Health system and patient-level factors associated with multidisciplinary care and patient education among hospitalized, older cancer survivors.

Objective: The purpose of this study was to examine system- and patient-level factors associated with the number of healthcare disciplines involved in delivery of patient education among hospitalized older cancer survivors. Methods: We used electronic health record (EHR) data from a single institution documenting patient education among hospitalized older patients (≥65 years) with a history of cancer between 9/1/2018 and 10/1/2019. We used parametric ordinal logistic regression to assess the number of healthcare disciplines involved in documented education activities. Results: The sample (n = 446) was predominantly male, White, and on average 74 years old. Adjusting for patient and system-level variables, men and larger department units had higher odds of receiving education from fewer healthcare disciplines. Patients with a history of breast or prostate cancer and longer lenths of stay had lower odds of receiving patient education from fewer healthcare disciplines. Conclusion: Hospital size, severity of illness, and cancer type are associated with delivery of multidisciplinary education in this sample. Innovation: EHR provides an opportunity to identify patterns in patient education among cancer survivors. Future research should investigate provider perspectives of the findings to inform provider- and system-level strategies to improve patient education.

Chronic condition clusters and associated disability over time.

Objectives: Recent evidence shows that more complex clusters of chronic conditions are associated with poorer health outcomes. Less clear is the extent to which these clusters are associated with different types of disability (activities of daily living (ADL) and functional mobility (FM)) over time; the aim of this study was to investigate this relationship. Methods: This was a longitudinal analysis using the National Health and Aging Trends Study (NHATS) (n = 6179). Using latent class analysis (LCA), we determined the optimal clusters of chronic conditions, then assigned each person to a best-fit class. Next, we used mixed-effects models with repeated measures to examine the effects of group (best-fit class), time (years from baseline), and the group by time interaction on each of the outcomes in separate models over 4 years. Results: We identified six chronic condition clusters: Minimal Disease, Cognitive/Affective, Multiple Morbidity, Osteoporosis, Vascular, and Cancer. Chronic condition cluster was related to ADL and FM outcomes, indicating that groups experienced differential disability over time. At time point 4, all chronic condition groups had worse FM than Minimal Disease. Discussion: The clusters of conditions identified here are plausible when considered clinically and in the context of previous research. All groups with chronic conditions carry risk for disability in FM and ADL; increased screening for disability in primary care could identify early disability and prevent decline.

Exploration of patient and caregiver cancer education using electronic health records.

The objective of this short report was to describe types of education provided to older, hospitalized patients with cancer and their caregivers using electronic health record data. A total of 437 patients, representing 512 inpatient stays (admissions), met the inclusion criteria. The sample were predominately male (58%) and White (95%). The average patient age at first admission was 74 years (SD 6.21 years) and the average length of admission was 5 days (SD 3.41 days). Out of all admissions, 89% included at least one documented education session with a provider. Three important results emerged from this study 1) education on medications is commonly conveyed to cancer patients (77%), 2) nurses are primarily responsible for providing education (65%), and 3) caregivers are infrequently involved (41%) in patient education. Additional educational topics tailored to the long-term needs of older adults with cancer are warranted. These topics should be delivered by an array of interprofessional care providers with demonstrated competency. Lastly, patient education should ensure inclusion of caregivers as part of the interprofessional cancer care team to promote successful management of cancer-related concerns.

Subjective Sleep Quality and Trajectories of Interleukin-6 in Older Adults.

BACKGROUND: We aimed to identify trajectories of inflammation in older adults at elevated risk for syndromal depression and anxiety and to determine whether baseline physical, cognitive, and psychosocial factors could distinguish 15-month longitudinal trajectories. METHODS: Older adults (N = 195, mean age (±SD) = 74.4 years (9.0) participating in three depression and anxiety prevention protocols completed a comprehensive battery of psychosocial assessments and provided blood samples for analysis of interleukin-6 (IL-6) every 3 months over a maximum of 15 months. Group-based trajectory modeling identified trajectories. Adjusted logistic regression examined associations between baseline factors and trajectory groups. RESULTS: Two 15-month trajectories were identified: stable lower IL-6 levels (84%; mean (±SD) = 3.2 (2.1) pg/mL); and consistently higher IL-6 levels (16%; mean = 9.5 (7.4) pg/mL). Poor sleep quality predicted consistently higher levels of IL-6 (OR = 1.9, 95% CI = 1.03-3.55). CONCLUSION: Poor sleep quality may represent a therapeutic target to reduce inflammation.