Retirement Concerns on Aging

Are you getting to that point in life where age has become a concern? Read on!!!Geriatric assessment (“GAM”) and pragmatic geriatric assessment (“PGA”) tools are designed to capture the unique vulnerabilities of older adults with cancer and then guide tailored treatment, supportive‐care planning, and survivorship follow-up. William Dale and colleagues emphasize that routine use of these brief, focused assessments can improve chemotherapy tolerance, reduce unplanned hospitalizations, and align care with each patient’s goals. Below is a high‐level road map for how a practice or health system can make GAM/PGA widely available: 1. Select and Standardize Your Assessment • Choose validated, oncology-specific modules. For example, the ASCO geriatric assessment core domains (function, comorbidity, cognition, nutrition, social support) and short PGA screeners (e.g., G8, VES-13) are each under 10 questions. • Agree on uniform thresholds and referral pathways (e.g., if G8 ≤14 ⇒ full GA by geriatrician or nurse navigator). 2. Embed into the Clinical Workflow • Integrate questions into your electronic health record (EHR) as discrete data fields. Use best-practice alerts to remind staff at check-in or before your patient’s first oncology visit. • Divide labor: front-desk or medical assistants distribute tablet/smartphone self-reports in the waiting room; nurses or navigators review “red flags” immediately; oncologists discuss results in real time. 3. Leverage Technology for Scalability • Deploy patient portals or mobile apps so patients can complete the assessment at home 48–72 hours before an appointment. • Use automated scoring and electronic referral triggers (e.g., an abnormal cognition screen automatically generates a referral to neuropsychology or social work). 4. Train Your Team • Conduct brief, case‐based workshops for oncologists, nurses, and advanced practitioners on how to interpret scores and intervene on common issues (polypharmacy, falls risk, malnutrition). • Develop pocket guides or EHR “smart phrases” so every provider speaks the same geriatric “language.” 5. Build Multidisciplinary Partnerships • Form a core “Geri‐Onc” committee: oncology, geriatrics, pharmacy, nutrition, social work, PT/OT, psychology. • Define rapid-response pathways—e.g., same-week geriatric clinics for high-risk patients and on-site or tele-geriatrics consults for rural sites. 6. Demonstrate Value and Advocate for Reimbursement • Collect simple process metrics (percent of older patients screened, time to intervention) and outcome metrics (hospitalizations, dose reductions, patient-reported quality of life). • Present data to your institution’s value‐analysis or quality committee. Use early wins to negotiate for dedicated staff, shared visits billing, or enhanced reimbursement under CMS’s Oncology Care Model and geriatric CPT codes. 7. Iterate and Scale • Gather regular feedback from patients and clinicians via short surveys. Address barriers (time burden, unclear follow-up). • Expand to satellite clinics, home-based care, or telehealth settings. Evaluate remote PGA completion rates and virtual geriatric consult satisfaction. 8. Engage in Collaborative Research and Dissemination • Partner with academic groups (SIOG, CARG) to contribute real‐world data and refine cut-points. • Publish your implementation toolkit so other centers can adapt your digital forms, referral algorithms, and training materials. By systematically embedding GAM/PGA into routine oncology practice—backed by a digital infrastructure, multidisciplinary support, staff training, and clear financial justification—you can transform geriatric assessment from an aspirational best practice into a seamlessly delivered standard of care for older adults with cancer.