Cumulative Illness Rating Scale For Geriatrics Research Articles

The Relationships between Caregiver Burden, Physical Frailty, Race, Behavioral and Psychological Symptoms (BPSD), and Other Associated Variables: An Exploratory Study.

Background and Objectives: For persons with dementia, the relationships between caregiver burden, physical frailty, race, behavioral and psychological symptoms (BPSD), and other associated variables are poorly understood. Only one prior study examined the relationships among these variables but did not include race, which is an important social determinant of health outcomes in the United States. To examine these interactions, we conducted a cross-sectional exploratory study based on a model by Sugimoto and colleagues. Materials and Methods: The sample comprised 85 patient-caregiver dyads (58% White) seen in four centers in diverse regions of New York State. All patients met DSM5 criteria for a major neurocognitive disorder, had a Clinical Dementia Rating sum score of ≥3, and Mini-Mental State Examination (MMSE) score of 10 to 26. Other measures included the SHARE-Frailty Instrument(FI), the Neuropsychiatric Inventory (NPI) to assess BPSD, Zarit's Caregiver Burden Interview (CBI), Lawton's Activities of Daily Living (ADL) Scale, the MMSE, the Cumulative Illness Rating Scale for Geriatrics (CIRSG), age, and gender. Results: In our sample, 59% met the criteria for prefrail/subsyndromal or frail/syndromal (SSF) on the SHARE-FI. SSF had significant direct effects on the NPI and significant indirect effects on the CBI mediated through the NPI; the NPI had significant direct effects on the CBI. Race (White) had significant direct effects on the CBI (higher) and SSF (lower) but did not have significant indirect effects on the CBI. MMSE, ADL, and CIRSG were not significantly associated with the NPI or the CBI. Conclusions: Our analysis demonstrated that frailty, race, BPSD, and caregiver burden may directly or indirectly influence one another, and therefore should be considered essential elements of dementia assessment, care, and research. These results must be viewed as provisional and should be replicated longitudinally with larger samples.

The effect of social frailty on mental health and quality of life in older people: a cross-sectional study.

This study aims to evaluate anxiety, depression, loneliness, death anxiety, and quality of life and investigate their relationship with social frailty in the geriatric population. Additionally, it aimed to identify social frailty predictors. The study included 136 participants admitted to the geriatric outpatient clinic. The 15-itemGeriatricDepressionScale(GDS-15), the Multidimensional Scale of Perceived Social Support (MSPSS), the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Templer Death Anxiety Scale (T-DAS), the Loneliness Scale for the Elderly (LSE), the Quality of Life Scale (CASP-19), the Generalized Anxiety Disorder-7 Test (GAD-7), the Tilburg Frailty Indicator (TFI), the FRAIL Scale, and the Clinical Frailty Scale (CFS) were performed. The TFI was used to collect data about social frailty. There were 61.8% females, and the median age (min-max) was 72.2 (65.3-90.3) years. The prevalence rate of social frailty was 26.7%. The rates of depression, loneliness, anxiety, death anxiety, the burden of chronic disease, and frailty were higher in the social frailty group. Furthermore, logistic regression analysis revealed a strong relationship between social frailty status and widowhood (odds ratio (OR) 6.86; 95% confidence interval (95% CI), 2.42-19.37;p < 0.001), moderate to severe anxiety symptoms (OR 4.37; 95% CI 1.08-17.68; p = 0.038), and a TFI-physical frailty score (OR 1.40; 95% CI 1.12-1.73;p = 0.002). In older adults, the social dimension of frailty is associated with quality of life and psychological state. Physical frailty and sociodemographic characteristics may affect the development of social frailty.

1709 Comparative performance of six multimorbidity indices to discriminate intrinsic capacity impairments among older adults

Abstract Introduction Optimal intrinsic capacity (IC) is crucial for preserving the functional abilities of older adults. The presence of multimorbidity is closely associated with IC impairments. Various multimorbidity indices have been developed for diverse health outcomes. This study aimed to compare the performance of six commonly used multimorbidity indices to discriminate IC impairments among community-dwelling older adults. Method We used data from a multidimensional geriatric assessment program including 627 community-dwelling older adults in five cities of Hunan, China. Six multimorbidity indices were extracted from the data, including disease counts, Functional Comorbidity Index (FCI), the Deyo Charlson comorbidity index, two indices (total score and comorbidity index) derived from the Cumulative Illness Rating Scale-Geriatric (CIRS-G), and medication counts. The IC was measured with five individual domains, i.e., locomotion, vitality, sensory, cognition, and psychological capacity. Individuals were regarded as having IC impairments if they had impairments in one or more domains. Associations between multimorbidity indices and IC impairments were examined using logistic regression analyses. The discriminative ability of multimorbidity indices for IC impairments was compared using the c-statistics. Results A total of 374 (59.6%) participants had IC impairments. All multimorbidity indices were significantly associated with IC impairments after adjusting for confounding factors. All indices showed acceptable discriminative power (c-statistic ranged from 0.711 to 0.759) for IC impairments. The comorbidity index derived from CIRS-G resulted in the highest c-statistic, followed by the total score of CIRS-G and FCI. Conclusions Our study results suggest that multimorbidity indices differed in their ability to discriminate IC impairments. The comorbidity index derived from CIRS-G performed better than other multimorbidity indices included in this study. The comorbidity index has the potential as a simple proxy measure of indicating the need for interventions to optimise IC for older adults in community settings.

