Presence Of Geriatric Syndromes Research Articles

Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation.

To assess clinicians' prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation. We performed a community-based retrospective cohort study of adults aged 65 years and older with a history of nonvalvular AF/F to determine the rate of oral anticoagulation utilization. We also assessed for associations between anticoagulation use and comorbid conditions and common geriatric syndromes. A total of 3832 patients with a diagnosis of nonvalvular AF/F were included (mean [SD] age, 79.9 [8.4] years), 2693 (70.3%) of whom were receiving anticoagulation (51.7%, a vitamin K antagonist; 48.1%, a direct-acting oral anticoagulant). Patients with higher Elderly Risk Assessment index (ERA) scores, a surrogate for health vulnerability, received anticoagulation less often than patients with lower scores. The percentage of patients with a history of falling was higher among those who did not receive anticoagulation than among those who did (44.4% vs 32.8%; P < .001). Similarly, a diagnosis of dementia was more common in the no-anticoagulation group than the anticoagulation group (18.5% vs 12.7%; P < .001). A substantial proportion of older adults with AF/F do not receive anticoagulation. Those without anticoagulation had higher risk of health deterioration based on higher ERA scores and had a higher incidence of dementia and fall history. This suggests that the presence of geriatric syndromes may influence the decision to withhold anticoagulation.

Critical Care in Older People in Low and Middle-Countries (LMICs): Comprehensive Geriatric Assessment (CGA) Protocol in Andes Mountains

Background: The number of older adults in ICU care is increasing. Nowadays, at least fifty percent of ICU patients are aged 65 years and older. The most frequent pathologies to be admitted to the ICU in older people include acute diseases, long-term conditions, and acute or chronic disease exacerbations. Furthermore, new clinical phenotypes, and geriatric syndromes (falls, frailty, immobility) result from the interaction of age-associated conditions and comorbidity. Severity of index disease, multimorbidity, premorbid functional status, frailty, nutritional status, and cognitive level are more important determinants of long-term outcome than chronological age. Comprehensive geriatric assessment (CGA) is a recognized and useful instrument in the management of elderly patients. Methods: We present a protocol for a clinical trial on the application ofCGA in ICU in the Andes Mountains in Colombia, a Low and Middle-Income Country (LMIC). This protocol could provide valuable information for the integration of geriatrics into critical care and provide practical information on how to implement CGA in this context. Results: The selection criteria of the tools to be used during the assessment of the patients were based on the available literature review and on reviews about interdisciplinary team interventions in acute care services based on the CGA. Conclusion: The care of critically ill elderly patients in the ICU is challenging due to factors such as frailty, psychosocial vulnerability, cognitive impairment, dependence on activities of daily living, and the presence of geriatric syndromes which are important conditions for adverse health outcomes in the future. CGA technology could be considered an excellent tool for managing older people in ICU.

Medication-Related Problems and Their Intervention in the Geriatric Population: A Review of the Literature.

In order to implement the principles of providing clinically and economicallyeffective care, the current state of healthcare must be evaluated, and challenges must be addressed. As part of a physician's role in such a context, one tool consists of identifying medication-related problems (MRPs) and accordingly implementing best practices and innovative strategies to improve patient healthcare outcomes. The geriatric population is expected to have passed through the natural ageing process and experienced several physiological and biological changes that impact their bodies and lives.In the presence of geriatric syndromes and the increased number of medications consumed, the risk of MRPs such as polypharmacy, potentially inappropriate medication (PIM), adverse events, drug-drug interactions, and risk of non-adherence increases. Different interventions that focus on practical and perceptual barriers have been studied, and different tools to define clinically important prescribing problems relating to PIM have been established. The Beers Criteria and STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) criteria are the most widely used sets of explicit PIM criteria; however, they are still limited in Saudi Arabia. These tools should be considered in clinical settings to improve healthcare outcomes in the geriatric population, and the clinical relevance of enhancing medication should also be explored from the point of view of both the patient and healthcare practitioners.

