scholarly journals Virtual Versus in-Person Frailty Assessments in Older Adults with Hematologic Malignancies

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2997-2997
Author(s):  
Clark Dumontier ◽  
Tim Jaung ◽  
Nupur E. Bahl ◽  
Emily S. Magnavita ◽  
Brad Manor ◽  
...  
Keyword(s):  
Older Adults ◽  
Grip Strength ◽  
Performance Measures ◽  
Gait Speed ◽  
Objective Measures ◽  
Deficit Accumulation ◽  
Frailty Assessment ◽  
Patient Reported ◽  
Objective Performance ◽  
Objective Performance Measures

Abstract Introduction : Time and resource barriers limit widespread implementation of frailty assessment in oncology practice, and the COVID-19 pandemic has reduced the number of in-person visits. To overcome these barriers, virtual geriatric assessments (GAs) have been developed, but lack important objective performance measures such as gait speed and cognitive tests-measures that are important predictors for poor outcomes in older patients with blood cancers (Liu et al., Blood, 2019; Hshieh et al., JAMA Oncol., 2018). We adapted an in-person frailty assessment to a virtual format that maintained both patient-reported and objective measures. Methods : Our cohort assessed in-person (February 2015 to March 2020; resumed June 2021 to July 2021) included all transplant-ineligible patients aged 75 years and older who presented to DFCI for initial consultation for their hematologic malignancy. On the same day as their initial consult, a research assistant administered to consented patients a screening geriatric assessment that assessed for 42 aging-related health deficits using patient-reported and objective performance measures spanning the domains of function, cognition, comorbidity, and mobility. From this assessment, frailty was measured using both the phenotypic (Fried et al., J Gerontol A Biol Sci Med Sci, 2001) and deficit-accumulation approaches (Rockwood et al., J Gerontol A Biol Sci Med Sci, 2007). The frailty phenotype uses five criteria to define a syndrome (slow gait speed, weakness [grip strength], self-reported exhaustion, low physical activity, and weight loss). The deficit-accumulation method calculates the proportion of deficits present in an individual out of the total number of possible deficits measured. To virtually adapt our assessment (Figure 1), patient-reported items were readily converted to questions administered over video- or teleconference. Of the objective measures, grip strength was replaced with self-reported grip strength. The Clock-in-the-Box test was changed to a simple clock draw that the patient completes and displays to the video camera for scoring. 4-meter gait speed is collected by teaching a caregiver to administer with a stopwatch and a 4-meter strip of ribbon. If video is unavailable, self-reported gait speed is measured instead. We expanded eligibility of virtual assessments to patients aged 70 and older. Geriatricians (C.D., T.H., and J.D.) and oncologists (G.A. and J.D.) reviewed the virtual GA for content validity. We measured the proportion of patients who consented and completed the virtual assessment. We assessed for differences in the distributions of age and frailty between virtual and in-person frailty assessments in patients 75 and older using Fisher exact (age) and Chi-square (frailty) tests. Results : Since starting our virtual frailty assessments in November 2020 through July 2021, 118 patients were enrolled and 89 (75%) completed assessments. Median age was 77.6 years (SD = 4.21), 55 (62%) were male, 38 (43%) had lymphoma, 32 (36%) had leukemia/myelodysplastic syndrome/myeloproliferative disorders, and 19 (21%) had multiple myeloma. Of the 89 who completed virtual assessments, 67 (75%) completed the assessment over video with the remaining 22 (25%) over telephone. For the objective measures, 68 (76%) participants were able to complete the clock draw and 47 (53%) were able to complete the gait speed tests. The distribution of age (p = 0.78) and frailty categories (p = 0.49) in our virtual assessments was similar to that of our in-person assessments (Table 1). Conclusion : We developed and successfully delivered a virtual frailty assessment for older adults with blood cancers and found no evidence that frail patients or patients of the highest age categories were unable to complete them. These data suggest that virtual frailty assessment will allow decentralization of assessments even beyond the pandemic, potentially reaching more older adults with blood cancers. The ability to scale to more patients and measure frailty where it matters most-in their own homes-could help overcome barriers to frailty assessments in busy oncology clinics. Virtual frailty assessments also allow for serial measurement while on treatment to better understand and track the trajectory of frailty in this population. Figure 1 Figure 1. Disclosures Kim: Alosa Health: Other: Personal Fee; NIH: Other: Grants; Alosa Health: Other: Personal Fee.

