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Objectives: Because of substantial toxicities in older adults, chemotherapy is often omitted while the frequency of radiotherapy changes only minimally. In this study, we addressed the value of different assessments for predicting fatigue after radiotherapy in older breast cancer patients., Patients and Methods: We included 74 women with primary breast cancer over the age of 65 years treated with radiotherapy (26 % with additional chemotherapy). Assessments were conducted before adjuvant treatment and after radiotherapy. The assessments included the Vulnerable Elders Survey (VES-13), the Karnofsky Performance Status (KPS), the EORTC Quality of Life assessment (EORTC-QLQ-C30), a cancer-specific comprehensive geriatric assessment (cancer-specific CGA), and the Fried frailty score. Multiple linear regression analyses were used to assess correlations with the FACIT-fatigue scale., Results: Patients were on average 71 years old (range, 65-86 years). Most tumors (n=62) were classified as intermediate risk according to the St. Gallen consensus. The cancer-specific CGA was best associated with fatigue (p < 0.001, β estimate = 1.75), followed by the Fried frailty score (for the score of 1 versus reference of 2 and higher: p = 0.035, β estimate = - 5.74). There were no significant ceiling effects but there were substantial floor effects for the VES-13, KPS, and frailty score., Conclusion: The cancer-specific CGA and the Fried frailty score (driven mainly by the item "exhaustion") outperformed the other indices in predicting fatigue in a group of rather well-functioning older women with primary breast cancer.

Background: there is ample literature showing pain and depression are related. However, different dimensions of pain have been used in former studies., Objective: the objective of the study was to compare the strength of the association of different pain dimensions with depression in older adults., Methods: assessments including evaluation of pain (severity, frequency, chronicity, quality, pain medication, painful body sites) and depression (measured by the Hospital Anxiety and Depression Scale) were performed in an observational study in community dwelling older adults (sample mean age 76, n = 1130) in Germany. The associations of different dimension of pain with depression were assessed using descriptive and multivariate methods., Results: the number of painful body areas was most significantly associated with self-reported late life depression (OR 1.20, CI 1.11-1.31). Pain severity and frequency (OR 1.12, CI 1.01-1.23 and OR 1.18, CI 1.01-1.37) were also associated with depression; quality and duration were not. Except for severity (OR 1.12, CI 1.02-1.24) associations of pain dimensions were strongly reduced when controlling for relevant confounders and gender was an effect modifier., Conclusions: multisite pain, pain severity and frequency were the best predictors of late life depression. Clinicians should be especially aware of depressive disorders when older patients are complaining of pain in multiple areas across the body., (© The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@ oup.com.)

Background: Aims of the present study are the following: 1. to describe the rationale and methodology of the Services and Health for Elderly in Long TERm care (SHELTER) study, a project funded by the European Union, aimed at implementing the interRAI instrument for Long Term Care Facilities (interRAI LTCF) as a tool to assess and gather uniform information about nursing home (NH) residents across different health systems in European countries; 2. to present the results about the test-retest and inter-rater reliability of the interRAI LTCF instrument translated into the languages of participating countries; 3 to illustrate the characteristics of NH residents at study entry., Methods: A 12 months prospective cohort study was conducted in 57 NH in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non EU country (Israel). Weighted kappa coefficients were used to evaluate the reliability of interRAI LTCF items., Results: Mean age of 4156 residents entering the study was 83.4 ± 9.4 years, 73% were female. ADL disability and cognitive impairment was observed in 81.3% and 68.0% of residents, respectively. Clinical complexity of residents was confirmed by a high prevalence of behavioral symptoms (27.5% of residents), falls (18.6%), pressure ulcers (10.4%), pain (36.0%) and urinary incontinence (73.5%). Overall, 197 of the 198 the items tested met or exceeded standard cut-offs for acceptable test-retest and inter-rater reliability after translation into the target languages., Conclusion: The interRAI LTCF appears to be a reliable instrument. It enables the creation of databases that can be used to govern the provision of long-term care across different health systems in Europe, to answer relevant research and policy questions and to compare characteristics of NH residents across countries, languages and cultures., (© 2012 Onder et al; licensee BioMed Central Ltd.)

