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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.

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Resumen Introducción: la sepsis se diagnostica en más de 60% de los adultos mayores (AM) en el mundo. Estos AM con frecuencia presentan multimorbilidad y alguno de los síndromes geriátricos, llevando a discapacidad física, cognitiva y psicosocial, lo cual produce altos costos para los sistemas de salud, resultando en un problema grave de salud pública. Objetivo: identificar el impacto de la multimorbilidad y los síndromes geriátricos en la morta lidad de AM hospitalizados por sepsis en una unidad geriátrica de agudos a 30 días de su ingreso. Material y métodos: estudio observacional, analítico de casos y controles anidado en una cohorte. Resultados: se analizaron 238 pacientes con edad media de 83.15±7.12 años, 52.1% fueron mujeres y el 99% tenían al menos una comorbilidad, la mortalidad a 30 días fue 34%. La infección urinaria fue la causa principal de hospitalización (42.9%), obteniendo un aislamiento microbio-lógico en 43.3% de los casos, siendo la Escherichia coli el agente causal más frecuente (46.6%). La regresión logística múltiple mostró que la enfermedad renal crónica (OR 2.1 IC 95% 1.1-4.8; p=0.037), el delirium (OR 3.1 IC 95% 1.6-5.8; p=0.001) y la discapacidad (índice de Barthel <60; OR 3.4 IC 95% 1.5-7.5; p=0.002) se asociaron de manera significativa con la mortalidad a 30 días desde el ingreso a la unidad geriátrica de agudos en paciente con sepsis. Conclusión: en los AM hospitalizados por sepsis, la multimorbilidad, la enfermedad re nal crónica y los síndromes geriátricos representados por delirium y discapacidad fueron los predictores de mortalidad a 30 días. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2125).

Abstract Introduction: sepsis is diagnosed in more than 60% of older adults (OAs) worldwide. These OAs often have multimorbidity and one of the geriatric syndromes, leading to physical, cognitive and psychosocial disability with consequently high healthcare costs, resulting in a serious public health problem. Objective: to determine the impact of multimorbidity and geriatric syndromes on the 30-day mortality rate of OAs hospitalized for sepsis in an acute geriatric unit Materials and methods: an observational, analytical, nested case-control study. Results: 238 patients with a mean age of 83.15±7.12 were analyzed; 52.1% were women and 99% had at least one comorbidity; the 30-day mortality was 34%. Urinary tract infection was the main cause of hospitalization (42.9%), with microbiological isolation achieved in 43.3% of cases and Escherichia coli being the most common causal agent (46.6%). Multiple logistic regression showed that chronic kidney disease (OR 2.1 95% CI 1.1-4.8; p=0.037), delirium (OR 3.1 95% CI 1.6-5.8; p=0.001) and disability (Barthel index <60; OR 3.4 95% CI 1.5-7.5; p=0.002) were significantly related to 30-day mortality in patients with sepsis admitted to an acute geriatric unit. Conclusion: in OAs hospitalized for sepsis, multimorbidity, chronic kidney disease and geriatric syndromes (represented by delirium and disability) were the predictors of 30-day mortality. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2125).

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Resumen Introducción: las caídas en el adulto mayor influyen de manera negativa en su estado funcional y el riesgo de caídas se eleva progresivamente con la edad, por lo que es importante objetivar todos los factores de riesgo de cada paciente. El objetivo fue describir la prevalencia y los factores asociados con caídas en los pacientes del servicio ambulatorio de geriatría del Hospital Universitario San Ignacio en Bogotá (Colombia). Materiales y métodos: se realizó un estudio descriptivo con pacientes valorados en la consulta externa de geriatría del Hospital Universitario San Ignacio desde enero de 2017 hasta diciembre de 2018. Resultados: se incluyeron 233 pacientes, en quienes se documentó una prevalencia de caídas del 44.5 %. En el análisis bivariado, las variables con asociación estadísticamente significativa fueron: la presencia de trastorno neurocognitivo mayor (TNCM) (OR: 2.31; IC 95 %: 1.28-4.18; p: 0.005), el miedo a caer (OR: 2.27; IC 95 %: 1.24-4.18; p: 0.008), un grado de dependencia moderado a total (OR: 1.93; IC 95 %: 1.11-3.35; p: 0.019) y un mal estado nutricional (OR: 1.18; IC 95 %: 1.099-3.18; p: 0.02). No obstante, en el análisis multivariado, las variables que mantuvieron la asociación fueron el TNCM (OR: 2.09; IC 95 %: 1.14-3.86; p: 0.001) y el miedo a caer (OR: 2.27; IC 95 %: 1.19-4.32; p: 0.001). Conclusión: las variables asociadas con caídas en nuestra población se relacionan con lo descrito en la literatura mundial; son necesarias intervenciones para corregir estos factores y evitar caídas, así como diseñar más estudios para detectar otros factores asociados.

