scholarly journals 158 Malnutrition Screening by an Interdisciplinary Integrated Care Team is an Essential Component of Comprehensive Geriatric Assessment

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Ciara Pender ◽  
Karen Sayers ◽  
Isweri Pillay ◽  
Christina Donnellan ◽  
Jennifer Maher ◽  
...  
Keyword(s):  
At Risk ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Screening Tool ◽  
Interdisciplinary Team ◽  
Female Ratio ◽  
Nutritional Interventions ◽  
Frail Patients ◽  
Patients At Risk ◽  
The Mean

Abstract Background Malnutrition plays a key role in the pathogenesis of frailty and nutritional interventions may reduce the incidence. Comprehensive Geriatric Assessment (CGA) is the gold standard in assessment once frailty has been identified. Recent Nutritional Screening Data indicated that only 20% of Irish hospitals screened 76-100% of patients. Twenty-three percent of those aged 60-79 years and 30% of those >80 years were at risk of malnutrition (Russell & Elia, 2011). This emphasises the importance of a validated malnutrition screening tool as an integral component of CGA. This study evaluates the use of the Malnutrition Screening Tool (MST) by an integrated interdisciplinary team aimed at early identification of frail patients at risk of malnutrition. Methods A prospective study of consecutive frail patients, admitted through the emergency department (ED) to an acute hospital over five months was performed. Each patient had an interdisciplinary assessment (IA) performed. The IA included a MST tool. Patients were identified as frail using the Variable Indicative of Placement (VIP). Team members, consisting of a physiotherapist, speech and language therapist and advanced nurse practitioner candidates were trained by the team dietitian to use MST. Age, gender, Clinical Frailty Score (CFS) and MST were recorded in an excel datasheet. A patient scoring ≥2 on the MST indicated risk of malnutrition and the need for Dietetic Assessment (Wu et al. 2012). Results Three-hundred and sixty CGA’s were completed by an integrated interdisciplinary team over five months. The mean age (+/-SD) was 82.4 (+/-7). The male to female ratio was 1:1. The mean CFS (+/-SD) was 5.5 (+/-1.2) (mildly to moderately frail). Ninety-two percent (n=331) were screened using the MST. Thirty-five percent (n=115) were at risk of malnutrition. Conclusion Integrated interdisciplinary team training on the MST, resulted in successful identification of 35% (n=115) of frail patients “At Risk of Malnutrition”. Identification, combined with appropriate dietetic intervention, may reverse frailty in some of these patients.

scholarly journals 262 Training and Use of the 4AT by a Multi-disciplinary Team to Screen for Delirium in the Frail Adult

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Siobhan Ryan ◽  
Eamonn Cooney ◽  
Karen Sayers ◽  
Aine O'Reilly ◽  
Jennifer Maher ◽  
...  
Keyword(s):  
At Risk ◽  
Visual Impairment ◽  
Functional Decline ◽  
Interdisciplinary Team ◽  
Interdisciplinary Teams ◽  
Community Dwelling ◽  
Patients At Risk ◽  
The Mean ◽  
The Relationship ◽  
Multi Disciplinary Team

