Geriatric Intervention Research Articles

Consequences of COVID-19 for geriatric patients during a pandemic

To investigate the outcomes of geriatric COVID-19 patients in a German academic setting during the pandemic. This study included 468 consecutive geriatric patients (≥ 70 years) who tested positive for SARS-CoV-2 and were treated at the University of Duisburg-Essen from 2/2020 to 3/2021. 74 patients were transferred to a geriatric hospital and a 12-month follow-up (prospective study) was performed in 51 patients. Clinical assessments evaluated depression (GDS), apathy (AES), cognitive status (MMST), mobility (TUG), health status (EQ-5D-5 L), and daily living activities (Barthel Index). Demographic and clinical data were also analyzed. Results showed that the mortality in this vulnerable group was 52% (n = 209). Long-term survival was higher in patients who received comprehensive geriatric treatment (74.3% vs. 51.8%). The duration of inpatient stay at the primary hospital was 13.3 ± 3.6 days, with 28.8% (n = 135) requiring intensive care. At the 12-month mark more patients with geriatric treatment lived in nursing homes. Barthel-Index/Timed-Up-and-Go-Test/MMST/AES/GDS, and EQ-5D-5 L indicated worse outcomes in the group who received geriatric treatment. Specialized geriatric care may improve survival in geriatric COVID-19 patients despite decreased long-term outcomes. Further research, including international studies like NAPKON, are encouraged to confirm these findings and explore potential interventions for improved outcomes in this vulnerable population.

Perioperative Supportive Care Interventions to Enhance Surgical Outcomes for Older Adults With Cancer: A Systematic Review.

Older adults with cancer have unique needs, which likely influence surgical outcomes in the geriatric oncology population. We conducted a systematic review to describe the literature focused on perioperative supportive care interventions for older adults with cancer undergoing surgery. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases for literature published from January 2010 to October 2023. We included randomized controlled trials (RCTs) focusing on supportive care interventions that enrolled adults older than 60 years with cancer. We included 11 RCTs with 2,177 patients in this review. Patients' age ranged from 60 to 95, and the median number of patients per study was 147 (range, 44-690). Most studies included patients with colorectal cancer (81.8%). Half of the studies (54.5%) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (27.2%), nutrition optimization (9.1%), and patient empowerment (9.1%). Primary outcomes included postoperative complications, quality of life, feasibility of exercise programs, inspiratory muscle endurance, and hospital length of stay, among others. All studies had postoperative complications as a primary or secondary outcome. We found implementation challenges that influenced several studies, including high dropout rates and intervention fidelity. We found 11 studies focused on perioperative supportive care interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. We also found heterogeneity in intervention modality and outcome assessment, thus demonstrating a need for ongoing work to address the unique needs of the geriatric oncology population.

Physical Prehabilitation for Older Patients with Cancer before Complex Medical-Surgical Interventions: An Umbrella Review.

Prehabilitation has become a field of increasing interest over recent decades. However, few studies specifically investigated prehabilitation for older patients with cancer. The objective of this umbrella review was to summarize evidence on prehabilitation programs to identify the physical interventions that may be applied with benefit to older cancer patients who will undergo complex medical-surgical procedures. The protocol was registered in Prospero. Major databases, namely PubMed, Embase, CINAHL, Cochrane, Web of Science and Prospero, were searched until summer 2020 and a second search was performed until November 2023. All systematic reviews and meta-analyses were included, dealing with the major topic of prehabilitation for older patients with cancer diagnosis. Among 1425 records (633 until 2020, 792 until November 2023), 14 reviews were selected for inclusion. According to the AMSTAR-2 checklist, the median quality score was 11 (range: 5-12). Total duration of prehabilitation ranged from 1 to 5 weeks, session duration from 20 to 50 minutes, session frequency from 3 to 6 per week. Reported program modes were aerobic and resistance exercises. Concerning the outcome measures, the functional as well as the respiratory status was significantly affected. Quality of life did not benefit significantly, but showed a positive trend. The length of hospital stay was not significantly improved in the majority of the studies. In contrast, most systematic reviews reported significantly lower numbers of total postoperative complications. Functional recovery was enhanced in half of the found reviews. Prehabilitation is a growing field, notably also in reviews focussing on oncological care for elderly patients included in this umbrella review. Aerobic and resistance exercises are the core of the majority of the programs evaluated but their characteristics (total duration, frequency) are partly heterogeneous. Prehabilitation for older patients may also include other modalities of geriatric interventions like nutritional or psychological optimization.