Abstract Introduction: Falls in the elderly have a negative impact on functional status and the risk of falls increases progressively with age, so it is important to objectify all the risk factors of each patient. Our objective was to describe the prevalence and factors associated with falls in patients from the geriatric outpatient service of the San Ignacio University Hospital in Bogotá, Colombia. Materials and methods: A descriptive study was carried out with patients assessed in the geriatric outpatient clinic of the San Ignacio University Hospital from January 2017 to December 2018. Results: 233 patients were included, documenting a prevalence of falls of 44.5%. In the bivariate analysis, the variables with a statistically significant association were: the presence of major neurocognitive disorder (MNCD) (OR: 2.31; 95 %> CI: 1.284.18; p: 0.005), fear of falling (OR: 2.27; 95 %> CI: 1.24-4.18; p: 0.008), a moderate to total degree of dependence (OR: 1.93; 95 %> ci 1.11-3.35; p: 0.019) and a poor nutritional status (OR: 1.18; 95 °/o CI: 1.099-3.18; p: 0.02). However, in the multivariate analysis, the variables that maintained the association were MNCD (OR: 2.09; 95 %> CI: 1.14-3.86; p: 0.001) and fear of falling (OR: 2.27; 95 %> CI: 1.19-4.32; p: 0.001). Discussion: The variables associated with falls in our population are related to what is described in the world literature; Interventions are necessary to correct these factors and avoid falls in our population, as well as to design more studies to detect other associated factors.

Resumo Introdução: as quedas em idosos impactam negativamente o estado funcional e o risco de quedas aumentam progressivamente com a idade, por isso é importante objetivar todos os fatores de risco de cada paciente. Nosso objetivo foi descrever a prevalência e os fatores associados às quedas em pacientes do ambulatório de geriatria do Hospital Universitário San Ignacio em Bogotá, Colômbia. Materiais e métodos: foi realizado um estudo descritivo com pacientes avaliados no ambulatório de geriatria do Hospital Universitário San Ignacio no período de janeiro de 2017 a dezembro de 2018. Resultados: foram incluídos 233 pacientes, documentando uma prevalência de quedas de 44,5%. Na análise bivariada, as variáveis com associação estatisticamente significativa foram: presença de trastorno neurocognitivo maior (TNCM) (OR: 2.31; IC 95%: 1,28-4,18; p: 0,005), medo de cair (OR: 2,27; IC 95%: 1,24-4,18; p: 0,008), grau de dependência moderado a total (OR: 1,93; IC 95%: 1,11-3,35; p: 0,019) e estado nutricional ruim (OR: 1,18; IC 95%: 1,099-3,18; p: 0,02); porém, na análise multivariada, as variáveis que mantiveram a associação foram TNCM (OR: 2,09; IC 95%: 1,14-3,86; p: 0,001) e medo de cair (OR: 2,27; IC 95%: 1,19-4,32; p: 0,001). Conclusão: as variáveis associadas às quedas em nossa população estão relacionadas ao que é descrito na literatura mundial; são necessárias intervenções para corrigir esses fatores e evitar quedas em nossa população, bem como desenhar mais estudos para detectar outros fatores associados.

