CGA
Glycoprotein hormones alpha chain precursor (Anterior pituitary glycoprotein hormones common subunit alpha) (Choriogonadotropin alpha chain) (Chorionic gonadotrophin subunit alpha) (CG-alpha) (Follicle-stimulating hormone alpha chain) (FSH-alpha) (Follitropin alpha chain) (Luteinizing hormone alpha chain) (LSH-alpha) (Lutropin alpha chain) (Thyroid-stimulating hormone alpha chain) (TSH-alpha) (Thyrotropin alpha chain)
Publications[править]
Comprehensive geriatric assessment (CGA) is a diagnostic method to assess the physical and mental health status of older patients. The purpose of this study was to assess the safety and efficacy of preoperative concurrent chemoradiotherapy (preCRT) for intermediate or locally advanced rectal cancer in older people who were classified as "fit" by CGA. The interim analysis focusing on safety was reported here as the first part of this trial. This is a single arm, multicenter, phase II trial. The eligible patients for this study were aged 70 years or above that fulfilled the standard of intermediate or locally advanced risk category, and met the standard of fit (SIOG1) evaluated by CGA. All patients received preCRT (50 Gy) with Raltitrexed (3 mg/m on d1 and d22). Qualitative and quantitative variables were described using descriptive statistics. The surgery adherence predicting was analyzed by multivariate logistic regression. Thirty-nine fit patients were enrolled. All patients except one finished radiotherapy without dose reduction. Thirty-two patients finished the prescribed Raltitrexed therapy as scheduled. A serious toxicity was observed in 12 patients (30.8%), and only six patients (15.4%) experienced non-hematological side effects. Overall, our results showed that preCRT was feasible and safe in older patients with rectal cancer who were evaluated as fit based on CGA, supporting the use of CGA to tailor oncological treatment and predict the tolerance of a specific therapy. Completing this trial as planned would provide further valuable insights.
Keywords
- Comprehensive geriatric assessment
- Geriatrics
- Preoperative chemoradiotherapy
- Rectal cancer
The world faces the serious problem of aging. In this study, we aimed to investigate the effect of chlorogenic acid (CGA) on vascular senescence. C57/BL6 female mice that were 14 ± 3 months old were infused with either Angiotensin II (AngII) or saline subcutaneously for two weeks. These mice were administered CGA of 20 or 40 mg/kg/day, or saline via oral gavage. AngII infusion developed vascular senescence, which was confirmed by senescence associated-β-galactosidase (SA-β-gal) staining. CGA administration attenuated vascular senescence in a dose-dependent manner, in association with the increase of Sirtuin 1 (Sirt1) and endothelial nitric oxide synthase (eNOS), and with the decrease of p-Akt, PAI-1, p53, and p21. In an in vitro study, with or without pre-treatment of CGA, Human Umbilical Vein Endothelial Cells (HUVECs) were stimulated with H O for an hour, then cultured in the absence or presence of 0.5-5.0 μM CGA for the indicated time. Endothelial cell senescence was induced by H O , which was attenuated by CGA treatment. Pre-treatment of CGA increased Nrf2 in HUVECs. After H O treatment, translocation of Nrf2 into the nucleus and the subsequent increase of Heme Oxygenase-1 (HO-1) were observed earlier in CGA-treated cells. Furthermore, the HO-1 inhibitor canceled the beneficial effect of CGA on vascular senescence in mice. In conclusion, CGA exerts a beneficial effect on vascular senescence, which is at least partly dependent on the Nuclear factor erythroid 2-factor 2 (Nrf2)/HO-1 pathway.
Keywords
- chlorogenic acid
- heme oxygenase-1
- nuclear factor erythroid 2-related factor 2
- vascular senescence
Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary method to identify geriatric conditions among older patients. The aim of the present study was to examine the associations between CGA and short-term outcomes among older adult inpatients with stroke. The study was a nationwide, retrospective cohort study. We used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify older adult stroke patients from 2014 to 2017. The associations between CGA and in-hospital mortality, length of hospital stay, readmission rate, rehabilitation intervention, and introduction of home health care were evaluated using propensity score matching and instrumental variable analysis. We identified 338,720 patients, 21·3% of whom received CGA. A propensity score-matched analysis of 53,861 pairs showed that in-hospital mortality was significantly lower in the CGA group than in the non-CGA group (3·6% vs. 4·1%, [i]p[/i] < 0·001). The rate of long-term hospitalization (> 60 days) was significantly lower in the CGA group than in the non-CGA group (8·7% vs. 10·1%, [i]p[/i] < 0·001), and the rates of rehabilitation intervention (30·3% vs. 24·9%, [i]p[/i] < 0·001) and home health care (8·3% vs. 7·6%, [i]p[/i] = 0·001) were both higher in the CGA group than in the non-CGA group. Instrumental variable analysis showed similar results. CGA was significantly associated with the examined short-term outcomes. These findings from Japan, one of the most aged countries worldwide, highlight the possible benefits of CGA for short-term outcomes and can be of use for health policy in other international contexts. This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).
