Treatment Outcomes In Elderly Patients Research Articles

Screening tool for sarcopenia (SARC-F) predicts unsatisfactory medical treatment of lower urinary tract symptoms in elderly men aged 75years or older: a preliminary observational study.

We investigated the influence of sarcopenia on treatment outcomes in elderly patients receiving medical therapy for lower urinary tract symptoms (LUTS). We included male patients with LUTS aged ≥ 75years who had not changed their medication for 1year. Current conditions were estimated using IPSS, overactive bladder symptoms score (OABSS), and screening tool for sarcopenia (SARC-F). We also evaluated prostatic volume (PV), serum testosterone level, grip strength, and nutrition status. SARC-F score of ≧4 was defined as sarcopenia. We included 59 patients in this study, including 16 patients (27.1%) with sarcopenia. The mean grip strength was significantly lower in the sarcopenia group than the non-sarcopenia group (25.5 vs. 30kg, p < 0.01). IPSS total score, voiding symptom score of IPSS, and IPSS-QOL were significantly higher in the sarcopenia group than the non-sarcopenia group. The non-sarcopenia group had significantly larger PV (40 vs. 20ml, p < 0.01) and higher testosterone levels (497.5 vs. 369ng/ml, p = 0.03) compared with the sarcopenia group, whereas the percentage of patients taking dutasteride tended to be higher in the non-sarcopenia group than the sarcopenia group (58.1% vs. 31.3%, p = 0.07). Moderate and severe LUTS (IPSS total ≥ 8) persisted in 34 patients (57.6%) after medical treatment. Multivariate analysis showed that only SARC-F was a significant factor affecting the IPSS total ≥ 8 despite medical treatment for 1year (OR 1.67, 95%CI: 1.13-2.46, p = 0.01). Sarcopenia defined by using SARC-F is a significant factor for unsatisfactory medical treatment of LUTS in elderly men aged ≥ 75years.

377P Prognostic model and treatment outcomes in elderly patients with metastatic pancreatic cancer

377P Prognostic model and treatment outcomes in elderly patients with metastatic pancreatic cancer

Treatment outcome of elderly patients (≥ 78 years) with head and neck squamous cell carcinoma: A single center experience.

Patients older than the expected age of the local population generally have limited life expectancy. The optimal treatment approach for very elderly patients with head and neck cancer remains uncertain. This study retrospectively analyzed patients over 78 years old, the expected age in 2019 for Chinese individuals, who underwent treatment for head and neck cancer at a tertiary cancer center in China. The study compared the overall survival rates among different treatment groups. The findings revealed that among patients eligible for surgery, radical resection yielded better outcomes compared to radiotherapy-based treatments, with a hazard ratio of 0.362 (95% CI 0.160-0.819, P = 0.015). Among patients who received radiotherapy, those who received a total dose exceeding 60 Gy had a significantly longer survival compared to those who received palliative doses, with median survival time of 31 months versus 14 months (P = 0.003). Among 78 patients who underwent conventional fractionated radiotherapy (CFRT), 15 patients (19.23%) experienced unscheduled treatment breaks with a median duration of 12 days. However, these treatment breaks did not appear to impact survival (P > 0.1). The study also suggested that altered fractionated radiotherapy, including hypofractionated radiotherapy (hypo-RT), could be a viable alternative to CFRT, offering similar survival outcomes with reduced treatment duration. In conclusion, eligible patients should be treated with curative intent, even if they are older than the expected age of the local population. When radiotherapy is indicated, altered fractionation, particularly hypo-RT, may be a favorable option to consider.

Skeletal muscle index impacts the treatment outcome of elderly patients with diffuse large B cell lymphoma.

