Screening tools for targeted comprehensive geriatric assessment in HIV-infected patients 50 years and older

2019 ◽  
Vol 30 (10) ◽  
pp. 1009-1017
Author(s):  
Aroonsiri Sangarlangkarn ◽  
Tanakorn Apornpong ◽  
Amy C Justice ◽  
Anchalee Avihingsanon
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Nutritional Assessment ◽  
Depression Scale ◽  
Mini Nutritional Assessment ◽  
Screening Tools ◽  
People Living With Hiv ◽  
Timed Up And Go ◽  
Symptom Index ◽  
Cross Sectional

Many people living with HIV (PLWH) are aging with geriatric syndromes, but few undergo comprehensive geriatric assessment (CGA) due to limited resources. Our study evaluates tools to identify aging PLWH who may forego CGA. We conducted a cross-sectional study on 357 PLWH ≥50 years old at the Red Cross, Thailand. Tools evaluated were the Veterans Aging Cohort Study Index (VACSI) and G-8, which is predictive among older cancer patients. CGA consists of eight tests: history of fall within 12 months, timed-up-and-go test (TUG), activities of daily living (ADL), instrumental ADL (IADL), Montreal cognitive assessment (MoCA), Thai depression scale (TDS), mini nutritional assessment (MNA), and HIV symptom index (HSI). We considered ≥2 impaired domains on CGA to be abnormal results. Forty-nine percent (n = 175) had ≥2 impaired domains on CGA. Few participants had experienced a fall (11%) or abnormal TUG/ADL/IADL (<2%), and only MoCA/TDS/MNA/HSI were analyzed. A VACSI < 17 produces 85% sensitivity (Se) and 30% specificity (Sp) (area under the ROC curve [AUC] = 63, 95%CI 58–69) and G-8 > 15.5 produces 90%Se and 33%Sp (AUC = 74, 95%CI 69–79) in identifying patients with <2 impaired domains. A G-8 > 13.5 produces 91%Se and 77%Sp (AUC = 89, 95%CI 86–92) in ruling out abnormal nutrition. Patients with VACSI < 17 and G-8 > 15.5 may forego CGA due to low likelihood of abnormal cognition, mood, nutrition, or symptom burden.

scholarly journals Evaluation of Malnutrition and Depression in Elderly People: An Epidemiological Study in Turkey

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Aydoğan ◽  
A Ünsal ◽  
D Arslantaş
Keyword(s):  
Health Care Providers ◽  
Nutritional Assessment ◽  
Short Form ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Mini Nutritional Assessment ◽  
The Elderly ◽  
Cluster Sampling ◽  
Care Providers ◽  
Cross Sectional

Abstract Background Malnutrition is an important cause of morbidity and mortality. Malnutrition increases the number of hospitalizations and prolongs the length of hospitalization by disrupting organ functions, increasing the number and severity of infections and delaying wound healing. The aim of this study was to determine the frequency of suspected malnutrition in the elderly, to examine some related variables and to evaluate the depression. Methods The study is a cross-sectional study conducted between March-April 2019 in individuals aged 60 years and older living in Sivrihisar. Sample size was calculated as 579. Cluster sampling method used. Data was collected by door to door in 4 neighborhoods determined by randomly. Mini Nutritional Assessment Test-Short Form (for malnutrition), Katz Daily Living Activities Scale (for dependency) and Geriatric Depression Scale-Short Form (for depression) were used. Chi-square test, Mann Whitney U test and logistic regression analysis were used for the analyzes. Results The study group consisted of 220 (38%) women and 359 (62%) men. The mean age was 68.9±6.4 (ranged 60-93). Frequency of suspected malnutrition was 25% (n = 145). Being 80 years of age or older (OR:3.24, CI:1.53-6.85), having a primary and lower education level (OR:2.54, CI:1.32-4.90), history of chronic illness (OR:2.34, CI:1.33-4.03), using dentures (OR:1.62, CI:1.03-2.55) and suspected depression (OR:4.97, CI:3.17-7.78) are important risk factors for malnutrition. Those with suspicion of malnutrition had lower scores on DLA (z = 8.982;p=0.001). Conclusions Malnutrition was found to be an important health problem for the elderly. The frequency of suspected malnutrition is higher in individuals with depression. Those with suspected malnutrition have higher level of dependency. In order to reduce the frequency of malnutrition, it may be beneficial to increase the awareness of the elderly and caregivers and to give importance to the elderly nutrition of primary health care providers. Key messages Depression is an important risk factor for malnutrition. Malnutrition increases the dependence of the individual on daily activities.

