scholarly journals Prediction of Unplanned Hospitalizations in Older Patients Treated with Chemotherapy

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1437
Author(s):  
Jaime Feliu ◽  
Enrique Espinosa ◽  
Laura Basterretxea ◽  
Irene Paredero ◽  
Elisenda Llabrés ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Risk Groups ◽  
Albumin Level ◽  
Chemotherapy Treatment ◽  
Patients With Cancer ◽  
The Past ◽  
Receiver Operation Characteristic ◽  
Charlson Comorbidity Score ◽  
Unplanned Hospitalizations

Purpose: To determine the incidence of unplanned hospitalization (UH) and to identify risk factors for UH in elderly patients with cancer who start chemotherapy. Methods: In all, 493 patients over 70 years starting new chemotherapy regimens were prospectively included. A pre-chemotherapy geriatric assessment was performed, and tumor and treatment variables were collected. The association between these factors and UH was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 37% of patients had at least one episode of UH. Risk factors were the use of combination chemotherapy at standard doses, a MAX2 index ≥1, a Charlson comorbidity score ≥2, albumin level <3.5 g/dL, falls in the past 6 months ≥1, and weight loss >5%. Three risk groups for UH were established according to the score in all patients: 0–1: 17.5%; 2: 34%; and 3–7: 57% (p < 0.001). The area under receiver operation characteristic (ROC) curve was 0.72 (95% CI: 0.67–0.77). Conclusion: This simple tool can help to reduce the incidence of UH in elderly patients with cancer who are scheduled to initiate chemotherapy treatment.

scholarly journals Patterns and Predictors of Unplanned Hospitalization in a Population-Based Cohort of Elderly Patients With GI Cancer

2014 ◽  
Vol 32 (31) ◽  
pp. 3527-3533 ◽  
Author(s):  
Joanna-Grace M. Manzano ◽  
Ruili Luo ◽  
Linda S. Elting ◽  
Marina George ◽  
Maria E. Suarez-Almazor
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Health Care Providers ◽  
Multivariable Analysis ◽  
Disease Stage ◽  
Charlson Comorbidity Index Score ◽  
Care Providers ◽  
Patients With Cancer ◽  
Gi Cancer ◽  
Unplanned Hospitalizations

Purpose Hospitalizations among patients with cancer are common and costly and, if unplanned, may interrupt oncologic treatment. The rate of unplanned hospitalizations in the population of elderly patients with cancer is unknown. We sought to describe and quantify patterns and risk factors for early unplanned hospitalization among elderly patients with GI cancer. Patients and Methods We conducted a retrospective cohort study using linked Texas Cancer Registry and Medicare claims data from 2001 to 2009. Texas residents age 66 years or older initially diagnosed with GI cancer between 2001 and 2007 were included in the study. The unplanned hospitalization rate was estimated, and reasons for unplanned hospitalization were evaluated. Risk factors were identified using adjusted Cox proportional hazards modeling. Results Thirty thousand one hundred ninety-nine patients were included in our study, 59% of whom had one or more unplanned hospitalizations. Of 60,837 inpatient claims, 58% were unplanned. The rate of unplanned hospitalization was 93 events per 100 person-years. The most common reasons for unplanned hospitalization were fluid and electrolyte disorders, intestinal obstruction, and pneumonia. Multivariable analysis showed that black race; residing in census tracts with poverty levels greater than 13.3%; esophageal, gastric, and pancreatic cancer; advanced disease stage; high Charlson comorbidity index score; and dual eligibility for Medicare and Medicaid increased the risk for unplanned hospitalization (all P values < .05). Conclusion Unplanned hospitalizations among elderly patients with GI cancer are common. Some of the top reasons for unplanned hospitalization are potentially preventable, suggesting that comorbidity management and close coordination among involved health care providers should be promoted.

scholarly journals Screening results of high-risk population of elderly cerebral stroke in a community in Pudong New Area, Shanghai

2020 ◽  
Author(s):  
Yumei Yang ◽  
Lingyu Li ◽  
Lei Feng ◽  
Xi Yang ◽  
Feifeng Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Elderly Patients ◽  
Detection Rate ◽  
Risk Groups ◽  
Smoking History ◽  
Cerebral Stroke ◽  
High Risk Population ◽  
Risk Population ◽  
Pudong New Area