Sarcopenia is a crucial factor in the physical fitness of elderly individuals. This study investigated the prognostic values of multiple parameters of sarcopenia in association with established prognostic factors in elderly Japanese patients with diffuse large B cell lymphoma (DLBCL). As candidate indicators for sarcopenia, the skeletal muscle index (SMI) (cm2 /m2 ), the psoas muscle index, the erector spinae muscle index, the visceral fat index, the subcutaneous fat index, and the visceral to subcutaneous fat area ratio at the third lumbar level were assessed by computed tomography at their initial diagnosis in 102 patients with DLBCL over 75years old those were diagnosed and treated in our institute from 2007 to 2020. The primary endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). The median age of patients analyzed was 80years at diagnosis. The sex-specific cut-offs for the indices adopted two approaches: (i) the historical cut-off values established in the previous study for healthy Japanese individuals (Hamaguchi Y. J Cachexia Sarcopenia Muscle. 2018), and (ii) each sex-specific lowest quartile in our cohort. As the results, SMI evaluated by the historical cut-off and sex-specific lowest quartile was identified as the most influential independent prognostic factor for both OS and PFS among various parameters for sarcopenia. Furthermore, we developed an elderly sarcopenia prognostic index (ESPI). ESPI, which combines SMI evaluated by the historical cut-off and LDH>ULN, demonstrated statistically significant prognostic impacts on OS and PFS. Moreover, compared to the R-IPI, ESPI showed the ability to identify intermediate-risk groups and indicated a trend toward improved predictive accuracy. Our study revealed that SMI is the most appropriate assessment method for evaluating sarcopenia and the critical prognostic factor in OS and PFS of elderly patients with DLBCL.

Effect of comprehensive nursing intervention on quality of life and treatment outcomes in elderly patients with Gout and Hyperuricemia complicated with hypertension.

To evaluate the effect of comprehensive nursing intervention on the quality of life and treatment outcomes of elderly patients with gout and hyperuricemia complicated with hypertension. This is a clinical comparative study. One hundred and twenty elderly patients with gout and hyperuricemia complicated with hypertension who were hospitalized at Baoding No.1 Central Hospital were included from March 20, 2021 to March 20, 2022, and randomly divided into two groups. Patients in the control group were given conventional nursing care in the perioperative period, while those in the experimental group were given comprehensive nursing intervention on the basis of the control group. The differences between the two groups in terms of clinical effects, quality of life were compared and analyzed. The response rate of the experimental group was higher than control group,with a statistically significant difference. After the intervention, the above indicators improved significantly in the experimental group compared to the control group, with statistically significant differences. There was no significant difference in Self-Rating Anxiety Scale(SAS) and Self-rating depression scale(SDS) levels between the two groups before the intervention. After the intervention, SAS and SDS decreased significantly in the experimental group compared to the control group, with statistically significant differences . The patient satisfaction rate of the experimental group was also higher than control group, with a statistically significant difference. Comprehensive nursing intervention is an effective treatment option for elderly patients with gout and hyperuricemia complicated with hypertension, resulting in obvious improvements in patient quality of life, improved mood, patient satisfaction and treatment outcomes.

Multicenter, Prospective Study to Investigate the Efficacy and Safety of Intravenous-Immunoglobulin Therapy in Elderly Patients with Diffuse Large B Cell Lymphoma Treated with R-Mini-CHOP

Background The median age at initial diagnosis of DLBCL is estimated to be between the ages of 60 and 70. The number of elderly patients with DLBCL is gradually increasing. But, treatment outcomes of elderly patients were not significantly improved compared to younger patients. Infection is an independent predictor of treatment outcome in patients with DLBCL, and the risk of infection increases with age. The incidence of hypogammaglobulinemia in patients with malignant lymphoma increased from 15% to 39% after rituximab therapy. There was a significant decrease in the occurrence of major infections after intravenous immunoglobulins (IVIG) prophylaxis in hypogammaglobulinemia patients with lymphoproliferative. disorders. In this multicenter prospective study, infection prevention effect and treatment outcomes were identified using IVIG in elderly DLBCL patients with hypogammaglobulinemia who received rituximab combination chemotherapy. Methods In the current study, newly diagnosed DLBCL patients aged 70 years or older who were planning to receive R-mini-CHOP therapy were included. Patients with hypogammaglobulinemia at diagnosis were assigned to the IVIG group. Patients received R-mini-CHOP (rituximab: 375mg/m 2 D1; cyclophosphamide: 400mg/m 2 D1; doxorubicin: 25mg/m 2 D1; vincristine: 1.0mg D1, and prednisolone 40mg/m 2 from D1 to D5), and pegylated G-CSF. After the first cycle of R-mini-CHOP, 400mg/kg of IVIG was administered on D3 and D11. After the second cycle to sixth cycle of chemotherapy, patients received 400mg/kg of IVIG on D11. The primary objective was to evaluate the efficacy of IVIG in reducing severe infections. Grade 3 or 4 infections were defined as severe infections. Results A total of 118 elderly patients were newly diagnosed with DLBCL and were scheduled to receive R-mini-CHOP therapy. Hypogammaglobulinemia was identified in 85 (72.0%) patients. Decreased immunoglobulin D (n=42) and immunoglobulin M (n=39) level were most common, and 18 patients had two or more types of hypogammaglobulinemia at the same time. Fifty-six patients were assigned to the group receiving IVIG. Median age was 77 years (range, 70-90), and 31 (55.4%) were male. In patients who completed R-mini-CHOP and IVIG treatment, complete remission rate was 79.4%. Severe infections of grade 3 or 4 occurred in 3 of 56 (5.4%) patients, and only five (8.9%) patients had COVID-19 infection during the study period. Adverse effects associated with IVIG include fever/chilling, nausea/vomiting which were generally manageable. Only one patient discontinued the study because of chest pain that occurred during IVIG administration. In patients with hypogammaglobulinemia who did not receive IVIG, severe infections occurred in 8 of 29 (27.6%) patients, and COVID-19 infection was developed in 7 of 29 (24.1%). In patients without hypogammaglobulinemia, severe infection occurred in 5 of 33 (15.2%), and COVID-19 infection was developed in 8 of 33 (24.2%) patients. Patients receiving IVIG had a significantly reduced incidence of severe infection compared to patients not receiving IVIG (p=0.028). Furthermore, COVID-19 infection rate during R-mini-CHOP therapy was lower in IVIG receiving patients (p=0.050). Long-term outcomes with relapse rate and survival will be followed up and updated. Conclusion In elderly patients with DLBCL, the combination of R-mini-CHOP and IVIG was safe and effective in preventing infection. In the COVID-19 era, the combination of chemotherapy and IVIG should be considered in elderly DLBCL patients to reduce infection rate and improve treatment outcomes.