Assessing the link between nutritional status, functional capacity, and morbidity profile in the community-dwelling elderly of Maharashtra, India

BackgroundAgeing challenges elderly individuals, increasing the risk of malnutrition due to physical, psychological, functional, and social changes. Poor nutritional status is directly related to functional capacity and can increase the risk of morbidity and mortality. Early identification of the risk of malnutrition among the elderly can promote independence and well-being with a good quality of life. ObjectivesTo assess the interrelationship between the nutritional status and indicators of functional capacity and morbidity profile among the elderly population from X. MethodsThe study followed a cross-sectional survey design. The convenience sampling technique was used to recruit participants. Three standardised instruments - the Mini-Nutritional Assessment – Short Form (MNA-SF), the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Cumulative Illness Rating Scale-Geriatric (CIRS-G) – were used to assess the nutritional status, functional capacity and morbidity profile respectively. The data were analysed using Chi-square tests of association, and independent t-test and one-way ANOVA for difference in means. ResultsParticipants were 100 older adults (age range: 60–90 years). 24 % of the sample were malnourished and 33 % were at risk for malnutrition. Dependent participants had a significantly lower MNA-SF score (5.6 ± 3.5) than independent participants (10.4 ± 3.0) (p < 0.001). There was a significant association between poor nutritional status and morbidity profile specific to disability in organ systems like eyes, ears, throat, haematopoietic, musculoskeletal, and upper GI systems, as well as psychiatric illness (p ≤ 0.05). The CIRS-G score was significantly higher for malnourished participants (12.6 ± 6.2) than those at risk of malnutrition (8.9 ± 4.8) and well nourished (6.0 ± 4.0) (p < 0.001). ConclusionNutritional status was associated with functional capacity and indicators of morbidity profile in the elderly. Incorporating routine nutritional risk screening as a component of healthcare can facilitate early identification of at-risk individuals, enabling timely intervention and improving health outcomes. Future research should prioritise investigating routine screening programs to assess the risk of malnutrition and the effectiveness of nutrition interventions such as dietary modifications and supplementation to prevent malnutrition in older adults.

Simplified Geriatric Assessment-Albumin: The Modified Tool for Older Diffuse Large B-Cell Lymphoma in China

Introduction Geriatric assessment can aid in optimizing treatment strategies and supportive interventions for older adults with diffuse large B-cell lymphoma (DLBCL). Recently, Fondazione Italiana Linforni developed the simplified Geriatric Assessment (sGA) and Elderly Prognostic Index (EPI) to tailor treatment and predict the prognosis of DLBCL in older adults. Herein, we validated the prognostic value of sGA and EPI, and modified the sGA to make it more effective for older DLBCL patients in China. Methods A total of 257 patients with DLBCL aged ≥65 years from Beijing Hospital and Peking University Third Hospital were included in the study. The sGA, which was modified from original geriatric assessment (oGA), incorporates age, activities of daily living (ADL), instrumental ADL, and Cumulative Illness Rating Scale for Geriatrics (CIRS-G), identifying patients into fit, unfit, and frail group. EPI integrated sGA with the IPI score and hemoglobin, identifying patients into low-, intermediate-, and high-risk group. Early mortality was defined as any death occurring within three months from the date of diagnosis. Kaplan-Meier and receiver operating characteristic (ROC) curves were used to assess survival rates and the sensitivity and specificity of the geriatric assessment tools, respectively, whereas the log-rank test was used for comparison. Univariate and multivariate Cox regression analyses were used to identify the independent biomarkers for the patients. Logistics regression analyses were used to analyze the correlation between the geriatric assessment tools and early mortality. Results In the study, both sGA and EPI were related to the progression-free survival (PFS; Figure 1A and 1B), overall survival (OS; Figure 1C and 1D), and early mortality of older patients with DLBCL in China (All p &amp;lt; 0.05). Although they had no ability to predict PFS ( p &amp;gt; 0.05; Figure 1E), ROC curves showed that sGA could predict OS ( p = 0.006; AUC: 0.602; 95%CI: 0.530-0.674; Figure 1F), and early mortality ( p = 0.002; AUC: 0.744; 95%CI: 0.634-0.853; Figure 1G) in older patients with DLBCL in China. As for EPI, it also could predict OS ( p = 0.027; AUC: 0.584; 95%CI: 0.512-0.656; Figure 1F) and early mortality ( p = 0.009; AUC: 0.703; 95%CI: 0.590-0.815; Figure 1G). To make the geriatric tools more effective for older patients with DLBCL in China, albumin, the independent prognostic biomarker for OS of the cohorts, was added into sGA to establish the modified tool sGA-A (Table 1). According to sGA-A, patients were stratified into fit (36.7%), unfit (30.9%), and frail (32.4%) group. However, 1 patient was excluded due to the deficiency of albumin. The sGA-A was associated with age ( p &amp;lt; 0.001), Ann Arbor stage ( p = 0.002), ECOG-PS ( p &amp;lt; 0.001), lactic dehydrogenase (LDH; p = 0.001), IPI score ( p &amp;lt; 0.001), B symptom ( p &amp;lt; 0.001), hemoglobin ( p &amp;lt; 0.001), and albumin ( p &amp;lt; 0.001). Besides, sGA-A was related to PFS ( p &amp;lt; 0.001; Figure 1H), OS (( p &amp;lt; 0.001; Figure 1I), and early mortality ( p = 0.010) of older patients with DLBCL in China. Furthermore, ROC curves showed that sGA-A not only could predict OS ( p &amp;lt; 0.001; ACU: 0.647; 95%CI: 0.577-0.717; Figure 1F), and early mortality (p = &amp;lt; 0.001; AUC: 0.769; 95%CI: 0.679-0.859; Figure 1G), but also could predict PFS ( p = 0.046; AUC:0.577; 95%CI: 0.502-0.652; Figure 1E). In predicting OS, sGA-A was superior to sGA ( p = 0.010), EPI ( p = 0.006). As for early mortality, sGA-A was superior to the EPI ( p = 0.033), but not sGA ( p = 0.520). Conclusions In the study, we validated that sGA and EPI could predict OS and early mortality of older patients with DLBCL in China. Based on sGA, we propose sGA-A, which combined sGA and albumin, as an effective tool for geriatric assessment in DLBCL. The sGA-A compensated for the deficits of the sGA and EPI in predicting PFS, and was superior to sGA and EPI in predicting OS and early mortality. However, further investigations on whether sGA-A could guide the treatment may assist clinicians in improve the prognosis of older patients with DLBCL.