Abstract Objective To investigate the exposure of risk factors and the characteristics of population distribution of elderly patients with high-risk of cerebral stroke in Sanlin Community, Pudong New Area, Shanghai, aiming to provide the evidence for the development of the prevention strategies for elderly patients with high-risk of stroke. Methods From 2015 to 2017, a cluster sampling method was adopted to conduct on-the-spot investigation and related physical examinations for resident populations ≥65 years old in Sanlin Community of Pudong New Area. The demographic characteristics, medical history, blood lipids, fasting glucose, glycosylated hemoglobin, homocysteine and electrocardiogram were collected to screen the relative risk factors of ischemic stroke. Results 9,195 residents were surveyed between 2015 and 2017. 1,504 residents were high-risk population and 535 residents (5.82%) had a history of transient ischemic attack or stroke. There were 969 residents (10.54%) with ≥ 3 risk factors. Risk factors were hypertension, overweight, hyperlipidemia, diabetes mellitus, stroke history, smoking history, family history, lack of exercise and atrial fibrillation in turn. Among the high-risk groups of 969 risk factors ≥ 3, women's diabetes and hyperlipidemia exposure rate was higher than that of men, and male smoking rate and overweight were higher than females. Among the community members who participated in the screening, the detection rate of hyperhomocysteinemia for male was 63.8%, which was significantly higher than 45.7% for female. Conclusion The detection rate of high-risk groups in people over 65 years old in Sanlin area is similar to that in other areas in Shanghai. Hypertension, overweight and hyperlipidemia are the highest exposure risk factors. There are differences in exposure to certain risk factors between men and women. There is a high detection rate of hyperhomocysteinemia in the elderly and male population. Regular follow-up management should be implemented in combination with the occurrence of risk factors in different populations in order to prevent stroke.

Incidence and risk factors of peritoneal dialysis-related peritonitis in elderly patients: A retrospective clinical study

2020 ◽  
Vol 40 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Haishan Wu ◽  
Hongjian Ye ◽  
Rong Huang ◽  
Chunyan Yi ◽  
Juan Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Albumin Level ◽  
Advanced Age ◽  
Retrospective Clinical Study ◽  
Technique Failure ◽  
Related Mortality

Background: This study was to analyze the incidence, risk factors, and clinical outcomes of peritonitis in elderly continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: Incident patients undergone CAPD from 1 January 2006 to 30 June 2015 in our center were enrolled and divided into aged < 65 years and ≥ 65 years groups. Risk factors were evaluated using a logistic regression model, and outcome comparison was evaluated using a Cox proportional model. Results: Among 1953 patients, 111(33.2%) in elderly ( n = 334) and 470 (29.0%) in younger ( n = 1619) developed at least one episode of peritonitis. Comparing with younger patients, elderly ones had a higher peritonitis rate (0.203 vs. 0.145 episodes/patient-year, p < 0.05). The multivariate Cox regression showed that advanced age (hazard ratio (HR) = 1.06, 95% confidence interval (CI) = 1.01–1.11, p = 0.015), assistant-assisted peritoneal dialysis (PD; HR = 2.64, 95% CI = 1.23–5.64, p = 0.012), higher body mass index (BMI; HR = 1.11, 95% CI = 1.02–1.20, p = 0.010), and low serum albumin level (HR = 0.94, 95% CI = 0.90–0.98, p = 0.004) were associated with increased peritonitis risk in elderly patients. Compared with younger ones with peritonitis, elderly patients had an approximately fourfold increased risk of peritonitis-related mortality (odd ratio (OR) = 3.57, 95% CI = 1.38–9.28, p = 0.009). During the cohort, peritonitis was the risk factor associated with technique failure (HR = 3.19, 95% CI = 2.33–4.39, p < 0.001) in younger patient but not in the elderly population (HR = 1.82, 95% CI = 0.84–3.94, p = 0.132). Conclusions: Elderly PD patients had higher prevalence for peritonitis and peritonitis-related mortality. Advanced age, assistant-assisted PD, a higher BMI, and lower serum albumin level were independently associated with the first episode of peritonitis in elderly patients. However, peritonitis was not the predictor of death-censored technique failure in elderly ones.

