title: Geriatric screening tools are of limited value to predict decline in functional status and quality of life: results of a cohort study.
abstract: BACKGROUND
  Geriatric screening tools are increasingly implemented in daily practice, especially in the oncology setting, but also in primary care in some countries such as the Netherlands. Nonetheless, validation of these tools regarding their ability to predict relevant outcomes is lacking. In this study we evaluate if geriatric screening tools predict decline in functional status and quality of life after one year, in a population of older cancer patients and an older primary care population without cancer with a life expectancy of at least six months.
  
  
  METHODS
  Older cancer patients and a general older primary care population without a history of cancer (≥ 70 years) were included in an on-going prospective cohort study. Data were collected at baseline and after one-year follow-up. Functional decline was based on the Katz Index and Lawton IADL-scale and was defined as deterioration on one or more domains. Decline in quality of life was measured using the global health related subscale of the EORTC QLQ-C30, and was defined as a decline ≥ 10 points. The selected geriatric screening tools were the abbreviated Comprehensive Geriatric Assessment, Groningen Frailty Indicator, Vulnerable Elders Survey-13, and G8. We calculated sensitivity, specificity, predictive values, and odds ratios to assess if normal versus abnormal scores predict functional decline and decline in quality of life.
  
  
  RESULTS
  One-year follow-up data were available for 134 older cancer patients and 220 persons without cancer. Abnormal scores of all screening tools were significantly associated with functional decline. However, this was only true for older persons without cancer, and only in univariate analyses. For functional decline, sensitivity ranged from 54% to 71% and specificity from 33% to 66%. For decline in quality of life, sensitivity ranged from 40% to 67% and specificity from 37% to 54%.
  
  
  CONCLUSIONS
  In older persons with a relatively good prognosis, geriatric screening tools are of limited use in identifying persons at risk for decline in functional status or quality of life after one year. Hence, a geriatric screening tool cannot be relied on in isolation, but they do provide very valuable information and may prompt physicians to also consider different aspects of functioning.
authors.affiliation: Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. Laura.deckx@med.kuleuven.be.
authors.forename: Laura
authors.initials: L
authors.lastname: Deckx
authors.affiliation: Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. Marjan.vandenakker@maastrichtuniversity.nl.|Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. Marjan.vandenakker@maastrichtuniversity.nl.
authors.forename: Marjan
authors.initials: M
authors.lastname: van den Akker
authors.affiliation: Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. Liesbeth.daniels@med.kuleuven.be.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Daniels
authors.affiliation: Department of Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium. Eric.dejonge@zol.be.
authors.forename: Eric T
authors.initials: ET
authors.lastname: De Jonge
authors.affiliation: Limburgs Oncologisch Centrum, Stadsomvaart 11, 3500, Hasselt, Belgium. paul.bulens@jessazh.be.
authors.forename: Paul
authors.initials: P
authors.lastname: Bulens
authors.affiliation: Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. vcg.tjan.heijnen@mumc.nl.
authors.forename: Vivianne C G
authors.initials: VC
authors.lastname: Tjan-Heijnen
authors.affiliation: Department of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. doris.van.abbema@mumc.nl.
authors.forename: Doris L
authors.initials: DL
authors.lastname: van Abbema
authors.affiliation: Department of General Practice, KU Leuven, Kapucijnenvoer 33, bus 7001, 3000, Leuven, Belgium. Frank.buntinx@med.kuleuven.be.|Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. Frank.buntinx@med.kuleuven.be.
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms; D011379:Prognosis; D011788:Quality of Life