Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic ...Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation(TAVI)and to analyze the ability of different tools for predicting clinical outcomes in this context.Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge.The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.Results A total of 377 patients were included(mean age of 80.4 years).Most patients were independent or mildly dependent,with an optimal cognitive status.The proportion of frailty ranged from 17.6%to 49.8%.A total of 20 patients(5.3%)died and 110/377 patients(29.2%)died or were readmitted during follow up.Overall,most components of the geriatric assessment showed an association with clinical outcomes.Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission.The association between frailty and clinical outcomes was higher for short physical performance battery(SPPB),essential frailty toolset(EFT)and the frailty index based on comprehensive geriatric assessment(IF-VIG)and lower for Fried criteria and FRAIL scale.Conclusions AS patients from this series presented a good physical performance,optimal cognitive status and a reasonably low prevalence of frailty.The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT,SPPB and the IF-VIG.展开更多
With the global population aging,the care of elderly cancer patients has become increasingly complex and significant.Comprehensive geriatric assessment(CGA),a multidimensional evaluation tool,has been widely implement...With the global population aging,the care of elderly cancer patients has become increasingly complex and significant.Comprehensive geriatric assessment(CGA),a multidimensional evaluation tool,has been widely implemented in oncology nursing to enhance the precision of treatment decisions and improve patient outcomes.This review examines the application of CGA in oncology nursing,drawing on literature published between 2010 and 2024 in major databases using keywords such as“Comprehensive Geriatric Assessment”and“Oncology Nursing”.It highlights how CGA contributes to optimizing treatment selection,monitoring the treatment process,and improving patients’quality of life and long-term outcomes.CGA provides a comprehensive evaluation of elderly cancer patients,including physical,psychological,and social aspects,enabling the identification of high-risk patients and reducing treatment-related side effects and complications.It also offers a critical foundation for developing personalized care plans.The article discusses various practical examples of CGA implementation across different countries and regions,including multidisciplinary collaborative models in France,the United States,and Australia,demonstrating CGA’s flexible application in diverse healthcare settings.Although significant progress has been made in applying CGA in oncology nursing,numerous challenges remain in its implementation,such as resource limitations and insufficient personnel training.Future research will focus on integrating CGA with emerging technologies,such as artificial intelligence and precision medicine,to further improve the quality of care and treatment outcomes for elderly cancer patients.By summarizing the current status and challenges of CGA in oncology nursing,this review provides guidance for future research and clinical practice,emphasizing the importance of advancing CGA application to meet the growing demands of elderly oncology care.展开更多
Objective:To study the application effect of comprehensive geriatric assessment tool-oriented chronic disease trajectory nursing in community elderly hypertension.Methods:Sixty nine elderly hypertensive patients admit...Objective:To study the application effect of comprehensive geriatric assessment tool-oriented chronic disease trajectory nursing in community elderly hypertension.Methods:Sixty nine elderly hypertensive patients admitted to the hospital from April 2022 to April 2024 were randomly assigned to the intervention group(n=35)and the control group(n=34).The control group received routine community hypertension health management,while the intervention group underwent comprehensive geriatric assessment for comprehensive screening of elderly health issues based on routine management,and implemented targeted nursing interventions based on the characteristics of the chronic disease trajectory.After three months of intervention,the blood pressure,medication compliance,self-efficacy,and quality of life of the two groups were evaluated and analyzed.Results:After the intervention,the intervention group showed significant improvement in blood pressure control,medication compliance,self-management efficacy scores,and quality of life scores compared to the control group(P<0.05).Conclusion:Combining comprehensive geriatric assessment with the concept of chronic disease trajectory nursing in the management of community elderly hypertension can effectively optimize the effect of chronic disease management,which has important practical value.展开更多
Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose...Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients （age 79.5 ＋ 6.7 years, male 63.8%） were recruited to the study. Comprehensive geriatric assessment （CGA）, including measurements about activity of daily living （ADL）, nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti perform- ance oriented mobility assessment （POMA） and history of fall in the recent years. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index （BMI）, and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease （COPD）, cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile （P 〈 0.01 T3 vs. T1, P 〈 0.01 T3 vs. T2）. Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale （P 〈 0.001）, as well as CGA and POMA （P 〈 0.001）. Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL im- pairment （OR： 2.748, 95%CI： 1.598-4.725）, （OR： 3.310, 95%CI： 1.893-5.788）. Decreased Tinetti POMA score was associated with Mini-Mental State Examination （MMSE） （OR： 4.035, 95%CI： 2.100-7.751）, ADL （OR： 2.380, 95%CI： 1.357-4.175） and shortened MNA form （MNA-SF） impairment （OR： 2.692, 95%CI： 1.147-6.319）. Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effec- tive interventions.展开更多
Background In a three-month report from the CGA-TAVI registry,we found the Multidimensional Prognostic Index(MPI)and Short Physical Performance Battery(SPPB)to be of value for predicting short-term outcomes in elderly...Background In a three-month report from the CGA-TAVI registry,we found the Multidimensional Prognostic Index(MPI)and Short Physical Performance Battery(SPPB)to be of value for predicting short-term outcomes in elderly patients undergoing transcatheter aortic valve implantation(TAVI).In the present analysis,we examined the association of these tools with outcomes up to one year post-TAVI.Methods CGA-TAVI is an international,observational registry of geriatric patients undergoing TAVI.Patients were assessed using the MPI and SPPB.Efficacy of baseline values and any postoperative change for predicting outcome were established using logistic regression.Kaplan-Meier analysis was carried out for each comprehensive geriatric assessment tool,with survival stratified by risk category.Results One year after TAVI,14.1%of patients deceased,while 17.4%met the combined endpoint of death and/or non-fatal stroke,and 37.7%the combined endpoint of death and/or hospitalisation and/or non-fatal stroke.A high-risk MPI score was associated with an increased risk of all-cause mortality(aOR=36.13,95%CI:2.77–470.78,P=0.006)and death and/or non-fatal stroke(aOR=10.10,95%CI:1.48–68.75,P=0.018).No significant associations were found between a high-risk SPPB score and mortality or two main combined endpoints.In contrast to a worsening SPPB,an aggravating MPI score at three months post-TAVI was associated with an increased risk of death and/or non-fatal stoke at one year(aOR=95.16,95%CI:3.41–2657.01).Conclusions The MPI showed value for predicting the likelihood of death and a combination of death and/or non-fatal stroke by one year after TAVI in elderly patients.展开更多
