Comprehensive Geriatric Evaluation Research Articles

The relationship between sarcopenia and central hemodynamics in older adults with falls: a cross-sectional study.

Falls are an important cause of morbidity and mortality in geriatric patients. Sarcopenia and central blood pressure may be associated with falls. This study aimed to investigate the association between sarcopenia and blood pressure parameters in older patients with falls. A comprehensive geriatric evaluation of 72 elderly patients was performed using established assessment tests. Peripheral and central hemodynamic measurements, including office DBP and SBP, daytime-night peripheral and central DBP and SBP, cardiac output, augmentation index, pulse wave velocity (PWV), pulse rate, and peripheral resistance and reflection, were measured with a 24-hour ambulatory blood pressure measuring device. Of 72 patients with a mean age of 77.51 ± 6.5 years, 12 (16.7%) were non-sarcopenic, 32 (44.4%) were probable, nine (12.5%) were confirmed, and 19 (26.4%) were severe sarcopenic. PWV, which is an indicator of arterial stiffness, was found to be significantly higher in the sarcopenic group. The other cardiac risk markers [daytime peripheral SBP, mean arterial pressure (night), pulse pressure (daytime), and peripheral resistance (daytime and night)] were significantly lower in the sarcopenic patients. PWV correlated with gait speed, Katz score, and hand grip strength (Spearman's rho: -0.337, -0.310, and -0.334; P < 0.001, 0.008, and 0.001, respectively). Age and hypertension were the most important factors increasing the risk of falls. Sarcopenia is associated with central and peripheral blood pressure changes in patients with falls. When sarcopenia is diagnosed in older people with falls, 24-hour ambulatory peripheral and central pressures should be evaluated for cardiac risk screening.

Knowledge, Attitude, and Practices of Indian Anesthesiologists Regarding the Comprehensive Preanesthetic Assessment of Geriatric Patients

Abstract Background: Comprehensive preoperative geriatric evaluations, including frailty, diet, mobility aid use, physical activity, cognitive testing, and mood state assessment, help predict perioperative outcomes in elderly patients. Material and Methods: An online questionnaire-based Google survey was prepared to assess preanesthetic checkup (PAC) in elderly patients by practicing anesthesiologists over 3 months. Data about respondent demographics, knowledge about preoperative investigations, and utilization of validated tools for risk assessment in geriatric patients were collected and analyzed descriptively using different percentages and frequencies. Results: The invitation was sent to 500 anesthesiologists. One hundred and fifty-six recipients responded to the e-mail invitation producing an overall response rate of 31.2%. About 47.4% and 42.4% of anesthesiologists had an equal preference for regional/general anesthesia in conducting elderly elective cases for surgeries, the choice of anesthesia was mainly regional anesthesia in cognitively impaired elderly patients. Nearly 88.5% and 78.2% of practicing anesthesiologists were well aware and conducted the functional assessment and mini—mental state examination in geriatric patients, but only 48.7% were aware of frailty scoring, 30.8% were aware of Charlson comorbidity scoring index, and 24.4% were about Elderly Mobility Scale (EMS). Conclusion: Surgical results are strongly influenced by the general health, work, and life expectancy of patients. A comprehensive preoperative geriatric evaluation of patients must be extended beyond an organ-based or disease-based evaluation. We support the inclusion in the PAC of geriatric patients of validated score systems, including frailty score, Charlson comorbidity score index, EMS, functional assessment, and mini—mental state assessment.

