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Objectives: The purposes were to investigate the health status of elderly cancer patients by comprehensive geriatric assessment (CGA) and to compare the complications with respect to baseline CGA and to evaluate the need for geriatric interventions in an elderly cancer patients' population. Material: Patients aged !70 years with lung cancer (LC), cancer of the head and neck (HNC), colorectal cancer (CRC), or upper gastro-intestinal cancer (UGIC) are referred to the Department of Oncology for cancer treatment. Methods: CGA was performed prior to cancer treatment and addressed the following domains: Activities of daily living (ADL), instrumental ADL (IADL), comorbidity, polypharmacy, nutrition, cognition, and depression. Complications, defined as dose reduction and discontinuation of treatment due to grade 3-4 toxicity, hospital admission, shift to palliative treatment, or death within 90 days, were identified from the medical files. Patients were classified as fit, vulnerable, or frail by CGA. Principal results: Patients (N ¼ 217) with a median age of 75 years (range: 70-93 yeas) were included: 13% were fit, 35% vulnerable, and 52% frail. CGA significantly predicted admittance to hospital in frail and vulnerable patients compared to fit patients: risk ratio (RR) 2.12 (95% CI: 1.01; 4.46). Vulnerable and frail patients had higher absolute risk of death within 90 days compared to fit patients: 7% and 23% versus 0%. HR for death within 90 days in frail patients as compared to vulnerable patients was 3.50 (95% CI: 1.34; 9.15). More frail patients (88%) needed geriatric interventions than the vulnerable (46%) and fit patients (32%). Major conclusion: Few elderly cancer patients seem to be fit. CGA predicts admittance to hospital in a population of elderly patients with mixed cancer diseases. Frail and vulnerable patients have higher risk of death within 90 days as compared to fit patients.

Background: Clostridioides difficile infection (CDI) is complex and associated with adverse clinical outcomes in older patients, including increased mortality rates. Effective transition of care for patients with CDI is critical to improve survival and health outcomes and to reduce recurrence rates. The aim of this study is to investigate the effects of a geriatric tailored intervention for older patients with CDI on patient survival, compared with older patients with CDI who receive usual care. Methods: This is a quality improvement study, comparing two organisational pathways. We include 216 patients aged 70 years or more and diagnosed with CDI. Patients with a positive Clostridioides difficiletoxin PCR test are randomised 1:1 to either 1) a geriatric tailored assessment and intervention (the CLODIFRAIL intervention) or 2) usual care at the treating physician’s discretion. The intervention consists of three main parts: 1) a clinical geriatric assessment; 2) a clinical evaluation of indication for and treatment with faecal microbiota transplantation (FMT); 3) weekly clinical assessments during eight weeks. The follow-up period is 90 days. The primary outcome is 90-day survival from the date of positive CDI PCR test. Patient-related secondary outcome measures include quality of life measured by EQ-5D-5L and by the Overall Quality of Life Depression List (OQoL-DL) and functional status measured by the Functional Recovery Score (FRS). Quality-related secondary outcome measures include time-to-treatment with FMT, time-to-treatment with vancomycin, CDI recurrence, readmission, and days in hospital. Discussion: This study will provide new knowledge on the effects of a geriatric tailored intervention for older patients with CDI, including an early assessment of the indication for FMT. Trial registration: The study was pre-registered at ClinicalTrials.gov on 28 June, 2022. Study identifier: NCT05447533.

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