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Kim W, Lee SC, Lee WR, Chun S. The effect of the introduction of the national lung cancer screening program on short-term mortality in Korea. Lung Cancer 2023; 186:107412. [PMID: 37856923 DOI: 10.1016/j.lungcan.2023.107412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND South Korea introduced the National Lung Cancer Screening Program (NLCSP) in 2019. This study investigated the effect of the NLCSP on one-year mortality in individuals with a history of lung cancer. METHODS This study used the 2018-2020 National Health Insurance Service claims data. The difference-in-differences approach was used to investigate the effect of participating in the NLCSP between the case and control groups before and after the intervention period. The case group included individuals aged between 54 and 74 years with a smoking history of ≥ 30 pack-years and the control group those aged between 54 and 74 years with a history of smoking of <30 pack-years and non-smokers. The pre-intervention period was from January 2018 to June 2019 and the post-intervention period from July 2019 to December 2020. RESULTS The introduction of the NLCSP was related to an overall decrease in one-year mortality (-3.21 % points, 95 % Confidence Interval (CI) -4.84 to -1.58). Specifically, this reduction was significant for lung cancer related mortality (lung cancer: -2.69 % points, 95 % CI -4.24 to -1.13). Furthermore, stronger associations were found in individuals of older age, residing in non-metropolitan areas, and who visited healthcare institutions in non-metropolitan areas. CONCLUSION The findings confirm a relationship between implementation of the NLCSP and one-year mortality in eligible individuals with a history of lung cancer, which is noteworthy considering that Korea is one of the first countries to include lung cancer into the national cancer screening program.
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Affiliation(s)
- Woorim Kim
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea; Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
| | - Sang Chul Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Woo-Ri Lee
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Sungyoun Chun
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea.
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Kanninen JC, Holm A, Koivisto AL, Hietasalo P, Heikkilä AM, Kunvik S, Bergman J, Airaksinen M, Puustinen J. Development of a Preventive Health Screening Procedure Enabling Supportive Service Planning for Home-Dwelling Older Adults (PORI75): Protocol for an Action Research Study. JMIR Res Protoc 2023; 12:e48753. [PMID: 37788079 PMCID: PMC10582811 DOI: 10.2196/48753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND In Finland, at least 1 in 4 residents will be >75 years of age in 2030. The national aging policy has emphasized the need to improve supportive services to enable older people to live in their own homes for as long as possible. OBJECTIVE This study aimed to develop a preventive health screening procedure for home-dwelling older adults aged 75 years to enable the use of clinical patient data for purposes of strategic planning of supportive services in primary care. METHODS The action research method was applied to develop the health screening procedure with selected validated health measures in cooperation with the local practicing interprofessional health care teams from 10 primary care centers in the Social Security Center of Pori, Western Finland (99,485 residents, n=11,938, 12% of them >75 years). The selection of evidence-based validated health measures was based on the national guide to screen factors increasing fall risk and the national functioning measures database. The cut-off points of the selected health measures and laboratory tests were determined in consecutive consensus meetings with the local primary care physicians, with decisions based on internationally validated measures, national current care guidelines, and local policies in clinical practice. RESULTS The health screening procedure for 75-year-old residents comprised 30 measures divided into three categories: (1) validated self-assessments (9 measures), (2) nurse-conducted screenings (14 measures), and (3) laboratory tests (7 measures). The procedure development process comprised the following steps: (1) inventory and selection of the validated health measures and laboratory tests, (2) training of practical nurses to perform screenings for the segment of 75-year-old residents and to guide them to possible further medical actions, (3) creation of research data from clinical patient data for secondary use purposes, (4) secondary data analysis, and (5) consensus meeting after the pilot test of the health screening procedure for 75-year-old residents procedure in 2019 based on the experiences of health care professionals and collected research data. CONCLUSIONS The developed preventive health screening procedure for 75-year-old residents enables the use of clinical patient data for purposes of strategic planning of supportive services in primary care if the potential bias by a low participation rate is controlled. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48753.