Autologous Stem Cell Transplantation in Multiple Myeloma Patients Over 60 Years Old

The incidence of Multiple myeloma (MM) increases with age; two-thirds of the patients are older than 65 years. Induction treatment, including new agents such as thalidomide, bortezomib, and lenalidomide followed by a conditioning regimen and upfront autologous stem cell transplantation (ASCT), has been accepted the standard treatment approach for newly diagnosed fit MM patients. We aimed to search the real-life data, the efficacy and safety of upfront ASCT following induction in patients with MM over 60 years old retrospectively. The data of MM patients who were ≥60 years old during autologous stem cell transplantation and treated at our center between 2010 and 2018 retrospectively analyzed. The study results were 63 patients included at the age of ≥ 60 years who underwent upfront ASCT. Median PFS was 15.5±2.6 months, and the median overall survival (OS) was 28.15±5 months. According to age groups, median PFS was 12±2.3 months in the 60-64 age group, 18.4±6 months in the 65-69 age group, and 26±15 months in the ≥70 age group. Median OS was 26.5±6.1 months in the 60-64 age group, 39.66±8.9 months in the 65-69 age group, and 18 months in the ≥70 age group. A significant relationship between the quantity of infused CD34+ stem cells and PFS and OS (p:0.05 and p&lt;0.00, respectively). Our study indicated that a high dose (200 mg/m2 ) melphalan could safely be used in the physically fit patients at the ages of 60-69, and a reduced amount (140 mg/m2 ) would be the appropriate dose for the patients over 70. The quantity of infused CD34+ stem cells affect elderly MM patients; mobilization dynamics are also important factors for elderly myeloma. Age itself should not consider a barrier to ASCT, and a comprehensive geriatric evaluation should perform on elderly patients

Autologous Stem Cell Transplantation in Multiple Myeloma Patients Over 60 Years Old

The incidence of Multiple myeloma (MM) increases with age; two-thirds of the patients are older than 65 years. Induction treatment, including new agents such as thalidomide, bortezomib, and lenalidomide followed by a conditioning regimen and upfront autologous stem cell transplantation (ASCT), has been accepted the standard treatment approach for newly diagnosed fit MM patients. We aimed to search the real-life data, the efficacy and safety of upfront ASCT following induction in patients with MM over 60 years old retrospectively. The data of MM patients who were ≥60 years old during autologous stem cell transplantation and treated at our center between 2010 and 2018 retrospectively analyzed. The study results were 63 patients included at the age of ≥ 60 years who underwent upfront ASCT. Median PFS was 15.5±2.6 months, and the median overall survival (OS) was 28.15±5 months. According to age groups, median PFS was 12±2.3 months in the 60-64 age group, 18.4±6 months in the 65-69 age group, and 26±15 months in the ≥70 age group. Median OS was 26.5±6.1 months in the 60-64 age group, 39.66±8.9 months in the 65-69 age group, and 18 months in the ≥70 age group. A significant relationship between the quantity of infused CD34+ stem cells and PFS and OS (p:0.05 and p&lt;0.00, respectively). Our study indicated that a high dose (200 mg/m2 ) melphalan could safely be used in the physically fit patients at the ages of 60-69, and a reduced amount (140 mg/m2 ) would be the appropriate dose for the patients over 70. The quantity of infused CD34+ stem cells affect elderly MM patients; mobilization dynamics are also important factors for elderly myeloma. Age itself should not consider a barrier to ASCT, and a comprehensive geriatric evaluation should perform on elderly patients

Cognitive dysfunction correlates with physical impairment in frail patients with acute myocardial infarction.

To the best of our knowledge, the association of physical impairment and cognitive decline has never been investigated in frail patients with acute myocardial infarction. The aim of our study is to assess the correlation between physical and cognitive dysfunction in frail patients with ST-elevation myocardial infarction (STEMI). We examined consecutive frail patients with first STEMI treated with primary percutaneous coronary intervention (PPCI). All patients were evaluated via Mini Mental State Examination (MMSE) and 5-m gait speed test after PPCI. A total of 871 frail patients with suspected STEMI were admitted and 301 patients successfully completed the study. We found that the gait speed significantly correlated with the MMSE score (r: 0.771; p: < 0.001). The independent effects on MMSE score were confirmed in a linear multivariate analysis. Taken together, our findings indicate that an assessment of both cognitive and physical conditions should be included in the comprehensive geriatric evaluation of hospitalized older STEMI patients.

