Geriatric Symptoms Research Articles

THE DETERMINANTS OF QUALITY OF LIFE IN OLDER ADULTS OF CORRECTIONAL FACILITIES

The growing number of older prisoners has become a global challenge (Brie W., Cyrus A., Robert G., 2012). Over the past decade, there has been a concurrent disproportionate growth in the number of older prisoners. These figures were observed in the USA, Japan, Spain, United Kingdom and other countries statistics (William B.,2012). The arrest and sentencing of older adults are on the rise, and researchers consider prisoners to be older, or geriatric, by the age of 50 or 55 years (Aday R. 2003, Williams B. 2010, Besdine R. 2005). Older prisoners are likely to suffer from geriatric syndromes, falls, sensory impairment, incontinence, mental illness, depression, and other disease than other population in prison and society (Landefeld CS. 2004, Greinfinger R. 2007). The main target of the research is to investigate QOL (quality of life) determinants of older offenders in Azerbaijan prisons. This research is the first step in Azerbaijan Penitentiary service to evaluate geriatric symptoms and QOL elements. The objectives of the research: 1) descriptive and comparative analysis of different international literature, articles, policy papers, 2) explanatory investigation survey results analyzed during the study. For this purpose WHOQOL-Bref survey instrument was used to assess determinants of quality of life. This survey contents four domains: Physical, Psychological, Social Relationships and environment, and the data was examined with SPSS program. Considering the results of survey and comparing different literatures the some recommendation were made, that can be used in different programs and future researches

Depression and anxiety in older patients with hematological cancer (70+) – Geriatric, social, cancer- and treatment-related associations

ObjectivesOlder patients are often underrepresented in clinical and epidemiological studies and the knowledge of the effect of hematologic cancer on mental health in the elderly is sparse. Objectives of our study are to provide information on depression and anxiety in older patients with hematological cancer (HCP), compared to a community sample (CS), and to investigate factors associated with depression and anxiety. Materials and MethodsWe conducted a prospective study with interview assessments of HCP (ICD: C81 – C96) age ≥ 70 years to assess depressive symptoms (PHQ-9) and anxiety (GAD-7) in comparison to a CS matched by age and sex. Hierarchical Regression analysis was used to determine the association of depression and anxiety with quality of life (QoL) as well as geriatric, social, cancer- and treatment-related factors. Results200 patients (response rate 50.5%, Mean age = 76 years, 64% male) and 225 citizens (response rate 44.5%) were interviewed. Compared to the CS, HCP showed significantly higher levels of depression. There was no difference in levels of anxiety between the two groups. Geriatric characteristics including limited mobility, need for care, comorbidity, as well as ongoing chemotherapy, lack of partnership, and low QoL were associated with depression. Anxiety in HCP was associated with detrimental social interaction, cognitive and emotional functioning, poor nutrition, and comorbidity. ConclusionsOlder patients with hematologic cancer are at high risk to experience depressive symptoms and low QoL. Health care professionals should assess geriatric symptoms and screen for depression to allow for early interventions and improve treatment outcomes.

Prevalence, risk factors, and burden of disease for falls and balance or walking problems among older adults in the U.S.

This study assesses the prevalence of falls, factors predicting future falls, and health impacts of falls and balance or walking problems for U.S. older adults. Data were from participants ≥65 years in the Medicare Health Outcomes Survey Cohort 15 (baseline survey in 2012; follow-up survey in 2014; n = 164,597). We examined baseline factors predicting falls at follow-up and estimated the impact of falls and balance/walking problems on health-related quality of life (HRQOL), mortality, and quality-adjusted life years (QALYs). About 23% reported falls and 34% reported balance/walking problems in the past 12 months. The strongest predictors of falls were previous falls [adjusted odds ratio (OR) = 2.9] and balance/walking problems (OR = 1.7). Many self-reported chronic conditions (e.g., depression, stroke, and diabetes), geriatric symptoms (e.g., urine leakage), and limitations of activities of daily living (e.g., transferring and walking) also predicted falls, but at a smaller magnitude (ORs = 1.1–1.3). Having balance/walking problems was associated with a greater decrease in HRQOL scores (0.195 points) than falls (0.077 points), while falls were associated with a greater increase in mortality [adjusted hazard ratio (HR) = 1.5] than balance/walking problems (HR = 1.1). Falls were associated with a 4.6-year (48%) decrease in QALYs, while balance/walking problems was associated with a 7.3-year (62%) decrease in QALYs. Falls are a major problem for U.S. elderly and will continue to have an even greater impact as the population ages. The nearly 50% decrease in QALYs for falls and >60% decrease for balance or walking problems demonstrates the substantial burden associated with these problems among older Americans.

