Selected Domains within a Comprehensive Geriatric Assessment in Older Patients with Non-Hodgkin Lymphoma are Highly Associated with Frailty.

Background: The incidence of Non-Hodgkin Lymphoma (NHL) is increasing, particularly among older patients who tend to have worse outcomes and can be predisposed to increased toxicities and less treatment tolerance. Therefore, a thorough pre-treatment assessment is essential. A comprehensive geriatric assessment (CGA) can be used to evaluate the older patient considering chemotherapy and is the preferred evaluation tool. However, a formal CGA is laborious, complex and time-consuming. Objectives: To characterize older adults with NHL and determine the CGA variables with the greatest association to frailty in order to propose a more simplified assessment. Methods: We performed a cross-sectional study using data collected from CGAs in NHL patients > 65 years admitted to our oncology service, from September 2015 to August 2017. Our evaluation parameters included: polypharmacy, a screening tool of older people's prescriptions (STOPP), the Lawton scale, Barthel index, Katz index, gait speed, a Timed Up and Go (TUG) test, a Mini-Mental state examination (MMSE), the Yesavage and Gijon scales, a Mini-nutritional assessment (MNA), a Geriatric Syndromes assessment, and a Cumulative Illness Rating Scale-Geriatric (CIRS-G). The formal CGA was comprised of nine domains; frailty was defined as an impairment in > 2 domains. Each parameter was individually compared with frailty, and the results were used to build different multivariate models using logistic regression analyses to obtain the variables with the highest frailty association. Results: A total of 253 patients were included. Their median age was 75.4 years (range 65-92), and 62.1% had > 1 impaired domain, with 39.9% considered frail. Bivariate analysis showed strong associations with age > 85 and all the geriatric parameters except for STOPP. Our final multivariate analysis resulted in 5 domains (the use of > 5 medications, a Lawton < 7, TUG > 20, Yesavage > 5, and the presence of at least one geriatric syndrome) being significantly associated with frailty and performing similarly to a CGA. Conclusion: In our population of older NHL patients, an abbreviated evaluation based of only five domains, polypharmacy, TUG, Lawton scale, Yesavage scale and the presence of at least one geriatric syndrome, had similar performance to a formal CGA in determining frailty.

Utilidad del CONUT frente al MNA en la valoración del estado nutricional del paciente adulto mayor hospitalizado / Utility of CONUT against MNA for assessing the status of hospitalized elderly patients

Objetivo: conocer la utilidad del CONUT frente a la aplicación del instrumento MNA y evaluación bioquímica, en la valoración del estado nutricional de pacientes adultos mayores (AM), hospitalizados en el Servicio de Medicina Interna 6C del Hospital Nacional Edgardo Rebagliati Martins de EsSalud. Material y Métodos: estudio transversal, en el que se aplió a 74 pacientes AM hospitalizados, el cuestionario MNA y el CONUT. El análisis estad¡stico se realiz¢ usando el chi cuadrado y análisis de varianza. Resultados: la edad promedio fue 75.65 ñ 4.8 años, predominó el sexo masculino. El peso fue de 66.95 ñ 10 kg; talla 1.62 ñ 0.07 mts; el IMC 27.4 ñ 6.6; albúmina 3.26 ñ 0.5 g/dL; colesterol 184.3 ñ 59.3 mg/d; y el recuento de linfocitos, 1847 ñ 967 cel/mm3. El resultado del MNA identificó 26 desnutridos (35.15%), 32 con riesgo de desnutrición (43.25%) y 16 con estado nutricional normal (21.60%). Según las variables del CONUT, asociada a los resultados del MNA, se comprueba que a medida que aumenta el grado de desnutrición, los valores de albúmina, colesterol y linfocitos descienden. Los porcentajes de las categorías del MNA, para los distintos grados de nutrición según las categor¡as de CONUT, se asocian significativamente en la variable albúmina. La sensibilidad y la especificidad para el CONUT frente al MNA, fue alta (86% y 62% respectivamente). Concluciones: estadísticamente, el CONUT se asociócon el MNA en la identificación de pacientes hospitalizados con riesgo de desnutrición.

Objective: to determine the usefulness of CONUT against the application of MNA instrument and biochemical evaluation in the assessment of the nutritional status of elderly patients (EP), hospitalized in the Internal Medicine 6C National Hospital Edgardo Rebagliati Martins EsSalud. Material and Methods: Cross-sectional study, in which CONUT MNA questionnaires were applied to 74 hospitalized EP. Statistical analysis was performed using the chi square test and analysis of variance. Results: the mean age was 75.65 ñ 4.8 years, predominantly male. The weight was 66.95 ñ 10 kg, height 1.62 ñ 0.07 m, BMI 27.4 ñ 6.6, 3.26 ñ 0.5 g albumin / dL, cholesterol 184.3 ñ 59.3 mg / d, and the lymphocyte count, 1847 ñ 967 cells/mm3. The result of the MNA identified 26 malnourished (35.15%), 32 with risk of malnutrition (43.25%) and 16 with normal nutritional status (21.60%). According to CONUTïs variables associated with the results of MNA, we found that with increasing degree of malnutrition, albumin, cholesterol and lymphocyte levels decline. The percentages of the categories of MNA, for different degrees of nutrition as CONUT categories are significantly associated in the variable albumin. The sensitivity and specificity for the CONUT against MNA was high (86% and 62% respectively). Conclusions: statistically, CONUT was associated with MNA in the identification of hospitalized patients at risk of malnutrition.

La Asistencia al Adulto Mayor / Assist elderly

Las personas de edad avanzada no constituyen un grupo mayoritario, requieren mayor atención de salud, por lo mismo que experimentan problemas y enfermedades crónicas que frecuentemente generan discapacidades, requieren de servicios más complejos y de una atención multidisciplinaria, razón por la cual conviene enfatizar en la necesidad de desarrollar servicios para el logro de la atención integral de los ancianos manteniéndolos en el seno familiar, para mayor beneficio del longevo, la familia y la comunidad.