Functional Status In Elderly Patients Research Articles

Impact of function-guided glioma treatment on oncological outcome in the elderly

IntroductionMany patients with high-grade gliomas (HGG) are of older age. Research questionWe hypothesize that pre- and intraoperative mapping and monitoring preserve functional status in elderly patients while gross total resection (GTR) is the aim, resulting in overall survival (OS) rates comparable to the general population with HGG. Material and methodsWe subdivided a prospective cohort of 168 patients above 65 years with eloquent high-grade gliomas into four groups ([years/cases] 1: 65–69/58; 2: 70–74/47; 3: 75–79/43; 4: >79/20). All patients underwent preoperative noninvasive mapping, which was also used for decision-making, intraoperative neuromonitoring in 138 cases, direct cortical and/or subcortical motor mapping in 66 and 50 cases, and awake language mapping in 11 cases. ResultsGTR and subtotal resection (STR) could be achieved in 65% and 28%, respectively. Stereotactic biopsy was performed in 8% of cases. Postoperatively, we found transient and permanent functional deficits in 13% and 11% of cases. Postoperative Karnofsky Performance Scale (KPS) did not differ between subgroups. Patients with long-term follow-up (51%) had a progression-free survival of 5.5 (1–47) months and an overall survival of 10.5 (0–86) months. Discussion and conclusionThe interdisciplinary glioma treatment in the elderly is less age-dependent but must be adjusted to the functional status. Function-guided surgical resections could be performed as usual, with maximal tumor resection being the primary goal. However, less network capacity in the elderly to compensate for deficits might cause higher rates of permanent deficits in this group of patients with more fast-growing malignant gliomas.

Evaluation of Quality of Life and Functional Status in Elderly Patients with Rheumatoid Arthritis

Evaluation of Quality of Life and Functional Status in Elderly Patients with Rheumatoid Arthritis

Early mobilization in elderly patients undergoing cardiovascular surgery

Today, the average life expectancy of people has increased, and it is predicted that this increase will continue in the coming years. Aging is the biggest risk factor for cardiovascular diseases. Cardiovascular diseases limit the life expectancy of the elderly and reduce their quality of life. The success of surgical methods used in the treatment of cardiovascular diseases in recent years is a significant contribution to the treatment of elderly patients. Early care of patients undergoing cardiovascular surgery and the effectiveness of treatments affect their recovery. For elderly patients, prolonged bed rest in the postoperative period increases the risk of complications. Early mobilization of elderly patients undergoing cardiovascular surgery may support postoperative treatment. Early mobilization methods improve the functional status of elderly patients, shortening the hospital discharge time.

Physical rehabilitation of elderly patients with acute cerebrovascular accident. Literature review

A sharp increase in life expectancy over the past century has led to a significant increase in demand for long-term medical and social care.
 With aging, the reactivity of the body to the effects of the external environment changes, in particular, a decrease in resistance to pathogenic factors. Older people have chronic diseases (cardiovascular system, respiratory and digestive organs, central nervous system, joints, organs of vision and hearing, as well as diabetes, oncological diseases, etc.) that reduce physical and social activity.
 Vascular diseases of the brain remain one of the most acute medical and social problems that cause enormous damage to society. A special place among them is occupied by cerebral stroke due to the high mortality rate, significant disability and social maladaptation of elderly patients. According to modern data, at least 1/3 of stroke patients develop motor function disorders on average. These disorders significantly worsen the daily functioning of the quality of life.
 The aim of rehabilitation of elderly patients who have suffered a stroke is to return the patient to active social and household activities, create optimal conditions for his active participation in society and, ultimately, improve the quality of life of both the patient and his relatives. The task of psychological and physical recovery, social and labor adaptation of post-stroke patients is most successfully solved in the system of complex multidisciplinary rehabilitation. The lack of timely restorative treatment leads to irreversible anatomical and functional changes and a violation of the psychoemotional status of a person.
 Evidence has been provided that physical rehabilitation measures for elderly patients can significantly improve the indicators of physical, mental and social functioning without increasing the risk of undesirable effects. Successful and safe interventions have made it possible to achieve the goal of rehabilitation, increasing the functional status of elderly patients and independence in everyday life, as well as reducing the burden of the disease for both the individual and his family and society as a whole.