Geriatric Assessment-driven INterventions among Hospitalized older adults with cancer (GAIN-HOSP), a prospective pilot study

Geriatric Assessment-driven INterventions among Hospitalized older adults with cancer (GAIN-HOSP), a prospective pilot study

PRIORITIZING GERIATRIC EDUCATION FOR HEALTH CARE PROVIDERS

Abstract Within the United States, there is a deficit of Geriatricians providing care for older adults, and this deficit will only grow as the population continues to age, meaning all health care providers will be responsible for the care of older adults. A learner needs assessment is a systematic approach to examining what individuals or groups need to learn in relation to health care practice. A learner needs assessment is a core element of designing effective, targeted geriatric educational interventions. In 2022, a brief six question online survey was distributed to all health care providers within the South Central Veterans Affairs (VA) Health Care Network to determine the top geriatric education needs. Within the survey, provider demographics requested were primary discipline and primary work setting (inpatient/outpatient). Respondents were requested to choose at least 5 out of 50 topics provided that would be the most useful for future geriatric education. Responses were received from 143 health care providers with the majority of the responses being from social workers 59(41.3%) and nurses 45(31.5%). There were 103 health care providers from outpatient areas and 40 from inpatient areas. The top geriatric education topics requested were mental health (50.4%), Alzheimer’s disease/dementia (48.3%), legal issues (38.5%), chronic pain (35.0%), depression (32.2%), and management of chronic conditions (30.1%). Experts were recruited to provide geriatric education on the highest priority requested topics. Providing geriatric education improves care for older adults ensuring health care providers are prepared to care and advocate for this diverse and often vulnerable population.

Prehabilitation for Chilean frail elderly people - pre-surgical conditioning protocol - to reduce the length of stay: randomized control trial.

Frail elderly patients have a higher risk of postoperative morbidity and mortality. Prehabilitation is a potential intervention for optimizing postoperative outcomes in frail patients. We studied the impact of a prehabilitation program on length of stay (LOS) in frail elderly patients undergoing elective surgery. An RCT study was conducted. Frail patients scheduled for elective surgery were randomized to receive either pre-surgical conditioning protocol (PCP) or standard preoperative care. PCP included nursing, anesthetic, and geriatric assessment, nutritional intervention, and physical training for 4-weeks preoperatively. A nurse followed both groups until discharge criteria were met. The primary outcome was postoperative LOS. Secondary outcomes were nutritional status, preoperative frailty status (frailty phenotype-FP) after PCP, and postoperative complications up to three months categorized according to the Clavien-Dindo Classification. Means and medians between the control and intervention groups were compared, with statistical significance set at α=5%. Thirty-four patients were to intervention and Thirty-seven to the control group. In the intervention group, adherence to prehabilitation was 90%. The median LOS after surgery was three days in both groups, without finding statistically significant differences between groups (P=0.754), although there was a trend towards lower LOS in the urologic surgery subgroup. We found a significant reduction in frailty status after PCP (FP<inf>pre</inf>=2.4±0.5 and FP<inf>post</inf>=1.7±0.5, P<0.001). Nutritional status significantly improved in frail patients after prehabilitation (MNA<inf>basal</inf>=9.0±2.5 and MNA<inf>post</inf>=10.6±2.6), P=0.028. The intervention group had less severe postoperative complications, which were not statistically significant. The PCP conducted both in-person and online, for older frail patients undergoing elective colorectal and urological surgery was not associated with shorter LOS. However, frailty status significantly improved after completing PCP.

Health related quality of life in an at‐risk population during an intervention study and extended follow‐up ‐ the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)

Health related quality of life in an at‐risk population during an intervention study and extended follow‐up ‐ the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)

