Table 2.
Geriatric Assessment-Guided Interventions for Older Patients With Cancer
| Geriatric Assessment (GA) Measure With examples of potential deficits | Potential GA-guided Interventions |
|---|---|
| PHYSICAL FUNCTION DOMAIN | |
| Impaired objective physical performance measures, such as: Short Performance Physical Battery (SPPB) <9 OR Timed Up and Go (TUG) >13.5 seconds | -Consider Physical Therapy (PT) /Occupational Therapy (OT) referral -Fall counseling handout -Home safety evaluation -Check vitamin D and repletion as indicated -Consider initial dose reduction |
| History of falls | -Consider PT/OT referral -Fall counseling handout -Home safety evaluation -Check vitamin D level and repletion as indicated -Medication review - minimize psychoactive meds -Personal Emergency Response System (PERS) if spend significant time alone -Consider initial dose reduction |
| Activities of daily living (ADL) and/or Instrumental Activities of Daily Living (IADL) impairment | Visiting nurse service and home health aide referral Consider initial dose reduction |
| NUTRITION DOMAIN | |
| Weight loss >10% Mini-Nutritional Assessment (MNA) <23.5 Symptoms of appetite loss | -Nutrition counseling -Nutrition referral -Consider meals-on-wheels |
| Symptoms of nausea | -Consider more aggressive antiemetic regimen |
| SOCIAL SUPPORT DOMAIN | |
| Social Support Impaired | -Visiting nurse service and/or home health aide -Ride assistance programs -Social work involvement -Consider meals-on-wheels if nutrition a concern |
| COGNITIVE DOMAIN | |
| Cognitive testing impairment (ie. Using Mini-Mental Status Exam or Montreal Cognitive Assessment) | -Identification of health care proxy -Co-sign for treatment consents -Delirium risk counseling for patient and family -Pillbox for medication administration -Medication review - minimize medications with higher risk of delirium -Social work involvement -Consider initial dose reduction |
| POLYPHARMACY DOMAIN | |
| Polypharmacy | -Pillbox |
| High risk medications based on BEERS criteria | -Medication reduction recommendations |
| COMORBIDITY DOMAIN | |
| Comorbidity considerations | -Consider initial dose reduction -Specific disease considerations, for example: -Diabetes - avoid neurotoxic agents -Heart failure/disease - minimize volume, slower rate -Kidney disease - avoid nephrotoxic agents |
| Geriatric Depression Screen (GDS) >5 | -Consider pharmacologic therapy -Consider referral for psychotherapy/psychiatry -Social work involvement |
| Distress screen positive (using National Comprehensive Cancer Network Distress Thermometer) | -Support group information -Social work involvement -Consider referral to chaplain/spiritual counseling |