scholarly journals Relationship between five Epigenetic Clocks, Telomere Length and Functional Capacity assessed in Older Adults: Cross-sectional and Longitudinal Analyses

2021 ◽  
Author(s):  
Valentin Max Vetter ◽  
Christian Humberto Kalies ◽  
Yasmine Sommerer ◽  
Dominik Spira ◽  
Johanna Drewelies ◽  
...  
Keyword(s):  
Telomere Length ◽  
Time Course ◽  
Nutritional Assessment ◽  
Depression Scale ◽  
Mini Nutritional Assessment ◽  
Epigenetic Clock ◽  
Cross Sectional ◽  
Biomarkers Of Aging ◽  
Functional Assessments

AbstractDNA methylation age acceleration (DNAmAA, derived from an epigenetic clock) and relative leukocyte telomere length (rLTL) are widely accepted biomarkers of aging. Nevertheless, it is still unclear which aspects of aging they represent best. Here we evaluated longitudinal associations between baseline rLTL and DNAmAA (estimated with 7-CpG clock) and functional assessments covering different domains of aging. Additionally, we made use of cross-sectional data on these assessments and examined their association with DNAmAA estimated by five different DNAm age measures.Two-wave longitudinal data was available for 1,083 participants of the Berlin Aging Study II (BASE-II) who were re-examined on average 7.4 years after baseline as part of the GendAge study. Functional outcomes were assessed with Fried’s frailty score, Tinetti mobility test, falls in the past 12 months (yes/no), Finger-floor distance, Mini Mental State Examination (MMSE), Center for Epidemiologic Studies Depression Scale (CES-D), Activities of Daily Living (ADL), Instrumented ADL (IADL) and Mini Nutritional Assessment (MNA).Overall, we found no evidence for an association between the molecular biomarkers measured at baseline, rLTL and DNAmAA (7-CpG clock), and functional assessments assessed at follow-up. Similarly, a cross-sectional analyses of follow-up data did also not show evidence for associations of the various DNAmAA measures (7-CpG clock, Horvath’s clock, Hannum’s clock PhenoAge, and GrimAge) with functional assessments.In conclusion, neither rLTL nor 7-CpG DNAmAA were able to predict impairment in the analyzed assessments over a ∼7 year time-course. Similarly, DNAmAA as estimated by five epigenetic clocks was not a good cross-sectional marker of health deterioration either.

scholarly journals Comprehensive geriatric assessment is correlated to overall survival among gynaecologic oncology patients

2019 ◽  
Vol 50 (3) ◽  
pp. 276-281
Author(s):  
Nadav Michaan ◽  
Sang Yoon Park ◽  
Myong Cheol Lim
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Activities Of Daily Living ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Cancer Type ◽  
Oncology Patients

Abstract Objective To investigate the correlation of comprehensive geriatric assessment to overall survival among older gynaecologic oncology patients. Methods Between 2011 and 2017, patients &gt;70 years had geriatric assessment before treatment. Geriatric assessment included the following tests: Old American resource and services, instrumental activities of daily living, modified Barthels index, mini-mental state examination, geriatric depression scale, mini-nutritional assessment, risk of falling and medication use. Overall survival was calculated for patients’ groups below and above median tests scores. Univariate as well as multivariate analysis was done to evaluate the association between each variable and survival. Results About 120 patients had geriatric assessment. Mean patients’ age was 76.4 ± 5. A total of 78 Patients had ovarian cancer, 16 uterine cancer, 17 cervical cancer and 9 had other gynaecologic malignancies. No correlation was found between age, BMI (body mass index) and cancer type to overall survival. Patients with scores below cut-off values of modified Barthels index, instrumental activities of daily living, mini-nutritional assessment and mini-nutritional assessment had significantly shorter overall survival (P = 0.004, 0.031, 0.046 and 0.004, respectively). This remained significant in both univariate and multivariate analysis. Conclusions Gynaecologic oncology patients with lower geriatric assessment scores have significantly lower overall survival, irrespective of cancer type. Geriatric assessment tests allow objective assessment of older patients with worst prognosis before treatment planning.

