151751-Najiba-Chargi

406 CHAPTER 20 COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) The CGA conducted in this study consists of four domains; the somatic, psychological, func - tional and social domains and was performed by a geriatrician. Specific, validated tools per geriatric domain were used. For the somatic domain the Charlson Comorbidity Index (CCI) 20 , the Malnutrition Universal Screening Tool (MUST) 21 , and polypharmacy are used. The psycho - logical domain was examined by the Mini Mental State Examination (MMSE) 22 for cognitive function and Geriatric Depression Scale (GDS) 23 for depression. For the functional domain, activities of daily living (ADL) was examined with The Katz Activities of Daily Living ( KATZ-6) 24 and KATZ-9 was used for scoring Instrumental ADL 25 . Social status was determent on ques - tions about current living situation, social activities, presence of informal care system/social support. Each instrument was defined as abnormal according to validated cutoff scores. The cutoff scores are listed in table 1. Overall, a patient was considered frail if the CGA had an abnormal outcome on at least two of the instruments used. Table 1. Overview of the selected screening instruments for CGA Geriatric domain Measure Score range or (cut- off) Somatic Comorbidity CCI 0 - 31 Nutrition MUST 0 - 3 ( ≥ 2) Medication - Ordinal ( > 4) Psychological Cognition MMSE 0 - 30 ( ≤ 24) Depression GDS-2 or 0 - 2 ( ≥ 1) GDS 15 0 - 15 ( ≥ 6) Functional Function ADL KATZ 0 - 6, ( ≥ 1) IADL KATZ 0 - 9, ( ≥ 1) Social Living situation, social activities and informal care system 0 - 3 ( ≥ 2) ADL= Activities of Daily Living, IADL= Instrumental Activities of Daily Living, MMSE= Mini-Mental State Exam, GDS= Geriatric Depression Scale, MUST= Malnutrition Universal Screening Tool, CCI= Charlson comorbidity index. FRIED FRAILTY CRITERIA The Fried Frailty criteria is an operational definition of physical frailty based on the presence of three or more of the following five criteria: unintentional weight loss, exhaustion, low phys- ical activity level, slow gait speed, and low handgrip strength. 26 In older patients with cancer the sensitivity and specificity of the Fried frailty criteria for predicting frailty, based on CGA, are amongst 25% to 37% and 86% to 96%, respectively. 10 The Fried frailty criteria are known to be a useful in predicting complications, length of hospital stay and other adverse health outcome in patients with HNC. 27