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PubMed2005

Evaluation of the effectiveness of treatment with erythropoietin on anemia, cognitive functioning and functions studied by comprehensive geriatric assessment in elderly cancer patients with anemia related to cancer chemotherapy.

The primary aim of the present study was to examine the relationship of changes in hemoglobin levels following recombinant human erythropoietin (rHuEPO) treatment to changes in cognitive functioning studied by Mini Mental State Examination (MMSE) in elderly cancer patients undergoing chemotherapy treatment. The secondary aim was that to assess the relationship of changes in hemoglobin levels following rHuEPO treatment to changes in functions studied by Comprehensive Geriatic Assessment (CGA), such as Activity of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Geriatric Depression Scale (GDS) and the Mini Nutritional Assessment (MNA). To this end, hemoglobin levels and cognitive functioning were evaluated in a sample of cancer patients prior to the start of chemotherapy treatment and again after 4, 8 and 12 weeks of treatment with chemotherapy plus rHuEPO. Ten elderly patients (mean age 71.4 years) were enrolled. At baseline, enrolled patients had a mean Hb value of 10.3g/dl. After 4 weeks of rHuEPO treatment, Hb values increased significantly (p<0.0001), with a mean increase of 1.2g/dl (range: 0.2-2.1). Remarkably, 8 out of 10 (80%) showed an increase of Hb levels >or=1g/dl in comparison to baseline and therefore were considered responders. At baseline, four patients (40%) showed a moderate cognitive impairment, whilst six patients (60%) showed a normal cognitive function. After 4 weeks of rHuEPO treatment nine patients (90%) showed a significant improvement of cognitive functions in comparison to baseline (p<0.005): eight of them were responders also to rHuEPO in terms of correction of anemia. The Spearman's rank correlation test showed a statistical significant correlation between Hb increase and increase in cognitive functioning assessed by MMSE after 4 weeks (p=0.049), 8 weeks (p=0.044) and 12 weeks (p=0.031) of rHuEPO treatment. Therefore, the findings of this study provide support for the hypothesis that significant increases in hemoglobin over the course of chemotherapy supplemented with rHuEPO administration would be accompanied by significant improvement in cognitive performance over the same interval.

Aged↗
PubMed2005

Incremental geriatric assessment.

Older adults value (1) independence and the ability to make their own decisions, (2) mobility (the ability to travel outside or simply inside the home), (3) family and friends and the time spent with those persons who are important to them, (4) ethnicity, religion, and spirituality, and (5) home, wherever that might be. The importance of recognizing each person's individuality cannot be overemphasized. The method of incremental assessment presented in this article and summarized in Box 9 is intended to provide the office-based clinician with sufficient information to make decisions regarding the preventive, therapeutic, rehabilitative, and supportive goals of care. IADL and nutritional triggers are used to identify early signs of dysfunction in the home environment. The strengths and weaknesses of cognitive, physical, psychosocial, and spiritual aspects of function are examined in an incremental manner. Health care providers determine whether there is a match between the person's functional capabilities, the available support network, and the home environment. The approach prompts appropriate use of services needed by older adults who are either at risk for becoming, or already are, chronically ill, disabled, and functionally dependent. Use of validated assessment tools provides structure for the assessment process, helps assure consistency, and provides a mechanism for periodic re-evaluation. The assessment approaches also foster a common language for the health care team and consist of measurable parameters that can be used to monitor outcomes. The clinician should be flexible and realize that the assessment or the tools may need to be modified depending on the circumstances.

Activities of Daily Living↗
PubMed1989

Geriatric assessment--an Australian idea.

Residential care provision for elderly people varies from country to country as well as from state to state within Australia, yet despite this a universal feature of all countries is community pressure for increased provision of both nursing home and hostel accommodation. Australia has developed the concept of multidisciplinary assessment of elderly people requesting residential care. This paper describes the effectiveness of one assessment team in the south of Tasmania in reducing demand for residential accommodation and in improving outcomes for the clients referred to the team.

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PubMed1997

Elderly care. A pilot project on opportunistic geriatric assessments in general practice.

OBJECTIVES: To develop a pilot program for systematic assessment of functional status of the elderly in general practice. METHOD: The program was developed in consultation with local GPs and aged care services and introduced to GPs at a workshop. The program was piloted for seven general practitioners with 41 patients, 70 years or older. RESULTS: While many problems had been previously identified by GPs additional problems with: home and social life; activities of daily living and mobility; cognition and depression; general health and medication problems were found in up to 2.5% of patients. CONCLUSION: Opportunistic health assessment of the elderly in general practice is practical and useful in detecting health problems.

Activities of Daily Living↗
PubMed1993

Effects of cognitive impairment on the reliability of geriatric assessments in nursing homes.

