Loneliness in older adults living with cancer: A scoping review of the quantitative and qualitative evidence on behalf of the International Society of Geriatric Oncology Nursing and Allied Health Interest Group.

INTRODUCTION: Loneliness is common in older adults. Cancer and its treatments can heighten loneliness and result in poor outcomes. However, little is known about loneliness in older adults with cancer. Our objective was to provide an overview of the prevalence of loneliness, contributing factors, evolution during the cancer trajectory, impact on treatment, and interventions to reduce loneliness. MATERIALS AND METHODS: We conducted a scoping review including studies on loneliness in adults with cancer aged ≥65. Original, published studies of any designs (excluding case reports) were included. A two-step screening process was performed. RESULTS: Out of 8,720 references, 19 studies (11 quantitative, 6 qualitative, 2 mixed-methods), mostly from the United States, Netherlands, and/or Belgium, and most published from 2010, were included. Loneliness was assessed by the De Jong Gierveld Loneliness Scale, and the UCLA loneliness scale. Up to 50% of older adults felt lonely. Depression and anxiety were often correlated with loneliness. Loneliness may increase over the first 6-12 months during treatment. One study assessed the feasibility of an intervention aiming at reducing primarily depression and anxiety and secondarily, loneliness in patients with cancer aged ≥70 after five 45-min sessions with a mental health professional. No studies investigated the impact of loneliness on cancer care and health outcomes. DISCUSSION: This review documents the scarcity of literature on loneliness in older adults with cancer. The negative impacts of loneliness on health in the general population are well known; a better understanding of the magnitude and impact of loneliness in older adults with cancer is urgently warranted.

A scoping review of ageism towards older adults in cancer care.

INTRODUCTION: Ageism towards older adults with cancer may impact treatment decisions, healthcare interactions, and shape health/psychosocial outcomes. The purpose of this review is twofold: (1) To synthesize the literature on ageism towards older adults with cancer in oncology and (2) To identify interventions that address ageism in the healthcare context applicable to oncology. MATERIALS AND METHODS: We conducted a scoping review following Arksey and O'Malley and Levac methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted an exhaustive multi-database search, screening 30,926 titles/abstracts. Following data abstraction, we conducted tabular, narrative, and textual synthesis. RESULTS: We extracted data on 133 papers. Most (n = 44) were expert opinions, reviews, and letters to editors highlighting the negative impacts of ageism, expressing the need for approaches addressing heterogeneity of older adults, and calling for increased clinical trial inclusion for older adults. Qualitative studies (n = 3) described healthcare professionals' perceived influence of age on treatment recommendations, whereas quantitative studies (n = 32) were inconclusive as to whether age-related bias impacted treatment recommendations/outcomes or survival. Intervention studies (n = 54) targeted ageism in pre/post-licensure healthcare professionals and reported participants' improvement in knowledge and/or attitudes towards older adults. No interventions were found that had been implemented in oncology. DISCUSSION: Concerns relating to ageism in cancer care are consistently described in the literature. Interventions exist to address ageism; however, none have been developed or tested in oncology settings. Addressing ageism in oncology will require integration of geriatric knowledge/interventions to address conscious and unconscious ageist attitudes impacting care and outcomes. Interventions hold promise if tailored for cancer care settings. 249/250.

International trends in cancer incidence in middle-aged and older adults in 44 countries.

OBJECTIVE: We examine international incidence trends of lung, colorectal, prostate, and breast cancers, as well as all cancers combined excluding non-melanoma skin cancer (NMSC) in adults aged 50 and older, over a fifteen-year period using data from 113 high quality population-based cancer registries included in the Cancer in Five Continents (CI5) series and NORDCAN. MATERIALS AND METHODS: We calculated annual incidence rates between 1998 and 2012 for ages 50-64, 65-74, and 75+, by sex and both sexes combined. We estimated average annual percentage change (AAPC) in rates using quasi-Poisson regression models. RESULTS: From 1998 to 2012, incidence trends for all cancers (excluding NMSC) have increased in most countries across all age groups, with the greatest increase observed in adults aged 75+ in Ecuador (AAPC = +3%). Colorectal cancer incidence rates increased in the majority of countries, across all age groups. Lung cancer rates among females have increased but decreased for males. Prostate cancer rates have sharply increased in men aged 50-64 with AAPC between 5% and 15% in 24 countries, while decreasing in the 75+ age group in 21 countries, by up to -7% in Bahrain. Female breast cancer rates have increased across all age groups in most countries, especially in the 65-74 age group and in Asia with AAPC increasing to 7% in the Republic of Korea. CONCLUSIONS: These findings assist with anticipating changing patterns and needs internationally. Due to the specific needs of older patients, it is urgent that cancer systems adapt to address their growing number.