Severe aortic stenosis in octogenarian: is surgical aortic valve replacement a good option?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Aortic stenosis (AS) is the most prevalent valvular heart disease among the elderly, reaching 8,1% in 85 years-old patients. Symptomatic severe AS entails a high risk of morbidity and mortality without valve replacement, and increasing age is associated with higher surgical risk. Purpose To determine the prognostic impact of advanced age in patients with severe AS referred to surgical valve replacement. Methods We conducted a retrospective study encompassing patients referred to surgical aortic valve replacement due to severe AS, from January 2016 to December 2018. Clinical characteristics, diagnostic studies and follow-up were analysed. Patients were divided in two groups according to the age: &amp;lt;80 and ≥80 years old. Independent predictors of mortality and/or re-hospitalization were identified through a binary logistic regression analysis, considering p = 0,05. Results A total of 222 patients were included, with a 64,4% male predominance and a median age of 75 years old. 27,5% had concomitant surgical coronary artery disease and 87,4% waited in an out-patient setting. Median delay until surgery was 87 days and median follow-up after surgical referral was 517 days. 59 patients (26,8%) had ≥ 80 years old. Male gender (69,6% vs 50,8%; p = 0,01), smoking habits (14,3% vs 1,7%; p = 0,024), higher glomerular filtration rate (75,5 vs 63,2 ml/min; p = 0,001) and lower Euroscore II values (2,89% vs 4,64%; p = 0,003) were more common in younger patients. Global mortality rate (27,1% vs 15,5%; p = 0,05) and the composite of mortality or re-hospitalization (52,5% vs 36,6%; p = 0,034) were more frequent in older patients. Despite re-hospitalizations were also more common (37,3% vs 29,2%), they did not reach statistical significance (p = 0,252). After multivariate analysis, advanced age was not an independent predictor of mortality and/or re-hospitalization. In this population, only the presence of extracardiac arteriopathy (p = 0,007; p = 0,006) and pulmonary hypertension (p = 0,004; p = 0,002) were both independent predictors of mortality and the composite of mortality or re-hospitalization. Conclusion Older patients with AS have higher mortality, but advanced age was not an independent predictor of mortality and/or re-hospitalization. The decision to perform aortic valve replacement should be discussed in the Heart Team, considering patient’s comorbidities and performing a comprehensive geriatric evaluation, not just focusing on age itself.

Association between sleep disturbance with motoric cognitive risk syndrome in Chinese older adults.

Sleep disturbance and cognitive impairment are common and related in the elderly population worldwide. The aim of the present study was to explore the association between sleep disturbance and motoric cognitive risk (MCR) syndrome, which is characterized by subjective cognitive complaints and objective slow gait in older individuals without dementia or any mobility disability in the community-dwelling elderly Chinese population. We recruited 940 participants aged≥65years from November 2016 to March 2017 in the Ningbo Community Study on Aging (NCSA). Self-reported sleep duration and sleep-quality variables, comprehensive geriatric evaluation, as well as indicators for diagnosing MCR syndrome were evaluated in this cross-sectional study. Multiple logistic regression analysis showed that a 1-SD increase in night (1.1h) and 24-h sleep duration (1.3h) was associated, respectively, with a 21% (95% confidence interval [CI], 1%-47%; p=0.04) and 30% (95% CI, 3%-64%; p=0.03) higher odds of having MCR syndrome. Considering sleep duration as a categorical variable, longer night-sleep duration (>8.5h) was associated with MCR syndrome (OR, 2.03; p=0.02) compared to shorter night-sleep duration (<8h). For sleep-quality factors, increasing frequency of trouble falling asleep, waking early or easily, nightmares, and taking sleep drugs were significantly associated with MCR syndrome after adjusting for potential covariables (all p for trend<0.05), but not for self-perceived sleep quality (p for trend=0.10). Long sleep duration, poor sleep quality, and taking sleep drugs were associated with higher odds of having MCR syndrome in the community-dwelling elderly Chinese population. Further research is needed to explore the underlying mechanisms.

Clinical characteristics of older patients with COVID-19: a systematic review of case reports.

