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4 September 2008
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Functional and physical impairment increase with ADT in older men
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MedWire News: Elderly prostate cancer patients receiving long-term androgen deprivation therapy (ADT) show significant functional and physical impairment and are at risk of falls, US study findings indicate.
It has been observed that men who receive ADT have decreases in lean muscle mass and strength during the first year of treatment, which could be harmful to a vulnerable subset of patients. However, the treatment is increasingly being used in older men.
To examine the impact of ADT on physical and functional impairment and the prevalence of falls in older men, Supriya Mohile, from the University of Rochester School of Medicine and Dentistry, and colleagues studied 50 men aged at least 70 years who had undergone ADT for systemic prostate cancer.
Assessments of function included Katz's Activities of Daily Living (ADL) and Lawton's Instrumental Activities of Daily Living (IADL). In addition, the patients completed the Vulnerable Elder's Survey (VES)-13 and the Short Form Physical Performance Battery (SFPPB). The history of falls was also recorded. Forty patients underwent follow-up assessment at 3 months after the initial assessment.
The median age of the patients was 78 years. Anemia was recorded in approximately half of the patients, while 75% were overweight or obese. Biochemical recurrence was seen in 80% of patients, and the median duration of ADT was 36 months, the team notes in the journal Urology.
Impairment in ADL was found in 24% of patients 3 months after the initial assessment, when 42% showed impairment in the IADL, 56% had abnormal SFPPB findings, with deficits on all subcomponents, and 22% reported falls in the previous 3 months.
On univariate analysis, the likelihood of an abnormal SFPPB score was predicted by increasing age, ADL deficit, IADL deficit, and abnormal cognitive and VES-13 scores, as well as the use of an assist device for walking. The risk for falls was linked to an ADL deficit, the use of an assist device, and abnormal VES-13 scores.
The team writes: "Recognizing the morbidity and mortality associated with fractures, physicians caring for this patient population should consider routinely screening for abnormal physical performance and falls."
Urology 2008; 72: 422-427
http://dx.doi.org/10.1016/j.urology.2008.03.032
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