Geriatric Assessments Can Predict Functional Outcome and Mortality after Urological Tumor Surgery

2021 ◽  
pp. 1-10
Author(s):  
Andreas Kahlmeyer ◽  
Christian Fiebig ◽  
Marco Mueller ◽  
Matthias Kraulich ◽  
Jonas Brendel-Suchanek ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Functional Recovery ◽  
Functional Outcomes ◽  
Older Patients ◽  
Assessment Tool ◽  
Assessment Tools ◽  
High Grade ◽  
Tumor Surgery ◽  
Care Dependency ◽  
Complications And Mortality

<b><i>Introduction:</i></b> Older patients undergoing major urological tumor surgery are at severe risk of functional deterioration, complications, and mortality. We prospectively evaluated geriatric assessment tools and developed a novel easy-to-use assessment tool for clinical use. <b><i>Methods:</i></b> In 159 patients, geriatric assessment tools were used prior to cystectomy, prostatectomy, and renal tumor surgery, and their peri- and postoperative courses were recorded. Using all the tests, a short and easy-to-use assessment tool was developed, and nomograms were generated to predict functional outcomes and mortality. <b><i>Results:</i></b> Of all the patients, 13.8% underwent radical cystectomy, 37.7% underwent radical prostatectomy, and 48.4% underwent tumor surgery of the kidney at the age of 70 years or older. The average age was 75.6 years. Incomplete functional recovery at day 30 and day 180 was observed in 37.7% and 36.1% of the patients, respectively, and incomplete functional recovery was associated with impaired mobility, previous care dependency, frailty, comorbidities, and a high ASA score. The only predictor for high-grade complications was comorbidities, whereas mortality was associated with the geriatric screening tool scores, impaired mobility, preoperative care dependency, and comorbidities. The Erlangen Index (EI), a combination of the selected assessment tools, showed a good prediction of early (<i>p</i> = 0.002) and medium-term (<i>p</i> = 0.002) functional outcomes and mortality (<i>p</i> = 0.001). <b><i>Conclusion:</i></b> Our prospective evaluation confirms the high risk of incomplete functional recovery, high-grade complications, and mortality in older patients undergoing major urological tumor surgery. The EI is an easy-to-use preoperative assessment tool and therefore should be used in preoperative patient counseling.

Prospective evaluation of geriatric assessments as predictors of complications and functional outcome after major urologic tumor surgery in the older population.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 597-597
Author(s):  
Andreas Kahlmeyer ◽  
Wencke Losensky ◽  
Danijel Sikic ◽  
Bastian Keck ◽  
Peter J. Goebell ◽  
...  
Keyword(s):  
Functional Status ◽  
Functional Outcome ◽  
Geriatric Assessment ◽  
Functional Recovery ◽  
Assessment Tools ◽  
Tumor Surgery ◽  
Old Patients ◽  
Asa Score ◽  
Impaired Mobility ◽  
Functional Deterioration

597 Background: Old patients undergoing major urologic tumor surgery are at severe risk of functional deterioration. In this study we prospectively performed a comprehensive geriatric assessment to identify potential risk predictors for early functional outcome. Methods: Since January 2016, 75 patients undergoing elective cystectomy, prostatectomy or nephrectomy at the age of 70 or older have been enrolled prospectively. A selection of geriatric assessment tools was applied before surgery. Follow up data including standardized peri- and postoperative parameters were obtained at discharge and at day 30 and 180 after surgery (DRKS-ID: DRKS00009825). Results: 14.7% had radical cystectomy, 33.3% had radical prostatectomy and 52.0% had kidney surgery due to malignant tumor. The average age was 75.7 (70-88) years. Within hospital stay, 20.3% had major complications (Clavien-Dindo > = 3) and 25% showed incomplete functional recovery at day 30 after surgery. The average reduction in activities of daily living (ADL) was -34.71. Major complications were significantly associated with impaired mobility (TUG, OR 7.350, p = 0.002), frailty (FrailScale, OR 5.007, p = 0.019) and ASA-Score (ASA, OR 4.400, p = 0.015). Incomplete functional recovery was strongly associated with preoperative impaired mobility (TUG, OR 11.524, p < 0.001) but correlation with ASA-Score (ASA, OR 3.288, p = 0.070) and comorbidities (CCI, OR 3.833, p = 0.106) missed statistical significance. No correlation of functional deterioration was found with age and functional status at admission. The combination of selected assessment tools showed good prediction of early functional recovery (ErlangerIndex, OR 4.400, p = 0.019). Conclusions: Major urologic tumor surgery has a high risk of severe complications and incomplete recovery in old patients. Fast and easy-to-do preoperative assessment tools may predict functional outcome more precisely than age or preoperative functional status alone. Clinical trial information: DRKS00009825.