Abstract Background Detection of delirium risk may improve outcomes. We assessed the prevalence of patients at risk of delirium assessed by a trained interdisciplinary team. Methods An interdisciplinary team: dietitian, physiotherapist and speech and language therapist was trained to use the 4AT. Community dwelling patients, identified as frail during triage in a hospital emergency department, were assessed including a 4AT, over a 2 month period. Age, gender, Clinical Frailty Score (CFS), 4AT, Modified Barthel index (mBI), polypharmacy (as defined by 5 or more medications) and presence of hearing or visual impairment were entered onto Excel. Performance of the 4AT was at the discretion of the assessor. Results 150 consecutive patients were assessed. The mean(SD) age was 83(5.1). Female to male ratio was 1.2:1. Mean(SD) CFS was 5.6(1.0). 29(19%) patients did not have a 4AT performed. 63(42%) patients had a 4AT of 1-3. 16(11%) patients had a 4AT of 4 or greater. 42(28%) had a 4AT of zero. Patients with a 4AT 4 or greater were older, mean(SD) age 86(4.2)years. Polypharmacy was present in 10(60%) patients with 4AT 4 or greater and 40(38%) with 4AT less than 4. 10(60%) of patients with 4AT 4 or greater had hearing and visual impairment. 16(15%) patients with a 4AT less than 4 had hearing and visual impairment. 10(60%) of patients with 4AT 4 or greater had a reduction in mBI. 33(31%) of patients with a 4AT less than 4 had a reduction in mBI. Conclusion Interdisciplinary teams can screen for delirium risk in ED. Frail patients at risk of delirium are older, have higher rates of polypharmacy, visual and hearing impairment and functional decline. It is possible to evaluate delirium in ED. Further work is needed to explore the relationship between the 4AT and frailty.

scholarly journals Comprehensive Geriatric Assessment in Consecutive Newly-Diagnosed Elderly Multiple Myeloma Patients in China: A Multicentered, Prospective, Non-Interventional Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5493-5493
Author(s):  
Yuan Yao ◽  
Dehui Zou ◽  
Aijun Liao ◽  
Xiaoxia Chu ◽  
Wei Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Geriatric Assessment ◽  
Real World ◽  
Comprehensive Geriatric Assessment ◽  
Newly Diagnosed ◽  
Frail Patients

Background: Multiple Myeloma (MM) is a disease of the elderly, whose prognoses are highly heterogeneous. Hence International Myeloma Working Group (IMWG) proposed geriatric assessment (GA) in 2015, including daily activity and comorbidity status, to better discriminate between fit and frail patients (Palumbo et al, 2015). However, IMWG recruited patients from clinical trials instead of real world practices. Therefore we studied GA in elderly MM patients consecutively in China, along with other perspectives which are known to be problematic in elderly population that were previously left unnoticed, such as nutrition status, risk of cognitive impairment, risk of depression, and quality of life. Aim: Our study centers on the feasibility to perform a more comprehensive geriatric assessment (cGA) in elderly MM patients, current cGA status in elderly MM patients in China, and the cGA difference between Chinese patients and patients in the IMWG study. Method: From August 2017 to April 2019, we continuously recruited 336 newly diagnosed elderly (age ≥ 65) MM patients from 21 centers in China. cGA was performed at diagnosis, after treatment cycle 1, after cycle 4, and 1 year after treatment. cGA includes physical conditions (ECOG), activities of daily living (ADL), instrumental ADL (IADL), mini-nutritional assessment (MNA-SF), geriatric depression scale (GDS), mini-mental state examination (MMSE), quality of life (SF-36) and Charlson comorbidity index (CCI). Staging was assessed at baseline (International Staging System (ISS) & Revised ISS) and hematological responses were evaluated along with each cGA timepoint. Results: We pool-analyzed data of 336 newly-diagnosed elderly MM patients. The median age was 70 (range 65-88) and 25.5% of patients were older than 75 years. 336 (100%) patients were able to complete cGA, and median assessment time was 40 minutes (range 20-70). Upon diagnosis, only 34% and 37.5% of patients had full ADL and IADL respectively. 38.5% of patients had moderate to high risk of depression (GDS ≥ 6). 13.2% of patients were malnourished (MNA-SF ≤ 7), while 46.3% of patients were at risk of malnutrition (8 ≤ MNA-SF ≤ 11). 41% of patients had at least one comorbidity (CCI ≥ 1). 45.7% of patients had moderate to intermediate risk of cognitive impairment (MMSE ≤ 26). Grouping by IMWG-GA index, our study identified 59.9% patients in frail group (vs 39% in IMWG study), 15.8% in intermediate (vs 31% in IMWG) and 24.3% in fit (vs 30% in IMWG). 69% of patients received proteasome inhibitor-containing regimens and 20.7% of patients received lenalidomide-containing regimens. Best hematological responses in fit and intermediate groups were better than responses in frail group (≥ PR rate: 88.5% in fit, 94.4% in intermediate vs 77.5% in frail). Median follow up time was 10 months. To date, 215 (64%) patients have finished the cGA after cycle 1; 164 (48.8%) patients have finished the cGA after cycle 4; 91 (27.1%) patients has finished all 4 planned cGA and improvements in cGA were observed in the majority of these patients. Conclusion: Our study showed significant CGA heterogeneity in elderly MM patients. Even in the IMWG-GA "fit" group, nutrition, depression and cognitive impairment remain problems. Frail patients took up a larger proportion in Chinese elderly MM patients compared to IMWG study. Our study strongly justifies the necessity for cGA in elderly patients with MM, more so in the real world MM patients than in the clinical trials. Disclosures No relevant conflicts of interest to declare.