Chronic pain in patients older than 60 years: a view of the geriatrics

To analyze the geriatric status of patients with chronic pain. One hundred and sixteen patients of a geriatric unit, aged 75.66±7.98 years (110 women, 94.8%), were studied. All patients underwent general clinical examination and complex geriatric assessment, on the results of which geriatric syndromes were identified. Characteristics of pain syndrome (cause, intensity, localization) are described. Chronic pain syndrome is identified in 85 (73.3%) patients. Most often pain is localized in large joints (n=44 (51.76%)) and back (n=50 (58.8%)). The intensity of pain was higher in patients with moderate dependence in daily activities compared to those with mild dependence (p<0.05). Pain intensity is associated with the degree of impairment of physical functioning (p<0.05). Patients with chronic pain have more geriatric symptoms (6.8±2.8). More syndromes (9.11±2.37) are identified in patients with marked impairment of physical functioning. The reduction of muscle strength is observed in 45.9% patients with- and 9.7% patients without chronic pain syndrome. The velocity of pace is 0.59 m/s and 0.71 m/s, respectively. The high prevalence of chronic pain in patients of a geriatric unit is shown. The intensity of pain iss higher in patients with moderate dependence in daily activities compared to those with mild dependence. Pain intensity increases with the reduction of patient's physical functioning. Patients with chronic pain more often have dynapenia and significantly lower velocity of pace that indicates the poor outcome in elderly patients.

Reasons for home care clients’ unplanned Hospital admissions and their associations with patient characteristics

BackgroundUnplanned hospitalizations and emergency room visits occur frequently among home care clients The aim of this study was to identify typical discharge diagnoses and their associations with patient characteristics among a total of 6812 Finnish home care clients aged ≥63 years who were hospitalized within one year of their first home care assessment. MethodsA register-based study based on Resident Assessment Instrument-Home Care (RAI−HC) assessments and nationwide hospital discharge records. The RAI−HC assessments were linked to the hospital discharge records of the participants’ first unplanned hospitalization. Univariate and multivariable regression analyses were used to evaluate the association of RAI−HC determinants with discharge diagnoses. ResultsThe most common reason for the first hospitalization was an infectious disease (21%; n = 1446). When hospitalizations were classified according to the main diagnosis, chronic skin ulcers, functional impairment and daily urinary incontinence were associated with hospitalization due to infectious diseases; impaired cognitive capacity, Alzheimer’s disease or other dementia and polypharmacy (protective effect) were associated with hospitalizations due to dementia; age of ≥90 years, congestive heart failure, coronary artery disease and using ≥10 drugs with hospitalizations due to heart diseases; and moderate or strong pain with hospitalization due to musculoskeletal disorders. Previous falls, female sex and an earlier hip fracture were associated with injury-related hospitalizations. Feelings of loneliness increased the odds of hospitalization due to geriatric symptoms without a specific diagnosis. ConclusionPatient characteristics and geriatric syndromes identified using RAI−HC predict the reasons for future hospitalizations among new home care clients.

Unmet supportive care needs of older adults with advanced cancer.