Relationships among Nontask Behaviors, Rated Performance, and Objective Performance Measures

1994 ◽  
Vol 74 (2) ◽  
pp. 571-578 ◽  
Author(s):  
Christopher M. Lowery ◽  
Thomas J. Krilowicz
Keyword(s):  
Performance Measures ◽  
Objective Measures ◽  
Regression Analyses ◽  
Actual Performance ◽  
Subjective Evaluations ◽  
Machine Operators ◽  
Objective Performance ◽  
Objective Performance Measures ◽  
Supervisory Ratings ◽  
Measures Of Performance

Correlations among nontask behaviors, subjective evaluations of performance, and objective performance measures were investigated for a sample of 73 machine operators. Correlation and regression analyses indicated that nontask behaviors were significantly related to both supervisory ratings of performance and to objective measures of performance. There was also a significant relationship between the subjective and objective performance measures, but the results indicated that supervisors based their evaluations more on nontask behaviors than on actual performance.

scholarly journals Multidimensional Sleep Health and Physical Functioning in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 428-428
Author(s):  
Caitlan Tighe ◽  
Ryan Brindle ◽  
Sarah Stahl ◽  
Meredith Wallace ◽  
Adam Bramoweth ◽  
...  
Keyword(s):  
Older Adults ◽  
Lower Extremity ◽  
Grip Strength ◽  
Physical Functioning ◽  
Gait Speed ◽  
The United States ◽  
Depression Symptoms ◽  
Sleep Health ◽  
Lower Extremity Strength ◽  
Sleep Parameters

Abstract Prior studies link specific sleep parameters to physical functioning in older adults. Recent work suggests the utility of examining sleep health from a multidimensional perspective, enabling consideration of an individual’s experience across multiple different sleep parameters (e.g., quality, duration, timing). We examined the associations of multidimensional sleep health with objective, performance-based measures of physical functioning in older adults. We conducted a secondary analysis of 158 adults (Mage=71.8 years; 51.9% female) who participated in the Midlife in the United States (MIDUS) 2 and MIDUS Refresher studies. We used data from daily diaries, wrist actigraphy, and self-report measures to derive a composite multidimensional sleep health score ranging from 0-6, with higher scores indicating better sleep health. Physical function was assessed using gait speed during a 50-foot timed walk, lower extremity strength as measured by a chair stand test, and grip strength assessed with dynamometers. We used hierarchical regression to examine the associations between sleep health and gait speed, lower extremity strength, and grip strength. Age, sex, race, education, depression symptoms, medical comorbidity, and body mass index were covariates in each model. In adjusted analyses, better multidimensional sleep health was significantly associated with faster gait speed (B=.03, p=.01). Multidimensional sleep health was not significantly associated with lower limb strength (B=-.12, p=.89) or grip strength (B=.45, p=.40). Gait speed is a key indicator of functional capacity as well as morbidity and mortality in older adults. Multidimensional sleep health may be a therapeutic target for improving physical functioning and health in older adults.

scholarly journals Urban-rural differences in the prevalence of muscle weakness and slow gait speed: A cross-sectional analysis from the NHANES (2001-2002 and 2011-2014)

2021 ◽  
pp. 1-7
Author(s):  
J.J. Aziz ◽  
K.F. Reid ◽  
J.A. Batsis ◽  
R.A. Fielding
Keyword(s):  
United States ◽  
Older Adults ◽  
Grip Strength ◽  
Muscle Weakness ◽  
Rural Areas ◽  
Gait Speed ◽  
The United States ◽  
Cross Sectional ◽  
Comorbidity Burden ◽  
Urban Rural

