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Geriatric Nutritional Risk Index as a prognostic marker in patients with extensive-stage disease small cell lung cancer: Results from a randomized controlled trial.
Lee, GW, Go, SI, Kim, DW, Kim, HG, Kim, JH, An, HJ, Jang, JS, Kim, BS, Hahn, S, Heo, DS
Thoracic cancer. 2020;(1):62-71
Abstract
BACKGROUND Clinical impact of the Geriatric Nutritional Risk Index (GNRI) in patients with extensive-stage disease small cell lung cancer (ED-SCLC) have not previously been reported. METHODS This study analyzed 352 patients enrolled in a previous randomized phase III trial comparing the efficacy of irinotecan plus cisplatin with that of etoposide plus cisplatin as the first-line therapy for ED-SCLC. GNRI values were calculated using serum albumin levels and actual and ideal bodyweights. Patients with a GNRI > 98, 92-98, and <92 were grouped into no, low, and moderate/major risk groups, respectively. RESULTS The objective response rates were 63.2%, 52.6%, and 49.2% in the no, low, and moderate/major risk groups, respectively (P = 0.024). The median progression-free survival (PFS) was shorter in patients with a lower GNRI than in those with a higher GNRI (no vs. low vs. moderate/major risk group; 6.5 vs. 5.8 vs. 5.9 months, respectively; P = 0.028). There were significant differences in median overall survival (OS) according to GNRI (no vs. low vs. moderate/major risk group; 13.2 vs. 10.3 vs. 8.4 months, respectively; P < 0.001). Multivariate analysis revealed that being in the moderate/major risk group was an independent poor prognostic factor for PFS (hazard ratio [HR]: 1.300, 95% confidence interval [CI]: 1.012-1.670; P = 0.040) and OS (HR: 1.539; 95% CI: 1.069-2.216; P = 0.020). CONCLUSIONS This prospective study shows that a low GNRI value was associated with a poor prognosis, and it supports the relationship between systemic inflammation, nutritional status, and clinical outcomes in patients with ED-SCLC.Key points SIGNIFICANT FINDINGS OF THE STUDY The lower GNRI group had a low response rate to chemotherapy for ED-SCLC. The HRs for PFS and OS were 1.300 and 1.539 in the patients with GNRI < 92. WHAT THIS STUDY ADDS Low GNRI is associated with poor prognosis in ED-SCLC.
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Impact of comprehensive geriatric assessment on short-term mortality in older patients with cancer-a follow-up study.
Ørum, M, Jensen, K, Gregersen, M, Meldgaard, P, Damsgaard, EM
European journal of cancer (Oxford, England : 1990). 2019;:27-34
Abstract
PURPOSE 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. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSION A CGA linked to oncology evaluation may reduce short-term mortality in older patients with cancer referred for oncological treatment.
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Neural correlates of perceived physical and mental fatigability in older adults: A pilot study.
Wasson, E, Rosso, AL, Santanasto, AJ, Rosano, C, Butters, MA, Rejeski, WJ, Boudreau, RM, Aizenstein, H, Gmelin, T, Glynn, NW, et al
Experimental gerontology. 2019;:139-147
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This pilot work examined associations of brain grey matter volumes (GMV) with perceived fatigability in older adults to elucidate disablement mechanisms. A subsample (n = 29; age = 77.2 ± 5.5; 86% female) of participants from the Lifestyle Interventions and Independence for Elders (LIFE) Study was utilized to quantify GMV for regions of interest in the basal ganglia and limbic system normalized to intracranial volume. The Pittsburgh Fatigability Scale measured physical and mental fatigability (score 0-50; higher physical fatigability ≥ 15; higher mental fatigability ≥ 13). We used an exploratory alpha level of p < 0.1. Nineteen (66%) participants had higher physical fatigability, 19 (66%) had higher mental fatigability, of these, 17 (57%) had both. Right hippocampal volumes/ICV were smaller in participants with higher verses lower physical fatigability (0.261 ± 0.039 vs. 0.273 ± 0.022, p = 0.07); associations were similar for right putamen and bilateral thalamus. Higher mental fatigability was associated with smaller right hippocampus, thalamus, and posterior cingulum and bilateral amygdala. Higher fatigability in older adults may be associated with smaller volumes of the basal ganglia and limbic system, indicating mechanisms for further exploration.
