Frailty in oncogeriatrics

The population is ageing and surgery is becoming more common as the treatment of choice for many diseases and conditions in older people. Although mortality rates are low for many operations, older patients are at increased risk of complications and may have poor outcomes including longer hospital stays and discharge to sub-acute care or aged care facilities. The aim of this thesis was to describe the occurrence of non-disease specific complications, known as geriatric syndromes, in older patients admitted to surgical wards, and to explore the association of ‘frailty’ and other key risk factors with geriatric syndromes and discharge outcomes in order to identify high risk groups who might benefit from interventions designed to prevent these complications and improve discharge outcomes. The specific aims were to: 1. Describe the occurrence of geriatric syndromes in older surgical ward patients (with the exception of hip fracture or cardiothoracic patients) 2. Investigate the association between key risk factors for geriatric syndromes and discharge outcomes (acute length of stay and discharge destination) in older surgical ward patients. A literature review of the occurrence of geriatric syndromes in the broader surgical population cared for in usual care wards is presented in Chapter 2(1). The occurrence of geriatric syndromes in older patients admitted under two surgical subspecialty units is presented in Chapter 3 (2). In this retrospective cohort study of 112 patients aged 65, admitted under the urology or vascular surgical units of Royal Brisbane and Women’s Hospital for three days or more, we found that geriatric syndromes occurred in 32 % of patients. We examined the association of pre-existing impairment in activities of daily living (a unidimensional marker of frailty), mode of admission (elective versus non-elective), extent of surgery (non-operative, minor, major) and surgical sub-specialty unit with ≥1 geriatric syndromes. In multivariable analysis, non-elective admission, major surgery and pre-existing impairment in activities of daily living increased the likelihood of geriatric syndromes. No significant association was seen in the adjusted model with surgical unit, age or comorbidity score. In Chapter 4, we describe the prevalence of frailty and the occurrence of geriatric syndromes in older vascular surgical ward patients and more precisely examine the association of pre-existing patient factors (frailty and comorbidities), illness severity, surgical severity and mode of admission with ≥1 geriatric syndromes, acute length of stay and discharge destination from the vascular surgical unit. In a prospective cohort study of 110 patients admitted to the vascular surgical unit of Royal Brisbane and Women’s Hospital for three days or more, we found that 39% of participants were frail and 36% developed ≥1 geriatric syndromes. In multivariable analysis, this study found multiple risk factors for geriatric syndromes; frailty and non-elective admission were important predictors for both geriatric syndromes and discharge destination; diabetes with end organ damage was an important predictor of longer length of stay and discharge destination. In conclusion, these studies add to the evidence that geriatric syndromes are common complications in older surgical ward patients. They contribute to the design of future studies by identifying that frail and non-elective patients are at increased risk and should be the target for interventions to prevent geriatric syndromes and therefore improve outcomes; and identify multiple risk factors for geriatric syndromes and discharge outcomes to be considered when designing or evaluating interventions. Finally, these studies have informed the design of a before-and-after study of an enhanced interdisciplinary model to prevent geriatric syndromes and improve outcomes of vascular surgical elders at Royal Brisbane and Women’s Hospital.

Geriatric syndromes are complex clinical manifestations and significant causes of mortality and morbidity. This study was aimed to determine the frequency and co-incidence of geriatric syndromes in older patients with chronic kidney disease (CKD). Older patients were included in this cross-sectional retrospective study. All patients were questioned in terms of geriatric syndromes including dementia, polypharmacy, malnutrition, frailty, probable sarcopenia, urinary incontinence, falls, fear of falling, depression, insomnia, and excessive daytime sleepiness. Geriatric syndromes were evaluated according to Glomerular Filtration Rate (GFR) ≥ 60ml/min/1.73 m2, 30-59ml/min/1.73 m2 and < 30ml/min/1.73 m2. Of the 1320 patients included, the mean age was 79.6 ± 7.8 and 929 (70%) were female. GFR groups ≥ 60ml/min/1.73 m2, 30-59ml/min/1.73 m2, and < 30ml/min/1.73 m2 comprised of 55%, 38%, and 7% patients, respectively. The rate of ≥ 3 syndromes in the same person was 66.4% in the group with GFR ≥ 60ml/min/1.73 m2. After age and sex adjusted; it was observed that frailty was 2.5 times, probable sarcopenia 2.4 times, and malnutrition 2.7 times more in those with GFR 30-59ml/min/1.73 m2 compared to those with GFR ≥ 60ml/min/1.73 m2 (p < 0.05). Dementia 1.4, frailty 1.55, polypharmacy 2.0, and urinary incontinence were 1.6 times more common in those with a GFR < 30ml/min/1.73 m2 (p < 0.05). Each of the geriatric syndromes and their co-incidence are high in older CKD patients. Geriatricians and nephrologists should be aware of geriatric syndromes in older CKD patients, and they should cooperate for the management of these patients.