Keywords
- Comprehensive geriatric assessment
- Geriatrics
- Japanese diagnosis procedure combination database
- Length of stay
- Mortality
- Stroke
Managing older patients with surgical conditions is a major challenge for hospitals. There is therefore a growing interest in providing geriatric perioperative services. The aim of this systematic review and meta-analysis was to characterize and assess the impact of targeted perioperative geriatric interventions on clinical outcomes of older adults admitted to nonorthopedic surgical teams. A systematic review and meta-analysis of studies of perioperative geriatric interventions in older adults hospitalized under nonorthopedic surgical teams. Ovid MEDLINE, EMBASE, PsycINFO, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and trial registry databases were searched. Primary outcomes were change in functional status and length of stay (LOS). Fifteen randomized controlled trials (RCTs) and 9 prospective before-and-after studies met the inclusion criteria (n = 3026 participants). Perioperative geriatric interventions included preoperative comprehensive geriatric assessment and management (CGA) (5 studies), multicomponent inpatient geriatric programs (8 studies), cognitive training (1 study), exercise (5 studies), and prehabilitation (5 studies). Exercise therapy [mean difference (MD) -1.90, 95% confidence interval (CI) -3.01, -0.80], multicomponent inpatient geriatric programs (MD -1.98, 95% CI -3.09, -0.88), and prehabilitation (MD -1.32, 95% CI -2.75, 0.11) reduced LOS. Functional decline was highly heterogeneous, with 4 of 8 studies reporting significantly less functional decline. Geriatric perioperative interventions reduced complications [exercise therapy risk ratio (RR) 0.74, 95% CI 0.48, 1.15; prehabilitation RR 0.61, 95% CI 0.47, 0.80] and delirium (multicomponent inpatient geriatric programs RR 0.49, 95% CI 0.27, 0.90; preoperative CGA RR 0.54, 95% CI 0.33, 0.89). There was no significant impact on mortality or readmissions. Perioperative geriatric interventions targeted at older nonorthopedic surgical patients improve some clinically relevant outcomes. There is a need for these interventions to be further evaluated in high-quality studies, and future research should explore how to effectively implement these interventions within complex health care systems.
Keywords
- Aging
- comprehensive geriatric assessment
- delirium
- functional status
- outcomes
- surgery
Frailty is characterized by loss of biological reserves and is associated with an increased risk of adverse health outcomes. Frailty can be operationalized using a Frailty Index (FI) based on the accumulation of health deficits; items under health evaluation in the well-established Comprehensive Geriatric Assessment (CGA) have been used to generate an FI-CGA. Traditionally, constructing the FI-CGA has relied on paper-based recording and manual data processing. As this can be time-consuming and error-prone, it limits widespread uptake of this proven type of frailty assessment. Here, we report the development of an electronic tool, the eFI-CGA, for use on personal computers by frontline healthcare providers, to collect CGA data and automate FI-CFA calculation. The ultimate goal is to support early identification and management of frailty at points-of-care, and make uptake in Electronic Medical Records (EMR) feasible and transparent. An electronic CGA (eCGA) form was implemented to operate on Microsoft's WinForms platform and coded using C# programming language. Users complete the eCGA form, from which items under the CGA evaluation are automatically retrieved and processed to output an eFI-CGA score. A user-friendly interface and secured data saving methods were implemented. The software was debugged and tested using systematically designed simulation data, addressing different logic, syntax, and application errors, and then tested with clinical assessment. The user manual and manual scoring were used as ground truth to compare eFI-CGA input and automated eFI score calculations. Frontline health-provider user feedback was incorporated to improve the end-user experience. The Standalone eFI-CGA software tool was developed and optimized for use on personal computers. The user interface adapted the design of paper-based CGA form to facilitate familiarity for clinical users. Compared to known scores, the software tool generated eFI-CGA scores with 100% accuracy to four decimal places. The eFI-CGA allowed secure data storage and retrieval of multiple types, including user input, completed eCGA form, coded items, and calculated eFI-CGA scores. It also permitted recording of actions requiring clinical follow-up, facilitating care planning. Application bugs were identified and resolved at various stages of the implementation, resulting in efficient system performance. Accurate, robust, and reliable computerized frailty assessments are needed to promote effective frailty assessment and management, as a key tool in health care systems facing up to frailty. Our research has enabled the delivery of the standalone eFI-CGA software technology to empower effective frailty assessment and management by various healthcare providers at points-of-care, facilitating integrated care of older adults.
Keywords
- aging
- comprehensive geriatric assessment (CGA)
- electronic assessment tools
- frailty
- frailty index
- healthcare
- older adults
The number of older patients admitted to acute hospitals has increased; however, their needs are heterogeneous and there is no gold-standard method of triaging them towards practicing comprehensive geriatric assessment (CGA). In our hospital, the SAFE (Specialist Advice for the Frail Elderly) team provide an initial geriatric assessment of all emergency admissions of patients aged ≥75 years (with some assessments also occurring in those aged 65 to 74 years) and recommend as to whether CGA in a dedicated Department of Medicine for the Elderly (DME) ward may be required. SAFE assessments include routine screening for geriatric syndromes using validated tools. Our aim was to compare the characteristics (age, gender, acute illness severity on admission as per modified early warning score (MEWS), Charlson Comorbidity Index, Clinical Frailty Scale (CFS), presence of dementia and delirium) and outcomes (length of stay, delayed discharge, inpatient mortality, discharge to usual place of residence, and new institutionalization) of patients listed to a DME ward, to those not listed. We analyzed all SAFE team assessments of patients admitted nonelectively between February 2015 and November 2016. Of 6192 admissions, 16% were listed for a DME ward. Those were older, had higher MEWS and CFS score, were more often affected by cognitive impairment, had longer hospital stay, higher inpatient mortality, and more often required new institutionalization. Higher CFS and presence of dementia and delirium were the strongest predictors of DME ward recommendation. Routine measurement of markers of geriatric complexity may help maximize access to finite inpatient CGA resources.
