Higher Instrumental Activities Of Daily Living Research Articles

Implications of cognitive and daily living capabilities on early type 2 diabetes management: a preliminary case–control study

BackgroundAdherence to the transition from oral agents to insulin injections in Type 2 Diabetes Mellitus therapy varies among patients and is not uniformly successful, leading to suboptimal glycemic control in certain cases. This study aims to investigate the potential correlation between cognitive and daily functional capabilities and glycemic control in middle-aged to older adults (40–74 years old) diagnosed with Type 2 Diabetes Mellitus for less than 10 years, specifically those who have recently transitioned to insulin injections and have lower education levels within the context of a developing country.MethodsA case–control study was conducted with 30 poorly controlled diabetes mellitus (PCDM) patients recognized by HbA1c levels > 8% compared to 30 fairly controlled diabetes mellitus (FCDM) patients with HbA1c levels ≤ 8%. Basic Montreal Cognitive Assessment (MoCA-B) score of less than 27 was investigated as the exposure among two groups. Additionally, intra- and inter-battery correlations were assessed among MoCA-B and Instrumental Activities of Daily Living (IADL) domains using Pearson’s r.ResultsThe primary outcomes showed no crude difference between MoCA-B scores in the two diabetic groups (p-value = 0.82). However, after adjusting for age, education, and IADL scores, cognitive decline in the less-educated younger elderly with high IADL scores demonstrated an unexpected protective effect against PCDM (p-value < 0.0001, OR 95% CI = 0–0.26). In linear regression analysis among MoCA-B and IADL scores, “delayed recall” and “orientation” domains from MoCA-B, and “managing medications” and “using the phone” from IADL were negatively associated with HbA1c levels (p-values of < 0.01, 0.043, 0.015, and 0.023, respectively). Intra- and inter-battery correlations further illustrated a strong association between MoCA-B’s “orientation” with IADL’s “using the phone” and “managing medications” (p-values < 0.0001).ConclusionSuperior performance in certain cognitive domains is linked to better glycemic control. Still, since assessing cognitive domains may be timely in clinical routine, a potential rapid approach might be taken by assessing patients’ instrumental abilities to use cell phone or manage medications. Future studies including a larger sample size and a broader spectrum of psychosocial factors are needed to elaborate on our findings.

How Social Connection and Engagement Relate to Functional Limitations and Depressive Symptoms Outcomes After Stroke.

Stroke commonly leads to disability and depression. Social connection and engagement can be protective against functional decline and depression in the general population. We investigated the effects of social connection and engagement on trajectories of function and depressive symptoms in stroke. This is a longitudinal study, which included 898 participants with incident stroke from the HRS study (Health and Retirement Study) between 1998 and 2012. Multilevel modeling was used to examine associations of social connection and engagement with changes in functional limitations in instrumental activities of daily living (IADLs) and depressive symptoms over time. Models controlled for age, gender, education, and race/ethnicity. Moderation analyses examined whether high social connection and engagement reduced depressive symptoms for survivors with high IADL impairment. Social connection and engagement were generally associated with fewer IADL limitations and depressive symptoms at the time of stroke and after stroke. For example, participants who felt lonely and did not provide help to others before stroke had more IADL limitations. Prestroke volunteering was associated with less increase in IADL limitations with stroke and increase in having friends and providing help to others compared with one's prestroke status were associated with fewer IADL limitations after stroke. For depressive symptoms, participants who felt lonely and did not have a friend or partner before stroke had more depressive symptoms, and participants who had children residing nearby before stroke showed less increase in depressive symptoms. Moderation effects were not found for social connection and engagement on high IADL impairment and depressive symptoms. Findings suggest that social connection and engagement may reduce the negative physical and psychological outcomes of stroke, both at baseline and after stroke. Efforts to enhance social engagement and diminish loneliness may both enhance population well-being and enhance resilience and recovery from stroke and other illnesses.

