisions about the future. They also perceived a lack of control over their future and the time they had left. Conclusions LGG have a significant impact on AYA patients. However, this impact is not fully understood by others close to them. The results highlight the importance of providing these patients with appropriate peer support, interventions tailored to both their disease and life phase, utilizing a multidisciplinary approach, and maintaining a focus on long-term support for these patients. It is crucial to provide AYA care for these patients within the neurology department, as LGG involve both tumor- and age-specific problems.

How personality factors, coping with identity-stress, and parental rearing styles contribute to the expression of somatic complaints in emerging adults in seven countries.

Somatic complaints are frequently named by emerging adults in many countries, but psychological factors contributing to the high level of these often medically unexplained symptoms have received little attention. This study examines the influence of shared risk factors on somatic complaints in a culturally diverse sample. In a cross-cultural survey study of 2,113 emerging adults (mean age = 22.0 yrs.; SD = 2.04) from seven countries (France, Germany, Turkey, Greece, Peru, Pakistan, and Poland) personality variables, parental rearing styles, coping abilities as well as identity-related stress were assessed. In a second step we successively entered these variables in hierarchical linear mixed models, controlling for country and gender effects and their respective interaction, in order to determine their impact on the level of somatic complaints across countries. All these dimensions varied extensively between all countries, with females reporting higher levels of somatic complaints than men in several countries. Despite this variation, our findings demonstrate a general and stable influence of neuroticism, openness, parental rearing styles, coping abilities and identity-related stress on somatic complaints across countries. Findings support the use of a general intervention model that includes appropriate coping strategies for emotion regulation, but also encourages support seeking for age-specific problems in dealing with identity stress during the transition to adulthood. In addition, this intervention model should be adjusted for a specific culture and gender.

From the infant to the geriatric patient-Strategies for inhalation therapy in asthma and chronic obstructive pulmonary disease.

Inhalation therapy represents the standard of care in children, adolescents as well as in young, middle-aged and geriatric adults with asthma or chronic obstructive pulmonary disease. However, there are only few recommendations for the choice of inhalation devices, which consider both, age-specific limitations in young and geriatric patients. Transition concepts are lacking. In this narrative review, the available device technologies and the evidence for age-specific problems are discussed. Pressurized metered-dose inhalers may be favoured in patients who fulfill all cognitive, coordinative and manual power requirements. Breath-actuated metered-dose inhalers, soft-mist inhalers or the use of add-on devices such as spacers, face masks and valved holding chambers may be suitable for patients with mild to moderate impairments of these variables. In these cases, available resources of personal assistance by educated family members or caregivers should be used to allow metered-dose inhaler therapy. Dry powder inhalers may be reserved for patients with a sufficient peak inspiratory flow and good cognitive and manual abilities. Nebulizers may be indicated in persons who are either unwilling or unable to use handheld inhaler devices. After initiation of a specific inhalation therapy, close monitoring is essential to reduce handling mistakes. An algorithm is developed that considers age and relevant comorbidities to support the decision-making process for the choice of an inhaler device.

Soft-tissue sarcoma in adolescents and young adults.

Soft-tissue sarcoma is a rare cancer that accounts for approximately 1% of all malignant tumors. Although they occur in various age groups, soft-tissue sarcomas account for 8% of all malignant tumors developing in adolescents and young adults, suggesting that they are not rare in this age group. This study aimed to evaluate the clinical and pathological characteristics of soft-tissue sarcoma in adolescents and young adults. According to the Bone and Soft-Tissue Tumor Registry in Japan, myxoid liposarcoma is the most common type of soft-tissue sarcoma found in adolescents and young adults; alveolar soft part sarcoma, extraskeletal Ewing sarcoma, epithelioid sarcoma, clear cell sarcoma and synovial sarcoma occur predominantly in this age group among soft-tissue sarcomas. The analysis based on this registry demonstrated that age was not a prognostic factor for poor survival of soft-tissue sarcoma, although the prognosis in adolescents and young adults was better than that in older patients in the US and Scandinavia. Adolescent and young adult patients with soft-tissue sarcoma have age-specific problems, and a multidisciplinary approach to physical, psychological, and social issues is necessary to improve the management of these young patients both during and after treatment.