ABSTRACT.In the context of the current COVID-19 pandemic, higher morbidity and mortality have been reported in older adults. This age group presents physiological changes and its own clinical conditions such as frailty, dementia, among others.Objective:To describe the characteristics of COVID-19 patients, both over and under 80 years old, by conducting a systematic review of the literature describing case reports, and to summarize and critically assess these characteristics.Methods:Systematic review. The study was registered on the Registry of Health Research Projects (PRISA) of the Peruvian National Institute of Health (code EI00000631). Five electronic databases (Scopus, PubMed, PubMed Central, LILACS, and SCIELO) were systematically searched during the period between December 31, 2019 and April 16, 2020. The search focused on case reports, case studies, and case series of older people with COVID-19 infection aged over or under 80 years. When selecting the cases, priority was given to clinical and epidemiological profile, laboratory and imaging patterns, and comprehensive geriatric evaluation.Results:1,149 articles were identified; after applying the filters, a total of 15 publications of case reports and complete records of 27 older adults were obtained. The most frequent age group was between 60 to 69 years old. There is little literature regarding case reports of older adults aged over 80 years. The most frequent parameters were hypertension, fever, cough, respiratory distress, ground-glass opacification in chest radiography and tomography. Furthermore, decrease in PaO2/FiO2 ratio and lymphocytes, and increase in C-reactive protein and Interleukin 6 were observed.Conclusions:This systematic review found little available information of patients under 80 years old, and far less for those over 80 years old, and an absence of comprehensive geriatric assessment.

Validity and reliability of Fried frailty phenotype in Turkish population.

Frailty is an important, multidimensional geriatric syndrome defined as increased vulnerability to stressors. Fried frailty phenotype (FFP) is one of the most widely used models to define physical frailty. The aim of this study is to investigate the cross-cultural validity and reliability of Fried frailty phenotype (FFP) in older Turkish population. A total of 450 patients, aged 59 years and over, were included. FFP translated into Turkish was used. Hand grip strength cut-off values that best predict low skeletal muscle mass index (SMI) for Turkish men and women were calculated. A modified version of FFP was created by rescoring FFP according to these cut-off values applicable to Turkish population. Correlation analysis between the frailty assessment by comprehensive geriatric evaluation of clinician experienced in geriatric medicine, and FFP and modified version of FFP were performed for validation. Thirty-five patients underwent frailty assessment with FFP twice for reliability assessment. Inter-rater and intra-rater agreements were investigated. Clinician's decision of frailty status demonstrated significant agreement with the results of FFP, as well as modified FFP. Interrater and intra-rater compliance were good. Best hand grip strength cut-off values for predicting low SMI in older Turkish population were determined as ≤13.6 kg (AUC: 0.841, p < 0.001) for women and ≤27.7 kg for men (AUC: 0.779; p < 0.001). Modified FFP had a good agreement with the FFP. FFP is a valid and reliable tool for Turkish population.

Valoración geriátrica integral: influencia en los resultados clínicos de la cirugía colorrectal en pacientes de edad muy avanzada

IntroductionThe objective of this work was to analyse the postoperative clinical results of patients surgically treated for colorectal cancer in relation to the results of the preoperative comprehensive geriatric evaluation. MethodsObservational study in which postoperative morbidity and mortality at 30 and 90 days were analysed in a cohort of patients surgically treated for colorectal cancer according to age groups: group 1) between 75 and 79 years old; group 2) between 80 and 84 years old, and group 3) ≥85 years old. In addition to the anaesthetic risk assessment, patients were assessed with the Karnofsky, Barthel and Pfeiffer indexes. Mortality at 30 and 90 days after surgery was analysed in relation to the results of the comprehensive evaluation. ResultsA total of 227 patients with colorectal cancer were included in the study period: 91 in group 1, 89 in group 2 and 47 in group 3. There were statistically significant differences in mortality at 30 days (p=0,029) but not at 90 days after surgery, according to age groups. Mortality at 90 days was significantly higher in patients with worse scores on the Karnofsky and Barthel scales. ConclusionsComprehensive geriatric assessment using different scales is a good tool to assess postoperative mortality in the mid-term postoperative period.