BACKGROUND The Comprehensive Geriatric Assessment(CGA)was introduced late in China and is primarily used for investigating and evaluating health problems in older adults in outpatient and community settings.However,th...BACKGROUND The Comprehensive Geriatric Assessment(CGA)was introduced late in China and is primarily used for investigating and evaluating health problems in older adults in outpatient and community settings.However,there are few reports on its application in hospitalized patients,especially older patients with diabetes and hypertension.AIM To explore the nursing effect of CGA in hospitalized older patients with diabetes and hypertension.METHODS We performed a retrospective single-center analysis of patients with comorbid diabetes mellitus and hypertension who were hospitalized and treated in the Jiangyin Hospital of Traditional Chinese Medicine between September 2020 and June 2022.Among the 80 patients included,40 received CGA nursing interventions(study group),while the remaining 40 received routine nursing care(control group).The study group's comprehensive approach included creating personalized CGA profiles,multidisciplinary assessments,and targeted inter-ventions in areas,such as nutrition,medication adherence,exercise,and mental health.However,the control group received standard nursing care,including general and medical history collection,fall prevention measures,and regular patient monitoring.After 6 months of nursing care implementation,we evaluated the effectiveness of the interventions,including assessments of blood glucose levels fasting blood glucose,2-h postprandial blood glucose,and glycated hemoglobin,type A1c(HbA1c);blood pressure indicators such as diastolic blood pressure(DBP)and systolic blood pressure(SBP);quality of life as measured by the 36-item Short Form Survey(SF-36)questionnaire;and treatment adherence.RESULTS After 6 months,the nursing outcomes indicated that patients who underwent CGA nursing interventions experienced a significant decrease in blood glucose indicators,such as fasting blood glucose,2-h postprandial blood glucose,and HbA1c,as well as blood pressure indicators,including DBP and SBP,compared with the control group(P<0.05).Quality of life assessments,including physical health,emotion,physical function,overall health,and mental health,showed marked improvements compared to the control group(P<0.05).In the study group,38 patients adhered to the clinical treatment requirements,whereas only 32 in the control group adhered to the clinical treatment requirements.The probability of treatment adherence among patients receiving CGA nursing interventions was higher than that among patients receiving standard care(95%vs 80%,P<0.05).CONCLUSION The CGA nursing intervention significantly improved glycemic control,blood pressure management,and quality of life in hospitalized older patients with diabetes and hypertension,compared to routine care.展开更多
BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect th...BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect the treatment effect and long-term prognosis.Therefore,it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression.AIM To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents.METHODS In this retrospective study,60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group.The control group was given routine nursing,and the observation group was given comprehensive assessment.Clinical symptoms,quality of life[COPD assessment test(CAT)score],anxiety and depression Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were compared between the two groups.RESULTS CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge,and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge.The average score was 22.1(P<0.05).In the observation group,HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge,and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge.The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge,and from an average of 14.1 at admission to an average of 11.8 at discharge.CONCLUSION The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients'clinical symptoms and quality of life,and can effectively reduce patients'anxiety and depression.展开更多
As the global population ages,the incidence of cancer among older adults is increasing.The management of older patients with cancer poses unique challenges due to the age-related physiological changes,multiple comorbi...As the global population ages,the incidence of cancer among older adults is increasing.The management of older patients with cancer poses unique challenges due to the age-related physiological changes,multiple comorbidities,and functional decline often observed in this population.Comprehensive Geriatric Assessment(CGA)has emerged as a valuable tool in oncology to evaluate the overall health and functional status of older cancer patients in order to optimise cancer care for older adults.This comprehensive approach acknowledges the unique challenges faced by elderly patients with cancer and seeks to optimize outcomes by considering their specific circumstances and individual requirements.展开更多
With the continuous development of science and technology,artificial intelligence(AI)is coming into our lives and changing our lives.Since China entered the aging society in 2000,the degree of population aging has dee...With the continuous development of science and technology,artificial intelligence(AI)is coming into our lives and changing our lives.Since China entered the aging society in 2000,the degree of population aging has deepened.Comprehensive geriatric assessment(CGA)is now the accepted gold standard for the care of older people in hospitals.However,some problems limit the clinical application,such as complexity and time consuming.Therefore,by analyzing previous studies,we summarize some existing AI tools in order to find a more optimized assessment tool to complete the entire CGA process.展开更多