The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

2014 ◽  
Vol 24 (3) ◽  
pp. 219-227 ◽  
Author(s):  
Francisco J Tarazona-Santabalbina ◽  
Juan R Doménech-Pascual ◽  
Ángel Belenguer-Varea A ◽  
Eduardo Rovira Daudi
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Functional Recovery ◽  
Functional Outcomes ◽  
Older Patients ◽  
Future Research ◽  
Research Perspectives ◽  
Increased Risk ◽  
Risk Of Falls

SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

scholarly journals Feminist approach to geriatric care: comprehensive geriatric assessment, diversity and intersectionality

2021 ◽  
Author(s):  
Merle Weßel
Keyword(s):  
Standardized Testing ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
Geriatric Medicine ◽  
Assessment Tools ◽  
Assessment Process ◽  
Social Category ◽  
Social Categories ◽  
The Social

AbstractDespite being a collection of holistic assessment tools, the comprehensive geriatric assessment primarily focuses on the social category of age during the assessment and disregards for example gender. This article critically reviews the standardized testing process of the comprehensive geriatric assessment in regard to diversity-sensitivity. I show that the focus on age as social category during the assessment process might potentially hinder positive outcomes for people with diverse backgrounds of older patients in relation to other social categories, such as race, gender or socio-economic background and their influence on the health of the patient as well as the assessment and its outcomes. I suggest that the feminist perspective of intersectionality with its multicategorical approach can enhance the diversity-sensitivity of the comprehensive geriatric assessment, and thus improve the treatment of older patients and their quality of life. By suggesting an intersectional-based approach, this article contributes to debates about justice and diversity in medical philosophy and advocates for the normative value of diversity in geriatric medicine.

Regaining a satisfactory quality of life and predicting functional decline after major cancer surgery in older adults: The Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery (GOSAFE) study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12051-12051
Author(s):  
Isacco Montroni ◽  
Giampaolo Ugolini ◽  
Nicole Saur ◽  
Antonino Spinelli ◽  
Siri Rostoft ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Recovery ◽  
Functional Outcomes ◽  
Older Patients ◽  
Functional Decline ◽  
Geriatric Oncology ◽  
Cancer Surgery ◽  
Before And After ◽  
After Cancer

12051 Background: Older cancer patients value quality of life (QoL) and functional outcomes as much as survival but surgical studies lack specific data. The international, multicenter GOSAFE study (ClinicalTrials.gov NCT03299270) aims to evaluate patients’ QoL and functional recovery (FR) after cancer surgery and to assess predictors of FR Methods: GOSAFE prospectively collected functional and clinical data before and after major elective cancer surgery on senior adults (≥70 years). Surgical outcomes were recorded (30, 90, and 180 days post-operatively) with QoL (EQ-5D-3L) and FR (Activities of Daily Living (ADL), Timed Up and Go (TUG) and MiniCog), 26 centers enrolled patients from February 2017 to April 2019. Results: 942 patients underwent a major cancer resection. Median age was 78 (range 70-95); 52.2% males, ASA III-IV 49%. 934 (99%) lived at home, 51% lived alone, and 87% were able to go out. Patients dependent (ADL < 5) were 8%. Frailty was detected by means of G8 ≤14 in 68.8% and fTRST ≥2 in 37% of patients. Major comorbidities (CCI > 6) were reported in 36% and 21% had cognitive impairment according to MiniCog (2.2% self-reported). 25% had > 3 kg weight loss, 27% were hospitalized in the last 90 days, 54% had ≥3 medications (6% none). Postoperative overall morbidity was 39.1% (30 day) and 22.5% (90 day), but Clavien-Dindo III-IV complications were only 13.4% and 6.9% respectively. 30/90/180-day mortality was 3.6/6/8.9% (10/30/33% in patients with severe functional disability). At 3 months after surgery, QoL was stable/improved (mean EQ-5D index 0.78 was equivalent before vs. after surgery, while the EQ-5D VAS score > 60 raised from 74.3% at baseline to 80.2%, p < 0.01). 76.6% experienced postoperative FR/stability. Logistic regression analysis showed that ASA 3-4, CCI≥7 and CD III-IV complications are significantly associated with functional decline while a G8 > 14 has a positive association with functional recovery. Age is not associated with functional outcomes. Conclusions: The largest prospective study on older patients undergoing structured frailty assessment before and after major elective cancer surgery has shown that QoL remains stable/improves after cancer surgery. The majority of patients return to independence and G8 can predict functional recovery. Older patients with multiple comorbidities, high ASA score or postoperative severe complications are likely to functionally deteriorate after oncologic surgery Clinical trial information: NCT03299270 .

