Comprehensive Geriatric Assessment Group Research Articles

Does Comprehensive Geriatric Assessment Reduce the Incidence of Postoperative Delirium? A Quasi-experimental Study in Older Adults Undergoing Transcatheter Aortic Valve Implantation.

Postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) is frequent in older adults and associated with multiple negative outcomes including a higher mortality. We aimed to investigate whether a comprehensive geriatric assessment (CGA) prior to TAVI reduces the odds of POD and results in a positive change in self-care ability, intended to lay a foundation for future geriatric comanagement. We used a retrospective, single-center study with a quasi-experimental design enrolling patients aged 70 years and older undergoing CGA before elective TAVI, and a nonrandomized comparison group without preoperative CGA. Data on POD occurrence during the first 5 days after TAVI (primary outcome) and change in self-care ability index (SPI) between admission and discharge (secondary outcome) were collected from electronic health records and CGA data (exposure) by clinical assessment. To explore associations between (1) CGA and POD, and (2) CGA and SPI, multivariate logistic regression and linear regression models were applied adjusting for age, sex, BMI, and number of medications. Among 435 patients (mean age 81.0 ± 5.6 years, 43.6% women, median [IQR] SPI at baseline 40 [39, 40] points), POD incidence was 14.3% in the CGA group vs 18.8% in the non-CGA group (P 0.219). Undergoing CGA before TAVI was not associated with the odds for POD (OR: 1.15; 95%CI: 0.65-2.04) or improved SPI (P 0.073). We observed no association of CGA prior to TAVI with POD incidence or postoperative self-care, highlighting the need for additional studies investigating the effect of POD preventive measures in older TAVI patients integrated into a comprehensive geriatric comanagement program.

Effectiveness of geriatric assessment and management in older cancer patients: a systematic review and meta-analysis.

Frailty and multimorbidity among older cancer patients affect treatment tolerance and efficacy. Comprehensive geriatric assessment and management is recommended to optimize cancer treatment, but its effect on various outcomes remains uncertain. Our objective was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) and cost-effectiveness studies comparing comprehensive geriatric assessment (with or without implementation of recommendations) to usual care in older cancer patients. We searched MEDLINE, EMBASE, CINAHL, and Cochrane trials from inception to January 27, 2023, for RCTs and cost-effectiveness studies. Pooled estimates for outcomes were calculated using random-effects models. A total of 19 full-text articles representing 17 RCTs were included. Average participant age was 72-80 years, and 31%-62% were female. Comprehensive geriatric assessment type, mode of delivery, and evaluated outcomes varied across studies. Meta-analysis revealed no difference in risk of mortality (risk ratio [RR] = 1.08. 95% confidence interval [CI] = 0.91 to 1.29), hospitalization (RR = 0.92, 95% CI = 0.77 to 1.10), early treatment discontinuation (RR = 0.89, 95% CI = 0.67 to 1.19), initial dose reduction (RR = 0.99, 95% CI = 0.99 to 1.26), and subsequent dose reduction (RR = 0.87, 95% CI = 0.70 to 1.09). However, the risk of treatment toxicity was statistically significantly lower in the comprehensive geriatric assessment group (RR = 0.78, 95% CI = 0.70 to 0.86). No cost-effectiveness studies were identified. Compared with usual care, comprehensive geriatric assessment was not associated with a difference in risk of mortality, hospitalization, treatment discontinuation, and dose reduction but was associated with a lower risk of treatment toxicity indicating its potential to optimize cancer treatment in this population. Further research is needed to evaluate cost-effectiveness.

Exploring the completeness of comprehensive geriatric assessment in relation to care outcomes in hospitalized older patients

Exploring the completeness of comprehensive geriatric assessment in relation to care outcomes in hospitalized older patients

Effectiveness of Perioperative Comprehensive Evaluation of Hip Fracture in the Elderly.

