Geriatric assessment: a closer look at health before chemotherapy

A geriatric assessment is a structured review of an older person's overall health, carried out before cancer treatment is decided. Rather than relying on age or a quick impression in clinic, it looks systematically at the things that most affect how someone copes with chemotherapy. These include daily activities such as bathing, dressing, cooking and handling money; walking speed, balance and past falls; memory and thinking; mood; appetite and weight; other illnesses; the full list of medicines; hearing and eyesight; and the practical and emotional support available at home. It uses short questionnaires, simple physical tests and conversation, and it may involve doctors, nurses, dietitians, physiotherapists or social workers.

It matters because two people of the same age can be very different underneath. A short clinic visit can miss hidden problems, such as early memory changes, unsteadiness, weight loss, low mood or a medicine combination that causes dizziness. These problems do not always rule out treatment, but they raise the chance of complications like falls, confusion, dehydration and hospital stays during chemotherapy. Research over many years has shown that this kind of assessment gives a clearer picture of how an older person may tolerate treatment than age or a general impression alone. Knowing the risks in advance allows the team and family to plan ahead instead of reacting to a crisis.

The findings can change the plan in several ways. The oncologist may choose a gentler medicine or schedule, arrange closer checks, or recommend a different treatment. Just as often, the assessment leads to extra support: physiotherapy for balance, nutrition advice, a review of unnecessary tablets, help with low mood, hearing aids, or arranging transport and a carer. Sometimes it confirms that a person is fit for standard treatment. It can also help a patient and family decide that treatment is not right for them. The assessment does not make the decision; it informs it. In India it is not yet routine everywhere, so it is reasonable to ask for one.

It looks at the whole person

Function, memory, mood, nutrition, medicines and support.

It reveals hidden risks

Problems a quick visit can miss come to light.

It shapes the plan and the support

Treatment choices and practical help can both change.

It cannot tell you what an assessment will find for your relative, or which treatment will then be advised.

It also cannot replace the assessment itself. Questionnaires found online are not a substitute for a trained team.

Who carries it out

Depending on the hospital, the assessment may be done by an oncologist, a geriatric specialist, a specialist nurse, or a small team including a dietitian, physiotherapist and social worker. Some parts can be completed by the patient or family on a form before the visit, which saves time on the day.

What the visit involves

Most of the assessment involves talking and simple tasks: answering questions about daily life, walking a short distance, standing up from a chair, and a brief memory check. Nothing is painful. Bring glasses, hearing aids, a list of medicines and a family member who knows the patient's routine well.

Why age is not enough

Age tells doctors how many years someone has lived, not how much reserve their body has. Two people in their late seventies may differ completely in strength, memory and independence. A structured assessment measures those differences directly, which is why many cancer organisations recommend it for older people starting chemotherapy.

Why it is rarely done in India

Busy clinics, limited geriatric specialists and short appointment times mean formal assessments are not yet routine in many Indian hospitals. Some teams do parts of it informally. Families can help by asking for one and by preparing honest information about the patient's daily life, falls, memory and eating.

Being honest about daily life

Older people sometimes play down difficulties, not wanting to seem weak or be refused treatment. Families may do the same. But the assessment only helps if it is accurate. Mentioning a recent fall or forgetfulness is not a reason for treatment to be denied; it is a reason for better planning.

Memory testing

Being asked to remember words or draw a clock can feel embarrassing. These checks are routine and are done kindly. Early memory changes matter because chemotherapy, infections and some medicines can cause sudden confusion during treatment, and people with existing memory problems are more vulnerable to it.

Medicine review

Older patients often take several medicines prescribed by different doctors over many years. The review looks for duplicates, interactions and tablets that increase falls or confusion, such as some sleeping tablets. Any changes are made by the doctors. Never stop or alter a medicine yourself because of something found in the assessment.

Nutrition findings

Unplanned weight loss and poor appetite reduce a person's reserves for coping with treatment. A dietitian may suggest higher-protein foods that suit the family's cooking, advice for dentures or swallowing, or nutritional drinks. Starting this before chemotherapy is easier than trying to catch up once side effects affect eating.

Mood and worry

Low mood and anxiety are common in older people facing cancer and can go unnoticed, especially if they do not complain. Identifying them allows counselling, family support or treatment for depression to begin. Feeling emotionally supported can make it easier to cope with the demands of chemotherapy.

When the assessment suggests high risk

A high-risk result does not automatically mean no treatment. It prompts a careful discussion about gentler options, extra support and how the risks compare with what treatment could offer. Some people then choose treatment with close monitoring, and some decide against it. Both are reasonable outcomes of an informed conversation.

Repeating the assessment

Health can change during treatment. Some teams repeat parts of the assessment later, especially after a difficult cycle, a hospital stay or a fall. Families can prompt this if they notice a decline in walking, eating or memory, so the plan can be adjusted in good time.

Using the results at home

The findings are useful beyond the clinic. They highlight where extra help is needed at home, such as removing trip hazards, helping with medicines, preparing meals or arranging someone to accompany hospital visits. Share the key points with everyone involved in caring for your relative.

What to do next

Ask the treating team whether a geriatric assessment can be done, prepare honest notes about daily life, falls, memory and eating, bring every medicine to the visit, and discuss how the findings could shape both treatment and support.