Geriatric Intervention Research Articles

657MO Effectiveness of geriatric assessment-driven interventions on quality of life for 2 years in older patients with head and neck cancer: Results from the EGeSOR trial

About 30% of Head and Neck Cancer (HNC) cases are diagnosed in patients aged 70 years and older. Due to their location, HNC and the toxicity of associated treatments may have consequences on quality of life. The aim of this study was to assess the effectiveness of Geriatric Assessment (GA)-driven interventions on quality of life for 2 years in older patients with HNC. The EGeSOR study was a two parallel group, multicenter, randomized, controlled and open-label trial, including HNC patients aged 65 years and over between 2013 and 2018. Patients were randomized 1 :1 to receive either a pre-therapeutic GA, a standardized geriatric intervention and follow-up (intervention group) or standard of care (control group). The main outcome was quality of life measures through the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30/100) and HNC questionnaire (QLQ-HN35/100) at 6, 12 and 24 months. Linear mixed models were performed. Among the 475 patients included (238 in the intervention group and 237 in the control group), the median age was 75.3 years, 31% were women, 44% with oral cancer and 21% metastasis. At baseline, the median score of global health status was 66.7 [50-83.3]. There were no statistically significant differences in evolution between the two groups in either the QLQ-C30 (15 dimensions) or HN35 scores (18 dimensions) over the 24-month period. The evolution of global health status followed a J-shape between M0 and M24 (median gain : 8 points). In the intervention group, 74% of patients did not receive the complete intervention as planned. Statistical analyses regarding age, tumor site and metastasis status are ongoing. Baseline GA did not improve quality of life for 2 years in older patients with HNC. Difficulties in implementation of complete interventions may have contributed to this result. Alternative models to implement GA-driven interventions could be explored.

Chemotherapy Toxicity in Older Adults Optimized by Geriatric Assessment and Intervention: A Non-Comparative Analysis.

The Comprehensive Geriatric Assessment (CGA) is recommended to guide treatment choices in older patients with cancer. Patients ≥ 70 years referred to our oncology service with a new cancer diagnosis are screened using the G-8. Patients with a score of ≤14 are eligible to attend the Geriatric Oncology and Liaison (GOAL) Clinic in our institution, with referral based on physician discretion. Referred patients undergo multidimensional assessments at baseline. CGA domains assessed include mobility, nutritional, cognitive, and psychological status. Chemotherapy toxicity risk is estimated using the Cancer Aging and Research Group (CARG) calculator. We undertook a retrospective analysis of patients attending the GOAL clinic over a 30-month period to April 2021. The objective was to determine rates of treatment dose modifications, delays, discontinuation, and unscheduled hospitalizations as surrogates for cytotoxic therapy toxicity in these patients. These data were collected retrospectively. Ninety-four patients received chemotherapy; the median age was 76 (70–87) and 45 were female (48%). Seventy-five (80%) had an ECOG PS of 0–1. Seventy-two (77%) had gastrointestinal cancer, and most had stage III (47%) or IV (40%) disease. Chemotherapy with curative intent was received by 51% (n = 48) and 51% received monotherapy. From the CGA, the median Timed Up and Go was 11 s (7.79–31.6), and 90% reported no falls in the prior 6 months. The median BMI was 26.93 (15.43–39.25), with 70% at risk or frankly malnourished by the Mini Nutritional Assessment. Twenty-seven (29%) patients had impaired cognitive function. Forty-three (46%) had a high risk of toxicity based on the baseline CARG toxicity calculator. Twenty-six (28%) required dose reduction, 55% (n = 52) required a dose delay, and 36% (n = 34) had a hospitalization due to toxicity. Thirty-nine patients (42%) discontinued treatment due to toxicity. Despite intensive assessment, clinical optimization and personalized treatment decisions, older adults with cancer remain at high risk of chemotherapy toxicity.

Integrating what matters to patients in the care of older adults with cancer

The field of geriatric oncology is advancing, and more level I evidence derived from randomised clinical trials now shows a range of clinically meaningful benefits associated with the integration of an oncogeriatric care approach into the routine management of older adults with cancer. Recently, the GAP70+ and the Geriatric Assessment-Driven Intervention (ie, GAIN) studies showed that older patients with cancer receiving systemic anticancer therapy who were randomised to oncogeriatric care exhibited significantly lower rates of severe toxicities than did those patients who received usual care.