Impact of Diabetes Mellitus and Frailty on Long-Term Outcomes in Elderly Patients with Acute Coronary Syndromes.

Diabetes mellitus (DM) and frailty are common in older patients with acute coronary syndromes (ACS). No data exists about its prognostic impact on long-term outcomes and their possible interaction in this setting. Observational prospective study. Multicenter registry conducted in 44 hospitals in Spain. Consecutive patients with ACS aged 80≥years. A comprehensive geriatric evaluation was performed during hospitalization, including frailty assessment by the FRAIL score. The impact of DM and frailty on the incidence of mortality/readmission at 24 months was analysed by a Cox regression model. A total of 498 patients were included (mean age 84.3 years). Prevalence of previous DM was 199/498 (40.0%). The rate of frail patients was 135/498 (27.1%). The incidence of mortality/readmission was higher frail patients (HR 2.49) (both p<0.001). In contrast, DM was not significantly associated to a higher rate of outcomes (HR 1.23, p=0.060) in the whole cohort. Among non-frail patients, patients with DM had a similar incidence of mortality or readmission (p=0.959). In contrast, among frail patients, DM was significantly associated with a higher incidence of events (HR 1.51, p=0.034). Unlike frailty status, DM was not associated to poorer long-term outcome in elderly patients with ACS. Among frail patients the presence of DM seems to provide additional prognostic information.

Prevalence and factors associated with motoric cognitive risk syndrome in community-dwelling older Chinese: a cross-sectional study.

A recently proposed pre-dementia syndrome, motoric cognitive risk (MCR) syndrome, is characterized by cognitive complaints and slow gait, and increases the risk of dementia and mortality. The aim of the present study was to explore the prevalence of and factors associated with MCR syndrome in elderly community-dwelling Chinese subjects. The Ningbo Community Study on Aging recruited 953 Chinese community-dwelling participants aged≥65years from November 2016 to March 2017. Handgrip, Five-Times-Sit-to-Stand (FTSS) test time and body composition, as well as comprehensive geriatric evaluation, were measured as potentially independent factors associated with MCR syndrome. The prevalence of MCR syndrome was 12.8% in men and 12.6% in women, and high prevalence of MCR syndrome was not associated with age or sex. Multiple logistic regression analysis by sex showed that a 1-SD increase in FTSS test time in males and females was associated with 45% (95% confidence intervals, 19-76; P<0.01) and 20% (95% confidence intervals, 9-33; P<0.01) higher risk of having MCR syndrome, respectively, whereas handgrip strength was inversely correlated with MCR syndrome in males [odds ratio (OR), 0.91; P=0.02] but not females (P=0.06). Moreover, the relationship of arm fat mass and MCR syndrome was statistically significant in both sexes (OR, 1.69-1.77), but leg fat mass was only associated with MCR syndrome (OR, 1.56; P=0.02) in men. Handgrip, FTSS test time and body composition were associated in a sex-specific manner with MCR syndrome in elderly community-dwelling Chinese subjects. Our results on MCR syndrome are novel and should be considered as important information in future studies.

Relationship Between Dysphagia and Sarcopenia with Comprehensive Geriatric Evaluation.