1757PD - Development of GOLD (Geriatric Oncology Liaison Development) service to improve outcomes in older people with cancer

BackgroundThe number of older people with cancer has been steadily increasing. Treating older people with anticancer treatments is challenging due to comorbidities, polypharmacy, poorer performance status and underrepresentation in clinical trials. An innovative service, GOLD, has been set up in our Cancer Centre. GOLD delivers comprehensive geriatric assessment (CGA) in older cancer patients to improve reversible factors and assist with anticancer treatment. We report outcomes of patients reviewed in GOLD clinic. MethodsA one-stop GOLD clinic for older cancer patients was set up in 2016. From October 2016 to April 2018, 596 patients between 50-99 years old were reviewed. The majority (69.9%) were between 70-84 years. For the purpose of this analysis, a representative sample of 298 patients with similar characteristics (73% between 70-84 years) was selected; analysis included primary site of malignancy, treatment type and setting, referral reason and GOLD interventions. Cancer treatment outcomes were divided into patients who continued with planned treatment, and those who required other types of management. ResultsReferrals to GOLD were predominantly from gastrointestinal (28.5%), urology oncology (26.1%) and haematology (13.7%); lung, gynaecology, skin and breast accounted for the remaining 31.7%. The majority (92.7%) had single GOLD reviews. The following treatments were given: systemic anti-cancer therapy (SACT) with chemotherapy (51.6%), hormone therapy (21.1%), immune checkpoint inhibitors (6.8%), chemo-radiotherapy (6.8%) or tyrosine kinase inhibitors (3.6%). Of the 298 patients, 218 (73.2%) were able to proceed with their planned oncology treatment following GOLD review, start or continue SACT. 12.4% were deemed unfit and continued with best supportive care, 0.3% were referred to other specialities. 14.1% of the patients were on surveillance post anticancer treatment. ConclusionsCollaborative working of oncologists with geriatricians may benefit older cancer patients with co-morbidities and age-specific problems. GOLD was largely “one-stop” and avoided multiple speciality referrals which may support cost-effectiveness whilst delivering more comprehensive care for older people with cancer. Legal entity responsible for the studyThe authors. FundingMacMillan Cancer Support. DisclosureAll authors have declared no conflicts of interest.

A longitudinal ICF-CY-based evaluation of functioning and disability of children born with very low birth weight

This paper aims to describe the longitudinal changes in disability, defined by the International Classification of Functioning, Disability, and Health - Children and Youth version (ICF-CY) biopsychosocial model, and developmental outcomes in a cohort of 56 very low birth weight children over 14-20 months. We used a neurofunctional assessment, the Griffiths Mental Development Scales-Revised: 2-8 years (Griffiths 2-8) to evaluate psychomotor development and the ICF-CY questionnaire for ages 0-3 and 3-6 to address children's disability. Extension indexes on the basis of ICF-CY categories were computed, and longitudinal change was tested. Complete follow-up was available for 55 children (mean age 36.7 months, SD 6.7). Considering the sample as a whole, neurofunctional assessment, Griffiths score and disability were basically stable. When the subsample of children with the higher baseline functioning was taken into account, some degree of worsening, in terms of an increase in the number of impairments and limitations, was found. Our results show that disability profiles, neurofunctional assessment and global development were basically stable, except for the subgroup of children who were in the intermediate/high-functioning cluster at baseline. The increased disability among these children might be because of the possibility to observe a wider set of age-specific problems, such as emotional, regulation and social abilities that are not detectable at an early stage of development and that might lead to reduced participation in social activities.

Non-oncology physician visits after diagnosis of cancer in adolescents and young adults.

