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Brief summary Premorbid frailty and neither age nor residence is associated with in-hospital mortality in oldest old with moderate COVID-19 disease.

Introduction This study aims to evaluate the relevance of geriatric assessment (GA) in older patients with colorectal cancer (CRC) and to study functional status (FS) and chemotherapy-related toxicity during treatment. Methods Patients with CRC aged ≥ 70 years were evaluated at baseline using a GA. Results were communicated to the treating physician. At 2 to 3 months follow-up, FS was reassessed, and chemotherapy-related toxicity was recorded. Results A total of 193 patients, with a median age of 77 years, were included. GA was abnormal in 75% and revealed unknown problems in 40%. Treatment was altered in 37% based on clinical assessment. GA led to geriatric interventions in 9 patients (5%) and additionally influenced treatment in 1 patient. At follow-up (n = 164), functional decline was observed in 29 patients (18%) for activities of daily living (ADL) and in 60 patients (37%) for instrumental activities of daily living (IADL). Baseline IADL, depression, fatigue, and cognition were predictors for ADL decline, whereas no predictors for IADL decline could be identified. In the 109 patients receiving chemotherapy, stage and baseline fatigue were predictive for grade 3/4 hematologic toxicity, and baseline ADL, fatigue, and nutrition were predictive for grade 3/4 nonhematologic toxicity. Conclusion Although GA identified previously unknown problems in more than one-third of older CRC patients, the impact on interventions or treatment decisions was limited. Baseline GA parameters may predict functional decline and chemotherapy-related toxicity. Education of physicians treating older patients with CRC is an essential step in the implementation of GA and subsequent interventions.

OBJECTIVES: This study aims to evaluate the evolution of functional status (FS) 2 to 3months after initiation of chemotherapy, to identify factors associated with functional decline during chemotherapy treatment and to investigate the prognostic value of functional decline for overall survival (OS). PATIENTS AND METHODS: Patients ≥70years with a malignant tumor were included when chemotherapy was initiated. All patients underwent a geriatric assessment (GA) including FS measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). FS of patients was followed by repeating ADL and IADL to identify functional decline. RESULTS: From 10/2009 until 07/2011, 439 patients were included. At follow-up, ADL and IADL data were available for 387 patients. Functional decline in ADL and IADL was observed in 19.9% and 41.3% of the patients respectively. In multivariable logistic regression analysis, baseline factors associated with decline in ADL are abnormal nutritional status (OR:2.02) and IADL dependency (OR:1.76). Oncological setting (disease progression/relapse vs new diagnosis) (OR:0.59) is the only determinant of decline in IADL. Functional decline in ADL is strongly prognostic for OS (logrank p-value

Introduction This study determined whether the multicomponent rehabilitation programme of a memory clinic had positive outcomes on ameliorating everyday functioning, quality of life, mood and behavioural disturbances of persons with dementia and reducing distress and burden of caregivers. Method A retrospective pre-test–post-test study without control group was conducted on the first cohort of persons with dementia ( n = 30) and their caregivers ( n = 30), who participated in a programme lasting for a maximum of 1 year with 25 1-hour counselling sessions. The assessment contained an evaluation of everyday functioning in basic, instrumental and advanced activities of daily living, cognition, mood, emotional and behavioural disturbances, quality of life and caregiver burden. Results Eight participants dropped out prematurely. For persons with dementia ( n = 22), participating in the programme did not improve everyday functioning and cognition but ameliorated quality of life significantly ( Z = –2.7, p = 0.006, 95% CI (.003–.005)) and stabilized mood, emotional and behavioural disturbances for 60% or more of them. For caregivers ( n = 22), the mild to moderate burden of care remained stable or got better for 63.6% of the caregivers. Conclusion This programme appears to be promising and valuable, and might reduce institutionalization rates. Future explorations are recommended to research how participants evolve and to investigate which participants responded in a positive way.

Purpose To compare the diagnostic characteristics of two geriatric screening tools (G8 and Flemish version of the Triage Risk Screening Tool [fTRST]) to identify patients with a geriatric risk profile and to evaluate their prognostic value for functional decline and overall survival (OS). Patients and Methods Patients ≥ 70 years old with a malignant tumor were included if a new cancer event occurred requiring treatment decision. Geriatric screening with G8 and fTRST (cutoff ≥ 1 [fTRST (1)] and ≥ 2 [fTRST (2)] evaluated) was performed in all patients, as well as a geriatric assessment (GA) evaluating social situation, functionality (activities of daily living [ADL] + instrumental activities of daily living [IADL]), cognition, depression, and nutrition. Functionality was re-evaluated 2 to 3 months after cancer treatment decision, and death rate was followed. Functional decline and OS were evaluated in relation to normal versus abnormal score on both screening tools. Results Nine hundred thirty-seven patients were included (October 2009 to July 2011). G8 and fTRST (1) showed high sensitivity (86.5% to 91.3%) and moderate negative predictive value (61.3% to 63.4%) to detect patients with a geriatric risk profile. G8 and fTRST (1) were strongly prognostic for functional decline on ADL and IADL, and G8, fTRST (1), and fTRST (2) were prognostic for OS (all P < .001). G8 had the strongest prognostic value for OS (hazard ratio for G8 normal v abnormal, 0.38; 95% CI, 0.27 to 0.52). Conclusion Both geriatric screening tools, G8 and fTRST, are simple and useful instruments in older patients with cancer for identifying patients with a geriatric risk profile and have a strong prognostic value for functional decline and OS.

