For cancer programs taking the initiative to enhance their care for older adults with cancer, a first step is completing the Geriatric Oncology Gap Assessment. Once your assessment is complete, return to this page for resources and tools to support your improvement plan(s). The first 9 categories below address criteria found in the gap assessment tool; additional resources follow.
Not sure where to start? The Practical Application of Geriatric Assessment: A How-To Guide for the Multidisciplinary Care Team offers detailed instructions for strategies in each domain that can be implemented without significant burden on staff or budgets.
Filter Resources By:
American Geriatrics Society 2019 Beers Criteria Update Expert Panel. Fick DM, Semla TP, Beizer J, Brandt N, Dombrowski R, et al. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J. Am Geriatr Soc 2015;63(11):2227-46.
Two levels of dynamic, online courses will empower you to help cancer patients navigate the complex and fragmented healthcare system to pay for treatment, while maximizing reimbursement at your program. Work at your own pace to acquire the key knowledge and skills necessary to succeed in the increasingly essential field of oncology financial navigation.
Free 6-part webinar series on caring for older adults with cancer. Topics include an overview of geriatric assessment, multidisciplinary team tips, clinical trials, pharmacy/medication management, and more.
(Sample instrument and Instructions included in link.) This ADL instrument assesses functional status as a measurement of the patient’s ability to perform activities of daily living independently. Clinicians typically use the tool to detect problems in performing activities of daily living and to plan care accordingly. The Index ranks adequacy of performance in six functions: bathing, dressing, toileting, transferring, continence, and feeding. The IADL instrument assesses independent living skills within eight domains of function. ADLs only (Katz) IADLs only (Lawton)
AUDIT-C : The first 3-items of the AUDIT are a self-report measure used to screen for risky or harmful alcohol use. Older adults with a score of 3 or above should complete the full AUDIT. AUDIT-10 : 10-item self-report, reliable and valid measure to assess risky and harmful use of alcohol.
Volunteer Driver program for cancer related appointments.
This screening tool allows family members, caregivers, or healthcare professionals to check for suspected dementia or cognitive disability for patients over age 55. It may also be used in younger patients to screen for cognitive disability.
Interactive online calculator for chemo-toxicity risk prediction. Also available in alternate languages.
Provides information through its national telephone assistance line, outreach programs and community activities to educate and to support cancer patients, their families, healthcare professionals and advocates on matters like maintaining employment through treatment, accessing healthcare and government benefits, taking medical leave and estate planning.
Presley, C.J., Krok-Schoen, J.L., Wall, S.A. et al. Implementing a multidisciplinary approach for older adults with Cancer: geriatric oncology in practice. BMC Geriatr 20, 231 (2020).
UAB Patient-Facing Sample Assessment: Integrating geriatric assessment into routine gastrointestinal (GI) consultation: The Cancer and Aging Resilience Evaluation (Williams et al.)
Caregiver Action Network (CAN) is the nation’s leading family caregiver organization working to improve the quality of life for the more than 90 million Americans who care for loved ones with chronic conditions, disabilities, disease, or the frailties of old age. CAN serves a broad spectrum of family caregivers ranging from the parents of children with significant health needs, to the families and friends of wounded soldiers; from a young couple dealing with a diagnosis of MS, to adult children caring for parents with Alzheimer’s disease. CAN (the National Family Caregivers Association EIN 52-1780405) is a non-profit organization providing education, peer support, and resources to family caregivers across the country free of charge.
Videos from UCLA Alzheimer’s & Dementia Care Program, available in several languages.
Fact sheets on exercise, physical activity, recovery from surgery, and more.
Fall prevention fact sheets, webinars, homes exercises, and more. This page also includes driving safety resources and medical alert systems.
A geriatric assessment is utilized to capture information about a patient’s medical history as well as functional, cognitive, and psychosocial status, which can then be used by treating physicians to identify the most vulnerable patients (for example, those at high risk for chemotherapy toxicity). However, these assessments have not been routinely used in oncology practice because of the time and resources required for their administration. A geriatric assessment tool (that can be completed primarily by patients) was developed for incorporation into oncology clinical trials and routine care settings. The domains that are assessed include functional status, comorbidities, medications, nutritional status, cognitive function, and psychosocial status.