Objective The objective is to observe the effect of Comprehensive Geriatric Assessment (CGA) in the perioperative period of hip fracture. Methods From October 2018 to October 2021, 155 patients over the age of 65 diagnosed with hip fracture and treated with surgery at the Department of Trauma Orthopaedics of General Hospital of Ningxia Medical University were randomly divided into two groups using a prospective research method. A total of 70 cases in the CGA group received a perioperative comprehensive assessment of the geriatric, and 85 cases in the control group received routine medical consultation. Results Elderly patients with hip fractures have a high comorbidity index. Patients with abnormal daily activity before injury accounted for 55%, the abnormal rate of nutrition was 58.1%, the abnormal rate of cognition, anxiety, and depression was 81.8%, and 77.3% of the patients were in a weak state. There was no significant difference in age, gender, ASA grade, fracture type, and operation mode between the two groups, but there were significant differences in operation rate at 48 h (χ2 = 22.153; P ≤ 0.001), preoperative waiting time (Z = −6.387; P ≤ 0.001), total hospital stay (Z = −11.756; P ≤ 0.001), and incidence of postoperative delirium (χ2 = 23.897; P ≤ 0.001). Conclusions The implementation of CGA shortened the preoperative waiting time and total hospital stay, increased the 48 h operation rate, and reduced the incidence of postoperative delirium.

Association between comprehensive geriatric assessment and polypharmacy at discharge in patients with ischaemic stroke: A nationwide, retrospective, cohort study.

SummaryBackgroundPolypharmacy and its adverse drug events are a major healthcare challenge related to falls, hospitalisations and mortality. Comprehensive geriatric assessment (CGA) may contribute to polypharmacy improvement, however, there is no clear evidence so far.MethodsUsing a national inpatient database in Japan from April 1, 2014 to March 31, 2018, we investigated the association between CGA and polypharmacy. We identified patients aged ≥65 years admitted for ischaemic stroke who could receive oral medications. Propensity score matching was conducted for patients with and without CGA during hospitalisation. The outcomes were polypharmacy (defined as use of five or more types of oral medications) at discharge, the number of medication types prescribed at discharge, and the difference between the numbers of medication types prescribed on admission and at discharge.FindingsA total of 162,443 patients were analysed, of whom 39,356 (24·2%) received CGA, and propensity score matching identified 39,349 pairs. Compared with non-CGA group, the CGA group had a significantly lower proportion of polypharmacy at discharge (34·3% vs. 32·9%, p < 0·001) and a smaller number of medication types prescribed at discharge (3·84 vs. 3·76, p < 0·001).InterpretationThis study shows the clear evidence that there is a positive relationship between CGA and a reduction in the number of medications in older inpatients with ischaemic stroke.FundingThe Ministry of Health, Labour and Welfare, Japan and the Ministry of Education, Culture, Sports, Science and Technology, Japan.

Impact of comprehensive geriatric assessment on treatment outcomes of chronic heart failure in elderly patients complicated with emotional disorders

Objective To investigate the impact of comprehensive geriatric assessment(CGA)on treatment outcomes of chronic heart failure(CHF)complicated with emotional disorders in the elderly. Methods A total of 216 CHF patients with emotional disorders at Henan Provincial People’s Hospital were recruited from September 2017 to March 2019 and were randomly divided into a CGA group and a control group with 108 cases in each group.The control group was given standard drug treatment and psychological counseling, whereas individualized treatment was given to participants in the CGA group in compliance with CGA guidelines.The clinical effects after intervention for 8 weeks in the two groups were examined, using measures such as Hamilton Depression Rating Scale for Depression(HAMD)-24, Hamilton Anxiety Scale(HAMA)-14, amino-terminal pro-brain natriuretic peptide(NT-proBNP), the 6 minute walk test(6MWT)and left ventricular ejection fraction(LVEF). The changes of cognitive status, nutritional status, fall risk and other indicators in patients were comprehensively assessed and statistically analyzed. Results Compared with pre-treatment data, 8 weeks of treatment for both the control group and the CGA group resulted in decreased HAMD-24 scores(Control group: 31.78±9.08, 23.69±10.16; CGA group: 32.09±8.98, 15.35±7.91; P<0.05), HAMA-14 scores(Control group: 22.38±7.09, 15.28±6.54; CGA group: 21.99±8.12, 10.48±6.82; P<0.05)and NT-proBNP levels[Control group: (4672±392)ng/L, (3279±282)ng/L; CGA group: (4861±378)ng/L, (2387±215)ng/L; P<0.05], and increased LVEF(%)[Control group(34.5±6.2)%, (39.8±7.5)%; CGA group(35.1±3.9)%, (42.5±6.1)%; P<0.05]and 6MWT scores[Control group(298±79±7.5)m, (358±102)m; CGA group(305±98)m, (402±178)m; P<0.05], with more marked changes in all the measures in the CGA group than in the control group(P<0.05). Conclusions The early application of CGA can improve the condition and prognosis in elderly heart failure patients complicated with emotional disorders. Key words: Geriatric comprehensive assessment; Heart failure; Mood disorders