10040 Background: Cancer disproportionately affects older adults, yet research defining the supportive care needs of these patients is lacking. We sought to examine associations between geriatric impairments, quality of life (QOL), and physical and psychological symptom burden in older adults with newly diagnosed incurable gastrointestinal (GI) cancer. Methods: We prospectively enrolled patients age ≥70 within 8 weeks of diagnosis of incurable GI cancer at Massachusetts General Hospital from 10/2015-11/2016. We used surveys to assess geriatric impairments (Vulnerable Elders Survey-13 [range 0-10, scores ≥3 identify patients with impairments), QOL (EORTC QLQ-C30 [range 0-100, higher scores indicate better QOL]), physical symptoms (Edmonton Symptom Assessment System [range 0-10, higher scores indicate greater symptom burden]) and psychological symptoms (Geriatric Depression Scale, [range 0-15, higher scores indicate greater depression symptoms]). We used descriptive statistics to determine differences in patient characteristics by the presence or absence of geriatric impairments. We used linear regression adjusted for age, employment, cancer type, and comorbidity to examine associations between geriatric impairments, QOL, and physical and psychological symptom burden. Results: We enrolled 50 of 58 (86%) patients approached (mean age = 78.7; 52% with pancreatic cancer). Nearly half (46%) screened positive for geriatric impairments; these patients were older (81.7 vs 76.1, p &lt; .01) and had more comorbid conditions (2.4 vs 1.2, p = .01). On linear regression, patients with geriatric impairments reported worse QOL across all domains (General QOL: B = -28.3, p &lt; .01; Physical: B = -36.8, p &lt; .01; Role: B = -36.8, p &lt; .01; Emotional: B = -30.1, p &lt; .01; Cognitive: B = -17.8, p = .03; Social: B = -39.7, p &lt; .01), higher depression scores (B = 5.1, p &lt; .01) and worse fatigue (B = 4.6, p &lt; .01), drowsiness (B = 4.0, p &lt; .01), appetite (B = 3.8, p &lt; .01), and pain (B = 2.7, p = .02). Conclusions: Older adults with advanced cancer experience considerable unmet supportive care needs, particularly those with geriatric impairments. Future research is needed to assess older patients for geriatric impairments and address their unique palliative and supportive care needs.

The effectiveness of optimised clinical medication reviews for geriatric patients: Opti-Med a cluster randomised controlled trial.

Inappropriate drug use is a frequent problem in older patients and associated with adverse clinical outcomes and an important determinant of geriatric problems. Clinical medication reviews (CMR) may reduce inappropriate drug use. The aim of this study is to investigate the effectiveness of CMR on quality of life (QoL) and geriatric problems in comparison with usual care in older patients with geriatric problems in the general practice. We performed a cluster randomised controlled trial in 22 Dutch general practices. Patients of ≥65 years were eligible if they newly presented with pre-specified geriatric symptoms in general practice and the chronic use of ≥1 prescribed drug. The intervention consisted of CMRs which were prepared by an independent expert team and discussed with the patient by the general practitioner. Primary outcomes: QoL and the presence of self-reported geriatric problems after a follow-up period of 6 months. 518 patients were included. No significant differences between the intervention and control group and over time were found for QoL, geriatric problems, satisfaction with medication and self-reported medication adherence. After 6 months the percentage of solved Drug Related Problems (DRPs) was significantly higher in the intervention group compared to the control group [B 22.6 (95%CI 14.1-31.1), P < 0.001]. The study intervention did not influence QoL and geriatric problems. The higher percentage of solved DRPs in the intervention group did not result in effects on the patient's health. CMRs on a large scale seem not meaningful and should be reconsidered.

Klotho as a Therapeutic Target during the Development of Renal Fibrosis.

Systemic symptoms such as the ectopic calcification, atrophy of skin and muscle, and impaired sexual function observed in chronic kidney diseases (CKD) have been reported to coincide with those observed in geriatric symptoms. Regarding the kidney, clinical/pathological characteristics in CKD patients also coincide with those in the aging kidney. These findings suggest common mechanisms in the development of both CKD and aging. Our investigation of aging factors associated with renal fibrosis in IgA nephropathy patients revealed a significant correlation between accumulation of cells with an arrested cell cycle and decreased expression of Klotho protein. Because cell cycle arrest has a protective effect on organs in the acute phase, the proposed therapeutic target against the aging process is to maintain expression of Klotho protein. In addition, it is recognized that TGF-β1 plays a central role in the development of renal fibrosis. However, TGF-β1 has also been reported to decrease expression of Klotho protein. In this report, we provide an interpretation of our new treatment strategy which involves controlling histone methylation.

One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index.

To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains. Retrospective cohort study. Health and Retirement Study (HRS). HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857). Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism. Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10% risk and 7 to 9 points predicting 66% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting. The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture.