Dementia prevention: The potential long-term cost-effectiveness of the FINGER prevention program.

The aim of this study was to estimate the potential cost-effectiveness of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) program. A life-time Markov model with societal perspective, simulating a cohort of people at risk of dementia reflecting usual care and the FINGER program. Costs were 1,653,275 and 1,635,346 SEK and quality-adjusted life years (QALYs) were 8.636 and 8.679 for usual care and the FINGER program, respectively, resulting in savings of 16,928 SEK (2023 US$) and 0.043 QALY gains per person, supporting extended dominance for the FINGER program. A total of 1623 dementia cases were avoided with 0.17 fewer person-years living with dementia. The sensitivity analysis confirmed the conclusions in most scenarios. The model provides support that programs like FINGER have the potential to be cost-effective in preventing dementia. Results at the individual level are rather modest, but the societal benefits can be substantial because of the large potential target population.

Protocol for a randomised controlled trial on impact of comprehensive geriatric and supportive assessment versus standard care in older adults with cancer undergoing curative treatment: The Geriatric Oncology SuPportive clinic for ELderly (GOSPEL) study

Cancer affects older adults with varying levels of frailty, but cancer treatment is extrapolated from clinical trials involving predominantly young and robust subjects. Recent geriatric oncology randomised controlled trials (RCT) report that geriatric assessment leading to frailty-guided intervention reduces treatment-related toxicity whilst maintaining survival and improving quality of life (QoL). However, these positive results have not have been consistently reported in the literature. We postulate that the impact of geriatric interventions has been underestimated in these studies with the inclusion of subjects receiving palliative-intent chemotherapy in whom dose reduction is common. Integrating supportive care with current geriatric oncology models may improve the QoL of older adults undergoing treatment. However, no studies as yet have examined such integrated geriatric and supportive models of care.The Geriatric Oncology SuPportive clinic for Elderly (GOSPEL) study is a single-centre, open-label, analyst-blinded RCT evaluating the impact of comprehensive geriatric and supportive care on QoL of older adults with cancer undergoing curative treatment. Older adults aged above 65, with a Geriatric-8 score ≤ 14, with plans for high dose radiotherapy and/or curative chemotherapy will be recruited. The primary QoL outcome is measured using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-ELD14 mobility scale at 12 weeks. Secondary outcomes include overall and disease-free survival, treatment-related adverse events, and hospital admissions. We pre-powered this study to recruit 200 subjects based on the minimally clinically important difference for EORTC QLQ-ELD14 to achieve 80% statistical power (alpha 0.05), assuming 25% attrition. Outcomes will be analysed using intention-to-treat.Intervention consists of multi-domain comprehensive geriatric and supportive care assessments from a multidisciplinary team targeting unmet needs. These include functional decline, falls, incontinence, cognitive impairment, multi-morbidity, polypharmacy, and symptom relief, as well as social and psycho-spiritual concerns. Standard care entails routine oncological management with referral to geriatrics based on the discretion of the primary oncologist. Recruitment has been ongoing since August 2020. Results from the GOSPEL study will increase understanding of the impact of integrated geriatric and supportive care programs in older adults with cancer receiving curative treatment.Trial registration: This study is registered under ClinicalTrials.gov (ID NCT04513977).

Effectiveness of Geriatric Assessment-Driven Interventions on Survival and Functional and Nutritional Status in Older Patients with Head and Neck Cancer: A Randomized Controlled Trial (EGeSOR).