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Affiliation(s)
- Jonna Carita Kanninen
- Faculty of Technology, Satakunta University of Applied Sciences, Pori, Finland
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Satasairaala Central Hospital, Pori, Finland
| | - Anu Holm
- Faculty of Technology, Satakunta University of Applied Sciences, Pori, Finland
| | | | | | | | - Susanna Kunvik
- Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Jussi Bergman
- Faculty of Technology, Satakunta University of Applied Sciences, Pori, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Juha Puustinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Unit of Neurology, Satasairaala Central Hospital, Satakunta Wellbeing County, Pori, Finland
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Smith J, Dodd RH, Hersch J, Cvejic E, McCaffery K, Jansen J. Effect of different communication strategies about stopping cancer screening on screening intention and cancer anxiety: a randomised online trial of older adults in Australia. BMJ Open 2020; 10:e034061. [PMID: 32532766 PMCID: PMC7295415 DOI: 10.1136/bmjopen-2019-034061] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess different strategies for communicating to older adults about stopping cancer screening. DESIGN 4 (recommendation statement about stopping screening)×(2; time) online survey-based randomised controlled trial. SETTING Australia. PARTICIPANTS 271 English-speaking participants, aged 65-90, screened for breast/prostate cancer at least once in past decade. INTERVENTIONS Time 1: participants read a scenario in which their general practitioner (GP) informed them about the potential benefits and harms of cancer screening, followed by double-blinded randomisation to one of four recommendation statements to stop screening: control ('this screening test would harm you more than benefit you'), health status ('your other health issues should take priority'), life expectancy framed positively ('this test would not help you live longer') and negatively ('you may not live long enough to benefit'). Time 2: in a follow-up scenario, the GP explained why guidelines changed over time (anchoring bias intervention). MEASURES Primary outcomes: screening intention and cancer anxiety (10-point scale, higher=greater intention/anxiety), measured at both time points. SECONDARY OUTCOMES trust (in their GP, the information provided, the Australian healthcare system), decisional conflict and knowledge of the information presented. RESULTS 271 participants' responses analysed. No main effects were found. However, screening intention was lower for the negatively framed life expectancy versus health status statement (6.0 vs 7.1, mean difference (MD)=1.1, p=0.049, 95% CI 0.0 to 2.2) in post hoc analyses. Cancer anxiety was lower for the negatively versus positively framed life expectancy statement (4.8 vs 5.8, MD=1.0, p=0.025, 95% CI 0.1 to 1.9). The anchoring bias intervention reduced screening intention (MD=0.8, p=0.044, 95% CI 0.6 to 1.0) and cancer anxiety (MD=0.3, p=0.002, 95% CI 0.1 to 0.4) across all conditions. CONCLUSION Older adults may reduce their screening intention without reporting increased cancer anxiety when clinicians use a more confronting strategy communicating they may not live long enough to benefit and add an explicit explanation why the recommendation has changed. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12618001306202; Results).
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Affiliation(s)
- Jenna Smith
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael H Dodd
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jolyn Hersch
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin Cvejic
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jesse Jansen
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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Kotwal AA, Walter LC, Lee SJ, Dale W. Are We Choosing Wisely? Older Adults' Cancer Screening Intentions and Recalled Discussions with Physicians About Stopping. J Gen Intern Med 2019; 34:1538-1545. [PMID: 31147981 PMCID: PMC6667516 DOI: 10.1007/s11606-019-05064-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/11/2019] [Accepted: 04/11/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND National guidelines recommend against cancer screening for older individuals with less than a 10-year life expectancy, but it is unknown if this population desires ongoing screening. OBJECTIVE To determine (1) if older individuals with < 10-year life expectancy have future intentions for cancer screening, (2) if they recall a doctor previously suggesting that screening is no longer needed, and (3) individual characteristics associated with intentions to seek screening. DESIGN National Social life Health and Aging Project (2015-2016), a nationally representative, cross-sectional survey. PARTICIPANTS Community-dwelling adults 55-97 years old (n = 3816). MAIN MEASURES Self-reported: (1) mammography and PSA testing within the last 2 years, (2) future intentions to be screened, and (3) discussion with a doctor that screening is no longer needed. Ten-year life expectancy was estimated using the Lee prognostic index. Multivariate logistic regression analysis examined intentions to pursue future screening, adjusting for sociodemographic and health covariates. KEY RESULTS Among women 75-84 with < 10-year life expectancy, 59% intend on future mammography and 81% recall no conversation with a doctor that mammography may no longer be necessary. Among men 75-84 with < 10-year life expectancy, 54% intend on future PSA screening and 77% recall no discussions that PSA screening may be unnecessary. In adjusted analyses, those reporting recent cancer screening or no recollection that screening may not be necessary were more likely to want future mammography or PSA screening (p < 0.001). CONCLUSION Over 75% of older individuals with limited life expectancy intend to continue cancer screening, and less than 25% recall discussing with physicians the need for these tests. In addition to public health and education efforts, these results suggest that older adults' recollection of being told by physicians that screening is not necessary may be a modifiable risk factor for reducing overscreening in older adults with limited life expectancy.