Background: Older adults living in rural areas suffer from health inequities compared to their urban counterparts. These include comorbidity burden, poor diet, and physical inactivity, which are also risk factors for sarcopenia, for which muscle weakness and slow gait speed are domains. To date, no study has examined urban-rural differences in the prevalence of muscle weakness and slow gait speed in older adults living in the United States. Objective: To compare the prevalence of grip strength weakness and slow gait speed between urban and rural older adults living in the United States. Design: A cross-sectional, secondary data analysis of two cohorts from the National Health and Nutrition Examination Survey (NHANES), using gait speed or grip strength data, and urban-rural residency, dietary, examination, questionnaire and demographic data. Participants: 2,923 adults (≥ 60 yrs.). Measures: Grip weakness was defined as either, an absolute grip strength of <35 kg. and <20 kg. or grip strength divided by body mass index (GripBMI) of <1.05 and <0.79 for men and women, respectively. Slow gait speed was defined as a usual gait speed of ≤0.8m/s. Results: The prevalence of GripBMI weakness was significantly higher in urban compared to rural participants (27.4% vs. 19.2%; p=0.001), whereas their absolute grip strength was lower (31.75(±0.45) vs. 33.73(±0.48)). No urban-rural differences in gait speed were observed. Conclusions: Older adults residing in urban regions of the United States were weaker compared to their rural counterparts. This report is the first to describe urban-rural differences in handgrip strength and slow gait speed in older adults living in the United States.

scholarly journals Can Functional Performance Predict Long-Term Mortality Post Hip Fracture in Older Adults (65–100 Years of Age)?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 268-268
Author(s):  
Rashmita Bajracharya ◽  
Denise Orwig ◽  
Jay Magaziner ◽  
Jack M Guralnik
Keyword(s):  
Hip Fracture ◽  
Grip Strength ◽  
Performance Measures ◽  
Gait Speed ◽  
Functional Performance ◽  
Underlying Disease ◽  
Prediction Of Mortality ◽  
Hazard Ratios ◽  
Long Term Mortality

Abstract Functional performance measures (grip strength, Short Physical Performance Battery (SPPB), and 3-meter gait speed) represent underlying disease progression and predict mortality. However, there is little information regarding whether these measures assessed at 2-months post-hip fracture predict long-term mortality (10-year follow-up). To address this gap, a longitudinal analysis of Baltimore Hip Studies-7 cohort, with mortality verified by National Death Index, was conducted. Mean difference in 2-month functional performance measures (n=242, men n=121, female n=121) among those who survived and did not survive over 10 years was determined using t-test. Prediction of mortality by these measures, overall and by sex, was estimated using cox proportional hazard models, for which Hazard ratios (HR) with 95% confidence intervals (CI) were estimated. We found that, gait speed [0.47(standard deviation,SD=0.39) versus 0.31(SD=0.27)] and SPPB score [4.89(SD=3.31) versus 2.83(SD=2.24)] were significantly higher at 2 months among those surviving compared to those who did not. Adjusting for covariates, functional performance predicted long-term mortality in men and women. Increase in gait speed by 0.1m/s predicted 15% decrease in mortality for men [HR=0.85(0.55-0.96)] and 17% for women [HR=0.83 (0.74-0.93)]. Increase in SPPB by 1 unit predicted decrease in mortality by 14% for men [HR=0.86(0.77-0.95)] and 17% for women [HR=0.83(0.74-0.93). Increase in grip strength by 1 kg predicted 5% decrease in mortality for men [HR=0.94(0.92-0.97)] and 9% for women [HR=0.90(0.86-0.95)]. Functional performance measured at 2-months post-hip fracture predicted long-term mortality. Those with poor functional performance at 2-months can be referred for further assessment to optimize their care to promote survival.

Improving service operations: linking safety culture to hospital performance

2017 ◽  
Vol 28 (1) ◽  
pp. 57-84 ◽  
Author(s):  
Gregory N. Stock ◽  
Kathleen L. McFadden
Keyword(s):  
Patient Safety ◽  
Performance Measures ◽  
Safety Culture ◽  
Linear Regression Analysis ◽  
Patient Safety Culture ◽  
Hospital Performance ◽  
Data Set ◽  
Content Type ◽  
Objective Performance ◽  
Objective Performance Measures