The Association Between Mild Cognitive Impairment and Medication Non-adherence Among Elderly Patients With Chronic Diseases.

Medication adherence is essential for optimizing treatment outcomes in elderly patients who frequently contend with multiple chronic diseases requiring pharmacological interventions. Mild cognitive impairment (MCI) is a prevalent cognitive disorder among the elderly population, but its impact on medication adherence among elderly patients is still uncertain. This cross-sectional study aimed to investigate the impact of MCI on medication adherence among elderly patients. A cross-sectional study of 436 elderly patients with common chronic diseases aged 60 years and above was conducted. Medication adherence was measured using the Morisky Medication Adherence Scale-8 (MMAS-8). MCI was screened, and cognitive status was assessed using the Mini-Mental State Examination (MMSE) questionnaire. Multivariate logistic regression analysis was performed to identify independent risk factors of medication non-adherence. Among these elderly patients, 212 (48.6%) had poor medication compliance, and 181 (41.5%) had MCI. Preliminary analyses showed a significant association between MCI and medication non-adherence among elderly patients (odds ratio (OR)=3.95, 95% confidence interval (95%CI)=2.63-5.92, P<0.001). Multivariate logistic regression analysis showed that MCI was independently associated with the risk of medication non-adherence among elderly patients (adjusted OR=2.64, 95%CI=1.64-4.24, P<0.001). Additionally, adverse drug reaction and poor evaluation of medication effects were also independently associated with medication non-adherence in elderly patients (P<0.05). Findings from this cross-sectional study proved the substantial adverse impact of MCI on medication adherence among elderly patients, and MCI was an independently influential factor of medication non-adherence. Identifying the MCI status early and providing interventions to enhance medication adherence are undoubtedly essential for optimizing healthcare outcomes in elderly patients.

Hodgkin lymphoma mortality trends in age subgroups from 1999 to 2020 in the United States.

e19515 Background: Hodgkin Lymphoma has a bimodal distribution with the first peak between ages 15-35 and the second peak being 55 years old and older. Advancements in treatment therapies have improved mortality such that Hodgkin Lymphoma is considered a curable disease. However, treatment outcomes in elderly patients are inferior to those of younger patients. In our study, we analyzed Hodgkin Lymphoma mortality from 1999 to 2020 in the United States. We investigated age-adjusted mortality rates and annual percent changes with a sub-group analysis. Methods: Using the CDC Wonder database, we examined mortality trends from 1999 to 2020 for Hodgkin Lymphoma in adults age 55 and older in the United States. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 people and stratified patients by sex, race/ethnicity, and census region. We computed the annual percentage change trends for the respective stratification using Joinpoint regression software. Additionally, a comparison group between ages 15 and 54 was added for the analysis. Results: In the United States, between 1999 and 2020 there were 24,898 deaths from Hodgkin Lymphoma in Adults 55 and older. The overall age adjusted mortality rate improved from 1.9 per 100,000 people to 1.4, with a respective APC of -2.06%. Our subgroup analysis by sex, race, and census region showed improvements circumferentially. Males consistently had higher rates of improvement than females. Most notably black patients had the lowest difference in AAMR from 1999 to 2020 (0.2), however, white patients and Hispanic patients respectively had higher AAMRs. The comparison group ages 15-54 had lower AAMR change from 1999 to 2020 by sex, race, and region. However, the respective AAMR for the age 15-54 group was significantly lower. Conclusions: Hodgkin Lymphoma has had significant age adjusted mortality rate improvements since 1999. Comparing adults 55 and older to patients 15-54 there is still a notable difference in AAMR. The greater magnitude of improvement in AAMR in older adults with Hodgkin Lymphoma may be related to the approval of agents such as brentuximab vedotin, which has improved tolerability as compared to bleomycin. Alleviating pulmonary toxicity with this novel agent may be more relevant in an older patient population with increased comorbidities. Further, research is needed to continue to identify more efficacious and less toxic therapies for older individuals with Hodgkin Lymphoma. [Table: see text]