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Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Louise C Walter
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Sei J Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, USA
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Zhang D, Zhang C, Sun X, Zhao Y, Tan Q, Zhou J, Huang H. BMI, Physical Inactivity, and Pap Test Use in Asian Women in the U.S. Am J Prev Med 2019; 56:e85-e94. [PMID: 30655085 DOI: 10.1016/j.amepre.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION In the U.S., limited epidemiologic studies have investigated associations between BMI and physical inactivity and Pap test use among Asian women. The aim was to disentangle associations using data from the Behavioral Risk Factor Surveillance System between 2014 and 2016. METHODS In the Behavioral Risk Factor Surveillance System, BMI was categorized into four levels (<18.5, 18.5 to <25, 25 to <30, and ≥30) and inactivity was defined as having no physical activity in addition to the individual's regular job during the past month. Analyses were conducted in June 2018. Weighted percentages of covariates were used to descriptively summarize the data. Multivariable logistic regression corrected for sampling weight was used to estimate associations between BMI and inactivity and Pap test use. Subgroup analysis was conducted by income and education. RESULTS The analysis included 9,424 women and 59.6% of them had their last Pap test within 3 years. OR in the mutually adjusted model suggested underweight (BMI <18.5 compared with normal weight) was inversely associated with Pap test use within the last 3 years (OR=0.56, 95% CI=0.36, 0.88). Inactivity (compared with activity) was not associated with Pap test use within the last 3 years (OR=0.80, 95% CI=0.60, 1.06). Different association patterns of BMI and inactivity were observed by education. CONCLUSIONS This study suggests that being underweight, rather than overweight or obesity, is associated with a lower rate of Pap test use in U.S. Asian women. Health interventions to facilitate Pap test use in Asian women should explore other potential targets, not aiming to just prevent obesity or change physical inactivity.
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Affiliation(s)
- Dongyu Zhang
- Department of Oncology, Georgetown University School of Medicine, Washington, District of Columbia.
| | - Chengchen Zhang
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Xuezheng Sun
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yuan Zhao
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Qi Tan
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Junmin Zhou
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Hongtai Huang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, California
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Fowler NR, Schonberg MA, Sachs GA, Schwartz PH, Gao S, Lane KA, Inger L, Torke AM. Supporting breast cancer screening decisions for caregivers of older women with dementia: study protocol for a randomized controlled trial. Trials 2018; 19:678. [PMID: 30541634 PMCID: PMC6292112 DOI: 10.1186/s13063-018-3039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 11/03/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) impact a woman's life expectancy and her ability to participate in medical decision-making about breast cancer screening, necessitating the involvement of family caregivers. Making decisions about mammography screening for women with ADRD is stressful. There are no data that suggest that breast cancer screening helps women with ADRD live longer or better. Decision aids may improve the quality of decision-making about mammography for ADRD patients and may inform family caregivers about the risks, benefits, and need for decision-making around mammography screening. METHODS/DESIGN The Decisions about Cancer Screening in Alzheimer's Disease (DECAD) trial, a randomized controlled clinical trial, will enroll 426 dyads of older women with ADRD (≥75 years) and a family caregiver from clinics and primary-care practices in Indiana to test a novel, evidence-based decision aid. This decision aid includes information about the impact of ADRD on life expectancy, the benefit of mammograms, and the impact on the quality of life for older women with ADRD. Dyads will be randomized to receive the decision aid or active control information about home safety. This trial will examine the effect on the caregiver's decisional conflict (primary outcome) and the caregiver's decision-making self-efficacy (secondary outcome). A second follow-up at 15 months will include a brief, semi-structured interview with the caregiver regarding the patient's experience with mammograms and decision-making about mammograms. At the same time, a review of the patient's electronic medical record (EMR) will look at discussions about mammography with their primary-care physician and mammogram orders, receipt, results, and burden (e.g., additional diagnostic procedures due to false-positive results, identification of an abnormality on the screening exam but further work-up declined, and identification of a clinically unimportant cancer). A third follow-up at 24 months will extract EMR data on mammogram orders, occurrences, results, and the burden of mammograms. DISCUSSION We hypothesize that caregivers who receive the decision aid will have lower levels of decisional conflict and higher levels of decision-making self-efficacy compared to the control group. We also hypothesize that the DECAD decision aid will reduce mammography use among older women with ADRD. TRIAL REGISTRATION Clinical Trials Register, NCT03282097 . Registered on 13 September 2017.