Risk Factors for Polypharmacy in Elderly Patients With Cancer Pain

2019 ◽  
Vol 36 (7) ◽  
pp. 598-602 ◽  
Author(s):  
Kayoko Morio ◽  
Isseki Maeda ◽  
Isao Yokota ◽  
Kazuyuki Niki ◽  
Taizo Murata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Cancer Pain ◽  
Patients With Cancer

Risk of Venous Thrombosis Associated with White Cell Count On Peripheral Blood and Its Interrelationship with Other Environmental Risk Factors

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1149-1149
Author(s):  
Suely M Rezende ◽  
Willem M. Lijfering ◽  
Frits R. Rosendaal ◽  
Suzanne C. Cannegieter
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Environmental Risk ◽  
Leukocyte Count ◽  
Risk Groups ◽  
Environmental Risk Factors ◽  
White Cell ◽  
Patients With Cancer ◽  
Leukocyte Counts ◽  
Blood Leukocyte

Abstract Abstract 1149 Background: Antithrombotic prophylaxis needs to be balanced against bleeding risk. Therefore, risk stratification is useful to identify patients who would benefit most. In this study, we analyzed how VT risk relates to different leukocyte count. We also analyzed the effect of high leukocyte counts in groups with high risk of VT. Methods: In the MEGA case-control study, blood leukocyte count and information on environmental risk factors were collected from 2443 patients with VT and 1459 partner controls. Logistic regression analyses were adjusted for age and sex. Results: Population characteristics are detailed in Table 1. Risk of VT increased for measurements above the 97.5th percentile for total white cells, granulocytes, lymphocytes and monocytes. Adjusted odds ratio, [OR] for 99th percentile was 1.37 (95% confidence interval [CI], 0.73–2.56), 1.48 (95% CI, 0.79–2.77), 1.20 (95% CI, 0.63–2.31) and 1.88 (95% CI, 1.02–3.46), for total white cells, granulocytes lymphocytes and monocytes, respectively, compared to the reference percentile (5th-95th) (Table 2). We also analysed the effect of high leukocyte counts on VT in high risk groups, including surgical patients, hospitalized patients, and patients with cancer. Adjusted OR for high leukocyte counts (white cell, lymphocyte, monocyte or granulocyte counts > 97.5th percentile) was 6.3 (95% CI, 0.84–47.1) for groups who had surgery or were hospitalized and 2.2 (95% CI, 0.6–8.2) for patients with cancer, respectively, compared with cell counts within the percentile between 5th and 97.5th. Conclusions: High blood leukocyte count is associated with increased risk of VT. The risk is further increased in high risk groups. These results may assist in individually tailored thromboprophylaxis in high risk groups. Disclosures: No relevant conflicts of interest to declare.

Development and validation of an early death risk score for older patients treated with chemotherapy for cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12030-12030
Author(s):  
Jaime Feliu Batlle ◽  
Alvaro Pinto ◽  
Laura Basterretxea ◽  
Irene Paredero Pérez ◽  
Elisenda Llabres ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Risk Score ◽  
Older Patients ◽  
Validation Cohort ◽  
External Validation ◽  
Early Death ◽  
Chemotherapy Treatment ◽  
Training Cohort ◽  
Death Risk ◽  
Patients With Cancer

12030 Background: Determining life expectancy in older patients is needed to select the best treatment strategy. We aimed to develop and validate a score to predict early death risk ( < 6 months) in elderly patients with cancer that are planned to initiate chemotherapy treatment. Methods: Patients over 70 years starting new chemotherapy regimens were prospectively included in a multicenter study. A pre-chemotherapy assessment that included sociodemographics, tumor/treatment variables, and geriatric assessment variables, was performed. Association between these factors and early death was examined by using multivariate logistic regression. Score points were assigned to each risk factor based on their b coefficient. We validated the risk score with an external validation cohort of 206 patients. Results: Three hundred forty two patients were included in the training cohort. The independent predictors for early death were metastasic cancers (odds ratio [OR] 4.8, 95% confidence interval [CI], [2.4-9.6]), ECOG performance status (OR 2.3, 95% CI:1.084-5.232), ADL (OR 1.7, 95% CI:1.08-3.5), serum albumin levels (3.3, 95% CI: 1.6-6.6), BMI (OR 2.4, 95% CI:1,2-4.8), serum GGT levels (OR 1.5, 95% CI:1.05-1.8) and hemoglobin levels (OR 2.3, 95% CI:1.2-4.6). With these results, a score was to stratify patients regarding their risk of early death: low (0 to 2 points; 5%), intermediate (3 to 5 points; 19%) or high (6 to 14 points; 50%) (p < 0.001). The area under the curve of the receiver-operating characteristic (ROC) curve was 0.79 for the training cohort (95% CI, 0.74 to 0.85), and 0.70 (95% CI: 0.60-0.80) for the validation cohort (difference between cohorts not statistically different). Conclusions: We developed a highly accurate tool that uses basic clinical and analytical information to predict the probability of early death in elderly patients with cancer that are planned to initiate chemotherapy treatment. This tool can help physicians in decision making for this population of patients.