Cost of Patients with Alzheimer's Disease in Spain According to Disease Severity.

Alzheimer's disease (AD) has been associated with great healthcare and non-healthcare resource consumption. The aim of this study was to estimate the burden of AD in Spain according to disease severity from a societal perspective. A self-administered questionnaire was designed by the researchers and completed by the informal caregivers of patients with AD, reporting data on themselves as caregivers and on the AD patients for whom they care. The patients' sociodemographic and clinical data, their healthcare and non-healthcare resource consumption in the previous 12 months, and the impact of the disease on labor productivity were compiled. Data collected on informal caregivers included sociodemographic data and the impact of caring for a person with AD on their quality of life and labor productivity. Costs were estimated by multiplying the number of consumed resources by their unit prices. The cost of informal care was assessed using the proxy good method, and labor productivity losses were estimated using the human capital method. Costs were estimated by disease severity and are presented per patient per year in 2021 euros (€). The study sample comprised 171 patients with AD aged 79.1 ± 7.4 years; 68.8% were female, time from diagnosis was 5.8 ± 4.1 years, diagnosis delay was 1.8 ± 2.3 years, and the mean Cumulative Illness Rating Scale-Geriatric (CIRS-G) total was score 8.2 ± 6.0. According to disease severity, 14% had mild cognitive impairment or mild AD, 43.9% moderate AD, and 42.1% severe AD. The average annual cost per patient was €42,336.4 in the most conservative scenario. The greatest proportion of this cost was attributed to direct non-healthcare costs (86%, €36,364.8), followed by direct healthcare costs (8.6%, €3647.1), social care costs (4.6%, €1957.1), and labor productivity losses (less than 1%, €367.4). Informal care was the highest cost item, representing 80% of direct non-healthcare costs and 69% of the total cost. The total direct non-healthcare cost and total cost were significantly higher in moderate to severe disease severities, compared to milder disease severity. AD poses a substantial burden on informal caregivers, the national healthcare system, and society at large. Early diagnosis and treatment to prevent disease progression could reduce this economic impact.

The effects of medical comorbidity, cognition, and age on patient-reported outcomes in Parkinson's disease

ObjectiveThe purpose of this cross-sectional study was to compare the independent contributions of medical comorbidity, cognition, and age on patient-reported outcomes in Parkinson's disease (PD). Methods572 PD patients completed the Patient-Reported Outcome Measurement Information System (PROMIS®)-29 v2.0 Profile (physical function, anxiety, depression, fatigue, sleep disturbance, satisfaction with participation in social roles, pain interference) and PROMIS Global Health (mental health and physical health) scales. Comorbidity was measured with the Cumulative Illness Rating Scale–Geriatric (CIRS-G) and cognition with the Montreal Cognitive Assessment (MoCA). Multiple regression models examined the 9 PROMIS measures as predicted by comorbidity, cognition, and age, adjusting for demographic and clinical characteristics (UPDRS and disease duration). ResultsComorbidity was associated with poorer outcomes in all nine PROMIS domains. Cognition was associated with two of nine domains: physical function and anxiety. Age was associated with five domains: anxiety, depression, sleep disturbance, satisfaction with participation in social roles, and global mental health. Comorbidity showed greater effects on all nine domains than cognition or age (higher standardized beta coefficients). ConclusionMedical comorbidity, cognition, and age have different impacts on patient-reported outcomes in PD. Medical comorbidity has a greater impact than either cognition or age on a range of patient-reported physical and mental health domains. Medical comorbidity is an important contributor to the patient's perspective of their physical and mental health.