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Affiliation(s)
- Nicole R. Fowler
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Internal Medicine and Geriatrics, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Sandra Eskenazi Center for Brain Care Innovation, 1101 West 10th Street, Indianapolis, IN 46202 USA
| | - Mara A. Schonberg
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Greg A. Sachs
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Internal Medicine and Geriatrics, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Sandra Eskenazi Center for Brain Care Innovation, 1101 West 10th Street, Indianapolis, IN 46202 USA
| | - Peter H. Schwartz
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Internal Medicine and Geriatrics, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Sujuan Gao
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Department of Biostatistics, 410 W. 10th Street, Suite 3000, Indianapolis, IN 46202 USA
| | - Kathleen A. Lane
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Department of Biostatistics, 410 W. 10th Street, Suite 3000, Indianapolis, IN 46202 USA
| | - Lev Inger
- Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202 USA
| | - Alexia M. Torke
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Internal Medicine and Geriatrics, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Center for Bioethics, 1101 West 10th Street, Indianapolis, IN 46202 USA
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Kotwal AA, Schonberg MA. Cancer Screening in the Elderly: A Review of Breast, Colorectal, Lung, and Prostate Cancer Screening. Cancer J 2018; 23:246-253. [PMID: 28731949 PMCID: PMC5608027 DOI: 10.1097/ppo.0000000000000274] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are relatively limited data on outcomes of screening older adults for cancer; therefore, the decision to screen older adults requires balancing the potential harms of screening and follow-up diagnostic tests with the possibility of benefit. Harms of screening can be amplified in older and frail adults and include discomfort from undergoing the test itself, anxiety, potential complications from diagnostic procedures resulting from a false-positive test, false reassurance from a false-negative test, and overdiagnosis of tumors that are of no threat and may result in overtreatment. In this paper, we review the evidence and guidelines on breast, colorectal, lung and prostate cancer as applied to older adults. We also provide a general framework for approaching cancer screening in older adults by incorporating evidence-based guidelines, patient preferences, and patient life expectancy estimates into shared screening decisions.
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Affiliation(s)
- Ashwin A. Kotwal
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mara A. Schonberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Cancer Screening in the Elderly: A Review of Breast, Colorectal, Lung, and Prostate Cancer Screening. Cancer J 2017. [DOI: 10.1097/00130404-201707000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Herr M, Robine JM, Pinot J, Arvieu JJ, Ankri J. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 2015; 24:637-46. [PMID: 25858336 DOI: 10.1002/pds.3772] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/09/2015] [Accepted: 02/24/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess the prevalence of polypharmacy and frailty, to examine their association, and to establish their independent and combined effects on mortality in a sample of French old people. METHODS This is a cross-sectional population study of people aged 70 years and over. A total of 2350 respondents were interviewed at home in 2008-2010. Frailty was defined as impairment in three domains or more among nutrition, energy, physical activity, strength, and mobility, in the absence of difficulties in basic activities of daily living. Mortality data were documented after a mean follow-up period of 2.6 years. RESULTS Mean age of the population was 83.3 +/- 7.5 years, with 59.4% of women. Prevalence of frailty was 17.0%. Polypharmacy (5-9 drugs) was reported in 53.6% of the population, and excessive polypharmacy (10 drugs or more) in 13.8%. After adjustment for socio-demographic and health variables, polypharmacy and excessive polypharmacy were associated with frailty with odds ratio 1.77 [1.20-2.61] and 4.47 [2.37-8.42], respectively. Frailty (hazard ratio [HR] 2.56 [1.63-4.04]) and excessive polypharmacy (HR 1.83 [1.28-2.62]) were independent predictors of mortality. Compared with non-frail people without polypharmacy, frail people with excessive polypharmacy were six times more likely to die during the follow-up period (HR 6.30 [3.09-12.84]). CONCLUSION By showing the independent and combined effects of polypharmacy and frailty on mortality risk, this study should reinforce the awareness of clinicians with regard to these factors, rather prevalent in old people.
