scholarly journals Observational study investigating Tolerance Of Anticancer Systemic Therapy In the Elderly (TOASTIE): a protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051104
Author(s):  
Helen Dearden ◽  
Mark A Baxter ◽  
Sally Martin ◽  
Michael Rowe ◽  
Kieran Zucker ◽  
...  
Keyword(s):  
Older Adults ◽  
Observational Study ◽  
Anticancer Agents ◽  
Systemic Therapy ◽  
Descriptive Analysis ◽  
Area Under The Curve ◽  
The Elderly ◽  
Primary Objective ◽  
Solid Organ ◽  
Chemotherapy Toxicity

IntroductionThe number of older adults diagnosed with cancer is increasing. Older adults are more likely to have pre-existing frailty, which is associated with greater chemotherapy-related toxicity. Early identification of those at risk of toxicity is important to reduce patient morbidity and mortality. Current chemotherapy toxicity prediction tools including the Cancer and Ageing Research Group (CARG) tool exist but are not in routine clinical use and have not been prospectively validated in a UK population. This study is the first prospective study to investigate the CARG tool in a UK population with cancer.Methods and analysisTolerance Of Anticancer Systemic Therapy In the Elderly is a prospective observational study of patients, aged ≥65 years, commencing first-line (any indication) chemotherapy for a solid-organ malignancy. Patients receiving other systemic anticancer agents or radiotherapy will be excluded. The primary objective will be to validate the ability of the CARG score to predict grade 3+ toxicity in this population. Secondary objectives include describing the feasibility of screening for frailty, as well as the prevalance of frailty in this population and assessing patient and clinician perception of chemotherapy toxicity risk. 500 patients will be recruited over a two year period. Baseline assessments will be recorded. At the end of the 6-month follow-up period, toxicity data will be retrospectively collected. A descriptive analysis of the recruited population will be performed. The validity of the CARG model will be analysed using receiver-operating characteristic curves and calculation of the area under the curve (c-statistic).Ethics and disseminationThe study has received ethical approval from the East of Scotland Research Ethics Service 20/ES/0114. Results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media.

Physical Activity Level and Motor Aptitude: Motor Domains and Identification Capacity of Brazilian Insufficiently Active Older Adults

2020 ◽  
Vol 13 ◽  
Author(s):  
Lucia Maria Andreis ◽  
Fernando de Aguiar Lemos ◽  
Lorenna Walesca de Lima Silva ◽  
Cassiana Luiza Pistorello Garcia ◽  
Gabrielli Veras ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Physical Activity Level ◽  
Area Under The Curve ◽  
The Elderly ◽  
Activity Level ◽  
General Motor ◽  
Body Scheme ◽  
Significant Difference ◽  
Global Coordination

Background: A decrease in the physical activity level in old age is common, which results in an increase in the number of falls and chronic conditions. Associated with that occurs the decline in motor skills as a result of the deficit in the interaction of cognitive and motor processes. Physical activity level can be associated differently with each motor domains. Objective: We analyzed the relationship between physical activity level and motor aptitude, and to identify which motor domains were most sensitive to detect insufficiently active level in older adults. Methods: Participated in the study 385 elderly people of both sexes. For the evaluation of the subjects were adopted the International Questionnaire on Physical Activity and the Motor Scale for Older Adults. Results: The majority of the elderly were active. In the comparison of motor aptitude between active and insufficiently active (IAC) elders a significant difference was found in the Global Coordination, Balance, Body Scheme and General Motor Aptitude. From the analysis of the area under the curve (AUC), we verified that these domains also were the ones that presented adequate diagnostic accuracy to identify IAC elderly. Besides that active elderly have presented the General Motor Aptitude classified within normality while the IAC below the normal. Conclusion: Our data suggest that IAC older adults present lower motor aptitude than the active elderly, especially in the domains of Global Coordination, Balance, Body Scheme and General Motor Aptitude, and that these domains were sensitive to indicate IAC older adults.

scholarly journals Assessment of judgment ability in a Brazilian sample of patients with mild cognitive impairment and dementia

2021 ◽  
Vol 15 (2) ◽  
pp. 200-209
Author(s):  
Patrícia Helena Figueirêdo do Vale-Britto ◽  
Laura Rabin ◽  
Livia Spindola ◽  
Ricardo Nitrini ◽  
Sonia Maria Dozzi Brucki
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Clinical Utility ◽  
Area Under The Curve ◽  
The Elderly ◽  
Relevant Information ◽  
Practical Judgment ◽  
Brazilian Sample ◽  
Everyday Problems