Keywords
- clinical frailty scale
- frail older adults
- geriatrics
- hospital medicine
The number of older people candidates for interventional cardiology, such as PCI but especially for transcatheter aortic valve implantation (TAVI) , would increase in the future. Generically, the surgical risk, the amount of complications in the perioperative period, mortality and severe disability remain significantly higher in the elderly than in younger. For this reason it's important to determine the indication for surgical intervention, using tools able to predict not only the classics outcome (length of stay, mortality), but also those more specifically geriatrics, correlate to frailty: delirium, cognitive deterioration, risk of institutionalization and decline in functional status. The majority of the most used surgical risks scores are often specialist-oriented and many variables are not considered. The need of a multidimensional diagnostic process, focused on detect frailty, in order to program a coordinated and integrated plan for treatment and long term follow up, led to the development of a specific geriatric tool: the Comprehensive Geriatric Assessment (CGA). The CGA has the aim to improve the prognostic ability of the current risk scores to capture short long term mortality and disability, and helping to resolve a crucial issue providing solid clinical indications to help physician in the definition of on interventional approach as futile. This tool will likely optimize the selection of TAVI older candidates could have the maximal benefit from the procedure.
MeSH Terms
- Aged
- Aged, 80 and over
- Cardiac Surgical Procedures
- Frail Elderly
- Frailty
- Geriatric Assessment
- Humans
- Percutaneous Coronary Intervention
- Risk Assessment
- Transcatheter Aortic Valve Replacement
Keywords
- Cardiac surgery
- Comprehensive geriatric assessment
- Disability
- Elderly
- Frailty
- Geriatrics
- Surgical risk scores
- TAVI
Acquiring medical competencies alone does not necessarily lead to the delivery of quality clinical care. Many UK training programs are soon to be based on the curricula of entrustable professional capabilities (EPCs). These are tasks carried out in practice requiring proficiency in several competencies for quality practice. Assessments to evaluate EPCs for independent practice are needed. Comprehensive geriatric assessment (CGA) is an EPC in geriatric medicine. We describe the development of an assessment of CGA as an example of examining EPCs. A CGA station was introduced in the Diploma in Geriatric Medicine clinical examination. Candidates rotate through four stations: three single competency-based stations (history, communication/ethics and physical examination) and an EPC-based station in CGA. One hundred and seventy-eight (female: 96 [53.9%]) candidates took it. There was a weak but significantly positive correlation between the score at CGA and the total score in the other stations (r = 0.46; P < 0.001). Most candidates passing the station passed the examination. Correlation with other stations similarly showed weak significant correlations (Station 1: r = 0.38; P < 0.001, Station 3: r = 0.28; P < 0.001, and Station 4: r = 0.37; P < 0.001). There was 61.4% (kappa: 0.61; P = 0.000) agreement between examiners whether a candidate passed or failed. Agreement was higher for the other stations, i.e. Station 1 (kappa: 0.85; P < 0.001), Station 3 (kappa: 0.72; P < 0.001), and Station 4 (kappa: 0.85; P < 0.001). Performance on the station correlated positively with overall performance, suggesting that it has discriminatory value in differentiating candidates with varying ability and the more able candidates pass the examination.
MeSH Terms
- Aged
- Clinical Competence
- Education, Medical, Graduate
- Educational Measurement
- Female
- Geriatric Assessment
- Geriatrics
- Humans
- Male
- Pilot Projects
- United Kingdom
Keywords
- Comprehensive geriatric assessment
- development
- entrustable professional capabilities
- objective structured clinical examination
- summative assessment
The proportion of elderly Japanese people (age ≥ 65 years) is currently 27.7%, and the average life span of women is 87.14 years, both of which are unprecedented. In gynecologic cancer, evidence of treatment for the elderly is scarce, and treatment policies are determined by each facility. The aim of the present study was to investigate the status of treatment policies for elderly patients with gynecologic cancer. A web-based questionnaire regarding how treatment strategies are currently determined for elderly patients with gynecologic cancer was conducted on gynecologic oncologists to develop a tool for the objective evaluation of treatment policy decisions for elderly patients. The responses showed that 48% of the gynecologic oncologists were aware of comprehensive geriatric assessment (CGA), but only 6% had actually conducted CGA. Age, comorbidities, performance status, and pretreatment evaluations were regarded as important in determining the treatment strategy. Invasive treatments such as radical hysterectomy and para-aortic lymph node dissection tended to have age limits. These findings suggest that awareness of CGA is low in Japan, and that elderly people may not be given standard therapy, which highlights the importance of building on these findings by gathering further evidence and developing a new tool for predicting treatment outcomes for elderly patients with gynecologic cancer.
MeSH Terms
- Aged
- Aged, 80 and over
- Comorbidity
- Female
- Genital Neoplasms, Female
- Geriatric Assessment
- Gynecology
- Humans
- Hysterectomy
- Japan
- Lymph Node Excision
- Oncologists
- Surveys and Questionnaires
Keywords
- Comprehensive geriatric assessment
- Elderly
- Geriatrics
- Gynecologic cancer
To assess the feasibility, reliability, and validity of the Pictorial Fit-Frail Scale (PFFS) among patients, caregivers, nurses, and geriatricians in an outpatient memory clinic. Observational study. A Canadian referral-based outpatient memory clinic. Fifty-one consecutive patients and/or their caregivers, as well as attending nurses and geriatricians. Participants (patients, caregivers, nurses, and geriatricians) were asked to complete the PFFS based on the patient's current level of functioning. Time-to-complete and level of assistance required was recorded. Participants also completed a demographic survey and patients' medical history (including the Mini-Mental State Examination [MMSE], and Comprehensive Geriatric Assessment [[[CGA]]]) was obtained via chart review. Patient participants had a mean age of 77.3±10.1 years, and average MMSE of 22.0±7.0, and 53% were female. Participants were able to complete the PFFS with minimal assistance, and their average times to completion were 4:38±2:09, 3:11±1:16, 1:05±0:19, and 0:57±0:30 (mins:sec) for patients, caregivers, nurses, and geriatricians, respectively. Mean PFFS scores as rated by patients, caregivers, nurses, and geriatricians were 9.0±5.7, 13.1±6.6, 11.2±4.5, 11.9±5.9, respectively. Patients with low MMSE scores (0-24) took significantly longer to complete the scale and had higher PFFS scores. Inter-rater reliability between nurses and geriatricians was 0.74, but it was lower when assessments were done for patients with low MMSE scores (0.47, p<0.05). The correlation between PFFS and a Frailty Index based on the CGA was moderately high and statistically significant for caregivers, nurses, and geriatricians (r=0.66, r=0.59, r=0.64, respectively), but not patients. The PFFS is feasible, even among people with some slight cognitive impairment, though it may be less useful when patients with severe dementia administer it to themselves. Further, the PFFS may help inform clinicians about areas of concern as identified by patients, enabling them to contribute more to diagnostic and treatment decisions or helping with health tracking and care planning.