Food insecurity and physical functioning in Boston area Puerto Rican older adults

AbstractObjective:Prior studies have found evidence of a relationship between food insecurity and functional limitations among older populations in the USA.Design:This is a longitudinal investigation of food security in relation to functional limitations, assessed as Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores.Setting:The Greater Boston, MA area.Participants:1461 Boston Puerto Rican Health study participants, predominantly (70·5 %) female and aged 57·1 years (sd ± 7·6) at baseline followed for 6·2 (sd ± 0·98) years.Results:In cross-sectional analysis at baseline, participants reporting severe food insecurity had greater functional limitations (higher ADL; β = 2·34; 95 % CI (1·48, 3·19)) and higher IADL (β = 1·17, 95 % CI (0·68, 1·65)) compared with food secure participants. In longitudinal linear mixed models, severely food insecure participants at baseline had greater functional limitations over 5 years, as assessed by ADL (β = 1·74; 95 % CI (0·95, 2·53); P &lt; 0·001) and IADL (β = 0·93, 95 % CI (0·48, 1·38)) compared with food secure participants. However, baseline food security did not significantly alter the 5-year trajectory in ADL (P-interaction between baseline food security and time for ADL and IADL = 0·41 and 0·47, respectively).Conclusions:In this cohort of Boston area Puerto Rican adults, those who are food insecure had consistently higher ADL and IADL scores over time, compared with those who are food secure. Baseline food security did not appear to alter the trajectory in ADL or IADL score.

Evaluation of the Clinical Effects of Insomnia and Excessive Daytime Sleepiness in Older Adults

Background: Insomnia and excessive daytime sleepiness (EDS) are common sleep disorders in older adults. Both are associated with numerous adverse health conditions. Objectives: The aim of our study is to evaluate the effects of insomnia and/or EDS on functionality, gait-balance functions, cognition, mood, falls and fear of falling (FoF) in older adults, to determine its importance in terms of nursing practice and to raise awareness on the subject. Methods: A cross-sectional study design was used. A total of 661 outpatients were included, aged ≥ 65 years. All patients underwent comprehensive geriatric assessment. Comorbidities, falls in the last year and drugs used were recorded. The Falls Efficacy Scale–International (FES-I) was used to determine and classify FoF. MMSE was applied to all patients for neurocognitive evaluation. Activities of daily living were assessed by Basic Activities of Daily Living Scale (BADL) and Instrumental Activities of Daily Living (IADL) scales. Insomnia Severity Index (ISI) with scores of 8 and over indicated insomnia. The Epworth Sleepiness Scale score of ≥ 11 points indicated EDS. Results: The mean age was 77.78 ± 7.73 years. The prevalences of EDS, insomnia, and EDS+insomnia were 5.45%, 50.38%, and 12.56%, respectively. As a result of bivariate and multivariate logistic regression analysis, there was a significant relationship between EDS+insomnia with moderate and high FoF (OR=2.24, 95% CI: 1.74 to 2.89), polypharmacy (OR=1.20, 95% CI: 1.09 to 1.30), BADL (OR=0.94, 95% CI: 0.93 to 0.96) ), IADL (OR=0.87, 95% CI: 0.84 to 0.91) and MMSE (OR=0.91, 95% CI: 0.86 to 0.98) (p&amp;lt;.05). Conclusions: There is a close relationship between EDS+insomnia and FoF, polypharmacy, activities of daily living and cognition in older adults.

Impact of radiotherapy on daily function among older adults living with advanced cancer (RT impact on function in advanced cancer)

BackgroundWhile radiation therapy (RT) improves function, and quality of life for patients with advanced cancers, patients frequently experience a period of acute toxicity during which functional abilities may decline. Little is understood about changes in functional outcomes after RT in older adults. This study aims to examine changes in daily function at 1 and 6 months following RT. MethodsWe reviewed the charts of 117 patients who underwent palliative RT on a prospective registry. Activities of daily living (ADL) and instrumental activities of daily living (IADL) scores ranging from 0 to 6 and 0–8, respectively, were collected at baseline, one-month, and six months post-RT. Patients were classified as low deficit for ADL/IADL if they had 0–1 deficits and high deficit if they had 2+ deficits. ResultsOne-hundred seventy RT courses were identified; 99 were evaluable at each time point. The median age was 67 years. At baseline, 29.5 and 29.9% of patients were classified as high-deficit for ADL and IADL functioning, respectively. At one-month, the majority of patients who were low-deficit at baseline remained so for both measures while approximately one quarter of high-deficit patients showed improvement. Most patients identified as low-deficit at one-month remained so at six-months, while no high-deficit patients improved from one- to six-months. Factors associated with high ADL and IADL deficits included: time (six months), increasing age, and Hispanic/other race. Compared to those with ECOG score of 3, patients with lower scores (0–2) had lower odds of high deficit. ConclusionADL and IADL tools may be useful in describing changes in daily function after palliative RT and in identifying groups of patients who may benefit from additional supportive geriatric care interventions.