Impact of comprehensive geriatric assessment on short-term mortality in older patients with cancer—a follow-up study

PurposeThe aim of this study was to evaluate the impact of comprehensive geriatric assessment (CGA) linked to intervention on identified problems on 90-day mortality in older patients with cancer. Patients and methodsEligible patients were 70 years or older and referred to the Oncology Department at Aarhus University Hospital in order to receive treatment for head and neck cancer (HNC), lung cancer (LC), upper gastrointestinal tract (UGI) cancer or colorectal cancer (CRC). All patients were intendedly invited for CGA. Patients for the study were identified by the oncology department. CGA evaluated six domains: comorbidity, autonomy, mental, cognitive, nutritional status and medication. Intervention was proposed if deficits were detected. Follow-up was performed 90 days after inclusion. ResultsFrom January 1st 2016 through July 31st 2018, 781 patients were identified. Sixty-seven patients were excluded. Median age: 76 (interquartile range: 72–80) years. Primary tumour sites: 5% HNC, 46% LC, 20% UGI and 29% CRC. A total of 407 patients had CGA, 307 had no CGA. Geriatric intervention was proposed in 325 patients (80%) and initiated in 319 patients (78%) in the CGA group. Within 90 days, 142 patients (20%) died. In the non-CGA group, 74 patients died (24%), versus 68 patients (17%) in the CGA group. A potential reduction of death in the CGA group was detected: crude odds ratio (OR): 0.63 (95% confidence interval: 0.43; 0.91), p = 0.014. Adjusted OR: 0.62 (95% confidence interval: 0.39; 1.00), p = 0.05. ConclusionA CGA linked to oncology evaluation may reduce short-term mortality in older patients with cancer referred for oncological treatment.

Systematic review on effects of comprehensive geriatric assessment among patients with hip fractures

Objective To comprehensively review the effect of comprehensive geriatric assessment (CGA) on reducing the incidence of delirium, shortening the length of stay and reducing the morbidity among elderly patients with hip fractures. Methods From June 2017 to February 2018, we retrieved the MEDLINE, EMBASE, PubMed, CENTRAL, PsycINFO, China Biology Medicine, China National Knowledge Infrastructure (CNKI) , Vip Database (VIP) and WanFang data published from establishing database to January 2018. We collected the randomized controlled trials and clinical trials on the application of comprehensive geriatric assessment in elderly patients with hip fractures. Two researchers independently explored literature, screen literature and assess the quality of the included literature according to the inclusion and exclusion criteria, and extract the data. ReManv 5.3 was used to Meta-analysis. Results A total of 14 literature were enrolled and RCT. Meta-analysis showed that there was statistical differences in the incidence of delirium [Z=3.33, P=0.001, OR=0.82, 95%CI (0.74-0.92) ]and the morbidity within half a year [Z=2.89, P=0.004, OR=0.66, 95%CI (0.49-0.87) ], function losing rate [Z=2.92, P=0.003, OR=0.82, 95%CI (0.66-0.92) ]but no statistical difference in the length of stay (Z=1.32, P=0.19) between the CGA group and control group. Conclusions CGA can reduce the incidence of delirium among elderly patients with hip fractures after surgery. Compared with the CGA based on elderly ward, CGA based on agile team follow-up has good effects which can reduce the morbidity within half a year and function losing rate of patients. Key words: Aged; Meta-analysis; Comprehensive geriatric assessment; Hip fractures; Delirium; Length of stay; Mortality; Systematic review

Optimal oncologic treatment of rectal cancer in patients over 75 years old: Results of a strategy based on oncogeriatric evaluation