Feasibility of a self-administered geriatric assessment tool for older patients with cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18519-18519
Author(s):  
A. Hurria ◽  
S. Lichtman ◽  
S. Priyadarshi ◽  
J. Gardes ◽  
E. Zuckerman ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Geriatric Assessment ◽  
Older Patients ◽  
Assessment Tool ◽  
Psychological State ◽  
Study Cohort ◽  
Healthcare Team ◽  
Mortality And Morbidity ◽  
Staff Members ◽  
Assessment Scores

18519 Background: As the population ages, there is an emerging need to develop a geriatric assessment (GA) tool for oncologists to characterize the ‘functional age‘ of older patients in order to tailor treatment, stratify outcomes by factors other than chronological age, and develop interventions to optimize cancer treatment. The GA tool must be easy to administer in order to minimize burden on clinic resources. The goal of this study was to determine the feasibility of administering a brief, comprehensive, self-administered GA tool to older patients before their meeting with the oncologist. Methods: The self-administered GA tool addresses the following domains: functional status, comorbidity, psychological state, nutritional status, and social support. The measures which comprise the tool are brief, reliable, validated, predictive of mortality and morbidity in older patients, and do not require a staff member to administer. Feasibility was assessed by the following parameters: 1) % able to complete the GA tool unassisted; 2) % requiring the assistance of staff members versus non-staff members; 3) overall patient satisfaction; 4) time to complete. Results: 168 (96%) of 175 patients completed the GA tool with a mean age of 76 (range 64–92) with AJCC stages [I (33%), II (17%), III (10%), IV (39%)] across a variety of tumor types. Of the study cohort, 67% were women, 57% were married, and 89% were retired. Median time to complete the GA tool was 13 minutes and mean time was 16 minutes (SD 11, range 3–60). Most completed the GA tool on their own (75%) or received assistance from a friend or family member (20%). Only 4% required assistance from a member of the healthcare team. Patient satisfaction with the GA tool was high: 88% satisfied with the length, 92% reported no difficult questions, and 97% reported no upsetting questions. Based on the assessment scores, the following interventions were offered: referral to a social worker (38%), nutritionist (43%), visiting nurse/home health aide (30%), internist (23%), rehabilitation (13%), ENT (13%), ophthalmology (7%), and psychiatry (5%). Conclusion: This brief, comprehensive, self-administered GA tool is feasible for use in the outpatient oncology setting. Prospective trials are needed to determine the effectiveness of the interventions offered. No significant financial relationships to disclose.

Functional and Psychosocial Consequences of Major Depressive Disorder

2019 ◽  
pp. 1-14
Author(s):  
Tracy L. Greer ◽  
Jeethu K. Joseph
Keyword(s):  
Functional Recovery ◽  
Functional Assessment ◽  
Functional Outcomes ◽  
Antidepressant Treatment ◽  
Great Part ◽  
Assessment Tools ◽  
Consensus Definition ◽  
Psychosocial Consequences ◽  
Home Work ◽  
Definition Of