Cognitive function and its influencing factors in chinese with advanced age: An observational study based on comprehensive geriatric assessment

AbstractBackgroundCognitive impairment is an age‐related clinical problem that has a significant negative impact on the quality of life of elderly individuals. Hence, it is necessary to identify and intervene the factors affecting cognitive impairment early. Comprehensive geriatric assessment (CGA) is a multidimensional, multidisciplinary diagnostic and therapeutic process used to evaluated the medical, psychosocial, and functional abilities of older adults. This study aimed to evaluated the cognitive function and to explored the risk factors in the old elderly in Chongqing, southwest China by analyzing the CGA assessment data.MethodA cross‐sectional study was conducted in 551 inpatients aged 80 years or older of Department of Geriatrics in The First Affiliated Hospital of Chongqing Medical University from July 2017 to August 2018. Participants were measured with CGA to assess the physical condition, cognition, mental health status, fatigue, nutrition, and presence of geriatric syndromes. Cognitive function was assessed with the Mini‐Mental State Examination (MMSE). The factors associated with cognitive function were analyzed with independent sample t‐test, chi‐square test, and rank‐sum test. The relationship between cognitive impairment and risk factors was examined with logistic regression analysis.ResultAmong the 551 subjects, 313 (56.8%) had different degrees of cognitive impairment. The cognition function was obviously correlated with literacy (z = ‐3.294,P&lt; 0.001), diabetes (x² = 6.862,P&lt; 0.009), nutrition (z = ‐3.466, P&lt;0.001), GDS‐5 (x² = 25.955, P&lt;0.000). Furthermore, logistic regression analysis showed that age (odds ratio (OR) = 1.117, 95% confidence interval (CI): 1.1048–1.190), no diabetes (OR = 0.628, 95% CI:0.400–0.984), normal GDS‐5 (OR = 2.417, 95%CI: 1.568–3.000), and malnourished (OR = 2.481, 95%CI:1.159–5.313) were significantly associated with cognitive function.ConclusionOur results suggest that age, poor literacy, diabetes, depression and malnutrition are significantly associated with an increased risk of cognitive impairment. Therefore, improving nutritional status, controlling blood glucose and regulating emotions have positive regulatory effects on cognitive function of the older elderly.

Effect of Familial Longevity on Frailty and Sarcopenia: A Case-Control Study.

Familial longevity confers advantages in terms of health, functionality, and longevity. We sought to assess potential differences in frailty and sarcopenia in older adults according to a parental history of extraordinary longevity. A total of 176 community-dwelling subjects aged 65-80 years were recruited in this observational case-control study, pair-matched 1:1 for gender, age, and place of birth and residence: 88 centenarians' offspring (case group) and 88 non-centenarians' offspring (control group). The main variables were frailty and sarcopenia based on Fried's phenotype and the European Working Group on Sarcopenia in Older People (EWGSOP) definitions, respectively. Sociodemographics, comorbidities, clinical and functional variables, the presence of geriatric syndromes, and laboratory parameters were also collected. Related sample tests were applied, and conditional logistic regression was performed. Cases had a higher percentage of robust patients (31.8% vs. 15.9%), lower percentages of frailty (9.1% vs. 21.6%) and pre-frailty (59.1% vs. 62.5%) (p = 0.001), and lower levels of IL-6 (p = 0.044) than controls. The robust adjusted OR for cases was 3.00 (95% CI = 1.06-8.47, p = 0.038). No significant differences in muscle mass were found. Familial longevity was also associated with less obesity, insomnia, pain, and polypharmacy and a higher education level and total and low-density lipoprotein cholesterol. The results suggest an inherited genetic component in the frailty phenotype, while the sarcopenia association with familial longevity remains challenging.

Frailty and its associates in community-dwelling older adults.

While the literature contains several studies on the frailty assessed during hospitalization and/or outpatient settings and nursing homes, few studies have assessed frailty in community-dwelling older adults. We investigated the prevalence of frailty and associated factors among older adults in a sample of community-dwelling older adults. We included community-dwelling older adults >60 years living in the Fatih District of the Istanbul Province. We conducted the study between November 2014 and May 2015. We collected the data such as age, sex, number of diseases and drugs, functional status, frailty, the presence of geriatric syndromes, common diseases, and quality-of-life assessment. Frailty was evaluated by the FRAIL scale. A total of 204 adults (mean age: 75.4±7.3 years) were included, of whom 30.4% were robust, 42.6% were pre-frail, and 27% were frail. In multivariate analyses, associated factors of frailty were the number of drugs [odds ratio (OR)=1.240, p=0.036], the presence of cognitive impairment (OR=0.300, p=0.016), and falls (OR=1.984, p=0.048). The present study established the prevalence of frailty in a large district in the largest metropolis in the country through a valid screening method. Our results suggest that clinicians should consider frailty evaluation in patients with multiple drug usage, cognitive impairment, and falls.

