Assessment Of Elderly Patients Research Articles

Correlation between cognition of depression and anxiety and recognition of physical and mental illness in hospitalized elderly patients with chronic diseases

Objective To investigate the cognition of depression and anxiety and recognition of physical and mental illness, and analyze their correlation in hospitalized elderly patients with chronic diseases. Methods A cross-sectional study was performed. A total of 206 hospitalized elderly patients with chronic diseases from a hospital were investigated using mini mental state examination (MMSE), Hamilton depression rating scale (HAMD), self rating anxiety scale (SAS) and elderly patients with chronic diseases questionnaire. Results The total scores in cognition of depression and anxiety were (5.95±3.05) and (4.92±3.20). The correct recognition rate of chronic disease was (97±8)%, and the correct recognition rate of mental illness was (47±29)%. The recognition of mental illness was positively correlated with the total cognition score of depression and three dimensions of thinking, spirit and mood (P 0.05). There was no significant correlation between recognition of mental illness and physical dimension of anxiety (P>0.05). Conclusions The cognitive level and cognition of depression and anxiety are low in elderly patients with chronic diseases. They tend to recognize the mental illness as chronic physical disease. Therefore, nurses should make depression and anxiety evaluation as routine assessment for the elderly patients with chronic diseases. Early identification of mental illness can avoid the delay of psychological intervention and acquire the best time of treatment. Key words: Chronic diseases; Depression; Anxiety; Cognition; Correlation

A prospective study assessing the value of geriatric assessment in elderly patients with stage III NSCLC for concurrent chemoradiation.

8509Background: Concurrent chemoradiotherapy (cCRT) has proven to increase survival in elderly patients (p) with unresectable stage III NSCLC, but it is not yet accepted as standard of care. The ge...

Nutritional assessment in elderly patients with esophageal cancer

Objective To evaluate the nutritional status and risks in elderly patients with esophageal cancer during their radiotherapy; to provide the evidence of nutritional assessment tools and interventions in clinical practice. Methods This retrospective study investigated 65 patients with esophageal cancer (>60 years) who had undergone radiotherapy in Zhejiang Cancer Hospital from June 2012 to August 2013. Nutritional status was assessed at the beginning and after the radiotherapy in every week; nutritional risks were screened every week with the help of NRS 2002. Results Compared with the status at the beginning of radiotherapy, the significant higher nutritional risk emerged: in the second week of the radiotherapy with NRS2002 [(2.34±1.24) vs (2.09±1.28); Z=3.234, P 0.05). The incidence of malnutrition during radiotherapy was 33.8%-49.2%; the score of NRS2002 was negatively correlated with BMI, TSF, AC and AMC. Nutritional support were provided to 62(93.8%)patients, three (4.8%) of the patients received enteral nutrition (EN), 59 (95.2%) patients received parenteral nutrition(PN). Conclusions The risk of malnutrition is high in elderly patients with esophageal cancer and will even worse with the process of radiotherapy. NRS2002 can precisely detect nutritional risks and provide the evidence of nutritional interventions in clinical practice. Key words: Esophageal cancer; Radiotherapy; Nutritional assessment; Elderly

Comprehensive geriatric assessment in elderly patients with newly diagnosed aggressive non-Hodgkin lymphoma treated with multi-agent chemotherapy

The purpose of this prospective observational study is to evaluate the relation of the comprehensive geriatric assessment (CGA) to tolerability and survival of multi-agent chemotherapy for curative intent in elderly patients with aggressive non-Hodgkin lymphoma (NHL). Patients who were 1) age ≥65 years, 2) newly diagnosed aggressive NHL, and 3) treated with multi-agent chemotherapy within 2 weeks from the time of diagnosis were enrolled from January 2011 to June 2014. Baseline clinical, laboratory, and CGA data being composed of Mini Nutritional Assessment-Short Form (MNA-SF), Korean version of Mini Mental Status Exam, Korean-Geriatric Depression Scale, and Groningen Frailty Index (GFI), were collected and analyzed for the relation to the outcome factors. Seventy patients were included; the median age was 73.5 years, 27 (38.6%) patients were Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 or more, and half of the patients were high or high-intermediate risk by age-adjusted international prognostic index (aaIPI). Most patients received CHOP or CHOP-like chemotherapy. Factors affecting discontinuation of chemotherapy within 12 weeks were poor MNA-SF, poor GFI, poor PS, and presence of B symptom. Among those, poor MNA-SF was independent of other variables in multivariate analysis. Poor MNA-SF, bone marrow involvement, and baseline anemia of hemoglobin<10g /dL were found to be independent factors associated with inferior overall survival whereas aaIPI factors were not. MNA-SF predicted tolerability to multi-agents chemotherapy and overall survival in elderly patients with aggressive NHL who were treated with multi-agent chemotherapy.