Keywords
- aging
- dementia
- frail elderly
- frailty
- psychometrics
This observational study investigated the impact of hyponatremia resolution on the results of a comprehensive geriatric assessment (CGA) in 150 patients with age ≥70 years and serum sodium <130 mEq/L. The test battery including Barthel index of Activities of Daily Living (ADL) and various tests of neurocognitive function, motor performance and mood stability was applied on admission and at discharge. Changes of individual test results (Δ) were analyzed and normonatremic patients matched for age, gender, and ADL served as reference group. Most CGA test results improved. The improvement was more pronounced in the hyponatremia group with respect to ADL (ΔADL: 14.3 ± 17.1 vs. 9.8 ± 14.7; p = 0.002) and MMSE (ΔMMSE: 1.8 ± 3.0 vs. 0.7 ± 1.9; p = 0.002). Effect sizes were small (i.e., >0.2) in the overall analysis for ΔADL and ΔMMSE and moderate (i.e., >0.5) for ΔMMSE in the euvolemic subgroup. Beneficial effects on ΔADL and ΔMMSE were only observed in the subgroup of patients in which [Na ] was raised by >5 mEq/L and multivariable linear regression analysis confirmed [Na ] increase to be an independent predictor of MMSE improvement. Resolution of hyponatremia has a beneficial impact on the geriatric patients' overall functional status, in particular in euvolemic cases.
MeSH Terms
- Activities of Daily Living
- Aged
- Aged, 80 and over
- Aging
- Cognition
- Female
- Geriatrics
- Humans
- Hyponatremia
- Male
- Mental Status and Dementia Tests
- Middle Aged
- Motor Activity
- Sodium
Hospitals are in need of valid and economic screening and assessment tools that help identifying older patients at risk for complications which require intensified support during their hospital stay. Five hundred forty-seven internal medicine in-patients (mean age 78.14 ± 5.96 years; 54.7% males) prospectively received Identification of Seniors at Risk (ISAR) screening. If screening results were positive (ISAR score ≥ 2), a comprehensive geriatric assessment (CGA) was performed. We explored sensitivity and specificity of different ISAR and CGA cutoffs. Further, we analyzed the risk of falls and how patients got discharged from hospital. ISAR /CGA abnormal patients spent more days in hospital (16.1 ± 14.5), received more nursing hours per day (3.0 ± 2.3), more hours of physiotherapy during their hospital stay (2.2 ± 3.2), and had more falls (10.1%) compared to ISAR /CGA normal (10.9 ± 12.3, 2.0 ± 1.2, 1.2 ± 4.3, and 2.8%, respectively, all p ≤ 0.016) and ISAR- (9.6 ± 11.5, 2.3 ± 4.5, 0.7 ± 2.0, and 2.2%, respectively, all p ≤ 0.002) patients. ISAR /CGA abnormal patients terminated their treatment regularly with being discharged back home less often (59.6%) compared to ISAR /CGA normal (78.5%, p = 0.002) and ISAR- (78.2%, p = 0.056) patients. ISAR cutoff≥2 and CGA defined as abnormal in case of impairment of ADL plus another CGA domain achieved best sensitivity/specificity. Abnormal geriatric risk screening and assessment are associated with longer hospital stay and higher amount of nursing and physiotherapy during hospital stay, greater risk of falling, and a lower percentage of successfully terminated treatment in older in-patients.
MeSH Terms
- Accidental Falls
- Aged
- Aged, 80 and over
- Cohort Studies
- Emergency Service, Hospital
- Female
- Geriatric Assessment
- Health Status
- Hospitalization
- Humans
- Internal Medicine
- Length of Stay
- Male
- Mass Screening
- Patient Discharge
- Risk Assessment
Keywords
- CGA
- Cutoff
- Geriatrics
- ISAR
- Internal medicine
- Older in-patients
- Risk screening
- Sensitivity
- Specificity
For years, surgeons have explored the relationship between age and surgical outcomes. Over time, it is more widely accepted that frailty and fitness of older patients, rather than their age, should be considered in surgical decision making. The gold standard of frailty assessment is comprehensive geriatric assessment (CGA) which is best performed by geriatricians. In the past decade, Digital Health Technologies that range from electronic solutions for electronic Patient-reported Outcomes to wearables and sensors have emerged. As these solutions are likely to expand and advance in the next years, we will review the history of investigating factors, especially aging-related factors associated with surgical outcomes, and the current supportive data about the potential and challenges of Digital Health Technologies in complementing or replacing some of the components of CGA by 2025.