Simple SummaryDue to population ageing, there is an increasing number of older patients with head and neck cancers (HNC). Management of HNCs is complex. This population may be frailer than other patients with solid cancer. The Geriatric Assessment (GA) is a multidimensional diagnostic and therapeutic tool focused on frailty to propose a coordinated treatment plan and long-term follow-up. Several trials assessed the efficacy of GA-driven interventions on diverse outcomes but no recent randomized controlled trial demonstrated the impact on mortality, functional, or nutritional status as a primary outcome in this particular population. This trial highlighted several difficulties in implementation of geriatric interventions and suggested that the assessment of other models as co-management with oncologists and/or experienced practice nurses could be useful in clinical routine practice.This study assesses the efficacy of Geriatric Assessment (GA)-driven interventions and follow-up on six-month mortality, functional, and nutritional status in older patients with head and neck cancer (HNC). HNC patients aged 65 years or over were included between November 2013 and September 2018 by 15 Ear, Nose, and Throat (ENT) and maxillofacial surgery departments at 13 centers in France. The study was of an open-label, multicenter, randomized, controlled, and parallel-group design, with independent outcome assessments. The patients were randomized 1:1 to benefit from GA-driven interventions and follow-up versus standard of care. The interventions consisted in a pre-therapeutic GA, a standardized geriatric intervention, and follow-up, tailored to the cancer-treatment plan for 24 months. The primary outcome was a composite criterion including six-month mortality, functional impairment (fall in the Activities of Daily Living (ADL) score ≥2), and weight loss ≥10%. Among the patients included (n = 499), 475 were randomized to the experimental (n = 238) or control arm (n = 237). The median age was 75.3 years [70.4–81.9]; 69.5% were men, and the principal tumor site was oral cavity (43.9%). There were no statistically significant differences regarding the primary endpoint (n = 98 events; 41.0% in the experimental arm versus 90 (38.0%); p = 0.53), or for each criterion (i.e., death (31 (13%) versus 27 (11.4%); p = 0.48), weight loss of ≥10% (69 (29%) versus 65 (27.4%); p = 0.73) and fall in ADL score ≥2 (9 (3.8%) versus 13 (5.5%); p = 0.35)). In older patients with HNC, GA-driven interventions and follow-up failed to improve six-month overall survival, functional, and nutritional status.

Comprehensive Geriatric Assessment for Older People with diabetes mellitus – Considerations for geriatricians and diabetes nurse educators

Older people are complex and have a higher absolute risk of diabetes-related complications and thus should be a target group for diabetes and geriatric nursing intervention. Patients with diabetes also have poor knowledge and understanding of the condition and self-management skills. Management of older people with diabetes should be individualized. Comprehensive geriatric assessment takes into account medical, psychosocial, and functional considerations. Many of the presenting complaints of older people are multifactorial. The reliability and objectivity of the history should also be considered. Other aspects of management include dentition, nutritional status, swallowing, medications, physical activity, fall prevention, palliative care, and support services as well as pressure injuries in dependent older people. Finally, with the current COVID-19 pandemic, the approach for service delivery may also need adjustments to take into account infection prevention and control measures, such as the use of virtual consultations.

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review.

The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.

Electroencephalography Findings in Older Adults Undergoing Geriatric Treatment: A Surrogate for the Outcome?

Background: Comprehensive geriatric care (CGC) is a multidisciplinary approach developed to meet the needs of older patients. Electroencephalography (EEG) provides valuable information for monitoring the cerebral function. As a surrogate, EEG findings may help to estimate the course of diseases as well as the treatment outcomes. Objectives: Therefore, the aim of the present study is to investigate EEG findings in older patients receiving CGC. Methods: Patients with an initial EEG in a geriatric unit between May 2019 and April 2020 and treated using the CGC approach were analyzed. EEG abnormalities were defined as generalized (diffuse) background slowing and/or intermittent/persistent focal slowing and/or epileptiform discharges. Assessment results for the Barthel index (BI), Tinetti Balance and Gait test (TBGT), and Timed Up and Go test (TUG) were analyzed in relation to the presence of EEG abnormalities. Results: The study included 398 patients (mean age: 83.0 ± 6.57 years, 69.3% were female). Abnormal EEG patterns were found in 94 (23.6%) patients. Patients with EEG abnormalities had a mean age of 83.4 years versus a mean of 82.8 years in those without (p = 0.451). Based on all calculated scores, the majority of the patients improved after CGC, with a tendency to higher-grade improvements in those without EEG abnormalities (BI: 86.2% vs. 75.5%, p = 0.024; TUG: 53.3% vs. 31.9%, p < 0.001); for TBGT, only a gradual difference was detected (TBGT: 79.9% vs. 71.3%, p = 0.088). The presence of EEG abnormalities was associated with the parameters dementia (36.2% vs. 22.4%, p = 0.010), known epilepsy/seizure (19.1% vs. 5.9%, p < 0.001), structural brain lesion (47.9% vs. 19.7%, p < 0.001), and delirium (9.6% vs. 3.6%, p = 0.030) during hospitalization. Conclusions: We found EEG abnormalities in almost a quarter of the patients treated in the geriatric unit. In older patients, the presence of EEG abnormalities is associated with lower improvements after CGC.