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Introducción: El cáncer es una enfermedad asociada al envejecimiento y tiene una alta prevalencia en los adultos mayores. La valoración geriátrica integral (VGI) mejora los cuidados de los adultos mayores (AM) con cáncer. En contextos sanitarios con recursos limitados, no todos los AM podrán ser evaluados por un geriatra. Un modelo en 2 pasos, incluyendo el test G8, en la consulta habitual del oncólogo, permite seleccionar aquellos pacientes que se beneficiarán de una VGI. Esta puede aportar en la toma de decisiones del tratamiento oncológico específico. Objetivo: Evaluar el beneficio del test G8 y la VGI en ≥ 70 años con cáncer candidatos a recibir quimioterapia. Material y Métodos: Estudio observacional, descriptivo, de corte transversal, de una muestra no probabilística de pacientes ≥ de 70 años con diagnóstico de cáncer y candidatos a recibir quimioterapia. Se aplicó el G8 por el oncólogo y se completó la VGI en los que presentaron alteración en algunas de las áreas evaluadas. Resultados: Se analizaron 32 pacientes. Se realizó G8 a todos, en 21 de ellos se completó la VGI. En estos, en reunión multidisciplinaria con oncólogo y geriatra se discutió el tratamiento. En el 38% de los pacientes se cambió la conducta oncológica tras contar con la valoración geriátrica integral. Conclusión: Creemos que la incorporación del G8 en la práctica clínica del oncólogo aporta una herramienta de cribado útil para identificar los pacientes ≥70 años que se benefician de una VGI previa al inicio de tratamiento oncoespecífico, optimizando de esta manera los recursos.

Introduction: Cancer is a disease associated with aging and has a high prevalence in older adults. Comprehensive geriatric assessment (CGA) improves the care of older adults (OA)with cancer. In healthcare settings with limited resources, not all OA may be evaluated by a geriatrician. A 2-step model, including the G8 test, in the usual oncologist consultation, allows selecting those patients who will benefit from CGA. This can contribute to decision-making regarding specific cancer treatment. Objective: To evaluate the benefit of the incorporation of the G8 test and CGA in the ≥ 70 years with cancer candidates for chemotherapy. Material and Methods: Observational, descriptive, cross-sectional study of a non-probability sample of patients ≥ 70 years of age with a diagnosis of cancer and candidates for chemotherapy. The G8 was applied by the oncologist and the CGA was completed in those who presented alteration in some of the evaluated areas. Results: 32 patients were analyzed. G8 was performed in all, in 21 of them the CGA was completed. In these, the treatment was discussed in a multidisciplinary meeting with an oncologist and a geriatrician. Oncological behavior was changed in 38% of patients after having a comprehensive geriatric evaluation. Conclusion: We believe that the incorporation of the G8 test in the clinical practice of the oncologist provides a useful screening tool to identify patients ≥70 years who benefit from CGA prior to the start of oncospecific treatment, thus optimizing resources.

Introdução: O câncer é uma doença associada ao envelhecimento e tem alta prevalência em idosos. A avaliação geriátrica ampla (AGA) melhora o atendimento a idosos com câncer. Em ambientes de saúde com recursos limitados, nem todos eles podem ser avaliadas por um geriatra. Um modelo de duas etapas, incluindo o teste G8, na consulta oncológica usual, permite selecionar os pacientes que serão beneficiados pela AGA. Isso pode contribuir para a tomada de decisões em relação ao tratamento específico do câncer. Objetivo: Avaliar o benefício da incorporação do teste G8 e AGA nos ≥ 70 anos com câncer, candidatos à quimioterapia. Material e Métodos: Estudo observacional, descritivo e transversal de uma amostra não probabilística de pacientes com idade ≥ 70 anos com diagnóstico de câncer e candidatos à quimioterapia. O G8 foi aplicado pelo oncologista e a AGA foi realizada naqueles que apresentaram alteração em algumas das áreas avaliadas. Resultados: 32 pacientes foram analisados. O G8 foi realizado em todos, em 21 deles a AGA foi aplicada. Nesses, o tratamento foi discutido em reunião multidisciplinar com oncologista e geriatra. O tratamento oncológico foi alterado em 38% dos pacientes após uma avaliação geriátrica amplia. Conclusão: Acreditamos que a incorporação do teste G8 na prática clínica do oncologista fornece uma ferramenta de triagem útil para identificar pacientes com idade ≥70 anos que se beneficiam da AGA antes do início do tratamento oncoespecífico, otimizando recursos.