Machine learning model prediction of 6-month functional outcome in elderly patients with intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) has an increasing incidence and a worse outcome in elderly patients. The ability to predict the functional outcome in these patients can be helpful in supporting treatment decisions and establishing prognostic expectations. We evaluated the performance of a machine learning (ML) model to predict the 6-month functional status in elderly patients with ICH leveraging the predictive value of the clinical characteristics at hospital admission. Data were extracted by a retrospective multicentric database of patients ≥ 70 years of age consecutively admitted for the management of spontaneous ICH between January 1, 2014 and December 31, 2019. Relevant demographic, clinical, and radiological variables were selected by a feature selection algorithm (Boruta) and used to build a ML model. Outcome was determined according to the Glasgow Outcome Scale (GOS) at 6 months from ICH: dead (GOS 1), poor outcome (GOS 2–3: vegetative status/severe disability), and good outcome (GOS 4–5: moderate disability/good recovery). Ten features were selected by Boruta with the following relative importance order in the ML model: Glasgow Coma Scale, Charlson Comorbidity Index, ICH score, ICH volume, pupillary status, brainstem location, age, anticoagulant/antiplatelet agents, intraventricular hemorrhage, and cerebellar location. Random forest prediction model, evaluated on the hold-out test set, achieved an AUC of 0.96 (0.94–0.98), 0.89 (0.86–0.93), and 0.93 (0.90–0.95) for dead, poor, and good outcome classes, respectively, demonstrating high discriminative ability. A random forest classifier was successfully trained and internally validated to stratify elderly patients with spontaneous ICH into prognostic subclasses. The predictive value is enhanced by the ability of ML model to identify synergy among variables.

Evaluation of the effect of chronic pain on the functional and physical status of patients in older age groups

Objective: to assess the structure and influence of chronic pain (CP) on the functional status of patients with geriatric syndromes.Patients and methods. The study included 370 geriatric patients who were divided into two groups. Group A included 300 patients (mean age 75.1±8.25 years) with CP, and group B – 70 subjects of comparable age (75.1±7.75 years) without CP. All study participants were found to have polymorbidity: the Charlson index was 5.55±1.59 points in group A and 5.56±1.64 points in group B (p=0.963). All patients underwent a comprehensive geriatric assessment (CGE) to determine the functional status and diagnose geriatric syndromes.Results and discussion. According to the CGE data, senile asthenia syndrome was detected in 127 (42.3%) patients with CP and in 20 (28.6%) patients without CP (p=0.035). The average number of geriatric syndromes in group A was 7.06±2.68, in group B – 5.2±1.8 (p<0.001).Group A patients differed from those without CP in a significantly higher degree of dependence in daily life (Bartel index) and a lower score on the Physical Performance Battery.Conclusion. Patients with CP have poorer physical functioning and a greater degree of dependence on others in their daily life. When planning the most effective complex strategies for the treatment and prevention of CP exacerbations, it is necessary to take into account the functional status of elderly patients.

Peritoneal dialysis as a therapeutic solution in elderly patients with cardiorenal syndrome and heart failure: a case-series report

