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Background: Centenarians develop diseases later than younger populations. Aims: Assessment of geriatric syndromes in centenarians living in Marseille in 2020. Methods: Observational preliminary study describing centenarians living in the Marseille area, being part of the patients base of the general practitioners (GPs). Results: Twenty-two centenarians were enrolled, including seventeen women (77.3%). Thirteen centenarians lived in nursing homes (NH) and nine in private housing (PH). All were dependent for daily living activities and 78.9% used walkers to get around. GPs consultations were exclusively home visits (in NH or PH). Centenarians living in NH presented more cognitive impairments, more comorbidities, and fewer hospitalizations during the past year compared to centenarians living in PH. Discussion: Although centenarians represent a model of successful aging for society, all were dependent and had at least one geriatric syndrome. Conclusions: Maintaining centenarians at home requires technical aids and intervention of several professional caregivers relying on family support. [ABSTRACT FROM AUTHOR]

The COVID-19 vaccination campaign began in December 2020, in France, and primarily targeted the oldest people. Our study aimed to determine the level of acceptance of vaccination in a population of older patients with cancer. From January 2021, we offered vaccination with the BNT162b2 COVID-19 vaccine to all patients 70 years and older referred to our geriatric oncology center in Marseille University Hospital (AP-HM) for geriatric assessment before initiation of an oncological treatment. Objectives were to evaluate acceptance rate of COVID-19 vaccination and to assess vaccine safety, reactogenicity, and efficacy two months after the first dose. Between January 18, 2021 and May 7, 2021, 150 older patients with cancer were offered vaccination after a geriatric assessment. The majority were men (61.3%), with a mean age of 81 years. The two most frequent primary tumors were digestive (29.4%) and thoracic (18%). The vaccine acceptance rate was 82.6% and the complete vaccination rate (2 doses) reached 75.3%. Among the vaccinated patients, 15.9% reported mild side effects after the first dose and 23.4% after the second dose, mostly arm pain and fatigue. COVID-19 cases were observed in 5.1% of vaccinated patients compared with 16.7% in unvaccinated patients. Of the 22 vaccinated patients who agreed to have their serum tested, 15 had antibodies against the spike protein at day 21 after the first dose. Our study showed a high acceptance rate of COVID-19 vaccination, with good tolerance in this frail population. These results highlight the benefits of organizing vaccination campaigns at the very beginning of oncological management in older patients. Clinical trial registration : This study was registered May 23, 2019 in ClinicalTrials.gov (NCT03960593). [ABSTRACT FROM AUTHOR]

Functional Status (FS) is an important domain in Comprehensive Geriatric Assessment (CGA) and is most often evaluated using the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales separately. This secondary analysis of a previous prospective cohort study was conducted between September 2015 and May 2018 at Marseille University Hospital, France, on 613 cancer outpatients aged ≥70 years. The first objective of this study was to determine the prevalence of FS impairment in older outpatients with cancer using a combination of the information collected with the ADL and short IADL scales. Our second objective was to describe the potential impact of this combined FS on three-month unplanned hospitalizations and three-month mortality in this population. The median age was 81 years and 61.2% were men. The most common types of tumours were lung and thoracic (22.3%). Concerning FS, 255 patients (41.6%) had unimpaired ADL-IADL, 131 patients (21.4%) had IADL impairment, 38 patients (6.2%) had ADL impairment, and 189 patients (30.8%) had impaired ADL-IADL. In the multivariate Cox analysis, metastatic stage (adjusted Hazard Ratio (aHR) = 1.79; 95% CI [1.14–2.80]) and impaired ADL-IADL (aHR = 3.46; 95% CI [1.89–6.33]) were independently associated with three-month mortality. In the logistic regression model, impaired ADL-IADL (adjusted Odd ratio (aOR) = 3.64; 95% CI [1.84–7.20]) was the only factor independently associated with three-month unplanned hospitalizations. The combined use of the ADL and IADL scales to evaluate functional status in older patients with cancer is of significant prognostic value regarding the risks of three-month unplanned hospitalizations and mortality. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: Compare G8 scores according to the cancer site and G8 items in older patients with thoracic cancers. Findings: In our sample study, older patients with thoracic and lung cancers presented a lower BMI, less neuropsychological disorders and were younger compared to older patients with other cancer pathologies. Message: Management of frailties in older patients treated for thoracic and lung cancers should consider nutritional status impairment and psychological status maintenance as priorities. Purpose: Assessment of vulnerability with the G8 screening tool according to cancer localization and weight of the G8 items when screening frailty in thoracic and lung cancer (TLC) compared to other cancer localizations. Methods: This study was conducted retrospectively on all G8 data collected for older cancer patients between April 2015 and December 2019 at Marseille University Hospital. Results: One thousand four hundred and thirty-one patients were included; the median age was 80.6 years and 62.3% of the patients were men. The most common type of cancer was thoracic cancer (34.5%). A majority of patients with thoracic cancers (74.4%) had an impaired G8. In a logistic regression model, male gender, age < 80 years, BMI < 23 kg/m2, normal psychological status, and health status perception were independent factors associated with thoracic cancers. Conclusion: Improving nutritional status and maintaining mental health are important issues to consider before treatment initiation in older patients with thoracic cancers. [ABSTRACT FROM AUTHOR]