Background/Introduction Heart failure (HF) self-care is important for the effective management of HF, reducing clinical events such as all-cause mortality and hospitalizations. HF self-care behaviours encompass comply with a regimen involving medication, diet, and exercise, symptom monitoring, and seeking assistance when symptoms occur. Frailty, prevalent among older patients with HF, involves physical, social, and cognitive domains. Identified factors influencing self-care behaviours in patients with HF include age, social support, and knowledge of the condition. Despite research on the association between self-care behaviours and frailty, there is a notable gap in studies that explore the relationship between self-care behaviour and multiple domains of frailty, particularly with adjustments for clinical characteristics. Purpose The aim of this study was to assess the association between self-care behaviour and multiple domains of frailty in older patients with HF. Methods The study included 182 patients with HF who were aged 65 years or older. Self-care behaviour was assessed 5 months after their discharge using the European Heart Failure Self-Care Behaviour Scale (EHFScBS), a self-report questionnaire. Frailty was assessed using the revised Japanese version of the Cardiovascular Health Study criteria (J-CHS) for physical frailty, and using Makizako’s five items for social frailty, and using Mini-Cog for cognitive decline. We used multiple regression analysis to assess the association between self-care score and multiple frailty domains and the number of frailty domains. The adjusted model was constructed based on age, gender, body mass index, New York Heart Association Classification, left ventricular ejection fraction, log-transformed B-type natriuretic peptide, estimated glomerular filtration rate and history of HF. In addition, we used multiple regression analysis to assess the association between the EHFScBS subitems score complying with regimen, asking for help, and adapting activities and multiple frailty domains and the number of frailty domains. Results According to the results of a multiple regression analysis, poor self-care behaviour was significantly associated with physical and social frailty and the number of frailty domains (all p &amp;lt; 0.05), even after adjusting for clinical characteristics. Poor complying with regimen was also significantly associated with physical and social frailty and the number of frailty domains (all p &amp;lt; 0.05). Poor asking for help was significantly associated with social frailty and the number of frailty domains (all p &amp;lt; 0.05). Conclusion The study indicates that poor self-care behaviour is linked to physical and social frailty, in addition to the cumulative number of frailty domains in older patients with HF, even when clinical characteristics are taken into consideration. This underscores the importance of factoring in the frailty status when guiding patients with HF in disease management.

Frailty, characterized by increased vulnerability to external stressors, has been found to increase the risk of healthcare utilization and nursing home admission. As the age group of 80 years or older remains frequently underrepresented in previous research, this study examined the impact of physical and social frailty on the utilization of nursing care services in very old population of North Rhine-Westphalia. Using data from a representative cross-sectional study, 1,577 community-dwelling and institutionalized individuals aged ≥80 years were included. Physical frailty was defined according to Fried’s criteria (exhaustion, weight loss, low handgrip strength, low physical activity). Social frailty was measured with self-reported loneliness, social isolation, and time spent with others. The use of outpatient care services, day care, informal and inpatient care were considered. Multinomial regression was applied to investigate the impact of physical and social frailty on the use of outpatient and inpatient care services, controlling for relevant sociodemographic and health related characteristics. Compared to very old adults who did not use any care services, no association was found between frailty and the use of outpatient or informal care. Comparing nonusers of care services with institutionalized individuals, nursing home residents were less likely to experience physical frailty and pre-frailty, but were more likely to be socially isolated and to feel lonely. These findings suggest that physical frailty might have been successfully prevented in the context of institutional inpatient care. However, early identification and intervention focused on social inclusion of the institutionalized very old individuals are needed to reverse social frailty.

There are no studies examining the prevalence of social frailty and associated factors in low- and middle-income countries. This study aimed to assess the prevalence of social frailty and identify the contributing factors among older adults in Türkiye. This cross-sectional study included 570 participants aged 65 and older, all outpatients at a geriatric clinic. Data for demographics and co-morbidities were collected. Anthropometric measurements and comprehensive geriatric assessments were conducted. Social frailty was assessed using the 5-item Social Frailty Index (SFI), and physical frailty was evaluated with the Fried Frailty Phenotype. Sarcopenia was diagnosed based on low handgrip strength and reduced calf circumference. Participants' mean age was 75.2 ± 6.3 years. Social frailty, depression, physical frailty and sarcopenia prevalence were 24%, 25%, 14% and 26%, respectively. Social frailty was reported to be statistically higher in women and those living alone, while significantly lower in married individuals. Depression, physical frailty and sarcopenia were more commonly observed in participants with social frailty (p < .01). Furthermore, participants with heart failure and Parkinson's disease were more socially vulnerable than those with other co-morbid conditions. Multivariate logistic regression analysis revealed that age, physical frailty and depressive mood significantly increased social frailty, whereas being married decreased it even after adjusting for potential confounding factors. Social frailty was more prevalent than physical frailty among Turkish older adults, reaching 24%. Advanced age, depression, physical frailty and being unmarried were strongly related factors to social frailty.