G8 as a screening tool for comprehensive geriatric assessment in patients with breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24010-e24010
Author(s):  
Rocio Grajales ◽  
Alicia Gutierrez Mata ◽  
José Enrique Martínez Hernández ◽  
Alejandro Zavala-Calderon
Keyword(s):  
Breast Cancer ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Screening Tool ◽  
Statistical Significance ◽  
Clinical Stage ◽  
Disease Free Survival ◽  
Rank Test ◽  
Spearman Correlation ◽  
Geriatric Screening

e24010 Background: G8 is a geriatric screening tool designed to identify elderly cancer patients who benefit from a comprehensive geriatric assessment (CGA). Despite the increase in the incidence of cancer in the geriatric patients, there is absence of trials targeting this population. Decisions are often made based on their age and ECOG/Karnofsky scales, which does not reflect the actual role of an elderly patient. It is necessary to identify patients who require a CGA for an accurate evaluation and optimal oncological management. The routine implementation of the G8 geriatric screening tool in the oncology consultation consumes little time and is useful for timely referral of vulnerable patients to specialized care, in order to generate a positive impact on oncological therapy decision-making, improving their outcomes. Our main objective was to determine, using the geriatric screening tool G8, the percentage of patients aged >65 years with breast cancer, which require a CGA. Methods: The G8 questionnaire was applied to patients >65 yo with a diagnosis of breast cancer from December 2019 to May 2020. The baseline characteristics were prospectively collected and included clinical and demographic characteristics. The prognostic value of the functional status of the ECOG was evaluated and compared with that obtained from the G8. The difference between groups was assessed using Pearson's chi square with Yates correction. Additional scores were calculated using the Kaplan-Meier method and compared between groups using the log rank test. The hazard ratio with a 95% confidence interval was estimated using a Cox proportional hazards analysis, considering an abnormal G8 score as an exposure variable. Spearman correlation was made between age and the G8 score obtained. SPSS v22 software (IBM, USA) was used for all analyzes. Results: From December 2019 to May 2020, 357 patients were recruited. The mean age was 73.57 years (SD+7.02 y). The most frequent clinical stage was IIA (27.7%), followed by I (21.8%). 74.2% had an ECOG 1. Regarding treatment, 317 patients (88.8%) were on hormone therapy. The percentage of patients requiring a CGA was 44.3% (n = 158), of which only 55.1% (n = 87) were performed. We found no significant association between the requirement of CGA and clinical stage (p = 0.27) or treatment received (p = 0.345); but according to the ECOG, we obtained statistical significance p < 0.0001. Spearman correlation was performed between age and the G8 score, a correlation of 0.422 was obtained with p < 0.0001.The most affected domains of G8 were polypharmacy (51%) and ingestion (28.3%). Disease-free survival analysis was performed, without finding differences between vulnerable-frail and healthy patients. Conclusions: The G8 is a tool that allows to discern which patients require a CGA, in order to carry out interventions to improve comprehensive cancer treatment, so it should be implemented routinely in the oncology consultation.