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Affiliation(s)
- Marie Herr
- INSERM, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, U1168, Villejuif, France.,UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
| | | | - Juliette Pinot
- INSERM, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, U1168, Villejuif, France.,UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
| | - Jean-Jacques Arvieu
- AG2R La Mondiale, Direction des Etudes, Prévoyance Individuelle et IARD, Paris, France
| | - Joël Ankri
- INSERM, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, U1168, Villejuif, France.,UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
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Razavi F, Gross S, Katz S. Endoscopy in the elderly: risks, benefits, and yield of common endoscopic procedures. Clin Geriatr Med 2014; 30:133-47. [PMID: 24267608 DOI: 10.1016/j.cger.2013.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There has been limited research examining the risks, benefits, and use of common endoscopic procedures in the elderly. Furthermore, gastroenterology training programs do not routinely incorporate elderly concerns when dealing with common gastrointestinal issues. There exists a broad array of endoscopic procedures with varying inherent risks that must be weighed with each elderly patient in mind. This article discusses the benefits and drawbacks of the most common procedures and indications for endoscopy including upper endoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, percutaneous endoscopic gastrostomy, and deep enteroscopy.
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Affiliation(s)
- Farid Razavi
- Division of Gastroenterology, Langone Medical Center, New York University, 550 1st Avenue, New York, NY 10016, USA.
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Tung EE, Chen CYY, Takahashi PY. Common curbsides and conundrums in geriatric medicine. Mayo Clin Proc 2013; 88:630-5. [PMID: 23726402 DOI: 10.1016/j.mayocp.2013.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/26/2013] [Accepted: 03/29/2013] [Indexed: 12/25/2022]
Abstract
Within the next 15 years, the population of adults 65 years and older in the United States will double to approximately 70 million. Physicians must be well prepared to care for this rapidly growing population. Senior adults comprise a large proportion of most primary care practices in the United States, and the unique needs of this population cannot be overstated. Although traditional preventive screening modalities and disease-specific care models are of great utility, these processes may not be appropriate or consistent with the health goals of many older patients with multiple chronic conditions and reduced functional capacity. This Concise Review highlights commonly encountered clinical scenarios important to the care of these older patients. The topics include diagnosis and management of mild cognitive impairment, assessment of the cognitively impaired driver, cancer screening in the older patient, and sarcopenia.
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Affiliation(s)
- Ericka E Tung
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Torke AM, Schwartz PH, Holtz LR, Montz K, Sachs GA. Older adults and forgoing cancer screening: "I think it would be strange". JAMA Intern Med 2013; 173:526-31. [PMID: 23478883 PMCID: PMC3748399 DOI: 10.1001/jamainternmed.2013.2903] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients' perceptions regarding cessation of cancer screening. Information on older adults' views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening. OBJECTIVE To obtain a deeper understanding of older adults' perspectives on screening cessation and their experiences communicating with clinicians about this topic. DESIGN Semistructured interview study. SETTING Senior health center affiliated with an urban hospital. PARTICIPANTS We interviewed 33 older adults presenting to a senior health center. Their median age was 76 years (range, 63-91 years). Of the 33 participants, 27 were women; 15 were African American, 16 were white, 1 was Asian, and 1 was American Indian. MAIN OUTCOME MEASURES We transcribed audio recordings of interviews and analyzed them using methods of grounded theory to identify themes and illustrative quotes. RESULTS Undergoing screening tests was perceived by participants as morally obligatory. Although many saw continued screening as a habit or custom not involving any decision, cessation of screening would require a major decision. Many asserted that they had never discussed screening cessation with their physicians or considered stopping on their own; some reported being upset when their physician recommended stopping. Although some would accept a physician's strong recommendation to stop, others thought that such a physician's recommendation would threaten trust or lead them to get another opinion. Participants were skeptical about the role of statistics and the recommendations of government panels in screening decisions but were more favorable toward stopping because of the balance of risks and benefits, complications, or test burdens. CONCLUSIONS AND RELEVANCE For many older adults, stopping screening is a major decision, but continuing screening is not. A physician's recommendation to stop may threaten patient trust. Effective strategies to reduce nonbeneficial screening may include discussion of the balance of risks and benefits, complications, or burdens.
