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Comprehensive Geriatric Assessment

CARG Geriatric Assessment – available in multiple languages including English (below), Spanish, Mandarin, Japanese, Korean, Armenian, Farsi, Arabic, Tagalog

Screening Tools

FACT-G: Functional Assessment of Cancer Therapy - General (constitutes the core of all subscales; the FACT-G can be used with patients of any tumor type)  - Download WORD | Download PDF | Language Availability
Scoring & Interpretation Materials

  • Find cancer-specific questionnaires: Breast, bladder, brain, colorectal, central nervous system, cervical, esophageal, endometrial, gastric, head and neck, hepatobiliary, lung, leukemia, lymphoma, melanoma, multiple myeloma, nasopharyngeal, ovarian, prostate, vulva

FACT-G7: Functional Assessment of Cancer Therapy - General - (7 item version; be used with patients of any tumor type) - Download WORD | Download PDF | Language Availability
Scoring & Interpretation Materials 

Geriatric 8
Eight items selected from Mini Nutritional Assessment concern nutritional status, weight loss, body mass index, motor skills, psychological status, number of medications, and self-perception of health. The score ranges from 17 (not at all impaired) to 0 (heavily impaired). A score lower or equal 14 requires further geriatric assessment. This assessment is most often performed by a nurse or clinical research associate. It takes less than 10 minutes to complete (median = 4 minutes).

Groningen Frailty Indicator (GFI)
A brief questionnaire to assess mobility, vision, hearing, nutrition, co-morbidity, cognition, psychosocial, and physical fitness.

Senior Adult Oncology Program 2 (SAOP2)
Questionnaire used with new patients at the Moffitt Senior Adult Oncology Program, aimed at defining who needs an additional multidisciplinary evaluation.

Vulnerability Elderly Survey-13 (VES-13)
A simple function-based tool for screening community-dwelling populations to identify older persons at risk for health deterioration. The VES considers age, self-rated health, limitations on physical function, and functional disabilities. See also Scoring Directions.

Cognitive Status

Blessed Orientation-Memory Concentration (BOMC) Test
This screening tool allows family members, caregivers, or healthcare professionals to check for suspected dementia in an elderly. Dementia is described as the progressive loss of memory and progressive loss in at least of one other cognitive area, such as language or behavior.

Mini Mental Status Examination (MMSE)
A brief, quantitative measure of cognitive status in adults. It 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.

This is a three-minute instrument that can increase detection of cognitive impairment in older adults. After 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.

Montreal Cognitive Assessment (MoCA)
A brief cognitive screening tool for mild cognitive impairment. Health professionals complete a 60-minute certification training. Assessment available for tablet or smart phones. (Cost $125)

Functional Status

ECOG Scale of Performance Status
This describes a patient’s level of functioning in terms of their ability to care for themselves, daily activity, and physical ability (walking, working, etc.)

Karnofsky Performance Status
The Karnofsky Performance Scale Index allows patients to be classified as to their functional impairment. This can be used to compare effectiveness of different therapies and to assess the prognosis in individual patients. The lower the Karnofsky score, the worse the survival for most serious illnesses.

Evaluation of Activities of Daily Living (ADLs)
This 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 the six functions of bathing, dressing, toileting, transferring, continence, and feeding.

Instrumental Activities of Daily Living Scale (IADL)
Assess independent living skills within eight domains of function.

Timed Get Up and Go (TGUG);
This brief physical test is used to assess functional ability and movement.

Psychological Status

Geriatric Depression Scale (GDS)
This self-administered assessment can be used to rate depression in elderly people. Note: this is not a diagnostic instrument-see DSM IV for this purpose. The scale groups 15 yes/no items concerning the vision of life, feelings, etc.

Hospital Anxiety and Depression Scale (HADS)
This Instrument can be used to detect states of depression and anxiety in the setting of a hospital medical outpatient clinic.

NCCN Distress Thermometer
Available from the National Comprehensive Cancer Network, this instrument is widely used for distress screening. The most recent version of the NCCN Practice Guidelines for the Management of Distress recommends that a distress thermometer score of 4 or higher indicates moderate-to-severe distress and should trigger follow-up care.

Comorbidity Assessment

Adult Comorbidity Evaluation-27 (ACE-27)
Identify the important medical comorbidities and grade severity using the index.

Charlson Comorbidity Index (CCI)
This is a weighted index used to predict risk of death within 1 year of hospitalization for patients with specific comorbid conditions.

Cumulative Illness Rating Scale (CIRS)
Cumulative Illness Rating Scale, designed to meet the need for a brief, comprehensive and reliable instrument for assessing physical impairment and multimorbidities. A scale format provides for 13 relatively independent areas grouped under body systems. Ratings are made on a 5‐point “degree of severity” scale, ranging from “none” to “extremely severe.”

Rough guide (calculators) to inform clinicians about possible mortality outcomes. It is not intended to be the only basis for making care decisions, nor is it intended to be a definitive means of prognostication. Clinicians should keep in mind that every patient is an individual, and that many factors beyond those used in these indices may influence a patient's prognosis.


