Preventing Treatment-Related Functional Decline: Strategies to Maximize Resilience

2018 ◽  
pp. 415-431 ◽  
Author(s):  
Armin Shahrokni ◽  
Koshy Alexander ◽  
Tanya M. Wildes ◽  
Martine T. E. Puts
Keyword(s):  
Older Adults ◽  
Functional Decline ◽  
Treatment Decision ◽  
Well Being ◽  
Cancer Prognosis ◽  
Screening Tools ◽  
Care Plan ◽  
Treatment Decision Making ◽  
Prediction Of Mortality ◽  
Individualized Prediction

The majority of patients with cancer are older adults. A comprehensive geriatric assessment (CGA) will help the clinical team identify underlying medical and functional status issues that can affect cancer treatment delivery, cancer prognosis, and treatment tolerability. The CGA, as well as more abbreviated assessments and geriatric screening tools, can aid in the treatment decision-making process through improved individualized prediction of mortality, toxicity of cancer therapy, and postoperative complications and can also help clinicians develop an integrated care plan for the older adult with cancer. In this article, we will review the latest evidence with regard to the use of CGA in oncology. In addition, we will describe the benefits of conducting a CGA and the types of interventions that can be taken by the interprofessional team to improve the treatment outcomes and well-being of older adults.

scholarly journals Creating an Age-Friendly Community in Affordable Housing Using a Resident Health Risk Assessment Focused on the 4Ms

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 49-49
Author(s):  
Jennifer DeGennaro ◽  
Sherry Pomerantz ◽  
Margaret Avallone ◽  
Melonie Handberry ◽  
Elyse Perweiler
Keyword(s):  
Risk Assessment ◽  
Health Risk ◽  
Health Risk Assessment ◽  
Affordable Housing ◽  
Risk Function ◽  
Well Being ◽  
Screening Tools ◽  
Care Plan ◽  
Care Plans

Abstract The NJGWEP team in partnership with Fair Share Housing/Northgate II (NGII), an affordable housing complex in Camden, NJ, employed an iterative quality improvement process to collaboratively develop a Resident Health Risk Assessment (RHRA) to meet the needs of the housing facility and incorporate the essential elements of the 4Ms framework (Mentation, Medication, Mobility, and What Matters). Using the RHRA, NG II social services staff and Rutgers School of Nursing (RSoN) students were trained to collect health information and administer several evidence-based screening tools (i.e., MiniCog, TUG, PHQ-2). A final element of the RHRA still in development is the documentation process of referral and follow-up based on personalized care plans. Since July 2019, 43 RHRAs have been completed (60% female, mean age 66, age range=43 to 88). Almost all residents (94%) have at least 1 chronic condition (HTN, DM, COPD, CHF), although only 26% have an advance care plan. Most (81%) were screened for future fall risk; function (ADLs/IADLs) was assessed for all (100%). Every resident who was able or did not refuse (88%) was screened for cognitive impairment. Just 7% were taking a high-risk medication (i.e., an opioid or benzodiazepine). The NJGWEP team has initiated an age-friendly community at NGII by providing education on geriatric-focused topics and implementing the 4Ms-focused RHRA to detect issues impacting the resident’s well-being. Establishing a follow-up process to track referrals to available resources will enable NGII to allow residents to age in place with appropriate supports.

scholarly journals Lay Referral Patterns Involved in Cardiac Treatment Decision Making Among Middle-Aged and Older Adults

2003 ◽  
Vol 43 (4) ◽  
pp. 493-502 ◽  
Author(s):  
N. E. Schoenberg ◽  
C. H. Amey ◽  
E. P. Stoller ◽  
S. B. Muldoon
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Treatment Decision ◽  
Middle Aged ◽  
Referral Patterns ◽  
Treatment Decision Making

scholarly journals Frailty Screening Tools: Frail Detection to Primary Assessment

2020 ◽  
Author(s):  
Jonathan Aseye Nutakor ◽  
Alexander Kwame Gavu
Keyword(s):  
Older Adults ◽  
Health Professionals ◽  
Functional Decline ◽  
Healthcare Providers ◽  
Screening Tools ◽  
Test Results ◽  
Huge Number ◽  
Early Screening ◽  
Precise Tool ◽  
Primary Assessment