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BACKGROUND: The demographic changes in Brazil as a result of population aging is one of the fastest in the world. The far-reaching new challenges that come with a large older population are particularly disquieting in low- and middle-income countries (LMICs). Longitudinal studies must be completed in LMICs to investigate the social and biological determinants of aging and the consequences of such demographic changes in their context. Therefore, we designed the Prospective GERiatric Observational (ProGERO) study, a longitudinal study of outpatient older adults in São Paulo, Brazil, to collect data both on aging and chronic diseases, and investigate characteristics associated with adverse outcomes in this population. METHODS: The ProGERO study takes place in a geriatric outpatient clinic in the largest academic medical center in Latin America. We performed baseline health examinations in 2017 and will complete subsequent in-person visits every 3 years when new participants will also be recruited. We will use periodic telephone interviews to collect information on the outcomes of interest between in-person visits. The baseline evaluation included data on demographics, medical history, physical examination, and comprehensive geriatric assessment (CGA; including multimorbidity, medications, social support, functional status, cognition, depressive symptoms, nutritional status, pain assessment, frailty, gait speed, handgrip strength, and chair-stands test). We used a previously validated CGA-based model to rank participants according to mortality risk (low, medium, high). Our selected outcomes were falls, disability, health services utilization (emergency room visits and hospital admissions), institutionalization, and death. We will follow participants for at least 10 years. RESULTS: We included 1336 participants with a mean age of 82 ± 8 years old. Overall, 70% were women, 31% were frail, and 43% had a Charlson comorbidity index score ≥ 3. According to our CGA-based model, the incidence of death in 1 year varied significantly across categories (low-risk = 0.6%; medium-risk = 7.4%; high-risk = 17.5%; P < 0.001). CONCLUSION: The ProGERO study will provide detailed clinical data and explore the late-life trajectories of outpatient older patients during a follow-up period of at least 10 years. Moreover, the study will substantially contribute to new information on the predictors of aging, senescence, and senility, particularly in frail and pre-frail outpatients from an LMIC city.

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BACKGROUND: The early identification of individuals at high risk for adverse outcomes by a Comprehensive Geriatric Assessment (CGA) in resource-limited primary care settings enables tailored treatments, however, the evidence concerning its benefits are still controversial. The main objective of this study was to examine the validity and reliability of the "Multidimensional Assessment of Older People in Primary Care (AMPI-AB)", a CGA for primary care in resource-limited settings. METHODS: Longitudinal study, with median follow-up time of 16 months. Older adults from a public primary care unit in São Paulo, Brazil, were consecutively admitted. Reliability was tested in a sample from a public geriatric outpatient clinic. Participants were classified by the AMPI-AB score as requiring a low, intermediate or high complexity of care. The Physical Frailty Phenotype was used to explore the AMPI-AB's concurrent validity. Predictive validity was assessed with mortality, worsening of the functional status, hospitalizations, emergency room (ER) visits and falls. The area under the ROC curve and logistic regression were calculated for binary outcomes, and a Cox proportional hazards model was used for survival analysis. RESULTS: Older adults (n = 317) with a median age of 80 (74-86) years, 67% female, were consecutively admitted. At the follow-up, 7.1% of participants had died, and increased dependency on basic and instrumental activities of daily living was detected in 8.9 and 41.1% of the participants, respectively. The AMPI-AB score was accurate in detecting frailty (area under the ROC curve = 0.851), predicted mortality (HR = 1.25, 95%CI = 1.13-1.39) and increased dependency on basic (OR = 1.26, 95%CI = 1.10-1.46) and instrumental (OR = 1.22, 95%CI = 1.12-1.34) activities of daily living, hospitalizations (OR = 2.05, 95%CI = 1.04-1.26), ER visits (OR = 1.20, 95%CI = 1.10-1.31) and falls (OR = 1.10, 95%CI = 1.01-1.20), all models adjusted for sex and years of schooling. Reliability was tested in a sample of 52 older adults with a median age of 72 (85-64) years, 63.5% female. The AMPI-AB also had good interrater (ICC = 0.87, 95%CI = 0.78-0.92), test-retest (ICC = 0.86, 95%CI = 0.76-0.93) and proxy reliability (ICC = 0.84, 95%CI = 0.67-0.93). The Cronbach's alpha was 0.69, and the mean AMPI-AB administration time was 05:44 ± 02:42 min. CONCLUSION: The AMPI-AB is a valid and reliable tool for managing older adults in resource-limited primary care settings.