BACKGROUND The role of comprehensive geriatric assessment(CGA)in screening for mild cognitive disorders was not known.AIM To evaluate the role of CGA in screening for mild cognitive disorders.METHODS A total of 100 el...BACKGROUND The role of comprehensive geriatric assessment(CGA)in screening for mild cognitive disorders was not known.AIM To evaluate the role of CGA in screening for mild cognitive disorders.METHODS A total of 100 elderly people who underwent health examinations in our hospital and community between January 2020 and December 2021 were included for analysis.Using Petersen as the diagnostic gold standard,healthy individuals were included in the control group and patients with mild cognitive impairment were assigned to the study group.The correlation between the cognitive function of the patients and their baseline clinical profiles was analyzed.Patients'Montreal Cognitive Assessment(MoCA)and CGA screening results were compared,and the sensitivity and specificity were calculated to assess the screening role of CGA.RESULTS CGA assessment yielded higher diagnostic accuracy than MoCA.The results of the multivariate regression analysis showed no correlation of gender,age,body mass index and literacy with cognitive function.Patients with mild cognitive impairment obtained significantly lower MoCA scores than healthy individuals(P<0.05).In the CGA scale,patients with mild cognitive impairment showed significantly lower Mini-mental State Examination,Miniature Nutritional Assessment and Berg Balance Scale scores,and higher Activity of Daily Living,Instrumental Activities of Daily Living Scale and Frailty Screening Inventory scores than healthy individuals(P<0.05),whereas the other assessment scales showed no significant differences(P>0.05).The CGA provides higher diagnostic sensitivity and specificity than the MoCA(P<0.05).CONCLUSION CGA allows accurate identification of mild cognitive impairment with high sensitivity and specificity,facilitating timely and effective intervention,and is thus recommended for clinical use.展开更多
The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior o...The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment(GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.展开更多
This study was conducted to investigate the clinical effects of applying the integrated geriatric assessment team approach on the care of elderly patients with debilitating syndromes.This study was conducted in Xi’an...This study was conducted to investigate the clinical effects of applying the integrated geriatric assessment team approach on the care of elderly patients with debilitating syndromes.This study was conducted in Xi’an Jiaotong University hospital from January 2021 to January 2022.Around 50 patients with the geriatric debilitating syndrome were selected and retrospectively were analyzed,and psychiatrists,geriatric nurses,pharmacists,medical specialists,physiotherapists,and dieticians were selected to form a comprehensive geriatric assessment team.The patients were then assessed,a treatment plan was developed,and care was provided according to the actual situation,and the effectiveness of the clinical intervention was analyzed.This study demonstrated that,of the 50 patients in this study,the longest hospital stay was 15 days,while the shortest was 4 days,and the average length of stay was 10.23±4.37 days.Around 40 of the patients were able to eat on their own and consume food as prescribed,with a compliance rate of 80%,showing the effectiveness rate of the geriatric assessment team.In summary,the use of a comprehensive geriatric assessment team to treat and care for patients with debilitating syndromes in the elderly is an effective way,and this can significantly improve the life quality of the patients.展开更多
Objective To evaluate the predictive value of simplified geriatric assessment(sGA)in elderly Chinese patients diagnosed with diffuse large B-cell lymphoma(DLBCL).Methods It retrospectively analyzed the relationships o...Objective To evaluate the predictive value of simplified geriatric assessment(sGA)in elderly Chinese patients diagnosed with diffuse large B-cell lymphoma(DLBCL).Methods It retrospectively analyzed the relationships of sGA with the clinical characteristics,outcome,and prognosis of 219 patients aged≥60 years who were newly diagnosed with DLBCL at six hospitals in Jiangsu province between January 2018 and December 2022.Results The median age of 219 patients was 68 years(60-87 years).According to the sGA system criteria,101(46.1%),103(47.0%),and 15(6.8%)elderly patients with DLBCL were categorized as fit,unfit,and frail,respectively.The most common adverse reactions after chemotherapy were hematologic,and the incidence of grade>2 hematologic adverse reactions was similar among the three groups(47.5%vs 41.7%vs 46.7%,respectively;X=0.712,P=0.700).Compared with the fit and unfit groups,the frail group showed tendencies toward for higher proportions of grade>2 gastrointestinal,pulmonary,and infectious adverse reactions(P>0.05 for all).The fit,unfit,and frail groups had respective remission rates of 74.3%,46.6%,and 20.0%(x²=25.249,P<0.001);disease progression rates of 5.9%,11.7%,and 26.7%(X=6.763,P<0.05);2-year overall survival rates of 92.1%(95%CI 86.6%to 97.9%),77.6%(95%CI 69.5%to 86.6%),and 70.1%(95%CI 49.4%to 99.6%)(P<0.05);and 2-year progression-free survival rates of 76.8%(95%CI 67.0%to 84.8%),69.7%(95%CI 61.8%to 82.0%),and 65.7%(95%CI 53.3%to 100%)(P=0.399).Conclusion sGA can effectively predict treatment adverse effects and efficacy,disease progression,and long-term survival in elderly DLBCL.展开更多
Background： Elderly multiple myeloma （MM） patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival （OS） time and sid...Background： Elderly multiple myeloma （MM） patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival （OS） time and side effects with elderly patients are unclear in China. The study tried to find out the role of geriatric assessment in the Chinese elderly MM. Methods： We retrospectively analyzed the data of 628 newly diagnosed patients from six hospitals from June 2011 to June 2013. A geriatric assessment had been performed to assess comorbidities, cognitive, and physical status for these patients. The primary endpoint was to evaluate different physical states of elderly patients with OS time and treatment-related side effects. Results： An additive scoring system （range： 0-5）, based on age, Katz＇s Activity of Daily Living （ADL） and Lawton＇s Instrumental Activity of Daily Living （IADL） 〈5 and Charlson Comorbidity Index （CC1） was developed to identify three groups： fit （score = 0）; intermediate-fitness （score = 1 ）; and fi＇ail （score ≥2）. The 3-year OS was 63% in fit patients, 63% in intermediate-fimess patients, and 49% in frail patients ≥3 hematologic adverse events （AEs） were documented in 45 （35.4%） fit, 34 （34%） intermediate-fitness, and 121 （30.2%） frail patients. The risk of a grade ≥3 hematologic AEs was not significantly increase in intermediate-fitness （hazard ratios [HR]： 0.99, 95% confidence interval [CI]： 0.54 1.47, P = 1.000） and in frail patients （tfR： 1.16, 95% CI： 0.70-1.93, P- 0.558） compared with fit ones. Conclusions： MM occurs earlier in life and being advanced when the diagnosis is made in the mainland of China. The overall survival in fi＇ailty with International Staging System （ISS） ll/lll was the worst in all patients.展开更多
Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAV...Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.展开更多
