Gait speed and recommended treatment intensity among older adults with blood cancers.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12041-12041 ◽  
Author(s):  
Andrew Hantel ◽  
Oreofe O Odejide ◽  
Marlise Rachel Luskin ◽  
Adam Samuel Sperling ◽  
Tammy Hshieh ◽  
...  
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Strong Predictor ◽  
Multivariable Analysis ◽  
Hematologic Malignancies ◽  
Treatment Recommendations ◽  
Treatment Intensity ◽  
Nccn Guidelines ◽  
Recommended Treatment ◽  
Standard Intensity

12041 Background: Gait speed identifies frailty and predicts survival among older adults with hematologic malignancies (Liu, Blood, 2019). It is not known if gait speed correlates with the intensity of oncologists’ recommended treatment in this population. Methods: From 2/2015-11/2019, patients ≥75 years presenting for an initial hematologic malignancy consultation at the Dana-Farber Cancer Institute were approached for a screening frailty assessment including a 4-meter gait speed test, reported as <0.4, 0.4-0.6, 0.6-0.8, or >0.8 meters/second (m/s). Faster gait speed is associated with less frailty and predicts better survival. Gait speed was not reported to the oncologist. Treatment recommendations were categorized into standard, reduced, or no therapy based on NCCN guidelines, as applicable. Gait/treatment intensity “mismatches” were characterized as patients with lowest quartile gait speed recommended standard intensity and highest quartile not recommended standard intensity. Multivariable regression was performed to assess if gait speed predicted treatment intensity (controlling for age, sex, ECOG performance status [PS], and disease type). Results: Of 786 patients enrolled, 408 required active treatment where NCCN guidelines vary by fitness. Mismatches were seen in 26.7% of patients (Table: column percentages with 95% CI, mismatches starred): 10 (21.3%) with lowest quartile gait speed recommended standard intensity and 99 (55.0%) with highest quartile recommended reduced or no therapy. In multivariable analysis, PS was predictive of no therapy as compared to standard intensity (all p<0.02) and age was predictive of reduced as compared to standard intensity (p<0.01); gait speed was not reliably predictive in either case. Conclusions: In this large cohort of older adults with hematologic malignancies, gait/treatment intensity mismatches occurred in over one-quarter of patients. Oncologists’ recommendations were predicted by age and PS but not gait speed. Given that gait speed is a strong predictor of survival in this population, oncologists should integrate it to minimize over- and under-treatment when making treatment recommendations. [Table: see text]

Gait speed, survival, and recommended treatment intensity in older adults with blood cancer requiring treatment

Cancer ◽  
2020 ◽  
Author(s):  
Andrew Hantel ◽  
Clark DuMontier ◽  
Oreofe O. Odejide ◽  
Marlise R. Luskin ◽  
Adam S. Sperling ◽  
...  
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Treatment Intensity ◽  
Blood Cancer ◽  
Recommended Treatment

scholarly journals Death Within 1 Month of Diagnosis in Childhood Cancer: An Analysis of Risk Factors and Scope of the Problem

2017 ◽  
Vol 35 (12) ◽  
pp. 1320-1327 ◽  
Author(s):  
Adam L. Green ◽  
Elissa Furutani ◽  
Karina Braga Ribeiro ◽  
Carlos Rodriguez Galindo
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Childhood Cancer ◽  
Race And Ethnicity ◽  
Lymphoblastic Leukemia ◽  
Strong Predictor ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
Early Death ◽  
Hematologic Malignancies

Purpose Despite advances in childhood cancer care, some patients die soon after diagnosis. This population is not well described and may be under-reported. Better understanding of risk factors for early death and scope of the problem could lead to prevention of these occurrences and thus better survival rates in childhood cancer. Methods We retrieved data from SEER 13 registries on 36,337 patients age 0 to 19 years diagnosed with cancer between 1992 and 2011. Early death was defined as death within 1 month of diagnosis. Socioeconomic status data for each individual’s county of residence were derived from Census 2000. Crude and adjusted odds ratios and corresponding 95% CIs were estimated for the association between early death and demographic, clinical, and socioeconomic factors. Results Percentage of early death in the period was 1.5% (n = 555). Children with acute myeloid leukemia, infant acute lymphoblastic leukemia, hepatoblastoma, and malignant brain tumors had the highest risk of early death. On multivariable analysis, an age younger than 1 year was a strong predictor of early death in all disease groups examined. Black race and Hispanic ethnicity were both risk factors for early death in multiple disease groups. Residence in counties with lower than median average income was associated with a higher risk of early death in hematologic malignancies. Percentages of early death decreased significantly over time, especially in hematologic malignancies. Conclusion Risk factors for early death in childhood cancer include an age younger than 1 year, specific diagnoses, minority race and ethnicity, and disadvantaged socioeconomic status. The population-based disease-specific percentages of early death were uniformly higher than those reported in cooperative clinical trials, suggesting that early death is under-reported in the medical literature. Initiatives to identify those at risk and develop preventive interventions should be prioritized.

