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Created by: Hellenbrecht (ELIC Project 2) , generated 2007/05/24 , last changed: 2007/05/31
The Geriatric Assessment (Freiburg Version, 04/07)
Authors: Dr. B. Deschler, Prof. Dr. M. Lübbert, University Clinic of Freiburg - Dept. Hematology/Onkology, Hugstetter Str. 55, 79104 Freiburg/Germany, E-mail: barbara.deschler@uniklinik-freiburg.de
Individuals above the age of 65 years are more than 10 times as likely to develop cancer than younger ones in industrialized nations. (Ries et al.: SEER website, 2007) There is an increasing call for specific management of these patients. One approach to the problem of aging in the cancer patient, as it is a highly individualized process, is described by Extermann (Extermann M, et al., The Cancer Journal 2005;11(5):474-80)
The Comprehensive Geriatric Assessment (CGA) is a "multidisciplinary evaluation in which the multiple problems of older persons are uncovered, described, and explained, if possible, and in which the resources and strengths of the person are catalogued, need for services assessed, and a coordinated care plan developed to focus on the person's problems." (3) (Solomon D BA, Brummel-Smith K, et al. NIH Consensus Development Conference Statement: geriatric assessment methods for clinical decision-making. . J Am Geriatr Soc. 1988;36:342-7) The International Society for Geriatric Oncology (SIOG) defines in their guidelines for the Comprehensive Geriatric Assessment (CGA) as a " dynamic process that identifies patient's resources and needs and generates an individualized recommendation plan and follow up. Considering this aspect, GCS has not been explored in geriatric oncology until now. A GCA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival. The Task Force cannot recommend any specific tool or approach above others at this point." (Terret C; SIOG CGA Guidelines 2006, Crit Rev Onco Hemtol 2006; 60)
We now present a combination of geriatric instruments applied at the University Hospital Freiburg
We wish to point out that this is a rational selection of established and validated geriatric instruments for the evaluation of elderly patients with myelodysplastic syndromes and acute myeloid leukaemia. This battery of tests does not claim completeness but rather reflects current knowledge and recommendations. An introduction to these tests, guidelines for their implementation and relevant literature sources are given.
The EORTC QLQ-C30 is a 30 item, cancer-specific questionnaire designed for patient self-completion. The development of the questionnaire has followed a theoretical construct that quality of life is a multidimensional measure within the human experience. It is understood that under the circumstances of a life-threatening disease certain areas of quality of life become of greater relevance for individual patients than others. Core matters relevant for quality of life are identifiable and measurable.
The questionnaire is organized into five functional scales (physical, role, cognitive, emotional and social), three symptom scales (fatigue, pain and nauseas and vomiting), and a global QL scale. The remaining single items assess additional symptoms commonly reported by cancer patients (dyspnoea, appetite loss, sleep disturbance, etc.). For ease of presentation and interpretation, all subscale and individual item responses are linearly converted to a 0-100 scale. For the functional and global QL scores, a higher score presents a better level of functioning. For the symptom scales and items, a higher score reflects a greater degree of symptoms. The time-frame of the questionnaire encompasses the previous week.
It is a copyrighted instrument, which has been translated and validated into 81 languages and is used in more than 3,000 studies worldwide.
Instructions:
Ask the patient to fill out the questionnaire. Duration: ~10 minutes
Scoring:
Obtain the free-of-charge "Scoring Manual" of the EORTC (s. Homepage: http://www.eortc.be/home/qol/)
Sources:
The Barthel Index of Activities of Daily Living is a quick and reliable assessment of a person's mobility and ability to perform daily self-care tasks. It shows if disability is present and estimates its extent, and determines when a patient begins to need help. It is simple to use, as information can be obtained either from the patient's self-report or from other informed parties, such as the patient's relatives. In addition, it can be administered periodically to assess a patient's improvement over time.
Instructions:
Choose the scoring point for the statement that most closely corresponds to the patient's current level of ability for each of the following 10 items. Record actual, not potential, functioning. Information can be obtained from the patient's self-report, from a separate party who is familiar with the patient's abilities (such as a relative), or from observation. The need for supervision renders the patient not independent. It is widely used in geriatric assessment settings. Reliability, validity and overall utility are rated as good to excellent.
Usually the performance over the preceding 24–48 hours is important, but occasionally longer periods will be relevant. Use of aids to be independent is allowed. Duration of the test: 5-10 minutes
Scoring:
Sum the patient's scores for each item. Total possible scores range from 0–100, with lower scores indicating increased disability. If used to measure improvement after rehabilitation, changes of more than two points in the total score reflect a probable genuine change, and change on one item from fully dependent to independent is also likely to be reliable.
