A Practical Guide to Geriatric Syndromes in Older Adults With Cancer: A Focus on Falls, Cognition, Polypharmacy, and Depression

Abstract

Geriatric syndromes are multifactorial conditions that are prevalent in older adults. Geriatric syndromes are believed to develop when an individual experiences accumulated impairments in multiple systems that compromise their compensatory ability. In older adults with cancer, the presence of a geriatric syndrome is common and may increase the complexity of cancer treatment. In addition, the physiologic stress of cancer and cancer treatment may precipitate or exacerbate geriatric syndromes. Common geriatric syndromes include falls, cognitive syndromes and delirium, depression, and polypharmacy. In the oncology setting, the presence of geriatric syndromes is relevant; falls and cognitive problems have been shown to be predictive of chemotherapy toxicity and overall survival. Polypharmacy and depression are more common in older adults with cancer compared with the general geriatric population. Multiple screening tools exist to identify falls, cognitive problems, polypharmacy, and depression in older adults and can be applied to the oncology setting to identify patients at risk. When recognized, several interventions exist that could be considered for this vulnerable population. We review the available evidence of four geriatric syndromes in the oncology setting, including clinical implications, validated screening tools, potential supportive care, and therapeutic interventions.

Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison

“…Both cancer and oncologic treatments can behave as potential stressors that may overwhelm the patient’s reserve capacity and, consequently, favor the development of GS. Therefore, the assessment of GS in the elderly cancer population is of interest when designing care plans or interventions [ 38 ].…”

Addressing distress management challenges: Recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work

“…Older patients often have lower rates of reporting depression and anxiety on standard screening instruments, particularly ethnically diverse older adults 68,69 . This group is also more likely to experience deficits in multiple functional domains, including visual or hearing impairments, mobility, cognition, and social support, and is at higher risk for experiencing polypharmacy and treatment toxicity 70,71 . These barriers may impair the ability of these patients to actively participate in their cancer care, complete distress screening, and/or participate in psychosocial interventions.…”

Achieving sequential therapy in advanced gastric cancer: the importance of appropriate patient management for the elderly and/or those with ascites

“…In addition, previous falls are associated with an increased risk of chemotherapy toxicity and poorer survival [29,59]. Screening for falls in elderly patients is, therefore, strongly recommended, from simply asking the patient if they have had any falls since their last visit to administering gait and balance tests, such as Timed Up and Go or Gait Speed tests [58,60]. Patients at risk for falls should be offered a multifactorial assessment followed by referral to a primary care provider, geriatric team, or falls clinic (Fig.…”

“…Patients at risk for falls should be offered a multifactorial assessment followed by referral to a primary care provider, geriatric team, or falls clinic (Fig. 1a) [60]. Possible interventions to prevent falls include evaluation of additional risk factors for falls, home safety evaluation, physical therapy referral for strength and balance training, home exercise program, and fall counseling education [60].…”