The Geriatric Assessment is available in Spanish, Mandarin, Japanese, Korean, Armenian, Farsi, Arabic, Tagalog, Vietnamese, and French. Production of the translated versions on the website is ongoing.
Patient-facing resources on nutrition, hearing, vision, emotional support, safety, medications, memory, transportation, sleep, advanced care planning, sexuality, living and care, supportive care, and more.
Resources for patients on depression, elder abuse, isolation, support groups, and more.
Resources for patients on safe medication use, herbs, cannabis, disposing of medications, and more.
Resources related to constipation, nutritional supplements, healthy eating, and food banks.
Fact sheets, planning sheets, communicating end-of-life wishes, and more.
Tips, resources, and age-related hearing loss fact sheets for patients.
Handouts, fact sheets, and community resources on vision loss for patients.
Resources on sexuality, incontinence, helpful strategies, and more.
Resources on sleep and getting older, good sleep practices, a sample bookmark, and more.
A program of the National Hospice and Palliative Care Organization provides free resources to help people make decisions about end-of-life care and services before a crisis.
University of Kansas Nurses Training Module: The goal of the CHATO course is to increase awareness of the importance of effective communication with older adults and to use evidence-based, person-centered communication during interactions with older adults in nursing homes and other health care settings. This course is designed for staff in independent and assistive living, nursing homes and health care settings in the community that includes registered nurses, nursing assistants, nursing home dieticians, direct care professionals, other administrations and support employees. The total program is approximately three hours and 15 minutes, split into three modules and the evaluation. Upon completion of all three modules, the evaluation, and 70 percent on a posttest, a certificate of completion (three nursing contact hours) will be awarded.
This weighted index is used to predict risk of death within 1 year of hospitalization for patients with specific comorbid conditions.
The clock-drawing test is a simple screening tool used to identify signs of cognitive problems. It is often combined with other screening tests but is useful even by itself. The test involves providing the patient with a blank piece of paper and asking them to draw a clock that shows the time of 10 minutes after 11. The benefits of this test are its simplicity and ease of use in a clinical setting.
End of life counseling, empowering everyone to choose end-of-life care that reflects their values, priorities, and beliefs.
This score stratifies patients in 4 risk categories of severe toxicity. Online Tool Scoring Analysis NOTE: The above calculators are not yet validated in hematologic malignancies. Consider IADLs as a non-solid tumor cancer-treatment toxicity predictor.
O'Mahony D, Gallagher P, Ryan C, Byrne S, Hamilton H, et al. STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med. 2010;1(1):45-51.
A comprehensive approach to recording all comorbidities, the CIRS-G categorizes comorbidities according to the organ system affected and rates them according to their severity from 0 to 4, with 0 being no severity and 4 being extremely severe. The scale typically includes 13-14 organ system subdivisions and results can be summarized as a total score, mean score, number of involved categories, or the number of severe categories (3 or more). Studies in older adults with cancer have shown the CIRS comorbidity method to be an independent predictor of mortality and progression-free survival. In order to improve the ease of use of the CIRS comorbidity scale, online interactive online tools and apps are available that help shorten the time required to complete and automatically calculate scores to aid in real-time interpretation. Scoring Sheet
10-item self-report , reliable and valid measure to identify illicit drug use and the misuse of prescription medications.
Oncology Nutrition Dietetic Practice Group, Academy of Nutrition and Dietetics. Printable tip sheets for patients regarding nutrition during chemotherapy, radiation, after surgery, managing side effects, and more.
National Cancer Institute
This tool is designed to assist in the assessment of 9 symptoms commonly experienced in patients with cancer: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath, and more. The ESAS can be used for palliative/supportive care assessment.
Article to train people in spotting warning signs of elder abuse.
5-item screen to detect elder abuse. Available in 15 languages.
41-item assessment to detect elder mistreatment.
Elder care locator.
Age Sensitivity Training is a 1.5-hour interactive training program for individuals who are interested in learning about the specific needs and challenges of older adults in the community. During this workshop, participants will experience sensory changes associated with aging through simulation. Age Sensitivity training will provide participants with valuable tools and information for working and interacting with older adults. A fee is associated with this workshop.
