Janine Overcash

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.

Predicting Falls in Older Patients Using Components of a Comprehensive Geriatric Assessment

This prospective study evaluated components of a comprehensive geriatric assessment (CGA) to identify rates and predictors of falls in older patients. Fall rates and scores on components of the CGA were compared among adults aged 70 or older in three groups: patients with cancer receiving chemotherapy, patients with cancer not receiving chemotherapy, and community-dwelling adults without cancer. Older adults in the chemotherapy group were hypothesized to fall significantly more often than those in the nonchemotherapy group. Among the patients with cancer, scores on the Activities of Daily Living Scale were a significant predictor of falls. The scores were the only domain of the CGA found to be a significant predictor; therefore, more research is needed to better understand fall risk assessment among older patients with cancer. Nurses should conduct fall risk assessments with measures of functional status as included in a CGA.

Prediction of Falls in Older Adults With Cancer: A Preliminary Study

PURPOSE/OBJECTIVES To determine the extent to which falls occur in older adult patients with cancer; to identify how falls relate to depression, age, functional status, and cognition; and to develop a model for predicting falls. DESIGN Descriptive, prospective, quantitative. SETTING Patients in the Senior Adult Oncology Program at the H. Lee Moffitt Cancer Center and Research Institute. SAMPLE 165 patients aged 70 years or older with any diagnosis of cancer, treatment type, and stage. METHODS Data were collected during a one-time interview using a comprehensive geriatric assessment consisting of the Instrumental Activities of Daily Living (IADL) Scale, Activities of Daily Living (ADL) Scale, Geriatric Depression Scale, Mini-Mental State Examination, and a fall assessment. MAIN RESEARCH VARIABLES Falls, functional status, depression, cognition, age, and gender. FINDINGS IADL scores were found to be a predictor of falls while controlling for age and ADL status. An IADL score of 22 predicts a 21% risk of a fall. Fall risk increases to 81% at an IADL score of 9. CONCLUSIONS IADL score is a predictor of falls in this older adult population with cancer. ADL scores are not a predictor of falls when IADL is included in the model. IMPLICATIONS FOR NURSING Nurses must play a vital role in conducting fall screening and risk assessments for older adults with cancer.

The Geriatric Cancer Experience at the End of Life: Testing an Adapted Model

PURPOSE/OBJECTIVES To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide evidence for the validity and reliability of the model for use in practice and research. DESIGN Nonexperimental and cross-sectional using baseline data collected within 24-72 hours of admission to hospice. SETTING Two hospices in the southeastern United States. SAMPLE 403 hospice homecare patients; 56% were men and 97% were Caucasian with a mean age of 77.7 years. METHODS Confirmatory factor analyses using structural equation modeling with AMOS statistical software. MAIN RESEARCH VARIABLES Clinical status; physiologic, psychological, and spiritual variables; and quality of life (QOL). FINDINGS A three-factor model with QOL as an outcome variable showed that 67% of the variability in QOL is explained by the patients symptom and spiritual experiences. CONCLUSIONS As symptoms and associated severity and distress increase, the patients QOL decreases. As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion), QOL also increases. IMPLICATIONS FOR NURSING The model supports caring for the physical and metaphysical dimensions of the patients life. It also highlights a need for holistic care inclusive of physical, emotional, and spiritual domains.

Predictors of Quality of Life in Elderly Hospice Patients with Cancer.

While quality of life is the focus of care in hospices, limited research has been conducted on the quality of life of cancer patients in hospice home care. The purpose of this study was to explore the predictors of quality of life of older adults who are receiving hospice care in their homes. A secondary analysis of data from a larger study was conducted using linear regression and including the following predictor variables: age, functional status, number of symptoms endorsed, overall symptom distress, pain intensity, and depressive symptoms. The outcome variable was quality of life. The sample consisted of 533 adults with an average age of 78.1 (SD, 7.4) years. A regression model that included symptom distress, number of symptoms, depression, and functional status accounted for 46% of the variance in quality of life. Pain, age, and caregiver depression did not contribute to predicting quality of life and therefore were not included in the final model. Because both physical symptoms and depression are predictors of quality of life, a continued focus is needed on these factors by those providing care to older adults with cancer near the end of life.

