Unless you work in pediatrics, as oncology nurses, you are most likely caring for older adults with cancer. In the next decade, approximately 70% of all individuals will be older than 65 years of age at the time of their cancer diagnosis. A cancer diagnosis is complex no matter the age, but older adults with cancer have unique issues that are not necessarily experienced by younger patients. They have more impaired physical and cognitive function, more preexisting chronic diseases, and a decrease in their physiological reserve, making them more vulnerable to short-term and long-term treatment side effects. In addition, older adults use more prescription and nonprescription medications making them at higher risk for medication errors and interactions due to polypharmacy.
Below are 3 tips for nurses who work with older patients.
- Assess Technology Health Literacy
Remember that older patients did not grow up with computers and handheld devices. What may seem like common knowledge to you may be a struggle for them. Most older adults can and do use technology if they have access to it and someone to teach them how to use it. Caregivers can be instrumental in helping them. Nurses can demonstrate how to use technology, like downloading medication reminder apps, accessing the patient portal, or practicing a telehealth video call. You may need to show or tell them things more than once, and multiple phone calls may be necessary to convey information. Use the teach-back method to check their understanding and clarify any education.
- Encourage Activity, Both Physical and Social
Nurses can encourage patients to keep active and stay connected. Exercise can improve quality of life, help patients cope with side effects, particularly fatigue, and possibly reduce recurrence. The American Cancer Society provides activity guidelines for cancer survivors. For older adults, physical activities vary, depending on their physical ability—chair exercises, walking 5-10 minutes, or stretch bands for strengthening. Social support can improve cancer outcomes—physical, emotional, and spiritual well-being in addition to survival. Nurses can urge patients to connect with others through video services while their counts are low and in-person group activities once blood counts recover.
- Watch for Depression
Although it’s natural to feel upset about a cancer diagnosis and other medical conditions, depression is NOT a normal part of aging. As people age, they often find themselves spending more time alone, contributing to the risk of depression. Older adults may present with different symptoms of depression than younger people. They may not feel “sad” but instead complain about lack of energy or physical problems. Assess older patients’ fatigue levels on a 0-10 scale, much like the pain scale. Ask about disruption in sleep patterns. Watch for comments from caregivers about irritability or changes in daily routines.
Oncology nursing care is increasingly complex in older adults, requiring nurses to know both gerontology and oncology to provide quality care, and geriatric oncology is moving from a specialty to a general practice requirement. Several resources are available to help you improve your care. For example, the American Society of Clinical Oncology geriatric resource hub contains “the most practice-changing, cutting-edge research and clinical guidelines in geriatric oncology, along with effective tools, assessments, and other resources for clinicians, patients, and caregivers.”