Multidomain interventions for risk reduction and prevention of cognitive decline and dementia: current developments.

The potential for dementia prevention is deemed substantial if modifiable risk factors were addressed. First large-scale multidomain lifestyle interventions aiming at reducing risk of cognitive decline and dementia have yielded mixed but promising evidence. Despite the impact of the COVID-19 pandemic on trials conduction, causing interruptions and delays, the research landscape on multidomain interventions is growing rapidly. The successful Finish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) has led to an adaptation of the FINGER model in trials underway or being planned in over 40 countries. Recent studies identified barriers and facilitators of and adherence to multidomain interventions, showed the suitability of dementia risk scores as surrogate outcomes, and suggested mechanisms. Multidomain interventions are increasingly conducted in the Global South, and study protocols are increasingly testing expanded FINGER models, for example, with pharmacological components, in digital/remote settings and co-designed personalized interventions. Though results remain mixed, the many ongoing trials will provide more conclusive evidence within the next few years and help to optimize interventions. Continued international collaboration is pivotal to scale and accelerate the development and implementation of effective multidomain interventions as part of larger public health strategies to counteract the global dementia increase.

Geriatric surgical service interventions in older emergency general surgery patients: Preliminary results.

Older adults comprise an increasing proportion of emergency general surgery (EGS) admissions and face high morbidity and mortality. We created a geriatric surgical service with geriatric and palliative expertise to mitigate risks of hospitalization most hazardous to older patients. We sought to identify geriatric surgical service interventions most relevant to EGS patients. We prospectively identified patients ≥75 years admitted to the EGS service at an urban tertiary care hospital from January 2020-March 2021 who screened positive for frailty (FRAIL score ≥3 [scale 0-5, higher being worse]) or with cognitive impairment. A pilot geriatric surgical service, led by a dually-board certified geriatric and palliative care specialist, conducted a comprehensive geriatric assessment and modified Rockwood Frailty Index calculation for each eligible patient. Patient, hospital admission, and geriatric consultation characteristics were collected via chart review. Fifty consecutive patients (median age 82 years [IQR 78-90], 56% female) received geriatric consultation (median time 3 days [IQR 1-6] from admission). The most common admission diagnosis was bowel obstruction (32%). Sixty-four percent of patients underwent ≥1 surgical procedure. Using the Frailty Index, 64% were moderately or severely frail. Interventions most frequently performed by the geriatric team included delirium prevention and management (66%), consideration of swallowing function (52%), individualized pain management (50%), and facilitation of serious illness conversations (58%). Geriatric service involvement addresses a high burden of both geriatric and palliative care needs in older EGS patients. Geriatric recommendations may direct interventions for surgical education in fundamental geriatric and palliative care knowledge to maximize geriatric resources for the most high-risk patients.