scholarly journals Effect of Geriatric Assessment and Intervention on Overall Survival Among Older Adults with Hematologic Malignancies

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 31-32
Author(s):  
Sarah A Wall ◽  
Ying Huang ◽  
Nicholas Yuhasz ◽  
Colin Kloock ◽  
Edmund Folefac ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Multivariable Analysis ◽  
Hematologic Malignancies ◽  
Modifiable Risk Factors ◽  
Geriatric Syndromes ◽  
Univariable Analysis ◽  
Clinical Frailty Scale ◽  
Care Clinic ◽  
Multivariable Analyses

Background: Older adults with hematologic malignancies have inferior survival outcomes due to multiple factors including under-treatment, drug toxicity, treatment discontinuation and concerns of frailty. However, aging is heterogeneous and chronological age is a poor indicator of underlying health. Standardizing the approach to identify frailty is an unmet need in malignant hematology. We have established a multi-disciplinary clinical model designed to identify frailty and develop personalized treatment based on objective measures of health. We have standardized a geriatric assessment (GA) model to identify vulnerability, frailty and geriatric syndromes. Here we report, the largest cohort to date, of older adults with hematologic malignancies (HM) depicting geriatric deficits and interventions with long-term clinical outcomes. Methods: From Feb 2016 to October 2019, 311 older adults with HM were evaluated in our multi-disciplinary Cancer and Aging Resiliency (CARE) clinic. The CARE clinic is a 7-member team prescriptively evaluating the following domains: pharmacy, audiology, psychosocial needs, nutrition, physical functioning, and cognition. Geriatric syndromes were documented by CARE physician. Referral to CARE clinic is recommended for patients 60 years of age or older but all referrals are accepted independent of age. Data was abstracted by retrospective chart review. Descriptive statistics for patient characteristics, frailty measures, and prescribed interventions in each of the GA domains were provided. Univariable and multivariable Cox models were fit to associate clinical factors with OS. OS by Rockwood Clinical Frailty Scale and deficits in activities of daily living (ADLs) was evaluated by Kaplan-Meier method. Correlation between number of geriatric syndromes, clinical frailty score, and deficits in ADLs and instrumental ADLs (IADLs) was also assessed. Results: Over the 42-month study period, 311 older adults with HM with a median age of 75.9 years were evaluated in CARE clinic. Key demographic features and the frequency of specific frailty measures are outlined in table 1.Geriatric interventions were common with 59% requiring 1-2 interventions and 34% requiring 3+ interventions. In univariable analysis, any degree of frailty by Clinical Frailty Scale (Hazard Ratio [HR]: 2.63, 95% Confidence Interval [CI]: 1.43-4.82, p &lt;0.01) and increasing number of geriatric syndromes (HR:1.13, 95% CI: 1.00-1.27, p = 0.04) were associated with inferior OS. In both univariable and multivariable analyses, 10-year increase in age (multivariable HR: 2.05, 95% CI:1.44-2.91, p&lt;0.01), deficit in ADL (multivariable HR: 2.60, 95% CI: 1.38-4.87, p&lt;0.01), diagnosis of acute leukemia (multivariable HR: 4.53, 95% CI:1.91-10.78, p&lt;0.01), and prescribed nutrition intervention (multivariable HR: 2.04, 95% CI: 1.32-3.15, p&lt;0.01) were associated with inferior OS. Anemia was also associated with OS in both univariable and multivariable analysis (multivariable HR for 1 g/dL increase in hemoglobin: 0.79, 95% CI: 0.69-0.91, p&lt;0.01). Additional variables for univariable and multivariable analyses are presented in table 2. There was significant correlation between the Clinical Frailty Scale and number of geriatric syndromes (Spearman correlation p &lt; 0.01). The same was true of correlation between ADL or IADL deficits and Clinical Frailty Scale (p &lt; 0.01 for both). OS by Clinical Frailty Scale and ADL deficit is pictured in figure 1. Discussion: The Clinical Frailty Scale is predictive of OS among older adults with HM. GA-directed intervention is warranted in the vast majority of older adults with HM. In univariable analysis, Clinical Frailty Scale, increasing age, anemia, high risk HM, and increasing geriatric syndromes are associated with inferior OS. In multivariable analysis, age, anemia, and high risk HM remain significant. Nutrition and physical function are key modifiable risk factors predictive of inferior OS. Prospective studies focusing on geriatric interventions are warranted in this population with an emphasis on modifiable risk factors. This demonstrated prognostic significance of both geriatric assessments and interventions in older adults with HM should give way to future improvements in OS, quality of life, and treatment tolerability through GA-directed intervention. Disclosures No relevant conflicts of interest to declare.