Purpose The purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on patient safety culture. Design/methodology/approach Patient safety culture is measured using data from the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture. Hospital performance is measured using objective patient safety and operational performance metrics collected by the Centers for Medicare and Medicaid Services (CMS). Control variables were obtained from the CMS Provider of Service database. The merged data included 154 US hospitals, with an average of 848 respondents per hospital providing culture data. Hierarchical linear regression analysis is used to test the proposed relationships. Findings The findings indicate that patient safety culture is positively associated with patient safety, process quality and patient satisfaction. Practical implications Hospital managers should focus on building a stronger patient safety culture due to its positive relationship with hospital performance. Originality/value This is the first study to test these relationships using several objective performance measures and a comprehensive patient safety culture data set that includes a substantial number of respondents per hospital. The study contributes to the literature by explicitly mapping high-reliability organization (HRO) theory to patient safety culture, thereby illustrating how HRO theory can be applied to safety culture in the hospital operations context.

The Journey From Development to Appraisal

2019 ◽  
pp. 327-342
Author(s):  
Tracy M. Maylett
Keyword(s):  
Performance Management ◽  
Performance Appraisal ◽  
Performance Measures ◽  
Past Performance ◽  
360 Feedback ◽  
Objective Performance ◽  
Objective Performance Measures ◽  
Performance Appraisal Process ◽  
Measures Of Performance

This case study describes an initiative to change a long-standing performance management process at a large manufacturing facility within General Mills that emphasized the attainment of objective performance measures (the “what” of performance) to one that also included the “how” of goal achievement. The organization embarked on a 3-year pilot evaluation of the use of 360 Feedback as a possible solution to replace or supplement their traditional single-source (supervisor) performance appraisal process. The two systems ran in parallel using 140 randomly selected employees. Results showed little correlation between the what measures of performance from the traditional appraisals and the how data collected using the 360 Feedback, supporting the view that job performance should be viewed as requiring both aspects of evaluation, using different methods of assessment. Ultimately, the organization maintained both systems but integrated 360 Feedback into the traditional appraisals as well, creating complementary processes that looked “forward” (development) and “past” (performance).

scholarly journals Detectable Changes in Physical Performance Measures in Elderly African Americans

2010 ◽  
Vol 90 (6) ◽  
pp. 921-927 ◽  
Author(s):  
Kathleen Kline Mangione ◽  
Rebecca L. Craik ◽  
Alyson A. McCormick ◽  
Heather L. Blevins ◽  
Meaghan B. White ◽  
...  
Keyword(s):  
Older Adults ◽  
African American ◽  
Physical Performance ◽  
Performance Measures ◽  
Gait Speed ◽  
Intraclass Correlation ◽  
Assistive Device ◽  
Minimal Detectable Change ◽  
6Mwt Distance ◽  
African American Older Adults

Background African American older adults have higher rates of self-reported disability and lower physical performance scores compared with white older adults. Measures of physical performance are used to predict future morbidity and to determine the effect of exercise. Characteristics of performance measures are not known for African American older adults. Objective The purpose of this study was to estimate the standard error of measurement (SEM) and minimal detectable change (MDC) for the Short Physical Performance Battery (SPPB), Timed “Up & Go” Test (TUG) time, free gait speed, fast gait speed, and Six-Minute Walk Test (6MWT) distance in frail African American adults. Design This observational measurement study used a test-retest design. Methods Individuals were tested 2 times over a 1-week period. Demographic data collected included height, weight, number of medications, assistive device use, and Mini-Mental Status Examination (MMSE) scores. Participants then completed the 5 physical performance tests. Results Fifty-two participants (mean age=78 years) completed the study. The average MMSE score was 25 points, and the average body mass index was 29.4 kg/m2. On average, participants took 7 medications, and the majority used assistive devices. Intraclass correlation coefficients (ICC [2,1]) were greater than .90, except for the SPPB score (ICC=.81). The SEMs were 1.2 points for the SPPB, 1.7 seconds for the TUG, 0.08 m/s for free gait speed, 0.09 m/s for fast gait speed, and 28 m for 6MWT distance. The MDC values were 2.9 points for the SPPB, 4 seconds for the TUG, 0.19 m/s for free gait speed, 0.21 m/s for fast gait speed, and 65 m for 6MWT distance. Limitations The entire sample was from an urban area. Conclusions The SEMs were similar to previously reported values and can be used when working with African American and white older adults. Estimates of MDC were calculated to assist in clinical interpretation.

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