The impact of COVID-19 pandemic on the geriatric inpatient unit

Objective We aimed to determine the effects of the pandemic on the inpatients in the geriatric unit by comparing the demographic and clinical characteristics, reasons for hospitalization, morbidity, and mortality of the patients before and during the pandemic. Methods The population of this retrospective, cross-sectional study consisted of inpatients in the geriatric unit for two years (11 March 2019–10 March 2021). The patients were separated into two groups according to the hospitalization time as pre-COVID-19 and COVID-19 period. Hospitalization types, reasons for hospitalization, length of stay, demographic data, chronic diseases, drugs, developed morbidities, discharge, and 1-year mortality status of the patients were recorded. Results Three hundred and fifty patients were included in our study. The mean age was 80.4 ± 8.02. It was observed that the number of hospitalized patients decreased by ∼50% in the COVID-19 period. However, there was a significant decrease in hospitalization due to the control of chronic diseases during the COVID-19 period (p = .008). The number of inpatients from the emergency department was found to be higher during the COVID-19 period (p < .001). Regarding the presence of geriatric syndromes, polypharmacy (p = .011) and delirium (p = .035) were found to be significantly less in the pre-COVID-19 period. The percentage of malnutrition was also detected as lower, but it was not statistically significant. In terms of 1-year mortality, although not statistically significant, the all-cause mortality rate was higher during the COVID-19 period (p = .08). Conclusions Pandemic has greatly affected the geriatric unit. The prognosis of the patients has worsened and mortality rates have increased. Physiological and psychological deterioration caused by quarantine measures, worsening chronic diseases, and immunosenescence affected the prognosis of geriatric patients. This adds to the previous literature by proving the fact that older individuals are the most vulnerable group in the pandemic.

Inside the Black Box: A Narrative Review on Comprehensive Geriatric Assessment-Driven Interventions in Older Adults with Cancer.

Simple SummaryComprehensive geriatric assessment is defined as a multi-dimensional, multi-disciplinary diagnostic and therapeutic process that is conducted to determine the medical, mental, and functional problems that older people with frailty have so that a coordinated and integrated plan for treatment and follow-up can be developed. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients. This review highlights the scarcity of published studies on this topic. Comprehensive geriatric assessment-based interventions have not yet demonstrated their specific impact. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain.There is a consensus that the use of comprehensive geriatric assessment (CGA) is good clinical practice for older patients with solid tumors or hematological malignancies. To be complete, a CGA must include a geriatric assessment and an intervention plan. According to the SIOG consensus, a CGA should assess several domains: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and the presence of geriatric syndromes. Progress has been made in the definition of the best way to detect problems, but the benefits are mostly based on prognosis stratification and on the adaptation of cancer treatment. The present review aims to evaluate the level of evidence regarding geriatric interventions proposed following the detection of a problem in cancer patients in each domain mentioned in the SIOG consensus. An online search of the PubMed database was performed using predefined search algorithms specific for each domain of the CGA. Eligible articles had to have well-defined interventions targeting specific domains of the CGA. We screened 1864 articles, but only a few trials on single-domain interventions were found, and often, these studies involved small groups of patients. This review highlights the scarcity of published studies on this topic. The specific impacts of CGA-based interventions have not yet been demonstrated. Multi-domain interventions seem promising, especially when they are based on global assessments. However, standardization seems difficult considering the lack of evidence for each domain. New studies are necessary in multiple care contexts, and innovative designs must be used to balance internal and external validity. An accurate description of the intervention and what “usual care” means will improve the external validity of such studies.

Frailty prevalence and its associations in a subacute geriatric ward in Singapore.