GW26-e1448 Prognostic Value of Pregnancy Associated Plasma Protein-A in Elderly Patients with non-ST Segment Elevation Acute Coronary Syndrome

This study sought to investigate whether pregnancy associated plasma protein-A (PAPP-A) is useful for risk assessment in elderly patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). PAPP-A was measured in 455 elderly patients with non NSTE-ACS, Study and followed-up for 12

Geriatric preoperative assessment of elderly patients with gastrointestinal cancer: Clinical factors and prognostic implication.

e20522 Background: Patient selection for surgical oncologic treatment is a challenge, particularly with elderly patients. The purpose of this study was to compare patient's characteristics with ger...

PO-071: ELAN Program: Personalized treatment according to geriatric assessment in elderly patients with head & neck cancer

PO-071: ELAN Program: Personalized treatment according to geriatric assessment in elderly patients with head & neck cancer

Hematopoietic Stem Cell Transplantation in the Elderly: Nutritional and Geriatric Assessment

Introduction: Hematopoietic stem cell transplantation (HSCT) may improve outcomes of patients with hematologic malignancies not curable with conventional therapies. Being in some diseases the only curative option. HSCT in elderly patients with good performance status and no comorbidities could, in fact, not only survive the transplant with reasonable risk, but also benefit in the same measure as younger patients.Objectives: To study and correlate nutrition and geriatric assessment in elderly patients undergoing HSCT.Methods: A retrospective study of 17 elderly patients (>60 years) undergoing HSCT May 2012 to January 2014 in the Hematology-Oncology and Bone Marrow Transplantation Center at Albert Einstein Hospital in São Paulo, Brazil. All patients were evaluated approximately one month prior to HSCT. In the geriatric assessment were done hand-grip strength(HGS), questions about mobility and functional limitation. In the nutrition, we studied the Body Mass Index(BMI) (kg/m2), and serum levels of vitamin D, zinc and albumin.Results: 17 elderly patients were observed in this study, mean age was 65,5±3,8 years, BMI was 28±6,0 kg/m2, HGS was 28±8,5 kg; serum levels of albumin 3,2±0,5g/dl(normal:3,5-5,0); serum level of vitamin D 23,4±14 ng/ml (normal >20); serum levels of zinc 65,5±18 mg/dl (normal: 66-132,5 mg/dl). We found the negative correlation between BMI and HGS (rp=0,42). There were a significant and positive association between serum levels of zinc and albumin, and HGS and grades of mobility questions(p<0,05). The serum levels of vitamin D weren‘t significantly associated with geriatric factors.Conclusion: Our study showed that the obese patients with more risks of complications in HSCT had more functional limitation. Besides low levels of zinc and albumin were associated with worst results in the geriatric assessment. In the elderly the immobility and weakness can increased the complications after HSCT. The geriatric and nutrition assessment are important to improve HSCT results. DisclosuresNo relevant conflicts of interest to declare.

The impact of comprehensive geriatric assessment on final treatment decisions

Introduction: Comprehensive geriatric assessment (CGA) is the predominantly used tool to identify geriatric problems in elderly patients with cancer (1,2). There is increasing evidence that CGA can predict toxicity and mortality (3–5). If the results of a CGA affect clinical decision making of oncologists is less clear. Objectives: The aim of this studywas to determine the impact of CGA on treatment decisions prior to systemic therapy in elderly patients with cancer. Methods: A review of the literature was performed including studies published until the 27th of January 2014 using search terms including Neoplasm, Aged, Geriatric Assessment. Results: The impact of CGA on treatment decisions has sparsely been studied and none of these studies were randomized controlled trials (1,3,6). A meta-analysis performed in 2012, combined 6 studies on the impact of CGA on treatment decision making. The weighted percent modification was 23% (3). A study published in 2013 by Kenis et al. showed an impact of the CGA on treatment decision in 282 of 1115 patients (25%) (2). Another recent French retrospective study showed that CGA impacted final cancer treatment decision in 19 of 107 (18%) frail heterogenous cancer patients (6) (Table 1). Image: Conclusion: Impact of CGA on final treatment decision varies between 18 and 25%. So far, no clinical studies have demonstrated that CGA based treatment changes do improve treatment outcome or quality of life in patients with cancer due to lack of follow-up. Research is needed to determine the timing and the content of the assessment modifying clinical decision making by oncologists (7). Outcome measure should include objectively measured outcome, such as physical activity, patient reported outcome measures and classical endpoints like overall survival.