Depression is associated with profound personal and societal costs worldwide, in great part due to negative functional and psychosocial consequences. These consequences can range from minimally disruptive to life-altering, and they occur across a wide variety of life domains (e.g. home, work, school, social). Despite patient preference for the inclusion of functional outcomes as the desired endpoint of antidepressant treatment and goal for the achievement of wellness, functional outcomes are still infrequently measured. This is likely due, at least in part, to the wide variety of assessment tools that are available and lack of consensus definitions of functional recovery. This chapter reviews several measures that are available to assess functioning; describes the functional impairment associated with depression and related symptoms, such as cognition, sleep, and pain; and briefly discusses issues associated with treating disrupted functioning in depression. Future directions include the need to develop and utilize a consensus definition of functional recovery, as well as consistent incorporation of functional assessment in both clinical monitoring and research outcomes.

scholarly journals Prospective clinical trial evaluating vulnerability and chemotherapy risk using geriatric assessment tools in older patients with lung cancer

2019 ◽  
Vol 19 (11) ◽  
pp. 1108-1111
Author(s):  
Yukari Tsubata ◽  
Yohei Shiratsuki ◽  
Takae Okuno ◽  
Akari Tanino ◽  
Mika Nakao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
Geriatric Assessment ◽  
Older Patients ◽  
Assessment Tools ◽  
Prospective Clinical Trial

scholarly journals Frailty Scores and Their Utility in Older Patients with Cardiovascular Disease

2021 ◽  
Vol 16 ◽  
Author(s):  
Kenneth Jordan Ng Cheong Chung ◽  
Chris Wilkinson ◽  
Murugapathy Veerasamy ◽  
Vijay Kunadian
Keyword(s):  
Cardiovascular Disease ◽  
Older Patients ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Clinical Settings ◽  
Transcatheter Aortic Valve ◽  
Frailty Assessment ◽  
Growing Body ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The world’s population is ageing, resulting in more people with frailty receiving treatment for cardiovascular disease (CVD). The emergence of novel interventions, such as transcatheter aortic valve implantation, has also increased the proportion of older patients being treated in later stages of life. This increasing population burden makes the assessment of frailty of utmost importance, especially in patients with CVD. Despite a growing body of evidence on the association between frailty and CVD, there is no consensus on the optimal frailty assessment tool for use in clinical settings. Previous studies have shown limited concordance between validated frailty instruments. This review evaluates the evidence on the utility of frailty assessment tools in patients with CVD, and the effect of frailty on different outcomes measured.

scholarly journals Assessing Frailty in the General Medical Clinic of a Tertiary Hospital in Northern Malaysia: The FRAIL Scale or the Clinical Frailty Scale

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Chiann Ni Thiam ◽  
Chin Yik Ooi ◽  
Yin Kar Seah ◽  
Deik Roy Chuan ◽  
Irene Looi ◽  
...  
Keyword(s):  
Older Patients ◽  
Assessment Tool ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Community Dwelling ◽  
Assessment Tools ◽  
Medical Clinic ◽  
Clinical Frailty Scale ◽  
The Difference ◽  
General Medical Clinic

Background. Frailty potentially influences clinicians’ decision making on treatment provided they can select the appropriate assessment tools. This study aims to investigate the difference between the FRAIL scale and the Clinical Frailty Scale (CFS) in assessing frailty among community-dwelling older adults attending the General Medical Clinic (GMC) in Seberang Jaya Hospital, Penang, Malaysia. Methods. The medical records of 95 older patients (age ≥ 65) who attended the GMC from 16 December 2019 to 10 January 2020 were reviewed. Frailty was identified using the FRAIL scale and the CFS. Patient characteristics were investigated for their association with frailty and their difference in the prevalence of frailty by the FRAIL scale and CFS. Results. The CFS identified nonsignificant higher prevalence of frailty compared to the FRAIL scale (21/95; 22.1% vs. 17/95; 17.9%, ratio of prevalence = 1.235, p = 0.481 ). Minimal agreement was found between the FRAIL scale and the CFS (Kappa = 0.272, p < 0.001 ). Three out of 5 components of the FRAIL scale (resistance, ambulation, and loss of weight) were associated with frailty by the CFS. Higher prevalence of frailty was identified by the CFS in those above 70 years of age. The FRAIL scale identified more patients with frailty in ischaemic heart disease patients. Conclusion. Patient characteristics influenced the choice of the frailty assessment tool. The FRAIL scale and the CFS may complement each other in providing optimized care to older patients who attended the GMC.

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