Comprehensive Assessment Is Key for Geriatric Patients

by Danielle Saff, MSW, LMSW, CancerCare

Older adults are faced with unique stressors, both physical and psychosocial, as they age. They may have difficulty navigating their activities of daily living (ADLs), including basic self-care tasks such as being able to eat, bathe, or dress. They may also struggle with the instrumental activities of daily living (IADLs). IADLs are more complicated and require complex organizational skills. Some examples of this include preparing meals, handling transportation, and basic home maintenance, which require attention and concentration.

In addition to the physical changes that may occur when one ages, older patients also face emotional challenges. Many express that loss is a common feeling one must navigate as we age, specifically the loss of one’s health, community, and independence. One may feel the loss of health when they struggle with ADLs and IADLs. If they have moved into a retirement home, this may bring feelings of loss of community and independence. These are only a few examples of the major life stressors that impact many older adults’ quality of life.

Research has shown that many older adults have comorbid medical conditions as a result of aging. At least 80% of adults older than 65 have at least one chronic condition: hypertension, high cholesterol, heart disease or arthritis. Sixty-eight percent of older adults have two or more chronic conditions. Many studies have shown that as one ages, the risk of being diagnosed with cancer increases; 60% of cancer diagnoses are found in individuals 65 or older.These statistics show the importance of having a thorough understanding and assessing an older adult patient’s needs.

Utilizing a comprehensive geriatric assessment can provide a wealth of information. Primarily, it is used by geriatricians. However, oncologists have begun to incorporate it into their practice. This is because it provides a “big picture” of the older adult, which helps analyze and assess their comorbidities, medications, psychological, social, financial, cognitive and functional status. For example, when evaluating psychological status, questions such as “during the past month, have you been bothered by feeling, down, depressed or hopeless” will be asked. Therefore, it implements questions similar to the Patient Health Questionnaire-9 that is used to assess depression.

Cancer clinical trials usually include younger individuals who are likely to have fewer comorbidities. Even when they incorporate older adults, they often choose “fit” older adults. Therefore, the comprehensive geriatric assessment can help guide the conversation to get a full picture of what the older adult presents with in addition to the cancer diagnosis. This assessment helps older adults who are making treatment decisions, and it can help oncologists predict and determine chemotherapy toxicity and other factors that may complicate treatment. The information provided by the assessment is essential as it contributes to shared decision making. The goal of shared decision-making is for patients and clinicians to partner together and make informed choices based on the patient’s needs, values and preferences. In 2015, CancerCare surveyed more than 3,000 American adults regarding their experience when planning for treatment. Many found that they did not have enough information about alternative therapies, cost and clinical trials.

When diagnosed with cancer, feelings of sadness, stress and anxiety frequently arise. Patients share they will follow their doctors’ lead, as they feel that guidance is needed. However, many explain that they don’t have a voice in their treatment. While some individuals are more proactive in their care, others take a “back seat” approach. Regardless of each patient’s style, the treatment team members should have conversations regarding the comprehensive geriatric assessment and how it can help the client.

Uncertainty is one of the most challenging emotions that comes with a cancer diagnosis. Uncertainty often leads to anxiety and rumination. A comprehensive geriatric assessment will make sure the patient is heard and is treated as an individual. While this won’t give the patient anymore certainty, it will help them feel comfortable as they know they are being looked at comprehensively. This will help the client understand what to expect with their decision regarding treatment choices. While the uncertainty will always be there, this process can help alleviate some of the doubt the patient and their doctors may have when deciding on the best course of action.

While earning my degree in social work, one of the guiding principles we learn is that people want to feel heard. We are taught that active listening is one of the best ways we can support our clients. Showing people that what they are saying and feeling is normal and valid, they feel our support. The comprehensive geriatric assessment is another way of showing that as medical professionals, we are listening. The treatment team needs to understand the patient’s level of functioning, comorbidities, psychological and social state, in addition to their cancer. Therefore, the patient feels that the treatment team hears and understands them. This helps with shared decisions regarding treatment and ultimately alleviates some of the anxiety and uncertainty that accompanies a cancer diagnosis.

References 1. Aging and Cancer. (2019). Cancer.net. Retrieved from https://www.cancer.net/navigating-cancer-care/older-adults/aging-and-cancer
2. Blanquicett, C., Johnson, T., Flowers, C., & Cohen, J. (2019). The Role of the Comprehensive Geriatric Assessment in the Evaluation of the Older Cancer Patient. Cancer Network, 33(11), 458¬– 466. https://www.cancernetwork.com/view/role-comprehensive-geriatric-assessment-evaluation-older-cancer-patient
3. Miller-Sonet, E. (2017, December). Informed decision making in cancer care: more myth than reality. STAT. Retrieved from https://www.statnews.com/2017/12/14/cancer-treatment-decision-making/