scholarly journals Malnutrition and cachexia among cancer out-patients in Nairobi, Kenya

2017 ◽  
Vol 6 ◽  
Author(s):  
L. U. Kaduka ◽  
Z. N. Bukania ◽  
Y. Opanga ◽  
R. Mutisya ◽  
A. Korir ◽  
...  
Keyword(s):  
At Risk ◽  
Screening Tool ◽  
Point Of Care ◽  
Cross Sectional Study ◽  
Fat Free Mass ◽  
Assessment Tools ◽  
Correct Identification ◽  
Cross Sectional ◽  
Cancer Management ◽  
Patients At Risk

AbstractCancer is the third leading cause of death in Kenya. However, there is scarce information on the nutritional status of cancer patients to guide in decision making. The present study sought to assess the risk of malnutrition, and factors associated with malnutrition and cachexia, among cancer out-patients, with the aim of informing nutrition programmes for cancer management in Kenya and beyond. This was a facility-based cross-sectional study performed at Kenyatta National Hospital and Texas Cancer Centre in Nairobi, Kenya. The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool (MUST). Diagnoses of malnutrition and cachexia were done using the European Society of Clinical Nutrition and Metabolism (ESPEN) and Fearon criteria, respectively. A total of 512 participants were assessed. Those at risk of malnutrition were 33·1 % (12·5 % at medium risk, 20·6 % at high risk). Prevalence of malnutrition was 13·4 %. The overall weight loss >5 % over 3 months was 18·2 % and low fat-free mass index was 43·1 %. Prevalence of cachexia was 14·1 % compared with 8·5 % obtained using the local criteria. Only 18·6 % participants had received any form of nutrition services. Age was a predictor of malnutrition and cachexia in addition to site of cancer for malnutrition and cigarette smoking for cachexia. The use of the MUST as a screening tool at the first point of care should be explored. The predictive value of current nutrition assessment tools, and the local diagnostic criteria for malnutrition and cachexia should be reassessed to inform the development of appropriate clinical guidelines and future capacity-building initiatives that will ensure the correct identification of patients at risk for timely care.

scholarly journals Comprehensive Geriatric Assessment in the Emergency Department for Identifying Elderly Individuals at Risk of Hip Fracture

2021 ◽  
Author(s):  
Pei-Ying Lin ◽  
Hsien-Hao Huang ◽  
David Hung-Tsang Yen
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Hip Fracture ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Handgrip Strength ◽  
Elderly Individuals ◽  
Female Sex ◽  
Asian Patients ◽  
Increased Risk

Abstract Background Hip fracture (HF) is a major challenge for healthcare systems in terms of increased costs and lengths of stay, and it has been estimated that by 2050, half of the projected 6.26 million global HFs will occur in Asia. Owing to the high morbidity and mortality associated with HF in elderly individuals, it is crucial to recognize at-risk elderly patients in the ED so that special precautions and preventive measures can be taken. While comprehensive geriatric assessment (CGA) has been shown to improve outcomes and prevent secondary fractures in elderly individuals with HF in outpatient settings, there is a lack of data to support the use of CGA in the emergency department (ED) to identify elderly Asian patients who are at risk of HF. Aim To identify the characteristics of elderly Asian patients in the ED who have an increased risk of HF via CGA. Methods A case-control study was conducted in the ED at Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from October 2018 to December 2019. Patients ≥75 years old with and without HF were compared using data obtained from CGAs conducted by trained nurses. Results A total of 85 HF patients (cases) and 680 non-HF patients were enrolled, among whom 85 non-HF control individuals (controls) were selected by simple random sampling. HF occurred more frequently in women and in patients with depressive symptoms. An association between decreased handgrip strength and HF risk, especially in men, was also identified (P < 0.001). The variables independently associated with the presence of HF in the multivariate analysis were female sex (odds ratio (OR) = 2.937; 95% CI = 1.519-5.677) and decreased handgrip strength (OR = 3.739; 95% CI = 1.641-8.519). Conclusions By performing CGAs in the ED, we found that female sex and decreased handgrip strength were associated with HF risk. Therefore, we propose that targeted assessment of handgrip strength in female patients aged ≥75 years in the ED may identify those at greatest risk of HF, resulting in improved emergency care for geriatric patients.

