Browsing by Subject "Geriatric assessment"

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    Breaking the Age Barrier: Physicians' Perceptions of Candidacy for Allogeneic Hematopoietic Cell Transplantation in Older Adults
    (Elsevier, 2021) Mishra, Asmita; Preussler, Jaime M.; Bhatt, Vijaya Raj; Bredeson, Christopher; Chhabra, Saurabh; D'Souza, Anita; Dahi, Parastoo B.; Danaher Hacker, Eileen; Gowda, Lohith; Hashmi, Shahrukh K.; Howard, Dianna S.; Jakubowski, Ann; Jayani, Reena; Koll, Thuy; Olin, Rebecca L.; Popat, Uday R.; Rodriguez, Cesar; Rosko, Ashley; Sabloff, Mitchell; Sorror, Mohamed L.; Sung, Anthony D.; Ustun, Celalettin; Wood, William A.; Burns, Linda; Artz, Andrew; School of Nursing
    Background: Despite continued increases in use of allogeneic hematopoietic cell transplantation (alloHCT) among older adults, no standardized geriatric assessment (GA) has been established to risk-stratify for transplant-related morbidity. We conducted a survey of transplant physicians to determine perceptions of the impact of older age (≥60 years) on alloHCT candidacy, and utilization of tools to gauge candidacy. Methods: We conducted a 23-item, online cross-sectional survey of HCT physicians caring for adults in the United States between May and July 2019. Results: Of the 770 invited HCT physicians, 175 (22.7%) completed the survey. The majority of respondents were 41–60 years old, male, and practiced in a higher volume teaching hospital. When considering regimen intensity, 29 physicians (17%) stated they would consider a myeloablative regimen for patients ≥70 years, and 141 (82%) would consider reduced intensity/non-myeloablative conditioning for patients ≥70 years. Almost all (90%) endorsed the need for a specialized assessment of pre-HCT vulnerabilities to guide candidacy decisions for older adults. Most physicians reported their centers rarely (33%) or never (46%) utilize a dedicated geriatrician/geriatric-oncologist to assess alloHCT candidates ≥60 years. Common barriers to performing a GA included uncertainty about which tools to use, lack of knowledge and training, and lack of appropriate clinical support staff. Conclusions: Many alloHCT physicians will consider alloHCT in patients up to age 75 years and not uncommonly, in patients older than that. However, application of tools and domains varies widely to assess candidacy in older adults. Incorporation of a standardized pre-transplant health assessment tool for risk stratification is a significant unmet need.
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    Validating administratively derived frailty scores for use in Veterans Health Administration emergency departments
    (Wiley, 2023) Dev, Sharmistha; Gonzalez, Andrew A.; Coffing, Jessica; Slaven, James E.; Dev, Shantanu; Taylor, Stan; Ballard, Carrie; Hastings, S. Nicole; Bravata, Dawn M.; Emergency Medicine, School of Medicine
    Objectives: Frailty is a clinical syndrome characterized by decreased physiologic reserve that diminishes the ability to respond to stressors such as acute illness. Veterans Health Administration (VA) emergency departments (ED) are the primary venue of care for Veterans with acute illness and represent key sites for frailty recognition. As questionnaire-based frailty instruments can be cumbersome to implement in the ED, we examined two administratively derived frailty scores for use among VA ED patients. Methods: This national retrospective cohort study included all VA ED visits (2017-2020). We evaluated two administratively derived scores: the Care Assessment Needs (CAN) score and the VA Frailty Index (VA-FI). We categorized all ED visits across four frailty groups and examined associations with outcomes of 30-day and 90-day hospitalization and 30-day, 90-day, and 1-year mortality. We used logistic regression to assess the model performance of the CAN score and the VA-FI. Results: The cohort included 9,213,571 ED visits. With the CAN score, 28.7% of the cohort were classified as severely frail; by VA-FI, 13.2% were severely frail. All outcome rates increased with progressive frailty (p-values for all comparisons < 0.001). For example, for 1-year mortality based on the CAN score frailty was determined as: robust, 1.4%; prefrail, 3.4%; moderately frail, 7.0%; and severely frail, 20.2%. Similarly, for 90-day hospitalization based on VA-FI, frailty was determined as prefrail, 8.3%; mildly frail, 15.3%; moderately frail, 29.5%; and severely frail, 55.4%. The c-statistics for CAN score models were higher than for VA-FI models across all outcomes (e.g., 1-year mortality, 0.721 vs. 0.659). Conclusions: Frailty was common among VA ED patients. Increased frailty, whether measured by CAN score or VA-FI, was strongly associated with hospitalization and mortality and both can be used in the ED to identify Veterans at high risk for adverse outcomes. Having an effective automatic score in VA EDs to identify frail Veterans may allow for better targeting of scarce resources.