MeSH Terms
- Age Factors
- Aged
- Colorectal Neoplasms
- Comorbidity
- Frailty
- Geriatric Assessment
- Geriatrics
- Humans
- Preoperative Period
Keywords
- Colorectal
- Comprehensive geriatric assessment
- Digital health technology
- Geriatric oncology
The aim of this study was to evaluate the impact of comprehensive geriatric assessment (CGA) linked to intervention on identified problems on 90-day mortality in older patients with cancer. Eligible patients were 70 years or older and referred to the Oncology Department at Aarhus University Hospital in order to receive treatment for head and neck cancer (HNC), lung cancer (LC), upper gastrointestinal tract (UGI) cancer or colorectal cancer (CRC). All patients were intendedly invited for CGA. Patients for the study were identified by the oncology department. CGA evaluated six domains: comorbidity, autonomy, mental, cognitive, nutritional status and medication. Intervention was proposed if deficits were detected. Follow-up was performed 90 days after inclusion. From January 1st 2016 through July 31st 2018, 781 patients were identified. Sixty-seven patients were excluded. Median age: 76 (interquartile range: 72-80) years. Primary tumour sites: 5% HNC, 46% LC, 20% UGI and 29% CRC. A total of 407 patients had CGA, 307 had no CGA. Geriatric intervention was proposed in 325 patients (80%) and initiated in 319 patients (78%) in the CGA group. Within 90 days, 142 patients (20%) died. In the non-CGA group, 74 patients died (24%), versus 68 patients (17%) in the CGA group. A potential reduction of death in the CGA group was detected: crude odds ratio (OR): 0.63 (95% confidence interval: 0.43; 0.91), p = 0.014. Adjusted OR: 0.62 (95% confidence interval: 0.39; 1.00), p = 0.05. A CGA linked to oncology evaluation may reduce short-term mortality in older patients with cancer referred for oncological treatment.
MeSH Terms
- Aged
- Aged, 80 and over
- Female
- Follow-Up Studies
- Geriatric Assessment
- Health Status
- Humans
- Male
- Neoplasms
Keywords
- Aged
- Cancer
- Comprehensive geriatric assessment
- Geriatrics
- Mortality
- Multidisciplinary
- Survival
Comprehensive Geriatric Assessment (CGA) is being employed in the perioperative setting to improve outcomes for older surgical patients. Traditionally CGA is delivered by a geriatrician led multidisciplinary team but with the acknowledged workforce challenges in geriatric medicine, it has been suggested that non-geriatricians may be able to deliver CGA. HOW-CGA developed a toolkit to facilitate the delivery of CGA by non-geriatricians in the perioperative setting. Across two hospital sites uptake and implementation of this toolkit was limited by a potential lack of face validity, behavioural and cultural barriers and an acknowledgement that geriatric medicine expertise is key to CGA and optimisation. In-keeping with this finding there has been an observed expansion in geriatrician led CGA services for older surgical patients in the UK. In order to demonstrate the effectiveness of perioperative CGA services, implementation science should be combined with health services research methodology and the use of big data through linked national audit.
MeSH Terms
- Aged
- Geriatric Assessment
- Geriatricians
- Geriatrics
- Humans
Keywords
- Comprehensive Geriatric Assessment (CGA)
- implementation science
- models of care
- older people
- perioperative
- quality improvement
A consensual and operational definition of frailty is necessary in geriatric oncology. While many studies have focused on geriatric syndromes evaluated in the comprehensive geriatric assessment (CGA) to select patients at higher risk of poor outcomes, few have compared CGA data with Fried's phenotype of frailty, the most consensual measurement of frailty in geriatrics. Our objective was to determine a threshold of impaired domains evaluated in CGA associated with Frailty status. A cross-sectional study including all patients with cancer, evaluated from January 2011 to February 2016 at the Geriatric Frailty Clinic, Toulouse. A CGA was performed evaluating seven geriatric domains. Frailty was measured by Fried's phenotype to classify patients into three groups (robust/pre-frail/frail). We plotted a ROC curve to determine the threshold of impaired domains associated with frailty according to Fried. We included 418 patients aged 82.8 years (range 66-100 years). Thirty-three patients (7.9%) were robust, 155 (37.1%) pre-frail and 230 (55%) frail. There was a significant difference in ADL, IADL, nutrition, cognition and polypharmacy between the three groups (p < .001 for each domain). Frail patients had more impaired geriatric domains on CGA than pre-frail and robust patients (respectively 4.5 ± 1.5, 2.8 ± 1.6 and 2.1 ± 1.2; p < .001). The threshold of 4 impaired geriatric domains associated with Fried's Frailty status was identified (Se 77.39%, Sp 67.55%). Area under the curve was 79.6%. The phenotype of frailty is associated with more impaired geriatric domains and a threshold of 4 altered domains could be used to detect frailty from CGA data.
MeSH Terms
- Activities of Daily Living
- Aged
- Aged, 80 and over
- Clinical Decision-Making
- Cross-Sectional Studies
- Disease Progression
- Female
- Frailty
- Geriatric Assessment
- Geriatrics
- Humans
- Male
- Medical Oncology
- Neoplasms
- Severity of Illness Index
Geriatric syndromes (GS) do not fit into discrete disease categories and are often underdiagnosed in hospitalized older adults. Geriatric resources (GR) are also not routinely collected in clinical settings, although this may potentiate the beneficial effects of clinical decisions. The prognostic relevance of GS and GR has never been systematically evaluated through clinical tools developed for clinical decision purposes. To ascertain the impact of common GS and GR on patients' prognosis as assessed by means of the comprehensive geriatric assessment (CGA)-based Multidimensional Prognostic Index (MPI). One hundred and thirty-five hospitalized patients aged 70 years and older underwent a CGA evaluation with calculation of the MPI on admission and discharge. Accordingly, patients were subdivided in low (MPI-1, score 0-0.33), moderate (MPI-2, score 0.34-0.66), and severe (MPI-3, score 0.67-1)-risk of mortality at 1 month and 1 year. Nine GR and 17 GS were identified and collected accordingly. A lower number of GS and a higher number of GR were shown to be highly significantly correlated with a lower MPI, as well as years of education, grade of care, and number of medications independent of age, sex and number of GS or GR. Underweight and obesity according to the BMI were significantly correlated to higher number of GS. Patients with more GR had a significantly higher chance of being discharged home. The MPI evaluation together with GS and GR in acute care for older patients should be encouraged to improve clinical decision-making.