Caring for the Ages: article that discusses eliminating elderspeak to restore dignity to older adults.
A rough guide (i.e., calculators) to inform clinicians about possible mortality outcomes. Eprognosis is not intended to be the only basis for making care decisions or to be a definitive means of prognostication. Clinicians should keep in mind that each patient is an individual and that many factors beyond those used in these indices may influence a patient's prognosis.
Caregiver.org: For more than 40 years, FCA has provided services to family caregivers of adults with physical and cognitive impairments, such as Parkinson’s, stroke, Alzheimer’s and other types of dementia. Our services include assessment, care planning, direct care skills, wellness programs, respite services, and legal/financial consultation vouchers. Ongoing support is available with FCA CareNav™, also now on a digital service platform. FCA is a longtime advocate for caregivers in the areas of policy, health and social system development, research, and public awareness, on the state, national and international levels.
18-question assessment to identify risk for malnutrition. Interactive versions of the MNA®-Long Form are now available in Bosnian, Dutch, English, Norwegian, Thai and Tagalog. Short-form versions are now available and recommended for clinical use.
Presley CJ, Han L, Leo-Summers L, et al. Published online 2018. Published in final edited form as J Geriatr Oncol. 2019;10(1):60-67.
GAD-7: 7-item self-report, reliable and valid measure of anxiety in older adults. GAD-2: 2-item self-report, reliable and valid measure for screening for anxiety in older adults.
This series of 8 questions can be answered by a patient in approximately 1 minute. G8 has been validated in older adults with cancer. See also G8 Online Scoring Calculator. Vulnerable Elders Survey-13 (VES-13) This is a simple function-based tool for screening community-dwelling populations to identify older persons at risk for health deterioration. The VES-13 considers age, self-rated health, limitations on physical function, and functional disabilities. See also Scoring Directions.
GDS Background and Instructional Video GDS-30 (Long Form) GDS-15 (Short Form) The scale groups 15 yes/no items concerning the vision of life, feelings, etc. Reliable and valid measure for screening for depression in older adults. 5-item GDS scale
GNRI
A simple calculation that includes height, weight, and albumin (requires lab work). Albumin is included as systemic indicator of disease, along with weight, for both acute and chronic nutritional implications. This tool is a nutritional risk indicator, not an assessment tool.
Use Lyft or Uber without a smartphone. 24/7 operators watch rides and offer support. Text alerts keep families in the loop.
The GFI is a 15-item questionnaire to assess mobility, vision, hearing, nutrition, co-morbidity, cognition, psychosocial, and physical fitness.
Through the Health in Aging Foundation, we advance our commitment to maintaining the health, independence, and quality of life of all older adults by increasing public awareness and providing access to needed resources. HealthinAging.org is the Foundation’s public education portal, providing older adults and caregivers with up-to-date information on health and aging—as well as access to a network of geriatrics healthcare professionals.
Nightingale G, Schwartz R, Kachur E, Dixon BN, Cote C, et al. Clinical pharmacology of oncology agents in older adults: a comprehensive review of how chronologic and functional age can influence treatment-related effects. JGeriatric Oncol. 2019;10(1):4-30.
In the setting of a hospital medical outpatient clinic, this Instrument can be used to detect states of depression and anxiety in patients.
Tip Sheet, Website or PDF
Pace University Gerontechnology Program
A guide on how to conduct senior sensitivity training for students, health professionals, any other group who works with seniors.
This toolkit created by the Institute for Healthcare Improvement is intended to help clinicians address some of the challenges of engaging with patients and families in end-of-life care conversations over time.
Resources related to the 4M project as well as improving care for older adults in healthcare systems.
Society focused on education, clinical practice and research to strengthen the capacity of health professionals in the field of geriatric oncology, in order to optimize treatment of older adults with cancer.
This validated 7-item tool is particularly suited for the high-burden clinic where there are limited resources. In a study of patients with advanced cancer in whom first-line palliative chemotherapy was planned, performance of the KG-7 was comparable to the G-8.