Prognostic value of comorbidities in older patients with cancer: the ELCAPA cohort study

In older patients, comorbidities competed with cancer for mortality risk. We assessed the prognostic value of comorbidities in older patients with cancer. We analysed all patients >70 years of age with colorectal, breast, prostate, or lung cancer included in the prospective ELCAPA cohort. The Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score was used to assess comorbidities. The primary endpoint was overall survival (OS) at 3, 12, and 36 months. The adjusted difference in the restricted mean survival time (RMST) was used to assess the strength of the relationship between comorbidities and survival. Of the 1551 patients included (median age 82 years; interquartile range 78-86 years), 502 (32%), 575 (38%), 283 (18%), and 191 (12%) had colorectal, breast, prostate, and lung cancer, respectively, and 50% had metastatic disease. Hypertension, kidney failure, and cognitive impairment were the most common comorbidities (67%, 38%, and 29% of the patients, respectively). A CIRS-G score >17, two or more severe comorbidities, more than seven comorbidities, heart failure, and cognitive impairment were independently associated with shorter OS. The greatest effect size was observed for CIRS-G >17 (versus CIRS-G <11): at 36 months, the adjusted differences in the RMST (95% confidence interval) were-6.0 months (-9.3 to-2.6 months) for colorectal cancer,-9.1 months (-13.2 to-4.9 months) for breast cancer,-8.3 months (-12.8 to-3.9 months) for prostate cancer, and-5.5 months (-9.9 to-1.1 months) for lung cancer (P < 0.05 for all). Comorbidities' type, number, and severity were independently associated with shorter OS. A 17-point cut-off over 56 for the total CIRS-G score could be considered in clinical practice.

The impact of psychological resilience on chronic patients’ depression during the dynamic Zero-COVID policy: the mediating role of stigma and the moderating role of sleep quality

ObjectiveChronic patients are experiencing depression caused by themselves or the surrounding environment, how to cope with the change of mentality and adjust the psychological stress response, especially under the background of the current dynamic Zero-COVID policy in China, is a problem worth further discussion. The researchers constructed a mediating regulation model to test the influence of psychological resilience on depression of chronic patients during dynamic Zero-COVID, as well as the mediating role of stigma and the moderating role of sleep.MethodFrom October 2021 to February 2022, this study used a multi-stage sampling method and random number table method to collect data in the Shang Cheng District of Hangzhou City, Zhejiang Province. Firstly, the Second Affiliated Hospital of the Zhejiang University School of Medicine, a third-class hospital was randomly selected from the Shang Cheng District. Secondly, three departments were strategically selected from this hospital: endocrinology, dermatology, and traditional Chinese medicine. Thirdly, survey points were set up in each department, and chronic patients were strategically selected for questionnaire surveys. Finally, a face-to-face survey was conducted on 398 chronic patients who met the criteria for inclusion. In addition, chronic medical illness burden was assessed using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G), psychological resilience was measured by the Conner-Davidson Resilience Scale (CD-RISC), stigma was measured by the Stigma Scale for Chronic Illness (SSCI), sleep was measured by the Pittsburgh Sleep Quality Index(PSQI) and depression was estimated by the Patient Health Questionaire-9(PHQ-9). SPSS (version 25.0) and PROCESS (version 4.0) were used for correlation analysis, mediation analysis, and mediated moderation analysis.ResultsPsychological resilience was negatively correlated with depression, stigma, and sleep. Depression was positively correlated with stigma and sleep. Stigma and sleep were positively correlated; Stigma played a mediating role in the relationship between psychological resilience and depression; Sleep moderated the first half of the pathway “psychological resilience to stigma to depression”.ConclusionPsychological resilience affected depression directly and indirectly through stigma. At the same time, sleep played a moderating role between psychological resilience and depression. The correlation between psychological resilience and stigma was stronger when levels of sleep levels were higher.

Effect of agitation and aggression on quality of life in patients with dementia

AbstractBackgroundBehavioral and psychological symptoms of dementia (BPSD) are highly prevalent in patients with dementia during the course of the disease. Among BPSD symptoms, agitation and aggression are a source of distress for both the patients and their caregivers. In this study, we investigated the impact of agitation and aggression on Quality of Life (QoL) of patients with dementia living in long‐term care homes or admitted to psychiatric inpatient units.MethodData were obtained from the Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study, a multisite trial conducted in Canada. Agitation and aggression were assessed with the Cohen‐Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory Clinician rating scale (NPI‐C); QoL with the informant‐rated Alzheimer’s Disease Related Quality of Life (ADRQL) tool; stage of dementia with the Functional Assessment Staging Tool (FAST); and burden of physical illness with the Cumulative Illness Rating Scale‐Geriatric (CIRS‐G). Regressions were performed to investigate the associations between agitation or aggression and QoL controlling for demographic factors, FAST score, and CIRS‐G score.Result179 participants were included (52.5% female; mean (SD) age = 80.79 (9.45) years. The ADRQL score was correlated with: (1) CMAI total frequency score (Pearson’s r = ‐.333, p&lt;.001); (2) NPI‐C agitation score (Pearson’s r = ‐.209, p = .005); and (3) NPI‐C aggression score (Pearson’s r = ‐.300, p&lt;.001). The associations remained significant for the CMAI total frequency score (β = ‐.235, SE B = 0.054, p&lt;.001), and NPI‐C agitation and aggression composite score (β = ‐.288, SE B = 1.254, p&lt;.001) after controlling for age, sex, current residence, FAST score and CIRS‐G score.ConclusionQoL is related to agitation and aggression in patients with dementia. The relationship is independent of demographic factors, stage of dementia, and burden of comorbid physical illness. This suggests that better management of agitation and aggression may be an important factor in improving QoL in patients with dementia.