MeSH Terms
- Aged
- Aged, 80 and over
- Aging
- Female
- Geriatric Assessment
- Hospitalization
- Humans
- Male
- Multiple Chronic Conditions
- Resilience, Psychological
- Socioeconomic Factors
- Syndrome
Keywords
- Aging medicine
- Comprehensive geriatric assessment (CGA)
- Geriatric resources
- Geriatric syndromes
- Grade of care
- Multidimensional prognostic index (MPI)
Comprehensive Geriatric Assessment (CGA), is used in older patients with cancer to identify frailties, which can interfere with specialized treatment, and to help with therapeutic care. Functional Status (FS) is a domain of CGA in which Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) are evaluation tools. Our study reviewed the data available on the most frequently used tools to assess ADL and IADL in a geriatric oncology setting and their predictive values on overall survival (OS), toxicity, treatment feasibility or decision and postoperative complications. This review was based on a systematic search of the MEDLINE® database for articles published in English and French between January 1, 2010, and December 31, 2017. In the final analysis, 40 out of 4061 studies were included. The most common ADL and IADL scales used are the Katz ADL (KL-ADL) in 25 studies and the Lawton IADL (IADL ) in 22 studies. FS is predictive of OS in 11 out of 24 studies, chemotoxicity in 2 out of 7 studies, treatment feasibility in 2 out of 5 studies, treatment decisions in 2 out of 3 studies, and postoperative complications in 4 out of 6 studies. FS is of prognostic value in a geriatric oncology setting despite heterogeneous methodology and inclusion criteria, in the studies included. Additional research is needed to explore more precisely the prognostic value of FS in overall survival, toxicity, treatment feasibility or decision and postoperative complications, in older cancer patients.
MeSH Terms
- Activities of Daily Living
- Aged
- Female
- Frailty
- Geriatric Assessment
- Geriatrics
- Humans
- Male
- Medical Oncology
- Neoplasms
- Observational Studies as Topic
- Physical Functional Performance
- Predictive Value of Tests
Keywords
- Cancer
- Chemotoxicity
- Functional status
- Older adults
- Overall survival
- Postoperative complications
- Treatment decision
- Treatment feasibility
The objective of this study was to describe the implementation of comprehensive geriatric assessment (CGA) in clinical trials dedicated to older patients before and after the creation of the International Society of Geriatric Oncology in the early 2000s. All phase I, II, and III trials dedicated to the treatment of cancer among older patients published between 2001 and 2004 and between 2011 and 2014 were reviewed. We considered that a CGA was performed when the authors indicated an intention to do so in the Methods section of the article. We collected each geriatric domain assessed using a validated tool even in the absence of a clear CGA, including nutritional, functional, cognitive, and psychological status, comorbidity, comedication, overmedication, social status and support, and geriatric syndromes. A total of 260 clinical trials dedicated to older patients were identified over the two time periods: 27 phase I, 193 phase II, and 40 phase III trials. CGA was used in 9% and 8% of phase II and III trials, respectively; it was never used in phase I trials. Performance status was reported in 67%, 79%, and 75% of phase I, II, and III trials, respectively. Functional assessment was reported in 4%, 11%, and 13% of phase I, II, and III trials, respectively. Between the two time periods, use of CGA increased from 1% to 11% ([i]p[/i] = .0051) and assessment of functional status increased from 3% to 14% ([i]p[/i] = .0094). The use of CGA in trials dedicated to older patients increased significantly but remained insufficient. This article identifies the areas in which research efforts should be focused in order to offer physicians well-addressed clinical trials with results that can be extrapolated to daily practice.
MeSH Terms
- Age Factors
- Aged
- Aged, 80 and over
- Clinical Decision-Making
- Clinical Trials as Topic
- Female
- Frailty
- Geriatric Assessment
- Geriatrics
- Humans
- Karnofsky Performance Status
- Male
- Medical Oncology
- Middle Aged
- Neoplasms
- Prognosis
- Retrospective Studies
Keywords
- Clinical trials
- Comprehensive geriatric assessment
- Older patients
Comprehensive Geriatric Assessment (CGA), the gold standard for detecting frailty in elderly cancer patients, is time-consuming and hard to apply in routine clinical practice. Here we compared the performance of two screening tools for frailty, G8 and SAOP2 for their accuracy in identifying vulnerable patients. We tested G8 and SAOP2 in 282 patients aged 65 or older with a diagnosis of solid cancer and candidate to undergo surgical, medical and/or radiotherapy treatment. CGA, including functional and cognitive status, depression, nutrition, comorbidity, social status and quality of life was used as reference. ROC curves were used to compare two screening tools. Mean patient age was 79 years and 54% were female. Colorectal and breast cancer were the most common types cancer (49% and 24%). Impaired CGA, G8, and SAOP2 were found in 62%, 89%, and 94% of the patients, respectively. SAOP2 had a better sensitivity (AUC 0.85, p<0.032) than G8 (AUC 0.79), with higher performance in breast cancer patients (AUC 0.93) and in patients aged 70-80 years (AUC 0.87). G8 and SAOP2 both showed good screening capacity for frailty in the cancer patient population we examined with SAOP2 showing a slightly better performance than G8.