Our aim was to study the prevalence of frailty and its associated factors in a subacute geriatric ward. This was a cross-sectional study of 167 participants between June 2018 and June 2019. Baseline demographics and participants' Mini Nutritional Assessment, Geriatric Depression Scale, Mini Mental State Examination, Charlson's Comorbidity Index and LACE index scores were obtained. Functional measurements such as modified Barthel's Index scores and hand grip strength (HGS) were taken. Frailty was assessed using the Clinical Frailty Scale (CFS) and the FRAIL scale. Data on history of healthcare utilisation, medications, length of stay, selected blood investigations and presence of geriatric syndromes were also collected. The prevalence of pre-frailty (CFS 4) and frailty (CFS ≥ 5) was 16.2% and 63.4%, respectively. There were significant associations between CFS and age (pre-frail vs. non-frail: odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.25, P = 0.006; frail vs. non-frail: OR 1.08, 95% CI 1.01-1.15, P = 0.021), HGS at discharge (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.025), serum albumin (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.035) and the presence of urinary incontinence (frail vs. non-frail: OR 3.03, 95% CI 1.19-7.77, P = 0.021). Frailty is highly prevalent in the subacute geriatric setting and has many associated factors. In this study, independent factors associated with frailty were age, HGS at discharge, serum albumin and urinary incontinence. This has implications for future resource allocation for frail older inpatients and may help direct further research to study the effectiveness of frailty-targeted interventions.

The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT

A low hemoglobin level in older adults impairs cognitive ability and functional status and associates with risk of falls and fractures, sarcopenia, malnutrition, depression, frailty, and decreased autonomy. Epidemiological data on the anemia prevalence in the geriatric population in our country is not available. To assess the prevalence of anemia and analyze its associations with geriatric syndromes (GS) in subjects aged 65 years. 4308 subjects (30% of men) aged 65107 years, living in 11 regions of the Russian Federation, were examined and divided into age groups (6574 years, 7584 years and 85 years). All the participants underwent a comprehensive geriatric assessment and determined hemoglobin level. The anemia prevalence in older adults was 23.9%. It has been shown that with an increase in age per 1 year, the risk of anemia detection increases by 4%. The incidence of anemia was higher in males than females (28.1% versus 22.1%; p0.001). In most cases, anemia was mild. The results of a comprehensive geriatric assessment show that patients with anemia had lower hand grip force, Barthel Index, the sum of points on Lawton instrumental activities of daily living scale, Mini Nutritional Assessment scale, the Mini-Cog test and higher the sum of points on the Geriatric Depression Scale (GDS-15) and the Age Is No Barrier scale. Patients with anemia were more likely to use hearing aids, absorbent underwear, and assistive devices during movement. Patients with anemia had a higher incidence of all GS, except for orthostatic hypotension and chronic pain syndrome. The presence of GS is associated with an increased risk of anemia by 1.33.4 times. EVKALIPT study obtained domestic data on the prevalence of anemia in older patients and examined its associations with other GS.

Malnutrition in elderly pilgrims attending kumbh festival 2019: A cross-sectional study

Background & Objectives: - Geriatric population is at increased risk of malnutrition which in turn leads to decreased immunity, sarcopenia, frailty and poor clinical outcomes. This study was planned to study the prevalence of malnutrition in the elderly people (>60 yrs) attending Kumbh Mahotsava. The objectives of the study were to see the association of malnutrition with socioeconomic status, gender, age and geriatric syndromes. Methods: - Cross sectional observational study in elderly more than 60 years attending Kumbh Festival. Nutritional assessment was done using Mini Nutritional Assessment (MNA) questionnaire. Socioeconomic status was assessed using the modified Kuppuswamy score. Anthropometric data like body mass index (BMI), calf circumference, and upper mid-arm circumference were measured. All the above data points were integrated into a web application and the socioeconomic and nutritional score were calculated automatically. Based on nutritional assessment nutritional advice was given by a short message service and verbal counseling. Prevalence of malnutrition and its association with socioeconomic status, gender, age and geriatric syndromes were analysed. Results: - Total 219 elderly were included in the study. Mean age was 68.5 years. Around 70% (152/219) were either malnourished or at risk of malnutrition. Nutritional status was significantly associated with modified Kuppuswamy socioeconomic status (P = < 0.001). There was a significant association between nutritional status and presence of geriatric syndromes in form of having a falls (P= 0.010), leaking of urine (P= <0.001) and forgetfulness (P < 0.01). Conclusion: - Around 70% (152/219) of the elderly were either malnourished or at risk of malnutrition with significant ssociation with socioeconomic status and geriatric syndromes. This study shows the importance of screening our geriatric population for malnutrition.