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Geriatric assessment and biomarkers in patients with metastatic breast cancer receiving first-line mono-chemotherapy: Results from the randomized phase III PELICAN trial.
Honecker, F, Harbeck, N, Schnabel, C, Wedding, U, Waldenmaier, D, Saupe, S, Jäger, E, Schmidt, M, Kreienberg, R, Müller, L, et al
Journal of geriatric oncology. 2018;(2):163-169
Abstract
OBJECTIVES To determine predictive/prognostic factors for patients with metastatic breast cancer (MBC) receiving first-line monochemotherapy using biomarker analysis and geriatric assessment (GA). MATERIALS AND METHODS Karnofsky Performance Status (KPS) and GA as clinical parameters, and prognostic inflammatory and nutritional index (PINI), and Glasgow prognostic score (GPS) as biomarkers were analyzed for association with clinical outcome within the randomized phase III PEg-LIposomal Doxorubicin vs. CApecitabin iN MBC (PELICAN) trial of first-line pegylated liposomal doxorubicin (PLD) or capecitabine. RESULTS Of 210 patients, 38% were >65years old. GA (n=152) classified 74% as fit, 10% as compromised, and 16% as frail. Biomarkers showed no age dependency. In multivariate analysis (n=70) KPS, GA, cumulative illness rating scale-geriatrics (CIRS-G), and GPS were significantly associated with time to progression, and KPS, CIRS-G, and instrumental activities of daily living (IADL) from GA, and PINI showed a significant correlation with overall survival. CONCLUSION GA evaluation was feasible. KPS significantly correlated with efficacy outcomes. Items of a GA and biomarkers of inflammation and nutrition may have prognostic significance in patients with MBC.
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Functional Impairments Mediate Association Between Clinical Fracture Risk and Type 2 Diabetes Mellitus in Older Women.
Lee, RH, Pieper, CF, Colón-Emeric, C
Journal of the American Geriatrics Society. 2015;(8):1546-51
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OBJECTIVES To examine the effect of functional impairments in older women with diabetes mellitus (DM) on incident clinical fractures. DESIGN Secondary analysis of two large prospective cohort studies. SETTING North Carolina Established Populations for Epidemiologic Studies of the Elderly (EPESE) and Women's Health Initiative (WHI) clinical trials. PARTICIPANTS EPESE included 2,704 community-dwelling women aged 65 and older; WHI clinical trials included 68,125 postmenopausal women. MEASUREMENTS Women with DM at baseline were compared with women without in successive Cox proportional hazards models. Functional limitations were determined according to self-reported difficulties with activities of daily living (ADLs) and physical activities. RESULTS The risk of any clinical fracture during the study period was greater in women with DM, after controlling for age, race and ethnicity, and body mass index, in the EPESE (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.08-1.72) and WHI (HR = 1.29, 95% CI = 1.19-1.39) cohorts. After inclusion of functional limitations, the greater risk of fracture associated with DM decreased in the EPESE (HR = 1.25, 95% CI = 0.98-1.59) and WHI (HR = 1.21, 95% CI = 1.12-1.31) cohorts. In participants with DM, difficulties with moderate physical activities, such as bending or stooping, walking several blocks, and heavy housework, were significantly associated with incident fracture (P < .05). CONCLUSION Older women with DM are at greater risk of clinical fractures than those without, independent of bone mineral density. Greater functional impairment in moderate physical activities mediates this greater fracture risk in part, although there remains an unexplained residual DM-associated risk for fracture.
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Geriatric assessment-identified deficits in older cancer patients with normal performance status.