Características de los pacientes con enfermedad crónica avanzada incluidos en un programa de cuidados paliativos domiciliario

ObjectiveTo describe the socio-demographic and clinic characteristics and aspects related to information of non-oncological patients (NOP) with advanced disease, which are included in a palliative-home care support unit. To identify the variables that could be associated with the death of NOP at home. Material and methodA retrospective descriptive study was performed by reviewing the clinical histories of NOP attended by a Palliative-home Care Support Unit during the period from November 2009 to March 2013. An analysis was performed on the socio-demographic and clinical data of the patients and their main caregivers, as well as the analysed, diagnostic and prognostic information provided by the family and the patient, preferences about end of life care of both parties, and the place of death. The data analysis was performed with the computer pack SPSS® v. 21. ResultsOf the 371 clinical histories reviewed, 249 patients met the inclusion criteria. The NOP represented the 36.19% of the activity, with a mean age of 81.4 years. The most common disease was dementia (22.1%). More than two-thirds (67.5%) of the patients came from Primary Care and residential homes for the elderly. The main reason for referral was to control symptoms in 85.5%, with the most frequent being asthenia, dyspnoea, and pain. A high comorbidity, geriatric symptoms, cognitive impairment was observed in 65%, and an important functional impairment (mean Barthel Index of 21.52, and Palliative Performance Scale score of 38.18). The majority of main caregivers were women, and the patient's daughter, and the burden of caring was identified in 55.4%. In the group without cognitive impairment, the diagnosis was known by 83%, and 30% knew the prognosis. Staying at home to receive end of life care was preferred by 95%, and 78% kept this preference for dying. Two-thirds (66%) of all the patients died at home or in residential homes for the elderly. The statistical analysis of the possible factors associated with dying at home showed a significant odds ratio when the patient lived in rural areas, and preferred home as the place of death. Another factor is when the main caregiver does not suffer care burden and has a subjective perception of good health. ConclusionsThe predominance of NOP in end of life situations is characterised by advanced age, high comorbidity, increased symptomatic burden, significant overall functional impairment on admission, and high mortality. More than the half of the caregivers showed excessive burden of caring. In conclusion, they are patients with similar needs to those with advanced oncological disease. The high prevalence of cognitive impairment suggested that only half of the patients were able to participate in the information and in the advanced care planning.

Patient-reported geriatric symptoms as risk factors for hospitalization and emergency department visits.

There is an urgent need to identify predictors of adverse outcomes and increased health care utilization in the elderly. The Mayo Ambulatory Geriatric Evaluation (MAGE) is a symptom questionnaire that was completed by patients aged 65 years and older during office visits to Primary Care Internal Medicine at Mayo Clinic in Rochester, MN. It was introduced to improve screening for geriatric conditions. We conducted this study to explore the relationship between self-reported geriatric symptoms and hospitalization and emergency department (ED) visits within 1 year of completing the survey. This was a retrospective cohort study of patients who completed the MAGE from April 2008 to December 2010. The primary outcome was an ED visit or hospitalization within 1 year. Predictors included responses to individual questions in the MAGE. Data were obtained from the electronic medical record and administrative records. Logistic regression analyses were performed from significant univariate factors to determine predictors in a multivariable setting. A weighted scoring system was created based upon the odds ratios derived from a bootstrap process. The sensitivity, specificity, and AUC were calculated using this scoring system. The MAGE survey was completed by 7738 patients. The average age was 76.2 ± 7.68 years and 57% were women. Advanced age, a self-report of worse health, history of 2 or more falls, weight loss, and depressed mood were significantly associated with hospitalization or ED visits within 1 year. A score equal to or greater than 2 had a sensitivity of 0.74 and specificity of 0.45. The calculated AUC was 0.60. The MAGE questionnaire, which was completed by patients at an outpatient visit to screen for common geriatric issues, could also be used to assess risk for ED visits and hospitalization within 1 year.

Opti-Med: the effectiveness of optimised clinical medication reviews in older people with 'geriatric giants' in general practice; study protocol of a cluster randomised controlled trial.

