Prognostic significance of geriatric assessment.

e18140 Background: More than 60% of cancer patients are older adults, and by 2020 the proportion of older adults with cancer will rise to 70%. Objective: To assess risk factors for overall survival (OS) in older cancer patients seen in a comprehensive cancer center. Methods: This is a single center, retrospective cohort study of older cancer patients (65 years of age and older). Patients receiving active cancer care underwent comprehensive geriatric assessment (including cognitive, mood, functional, nutritional, physical, and comorbidity assessment using validated scales). Hematologic, and solid tumors (urologic, breast, gastrointestinal cancers) were evaluated. Targeted interventions were implemented. Analysis: Univariate and multivariable Cox proportional hazards regression analysis were performed to identify factors associated with OS (SAS 9.4). Results: Among 304 eligible patients, the median follow-up was 12.7 months, 98 (32%) died, the median OS was 25.4 months. Median age is 78 years. Univariate analysis revealed known risk factors for mortality (advanced age [p = 0.004], and metastatic disease [p = 0.002]), functional impairment (ADL scores 0-4, p = 0.02), and major depression (p = 0.005). Comorbidity (p = 0.07) and functional impairment showed a marginal significance on OS. Factors with a univariate p-value less than 0.1 were considered in multivariable regression models. A final multivariable model included age group, cancer stage, functional impairment, and major depression. Risk factors for OS include major depression (HR 1.88 (95% CI, 1.12, 3.15), p-value = 0.02), functional impairment (HR 2.47 (95% C.I. 1.28, 4.74), p = 0.007), and metastatic disease (HR 2.2 (95% C.I. 1.30, 3.97), p = 0.004). Conclusions: Major depression and functional impairment were identified as risk factors for OS in older cancer patients. Prospective studies are recommended.

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Risk factors for falls in older patients with cancer

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2017-001388 ◽

2017 ◽

Vol 8 (1) ◽

pp. 34-37 ◽

Cited By ~ 13

Author(s):

Xiaotao Zhang ◽

Ming Sun ◽

Suyu Liu ◽

Cheuk Hong Leung ◽

Linda Pang ◽

...

Keyword(s):

Risk Factors ◽

Social Support ◽

Older Adults ◽

Logistic Regression ◽

Major Depression ◽

Functional Impairment ◽

Older Patients ◽

Patients With Cancer ◽

Number Of Patients ◽

Risk Factors For Falls

ObjectivesA rising number of patients with cancer are older adults (65 years of age and older), and this proportion will increase to 70% by the year 2020. Falls are a common condition in older adults. We sought to assess the prevalence and risk factors for falls in older patients with cancer.MethodsThis is a single-site, retrospective cohort study. Patients who were receiving cancer care underwent a comprehensive geriatric assessments, including cognitive, functional, nutritional, physical, falls in the prior 6 months and comorbidity assessment. Vitamin D and bone densitometry were performed.AnalysisDescriptive statistics and multivariable logistic regression.ResultsA total of 304 patients aged 65 or above were enrolled in this study. The mean age was 78.4±6.9 years. They had haematological, gastrointestinal, urological, breast, lung and gynaecological cancers. A total of 215 patients with available information about falls within the past 6 months were included for final analysis. Seventy-seven (35.8%) patients had at least one fall in the preceding 6 months. Functional impairment (p=0.048), frailty (p<0.001), dementia (p=0.021), major depression (p=0.010) and low social support (p=0.045) were significantly associated with the fall status in the univariate analysis. Multivariate logistic regression analysis identified frailty and functional impairment to be independent risk factors for falls.ConclusionsFalls are common in older patients with cancer and lead to adverse clinical outcomes. Major depression, functional impairment, frailty, dementia and low social support were risk factors for falls. Heightened awareness and targeted interventions can prevent falls in older patients with cancer.