Clinical and Diffusion Tensor Imaging to Evaluate Falls, Balance and Gait Dysfunction in Leukoaraiosis: an Observational, Prospective Cohort Study

2019 ◽  
Vol 33 (4) ◽  
pp. 223-230
Author(s):  
Weiyi Zhang ◽  
Huicong Shen ◽  
Xiaomei Yao ◽  
Fei Liu ◽  
Shuo Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Corpus Callosum ◽  
Elderly Patients ◽  
Diffusion Tensor ◽  
White Matter Tracts ◽  
The Past ◽  
History Of ◽  
Gait Function ◽  
Risk Factors For Falls

Objective: To assess the correlation between leukoaraiosis (LA) and falls, to determine the risk factors for falls in patients with LA, and to detect specific white matter tracts are associated with the falls by using the diffusion tensor magnetic resonance imaging (DTI) screen. Methods: For the elderly patients with LA, we collected demographic information and scores for the Tinetti Balance and Gait Scale, Berg Balance Scale, Timed up-and-go test, and Cognitive, Emotional, Sleep-related Scale. All the patients underwent DTI scanning and were followed up for 1 year. Results: Ninety-four individuals were prospectively enrolled. After multivariable analyses, age, history of falls in the past year, antidepressants usage, and LA-Fazekas grade were reported to be risk factors for falls. In patients with severe LA, the fall incidence was higher than in those with mild LA. Tract-Based Spatial Statistics showed that fractional anisotropy values of the corpus callosum, cingulate gyrus, anterior limb of internal capsule, cerebral peduncle, anterior corona, and fronto-occipital fasciculus were significantly reduced in the patients who fell. The body of the corpus callosum and anterior corona radiate were significantly related to balance and gait function. Conclusions: Our findings indicated that age, history of falls in the past year, antidepressants usage, and LA-Fazekas grade were risk factors for falls in elderly patients with LA. Leukoaraiosis was relevant for falls, but LA severity had a threshold effect with falls. The loss of integrity of some white matter tracts might influence balance and gait function. The DTI had preeminent clinical application prospects for identifying fall risk in patients with LA.

Frequency, etiologies, risk factors, and sequelae of falls among patients with brain metastases: a population- and institutional-level analysis

2021 ◽  
Author(s):  
Nayan Lamba ◽  
Fang Cao ◽  
Daniel N Cagney ◽  
Paul J Catalano ◽  
Daphne A Haas-Kogan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Metastases ◽  
Emergency Department Visits ◽  
Urban Residence ◽  
Patients With Cancer ◽  
Medicare Data ◽  
Medical Evaluation ◽  
Charlson Comorbidity Score ◽  
Medicare Patients ◽  
Risk Reduction Measures

Abstract Background Falls in patients with cancer harbor potential for serious sequelae. Patients with brain metastases (BrM) may be especially susceptible to falls but supporting investigations are lacking. We assessed the frequency, etiologies, risk factors, and sequelae of falls in patients with BrM using two data sources. Methods We identified 42,648 and 111 patients with BrM utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2008-2016) and Brigham/Dana Farber (BWH/DFCI) institutional data (2015), respectively, and characterized falls in these populations. Results Among SEER-Medicare patients, 10,267 (24.1%) experienced a fall that prompted medical evaluation, with cumulative incidences at 3, 6, and 12 months of 18.0%, 24.3%, and 34.1%, respectively. On multivariable Fine/Gray’s regression, older age (&gt;81 or 76-80 vs. 66-70 years, hazard ratio [HR] 1.18 [95% CI, 1.11-1.25], p&lt;0.001 and HR 1.10 [95% CI, 1.04-1.17], p&lt;0.001, respectively), Charlson comorbidity score of &gt;2 vs. 0-2 (HR 1.08 [95% CI, 1.03-1.13], p=0.002) and urban residence (HR 1.08 [95% CI, 1.01-1.16], p=0.03) were associated with falls. Married status (HR 0.94 [95% CI, 0.90-0.98], p=0.004) and Asian vs. white race (HR 0.90 [95% CI, 0.81-0.99], p=0.03) were associated with reduced fall-risk. Identified falls were more common among BWH/DFCI patients (N=56, 50.4% of cohort), resulting in emergency department visits, hospitalizations, fractures, and intracranial hemorrhage in 33%, 23%, 11%, and 4% of patients, respectively. Conclusions Falls are common among patients with BrM, especially older/sicker patients, and can have deleterious consequences. Risk-reduction measures, such as home safety checks, physical therapy, and medication optimization, should be considered in this population.