Early Dementia Questionnaire (EDQ): A Screening Instrument for early Dementia among elderly in Cairo governorate

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Aya Ashraf Sayed ◽  
Nayera Samy Mostafa ◽  
Salma Mohamed Samir El Said
Keyword(s):  
Predictive Value ◽  
Assessment Tool ◽  
Nutritional Assessment ◽  
Depression Scale ◽  
Mini Nutritional Assessment ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Sectional Study ◽  
Cross Sectional ◽  
Early Dementia

Abstract Objectives To screen elderly participants for early Dementia in primary care in Egypt using a newly developed Early Dementia Questionnaire (EDQ) and comparing it with standard assessment tool, Mini Mental State Examination (MMSE). Design A cross-sectional study. Setting and Participants The study included 220 elder adults (both men and women) recruited from a primary healthcare center, the outpatient geriatric clinic at Ain Shams University hospitals and elderly clubs (Community dwelling) in Cairo Governorate, Egypt. Methods A cross-sectional study was conducted on a group of elderly patients using systematic random sampling. Elderly depression was excluded using the Geriatric Depression Scale (GDS). Diagnosed cases of dementia and other mental or psychiatric disorders and illiterate participants were excluded from the study. A face-to-face interview was done using EDQ with the participants to elicit symptoms of early dementia. The participants were then assessed with MMSE using variable cut-off points according to age and educational level. Results Prevalence of dementia among the study participants was 81.4% by EDQ and 19.5% by MMSE. The EDQ demonstrated a sensitivity of 97.7% with specificity of 22.6%. Positive predictive value of EDQ was 23.5% with the negative predictive value of 97.6%. A significant association was found between possible dementia, hypertension, Mini Nutritional Assessment and urinary incontinence. Conclusion The EDQ is more sensitive than MMSE for screening of early dementia.

scholarly journals Development of a comprehensive frailty test battery including physical, socio-psychological and cognitive domains for patients with cardiovascular disease

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
N Marinus ◽  
C Vigorito ◽  
F Giallauria ◽  
P Dendale ◽  
R Meesen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Nutritional Assessment ◽  
Handgrip Strength ◽  
Depression Scale ◽  
Mini Nutritional Assessment ◽  
Test Battery ◽  
Timed Up And Go ◽  
Cognitive Domains ◽  
Efficient Test ◽  
Age Related

Abstract Funding Acknowledgements Type of funding sources: None. Background Frailty is an age-related decline in physical, socio-psychological and cognitive function resulting in extreme vulnerability to stressors. In patients with cardiovascular disease (CVD) it remains to be elucidated which tests to select to detect/establish frailty in a comprehensive, valid and feasible manner. Purpose 1) To compare the frailty prevalence rates using Fried vs. the more comprehensive Vigorito criteria in CVD patients; 2) To establish which tests, from the physical, socio-psychological and cognitive domains, should be selected to be able to detect frailty in patients with CVD; 3) To establish a total score that may represent a valid measurement of frailty severity, and 4) To examine the association of frailty with long-term clinical outcomes. Methods Patients (n = 133, mean age 78 ± 7 years) hospitalised for coronary revascularisation or heart failure (HF) were examined by the Fried and Vigorito criteria (Mini Nutritional Assessment (MNA), Katz-scale, 4.6m gait speed, timed up-and-go test (TUG), handgrip strength, Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), number of medications). Additionally, physical activity, time spent sitting, knee extension and hip flexor muscle strength, timed chair-stand test and fear of falling were measured. Multivariate regression and sensitivity/specificity analyses were performed to assess which tests to adopt to detect frailty in CVD patients. Moreover, hospitalisations and mortality, up to six months after the initial hospital admission were examined. Results Any level of frailty was detected in 44% of the patients by the Vigorito criteria and in 65% of the patients by the Fried criteria. However, frailty state may have been overestimated by Fried score as 20% of patients classified as non-frail by Vigorito, were pre-frail by Fried. Furthermore, 10% vs. 38%, respectively, were classified as moderate-frail (by Vigorito) vs. frail (by Fried). Frailty could best be detected (at the earliest stage) by a score from: sex, MNA, Katz-scale, TUG, handgrip strength, MMSE, GDS-15, total number of medications (cut-off score ≥5.56: sensitivity: 1.0, specificity: 0.54, correlation with Vigorito score: r = 0.98, p &lt; 0.001). During the six-month follow-up period, 39% of the patients were readmitted to the hospital (56% of these hospitalisations were attributed to the HF patients) and 7% of the subjects died (89% of them were HF patients). Frailty and specific markers of frailty were significantly associated with mortality and six-month general, urgent, orthopaedic and cardiovascular hospitalisations. Conclusions To detect frailty in patients with CVD, even at an earliest stage, sex, MNA, Katz-scale, TUG, handgrip strength, MMSE, GDS-15 and total number of medications play a key role, assessed by a new time- and cost-efficient test battery for frailty.