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BACKGROUND: Motor and cognitive deficits and consequently mobility problems are common in geriatric patients. The currently available methods for diagnosis and for the evaluation of treatment in this vulnerable cohort are limited. The aims of the ComOn (COgnitive and Motor interactions in the Older populatioN) study are (i) to define quantitative markers with clinical relevance for motor and cognitive deficits, (ii) to investigate the interaction between both motor and cognitive deficits and (iii) to assess health status as well as treatment outcome of 1000 geriatric inpatients in hospitals of Kiel (Germany), Brescia (Italy), Porto (Portugal), Curitiba (Brazil) and Bochum (Germany). METHODS: This is a prospective, explorative observational multi-center study. In addition to the comprehensive geriatric assessment, quantitative measures of reduced mobility and motor and cognitive deficits are performed before and after a two week's inpatient stay. Components of the assessment are mobile technology-based assessments of gait, balance and transfer performance, neuropsychological tests, frailty, sarcopenia, autonomic dysfunction and sensation, and questionnaires to assess behavioral deficits, activities of daily living, quality of life, fear of falling and dysphagia. Structural MRI and an unsupervised 24/7 home assessment of mobility are performed in a subgroup of participants. The study will also investigate the minimal clinically relevant change of the investigated parameters. DISCUSSION: This study will help form a better understanding of symptoms and their complex interactions and treatment effects in a large geriatric cohort.

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O sistema de saúde deve ser capaz de identificar idosos com maiores necessidades de atenção, a fim de postergar ao máximo a perda da capacidade funcional. Esta pesquisa descreve os achados obtidos pela aplicação da Avaliação Multidimensional do Idoso a um grupo de pessoas acima de 65 anos vinculadas a um plano de saúde, moradoras na cidade de São Paulo, SP. O grupo pesquisado apresenta média de idade elevada, predomínio de mulheres e agravos que ocasionam comprometimento importante da capacidade funcional de seus membros.

The health system should be able to identify older people with greater attention needs in order to foregone as much as possible the loss of functional capacity. This study describes the findings obtained by the application of the Comprehensive Geriatric Assessment to a group of people over 65 years old linked to a health plan, living in the city of São Paulo. The studied group had a high age average, a predominance of women and injuries that caused important impairment of their functional capacity.

El sistema de salud debe ser capaz de identificar a los ancianos con mayores necesidades de atención, a fin de postergar al máximo la pérdida de la capacidad funcional. Esta investigación describe los hallazgos obtenidos por la aplicación de la Evaluación Multidimensional del Anciano a un grupo de personas mayores de 65 años vinculadas a un plan de salud, residentes en la ciudad de São Paulo. El grupo investigado presenta un promedio de edad elevada, predominio de mujeres y agravios que ocasionan un compromiso importante de la capacidad funcional de sus miembros.

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OBJECTIVES: To develop and examine the validity and reliability of a targeted geriatric assessment (TaGA) for busy healthcare settings. DESIGN: The TaGA was developed through the consensus of experts (Delphi technique), and we investigated its construct validity and reliability in a cross-sectional study. SETTING: Geriatric day hospital specializing in acute care in Brazil. PARTICIPANTS: Older adults (N = 534) aged 79.5 ± 8.4, 63% female, consecutively admitted to the geriatric day hospital. MEASUREMENTS: The Frailty Index (FI), Physical Frailty Phenotype, and Identification of Seniors at Risk (ISAR) were used to explore the TaGA's validity. External scales were used to investigate the validity of each matched TaGA domain. The interrater reliability and time to complete the instrument were tested in a 53-person subsample. RESULTS: In 3 rounds of opinion, experts achieved consensus that the TaGA should include 10 domains (social support, recent hospital admissions, falls, number of medications, basic activities of daily living, cognitive performance, self-rated health, depressive symptoms, nutritional status, gait speed). They arrived at sufficient agreement on specific tools to assess each domain. A single numerical score from 0 to 1 expressed the cumulative deficits across the 10 domains. The TaGA score was highly correlated with the FI (Spearman coefficient = 0.79, 95% confidence interval (CI)=0.76-0.82) and discriminated between frail and nonfrail individuals better than the ISAR (area under the receiver operating characteristic curve 0.84 vs 0.72; P < .001). The TaGA score also had excellent interrater reliability (intraclass correlation coefficient = 0.92, 95% CI=0.87-0.95). Mean TaGA administration time was 9.5 ± 2.2 minutes. CONCLUSION: The study presents evidence supporting the TaGA's validity and reliability. This instrument may be a practical and efficient approach to screening geriatric syndromes in fast-paced healthcare settings. Future research should investigate its predictive value and effect on care.

