scholarly journals Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

2020 ◽  
Vol 18 (3) ◽  
pp. 305-313 ◽  
Author(s):  
Ryan D. Nipp ◽  
Leah L. Thompson ◽  
Brandon Temel ◽  
Charn-Xin Fuh ◽  
Christine Server ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
At Risk ◽  
Overall Survival ◽  
Symptom Burden ◽  
Hazard Ratio ◽  
Screening Tools ◽  
Vulnerable Patients ◽  
Poor Outcomes

Background: Oncologists often struggle with managing the complex issues unique to older adults with cancer, and research is needed to identify patients at risk for poor outcomes. Methods: This study enrolled patients aged ≥70 years within 8 weeks of a diagnosis of incurable gastrointestinal cancer. Patient-reported surveys were used to assess vulnerability (Vulnerable Elders Survey [scores ≥3 indicate a positive screen for vulnerability]), quality of life (QoL; EORTC Quality of Life of Cancer Patients questionnaire [higher scores indicate better QoL]), and symptoms (Edmonton Symptom Assessment System [ESAS; higher scores indicate greater symptom burden] and Geriatric Depression Scale [higher scores indicate greater depression symptoms]). Unplanned hospital visits within 90 days of enrollment and overall survival were evaluated. We used regression models to examine associations among vulnerability, QoL, symptom burden, hospitalizations, and overall survival. Results: Of 132 patients approached, 102 (77.3%) were enrolled (mean [M] ± SD age, 77.25 ± 5.75 years). Nearly half (45.1%) screened positive for vulnerability, and these patients were older (M, 79.45 vs 75.44 years; P=.001) and had more comorbid conditions (M, 2.13 vs 1.34; P=.017) compared with nonvulnerable patients. Vulnerable patients reported worse QoL across all domains (global QoL: M, 53.26 vs 66.82; P=.041; physical QoL: M, 58.95 vs 88.24; P<.001; role QoL: M, 53.99 vs 82.12; P=.001; emotional QoL: M, 73.19 vs 85.76; P=.007; cognitive QoL: M, 79.35 vs 92.73; P=.011; social QoL: M, 59.42 vs 82.42; P<.001), higher symptom burden (ESAS total: M, 31.05 vs 15.00; P<.001), and worse depression score (M, 4.74 vs 2.25; P<.001). Vulnerable patients had a higher risk of unplanned hospitalizations (hazard ratio, 2.38; 95% CI, 1.08–5.27; P=.032) and worse overall survival (hazard ratio, 2.26; 95% CI, 1.14–4.48; P=.020). Conclusions: Older adults with cancer who screen positive as vulnerable experience a higher symptom burden, greater healthcare use, and worse survival. Screening tools to identify vulnerable patients should be integrated into practice to guide clinical care.

scholarly journals Implementation and effectiveness of a multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pei Ern Mary Ng ◽  
Sean Olivia Nicholas ◽  
Shiou Liang Wee ◽  
Teng Yan Yau ◽  
Alvin Chan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
At Risk ◽  
Cognitive Impairment ◽  
Mobile Application ◽  
Intervention Group ◽  
Blood Parameters ◽  
Attrition Rate ◽  
Control Group

AbstractTo address the paucity of research investigating the implementation of multi-domain dementia prevention interventions, we implemented and evaluated a 24-week, bi-weekly multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres (SCs). It comprised dual-task exercises, cognitive training, and mobile application-based nutritional guidance. An RCT design informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework was adopted. Outcome measures include cognition, quality of life, blood parameters, and physical performance. Implementation was evaluated through questionnaires administered to participants, implementers, SC managers, attendance lists, and observations. The program reached almost 50% of eligible participants, had an attrition rate of 22%, and was adopted by 8.7% of the SCs approached. It was implemented as intended; only the nutritional component was re-designed due to participants’ unfamiliarity with the mobile application. While there were no between-group differences in cognition, quality of life, and blood parameters, quality of life reduced in the control group and physical function improved in the intervention group after 24 weeks. The program was well-received by participants and SCs. Our findings show that a multi-domain program for at-risk older adults has benefits and can be implemented through neighborhood SCs. Areas of improvement are discussed.Trial registration: ClinicalTrials.gov NCT04440969 retrospectively registered on 22 June 2020.

scholarly journals Health-Related Quality of Life in Older Adults at Risk for Disability

2007 ◽  
Vol 33 (3) ◽  
pp. 214-218 ◽  
Author(s):  
Erik J. Groessl ◽  
Robert M. Kaplan ◽  
W. Jack Rejeski ◽  
Jeffrey A. Katula ◽  
Abby C. King ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
At Risk ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Risk For Disability

scholarly journals Evidence-Based Integrative Health Care to Promote Quality of Life in Older Adults With Cancer