Survey on knowledge of Uruguayan neurologist about the FINGER intervention

AbstractBackgroundThe Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm‐FINGERS) is based on the study FINGER (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) in which participate 12 Latin American countries. Is the first non‐pharmacological multicenter randomized clinical trial to prevent cognitive impairment in Latin America (LA), and investigates the feasibility of a multi‐domain lifestyle intervention and the efficacy of the intervention in LA.We were interested in knowing what information Uruguayan neurologists have on the subject. In Uruguay, according to official information, in 2021 there were 139 registered neurologists. No surveys have been carried out on the subject in Uruguay.Objectives: To know what information the Uruguayan neurologists have about the results of the FINGER intervention and the frequency of indication of primary prevention measures to people at risk of cognitive impairment.MethodsThis is a cross sectional, observational and descriptive trial. A survey was designed in the SurveyMonkey application with 13 questions and it was sent to neurologists through social networks. Informed consent was requested.ResultsThe survey was answered by 41 neurologists. 38.5% of responders were aware of the results of the FINGER intervention in Finland and 36% have made prevention recommendations taking them into consideration.40 participants responded regarding primary prevention measures. Of these, 90% stated that they made recommendations to people at risk of cognitive impairment. 30% reported making nutritional suggestions frequently, 95% suggested cognitive stimulation exercises and 92.5% suggested participating in regulated physical activity programs.47.5% knew about the LatAm FINGERS initiative and 42.5% knew that Uruguay was participating in it. All respondents expressed interest in knowing the results of the LatAm FINGERS initiative when it has concluded.ConclusionsMost Uruguayan neurologists make recommendations on primary prevention measures for cognitive impairment. There was moderate knowledge about the results of the FINGERS study, but there is a marked interest in learning more about the topic.It is planned to extend the survey to other medical specialists involved in the care of people at risk of cognitive impairment.

A digitally supported multimodal lifestyle program to promote brain health among older adults (the LETHE randomized controlled feasibility trial): study design, progress, and first results

BackgroundThe Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) multimodal lifestyle intervention yielded cognitive and other health benefits in older adults at risk of cognitive decline. The two-year multinational randomized controlled LETHE trial evaluates the feasibility of a digitally supported, adapted FINGER intervention among at-risk older adults. Technology is used to complement in-person activities, streamline the intervention delivery, personalize recommendations, and collect digital biomarkers.MethodsTrial includes older adults (60–77 years) with digital readiness/experience with smart devices and increased dementia risk but without substantial cognitive impairment. Participants are enrolled at four sites (Austria, Finland, Italy, Sweden). At baseline, participants were randomized 1:1 ratio to 1) intervention i.e., structured multimodal lifestyle program (including diet, exercise, cognitive training, vascular/metabolic risk management, social stimulation, sleep/stress management) where in-person activities led by professionals are supported with an Android mobile phone application developed by the consortium (the LETHE App); or 2) control i.e., self-guided program (regular health advice; simplified App with no personalized/interactive content). All participants wear smartwatches to gather passive data (e.g., physical activity, sleep). Primary outcomes are retention, adherence, and change in validated dementia risk scores. Secondary outcomes include changes in lifestyle, cognition, stress, sleep, health-related quality of life, and health literacy. Additional outcomes (exploratory) include e.g. participant experiences and dementia-related biomarkers (Alzheimer’s disease blood markers, neuroimaging). A sub-study explores the feasibility of novel interactive technology (audio glasses, social robot).ResultsRecruitment began in September 2022, and the last participant was randomized in June 2023. In total, 156 individuals were randomized (mean age 69 years, 65% women; balanced recruitment across the four sites). Vascular and lifestyle risk factors were common (e.g., 65% with hypertension, 69% with hypercholesterolemia, 39% physically inactive), indicating successful recruitment of a population with risk reduction potential. Trial will be completed by summer 2025. Retention until the first post-baseline visit at 6 months is high (n = 2 discontinued, retention 98.7%).ConclusionLETHE provides crucial information about the feasibility of technology and a digitally supported FINGER lifestyle program to promote brain health. Digital tools specifically designed for older adults could offer potential for large-scale, cost-effective prevention programs.Trial registrationClinicalTrials.gov (NCT05565170).

The effect of multidomain lifestyle intervention on health care service use and costs - secondary analyses from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): a randomised controlled trial.