Особенности хирургической тактики в лечении переломов проксимального отдела бедренной кости у геронтологических пациентов

The paper is dedicated to improving the treatment outcomes and consequences in elderly patients with femoral neck fracture by improving the diagnostics, osteosynthesis and total hip arthroplasty. The main causes and factors influencing the complication rates and final treatment outcomes in elderly patients with femoral neck fracture were identified. The evidence based diagnostic and treatment algorithm for such patients was designed. The proposed treatment system helped to reduce lethality, general and local complication rates among these patients. The active surgery helps to solve massive healthcare problems by easing the pain in elderly patients, restoring the hip joint mobility and weight bearing ability of extremity, enhancing independent living skills, and improving vitality and psychological state.

A Cross-Sectional Assessment of Urinary Tract Infections Among Geriatric Patients: Prevalence, Medication Regimen Complexity, and Factors Associated With Treatment Outcomes.

Background: Urinary tract infections (UTIs) are the second most prevalent infection among the elderly population. Hence, the current study aimed to evaluate the prevalence of UTIs among older adults, medication regimen complexity, and the factors associated with the treatment outcomes of elderly patients infected with UTIs.Methods: A retrospective cross-sectional study was conducted at the Department of Urology, Hospital Pulau Pinang, Malaysia. The patients ≥65 years of age were included in the present study with a confirmed diagnosis of UTIs from 2014 to 2018 (5 years).Results: A total of 460 patients met the inclusion criteria and were included in the present study. Cystitis (37.6%) was the most prevalent UTI among the study population followed by asymptomatic bacteriuria (ASB) (31.9%), pyelonephritis (13.9%), urosepsis (10.2%), and prostatitis (6.4%). Unasyn (ampicillin and sulbactam) was used to treat the UTIs followed by Bactrim (trimethoprim/sulfamethoxazole), and ciprofloxacin. The factors associated with the treatment outcomes of UTIs were gender (odd ratio [OR] = 1.628; p = 0.018), polypharmacy (OR = 0.647; p = 0.033), and presence of other comorbidities (OR = 2.004; p = 0.002) among the study population.Conclusion: Cystitis is the most common UTI observed in older adults. Gender, the burden of polypharmacy, and the presence of comorbidities are the factors that directly affect the treatment outcomes of UTIs among the study population.

Abstract PS6-35: Real world outcomes in elderly women with HER2 positive advanced breast cancer