Website to organize help for someone in need– coordinate food drop-offs, house cleaning, etc.
Tips from the National Institute on Aging
Validated tool to screen patients for risk of malnutrition. The tool is suitable for use in a residential aged-care facility or for adults in the inpatient/outpatient hospital setting. Nutrition screen parameters include weight loss and appetite.
Creatinine Clearance Calculator to estimate glomerular filtration rate (GFR).
Measures of the appropriateness of prescribing for elderly patients, using 10 criteria for each medication prescribed.
A brief, quantitative measure of cognitive status in adults, the MMSE can be used to screen for cognitive impairment, to estimate the severity of cognitive impairment at a given point in time, to follow the course of cognitive changes in an individual over time, and to document an individual's response to treatment. Note: There is a fee to use this tool.
The MNA® is a validated tool for identifying malnutrition and risk of malnutrition in the elderly. The 6- question tool is easy to complete and has been validated to be as effective as the original 18-MNA, now referred to as the “full MNA®”. The Self-MNA® is validated to be as effective as the MNA® and can be completed by the patient or their caregiver.
This is a three-minute instrument that can increase detection of cognitive impairment in older adults. After a brief training, the MiniCog can be used effectively in both healthcare and community settings. It has two components: a three-item recall test for memory and a simply scored clock drawing test.
The MoCA is a brief screening test to assess for dementia. It includes 30 questions, is available in multiple languages, and takes about 10-15 minutes to complete. The MoCA assesses several different types of cognitive abilities including orientation, short-term memory, executive function, language, abstraction, attending, and animal naming. It also includes a clock-drawing test. Health professionals complete a 60-minute certification training. The assessment is available for tablet or smartphones. Note: Cost = $125.
The SF-36 is an indicator of overall health status.
This brief, multidimensional, self-administered, social support survey was developed for patients in the Medical Outcomes Study (MOS), a two-year study that was developed for patients with chronic conditions.
The Medical Outcomes Study (MOS) Physical Functioning Scale is a 12-item scale used to assess the relationship between health and physical activities such as self-care, walking, climbing hills and stairs, bending, lifting, and moderate and vigorous activities. The MOS physical functioning scale is advantageous because of the low-test administration burden on staff and patients. Interpretation of score results from the MOS physical functioning scale may limit widespread use. This tool requires a license to use.
Nutrition in Cancer Care (PDQ®)–Patient Version
Nutrition in Cancer Care (PDQ®)–Health Professional Version
Short screening question to be asked in the patient interview to assess illicit drug use or misuse of prescribed medication. How many times in the past year have you used illicit drugs or used a prescription medication for nonmedical reasons (for instance because of the feeling it caused or experience you had)?
Referral request for charitable transportation (long distance.) For those in need of assistance in getting transportation to receive medical treatment. Assistance in the air with commercial airline tickets and volunteer pilots and on the ground with gas cards, bus and train ticket
Available from the National Comprehensive Cancer Network, this instrument is widely used for distress screening. According to the most recent version of the NCCN Practice Guidelines for the Management of Distress, a Distress Thermometer score of 4 or higher indicates moderate-to-severe distress and should trigger follow-up care.
American Cancer Society: A guide for patients and families.
Version 1.2020 OAO- B “Optimizing Communication with Older Adults.”
The OARS subscale is a patient-reported measure that assesses the presence of 14 specific conditions as well as the degree to which each interferes with activities. Commonly used in comprehensive geriatric assessments of older patients with cancer, results of the OARS subscale measure have been found to be associated with overall survival? It is recommended that healthcare professionals planning to use the OARS multidimensional functional assessment review the training video and manual to assure consistent and reliable data collection. Note: Cost = $5 for electronic questionnaire.
Oklahoma Geriatric Education Center: This module provides an overview of a variety of brief cognitive screening measures that are in the public domain and can easily be integrated in care settings that serve older adults. The online module is an interactive didactic experience that includes short videos, reflection questions, and role-play experiential exercises.
9-item self-report, reliable and valid measure of depression among older adults. PHQ-4: 4-item self-report, reliable and valid measure for screening for depression among older adults, includes suicidal ideation. PHQ-2: 2-item self-report, reliable and valid measure for screening for depression among older adults.