Talk or Walk? Gait Speed over Self-Report in Association with Cognitive Speed in Healthy Older Adults

GeroPsych ◽  
2019 ◽  
Vol 32 (1) ◽  
pp. 41-52
Author(s):  
Matthew C. Costello ◽  
Shane J. Sizemore ◽  
Kimberly E. O’Brien ◽  
Lydia K. Manning
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Gait Speed ◽  
Well Being ◽  
Self Report ◽  
Subjective Report ◽  
Healthy Older Adults ◽  
Relative Value ◽  
Cognitive Speed ◽  
Age Range

Abstract. This study explores the relative value of both subjectively reported cognitive speed and gait speed in association with objectively derived cognitive speed. It also explores how these factors are affected by psychological and physical well-being. A group of 90 cognitively healthy older adults ( M = 73.38, SD = 8.06 years, range = 60–89 years) were tested in a three-task cognitive battery to determine objective cognitive speed as well as measures of gait speed, well-being, and subjective cognitive speed. Analyses indicated that gait speed was associated with objective cognitive speed to a greater degree than was subjective report, the latter being more closely related to well-being than to objective cognitive speed. These results were largely invariant across the 30-year age range of our older adult sample.

scholarly journals Combining tDCS With a Motor-Cognitive Task to Reduce the Negative Impact of Dual-Tasking on the Gait of Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 287-288
Author(s):  
Jeffrey Hausdorff ◽  
Nofar Schneider ◽  
Marina Brozgol ◽  
Pablo Cornejo Thumm ◽  
Nir Giladi ◽  
...  
Keyword(s):  
Older Adults ◽  
Virtual Reality ◽  
Executive Function ◽  
Dual Task ◽  
Gait Speed ◽  
Negative Impact ◽  
Virtual Reality Environment ◽  
Dual Tasking ◽  
Concurrent Performance ◽  
Dual Task Cost

Abstract The simultaneous performance of a secondary task while walking (i.e., dual tasking) increases motor-cognitive interference and fall risk in older adults. Combining transcranial direct current stimulation (tDCS) with the concurrent performance of a task that putatively involves the same brain networks targeted by the tDCS may reduce the negative impact of dual-tasking on walking. We examined whether tDCS applied while walking reduces the dual-task costs to gait and whether this combination is better than tDCS alone or walking alone (with sham stimulation). In 25 healthy older adults (aged 75.7±10.5yrs), a double-blind, within-subject, cross-over pilot study evaluated the acute after-effects of 20 minutes of tDCS targeting the primary motor cortex and the dorsal lateral pre frontal cortex during three separate sessions:1) tDCS while walking on a treadmill in a virtual-reality environment (tDCS+walking), 2) tDCS while seated (tDCS+seated), and 3) walking in the virtual-reality environment with sham tDCS (sham+walking). The complex walking condition taxed motor and cognitive abilities. During each session, single- and dual-task walking and cognitive function were assessed before and immediately after stimulation. Compared to pre-tDCS performance, tDCS+walking reduced the dual-task cost to gait speed (p=0.004) and other gait features (e.g., variability p=0.02), and improved (p&lt;0.001) executive function (Stroop interference score). tDCS+seated and sham+walking did not affect the dual-task cost to gait speed (p&gt;0.17). These initial findings demonstrate that tDCS delivered during challenging walking ameliorates dual-task gait and executive function in older adults, suggesting that the concurrent performance of related tasks enhances the efficacy of the neural stimulation and mobility.

scholarly journals Dual Decline in Gait and Cognition Is Associated With Future Dementia: Evidence for a Phenotype