Abstract BackgroundThe development of anti-human epidermal growth factor receptor 2 (HER2) therapies has significantly improved disease outcomes in patients with HER2-positive advanced breast cancer (ABC). However, elderly patients are persistently under-represented in clinical trials, with only 2.4% of patients aged ≥75 years in the pivotal CLEOPATRA study. Despite a lack of research addressing treatment outcomes in elderly patients, advanced age at diagnosis is associated with a greater likelihood of receiving no initial systemic therapy for de novo metastatic breast cancer. Studies have also shown that older women diagnosed with metastatic breast cancer have a poorer prognosis and shorter life expectancy. We examined treatment patterns and outcomes in an elderly (defined as ≥70) ‘real world’ Australian population. MethodsData was extracted from the Treatment of Advanced Breast Cancer in the HER2-positive Australian Patient (TABITHA) multi-site clinical registry, and patients stratified according to age (&amp;lt;70 and ≥70 years). Descriptive statistics were used to report baseline characteristics and compared using T-tests and Chi square analyses. Treatment duration and overall survival were calculated via the Kaplan-Meier method using GraphPad Prism 8.0 software. ResultsWe identified 319 patients, including 67 patients (21%) aged ≥70 years. Older patients were more likely to have an Eastern Cooperative Oncology Group performance status of ≥2 (16% vs 3%; p&amp;lt;0.001) and a Charlson Comorbidity Index of ≥2 (13% vs 7%; p&amp;lt;0.001). There were no significant differences in hormone receptor status, de novo metastatic presentation, or presence of visceral disease between groups. A similar proportion of patients in each group received first line HER2-directed therapy (85% vs 93%; p=0.054), and the duration of therapy was not significantly different between groups (16 vs 22 months; p=0.70). Despite no difference between groups in the proportion of patients who received first-line chemotherapy, older patients demonstrated shorter chemotherapy durations (2.7 months vs 3.5 months; p&amp;lt;0.02). Median overall survival was significantly longer in younger patients (82 months vs 42 months; hazard ratio, 0.50; 95%CI, 0.29-0.87; p&amp;lt;0.001). In the first-line setting, overall adverse events rates were higher in the older group (34% vs 20%; p=0.04), including cardiotoxicity (7% vs 0.9%; p=0.02), and on-treatment deaths (5% vs 0%; p=0.01). ConclusionElderly patients with HER2-positive ABC demonstrated shorter chemotherapy durations, poorer overall survival, and increased rates of adverse events despite having similar disease characteristics and treatment patterns. Prospective studies are required to improve outcomes in the elderly HER2 positive population. Citation Format: Nicole Evans, Angelyn Anton, Rachel Wong, Sheau Wen Lok, Richard De Boer, Laeeq Malik, Sally Greenberg, Belinda Yeo, Louise Nott, Gary Richardson, Ian M Collins, Javier Torres, Frances Barnett, Peter Gibbs, Bianca Devitt. Real world outcomes in elderly women with HER2 positive advanced breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-35.

Преемственность поколений на кафедре травмато- логии и ортопедии в лечении пациентов с переломами шейки бедренной кости

The paper is dedicated to improving the treatment outcomes and their consequences in elderly patients with femoral neck fracture by developing a diagnostic procedure and performing the total hip arthroplasty. The main causes and factors influencing the complication rates and final treatment outcomes in elderly patients with femoral neck fracture were identified. The evidence based diagnostic and treatment algorithm for such patients was designed. The proposed treatment system helped to reduce lethality, general and local complications among patients. The active surgery helps to solve massive healthcare problems by easing the pain in elderly patients, restoring the hip joint mobility and supportive ability of extremity, enhancing independent living skills, and improving vitality and psychological state.

Clinical impact of frailty on treatment outcomes of elderly patients with relapsed and/or refractory multiple myeloma treated with lenalidomide plus dexamethasone.

We compared efficacy and safety, according to frailty, of elderly patients with relapsed and refractory multiple myeloma (RRMM) treated with lenalidomide and dexamethasone (Rd), for whom bortezomib treatment had failed. Patients, 164 (52.9%) and 146 (47.1%), were classified as non-frail and frail using a simplified frailty scale. The overall response rates (ORR) and survival outcomes were lower in frail than in non-frail patients (ORR: 56.2% vs. 67.7%, P = 0.069; median progression free survival: 13.17 vs. 17.80months, P = 0.033; median overall survival: 23.00 vs. 36.27months, P = 0.002, respectively). The number of treatment emergent adverse events in grade 3 or worse was higher in frail than in non-frail patients (41.8% vs. 24.4%, P = 0.002, respectively). In frail patients, independent poor prognostic factors for survival were two or more Charlson comorbidity index (CCI) score, prior to exposure to both bortezomib and thalidomide, and achieved less than partial response In conclusion, frailty could predict clinical outcomes of Rd treatment in elderly patients with RRMM who had failed prior bortezomib. In frail patients, lower CCI in addition to less previous treatment exposure and deep response were associated with better survival.

Active Pulmonary Tuberculosis in Elderly Patients: A 2016-2019 Retrospective Analysis from an Italian Referral Hospital.