ABSTRACT. Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions. Objective: Adaptation of TOP-J for a Brazilian sample, preparation of a reduced version and verification of the accuracy of both. Methods: Eighty-five older adults, including 26 with MCI, 20 with Alzheimer’s disease (AD), 15 with frontotemporal dementia behavioral variant (FTDbv) and 24 controls, underwent neuropsychological assessment including the Brazilian adaptation of the TOP-J (TOP-J-Br). Results: On both TOP-J-Br versions, controls outperformed MCI, AD and FTDbv patients (p<0.001) and MCI outperformed AD and FTDbv (p<0.001). For the TOP-J/15-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 91.7%, specificity of 59.0% and area under the curve of 0.8. For the TOP-J/9-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 79.9%, specificity of 72.1% and area under the curve of 0.82. Conclusion: The TOP-J/15-Br, and particularly the TOP-J/9-Br, showed robust psychometric properties and the potential for clinical utility in Brazilian older adults at various stages of neurodegenerative cognitive decline.

scholarly journals Needs of older adults living in long-term care institutions: an observational study using Camberwell Assessment of Need for the Elderly

2018 ◽  
Vol Volume 13 ◽  
pp. 2389-2395 ◽  
Author(s):  
Sławomir Tobis ◽  
Katarzyna Wieczorowska-Tobis ◽  
Dorota Talarska ◽  
Mariola Pawlaczyk ◽  
Aleksandra Suwalska
Keyword(s):  
Older Adults ◽  
Observational Study ◽  
Long Term Care ◽  
The Elderly ◽  
Term Care ◽  
Camberwell Assessment Of Need ◽  
Assessment Of Need

Measures of polypharmacy and chemotherapy toxicity in older adults with cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9545-9545 ◽  
Author(s):  
Ronald John Maggiore ◽  
Tao Feng ◽  
William Dale ◽  
Cary Philip Gross ◽  
William P. Tew ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Geriatric Oncology ◽  
Stage Iv ◽  
The Elderly ◽  
Chi Square ◽  
Chemotherapy Toxicity ◽  
Chi Square Test ◽  
Grade 3

9545 Background: Polypharmacy is common and associated with adverse clinical outcomes in older adults. Potentially inappropriate medication (PIM) use serves as an adjunctive assessment of polypharmacy. The goals of this study in an outpatient population of older adults with cancer (CA) were: 1) to estimate the prevalence of polypharmacy using multiple measures; and 2) to determine the relationship between polypharmacy and chemotherapy (chemo) toxicity. Methods: Medication use was evaluated in 500 patients (pts) age ≥65 years with invasive CA who were starting a new chemo regimen. Polypharmacy was defined by number of daily medications (meds), including non-prescription meds. PIM use was defined by 4 indices: Beers (2003 and 2012 update), Zhan, and HEDIS Drugs to Avoid in the Elderly (DAE) criteria. Prevalence of polypharmacy, PIM, and their association with grade 3-5 chemo toxicity [NCI Common Toxicity Criteria (v. 3.0)] were analyzed using chi square test and unconditional logistic regression. Results: All 500 pts were evaluable [mean age, 73 years (range 65-91); 56% female; 61% stage IV]. The mean number of daily meds was 5 (range 0-23); 38% used ≤3 daily meds, 51% used 4-9 meds, and 11% using ≥10 meds. Using 0-3 daily meds as the referent group, no association was found between daily meds and chemo tox: 4-9 meds, OR 1.34 (95% CI: 0.92-1.97); ≥10, OR 0.82 (95% CI: 0.45-1.49). PIM use was identified in 87 (17%), 147 (29%), 54 (11%), and 69 (13%) patients utilizing the 2003 Beers, 2012 Beers, Zhan, and HEDIS DAE criteria, respectively. There was no association between each PIM use index and chemo toxicity (p>0.10 for all). Conclusions: Polypharmacy and PIM use were common in the geriatric oncology population. Although polypharmacy did not increase the risk of chemotherapy toxicity in this sample, further studies of polypharmacy’s impact on additional outcomes, including non-chemotherapy adverse drug events, in older persons with cancer are warranted.

scholarly journals The Epidemiology of Prehospital Emergency Responses for Older Adults in a Provincial EMS System