New Options to Simplify the Treatment of Severe Hypoglycemia in Long-Term Care

New Options to Simplify the Treatment of Severe Hypoglycemia in Long-Term Care

Preoperative evaluation of the pacient with bronchopulmonary cancer

BACKGROUND.In the Republic of Moldova, we have reported 983 cases of bronchopulmonary cancer (BPC) annually, in 2019. This impressive number of patients requires a more efficient mobilization of the medical system to solve these cases. AIM. The high incidence of newly diagnosed cases of BPC in advanced stages implies a reserved attitude for the surgical treatment of these patients, as well as the presence of associated pathologies, compromise more the situations, and the possibility to provide effective solutions to solve these cases. The group of patients who have tertiary prevention as a measure of treatment becomes imposing. This order of ideas outlines the need for a different medical-surgical approach for this category of patients. METHODS AND RESULTS.For the assessment of functional criteria for operability for patients with BPC, especially in advanced lung cancer, using comorbidity scores (ASA, Charlson, Elixhauser) and the formation of indications for surgical treatment are significant, because surgery offers the greatest opportunity for healing. The team responsible for the preoperative assessment should include both a perioperative mortality risk assessment and a postoperative pulmonary function prediction to optimally advise patients on anticipated outcomes. Due to both advanced cancer on presentation and comorbid conditions, only one-third of patients are ultimately considered candidates for surgical resection. Despite modern surgical, anesthetic, and postoperative techniques, there is still a perioperative mortality rate of 1-5%. Postoperative myocardial infarction is an important source of morbidity and mortality for those undergoing extensive lung resections, especially trans-pericardial pneumonectomies. Until surgery is suggested, preoperative evaluation of the cardiovascular system should be required for the existence of active heart disease (unstable angina, recent myocardial infarction, decompensated heart failure, arrhythmias, or valve defects).In addition to identifying cardiac risk factors, a preoperative assessment is incomplete without quantifying a patient's functional capacity. This can be achieved by the results of a formal stress test, measured in units of metabolic equivalents of task (MET). Geriatric assessment (GA) is a method used to collect information about the physical condition of elderly patients, which may be useful in estimating life expectancy and predicting treatment toxicity. GA includes an assessment of functional status, fatigue, cognitive function, mental health, nutritional status, the individual's ability to complete instrumental activities of daily living, comorbidities, social support, and the presence of geriatric syndromes. CONCLUSIONS. A thorough analysis of the results of diagnostic tests, referring to the functional evaluation of patients with advanced BPC and/or comorbidities, would allow the extension of surgical indications to obtain new results and increase over time the survival and quality of life of these patients.

A Practical Guide to Geriatric Syndromes in Older Adults With Cancer: A Focus on Falls, Cognition, Polypharmacy, and Depression

Geriatric syndromes are multifactorial conditions that are prevalent in older adults. Geriatric syndromes are believed to develop when an individual experiences accumulated impairments in multiple systems that compromise their compensatory ability. In older adults with cancer, the presence of a geriatric syndrome is common and may increase the complexity of cancer treatment. In addition, the physiologic stress of cancer and cancer treatment may precipitate or exacerbate geriatric syndromes. Common geriatric syndromes include falls, cognitive syndromes and delirium, depression, and polypharmacy. In the oncology setting, the presence of geriatric syndromes is relevant; falls and cognitive problems have been shown to be predictive of chemotherapy toxicity and overall survival. Polypharmacy and depression are more common in older adults with cancer compared with the general geriatric population. Multiple screening tools exist to identify falls, cognitive problems, polypharmacy, and depression in older adults and can be applied to the oncology setting to identify patients at risk. When recognized, several interventions exist that could be considered for this vulnerable population. We review the available evidence of four geriatric syndromes in the oncology setting, including clinical implications, validated screening tools, potential supportive care, and therapeutic interventions.