1259-P: Using Simplification Strategies for Older Adults with Type 1 Diabetes

Objective: Simplification of insulin regimen algorithms for older adults with type 2 diabetes have been established and recommended as the standard of care. However, simplification of insulin regimens in older adults with type 1 diabetes (T1D) has not been described. Methods: Community-living older adults ≥65 years with T1D were randomized to assess the impact of technology use, combined with geriatric specific interventions to reduce the risk of hypoglycemia (Clinicaltrials.gov NCT03078491) . We developed simplification strategies as part of a geriatric intervention program. Glycemic parameters and quality of life measures were evaluated at baseline and 6-months after enrollment. Results: Thirty-four out of forty-one older adults (83%) with T1D (age 71±4 years, T1D duration 41±16 years, 36% with cognitive dysfunction, 22% living alone) in the subpopulation from the intervention arm were considered appropriate for simplification. We identified four procedures for simplification.1) Liberalization of goals for A1C and/or pump and CGM targets were recommended for 16/34 (47%) participants;2) Fixed-dose boluses for routinely eaten meals, especially at breakfast and lunch, were recommended for 24/34 (71%) participants;3) Avoiding multiple correction doses was recommended for to 25/34 (74%) participants; and4) Proactive adjustment to boluses, rather than constantly reacting to hyper- and hypoglycemia was recommended to 13/34 (38%) . The change in glycemic metrics from baseline to 6-months post-enrollment showed a decreased percent of hypoglycemia (6% vs. 2%; p&amp;lt;0.0001) and decreased glycemic variability (coefficient of variation (%)) (41% vs. 35%, p=0.0001) . A1c and time-in-range remained stable (7.5% vs. 7.6%: 56% vs. 57%, respectively) . Conclusions: In this study, simplification procedures for insulin regimens in older adults with T1D were developed. Simplification of regimens did not contribute to worsening of glycemic parameters. Prospective studies are needed to confirm our findings. Disclosure M.Munshi: Consultant; Sanofi. C.Slyne: None. R.Hurlbert: None. E.Toschi: Consultant; Medtronic. Funding This research was supported by an NIH DP3 Grant (1DP3DK112214-01) and an NIH P30 Grant (P30DK036836) . Continuous glucose monitoring materials were partially suppliedby Dexcom.

Comparative study of two cohorts of older adults with advanced cancer treated before and after implementation of a geriatric oncology service.

12036 Background: A comprehensive geriatric assessment (CGA) has been recommended by guidelines for older adults with cancer for whom chemotherapy is considered. As a quality assessment effort, we examined the effect of CGA conducted by a geriatric oncology service (GOS) in routine practice on clinical outcomes. Methods: This was a comparative study of two cohorts of consecutive patients aged ≥ 70 years with unresectable, locally advanced or metastatic cancer who were referred to medical oncology for first-line chemotherapy before (September 2015-August 2018) and after (September 2018-March 2021) the establishment of a GOS at a single institution in Japan. When the treating physician requested a consultation, the GOS conducted a CGA and provided recommendations for the oncologic treatment plan and geriatric interventions. We compared time to treatment failure (TTF) rates at 30, 60 and 90 days as well as 6-month overall survival (OS) rates between the two cohorts adjusting for potential confounders. TTF was defined as the time from start of first-line chemotherapy to discontinuation of first-line chemotherapy for any reason. Results: The study population consisted of 342 patients. Median age was 75 years (range: 70-95 years) and 85% had gastrointestinal tract cancer including gastroesophageal (43%) and colorectal (41%). Baseline characteristics of the patients treated before (n = 151) and after (n = 191) GOS implementation were similar with regard to age, sex, cancer type, and performance status. In the after GOS cohort, 82 patients (43%) received CGA before the treatment decision and oncologic treatment plans were changed after consultation in 49 patients (60%). For the majority of these patients, the treatment plan was adjusted to a less intensive option. Two hundred and eighty-two patients received chemotherapy (n = 128 before, n = 154 after GOS cohort) and 60 patients were treated with best supportive care only (n = 23 before, n = 37 after GOS cohort). More patients in the after GOS cohort were treated with reduced-intensity chemotherapy compared with those in the before GOS cohort (55% vs. 39%, P = 0.007). TTF event rates at 30 days (5.7% after vs. 14% before, P = 0.02), 60 days (13% after vs. 29% before, P = 0.001) and 90 days (26% after vs. 36% before, P = 0.06) were lower in the after GOS cohort compared to the before GOS cohort. Among patients receiving chemotherapy, significantly more patients were alive at 6 months in the after GOS cohort compared to the before GOS cohort (84% vs. 72%, P = 0.01). In all patients receiving CGA (n = 94), 219 interventions to address health problems were recommended and 97 interventions were conducted with an overall implementation rate of 44%. Conclusions: In this before-and-after quality assessment study, implementation of the GOS was associated with improved TTF and OS in older adults with advanced cancer receiving first-line chemotherapy.