Remark: In the United States, the ADL Score according to Katz is frequently used
Sources:
The Instrumental Activities of Daily Living (IADL) scale measures eight complex activities related to independent functioning, objectively evaluating a patient's ability to perform these functions and assessing how much assistance he or she requires for each activity, if any. The more these abilities are impaired, the more services will be necessary to maintain a person in an ambulatory setting.
The IADL scale is a brief tool that aids in the formulation, implementation, and evaluation of treatment plans. It is useful in elderly community populations and provides information about a patient's need for support services. It can be completed by obtaining the requested information from either the patient or an informant, such as a family member or other caregiver.
Instructions:
Circle the scoring point for the statement that most closely corresponds to the patient's current functional ability for each task. The examiner should complete the scale based on information about the patient from the patient him-/herself, informants (such as the patient's family member or other caregiver), and recent records. Duration of the test: 5 minutes.
Scoring:
The patient receives a score of 1 for each item labeled A – H if his or her competence is rated at some minimal level or higher. Add the total points circled for A – H. The total score may range from 0 – 8. A lower score indicates a higher level of dependence.
Sources:
The Mini Mental State Examination (MMSE, developed by Folstein 1975) is the most widely used instrument for assessing cognitive function, which takes up to 10 minutes. It is a widely used method to detect impairment, follow the course of an illness, and monitor response to treatment. The MMSE has also been used as a research tool to screen for cognitive disorders in epidemiological studies and follow cognitive changes in clinical trials. It assesses orientation, attention, immediate and short-term recall, language, and the ability to follow simple verbal and written commands. Furthermore, it provides a total score that places the individual on a scale of cognitive function. Further information on the test and its copy right considerations are to obtained from: www.minimental.com.
Instructions:
Scoring:
A score of 20 or less generally suggests dementia but may also be found in acute confusion, schizophrenia or severe depression. A score of less than 24 may indicate dementia in some patients who are well educated and who do not have any of the above conditions. Serial testing may be of value to demonstrate a decline in cognitive function in borderline cases.
Sources:
The Geriatric Depression Scale (GDS) is a self-report questionnaire designed specifically to screen for depression in older adults. The GDS can be used with both cognitively intact patients and patients who have mild to moderate cognitive impairments. It has been used as an observer-rated questionnaire with mildly cognitively impaired patients. It is also effective in detecting depression among patients who have physical illnesses.
The GDS Short Form, included here, is comprised of 15 yes/no items and can be completed in approximately five minutes.
Instructions:
Ask the patient to choose the best answer for how he/she felt over the past week. Duration of the test: ~5 minutes.
Scoring:
Answers indicating depression are in bold and italicized; score one point for each one selected. A score of 0 to 5 is normal. A score greater than 5 suggests depression.
Sources:
The Get-up and Go Test is a brief assessment of gait and balance in older patients that has been used in the clinical setting. The patient is asked to stand up from a chair, walk a short distance, turn around, return to the chair, and sit down again.
Instructions:
Ask the patient to perform the following series of maneuvers:
Scoring:
< 10 sec.: no impairment in mobility
> 20 sec.: relevant impairment in mobility
Sources:
(Charlson-Index and the Hematopoietic Stem Cell Transplantation Comorbidity Index (HCT-CI), also "modified Charlson Index")
Comorbidity describes any distinct additional clinical entity that has existed or may occur during the clinical course of a patient with a primary (index) disease. There is currently no consensus on how to quantify comorbidities but several scales and indices are available.
The Charlson Comorbidity Index (CCI) is the most frequently used in oncology and recently has been applied in the HCT setting. It has a good reliability, excellent correlation with mortality and progression-free survival outcomes. Basic limitations include preservation of data only for the 19 conditions listed in the index, the exclusion of non-malignant hematologic disease, such as anemia, and reduced predictive ability for outcomes < 6months. It is praised for its ease of use, short rating time, extractability from other indices, and widespread use
Instructions:
Mark the mentioned relevant comorbidity and add scores
Scoring:
Comorbidities increase the risk for mortality and morbidity.
Sources:
David A Karnofsky and colleagues described the first performance status (PS) in 1948. Each patient was given a score on a linear scale between 0 (dead) and 100 (normally active), summarising their ability to perform daily activities, and the level of assistance they required in order to do so. This scoring system was subsequently used throughout oncology practice as a numerical guide to patients' general health. In 1960, the Eastern Co-operative Oncology Group (ECOG) introduced a simpler "ECOG performance status" scale, similar to the Karnofsky PS (KPS) scale, with only five points. This is now termed the ECOG/WHO score (1982). Generally, the two scores have been proven interchangeable (Taylor et al), although the ECOG is often preferred for its simplicity.Sources:
Instruments for the Geriatric Assessment
Questionnaires
(147KB)Printing Date: 08.01.2009 © 2004-2008 ELIC European Leukemia Information Center
