Blood cancers

Geriatric assessments needed for older haematology patients

Haematologists are managing increasing numbers of older patients with complex geriatric syndromes and there is a need for closer collaboration with geriatric services, Australian researchers say.

The number of elderly patients treated in a Sydney haematology unit doubled between 2000 and 2014, with many patients having multiple geriatric related conditions such as dementia and malnutrition, a study at Concord Hospital found.

In a review of 7419 admissions to the haematology unit, one in three were for patients over the age of 75, and the proportion of “oldest old” patients (over 85 years of age) increased by 200% over the study period.

The prevalence of geriatric syndrome was around 60% in the older age patients, with the most common age-related conditions being dementia, delirium, depression, falls in hospital, malnutrition and pressure injury.

Up to 90% of older patients in the haematology unity required an allied health intervention, most commonly from physiotherapists, social workers and dieticians.

The authors of the study say their findings show that a recent focus on “oncogeriatrics” in patients with solid cancers needs to extend to haematological cancers, particularly as these are more common in old age.

“If haematologists are managing many older frail people, it does raise the question of whether the assessments and interventions that take place in geriatric medicine units might be of value,” they write in the Australasian Journal of Ageing.

The routine use of Comprehensive Geriatric Assessments in older haematology patients could influence an oncologist’s decision making and lead to changes in treatment, the authors say.

However, more work is needed to develop an optimum geriatric care model for haematology patients, with consideration of whether this should be done via a geriatric liaison service or shared care model. At the Concord Hospital the preferred model is to have geriatric assessments delivered by consultative geriatric teams when requested by the haematology care team.

“An alternate model is for haematologists to ‘upskill’ in geriatrics”, they suggest.

“These study findings support the need for collaboration between geriatricians and haematologists and a need for future studies that explore the role of geriatric assessment and interventions in older patients with haematological malignancies,” they conclude.

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