Oropharyngeal dysphagia has features of geriatric syndromes and is strongly associated with sarcopenia. In this cross-sectional study, we aimed to evaluate the association between dysphagia and sarcopenia, in a practical way, accompanied by comprehensive geriatric assessment. Dysphagia and sarcopenia were defined by the EAT-10 and SARC-F questionnaires, respectively. Cognition and mood, was evaluated by the Mini-mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Physical performance was assessed by the Timed up and Go Test (TUG) and muscle strength was determined by Hand Grip Strength (HGS). Functionality was stated by Katz and Lawton Indexes. Serum levels of hemoglobin, triglyceride, albumin, and total cholesterol were recorded. A total of 512 (151 male/361 female) patients age 60 and older were included in the study. Prevalences of dysphagia and sarcopenia were 23% and 40.6%, respectively. In multivariate analysis sarcopenia (OR:2.596, p = 0.008), depressive symptoms (OR:1.115, p < 0.001), and lower KATZ scores (OR:0.810, p = 0.036) were independently related with dysphagia. Dysphagic patients with sarcopenia had lower scores on the Katz and Lawton scales (p < 0.001, rpb = 0.380 and p < 0.001, rpb = 0.447 respectively) and TUG performances were worse (p = 0.009, rpb = - 0.254). Serum hemoglobin and albumin levels were significantly low in dysphagic patients with sarcopenia (p < 0.001, rpb = 0.345, p = 0.008, rpb = 0.243). Dysphagia is independently associated with sarcopenia, depressive symptoms, and functionality. Dysphagia coexist with sarcopenia is associated with worse clinical consequences than without sarcopenia.

482Direct oral anticoagulant rivaroxaban in very old and frail patients: A one-year prospective follow-up of a large-scale cohort (SAFIR-AC)

Abstract Background/Introduction Age is one of the strongest predictors/risk factors for ischemic stroke in subjects with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) have been shown to be effective in the prevention of this condition; however, clinical evidence on bleeding risk with this therapeutic strategy in very old and frail geriatric patients is poor. Purpose To assess bleeding risk in French geriatric patients aged ≥80 years and diagnosed with AF newly treated with rivaroxaban. Methods Subjects, presenting to one of 33 geriatric centers, with non-valvular AF and recent initiation of a treatment with rivaroxaban were enrolled in the study and followed-up every 3 months for 12 months. Clinical and routine laboratory data and evaluation scores, such as HAS-BLED, HEMORR2HAGES, ATRIA, and CHA2DS2-VASc, as well as comprehensive geriatric evaluation were reported. Major bleeding, as defined in ROCKET AF study, was reported at each visit, and this primary outcome was adjudicated by an independent committee. Results of this cohort were compared with findings from a similar cohort treated with vitamin K antagonists (VKAs) from the same centers (n=924). Results A total of 1045 subjects were enrolled in the study of whom 995 (95%) had a one-year follow-up (analyzed population). The mean (standard deviation (SD)) age was 86.0 (4.3) years, with the majority of patients being female (61%), 23% aged 90 years or older, and 48% having an estimated glomerular filtration rate (eGFR) &lt;50 mL/min. The main comorbidities were hypertension in 77% of subjects, malnutrition 49%, anemia 43%, dementia 39%, heart failure 36%, and falls 27%. The mean (SD) score for CHA2DS2-VASc was 4.8 (1.4), HAS-BLED 2.4 (0.9), Mini-Mental State Examination (MMSE) 21.5 (6.9), Activities of Daily Living (ADL) 4.4 (1.9), and Charlson Comorbidity Index 6.7 (2.0). The one-year rate of major bleeding events was 6.4% of which 0.8% were fatal and 1.1% intracranial hemorrhages (ICH), whereas the one-year rate of ischemic stroke was 1.4% and all-cause mortality 17.9%. Computed with VKA cohort findings and adjusted for age, gender, eGFR and Charlson score, this would result in a hazard ratio of 0.54 (95% confidence interval [CI], 0.38 to 0.78) for major bleeding, 0.36 (0.17 to 0.76) for ICH, 0.62 (0.29 to 1.33) for ischemic stroke, and 0.82 (0.65 to 1.02) for all-cause mortality, in favor of rivaroxaban. Conclusions This is the first large-scale prospective study in geriatric population in AF subjects treated with DOAC (rivaroxaban) Major bleeding risk appeared higher in very old than younger population, however major bleeding and ICH rates were significantly lower with rivaroxaban than with VKAs when used in the same geriatric population. This study indicates that Rivaroxaban can be used in very old and frail patients for the treatment of non-valvular AF. Acknowledgement/Funding Unrestricted grant from Bayer

