Geriatric assessment predicts non-fatal toxicities and survival for intensively treated older adults with AML

Given a few prospective studies with conflicting results, we investigated the prognostic value of multi-parameter geriatric assessment (GA) domains on tolerance and outcomes after intensive chemotherapy in older adults with acute myeloid leukemia (AML). Newly diagnosed AML aged over 60 years who received intensive chemotherapy consisting of cytarabine and idarubicin (n=105) were enrolled prospectively. Pretreatment GA included evaluations for social and nutritional support, cognition, depression, distress, and physical function. The median age was 64 years (range, 60-75), and 93% had an Eastern Cooperative Oncology Group score <2. Between 32.4% and 69.5% of patients met the criteria for impairment for each domain of GA. Physical impairment by the Short Physical Performance Battery (SPPB) and cognitive dysfunction by the Mini-Mental State Examination in the Korean version of the CERAD Assessment Packet (MMSE-KC) were significantly associated with non-fatal toxicities, including grade III-IV infections (SPPB, P=0.024; MMSE-KC, P=0.044), acute renal failure (SPPB, P=0.013), and/or prolonged hospitalization (³40 days) during induction chemotherapy (MMSE-KC, P=0.005). Reduced physical function by SPPB and depressive symptoms by the Korean version of the short form of geriatric depression scales (SGDS-K) were significantly associated with inferior survival (SPPB, P=0.027; SGDS-K, P=0.048). Gait speed or sit-and-stand speed was the single powerful tool to predict survival outcomes. Notably, the addition of SPPB and SGDS-K, gait speed and SGDS-K, or sit-and-stand speed and SGDS-K significantly improved the power of existing survival prediction models. In conclusion, GA improved risk stratification for treatment decisions and may inform interventions to improve outcomes for older adults with AML. This study was registered at the Clinical Research Information Service (KCT0002172).

Changes in Function and Muscle Strength of Encephalitis Survivors After Inpatient Rehabilitation

Objective To investigate the clinical demographics and rehabilitative assessments of encephalitis survivors admitted to a rehabilitation center, and to confirm the effects of inpatient rehabilitation manifested by changes in muscle strength and function after hospitalization.Methods Data of encephalitis survivors who received rehabilitation at our institution from August 2009 to August 2019 were reviewed. Medical charts were retrospectively reviewed, and motor, functional, and cognitive assessments were collected. Manual muscle testing (MMT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), Korean version of Modified Barthel Index (K-MBI), grip strength, Box and Block Test (BBT), and Korean version of Mini-Mental State Examination (K-MMSE) were performed, and the results upon admission and discharge were compared and analyzed.Results Most of the patients with encephalitis admitted to our institution had viral or autoimmune etiologies. The assessment results of 18 encephalitis patients upon admission and discharge were compared. The total K-MBI score, FAC, grip strength, and BBT significantly improved, but not the MMT and FMA. Subgroup analysis was performed for viral and autoimmune encephalitis, which are the main causes of the disease, but there was no difference in items with significant changes before and after hospitalization.Conclusion Encephalitis survivors showed a significant improvement in functional assessment scale during their hospital stay through rehabilitation, without significant changes in motor strength. Hence, we can conclude that encephalitis survivors benefit from inpatient rehabilitation, targeting functional gains in activities of daily living training more than motor strength.

Validity and Reliability of the Korean version of the Communication Scale for Older Adults

Purpose: Aural rehabilitation has been used to reduce communication difficulties related to hearing loss and minimize their consequence in everyday life. Aural rehabilitation includes diagnosis and identification of hearing loss, provision of appropriate assistive listening devices such as hearing aids and cochlear implants, auditory training, speechreading, and communication strategies training. Communication strategies refer to a course of action taken to facilitate conversation interaction or to correct communication problems. Compared to other components of aural rehabilitation, communication strategies have not been focused on as a significant evaluation tool in spite of their importance in daily life. This study aimed to develop a Korean version of the Communication Scale for Older Adults (K-CSOA) originally designed by Kaplan et al. (1997) to evaluate the changes in communication strategies and attitudes.Methods: The K-CSOA was composed of communication strategies and communication attitudes. The Communication strategies have three subcategories of Facilitative (10 items), Repair (15 items), and Preparatory strategies (16 items). The communication attitudes have also three subcategories of Own Attitude (19 items), Family’s Attitude (7 items), and Others Attitude (5 items). The validity and reliability of K-CSOA were obtained with total sixty subjects consisting of thirty subjects with normal hearing and thirty subjects with different degrees of hearing loss with mean age of 72 years old ranging from 60 years old to 85 years old.Results: The validity and reliability of the K-CSOA were measured using Pearson`s correlation coefficient, Cronbach Alpha coefficient, and independent t-tests. The correlation coefficients were high (.502-.984) between total means of K-CSOA and subcategories of K-CSOA. The internal consistency ranged from .802 to .930 for Communication Strategies and from .620 to .962 for Communication Attitudes. The test-retest correlation of the K-CSOA was .986 and .988 for Communication Strategies and Attitudes, respectively. The correlation coefficient was .784 between the K-CSOA and Korean Hearing Handicap for the Elderly (KHHIE). In addition, there were significant differences in Communication Strategies and Communication Attitudes between the normal hearing and hearing loss groups.Conclusion: These results indicate that K-CSOA can be used as a useful clinical tool providing in-depth information regarding communication strategies and attitudes in Korean elderly people.