Terapia ocupacional y paciente crítico / Occupational therapy and critical ill patients

El presente estudio fue realizado en la Unidad de Pacientes Críticos adultos, del Hospital Clínico de la Pontificia Universidad Católica de Chile (UPC-HCPUC), durante el año 2012, donde se exploraron las características del paciente crítico, para obtener un perfil de salud global durante su estadía en la UPC, con el fin de determinar si sería posible realizar una intervención desde la Terapia Ocupacional que fuese un aporte a esta unidad.Se realizó un estudio prospectivo, observacional en la UPC médico quirúrgica durante 25 días. Los resultados obtenidos permitieron caracterizar al paciente crítico de esta unidad, como un sujeto con alta probabilidad de presentar compromiso de conciencia, edema en mano, limitación de rango de movimiento articular (ROM) en muñeca y dedos, y carencia de estímulos que evoquen su realidad previa a la hospitalización. Finalmente, a partir del análisis del perfil del paciente crítico de la UPC HCPUC y del contexto al que se encuentra expuesto, se concluye que la intervención temprana de Terapia Ocupacional podría disminuir y prevenir la aparición de algunos signos asociados al paciente crítico, comprobándose la hipótesis, que dadas las características de este paciente, sería posible realizar una intervención desde la Terapia Ocupacional.

This study was conducted in The Unit Critics adult patients, Clinical Hospital of the Catholic University of Chile (UPC HCPUC), in 2012, where the characteristics of critical patients were explored to obtain a profile of global health while in the UPC, in order to determine whether it would be possible to make an intervention from occupational therapy to be a contribution to this unit.A prospective, observational study in medical UPC-surgery for 25 days. The results allowed to characterize critical patients of this unit, as a subject with high probability of impairment of consciousness, edema in hand, limitation of joint range of motion (ROM) in the wrist and fingers, and lack of stimuli that evoke your reality prior to hospitalization.Finally, from the analysis of the profile of critical patient - HCPUC UPC and the context to which it is exposed, it is concluded that early intervention occupational therapy could reduce and prevent the appearance of certain signs associated with critical patient, checking hypothesized that given the characteristics of this patient, it would be an intervention from Occupational Therapy.

Percepciones de personas mayores sobre su desempeño en el uso de transporte público en Santiago de Chile / Perceptions of older people on their performance in the use of public transportation in Santiago, Chile

Justificación: la movilidad en la comunidad es esencial en la vida de toda persona. El uso de transporte es una actividad instrumental que posibilita la movilidad en la comunidad. En la vejez esta actividad puede presentar características asociables al envejecimiento individual, la actividad misma, y el ambiente. Emerge la relevancia de conocer esta ocupación en las personas mayores chilenas y su implicancia para la terapia ocupacional como disciplina promotora de participación y autonomía en la vejez. Objetivo: se buscó explorar características del desempeño de un grupo de personas mayores en el uso transporte en Santiago a partir de sus experiencias y percepciones. Metodología: se realizó diez entrevistas a adultos mayores que luego fueron analizadas con un enfoque interpretativo – hermenéutico. Resultados: cinco temas principales emergieron del análisis de entrevistas: “función del uso del transporte público”, “adaptaciones preparatorias para un mejor desempeño”, “influencia del ambiente”, “¿bus o metro? razones para la elección” y “significado del uso: autonomía versus exclusión”. Conclusiones: en el grupo participante el uso del transporte se veía limitado por el ambiente físico, y facilitado por el ambiente social, y las personas desplegaban estrategias adaptativas para un mejor desempeño. El significado del uso de transporte se relacionó con la mantención de la autonomía y la identidad. El sistema de transporte en Santiago puede no ajustarse a las necesidades de la población mayor y puede percibirse como un elemento de exclusión social para las personas mayores.

Justification: community mobility is essential for daily living. The use of transportation is an instrumental activity of daily living that facilitates community mobility. In the elderly this activity may be conditioned by features related to the aging process, the activity itself, and the environment in which it is carried out. The importance of learning about the characteristics of this occupation in Chilean older people emerges as well as implications for occupational therapy as a promoter of social participation and autonomy in old age. Objective: to explore performance characteristics of a group of older people in the use of public transportation system in the city of Santiago. Methods: ten interviews were conducted to older adults. Interviews were later interpretively analyzed from a hermeneutic approach. Results: five main themes emerged from the speeches of the participants, "function of the use of public transportation", "preparatory adaptations for better performance," "environmental influence", "bus or subway? Reasons for this choice" and "meaning of the use of transport: autonomy versus exclusion." Conclusions: in the group of participants the use of transport is interfered by the physical environment, and facilitated by the social environment, and adaptive strategies are deployed. The meaning of the activity relates to the maintenance of autonomy and identity. The transport system in Santiago may not fit the needs of older people and may be perceived as an element of social exclusion in the elderly.

Definición y desarrollo del concepto de ocupación: ensayo sobre la experiencia de construcción teórica desde una identidad local / Concept of occupation: definition and development: essay about an experience of theoretical construction from a local ident

En el proceso de construcción teórica, al que se ha dedicado el Comité de Ciencia de la Ocupación, se ha hecho necesaria una aproximación a conceptos, ya definidos por la Ciencia Ocupacional con una visión que provea identidad al grupo de investigadores, por sobre los elementos de universalidad que se han usado previamente. Si bien todo proceso de generación de conocimiento debe considerar la investigación, este comité comenzó su trabajo de desarrollo teórico a través de una construcción colectiva, basada en lectura y análisis profundo. El presente ensayo refleja ese proceso colectivo.

In the process of theoretical construction, on which the Committee of Occupational Science (of the School of Occupational Therapy of University of Chile) has been devoted, it was needed an approach to concepts, already defined by Occupational Science, from a view that provides identity to this recent group of study and research. Even though generation of knowledge requires research, this committee began its work of theoretical development through a collective construction; reading and discussion based. The present essay reflects that collective process, and the authors took the task of giving to it the written form.