Abstract Background The aim of this work was to evaluate the impact of peritoneal dialysis (PD) on venous congestion, right ventricle function, systolic arterial pulmonary pressure and clinical functional status in elderly patients with cardiorenal syndrome (CRS) and chronic heart failure (HF). Methods A case series of 21 (17 males, 70±11 years) consecutive pts with diuretic-resistance heart failure and right ventricular dysfunction (median renal failure duration (RF) 60 months, range 13–287 months, mean ejection fraction 36±11%) having been engaged in PD (median of 12.5 months, range 2–28); 77% of the pts were under Automated Peritoneal Dialysis (APD), whereas the rest were under Continuous Ambulatory PD (CAPD). Patients' Pulmonary Artery Systolic Pressure (PASP), Central Venus Pressure (CVP) – through compression sonography – and body weight were evaluated in 6 intermediate clinical visits. Results During the follow-up period, the mortality rate was 8 deaths out of 21 pts (38%) (or 3 deaths/100 person-months).A significant reduction by 29.9% in PASP levels (p=0.013)and by 42% in CVP levels (p<0.001), and in right ventricular function was observed; whereas pts weight increased by 3.7% (p=0.001). NYHA class improved in 12 pts; whereas, in the rest pts remained constant (p=0.046). In 8 pts complications were reported (mainly presence of staphylococcus. aureus). Conclusion PD seems to confer a substantial benefit in clinical status, in line with improvement in venous congestion and right ventricle systolic pressure among elderly HF patients with CRS. Funding Acknowledgement Type of funding sources: None.

Conventional chemotherapy for acute myeloid leukemia in older adults: Impact on nutritional, cognitive, and functional status.

The impact of conventional treatment for acute myeloid leukemia (AML) on the nutritional, cognitive, and functional status of elderly patients is seldom studied. This assessment was performed in the context of the LAMSA 2007 trial. The trial enrolled 424 patients with de novo AML. Among them, 316 benefited from geriatric assessment (GA) including nutritional, cognitive, and functional status and were scored according to Eastern Cooperative Oncology Group (ECOG) and sorror for the prediction of treatment toxicity, morbidity, and mortality. Patients were investigated at diagnosis for three times during follow-up. This study showed that AML and its treatment have no impact on cognitive (P=.554) nor functional status (P=.842 for Activity of Daily Living and P=.087 for Instrumental Activities of Daily Living). The nutritional status improved over time (P=.041). None of these three parameters at baseline, associated or not with ECOG and sorror scores, impacted survivals or toxicities. The cognitive, functional, and nutritional status had no impact in this cohort of fit elderly AML patients without unfavorable cytogenetics. The GA tools used provided no additional information compared with ECOG and sorror scores, to predict toxicity, morbidity, or mortality due to intensive chemotherapy.

Brain Metastases in Elderly Patients-The Role of Surgery in the Context of Systemic Treatment.

In patients with brain metastases (BM), advanced age is considered a negative prognostic factor. To address the potential reasons for that, we assessed 807 patients who had undergone BM resection; 315 patients aged at least 65 years (group A) were compared with 492 younger patients (group B). We analyzed the impact of the pre- and postoperative Karnofsky performance status (KPS), postoperative treatment structure and post-treatment survival. BM resection significantly improved KPS scores in both groups (p = 0.0001). Median survival after BM resection differed significantly between the groups (A: 5.81 vs. B: 8.12 months; p = 0.0015). In both groups, patients who received postoperative systemic treatment showed significantly longer overall survival (p = 0.00001). However, elderly patients less frequently received systemic treatment (p = 0.0001) and the subgroup of elderly patients receiving such therapies had a significantly higher postsurgical KPS score (p = 0.0007). In all patients receiving systemic treatment, age was no longer a negative prognostic factor. Resection of BM improves the functional status of elderly patients, thus enhancing the likeliness to receive systemic treatment, which, in turn, leads to longer overall survival. In the context of such a treatment structure, age alone is no longer a prognostic factor for survival.

Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial.

IntroductionAfter surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients.MethodsPatients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, B1, B2, C1, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct. The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury.ResultsThirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups.ConclusionsThere were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.

Gonartrozlu Yaşlı Hastada D Vitamininin Kas Gücü ve Fonksiyonel Durum Üzerine Etkisi

Introductıon: The aim of this study was to evaluate the effects of vitamin D levels on pain intensity, muscle strength and functional status of elderly patients with osteoarthritis of the knee. 
 Methods: Eighty one patients with osteoarthritis of the knee were enrolled in this study. The pain was measured with visual analogue scale (VAS). Western Ontario and McMaster University Arthritis Index (WOMAC) was used to evaluate pain, stiffness, and physical function. The maximum isokinetic muscle strength and the peak torque/body weight values were measured. 
 Results: The patients were divided into two groups according to their 25 (OH) vitamin D levels: Group 1 consisted of patients whose 25 (OH) vitamin D levels were below 20 ng/ml and Group 2 comprised those with levels above 20 ng/ml. The VAS scores, the mean WOMAC pain, function and total scores were higher in Group 1 than Group 2. The maximal isokinetic muscle strength of extensor and flexor muscles of the knee and the peak torque/body weight values were significantly lower in Group 1 than in Group 2 (p

The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis.

Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario.

Medium-long-term mortality and change in functional status in elderly patients with pacemaker.

Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. We designed a prospective study to analyze the cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. An observational study including pacemaker implants in individual older than 70 years old in a single-center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long-term mortality, and functional status after implantation was undertaken. About 60% of patients were older than 80 years old. The third-degree atrioventricular blockage (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel Index and functional status in this subgroup of patients, 3 years after pacing. Long-term mortality in individuals older than 80 years old with pacemaker implantation was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.

Medium-long term mortality and change in functional status in elderly patients with pacemaker.

Nowadays, 49% of patients with pacemakers are older than 80 years old. Nevertheless, mortality and change in functional status after pacemaker implantation are not well documented in elderly patients. We designed a prospective study to analyze cardiovascular mortality and change in functional status of elderly patients, medium-long term after pacemaker implantation. Observational study including pacemaker implants in individual older than 70 years old in a single center university hospital between 2012 and 2014. Analysis testing for an association between pacemaker system, medium-long term mortality and functional status after implantation were undertaken. 60% of patients were older than 80 years old. Third-degree atrio-ventricular block (44.3%) and slow ventricular response atrial fibrillation (16.7%) were the most frequent electrocardiogram abnormalities, while bicameral DDD was the sort of pacing our department used the most (38.6%) (VVI in octogenarian patients, 38.7%). Long-term mortality was significantly higher in ventricular devices, especially in octogenarian patients (p = 0.001 respectively). Single-chamber VVI pacing acted as independent predictors of all-cause mortality in these individuals (p = 0.001). We found no significant improvement in Barthel index and functional status in this subgroup of patients, 3 years after pacing. Long-term mortality in individuals older than 80 years old with pacemaker implantation, was significantly higher comparing with general population, especially in ventricular devices. No significant improvement in functional status was detected in this subgroup of patients.

Efficacy and Safety of Ibrutinib in Elderly Patients with Chronic Lymphocytic Leukemia