The Finnish multidomain lifestyle intervention study to prevent cognitive impairment and disability (FINGER, N = 1259), a randomised controlled trial had beneficial effects on morbidity in older people, but to what extent such a lifestyle intervention may affect the use of health care services and their costs especially in long term are unknown. This study investigated the effect of a two-year FINGER multidomain intervention on health care service use during the 8-year follow-up. The costs of service use were also evaluated. Health care service use obtained from national health care registers (days of inpatient hospital stay and long-term care, number of visits to emergency services, hospital as outpatient, home care, primary care physician and primary care nurse) was analysed among participants of the FINGER. Trial targeted community-dwelling people aged 60-77years at risk for cognitive impairment, who were randomly allocated to the multidomain intervention or control group. Costs were evaluated as the mean costs of services used. There were no significant differences in total health care costs between the intervention and control groups. The participants in the intervention group, however, had a lower use of the hospital inpatient care (RR 0.73, 95% CI 0.54-1.00) and emergency services (RR 0.83, 95% CI 0.70-0.97) than those in the control group. Hospital inpatient care was lower especially among men. The use of other types of health care services did not differ between the groups. The costs of health care service use without including long-term care were lower in the intervention group (RR 0.81, 95% CI 0.68-0.99). The FINGER intervention has a potential to reduce the need for the inpatient hospital care and emergency visits and associated costs, especially among men.

Subjective Memory Complaints and the Effect of a Multidomain Lifestyle Intervention on Cognition: The FINGER Trial.

Older people reporting subjective memory complaints (SMCs) may have a greater risk of cognitive decline. Multidomain lifestyle interventions are a promising strategy for the prevention of cognitive decline. The aim of this study was to investigate whether the presence of SMCs affects the efficacy of a 2-year multidomain lifestyle intervention on cognition. This study is part of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) project. Participants (a subsample of 568 individuals, baseline age 60-77 years) were randomized (1:1) to receive a 2-year multidomain lifestyle intervention group including dietary advice, exercise, cognitive training, and vascular risk management, or regular health advice control group. Cognitive performance was assessed at baseline and at 1- and 2-year visits, using a neuropsychological test battery, including tests assessing memory, executive functions, and processing speed. Participants rated the frequency of SMCs using the Prospective and Retrospective Memory Questionnaire. Having more retrospective SMCs was linked to a less favorable cognitive trajectory over 2 years. The difference between the intervention and control groups in annual change in tested memory performance was 0.077 (95% CI, 0.008-0.146) among those reporting more retrospective SMCs and -0.011 (-0.074 to 0.053) among those with less SMCs; interaction effect p = .019. No other interactions between SMCs and intervention allocation were observed. A lifestyle intervention may be beneficial for older adults with and without SMCs. Persons having more retrospective SMCs may benefit more from the intervention regarding memory functioning. Clinical Trials Registration Number: NCT01041989.

Perioperative interventions to enhance surgical outcomes for older adults with cancer: A systematic review.

219 Background: Older adults with cancer have unique needs, particularly in the perioperative setting, which likely influence surgical outcomes in the geriatric oncology population. Little work has sought to describe available literature investigating perioperative interventions to enhance surgical outcomes for these individuals. Our systematic review sought to describe the literature on perioperative interventions in older adults with cancer undergoing surgery. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search using the Ovid MEDLINE, CINAHL, and Embase databases, searching for literature published from 1/2010-10/2023 (search terms used relevant terminology for geriatric oncology in the perioperative setting). We included randomized controlled trials (RCT) focusing on patient-centered interventions that enrolled adults &gt;60 years old with cancer, excluding studies with pharmacologic, procedural, and radiographic interventions. Results: We included 11 RCTs with 2,177 patients. Patients’ age ranged from 60-95, and median number of patients per study was 147 (range: 44-690). Most studies included patients with colorectal cancer (81.8% [9/11]), all involving non-emergent elective surgeries. Half the studies (54.5% [6/11]) evaluated exercise interventions, and the remaining assessed geriatric assessment-guided interventions (27.2% [3/11]), nutrition optimization (9.1% [1/11]), and patient empowerment (9.1% [1/11]). Primary outcomes were as follows: postoperative complications, quality of life, feasibility of exercise programs, delirium incidence, inspiratory muscle endurance, hospital length of stay, and consistency of nutritional management. All studies had postoperative complications as a primary or secondary outcome. In studies with exercise-based interventions, all but one (83.3% [5/6]) found reduction in postoperative complications, and one showed improvement in quality of life (16.7% [1/6]). Studies focusing on geriatric assessment did not achieve significant differences in outcomes. We found implementation challenges that influenced several studies, including high drop-out rates and intervention fidelity. Conclusions: In this review, we found 11 studies focused on perioperative interventions in older adults with cancer undergoing surgery. Notably, interventions involved exercise, geriatric assessment-guided care, nutrition optimization, and patient empowerment. RCTs to date seem to primarily focus on exercise interventions and geriatric assessment-guided strategies. Although most studies met their primary endpoint, we found heterogeneity in intervention modality and outcome assessment, thus demonstrating a need for ongoing work to address the unique needs of the geriatric oncology population.