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 609-610
Author(s):  
Robin Majeski ◽  
Delia Chiaramonte
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Health Care ◽  
Cancer Care ◽  
Symptom Burden ◽  
Integrative Approach ◽  
Evidence Based ◽  
Cancer Symptoms ◽  
Integrative Health

Abstract Cancer disproportionately affects older adults and presents significant challenges to patients’ quality of life. Use of complementary medicine is increasing among older adults with cancer and these modalities have the potential for both benefit and harm. Thus, it is important that health care professionals are knowledgeable about the evidence-supported benefits and risks of complementary and integrative health approaches in the care of older adults with cancer. Integrative cancer care provides a comprehensive approach to reducing symptom burden in patients suffering with cancer symptoms and side effects of cancer treatment. Symptoms such as pain, fatigue, nausea, sleep disturbance, mood disorder, perceived stress, and reduced quality of life are common in this population.This session will discuss an evidence-based integrative approach to cancer care which incorporates both pharmacologic and non-pharmacologic modalities to decrease symptom burden, enhance patient well-being, and improve quality of life. Non-pharmacologic modalities used in the integrative approach to care will be described and relevant evidence for risks, benefits and indications will be presented. Case studies will be discussed to demonstrate the integration of these techniques into conventional western medical treatment plans for older adults with cancer. Diversity and inclusion issues relevant to integrative medicine for underserved cancer patients will be addressed, as well as recommendations for future research to expand access of underserved populations to evidence-supported integrative cancer care. A resource list will be provided to participants.

Evaluation of Implementation and Effectiveness of a Pilot Multi-Domain Program for Older Adults at Risk of Cognitive Impairment at Neighborhood Senior Centres – A Randomized Controlled Trial

2020 ◽  
Author(s):  
Pei Ern Mary Ng ◽  
Sean Olivia Nicholas ◽  
Shiou-Liang Wee ◽  
Teng Yan Yau ◽  
Alvin Chan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
At Risk ◽  
Cognitive Impairment ◽  
Intervention Group ◽  
Blood Lipid ◽  
Community Based ◽  
Randomized Controlled ◽  
Lipid Panel

Abstract Background The efficacy of multi-domain interventions for dementia prevention has been investigated in a few large randomized controlled trials (RCT). To link research to community action, we evaluated the implementation and effectiveness of a community-based multi-domain program for older adults at risk of cognitive impairment. Methods Three enterprises implemented a 24-week, bi-weekly, multi-domain program for older adults at risk of cognitive impairment through neighborhood senior centres (SCs). The program comprised a combination of dual-task group physical exercise, pen-and-paper cognitive games, computerised cognitive training, and mobile application-based personalized nutritional guidance. An effectiveness-implementation hybrid design using a RCT design and informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was adopted to evaluate the program. Cognition and quality of life were assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and EuroQol EQ-5D-5L (EQ-5D) respectively, at baseline and 24-weeks. Blood lipid panel and physical assessments were also conducted. Questionnaires on implementation outcomes were administered at the participants-, provider- and community-levels to participants, implementers, and SC managers. Program schedules and attendance were obtained from implementers and the research team conducted unannounced, random and non-intrusive observations of the program. Results The intervention program reached almost 50% of eligible participants, had an attrition rate of 22%, and was adopted by 8.7% of the SCs approached. The intervention was implemented as intended, except the nutritional component that was re-designed due to participants’ unfamiliarity with the application. There were no between-group differences in cognition, quality of life, and blood lipid panel, though there was a reduction in quality of life in the control group and improved physical function in the intervention group at 24-weeks. Intervention group participants reported improvement in their physical and cognitive functions. The program was well-received by participants and centre managers, who wanted the intervention to continue post-study. Conclusions A six-month multi-domain program for older adults at risk of cognitive impairment can be implemented through neighborhood SCs and elicit improvement in physical but not cognitive performance. Implementation evaluation highlight areas to improve on the uptake of such community-based interventions. Trial registration Trial registration: ClinicalTrials.gov NCT04440969. Registered 22 June 2020 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04440969

scholarly journals Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability

2019 ◽  
Vol 56 (1) ◽  
pp. 141-146 ◽  
Author(s):  
Erik J. Groessl ◽  
Robert M. Kaplan ◽  
W. Jack Rejeski ◽  
Jeffrey A. Katula ◽  
Nancy W. Glynn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Older Adults ◽  
At Risk ◽  
Mobility Disability ◽  
Performance Impact ◽  
And Performance

Factors Associated with Higher Symptom Burden and Lower Quality of Life Among Older Adults with Advanced Cancer (RP507)

2020 ◽  
Vol 60 (1) ◽  
pp. 232-233
Author(s):  
Yael Schenker ◽  
Andrew Althouse ◽  
Margaret Rosenzweig ◽  
Douglas White ◽  
Edward Chu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Factors Associated
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