Aim: To record in real life the appreciation of elderly patients, their caregivers and physicians of a once daily formulation of prolonged release of galantamine in the treatment of mild to moderate Alzheimer's disease. Methods: A prospective, multicenter, observational study was conducted in 128 elderly patients, treated for 6 months with galantamine, donepezil or rivastigmine. Results: Of the patients treated with galantamine, 82 of the 97 (84.5%) were continuing their treatment after 6 months. These patients reported their condition as improved in 49%, unchanged in 47% and worsened in 4%. Caregivers rated global evaluation as 37% better, 41% unchanged and 22% worse. Physicians rated global clinical impression of change as 46% better, 34% unchanged and 20% worse. Measurements of cognition and behavior remained stable. The appreciation of physicians and caregivers corresponded well (P

Background In the older population falls are a common problem and a major cause of morbidity, mortality and functional decline. The etiology is often multifactorial making the identification of fall predictors essential for preventive measures. Despite this knowledge, data on falls within the older cancer population are limited. The objective of this study was to evaluate the occurrence of falls within 2 to 3 months after cancer treatment decision and to identify predictors of falls (>=1 fall) during follow-up. Methods Older patients (70 years or more) with a cancer treatment decision were included. At baseline, all patients underwent geriatric screening (G8 and Flemish Triage Risk Screening Tool), followed by a geriatric assessment including living situation, activities of daily living (ADL), instrumental activities of daily living (IADL), fall history in the past 12 months, fatigue, cognition, depression, nutrition, comorbidities and polypharmacy. Questionnaires were used to collect follow-up (2-3 months) data. Univariate and multivariate analyses were performed to identify predictors for falls (>=1 fall) during follow-up. Results At baseline, 295 (31.5%) of 937 included patients reported at least one fall in the past 12 months with 88 patients (29.5%) sustaining a major injury. During follow-up (2-3 months), 142 (17.6%) patients fell, of whom 51.4% fell recurrently and 17.6% reported a major injury. Baseline fall history in the past 12 months (OR = 3.926), fatigue (OR = 0.380), ADL dependency (OR = 0.492), geriatric risk profile by G8 (OR = 0.471) and living alone (OR = 1.631) were independent predictors of falls (>=1 fall) within 2-3 months after cancer treatment decision. Conclusion Falls are a serious problem among older cancer patients. Geriatric screening and assessment data can identify patients at risk for a fall. A patient with risk factors associated with falls should undergo further evaluation and intervention to prevent potentially injurious fall incidents.

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 (ChEIs) or memantine. The aim of this study was to describe the use of ChEIs 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 ChEIs 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 ChEIs or memantine. Conclusions. Less than half of the AD patients in nursing homes receive ChEIs 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.

To record in real life the appreciation of elderly patients, their caregivers and physicians of a once daily formulation of prolonged release of galantamine in the treatment of mild to moderate Alzheimer's disease.A prospective, multicenter, observational study was conducted in 128 elderly patients, treated for 6 months with galantamine, donepezil or rivastigmine.Of the patients treated with galantamine, 82 of the 97 (84.5%) were continuing their treatment after 6 months. These patients reported their condition as improved in 49%, unchanged in 47% and worsened in 4%. Caregivers rated global evaluation as 37% better, 41% unchanged and 22% worse. Physicians rated global clinical impression of change as 46% better, 34% unchanged and 20% worse. Measurements of cognition and behavior remained stable. The appreciation of physicians and caregivers corresponded well (P0.001). The incidence of serious side-effects possibly related to galantamine was 9.3%, which was not different from that in patients treated with other cholinesterase inhibitors.In a real life setting, galantamine once daily is safe and is favorably appreciated by patients, their caregivers and physicians.

No abstract available Comment on The effect of non-steroidal anti-inflammatory agents on behavioural changes and cytokine production following systemic inflammation: Implications for a role of COX-1. [Brain Behav Immun. 2010]