BackgroundInappropriate drug use has been identified as one of the most important problems affecting the quality of care in older people. Inappropriate drug use may increase the risk of the occurrence of ‘geriatric giants’ such as immobility, instability, incontinence and cognitive impairment. There are indications that clinical medication reviews (CMR) can reduce inappropriate drug use. However, CMRs have not yet been implemented at a large scale in primary care. An innovative medication review program in primary care will be developed which tackles the most important obstacles for a large scale implementation of CMRs. The aim of this study is to assess whether this CMR program is (cost-) effective compared with usual general practice care for older patients with geriatric symptoms with regard to quality of life and geriatric symptoms.MethodsA cluster randomised controlled trial will be performed in 20 Dutch general practices including 500 patients. Patients of 65 years and older are eligible if they newly present with pre-specified geriatric symptoms in general practice and chronic use of at least one prescribed drug. GP practices will be stratified by practice size and randomly allocated to control (n = 10) or intervention group (n = 10). The intervention consists of CMRs which will be facilitated and prepared by an expert team consisting of a GP and a pharmacist. Primary outcome measures are patient’s quality of life and the presence of self-reported geriatric symptoms during a follow-up period of 6 months. Secondary outcomes are costs of healthcare utilisation, feasibility, number of drug related problems, medication adherence and satisfaction with medication.DiscussionThis study is expected to add evidence on the (cost-) effectiveness of an optimally facilitated, prepared and structured CMR in comparison with usual care in older patients who present a geriatric symptom to their GP. The strength of this study is that it will be conducted in daily clinical practice. This improves the possibilities to implement the CMRs in the primary care setting on a large scale.Trial registrationNetherlands Trial register: NTR4264Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2318-14-116) contains supplementary material, which is available to authorized users.

A computer-aided diagnosis system for geriatrics assessment and frailty evaluation.

It is a common knowledge that frailty is a condition associated with getting older, and it has been considered as highly prevalent as far as falls, disability, hospitalization, and mortality are concerned. At the present time a standardized definition has not yet been established. With that in mind and for frailty being of a vital importance as a term identifying geriatric symptoms, we pursued to embody the well-known 70-scale CSHA Frailty index of the Canadian Study of Health and Aging in a Clinical Decision Support System, after categorizing and expanding it. The proposed categorization in this chapter can be helpful for usage by patients and their relatives, care givers, and medical doctors.

Trajectory of geriatric syndromes changes among elderly patients receiving intensive care

Background: Geriatric syndromes are a series of clinical conditions in the elderly that do not fit into distinct categories, and has the characteristics of complex interaction among aging and multiple chronic diseases. They affect the quality of life of patients and are associated with disability. In the intensive care unit (ICU), life-maintenance and disease-control are the aims of the medical care, so geriatric syndromes care is often neglected and not given attention. Therefore, the medical care of elderly patients should gradually be shifted from the disease-oriented to geriatric symptom control in order to maintain elders’ life quality. Objective: The aim of this study was to expose the trajectory of geriatric syndromes changes among elderly receiving intensive care. Methods: The prospective survey was designed to collect data from the medical center at southern Taiwan for elderly patients who are older than 65 years old, have stayed in the ICU. A structured questionnaire will collect data associated with five geriatric symptoms, across four time points, 2 weeks before hospitalization, leaving ICU, discharge from hospital, and one month after discharge. The factors that associate with the changes of geriatric symptoms will be analyzed. Results: Research is still ongoing and is expected to recruit 250 patients; 58 patients have been recruited so far. Preliminary results showed 45.6% of subjects had at least one geriatric syndrome before admission; when they left the ICU, the incidents doubled, which mostly were urinary incontinence and delirium. After discharge from hospital, 49% of the elderly still have 2 or 3 geriatric syndromes, such as activities of daily living dysfunction, urinary and fecal incontinence. Discussion: The prevalence of geriatric syndromes among elderly patients who needed intensive care is high. Conclusion: The study reveals the current clinical issues in management of geriatric symptoms in ICU elderly patients and can provide research evidence to develop an effective critical care model for elderly patients in the future.

A Population-Based Intervention for the Prevention of Falls and Fractures in Home Dwelling People 65 Years and Older in South Germany: Protocol