Accumulation of Chronic Disease Among Survivors of Childhood Cancer Predicts Early Mortality.

Cancer survivors develop cancer and treatment-related morbidities at younger than normal ages and are at risk for early mortality, suggestive of an aging phenotype. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) is specifically designed to describe the accumulation of comorbidities over time with estimates of severity such as total score (TS) which is a sum of possible conditions weighted by severity. These severity scores can then be used to predict future mortality. CIRS-G scores were calculated in cancer survivors and their siblings from Childhood Cancer Survivor Study cohort members from two time points 19 years apart and members of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. CIRS-G metrics were analyzed using Cox proportional hazards regression to determine subsequent mortality risk. In total, 14,355 survivors with a median age of 24 (IQR, 18-30) years and 4,022 siblings with a median age of 26 (IQR, 19-33) years provided baseline data; 6,138 survivors and 1,801 siblings provided follow-up data. Cancer survivors had higher median baseline TS than siblings at baseline (5.75 v 3.44) and follow-up (7.76 v 4.79), all P < .01. The mean increase in TS from baseline to follow-up was significantly steeper in cancer survivors (2.89 males and 3.18 females) vs. siblings (1.79 males and 1.69 females) and NHANES population (2.0 males and 1.94 females), all P < .01. Every point increase in baseline TS increased hazard for death by 9% (95% CI, 8 to 10) among survivors. Application of a geriatric rating scale to characterize disease supports the hypothesis that morbidity accumulation is accelerated in young adult survivors of childhood cancer when compared with siblings and the general population.

Current Treatment Options and the Role of Functional Status Assessment in Classical Hodgkin Lymphoma in Older Adults: A Review.

Along with the fact that classical Hodgkin lymphoma (cHL) in older adults is frequently considered biologically different from cHL in younger patients, its most distinctive feature is its dismal clinical outcome due to the decreased effectiveness and greater toxicity of therapies. Although strategies to mitigate specific toxicities (e.g., cardiological and pulmonary) have obtained some results, in general, reduced-intensity schemes, proposed as an alternative to ABVD, have proved to be less effective. The addition of brentuximab vedotin (BV) to AVD, especially in a sequential scheme, has demonstrated good efficacy. However, the problem of toxicity persists even with this new therapeutic combination, with comorbidities remaining an important prognostic factor. The adequate stratification of functional status is necessary to distinguish between those patients who will benefit from full treatment and those who will benefit from alternative strategies. A simplified geriatric assessment based on the determination of ADL (activity of daily living), IADL (instrumental ADL), and CIRS-G (Cumulative Illness Rating Scale-Geriatric) scores is an easy-to-use tool that permits adequate patient stratification. Other factors of considerable impact on functional status such as sarcopenia and immunosenescence are currently being studied. A fitness-based treatment choice would also be very useful for relapsed or refractory patients, a more frequent and challenging situation than that is found in young cHL patients.

How to adjust therapy for elderly AML patients in developing countries?

Abstract Background Acute myeloid leukemia (AML) with advancing age represents a therapeutic challenge. The tools used for comprehensive geriatric assessment (CGA) in elderly AML are not uniform. Methods This is a retrospective study that included 226 elderly AML patients (≥60 years), identified from the electronic database and followed till the end of 2021. Comorbidities were assessed using Charlson Comorbidity Index (CCI), Cumulative Illness Rating Scale-Geriatric (CIRS-G), Hematopoietic cell transplantation-specific comorbidity index (HCT-CI) scores, and Chia-Jen Liu and colleagues simplified proposed models. The primary outcome was 30 days mortality. The secondary outcomes were the achievement of complete remission. Results 226 patients were included, the median age was 67 years, and 86.2% of patients had ECOG greater than or equal to 2 performance status at diagnosis. 82 patients received intensive induction treatment, 85 patients received reduced-intensity treatment, and 59 patients were unfit for therapy. 30-Day mortality was reported in 49.1% of included patients. With multivariate analysis; ECOG-PS (3-4), high CIRS-G or HCT-CI scoring system (≥3), and intermediate-high Chia-Jen Liu score were considered as prognostic factors for early mortality in elderly AML patients. Complete remission (CR) was achieved in 38.3% and 4.7% of the patients who received intensive induction and low-intensity therapy, respectively. Conclusion Geriatric and comorbidity assessment tools can be used to predict early mortality in elderly AML. Higher scores and poor PS are predictors for early death rather than a prediction of response to treatment.

Somatoform Symptoms in Parkinson Disease.