Complejidad y prevalencia de síndromes geriátricos de los pacientes atendidos en unidades sociosanitarias en Catalunya. Estudio multicéntrico del proyecto XARESS

BackgroundDescriptive study is presented on the complexity and prevalence of geriatric syndromes (GS) in Intermediate Care Units in Catalonia. MethodsA retrospective study was conducted on 6471 stays completed during the year 2014 in the participating centres of the XARESS network. Data was obtained by extracting the information routinely collected on the CMBD-RSS registry (Minimum Basic Dataset for the Intermediate Care Resources). The prevalence and associations between geriatric síndromes (resource group) RG category, length of stay, and destination at discharge is described. Results were stratified by type of unit (convalescence or long stay). ResultsParticipants presented a median of 3 GS at admission in long stay units, and 2 GS at admission in convalescence units. The number of GS varied with RG category, although in all RG categories, there were patients without complexity (no SG), and patients with extreme complexity (up to 9 GS). Patients with geriatric syndromes had a longer mean length of stay and greater dependence than patients without syndromes, although with great variability across GS. However, the presence of geriatric syndromes had no impact on the destination at discharge. ConclusionsThe population cared for in intermediate care units have high complexity and a high prevalence of geriatric syndromes at admission. The CMBD-RSS registry allows the characterisation of complexity of the population admitted to the Catalan convalescence and long term intermediate care units.

Assessment of the needs for palliative care in advanced chronic patients on discharge

ObjectivesTo describe the advanced chronic patients admitted to an internal medicine department and to identify whether they meet the criteria for the need for palliative care at the time of hospital discharge according to the NECPAL-CCOMS.ICO® instrument. Material and methodsObservational, descriptive and cross-sectional study performed on patients admitted to the internal medicine department of the Hospital Clínico Universitario Lozano Blesa (Saragossa), with a diagnosis of advanced progressive chronic diseases, from May 1, 2017 to September 1, 2017 Variables: sex, age, advanced chronic disease, reason for admission, primary caregiver, origin (residence, address, etc.), number of readmissions in the previous year, existence of advance directives, disability of the patient, existence of order not to resuscitate, Charlson Index and all the variables contained in the NECPAL Instrument CCOMS-ICO® VERSION 3.0 2016. The data collection was done when the patient was scheduled to be discharged, having resolved the acute circumstance that led to the admission. Resultsthe sample size was 142 patients who met the inclusion criteria: diagnosis of disease advanced evolutionary chronic ages, Charlson Index ≥3 at the time the patient was scheduled to be discharged and signed their informed consent. The average age was 85.80 years and 50.7% were men. The average age of the women was higher than that of the men. The most prevalent advanced chronic disease was chronic heart disease. None of the patients had advance care directives in place. Nutritional, functional, cognitive and severe dependence was determined in more than 50%. In more than 90% there was the presence of geriatric syndromes and persistent symptoms. The presence of emotional distress was also evident, as was the use of resources. ConclusionsA palliative approach in the care of chronicity would have a very positive impact on the quality of life of the patient and family, would positively influence health systems and would result in cost savings.Implementing the NECPAL CCOMS-ICO® instrument in the health services that serve high proportions of chronically ill patients, accompanied by training measures for health personnel and adaptation of resources, can introduce a qualitative and quantitative change that is very relevant in our the health system.

P01.021 Comprehensive Geriatric Assessment (CGA) for outcome prediction in elderly patients (PTS)with glioblastoma (GBM): a mono-institutional experience