Disability prevalence in midlife (aged 55\u201365 years): Cross-Country comparisons of gender differences and time trends

BackgroundPrior literature on disability has centered on disability prevalence among older adults ages 65 and older, providing only limited insight to potential gender differences in disability prevalence in mid-life. Midlife is, however, a critical time to be examined, as it is typically the time in the life course when large inequalities in physical health first emerge.MethodsUsing the Harmonized data files provided by the Gateway to Global Aging Data, we estimate disability prevalence of nationally representative adults ages 55–65 from 23 countries (N = 79,465). We examine gender differences in two disability indicators, limitations in instrumental activities of daily living (IADLs) and activities of daily living (ADLs) in two time periods, 2004/05 and 2014/15.ResultsThere are substantial cross-country variations in IADL and ADL disability prevalence in midlife. Within countries, we find that women have higher IADL prevalence than men in only one out of five countries. Similarly, for ADL prevalence, women have higher ADL prevalence than men in only one out of ten countries. Further, comparing disability prevalence in two time periods, we observe different country-specific time trends.ConclusionsIn the majority of mid and high-income countries, there is no significant gender difference in IADL and ADL prevalence, but there are few countries where women show higher prevalence of disability than men in mid-life. This finding calls for future research into what contributes to cross-country variations.

Who Wants to Be Alone? Antecedents of Motivation for Solitude in Adulthood

Objectives: As an inevitable part of daily life, solitude has both positive and negative consequences which are moderated by one’s motivation for solitude. Self-determined motivation correlates with few psychological risks, whereas other-determined motivation correlates with higher risks (e.g., loneliness, depression, lower well-being). However, little is known about the antecedents of different motivations for solitude. The purpose of this study is to investigate the antecedents of motivation for solitude in a sample with younger, middle-aged, and older adults. Methods: We recruited 468 participants from Amazon Mechanical Turk and Introduction to Psychology class (age range: 17-70, M = 30.7, 50.4 % females). Preference and motivation for solitude were measured with the Preference for Solitude Scale and Motivation for Solitude Scale-Short Form. Age, sex, marital status, education level, living arrangement, instrumental activities of daily living (IADLs), civic engagement, social contact frequency, introversion, and empathy were measured as antecedents. Results: People with older age, higher empathy for fictional characters, lower personal distress, higher introversion, and females tended to have higher general preference for solitude. People with higher empathy for fictional characters tended to have higher self-determined motivation. People with higher empathy for fictional characters, lower empathic concern, higher personal distress, higher IADLs, and higher introversion were more likely to have higher other-determined motivation. Discussion: A person with an introverted personality, functional limitation, more negative empathic reactions towards others are likely to have maladaptive motivation for solitude and may need intervention. Future research should further investigate other antecedents for self-determined motivation.

Behavioral Factors Related to the Incidence of Frailty in Older Adults.

Frailty is a widely prevalent geriatric condition whereby individuals experience age-related functional declines. This study aimed to identify behavioral factors related to the incidence of frailty in older adults. Participants were 2631 older adults (average age: 71) without physical frailty at a baseline assessment in 2011–2012 who took part in a second-wave assessment in 2015–2016. Physical frailty was defined as having limitations in at least three of the following domains: weight loss, low physical activity, exhaustion, slow walking speed, and muscle weakness. Participants completed a 16-item questionnaire examining cognitive, social, and productive activity as well as instrumental activities of daily living (IADL) as varying dimensions of lifestyle activity. During the follow-up period, 172 participants (6.5%) converted from nonfrail to frail. Logistic regression showed that the odds ratios (ORs) for conversion were significantly lower in the participants who had high IADL scores (OR: 0.78; 95% confidence interval (CI): 0.64–0.96), cognitive activity (OR: 0.74; 95% CI: 0.62–0.89), social activity (OR: 0.52; 95% CI: 0.43–0.63), and total activity (OR: 0.81; 95% CI: 0.75–0.87). There was no significant association between frailty and productive activity. Health care providers should recommend an active lifestyle to prevent frailty in older adults.