Co-occurring somatoform symptoms complicate the diagnosis and treatment of Parkinson disease (PD). To learn more about the relationship between somatoform symptoms and PD by comparing demographic and clinical features across PD groups differing in somatoform symptom severity. Using standardized Brief Symptom Inventory-18 (BSI-18) scores to measure somatoform symptom severity, we assigned 1093 individuals with PD to one of four subgroups using comparisons to normative means: low (M < -½ SD), average (M ± ½ SD), high (M +½ SD to +1 SD), very high (M > +1 SD). We used demographics and disease severity measures to assess each subgroup. Most of the individuals with PD (56%) had high or very high somatoform symptom levels. Increased somatoform symptom levels were associated with female gender, lower socioeconomic status, greater disease duration, increased PD severity (Total Unified Parkinson's Disease Rating Scale), greater disability (Older Americans Resource and Services Disability subscale), increased BSI-18 Depression and Anxiety subscale scores, lower cognitive function (Mini-Mental State Examination), lower self-efficacy scores (Self-Efficacy to Manage Chronic Disease Scale), lower quality of life scores (SF-12 Health Status Survey), and greater medical comorbidity (Cumulative Illness Rating Scale-Geriatrics) (all comparisons: P < 0.001). We found no significant between-group differences for age, race, or marital status. Somatoform symptom severity in individuals with PD is associated with greater PD severity and disability and is more common in females and in individuals with low socioeconomic status. Greater awareness of somatoform symptoms should help improve PD treatment.

Assessment of Comorbidities and Their Association with Outcomes in Adults with Acute Lymphoblastic Leukemia (ALL)Using Various Comorbidity-Based Scoring Systems

Background: Outcomes of adults with ALL has remained poor as compared to pediatric ALL. While biological characteristics of the disease can increase the risk of poor treatment responses and resistance, age and concurrent comorbidities limit patient's tolerability to aggressive therapies and predispose to treatment related adverse effects, ultimately affecting survival. Despite similar chronological age, patients vary widely with respect to comorbidities and other aspects of health such that routine performance assessment scales such as Eastern Cooperative Oncology Group (ECOG) or Karnofsky Performance Scale (KPS) may not be accurate in assessing their fitness for therapy. Several measures such as Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI), Charlson Comorbidity Index (CCI), Cumulative Illness Rating Scale-Geriatric (CIRS-G) and Adult Comorbidity Evaluation-27 (ACE-27) have been reported in the literature to assess comorbidities in patients receiving intensive treatments, but their utility when it comes specifically to ALL patients is unknown, given the lack of studies assessing role comorbidities in ALL. Methods: We conducted a retrospective single center analysis of adults (age >=18) with ALL to assess the effect of comorbid conditions using available scales and determined their association with outcomes. Patients with a diagnosis of ALL (B/T-cell) who received first line therapy between 2009-2021 were included. Key exclusion criteria were patients with relapsed/refractory ALL and with incomplete follow-up. Comorbid conditions prior to first line therapy were calculated using four scales - HCT-CI, CCI, CIRS-G and ACE-27. Baseline demographic and disease characteristics, first line treatment, response, outcomes were collected using chart review. Descriptive statistics, logistic regression, Cox Proportional Hazards regression method was used for analysis. Concordance (C-statistic) and 95% confidence interval was reported for each model for comparison. A receiver operating characteristic (ROC) curve was also created for each outcome to compare the performance of base and comorbidity score models. Results: A total of 201 patients were included for analysis. Median age was 54(range 39-65), 53% were males, 82% were Caucasians, 8.5% Hispanics. 86% had B-ALL (32% were Philadelphia chromosome positive), 83% received intensive therapy. Median OS was 3.8 years (3.7-not reached) and Event free survival was 2.0(1.5,3.3) for the entire patient population. Patients were categorized in 0(22%), 1 (19%),2(13%) and 3+(46%) per HCT-CI, 0(32%), 1(23%),2(12%) and 3+(33%) per CCI. In CIRS-G scale patients were categorized in to 2 groups of <6 and >=6(51.5% vs 48.5%). In ACE-27 scale there were 4 categories (none(0),mild(1) moderate(2) and severe(3)) with 19%, 41%, 21% and 18% in each group consecutively. All four comorbidity scales were able to predict overall and event-free survival with statistical significance. Patients with HCT-CI category of <=1 had statistically significant OS and EFS advantage when compared to patients with a score of >=2 (Not reached vs 3.1-3.7 yrs for OS, 2.4-5.2 vs 1.4-1.6 yrs for EFS). Patients with CCI category 0 (not reached, 3.4) had better median OS and PFS than categories 1,2 (3.7 years OS, 1.8-3.1 yrs PFS) and 3+ (3.4, 1.4 yrs). CIRS-G category of <6 score had better median OS and PFS (not reached) than 6+ category (3.0 yrs). In ACE-27 scale, 0 and 1 categories had better OS and PFS (not reached and 3.4 yrs, not reached and 2.3 yrs vs 3.0-3.2 and 1.4 yrs) than moderate and severe (2,3) categories. Though all scales could predict OS and EFS, the overall survival model with CIRS-G scale had a significantly higher C-statistic compared to the base model than other scales. The HCT-CI and CIRS scores were each significant in their models for complete remission, but there were no significant differences between c-statistics among any of the CR models. None of the comorbidity scores were significant in predicting 90-day readmission or ED visit. Conclusions: Comorbidities as assessed by HCT-CI, CCI, ACE-27 or CIRS-G were significantly associated with survival in adults with ALL. Incorporation of these formal methods of comorbidity assessment in clinical practice is needed to assess ALL patients at baseline and tailor therapy accordingly. Prospective studies to validate and identify the optimal comorbidity determination scale in ALL is needed. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