Treatment for GBM elderly PTS is still a challenge in neuro-oncology. Clinical tools, including CGA, are needed for improving treatment decision and outcome. To date, few studies exploring the impact of CGA on outcome have been performed in these PTS. The aim of this study was to evaluate CGA as a prognostic tool in terms of PFS and OS in elderly GBM PTS. we performed a retrospective analysis of elderly PTS ≥ 65 years, treated at Veneto Institute of Oncology between January 2011 and January 2018, with newly histologically diagnosed GBM and receiving a baseline CGA after 3–4 weeks from surgery. CGA included the following domains: age, activities and instrumental activities of daily living (ADL, IADL), cognitive status(MMSE), mood (GDS), nutritional status (MNA), number of drugs, comorbidity (cumulative Illness Rating Scale-CIRS), presence of geriatric syndromes, presence of caregiver. PTS were classifiedaccording to Balducci’s criteria into Fit or Unfit (Frail and Vulnerable). 113 PTS were enrolled: 72 (64%) were male, KPS were ≥ 70 in 90 PTS (80%); 37 PTS (33%) had a radical surgery, 63% partial surgery and 4% received a biopsy. 90 PTS (80%) received Stupp treatment, 16 (14%) temozolomide or radiotherapy alone and, only 7 (6%) received no treatment. MGMT methylation status was analyzed in 96 PTS: 44% were metMGMT. According to CGA evaluation: 40 PTS (35.4%) were classified as Fit and 73 PTS (64.6%) Unfit. PFS was 11.2 (95% CI 6.0–16.4) and 7.2 (95% CI 5.8–8.6) months for Fit and Unfit PTS (p=0.1). On multivariate analysis, adjusted for type of surgery, MGMT methylation status and type of therapy, PFS wassignificantly different between the two groups (HR=0.6, 95% CI 0.2–0.9; p=0.04). OS was 16.4 (95% CI 14.6–18.2) and 10.6 (95% CI 8.3–12.8) ms for Fit and Unfit PTS (p=0.04); on multivariate analysis the HR was 0.51 (95% CI 0.2–0.9; p=0.04). CGA demonstrated significant outcome prediction in terms of OS and PFS, regardless of therapy. It could be a useful treatment decision-tool suggesting to treat FIT PTS with radiochemotherapy while a prospective study to evaluate the best treatment in Unfit PTS should be warrant.

Electrophysiology and heart rhythm disorders in older adults.

Heart rhythm disorders, including bradyarrhythmias, atrial fibrillation (AF), and ventricular arrhythmias, become increasingly common with aging and represent important causes of morbidity and mortality among older adults.[1]–[3] Older adults are particularly predisposed to these conditions due to the high prevalence of cardiovascular disease in conjunction with age-related changes that occur in the heart and cardiac conduction system. Management of heart rhythm disorders often differs in older compared to younger individuals due to reduced life expectancy, multimorbidity, polypharmacy, and increased vulnerability to adverse effects of therapies. The presence of geriatric syndromes, particularly frailty,[4] and cognitive impairment,[5],[6] which have been increasingly recognized as important factors associated with poor outcomes in many cardiovascular conditions, further contribute to the complexity of decision-making in this vulnerable population. Accordingly, this review seeks to describe the evaluation and treatment of common rhythm disturbances among older adults.

Comprehensive Geriatric Assessment (CGA) based risk factors for increased caregiver burden among elderly Asian patients with cancer.

This study aims to identify Comprehensive Geriatric Assessment (CGA) based risk factors to help predict caregiver burden among elderly patients with cancer. The study evaluated 249 patients newly diagnosed with cancer, aged 70years and above, who attended the geriatric oncology clinic at the National Cancer Centre Singapore between 2007 and 2010. Out of 249 patients, 244 patients had information available on family caregiver burden and were analysed. On univariate analysis, ADL dependence, lower IADL scores, ECOG performance status of 3-4, higher fall risk, lower scores in dominant hand grip strength test and mini mental state examination, polypharmacy, higher nutritional risk, haemoglobin <12g/dL and presence of geriatric syndromes were significantly associated with mild to severe caregiver burden. On multivariate analysis, only ECOG performance status of 3-4 (odds ratio [OR], 4.47; 95% confidence interval [CI], 2.27-8.80) and haemoglobin <12g/dL (OR, 2.38; 95% CI, 1.14-4.99) were associated with an increased probability of mild to severe caregiver burden. The model achieved a good fit (Hosmer-Lemeshow's p=0.196) and discrimination (area under the curve [AUC]=0.742; bias-corrected AUC=0.737). Based on this, patients were stratified into 3 risk groups with different proportion of patients with increased caregiver burden (low risk: 3.9% vs intermediate risk: 18.8% vs high risk: 39.6%; p<0.001). ECOG performance status and haemoglobin were associated with increased caregiver burden among elderly patients with cancer. Using these two factors in the clinic may help clinicians identify caregivers at risk and take preventive action to mitigate that.