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OBJECTIVE: To evaluate the capacity of total anterior thigh thickness, quadriceps muscle thickness, and quadriceps contractile index, all measured by bedside ultrasound, to predict rehospitalization, functional decline, and death in elderly patients 3 months after hospital discharge. To evaluate intra and interobserver reproducibility of the dominant thigh evaluation method by point of care ultrasound. METHODS: Cohort study of patients aged 65 years or more admitted to a medium complexity unit in a teaching hospital in southern Brazil. Comprehensive geriatric assessment and ultrasound evaluation of the dominant thigh of each participant were performed. After 3 months of hospital discharge, telephone contact was made to evaluate the outcomes of rehospitalization or death and functional decline-assessed by the 100 points Barthel scale and defined as a decrease of five or more points. RESULTS: 100 participants were included. There was no statistically significant difference between intraobserver measurements in the GEE method analysis (p > 0.05), and the mean bias obtained in Bland-Altman plots was close to zero in all four analyses performed, suggesting good intra and interobserver agreement. There was a significant correlation between the echographic measurements (quadriceps thickness and contractile index) and gait speed, timed up and go, and handgrip tests. There was a significant association between contractile index (quadriceps thickness over total anterior thigh thickness multiplied by 100) lower than 60% and functional decline (relative risk 1.35; CI 95% 1.10-1.65; p = 0.003) as well as between the thickness of the quadriceps and rehospitalization or death, in both individuals with preserved walking capacity and in bedridden elders (relative risk 1.34; CI 95% 1.02-1.75; p = 0.04). CONCLUSION: The ultrasonographic method to evaluate thigh thickness was easily applicable and reproducible. The thickness of the quadriceps could predict rehospitalization or death, even in those patients without walking capacity-unable to perform gait speed and timed up and go tests. Additionally, the contractile index was associated with functional decline after 3 months of hospital discharge. This is a promising result, which highlights the bedside ultrasound of the quadriceps as a potential tool for the prognosis evaluation of bedridden hospitalized elderly patients.

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Con el objeto de proponer un método de evaluación geriátrica integral (EGI) fundamentado en el modelo de autonotificación del estado de salud utilizado en el estudio SABE (OPS/OMS), se hizo un estudio de corte transversal, descriptivo, muestra no probabilística conformada por 50 adultos mayores que aceptaron participar voluntariamente. 62% del sexo femenino, edad 72,62 años + 9,18. 48% estaba en pobreza relativa, 66% completó estudios básicos. 74% dependía de ingresos por pensiones, 98% padecía más de dos enfermedades; 38% estaban polimedicados, sobrepeso en 70%, la obesidad fue más frecuente en mujeres. 70% padecía hipertensión arterial, más frecuente en hombres. La autonotificación reportó depresión en 30%, dependencia para actividades básicas de la vida diaria (ABVD) en 12%, para actividades instrumentales de la vida diaria (AIVD) la dependencia 30%, ambas condiciones y la depresión fueron más frecuentes en mujeres. La aplicación conjunta del “mini mental state examination” (MMSE) y el “Pfeffer Functional Activities Questionnaire” (PFAQ) demostró déficit cognitivo en 8%, el riesgo de trastorno cognitivo en sujetos con dependencia fue 15 veces superior. Concluimos que la mayoría presentó condiciones de riesgo para fragilidad y/o dependencia. El modelo de autonotificación del estado de salud es: viable, no requiere entrenamiento especial, sencillo para su aplicación y corrección, y no recarga la actividad del médico, se recomienda su uso para la evaluación integral de adultos mayores en las consultas de atención primaria en salud.

