Key Messages:

• A health assessment is a process that checks a person’s physical, mental, and emotional well-being before and during cancer treatment.
  
  
• A rating scale called the comprehensive geriatric assessment is used to describe how the cancer affects a person’s ability to do everyday activities.
  
  
• During a health assessment, doctors evaluate how a person is functioning physically, emotionally, and socially.

For an older adult with cancer, an accurate health assessment, perhaps involving caregivers, can help doctors find out how any co-existing conditions

(such as poor hearing, limited mobility, or depression) affect a person's overall health and ability to make decisions about treatment. Furthermore, having a health assessment before cancer treatment begins can make it easier to notice any health changes once treatment starts.

For your health assessment doctors may use a rating scale called a Performance Status scale or may recommend the comprehensive geriatric assessment (CGA) tool. The CGA includes assessments of how well people can bathe and dress themselves (sometimes referred to as activities of daily living), the number and severity of coexisting illnesses, how well and how much they are eating (for example, whether they are losing weight), memory, how well they can cope (including evaluation for depression), and a comprehensive review of a person’s medications.

As mentioned earlier, other tools to measure functional status include the activities of daily living (ADL) and the instrumental activities of daily living (IADL). The ADL looks at whether a person can care for himself or herself and includes activities of bathing, dressing, going to the toilet, and feeding oneself. The IADL includes slightly more complex skills, such as managing finances, preparing meals, shopping, using the telephone, and managing medications. As people age, these skills diminish and may cause treatment to be interrupted or stopped in people with cancer. Not being able to do these skills is also associated with lower survival. For that reason, before treatment begins, the doctor will consider skill performance and the results of a geriatric assessment to make sure it is safe for the patient to undergo treatment.

Other factors in the assessment include:

The ability to think, reason, and recall facts. To make treatment choices, people with cancer need to be able to make informed decisions. Because older adults often have varying cognitive abilities, doctors may do certain tests for some older adults, depending on individual circumstances. For example, some older adults have dementia, meaning they have a decline in the ability to recall events, concentrate, or be aware of specific times, places, and people. About 6% to 8% of people older than 65 have dementia, and the risk of dementia increases after age 80. Dementia does not necessarily mean that a person cannot make informed decisions, but the doctor should do a careful assessment to make sure that the patient can understand and make decisions.

Physical function. A thorough physical examination and laboratory tests are usually done to check a person’s general health. This helps doctors monitor any health changes once treatment begins.

Vision. Many older adults have some type of vision loss. It is important to check for these problems before treatment because chemotherapy can cause fatigue and dizziness, which increase the chance of falling. In addition, if an older adult is unable to read a prescription or the doctors' instructions, special care should be taken to find another way to provide this information.

Hearing. Approximately 25% to 40% of older adults have trouble hearing. Also, some chemotherapy can contribute to hearing loss, so it’s important to know if a person has hearing loss before treatment. People need to be able to hear and understand what is being told to them to make treatment choices.

Difficulty walking and balancing. Difficulty walking increases an older adult’s risk of falling and other related injuries, and the side effects of chemotherapy can further increase this risk.

Nutrition. It is important that all people receiving chemotherapy or radiation therapy eat enough food. Looking at what and how much a person eats may be useful. A registered dietitian (RD) or nutritionist can help provide suggestions for balanced meals.

Emotional status. Depression and anxiety can be common for older adults, and all people have different reactions when hearing that they have cancer. Depression and anxiety can cause weight loss, fatigue, and a lowering of a person’s quality of life. In addition, mental health issues may interfere with the ability to make treatment choices.

Continence (controlling bowel or bladder function). Many older adults with cancer have continence problems from the use of diuretics (pills that promote urination), bladder conditions unrelated to cancer, or a brain or spinal cord disease, including metastatic cancer (cancer that has spread). It is important to talk with the doctor about continence problems, as these conditions are managed differently depending on individual circumstances.

Social support. All people with cancer need social and emotional support. It is important to find out who is able to support an older adult with cancer, including the person who will be caring for the older person. A social worker can help older adults who live alone or those who do not have family members or friends nearby.

More Information

Resources for Older Adults

Chronic Conditions: When Cancer is Not Your Only Health Concern

Cancer in Older Adults