Few data are available on the management of elderly rectal cancer patients, and especially on the ability to provide optimal oncological treatment. The aim of this study was to determine the feasibility and results of multimodality treatment for rectal cancer in patients 75years and older after simplified comprehensive geriatric assessment (CGA) according to Balducci score. We reviewed the charts of elderly patients who underwent surgery for localized middle or low rectal cancer. Patients were classified into three CGA groups depending on their functional reserve, comorbidities, geriatric syndromes, and life expectancy. Neoadjuvant therapy was discussed for 27 patients (47%), but only 56% of them were treated, including 8, 7, and 1 patient from CGA groups 1, 2, and 3, respectively. Fifty-three patients (93%) underwent sphincter-preserving surgical resection and four patients underwent abdominoperineal resection (7%). Postoperative complications were observed in 21 patients (37%). The postoperative complication rate was correlated non-significantly with age (<85years: 40.6%; ≥85years: 57.1%; P=0.3), and with the CGA (P=0.64). In total, 10 patients (18%) had definitive colostomy, including five anastomotic leakages (9%), and one incontinence (2%). The total rate of sphincter preservation was 82% (n=47). The risk of secondary definitive colonic stoma formation was not correlated with CGA (group 1: 14%; group 2/3: 16%; P=0.8). Estimated OS at five years was 52%. After routine geriatric assessment, elderly rectal cancer patients have good rates of sphincter conservation and acceptable morbidity/mortality.

Cost-effectiveness of comprehensive geriatric assessment at an ambulatory geriatric unit based on the AGe-FIT trial

BackgroundOlder people with multi-morbidity are increasingly challenging for today’s healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people ≥75 years with multi-morbidity.MethodThe primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs were discounted by 3% per annum and are reported in 2016 euros.ResultsCompared with usual care CGA was associated with a per patient mean incremental cost of approximately 25,000 EUR and a gain of 0.54 QALYs resulting in an ICER of 46,000 EUR. The incremental costs were primarily caused by intervention costs and costs associated with increased survival, whereas the gain in QALYs was primarily a consequence of the fact that patients in the CGA group lived longer.ConclusionCGA in an ambulatory setting for older people with multi-morbidity results in a cost per QALY of 46,000 EUR compared with usual care, a figure generally considered reasonable in a Swedish healthcare context. A rather simple reorganisation of care for older people with multi-morbidity may therefore cost effectively contribute to meet the needs of this complex patient population.Trial registrationThe trial was retrospectively registered in clinicaltrial.gov, NCT01446757. September, 2011.

The effect of comprehensive nursing intervention based on Comprehensive Geriatric Assessment on the life quality and pulmonary function in the rehabilitation of old patients with chronic obstructive pulmonary disease

Objective To discuss the effect of comprehensive nursing intervention based on Comprehensive Geriatric Assessment (CGA) on the quality of life and pulmonary function in the rehabilitation of old patients with chronic obstructive pulmonary disease (COPD). Methods A total of 70 cases of COPD patients admitted from December 2013 to December 2016 in our hospital were randomly divided into the control group and CGA group, 35 cases in each group. The control group received routine nursing intervention, while the CGA group received comprehensive nursing intervention based on CGA assessment. The improvement of lung function and quality of life before and after nursing intervention was compared between the two groups. Results Before nursing intervention, the patients in CGA group and the control group showed no statistical significance in scores of each dimension of quality of life, such as daily life, social activities, anxiety, depression (P > 0.05). After nursing intervention, scores of each dimension of quality of life were significantly lower compared with before nursing intervention, and the quality of life score in CGA group were significantly higher than those of the control group: 1.81±0.21 vs. 2.61±0.17, 1.51±0.29 vs. 1.97±0.34, 1.72±0.32 vs. 2.29±0.37, 1.91±0.23 vs. 2.86±0.48, each dimension score lower amplitude differences all had statistical significance (t=6.089 8-17.517 1, P 0.05) . After nursing intervention, two groups of patients with the lung function of each index were significantly improved compared with before nursing intervention, the index of lung function and CGA group improved significantly better than control group: (2.80±0.41) L vs. (2.24±0.31) L, (1.98±0.24) L vs. (1.50±0.21) L, (70.31±10.21) % vs. (61.50±8.92) %, (4.49±0.28) % vs. (3.75±0.39) %, the differences were statistically significant (t=3.844 4- 9.118 6, P < 0.05) . Conclusions Comprehensive nursing intervention based on CGA can effectively improve the pulmonary function of patients with COPD, improve the quality of life of patients, relieve anxiety and depression, and improve the effect of nursing intervention. It is worth popularizing in clinical practice. Key words: Nursing care; Pulmonary disease, chronic obstructive; Quality of life