An 18-month multimodal intervention trial for preventing dementia: J-MINT PRIME Tamba.

The number of people with dementia is increasing in Japan, and establishing evidence for preventing dementia is necessary. This study was a randomized controlled trial in cognitively normal community-dwelling older adults aged 65 to 85 with diabetes and/or hypertension. Participants were randomly assigned in a 1:1 ratio. The intervention group underwent 90min of group-based weekly physical exercise, cognitive training, nutritional counseling, and vascular risk management for 18 months. The primary endpoint was the change in a cognitive composite score calculated by averaging the z-scores of seven neuropsychological tests from baseline to 18 months. We randomly assigned 203 participants to two groups, and 178 (87.7%) completed the 18-month follow-up. There was a significant group difference in the cognitive composite score change at 18 months (mean difference 0.16, 95% confidence interval: 0.04 to 0.27; p=0.009). An 18-month multimodal intervention for older adults at risk of dementia could improve their cognitive function. The trial was registered in the Clinical Trial Registration System (UMIN000041938). Japan-Multimodal Intervention Trial for Prevention of Dementia (J-MINT) PRIME Tamba was a randomized controlled trial to prevent dementia. We provided a multifactorial intervention based on the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial methodology. The primary outcome, the cognitive composite score, improved with our intervention. Executive function/processing speed and memory improved in the intervention group. Intervention adherence was high, and no serious adverse events occurred.

Development and Implementation of a Geriatric Oncology Interdisciplinary Case-Based Educational Intervention for Cancer Care Providers.

To develop and implement a continuing professional development (CPD) activity focused on geriatric assessment (GA) in oncology for oncologists and geriatricians. We evaluated the impact of this activity on knowledge, skills, and performance regarding GA in oncology, as well as its feasibility and acceptability. We included teams composed of an oncologist and a geriatrician working in Mexico. Curriculum content was selected from geriatric oncology guidelines. We used Project Extension for Community Healthcare Outcome (ECHO)'s model to create a 12-week online course. A one-group pretest post-test quasi-experimental design was used to evaluate the intervention's effectiveness. At baseline, participants answered a multiple-choice knowledge assessment, a survey on self-perceived competence in GA, and an adaptation of the Association for Community Cancer Centers Geriatric Oncology Gap Assessment Tool, evaluating self-perceived performance in conducting geriatric interventions. These assessments and a satisfaction questionnaire were also completed postintervention. Baseline and postintervention scores were compared using paired t-tests. We included 40 participants (20 oncologists and 20 geriatricians). Median attendance was 10 sessions (range 2-12). Thirty-eight participants completed the satisfaction questionnaire, with a median score of 10/10 (range 8-10). The mean baseline and postintervention knowledge scores were 59.5 ± 12.8 and 74.4 ± 9.7, respectively (P < .001, effect size 1.14). The mean baseline and postintervention competence scores were 6.42 ± 2.5 and 9.02 ± 0.8, respectively (P < .001, effect size 1.03). The mean baseline and postintervention performance scores were 2.58 ± 0.65 and 3.29 ± 0.5, respectively (P < .001, effect size 1.64). A CPD activity for oncologists and geriatricians on the basis of the Project ECHO model was feasible and acceptable, leading to increased knowledge, competence, and performance in geriatric oncology. This could represent a novel method for increasing the geriatric competence of the cancer care workforce in Latin America and globally.

