Memorial Sloan Kettering-Frailty Index (MSK-FI): Validation and its relationship with postoperative outcomes of older survivors of cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 172-172
Author(s):  
Armin Shahrokni ◽  
Amy Tin ◽  
Koshy Alexander ◽  
Saman Sarraf ◽  
Anoushka Afonso ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Cancer Patients ◽  
Daily Living ◽  
Frailty Index ◽  
Postoperative Outcomes ◽  
Care Process ◽  
Icu Admission ◽  
Frail Patients ◽  
Instrumental Activities

172 Background: Older cancer patients are at higher risk for poor postoperative outcomes. We tested the validity and utility of Memorial Sloan Kettering-Frailty Index (MSK-FI) in this setting. Methods: In a single institution, prospective cohort study, patients age 75+ received comprehensive geriatric assessment (CGA) by the Geriatrics service during preoperative evaluation. The MSK-FI was developed based on the modified Frailty Index, incorporating 10 comorbid conditions and one item related to basic and instrumental activities of daily living. With the total score ranging from 0 to 11, a score of ≥ 3 was considered frail. We validated the MSK-FI against the CGA, and assessed the relationship between MSK-FI frailty with short term (hospital length of stay (LOS), intensive care unit (ICU) admission) and long-term (overall survival) postoperative outcomes utilizing multivariable linear, logistic, and cox regression models, adjusting for age, duration of surgery, American Society of Anesthesiologists physical status classification, and preoperative albumin level. Results: In total, 1,137 cancer patients (median age 80) were included in the study. The prevalence of frailty based on MSK-FI was 41%. Frail patients were more likely to have poor Karnofsky Performance Status (56% vs. 29%), be dependent in basic and instrumental activities of daily living (72% vs. 40% and 64% vs. 34%), experienced a fall in the past year (30% vs. 18%), have slower gait speed (49% vs. 22%),be depressed (66% vs. 49%), have limited social activity (62% vs. 43%), take ≥ 5 medications (63% vs. 25%), experienced significant weight loss (24% vs. 16%), and suffer from polycomorbid conditions (87% vs. 26%). Frailty was associated with longer LOS in the hospital (1.9 days, p <0.0001) and higher odds of ICU admission (OR = 2.34, p = 0.005). With the median follow up of 12.1 months for survivors, frail patients were at higher risk for overall mortality (HR = 1.67, p < 0.001). Conclusions: MSK-FI is a valid instrument in predicting short and long-term postoperative outcomes of older adults with cancer. Future studies should assess the impact of administering MSK-FI on surgical decision-making, postoperative health care process, and outcomes.

scholarly journals Fatigue as a long-term risk factor for limitations in instrumental activities of daily living and/or mobility performance in older adults after 10 years

2016 ◽  
Vol Volume 11 ◽  
pp. 1579-1587 ◽  
Author(s):  
Sigrid Mueller-Schotte ◽  
Nienke Bleijenberg ◽  
Yvonne T. van der Schouw ◽  
Marieke J. Schuurmans
Keyword(s):  
Older Adults ◽  
Risk Factor ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Mobility Performance ◽  
Instrumental Activities

scholarly journals Gait Speed and Instrumental Activities of Daily Living in Older Adults After Hospitalization: A Longitudinal Population-Based Study

2021 ◽  
Author(s):  
Juraj Sprung ◽  
Mariana Laporta ◽  
David S Knopman ◽  
Ronald C Petersen ◽  
Michelle M Mielke ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Functional Status ◽  
Gait Speed ◽  
Daily Living ◽  
Functional Limitations ◽  
Parameter Estimate ◽  
Population Based ◽  
Instrumental Activities