Evaluating the cost-effectiveness of population health interventions alongside literature reviews: the case of comprehensive geriatric assessment

Introduction: Decision-makers are interested in the cost-effectiveness of population health interventions but there is often lack of (robust) evidence from empirical economic evaluations. Thus, data synthesis and decision-modelling are frequently used by health economists to inform evidence-based decision-making. However, most literature reviews of evaluation studies are not designed to support an economic evaluation. Aim: We sought to develop a methodological approach to assess the cost-effectiveness of population health interventions alongside literature reviews. Methods: Several research methods and data sources were used to perform an economic analysis alongside a COCHRANE literature review of randomised controlled trials that compared inpatient comprehensive geriatric assessment (CGA) to usual care for older people urgently admitted to hospital. The review followed standard methodological procedures expected by Cochrane and EPOC. In addition, individual patient data (IPD) was requested from trialists and a survey of trialists was conducted to obtain details of the delivery of CGA. Mean hospital length of stay was derived from meta-analysis of seventeen studies and the relative costs were valued using English unit cost prices 2013/2014. Quality Adjusted Life Years (QALYs), were calculated by converting the Barthel Index from 3 trials, using IPD, to EQ-5D scores based on mapping studies. Life years (LYs) were estimated using the IPD from four trials by calculating the time-to-death from recruitment, and expressed as a fraction of a year. We created a variable 'life years living at home' (LYLAHs) after discharge from hospital, as a measure of independence and well-being in an older population, based on IPD from two trials. A decision model combined information from the meta-analyses and IPD and estimated an incremental cost-effectiveness ratio (ICER) of inpatient CGA expressed as a cost per QALY gained, cost per LY gained and cost per LYLAH gained from a health service perspective. Uncertainty was addressed by performing probabilistic and univariate sensitivity analysis. Results: The review of twenty nine trials recruiting 13,766 participants across nine countries found that patients who received CGA were more likely to be alive and in their own homes at follow-up. This is similar to the results from the economic evaluation that showed that CGA was more effective with respect to all three health outcome measurements (0.012 more QALYs, 0.037 more LYs, and 0.019 LYLAHs per patient). The health care costs per patient in the CGA group were £234 (95% CI -£144 to £605) higher than in usual care group. The ICER in terms of QALYs was £19,802, which is close to the £20,000 threshold that NICE suggests as a ceiling value for a QALY; the cost for a LY gained was £6,305 and for a LYLAH gained was £12,568. The probability of CGA to be cost-effective at a £20,000 ceiling ratio for a QALY, LY and LYLAH was 0.50, 0.89, and 0.47 respectively. Conclusions: The methodological approach used in this study provides decision-makers with economic evidence about CGA and could be used to evaluate any other health intervention. CGA is likely to be cost-effective at the NICE cut-off value of £20,000 for a QALY but the uncertainty is high. Limitations: The analysis did not include costs after patient discharge. Future research: Further work is required to establish the optimum way of combining review-based results with model-based economic evaluations.

Comprehensive geriatric assessment for older adults admitted to hospital.