P-190 The Geriatric 8 score is associated with risk of hospitalisation and 6-month survival in patients with incurable pancreatic cancer receiving gemcitabine and capecitabine

Assessing frailty in cancer patients can aid treatment decisions, target geriatric interventions and improve outcomes. The G8 score is a screening tool to detect frailty, however there are limited data on its utility in patients receiving chemotherapy for pancreatic cancer. We assessed the G8 score retrospectively in a population of older patients with incurable pancreatic cancer receiving gemcitabine and capecitabine chemotherapy. We performed a retrospective analysis of patients aged 65 or older, who had received Gemcitabine and capecitabine in the Northern Ireland Cancer Centre identified from electronic clinical databases. Clinico-pathological, treatment and outcome data were collected. Outcomes were 6-month survival, grade 3 toxicities, and hospitalisation risk 6 months from starting treatment. Toxicities were graded according to CTCAE v5. Descriptive statistics Fischer’s exact test was used to assess G8 scores and individual domains with outcomes. Univariable and multivariable analysis were undertaken assessing associations between the individual G8 domains and outcomes. Kaplan-Meier techniques were used to assess survival. SPSS version 26 was used. 95 patients treated between 11/2017 and 8/2021, were identified. Median age 73 (IQR 70 – 77) and 53% female. All G8 variables were collected except patient reported health status. 48% had metastatic disease and 52%, locally advanced disease. The median G8 score was 10.5 (IQR 9-12). Median overall survival in patients with a G8 score greater than 12 (n=22) was 13.9 months; and less than 12 (n=73), 8.6 months (log rank 2.4, p=0.118). 6 month and 12 month survival rates in the entire group were 65% and 39%, in G8 >12 77% and 50%, and in G8 12 and less 61% and 36%. Grade III toxicities were observed in 60% in both G8>12 and G8 12 and below p=0.888. Risk of hospitalisation or death in 6 months was associated with weight loss (p=0.048) and reduced BMI (p=0.04). A logistic regression model found the G8 domains were associated with risk of Hospitalisation or death at 6 months in this population (X2=29.9, p=0.008), explained 42.7% of variation of hospitalisation or death and correctly predicted 84.2% of cases. No individual variable was statistically significant in this model. This retrospective analysis suggests that the Geriatric- 8 score is associated with of risk of hospitalisation or death within 6 months of starting chemotherapy in older patients with pancreatic cancer. Given the poor survival of patients with advanced pancreatic cancer, time spent as an inpatient will have a greater proportional impact on quality of life compared to cancers with longer survival. Geriatric assessment may improve treatment decisions in these patients. Larger prospective studies are required to validate the utility of the G8 score specifically in older pancreatic cancer patients.

Association of two geriatric treatment systems on care home admission and mortality in patients with hip fracture

BackgroundIn Germany, geriatricians deliver acute geriatric care during an acute hospital stay and subacute rehabilitation after transfer to a rehabilitation clinic. However, the proportion of patients who receive acute geriatric care (AGC) or are transferred to subacute rehabilitation (TSR) differs considerably between hospitals. The aim of this study was to analyse the association between the two geriatric treatment systems and care home admission or mortality in patients following hip fracture.MethodsHealth insurance claims data were used to identify the rate of AGC per hospital and the rate of TSR per hospital following hip fracture surgery in patients aged ≥ 80 years. Outcomes were cumulative admission to a care home and cumulative mortality within 6 months after hospital admission.ResultsData from 23,046 hip fracture patients from 561 hospitals were analysed. The rate of AGC was not associated with care home admission. However, compared to high rates of AGC medium rates or no AGC were associated with increased death rates by 12% or 20%, respectively. Treatment in hospitals with low rates of TSR was associated with a 8% higher risk of care home admission and a 10% increased risk of death compared to treatment in hospitals with high rates of TSR.ConclusionsOur study suggests potential effects of geriatric treatment: reduction of mortality in hospitals with high rates of AGC or reduction of care home admission and mortality in hospitals with high rates of TSR.