The main objective of this study was always to know the profile of the institutionalized people in our environment, to know their reality： age, age of admission, level of dependency and evolution during their stay, y...The main objective of this study was always to know the profile of the institutionalized people in our environment, to know their reality： age, age of admission, level of dependency and evolution during their stay, years of stay, number of children, reason for admission. We use data from more than 600 patients from different residences of different backgrounds： public and private, lay and religious, rural and urban. We performed a descriptive study expressing the results in percentages with standard deviation and later evaluated the statistical significance of the differences using the student＇s t-test for the quantitative and Chi-square variables to compare qualitative variables. The results of the study are numerous and of diverse nature, because of their extension, from the general profile of the resident, to the important gender differences, attributed in principle to the different roles of each gender in the studied generations. There are also differences depending on the funding, the reason for admission or the environment. This is at the end only the beginning of a large comparative study with non-institutionalized population, in order to compare this population.展开更多
A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ fun...A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology(SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.展开更多
BACKGROUND National cancer strategy calls for comprehensive assessments for older people but current practice across the United Kingdom is not well described.AIM To identify current assessment methods and access to re...BACKGROUND National cancer strategy calls for comprehensive assessments for older people but current practice across the United Kingdom is not well described.AIM To identify current assessment methods and access to relevant supporting services for older people with cancer.METHODS A web-based survey(SurveyMonkey)targeting health professionals(oncologists,cancer surgeons,geriatricians,nurses and allied health professionals)was distributed January-April 2016 via United Kingdom nationally recognised professional societies.Responses were analysed in frequencies and percentages.Chi Square was used to compare differences in responses between different groups.RESULTS 640 health care professionals responded.Only 14.1%often/always involved geriatricians and 52.0%often/always involved general practitioners in assessments.When wider assessments were used,they always/often influenced decision-making(40.5%)or at least sometimes(34.1%).But 30.5%-44.3%did not use structured assessment methods.Most clinicians favoured clinical history taking.Few used scoring tools and few wished to use them in the future.Most had urgent access to palliative care but only a minority had urgent access to other key supporting professionals(e.g.geriatricians,social workers,psychiatry).69.6%were interested in developing Geriatric Oncology services with geriatricians.CONCLUSION There is variability in assessment methods for older people with cancer across the United Kingdom and variation in perceived access to supporting services.Clinical history taking was preferred to scoring systems.Fostering closer links with geriatricians appears supported.展开更多
Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated ev...Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated events can predict two-year survival.Methods Subjects were recruited from participating outpatient practices if they had non-valvular AF, were 65 or over with CHA_(2)DS_(2)-VASc scores of at least 2, and were candidates for anticoagulation. Demographics, clinical history, and geriatric qualities of life were assessed by interview and medical records review using standardized protocols and repeated at one and two years. Events identified were abstracted and submitted for adjudication using standard definitions of events and categories. Nonmortality event categories included hospitalizations(cardiovascular, bleeding, other), bleeding(major, clinically relevant non-major, minor), and seven major adverse cardiovascular events.Results The 1245 subjects experienced 1960 events, primarily hospitalizations(935) and/or bleeding(817);114 subjects(9.2%)died during two years of follow-up. Events initially abstracted to more than one category(172) were combined, resulting in 1788unique incidents. Most subjects had zero or one event(69%) and fewer than 7% had more than 3 types. Most variables were significant in bivariate analysis. Using multiple logistic regression with two-year survival as the outcome variable, the best-fit model included event number and type, number of unique incidents, and number of bleeding events(R^(2) = 0.511, C = 93.1) with sensitivity = 97.9% and specificity = 44.7%.Conclusions Two-year survival was high. This model, if validated, could have major implications for treatment of patients with AF. Patients in the large group with no or one event are at very low risk of death(under 2%). The small group with high risk for further complications, including death, deserve reassessment to determine if this trajectory can be altered.展开更多
Colorectal cancer(CRC)in the elderly is extremely common but only a few clinicians are familiar with the complexity of issues which present in the geriatric population.In this phase of the life cycle,treatment is freq...Colorectal cancer(CRC)in the elderly is extremely common but only a few clinicians are familiar with the complexity of issues which present in the geriatric population.In this phase of the life cycle,treatment is frequently suboptimal.Despite the fact that,nowadays,older people tend to be healthier than in previous generations,surgical undertreatment is frequently encountered.On the other hand,surgical overtreatment in the vulnerable or frail patient can lead to unacceptable postoperative outcomes with high mortality or persistent disability.Unfortunately,due to the geriatric patient being traditionally excluded from randomized controlled trials for a variety of factors(heterogeneity,frailty,etc.),there is a dearth of evidence-based clinical guidelines for the management of these patients.The objective of this review was to summarize the most relevant clinical studies available in order to assist clinicians in the management of CRC in the elderly.More than in any other patient group,both surgical and non-surgical management strategies should be carefully individualized in the elderly population affected by CRC.Although cure and sphincter preservation are the primary goals,many other variables need to be taken into account,such as maintenance of cognitive status,independence,life expectancy and quality of life.展开更多
文摘Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation(TAVI)and to analyze the ability of different tools for predicting clinical outcomes in this context.Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge.The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.Results A total of 377 patients were included(mean age of 80.4 years).Most patients were independent or mildly dependent,with an optimal cognitive status.The proportion of frailty ranged from 17.6%to 49.8%.A total of 20 patients(5.3%)died and 110/377 patients(29.2%)died or were readmitted during follow up.Overall,most components of the geriatric assessment showed an association with clinical outcomes.Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission.The association between frailty and clinical outcomes was higher for short physical performance battery(SPPB),essential frailty toolset(EFT)and the frailty index based on comprehensive geriatric assessment(IF-VIG)and lower for Fried criteria and FRAIL scale.Conclusions AS patients from this series presented a good physical performance,optimal cognitive status and a reasonably low prevalence of frailty.The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT,SPPB and the IF-VIG.