Objective: The evaluation of rehabilitation success as measured by different tools is becoming increasingly important in terms of time and money allocation. We wanted to know whether functional change in the first week predicts subsequent improvement in a geriatric inpatient rehabilitation clinic., Design: Observational longitudinal study., Setting: Geriatric inpatient rehabilitation clinic in Germany., Subjects: One hundred and sixty-one inpatients (117 women) with a median age of 82 years, capable of walking at baseline., Main Measures: Weekly assessments of physical function were performed from admission until three weeks later. We used a self-rated tool (the function component of the Short Form - Late Life Function and Disability Index), a proxy-rated tool (the Barthel Index) and a performance-based tool (gait speed). We set up linear regression models to estimate the predictive capacity of change in physical function within the first week on change in physical function within the following two weeks., Results: Positive correlations were found between functional change within the first week and total change within three weeks. However, correlations of the same periods of change with subsequent change were negative. Correlations were highly significant for both analysis with P-values <0.0001 when the same measures for prediction and outcome were used. Correlations were inconsistent when prediction and outcome were different., Conclusions: Improvement within the first week of inpatient rehabilitation is negatively correlated with subsequent functional change.

Objectives: To evaluate the function component of the Short Form of the Late-Life Function and Disability Instrument (SF-LLFDI, German version) in geriatric inpatients and compare it with established performance-based and self-rated assessment tools., Setting: Geriatric inpatient rehabilitation unit., Participants: One hundred fifty-six geriatric rehabilitation inpatients (44 men, 112 women) with a mean age of 81.7 who were capable of walking at baseline., Measurements: Weekly assessments were performed from admission until discharge (3 weeks later) using the function component of the SF-LLFDI, the Barthel Index (BI), the Falls Efficacy Scale International (FES-I), gait characteristics, the Timed Up and Go Test, and the Short Physical Performance Battery. Baseline characteristics were measured at admission. Construct validity was evaluated using Spearman correlation coefficients, internal consistency was measured using Cronbach alpha, and sensitivity to change was estimated using standardized response means., Results: The SF-LLFDI did not show significant floor or ceiling effects. Internal consistency was good, with alpha (function component sub-scores) equal to 0.80 to 0.86. Convergent validity measures concerning performance-based scores were moderate to good, and correlations increased over time (correlation coefficient (r)=0.35-0.64). There was a high correlation with the FES-I (admission: r=0.61, discharge: r=0.76). Sensitivity to change was significant for all examined scores, with the BI outperforming all other instruments, although the SF-LLFDI showed better responsiveness than the BI regarding change characteristics over time., Conclusion: The SF-LLFDI is a reliable and valid self-report instrument to measure functional status in geriatric rehabilitation inpatients. It improves the assessment of clinically relevant responsiveness. Further research is warranted to improve its sensitivity to change.

Elderly persons living in the community are a heterogeneous population. Among them, the screening of persons at risk of falling is still a matter of debate. The aim of this analysis was to improve the identification process of elderly persons living in the community at risk for falling by nursing staff of community- based services. A secondary analysis was performed with the data from a prospective non-randomized interventional trial. The study included 268 community-dwelling older adults (mean age of 82 years, 81.3% female) from Ulm and Neu-Ulm with a followup period of 12 months. Fall risk indicators were extracted from the nursing assessment and analysis with crude odds ratios revealed the following risk indicators for falls: assistance when transferring, bathing and climbing a flight of stairs as well as fall history. Afterwards, fall risk indicators were selected by backward elimination in a multiple logistic regression. Variable selection identified a positive fall history and the need for assistance when bathing as important risk indicators. These two risk indicators could be used as a screening tool, which would be easy to perform by nursing staff in their daily work. This screening test defined as more than one fall in the last 12 months or bathing assistance, the first ADL to be affected in the disablement process, has a sensitivity of 85.3% and a specificity of 42.1%.