AI-Based Predictive Modelling of the Onset and Progression of Dementia

Dementia, the most severe expression of cognitive impairment, is among the main causes of disability in older adults and currently affects over 55 million individuals. Dementia prevention is a global public health priority, and recent studies have shown that dementia risk can be reduced through non-pharmacological interventions targeting different lifestyle areas. The FINnish GERiatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) has shown a positive effect on cognition in older adults at risk of dementia through a 2-year multidomain intervention targeting lifestyle and vascular risk factors. The LETHE project builds on these findings and will provide a digital-enabled FINGER intervention model for delaying or preventing the onset of cognitive decline. An individualised ICT-based multidomain, preventive lifestyle intervention program will be implemented utilising behaviour and intervention data through passive and active data collection. Artificial intelligence and machine learning methods will be used for data-driven risk factor prediction models. An initial model based on large multinational datasets will be validated and integrated into an 18-month trial integrating digital biomarkers to further improve the model. Furthermore, the LETHE project will investigate the concept of federated learning to, on the one hand, protect the privacy of the health and behaviour data and, on the other hand, to provide the opportunity to enhance the data model easily by integrating additional clinical centres.

Assessing frailty using comprehensive geriatric assessment in older patients with hematologic malignancy.

The incidence of hematologic malignancy increases with age; thus, the number of older patients who require intensive chemotherapy is expected to increase with the aging population. In Korea, 61.8%, 59.3%, 47.0%, and 46.7% of newly diagnosed cases of multiple myeloma, myelodysplastic syndrome, myeloproliferative disorder, and non-Hodgkin lymphoma, respectively, occurred in patients aged >65 years in 2018. Health status among older patients, defined by frailty, age-related syndrome of physiological decline and increased vulnerability, is associated with adverse health outcomes. Health status is highly heterogeneous among older patients, and treatment outcomes vary according to frailty and physiologic age rather than chronologic age. Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary diagnostic and treatment process that identifies multiple domains, including functional status, cognition, comorbidities, medications, socioeconomic status, and nutritional status, to develop a coordinated plan to improve treatment-related outcomes and quality of life. Frailty can be assessed with CGA findings, and CGA is considered the “gold standard of care” for frail, older patients. Through CGA, unidentified problems can be assessed, and pre-emptive and non-oncologic interventions can be delivered. CGA is an objective and reliable tool for predicting further treatment-related complications and identifying patients for whom intensive chemotherapy with curative intent is appropriate. CGA should be considered a routine practice before starting treatment planning in older patients diagnosed with hematologic malignancies who require intensive chemotherapy. Further study is needed to allocate individualized treatment plans or multidisciplinary geriatric interventions according to CGA results.

The older, the less potential benefit for type 2 diabetes from weight control

BackgroundAlthough moderate weight loss improves outcomes of type 2 diabetes mellitus (T2DM) in young and middle-aged adults, there is a lack of high-quality evidence to support the strong relationship between obesity and T2DM in older people. This study aims to investigate whether the association of obesity with T2DM changes with aging.MethodsIn this cross-sectional study, we recruited 63,180 Chinses and US subjects from 3 datasets. Subjects were divided into young & middle-aged (≤59 years), young-old (60–75 years), and old-old (≥75 years). Logistic regression was used to determine the odds ratio (OR) and 95% confidence intervals (95% CI) for the association between obesity and T2DM, stratified by common confounders. A sliding-window based algorithm and restricted cubic splines were used to smoothly estimate the changes with aging.ResultsThe OR (95% CI) for the associations between general obesity and T2DM were decreased from the young & middle-aged group (OR, 5.91; 95% CI, 5.33–6.56) to the young-old group (OR, 3.98; 95% CI, 3.56–4.45) and then to the old-old group (OR, 3.06; 95% CI, 2.57–3.66). The trend for this reduced association with aging persisted after stratification by obesity type, region, gender, recruiting time, hypertension, and hyperlipidemia in both Chinese and Americans. We also identified a weakened gender disparity for this association between the young & middle-aged subjects (P for disparity < 0.001) and the old-old group (P for disparity = ~ 0.36).ConclusionsThe obesity-T2DM association is clearly reduced with aging, which indicates that the elderly may gain fewer potential benefits in weight lose than the younger patients. Considering this attenuated association, as well as the increased incidence of geriatric syndrome in the elderly, clinicians should comprehensively balance the benefits and side effects of weight loss in geriatric T2DM interventions.