Health care needs of adolescents and young adults (AYAs) with cancer are probably different from other age groups. Studying their non-oncology physician visits in the first years after diagnosis may provide insight into the specific health problems AYA patients experience and thereby help to improve care for these patients. Seven hundred seventy-four AYAs identified from a Canadian provincial registry diagnosed with cancer between ages 15 and 24years in 1991/2001 were included, matched by birth year and sex to ten controls. Based on provincial health insurance plan records, we determined the number of family physician and non-cancer specialist visits in the 5years after diagnosis (for patients) or inclusion (for controls). The percentage of patients visiting a non-cancer specialist decreased from 96 to 49% over the 5-year period. The percentage visiting a family physician decreased from 96 to 84%. Visits in all years were significantly higher than among controls. In the first year after diagnosis, many patients visited a non-cancer specialist or a family physician for neoplasm-related health problems (77 and 55%, respectively). In addition, family physicians were also consulted for general age-specific problems, such as genitourinary symptoms In the first years after diagnosis of cancer in AYAs, both non-cancer specialist and family physician visits are common, although non-cancer specialist visits are less common and decline considerably faster than in younger children. The specific pattern of physician visits of this age group calls for care that is tailored to their specific needs.

Primary headache syndromes in the elderly: epidemiology, diagnosis and treatment

Although secondary headaches due to e.g. temporal arteritis or a brain tumor are common among the elderly, primary headache disorders also occur in this age group, albeit less frequently than in younger individuals. A different presentation in the older age groups often makes a diagnosis difficult. Some headache syndromes, such as hypnic headache, are typical for the elderly. Furthermore, age-related physiologic changes, co-morbidities and contra indications require appropriate and targeted treatment in the elderly. Although treatments for the most common primary headaches are available, many limitations hamper their use in this group. For many headaches syndromes randomized controlled treatment trials in elderly are not available. In this article we review the clinical aspects of common primary headaches and medication overuse headache in the elderly and their treatments, with emphasis on age-specific problems. Relevance for patients: Primary headache syndromes in older patients ask for specific treatment considerations due to comorbidity, polypharmacy and an increased risk of side effects. Clinically, the headaches can be different and atypical. Results from clinical trials cannot be generalized to the elderly because these groups usually are not included in studies. In migraine, non-pharmacologic treatment should be considered, with depression and cerebrovascular disease as major comorbidities. Tension type headache, being the most common headache presentation in elderly, also includes a relatively large proportion of patients with a secondary headache warranting further testing. Trigeminal autonomous cephalalgias are rare, and can present with pseudo dementia. Medication overuse and medication-induced headaches are relatively common, for which patient education, ceasing drugs and withdrawal from caffeine containing substances are pivotal. Furthermore, hypnic headache, exploding head syndrome and benign thunderclap headache are specific for this patient group and require specific treatment.

Systemic Treatment of Older Patients with Advanced Breast Cancer

Due to its increasing incidence and longer life expectancy, more patients are being diagnosed with breast cancer at older ages. There are very limited data on the optimum management of older patients with advanced breast cancer, due to the under-representation of such individuals in clinical trials. Although older patients have more indolent disease with more Hormone Receptor positive disease and less HER2-positive disease, their disease-specific mortality remains lower than in younger patients, owing to the late diagnosis, under treatment due to age bias, reduced access to healthcare, and socioeconomic issues. Older patients with advanced breast cancer should be treated based on their biological tumor type, according to the patient’s general health and preferences: endocrine treatment for HR-positive disease; Human Epidermal Growth Factor Receptor 2-targeted agent with chemotherapy, endocrine therapy or HER2-targeted agent alone for HER2 positive disease. Chemotherapy should be considered for patients who are HR-negative, HR-positive but refractory to endocrine treatment, or with a rapidly progressing visceral crisis. Generally, sequential chemotherapy with a single agent is recommended over combination chemotherapy, and agents with known toxicities in older patients are recommended, including weekly taxane, vinorelbine, capecitabine, and liposomal doxorubicin. Some form of geriatric assessment should be performed for older patients to assess the patients’ biological age, functional status, and address age-specific problems, leading to early interventions. The goal of therapy should be individualized to maintain the quality of life, function, and independence of older patients with cancer. (Korean J Med 2014;87:542-547)

What Are The Ethical Considerations Surrounding a Minor's Request for Confidentiality?

What Are The Ethical Considerations Surrounding a Minor's Request for Confidentiality?

