Goals for frailty assessment and treatment among patients with blood cancer
| Goals and approach . |
|---|
| 1. Screen for frailty |
| a. Refer to geriatrician, if appropriate |
| b. Even if robust, repeat screen(s) after treatment of disease progression |
| 2. Tailor treatment goals |
| a. Assess and frequently reassess goals |
| b. Integrate frailty-specific treatment data when available |
| c. Balance potential for longer life and/or cure with treatment toxicity, visit burden, and potential for hospitalization |
| 3. Improve strength and address exhaustion |
| a. PT and/or OT |
| b. Consider medication side effects |
| c. Judicious use of transfusions and/or ESAs (MDS) |
| d. Evaluate for mood disorders |
| 4. Address weight loss |
| a. Nutritionist evaluation |
| b. Socialized meals |
| c. Food access (eg, Meals on Wheels) |
| d. Replace/fix dentures |
| e. Liberalize diet (beware of transplant or neutropenic diet) |
| 5. Reduce polypharmacy |
| a. Frequent medication reconciliation |
| b. Review evolving medication plans of other providers |
| c. “Start low and go slow” with new medications |
| d. Frequently assess for side effects |
| 6. Screen for and address social support |
| a. Obtain contact information for all caregivers |
| b. Establish surrogate or health care power of attorney |
| c. Assess for loneliness |
| d. Assess for caregiver burnout |
| e. Evaluate for financial strain and refer to social work, if appropriate |
| 7. Screen for and address cognitive impairment |
| a. Administer validated assessment tool |
| b. Anticipate potential cognitive decompensation when hospitalized |
| c. Consider role of pharmacotherapy |
| Goals and approach . |
|---|
| 1. Screen for frailty |
| a. Refer to geriatrician, if appropriate |
| b. Even if robust, repeat screen(s) after treatment of disease progression |
| 2. Tailor treatment goals |
| a. Assess and frequently reassess goals |
| b. Integrate frailty-specific treatment data when available |
| c. Balance potential for longer life and/or cure with treatment toxicity, visit burden, and potential for hospitalization |
| 3. Improve strength and address exhaustion |
| a. PT and/or OT |
| b. Consider medication side effects |
| c. Judicious use of transfusions and/or ESAs (MDS) |
| d. Evaluate for mood disorders |
| 4. Address weight loss |
| a. Nutritionist evaluation |
| b. Socialized meals |
| c. Food access (eg, Meals on Wheels) |
| d. Replace/fix dentures |
| e. Liberalize diet (beware of transplant or neutropenic diet) |
| 5. Reduce polypharmacy |
| a. Frequent medication reconciliation |
| b. Review evolving medication plans of other providers |
| c. “Start low and go slow” with new medications |
| d. Frequently assess for side effects |
| 6. Screen for and address social support |
| a. Obtain contact information for all caregivers |
| b. Establish surrogate or health care power of attorney |
| c. Assess for loneliness |
| d. Assess for caregiver burnout |
| e. Evaluate for financial strain and refer to social work, if appropriate |
| 7. Screen for and address cognitive impairment |
| a. Administer validated assessment tool |
| b. Anticipate potential cognitive decompensation when hospitalized |
| c. Consider role of pharmacotherapy |
ESA, erythropoiesis-stimulating agents; OT, occupational therapy; PT, physical therapy. Adapted with permission from Huisingh-Scheetz and Walston.69