Keywords
- aging
- cancer
- frailty
- geriatric assessment
- screening tool
The multidimensional prognostic index (MPI) is a validated, sensitive, and specific prognosis estimation tool based on a comprehensive geriatric assessment (CGA). The MPI accurately predicts mortality after 1 month and 1 year in older, multimorbid patients with acute disease or relapse of chronic conditions. To evaluate whether the MPI predicts indicators of healthcare resources, i.e. grade of care (GC), length of hospital stay (LHS) and destination after hospital discharge in older patients in an acute medical setting. In this study 135 hospitalized patients aged 70 years and older underwent a CGA evaluation to calculate the MPI on admission and discharge. Accordingly, patients were subdivided in low (MPI‑1, score 0-0.33), moderate (MPI-2, score 0.34-0.66) and high (MPI-3, score 0.67-1) risk of mortality. The GC, LHS and the discharge allocation were also recorded. The MPI score was significantly related to LHS (p = 0.011) and to GC (p < 0.001). In addition, MPI-3 patients were significantly more often transferred from other hospital settings (p = 0.007) as well as significantly less likely to be discharged home (p = 0.04) than other groups. The CGA-based MPI values are significantly associated with use of indicators of healthcare resources, including GC, LHS and discharge allocation. These findings suggest that the MPI may be useful for resource planning in the care of older multimorbid patients admitted to hospital.
MeSH Terms
- Activities of Daily Living
- Aged
- Female
- Geriatric Assessment
- Hospitalization
- Humans
- Male
- Patient Admission
- Patient Discharge
- Predictive Value of Tests
- Prognosis
- Risk Assessment
- Risk Factors
Keywords
- Aging medicine
- Clinical decision making
- Comprehensive Geriatric Assessment
- Grade of care
- Prognosis
Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process used to determine the medical, psychological and functional capabilities of frail older people. The primary aim of our current study is to confirm whether CGA-based outpatient care is superior than usual care in terms of health-related outcomes, resource use and costs. The Geriatric Mobile Team trial is designed as a single-centre randomised, controlled, assessor-blinded (at baseline) trial. All participants will be identified via local healthcare registries with the following inclusion criteria: age ≥75 years, ≥3 different diagnoses and ≥3 visits to the emergency care unit (with or without admittance to hospital) during the past 18 months. Nursing home residency will be an exclusion criterion. Baseline assessments will be done before the 1:1 randomisation. Participants in the intervention group will, after an initial CGA, have access to care given by a geriatric team in addition to usual care. The control group receives usual care only. The primary outcome is the total number of inpatient days during the follow-up period. Assessments of the outcomes: mortality, quality of life, health care use, physical functional level, frailty, dependence and cognition will be performed 12 and 24 months after inclusion. Both descriptive and analytical statistics will be used, in order to compare groups and for analyses of outcomes over time including changes therein. The primary outcome will be analysed using analysis of variance, including in-transformed values if needed to achieve normal distribution of the residuals. Ethical approval has been obtained and the results will be disseminated in national and international journals and to health care leaders and stakeholders. Protocol amendments will be published in ClinicalTrials.gov as amendments to the initial registration NCT02923843. In case of success, the study will promote the implementation of CGA in outpatient care settings and thereby contribute to an improved care of older people with multimorbidity through dissemination of the results through scientific articles, information to politicians and to the public. NCT02923843; Pre-results.
MeSH Terms
- Aged
- Ambulatory Care
- Cognition
- Disability Evaluation
- Frailty
- Geriatric Assessment
- Geriatrics
- Hospitalization
- Humans
- Mortality
- Patient Care Team
- Quality of Life
- Randomized Controlled Trials as Topic
- Sweden
Keywords
- Comprehensive Geriatric Assessment
- Frailty
- Geriatric Medicine
- Out-patient Care
- Randomised Controlled Trial
In Japan, the Kihon checklist, which a useful part of the Comprehensive Geriatric Assessment (CGA), is performed using questionnaire. On the other hand, specific health checkup screens are available for some basic diseases, such as diabetes and dyslipidemia, which can cause stroke, the largest cause of long-term care need. However, to date, no report has compared CGA and health checkups in older people for their ability to predict healthy life expectancy; therefore, this study was undertaken to do that. Data from the Japan Gerontological Evaluation Study (JAGES) 2010, a self-administered mail survey of independent people aged 65 years or older, were used. A total of 9,756 participants in six cities responded to the questionnaire, underwent a health check, and were followed up for 3 years.Cox proportional hazards models were used to estimate hazard ratios (HR) for the eventual need for long-term care level 2 or more or death, adjusting for sex, age, drinking or smoking habits, educational years, and equivalent income. Explanatory variables in the Kihon checklist included seven risks, namely, general frailty, functional disability, malnutrition, oral dysfunction, seclusion, cognitive impairment, and depression, and in specific health checkups, 15 required items including metabolic syndrome. The incident rate of long-term care level 2 or more or death was 19.4/1,000 person-years. All risks in the Kihon checklist, excluding oral dysfunction, were significant (range of HRs: 1.44-3.63). Six items in the specific health checkups (urine protein, low BMI, AST, HDL, FPG, and HbA1c) were significant (range of HRs: 1.37-2.07). Metabolic syndrome was not significant (HR: 1.05). Therefore, CGA performed using questionnaire predicts healthy life expectancy better than a health checkup based on a blood test.