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 491-496 ◽  
Author(s):  
Judah Goldstein ◽  
Jan L. Jensen ◽  
Alix J. E. Carter ◽  
Andrew H. Travers ◽  
Kenneth Rockwood
Keyword(s):  
Older Adults ◽  
Overall Response Rate ◽  
The Elderly ◽  
Primary Objective ◽  
High Rate ◽  
Emergency Call ◽  
Prehospital Emergency ◽  
Secondary Objective ◽  
The Mean ◽  
Emergency Responses

AbstractObjectivesSocietal aging is expected to impact the use of emergency medical services (EMS). Older adults are known as high users of EMS. Our primary objective was to quantify the rate of EMS use by older adults in a Canadian provincial EMS system. Our secondary objective was to compare those transported to those not transported.MethodsWe analysed data from a provincial EMS database for emergency responses between January 1, 2010 and December 31, 2010 and included all older adults (≥65 years) requesting EMS for an emergency call. We described EMS use in relation to age, sex, and resources.ResultsThere were 30,653 emergency responses for older adults in 2010, representing close to 50% of the emergency call volume and an overall response rate of 202.8 responses per 1,000 population 65 years and older. The mean age was 79.9±8.5 years for those 57.3% who were female. The median paramedic-determined Canadian Triage and Acuity Scale (CTAS) score was 3 and the mean on-scene time was 24.2 minutes. Non-transported calls (12.3%) for the elderly involved predominantly (54.9%) female patients of similar mean age (78.3 years) but lower acuity (CTAS 5) and longer average on-scene times (32.6 minutes).ConclusionsWe confirmed the increasingly high rate of EMS use with age to be consistent with other industrialized populations. The low-priority and non-transport calls by older adults consumed considerable resources in this provincial system and might be the areas most malleable to meet the challenges facing EMS systems.

DSM-5 alcohol use disorder features among treatment-seeking older adults

2018 ◽  
Vol 64 (4) ◽  
pp. 185-196 ◽  
Author(s):  
Silke Behrendt ◽  
Barbara Braun ◽  
Randi Bilberg ◽  
Gerhard Bühringer ◽  
Michael Bogenschutz ◽  
...  
Keyword(s):  
Older Adults ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
The Elderly ◽  
Treatment Seeking ◽  
Controlled Clinical Trial ◽  
Dsm 5 ◽  
Wide Range ◽  
And Gender ◽  
International Multicenter

Abstract. Background: The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims: To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results: Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion: European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.

scholarly journals Sex disparities in cardiovascular health metrics among rural-dwelling older adults in China: a population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaolei Han ◽  
Ziying Jiang ◽  
Yuanjing Li ◽  
Yongxiang Wang ◽  
Yajun Liang ◽  
...  
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Cardiovascular Health ◽  
Rural China ◽  
Descriptive Analysis ◽  
Population Based ◽  
Baseline Survey ◽  
Chinese Older Adults ◽  
Face To Face ◽  
Sex Disparities

Abstract Background Cardiovascular health (CVH) metrics among Chinese older adults are poorly understood. We investigated sex disparities in CVH metrics and their management among rural-dwelling older adults in China. Methods This community-based study included 5026 participants (age ≥ 65 years; 57.2% women) in the baseline survey of a multimodal intervention study in rural China. In March–September 2018, data were collected through face-to-face interviews, clinical examinations, and laboratory tests. We defined six CVH metrics (three behavioral factors—smoking, body mass index, and physical activity; three biological factors—blood pressure, total cholesterol, and blood glucose) following the modified American Heart Association’s recommendations. We performed descriptive analysis separately for men and women. Results Of all participants, only 0.8% achieved ideal levels in all six CVH metrics. Men were more likely than women to have ideal levels in all CVH metrics but smoking. Women had higher prevalence of ideal global (9.7% vs. 7.8%) and behavioral (18.3% vs. 9.5%) CVH metrics (p < 0.001), whereas men had higher prevalence of ideal biological CVH metrics (5.4% vs. 3.5%, p < 0.001). The prevalence of ideal global and behavioral CVH metrics increased with age in both women and men (p for trend< 0.001). Women were more likely to be aware of their hypertension and diabetes, and to receive antihypertensive treatment, while men were more likely to achieve the goal of high cholesterol treatment (p < 0.05). Conclusions The CVH metrics among older adults living in the rural communities in China are characterized by an extremely low proportion of optimal global CVH metrics and distinct sex differences, alongside poor management of major biological risk factors. Trial registration ChiCTR1800017758 (Aug 13, 2018).

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