The Association between BMI and Different Frailty Domains: A U-Shaped Curve?

12045 Background: Non-small cell lung carcinoma (NSCLC) predominantly affects older adults (≥65 years), where immune checkpoint inhibitors (ICIs) are a key treatment, especially in those without driver mutations. However, the effect of ICIs on age-related health issues (geriatric syndromes), which impact quality of life in this population, is unclear. This study aims to investigate the impact of ICIs on geriatric syndromes in older adults with NSCLC. Methods: We utilized data from the Global Collaborative Network-TrinetX to evaluate the impact of pembrolizumab on geriatric syndromes in elderly NSCLC patients, dividing them into two groups based on pembrolizumab treatment status defined by International Classification of Diseases (ICD-10) codes. Propensity score matching (PSM) was used to balance the cohorts based on demographic characteristics, comorbidities, medications, and without driver mutations. Geriatric syndromes were assessed over 30-day and 1-year follow-up periods. Multivariate logistic regression models assessed the association between pembrolizumab treatment and geriatric syndromes, with results expressed as odds ratios and 95% confidence intervals. Results: Following PSM, there were two balanced cohorts of 3288 patients each. The pembrolizumab cohort had a mean age of 75.6 ± 6.93 years, while the non-pembrolizumab cohort had a mean age of 78.2 ± 7.9 years. Multivariate analysis revealed that pembrolizumab treatment was significantly associated with increased fatigue risk at 30 days (OR 1.600, 95% CI 1.062-2.411, P=0.023), persisting at 1 year (OR 1.769, 95% CI 1.463-2.140, P&lt;0.001). Additionally, pembrolizumab treatment was linked to increased risks of insomnia (OR 1.331, 95% CI 1.052-1.683, P=0.017) and delirium (OR 1.494, 95% CI 1.105-2.019, P=0.009) at 1 year. Notably, pembrolizumab treatment was not significantly associated with risk of dementia, frailty, urinary incontinence, or falls at 30 days and 1 year. Conclusions: Our study shows that pembrolizumab was significantly associated with increased risks of persistent fatigue, delirium, and insomnia in geriatric NSCLC patients at one-year follow-up. This emphasizes the need for monitoring and targeted interventions to mitigate these adverse events and improve quality of life in this population. Geriatric syndromes in NSCLC patients on pembrolizumab. OUTCOME 30 DAYS FOLLOW-UP 1 YEAR FOLLOW-UP OR and 95% CI P-value OR and 95% CI P-value Falls 1.381 (0.631-3.114) 0.434 1.264 (0.946-1.690) 0.113 Dementia 0.993 (0.413 –2.390) 0.988 0.993 (0.581-1.697) 0.980 Delirium 1.400 (0.621-3.156) 0.416 1.494 (1.105-2.019) 0.009 Insomnia 1.656 (0.998-2.748) 0.049 1.331 (1.052-1.683) 0.017 Urinary incontinence N/A* N/A Fatigue 1.600 (1.062-2.411) 0.023 1.769 (1.463-2.140) &lt;0.001 Frailty 1.000 (0.416-2.405) 0.999 1.233 (0.733 –2.073) 0.429 *No outcomes were observed within the follow-up period.

A Retrospective Analysis of Factors Affecting Treatment Outcome and Patient Experience in Elderly Head and Neck Cancer Patients: The Odette Cancer Centre Experience

AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Elderly Patients: Expert Review

Preoperative prevalence of multidimensional frailty and the associations with health-related quality of life in elderly cancer patients

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Influence of combined cognitive impairment and social frailty on physical frailty in community-dwelling older adults

