| Abnormal score on cognitive screening tool |
Referral to geriatric medicine or memory clinic for further diagnostic work-up if patient is interested. Involve caregiver if available. Assess/minimise medications. Delirium prevention. Refer to social work as appropriate. Assess ability to consent to treatment. Identify healthcare proxy.
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| PHQ-9 indicating depressive disorder |
Diagnosis of depression may be made in the clinic according to DSM-V criteria and antidepressant therapy started. Referral to psychosocial oncology/psychiatry as appropriate. Referral to social work. Refer to support programmes as available inside the cancer centre and those available in the community.
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| Inappropriate medication use, potential drug interaction, unsafe medication use, issues with medication adherence |
Problems regarding medications will be addressed immediately in the clinic with the patient and appropriate changes will be suggested to the treating oncologist/family physician. If patient education needs are identified (such as the need for dosettes), the MD and RN of the geriatric oncology clinic will provide counselling on medications management and/or contact the patient’s pharmacist. Changes will be communicated with the patient’s usual pharmacist, oncologist and primary care physician.
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| Weight loss of more than 3 kg in the previous 6 months |
Refer to a dietician for nutritional assessment and recommendations. MD in geriatric oncology clinic to review contributing medications and consider prescribing nutritional supplements if indicated. Counselling on oral care and ability to eat (eg, rule out pain, etc). Referral to social work if needed (for meals on wheels and other community supports).
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| Disability in IADL activities |
Review support available to assist the patient with IADLs, such as support from family and friends, support in the community (meals on wheels, cleaning services, transportation, etc). Depending on needs identified, referral to appropriate allied healthcare professional and/or services will be made (occupational therapist, social worker, physical therapy, home care personal support worker/nursing services, exercise classes, home safety evaluation). Referral to occupational therapy/outpatient rehabilitation as appropriate.
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| Falls risk |
Referral to occupational therapy and/or physical therapy during the clinic visit and/or home occupational/physical therapy assessment to evaluate and decrease fall risk. MD to review medications and comorbidities for possible contributing factors. Possible referral to falls clinic. If indicated, patient can be prescribed a walking aid. If indicated, referral to an outpatient geriatric rehabilitation programme/exercise program (eg, geriatric day hospital) will be made.
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| Pain |
MD may investigate aetiology of pain with specific investigations (eg, X-rays, CT scan and bone scan). MD will review present pain management including medications. MD will prescribe medications to optimise pain control and may refer to other specialists (eg, palliative care, pain service) if necessary. Discussion of non-pharmacological pain management strategies as appropriate. Referral to allied health professionals as appropriate (occupational therapy, physical therapy, spiritual care, psychosocial oncology).
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| Hearing impairment |
If indicated, MD will refer to ear-nose-throat and/or audiology for further assessment and management.
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| Vision impairment |
Review medication management, safety at home, social support available, visual aids and community support. May refer to optometrist or ophthalmologist, if indicated.
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| Lack of social support/isolation |
Review caregiver support/burden. Arrange for transportation support assistance if indicated. Refer to social work. Review home safety. Referral to nursing/home health care services as appropriate. Refer caregiver to social work/psychosocial oncology if indicated. Refer to support groups/spiritual care as appropriate.
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| Other abnormal CGA findings | Intervention and referrals as indicated. |