基金Supported by Henan Province Key Research and Development Program,No.231111311000Henan Provincial Science and Technology Research Project,No.232102310411+2 种基金Henan Province Medical Science and Technology Key Project,No.LHGJ20220566 and No.LHGJ20240365Henan Province Medical Education Research Project,No.WJLX2023079Zhengzhou Medical and Health Technology Innovation Guidance Program,No.2024YLZDJH022.
文摘With the global population aging,the care of elderly cancer patients has become increasingly complex and significant.Comprehensive geriatric assessment(CGA),a multidimensional evaluation tool,has been widely implemented in oncology nursing to enhance the precision of treatment decisions and improve patient outcomes.This review examines the application of CGA in oncology nursing,drawing on literature published between 2010 and 2024 in major databases using keywords such as“Comprehensive Geriatric Assessment”and“Oncology Nursing”.It highlights how CGA contributes to optimizing treatment selection,monitoring the treatment process,and improving patients’quality of life and long-term outcomes.CGA provides a comprehensive evaluation of elderly cancer patients,including physical,psychological,and social aspects,enabling the identification of high-risk patients and reducing treatment-related side effects and complications.It also offers a critical foundation for developing personalized care plans.The article discusses various practical examples of CGA implementation across different countries and regions,including multidisciplinary collaborative models in France,the United States,and Australia,demonstrating CGA’s flexible application in diverse healthcare settings.Although significant progress has been made in applying CGA in oncology nursing,numerous challenges remain in its implementation,such as resource limitations and insufficient personnel training.Future research will focus on integrating CGA with emerging technologies,such as artificial intelligence and precision medicine,to further improve the quality of care and treatment outcomes for elderly cancer patients.By summarizing the current status and challenges of CGA in oncology nursing,this review provides guidance for future research and clinical practice,emphasizing the importance of advancing CGA application to meet the growing demands of elderly oncology care.
基金Nanjing Medical University 2023 Education Research Project(Project No.:2023LX103):Design and Practice of a Primary Care Chronic Disease Management Course Based on the BOPPPS Model-A Case Study of Taizhou RegionTaizhou People’s Hospital Nursing Research Special Project(Project No.:HLYB202411):The Impact of 5A Model-Based Exercise Rehabilitation Guidance on Exercise Adherence in Young and Middle-Aged Hypertensive Patients.
文摘Objective:To study the application effect of comprehensive geriatric assessment tool-oriented chronic disease trajectory nursing in community elderly hypertension.Methods:Sixty nine elderly hypertensive patients admitted to the hospital from April 2022 to April 2024 were randomly assigned to the intervention group(n=35)and the control group(n=34).The control group received routine community hypertension health management,while the intervention group underwent comprehensive geriatric assessment for comprehensive screening of elderly health issues based on routine management,and implemented targeted nursing interventions based on the characteristics of the chronic disease trajectory.After three months of intervention,the blood pressure,medication compliance,self-efficacy,and quality of life of the two groups were evaluated and analyzed.Results:After the intervention,the intervention group showed significant improvement in blood pressure control,medication compliance,self-management efficacy scores,and quality of life scores compared to the control group(P<0.05).Conclusion:Combining comprehensive geriatric assessment with the concept of chronic disease trajectory nursing in the management of community elderly hypertension can effectively optimize the effect of chronic disease management,which has important practical value.
文摘Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients （age 79.5 ＋ 6.7 years, male 63.8%） were recruited to the study. Comprehensive geriatric assessment （CGA）, including measurements about activity of daily living （ADL）, nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti perform- ance oriented mobility assessment （POMA） and history of fall in the recent years. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index （BMI）, and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease （COPD）, cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile （P 〈 0.01 T3 vs. T1, P 〈 0.01 T3 vs. T2）. Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale （P 〈 0.001）, as well as CGA and POMA （P 〈 0.001）. Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL im- pairment （OR： 2.748, 95%CI： 1.598-4.725）, （OR： 3.310, 95%CI： 1.893-5.788）. Decreased Tinetti POMA score was associated with Mini-Mental State Examination （MMSE） （OR： 4.035, 95%CI： 2.100-7.751）, ADL （OR： 2.380, 95%CI： 1.357-4.175） and shortened MNA form （MNA-SF） impairment （OR： 2.692, 95%CI： 1.147-6.319）. Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effec- tive interventions.