Tuberculosis (TB) in the elderly (>65 years old) has increasingly become a global health problem. It has long been recognized that older people are vulnerable to developing tuberculosis. We retrospectively evaluated data from patients older than 65 years diagnosed with pulmonary TB admitted to the National Institute for Infectious Diseases L. Spallanzani, Rome, Italy, from 1 January 2016 to 31 December 2019. One hundred and six consecutive patients were diagnosed with pulmonary TB and 68% reported at least one comorbidity and 44% at least one of the TB risk-factors. Out of the 26 elderly patients who reported an adverse event, having risk factors for TB (O.R. (Odds Ratios) = 1.45; 95% CI 1.12–3.65) and the presence of cavities on Chest X-rays (O.R. = 1.42; 95% CI 1.08–2.73) resulted in being more likely to be associated with adverse events in elderly patients. Having weight loss (O.R. = 1.31; 95% CI 1.08–1.55) and dyspnea (O.R. = 1.23; 95% CI 1.13–1.41) resulted in being significant predictors of unsuccessful treatment outcome in elderly patients. Older people with TB represent a vulnerable group, with high mortality rate, with a challenging diagnosis. Hospitalizations in tertiary referral hospital with clinical expertise in TB management can be useful to improve the outcome of these fragile patients.

Treatment outcomes and prognostic analysis of elderly patients with extranodal natural killer/T-cell lymphoma, nasal type: a retrospective analysis

We retrospectively analyzed the treatment outcomes of elderly patients (aged ≥ 60 years) with extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) and investigated the prognostic factors. Fifty-two elderly patients received chemotherapy alone, radiotherapy alone, or chemotherapy followed by radiotherapy ± consolidation chemotherapy as induction therapy. Overall, 97.26% patients in stage I/II had overall response (OR) and 86.1% had complete response (CR), whereas 71.4% of patients in stage III/IV had OR and 35.7% had CR. The 3-year freedom from progression (FFP) rate and overall survival (OS) rate of patients with stage I/II were 78.2% and 85.0%, respectively, and those with stage III/IV were 23.3% and 33.3%. Following multivariate analysis of Cox regression, ECOG performance status scores of 3–4 and stage III/IV were independent prognostic factors for elderly ENKTL patients. Elderly patients with stage I/II or stage III/IV and good or poor performance status can benefit from the commonly used or personalized treatment.

P1486CHRONIC DIALYSIS IN ELDERLY PATIENTS: FUNCTIONAL PERFORMANCE STATUS AND TREATMENT OUTCOMES - A SINGLE-CENTER STUDY

Abstract Background and Aims The presence of multiple comorbid conditions and different geriatric impairments in elderly patients leads to a certain specificity in the management of this cohort of patients. The aim was to assess changes in functional performance status and treatment outcomes in elderly patients on chronic dialysis. Method A single-center longitudinal prospective study was conducted, which included 48 patients aged 65 years and older who underwent dialysis (hemodialysis and continuous ambulatory peritoneal dialysis) for more than 3 months. Participants’ functional performance status was measured by the Frailty Scale of Rockwood (FSR) at baseline and after a year of treatment. Functional performance status decline was defined as deterioration by 1 or more positions on the FSR, stable was defined as no difference between baseline and follow-up, and improvement was defined as a gain of 1 or more positions. At baseline, all participants were assessed by the Charlson Comorbidity Index (CCI) and standard lab tests were carried out. All data are presented as median and quartiles (25%; 75%). Results The median of age was 69 (67; 74) and 39.6% were women. The main causes of end-stage renal disease were hypertension (33.3%) and diabetes (31.3%). There were 83.3% hemodialysis patients and 31.3% received dialysis up to 1 year. At baseline 16.7% of patients were frail, 54.2% - pre-frail and 29.1% were fit. Among frail patients at the 1-year follow-up, 62.5% died, 12.5% had received a kidney transplant (KT), 25% showed a further functional performance status decline. Among pre-frail patients, almost half (46.2%) experienced functional decline and 15.4% died; the functional status remained unchanged in 30.8% of patients and 3.8% was transplanted; 1 patient (3.8%) had an improvement in functional performance status. Among fit patients, over half (57.2%) showed stable functional status, a functional decline was observed in 21.4% of patients (all of them became frail), 7.1% died and 14.3% had received a KT. All patients, who had stable functional performance status after a year of treatment, had target values of kt/v, albumin, and phosphorus at baseline. All deceased patients (20.8%) had CCI ≥ 6, 60% of them had high serum phosphorus level. Most functional performance status decline among participants was associated with a loss of mobility, which was most often caused by the progression of chronic heart failure (both independently and after heart attack) or chronic arterial failure (diabetic, due to obliterating atherosclerosis of the lower extremities), including the development of critical limb ischemia, especially in patients on hemodialysis. The distribution of patients according to the FSR in the initial assessment and re-assessment are presented in the table below. Conclusion Functional decline is highly prevalent in elderly patients on chronic dialysis, the risk is higher among frail and pre-frail patients. In most cases, functional performance status decline is associated with a loss of mobility due to the progression of chronic heart or arterial failure. Death probability is higher among frail patients and those with high serum phosphorus level (because of inadequate dialysis due to the initially severe condition of these patients) and high CCI. Achievement in the complex of the target values of kt/v, serum albumin, and phosphorus levels can help to maintain the functional status stable.