New conditions identified through a comprehensive geriatric assessment in cancer patients.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 133-133 ◽  
Author(s):  
Beatrice Jara-Almonte Edwards ◽  
Holly Michelle Holmes ◽  
Heather Valladarez ◽  
Ming Sun ◽  
Peter Khalil ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Healthy Aging ◽  
Nutritional Assessment ◽  
Cohort Analysis ◽  
Mini Nutritional Assessment ◽  
Hematologic Malignancies ◽  
Cancer Center ◽  
Co Morbidity

133 Background: Chronologic age cannot be used to predict the degree of comorbidity and of functional deterioration of older adults. Assessment of older adults includes health, functional status, nutrition, cognition, socio-economic and mood disorders evaluations. This multidisciplinary assessment is referred to as comprehensive geriatric assessment (CGA). The risk of comorbid conditions increases with age and may result in under diagnosis: in older patients, new symptoms may not be clearly recognized by the patient and may be dismissed by practitioners as manifestations of preexisting conditions. Methods: We conducted a retrospective cohort analysis, of older adult patients (aged 70 years of age and older) evaluated at the Program for Healthy Aging at MD Anderson from January 1, 2013 through December 31, 2014. Assessment was conducted using Katz’ ADLs, Lawton’s IADLs, PHQ-9, the short physical performance battery, the Montreal cognitive assessment, mini nutritional assessment and Charlson co-morbidity index. Medication review and social assessment were also included. Analysis: cross tabulations were performed in SAS 9.4 (SAS Institute INC, Cary, NC) Results: We evaluated 198 patients, (n = 99, 51.6% females). Most common malignancies evaluated included hematologic malignancies (n = 62, 33%), breast cancer (n = 32, 13.2 %), prostate cancer (n = 19, 10 %) and other solid malignancies (n = 85, 43%). The comprehensive geriatric assessment identified a mean of 3 new conditions (range 1-10). The most commonly identified conditions included cognitive impairment and dementia (n = 148, 77%), low bone mass and osteoporosis (n = 67, 34%), malnutrition (n = 65, 34%), frailty (n = 58, 30.2%), and polypharmacy (n = 64, 33%). These conditions are relevant in the management of such patients and could lead to recurring admissions if left unaddressed. Conclusions: A CGA program in a cancer center allows for the identification of medical conditions that directly contribute to clinical outcomes. A CGA allows for the development of a comprehensive plan of care that addresses such issues preventing adverse consequences.

scholarly journals Anthropometric Profile and Nutritional Status in Elderly: A Cross-Sectional Study

2021 ◽  
Vol 9 (02) ◽  
pp. 320-326
Author(s):  
Zeynel Abidin Erbesler ◽  
Tufan Ulcay
Keyword(s):  
At Risk ◽  
Nutritional Status ◽  
Elderly Population ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Normal Weight ◽  
Anthropometric Measurements ◽  
Screening Tools ◽  
Cross Sectional ◽  
Not At Risk

Background: Various screening tools are used to identify elderly individuals who are malnourished or at risk for malnutrition based on their nutritional status. Anthropometric measurements are important indicators of an individual’s nutritional status. In this study, we aimed to establish anthropometric standards for the Turkish elderly population and to investigate any significant relationship between anthropometric characteristics and nutritional status. Materials and Methods: Age, sex, weight, height, waist-to-hipratio (WHR) and body massindex (BMI) were recorded. We also administered the Mini Nutritional Assessment (MNA) and a hand grip test. Results: In our study, 72% of males and 84% of females were in the overweight group, 24% of males and 16% of females were in the normal weight group, and only 4% of males were in theweak group. For males, 76% were not at risk for malnutrition, 20% were at risk, and 4% were determined to have malnutrition. For females, 68% were not at risk for malnutrition, and 32% were at risk. There were no females who had malnutrition. With regard to muscle strength, 80% of males and 92% of females did not have sufficient strength. Weight, grip strength and WHR were significantly related to MNA (p < 0.05). Conclusion: We provided sex-specific distributions for many anthropometric measurements for the elderly which can be used as reference values for the Turkish elderly population to identify individuals at greater risk for nutritional disorders.