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Prevalence of vitamin D insufficiency and falls in older cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.138 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 138-138

Author(s):

Xiaotao Zhang ◽

Ming Sun ◽

Jay Bakul Shah ◽

Colin P.N. Dinney ◽

Uday R. Popat ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Vitamin D ◽

Cognitive Impairment ◽

Cancer Patients ◽

Vitamin D Insufficiency ◽

Low Bone Mass ◽

Injurious Falls ◽

Older Cancer Patients ◽

Risk Factors For Falls

138 Background: More than 60% of cancer patients are older adults. Such patients undergo age and cancer therapy related changes. Older adults also have geriatric risk factors for falls such as frailty, cognitive impairment (mild cognitive impairment [MCI] and dementia), and malnutrition-including vitamin D deficiency. Objective: To assess the prevalence of vitamin D insuffiency and risk factors for falls in older cancer patients. Retrospective cohort study. Methods: Patients underwent prospective data collection and retrospective analysis. Patients underwent a comprehensive geriatric assessments, including cognitive, functional, nutritional, physical, and comorbidity assessment. Vitamin D was assayed. Bone densitometry was performed. Analysis: Descriptive statistics, and multivariable logistic regression. Results: We enrolled 318 patients and 305 patients with complete data were included for final analysis. Patients were undergoing active cancer care. Patients had gastrointestinal, urologic, breast, lung and gynecologic cancers. The mean age was 78.4 ± 6.9 years. Low bone mass and osteoporosis were very common (80%) in this cohort. Twenty-six percent had one or more falls in the preceding six months. Dementia and mild cognitive impairment were seen in 33% and 37% of patients, and 53% presented frailty. In 256 patients, 48.8% (n = 125) had Vitamin D insufficiency ( < 30 ng/ml). In univariate analysis, co-morbidity (p = 0.05), frailty (p < 0.01), and cognitive impairment (0 = 0.02) were significantly associated with falls, while in multivariate analysis, frailty remained significantly associated with falls (OR = 3.51, 95%CI = 1.88, 6.52). Conclusions: Older cancer patients have a high prevalence of falls, osteoporosis and vitamin D insufficiency, raising the possibility of injurious falls (fractures). Frailty was found to be the most prominent risk factor for falls in this cohort. Greater awareness and targeted interventions such as vitamin D replacement, physical therapy, nutrition interventions, and therapy for low bone mass/osteoporosis will be effective preventing injurious falls.

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Vascular lesions and functional limitations among older adults: does depression make a difference?

International Psychogeriatrics ◽

10.1017/s1041610214000829 ◽

2014 ◽

Vol 26 (9) ◽

pp. 1501-1509 ◽

Cited By ~ 5

Author(s):

Celia F. Hybels ◽

Carl F. Pieper ◽

Lawrence R. Landerman ◽

Martha E. Payne ◽

David C. Steffens

Keyword(s):

Risk Factors ◽

Older Adults ◽

White Matter ◽

Functional Impairment ◽

Functional Limitations ◽

Late Life ◽

Cognitive Status ◽

Cerebral White Matter ◽

Late Life Depression ◽

Increased Risk

ABSTRACTBackground:The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment.Methods:The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging.Results:In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression.Conclusions:These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.

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Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations

Annals of Oncology ◽

10.1093/annonc/mdu210 ◽

2015 ◽

Vol 26 (2) ◽

pp. 288-300 ◽

Cited By ~ 335

Author(s):

L. Decoster ◽

K. Van Puyvelde ◽

S. Mohile ◽

U. Wedding ◽

U. Basso ◽

...

Keyword(s):

Cancer Patients ◽

Geriatric Assessment ◽

Health Problems ◽

Screening Tools ◽

Older Cancer Patients ◽

Multidimensional Health

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Communicating with the Older Adult Cancer Patient

Psycho-Oncology ◽

10.1093/med/9780190097653.003.0085 ◽

2021 ◽

pp. 678-684

Author(s):

Patricia A. Parker ◽

Smita C. Banerjee ◽

Beatriz Korc-Grodzicki

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Psychological Distress ◽

Cancer Patients ◽

Older Adult ◽

Adult Population ◽

Healthcare Providers ◽

Multiple Morbidity ◽

Older Adult Population

The older adult population continues to increase. Among all known risk factors for developing cancer, the most important is growing old. Thus, caring for older adults with cancer is of increasing importance. This chapter describes important considerations involved in communicating with cancer patients including sensory impairment, cognitive impairment, multiple morbidity, polypharmacy, and psychological distress. It also describes how stereotyping and ageism affect communication with older adults with cancer. Finally, the chapter discusses ways to facilitate communication with older adult cancer patients and their families and provides an example of a training program that was created specifically to enhance communication between healthcare providers and older adult cancer patients and their families.