IMPACT OF PAIN INTERFERENCE ON TREATMENT OUTCOMES AMONG OLDER ADULTS WITH DEPRESSIVE AND ANXIETY SYMPTOMS RECEIVING COLLABORATIVE MENTAL HEALTH CARE

Introduction Depression, anxiety and chronic pain are highly comorbid in the elderly population. These symptoms can interfere with daily activities and adversely affect quality of life. The mechanisms underlying the associations among pain and mental health symptoms are complex and likely bidirectional in nature. This interrelatedness between pain, depression and anxiety symptoms can often lead to diagnostic uncertainty and polypharmacy. Moreover, the literature points to less favorable outcomes among those receiving treatment for depression and anxiety who report comorbid pain. However, less is known about whether pain moderates outcomes among community-dwelling older adults engaged in care for more moderate symptomatology. The primary aim of the study was to examine if baseline pain interference with daily activities had an impact on treatment outcomes in elderly patients with depressive and anxiety symptoms at 3 months and 6 months. The sample consisted of low income, community-dwelling older adults with comorbid pain, depression and anxiety symptoms who were enrolled in a telephone-based collaborative care management program. Methods The sample included 519 older adults newly prescribed an antidepressant or benzodiazepine by a primary care provider and enrolled in the SUpporting Seniors Receiving Treatment And INtervention (SUSTAIN) program. The SUSTAIN program provides behavioral health services by telephone to enrollees in the Pennsylvania Department of Aging's pharmaceutical assistance program (PACE/PACENET). The PACE/PACENET program serves low and moderately low-income seniors. Patients who agree to participate in SUSTAIN complete comprehensive assessments of mental health symptoms, cognition, sleep, pain, and functional status by a health technician. The current study included those patients meeting criteria for clinically significant baseline mental health symptoms who agreed to engage in care management services delivered by a clinician (LSW or RN). Over the course of care management, patients received symptom and medication monitoring, brief behavioral therapy, and psychosocial support, and were connected to needed community resources. Summary reports were also sent to patients’ prescribers with recommendations for treatment planning (where indicated). Baseline clinical program data extracted for the current analyses included self-reported socio-demographics (age, financial status, gender), clinical symptoms (depressive [PHQ-9] and anxiety [GAD-7] symptoms), overall mental functioning (Veterans RAND 12-Item Health Survey [VR12]), and self-reported pain over the past 24?hours and 3 months. Pain interference was rated on a scale of 0 (no interference) to 10 (complete interference). Data on depression, anxiety, and overall mental health outcomes were also collected at 3 and 6-month follow-up. Bivariate analyses were run to examine associations among pain and various clinical and sociodemographic variables at baseline. Longitudinal, mixed effects models were run to examine the extent to which baseline pain moderated changes in depressive symptoms, anxiety symptoms, and overall mental functioning over time. Results Patients were on average 77.7 (SD 6.8) years old. The majority were female (86.7%), non-Hispanic white (92.9%), and reported having enough finances to “get along” (83.4%). Antidepressant or benzodiazepine was reported as the index medication for 59.3% and 40.7% of the patients, respectively. 51.4% reported pain interference with activities. Patients had a mean baseline score of 8.81 (SD 4.6) on the PHQ-9 (range=0-24), 4.74 (SD 4.4) on the GAD-7 (range=0-21), and 47.4 (SD 11.1) on overall mental functioning (range=4.85-72.85). Bivariate results revealed that greater baseline pain was significantly associated with lower financial status (p Conclusions The data suggest that in this sample of community-dwelling older adults enrolled in a state-sponsored pharmacy benefit and treatment support program, baseline pain interference did not impact treatment outcomes of depressive and anxiety symptoms over a period of 6 months. The findings suggest that a collaborative care program for depression and anxiety may be effective in reducing mental health symptoms even in the presence of self-reported pain interference with activities. This research was funded by: Commonwealth of Pennsylvania, Department of Aging, PACE Program, PACE/PACENET.