Impact of geriatric vulnerability on outcomes of older patients in allogeneic hematopoietic cell transplantation.

7017 Background: Older patients are at increased risk for complications and death following allogeneic hematopoietic cell transplantation (allo-HCT). Traditional transplant-specific prognostic indices such as hematopoietic cell transplant comorbidity index (HCT-CI) may not capture all underlying geriatric vulnerabilities, and in-depth evaluation by a geriatrician prior to transplant may not always be available. We hypothesize that routine pre-transplant assessments by interdisciplinary clinical providers may help uncover additional geriatric deficits. Methods: Using an institutional database of 457 adults age 60 years and older (range 60-78.7) who underwent first allo-HCT for hematological malignancies from 2010 to 2017, we retrospectively examined the prevalence and the prognostic impact of pre-transplant geriatric deficits identified by interdisciplinary clinical providers including geriatric domains of functional activity, cognition, medication, nutrition, mobility, and routine laboratory tests. Results: With a median follow-up of 37 months for survivors, the 3-year probability of overall survival (OS) was 50% (95% CI 45-55). The 2-year cumulative incidence of non-relapse mortality (NRM) was 25% (95% CI 22-28). Among pre-transplant geriatric variables, we found that impairment in instrumental activities of daily living (IADL) was associated with increased NRM and inferior PFS and OS. In multivariate analyses, mismatched donor, age-adjusted HCT-CI &gt; 4 (aaHCTCI), and IADL impairment were associated with NRM, while high/very high disease risk index (DRI), IADL impairment, and positive CMV status were associated with OS. The combination of IADL impairment with either aaHCTCI or DRI readily stratifies NRM and OS, respectively. Conclusions: Our findings establish a simple assessment tool to risk stratify older patients prior to allo-HCT using IADL and aaHCTCI and DRI. These results may provide an entry point for prospective, interventional trials to reduce NRM and toxicities for older allo-HCT patients.

A Simple Geriatric Vulnerability Index for Older Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Older patients are at increased risk for complications and death following allogeneic hematopoietic cell transplantation (allo-HCT). Traditional transplant-specific prognostic indices such as hematopoietic cell transplant comorbidity index (HCT-CI) may not capture all underlying geriatric vulnerabilities, and in-depth evaluation by a geriatrician prior to transplant may not always be available. We hypothesize that routine pre-transplant assessments by interdisciplinary clinical providers including advanced practice providers, nursing staff, physical therapists, occupational therapists, and dietitians, as well as common laboratory tests, may uncover additional geriatric deficits.Using an institutional database and the electronic medical records of 406 adults age 60 years and older (range 60-78.7) who underwent first allo-HCT for hematological malignancies from 2010 to 2016, we examined the prevalence and the prognostic impact of pre-transplant geriatric deficits identified by interdisciplinary clinical providers including geriatric domains of functional activity, cognition, medication, nutrition, and mobility (Table 1), and by routine laboratory tests. With a median follow-up of 39 months for survivors, the 3-year probability of overall survival (OS) and progression-free survival was 47% (95% CI 42-53) and 40% (95% CI 35-45), respectively. The 2-year cumulative incidence of non-relapse mortality (NRM) was 26% (95% CI 22-29). Among pre-transplant geriatric and laboratory variables, we found that impairment in instrumental activities of daily living (IADL) and pre-transplant ferritin level ≥1200 was independently associated with increased NRM and inferior OS. In the multivariate analysis, HCT-CI ≥3, IADL impairment, ferritin level ≥1200, and Karnofsky Performance Scale (KPS) <90 are predictive of NRM (Table 2). Similarly, IADL impairment, ferritin level ≥1200, and high/very high modified disease risk index predict OS (Table 2).Most importantly, the combination of either IADL impairment or ferritin ≥1200 with HCT-CI further stratifies NRM and OS into distinct risk categories, including a group of highly vulnerable, high risk patients with high HCT-CI (≥3) plus IADL impairment and/or ferritin level ≥1200 (Figure 1). Detailed examination of non-relapse death among all vulnerable patients (≥2 risk factors) reveals a higher proportion of death from organ toxicities than patients with zero or 1 risk factor. Our findings establish a rapid and simple assessment tool to risk stratify older patients prior to allo-HCT. While requiring validation, the geriatric vulnerability index can be easily completed and integrated into outpatient clinics and the electronic medical record. It may also provide an entry point for prospective, interventional trials aimed at reducing non-relapse mortality and toxicities, and at improving survival and quality of life of older allo-HCT patients. [Display omitted] DisclosuresPerales:Takeda: Other: Personal fees; Merck: Other: Personal fees; Incyte: Membership on an entity's Board of Directors or advisory committees, Other: Personal fees and Clinical trial support; Abbvie: Other: Personal fees; Novartis: Other: Personal fees. Sauter:Juno Therapeutics: Consultancy, Research Funding; Sanofi-Genzyme: Consultancy, Research Funding; Spectrum Pharmaceuticals: Consultancy; Novartis: Consultancy; Precision Biosciences: Consultancy; Kite: Consultancy.

