Life In Older Patients Research Articles

Improved Function and Quality of Life for Older Patients Receiving Radiotherapy, Part II

Improved Function and Quality of Life for Older Patients Receiving Radiotherapy, Part II

Assessment of Quality of Life in Chronic Renal Disease Patients Undergoing Hemodialysis at Public Hospital, Lahore

Quality of life of chronic renal disease patients is affected by several factors, depending on stage of disease, type of treatment and sociodemographic factors Objective: To assess the quality of life undergoing hemodialysis patients Methods: A cross-sectional study was carried out at Sir Ganga Ram Hospital, Lahore during February to May-2019. Patients suffering from chronic renal disease were included in the study and uncooperative patients were excluded in the study. Total 100 samples of chronic renal disease patients were selected through non-probability convenient sampling technique. Patients were assessed through pre-tested questionnaire. SPSS version 21.0 was used for data analysis Results: According to results 39% patients reported that they were suffering from depression, 47% patients of chronic renal disease were unemployed, 28% patients were malnourished and 98% patients were having 3 or more dialysis sessions per week. Also only 26% patients thought that quality of life of older patients is better while 74% considered it poor. Only 77% patients thought that quality of life of middle aged patients is better while 23% patients considered that quality of life of middle aged patients was poor. 42% patients thought that quality of life of young aged patients is better while 58%considered it poor. Conclusions: Malnutrition, unemployment and hypertension are the factors affecting the quality of life in patients undergoing hemodialysis in this study. The quality of life of middle aged patients was comparatively better.

Determining clinically important differences in health-related quality of life in older patients with cancer undergoing chemotherapy or surgery.

Using the EORTC Global Health Status (GHS) scale, we aimed to determine minimal clinically important differences (MCID) in health-related quality of life (HRQOL) changes for older cancer patients with a geriatric risk profile, as defined by the geriatric 8 (G8) health screening tool, undergoing treatment. Simultaneously, we assessed baseline patient characteristics prognostic for HRQOL changes. Our analysis included 1424 (G8 ≤ 14) older patients with cancer scheduled to receive chemotherapy (n = 683) or surgery (n = 741). Anchor-based methods, linking the GHS score to clinical indicators, were used to determine MCID between baseline and follow-up at 3months. A threshold of 0.2 standard deviation (SD) was used to exclude MCID estimates too small for interpretation. Logistic regressions analysed baseline patient characteristics prognostic for HRQOL changes. The 15-item Geriatric Depression Scale (GDS15), Visual Analogue Scale (VAS) for Fatigue and ECOG Performance Status (PS) were selected as clinical anchors. In the surgery group, MCID estimates for improvement and deterioration were ECOG PS (5*, 11*), GDS15 (5*, 2) and VAS Fatigue (3, 9*). In the chemotherapy group, MCID estimates for improvement and deterioration were ECOG PS (8*, 7*), GDS15 (5, 4) and VAS Fatigue (5, 5*). Estimates with * were > 0.2 SD threshold. Patients experiencing pain or malnutrition (surgery group) or fatigue (chemotherapy group) at baseline showed a significantly stable or improved HRQOL (p < 0.05) after their treatment. The reported MCID for improvement and deterioration depended on the anchor used and treatment received. The estimates can be used to evaluate significant changes in HRQOL and to determine sample sizes in clinical trials.

Bifactor model of the CASP-12\u2019s general factor for measuring quality of life in older patients

Bifactor model of the CASP-12\u2019s general factor for measuring quality of life in older patients

Long-term quality of life in older patients with HPV-related oropharyngeal cancer.

We explored if age affects quality of life (QOL) in survivors of locally advanced human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC). In a cross-sectional survey of 185 patients, at least 12 months from radiation, we evaluated generic (EuroQOL-5D questionnaire [EQ-5D]) and head and neck specific (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35-questions [EORTC-QLQ-H&N35]) QOL questionnaires and compared differences between younger (<65) and older (≥65) patients. The median age was 57.0 years (range 25-77 years), and 31 patients (16.8%) were ≥65 years old. There was no significant difference in EQ-5D global QOL scores by age (P = .53). Patients ≥65 years reported more immobility (P < .01), problems with social eating (P < .0001), and coughing (P < .01). Patients ≥65 years were not more likely to ever require a gastrostomy (P = .24) but were more likely to remain gastrostomy-dependent at the time of the survey (P = .02). Despite similar generic QOL, older survivors may have more mobility problems and issues with social eating compared with younger survivors deserving of further evaluation.

Predictors of quality of life among older patients with cancer during treatment.