The effect of anticholinergic medications on cognitive function of patients 80 years and older with essential hypertension

Background . Cognitive impairment and dementia are the symptoms of brain damage in hypertension (HTN), which impair quality of life and autonomy, in particular, in elderly patients. However, the influence of various drugs on the cognitive functions remains unclear. Objective. To assess the effect of anticholinergic drugs on cognitive functions in hypertensive patients aged 80 years and older. Design and methods . We consistently included 74 patients (77 % women) aged 80 years and older (median age 86 [82-89] years) with essential HTN stage I—III, who were admitted to the Department of Internal Diseases at the multidisciplinary hospital. Inclusion criteria were the following: patients with essential HTN stage I—III of both sexes; 2) age at the time of inclusion in the study — 80 years and older; regular antihypertensive therapy. The main non-inclusion criteria were the following: 1) age less than 80 years; myocardial infarction during the previous 3 months; mental illness, dependence on drugs or alcohol; acute cerebrovascular events during previous 6 months; non-compliance with the study protocol. Each patient underwent the assessment of cognitive status, depression, comprehensive geriatric evaluation. Medical records were studied. When medications were administered, the prescribed anticholinergic (AH) drugs were assessed by the scale of anticholinergic Cognitive Burden (ACB). The following scales and tests were used to evaluate cognitive functions: Mini-mental State Examination (MMSE), Montreal-Cognitive Assessment (MoCA), the Boston naming test (Boston Naming Test (BNT), Category fluency tests, subtest Wechsler Adult Intelligence Scale (WAIS-IV), Digit symbol substitution test (DSST), Word List Test (WLT), Alzheimer’s Disease Assesment Scale — Cognitive (ADAS-cog). Symptoms of depression were assessed using a shortened version of the geriatric Depression Scale (GDS 15). Results. Based on the AH burden (the ACB scale), the patients were divided into 2 groups: 1 st group included patients who do not take drugs with AH burden (n = 25, 33,8 %), 2 nd group included patients taking drugs with AH burden (n = 49, 66,2 %). Patients who took drugs with AH burden showed a more pronounced decrease in cognitive functions: MMSE (lower overall score: 21 [18—23] and 22,5 [20—26] points, respectively, p = 0.04), number of recognizable images on the Boston test (lower number of the images: 27 [25— 30] and 30 [28—31], respectively, p = 0.014), and the cognitive adas-cog subscale (higher score, 16,7 [12—19,3] and 12,7 [11—14,6], respectively, p = 0.03). Conclusion. In HTN patients aged 80 years and older, therapy with AH burden is associated with the more profound decrease in cognitive functions.

Follicular lymphomas in vulnerable/older patients.

Unlike for diffuse large-cell lymphoma, both the management of elderly patients with follicular lymphoma and the role of comprehensive geriatric evaluation to optimize treatment choices have been rarely addressed. This review analyses available evidence on follicular lymphoma occurring in aged persons. Most retrospective studies and expert recommendations agree that the diagnostic approach and the treatment algorithm in elderly follicular lymphoma should not differ from younger patients up to the age of 80. However, slowly progressing follicular lymphoma low-tumor burden should start treatment even though asymptomatic. Prospective identification of those unfit patients is needed where a treatment deintensification may not be detrimental. Octogenarians have more aggressive disease and do not benefit from chemoimmunotherapy more than from single-agent rituximab. An activity of daily living loss significantly impact on their outcome and specific prognostic scores may help in the better manage these oldest patients. Given the lack of prospective studies there is an urgent need to investigate if geriatric assessment including comorbidities, geriatric parameters, patient's reported outcomes and quality of life issues, may help selecting those frail elderly follicular lymphoma patients less suitable for full-dose treatments. In addition, the potential usefulness of the new noncytotoxic agents of proven efficacy in follicular lymphoma warrants specific investigations in older patients.