Docetaxel plus gemcitabine versus gemcitabine in elderly patients with advanced non-small cell lung cancer and use of a geriatric assessment: Lessons from a prematurely closed Hellenic Oncology Research Group randomized phase III study.

To compare first-line treatment with docetaxel plus gemcitabine (DG) versus gemcitabine (G) in elderly patients with advanced/metastatic non-small-cell lung cancer (NSCLC). Chemotherapy-naïve patients with inoperable stage IIIB/IV NSCLC, ≥70years, with an ECOG performance status (PS) of 0-2 were enrolled. Patients were stratified by PS and disease stage and randomized to either DG (docetaxel 30mg/m2 plus gemcitabine 900mg/m2 i.v.) or G (gemcitabine 1200mg/m2 i.v.) on days 1 and 8, every 3weeks. The study's primary end-point was overall survival (OS). In this prematurely closed study, 106 patients with a median age of 75years (range, 70-92) were enrolled (DG: n=54; G: n=52); 77 (73%) had stage IV disease and 18 (17%) a PS of 2. There was no difference in terms of median OS (14.6 vs 12.2months; p=0.121), progression-free survival (PFS) (3.4 vs 2.6months; p=0.757) and overall response rate (26.0% vs 15.4%; p=0.233) between DG and G arm, respectively. Patients with an Instrumental Activities of Daily Living (IADL) score<7 had significantly lower median OS (7.6 vs 15.4months; p=0.002) and median PFS (1.7 vs 4.4months; p=0.009) than patients with higher IADL score. The regimens were well tolerated with no significant difference in severe toxicity. DG and G demonstrated comparable efficacy in elderly patients with NSCLC and high IADL score was correlated with superior clinical outcome.

Functional Decline in Older Patients With Cancer Receiving First-Line Chemotherapy

To determine factors associated with early functional decline during first-line chemotherapy in older patients. Patients age ≥ 70 years receiving first-line chemotherapy for cancer were prospectively considered for inclusion across 12 centers in France. Functional decline was defined as a decrease of ≥ 0.5 points on the Activities of Daily Living (ADL) scale between the beginning of chemotherapy and the second cycle. Factors associated with functional decline were sought from pretreatment abbreviated comprehensive geriatric assessment, including ADL, Instrumental ADL (IADL), Mini-Nutritional Assessment (MNA), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS15), and Timed Get Up and Go (GUG) test, and from comorbidities (Cumulative Illness Rating Scale-Geriatrics), MAX2 index, and baseline biologic and clinical information. Of 364 included patients, 50 experienced functional decline (16.7%; median, 0.5 points). Abnormal preadmission performance status, IADL, GDS15, MMSE, GUG, and MNA were associated with increased likelihood of functional decline (univariate analysis). In the multivariate model adjusted for baseline ADL and MAX2 index, high baseline GDS (odds ratio [OR], 2.16; 95% CI, 1.09 to 4.30; P = .03) and low IADL scores (OR, 2.87; 95% CI, 1.06 to 7.79; P = .04) were independently associated with increased risk of functional decline. Our results outline associations between baseline depression, instrumental dependencies, and early functional decline during chemotherapy for older patients. ADL should be sequentially evaluated early during treatment. Baseline evaluation of GDS15 and IADL may be proposed to anticipate this event.

