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Geriatric assessment is important right at diagnosis

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Corien Eeltink

31 August 2017

As a nurse practitioner working in the multidisciplinary team of Prof. Dr. Arjan van de Loosdrecht in Amsterdam, I have experienced how important geriatric assessment is for haematology patients with MDS, particularly at diagnosis. After diagnosing the disease, the features of the disease and results from the geriatric assessment are discussed by our multidisciplinary team in order to design and develop an individualised intervention plan. In our team we have implemented a proactive approach in caring for an elderly population, because we do not want to be overtaken by events that could be avoided. Based on my experience I would like to claim two statements:

1. A Geriatric Assessment needs to be done as early as possible in the patients’ pathway

2. Quality of Life is an important outcome for the patient, and results of questionnaires need to be discussed with the patient.

With a median age of 75 years, MDS patients represent a very heterogeneous group of older people with respect to overall health status. Some individuals stay fit, while others are frail or become fragile suddenly. Unfortunately, most health care professionals working in haematology settings are not trained in geriatrics. Extended assessments (such as a Geriatric Assessment) can identify unknown medical, functional, cognitive, and social issues, making it possible to uncover potential problems and plan early interventions. In our setting we have supplemented the Geriatric Assessment with issues we think are important to get to know our patients and his or her informal caregiver, and an evaluation of quality of life ( particularly to address sequelae such as fatigue and loss of energy). Performing a geriatric assessment is important for many reasons: firstly to help health care professionals decide on the best treatment option for their older patients, and secondly, to facilitate decision-making. Thus, patients with MDS benefit the most from a geriatric assessment if this has been done as soon as the diagnosis is known.

Living with MDS is accompanied by changes in quality of life. Quality of life has been found to be an important outcome for the assessment of treatments and supportive care regimens. Health care professionals have access to various validated quality of life or distress questionnaires. These questionnaires can also identify functional, cognitive, emotional and social issues making it possible to explore and discuss the concerns with the patient. Although in case of a blood or bone marrow test it would be unlikely that the patient does not receive the results, in case of quality of life outcomes it is quite common that we do not discuss these results with our patients. An important reason for not discussing is probably the difficulty to interpret the results. Most of the existing questionnaires have been developed for research purposes and not for the individual patient. So, in my opinion, the interpretation of quality of life results must be made simpler, and patients must be empowered to ask for their individual results. Accordingly, quality of life results need to be discussed with every patient.

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