Comprehensive geriatric assessment (CGA) is a multi-dimensional, multi-disciplinary diagnostic and therapeutic process conducted to determine the medical, mental, and functional problems of older people with frailty so that a co-ordinated and integrated plan for treatment and follow-up can be developed. This is an update of a previously published Cochrane review. We sought to critically appraise and summarise current evidence on the effectiveness and resource use of CGA for older adults admitted to hospital, and to use these data to estimate its cost-effectiveness. We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 5 October 2016; we also checked reference lists and contacted study authors. We included randomised trials that compared inpatient CGA (delivered on geriatric wards or by mobile teams) versus usual care on a general medical ward or on a ward for older people, usually admitted to hospital for acute care or for inpatient rehabilitation after an acute admission. We followed standard methodological procedures expected by Cochrane and Effective Practice and Organisation of Care (EPOC). We used the GRADE approach to assess the certainty of evidence for the most important outcomes. For this update, we requested individual patient data (IPD) from trialists, and we conducted a survey of trialists to obtain details of delivery of CGA. We calculated risk ratios (RRs), mean differences (MDs), or standardised mean differences (SMDs), and combined data using fixed-effect meta-analysis. We estimated cost-effectiveness by comparing inpatient CGA versus hospital admission without CGA in terms of cost per quality-adjusted life year (QALY) gained, cost per life year (LY) gained, and cost per life year living at home (LYLAH) gained. We included 29 trials recruiting 13,766 participants across nine, mostly high-income countries. CGA increases the likelihood that patients will be alive and in their own homes at 3 to 12 months' follow-up (risk ratio (RR) 1.06, 95% confidence interval (CI) 1.01 to 1.10; 16 trials, 6799 participants; high-certainty evidence), results in little or no difference in mortality at 3 to 12 months' follow-up (RR 1.00, 95% CI 0.93 to 1.07; 21 trials, 10,023 participants; high-certainty evidence), decreases the likelihood that patients will be admitted to a nursing home at 3 to 12 months follow-up (RR 0.80, 95% CI 0.72 to 0.89; 14 trials, 6285 participants; high-certainty evidence) and results in little or no difference in dependence (RR 0.97, 95% CI 0.89 to 1.04; 14 trials, 6551 participants; high-certainty evidence). CGA may make little or no difference to cognitive function (SMD ranged from -0.22 to 0.35 (5 trials, 3534 participants; low-certainty evidence)). Mean length of stay ranged from 1.63 days to 40.7 days in the intervention group, and ranged from 1.8 days to 42.8 days in the comparison group. Healthcare costs per participant in the CGA group were on average GBP 234 (95% CI GBP -144 to GBP 605) higher than in the usual care group (17 trials, 5303 participants; low-certainty evidence). CGA may lead to a slight increase in QALYs of 0.012 (95% CI -0.024 to 0.048) at GBP 19,802 per QALY gained (3 trials; low-certainty evidence), a slight increase in LYs of 0.037 (95% CI 0.001 to 0.073), at GBP 6305 per LY gained (4 trials; low-certainty evidence), and a slight increase in LYLAH of 0.019 (95% CI -0.019 to 0.155) at GBP 12,568 per LYLAH gained (2 trials; low-certainty evidence). The probability that CGA would be cost-effective at a GBP 20,000 ceiling ratio for QALY, LY, and LYLAH was 0.50, 0.89, and 0.47, respectively (17 trials, 5303 participants; low-certainty evidence). Older patients are more likely to be alive and in their own homes at follow-up if they received CGA on admission to hospital. We are uncertain whether data show a difference in effect between wards and teams, as this analysis was underpowered. CGA may lead to a small increase in costs, and evidence for cost-effectiveness is of low-certainty due to imprecision and inconsistency among studies. Further research that reports cost estimates that are setting-specific across different sectors of care are required.

Application of comprehensive geriatric assessment nursing model on the quality of life in elderly patients with coronary heart disease

Objective To explore the effects of the comprehensive geriatric assessment （ CGA） nursing model on the quality of life in elderly patients with coronary heart disease （ CHD ） .Methods A total of 143 cases of hospitalized elderly patients with CHD were randomly divided into two groups , from January 2012 to June 2013 .The control group （ 69 cases ） was given the cardiovascular specialty nursing and the CGA group （74 cases） was given the cardiovascular nursing based on the CGA nursing model .The scores of patients ’ physical strength, illness, medical condition, general life, social psychology, working and interpersonal relationship were surveyed using the questionnaire of quality of life in patients with cardiovascular diseases （ CQQC） when patients first admitted to the hospital and 6 months after discharge .Results In the CGA group , 75.7%patients had two or more kinds of elder problems , within which 67.6% was depression, 66.2% was sleep disorder, 62.2% were hearing disability and 60.8% was visual disability.Before the intervention, the scores of quality of life between groups had no significant differences （P 〉0.05）.After the nursing intervention, the scores of physical strength , illness, medical condition, general life, social psychology, working and interpersonal condition in the CGA group were （10.86 ±5.06）, （8.75 ±4.54）, （5.90 ±0.40）, （5.22 ±1.95）, （8.41 ±3.22）, （0.97 ±0.66） and （40.11 ±9.05）.Those scores in the control group were （7.35 ±4.12）, （4.57 ±0.85）, （4.72 ±0.82）, （3.85 ±1.45）, （3.67 ±1.52）, （0.70 ±0.64） and （24.86 ±4.43）.The differences of scores between groups were significant （ t =4.541, 7.545, 11.137, 4.720, 11.095, 2.470, 12.653, respectively;P 〈0.05 ）.Conclusions Based on the comprehensive evaluation, the CGA nursing model can play a positive role in clinical nursing of elderly CHD patients , and it also can improve the quality of life in elderly patients with CHD . Key words: Coronary heart disease; Quality of life; Comprehensive geriatric assessment