Associations of instrumental activities of daily living and handgrip strength with oral self‐care among home‐dwelling elderly 75+

To study the associations of instrumental activities of daily living (IADL) and the handgrip strength with oral self-care among dentate home-dwelling elderly people in Finland. The study analysed data for 168 dentate participants (mean age 80.6 years) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study. Each participant received a clinical oral examination and structured interview in 2004-2005. Functional status was assessed using the IADL scale and handgrip strength was measured using handheld dynamometry. Study participants with high IADL (scores 7-8) had odds ratios (ORs) for brushing their teeth at least twice a day of 2.7 [95% confidence intervals (CI) 1.1-6.8], for using toothpaste at least twice a day of 2.0 (CI 0.8-5.2) and for having good oral hygiene of 2.8 (CI 1.0-8.3) when compared with participants with low IADL (scores ≤6). Participants in the upper tertiles of the handgrip strength had ORs for brushing the teeth at least twice a day of 0.9 (CI 0.4-1.9), for using the toothpaste at least twice a day of 0.9 (CI 0.4-1.8) and for good oral hygiene of 1.1 (CI 0.5-2.4) in comparison with the study subjects in the lowest tertile of handgrip strength. The results of this study suggest that the functional status, measured by means of the IADL scale, but not handgrip strength, is an important determinant of oral self-care among the home-dwelling elderly.

Rituximab and Reduced Dose CHOP (R-mini-CHOP) for Patients Over 80 Years with Diffuse Large B-Cell Lymphoma (DLBCL) – Groupe d'Etude Des Lymphomes De l'Adulte (GELA) Study LNH03-7B

AbstractAbstract 853 Introduction:Half of the cases of DLBCL occurs in patients over 65 years but very few data are available for patients over 80 years. These older patients however seem to respond as younger patients when treatment can be tolerated. In the aim to evaluate tolerance and efficacy of a reduced dosage chemotherapy regimen associated with rituximab in this population, the GELA initiated in 2005 a prospective, multicenter, phase II study. Patients and methods:Patients older than 80 years with untreated CD20+ DLBCL, Ann Arbor stage I with bulky mass to IV and a performance status (PS) of 0 to 2 were eligible. Patients were treated with mini-CHOP chemotherapy (cyclophosphamide: 400 mg/m2 D1; doxorubicine: 25 mg/m2 D1; vincristine: 1 mg total dose D1 and prednisolone 40 mg/m2 by oral route from D1 to D5) plus rituximab (375 mg/m2 D1) every 21 days for 6 cycles. GCSF was optional. The primary objective was to evaluate the efficacy of R-mini-CHOP as measured by the overall survival. Secondary endpoints were response rate, progression free survival (PFS), event-free survival (EFS), disease-free survival (DFS) for complete responders and toxicities. Survival results are presented on an intend-to-treat basis. Response to treatment was evaluated according to 1999 Cheson criteria. Results:One-hundred-and-fifty-patients (51 male, 99 female) were included in 38 centers of the GELA. The median age was 84 years (range 80–95). Seventy-five percent of patients had a stage III/IV. LDH level was elevated in 69% of patients. Age-adjusted (aa) IPI was 2–3 in 66% of patients. One-hundred-twenty-nine patients completed the first three cycles and 108 received the whole regimen. The Dose-Intensity for patients who completed the three first cycle was 100% and 96.8% for doxorubicine and cyclophosphamide respectively. Thirty-six percent of patient received at least one injection of GCSF. The overall response rate was 74%, including 40% of complete response and 23% of unconfirmed complete response. At the time of this analysis, in July 2010, the median follow-up time was 20 months. The 2-year overall survival was 58.9% [95% CI: 49.3–67.2%]. The two-year estimated PFS, EFS and DFS were 47.4% [95% CI: 38.1–56.2%], 44.8% [95% CI : 35.7–53.6%] and 56.6% [95% CI : 49.3–67.2%] respectively. Hematological toxicity was the most common side effect. Grade 3–4 neutropenia was observed in 39% of the patients and grade 3–4 thrombocytopenia in 7%. Eleven patients (7%) experienced at least one episode of febrile neutropenia. Overall patients experienced a median of 4 nights of hospitalization during treatment phase (range 0–46).Thirty patients died during the treatment evenly distributed between treatment toxicity (6.7%) lymphoma (6.7%) and intercurrent causes (6.7%). In a univariate analysis, PS 0 or 1, aaIPI 0 or 1, number of extra-nodal sites <2, albumin level >35g/l, mass <10cm and a high IADL (Instrumental activities of daily living) score appear to be highly predictive of a prolonged survival. In a multivariate analysis a PS equal to 0 or 1 and an albumin level >35 g/l were significantly associated with a longer survival. Conclusion:In patients over 80 years with DLBCL and a good performance status, immunochemotherapy with R-mini-CHOP appears to be safe and effective, indicating that a substantial proportion of very old patients could indeed be cured. This regimen could be considered as a platform for the introduction of new drugs in the first line treatment of this population. Disclosures:No relevant conflicts of interest to declare.