scholarly journals Elderly patients with stage III or IV ovarian cancer: should they receive standard care?

2008 ◽  
Vol 18 (5) ◽  
pp. 896-907 ◽  
Author(s):  
M. Janda ◽  
D. R. Youlden ◽  
P. D. Baade ◽  
D. Jackson ◽  
A. Obermair
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Overall Survival ◽  
Risk Factor ◽  
Elderly Patients ◽  
Advanced Ovarian Cancer ◽  
Risk Groups ◽  
Stage Iii ◽  
Accelerated Failure Time Model ◽  
Perioperative Mortality

Due to the higher risk of morbidity and perioperative mortality compared to younger patients, elderly patients with advanced ovarian cancer are challenging to treat. A population-based analysis was performed to predict treatment outcomes and establish risk factors for early death of elderly patients with advanced ovarian cancer using a cohort of 3994 women diagnosed with stage III or IV ovarian cancer between 1992 and 1999, registered with the Surveillance, Epidemiology and End Results Cancer Registries. A multivariate accelerated failure time model allowed estimation of a risk factor model for overall survival. Patient's age, stage at presentation, presence of comorbidities, and oncology treatment facility were independently associated with overall survival at 12 months from diagnosis. Patients were assigned to low (0–7 points), moderate (8–14 points) or high (≥15 points) risk groups according to accumulation of risk factors, which showed good ability to predict 12-month mortality (receiver–operator characteristics curve [ROC] derivation cohort = 0.763; ROC validation cohort = 0.756). Across all three risk groups, patients who received both surgery and chemotherapy showed significantly improved survival as compared to patients who received only surgery or chemotherapy. For patients 80 years and over who had upfront surgery, perioperative mortality was significantly greater in the high-risk group (21%; 95% CI = 16–26%) compared to patients within the moderate (8%; 95% CI = 5–12%) and low-risk groups (0%; 95% CI = 0–11%). The risk factor profile established could be helpful to plan future clinical trials to establish optimal treatment for elderly patients with advanced stage ovarian cancer

scholarly journals Prevalence of Workplace Bullying and Risk Groups in Chinese Employees in Hong Kong

2021 ◽  
Vol 18 (1) ◽  
pp. 329
Author(s):  
Catalina Sau Man Ng ◽  
Victor C. W. Chan
Keyword(s):  
Risk Factors ◽  
Hong Kong ◽  
Workplace Bullying ◽  
Sampling Technique ◽  
Risk Groups ◽  
Lifetime Prevalence ◽  
Public Health Issue ◽  
Monthly Income ◽  
The Past ◽  
Higher Educational Attainment

Most studies on workplace bullying have been conducted in high-income countries and on Caucasian samples. Little is known about workplace bullying in Asian countries despite its recognition as a serious public health issue in the workplace. We examined the annual and lifetime prevalence of workplace bullying and its risk factors among Chinese employees in Hong Kong. The study was part of a larger project consisting of two waves. Respondents were recruited from a convenience sampling technique and completed a self-reported survey. Respondents reported whether they had been bullied at work for the past 12 months and during their lifetime. A multivariate logistic regression was conducted to explore the sociodemographic risk factors for workplace bullying. There were a total of 2657 respondents (54.6% male), with a mean age of 41.53 years. The annual and lifetime prevalence of workplace bullying were 39.1% and 58.9%, respectively. Multivariate analyses showed that workplace bullying in the past 12 months was associated with a high monthly income, and the combination of a high monthly income and higher educational attainment was associated with bullying at some point in the participants’ career. Suitable policies and interventions to reduce the extent of workplace bullying in Hong Kong are warranted.

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