A Systemic Review &amp; Meta-Analysis of the Impact of Vascular-Geriatric Service Models on Short-Term Outcomes in Vascular Surgery Inpatients

Abstract Background Vascular surgeons are treating progressively older, frailer and more medically complex patients. Care models including both surgeons and geriatricians have improved peri-operative outcomes in orthopaedics and surgical oncology. This meta-analysis investigates the impact of “vascular-geriatric” services on short-term inpatient outcomes. Methods Search strategy included PubMed, Scopus and Embase databases, conference abstracts and clinical trial registries. All study methodologies comparing outcomes before and after the introduction of a dedicated vascular-geriatrics service were eligible. Meta-analyses compared the relative risk (RR) of mortality, complications and 30-day readmission using a random-effects model. Risk of bias was assessed with the MINORS tool. Results Eight studies were identified, including one randomised trial and seven ‘before &amp; after’ observational studies. 2074 patients were included, 1065 in the “Vascular-Geriatrics” cohort and 1009 in standard care. Care models included comprehensive geriatric assessment as part of the pre-operative review process before elective aortic surgery, inpatient geriatric liaison services and formal vascular-geriatric co-management arrangements. Source studies were of moderate to high risk of bias. A meta-analysis of five studies demonstrated vascular-geriatrics models were significantly associated with lower mortality rates than standard care (pooled 2.4% vs 4.9%) (RR 0.51, 95% CI 0.28-0.94, p=.03) (I2=0%). Vascular-Geriatrics models were also significantly associated with lower risk of infective complications (RR 0.49, 95% CI 0.36–0.66, p&amp;lt;.001) (I2=0%) and delirium (RR 0.58, 95% CI 0.35–0.97, p=.04) (I2=48%). There was no difference in mean length of stay (SMD -2.20, 95% CI -4.6-0.19, p=.07) (I2=86%). or 30-day readmission rates between Vascular-Geriatrics models and standard care (RR 1.10, 95% CI 0.81-1.51, p=.54) (I2=38%). Conclusion While the source data is heterogenous and of limited quality, this meta-analysis suggests that dedicated geriatric intervention may reduce adverse peri-operative outcomes in vascular patients compared to traditional care models. Further studies are needed to investigate the most effective design of geriatrician-surgeon partnership.

Evaluating the Impact of Nurse-led Geriatric Homecare Interventions: A Systematic Review of Randomized Controlled Trials

Nurse-led interventions have gained prominence as a promising approach for geriatric care, yet the existing evidence base remains limited. This systematic review aimed to evaluate the impact of nurse-led home care interventions on health outcomes. Adhering to the PRISMA guidelines, we conducted a comprehensive search of PubMed, ScienceDirect, Scopus, ProQuest, and Embase databases from their inception until April 2024. A narrative synthesis was used. Following the screening of 901 studies derived across five electronic databases, nine trials were analyzed in this review. The interventions showed mixed results on quality of life, with significant improvements in some studies but not others. Physical health and performance generally improved, with fewer falls and better functional status in the intervention groups. Mental health outcomes were also mixed. Caregiver burden did not significantly change overall, but some aspects, such as isolation, improved. Hospitalization rates did not significantly differ between groups in most studies, but emergency department visits were lower in the intervention groups. Mortality rates were also similar between groups, but more patients in the intervention groups died at home. Despite the diversity in approaches, nurses played an active and comprehensive role in all programs. These findings highlight the adaptability and flexibility of nurse-led interventions. Further research is needed to refine these interventions, identify their most effective components, and understand how they can be tailored to meet the unique needs of older adults and their caregivers.

Brain amyloid load, subjective memory complaints, and cognitive trajectories in older individuals at risk for dementia.

This study evaluated associations of brain amyloid with 2-year objective and subjective cognitive measures in a trial-ready older general population at risk for dementia. Forty-eight participants in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability underwent 11C-Pittsburgh compound B (PiB) positron emission tomography (PET) scans and assessment of cognition (modified Neuropsychological Test Battery [NTB]) and subjective memory complaints (Prospective and Retrospective Memory Questionnaire). Mean age was 71.4 ± 5.06 years, and 20 participants (42%) had positive baseline PiB-PET scans. Amyloid positivity was associated with lower NTB executive function at baseline and less favorable 2-year NTB total score and memory trajectories, but not with other objective or subjective cognitive measures. Overall, there was little cognitive decline during 2 years. Amyloid accumulation may affect objective but not necessarily subjective cognition from a very early at-risk stage, although substantial decline likely requires >2 years to occur.