Docetaxel (D) plus gemcitabine (G) compared with G in elderly patients with advanced non-small cell lung cancer (NSCLC): Preliminary results of a randomized phase III Hellenic Oncology Research Group trial.

7605 Background: To compare the docetaxel/gemcitabine (DG) combination versus gemcitabine (G) as first-line treatment of elderly patients with advanced non-small cell lung cancer (NSCLC). Methods: Chemotherapy-naïve patients >70y old with stage IIIB/IV NSCLC and performance status (PS) 0-2 were stratified according to stage and PS and randomized to either D 30 mg/m2 plus G 900mg/m2 (days 1 and 8) or G 1,200mg/m2 (days 1 and 8) every 21 days. A comprehensive geriatric assessment (CGA) was also performed. Results: From 3/2006 to 12/2009, 94 patients (DG n=49; G n=45) were enrolled onto the study. Median age was 74 (range, 70 to 84) and 78 years (range, 70 to 92) in the DG and D arm respectively (p<0.001). Sixty-five (69%) patients had stage IV disease and 16 (17%) a PS of 2. With a median follow-up of 10.27 months, there was no difference in terms of median OS (15.9 vs. 12.2 months; p=0.072), median TTP (3.17 vs. 2.53 months; p=0.227) and ORR (28.3% vs. 11.6%; p=0.066). Patients with an Instrumental Activities of Daily Living (IADL) score <7 had a significantly lower median OS (10.13 vs. 17.3 months; p=0.025) and median TTP (2.13 vs. 4.7 months; p=0.023) than patients with an IALD score of 7-8. The most common toxicity was grade 3/4 neutropenia (8.1% and 6.6% for DG and G, respectively; p=0.545). Conclusions: The DG regimen did not improve OS and TTP in elderly patients with NSCLC; however, patients with high IADL score have a significantly better clinical outcome than patients with low IADL score. No significant financial relationships to disclose.

Influence of comorbidity and cognitive status on instrumental activities of daily living in amnestic mild cognitive impairment: results from the ReGAl project