Increased physical activity is positively associated with better health in community-dwelling older persons. It is unclear whether physical activity also influences success of inpatient rehabilitation. For the assessment of physical activity in inpatient rehabilitation the Physical Activity in Inpatient Rehabilitation Assessment (PAIR), a short questionnaire based on five questions, was developed and preliminary validated. In this study, the PAIR was validated against a sensor-based physical activity measurement. Seventy functionally impaired and cognitively mostly intact patients of a German geriatric inpatient rehabilitation clinic who had undergone hip surgery ( n = 62 women, median age = 83 years) participated. Physical activity was measured using the PAIR and a sensor-based activity monitor (Physilog ®; BioAGM, CH). Assessments were conducted at admission (T1) and 2 weeks later (T2) during the rehabilitation process. To assess concurrent and predictive validity, Spearman correlations and linear regression models were calculated using sensor-based walking activity and uptime activity (walking and standing time) as dependent variables. Criterion-related concurrent validity using physical activity sensors was weak to moderate. Correlations were slightly higher at T2 ( r = 0.45-0.53) than at T1 ( r = 0.44-0.46). The objectively measured variance of physical activity, explained by the PAIR, ranged from 25 to 43 %. PAIR activity scores and sensor-based walking or total activity increased in a dose-dependent manner, confirming the scoring system of the PAIR. The application time was usually less than 2 min. The validity of the PAIR is weak to moderate when compared to a sensor-based activity monitor and comparable to existing physical activity assessments for community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify pharmacological and nonpharmacological pain management approaches and associated factors in nursing home residents across Europe. Setting, Participants, and Measurements: Cross-sectional study with 4156 residents who were assessed using the interRAI instrument for Long Term Care Facilities (interRAI LTCF), including pharmacological and nonpharmacological pain management modalities. Those reporting pain were included in the analyses (n = 1900). A deeper analysis was performed for the subsample of residents who reported “current pain,” defined as pain at least 1 day within the past 3 days (n = 838), and those who reported “current pain of moderate to severe intensity” (n = 590). Results: Up to 24% of residents who reported pain did not receive any pain medication and up to 11% received it only PRN (as-needed basis), independent of current pain-intensity levels; 61% did not receive any nonpharmacological treatment and 21% received neither pharmacological nor nonpharmacological pain modalities. Considerable differences could be demonstrated across European countries. Factors positively associated with pharmacological pain management were being of female gender, reporting cancer, and having moderate or severe pain. High turnover rates of regular staff and low-to-moderate physicians’ availability were negatively associated. Factors positively associated with nonpharmacological treatment were fractures and need of assistance in activities of daily living. Dementia, large nursing home facilities, above-average and high turnover rates of nursing staff, a low physicians’ availability, and severe pain intensity were negatively associated. Conclusion: Despite some advances in recent years, pain treatment in European nursing home residents remains to be suboptimal and requires further improvement. [Copyright &y& Elsevier]

Abstract: Objective and Design: Few studies have compared cross-national characteristics of residents with pain in European long term care facilities. The SHELTER project, a cross-national European study on nursing home residents, provides the opportunity to examine this issue. The present study aimed to evaluate key figures about pain and compare them with seven European countries and Israel. Setting, Participants, and Measurements: A total of 3926 nursing home residents were assessed by the interRAI instrument for Long Term Care Facilities (interRAI LTCF). Prevalence of pain, frequency, intensity, consistency, and control were estimated and compared cross-nationally. Correlates between patient-related characteristics and inadequate pain management were tested using bivariate and multivariate logistic regression models. Results: Overall, 1900 (48.4%) residents suffered from pain. Pain prevalence varied significantly among countries, ranging from 19.8% in Israel to 73.0% in Finland. Pain was positively associated with female gender, fractures, falls, pressure ulcers, sleeping disorders, unstable health conditions, cancer, depression, and number of drugs. It was negatively associated with dementia. In a multivariate logistic regression model, all associations remained except for sleeping disorders. Clinical correlations varied considerably among countries. Although in 88.1% of cases, pain was self-rated by the residents as sufficiently controlled, in only 56.8% of cases was pain intensity self-rated as absent or mild. Pain control and intensity improved within 1 year. Conclusion: Pain prevalence is high and varies considerably across Europe. Although most residents considered pain as adequately controlled, a closer look confirmed that many still suffer from high pain intensities. Analyzing the reasons behind these differences may help to improve pain management. [Copyright &y& Elsevier]

Abstract: Objective: Elderly patients with diabetes often have difficulty with self-administering insulin. It was the aim of the present study to find a short, easy performance test, such as the Timed Test of Money Counting (TTMC), that identifies elderly patients with diabetes, in grade to undertake proper insulin injection autonomously and correctly. Patients and Methods: A total of 73 insulin-dependent patients (age 77.3 ± 7.1 years, HbA1c 8.2% ± 2.0%) completed the TTMC as part of a comprehensive geriatric assessment before and 3 months after structured diabetes education. Results: The TTMC showed a sensitivity of 69.2% for autonomous injection of insulin 3 months after diabetes education, if patients performed the test within a time duration of less than 46 seconds. Specificity is 70% and positive predictive value 78.7% in this case. Study Implication: The TTMC seems to be a suitable predictor for ability to inject insulin autonomously after receiving diabetes education. The expenditure of time is only about 5 minutes and it helps to identify patients with diabetes who are able to inject insulin themselves after diabetes education. [Copyright &y& Elsevier]