Background: For most of the elderly chronic lymphocytic leukemia (CLL) patients, treatment outcome focus on achievement of clinical response, relief of symptoms and prolongation of life expectancy, but comorbidities, frailty and reduced functional status in elderly patients make the standard treatments intolerable and less efficacious. Single agent Ibrutinib (Ibr), an inhibitor of oral Bruton's tyrosine kinase, is approved for the front-line treatment of patients with CLL by Chinese Food and Drug Administration (CFDA) in 2017. Objectives: This study evaluated effeicacy and safety of single agent Ibrutinib in elderly patients with treatment-naive chronic lymphocytic leukemia for 2 years in our center. Methods: Patients over 65 years old with previously untreated CLL/SLL (n = 37) were received Ibr 420 mg once daily continuously until disease progression or unacceptable toxicity. We examined baseline demographics/disease characteristics, endpoints included overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and safety in patients with CLL receiving ibrutinib. Results: 37 CLL patients over 65 years old were enrolled and treated with from June 2017 to May 2019 in our center. The median follow-up was 19.4 months (range, 0.8-31.6 months). Their F/M ratio was 16/21 and the median age of the enrolled population was 77.3 years (range, 65.4-92.7 years). 31 (83.8%) patients had an Eastern Cooperative Oncology Group performance status of 0-1. In these patients, 18/34 (52.9%) had del17p and/or TP53 mutation, and 20/30 (66.7%) had unmutated IGHV. With Ibr, Overall response rate (ORR) was 91.9%; complete response (CR) was 8.0%, partial response (PR) was 51.4%, and PR with lymphocytosis (PRwL) was 32.4%. Median progress free survival (PFS) was 17.3 months (95% CI, 14.3-24.0); PFS rates at 12 and 24 months were 87.1% and 74.0%, respectively. Median PFS with ibrutinib was comparable in pts with/without del17p and/or TP53 mutation (16.4 [95% CI, 14.3-NE] vs 14.5 months [95% CI, 13.9-NE]) and with unmutated/mutated IGHV (16.8 [95% CI, 12.1-22.8] vs 19.7 months [95% CI, 14.3-23.0]). Overall survival (OS) rates were 95.8% and 86.8% at 12 and 24 months, respectively. Median time to best response was 4.8 months (95% confidence interval [CI], 3.7-5.5). With median follow-up of 19.4 months, 21.6% (8/37) of pts had progressed or died. In the safety analysis, the most common serious adverse events (AEs) were recorded in 6 patients include neutropenia (4 pts), pneumonia (3 pts), hypertension (3 pts), anemia (2 pts), hyponatremia (2 pts), and atrial fibrillation (2 pts). AEs of any grade leading to ibr discontinuation occurred in 3 pts over time. Conclusions: In total, single agent ibrutinib was well tolerated and yielded high response rates, including for pts with high-risk genomic features, that were durable and deepened over time in treatment-naive elderly patients with CLL. Ibrutinib also had sustained PFS and OS benefit. Safety profile was acceptable and the most serious adverse events were neutropenia, pneumonia, hypertension, anemia, hyponatremia, and atrial fibrillation. Disclosures No relevant conflicts of interest to declare.

Impacto da capacidade funcional na mortalidade seis meses após alta em idosos internados em UTI

INTRODUÇÃO: O envelhecimento é um processo natural de redução progressiva da reserva funcional dos indivíduos e o fator que determina saúde dos idosos é a independência nas suas atividades habituais, que consiste em sua funcionalidade e quando acometidos por alguma enfermidade tendem a ter uma recuperação mais lenta, em comparação aos pacientes jovens, devido ao declínio funcional inerente ao processo de senescência, o que pode resultar em maior risco de morte. OBJETIVO: Avaliar o impacto da capacidade funcional na mortalidade de idosos após seis meses de alta da Unidade de Terapia Intensiva. MÉTODOS: Trata-se de um estudo de coorte, ambispectivo, realizado em uma Unidade de Terapia Intensiva de um hospital público de grande porte, localizado na cidade de Salvador, Bahia em 2018. A amostra foi composta por pacientes idosos admitidos na UTI, com idade igual ou superior a 60 anos, onde foram aplicadas as Escalas de Mobilidade em UTI (EMU) e Estado Funcional (FSS) para avaliar a capacidade funcional no dia da alta da UTI e através de contato telefônico, foi observado a ocorrência de óbito após 6 meses da alta. Foram excluídos pacientes com instabilidade hemodinâmica, desordens congnitivas. e aqueles onde houve impossibilidade de contato telefônico. Para análise estatística dos dados de variáveis contínuas foram avaliados com medidas de tendência central e dispersão, variáveis categóricas avaliadas com medidas de frequência e para relacionar a capacidade funcional e mortalidade foi utilizado o teste não paramétrico de Mann-Whitney com o uso do software SPSS. RESULTADOS: A amostra foi composta por 30 pacientes, sendo a maior parte composta por indivíduos do sexo masculino (60,0%), com média de idade 68,0(±6,7) anos, com perfil diagnóstico predominantemente clínico (70,0%), média de tempo de internamento de 3,2 (±1,8) dias, capacidade funcional aferida pela escala do estado funcional (FSS) da alta de 29,3(±8,5) e pela escala de mobilidade em UTI (EMU) da alta de 8,8 (± 2,6) . Dos pacientes inicialmente avaliados, 08 (21,1%) foram excluídos por impossibilidade de contato por telefônico após a alta, tendo completado o estudo com 30 pacientes, destes 11 (28,9%), evoluíram a óbito em até seis meses após a alta da UTI. Um dado que chama atenção é a taxa de mortalidade nos pacientes estudados, que chegou a 36,6% CONCLUSÃO: O status funcional, de pacientes idosos, no momento da alta da UTI está relacionado com uma maior taxa de mortalidade em seis meses após a alta da unidade de terapia intensiva.