MeSH Terms
- Aged
- Cohort Studies
- Directed Tissue Donation
- Geriatric Assessment
- Humans
- Life Expectancy
- Proportional Hazards Models
- Surveys and Questionnaires
Keywords
- Care prevention
- Kihon checklist
- Long-term care
- Metabolic syndrome
- Specific health checkup
Multimorbidity and frailty are often associated and Comprehensive Geriatric Assessment (CGA) is considered the gold standard of care for these patients. This study aimed to evaluate the effect of outpatient Comprehensive Geriatric Assessment (CGA) on frailty in community-dwelling older people with multimorbidity and high health care utilization. The Ambulatory Geriatric Assessment-Frailty Intervention Trial (AGe-FIT) was a randomized controlled trial (intervention group, n = 208, control group n = 174) with a follow-up period of 24 months. Frailty was a secondary outcome. Inclusion criteria were: age ≥ 75 years, ≥ 3 current diagnoses per ICD-10, and ≥ 3 inpatient admissions during 12 months prior to study inclusion. The intervention group received CGA-based care and tailored interventions by a multidisciplinary team in an Ambulatory Geriatric Unit, in addition to usual care. The control group received usual care. Frailty was measured with the Cardiovascular Health Study (CHS) criteria. At 24 months, frail and deceased participants were combined in the analysis. Ninety percent of the population were frail or pre-frail at baseline. After 24 months, there was a significant smaller proportion of frail and deceased (p = 0.002) and a significant higher proportion of pre-frail patients in the intervention group (p = 0.004). Mortality was high, 18% in the intervention group and 26% in the control group. Outpatient CGA may delay the progression of frailty and may contribute to the improvement of frail patients in older persons with multimorbidity.
MeSH Terms
- Aged
- Aged, 80 and over
- Aging
- Female
- Frailty
- Geriatric Assessment
- Humans
- Independent Living
- Male
- Multimorbidity
- Prospective Studies
Keywords
- Community dwelling
- Comprehensive Geriatric Assessment
- Frailty
- Multimorbidity
- Outpatient
- Randomized controlled trial
Comprehensive geriatric assessment (CGA) of older adults with cancer aids treatment decision-making and prognostication. Much less is known about the supportive care elements or enhancements to care afforded by the CGA. We characterized the enhancements to care provided by a geriatric oncology clinic and determined how these vary by indication for referral. All patients age 65 or older referred to a single academic geriatric oncology clinic between July 2015 (clinic opening) and June 2017 were included. Treatment enhancements were prospectively recorded in 5 categories: educational support, comorbidity management, symptom management, oncologic treatment delivery, and peri-operative management recommendations. Indications for referral were categorized into 3 groups: pre-treatment (n = 97, 44%), on active treatment (n = 89, 41%), and survivorship phase (n = 33, 15%). Data were analyzed using descriptive statistics and multivariable logistic regression. 219 patients were seen during the study period (mean age 79.7 years, 69% male). Overall, educational support (96%) and comorbidity management (95%) were the most common enhancements, whereas peri-operative management (10%) was the least common and provided only to pre-treatment patients. Enhancements to cancer treatment delivery were offered more often to patients pre-treatment than on active treatment (61% versus 41%, p < 0.001). Other enhancements to care did not vary by indication for referral. Educational support and comorbidity management are nearly universally offered. Most enhancements to care do not vary by indication for referral. Understanding the enhancements to care provided by geriatric oncology clinics can help with resource planning and program design.
MeSH Terms
- Aged
- Aged, 80 and over
- Clinical Decision-Making
- Female
- Geriatric Assessment
- Geriatrics
- Humans
- Male
- Medical Oncology
- Neoplasms
- Patient Education as Topic
- Prospective Studies
- Referral and Consultation
Keywords
- Comorbidity
- Comprehensive geriatric assessment
- Geriatric oncology
- Outpatient
- Patient education
- Symptom management
Population aging is associated with greater numbers of older people with cancer. Thanks to treatment advances, not only are more seniors diagnosed with cancer, but there are also more and more older cancer survivors. This upward trend will continue. Given the heterogeneity of aging, managing older patients with cancer poses a significant challenge for Medical Oncology. In Spain, a Geriatric Oncology Task Force has been set up within the framework of the Spanish Society for Medical Oncology (SEOM). With the aim of generating evidence and raising awareness, as well as helping medical oncologists in their training with respect to seniors with cancer, we have put together a series of basic management recommendations for this population. Many of the patients who are assessed in routine clinical practice in Oncology are older. CGA is the basic tool by means of which to evaluate older people with cancer and to understand their needs. Training and the correct use of recommendations regarding treatment for comorbidities and geriatric syndromes, support care, and drug-drug interactions and toxicities, including those of antineoplastic agents, as detailed in this article, will ensure that this population is properly managed.
MeSH Terms
- Aged
- Geriatric Assessment
- Humans
- Medical Oncology
- Neoplasms
Keywords
- Aging
- Geriatric oncology
- Geriatric oncology task force
- Spanish society for medical oncology
{{medline-entry |title=Delirium, Frailty, and Fast-Track Surgery in Oncogeriatrics: Is There a Link? |pubmed-url=https://pubmed.ncbi.nlm.nih.gov/29515621 |abstract=Postoperative delirium (POD) is more frequent in elderly patients undergoing major cancer surgery. The interplay between individual clinical vulnerability and a series of perioperative factors seems to play a relevant role. Surgery is the first-line treatment option for cancer, and fast-track surgery (FTS) has been documented to decrease postoperative complications. The study sought to assess, after comprehensive geriatric assessment (CGA) and frailty stratification (Rockwood 40 items index), which perioperative parameters were predictive of POD development in elderly patients undergoing FTS for colorectal cancer. A total of 107 consecutive subjects admitted for elective colorectal FTS were enrolled. All patients underwent CGA, frailly stratification, Timed up