1
|
Zolnowski-Kolp V, Um Din N, Havreng-Théry C, Pariel S, Veyron JH, Lafuente-Lafuente C, Belmin J. Assessment of Frailty by the French Version of the Vulnerable Elders Survey-13 on Digital Tablet: Validation Study. J Med Internet Res 2023; 25:e42017. [PMID: 37531175 PMCID: PMC10433029 DOI: 10.2196/42017] [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: 08/18/2022] [Revised: 04/30/2023] [Accepted: 04/30/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor. OBJECTIVE This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it. METHODS The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the κ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire. RESULTS In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (κ=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI-1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version. CONCLUSIONS The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them.
Collapse
Affiliation(s)
- Victoria Zolnowski-Kolp
- LivingLab Pratiques en santé dans le grand âge, Hôpital Charles Foix, Ivry-sur-Seine, France
| | - Nathavy Um Din
- LivingLab Pratiques en santé dans le grand âge, Hôpital Charles Foix, Ivry-sur-Seine, France
- Sorbonne Université and Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé (LIMICS), Paris, France
| | - Charlotte Havreng-Théry
- Sorbonne Université and Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé (LIMICS), Paris, France
- Presage Care, Paris, France
| | - Sylvie Pariel
- Service de gériatrie ambulatoire, Hôpital Charles Foix, Ivry-sur-Seine, France
| | | | - Carmelo Lafuente-Lafuente
- Service de gériatrie à orientation cardiovasculaire et neuropsychogériatrique, Hôpital Charles Foix, Ivry-sur-Seine, France
- Clinical Epidemiology and Ageing (CEpiA), Unit Institut National de la Santé et de la Recherche Médicale (INSERM), Créteil, France
| | - Joel Belmin
- LivingLab Pratiques en santé dans le grand âge, Hôpital Charles Foix, Ivry-sur-Seine, France
- Sorbonne Université and Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé (LIMICS), Paris, France
- Service de gériatrie à orientation cardiovasculaire et neuropsychogériatrique, Hôpital Charles Foix, Ivry-sur-Seine, France
| |
Collapse
|
2
|
Lee W, Cheng SJ, Grant SJ, Marcum ZA, Devine B. Use of geriatric assessment in cancer clinical trials: A systematic review. J Geriatr Oncol 2022; 13:907-913. [PMID: 35550351 PMCID: PMC10129289 DOI: 10.1016/j.jgo.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/17/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Older adults are underrepresented in cancer clinical trials despite accounting for most of the disease burden. Geriatric assessment (GA) could be used in clinical trials of cancer drugs for older adults to improve the clinical evidence for cancer drug use among older adults. OBJECTIVE To examine patterns of use of GA in cancer clinical trials. METHODS We undertook a systematic review of the studies reporting use of GA in a clinical trial setting for all cancer types and published between January 2010 and January 2020. Characteristics of GA use were extracted for each study, along with study phase, cancer type, and participant age (PROSPERO: CRD42020170584). RESULTS We identified 320 studies and 63 studies met the final inclusion criteria. Among 74 purposes of GA use, the most common was to examine the association between impairments in GA domains and clinical outcomes (28/74, 38%). Among 258 GA domains assessed across 63 studies, physical status (59/258, 23%) and comorbidities (50/258, 19%) were most often evaluated. There was significant heterogeneity in the instruments used to assess physical function (n = 16) and mood disorders (n = 7). Most studies were phase 2 (32/63, 51%). CONCLUSIONS GA is most often used in clinical trial settings to examine associations between GA-identified deficits and clinical outcomes. Significant heterogeneity exists in the GA instruments used across trials. Comprehensive and consistent incorporation of GA into future cancer clinical trial designs could help collect more older adult-specific clinical information and adjust trial eligibility criteria to increase representation by older adults.
Collapse
Affiliation(s)
- Woojung Lee
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, USA.