AGS Beers Criteria- UPDATED 2019

STOPP 2014 - version 2 criteria for potentially in appropriate prescribing in older people.
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.

Medication Appropriateness Index
Hanlon J, Schmader K, Samsa G, Weinberger M, Uttech KM, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45:1045-51.

Patient Tools

Cancer Legal Resource Center
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.

National Patient Travel Center
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

Use Lyft or Uber without a smartphone. 24/7 operators watch rides and offer support. Text alerts keep families in the loop. – elder care locator

Information for Caregivers

Compassion & Choices
End of life counseling, empowering everyone to choose end-of-life care that reflects their values, priorities, and beliefs.

Additional Materials

Gerontological Society of America Webinars
View archived webinars on topics such as Sun Protection and Sunburn Among Older U.S. Adults, Health Literacy Considerations for Cancer Prevention Initiatives With Older Adults, and more.

Triage Risk Screening Tool (TRST)

Mini Nutritional Assessment
18 question assessment to identify risk for malnutrition

Chemo Toxicity Calculator
Pre-chemotherapy assessment that captures sociodemographics, tumor/treatment variables, laboratory test results (hemoglobin, creatinine clearance), and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status).

CARG Resources for the Older Adult
A compiled list of resources for post-assessment care on topics including: activity and mobility, nutrition, hearing, vision, emotional support, safety, medications, memory, transportation, sleep, advance care planning, sexuality/urinary, living and care options, caregivers, supportive care (pain management, palliative care, hospice care), and financial.

CRASH Score Calculator
This score stratifies patients in four risk categories of severe toxicity.

Edmonton Symptom Assessment Scale (ESAS)
This tool is designed to assist in the assessment of nine symptoms common in cancer patients: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing and shortness of breath, (there is also a line labelled “Other Problem”). This can be used for palliative/supportive care assessment.


Defining Undertreatment and Overtreatment in Older Adults With Cancer: A Scoping Literature Review. 
DuMontier C, Kah Poh Loh, Bain P, Silliman R, Hshieh T, Abel G, Djulbegovic B, Driver J, Dale W, J Clin Oncol, April 2020.

Clinical pharmacology of oncology agents in older adults: A comprehensive review of how chronologic and functional age can influence treatment-related effects.
Nightingale G, Schwartz R, Kachur E, et al. J Geriatr Oncol. 2018; in press.

Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology.
Mohile SG, Dale W, Somerfield MR, et al. J Clin Oncol. May 21, 2018.

Improving the Evidence Base for Treating Older Adults with Cancer: American Society of Clinical Oncology Statement
Hurria A, Levit LA, Dale W, et al. J Clin Oncol. 2015;(33):32. 

What Every Oncologist Should Know About Geriatric Assessment for Older Patients with Cancer: Young International Society of Geriatric Oncology Position Paper

Aging and Disability: Beyond Stereotypes to Inclusion: Proceedings of a Workshop
National Academies of Sciences, Engineering, and Medicine.
Proceedings summarize the National Academies of Sciences, Engineering, and Medicine 2017 public workshop, which explored how stereotypes affect older adults and those with disabilities.

Future of Cancer Incidence in the United States: Burdens Upon an Aging, Changing Nation.
Smith BD, Smith GL, Hurria A, et al. J Clin Oncol. 2009;27(17):2758-65.

Geriatric Oncology Ambulatory Care Clinics
Overcash J, Abels S, Erdeljac HP, et al. Oncol Issues. 2018;33(3):54-59.

International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer.
Wildiers H, Heeren P, Puts M, et al. J Clin Oncol. 2014;32:2595-2603

Evaluation of the Senior Cancer Patient: Comprehensive Geriatric Assessment and Screening Tools for the Elderly.
Extermann M.

Screening Tools for Multidimensional Health Problems Warranting a Geriatric Assessment in Older Cancer Patients: An Update on SIOG Recommendations.
Ann Oncol. 2015;Feb 26(2):288-300.

An Interprofessionally Developed Geriatric Oncology Curriculum for Hematology–Oncology Fellows.
Ahmed E, Hughes C, Karuturi M, et al. J Geriatric Oncol. 2015;6(2):165-173.

Evaluation of a Pharmacist-Led Medication Assessment Used to Identify Prevalence of and Associations with Polypharmacy and Potentially Inappropriate Medication Use Among Senior Adults with Cancer.
Nightingale G, Hajjar E, Swartz K, et al. J Clin Oncol. 2015;33:1453-59.

Geriatric Assessment in Daily Oncology Practice for Nurses and Allied Health Care Professionals: Opinion Paper of the Nursing and Allied Health Interest Group of the International Society of Geriatric Oncology (SIOG).
Burhenn PS, McCarthy AL, Begue A, Nightingale G, et al. J Geriatric Oncol. 2016.

National Comprehensive Cancer Network. NCCN Older Adult Guidelines.
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