Improving quality of life in older patients with cancer has become an important goal of healthcare providers. The purpose of this study was to identify the predictors of quality of life among older patients with cancer, aged 60 years and over during the treatment period. A descriptive correlational study was conducted among 150 patients. The Functional Assessment of Cancer Therapy Scale, Herth Hope Index and Hospital Anxiety and Depression Scale were used. The results showed that the total quality-of-life mean score was 58.50 (SD = 7.44), indicating low overall quality of life. The social-family well-being subscale had the highest mean (20.50, SD = 3.79) among all subscales of quality of life, while the emotional well-being subscale had the lowest mean (8.06, SD = 4.23). Hope and educational level had statistically significant positive relationships with all subscales of quality of life. However, anxiety was associated negatively with physical, social-family and functional well-being subscales, but positively with the emotional well-being subscale. Anxiety, income, marital status, health insurance, duration of treatment, educational level, gender and hope were identified as predictors of quality-of-life subscales. The results could help to develop specific programmes that may improve quality of life among older patients with cancer during treatment.

The impact of financial toxicity on quality of life in older patients with cancer: Baseline data from the University of Rochester NCI Community Oncology Research Program (NCORP).

87 Background: Financial toxicity (FT), or the stress and strain patients (pts) experience as a result of paying for cancer care, can have profound negative impacts on pts’ overall quality of life (QoL). This study examined associations of FT with anxiety, depression, and QoL in older pts with advanced cancer. Methods: This is a secondary analysis of baseline data from a Geriatric Assessment intervention study conducted by UR NCORP across 31 practice sites (PI: Mohile). Pts were categorized as experiencing FT if they reported any one of the following: delaying medications due to cost, insufficient income in a typical month for food and housing, or insufficient income in a typical month for other basic needs. Pts also completed the Generalized Anxiety Disorder-7 (GAD7, score 0-21) to evaluate anxiety, the Geriatric Depression Scale (GDS, score 0-15) to assess depression, and the Functional Assessment of Cancer Therapy- Generation (FACT-G, score 0-108), to measure overall QoL. Associations of FT with anxiety, depression, and QoL were assessed in separate multivariate linear regression models controlling for covariates at p &lt; 0.1. Results: Among 542 pts (mean age 77; range 70-96, 49% female), 18% (98 pts) experienced FT. In separate regression analysis, FT was significantly associated with all 3 outcome measures. On average, pts experiencing FT scored 1.76 higher (p &lt; 0.01) on the GAD7 (indicating greater anxiety severity), 0.76 points higher (p = 0.02) on the GDS (indicating greater depression severity), and 5.16 points lower (p &lt; 0.01) on the FACT-G (indicating lower QoL). Conclusions: Older pts with advanced cancer who experience income and cost-related barriers to quality cancer care reported worse anxiety, depression, and QoL than those without FT. Given the association between FT and these outcomes, these 3 FT questions may help identify vulnerable older pts and allow providers to intervene sooner and thereby enhance the quality of care pts receive.

Efficacy of Comprehensive Rehabilitation on Quality of Life in Elderly Head and Neck Cancer Patients after Radiotherapy

Objective: To evaluate the effects of comprehensive rehabilitation on quality of life in elderly head and neck cancer patients after radiotherapy. Methods: Sixty-four subjects were randomly assigned to the rehabilitation group (RG) and control group (CG). Both groups were given routine healthy counseling, but RG was additionally provided with comprehensive rehabilitation. The depressive status, nutritional status and quality of life were assessed at the end of and three months after RT. Results: After comprehensive rehabilitation for three months, the patients in RG exhibited lower GDS, MNA-SF and higher QLQ-c30 score compared with those before rehabilitation and those in CG (P<0.05). The score of MNA-SF in CG at three months after RT was significantly better than those at the end of RT (P<0.05). Conclusion: The comprehensive rehabilitation can improve the depressive status, nutritional status and quality of life in older patients with head and neck cancer after radiotherapy.

Geriatric CO-mAnagement for Cardiology patients in the Hospital (G-COACH): study protocol of a prospective before-after effectiveness-implementation study

IntroductionAlthough the majority of older patients admitted to a cardiology unit present with at least one geriatric syndrome, guidelines on managing heart disease often do not consider the complex needs...