OBJECTIVE: To explore the relationship between an elderly subject's cognitive status and the reliability of multidimensional assessment data. DESIGN: Survey, with cognitive status as the independent variable and interrater reliability as dependent variable. SETTING: Medicare/Medicaid-certified nursing homes. PARTICIPANTS: 147 residents age 65 or older. MEASUREMENTS: Dual assessments of elderly nursing home residents were performed by nurse assessors using the Health Care Financing Administration's new Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS). Assessments were classified on the basis of residents' cognitive status, and levels of disagreement between assessors were analyzed. MAIN RESULTS: Overall assessment reliability, agreement concerning a resident's activities of daily living status, and the reliability of estimates of his or her communication skills and sensory abilities were significantly affected by a resident's cognitive status. The presence of cognitive impairment made these measurements less reliable--especially those related to communication skills, vision, and hearing. CONCLUSIONS: Assessments of residents suffering from cognitive impairment were significantly less reliable than assessments of cognitively intact residents. However, these differences in reliability were not uniform across all assessment domains. When treating the cognitively impaired elderly, clinicians must exercise caution in their reliance on standardized measurements that may be less reliable for this population.

Activities of Daily Living↗
PubMed1995

Geriatric assessment in the diagnosis and treatment of elder abuse.

With the growing problem of elder abuse, it is imperative that physicians become aware of the warning signs of elder abuse. In addition, physicians must be knowledgeable in the diagnosis and treatment of elder abuse. Educated physicians can help to alleviate this problem.

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PubMed2006

The abbreviated comprehensive geriatric assessment (aCGA) for use in the older cancer patient as a prescreen: scoring and interpretation.

UNLABELLED: The abbreviated CGA (aCGA) can be used as a prescreening assessment to identify patients who would most benefit from the complete CGA. OBJECTIVE: To develop cutpoints for scoring the aCGA that are consistent with existing limitations as revealed by the full CGA. DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on cancer patients 70 and over. MEASUREMENTS: Each of the four domains: functional status (activities of daily living (ADL), instrumental activities of daily living (IADL), depression, using the geriatric depression scale (GDS), and cognition using the mini-mental state examination (MMSE)) are scored separately. RESULTS: For the depression domain, a score of 2 or more toward depression indicates that the entire GDS be administered. For the MMSE, a score of 6 or lower indicates necessity of the entire MMSE. For the ADL/IADL, any deficit on either scale (needs assistance or complete assistance) requires further clinical evaluation using the entire instruments. CONCLUSIONS: These guidelines provide the clinician with parameters to target patients most likely to benefit from more intensive geriatric evaluation.

Activities of Daily Living↗
PubMed2006

The Tinetti test: Babylon in geriatric assessment.

The Tinetti test has been recommended and widely used in the elderly to assess mobility, balance and gait, and predict falls. Different versions can be found. A systematic literature search identified 37 publications on the Tinetti test and falls. Wide variations were found concerning name of the instrument, test items, scoring, and cut-off values. This heterogeneity interferes with evaluations of the test's validity, reliability and generalisability. Researcher and clinicians should be aware of this fact, when dealing with the Tinetti test.

Accidental Falls↗
PubMed2000

Focus on function in geriatric assessment and rehab.

In 1994, the province of Alberta, driven by the need for deficit reduction, began a major restructuring of the provincial health care system. An integral component of this new health structure was accountability for service delivery, including the use of outcome measures to determine service effectiveness. This paper describes the efforts of one program to evaluate the effectiveness of its service delivery, in terms of functional patient outcomes, in the midst of restructuring and budget constraints.

Activities of Daily Living↗
PubMed2003

[Falls in institutionalized elderly subjects. Features and geriatric assessment].

BACKGROUND: Falls are an important cause of disability and mortality among elderly subjects. AIM: To study the features and incidence of falls in institutionalized elderly subjects. PATIENTS AND METHODS: Prospective recording of all falls, occurring in a period of eight months, to 453 subjects older than 60 years, living a home for the elderly. Evaluation of functional status of subjects suffering falls, using the Spanish Red Cross score. One hundred and two subjects living in the same place, but not suffering falls, were considered as controls. RESULTS: One hundred and three subjects, aged 80 +/- 6 years (24% of the sample) suffered falls. Most falls were during the day and while walking. Seventy percent of subjects suffering falls did not have a history of previous falls. Nine percent of those falling, suffered a fracture. Compared to controls, falling subjects had a more deteriorated functional and mental status and consumed more benzodiazepines and neuroleptics. CONCLUSIONS: There is an association between functional status and psychotropic medication consumption and the incidence of falls in institutionalized elderly subjects.

Accidental Falls↗