Effects of Medication Assessment as Part of a Comprehensive Geriatric Assessment on Drug Use over a 1-Year Period

High drug consumption among the elderly and inappropriate prescribing practices increase the risk of adverse drug effects in this population. This risk may be decreased by conducting, for example, a medication review alone or as part of a comprehensive geriatric assessment (CGA); however, little is known about the fate of the changes in medication made as a result of the CGA or medication review. To study the performance of the CGA with regards to medication changes and to determine the persistence of these changes over a 1-year period. This study was a population-based intervention study. A random sample of 1000 elderly (age > or =75 years) was randomized either to a CGA group or to a control group. Home-dwelling patients from these groups (n = 331 and n = 313 for intervention and control groups, respectively) were analysed in this study. Study nurses collected information on medication at study entry and 1 year later in both groups; in the intervention group, study physicians assessed, and changed when appropriate, the medication at study entry. The medication changes and their persistence over 1 year were then evaluated. Medication changes were more frequent in the intervention group than in the control group. Regular medication was changed during follow-up in 277 (83.7%) and in 228 (72.8%) [odds ratio (OR) 1.9; 95% CI 1.3, 2.8] patients in the intervention and control groups, respectively. In the intervention group, study physicians were responsible for 35.4% of all new prescriptions and for 15.6% of all drug terminations. Changes took place particularly in the prescription of CNS drugs. About 58% of the drugs initiated by study physicians were still in use 1 year later, and 25.5% of those terminated by study physicians had been reintroduced. Drug intervention as part of a CGA can be used to rationalize the drug therapy of a patient. However, its effectiveness is subsequently partly counteracted by other physicians working in the healthcare system.

Incorporation of a Comprehensive Geriatric Assessment (CGA) into a randomized phase III trial for metastatic breast cancer: The PELICAN Study

9551 Background: The PELICAN trial is a randomized phase III trial evaluating efficacy and safety of pegylated liposomal doxorubicin (PLD) versus capecitabine as first-line therapy in patients (pts) with metastatic breast cancer who are not considered candidates for combination chemotherapy. Randomisation was stratified according to age (cut-off 65 years) and anthracycline pretreatment. CGA results and adverse events (AEs), dose reductions, and number of applied cycles were evaluated. Methods: CGA comprised data on activities of daily living (ADL), instrumental activities of daily living (IADL), ECOG and Karnofsky performance score, comorbidity (CIRS-G), and number of comedication. According to CGA, pts were classified into groups 1–3 (Balducci 2000). Associations of CGA groups and single CGA items with outcome measures were assessed using Fisher's exact test, Wilcoxon test, and logistic regression. Results: Results of 210 pts, mean age 61 years (SD 11; range 22–85) were analysed. According to CGA, 102 pts were considered fit (group 1, 72%), 21 compromised (group 2, 15%), and 19 frail (group 3, 13%). Age was associated neither with overall AEs, nor with dose reductions or number of applied cycles. However, the following significant associations were observed: any AE and number of comedication (p=0.026); less hand foot syndrome (HFS) and CGA group 2/3 (p=0.032); and more constitutional symptomes and age &gt;=65 as well as CGA group 2/3 (p=0.002 and 0.015, respectively). Comedication was the variable most frequently associated with single AEs (dermatology other than HFS, p=0.038; gastrointestinal, p=0.035; constitutional symptomes, p=0.002; pain, p=0.001; pulmonary, p&lt;0.0001; fatigue, p=0.01). Whereas no association between any item and dose reduction was found, CIRS-G grade 3–4 was associated with a reduced number of applied cycles (p=0.049). Conclusions: Incorporation of CGA into a phase III trial is feasible and yields information that would otherwise have been missed. Results of CGA should be validated prospectively in treatment algorithms for this population. [Table: see text]