The “Elderly Project” by The Fil (Fondazione Italiana Linfomi): A project aimed at the prospective multidimensional assessment of elderly patients with diffuse large B-cell lymphoma

The “Elderly Project” by The Fil (Fondazione Italiana Linfomi): A project aimed at the prospective multidimensional assessment of elderly patients with diffuse large B-cell lymphoma

PP104-SUN: Discordance between Physicians and Patients in Nutritional Assessment in Elderly Patients with Cancer; Subgroup Analysis from the French Nutricancer 2012 Survey

(3.4±4.0) as part of the abPG-SGA contributed most to its total score (6.1±6.0). Only abPG-SGA total score correlated significantly to all EORTC QLQ-C30 function scales and six symptom scales and single items (p = 0.01). Conclusion: Components of established malnutrition screening tools for the general hospital might not be appropriate for the requirements of an oncology outpatient setting. Cancerand treatment-related symptoms, QoL and development of malnutrition closely affect one another and should be taken into account as the abPG-SGA does.

Comprehensive geriatric assessment in elderly patients with dementia.

We have recently developed and validated a screening test for comprehensive geriatric assessment (CGA) named "Dr. SUPERMAN". We compared the results obtained by the CGA of patients with Alzheimer's disease (AD), vascular dementia (VaD) and dementia with Lewy bodies (DLB), and determined the relationship between functional deficits and clinical characteristics in each type of dementia. We used Dr. SUPERMAN to examine patients with AD (24 men and 53 women, mean age 83.0 ± 5.1 years), VaD (10 men and 12 women, mean age 80.4 ± 5.0 years) and DLB (28 men and 20 women, mean age 81.2 ± 5.5 years). Patients with DLB or VaD had functional deficits more frequently than those with AD in many fields. Significant correlations between functional impairments and clinical characteristics, such as age, sex and Mini-Mental State Examination scores, in the non-AD group (including DLB and VaD) were found in more extensive fields than those in the AD group. Patients with dementia, particularly DLB, have several geriatric problems. Correlations between functional deficits and clinical characteristics differ between the AD group and the non-AD group. Non-AD patients of older age who are male and have advanced dementia are more likely have several functional deficits. In addition to age and severity of dementia, the type of dementia should be considered in the treatments and interventions of elderly patients with dementia.

Risk Assessment in Elderly Patients Undergoing Emergency Surgery for Complicated Appendicitis: Serum Albumin More Predictive than other Indices

Risk Assessment in Elderly Patients Undergoing Emergency Surgery for Complicated Appendicitis: Serum Albumin More Predictive than other Indices

Value study of National Early Warning Score in the emergency pre-screening assessment of elderly patients

Objective To analyze the correlation between the UK National Early Warning Score (NEWS) and emergency elderly patients within six hours' outcomes,study the value of NEWS in the prescreening assessment of elderly patients.Methods 213 cases of emergency elderly patients were selected as a sample,and were evaluated with NEWS pre-check.Then we tracked patients' outcomes within six hours were analyzed the correlation between the two.Results With NEWS score increased,the salvage rate and fatality rate were increased.Conclusions NEWS shows independent predictive value in the pre-screening assessment of the emergency system,and should be widely applied in it. Key words: National Early Warning Score; Pre-screening assessment; Emergency; Elderly

Comparison of tools for nutritional assessment in elderly patients: A pilot study