This tool is not specific to older adults but is oncology-specific. The scored PG-SGA© includes the four patient-generated historical components (Weight History, Food Intake, Symptoms, and Activities, and Function – also known as the PG-SGA Short Form©) and four professionally generated components (Diagnosis, Age, Metabolic Stress, and Physical Exam), Nutritional triage recommendations are provided with the score.
Part of advance care planning, POLST is a conversation tool and medical order form. (Name varies by state) Gives seriously ill or frail people more specific direction regarding their healthcare treatments compared to advance directives and more options than Do Not Resuscitate (DNR) orders.
Rijk JM, Roos P, Deckx L, et al GeriatrGerontolInt. 2016;16:5-20.
Organizations may use these ROI Calculators with their own data to evaluate their Age-Friendly programs.
Examples of QI goals from the CARG R25 Grant program.
City of Hope’s Patient Transportation Flyer
Simple tool that can be used by adults 65 years of age and older or their caregivers. This new tool has been scientifically validated and is as effective as the MNA® in identifying malnutrition. The Self-MNA® is available in English with Imperial or US customary measurements, English with metric measurements, Danish, Dutch, Finnish, French, German, Greek, Hebrew, Italian, Korean, Lithuanian, Portuguese, Spanish, Swedish and Turkish. Older adults may click on the desired version to download and complete the Self-MNA®. Results should be shared and discussed with a health care provider to help optimize nutrition and health.
Used with new patients at the Moffitt Senior Adult Oncology Program, this questionnaire aims at identifying individuals who need an additional multidisciplinary evaluation. A list of tools associated with this aggregated screening tool is available on the Moffitt website. The questionnaire is available in 9 languages.
Check your local Area Agency on Aging
This battery of tests assesses lower extremity function using measures of balance, mobility, and strength. Clinically, the results of SPPB predict impairments in activities of daily living, falls, and mobility. This Page includes training materials and videos.
J Am Geriatri Soc. 2019;64(4):644-646.
A 4-item screen for risk of suicide.
The Elder Assessment Instrument (EAI) is a 41-item assessment to detect elder mistreatment. This instrument is comprised of seven sections that review signs, symptoms, and subjective complaints of elder abuse, neglect, exploitation, and abandonment.
This brief physical test is used to observe the patient’s postural stability, gait, stride length, and sway. The TUG considers balance in the ability to rise from a sitting position and ambulate 10 feet and return to a sitting position. The TUG has been found to be correlated with falls and can be administered by anyone on the healthcare team. This test can be used with any older patient to screen for risk of falls and lower extremity weakness that could potentially be addressed with a physical therapy referral. The TUG is an objective measure that provides the clinician a view of how a patient can rise from a chair and walk a short distance. An objective measure avoids patients who may over-estimate physical abilities and may need some help with tasks to live independently. The TUG is measured in seconds and can be compared at each visit. A limitation of the TUG is that it is only an objective measure and narrative surrounding physical ability is not recorded. Other mobility activities for consideration are the ability to walk a quarter mile, climb a flight of stairs, lift/carry 10 lbs., and driving. Patients can report the extent of their ability to perform these tasks which offers the clinician a sense of functional capability. Difficulty on any of the activities may indicate pending or worsening disability.
Provided by City of Hope
Handout offering options for mobility and independence.
A sample older adult risk-assessment screening tool from St. Joseph Healthcare, Hamilton, Ontario.
Steinman MA, Fick M.
Evidence-based training for clinicians on improving communication skills and having difficult conversations.
This is a simple function-based tool for screening community-dwelling populations to identify older persons at risk for health deterioration. The VES-13 considers age, self-rated health, limitations on physical function, and functional disabilities.
Toolkit from the Institute for Healthcare Improvement to enable healthcare teams to discover “What Matters” (beyond the context of end-of-life care) to older adults across their lifespan so that care and decisions are aligned with the older adult’s health outcome goals.
This white paper presents the Institute for Healthcare Improvement’s "Conversation Ready" approach to help healthcare organizations and clinicians provide respectful end-of-life care that is concordant with patients’ stated goals, values, and preferences.