Tibial Nerve and Sacral Neuromodulation in the Elderly Patient

This article aims to review sacral and tibial neuromodulation outcomes in elderly patients. Safety and efficacy of these two neuromodulatory treatments for both urinary and fecal indications are addressed. Recent data assessing sacral neuromodulation (SNM) for refractory overactive bladder and urge urinary incontinence (UUI) demonstrates that older patients have similar outcomes and complication rates when compared to the general population. For both urinary and fecal indications, SNM has been shown to significantly increase quality of life in older patients. Age has additionally not been a factor affecting tibial nerve stimulation outcomes. Limited data specifically addresses use of tibial and sacral neuromodulation in elderly patients. Available studies suggest that both treatment options are safe and effective in the older population for urinary and fecal indications, although further study is necessary.

Association of higher IL-6, TNF-alpha and IFN-gamma levels with health-related quality of life in older patients

Rationale: The pro-inflammatory cytokines interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) have been described as markers of inflammageing. Chronic inflammation has been associated with decreased quality of life in cancer [1]. Therefore, aim of this study was to measure pro-inflammatory cytokine concentrations of IL-6, TNF-α and IFN-γ in old inpatients and healthy old controls and evaluate their association with health-related quality of life (HRQOL).

Fit for Dialysis: a qualitative exploration of the impact of a research-based film for the promotion of exercise in hemodialysis

BackgroundExercise improves functional outcomes and quality of life of older patients with end-stage renal disease undergoing hemodialysis. Yet exercise is not promoted as part of routine care. Health care providers and family carers rarely provide encouragement for patients to exercise, and the majority of older patients remain largely inactive. There is thus the need for a shift in the culture of hemodialysis care towards the promotion of exercise for wellness, including expectations of exercise participation by older patients, and encouragement by health care providers and family carers. Film-based educational initiatives hold promise to effect cultures of best practice, but have yet to be utilized in this population.MethodsWe developed a research-based film, Fit for Dialysis, to promote exercise for wellness in hemodialysis care. Using a qualitative approach, we evaluated the effects that resulted from engagement with this film (e.g. knowledge/attitudes regarding the importance of exercise-based principles of wellness) as well as the generative mechanisms of these effects (e.g. realism, aesthetics). We also explored the factors related to patients, family carers, and health care providers that influenced engagement with the film, and the successful uptake of the key messages of Fit for Dialysis. We conducted qualitative interviews with 10 patients, 10 health care providers, and 10 family carers. Data were analyzed using thematic analysis.ResultsThe film was perceived to be effective in increasing patients’, family carers’ and health care providers’ understanding of the importance of exercise and its benefits, motivating patients to exercise, and in increasing encouragement by family carers and health care providers of patient exercise. Realism (e.g. character identification) and aesthetic qualities of the film (e.g. dialogue) were identified as central generative mechanisms.ConclusionsFit for Dialysis is well-positioned to optimize the health and wellbeing of older adults undergoing hemodialysis.Trial registrationNCT02754271 (ClinicalTrials.gov), retroactively registered on April 21, 2016.

Effectiveness of multidisciplinary nutritional support in older hospitalised patients: A systematic review and meta-analyses

Malnutrition is common in older hospitalised patients. As the aetiology is multifactorial, nutritional care should involve a multidisciplinary team. However, the knowledge of the effectiveness of this strategy is limited. This systematic review aims at investigating the effectiveness of multidisciplinary nutritional support on mortality, readmissions and quality of life (QoL) in patients aged 65 years and above during hospitalisation and after discharge compared to usual practise. We conducted a series of systematic literature search from 2013 to 2017, with additional studies hand-searched from reference lists of retrieved publications. Eligible studies were controlled trials with a multidisciplinary nutritional intervention during hospitalisation and after discharge in older (65+) patients. A intervention by more than one profession incorporating a nutritional component was defined as "Multidisciplinary". The nutritional intervention included use of oral nutritional supplements (ONS), improved nutritional care, and/or dietary counselling. For quality assessment of studies, "Cochrane Collaboration's tool for assessing risk of bias" was used. Conduction of meta-analyses were by combining data from homogenous trials. The search resulted in five studies fulfilling the inclusion criteria, but varied in quality and type of interventions used. 598 patients were included. Meta-analyses found improved QoL (MD 0.13 (0.02, 0.23), P=0.01) and indicated tendencies towards lower mortality (OR 0.50 (0.22, 1.14), P=0.10), in the intervention group vs. control group. Meta-analysis showed no difference between intervention and control group regarding readmissions during intervention (OR 1.04 (0.40, 2.70)) or at a 26 weeks follow-up (OR 0.84 (0.18, 3.82)) Although a small number of studies and a relatively small sample size, a suggestion is that provision of multidisciplinary nutritional support may have a positive effect on mortality and improves quality of life in older patients. There is a need for more high-quality studies including multidisciplinary nutritional support to verify these findings. Study registration in PROSPERO is no. CRD42016047997.

Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial.

To assess the cost-utility of adding a disease management program (DMP) delivered by geriatric day hospital (GDH) for older patients with heart failure (HF) after hospital discharge. 117 older HF patients discharged by a geriatric service were randomly assigned to DMP (n = 59) and usual care (UC) (n = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using EuroQol (EQ-5D-3L). The cost-effectiveness analysis used the package ICEinfer in R 2.13.0. The mean age was 85years, and 73% of the patients were women. The mean values of QALYs after 12months were - 0.083 in DMP and - 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was €38,274 and €25,390 from health-care or societal perspective, respectively. An investment of €44,000/QALY (Spanish Health System Threshold) showed a 91 and 85% of probability to be cost-effective from health-care and societal perspectives. The intervention was moderately cost-effective in delaying deaths and preserving the loss of health-related quality of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.

1096 - Quality of life in older patients with overactive bladder treated with mirabegron in routine clinical practice: Secondary analysis of a pan-European non-interventional study (BELIEVE)

1096 - Quality of life in older patients with overactive bladder treated with mirabegron in routine clinical practice: Secondary analysis of a pan-European non-interventional study (BELIEVE)

Geriatric assessment and quality of life in older patients considered for allogeneic hematopoietic cell transplantation: a prospective risk factor and serial assessment analysis.

Allogeneic hematopoietic cell transplantation (alloHCT) in older patients requires the weighing of risks and benefits for this potentially curative treatment while facing age-related limitations. Comprehensive geriatric and quality of life (EORTC QLQ C-30) assessements (CGA/QOL) in addition to disease-specific data were obtained in 108 consecutive patients (≥60 years) pre-HCT, at day +30, +100, and +180. Median follow-up of 106 patients alive at alloHCT was 43.5 months, median age 66 years (range 60-78). Eighty-six (81.2%) had advanced disease risk at HCT and 99 (91.7%) patients received reduced intensity conditioning (RIC). Median PFS was 13.4 months with 38.3% (95% CI: 28.6-47.4) alive and in remission at 2 years; median OS was 15.6 months with 43.9% (95% CI: 34.3-53.4) alive at 2 years. Prognostic factors for PFS were: age: HR 1.084 (95% CI: 1.032-1.137, p = 0.0011); HCT-CI: HR 1.13 (95% CI: 1.001-1.274, p = 0.048); for OS: age: HR 1.08 (95% CI: 1.031-1.139, p = 0.0017), Karnofsky Index: HR 0.97 (95% CI: 0.954-0.996, p = 0.02); EORTC QLQ C-30 fatigue: HR 1.09 (95% CI: 1.004-1.185, p = 0.039); Up-and-Go: HR 3.26 (95% CI: 1.001-10.6, p = 0.049). Follow-up assessments as time-dependent covariates were highly prognostic for OS and PFS. CGA/QOL confer additional prognostic utility in older alloHCT recipients.

Association of Advance Directives Completion With the Utilization of Life-Sustaining Treatments During the End-of-Life Care in Older Patients

ContextEvidence is mixed regarding the impact of advance directives (ADs) on the utilization of end-of-life treatments. ObjectivesThis study evaluated the effect of AD on the utilization of end-of-life treatments during the last month of life in older patients. MethodsTaipei City Hospital initiated an advance care planning program to promote AD for admitted patients in 2015. This prospective study recruited deceased older patients who completed advance care planning communication between 2015 and 2016. Multiple logistic regression was used to determine the association of AD completion with utilization of life-sustaining treatments. ResultsOf 1307 deceased older patients, overall mean age was 84.1 years and 78.7% of the subjects had AD completion. During the study follow-up period, 31 older patients received life-sustaining treatments during the last month of life, including 17 patients (1.7%) with AD completion and 14 patients (5.0%) without AD completion. After adjusting for the sociodemographic factors and co-morbidities, older patients with AD completion were less likely to receive life-sustaining treatments during the last month of life (adjusted odds ratio [AOR] = 0.32, 95% confidence interval [CI]: 0.16–0.67). Considering type of life-sustaining treatments, AD completion was associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.21, 95% CI: 0.06–0.70) as well as intubation and mechanical ventilation support (AOR = 0.32, 95% CI: 0.14–0.70) during the last month of life in older patients. ConclusionAD completion was associated with a lower likelihood of receiving life-sustaining treatments during the last month of life in older patients. These findings support the continued use of AD in older population.