Sequencing Therapy for Elderly Chronic Lymphocytic Leukemia Patients in the Era of Novel Therapies: An Overview of Randomized Clinical Trials

Background:For most of the elderly or unfit CLL patients, treatment algorithms focus on achievement of clinical response, relief of symptoms and prolongation of life expectancy. Comorbidities, frailty and reduced functional status in elderly patients make some of the standard treatments intolerable and less efficacious. However, recent advancements in understanding of CLL biology, approval of target agents including novel monoclonal antibodies and kinase inhibitors have expanded the horizons for treatment of CLL in elderly.Methods:We conducted a literature search on PubMed, Embase, Web of Science and ClinicalTrials.gov which was completed on July 1, 2018. To assess the CLL treatment protocols in the elderly population, we included data from phase II and phase III clinical trials from the last decade (Jan 2008 to Jan 2018).Results:From a total of 1259 studies, we selected 34 studies (n=3122) after inclusion criteria were met. The patients included are from the age group of ≥65 years with the mean age of 68.8 years. Male to female ratio was 3:2. On comparison of different parameters to look for the drug or regimen efficacy, we found that ibrutinib is very effective and tolerable in older (aged ≥65 years) treatment-naïve (TN) as well as relapsed refractory patients (RR), with overall response rate (ORR) of 91% for combined group in one study when compared to ofatumumab. When used in combination with ublituximab, the ORR peaked to 80% as compared to ibrutinib alone in patients with high risk cytogenetics (ORR=47%, p<0.001). Phase III RESONATE trial showed a comparison between ibrutinib and chlorambucil treated del 17p negative elderly patients; ibrutinib was superior in terms of ORR (86% vs. 35%) and overall survival (OS) (2-year OS, 98% vs. 85%, p=0.001). The OS with ibrutinib turned out to be 89% showing better disease control as compared to idelalisib (OS= 61%) when used in combination with rituximab, with a 33% reduction in mortality with ibrutinib as compared with idelalisib in RR patients. The combination of rituximab with idelalisib has shown promising results in patients with specific mutations (i.e. 100% ORR in those with del (17)/ Tp53 mutations, 97% ORR in those with unmutated IGHV). Similarly, when compared with placebo and rituximab combination progression free survival (PFS) was 13%, idelalisib is found to have PFS of 66% at 12 months in patients with del 17p/ Tp53 mutations and unmutated IGHV status. Moreover, in a phase II study, ofatumumab monotherapy showed ORR of 72%. In newly diagnosed (ND) CLL, an ORR of 98% is found with the pentostatin, cyclophosphamide, rituximab, and lenalidomide regimen. Other worth sharing results include; complete remission (CR) in 71% (24 out of 34 included) patients who were given lenalidomide as an initial therapy, with OS of 88% and ORR of 65%. The OS is surprisingly as high as 97.9% in those who were given pentostatin and cyclophosphamide in combination with ofatumumab. Traditional chemotherapy with fludarabine and rituximab (FR) showed OS of 67% in one study with rates of grades II and III-IV acute GVHD as 60% and 15% respectively. The most common hematological side effects seen with ibrutinib in one of the studies are neutropenia (12%), thrombocytopenia (4%) and anemia (7%). The non-hematological complications may be secondary due to cytopenias (infections, pneumonia, bleeding, and neutropenic fever) or due to constitutional symptoms like myalgia, fatigue, vomiting, or nausea.Conclusion:The rapid clinical development of novel therapy agents has changed the prognosis for CLL patients. Ibrutinib is considered as a standard option and an up front therapy for high risk CLL patients especially who are elderly and have del 17p, despite its significant toxicity profile in very elderly patients (80 years and above) where multiple deaths were reported. Future prospects include ibrutinib combinations with frontline chemo-immunotherapy (CIT) and other novel agents for TN and RR del 17p negative patients. DisclosuresNo relevant conflicts of interest to declare.