基金provided by Edwards Lifesciences(Nyon,Switzerland)to the Sponsor IPPMed(Cloppenburg,Germany)funding from Edwards Lifesciences as did Andrea Ungar
文摘Background In a three-month report from the CGA-TAVI registry,we found the Multidimensional Prognostic Index(MPI)and Short Physical Performance Battery(SPPB)to be of value for predicting short-term outcomes in elderly patients undergoing transcatheter aortic valve implantation(TAVI).In the present analysis,we examined the association of these tools with outcomes up to one year post-TAVI.Methods CGA-TAVI is an international,observational registry of geriatric patients undergoing TAVI.Patients were assessed using the MPI and SPPB.Efficacy of baseline values and any postoperative change for predicting outcome were established using logistic regression.Kaplan-Meier analysis was carried out for each comprehensive geriatric assessment tool,with survival stratified by risk category.Results One year after TAVI,14.1%of patients deceased,while 17.4%met the combined endpoint of death and/or non-fatal stroke,and 37.7%the combined endpoint of death and/or hospitalisation and/or non-fatal stroke.A high-risk MPI score was associated with an increased risk of all-cause mortality(aOR=36.13,95%CI:2.77–470.78,P=0.006)and death and/or non-fatal stroke(aOR=10.10,95%CI:1.48–68.75,P=0.018).No significant associations were found between a high-risk SPPB score and mortality or two main combined endpoints.In contrast to a worsening SPPB,an aggravating MPI score at three months post-TAVI was associated with an increased risk of death and/or non-fatal stoke at one year(aOR=95.16,95%CI:3.41–2657.01).Conclusions The MPI showed value for predicting the likelihood of death and a combination of death and/or non-fatal stroke by one year after TAVI in elderly patients.
基金the Research Project of the Jiangyin Municipal Health Commission,No.G202008。
文摘BACKGROUND The Comprehensive Geriatric Assessment(CGA)was introduced late in China and is primarily used for investigating and evaluating health problems in older adults in outpatient and community settings.However,there are few reports on its application in hospitalized patients,especially older patients with diabetes and hypertension.AIM To explore the nursing effect of CGA in hospitalized older patients with diabetes and hypertension.METHODS We performed a retrospective single-center analysis of patients with comorbid diabetes mellitus and hypertension who were hospitalized and treated in the Jiangyin Hospital of Traditional Chinese Medicine between September 2020 and June 2022.Among the 80 patients included,40 received CGA nursing interventions(study group),while the remaining 40 received routine nursing care(control group).The study group's comprehensive approach included creating personalized CGA profiles,multidisciplinary assessments,and targeted inter-ventions in areas,such as nutrition,medication adherence,exercise,and mental health.However,the control group received standard nursing care,including general and medical history collection,fall prevention measures,and regular patient monitoring.After 6 months of nursing care implementation,we evaluated the effectiveness of the interventions,including assessments of blood glucose levels fasting blood glucose,2-h postprandial blood glucose,and glycated hemoglobin,type A1c(HbA1c);blood pressure indicators such as diastolic blood pressure(DBP)and systolic blood pressure(SBP);quality of life as measured by the 36-item Short Form Survey(SF-36)questionnaire;and treatment adherence.RESULTS After 6 months,the nursing outcomes indicated that patients who underwent CGA nursing interventions experienced a significant decrease in blood glucose indicators,such as fasting blood glucose,2-h postprandial blood glucose,and HbA1c,as well as blood pressure indicators,including DBP and SBP,compared with the control group(P<0.05).Quality of life assessments,including physical health,emotion,physical function,overall health,and mental health,showed marked improvements compared to the control group(P<0.05).In the study group,38 patients adhered to the clinical treatment requirements,whereas only 32 in the control group adhered to the clinical treatment requirements.The probability of treatment adherence among patients receiving CGA nursing interventions was higher than that among patients receiving standard care(95%vs 80%,P<0.05).CONCLUSION The CGA nursing intervention significantly improved glycemic control,blood pressure management,and quality of life in hospitalized older patients with diabetes and hypertension,compared to routine care.
文摘BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect the treatment effect and long-term prognosis.Therefore,it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression.AIM To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents.METHODS In this retrospective study,60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group.The control group was given routine nursing,and the observation group was given comprehensive assessment.Clinical symptoms,quality of life[COPD assessment test(CAT)score],anxiety and depression Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were compared between the two groups.RESULTS CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge,and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge.The average score was 22.1(P<0.05).In the observation group,HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge,and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge.The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge,and from an average of 14.1 at admission to an average of 11.8 at discharge.CONCLUSION The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients'clinical symptoms and quality of life,and can effectively reduce patients'anxiety and depression.
文摘As the global population ages,the incidence of cancer among older adults is increasing.The management of older patients with cancer poses unique challenges due to the age-related physiological changes,multiple comorbidities,and functional decline often observed in this population.Comprehensive Geriatric Assessment(CGA)has emerged as a valuable tool in oncology to evaluate the overall health and functional status of older cancer patients in order to optimise cancer care for older adults.This comprehensive approach acknowledges the unique challenges faced by elderly patients with cancer and seeks to optimize outcomes by considering their specific circumstances and individual requirements.
基金supported by the Foundation of Aerospace Center Hospital(No.YN202107)the Foundation of Aerospace Medical Health Technology Group(No.2021YK02)。
文摘With the continuous development of science and technology,artificial intelligence(AI)is coming into our lives and changing our lives.Since China entered the aging society in 2000,the degree of population aging has deepened.Comprehensive geriatric assessment(CGA)is now the accepted gold standard for the care of older people in hospitals.However,some problems limit the clinical application,such as complexity and time consuming.Therefore,by analyzing previous studies,we summarize some existing AI tools in order to find a more optimized assessment tool to complete the entire CGA process.
基金Supported by Jiangsu Provincial Elderly Health Research Project,No.LR2021020,No,LD2021016Major Project of Wuxi Municipal Health Commission,No.Z202002Scientific Research Project of Jiangsu Provincial Health Commission,No.BJ21008.