RETRACTED: How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial

Objective: To evaluate the efficacy of a rehabilitation programme including balance task-specific training in improving physical function, pain, activities of daily living (ADL), balance and quality of life in subjects after a hip fracture. Design: Randomized controlled trial. Subjects: A total of 52 older subjects selected for internal fixation due to extra-capsular hip fracture were randomized to be included in an experimental (n = 26) and control group (n = 26). Interventions: The experimental group underwent a rehabilitation programme based on balance task-specific training. The control group underwent general physiotherapy, including open kinetic chain exercises and walking training. Both groups individually followed programmes of 90-minute sessions five times/week for three weeks. Outcome measures: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a Pain Numerical Rating Scale, the Berg Balance Scale, the Functional Independence Measure and the 36-item Short-Form Health Survey. The participants were evaluated before and after training, and after 12 months. Results: Significant effects of time, group and time × group were found for all outcome measures in favour of the experimental group. A clinically important between-group difference of 25 points was achieved after training and at follow-up in terms of the primary outcome (WOMAC function before treatment, after treatment and at follow-up was 84.8 (3.7), 39.8 (4.9) and 35.7 (6.2) for the experimental group and 80.9 (5.7), 65.2 (7.1) and 61.0 (11.1) for the control group). Conclusion: An inpatient rehabilitation programme based on balance task-specific training is useful in improving physical function, pain, ADL and quality of life in older patients after hip fracture.

Health-related quality of life in older patients with acute coronary syndrome randomised to an invasive or conservative strategy. The After Eighty randomised controlled trial

in the After Eighty study (ClinicalTrials.gov.number, NCT01255540), patients aged 80 years or more, with non-ST-elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UAP), were randomised to either an invasive or conservative management approach. We sought to compare the effects of these management strategies on health related quality of life (HRQOL) after 1 year. the After Eighty study was a prospective randomised controlled multicenter trial. In total, 457 patients aged 80 or over, with NSTEMI or UAP, were randomised to either an invasive strategy (n = 229, mean age: 84.7 years), involving early coronary angiography, with immediate evaluation for percutaneous coronary intervention, coronary artery bypass graft, optimal medical therapy, or to a conservative strategy (n = 228, mean age: 84.9 years). The Short Form 36 health survey (SF-36) was used to assess HRQOL at baseline, and at the 1-year follow-up. baseline SF-36 completion was achieved for 208 and 216 patients in the invasive and conservative groups, respectively. A total of 137 in the invasive group and 136 patients in the conservative group completed the SF-36 form at follow-up. When comparing the changes from follow-up to baseline (delta) no significant changes in quality-of-life scores were observed between the two strategies in any of the domains, expect for a small but statistically significant difference in bodily pain. This difference in only one of the SF-36 subscales may not necessarily be clinically significant. from baseline to the 1 year follow-up, only minor differences in change of HRQOL as measured by SF-36 were seen by comparing an invasive and conservative strategy. NCT01255540.

Meaning in life of older persons: An integrative literature review.

Meaning in life of older persons is related to well-being, health, quality of life, and "good life." However, the topic is scarcely covered in nursing literature. The aim of this integrative review for nurses is to synthesize knowledge from scholarly literature to provide insight into how older persons find meaning in life, what are influencing circumstances, and what are their sources of meaning. The review serves as a starting point for including meaning in life of older persons as a major concern for nurses in their role as health promoters. An integrative review was performed including empirical research literature and texts on theoretical perspectives. Researches agree with ethical codes for research of universities in the Netherlands. For literature reviews no additional procedures are necessary according to Dutch law. A total of 44 heterogeneous texts were included in this review. Finding meaning in life is challenging for older persons. Older persons find meaning through a developmental process, by creating and discovering. Meaning in life is found in connection with self and others. Health, living together, high socio-economic status, social relations, activities, and religion are associated with experiencing meaning in later life. The main source of meaning in life of older persons is human relationships. Other sources of meaning in life vary by age and culture. The review provides insight into meaning in life of older persons. There are several gaps in knowledge: literature is culturally biased, research on discovery of meaning and daily meaning is limited, and research from a nursing perspective is lacking. In practice, nurses have many opportunities to attune to meaning in life of patients. Further development of competence and training are needed. Older persons find meaning in life through different processes. Meaning in life is associated with the circumstances old persons live in. Human relationship is the major source of meaning. The knowledge from this review is a necessary knowledge base for nurses to include meaning in life of older patients in care. Further research is needed to explore the role of nurses.