Abstract Background Hospitalization can impair physical and functional status of older adults, but it is unclear whether these deficits are transient or chronic. This study determined the association between hospitalization of older adults and changes in long-term longitudinal trajectories of two measures of physical and functional status: gait speed (GS) and Instrumental Activities of Daily Living measured with Functional Activities Questionnaire (FAQ). Methods Linear mixed effects models assessed the association between hospitalization (non-elective vs. elective, and surgical vs. medical) and outcomes of GS and FAQ score in participants (&gt;60 years old) enrolled in the Mayo Clinic Study of Aging who had longitudinal assessments. Results Of 4,902 participants, 1,879 had ≥1 hospital admission. Median GS at enrollment was 1.1 m/s. The slope of the annual decline in GS before hospitalization was -0.015 m/s. The parameter estimate [95%CI] for additional annual change in GS trajectory after hospitalization was -0.009 [-0.011 to -0.006] m/s, P&lt;0.001. The accelerated GS decline was greater for medical vs. surgical hospitalizations (-0.010 vs. -0.003 m/s, P=0.005), and non-elective vs. elective hospitalizations (-0.011 vs -0.006 m/s, P=0.067). The odds of a worsening FAQ-score increased on average by 4% per year. Following hospitalization, odds of FAQ-score worsening further increased (multiplicative annual increase in odds ratio per year [95%C] following hospitalization was 1.05 [1.03, 1.07], P&lt;0.001). Conclusions Hospitalization of older adults is associated with accelerated long-term decline in GS and functional limitations, especially after non-elective admissions and those for medical indications. However, for most well-functioning participants these changes have little clinical significance.

scholarly journals Frailty and depression predict instrumental activities of daily living in older adults: A population-based longitudinal study using the CARE75+ cohort

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243972
Author(s):  
Peter A. Coventry ◽  
Dean McMillan ◽  
Andrew Clegg ◽  
Lesley Brown ◽  
Christina van der Feltz-Cornelis ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Frailty Index ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Population Based ◽  
Physical And Mental Health ◽  
Living Situation ◽  
Instrumental Activities

Objectives To evaluate if depression contributes, independently and/or in interaction with frailty, to loss of independence in instrumental activities of daily living (ADL) in older adults with frailty. Methods Longitudinal cohort study of people aged ≥75 years living in the community. We used multi-level linear regression model to quantify the relationship between depression (≥5 Geriatric Depression Scale) and frailty (electronic frailty index), and instrumental activities of daily living (Nottingham Extended Activities of Daily Living scale; range: 0–66; higher score implies greater independence). The model was adjusted for known confounders (age; gender; ethnicity; education; living situation; medical comorbidity). Results 553 participants were included at baseline; 53% were female with a mean age of 81 (5.0 SD) years. Depression and frailty (moderate and severe levels) were independently associated with reduced instrumental activities of daily living scores. In the adjusted analysis, the regression coefficient was -6.4 (95% CI: -8.3 to -4.5, p<0.05) for depression, -1.5 (95% CI: -3.8 to 0.9, p = 0.22) for mild frailty, -6.1 (95% CI: -8.6 to -3.6, p<0.05) for moderate frailty, and -10.1 (95% CI: -13.5 to -6.8, p<0.05) for severe frailty. Moreover, depression interacted with frailty to further reduce instrumental activities of daily living score in individuals with mild or moderate frailty. These relationships remained significant after adjusting for confounders. Conclusion Frailty and depression are independently associated with reduced independence in instrumental activities of daily living. Also, depression interacts with frailty to further reduce independence for mild to moderately frail individuals, suggesting that clinical management of frailty should integrate physical and mental health care.

scholarly journals Effect of Instrumental Activities of Daily Living habituation due to routinising therapy in patients with frontotemporal dementia

2021 ◽  
Vol 14 (2) ◽  
pp. e240167
Author(s):  
Kosuke Nakanishi ◽  
Takayoshi Yamaga
Keyword(s):  
Activities Of Daily Living ◽  
Frontotemporal Dementia ◽  
Daily Living ◽  
Long Term Care ◽  
Care Staff ◽  
Term Care ◽  
Household Chores ◽  
Care Burden ◽  
Instrumental Activities

We examined whether Instrumental Activities of Daily Living (IADL) improves with routinising therapy for a patient with frontotemporal dementia (FTD) living in a group home. The patient exhibited symptoms of agitation, apathy, disinhibition, irritability and stereotyped behaviour. The care staff experienced long-term care burden and the patient was spending time idly. An occupational therapist, in collaboration with care staff, evaluated the patient and routinised the household chores included in IADL. Consequently, a routine of household chores was established, reducing behavioural and psychological symptoms of dementia and long-term care burden, and the quality of life (QOL) of the patient improved. The results suggested that routinising IADL of the patient with FTD reduced long-term care burden and improved QOL of the patient.