Jolly, TA, Deal, AM, Nyrop, KA, Williams, GR, Pergolotti, M, Wood, WA, Alston, SM, Gordon, BB, Dixon, SA, Moore, SG, et al
The oncologist. 2015;(4):379-85
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BACKGROUND We investigated whether a brief geriatric assessment (GA) would identify important patient deficits that could affect treatment tolerance and care outcomes within a sample of older cancer patients rated as functionally normal (80%-100%) on the Karnofsky performance status (KPS) scale. METHODS Cancer patients aged ≥65 years were assessed using a brief GA that included both professionally and patient-scored KPS and measures of comorbidity, polypharmacy, cognition, function, nutrition, and psychosocial status. Data were analyzed using descriptive statistics and multivariable logistic regression. RESULTS The sample included 984 patients: mean age was 73 years (range: 65-99 years), 74% were female, and 89% were white. GA was conducted before (23%), during (41%), or after (36%) treatment. Overall, 54% had a breast cancer diagnosis (n = 528), and 46% (n = 456) had cancers at other sites. Moreover, 81% of participants (n = 796) had both professionally and self-rated KPS ≥80, defined as functionally normal, and those patients are the focus of analysis. In this subsample, 550 (69%) had at least 1 GA-identified deficit, 222 (28%) had 1 deficit, 140 (18%) had 2 deficits, and 188 (24%) had ≥3 deficits. Specifically, 43% reported taking ≥9 medications daily, 28% had decreased social activity, 25% had ≥4 comorbidities, 23% had ≥1 impairment in instrumental activities of daily living, 18% had a Timed Up and Go time ≥14 seconds, 18% had ≥5% unintentional weight loss, and 12% had a Mental Health Index score ≤76. CONCLUSION Within this sample of older cancer patients who were rated as functionally normal by KPS, GA identified important deficits that could affect treatment tolerance and outcomes.
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Accumulation of geriatric conditions is associated with poor nutritional status in dependent older people living in the community and in nursing homes.
Hirose, T, Hasegawa, J, Izawa, S, Enoki, H, Suzuki, Y, Kuzuya, M
Geriatrics & gerontology international. 2014;(1):198-205
Abstract
AIM: To clarify the association between nutritional status and the prevalence of geriatric conditions in dependent older adults. METHODS A cross-sectional observational study of dependent older adults aged 65years or older who were living either in the community (n = 511, mean age 81.2years) or in nursing homes (n = 587, mean age 85.2years) was carried out. Data included the participants' demographic characteristics, basic activities of daily living, Charlson Comorbidity Index and the prevalence of eight geriatric conditions (visual impairment, hearing impairment, falls, bladder control problems, cognitive impairment, impaired mobility, swallowing disturbance and loss of appetite). Nutritional status was assessed by the Mini Nutritional Assessment short form (MNA-SF). RESULTS Of 1098 participants, 21.4% (n = 235) were categorized as "malnourished", according to the MNA-SF classification. Participants in the "malnourished" group had a greater number of geriatric conditions than those in the other two groups. A higher prevalence of all the geriatric conditions except for falls was detected in the group with poorer nutritional status. Multivariate logistic regression analysis showed that malnutrition was associated with the number of geriatric conditions, but not with that of comorbidities, even after controlling for confounders. CONCLUSIONS Malnutrition was confirmed to have significant associations with geriatric conditions in dependent older adults.
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Accuracy of prediction equations for serum osmolarity in frail older people with and without diabetes.
Siervo, M, Bunn, D, Prado, CM, Hooper, L
The American journal of clinical nutrition. 2014;(3):867-76
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BACKGROUND Serum osmolality is an accurate indicator of hydration status in older adults. Glucose, urea, and electrolyte concentrations are used to calculate serum osmolarity, which is an indirect estimate of serum osmolality, but which serum osmolarity equations best predict serum osmolality in the elderly is unclear. OBJECTIVE We assessed the agreement of measured serum osmolality with calculated serum osmolarity equations in older people. DESIGN Serum osmolality was measured by using freezing point depression in a cross-sectional study. Plasma glucose, urea, and electrolytes were analyzed and entered into 38 serum osmolarity-prediction equations. The Bland-Altman method was used to evaluate the agreement and differential bias between measured osmolality and calculated osmolarity. The sensitivity and specificity of the most-promising equations were examined against serum osmolality (reference standard). RESULTS A total of 186 people living in UK residential care took part in the Dehydration Recognition In our Elders study (66% women; mean ± SD age: 85.8 ± 7.9 y; with a range of cognitive and physical impairments) and were included in analyses. Forty-six percent of participants had impending or current dehydration (serum osmolality ≥295 mmol/kg). Participants with diabetes (n = 33; 18%) had higher glucose (P < 0.001) and serum osmolality (P < 0.01). Of 38 predictive equations used to calculate osmolarity, 4 equations showed reasonable agreement with measured osmolality. One [calculated osmolarity = 1.86 × (Na⁺ + K⁺) + 1.15 × glucose + urea +14; all in mmol/L] was characterized by narrower limits of agreement and the capacity to predict serum osmolality within 2% in >80% of participants, regardless of diabetes or hydration status. The equation's sensitivity (79%) and specificity (89%) for impending dehydration (≥295 mmol/kg) and current dehydration (>300 mmol/kg) (69% and 93%, respectively) were reasonable. CONCLUSIONS The assessment of a panel of equations for the prediction of serum osmolarity led to identification of one formula with a greater diagnostic performance. This equation may be used to predict hydration status in frail older people (as a first-stage screening) or to estimate hydration status in population studies. This trial was registered at the Research Register for Social Care (http://www.researchregister.org.uk) as 122273.
