ABSTRACT
BACKGROUND: Comprehensive Geriatric Assessment (CGA) is the gold standard to help oncologists select the best cancer treatment for their older patients. Some authors have suggested that the concept of frailty could be a more useful approach in this population. We investigated whether frailty markers are associated with treatment recommendations in an oncogeriatric clinic. METHODS: This prospective study included 70 years and older patients with solid tumors and referred for an oncogeriatric assessment. The CGA included nine domains: autonomy, comorbidities, medication, cognition, nutrition, mood, neurosensory deficits, falls, and social status. Five frailty markers were assessed (nutrition, physical activity, energy, mobility, and strength). Patients were categorized as Frail (three or more frailty markers), pre-frail (one or two frailty markers), or not-frail (no frailty marker). Treatment recommendations were classified into two categories: standard treatment with and without any changes and supportive/palliative care. Multiple logistic regression models were used to analyze factors associated with treatment recommendations. RESULTS: 217 patients, mean age 83 years (± Standard deviation (SD) 5.3), were included. In the univariate analysis, number of frailty markers, grip strength, physical activity, mobility, nutrition, energy, autonomy, depression, Eastern Cooperative Oncology Group Scale of Performance Status (ECOG-PS), and falls were significantly associated with final treatment recommendations. In the multivariate analysis, the number of frailty markers and basic Activities of Daily Living (ADL) were significantly associated with final treatment recommendations (p<0.001 and p = 0.010, respectively). CONCLUSION: Frailty markers are associated with final treatment recommendations in older cancer patients. Longitudinal studies are warranted to better determine their use in a geriatric oncology setting.
Subject(s)
Ambulatory Care Facilities , Clinical Decision-Making , Frail Elderly , Geriatric Assessment , Neoplasms/therapy , Aged, 80 and over , Biomarkers/metabolism , Female , Humans , Male , Neoplasms/metabolism , Neoplasms/physiopathology , Pilot Projects , Prospective StudiesABSTRACT
Tetanus is an acute severe disease induced by an exotoxin, often lethal. All cases occur in untreated or inadequately vaccinated patients and mainly in elderly patients who accumulate many risk factors. The current management of wounds faced difficulties in the assessment of immunization status and wound risks status. Indeed, all injuries can potentially lead to tetanus. Minor risks and chronic wounds are mainly found as tetanus cause. Vaccination remains the key element in reducing the morbidity and mortality associated with tetanus. It is estimated that the vaccine's coverage is fairly good, but decreases with age. To improve tetanus prevention, new vaccine recommendations have been established which recommend vaccine's injections at fixed age, but their impact seems to be limited especially in the elderly. The immunochromatographic tests have demonstrated cost-effectiveness in the Emergency department settings. They are currently not available outside hospital while general practionners also face a significant risk. Effectiveness of these tests should be studied in outpatients population including cost-effectiveness.
Subject(s)
Emergency Medical Services/methods , Tetanus Toxoid/administration & dosage , Tetanus/therapy , Aged , Aged, 80 and over , Female , France , Humans , Male , Middle Aged , Tetanus/economics , Tetanus/prevention & control , Vaccination , Wounds and Injuries/complications , Wounds and Injuries/therapyABSTRACT
Atrial fibrillation (AF) is the most common arrhythmia. Its prevalence increases with age and increases the risk of stroke and systemic embolism. Few data are currently available on the quality of life (QOL) of anticoagulated patients with the advent of direct oral anticoagulants (DOAC). Our study aims to describe levels of QOL in elderly patients with AF receiving oral anticoagulants and compare QOL of patients treated with vitamin K antagonists (VKA) and DOAC. This prospective study included patients of 65 years and over, receiving anticoagulants for AF (VKA or DOAC) from general practice (n=70) or cardiac practice (n=30). The patients completed a self-administered questionnaire that included demographic, geriatric data and a QOL standardized scale: the anti-clot treatment scale (ACTS) 17 items exploring two dimensions "Burdens" and "Benefits". Eighty-nine patients were enrolled: 61 were taking VKA and 28 taking DOAC. Our two groups were comparable for all demographic and clinical characteristics studied. Our patients' mean scores were 48.6±12.1 on Burdens and 9.7±3.8 on Benefits. Burdens and Benefits scores were significantly better for patients treated with DOAC compared to patients with VKA (p<0.0001 and p<0.01, respectively). Anticoagulation in the elderly should be encouraged given the high thrombotic risk of AF. No matter what kind of molecule is chosen if in accordance to good guidance. Patients treated with ACOD seem to have a better QOL, but these results should be confirmed through larger randomized studies.
Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Fibrillation/psychology , Quality of Life , Vitamin K/antagonists & inhibitors , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Female , Geriatrics , Humans , Male , Patient Satisfaction , Prospective Studies , Surveys and QuestionnairesABSTRACT
One of the missions of the Centre mobile geriatrics unit in Marseille is to ensure the orientation towards the most suitable medical services of elderly patients seen in emergency departments who require admission to hospital. This regulation is preceded by the collection of geriatric and gerontological clinical data which are transferred to the ward to which the patient is being admitted. The 1 039 patients assessed in 2011 were fragile, polypathological people requiring specific geriatric patient management.