Falls in Older Adults with Multiple Myeloma

Introduction: Multiple myeloma (MM) is a disease of aging. The prognosis of older adults with MM is influenced by the presence of geriatric syndromes, including dependence in daily activities and comorbidities. Falls, another common geriatric syndrome, are associated with greater risk for severe toxicity of chemotherapy and survival in older adults with solid tumors. Among older adults with MM, the prevalence of falls and factors predictive of falls are yet unknown. Thus, we sought to determine the prevalence of falls in a cohort of older adults with newly diagnosed MM and examine associations between falls and functional status, comorbidities and self-reported health.Methods: Using data from the linkage of the Surveillance, Epidemiology, and End Results (SEER) national cancer registry with the Medicare Health Outcomes Survey (MHOS), we identified unique patients with a diagnosis of MM in the SEER registry who participated in the MHOS survey, which includes individuals who are enrolled in Medicare Advantage organizations. An item inquiring about falls was present in the MHOS survey starting in 2006. For this analysis, participants (pts) were included if they completed the MHOS baseline survey within 1 year of their diagnosis of MM. Baseline characteristics were examined with descriptive statistics. Associations between falls and patient-reported data on function, comorbidities and self-rated health were examined using Student's t-test, Pearson Chi-square or Fisher's exact test, as appropriate. We identified 1327 unique patients, of whom 376 completed their baseline MHOS survey within 1 year of diagnosis. Of these, 190 provided responses to the item regarding falls and are included in this analysis.Results: The median age of the cohort was 77 years (range 47-97). The cohort was diverse, with 58.9% white race, 19.5% Asian/Pacific Islander, 11.6% Hispanic/Latino and 10.0% black race. Half (50.0%) were male, 48.4% female, and 1.6% unknown gender. Over one-quarter (25.2%) of pts reported a fall within the prior 12 months. Fallers were more likely to report a history of congestive heart failure than nonfallers (22.7% vs 7.9%, p=0.012); the remaining comorbidities examined (coronary artery disease, stroke, chronic obstructive pulmonary disease and diabetes) were not associated with falls. Of those who reported 2 or more weeks of depression in the past year, 41.4% reported a fall, compared with only 20.1% of those who did not report depression (p=0.004). Fallers were more likely to report limitations in moderate activities (81.2% vs 62.1%, p=0.015) and in climbing several flights of stairs (89.1% vs 64.9%, p=0.001). Pts who reported numbness in their feet some, most or all of the time were numerically but not statistically more likely to report a fall (35% vs 21.9%, p=0.070). Compared with nonfallers, fallers reported more days in the past 30 days when their physical health was not good (15.8 vs 10.0 days, p=0.024), more days in the past 30 days when their mental health was not good (10.7 days vs 4.1 days, p=0.002) and more days in the past 30 days when their health interfered with their daily activities (14.3 vs 7.0 days, p=0.001). Pts who had fallen were more likely to report that their health was fair or poor than those who had not fallen (67.4% vs 33.8%, p<0.001).Of pts who reported a fall, one-third (33.3%) had not talked with their doctor about falling or walking problems. Nonetheless, pts who had fallen were much more likely to have received a recommendation to use an assistive device, attend physical therapy, or have other fall-prevention screenings performed (72.9% vs 29.4%, p<0.001). The median overall survival among fallers was 25.0 months (95% confidence intervals 15.3-34.7), versus 52.0 months (95% CI 36.7-67.3), p=0.072.Conclusions: Falls are a common occurrence in older adults with newly diagnosed MM, occurring in 25% of pts in the past year. Falls are associated with more limited activity, depression and congestive heart failure. Pts who fell also reported poorer physical and mental health than nonfallers. Prospective studies are needed to determine factors predictive of falls in order to target interventions to those at high fall-risk and to prevent falls. DisclosuresTuchman:celgene: Consultancy, Honoraria, Research Funding, Speakers Bureau; Millennium/takeda: Honoraria, Research Funding, Speakers Bureau. O'Donnell:Millennium: Consultancy. Vij:Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy; Takeda, Onyx: Research Funding.