Vitamin D in Older Patients With Cancer

Vitamin D insufficiency has been found to be as high as 75% among community-dwelling adults aged 65 and older. The purpose of this article is to provide a review of published literature focused on the benefits of vitamin D and calcium supplementation in older patients with cancer. Insufficient vitamin D levels may have considerable effects on cancer-related diagnosis and treatment. Patient education should include information concerning vitamin D and calcium administration to reduce falls and injury from falls and enhance functional status. This article will consider the issue of vitamin D levels related to cancer prevention, diagnosis, treatment, functional status, and falls in older patients with cancer. Dosing and serum measurement information will be discussed.

The Benefits of Medical Qigong in Patients With Cancer: A Descriptive Pilot Study

Medical Qigong (MQ) is a mind-body exercise that includes movement and meditation and is beneficial in reducing high blood pressure, high cholesterol, anxiety, stress, pain, and incidence of falls. The purpose of the current study was to determine whether patients with cancer and survivors who participated in an MQ class experienced a change in fatigue, depression, and sleep from a preintervention evaluation to a postintervention evaluation. Participants were patients diagnosed with cancer who participated in MQ classes. Some were actively undergoing cancer treatment (e.g., surgery, hormone therapy, radiation therapy, chemotherapy) and some were receiving no treatment. Patients diagnosed with cancer and enrolled in an MQ class were invited to participate. A packet of surveys was completed before the first class and before the final class. Scores showed a reduced depression score after completing the five-week MQ course. Those findings indicate that MQ is helpful in reducing some of the problems associated with cancer and cancer treatment.

Assessing the Functional Status of Older Cancer Patients in an Ambulatory Care Visit.

Functional status assessment is a useful and essential component of the complete history and physical exam of the older patient diagnosed with cancer. Functional status is the ability to conduct activities that are necessary for independence and more executive activities, such as money management, cooking, and transportation. Assessment of functional status creates a portal into interpreting the health of in older persons. Understanding limitations and physical abilities can help in developing cancer treatment strategies, patient/family teaching needs, and in-home services that enhance patient/family care. This article will review the benefits of functional assessment, instruments that can be used during an ambulatory care visit, and interventions that can address potential limitations.

Integrating Geriatrics Into Oncology Ambulatory Care Clinics

BACKGROUND Geriatric oncology offers specialized care that incorporates comprehensive geriatric assessment (CGA) and multidisciplinary teams (MDTs) with oncology care. Geriatric syndromes, comorbidities, and caregiver concerns are relevant to the oncology assessment in older adult patients to make treatment decisions, which should be based not on age but on health and functional status, as well as on life expectancy. Developing a geriatric oncology ambulatory care clinic (GOACC) requires numerous resources and entails planning for longer patient encounter times, devising collaboration strategies with community care providers, and establishing dedicated time for team members. OBJECTIVES The purpose of this article is to provide information regarding the construction and sustainability of a GOACC. METHODS A comprehensive review of literature published from 1991-2015 was conducted using the following key words. FINDINGS Oncology primary care nurses and advanced practice nurses have a large role in the development and maintenance of GOACCs. Managing comorbidities, identifying patients who likely would benefit from a CGA, providing caregiver support, conducting a CGA, and creating an MDT are core elements of developing a sustainable GOACC.

Attitudes Among Healthcare Providers and Patients Diagnosed With Sickle Cell Disease: Frequent Hospitalizations and Stressors

Sickle cell disease (SCD) is a chronic condition that affects thousands of people worldwide. The purpose of this study is to illustrate some of the challenges and perceptions of people diagnosed with SCD. The aims were to describe stressors, problematic symptoms, sources of support, and interactions with healthcare providers. This descriptive study, using mostly open-ended questions and conceptual analysis, included a sample of patients with SCD who were older than 18 years in ambulatory (57%) and inpatient (43%) clinics. Participants completed a 20-minute interview. Pain or SCD crisis were the chief reasons for hospitalization, and a wellness checkup was the chief reason people returned to an ambulatory clinic. Most (74%) were able to perform chores. Family was reported to cause the most stress in the home and also provide the most help. Pain is a pervasive aspect of life, limiting activities of daily living. Negative interactions with healthcare providers are common; therefore, advocacy is necessary for patients with SCD.