Adolescent coping with everyday stressors: A seven-nation study of youth from central, eastern, southern, and northern Europe

The present study compares problem-specific coping strategies and coping styles of European adolescents from seven nations. The sample consisted of 3031 adolescent participants, aged 11 to 20, from Croatia, the Czech Republic, Germany, Italy, Norway, Portugal, and Switzerland. The adolescents completed the Coping Across Situations Questionnaire (CASQ) by indicating which coping strategies (from 20 alternatives) they usually employed in dealing with age-specific problems (covering 8 different domains). The strategies can be collapsed to three coping styles: active coping, internal coping, and withdrawal. Results show that adolescents from all seven nations predominantly employed functional forms of coping, i.e., active coping and internal coping. In addition, the pattern of frequently and rarely applied coping strategies was similar across cultures. Differences in coping style were revealed for some, but not all problem domains, suggesting that cross-cultural similarity in coping exists for specific stressors. Problem-specific analyses helped to clarify where cultural influence is most distinct. Whereas cultural diversity was highest for coping with job-related problems, coping with self- and future-related problems was highly similar among adolescents from all the nations. Despite the considerable traditional, educational, and economic differences among the cultures investigated, the similarities in coping behaviour were impressive. Explanations for cultural universals and differences in adolescent coping are discussed.

Prognostic Factors of Perforated Sigmoid Diverticulitis in the Elderly

Background: The Finnish population is aging fast and the prevalence of perforated sigmoid diverticulitis is simultaneously increasing in northern Finland. The fact that an increasing number of elderly patients, with their age-specific problems, are subjected to emergency surgery for acute diverticulitis underlines the importance of risk stratification.Methods: One hundred and seventy-two patients admitted to Oulu University Hospital because of diverticular perforation from 1983 to 2002 were identified from the computer database. The clinical variables were evaluated as prognostic indicators of postoperative complications, mortality and time of hospitalization. Results: The resection rate was 91%; 64 primary anastomoses, 93 Hartmann’s procedures and two covering colostomies were performed. The overall complication rate was 33%. In patients under 70 years, a stepwise logistic regression analysis showed that the Mannheim Peritonitis Index (MPI) score and American Society of Anesthesiologists (ASA) score were independent prognostic factors. None of factors predicted morbidity in patients over 70 years. Overall mortality rate was 8%, without any significant difference between the procedures. Of the clinical variables, MPI score, ASA score, Hinchey classes and malnutrition correlated with mortality. All patients who died presented with ASA scores of III–IV, and 12 out of 14 patients had an MPI score of II. In a stepwise logistic regression analysis, only the MPI score seemed to be an independent predictor of mortality. Conclusions: Mortality is related to age but age alone is not an independent predictor of mortality. The MPI score is useful in predicting the risk of death in patients with perforated diverticulitis.

Age-specific problems in rhythmic timing.

Age-specific problems in rhythmic timing.

Age-specific problems in rhythmic timing.

The authors investigated performance in 2 rhythm tasks in young (M = 23.8 years) and older (M = 71.4 years) amateur pianists to test whether slowing of a central clock can explain age-related changes in timing variability. Successive keystrokes in the rhythm tasks were separated by either identical (isochronous) time intervals or varying (anisochronous) intervals. Variability was comparable for young and older adults in the isochronous task; pronounced age effects were found for the anisochronous rhythm. Analyses of covariances between intervals rule out slowing of a central clock as an explanation of the findings, which instead support the distinction between target specification, timekeeper execution, and motor implementation proposed by the rhythm program hypothesis (D. Vorberg & A. M. Wing, 1996). Age stability was found at the level of motor implementation, but there were age-related deficits for processes related to target-duration specification.

Attitudes of aging Athenians to andropenia and its consequences, and to potential hormone substitution therapy

This population-based study has attempted to chart and characterize aging men's perception of andropenia and its clinical consequences and their attitudes towards possible hormone replacement therapy in a fashion similar to that of postmenopausal women. To this end, a total of 160 men, aged 50–75 years, selected randomly from a population of 366 860 men of this age range, living in the Greater Athens area, were personally interviewed. The sets of questions asked were graded from 1 to 5 and were related to present and past general mood, physical fitness, mental condition, sexual activity and presence of symptoms of andropenia.A marked reduction in the mean scores for general mood, concentration, physical fitness, sexual mood and ability to initiate or maintain an erection and an increase in the incidence of hot flushes were observed in the subjects studied when their present condition was self-compared to their condition during their early forties. Moreover, significant correlations were observed between the scores for each of these parameters and advancing age in this sample. Questions related to the cause of the problems described, awareness of their possible relationship to andropenia and its long-term consequences, interest in additional information, need for expert advice and to the men's attitudes towards replacement therapy revealed low public awareness, acceptance of the symptoms as an inevitable part of the aging process, an interest in impersonal channels of information and severe apprehension about replacement therapy because of fear of side-effects.These results provide a suitable platform to formulate appropriate communication strategies and to launch efforts to educate this age section of the population about their age-specific problems and the possible therapies for relief.