ABCL-272 A Phase 2, Open-Label Study of Loncastuximab Tesirine in Combination With Rituximab (Lonca-R) in Previously Untreated Unfit/Frail Patients With Diffuse Large B-Cell Lymphoma (LOTIS-9)

Rituximab in combination with chemotherapy (R [rituximab]-CHOP [cyclophosphamide, doxorubicin, vincristine, and prednisone]) is standard first-line therapy for patients with diffuse large B-cell lymphoma (DLBCL). With an aging population, unfit or frail patients who may not tolerate R-CHOP represent an increasing unmet need. To determine the safety and efficacy of the approved loncastuximab tesirine (loncastuximab tesirine-lpyp; Lonca), an antibody-drug conjugate comprising a humanized anti-CD19 monoclonal antibody conjugated to a pyrrolobenzodiazepine dimer toxin, in combination with rituximab (Lonca-R) in previously untreated unfit/frail patients (LOTIS-9; NCT05144009). This is a phase 2, open-label, response-adapted study of Lonca-R in previously untreated unfit (Cohort A) or frail (Cohort B) patients with DLBCL. The simplified geriatric assessment (sGA), which identifies three categories of fitness (fit, unfit, and frail) based on age, activities of daily living (ADL), and instrumental activities of daily living (IADL), and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) will be utilized to differentiate the cohorts. Key inclusion criteria include diagnosis of DLBCL (including DLBCL transformed from indolent lymphoma), high-grade B-cell lymphoma, or grade 3b follicular lymphoma; Eastern Cooperative Oncology Group performance status of 0-2; and measurable disease (2014 Lugano Classification). Each cohort will enroll 40 patients, with fitness (Cohort A) and frailty (Cohort B) assessed using the sGA. efficacy (Cohorts A and B) and tolerability (Cohort B) of Lonca-R. complete response (CR) rate (both Cohorts) and tolerability (Cohort B) following completion of 4 therapy cycles. Lonca-R treatment consists of R intravenously [IV] 375 mg/m2 on day 1/cycles 1-4, (subcutaneously allowed starting at C2), Lonca 150 µg/kg IV on day 2/cycle 1 and day 1/cycle 2, and 75 µg/kg IV on day 1/cycles 3 and 4. Patients who achieve CR or partial response (PR) after three cycles will receive 1 or 3 additional cycles of Lonca-R, respectively. Cohort B patients who achieve stable disease may continue to receive 3 additional cycles. All patients will be followed for up to 5 years. The study opened for recruitment in April 2022. This abstract was accepted for publication only at the 2022 EHA Congress. ADC Therapeutics SA; medical writing: CiTRUS Health Group.

AML-021 A Retrospective Study of Clinical Characteristics and Outcomes of Elderly Acute Myeloid Leukemia (AML) Patients at Oncology Center Mansoura University (OCMU)

Acute myeloid leukemia incidence increases progressively with advancing age and represents a therapeutic challenge. The tools used for comprehensive geriatric assessment (CGA) in elderly AML are not uniform. Outcome of treatment for patients of advanced age is often compromised by comorbidities and an enhanced susceptibility to toxicities from therapy. This study intended to determine the demographic data, clinical characteristics, and the treatment and outcomes in de novo elderly AML patients. This is a retrospective single-center study of 226 patients; (≥ 60 years) with a diagnosis of AML identified from the Database (2010- 2020) and were followed till the end of 2021. It was carried out at Oncology Center Mansoura University (OCMU). The median age were 67.12±5.65 years, M/F: 128/98. 196 (86.7%) showed ECOG ≥2 performance status at diagnosis. Eighty-three patients received standard induction treatment (7+3), 83 received reduced-intensity treatment (LDAC, azacytidine) and 60 patients were unfit for treatment. At the end of the review of the study, 65 were alive. Comorbidities were assessed using Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale-Geriatric (CIRS-G) scores. Treatment-associated adverse events were evaluated by WHO toxicity grades. The Cox regression model was used to examine predictors affecting overall survival (OS). Hypertension (37%), pulmonary infections (24.7%) and diabetes mellitus (20.8%) were the most common comorbidities. 207 patients were available for response assessment: 35(16.9%) achieved CR, 57 (27.5%) achieved PR. Grade 3-4 hematological toxicities were: anemia (62.7%), granulocytopenia (63.85%) and thrombocytopenia (82%). The median OS was 2 (95%CI 1.66-2.34) months. PS ≥2, CCI >4 and high CIRS-G scores were shown to be risk factors of dismal OS in older AML patients (P<0.001, 0.021 and 0.001, respectively). Patients with CR had better median OS (21 months (95%CI 7.55-34.45, P<0.001) and DFS (12 months (95%CI 6.74-17.26, P<0.001). Early mortality in elderly AML patients is common, especially in institutions with low resources due to lack of novel therapies and clinical trials. Geriatric assessment tools should be updated for detection and prediction of prognostic factors and plan management strategies according to disease risk stratification.