Diet quality in relation to healthy ageing: the Israeli Longitudinal Study on Aging (ILSA)—a study protocol

IntroductionPopulation ageing is accelerating rapidly in Israel as well as worldwide, necessitating adaptation of the healthcare system and consideration of new approaches that serve the specific needs of older adults....

Characteristics, treatment patterns, prognostic determinants and outcome of peripheral T cell lymphoma and natural killer/T cell non-Hodgkin Lymphoma in older patients: The result of the nationwide multi-institutional registry Thai Lymphoma Study Group

IntroductionPeripheral T cell NHL (PTCL) and natural killer/T cell NHL (NKTCL) are relatively rare disorders. Data on clinical presentation, treatment and outcome are limited especially in older age groups. MethodsWe identified 127 patients with PTCL and NKTCL, excluding cutaneous T/NK cell lymphoma, aged over 60 years old from Thailand nationwide multicenter registry. ResultsOf 127 patients, median age of diagnosis was 67 years old. Patients aged older than 75 years old had similar characteristics to younger (60–74 years old) but higher comorbidity index. Seventy-nine patients (62.2%) received intensive/definite multi-agent chemotherapy, however, the proportion was significant lower in older patients (70.4% vs 34.5%, p < .001). After a median follow up duration of 17.3 months, 2-year progression free survival and overall survival were 38.1% and 48.5%. Univariate and multivariable analysis demonstrated older age, poor performance status and absence of definite multi-agent chemotherapy were associated with inferior survival. Definite multi-agent lymphoma specific chemotherapy was an independent factor for overall survival after adjustment for age, comorbidity index, performance status and prognostic index for T cell lymphoma. ConclusionDespite overall poor prognosis of PTCL and NKTCL in older adults, chemotherapy could result in objective response and long-term survival in selected patients of this vulnerable age group thus emphasizing the importance of comprehensive geriatric evaluation.

Explicit versus implicit evaluation to detect inappropriate medication use in geriatric outpatients

Aim: The rates and reasons why clinicians decide not to follow recommendations from explicit-criteria have been studied scarce. We aimed to compare STOPP version 2 representing one of the most commonly used excplicit tool with the implicit comprehensive geriatric assessment mediated clinical evaluation considered as gold standard.Methods: Two hundred and six (n = 206) outpatients ≥65 years old were included. The study was designed as retrospective, cross-sectional, and randomised. STOPP version 2 criteria were systematically used to assess pre-admission treatments followed by implicit clinical evaluation regarding two questions: Were the STOPP criteria recommendations valid for the individual patient and were there any potentially inappropriate-prescription other than depicted by STOPP version 2 criteria? The underlying reason(s) and associated clinical-features were noted.Results: About 62.6% potentially inappropriate-prescriptions were identified (0.6 per-subject) according to systematic application of STOPP v2 while it was 53.4% (0.5 potentially inappropriate-prescriptions per subject) by clinician’s application of STOPP v2. Prevalence of non-compliance was 14.7% in 18 (21.7%) of 83 patients identified by systematic application. Suggestion to stop a drug was not accepted because of need of treatment despite likelihood of anticipated side-effects in about 2/3 and with no-anticipated side-effects in about 1/3 of non-compliances. Not following STOPP v2 was significantly associated with lower functional level. According to clinician’s implicit-evaluation, there were an extra 59.2% potentially inappropriate-prescriptions (0.6 per subject) in 80 (38.8%) patients yielding a total of 112.6% potentially inappropriate-prescription.Conclusions: Most of the STOPP v2 directed drug cessations are decided valid by the clinicians. In patients with higher functional dependency, it is likely that they are not followed due to palliation focussed care/patient–family preferences. There may be as much as STOPP v2 identified potentially inappropriate-prescriptions by implicit evaluation in a significant percent of geriatric patients signifying need for comprehensive geriatric evaluation in practice.

A Comprehensive Geriatric Evaluation Center for High-Need Patients in an Under-Resourced Community

A Comprehensive Geriatric Evaluation Center for High-Need Patients in an Under-Resourced Community