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Affiliation(s)
- Alexia M Torke
- Indiana University Center for Aging Research, Indianapolis, IN 46202, USA.
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Eckstrom E, Feeny DH, Walter LC, Perdue LA, Whitlock EP. Individualizing cancer screening in older adults: a narrative review and framework for future research. J Gen Intern Med 2013; 28:292-8. [PMID: 23054920 PMCID: PMC3614148 DOI: 10.1007/s11606-012-2227-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 08/21/2012] [Accepted: 08/31/2012] [Indexed: 12/18/2022]
Abstract
Older adults often have multiple chronic conditions that may decrease additional life expectancy. Research evaluating the benefits and harms of screening must include consideration of competing morbidities and patient heterogeneity (beyond age), potentially increased harms of screening, and patient preferences. Other areas in need of additional research include the lack of evidence for older adults on the harms of screening tests; the overdiagnosis of disease; the burden of disease labeling; the effects of inaccurate test results; the harms of disease treatment; and harms related to prioritization of healthcare (e.g., for a particular patient, lifestyle counseling may be more important than screening). Nontraditional outcomes, such as the effects on family caregivers, are also relevant. Studies comparing trajectories of quality-adjusted survival with and without screening to assess net benefit are typically lacking. There is little evidence on the preferences of older adults for deciding whether to be screened, the process of being screened, and the health states associated with being or not being screened. To enhance the quality and quantity of evidence, older adults need to be enrolled in screening trials and clinical studies. Measures of functional status and health-related quality of life (HRQL) need to be included in trials, registries, and cohort studies. This article addresses these challenges, and presents a framework for what research is needed to better inform screening decisions in older adults.
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Affiliation(s)
- Elizabeth Eckstrom
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L475, Portland, OR 97239, USA.
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Theou O, Rockwood K. Should frailty status always be considered when treating the elderly patient? ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ahe.12.8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fowler NR, Boustani MA, Frame A, Perkins AJ, Monahan P, Gao S, Sachs GA, Hendrie HC. Effect of patient perceptions on dementia screening in primary care. J Am Geriatr Soc 2012; 60:1037-43. [PMID: 22690979 PMCID: PMC3711396 DOI: 10.1111/j.1532-5415.2012.03991.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine individuals' perceptions concerning dementia screening and to evaluate the possibility of an association between their perceptions and their willingness to undergo screening. DESIGN Cross-sectional study of primary care patients aged 65 and older. SETTING Urban primary care clinics in Indianapolis, Indiana, in 2008 to 2009. PARTICIPANTS Five hundred fifty-four primary care patients without a documented diagnosis of dementia. MEASUREMENTS The Perceptions Regarding Investigational Screening for Memory in Primary Care Questionnaire (PRISM-PC) and agreement or refusal to undergo dementia screening. RESULTS Of the 554 study participants who completed the PRISM-PC, 65.5% were aged 70 and older, 70.0% were female, and 56.5% were African American; 57 (10.3%) refused screening for dementia. Of the 497 (89.7%) who agreed to screening, 63 (12.7%) screened positive. After adjusting for age, perception of depression screening, perception of colon cancer screening, and belief that no treatment is currently available for Alzheimer's disease, the odds of refusing screening were significantly lower in participants who had higher PRISM-PC domain scores for benefits of dementia screening (odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.75-0.97; P = .02). In the same regression model, the odds of refusing screening were significantly higher in participants aged 70 to 74 (OR = 5.65, 95% CI = 2.27-14.09; P < .001) and those aged 75 to 79 (OR = 3.63, 95% CI = 1.32-9.99; P = .01) than in the reference group of patients aged 65 to 69. CONCLUSION Age and perceived benefit of screening are associated with acceptance of dementia screening in primary care.