文摘BACKGROUND The role of comprehensive geriatric assessment(CGA)in screening for mild cognitive disorders was not known.AIM To evaluate the role of CGA in screening for mild cognitive disorders.METHODS A total of 100 elderly people who underwent health examinations in our hospital and community between January 2020 and December 2021 were included for analysis.Using Petersen as the diagnostic gold standard,healthy individuals were included in the control group and patients with mild cognitive impairment were assigned to the study group.The correlation between the cognitive function of the patients and their baseline clinical profiles was analyzed.Patients'Montreal Cognitive Assessment(MoCA)and CGA screening results were compared,and the sensitivity and specificity were calculated to assess the screening role of CGA.RESULTS CGA assessment yielded higher diagnostic accuracy than MoCA.The results of the multivariate regression analysis showed no correlation of gender,age,body mass index and literacy with cognitive function.Patients with mild cognitive impairment obtained significantly lower MoCA scores than healthy individuals(P<0.05).In the CGA scale,patients with mild cognitive impairment showed significantly lower Mini-mental State Examination,Miniature Nutritional Assessment and Berg Balance Scale scores,and higher Activity of Daily Living,Instrumental Activities of Daily Living Scale and Frailty Screening Inventory scores than healthy individuals(P<0.05),whereas the other assessment scales showed no significant differences(P>0.05).The CGA provides higher diagnostic sensitivity and specificity than the MoCA(P<0.05).CONCLUSION CGA allows accurate identification of mild cognitive impairment with high sensitivity and specificity,facilitating timely and effective intervention,and is thus recommended for clinical use.
基金supported in part by Beatrice & Samuel A Seaver Foundationby the Memorial Sloan Kettering Cancer and Aging Research Program
文摘The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment(GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.
文摘This study was conducted to investigate the clinical effects of applying the integrated geriatric assessment team approach on the care of elderly patients with debilitating syndromes.This study was conducted in Xi’an Jiaotong University hospital from January 2021 to January 2022.Around 50 patients with the geriatric debilitating syndrome were selected and retrospectively were analyzed,and psychiatrists,geriatric nurses,pharmacists,medical specialists,physiotherapists,and dieticians were selected to form a comprehensive geriatric assessment team.The patients were then assessed,a treatment plan was developed,and care was provided according to the actual situation,and the effectiveness of the clinical intervention was analyzed.This study demonstrated that,of the 50 patients in this study,the longest hospital stay was 15 days,while the shortest was 4 days,and the average length of stay was 10.23±4.37 days.Around 40 of the patients were able to eat on their own and consume food as prescribed,with a compliance rate of 80%,showing the effectiveness rate of the geriatric assessment team.In summary,the use of a comprehensive geriatric assessment team to treat and care for patients with debilitating syndromes in the elderly is an effective way,and this can significantly improve the life quality of the patients.
文摘Objective To evaluate the predictive value of simplified geriatric assessment(sGA)in elderly Chinese patients diagnosed with diffuse large B-cell lymphoma(DLBCL).Methods It retrospectively analyzed the relationships of sGA with the clinical characteristics,outcome,and prognosis of 219 patients aged≥60 years who were newly diagnosed with DLBCL at six hospitals in Jiangsu province between January 2018 and December 2022.Results The median age of 219 patients was 68 years(60-87 years).According to the sGA system criteria,101(46.1%),103(47.0%),and 15(6.8%)elderly patients with DLBCL were categorized as fit,unfit,and frail,respectively.The most common adverse reactions after chemotherapy were hematologic,and the incidence of grade>2 hematologic adverse reactions was similar among the three groups(47.5%vs 41.7%vs 46.7%,respectively;X=0.712,P=0.700).Compared with the fit and unfit groups,the frail group showed tendencies toward for higher proportions of grade>2 gastrointestinal,pulmonary,and infectious adverse reactions(P>0.05 for all).The fit,unfit,and frail groups had respective remission rates of 74.3%,46.6%,and 20.0%(x²=25.249,P<0.001);disease progression rates of 5.9%,11.7%,and 26.7%(X=6.763,P<0.05);2-year overall survival rates of 92.1%(95%CI 86.6%to 97.9%),77.6%(95%CI 69.5%to 86.6%),and 70.1%(95%CI 49.4%to 99.6%)(P<0.05);and 2-year progression-free survival rates of 76.8%(95%CI 67.0%to 84.8%),69.7%(95%CI 61.8%to 82.0%),and 65.7%(95%CI 53.3%to 100%)(P=0.399).Conclusion sGA can effectively predict treatment adverse effects and efficacy,disease progression,and long-term survival in elderly DLBCL.
文摘Background： Elderly multiple myeloma （MM） patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival （OS） time and side effects with elderly patients are unclear in China. The study tried to find out the role of geriatric assessment in the Chinese elderly MM. Methods： We retrospectively analyzed the data of 628 newly diagnosed patients from six hospitals from June 2011 to June 2013. A geriatric assessment had been performed to assess comorbidities, cognitive, and physical status for these patients. The primary endpoint was to evaluate different physical states of elderly patients with OS time and treatment-related side effects. Results： An additive scoring system （range： 0-5）, based on age, Katz＇s Activity of Daily Living （ADL） and Lawton＇s Instrumental Activity of Daily Living （IADL） 〈5 and Charlson Comorbidity Index （CC1） was developed to identify three groups： fit （score = 0）; intermediate-fitness （score = 1 ）; and fi＇ail （score ≥2）. The 3-year OS was 63% in fit patients, 63% in intermediate-fimess patients, and 49% in frail patients ≥3 hematologic adverse events （AEs） were documented in 45 （35.4%） fit, 34 （34%） intermediate-fitness, and 121 （30.2%） frail patients. The risk of a grade ≥3 hematologic AEs was not significantly increase in intermediate-fitness （hazard ratios [HR]： 0.99, 95% confidence interval [CI]： 0.54 1.47, P = 1.000） and in frail patients （tfR： 1.16, 95% CI： 0.70-1.93, P- 0.558） compared with fit ones. Conclusions： MM occurs earlier in life and being advanced when the diagnosis is made in the mainland of China. The overall survival in fi＇ailty with International Staging System （ISS） ll/lll was the worst in all patients.
文摘Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.