Background: Malnutrition is a major health related concern associated with higher morbidity and mortality in the elderly compared to their younger counterparts. Malnutrition is not an inevitable side effect of ageing, but many changes related to ageing can cause malnutrition. The early recognition of patients at high risk of malnutrition is needed to timely manage the condition and avoid its adverse outcomes. Several types of nutrition screening tools have been developed for evaluating the nutritional status of elders; however, the Mini-Nutritional Assessment-Short Form (MNA-SF) is the most widely used tool. Aim: The aim of this study is to identify the most appropriate nutritional screening tool for use in hospitalized elderly population. Method: Mini-Nutritional Assessment-Short Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), The Nutritional risk screening (NRS), Patient-Generated Subjective Global Assessment (PG-SGA) and Geriatric nutritional risk index (GNRI) were administered to 20 patients. All patients were 60 years and over. Results: Using the MNA-SF 12 (60%) of the studied sample were malnourished and 8 (40%) had normal nutritional status. Tools performance in predicting malnutrition was calculated. The sensitivity was 91%, 83%, 83% and 66% and specificity was 50%, 62%, 12% and 75% with the NRS, MUST, PG-SGA and GNRI, respectively. Combining different pairs of tools MUST and NRS together had better sensitivity 92.8% and specificity 66.6% then 2nd better two tools together is NRS and GNRI with sensitivity 91.6% and specificity 50% with accuracy 75% other tools showed high sensitivity but low specificity as PGSGA with NRS and PGSGA and GNRI. Conclusion: NRS had the highest sensitivity while GNRI had the highest specificity among different studied assessment tools. MUST and NRS together had better sensitivity but lower specificity than either tool alone. Combining the NRS and GNRI had better sensitivity than GNRI alone and better specificity than NRS alone. We recommend using NRS alone as the optimal screening tool.

Focus on the person in an international conference: inclusiveness, cost, human values, and compassion

This year the American Society of Hematology had several presentations that involved individualized assessment of elderly patients. This was an important step toward personalized medicine encompassing the general population. This article reviews the most important aspects of this approach and the interesting discussion that followed

Comprehensive Prospective Cognitive and Physical Function Assessment in Elderly Patients Undergoing Transcatheter Aortic Valve Implantation

Objective: Transcatheter aortic valve implantation (TAVI) is occasionally associated with stroke and silent cerebral ischemia, which may affect cognitive and functional performance. The aim of this study was to evaluate the changes in cognitive performance and functional status following TAVI. Methods: We performed a comprehensive prospective functional, cognitive and quality of life (QOL) evaluation in consecutive patients who underwent TAVI using the CoreValve device (Medtronic Inc.). The evaluation was performed at baseline and 1 month after the procedure and included the 36-item Short-Form Health Survey for QOL assessment, Mini-Mental State Examination (MMSE), quantitative clock drawing test (Rouleau), color trails test, Cognistat evaluation, Barthel Index and Duke Activity Status Index. Results: A total of 36 patients completed the full pre- and post-TAVI evaluation. Mean age was 82.2 ± 4.2 years (52.8% men); 94.5% of patients had low functional class (New York Heart Association III/IV), and 13.9% had prior stroke. After the procedure, all patients had improved functional status and valve hemodynamics. At 1 month, there was a significant improvement in the MMSE and Cognistat evaluations (from 25.9 ± 3.3 to 27.6 ± 2.4, p < 0.001, and from 5 ± 1 to 5.7 ± 0.7, p = 0.001, respectively). Conclusions: Our preliminary results of a comprehensive assessment of patients undergoing TAVI indicate favorable results for both functional performance and cognitive function early after the procedure.

Autologous stem cell transplantation for elderly patients with newly diagnosed multiple myeloma in the era of novel agents