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A Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment predicts short- and long-term all-cause mortality in older hospitalized patients with transient ischemic attack.
Sancarlo, D, Pilotto, A, Panza, F, Copetti, M, Longo, MG, D'Ambrosio, P, D'Onofrio, G, Ferrucci, L, Pilotto, A
Journal of neurology. 2012;(4):670-8
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A multidimensional impairment may influence the clinical outcome of acute diseases in older patients. The aim of the current study was to evaluate whether a Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment (CGA) predicts short- and long-term all-cause mortality in older patients hospitalized for transient ischemic attack (TIA). In this prospective study with 1-year follow-up, 654 patients aged 65 and older with a diagnosis of TIA according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM 435.x) were enrolled. A standardized CGA that included information on functional (activities of daily living, ADL, and Instrumental ADL), cognitive status (Short Portable Mental Status Questionnaire), nutrition (Mini Nutritional Assessment), risk of pressure sores (Exton-Smith Scale), comorbidities (Cumulative Illness Rating Scale), medications and co-habitation status was used to calculate the MPI for mortality using a previously validated algorithm. Higher MPI values were significantly associated with higher 1-month all-cause mortality (incidence rates: MPI-1 low risk = 0.32%, MPI-2 moderate risk = 5.36%, MPI-3 high risk = 10.42%; p < 0.001), 6-month all-cause mortality (MPI-1 = 1.95%, MPI-2 = 9.77%, MPI-3 = 27.22%; p < 0.001) and 12-month all-cause mortality (MPI-1 = 5.19%, MPI-2 = 16.47%, MPI-3 = 44.32%; p < 0.001). Age- and gender-adjusted Cox regression analyses demonstrated that MPI was a significant predictor of all-cause mortality. MPI showed a significant high discriminatory power with an area under the receiver operating characteristics (ROC) curve of 0.819, 95% CI = 0.749-0.888 for 1-month mortality, 0.799, 95% CI = 0.738-0.861 for 6-month mortality and 0.770, 95% CI = 0.716-0.824 for 12-month mortality. The MPI, calculated from information collected in a standardized CGA, appeared to be effective in estimating short- and long-term all-cause mortality in older patients hospitalized for TIA.
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Improving nutrition care for nursing home residents using the INRx process.
Crogan, NL, Alvine, C, Pasvogel, A
Journal of nutrition for the elderly. 2006;(3-4):89-103
Abstract
The purpose of this article is to describe the Individual Nutrition Rx (INRx) assessment process and report findings on elder nutritional status, common nutrition problems identified by the INRx process, resolution outcomes from each problem, and the most efficacious approaches used to address the identified nutrition problems. The study used a two-group prospective quasi-experimental design with measures taken at baseline and at 6 months. Participants in the treatment group (n = 41) received the 6-month INRx assessment process, while residents in the comparison group (n = 40) received routine care specific to their nursing home. The most frequent nutritional problems identified were appetite change, poor positioning while eating, and problems with oral status. A total of 39 approaches were recommended by the interdisciplinary research team. Serum albumin and prealbumin, and depression scores were all significantly improved post intervention. The problems, approaches, and outcomes identified during the INRx process support the premise that interdisciplinary teams following the INRx process can assess complex nutritional problems and influence outcomes for older adults living in nursing homes.