Translation of the geriatric emergency department intervention into other emergency departments: a post implementation evaluation of outcomes for older adults

BackgroundIncreasing numbers of older adults with complex health deficits presenting to emergency departments has prompted the development of innovative models of care. One such model designed to reduce poor outcomes associated with acute healthcare, is the Geriatric Emergency Department Intervention. This intervention is a nurse-led, physician-championed, Emergency Department intervention that improves the health outcomes for frail older adults in the emergency department.MethodsThis quantitative cohort study aimed to evaluate the healthcare outcomes and costs associated with the implementation of the Geriatric Emergency Department Intervention (GEDI) for adults aged 70 years and over at two hospital sites that implemented the model using the integrated-Promoting Action on Research Implementation in Health Services (i-PARHIS) framework. Hospital A was large teaching hospital located in the tropical north of Australia. Hospital B was a medium sized teaching hospital near Brisbane, Queensland Australia.The effect of the intervention was examined in two ways. Outcomes were compared between: 1) all patients in the pre- and post- implementation periods, and 2) patients seen or not seen by the Geriatric Emergency Department Intervention team in the post-implementation period. The outcomes measured were disposition (discharged home, admitted); emergency department length of stay; hospital length of stay; all cause in-hospital mortality within 28 days; time to re-presentation up to 28 days post-discharge; emergency department and in-hospital costs.Survival analyses were used for the primary and secondary outcome variables and a Cox survival model was used to estimate the associations between variables and outcomes. Multiple regression models were used to examine other secondary outcomes whilst controlling for a range of confounders.ResultsThe Geriatric Emergency Department Intervention was successfully translated into two different emergency departments. Both demonstrated an increased likelihood of discharge, decreased emergency department length of stay, decreased hospital costs for those who were admitted, with an associated reduction in risk of mortality, for adults aged 70 years and over.ConclusionsThe Geriatric Emergency Department Intervention was successfully translated into new sites that adapted the model design. Improvement in healthcare outcomes for older adults presenting to the emergency department was demonstrated, although this was more subtle than in the original model setting.

Effectiveness of Comanagement Model: Geriatric Medicine and Vascular Surgery.

Older surgical patients frequently develop postoperative complications due to their frailty and multiple comorbidities. Geriatric medicine consultation helps to optimize risk factors and improve outcomes in patients with hip fracture. This study aimed to evaluate patient outcomes before and after comanagement model implementation between geriatric medicine (Geriatric Surgical Service) and vascular surgery services. This was a case-control study involving emergency vascular surgical patients who were comanaged by vascular surgery, geriatric medicine, and geriatric nursing services. This study was conducted in a tertiary hospital in Singapore from 2015 to 2018 with acute vascular surgical patients aged older than 65years. A retrospective cohort of 135 patients from 2013 to 2014 (control group) who fulfilled the criteria for the comanagement model was compared with a prospective cohort of 348 patients who were comanaged by a geriatric surgical service from 2015 to 2018, and a further subgroup analysis of patients between 2015 and 2016 (n= 150) (early intervention group) and between 2017 and 2018 (n= 198) (late intervention group) was performed. Comanaged patients had a significantly shorter length of hospital stay (11.6 vs 20.8days, P=.001), reduced nosocomial infections (3% vs 12% for urinary tract infection, P= .003) and decreased 30-day readmission rates (22% vs 34%, P= .011). A trend of a decreased incidence of fluid overload was noted in patients comanaged with the geriatric surgical service (3% vs 7%, P= .073). Subgroup analysis showed progressive reductions in the length of stay (15.4 vs 11.6days, P= .001), 30-day readmission rate (35% vs 22%, P= .01), and nosocomial urinary tract infection (8% vs 3%, P= .003) between the early intervention group and the late intervention group. Although they were not statistically significant, reductions were also observed in the delirium rate (13% vs 11%) and other postoperative medical complications in the early intervention group and the late intervention group. Despite having increasing comorbidities, older vascular surgical inpatients had a significantly shorter length of stay, reduced nosocomial infections, and decreased 30-day readmission rates through a comanagement model with vascular surgery and geriatric medicine services. Improvements in outcomes were observed over time as the model of care evolved. Geriatric medicine intervention in the perioperative period improves the outcomes of older acute vascular surgical patients.