scholarly journals The Brief Gah Scale (Geriatric Assessment in Hematology) Correlates Well with a Comprehensive Geriatric Assessment in Patients with Hematologic Malignancies

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4753-4753
Author(s):  
Raul Cordoba ◽  
Ana-Isabel Hormigo ◽  
Javier Martinez-Peromingo ◽  
Maria Jarana ◽  
Marta Perez-Albacete ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Roc Curve ◽  
Comprehensive Geriatric Assessment ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Well Being ◽  
Hematologic Malignancies ◽  
Frail Patients

Abstract Introduction The comprehensive geriatric assessment (CGA) in older patients with cancer is the gold standard to identify robust, frail or poor prognosis patients according Balducci classification. In Spain, a new proposal of a specific Geriatric Assessment in Hematology (GAH) scale has been designed and validated in patients with hematologic malignancies such as MDS/AML, multiple myeloma and CLL. The GAH scale has not been explored in patients with lymphoma. In this study, we have analyzed the utility of using the GAH scales in patients with hematologic malignancies, mostly lymphoma patients. Patients and methods. From March 2016 and September 2017, patients with hematologic malignancies were prospectively referred to the Geriatric Oncology clinic after a frailty screening test using G8 scale and with score <14 points. All patients were assessed with CIRS-G and GAH scales performed by the oncology nurses and a comprehensive geriatric assessment performed by the geriatrician. Results Of the 96 patients referred aged 70 years or over, 41 were males (42.7%) and 55 females (57.3%), the median age was 79 years (range, 70-89), and with the diagnosis of lymphoma in 53 patients (55.2%), multiple myeloma in 23 patients (24.0%), CLL in 13 patients (13.6%), MDS/AML in 5 patients (5.2%) and CML in 2 patients (2.0%). Seventy-five patients (78.1%) had good performance status with ECOG score 0-1. Regarding frailty, 20 patients (20.8%) had a score of 15 points or over at G8 scale and 76 patients (79.2%) were identified as frail because of a score of 14 points or below. Regarding comorbidities, the median CIRS-G score was 9 (range, 4-20). After the GAH scale assessment, the median number of domains affected in robust patients was 2 (1-4) and in frail patients was 4 (3-5) (p=0.0001). In the ROC curve, with an AUC of 0.7595 and a likelyhood ratio of 9, the cut-off in this series was 2 domains with impairment, with a sentivity of 13.79% and a specificity of 92.5% (p= 0.0003). Using a correlation factor for each domain, the mean score at GAH scale in robust patients was 26 points and in frail patients was 42.5 points (p=0.0038). In the ROC curve, with an area under the curve of 0.7026 and a likelihood ratio of 2.04, the cut-off value to identify robust vs frail patients was 33 points in the GAH scale, with a sensitivity of 77.5% and a specificity of 62.07% (p=0.0043). Analyzing the eight domains explored in the GAH scale, robust patients according CGA had less risk of polypharmacy of 31.25% vs 81.48% in frail patients (OR 0.1033, 95% CI 0.0472-0.2541) (p<0.0001), less gate speed/FAC impairment of 16.66% vs 81.48% (OR 0.04545, 95% CI 0.0183-0.1313) (p<0.0001), less ADL impairment 37.5% vs 85.19% (OR 0.1043, 95% CI 0.0398-0.2684) (p<0.0001), less mood impairment in 4.17% vs 40.74% in frail patients (OR 0.06324, 95% CI 0.01421-0.2498) (p<0.0001), less mental health impairments in 2.08% vs 22.22% in frail patients (OR 0.0744, 95% CI 0.0068-0.4531) (p=0.0023), less comorbidities in 2.08% vs 42.59% (OR 0.0286, 95% CI 0.0027-0.1817) (p<0.0001), less malnutrition in 10.42% vs 37.04% (OR 0.1977, 95% CI 0.0759-0.5495) (p=0.0024), and less poor self-reported well-being in 6.25% vs 66.67% (OR 0.0333, 95% CI 0.0101-0.1187) (p<0.0001). The median overall survival for patients with 3 or less domains impaired was not reached vs 90.77 months in those patients with 4-8 domains impaired (Log-rank test, p=0.0003), with HR (Log-rank) of 0.11 (95% CI, 0.04474-0.2846). Mean G8 score were similar between robust (11.68) and frail (11.04) patients (p=n.s.) among all patients with score below 14 points. Robust patients had less comorbidities according to CIRS-G scale, with a median of 9 vs 11 points (p=0.0001). There was correlation between CIRS-G and ECOG with G8 score, not found in previous studies. There is a correlation between the brief comorbidity assessment in the GAH scale with CIRS-G score. Among patients identified as not having comorbidities, the median CIRS-G score was 9 vs 13.5 among patients with comorbidities according the GAH scale (p<0.0001). Conclusions. The GAH scale is a valid tool for patients with hematologic malignancies, including patients with lymphoma, in order to classify patients according frailty phenotype. All domains explored in GAH scale were impaired with higher frequency in frail patients. Robust patients had less comorbidities and better performance status. The brief comorbidities assessment in the GAH scale correlates well with the CIRS-G. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