High-dose therapy (HDT) with autologous stem cell transplantation (ASCT) is considered the standard of care for multiple myeloma (MM) patients <65 years. Safety and outcome of ASCT for patients >65 years is currently uncertain, especially since the introduction of novel agents for induction and maintenance therapy. Furthermore, there are no conclusive data available on risk assessment in elderly patients treated with HDT. We retrospectively analyzed 202 patients ≥60 years with newly diagnosed MM who underwent ASCT at our institution. Patients were stratified by age into three groups (60-64, 65-69 and 70-75 years). For safety assessment, we compared data about hospitalization, hematopoetic reconstitution and early mortality. Remission before and after ASCT was analyzed according to age and application of novel agents. Event-free (EFS) and overall survival (OS) were analyzed to identify impact of age, remission before/after ASCT and maintenance therapy as well as ISS score and cytogenetic aberrations on outcome in elderly patients. The assessment of safety, remission before/after ASCT as well as EFS and OS showed no significant differences between the three groups (median EFS: 60-64 years: 27 months; 65-69 years: 23 months; 70-75 years: 23 months; median OS: not reached). Patients receiving novel agents as part of induction therapy achieved significantly higher nCR + CR rates than patients treated without novel agents. In Cox regression analysis, ISS and cytogenetics as well as remission after ASCT had the highest prognostic impact on EFS and OS. Maintenance therapy was associated with longer EFS in uni- and multivariate analyses. ASCT is feasible for selected patients >65 and >70 years without increased mortality. Age at transplantation has no prognostic significance on outcome after ASCT. Novel agents during induction therapy and maintenance therapy improves outcome of older patients eligible for ASCT. ISS and cytogenetic analysis should be carried out routinely for risk assessment.

Oral health in older patients with oropharyngeal dysphagia

oropharyngeal dysphagia (OD), aspiration and poor oral health status are potential risk factors in elderly patients with aspiration pneumonia (AP). to assess the oral hygiene status and the prevalence of periodontal disease and dental caries in elderly patients with OD. fifty elderly patients (79.7 ± 6.64 years) with OD associated with ageing or neurological diseases and 15 elderly patients without OD (77.01 ± 4.51 years) were enrolled in this observational-transversal study. OD and aspiration were evaluated by videofluoroscopy (VFS). Oral health was assessed by: (i) the Simplified Oral Hygiene Index (OHI-S); (ii) a complete periodontal examination, assessing the periodontal pocket depth, clinical attachment loss and bleeding on probing to study periodontal diseases (periodontitis, gingivitis); and (iii) the presence of dental caries. 8/50 elderly patients with OD presented VFS signs of aspiration, half of them silent; 40/50, signs of penetration into laryngeal vestibule and 16/50, oropharyngeal residue. Prevalence of edentulism and caries was higher in patients with OD. Dentate older patients with OD (30/50) presented the following complications (i) poor oral hygiene in 18 patients (OHI-S 3.1-6), (ii) gingivitis in 2 and periodontitis in 28 and (iii) caries in 16. older patients with OD presented polymorbidity and impaired health status, high prevalence of VFS signs of impaired safety of swallow and poor oral health status with high prevalence of periodontal diseases and caries. These patients are at great risk of developing AP. We recommend a policy of systematic oral health assessment in elderly patients with OD.

Prognostic Effect of High-Sensitive Troponin T Assessment in Elderly Patients With Chronic Heart Failure

Background— The incremental prognostic value of high-sensitive troponin T (hs-cTnT) in heart failure (HF) beyond that of high-sensitivity C-reactive protein and amino-terminal probrain natriuretic peptide is debated. We examined the prognostic value of hs-cTnT in a subgroup of patients from the Controlled Rosuvastatin Multinational Trial in HF (CORONA) study. Methods and Results— Hs-cTnT as a risk factor for the primary end point (cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke; n=356), as well as all-cause mortality (n=366), cardiovascular mortality (n=299), and the composite of cardiovascular mortality and hospitalization from worsening of HF (n=465), was investigated in 1245 patients (≥60 years; New York Heart Association [NYHA] class II–IV, ischemic systolic HF) randomly assigned to 10 mg rosuvastatin or placebo. In multivariable analyses, adjusting for left ventricular ejection fraction, NYHA class, age, body mass index, diabetes mellitus, sex, intermittent claudication, heart rate, estimated glomerular filtration rate, apolipoprotein B/apolipoprotein A-1 ratio, amino-terminal probrain natriuretic peptide, high-sensitivity C-reactive protein, and hs-cTnT (both dichotomized according to the 99th percentile and as a continuous variable) was associated with all end points (primary end point: hazard ratio, 1.87 and 1.51, respectively, per SD change; P &lt;0.001; all other end points: hazard ratio, 1.39–1.70). However, improved discrimination as assessed by C-statistics was only seen for the primary end point and all-cause mortality. Conclusions— Elevated hs-cTnT levels provide strong and independent prognostic information in older patients with chronic ischemic HF. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00206310.