A Belgian Survey on Geriatric Assessment in Oncology Focusing on Large-Scale Implementation and Related Barriers and Facilitators.

OBJECTIVES: The aim of this study is to describe a large-scale, Belgian implementation project about geriatric assessment (=GA) in daily oncology practice and to identify barriers and facilitators for implementing GA in this setting. Design / setting / participants: The principal investigator of every participating hospital (n=22) was invited to complete a newly developed questionnaire with closed- and open-ended questions. The closed-ended questions surveyed how GA was implemented. The open-ended questions identified barriers and facilitators for the implementation of GA in daily oncology practice. Descriptive statistics and conventional content analysis were performed as appropriate. RESULTS: Qualifying criteria (e.g. disease status and cancer type) for GA varied substantially between hospitals. Thirteen hospitals (59.1%) succeeded to screen more than half of eligible patients. Most hospitals reported that GA data and follow-up data had been collected in almost all screened patients. Implementing geriatric recommendations and formulating new geriatric recommendations at the time of follow-up are important opportunities for improvement. The majority of identified barriers were organizational, with high workload, lack of time or financial/staffing problems as most cited. The most cited facilitators were all related to collaboration. CONCLUSION: Interventions to improve the implementation of GA in older patients with cancer need to address a wide range of factors, with organization and collaboration as key elements. All stakeholders, seeking to improve the implementation of GA in older patients with cancer, should consider and address the identified barriers and facilitators.

Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations†.

BACKGROUND: Screening tools are proposed to identify those older cancer patients in need of geriatric assessment (GA) and multidisciplinary approach. We aimed to update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on the use of screening tools. MATERIALS AND METHODS: SIOG composed a task group to review, interpret and discuss evidence on the use of screening tools in older cancer patients. A systematic review was carried out and discussed by an expert panel, leading to a consensus statement on their use. RESULTS: Forty-four studies reporting on the use of 17 different screening tools in older cancer patients were identified. The tools most studied in older cancer patients are G8, Flemish version of the Triage Risk Screening Tool (fTRST) and Vulnerable Elders Survey-13 (VES-13). Across all studies, the highest sensitivity was observed for: G8, fTRST, Oncogeriatric screen, Study of Osteoporotic Fractures, Eastern Cooperative Oncology Group-Performance Status, Senior Adult Oncology Program (SAOP) 2 screening and Gerhematolim. In 11 direct comparisons for detecting problems on a full GA, the G8 was more or equally sensitive than other instruments in all six comparisons, whereas results were mixed for the VES-13 in seven comparisons. In addition, different tools have demonstrated associations with outcome measures, including G8 and VES-13. CONCLUSIONS: Screening tools do not replace GA but are recommended in a busy practice in order to identify those patients in need of full GA. If abnormal, screening should be followed by GA and guided multidisciplinary interventions. Several tools are available with different performance for various parameters (including sensitivity for addressing the need for further GA). Further research should focus on the ability of screening tools to build clinical pathways and to predict different outcome parameters.

Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study.

BACKGROUND: To evaluate the large-scale feasibility and usefulness of geriatric screening and assessment in clinical oncology practice by assessing the impact on the detection of unknown geriatric problems, geriatric interventions and treatment decisions. PATIENTS AND METHODS: Eligible patients who had a malignant tumour were ≥70 years old and treatment decision had to be made. Patients were screened using G8; if abnormal (score ≤14/17) followed by Comprehensive Geriatric Assessment (CGA). The assessment results were communicated to the treating physician using a predefined questionnaire to assess the topics mentioned above. RESULTS: One thousand nine hundred and sixty-seven patients were included in 10 hospitals. Of these patients, 70.7% had an abnormal G8 score warranting a CGA. Physicians were aware of the assessment results at the time of treatment decision in two-thirds of the patients (n = 1115; 61.3%). The assessment detected unknown geriatric problems in 51.2% of patients. When the physician was aware of the assessment results at the time of decision making, geriatric interventions were planned in 286 patients (25.7%) and the treatment decision was influenced in 282 patients (25.3%). CONCLUSION: Geriatric screening and assessment in older patients with cancer is feasible at large scale and has a significant impact on the detection of unknown geriatric problems, leading to geriatric interventions and adapted treatment.

The use of acetyl cholinesterase inhibitors and memantine in nursing home residents.

AIM: Although a high proportion of elderly nursing home residents suffer from Alzheimer's disease (AD), data from the literature indicate that they are only rarely treated with Acetyl Cholinesterase Inhibitors (ChEls) or memantine. The aim of this study was to describe the use of ChEls or memantine by elderly residents in nursing homes, suffering from AD and to document who might qualify for pharmacological treatment according to the Belgian reimbursement rules. METHOD: Descriptive data was collected from 11 nursing homes through a standardized questionnaire consisting of a general section for nurses and a specific medical section for general practitioners (GP). All residents (N = 1032) from these institutions were eligible for inclusion in the study; 718 (69.6%) questionnaires were completed by the nurses of which 533 (51.6%) were also completed by the GP's. RESULTS: AD was diagnosed in 29.4% (n = 211) of the residents of whom 56.4% (n = 119) did not receive an anti-AD treatment, although nearly all of these patients fulfilled the Belgian requirements for reimbursement of ChEls or memantine. The mental status of the residents was often incompletely documented, but it can be estimated that at least an additional 30.1% (n = 216) of all screened residents might possibly qualify for reimbursement of ChEls or memantine. CONCLUSIONS: Less than half of the AD patients in nursing homes receive ChEls or memantine and approximately one third of the residents could possibly qualify for reimbursement. Many residents with cognitive deficits remain undetected and undiagnosed and consequently do not receive appropriate treatment.

