A geriatric assessment is a tool that doctors use to evaluate a person's health and well-being. It looks at your physical function, nutrition, other medical conditions, mental health, and how much social support you have at home.
In cancer care, a geriatric assessment may be used to understand your current health status and discuss treatment options. As we age, our bodies change. People who are 65 years and older may have specific needs that their health care team wants to understand. This tool will help them to recommend the best treatment plan and provide the right amount of support.
Why are geriatric assessments important?
A geriatric assessment is an important tool because it can uncover information that may not be found during traditional exams done during cancer care. This is because people who are 65 years and older often have other illnesses besides cancer than affect how side effects could affect them and how treatment may need to be adapted to their needs.
Research has shown that geriatric assessments can help doctors understand a person's "functional age" compared to their "chronological age." Chronological age is a person's calendar age. It tells a doctor how much time has passed since a person was born. Functional age describes a person's level of physical functioning in their daily lives. This is useful because not everyone who is the same chronological age has the same physical health or abilities.
As people get older, there can be more differences in health when compared to people of the same chronological age. For example, two people who are in their 70s might have a very different health status from each other. One person might live in their own home, be able to drive, and have a network of family and friends nearby. Another person might live in an assisted living facility, need help with daily care, and have long-distance caregivers.
These differences in lifestyle and health have a significant impact on the approach to cancer care. That is why geriatric assessments can be so helpful. The assessment is an effort to identify these health differences, use them to make better treatment decisions, and improve your life during and after cancer.
Both the American Society of Clinical Oncology (ASCO) and the International Society of Geriatric Oncology recommend geriatric assessments for people 65 or older with cancer, particularly people who may need chemotherapy. (Please note these links take you to other websites.)
What does a geriatric assessment include?
A geriatric assessment is not a single test, like a blood pressure reading. And there is not an official geriatric assessment procedure that all oncologists follow. Instead, a geriatric assessment is a series of evaluations that can include questionnaires and/or physical evaluations.
A geriatric assessment will typically evaluate:
Daily living activities
Mood, anxiety, and depression
Social activity and support
Cognition and memory function
To evaluate your daily activities, you may be asked fill out a survey that asks about your ability to prepare your own food and take medications. This is usually done before you see the doctor, such as in the waiting room. To measure your risk for falls, your oncologist may ask a simple question like, "How many falls have you had in the past 6 months or since our last visit?" And details about any other medical conditions may be included as part of your health records. Your oncologist may use these tools together to help inform treatment planning.
Other tools that are specific to older adults undergoing chemotherapy include the Cancer and Aging Research Group's (CARG) toxicity tool and the Chemotherapy Risk-Assessment Scale for High-Risk Patients (CRASH) tool. These tools help predict your chances of experiencing major side effects, also called toxicity, with chemotherapy and can be useful in planning your treatment.
Will I get a score on my geriatric assessment?
A geriatric assessment does not typically include a number score or grade. More likely, your oncologist will discuss your results as part of a larger discussion about treatment planning.
For example, older patients with cancer have a higher risk of falls. Falls can lead to life-changing injuries that can make it harder to live alone. If you have recently had several falls, your oncologist may recommend physical therapy or suggest other options.
How will a geriatric assessment help me?
Cancer treatment always involves certain risks, including possible severe side effects. A geriatric assessment helps your cancer care team understand your current health status and the kind of support you have at home. With this information, you and your oncologist can talk about the risks and benefits of a proposed treatment plan and how they fit with your treatment goals and your values.
Research shows that geriatric assessments have a variety of benefits for older adults with cancer. These include improved communication, fewer unplanned hospital and emergency room visits, and improved quality of life and well-being.
How common are geriatric assessments?
While it is becoming a more common part of cancer care for adults over age 65, not all patients are asked to complete a geriatric assessment. When you are choosing a doctor for your cancer care, you might consider asking if they use geriatric assessments in their practice.
Whether or not geriatric assessments are a part of your regular cancer care, be sure to tell your oncologist about your complete medical history, including any recent changes. This includes telling them about:
Any changes to your health
New or worsening symptoms of anxiety or depression
Medications you are taking
Any changes to your living situation or support system
Questions to ask the health care team
Consider asking your health care team the following:
Why is it important to provide details about my health history after my cancer diagnosis?
What tests will I need before my cancer treatment planning is complete?
What is the goal of each treatment you are recommending? Is it to eliminate the cancer, help me feel better, or both?
What are the expected side effects of each treatment? How can they be managed or relieved?
How can I keep myself as healthy and independent as possible during cancer treatment?
Why is it important to prevent falls at home?
Are there cancer rehabilitation services or other care services that can help me?
How Do Geriatric Assessments Help Older Adults with Cancer?
How to Stay Safe and Independent During Cancer Treatment
NCI’s Integrating Geriatric Assessment into Cancer Care: A Conversation with Dr. Supriya Mohile