文摘The main objective of this study was always to know the profile of the institutionalized people in our environment, to know their reality： age, age of admission, level of dependency and evolution during their stay, years of stay, number of children, reason for admission. We use data from more than 600 patients from different residences of different backgrounds： public and private, lay and religious, rural and urban. We performed a descriptive study expressing the results in percentages with standard deviation and later evaluated the statistical significance of the differences using the student＇s t-test for the quantitative and Chi-square variables to compare qualitative variables. The results of the study are numerous and of diverse nature, because of their extension, from the general profile of the resident, to the important gender differences, attributed in principle to the different roles of each gender in the studied generations. There are also differences depending on the funding, the reason for admission or the environment. This is at the end only the beginning of a large comparative study with non-institutionalized population, in order to compare this population.
文摘A paradox in cancer research is that the majority of patients enrolled in clinical trials are relatively young and fit while typical patients in daily practice are elderly and have comorbidities and impaired organ function. Given these differences, many major studies provide an imperfect guide to optimizing the treatment of the majority of patients. Since cancer incidence is highly correlated with age, and since the world's population is rapidly ageing, this problem can only increase. For this reason, oncologists and geriatricians need to collaborate in developing tools to systematically assess the health status of elderly patients and their fitness to receive cancer therapies of various intensity. Tailoring anti-cancer treatments and supportive care to individual needs should be seen as part of the move towards personalized medicine. Achieving this goal is as much of a challenge to developing and middle-income countries as it is to western nations. The 2015 annual conference of the International Society of Geriatric Oncology(SIOG) held in Prague, Czech Republic, November 2015 and had a global focus on advancing the science of geriatric oncology and supportive care. Central to this approach is the systematic assessment of life expectancy, independent functioning, and the physical and psychological health of older cancer patients. The assumption behind comprehensive geriatric assessment is that elderly cancer patients have complex needs. The implication is that effective intervention will require a multidisciplinary team. Examples of effective geriatric assessment, multidisciplinary working and supportive care were presented at the SIOG conference.
文摘BACKGROUND National cancer strategy calls for comprehensive assessments for older people but current practice across the United Kingdom is not well described.AIM To identify current assessment methods and access to relevant supporting services for older people with cancer.METHODS A web-based survey(SurveyMonkey)targeting health professionals(oncologists,cancer surgeons,geriatricians,nurses and allied health professionals)was distributed January-April 2016 via United Kingdom nationally recognised professional societies.Responses were analysed in frequencies and percentages.Chi Square was used to compare differences in responses between different groups.RESULTS 640 health care professionals responded.Only 14.1%often/always involved geriatricians and 52.0%often/always involved general practitioners in assessments.When wider assessments were used,they always/often influenced decision-making(40.5%)or at least sometimes(34.1%).But 30.5%-44.3%did not use structured assessment methods.Most clinicians favoured clinical history taking.Few used scoring tools and few wished to use them in the future.Most had urgent access to palliative care but only a minority had urgent access to other key supporting professionals(e.g.geriatricians,social workers,psychiatry).69.6%were interested in developing Geriatric Oncology services with geriatricians.CONCLUSION There is variability in assessment methods for older people with cancer across the United Kingdom and variation in perceived access to supporting services.Clinical history taking was preferred to scoring systems.Fostering closer links with geriatricians appears supported.
文摘Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated events can predict two-year survival.Methods Subjects were recruited from participating outpatient practices if they had non-valvular AF, were 65 or over with CHA_(2)DS_(2)-VASc scores of at least 2, and were candidates for anticoagulation. Demographics, clinical history, and geriatric qualities of life were assessed by interview and medical records review using standardized protocols and repeated at one and two years. Events identified were abstracted and submitted for adjudication using standard definitions of events and categories. Nonmortality event categories included hospitalizations(cardiovascular, bleeding, other), bleeding(major, clinically relevant non-major, minor), and seven major adverse cardiovascular events.Results The 1245 subjects experienced 1960 events, primarily hospitalizations(935) and/or bleeding(817);114 subjects(9.2%)died during two years of follow-up. Events initially abstracted to more than one category(172) were combined, resulting in 1788unique incidents. Most subjects had zero or one event(69%) and fewer than 7% had more than 3 types. Most variables were significant in bivariate analysis. Using multiple logistic regression with two-year survival as the outcome variable, the best-fit model included event number and type, number of unique incidents, and number of bleeding events(R^(2) = 0.511, C = 93.1) with sensitivity = 97.9% and specificity = 44.7%.Conclusions Two-year survival was high. This model, if validated, could have major implications for treatment of patients with AF. Patients in the large group with no or one event are at very low risk of death(under 2%). The small group with high risk for further complications, including death, deserve reassessment to determine if this trajectory can be altered.
文摘Colorectal cancer(CRC)in the elderly is extremely common but only a few clinicians are familiar with the complexity of issues which present in the geriatric population.In this phase of the life cycle,treatment is frequently suboptimal.Despite the fact that,nowadays,older people tend to be healthier than in previous generations,surgical undertreatment is frequently encountered.On the other hand,surgical overtreatment in the vulnerable or frail patient can lead to unacceptable postoperative outcomes with high mortality or persistent disability.Unfortunately,due to the geriatric patient being traditionally excluded from randomized controlled trials for a variety of factors(heterogeneity,frailty,etc.),there is a dearth of evidence-based clinical guidelines for the management of these patients.The objective of this review was to summarize the most relevant clinical studies available in order to assist clinicians in the management of CRC in the elderly.More than in any other patient group,both surgical and non-surgical management strategies should be carefully individualized in the elderly population affected by CRC.Although cure and sphincter preservation are the primary goals,many other variables need to be taken into account,such as maintenance of cognitive status,independence,life expectancy and quality of life.