Frailty is a vulnerable situation among older adults which can lead to unfavorable health outcomes such as falls, mortality, functional decline and institutionalization. The increasing number of elderly people and low rate of mortality has necessitated the need for high-quality medical services for this aging population, and this has led to a high cost of geriatric health care. There exist a huge number of screening tools to detect frailty and it is important for researchers and general practitioners (GPs) to select the appropriate and precise tool that would effectively lead to quality results. Frail individuals can be managed effectively when there is an early screening and intervention. Healthcare providers need tools that are simple and validated in order for screening and interventions to become effective. Self-reported frailty screening tools are very simple to use, not expensive and test results can be interpreted by non-health professionals. This work reviewed some of the commonly used frailty screening tools, and proposed a practical approach that would assist GPs in assessing frailty in older adults.

scholarly journals AGING IN COMMUNITY: A LEGAL MAPPING ANALYSIS OF MASSACHUSETTS MUNICIPAL ACCESSORY DWELLING UNIT ZONING BYLAWS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S250-S251
Author(s):  
Travis M Gagen
Keyword(s):  
Older Adults ◽  
Functional Decline ◽  
Institutional Care ◽  
Well Being ◽  
Functional Health ◽  
Dwelling Unit ◽  
Older Americans ◽  
Alternative Housing ◽  
Accessory Dwelling Units ◽  
Health Promoting

Abstract Accessory-dwelling units (ADUs) are one alternative housing arrangement that enable older adults to remain in the home despite functional decline. Functional decline increases with age making older adults more susceptible to loosing independent housing. Involuntary relocation to institutional care can result in a decline of functional health, reduced life satisfaction, impairment of psychological well-being and increased mortality rate. The majority of older Americans (93%) wish to remain in their home for as long as possible. ADUs function to maintain, stimulate and support an older adult as a means to prevent relocation to an institution. The modified environment coupled with adaptable features maintains and supports activities of daily living (ADL) within a familiar place. Under Massachusetts law MGL c. 40A, the state gives authority to cities and towns to adopt ordinances and bylaws to regulate the use of land, buildings and structures. Restrictive zoning laws limit the ability to construct health-promoting built-environments to age-in-community. All 351 Massachusetts municipalities Accessory Dwelling Unit (ADU) zoning bylaws were coded using the ADU Friendliness Score. Once scored, the 351 municipalities were placed into four categories based off their ADU score; the four categories are poor (0-24), fair (25-49), good (50-74), and excellent (75-100). Eighty-nine municipalities (25%) are in the poor category; thirty municipalities (8.5%) are in the fair category; one hundred and eighty-five municipalities (53%) are in the good category; forty-seven municipalities (13.5%) are in the excellent category. These findings contributed to a model ADU bylaw specific for aging Americans for municipalities to adopt.

scholarly journals Validation of the detection of elder abuse through emergency care technicians (DETECT) screening tool: a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037170
Author(s):  
Brad Cannell ◽  
Julie Weitlauf ◽  
Melvin D Livingston ◽  
Jason Burnett ◽  
Megin Parayil ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Care ◽  
Screening Tool ◽  
Elder Abuse ◽  
Well Being ◽  
Living Environment ◽  
Community Dwelling ◽  
Screening Tools ◽  
Semistructured Interview

IntroductionElder mistreatment (EM) is a high prevalence threat to the health and well-being of older adults in the USA. Medics are well-positioned to help with identification of older adults at risk for EM, however, field robust screening tools appropriate for efficient, observation-based screening are lacking. Prior work by this team focused on the development and initial pilot testing of an observation-based EM screening tool named detection of elder abuse through emergency care technicians (DETECT), designed to be implemented by medics during the course of an emergency response (911) call. The objective of the present work is to validate and further refine this tool in preparation for clinical dissemination.Methods and analysisApproximately 59 400 community-dwelling older adults who place 911 calls during the 36-month study observation period will be screened by medics responding to the call using the DETECT tool. Next, a random subsample of 2520 of the 59 400 older adults screened will be selected to participate in a follow-up interview approximately 2 weeks following the completion of the screening. Follow-up interviews will consist of a medic-led semistructured interview designed to assess the older adult’s likelihood of abuse exposure, physical/mental health status, cognitive functioning, and to systematically evaluate the quality and condition of their physical and social living environment. The data from 25% (n=648) of these follow-up interviews will be presented to a longitudinal, experts and all data panel for a final determination of EM exposure status, representing the closest proxy to a ‘gold standard’ measure available.Ethics and disseminationThis study has been reviewed and approved by the Committee for the Protection of Human Subjects at the University of Texas School of Public Health. The results will be disseminated through formal presentations at local, national and international conferences and through publication in peer-reviewed scientific journals.