In order to propose a method of comprehensive geriatric assessment (CGA) based on the model of self-reported health status used in the study KNOWS (PAHO / WHO), a cross-sectional, descriptive study was carried out, with a non-random sample of 50 older adults who voluntarily agreed to participate. 62% were female, age 72.62 years + 9.18. 48% were in relative poverty, 66% completed basic studies. 74% depended on pension income, 98% had more than two diseases; 38% were in polypharmacy, 70% overweight, obesity was more common in women. 70% had hypertension, more frequent in men. 30% reported depression in self-report, dependence for basic activities of daily living (ADLs) in 12%, for instrumental activities of daily living (IADL) dependence 30%, both conditions and depression were more frequent in women. Joint implementation of the “mini mental state examination” (MMSE) and the “Pfeffer Functional Activities Questionnaire” (PFAQ) showed cognitive deficit in 8.0%. Risk of cognitive impairment in subjects with dependence was 15 times higher. We conclude that most of the studied subjects presented risk factors for fragility and/or dependency. The self-reported health status model is feasible, it does not require special training, it is simple to implement and correct, it does not overload the physician. It is recommended for a comprehensive assessment of older adults in primary care medical visits.

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PURPOSE OF THE STUDY: Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy worldwide. Its incidence increases with age and about 40% of cases occur in patients over 70 years. Herein, we describe a case of a frail elderly patient with renal insufficiency and DLBCL treated with R-mini-CHOP. CASE REPORT: A 77-year-old man on maintenance hemodialysis started experiencing persistent fatigue. He was diagnosed with a large mass on the left lobe of the lung. Biopsy demonstrated a DLBCL, CD20 positive. The patient was assigned clinical stage IIBX, with a high age-adjusted international prognosis index. A proper geriatric assessment revealed a frail patient. Thus, an adapted chemotherapy regimen was proposed which consisted of R-mini-CHOP every 21 days, with a reduction of 10% in the doses of doxorubicin and cyclophosphamide. During the treatment, the patient went through regular dialysis sessions, 3 times per week, with an extra session performed 12 h after each chemotherapy administration. The patient experienced no adverse events or grade 3/4 toxicities. After 6 cycles of R-mini-CHOP, the patient achieved unconfirmed complete remission, and consolidation radiotherapy was performed. At the last follow-up, he was still in unconfirmed complete remission, with a progression-free survival of 11.3 months. CONCLUSIONS: R-mini-CHOP represented a reasonable treatment option for this patient with renal failure. The oncogeriatric approach led to a successful management of this frail patient, highlighting that an adapted plan of care is a key issue to improve the outcomes of elderly cancer patients.

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Graças à melhoria global das condições de saúde e de vida, a população mundial está envelhecendo. Aproximadamente 60% da incidência de câncer ocorre em adultos de 65 anos ou mais. O câncer é um importante problema de saúde na população idosa. Oncologia geriátrica é definido pela abordagem multidimensional e multidisciplinar dos idosos portadores de câncer. A avaliação geriátrica ampla (AGA) foi desenvolvida para avaliar individualmente o estado de saúde dos pacientes idosos e é a ferramenta mais adequada para detectar os problemas funcionais nestes pacientes. O objetivo deste estudo, através de uma revisão da literatura, foi analisar o impacto da AGA em pacientes idosos com câncer. Resultados: A AGA pode detectar vários problemas sub ou não diagnosticados em pacientes com câncer. Alguns estudos sugerem que os critérios utilizados pela AGA são preditores de morbidade e mortalidade e podem influenciar as decisões do tratamento oncológico, tendo um impacto positivo no prognóstico dos pacientes com esta doença. Conclusões: Avaliação geriátrica ampla é um importante instrumento que pode ajudar a definir o prognóstico e influenciar na decisão e resultado do tratamento do idoso com câncer.

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