Grip work estimation during sustained maximal contraction: validity and relationship with dependency and inflammation in elderly persons.

OBJECTIVES: To validate muscle endurance estimation and to examine relationships with dependency and inflammation in elderly persons. DESIGN: Cross sectional validation and explorative study. SETTING: Hospitalized geriatric patients and community-dwelling controls. PARTICIPANTS: 91 elderly patients (aged 83±5 years), 100 elderly controls (aged 74±5 years) and 100 young controls (aged 23±3 years). MEASUREMENTS: Grip strength (GS) was recorded continuously during sustained maximal contraction until exhaustion. Fatigue resistance (FR) was expressed as the time during which GS drops to 50% of its maximum. Grip work (GW) was estimated as GW=GS*0.75*FR, and compared to the measured GW. In the elderly participants, relationships (controlling for age and physical activity) of GS, FR, GW and GW corrected for body weight (GW/BW) with dependency (Katz-scale) and inflammation (circulating IL-6 and TNF-alpha) were analyzed. RESULTS: Excellent correlation between estimated and measured GW was found (r=0.98, p<0.001). The method error coefficient of variance was 10% for all participants; 7% for all elderly and 8% for young controls. Better GS, FR, GW and GW/BW was significantly related with less dependency (all p<0.05 or p<0.01, except for FR in the male) and with lower circulating IL-6 (all p<0.05 or p<0.01, except for GS in both genders). Higher IL-6 was significantly related to worse dependency (p<0.01). No significant relationships with TNF-alpha were found. CONCLUSION: GW estimation is a valid parameter reflecting muscle endurance in elderly persons presenting diverse clinical conditions. GW is significantly related to both dependency and circulating IL-6, and is a promising outcome parameter in comprehensive geriatric assessment.

atetra, a new software program to analyse tetraploid microsatellite data: comparison with tetra and tetrasat.

Despite the importance of tetraploid species, most population genetic studies deal with diploid ones because of difficulties in analysing codominant microsatellite data in tetraploid species. We developed a new software program-atetra-which combines both the rigorous method of enumeration for small data sets and Monte Carlo simulations for large ones. We discuss the added value of atetra by comparing its precision, stability and calculation time for different population sizes with those obtained from previous software programs tetrasat and tetra. The influence of the number of simulations on the calculation stability is also investigated. atetra and tetrasat proved to be more precise when compared with tetra, which, however, remains faster. atetra has the same precision than tetrasat, but is much faster, can handle an infinite number of partial heterozygotes and calculates more genetic variables. The more user-friendly interface of atetra reduces possible mistakes.

Anaemia in the elderly.

Anaemia is highly prevalent in elderly populations, particularly in long term care facilities and geriatric wards. Even mild anaemia is associated with adverse health outcomes. Although senescence is considered to be a contributing factor, underlying pathology always has to be thoroughly explored. The most frequent etiologies of anaemia in the elderly are anaemia of chronic disease/inflammation; iron, folate and cobalamin deficiency; and myelodysplastic syndrome. Multiple concomitant etiologies are frequently present. The diagnostic workup is straightforward, not very invasive and should be done systematically. Nutrient deficiencies require complete workup and cure. Anaemia of chronic disease/inflammation ideally is taken care of by treating the underlying disease. If this is not possible and if glomerular filtration rate is significantly decreased, treatment with erythropoietin should be considered. Most cases of myelodysplastic syndrome will benefit from supportive care, but a specific subgroup responds particularly well to oral thalidomide analogues. Transfusions should be avoided.

A new protocol for the detection of Enterobacter sakazakii applied to environmental samples.

Enterobacter sakazakii is a motile, peritrichous, gram-negative rod that was previously known as a yellow pigmented Enterobacter cloacae. It is documented as a rare cause of outbreaks and sporadic cases of life-threatening neonatal meningitis, necrotizing enterocolitis, and sepsis. E. sakazakii has been isolated from milk powder-based formulas, and there is thus a need to investigate whether and where E. sakazakii occurs in these manufacturing environments. For this purpose, a simple detection method was developed based on two features of E. sakazakii: its yellow pigmented colonies when grown on tryptone soy agar and its constitutive alpha-glucosidase, which is detected in a 4-h colorimetric assay. Using this screening method, E. sakazakii strains were isolated from three individual factories from 18 of 152 environmental samples, such as scrapings from dust, vacuum cleaner bags, and spilled product near equipment. The method is useful for routine screening of environmental samples for the presence of E. sakazakii.