BackgroundFalls and fall-related injuries pose a major threat to older peoples’ health, and are associated with increased morbidity and mortality. In the course of demographic changes, development and implementation of fall prevention strategies have been recognized as an urgent public health challenge. Various risk factors for falls and a number of effective interventions have been recognized. A substantial proportion of falls occur for people who are neither frail nor at high risk. Therefore, population-based approaches reaching the entire older population are needed.ObjectiveThe objective of the study presented is the development, implementation, and evaluation of a population-based intervention for the prevention of falls and fall-related injuries in a medium sized city in Germany.MethodsThe study is designed as a population-based approach. The intervention community is a mid sized city named Reutlingen in southern Germany with a population of 112,700 people. All community dwelling inhabitants 65 years and older are addressed. There are two main measures that are defined: (1) increase of overall physical activity, and (2) reduction of modifiable risk factors for falls such as deficits in strength and balance, home and environmental hazards, impaired vision, unsafe footwear, and improper use of assistive devices. The implementation strategies are developed in a participatory community planning process. These might include, for example, training of professionals and volunteers, improved availability of exercise classes, and education and raising awareness via newspaper, radio, or lectures.ResultsThe study starts in September 2010 and ends in December 2013. It is evaluated primarily by process evaluation as well as by telephone survey.ConclusionsPhysical activity as a key message entails multiple positive effects with benefits on a range of geriatric symptoms. The strength of the design is the development of implementation strategies in a participatory community planning. The problems that we anticipate are the dependency on the stakeholders’ willingness to participate, and the difficulty of evaluating population-based programs by hard end points.

Development and usefulness of a new questionnaire for assessing geriatric syndrome.

To assess the validity and reliability of a pre-visit questionnaire newly developed to identify geriatric conditions in older adults in an outpatient clinical setting. A new self-administered questionnaire consisting of 17 items was distributed to 277 patients or their caregivers visiting a memory clinic. The questionnaire was designed to address common symptoms associated with an increasing age based on yes/no responses with symptom-oriented questions avoiding the use of 'jargon'. The patients also underwent comprehensive geriatric assessments (CGAs), as well as tests of the Barthel index, Lawton instrumental activities of daily living, mini-mental state examination (MMSE), geriatric depression scale and vitality index to assess construct validity in a factor analysis. The differences in the prevalence of symptoms between the patients and their caregivers were also assessed. The factor analysis detected eight components that included symptoms referring to gait disturbance, numbness, urinary incontinence, insomnia or body weight loss and were significantly correlated with the measurements of the CGA. Cronbach's alpha coefficient for the internal consistency of the questionnaire was 0.729. The caregivers tended to respond to the questionnaire for older patients (81.6±5.5 vs. 76±9.7 years of age for patients with caregivers as responders versus patients as responders respectively, p<0.001) and those with lower MMSE scores (19.4±5.8 vs. 24.8±4.2 points, p<0.001). A higher prevalence of falls and episodes of delusions was observed among the patients with caregivers as responders. These results demonstrate that the current questionnaire is a valid and reliable instrument for use in clinical practice and that obtaining collateral source information is essential for assessing significant geriatric symptoms. Such information also provides clinicians with a guide to conducting more detailed evaluations of geriatric conditions and aids in the diagnostic process in older patients with multidisciplinary complications.

Multimorbidität bei älteren Rheumapatienten Teil 1

An appropriate treatment of elderly rheumatic patients implements comprehensive diagnostics and exclusion diagnostics of e.g. coronary heart disease, osteoporosis, renal failure, diabetes mellitus type 2 and thyroid gland dysfunction. Furthermore, the complex disease situation might require the integration of other faculties or might be a reason for inpatient treatment. The complexity in the treatment of multimorbid elderly patients suffering from rheumatism not only rises with increasing age but also constitutes a considerable challenge due to existing incapacities and preceding as well as currently performed immunosuppressive therapies. The necessary treatment framework is outlined from the perspective of rheumatologists and geriatricians. Typical geriatric symptoms, such as malnutrition, immobility and frailty might be enhanced if multimorbidity is simultaneously present.

Quality of life of elderly patients undergoing concomitant chemoradiation therapy for head and neck cancers, including assessment of geriatric parameters.