| | - Spencer J Cheng
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, USA
| | - Zachary A Marcum
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, USA
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, USA
| |
Collapse
|
3
|
Levassort H, Pépin M, Teillet L, Ghebriou D, Cudennec T. [Oncogeriatric assessment: The first step in personalizing cancer treatment in the elderly]. Rev Med Interne 2021; 43:152-159. [PMID: 34823918 DOI: 10.1016/j.revmed.2021.10.006] [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: 05/07/2021] [Revised: 09/21/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022]
Abstract
With aging worldwide population and the high incidence of cancer in the population of people over 75 years old, there is a need for oncologists and geriatricians to strengthen their collaboration to improve elderly patients care. Complexity of cancer and aging issues must be considered simultaneously to establish a personalized care plan. Thus, the G8 is a screening tool that allows to identify patients who should benefit from a geriatric assessment, which is a key step in the management process. This specific evaluation offers a multidisciplinary approach to functional, psychological, nutritional, cognitive and social status and has demonstrated its prognostic value in terms of choice of treatment but also in terms of patient survival. In nearly 20% of cases, the geriatric assessment leads to a change in the choice of treatment, and at one year the initial care plan is not carried out in a quarter of cases. The presence of malnutrition and functional impairment leading to dependence on basic activities of daily living had a significant impact on this change in therapeutic choice. Survival is not only impacted by malnutrition and functional impairment but also by the presence of severe comorbidities and thymic and neurocognitive impairment. The patient's choice must remain at the center of the elaboration of the care plan with the oncologists and geriatricians in order to propose the most appropriate treatment for his or her situation.
Collapse
Affiliation(s)
- H Levassort
- Service de médecine gériatrique, AP-HP, Université Paris-Saclay site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - M Pépin
- Service de médecine gériatrique, AP-HP, Université Paris-Saclay site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Université Paris Saclay, UVSQ, INSERM, CESP, Equipe épidémiologie clinique, 92100 Boulogne-Billancourt, France
| | - L Teillet
- Service de médecine gériatrique, AP-HP, Université Paris-Saclay site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - D Ghebriou
- Oncologie Médicale, Hôpital Tenon, Institut Universitaire de Cancérologie AP-HP, Sorbonne Université, Paris, France
| | - T Cudennec
- Service de médecine gériatrique, AP-HP, Université Paris-Saclay site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| |
Collapse
|
4
|
Levasseur M, Lussier-Therrien M, Biron ML, Dubois MF, Boissy P, Naud D, Dubuc N, Coallier JC, Calvé J, Audet M. Scoping study of definitions and instruments measuring vulnerability in older adults. J Am Geriatr Soc 2021; 70:269-280. [PMID: 34669967 DOI: 10.1111/jgs.17451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/02/2021] [Accepted: 08/08/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND It is important to foster social participation and health equity, especially for older adults in situations of vulnerability. Despite growing interest in vulnerability, there is no consensus regarding how to define or measure this concept. This paper provides an inventory and synthesis of definitions of and instruments measuring vulnerability in older adults. METHODS Using a scoping study framework, eight databases (Abstracts in Social Gerontology, Academic Search Complete, AgeLine, CINAHL, MEDLINE, SocINDEX, PsycInfo, Scopus) were searched with relevant keywords [Vulnerab* AND (Concept*, Defin*, Meaning, Terminology, Measurement, Assessment*, Indicator*, Instrument*, Scale*, Questionnaire* OR Test*) AND (Aging, Aging, Elder*, Gerontolog*, Older OR Senior*)]. RESULTS Thirty-one original definitions and five measuring instruments were identified, content-analyzed, and compared. Vulnerability definitions mostly focused on people under conditions that increased their risk of harm because of individual physical factors, the environment, and their interaction. Considering these definitions, experts in the field of aging, including two representing older adults, participated in a workshop, and a consensus was reached to define a situation of vulnerability as "a set of circumstances in which one or more individuals experience, at a specific moment in time, one or multiple physiological, psychological, socioeconomic or social difficulties that may interact to increase their risk of being harmed or having coping challenges that have a negative impact on their life." Although none of the measures fully targeted this definition, the Perceived Vulnerability Scale (PVS) is one of the most complete measures, with 22 items considering feelings of vulnerability toward personal and environmental factors, and good psychometric properties. CONCLUSIONS The proposed definition and the PVS help to provide a common language and measure in health and social sciences research, policy and practice identifying and reaching older adults in situations of vulnerability and intervening to foster social participation and health equity.
Collapse
Affiliation(s)
- Mélanie Levasseur
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Marika Lussier-Therrien
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada
| | - Marie Lee Biron
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada
| | - Marie-France Dubois
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Patrick Boissy
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,Department of Surgery, Orthopedic Division, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Daniel Naud
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada
| | - Nicole Dubuc
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jean-Claude Coallier
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,Department of Career Counseling, Faculty of Education, Université de Sherbrooke, Québec, Canada
| | | | - Mélisa Audet
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada
| |
Collapse
|
5
|
|
6
|
Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, De Souto Barreto P, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won Won C, Woo J, Vellas B. Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2021; 24:920-927. [PMID: 33155616 PMCID: PMC7568453 DOI: 10.1007/s12603-020-1492-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J G Ruiz
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|