Conducting a health assessment is the process of evaluating the physical, mental, and emotional functioning of a person. For an older adult with cancer, an accurate assessment, perhaps involving caregivers, can help determine the relevance of various conditions (such as poor hearing, limited mobility, or depression) to the person's overall health. In addition, any health changes in the older person with cancer may be harder to detect during treatment unless an initial assessment is made.

As part of the health assessment, cancer doctors follow a rating scale called the Performance Status Scale. This scale ranges from zero to five, and describes how much of an effect the cancer has on everyday functioning. For example, a performance status of zero means that cancer is not affecting that person's ability to do everyday activities, whereas a performance rating of four indicates a person is severely debilitated from the cancer. Performance status often correlates with how well a person responds to treatment and the likelihood of experiencing treatment-related side effects. The doctor will consider performance status along with a thorough physical, emotion, and social assessment when deciding on treatment. Important aspects of the initial evaluation should include an assessment of the following factors:

Cognitive function (ability to think, reason, and recall facts). The older adult with cancer must have the capacity to make informed decisions. Because older people often have varying degrees of mental health abilities, some doctors may perform standardized testing in select people. Some older adults suffer from dementia, which is characterized by a decline in the ability to recall events, concentrate, or be aware of specific times, places, and people. Some form of dementia occurs in about 6% to 8% of people over 65, and the prevalence of dementia increases after age 80. Dementia does not necessarily mean that the person cannot make informed decisions, but the doctor should carefully assess the person’s competency to ensure that he or she is able to understand and make decisions.

Physical function. A thorough physical examination and laboratory tests are routinely performed to establish a person’s general level of health.

Vision. Many older adults have some degree of vision loss. It is important to evaluate these problems before treatment, as some chemotherapy drugs can cause fatigue and dizziness, placing the person with cancer at an increased risk for falling. In addition, if an older adult is unable to read a prescription or doctors' instructions, special care should be taken to find an alternative.

Hearing. Approximately 25% to 40% of older adults have some degree of hearing difficulty. A hearing assessment is important because some chemotherapy drugs can contribute to hearing loss. It is also essential that people can hear and understand what is being told to them to be able to give informed consent to treatment.

Difficulty walking and balancing. Difficulty walking may place older adults at an increased risk for falling and other injuries, and this may be further complicated by the side effects of chemotherapy.

Nutrition. It is crucial for all people undergoing chemotherapy or radiation therapy to eat enough food. An initial nutritional assessment may be useful as well as regular meetings with a registered dietitian (RD) or nutritionist to provide suggestions for balanced meals.

Emotional status. Many people with cancer experience varying degrees of distress and even anxiety and depression, especially after receiving news that they have cancer. Depression and anxiety can contribute to weight loss, fatigue, and may contribute to the person's quality of life.

Continence (controlling bowel or bladder function). Many older adults with cancer have continence problems for a variety of reasons, such as the use of diuretics (pills that promote urination), pre-existing bladder conditions, or brain or spinal cord disease, including metastatic cancer. These problems need to be brought to the attention of the doctor and addressed individually.

Social support. Older people with cancer need social and emotional support, and it is important to assess the availability of this support, including identifying the person who will be caring for the older person with cancer. Social work support may be necessary for older adults who live alone or for those who do not have family members or friends nearby to help.