How to compensate for frailty? The real life impact of geriatric co-management on morbi-mortality after colorectal cancer surgery in patients aged 70 years or older

In Europe, CRC is the second most common cause of cancer death, and surgery remains the mainstay curative treatment. Age and frailty are associated with an increased risk of postoperative morbidity and 1-year mortality. Chronological age is not sufficient to assess the risk of postoperative complications. The CGA has been developed to better identify frail patients. Geriatric co-management have been developed to optimize the post-operative outcomes. We analyzed the real-life of geriatric co-management within an ERAS program on surgical outcomes at 90 days and oncologic outcomes at 1 year in patients aged 70 years or older after surgery for CRC. This was a retrospective study based on a prospective cohort. Fifty-one patients with a G8 score ≤ 14 were referred to geriatricians for preoperative CGA (Frail Group). They were compared with 151 patients with a G8 score ≥ 15 (Robust Group). In the Frail Group, patients were significantly older with more comorbidities than the patients in the Robust Group. Oncologic characteristics, treatments and global post-operative outcomes were comparable between the two groups. One year after surgery mortality and recurrence rates were similar between the two groups. Our study suggests that geriatric co-management is feasible and contributes to the reduction of postoperative morbimortality. Moreover, performing the CGA after G8 score screening and completion of geriatric interventions resulted in similar 90-day postoperative outcomes, in frail patients than in robust patients. Our results confirmed the benefit of geriatric co-management, involving G8 screening, CGA, and ERAS, for frail older patients undergoing surgery for CRC.

AEGIS-AcutE Geriatric Intervention Study: pilot study of frontline acute geriatric assessment to improve quality of care in emergency department.

Due to the increasing number of older patients in emergency departments (EDs) with frailty, cognitive impairment and multimorbidity, there is a need for geriatric expertise in EDs. This retrospective study is of older patients visiting Turku University Hospital ED between 2 January and 31 December 2022. Patients aged 75years of older were screened for frailty using Triage Risk Screening Tool (TRST) and Clinical Frailty Scale (CFS). Nonacute, frail patients (CFS ≥4) suitable for Targeted Geriatric Assessment (TGA) (n = 1096) were scanned for the risk of delirium, cognitive impairment, change in functional status, falls, malnutrition and depression. A comprehensive patient record was made with recommendations for future care. TRST was completed in 70% of the ED visits, and two-thirds of those were considered high-risk. Among the patients assessed by the geriatric team (TGA), nonspecific complaint (38%) and falls (35%) were the main reasons for ED admission. Cognitive impairment was present in over 60% and orthostatic hypotension in 40% of the patients. The 72-hour revisit rate for TGA-patients was 2.3%. For the real-life control group, the 72-hour revisit rate was 4.6% (P = .001). Thirty-day revisit rates were 10% and 16%, respectively (P < .001). The need for rehabilitation, cognitive evaluation and intensifying home care were the main recommendations for future care. TGA approach provides structured and accurate information on older patients' background. This may lead to more precise diagnostics, a thorough consideration of hospital intake and a secure discharge from the ED. Ensuring continuity of care may help to reduce readmissions to EDs.

The relationship of mental health symptoms to chemotherapy toxicity risk in older adults with cancer: Results from the geriatric assessment-driven intervention study.

Depression and anxiety are prevalent in older adults with cancer but are often undertreated. Older adults are also at increased risk of chemotherapy toxicity (CT). This study evaluated the impact of depression and anxiety symptoms on severe CT risk in older adults with cancer. This is a secondary analysis of a randomized trial (2:1) evaluating geriatric assessment-driven intervention (GAIN) versus standard of care (SOC) to reduce grade 3+ CT in older adults with cancer. Mental health was assessed via the Mental Health Inventory 13. CT was graded by National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. A total of 605 patients enrolled (402 GAIN; 203 SOC). Overall, 35% were depressed and 47% were anxious. Patients with depression had increased CT in the SOC arm (70.7% vs. 54.3%; p=.02) but not in the GAIN arm (54.3% vs. 48.5%; p=.27). CT was more likely in SOC patients with depression (odds ratio [OR], 2.03; 95% CI, 1.10-3.72). This association persisted after adjusting for Cancer and Aging Research Group toxicity score (OR,1.98; 95% CI, 1.07-3.65) and for demographic, disease, and treatment factors (OR,2.00; 95% CI, 1.03-3.85). Depression and CT were not associated in the GAIN arm (OR, 1.26; 95% CI, 0.84-1.91). Anxiety and CT were not associated in either arm. Elevated depression symptoms are associated with increased risk of severe CT in older adults with cancer, which was mitigated with GAIN. This suggests that treating depression symptoms may lower toxicity risk. Future studies are needed to confirm and investigate the impact of depression-specific interventions on outcomes.