senior adult oncology
Post on 02-Jan-2016
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OverviewOverview
Cancer is the leading cause of death Cancer is the leading cause of death for those 60-79 yearsfor those 60-79 years
60% of all cancers occur in patients 60% of all cancers occur in patients who are 65 years or olderwho are 65 years or older
Older individuals are more prone to Older individuals are more prone to develop cancer due to physiological develop cancer due to physiological changes associated with agingchanges associated with aging
Older AdultsOlder Adults
Older patients can be classified into three Older patients can be classified into three categories:categories:
Young Old: 65-75 yearsYoung Old: 65-75 years Old: 76-85 yearsOld: 76-85 years Oldest Old: over 85 yearsOldest Old: over 85 years
Age Distribution of U.S. Population, 1980, Age Distribution of U.S. Population, 1980, 1990, and 20051990, and 2005
Data source: The Bureau of the Census
Year 1980 Year 1990 Year 2005
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
FrailtyFrailtyDecreased reserve and resistance to Decreased reserve and resistance to
stressorsstressors
Frail patients have an increased risk of Frail patients have an increased risk of complications from cancer treatmentscomplications from cancer treatments
Risk for falling, disability, hospitalization, and Risk for falling, disability, hospitalization, and deathdeath
Fraility CriteriaFraility Criteria
Unintentional weight loss (10 lbs or more in past year)Unintentional weight loss (10 lbs or more in past year)
Self reported exhaustionSelf reported exhaustion
WeaknessWeakness
Slow walking speedSlow walking speed
Low physical activityLow physical activity
Geriatric SyndromesGeriatric Syndromes
MalnutritionMalnutrition
PolypharmacyPolypharmacy
Lack of Social Lack of Social SupportSupport
DepressionDepression
DementiaDementia
Fall RiskFall Risk
FallsFalls
One of the most common geriatric One of the most common geriatric syndromessyndromes
30-40% of adults older than 65 years fall 30-40% of adults older than 65 years fall each yeareach year
Risk factors: muscle weakness and Risk factors: muscle weakness and impairments in gait, vision, cognition, and impairments in gait, vision, cognition, and ADLsADLs
Activities of Daily Living (ADLs)Activities of Daily Living (ADLs)
Able to bathe selfAble to bathe self Able to dress selfAble to dress self Able to toilet selfAble to toilet self Control over bowel & bladderControl over bowel & bladder Able to transfer selfAble to transfer self Able to feed selfAble to feed self
Instrumental Activities of Daily Instrumental Activities of Daily Living (IADLs)Living (IADLs)
Use the telephoneUse the telephone Get to places beyond walking distanceGet to places beyond walking distance Grocery shopGrocery shop Prepare mealsPrepare meals HouseworkHousework LaundryLaundry Take medicationsTake medications Manage moneyManage money
Percent of Medicare Beneficiaries Reporting Difficulty with Percent of Medicare Beneficiaries Reporting Difficulty with IADLs or ADLs by Age, 2004IADLs or ADLs by Age, 2004
Data Source: Medicare Current Beneficiary Survey
Per
cent
(%
)
0
5
10
15
20
25
30
35
65-74 75-84 85 years and over
IADL Only 1 to 2 ADLs 3 to 6 ADLs
Percent of Persons Age 65 and Over (age-adjusted) Percent of Persons Age 65 and Over (age-adjusted) Reporting Selected Chronic Conditions by Sex, 2004-2005Reporting Selected Chronic Conditions by Sex, 2004-2005
0
10
20
30
40
50
60
Hypertension Arthritis Heart disease Cancer Diabetes
Male Female
Data Source: National Health Interview Survey
Per
cent
(%
)
Years of Education Among Persons Age 65 and Over Years of Education Among Persons Age 65 and Over (age-adjusted) by Sex and Race/Ethnicity, 2006(age-adjusted) by Sex and Race/Ethnicity, 2006
0
10
20
30
40
50
60
70
Less than HighSchool
High School More than HighSchool
Less than HighSchool
High School More than HighSchool
White non-Hispanic Black non-Hispanic HispanicData source: Current Population Survey
Per
cent
(%
)
Male Female
Cancer TreatmentCancer Treatment
Benefits:Benefits: Prolonged survivalProlonged survival
Maintenance and improvement of quality Maintenance and improvement of quality of life and functionof life and function
Palliation of symptomsPalliation of symptoms
Cancer TreatmentsCancer Treatments
Risks:Risks: Complications of surgery, radiation, and/or Complications of surgery, radiation, and/or
chemotherapychemotherapy
Affects on cognition, function, balance, Affects on cognition, function, balance, vision, hearing, continence, and moodvision, hearing, continence, and mood
Treatment DecisionsTreatment Decisions
Life ExpectancyLife Expectancy Aggressiveness of DiseaseAggressiveness of Disease Functional AbilitiesFunctional Abilities ComorbiditiesComorbidities Patient GoalsPatient Goals Social ResourcesSocial Resources Tolerance of TreatmentTolerance of Treatment
Treatment DecisionsTreatment Decisions
Advanced age alone should not preclude the Advanced age alone should not preclude the use of effective cancer treatmentuse of effective cancer treatment
Older patients with good performance status are Older patients with good performance status are able to tolerate most forms of treatmentsable to tolerate most forms of treatments
Treatment that diminishes quality of life with no Treatment that diminishes quality of life with no significant survival benefit should be avoidedsignificant survival benefit should be avoided
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