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in the last video I talked about the
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role geriatricians play in the care of
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older adults with cancer We discussed
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how geriatric assessment is a major tool
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that geriatricians use to assess the
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patients overall status Now let's
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discuss more how performing a geriatric
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assessment influences the decisions made
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about cancer treatment for an older
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adult with cancer Geriatric assessment
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is not just an academic exercise It
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directly influences the path forward in
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the very practical ways Think about it
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like this We are moving from a blurry
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photograph to a high resolution image of
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the patient We will see the details that
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matter more clearly Let's discuss how
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geriatric assessment can influence the
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care The standard oncology visit
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correctly focuses on cancer is stage and
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immediate treatment options The doctor
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might ask general questions like how are
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you feeling or assess performance status
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observation However this often misses
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critical issues that are specific to
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aging population On the other hand
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geriatric assessment intention is to
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probe for these Someone might seem fine
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in conversation but struggle with
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complex instructions forget medications
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or fail to recognize and report serious
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treatment side effects The geriatric
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assessment cognitive screening can flag
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this risk which is crucial for treatment
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adherence Unintentional weight loss or
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poor appetite might be dismissed as just
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part of getting older but geriatric
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assessment quantifies it Poor nutrition
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significantly impairs healing after
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surgery tolerance of chemotherapy and
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overall strength Identifying this issue
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allows for intervention before treatment
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stresses the body even more Difficulty
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with walking balance or even basic
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self-care like bathing that we may
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identify through the geriatric
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assessment tells us about the limited
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functional reserve This person might be
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at risk for falls especially if their
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treatment causes fatigue or neuropathy
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which is the numbness and tingling in
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your fingers and toes If we know this we
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can provide protective
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interventions Undiagnosed depression or
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anxiety can severely impact your
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motivation ability to cope with side
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effects and overall quality of life
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during a very toxic and demanding
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treatment Geriatric assessment
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specifically screens for these opening
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the door for mental health support
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should you need it Geriatric assessment
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asks about living situation and
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caregiver support If a patient lives
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alone with no one to help them to get to
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their daily radiation appointments or
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manage side effects at home the whole
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treatment may fall apart The geriatric
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assessment provide critical information
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about how well an older adult would be
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able to tolerate the physical and
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emotional stress of cancer therapy It
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helps us to move beyond age and to
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estimate physiological reserve or
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resilience The geriatric assessment
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doesn't just list other diseases It
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helps weigh their severity and impact
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Someone with well-controlled diabetes is
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different from someone with diabetes and
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unstable heart failure and kidney
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disease The total burden of these
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diseases and illnesses significantly
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affects how the body can tolerate
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chemotherapy or recover from surgery
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Components of the geriatric assessment
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like walking speed grip strength weight
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loss exhaustion low physical activity
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are often used to formally assess
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frailty Frailty is a state where we are
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more at risk for falling apart if we are
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stressed more than what we can handle A
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frail patient is much more likely to
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experience severe side effects
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hospitalization functional decline or
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even death from a standard cancer
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treatment compared to a non-frail
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patient of the same age with the same
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cancer Geriatric assessment helps
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quantify this risk Geriatric assessment
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also allows us to identify polyarm
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pharmacy which is the use of many
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medications It also allows us to flag
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potential interactions between your
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current medications and the proposed
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cancer treatment with the goal of
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preventing avoidable toxicity in the
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future This is where the geriatric
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assessment has perhaps its most direct
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impact The oncology team can personalize
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the treatment strategy based on
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vulnerabilities and the likelihood of
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you tolerating the treatment
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For someone identified as vulnerable or
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frail standard chemotherapy doses might
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be too toxic Geriatric assessment
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provides justification for starting with
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a lower dose using a single agent
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instead of a combination chemotherapy or
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choosing drugs known to be better
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tolerated in older adult If surgery
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seems to be too risky due to poor
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functional status or illnesses
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identified through the geriatric
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assessment perhaps radiation therapy or
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systemic therapy like chemo or targeted
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drugs can become the primary treatment
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or the other way around Sometimes
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geriatric assessment reveals significant
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frailty that the risk and the burdens of
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any cancer treatment even modified ones
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are likely to outweigh potential
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benefits In these cases the assessment
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supports an informed decision to forego
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aggressive anti-cancer therapy and focus
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mainly on palative and supportive care
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managing symptoms maximizing comfort and
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ensuring the best quality of life
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Importantly geriatric assessment can
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also work the other way around A robust
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82year-old might score very well on the
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geriatric assessment This provides
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objective evidence that they are likely
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fit enough to receive the standard
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potentially curative treatment which
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hopefully means avoiding potential
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age-based bias that may have led to
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treatment Geriatric assessment serves as
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a needs assessment showing us where
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proactive support can make a huge
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difference in the patients ability to
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navigate treatment successfully It gives
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us specific targeted interventions
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before problems worsen Fun functional
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decline or false risk Refer to physical
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therapy or occupational therapy
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Nutritional concerns Consultation with
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the registered dietician Cognitive
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issues or complex medication schedule
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Involvement of the pharmacist
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geriatrician or home health nurse Signs
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of depression or anxiety Referral to a
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social worker or a mental health
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professional Lack of transportation or
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home support Social worker connects
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patients with the community
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resources These wraparound services
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prompted by geriatric assessment
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findings are very important for
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optimizing patients overall well-being
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and to make sure that they can actually
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complete their planned cancer therapy
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Finally the comprehensive picture that
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geriatric assessment provides becomes
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very important in communication between
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the medical team the patient and their
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family It translates complex medical
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factors into much more understandable
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domains like mobility memory nutrition
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and support The assessment gives us
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meaningful and understandable
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information to have a discussion about
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risk and benefit It helps us move beyond
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gut feelings or ageypes
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Patients and families can better
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understand the full scope of the
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challenges and strength which will
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enable them to participate more actively
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in choosing a treatment that is aligned
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with their values and goals For example
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one may prioritize independence over
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living longer or the other way around
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The assessment also helps everybody to
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have a much more realistic expectation
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about the outcomes based on the overall
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health of the patient
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So in a nutshell geriatric assessment
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transforms cancer treatment decisions
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for older adults from a one-sizefititall
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approach that is based mainly on the
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tumor and the patients age into a highly
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personalized strategy that considers the
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whole person It leads to the care that
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is safer more effective better tolerated
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and more closely aligned with the
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patients individual situation and life
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If you've liked this video I really
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appreciate if you hit the like button
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subscribe to this channel and share this
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video with all of your friends and
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family members Until next video goodbye