P3477Frailty and functional status in elderly patients with acute coronary syndrome: prospective cohort study to assess mortality risk

P3477Frailty and functional status in elderly patients with acute coronary syndrome: prospective cohort study to assess mortality risk

CHEMOTHERAPY IN ELDERLY PATIENTS WITH STOMACH CANCER

Stomach cancer (SC) (in the structure of morbidity) is one of the most frequent malignant diseases that occurs in the elderly. Systemic chemotherapy showed improved quality of life and survival rate compared with palliative therapy in patients with advanced SC. It has also been shown that elderly patients with SC are able to tolerate and receive effective systemic chemotherapy, as are the younger patients with the same stage of cancer. The only one age limit should not be the only criterion for excluding effective chemotherapy. However, proper patient selection is extremely important to ensure effective safe treatment. The article analyzes the optimal regimens of chemotherapy, taking into account the general condition and geriatric functional status of elderly patients with SC.

Effectiveness of an oral diabetes-specific supplement on nutritional status, metabolic control, quality or life, and functional status in elderly patients. A multicentre study

The purpose of this study was to assess nutritional status, quality of life (QoL) and function in malnourished or at risk for malnutrition community-dwelling (CD) and nursing home-dwelling (NHD) elderly patients with type 2 diabetes mellitus (DM2), receiving treatment with a diabetes-specific oral nutritional supplement (DSONS). A prospective, multicentre, observational study was conducted. A DSONS (high-calorie, high-protein, with slow-digestible carbohydrate and high monounsaturated fatty acid - MUFA-content - Glucerna® 1.5 Cal) had been prescribed the week before inclusion. The following assessments were undertaken at baseline (BL), at week 6 (V1) and at month 3 (FV): body mass index (BMI), glycosylated haemoglobin (HbA1c), nutritional status (Mini Nutritional Assessment - MNA), QoL (EQ-5D questionnaire), and functional status (Katz Index - KIof Independence in Activities of Daily Living). The data were reported in the overall population (OP) and in the CD and NHD groups. A total of 402 patients aged 80.8±8.5 years were evaluable (44.5% men), including 61.7% CD and 38.3% NHD. BMI (kg/m2) increased in the OP from 22.0±3.5at BL to 22.5±3.6at V1 (p<0.001) and 23.0±3.7at the FV (p<0.001). BMI also increased in the CD group (p<0.001) and in the NHD group (p<0.001). HbA1c decreased in the OP from 7.3±1.1% at BL to 7.2±1.0% at V1 and 7.0±0.9% at the FV (p<0.001), in both the CD (p<0.001) and the NHD groups (p=0.020). The mean overall MNA score increased in the OP from 13.1±4.8at BL to 17.0±4.7at V1 and 18.6±5.1at the FV (p<0.001). The mean overall MNA score also increased in the CD (p<0.001) and the NHD groups (p<0.001). The mean overall EQ-5D score improved in the OP from 46.0±18.0at BL to 54.8±17.5at V1 and 59.7±18.8at the FV (p<0.001). The mean overall EQ-5D score also improved in the CD (p<0.001) and the NHD groups (p<0.001). Gastrointestinal adverse events were seen in only 2% of patients. Treatment compliance was 94.4%. In this study, conducted in routine, multicentre, clinical settings, the treatment with the high-calorie, high-protein, with slow-digestible carbohydrate, and high MUFA content DSNOS - Glucerna® 1.5 Cal-, was associated with improvements in HbA1c, nutritional status, BMI and QoL following 6 weeks and 3 months of treatment in both institutionalised and non-institutionalised elderly patients with diabetes who were malnourished or at risk for malnutrition. A slight improvement in functional status was also observed at 12 weeks. As this is an observational effectiveness study, a randomized controlled trial would be necessary to establish a causal relationship between the DSNOS and the described events.