9035 Background: The aim of this prospective study was to examine how age and standard clinical approach with and without CGA results determine treatment decisions in older cancer patients (pts). Methods: This study,conducted in 2 Belgian university hospitals, included pts ≥ 70 years with a malignant tumor (breast, colorectal, ovarian, lung, prostate and hematological) if a new cancer therapy was considered. All pts underwent a uniform CGA. Results were communicated to the treating physician. After the treatment decision, an interview with the treating physician was performed, using a predefined questionnaire: 1/ What would be your oncological treatment proposal in case the pt was 55y without other comorbidity? 2/ Is this different from your treatment proposal for this pt according to age and standard clinical approach without CGA results? 3/ Is this different from your treatment proposal for this pt with CGA results? Results: From October 2009 till July 2011, 937 pts were included in the study. Median age was 76y (range 70-95) and 63.5% was female. A total of 902 (96.3%) questionnaires were completed and 56.2% of the physicians were aware of the CGA results at treatment decision. In 381 pts (42.2%; 95%CI 39.0-45.5) age and standard clinical approach led to a different treatment decision compared to younger pts without comorbidity. This influence was most prominent for chemotherapy decisions: 309 patients did not receive standard chemotherapy (reduced dose (13), less toxic regimen (163), less toxic regimen at reduced dose (5) or no chemotherapy (128)). When the physician was aware of the CGA, these results influenced their treatment in 6.7% (95%CI: 4.5-8.9), mostly concerning chemotherapy. In 8 pts CGA results encouraged the treating physician to choose a more aggressive chemotherapy regimen and in 11 pts CGA results led to a decision of palliative care. Conclusions: Based on this prospective trial, we conclude that physicians use adapted treatment regimens in older versus younger pts, only based on age and standard clinical approach. CGA results change the treatment decision in 6.7% and sometimes trigger the use of a more aggressive treatment.

Twenty years ago, the term 'sarcopenia' has been introduced to describe the ageing related loss of skeletal muscle mass. Since then, sarcopenia has been intensively studied and prevalence values have been reported in fifteen papers covering several continents and races. However, consistency regarding the outcome measures and corresponding cut-off values defining sarcopenia is lacking. Most approaches are based on estimations of muscle mass and proposed cut-off values might be too strict, thus reducing their use in daily practice. From a clinical viewpoint, the assessment of muscle performance (grip strength and endurance) can be proposed as a screening tool showing sufficient sensitivity. The pathophysiology of sarcopenia is multifactorial, and important changes at the tissue level have been identified. Close relationships with inflammatory processes have been demonstrated and there is strong evidence for the involvement of a chronic low-grade inflammatory activity. Sarcopenia is aggravated by a complex interaction of several factors among which aging, disuse, immobilization, disease and malnutrition. A comprehensive geriatric assessment should allow the clinician to estimate the relative contribution of these factors and to elaborate appropriate management. From all interventions studied, intensive resistance training seems the most efficient to counter sarcopenia, even in the very old geriatric patients. Significant ameliorations (up to >50% strength gain) can be expected after six weeks of training at a rhythm of 2-3 sessions per week. From a preventive viewpoint, all elderly patients should be advised to start such an exercise program and continue it as long as possible. To date, most pharmacological interventions to counter sarcopenia include drugs with anabolic effects. Unfortunately, their effect is questionable and no clear guidelines exist for the prescription of these products in the context of sarcopenia.

Objectives The aim of this prospective study in older patients with cancer was to evaluate how clinical assessment (including age) determines the physician's treatment decisions, and how geriatric assessment (GA) further influences these decisions. Patients and Methods Patients aged ≥ 70 years old with cancer were included if a new therapy was considered. All patients underwent a GA and results were communicated to the treating physician. After the final treatment decision, a predefined questionnaire was completed by the physician. Results In total, 937 patients with median age of 76 years old were included. A total of 902 (96.3%) questionnaires were completed by the treating physicians. In 381/902 patients (42.2%) clinical assessment led to a different treatment decision compared to younger patients without co-morbidities. This difference was most prominent for chemotherapy/targeted therapy decisions. In 505/902 cases (56%) the treating physician consulted GA results before the final treatment decision. In these patients, the treatment decision was influenced by clinical assessment in 44.2%. In 31/505 patients (6.1%) the GA further influenced treatment, mostly concerning chemotherapy/targeted therapy. In eight patients GA influenced the physician to choose a more aggressive chemotherapy. Conclusions Physicians use different treatment regimens in older versus younger patients, based on clinical assessment, including age. GA results further influence treatment decisions in a minority of patients and may trigger the use of less aggressive as well as more aggressive treatments. GA information is not always utilized by oncologists, indicating the need for better education and sensitization.

Door de vergrijzing van de bevolking en met name de dubbele vergrijzing in het bijzonder (het zijn vooral de oudste ouderen die in aantal stijgen) neemt het aantal personen met dementie drastisch toe. Stijgende leeftijd is namelijk de belangrijkste risicofactor op het ontwikkelen van dementie. Ongeveer 5% van alle 65-plussers en 40% van de 85-plussers lijdt aan dementie. Dementie is een syndroom, dit betekent dat de kenmerkende symptomen van dementie (geheugenverlies, cognitieve achteruitgang, verminderd functioneren) verschillende - niet aangeboren - oorzaken kunnen hebben. Bij ouderen zijn de voornaamste oorzaken de ziekte van Alzheimer, vasculaire dementie, lewy body dementie en frontotemporale dementie. Kenmerkend is dat steeds meer zenuwcellen in de hersenen en/of verbindingen tussen deze zenuwcellen verloren. Een juiste subtypering is belangrijk aangezien het verloop, prognose van de types en dus ook de behandeling kan verschillen.

no abstract available