Lung cancer affects older and older old adults and is the leading cause of death by cancer. Comprehensive Geriatric Assessment (CGA) is recommended before and during cancer treatment to guide therapy management in this population. This study was conducted between September 2015 and January 2019 at Marseille University Hospital (AP-HM). During this period, all consecutive outpatients 70 years or older referred for a CGA before initiation of lung cancer treatment were enrolled. The objective of this study was to compare lung and thoracic cancer management of octogenarians (≥80 years) and their geriatric profile versus patients aged 70 to 79 years (<80 years). In our study, 228 patients were recruited. The median age was 78.7 ± 5 years. There were 94 octogenarians (41.2%), 36.2% of them were diagnosed with stage IV neoplasm and the most common treatment was chemotherapy (43.6%). The logistic regression analysis highlights that handgrip strength was the most commonly impaired domain (OR 2.3; 95% CI [1.3–4.3]) in octogenarians and that they are more likely than their younger counterparts to be treated by targeted therapy (OR 9.8; 95% CI [1.0–92.9]). Overall survival (OS) was similar in both age groups (log rank = 0,95). In our study, octogenarians and patients <80 years had equivalent survival, across the different thoracic cancer treatments and tumor stages. Measure of muscle strength in CGA could be very useful in a clinical setting to help improve the management of older old patients treated for lung or thoracic cancer. • Octogenarians have the same survival than younger patients in thoracic cancers. • Impaired muscle strength is an important factor to help improve the management of octogenarians. • Some geriatric assessments domains may predict outcomes in older patients with thoracic cancers. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: The main objective of this work was to identify the criteria of a simplified standardized geriatric assessment (mini-CGA) that were associated with unplanned hospital readmission within 3 months after planned hip and/or knee arthroplasty in patients ≥ 65 years, and the secondary objective was to determine the geriatric frailties associated with postoperative complications. Findings: We found that dependence assessed using the activities of daily living (ADL) scale was associated with the risk of early readmission in older patients undergoing planned arthroplasty, and that living alone prior to surgery was associated with complications during the first 3 postoperative months. Message: Preoperative assessment before planned orthopedic surgical procedures using the simplified geriatric assessment (mini-CGA) appears essential to limit the risks of postoperative morbidity and to identify larger numbers of frail older patients in order to propose appropriate interventions after geriatric assessment. Introduction: Hip and knee arthroplasties are the most common planned orthopedic surgical procedures in older persons. It would be useful to identify frailties before surgery to improve the outcome of older patients. Purpose: The objective of this work was to identify the criteria of a simplified comprehensive geriatric assessment (mini-CGA) that were associated with unplanned hospital readmission and postoperative complications within 3 months after the planned hip and/or knee arthroplasty in patients ≥ 65 years. Methods: This prospective study was carried out in the orthopedic department of Marseille University Hospital from January to May 2019. A mini-CGA was performed preoperatively. Results: One hundred four patients were included in the study. The rate of early readmission within 3 months after surgery was 12.5% and the rate of postoperative complications was 40.4%. In multivariate analysis, dependence in the activities of daily living (ADL ≤ 5) was the only factor associated with unplanned readmission (aOR = 9.9, 95% CI 1.9–50.8), and living alone was the only factor associated with postoperative complications (aOR = 3.2, 95% CI 1.2–8.8). Conclusions: We found that the ADL score was associated with the risk of unplanned readmission in older patients undergoing planned arthroplasty, and that living alone was associated with postoperative complications. A preoperative mini-CGA appears essential to limit postoperative morbidity. [ABSTRACT FROM AUTHOR]

Comprehensive Geriatric Assessment (CGA), is used in older patients with cancer to identify frailties, which can interfere with specialized treatment, and to help with therapeutic care. Functional Status (FS) is a domain of CGA in which Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) are evaluation tools. Our study reviewed the data available on the most frequently used tools to assess ADL and IADL in a geriatric oncology setting and their predictive values on overall survival (OS), toxicity, treatment feasibility or decision and postoperative complications. This review was based on a systematic search of the MEDLINE® database for articles published in English and French between January 1, 2010, and December 31, 2017. In the final analysis, 40 out of 4061 studies were included. The most common ADL and IADL scales used are the Katz ADL (KL-ADL) in 25 studies and the Lawton IADL (IADL 8) in 22 studies. FS is predictive of OS in 11 out of 24 studies, chemotoxicity in 2 out of 7 studies, treatment feasibility in 2 out of 5 studies, treatment decisions in 2 out of 3 studies, and postoperative complications in 4 out of 6 studies. FS is of prognostic value in a geriatric oncology setting despite heterogeneous methodology and inclusion criteria, in the studies included. Additional research is needed to explore more precisely the prognostic value of FS in overall survival, toxicity, treatment feasibility or decision and postoperative complications, in older cancer patients. [ABSTRACT FROM AUTHOR]