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Affiliation(s)
- Nicole R. Fowler
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Malaz A. Boustani
- Indiana University Center for Aging Research, Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Amie Frame
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Anthony J. Perkins
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
| | | | - Sujuan Gao
- Indiana University School of Medicine, Indianapolis, IN
| | - Greg A. Sachs
- Indiana University Center for Aging Research, Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Hugh C. Hendrie
- Indiana University Center for Aging Research, Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
- Indiana University Department of Psychiatry, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
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Brotons C, Soriano N, Moral I, Rodríguez-Artalejo F, Banegas JR, Martín-Moreno JM. Intervenciones preventivas en el ámbito de la atención primaria. El ejemplo del PAPPS. Informe SESPAS 2012. GACETA SANITARIA 2012; 26 Suppl 1:151-7. [DOI: 10.1016/j.gaceta.2011.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 10/20/2011] [Accepted: 10/24/2011] [Indexed: 10/14/2022]
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Nicholas JA, Hall WJ. Screening and preventive services for older adults. ACTA ACUST UNITED AC 2011; 78:498-508. [PMID: 21748739 DOI: 10.1002/msj.20275] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Federal, professional, and academic efforts are converging to address the preventive care needs of older Americans. Medicare is placing an increased emphasis on preventive care services for older adults. With the passage of the Patient Protection and Affordable Care Act, access to preventive services has been enhanced by reducing out-of-pocket costs for older adults and increasing reimbursement to healthcare providers. In 2010-11, newly revised guidelines for screening and preventive services have been issued by the US Preventive Services Task Force and the Centers for Disease Control and Prevention. In addition to these guidelines and the landmark changes in Medicare coverage, there are significant new attempts to modify national screening recommendations based on age and expected risk/benefit for older adults. These population-specific guidelines with new emphasis on functional status and multiple risk factor reduction are of increasing importance to an aging population, where more conventional disease-focused guidelines are less suitable for maintaining physical function and quality of life. Evidence-based measures of physical performance appropriate for primary-care office use are being developed and piloted. As a result of these policies, guidelines, and tools, we have the ability to offer older adults more comprehensive, cost-effective screening and preventive measures than in any other previous time. Mt Sinai J Med 78:498-508, 2011. © 2011 Mount Sinai School of Medicine.
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Drewes YM, Gussekloo J, Meer V, Rigter H, Dekker JH, Goumans MJBM, Metsemakers JFM, Overbeek R, Rooij SE, Schers HJ, Schuurmans MJ, Sturmans F, Vries K, Westendorp RGJ, Wind AW, Assendelft WJJ. Assessment of Appropriateness of Screening Community-Dwelling Older People to Prevent Functional Decline. J Am Geriatr Soc 2011; 60:42-50. [DOI: 10.1111/j.1532-5415.2011.03775.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Henk Rigter
- Department of Public Health; Erasmus Medical Center; Rotterdam
| | - Janny H. Dekker
- Department of General Practice; University Medical Center Groningen; University of Groningen; Groningen
| | - Marleen J. B. M. Goumans
- Institute for Research and Innovation, Centre of Expertise Innovations in Care; Rotterdam University; Rotterdam
| | | | | | - Sophia E. Rooij
- Section of Geriatric Medicine; Department of Internal Medicine; Academic Medical Center; University of Amsterdam; Amsterdam
| | - Henk J. Schers
- Department of Primary and Community Care; Radboud University Nijmegen Medical Centre; Nijmegen
| | | | - Ferd Sturmans
- Department of Public Health; Erasmus Medical Center; Rotterdam
| | - Kerst Vries
- Department of Nursing Home Medicine; VU University Medical Center; Amsterdam; the Netherlands
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