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WHITE MATTER INTEGRITY UNDERLYING SUBSYNDROMAL DEPRESSION SYMPTOMS IN DEMENTIA CAREGIVERS

Innovation in Aging ◽

10.1093/geroni/igz038.3300 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S903-S904

Author(s):

Stephen Smagula ◽

Tales Santini ◽

Sarah Stahl ◽

Tamer Ibrahim ◽

Charles Reynolds ◽

...

Keyword(s):

Risk Factors ◽

White Matter ◽

Major Depression ◽

White Matter Integrity ◽

P Value ◽

Depression Symptoms ◽

Dementia Caregivers ◽

Posterior Cingulate ◽

Subsyndromal Depression ◽

Dorsolateral Prefrontal

Abstract Past research shows that major depression is associated with lower white matter integrity in fronto-limbic and other areas. But it is not known whether the integrity of these white matter connections is associated with subsyndromal depression symptoms, a marker of risk for major depression, in family dementia caregivers (dCGs) who reported stress. If specific aspects of white matter integrity are related to depression symptoms in this high-risk group, this could provide a biomarker of vulnerability or target for treatment. Participants included 41 dCGs (average age=69, standard deviation=6.4), who underwent a 7 Tesla 64-direction (12-minute) diffusion-weighted imaging sequence. Analyses compared dCGs with (n=20) and without (n=21) subsyndromal depression symptoms (nine-item Patient Health Questionnaire scores ≥5). Using fractional anisotropy (FA), we assessed differences in the integrity of 11 white matter aspects implicated in prior studies of major depression. We found that caregivers with subsyndromal depression had lower FA in tracts connecting to the posterior cingulate cortex (Cohen’s D=-0.9, p-value=0.006, FDR=0.03) and in white matter connecting the dorsolateral prefrontal cortex with the rostral cingulate (Cohen’s D=-1.2, p-value=0.0005, FDR=0.006). Thus, differences in the integrity of white matter (and related functions) reaching the posterior cingulate (autobiographical memory/planning) and connecting dorsolateral prefrontal and rostral cingulate regions (emotion re-appraisal) may contribute to depression vulnerability in dCGs. These observations require contextualizing further (e.g., assessing roles of depression history and other risk factors) for their meaning to be fully elucidated. Potentially, relationships between known risk factors (e.g., subjective stress) and depression emerge from or drive changes in white matter.

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Does Aging and Disease Increase the Importance of Cognitive Strategies? Social and Temporal Comparisons in Healthy Younger and Older Adults and in Younger and Older Cancer Patients

The International Journal of Aging and Human Development ◽

10.1177/0091415017748366 ◽

2017 ◽

Vol 88 (1) ◽

pp. 60-81

Author(s):

Mimi Mehlsen ◽

Mai Bjørnskov Mikkelsen ◽

Christina Maar Andersen ◽

Chaitali Ollars

Keyword(s):

Older Adults ◽

Cancer Patients ◽

Control Strategies ◽

Cognitive Strategies ◽

Well Being ◽

Primary Control ◽

Physical Decline ◽

Age Related ◽

Older Cancer Patients ◽

The Individual

Social and temporal comparisons may help the individual anchor his or her self-image in a social and temporal context. In the Life-Span Theory of Control, comparisons are included in the repertoire of secondary control strategies individuals may apply when primary control strategies are obstructed, for example, by age-related losses or physical decline. The aim of this study was to explore differences in prevalence and effects of social and temporal comparisons in younger and older adults and healthy and diseased individuals ( n = 34). Semistructured interviews were conducted and analyzed using a mixed-methods approach combining qualitative and quantitative data analysis. The results revealed that older adults engaged in more comparisons than younger adults and that the outcomes of comparisons were more positive for older adults, particularly older cancer patients. The results indicate that comparisons may be applied more often by older and diseased individuals in the service of maintaining well-being.

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