scholarly journals P131: Emergency department falls risk management screening tool comparison

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S121-S122
Author(s):  
R. Tomlinson ◽  
T. Yokota ◽  
P. Jaggi ◽  
C. Kilburn ◽  
D. Bakken ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Risk Management ◽  
Fall Risk ◽  
Screening Tool ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Screening Tools ◽  
Procedural Sedation ◽  
Patients At Risk

Introduction: Emergency Department (ED) fall risk screening has been newly implemented in Alberta based on Accreditation Canada requirements. Two existing inpatient tools failed to include certain ED risk conditions. One tool graded unconsciousness as no risk for falling, and neither considered intoxication or sedation. This led to the development of a new fall risk management screening tool, the FRM (Tool1). This study compared Tool1 with inpatient utilized Schmid Fall Risk Assessment Tool (Tool2) and the validated Hendrich II Fall Risk Model (Tool3). Methods: Patients (≥17 years old) in a tertiary care adult ED with any of the following; history of falling in the last 12 months, elderly/frail, incontinence, impaired gait, mobility assist device, confusion/disorientation, procedural sedation, intoxication/sedated, or unconscious were included. Forms were randomized to score patients using different paired screening tools: Tool1 paired with either Tool2 or Tool3. Percent agreement (PA) between the tools based on identification of a patient at either risk/no risk for falling; higher PA indicating more tool homogeneity. Results: A total of 928 screening forms were completed within our 8-week study period; 452 and 443 comparing Tool1 to Tool2 and Tool1 to Tool3, respectively. Thirty-two forms included only Tool1 scores, excluding them from comparative analysis. The average patient age (n=895) was 64.8±21.4 years. Tool1 identified 66.4% of patients at risk, whereas Tool2 and Tool3 identified only 19.2% and 31.4%, respectively. Tool1 and 2 had a PA of 50.2%, whereas Tool1 and Tool3 had a PA of 65.9%. Conclusion: The FRM tool had higher agreement with the validated assessment tool, identifying patients at risk for falling but better identified patients presenting with intoxication, need for procedural sedation and unconsciousness. The other tools generally miss these common ED conditions, putting these patients at risk. Validation and reliability assessments of the FRM tool are warranted.

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