PubMed · 439436
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S Nakano, K Nagami. 1979-03-10. [Motor function tests in adults].. https://pubmed.ncbi.nlm.nih.gov/439436/
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BACKGROUND: Elderly people constitute a heterogeneous group and are at an increased risk for the development of cancer. It is not clear whether comorbid conditions and functional status influence clinical decisions and the pattern of referral in elderly cancer patients. The current study investigated functional status measured by Eastern Cooperative Oncology Group performance status, comorbid conditions, and medication taken as well as social environment in three series of patients grouped according to age and diagnosis. METHODS: A total of 593 patients were involved: 138 neoplastic patients age > 70 years with breast, colon, or prostate carcinoma, 177 neoplastic patients age < 70 years with the same types of pathology, and 278 elderly patients with nonneoplastic conditions. Patients with neoplastic disease were recruited from cancer centers; patients with nonneoplastic disease were recruited from either geriatric or general medicine departments. Differences in the distribution of variables were analyzed by univariate and bivariate analyses. RESULTS: No significant differences in social environment, marital status, or education were observed. Statistical differences were noted when comparing the distribution of comorbidities, performance status, and medication taken, elderly neoplastic patients presented in poorer condition compared with younger patients but in better condition compared with elderly patients with nonneoplastic disease. CONCLUSIONS: The overall better health of older cancer patients compared with those without cancer needs to be assessed further. It is possible that cancer is more likely to be diagnosed in healthier elderly, or that primary care providers are reluctant to refer for cancer care patients in poor general health. Studies of comorbidity, function, and social resources are necessary to establish the impact of cancer on survival and quality of life of older patients and to determine the social resources necessary for adequate care.
The aim of the present study was to examine the degree of medical treatment wanted by nursing home residents, their relatives, and staff members in case the resident develops a serious and life-threatening disease, and to analyse the degree of agreement between the wishes of these parties. The study population consisted of 101 competent and 106 incompetent residents from 16 nursing homes. In addition, 142 relatives and 207 staff members were interviewed. A hypothetical disease story was presented to residents, relatives, and staff members, and their choices classified in four defined groups according to degree of treatment. Direct comparisons for the individual resident showed the greatest degree of disagreement as to acceptance/refusal of referral to hospital between relatives of incompetent residents and staff members, in that the preference for curative treatment was significantly more frequent among the relatives. It would be profitable if the staff of nursing homes make an effort to discuss treatment preferences with the relatives of incompetent residents in case the resident develops a serious disease and to do so before an acute situation arises.
BACKGROUND: Although most epidemiologic studies have defined disability in basic activities of daily living (BADLs) as dependence, some investigators have argued that BADL disability should be defined as degree of difficulty. OBJECTIVE: To determine whether the responses to questions about difficulty and dependence provide complementary information that together can depict the continuum of disability more fully than the response to either question alone. SETTING: General community. PARTICIPANTS: 1065 persons 72 years of age and older. MEASUREMENTS: On the basis of self-reported information collected at baseline, participants were categorized into three BADL groups: independent without difficulty, independent with difficulty, and dependent. Additional baseline information was collected on several measures of higher-level function and physical performance. Follow-up information was collected on regular home care visits and BADL function at 1 and 3 years and on hospitalizations, admissions to skilled-nursing facilities, and deaths over a 4-year period. RESULTS: In a cross-sectional analysis, the proportion of participants with poor higher-level function and physical performance increased substantially across the three BADL groups. In a longitudinal analysis, the rates of hospitalization and regular home care visits for the independent without difficulty group, the independent with difficulty group, and the dependent group were 46%, 57%, and 72% (P < 0.001) and 17%, 30%, and 49% (P < 0.001), respectively; survival curves for admission to a skilled-nursing facility and death differed significantly for each pair-wise comparison. Among persons who were BADL independent, those with difficulty were significantly more likely to develop BADL dependence over a 3-year period than those without difficulty (31% compared with 18%; P < 0.001). CONCLUSIONS: In the assessment of BADL function in older persons, questions about difficulty and dependence provide complementary information that together can depict the continuum of disability more fully than either question alone.