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J Am Geriatr Soc. 2019 May;67(5):889-897. doi: 10.1111/jgs.15835. Epub 2019 Apr 4.

Function, Survival, and Care Utilization Among Older Adults With Hematologic Malignancies.

Author information

1
Division of Gerontology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
2
Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
3
Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.
4
Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts.
5
Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.
6
Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.

Abstract

BACKGROUND/OBJECTIVES:

Cancer-focused organizations now recommend routine assessment of instrumental activities of daily living (iADLs) for all older patients with cancer, along with assessment of basic activities of daily living (ADLs) if possible. However, little is known regarding the role of iADLs in predicting survival and acute-care utilization in populations of older adults with different hematologic malignancies.

DESIGN:

Prospective cohort study.

SETTING AND PARTICIPANTS:

A screening geriatric assessment was conducted for adults 75 years and older with hematologic malignancies (n = 464) presenting for initial consultation at a large tertiary cancer hospital in Boston, MA.

MEASUREMENTS:

Univariable and multivariable analyses assessed the association of dependency in ADLs and dependency in iADLs with survival and care utilization (emergency department [ED] visits and unplanned hospitalizations).

RESULTS:

Subjects were a mean age of 79.7 years and had a mean follow-up of 13.8 months. Overall, 11.4% had dependency in ADLs and 26.7% had dependency in iADLs. Only iADL dependency was associated with higher mortality (hazard ratio = 2.34 [95% confidence interval [CI] = 1.46-3.74]) independently of age, comorbidity, cancer aggressiveness, and treatment intensity. The effect was dose dependent, and impairments in shopping, meal preparation, and housework were all independently associated with a higher hazard of death. iADL dependency was also associated with higher odds of ED visits (odds ratio [OR] = 2.76 [95% CI = 1.30-5.84]) and hospitalizations (OR = 2.89 [95% CI = 1.37-6.09]). Several geriatric domain impairments, including probable cognitive impairment and physical dysfunction, were associated with iADL dependency.

CONCLUSION:

These findings suggest that older adults with hematologic malignancies and iADL dependency experience higher mortality and acute-care utilization, arguing that iADLs should be formally assessed as part of routine oncology care. J Am Geriatr Soc 67:889-897, 2019.

KEYWORDS:

function; geriatric assessment; geriatric oncology; hematologic malignancies; instrumental activities of daily living

PMID:
30945759
DOI:
10.1111/jgs.15835

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