Geriatric screening and assessment in a clinical setting
Prof Cindy Kenis - University Hospital Leuven, Leuven, Belgium
We have discovered several things. First of all we performed a geriatric screening and assessment and normally if we talk about geriatric screening outcome parameters are different. Geriatric screening tools and assessment tools are not developed to perform the outcome parameter of survival because initially they are developed to look after the patients, older patients, in general to look after how they are… have they got a geriatric profile or do they not have a geriatric profile? And they are more developed to outcome parameters like functional decline and several other things but they are under-investigated to overall survival in specific older cancer patients.
What have been the benefits?
Simple screening tools and simple geriatric assessment tools have a great prognostic value for overall survival. If the result is a good thing, if we have a normal result on the screening tool, then you can be pretty sure that your patient has a good survival time. If the result is coming out bad then we see that patients have less survival or a more worse survival than the other ones. That’s the biggest issue because screening tools are very easy, very quick to investigate and you have a lot of information on only five minutes, for example. It could change your management decisions on what you can find based on all the information you gather from the geriatric screening and the geriatric assessment is definitely worth considering in your treatment plan and care plan.
You surveyed physicians’ experiences of geriatric assessment – what did you find?
The most important issue there is because it’s other people who are performing the geriatric screening and the geriatric assessment and it’s pretty important to know what physicians really want to know about it. They have sometimes other experience and you can find some things pretty important but they are not always feasible in clinical practice. So we discovered a little bit both. We particularly asked what they expect, the treating physicians, of trained healthcare workers, nurses or others, to perform the geriatric assessment and what do they expect from the geriatrician because the geriatrician is pretty important also in the whole process. The domains that are quite important in geriatric assessment are functionality, cognition, depression, nutritional status; physicians want that information from the geriatric assessment. They also want that the trained healthcare workers will co-ordinate the whole process and they need to know which recommendations from the geriatricians they have to follow.
What should doctors do to get what they need?
They have to ask the right questions and they have to look at the results and to integrate that in the treatment plan of the specific patient.
You surveyed with regards to the barriers to implementing this kind of assessment – what did you find?
What we found there was that there are several facilitators and barriers for implementing the geriatric screening and assessment in daily clinical practice. The barriers are often related to organisational aspects like time, workload, personal staff and that kind of stuff and that facilitators are often related to collaboration aspects. If physicians know the relevance of a geriatric assessment it is more easy to implement it, for example, in their daily practice.
What advice would you give to clinicians caring for older patients?
The biggest message I can give to everyone in the care for older patients with cancer is that you can better do something than doing nothing. I think that’s the most relevant and important part of the geriatric screening and assessment.
Are any of the main points of the assessment considered more important than others?
No, I think there are ten points in a geriatric assessment that they have to take into account but functionality and cognition and nutritional status are three of the things that are coming back all the time in both physicians as geriatricians as other healthcare workers.