To investigate whether amnestic mild cognitive impairment (aMCI) is characterised by restriction in instrumental activities of daily living (IADL). Further, to examine the role of comorbidity and cognitive performance on IADL changes in aMCI subjects. The study included 132 subjects with aMCI and 249 subjects with no cognitive impairment (NCI), consecutively enrolled as outpatients in a multicentric Italian clinical-based study, the ReGAl Project. All subjects underwent a comprehensive evaluation including clinical examination, laboratory screening, neuroimaging and cognitive and behavioral assessments. Functional status was evaluated by the Lawton's Instrumental Activities of Daily Living (IADL) scale. Comorbidity was evaluated by the Cumulative Illness Rating Scale (CIRS). Cognitive evaluation included tests assessing episodic memory, language, attention/executive functioning and praxis, as well as the the Mini-Mental State Examination (MMSE) as a measure of global cognition. Subjects with aMCI had higher IADL changes than NCI. Among IADL items, aMCI subjects showed a significant impairment in shopping, taking drugs, and handling economy; however also NCI had minor IADL changes regarding cooking, washing and cleaning. IADL restriction in aMCI subjects was significantly associated with cognitive performance, mainly related to executive functioning, but not with comorbidity. On the contrary, in NCI sensory impairment accounts for slight IADL changes. In aMCI subjects a mild degree of cognitive deterioration has a stronger impact on IADL than somatic comorbidity. Current diagnostic criteria for MCI should include a mild impairment in IADL.

Behavior-Based Interventions to Enhance Cognitive Functioning and Independence in Older Adults

THE CURRENT AND PROJECTED FINANCIAL AND EMOtional burden of cognitive impairment to individuals and their families, as well as the financial burden to society, are staggering. There are 24 million individuals with dementia in the world, and 4.6 million new cases are diagnosed annually. The combined worldwide prevalence of age-associated cognitive impairment and cognitive disorders is predicted to reach 84 million individuals affected by 2040. In 2000, more than 4 million US adults had Alzheimer disease; by 2050, this will increase to 13 million. Furthermore, declines in specific cognitive domains (eg, memory, executive functions) are predictive of deficits in the performance of instrumental activities of daily living (IADL) in older adults, an outcome that seriously threatens the ability of the aging population to live independently. A growing number of studies of various pharmacologically based interventions hold promise for the postponement or limitation of cognitive decline and its consequences, and new drugs are under development. However, only modest success has been achieved to date, with available drugs producing generally low to moderate improvements in cognition and IADL, effects that are further limited by drug adverse effects and nonadherence. Other biological treatments formerly believed to be promising, such as hormone (estrogen) therapy, vitamin E, and nonsteroidal anti-inflammatory drugs, have proven to be neutral or detrimental. Less common than the studies of biological treatments are investigations of nonpharmacological interventions, such as memory training, other cognitive training, or increased physical activity. Although such interventions are recommended by physicians for general cognitive protection, supporting evidence for their efficacy is limited. Welldesigned randomized clinical trials are needed to identify additional nonbiological mechanisms that may prevent, reduce, or delay cognitive decline in older adults. The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, reported by Willis and colleagues in this issue of JAMA, represents an important step in this direction. The ACTIVE study is, to date, the only long-term randomized controlled trial in which the effects of cognitive enhancement interventions were assessed after 5 years for both cognitive and functional status. The design of the ACTIVE study and its results provide insights into the potential promise of behavior-based interventions to improve cognition, as well as their consequences for improving functional status. The ACTIVE study also underscores the complexities and challenges inherent in this type of research, the difficulty in interpreting the results, and the problems associated with applying these results to clinical care. ACTIVE is a well-designed study in which a large community-based cohort of 2802 participants was enrolled and followed up for 5 years. The retention rate (67% at 5 years) is comparable with other trials with similar populations of older adults. The ACTIVE investigators found that a relatively short (10-session) training intervention for specific cognitive functions (memory, reasoning, and speed of processing) produced immediate improvements in these domains compared with a nonintervention control group, replicating prior research findings. More important, these cognitive improvements were sustained after 5 years of follow-up, although none of these improvements had effects beyond the specific cognitive domains of the intervention, either immediately or after the 5-year follow-up period. Also, results addressing the investigators’ primary hypothesis— that cognitive training would delay declines in functional status measured by self-reported IADL scores and performance assessments—were less clear and less compelling. Only participants who underwent reasoning training (verbal episodic) self-reported significantly higher IADL functioning compared with the control group. The remaining 2 intervention groups had higher, but nonsignificant, selfreported IADL scores than the control group. None of the original groups (intent-to-treat cohort) demonstrated significant improvements in the performance-based measures.