Integrating a touchscreen-based brief geriatric assessment in older adults with multiple myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21703-e21703 ◽  
Author(s):  
Nitya Nathwani ◽  
Supriya Gupta Mohile ◽  
Brea Lipe ◽  
Karen Carig ◽  
Laura DiGiovanni ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Daily Living ◽  
Dose Intensity ◽  
Treatment Decision ◽  
Activity Of Daily Living ◽  
Treatment Decision Making ◽  
Frailty Score

e21703 Background: Multiple myeloma (MM) is a disease of older adults (OAs) with > 60% of diagnoses and nearly 75% of deaths occurring in patients > 65 years old (YO). Geriatric Assessment (GA) is associated with toxicity and survival in OAs with MM, but not routinely used in practice. This project pilot tests a tablet-based modified Geriatric Assessment (mGA) that presents compiled GA results, including (the Palumbo) frailty score, to clinicians at a treatment decision-making visit in a single screen dashboard. Methods: In this multisite ongoing study, 210 patients with MM ≥65 YO facing a decision point for care will complete a mGA that includes the Charlson Comorbidity Index (CCI), Katz Activity of Daily Living (ADL) Score, and Lawton Instrumental Activity of Daily Living (IADL) Score prior to meeting with a physician. mGA results, including composite frailty score, are provided to physicians at the start of a visit. Results: Thirty-six patients have been enrolled to date; enrollment continues. Participants are 69% (n = 25) white, 64% (n = 23) male, and mean age of 72 YO (range 65-87). Most (74%, n = 20) currently receive ≥1 therapy and have few co-morbidities (CCI median 1, SD 1.95, range 0-8); 57% require assistance with IADLs and 37% require assistance with ADLs. Based on Palumbo score, 36% of participants were frail (n = 13), 33% intermediate (n = 12), and 31% fit (n = 11). Providers report mGA results influenced treatment decision (54%, n = 28) and frailty score was the most frequently cited result to impact treatment decision-making (61%, n = 39). The most common way the mCGA influenced decision-making was to reduce dose/dose intensity (25%, N = 8). Clinicians on average spent 5 minutesreviewing the mGA results. Patients reported an average of 7 minutes to complete the survey, most independently (83%, n = 30), and were satisfied with the electronic program overall (80%, n = 29), including how easy it was to use (88%, n = 32). Conclusions: Preliminary data support feasibility, usability, and acceptability of the tablet-based mGA and that frailty score influences provider decision-making ≥50% of the time. Future analyses will explore the relationship of the mGA with toxicity, dose modification and/or treatment discontinuation in OAs with MM.

scholarly journals Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026960 ◽  
Author(s):  
Kirsten McCaffery ◽  
Brooke Nickel ◽  
Kristen Pickles ◽  
Ray Moynihan ◽  
Barnett Kramer ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Lived Experience ◽  
Treatment Decision ◽  
Well Being ◽  
Management Options ◽  
Treatment Decision Making ◽  
Recommended Treatment ◽  
Qualitative Interview Study ◽  
The Impact

ObjectiveTo describe the lived experience of a possible prostate cancer overdiagnosis in men who resisted recommended treatment.DesignQualitative interview studySettingAustraliaParticipants11 men (aged 59–78 years) who resisted recommended prostate cancer treatment because of concerns about overdiagnosis and overtreatment.OutcomesReported experience of screening, diagnosis and treatment decision making, and its impact on psychosocial well-being, life and personal circumstances.ResultsMen’s accounts revealed profound consequences of both prostate cancer diagnosis and resisting medical advice for treatment, with effects on their psychological well-being, family, employment circumstances, identity and life choices. Some of these men were tested for prostate-specific antigen without their knowledge or informed consent. The men felt uninformed about their management options and unsupported through treatment decision making. This often led them to develop a sense of disillusionment and distrust towards the medical profession and conventional medicine. The findings show how some men who were told they would soon die without treatment (a prognosis which ultimately did not eventuate) reconciled issues of overdiagnosis and potential overtreatment with their own diagnosis and situation over the ensuing 1 to 20+ years.ConclusionsMen who choose not to have recommended treatment for prostate cancer may avoid treatment-associated harms like incontinence and impotence, however our findings showed that the impact of the diagnosis itself is immense and far-reaching. A high priority for improving clinical practice is to ensure men are adequately informed of these potential consequences before screening is considered.

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