scholarly journals The Effect of Long-Term Changes in Daily Stress Processes on Prospective Health: An Application of Three-Level SEM

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 509-510
Author(s):  
Jonathan Rush ◽  
Emily Willroth ◽  
Eileen Graham ◽  
Daniel Mroczek ◽  
David Almeida
Keyword(s):  
Individual Differences ◽  
Activities Of Daily Living ◽  
Longitudinal Studies ◽  
Daily Living ◽  
The United States ◽  
Short Term ◽  
Instrumental Activities ◽  
Long Term Changes ◽  
Over Time

Abstract The study of change over time, contexts, cohorts, and people is influenced by the sampling of observations within longitudinal studies. Intensive measurement designs, embedded within long-term longitudinal studies, provide new opportunities to understand changes in dynamic processes, as well as determinants and consequences of these changes over time. The present investigation examined whether short-term dynamic associations accounted for individual differences in prospective health functioning. We used measurement burst data from the National Study of Daily Experiences subsample (N = 2485) embedded within the Midlife in the United States longitudinal study. Two measurement bursts were separated by ten years, with each containing daily measures of stress and affect across eight consecutive days. Functional health was measured by basic and instrumental activities of daily living at three measurement waves spanning 20 years. Three-level structural equation models were fit to simultaneously model short-term within-person associations between stress and affect (i.e., stress reactivity) and long-term changes in these associations over the ten year period. Individual differences in long-term changes of the short-term dynamic association predicted both basic and instrumental activities of daily living at 20 year follow-up (estimate = 5.26, SE = 2.54, p &lt; .01; and estimate = 5.48, SE = 2.81, p &lt; .01, respectively). These effects were present after adjusting for mean levels of both stress and affect. We highlight how characterizing individuals based on the strength of their within-person associations across multiple time scales can be informative in predicting distal health outcomes.

Abstract 112: One Year Later: Patient-reported Outcomes Among Survivors of In-hospital Cardiac Arrest in Veterans Administration Hospitals

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Elizabeth M Viglianti ◽  
Kaitlyn Hanisko ◽  
Rachel Bucy ◽  
Lee Ewing ◽  
Bradley Youles ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Patient Reported Outcomes ◽  
Veterans Administration ◽  
Instrumental Activities ◽  
Number Of Patients ◽  
Patient Reported

Background: Short term mortality following in-hospital cardiac arrests (IHCA) is well understood. However, little is known about long term patient-reported outcomes - such as activities of daily living, cognitive function, and depression among survivors of IHCA. Objective: To assess the patient-reported outcomes in IHCA survivors 12-months after cardiac arrest. Methods: Veteran survivors of IHCA (ICD-9-CM codes 99.60, 99.63 or 427.5) who were discharged alive from a U.S. Veterans Administration Medical Center from September 1, 2013 to October 31, 2013 were identified. After confirmation of eligibility by medical record review, they were mailed a research information packet. Those who did not opt-out were contacted by phone two weeks later. Veterans who consented were surveyed by phone or mail. The survey encompassed Katz Activities of Daily Living (ADL), Lawton Instrumental Activities of Daily Living (IADLs), self-reported depressive symptoms (via the PHQ-9) and an assessment of cognition (via the modified Telephone Interview for Cognitive Status (mTICS) as used by the Health and Retirement Study). Results: Among 50 IHCA survivors, 37 (74%) completed surveys; survey operations are detailed in another abstract. Among those 37 who completed the survey, answers to all patient-reported outcomes items were obtained from 29 (78%). Respondents’ median age was 66 years old (range 38 to 87) and 95% were male. The survivors self-reported health assessment of their health was poor, with 8% and 40% describing their health as “poor” or fair” respectively, but only 5% saying “very good” and none reporting “excellent”. Similarly, 27% reported having 4 or more health-related difficulties in their basic and instrumental activities of daily living, 24% reported 1-3, and 46% none. On the PHQ-9, 19% had scores consistent with severe depression. Of those tested for cognitive impairment, 32% were at risk for at least some cognitive impairment. Conclusion: Among survivors of IHCA, we found that few patients at 12-months reported an overall sense of good health, and a significant number of patients had high-levels of disability, cognitive impairment and depression. There is an urgent need to understand the epidemiology and trajectory of this poor health, and develop interventions to improve the long term outcomes of IHCA.

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