How do doctors choose treatment for older gynecological cancer patients? A Japanese Gynecologic Oncology Group survey of gynecologic oncologists.

The proportion of elderly Japanese people (age ≥ 65years) is currently 27.7%, and the average life span of women is 87.14years, both of which are unprecedented. In gynecologic cancer, evidence of treatment for the elderly is scarce, and treatment policies are determined by each facility. The aim of the present study was to investigate the status of treatment policies for elderly patients with gynecologic cancer. A web-based questionnaire regarding how treatment strategies are currently determined for elderly patients with gynecologic cancer was conducted on gynecologic oncologists to develop a tool for the objective evaluation of treatment policy decisions for elderly patients. The responses showed that 48% of the gynecologic oncologists were aware of comprehensive geriatric assessment (CGA), but only 6% had actually conducted CGA. Age, comorbidities, performance status, and pretreatment evaluations were regarded as important in determining the treatment strategy. Invasive treatments such as radical hysterectomy and para-aortic lymph node dissection tended to have age limits. These findings suggest that awareness of CGA is low in Japan, and that elderly people may not be given standard therapy, which highlights the importance of building on these findings by gathering further evidence and developing a new tool for predicting treatment outcomes for elderly patients with gynecologic cancer.

Emergency Surgery and Male Gender Are Risk Factors of Postoperative Delirium After General or Gastrointestinal Surgery in Elderly Patients: A Multicenter Cohort Study

Objective The aim of this study was to investigate the incidence and risk factors of postoperative delirium (PD) in elderly patients after general or gastrointestinal surgery. Summary of background data Societies worldwide are rapidly aging, and the number of surgeries in elderly patients has been increasing. PD, which adversely influences postoperative course, has thus become more common. Methods The Surgery and Anesthesia Network Group of the National Hospital Organization in Japan conducted this retrospective cohort study of patients older than 70 years of age who underwent general or gastrointestinal surgery. Results A total of 219 patients from 9 participating institutes underwent surgery between July 2013 and August 2014. We excluded 2 patients who died within 2 weeks after surgery. Of the remaining 217 cases, 31 (14.3%) developed PD. These patients were older (80 versus 76 years, P = 0.013), more likely to be male (74.2 versus 54.8%, P = 0.039), and had higher American Society of Anesthesia Physical Status scores than those without PD. Emergency surgery was more common than elective surgery in the PD group (41.9 versus 10.2%, P &amp;lt; 0.0001). Multivariate analysis showed that male gender (odds ratio, 3.31; 95% confidence interval, 1.32 to 9.39; P = 0.0098) and emergency surgery (odds ratio, 7.47; 95% confidence interval, 2.79 to 20.83; P &amp;lt; 0.0001) were independent risk factors of PD. Conclusions The incidence of PD was high in male patients and those undergoing emergency surgery. Effective interventions in these groups will be necessary to improve treatment outcomes in elderly patients.

Geriatric 8 can predict treatment outcomes of elderly patients with de novo AML who received low-dose chemotherapy

Abstract Background Geriatric assessments (GAs) used to evaluate various aspects in elderly patients have recently been introduced for their usefulness in predicting toxicities of cancer treatments and subsequent patient prognoses. Utilizing GAs to decide on treatment policies has been recommended. However, there are few reports on the relationship between Geriatric 8 (G8), a screening tool for GA, and treatment outcomes of elderly patients with de novo acute myeloid leukemia (AML) who received low-dose chemotherapy (LDC). Patients and Methods We reviewed 47 patients aged≥70 years who were newly diagnosed with de novo AML (except for acute promyelocytic leukemia) and received LDC as an initial treatment at our hospital between April 2012 and June 2018. We divided them into two groups (high: N = 11, low: N = 36) according to G8 scores (cutoff: 14 points) at the time of diagnosis and retrospectively analyzed the differences in clinical features and treatment outcomes. Results Statistically significant differences in age (median, 73 vs. 79 years, p = 0.009) were observed between the two groups. The proportions of sex, median white blood cell and bone marrow blast counts, and percentages of patients with unfavorable cytogenetic abnormalities did not differ significantly between groups. The most frequent initial LDC in both groups was low-dose cytarabine combined with acrarubicine. The complete remission rate and overall survival at two years were significantly higher in the G8 high-score group than those in the low-score group (72.7% vs. 19.4%; p = 0.002 and 55.6% vs. 11.0%; p Conclusion Our data suggest that G8 scores can predict treatment outcomes in elderly patients with de novo AML who received LDC.