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 264-264
Author(s):  
Manuel Montero Odasso ◽  
Mark Speechley ◽  
Richard Camicioli ◽  
Nellie Kamkar ◽  
Qu Tian ◽  
...  
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Regression Models ◽  
Community Dwelling ◽  
Hierarchical Regression ◽  
Chi Square ◽  
Cox Models ◽  
Incident Dementia ◽  
Risk Of Progression ◽  
Community Dwelling Older Adults

Abstract BACKGROUND: The concurrent decline in gait speed and cognition are associated with future dementia. However, the clinical profile of those who present with dual-decline has not yet been described. We aimed to describe the phenotype and risk for incident dementia of individuals who present a dual-decline in comparison with non dual-decliners. METHODS: Prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants’ gait speed, cognition, medical status, functionality, incidence of adverse events, and dementia biannually over 7 years. Gait speed was assessed with a 6-meter electronic-walkway, and global cognition was assessed using the MoCA test. We compared characteristics between dual-decliners and non dual-decliners using t-test, Chi-square, and hierarchical regression models. We estimated incident dementia using Cox models. RESULTS: Among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual-decliners had a three-fold risk (HR: 3.12, 95%CI:1.23-7.93, p=0.017) of progression to dementia compared with non dual-decliners. Dual-decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (p=0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual-decliners group, while adding hypertension and dyslipidemia increased the explained variation to 8% and 10 %, respectively. The risk of becoming a dual-decliner was 4-fold if hypertension was present. CONCLUSION: Older adults with concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. These dual-decliners have a distinct phenotype with a higher prevalence of hypertension, a potentially treatable condition.

Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed

Gerontology ◽  
2021 ◽  
pp. 1-10
Author(s):  
He Zhou ◽  
Catherine Park ◽  
Mohammad Shahbazi ◽  
Michele K. York ◽  
Mark E. Kunik ◽  
...  
Keyword(s):  
Older Adults ◽  
Steady State ◽  
Dual Task ◽  
Gait Speed ◽  
Stride Length ◽  
Cognitive Frailty ◽  
Single Task ◽  
Double Support ◽  
Gait Parameters ◽  
Digital Biomarkers

<b><i>Background:</i></b> Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. <b><i>Methods:</i></b> Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m<sup>2</sup>) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. <b><i>Results:</i></b> Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size <i>d</i> = 0.42–0.97, <i>p</i> &#x3c; 0.050). The largest effect size was observed in normalized dual-task gait speed (<i>d</i> = 0.97, <i>p</i> &#x3c; 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. <b><i>Conclusions:</i></b> This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

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.

Frailty, with or without Cognitive Impairment, is a Strong Predictor of Recurrent Falls in a US Population-Representative Sample of Older Adults

2021 ◽  
Author(s):  
Mei-Ling Ge ◽  
Eleanor M Simonsick ◽  
Bi-Rong Dong ◽  
Judith D Kasper ◽  
Qian-Li Xue
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Strong Predictor ◽  
Word Recall ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Clock Drawing Test ◽  
Recurrent Falls ◽  
Health Aging ◽  
Marginal Means

Abstract Background Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults. Methods The analysis included 6000 older adults in community or non-nursing home residential care settings who were ≥65 years and participated in the National Health Aging Trends Study (NHATS). Frailty was assessed using the physical frailty phenotype; cognitive impairment was defined by bottom quintile of clock drawing test or immediate and delayed 10-word recall, or self/proxy-report of diagnosis of dementia, or AD8 score≥ 2. The marginal means/rates models were used to analyze the associations of frailty (by the physical frailty phenotype) and cognitive impairment with recurrent falls over 6 years follow-up (2012-2017). Results Of the 6000 older adults, 1,787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3,264 (54.4%) had neither. After adjusting for age, sex, race, education, living alone, obesity, disease burden, and mobility disability, those with frailty (with or without cognitive impairment) at baseline had higher rates of recurrent falls than those without cognitive impairment and frailty (frailty only: Rate ratio (RR)=1.31, 95% confidence interval (CI)=1.18-1.44; both: RR=1.28, 95% CI=1.17-1.40). The association was marginally significant for those with cognitive impairment only (RR=1.07, 95% CI=1.00-1.13). Conclusions Frailty and cognitive impairment were independently associated with recurrent falls in non-institutionalized older adults. There was a lack of synergistic effect between frailty and cognitive impairment.

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