Selected Domains within a Comprehensive Geriatric Assessment in Older Patients with Non-Hodgkin Lymphoma are Highly Associated with Frailty

BackgroundThe incidence of Non-Hodgkin Lymphoma (NHL) is increasing, particularly among older patients who tend to have worse outcomes and can be predisposed to increased toxicities and less treatment tolerance. Therefore, a thorough pre-treatment assessment is essential. A comprehensive geriatric assessment (CGA) can be used to evaluate the older patient considering chemotherapy and is the preferred evaluation tool. However, a formal CGA is laborious, complex and time-consuming.ObjectivesTo characterize older adults with NHL and determine the CGA variables with the greatest association to frailty in order to propose a more simplified assessment.MethodsWe performed a cross-sectional study using data collected from CGAs in NHL patients > 65 years admitted to our oncology service, from September 2015 to August 2017. Our evaluation parameters included: polypharmacy, a screening tool of older people's prescriptions (STOPP), the Lawton scale, Barthel index, Katz index, gait speed, a Timed Up and Go (TUG) test, a Mini-Mental state examination (MMSE), the Yesavage and Gijon scales, a Mini-nutritional assessment (MNA), a Geriatric Syndromes assessment, and a Cumulative Illness Rating Scale-Geriatric (CIRS-G). The formal CGA was comprised of nine domains; frailty was defined as an impairment in > 2 domains. Each parameter was individually compared with frailty, and the results were used to build different multivariate models using logistic regression analyses to obtain the variables with the highest frailty association.ResultsA total of 253 patients were included. Their median age was 75.4 years (range 65–92), and 62.1% had > 1 impaired domain, with 39.9% considered frail. Bivariate analysis showed strong associations with age > 85 and all the geriatric parameters except for STOPP. Our final multivariate analysis resulted in 5 domains (the use of > 5 medications, a Lawton < 7, TUG > 20, Yesavage > 5, and the presence of at least one geriatric syndrome) being significantly associated with frailty and performing similarly to a CGA.ConclusionIn our population of older NHL patients, an abbreviated evaluation based of only five domains, polypharmacy, TUG, Lawton scale, Yesavage scale and the presence of at least one geriatric syndrome, had similar performance to a formal CGA in determining frailty.

The Prognostic Value of Eight Comorbidity Indices in Older Patients with Cancer: The ELCAPA Cohort Study.

Simple SummaryA prognostic assessment is crucial for making cancer treatment decisions. However, the frequent presence of comorbidities makes this assessment particularly challenging in older adults. Many comorbidity indices are available, but none have been developed for older patients with cancer. We assessed the prognostic performance (relative to one-year mortality) of eight comorbidity indices in a cohort of older patients with cancer. All the comorbidity indices were independently associated with 1-year mortality in the whole study population, and had very good discriminant ability. Among patients with metastatic cancer, only CIRS-G was independently associated with 1-year mortality.Background: A prognostic assessment is crucial for making cancer treatment decisions in older patients. We assessed the prognostic performance (relative to one-year mortality) of eight comorbidity indices in a cohort of older patients with cancer. Methods: We studied patients with cancer aged ≥70 included in the Elderly Cancer Patient (ELCAPA) cohort between 2007 and 2010. We assessed seven nonspecific indices (Charlson Comorbidity Index (CCI), three modified versions of the CCI, the Elixhauser Comorbidity Index, the Gagne index, and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G)) and the National Cancer Institute Comorbidity Index. Results: Overall, 510 patients were included. Among patients with nonmetastatic cancer, all the comorbidity indices were independently associated with 1-year mortality (adjusted hazard ratios (aHRs) of 1.44 to 2.51 for one standard deviation increment; p < 0.05 for all) and had very good discriminant ability (Harrell’s C > 0.8 for the eight indices), but were poorly calibrated. Among patients with metastatic cancer, only the CIRS-G was independently associated with 1-year mortality (aHR (95% confidence interval): 1.26 [1.06–1.50]). Discriminant ability was moderate (0.61 to 0.70) for the subsets of patients with metastatic cancer and colorectal cancer. Conclusion: Comorbidity indices had strong prognostic value and discriminative ability for one-year mortality in older patients with nonmetastatic cancer, although calibration was poor. In older patients with metastatic cancer, only the CIRS-G was predictive of one-year mortality.

A comparison of two approaches for modeling dementia progression in a changing patient context.

ObjectivesTo explain the heterogeneity in dementia disease trajectory, we studied the influence of changing patient characteristics on disease course by comparing the association of dementia progression with baseline comorbidity and frailty, and with time‐varying comorbidity and frailty.MethodsWe used individual growth models to study baseline and time‐varying associations in newly diagnosed dementia patients (n = 331) followed for 3 years. We measured cognition using the Mini‐Mental State Examination (MMSE), daily functioning using the Disability Assessment for Dementia (DAD), frailty using the Fried criteria and comorbidity using the Cumulative Illness Rating Scale for Geriatrics (CIRS‐G).ResultsAlthough baseline comorbidity and frailty were associated with decreased daily functioning at diagnosis, their effects clearly diminished over time. In contrast, when incorporating comorbidity and frailty as time‐varying covariates, comorbidity was associated with lower daily functioning, and frailty with both lower cognition and daily functioning. Being frail was associated with a 0.9‐point lower MMSE score (p = 0.03) and a 14.9‐point lower DAD score (p < 0.01). A 1‐point increase in CIRS‐G score was associated with a 1.1‐point lower DAD score (p < 0.01).ConclusionsTime‐varying comorbidity and frailty were more consistently associated with dementia disease course than baseline comorbidity and frailty. Therefore, modeling only baseline predictors is insufficient for understanding the course of dementia in a changing patient context.