Introduction: Neoadjuvant chemo-immunotherapy with pembrolizumab (NAC+P) has become the standard care for stage II-III triple-negative breast cancer (TNBC) following the KEYNOTE-522 (KN522) trial, which showed improved pathologic complete response (pCR) rates and event-free survival compared to chemotherapy alone (NAC). We aimed to describe pCR rates by age and treatment in TNBC patients receiving either NAC+P or NAC alone at our institution. Methods: Women aged ≥65 years with stage I-III TNBC treated with NAC+P from 6/2021 to 9/2023 were compared to patients aged &amp;lt;65 years treated with NAC+P and to patients ≥65 who received NAC alone from 03/2010 to 9/2019. Patients with metaplastic breast cancer and neoadjuvant radiotherapy were excluded. Clinicopathological characteristics and pCR rates (ypT0/is pN0) - were compared between groups using Chi-square tests. Logistic regression for univariate (UVA) and multivariable analysis (MVA) was used to evaluate the association between age, treatment, and pCR. Results: 481 patients were included: 69 NAC+P ≥65 years (median age 69, IQR: 67-73); 338 NAC+P &amp;lt;65 years (median age 48, IQR: 38-56); and 74 NAC ≥65 years (median age 69, IQR: 66-73). Compared to younger patients, older patients treated with NAC+P were more likely to have public insurance (87% vs 13%, p&amp;lt;.001), lobular and other non-ductal histologies (6% vs 1.2% and 10% vs 5%, respectively, p= .009), cT1 and cT4 stages (22% vs 11% and 13% vs 3.9%, respectively, p&amp;lt; .001) and cN+ disease at presentation (58% vs 45%, p=.04). In both age groups, 81% received the KN522 backbone regimen with carboplatin, and the remaining mostly received NAC with cyclophosphamide, anthracycline, and taxane. There was no difference in treatment completion rate - defined as the completion of all preplanned neoadjuvant therapy cycles regardless of interruptions, regimen changes, or dose reductions - and in immune-related adverse events (33%) between age groups. However, older patients had a longer time from NAC+P to surgery (38 vs 32 days, p= .002). Breast surgery was similar between age groups, but axillary dissection (ALND) was more common in older patients (32% vs 19%, p= .023). The pCR rates did not differ between older and younger patients (49% vs 58%, p=.2). On MVA, high tumor grade (OR 13.9, 95% CI 4.54-61.7, p&amp;lt; .001) was positively associated with pCR, whereas other histologies (OR 0.13, 95% CI 0.04-0.39, p&amp;lt; .001), cT4 stage (OR 0.10, 95% CI 0.02-0.36, p&amp;lt;.001) and cN+(OR 0.60, 95% CI 0.38-0.95, p= .029) were less likely to facilitate pCR.In patients ≥65 years, those receiving NAC+P, compared to NAC alone, more frequently had lobular and other histologies (6% vs 0% and 10% vs 4.1%, respectively, p= .028), intermediate tumor grade (15% vs 1.4%, p=0.003), and cT1 and cT2 stages (22% vs 16% and 61% vs 46%, respectively, p= .045).NAC+P patients more frequently received carboplatin (81% vs 6.8%, p&amp;lt;.001). There was no difference in NAC completion and time to treatment start, but the NAC+P group had longer time to surgery (38 vs. 30 days, p = 0.039). More NAC patients underwent ALND (56% vs 32%, p= .005), with no difference in cN+ disease and breast surgery. The pCR rates were significantly higher in the NAC+P group (49%) compared to NAC (23%, p=.001). On UVA, NAC+P significantly improved overall pCR (OR 3.26 p=.001). However, on MVA, after adjusting for tumor histology, grade, stage, neoadjuvant carboplatin, and completion rate, the use of immunotherapy was not independently associated with pCR. Conclusions: Within the NAC+P cohort, pCR rates did not differ by age, and no significant increase in irAEs was seen in elderly patients, though we acknowledge a possible selection bias toward healthier elderly patients. Compared to NAC only, NAC+P showed potential for improving pCR in older individuals and could be a viable treatment option for elderly TNBC patients who are likely to tolerate it. Citation Format: Natalia Polidorio, Lauren M. Perry, Srinivasa Sevilimedu Veeravalli, Giacomo Montagna, Nour Abuhadra, Diana Lake, Mark Robson, Monica Morrow, Stephanie Downs-Canner, Iris Zhi. Outcomes in Elderly Patients with Triple-Negative Breast Cancer Receiving Neoadjuvant Chemo-immunotherapy and Chemotherapy Alone [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P5-11-16.

Marginal zone lymphoma in elderly and geriatric patients

Background: Most activities in community centers have declined as a countermeasure against the COVID-19 pandemic. Consequently, multidimensional frailty rates gradually worsened. This research aimed to explore coronavirus-related anxiety and others factors that influence physical, psychological, and social frailty in older community-dwellers in Taiwan during the COVID-19 pandemic.