Geriatric Syndromes and Geriatric Assessment for the Generalist

Carlson, Charlotte M.; Merel, Susan E.; Yukawa, Michi

doi:10.1016/j.mcna.2014.11.003

Cited by 63 publications

(44 citation statements)

References 59 publications

(67 reference statements)

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“…With regard to clinical practice, the findings call for the use of such instruments as the Comprehensive Geriatric Assessment to evaluate the health status and clinical presentation of older individuals in a way that makes it possible to identify subgroups of older adults that are most vulnerable to experience adverse outcomes, [22][23][24][25] especially when making clinical decisions. For example, our findings document the importance of visual impairment in predicting health outcomes, and yet this condition has been mostly ignored in the literature.…”

Section: Discussionmentioning

confidence: 99%

Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes

et al. 2016

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BACKGROUND:The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health. OBJECTIVE: We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50 years of age or older (n=16,640). MAIN MEASURES: Outcomes were: Self-reported fair/poor health, self-rated worse health at 2 years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes. KEY RESULTS: Twenty-nine percent and 23 % of respondents reported fair/poor health and self-rated worse health at 2 years, respectively, and 5 % died in 2 years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80 %); b) for selfrated worse health at 2 years: 68.5 years of age or older, difficulty walking several blocks and being in fair/poor health (60 %); and c) for 2-year mortality: 80.5 years of age or older, and presenting with limitations in both ADLs and IADLs (> 40 %). CONCLUSIONS: Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.

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Section: Discussionmentioning

confidence: 99%

Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes

et al. 2016

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“…These findings support the need to evaluate not only the number but the impact of specific comorbid conditions on older oncology patients’ functional status as part of a comprehensive geriatric assessment. 51–53 …”

Section: Discussionmentioning

confidence: 99%

Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy

Miaskowski

Wong

Cooper

et al. 2017

Journal of Pain and Symptom Management

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Context While physical function is an important patient outcome, little is known about changes in physical function in older adults receiving chemotherapy (CTX). Objectives Identify subgroups of older patients based on changes in their level of physical function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality of life (QOL) outcomes. Methods Latent profile analysis (LPA) was used to identify groups of older oncology patients (n=363) with distinct physical function profiles. Patients were assessed six times over two cycles of CTX using the Physical Component Summary (PCS) score from the SF12. Differences, among the groups, in demographic and clinical characteristics and quality of life (QOL) outcomes were evaluated using parametric and nonparametric tests. Results Three groups of older oncology patients with distinct functional profiles were identified: Well Below (20.4%), Below (43.8%), and Above (35.8%) normative PCS scores. Characteristics associated with membership in the Well Below class included: lower annual income, a higher level of comorbidity, being diagnosed with depression and back pain, and lack of regular exercise. Compared to the Above class, patients in the other two classes had significantly poorer QOL outcomes. Conclusions Almost 65% of older oncology patients reported significant decrements in physical function that persisted over two cycles of CTX. Clinicians can assess for those characteristics associated with poorer functional status to identify high risk patients and initiate appropriate interventions.

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“…Urinary incontinence affects approximately 15 to 30% of healthy community-dwelling older adults (Carlson, Merel, & Yukawa, 2015;Irwin et al, 2006;Menezes, Hashimoto, & Santos, 2009) and the prevalence of fecal incontinence can reach 7% (Oliveira, 2006;Pretlove et al, 2006). However, elderly individuals will often limit their complaints on this subject as it is seen as a threat to their dignity and a source of embarrassment, making its prevalence underestimated and hindering actions aimed at prevention (Maciel, 2006).…”

Section: Discussionmentioning

confidence: 99%

<b>Frailty and geriatric syndromes in elderly assisted in primary health care

Closs

Ziegelmann

Gomes

et al. 2016

Acta Sci. Health Sci.

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ABSTRACT. The aim of this study was to describe the association between frailty and geriatric syndromes (GS) [cognitive impairment (CI); postural instability (PI); urinary/fecal incontinence (UFI); polypharmacy (PP); and immobility (IM)] and the frequency of these conditions in elderly people assisted in primary health care. Five hundred twenty-one elderly participants of The Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS) were evaluated. Sociodemographic data, identification of frailty (Fried phenotype) and GS were collected. Multinomial logistic regression analysis was performed. The frequency of frailty was 21.5%, prefrailty 51.1% and robustness 27.4%. The frequency of CI was 54.7%, PP 41.2%, PI 36.5%, UFI 14% and IM 5.8%. The odds of frailty when compared to robustness and adjusted for gender, age, depression, selfperception of health, nutritional status, falls, vision and hearing, was significantly higher in elderly with CI, PI and PP. The adjusted odds of prefrail when compared to robustness was significantly higher only in elderly with CI. The most frequently presented number of GS (0-5) was two geriatric syndromes (26.87%). The frequency of frailty was high among elderly in primary health care and was associated with three of five GS (CI -PI -PP).Keywords: frail elderly. geriatric syndrome. gerontology. primary health care.Fragilidade e síndromes geriátricas em idosos assistidos na atenção primária à saúde RESUMO. O objetivo deste estudo foi descrever a associação entre fragilidade e síndromes geriátricas (SG) [declínio cognitivo (DC); instabilidade postural (IP); incontinência urinária/fecal (IUF); polifarmácia (PF); e imobilidade (IM)] e a frequência destas condições em idosos assistidos na atenção básica. Foram avaliados 521 idosos, participantes do Estudo Multidimensional dos Idosos da Estratégia Saúde da Família (EMI-SUS). Foram coletados dados sociodemográficos, de identificação da fragilidade (fenótipo de Fried) e das SG. Realizou-se análise de regressão logística multinomial. A frequencia de fragilidade foi 21,5%, de pré-fragilidade 51,1% e de robustez 27,4%. A frequência de DC foi 54,7%, de PF 41,2%, de IP 36,5%, de IUF 14% e de IM 5,8%. A chance de fragilidade quando comparada à robustez, ajustada para sexo, idade, depressão, autopercepção de saúde, estado nutricional, quedas, visão e audição, foi significativamente maior em idosos com DC, IP e PF. A chance ajustada de pré-fragilidade, quando comparada à robustez foi significativamente maior somente nos idosos com DC. O número mais frequente de SG (0-5) presentes foram duas SG (26,8%). A frequência de fragilidade foi alta entre idosos da atenção básica e mostrou-se associada a três das cinco SG (DC-IP-PF).Palavras-chave: idoso fragilizado. síndrome geriátrica. gerontologia. atenção primária à saúde.

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Geriatric Syndromes and Geriatric Assessment for the Generalist

Cited by 63 publications

References 59 publications

Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes

Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes

Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy

<b>Frailty and geriatric syndromes in elderly assisted in primary health care

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