The true meaning of a 'geriatric assessment'

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Published: 22 Nov 2018
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Prof Martine Puts - University of Toronto, Toronto, Canada

Prof Martine Puts speaks to ecancer at the International Society of Geriatric Oncology 2018 conference in Amsterdam about the importance of understanding the meaning of 'geriatric assessment'.

The phrase 'geriatric assessment' has become overused and often applied to something which should be described using different terminology, Prof Puts and Dr Alibhai wrote an editorial on this recently which she briefly outlines.

Often the phrase is used to describe a geriatric screening, and Prof Puts reiterates that this is not the same thing.

This service has been kindly supported by an unrestricted grant from Janssen Oncology.

I was invited to speak about the perspective Dr Alibhai and I wrote in The Journal of Geriatric Oncology earlier this year. We wanted to push the oncology world to think about if you do a geriatric assessment how important it is to use the right name for it, the right terminology, because we see a lot of times in the literature that the term geriatric assessment is used for everything and nothing and within the field and outside the field it creates confusion about what is being done. Then people are reporting on doing geriatric assessment in five minutes, that really was geriatric screening, that wasn’t comprehensive geriatric assessment. So we wrote this editorial to highlight the importance of what is a geriatric assessment because we are taking it from geriatric medicine so we just wanted to remember everyone about what it is in geriatric medicine so that it’s a comprehensive assessment of four core domains. It should be followed up with an intervention plan – if you identify the issues then you should do something about it which is not what always is happening in the oncology world. They use it for treatment decision making but there is not always immediately a plan developed to address the issues identified. So we wanted to push the oncology world in this editorial to stop thinking about just using assessment, stop using the term assessment when you just use one or two domains and also think about if you do these assessments to come up with a care plan to deal with it. It doesn’t always have to be the oncologist because that is often the barrier at the time. Because there are many multidisciplinary team members, nursing in particular, that can take a lead in follow-up care and care coordination. We know from geriatric medicine that the more intensive intervention is really the one improving the outcome so an assessment is just an assessment, in itself there’s no evidence that it improves outcomes. So we wrote an editorial.

After years that the field is now growing in that sense because before we were not all assessing and things like that. But now that we are assessing in various ways it’s important that we know what you are doing, so whether it’s a geriatric screening or a comprehensive geriatric assessment. If you’re only doing one or two domains we shouldn’t be calling it a geriatric assessment if you’re not doing the full thing because then it gets confusing if you have a ten minute assessment or a one hour assessment. If we want to summarise all the evidence in systematic reviews and meta-analyses it’s hard to compare apples and oranges that way.

Is there often confusion between some of these processes and their descriptive terms?

To think about which term you use, what you’re doing and use an appropriate term. So if you’re doing geriatric screening that’s fine, then just call it geriatric screening if you’re using a geriatric screening tool. If you’re using a geriatric screening tool and you call it geriatric assessment that is when it creates confusion and also by saying you’re doing a comprehensive geriatric assessment, that’s why we’ve had dilution of the effects. Do we still expect the same benefits? We’re using this intervention, we tried to get the oncology world to use this geriatric medicine intervention because it had benefits in the geriatric medicine setting but if we are dressing it down to very minor, little bit-part of intervention, do we still expect the same benefits to happen in older cancer patients? We don’t know that yet and there are several randomised trials ongoing that will show. But if this was a one to two hour intervention in geriatric medicine and if you plonk it in oncology and you say, ‘I can do this in five minutes,’ can we really expect the same benefit or are we diluting the potential effect in the oncology setting?