Depression among the oldest old: the Umeå 85+ study

2005 ◽  
Vol 17 (4) ◽  
pp. 557-575 ◽  
Author(s):  
Ellinor Bergdahl ◽  
Janna M. C. Gustavsson ◽  
Kristina Kallin ◽  
Petra von Heideken Wågert ◽  
Berit Lundman ◽  
...  
Keyword(s):  
Rating Scale ◽  
Nutritional Assessment ◽  
Oldest Old ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Mini Nutritional Assessment ◽  
Well Being ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Prevalence Of Depression

Objectives: To investigate the prevalence of depression among the oldest old and to analyze factors associated with depression.Methods:A cross-sectional, population-based study was undertaken in Umeå, Sweden. Out of 319 eligible participants aged 85, 90 and 95 years and older, it was possible to evaluate 242 people (75.9%) for depression. Data were collected from structured interviews and assessments in the participants’ homes, and from medical charts, relatives and caregivers. Depression was screened for using the Geriatric Depression Scale-15 and further assessed with the Montgomery–Åsberg Depression Rating Scale. Cognition was assessed using the Mini-mental State Examination, activities of daily living (ADL) using the Barthel ADL Index, nutrition using the Mini Nutritional Assessment and well-being using the Philadelphia Geriatric Center Morale Scale.Results:The 85-year-olds had a significantly lower prevalence of depression than the 90- and 95-year-olds (16.8% vs. 34.1% and 32.3%). No sex differences were found. One-third of those with depression had no treatment and among those with ongoing treatment 59% were still depressed. Persons diagnosed with depression had a poorer well-being and a higher 1-year mortality. Logistic regression analyses showed that depression was independently associated with living in institutions and number of medications.Conclusion:Depression among the oldest old is common, underdiagnosed and inadequately treated, and causes poor well-being and increased mortality. More knowledge about depression is essential to improve the assessment and treatment of depression among the oldest old.

Prospective validation of a novel geriatric screening tool, the Korean cancer study group geriatric score (KG)-7, in older patients with advanced cancer undergoing 1st line palliative chemotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21540-e21540
Author(s):  
Jin Won Kim ◽  
Se Hyun Kim ◽  
Yun-Gyoo Lee ◽  
In Gyu Hwang ◽  
Hong-Suk Song ◽  
...  
Keyword(s):  
Screening Tool ◽  
Nutritional Assessment ◽  
Short Form ◽  
Depression Scale ◽  
Mini Nutritional Assessment ◽  
Screening Tools ◽  
Study Group ◽  
Cancer Study ◽  
Cancer Study Group ◽  
Geriatric Screening

e21540 Background: Full geriatric assessment is time-consuming and labor intensive, and most screening tools were developed in Western countries, which cannot reflect differences in some domains such as nutrition deficit, in Asians. Methods: This prospective study to validate a novel geriatric screening tool, the Korean Cancer Study Group Geriatric Score (KG)-7, was conducted as a substudy of a multicenter study for the prediction tool of toxicity in older cancer patients receiving 1st line chemotherapy (KCSG PC13-09). Abnormal GA was defined as deficits in at least 2 out of 6 domains [activities of daily living (ADL), Korean-instrument ADL (K-IADL), Mini-Mental Status Examination in the Korean version of the Consortium (MMSE-KC), Short-Form Geriatric Depression Scale (SGDS), the Mini Nutritional Assessment (MNA), Timed Get Up and Go test (TGUG)]. KG-7 questionnaire was answered before full GA. We compared the performance of KG-7 with G-8 score, obtained from MNA, by calculating AUC of accuracy, and also sensitivity (SE), specificity (SP), positive and negative predictive value (PPV and NPV). Results: Baseline GA and KG-7 results of 301 patients were collected. Median age was 75 years old (range 70-93). Eighty six (28.6%) and 124 patients (41.2%) showed dependent ADL and IADL, respectively. Impairment for domains of MMSE, SGDS, MNA, and TGUG was identified in 166 (55.1%), 132 (43.9%), 230 (76.4%), and 52 patients (17.3%), respectively. Abnormal GA was documented in 221 patients (73.4%). Based on the ≤ 5 cut-off value of KG-7 for abnormal GA, the AUC was 0.741 (95% CI, 0.683-0.800), and the SE, SP, PPV, and NPV were 75.6%, 58.7%, 84.3%, and 44.9%, respectively. Abnormal KG-7 score was shown in 198 patients (66.9%). With the ≤ 14 cut-off value of G-8 for abnormal GA, the G-8 showed a SE, SP, PPV, and NPV of 93.6%, 28.0%, 79.2%, and 60.0% with AUC of 0.766 (95% CI, 0.703-0.829). Abnormal G-8 score was shown in 260 patients (88.1%). Conclusions: KG-7 could identify patients with abnormal GA with comparable performance with G-8 and can be a useful screening tool for Asian countries with limited resources and high patient volume.

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