Health-related quality of life of patients with genetic skeletal dysplasias.

While medical knowledge on genetic skeletal dysplasias has expanded, very little is known about the patients' health-related quality of life (HRQOL). To test the validity and sensitivity of the fifteen and sixteen dimensional measures of HRQOL in patients with chondrodysplasias, we examined 121 adults aged 16-54 and 19 adolescents aged 12-15 with achondroplasia, cartilage-hair hypoplasia and diastrophic dysplasia. The age and sex standardized overall HRQOL score of the adult patients (0.885 on a scale from 0 to 1) was significantly lower than that of normal controls (0.928) (P < 0.001). The difference in the HRQOL between the patients and the controls consisted mainly of the differences in dimensions of mobility, usual activities, sexual activity and discomfort, for which the patients reported a significantly lower status (more problems) than the controls (P < 0.001). Adolescent patients demonstrated HRQOL profiles similar to those of adults. However, age-specific problems occurred on the dimensions of school and hobbies, friends and physical appearance (P < 0.05). In a detailed examination of different patient groups, some clinically unexpected findings were observed, suggesting that denial is at least in part involved. Subjective assessment of HRQOL of patients with chondrodysplasias is valuable for provision of optimal care. In treatment and management special attention should be paid to those dimensions on which the patients' perceived status is currently suboptimal, especially during adolescence which probably is the most critical period in the lives of these individuals.

Coping behavior in normal and clinical samples: more similarities than differences?

In our studies we tried to integrate a developmental and a clinical perspective on coping and adaptation in adolescence. Starting with a review of the author's own research, involving over 3000 12- to 20-year-olds from various cultures, the problems typical of this developmental phase and the ways of coping with these normative demands are presented. The results show that coping skills of young people in dealing with age-specific problems have so far been considerably underestimated. Their response to problems stemming from different developmental fields such as parents, peers, school or future involved three main modes of coping: Active Coping, Internal Coping and Withdrawal. Withdrawal was employed very rarely and only for certain types of problems. Age, gender and problem-specific effects in coping were found. Whereas normal adolescents most frequently choose to cope with difficulties actively by means of social resources and to think out possible solutions, risk populations appear to have a more ambivalent pattern of coping strategies with high functionality and high dysfunctionality. Even their appraisal of problems is already disturbed; they feel more readily threatened by everyday problem situations and respond more uniformly with withdrawal. Finally, similarities between the female coping style in normal samples and the more pronounced ambivalent pattern in clinical samples were discussed and related to psychopathology.

Continuous Subcutaneous Insulin Infusion in Children

Insulin-dependent diabetes mellitus usually presents in childhood. Since it i is generally accepted that persisting metabolic derangements contribute to the development of micro- and macrovascular complications, a primary aim of the management of children with diabetes is to achieve near normalization of metabolism. In adults continuous subcutaneous insulin infusion (CSII) has been used to optimize control. Despite a reluctance amongst paediatricians to use CSII in children, several studies with pumps have been performed in adolescents. The results of these studies are contradictory with respect to acceptability and achieved metabolic control. Thus, some authors report a near normalization of blood glucose concentrations, whereas others only find a temporary improvement. Patient selection seems to account for many of these differences. This suggests that methods ought to be developed to predict success or failure of CSII in a particular adolescent patient. For diabetic toddlers with their age-specific problems CSII may be a therapy of choice. So far, good acceptability and improved metabolic control are reported in this group. More studies are needed to confirm this. It is important that the diabetic clinic as well as the patient is organized to high standard before starting CSII. Home blood glucose measurements, education, and a 24-h telephone service are essential factors for the management of diabetic children, treated conventionally or with CSII.