6100 Background: Data on the quality of life of older patients undergoing concomitant chemoradiation therapy (CCRT) for head and neck (H&amp;N) cancer are very scarce and no study has focused specifically on them. Furthermore, no study has assessed the contribution of geriatric symptoms to their quality of life. Methods: We prospectively assessed patients aged 65 and older undergoing curative intent CCRT for H&amp;N cancers, either alone or adjuvantly after surgery. We used the Quality of life-Radiation Therapy Instrument (QOL-RTI), with its H&amp;N module (Trotti et al., 1998). In addition we created a 12-items senior adult questionnaire (SAQ). Patients were assessed at baseline, at 4 weeks, at the end of treatment (EOT), and 2 months after EOT (recovery). Results: Fifty patients were enrolled. Median age was 69 years (range 65-87). Eighty-two percent of patients had locally advanced stage IV disease. Twenty-eight percent had prior surgery. All patients were treated with IMRT, 92% at 70 Gy. The most frequent chemotherapy regimen was cisplatin q3wks (58%), followed by weekly carboplatin (24%). Patients had on average 4 comorbidities (CIRS-G), 54% of them a grade 3 or 4 disease. Forty-four percent were independent in IADL, and 98% were ECOG PS 0 or 1. The baseline scores were QOL-RTI: 7.72 (SD 1.36), H&amp;N module 7.7 (SD 2.16), SAQ 8.21 (SD 1.54). At EOT, the scores were 6.22 (1.26), 4.59 (1.82), 7.38 (1.38) respectively, and at recovery 7.17 (1.25), 6.06 (1.66), 7.96 (1.16). The scores paralleled functional evolution, as 24% of patients had an ECOG PS 2 and 76% were IADL dependent at EOT; 16% ECOG 2-3 and 55% IADL dependent at recovery. Cronbach alphas for the 3 QOL measures were 0.88, 0.89, and 0.81, suggesting adequate internal consistency reliability. The SAQ was low-to-moderately correlated with the other two QOL measures (r=0.22 to 0.59) at different points of assessment. Conclusions: Older H&amp;N cancer patients experience significant impact of CCRT on their function, and on their quality of life on all three measures. Most recover after two months, although some may take longer. A geriatric module adds significant information to the general QOL-RTI and H&amp;N questionnaires.

Effects of Multimodal Nondrug Therapy on Dementia Symptoms and Need for Care in Nursing Home Residents with Degenerative Dementia: A Randomized‐Controlled Study with 6‐Month Follow‐Up

To determine the efficacy of multimodal, nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia. Randomized, controlled, longitudinal trial. Data were analyzed using multiple linear regression. Five German nursing homes. One hundred thirty-nine nursing home residents with primary degenerative dementia (Mini-Mental State Examination score < 24). The 6-month intervention comprised three components: motor stimulation, activities of daily living, and cognitive stimulation (MAKS). Groups of 10 patients led by two therapists participated in the standardized intervention for 2 hours, 6 days a week. The intervention was described in detail in an intervention manual. Adherence to the manual was high. Controls received treatment as usual. Overall geriatric symptoms were recorded using the Nurses' Observation Scale for Geriatric Patients, functional independence using the Barthel Index, and care time using the Resource Utilization in Dementia-Formal Care. Of 646 individuals screened, 146 were eligible, and 130 were included in the intention-to-treat analysis. At 6 months, results of the per-protocol analysis (n = 119) showed improvement in overall dementia symptoms in the MAKS group and no change in the control group (adjusted mean difference (AMD) = -6.8, 95% confidence interval (CI) = -10.3 to -3.3; P < .001, Cohen d = 0.66). This effect was greatest on the social behavior (AMD = -1.9, 95% CI = -2.9 to -0.8; P < .001; Cohen d = 0.54) and instrumental activity of daily living (IADL) (AMD = -1.4, 95% CI = -2.5 to -0.30; P = .01; Cohen d = 0.43) subscales. No effect was seen on functional independence or total care time. This 6-month nondrug multimodal intervention improved dementia symptoms in nursing home residents, especially in social behavior and IADL capabilities.

FI-J（Frailty Index for Japanese elderly）を用いた「虚弱」の予知因子に関する研究

To identify predictors for the onset of frailty in Japanese older adults using the Frailty Index for Japanese elderly people, we focused on subjects who participated in a routine health check. Of 357 older people (age, ≥70 years) who participated in a routine health check-up in Kusatsu, Japan in 2005, 334 individuals were identified as non-frail and were followed up 2 years later. A logistic regression model using the stepwise method was used to identify predictors for the onset of frailty, after controlling for age and gender. A total of 45 subjects (13.5%) had developed symptoms of frailty at follow-up. Even after multiple adjustment for controlling factors, a history of hypertension, hand grip strength, and albumin were significantly associated with frailty 2 years later (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.24-5.25; OR per 1 kg decrease, 1.08; 95% CI, 1.00-1.16; OR per 0.1 g/dl decrease, 1.22; 95% CI, 1.03-1.46, respectively). These results supported a definition of frailty which includes geriatric symptoms such as vascular disease and sarcopenia in Japanese older adults. Undernutrition was strongly associated with the onset of frailty and is an important target for prevention.