Editorial I have been struck over the past few months by how many presentations and conversations I have heard that focus on older adults in our country, defined as those who are 65 years of age and older. According to the Stats Canada website, the number of individuals in the older population is expected to accelerate fairly rapidly between 2010 and 2031. To review the numbers, one in seven Canadians are 65 or older now; in 2036, it is expected to be one in four. We had 5,825 Centenarians (100 years or older) in 2011 and anticipate there will be 20,300 by 2036. Life expectancy in our country has increased by 25 years since 1921. At present, the average life expectancy for Canadians is 81.7 years (79 for men and 83 for women). Needless to say, the demographic distribution of our population is rapidly shifting and we will soon see proportionally more older adults than individuals less than 15 years of age. With this shift in population demographics, there are accompanying health care challenges. Several key challenges emerge in particular for cancer care and are important for oncology nurses to know about and take into consideration. Firstly, the older adult population is a heterogeneous group in terms of health, functional status, psychology, and social and economic status. Aging is a highly individualized process and embraces multiple dimensions. Aging individuals are highly diverse. Some are running marathon races at 85 while others are bedbound; some are actively engaged in work and volunteer activities at 80 while others are suffering from advanced dementia. At present, 25% of adults 65 years and older have four or more comorbid conditions (e.g., hypertension, arthritis, diabetes, back problems, etc.) while 37% do in the 80+ age group. Hence, health status can range from fit to frail and is not necessarily related to chronological age. Secondly, cancer is primarily a disease of aging, as it is most commonly diagnosed in the 65 years and older population. For both males and females, the median age of cancer diagnosis is between 65 and 69 years of age. It is estimated that in 2015, 43% of all new cases will occur in people aged 70 years or older, and 28% of all new cases will occur in people aged 60-69 years (Canadian Cancer Society’s Advisory Committee on Cancer Statistics, 2015). Thirdly, despite the prevalence of older adults diagnosed with cancer, there are many unanswered questions about the most appropriate treatment and care approaches for this age group. One of the reasons there are gaps in our understanding 182 of how cancer and its treatment affect this population is that so few older adults are actually participating in research. Not only are there gaps in our knowledge and understanding of the safest, most effective ways to treat cancer in older adults, but also there are gaps in understanding how geriatric or comorbid conditions affect cancer treatment and how psychosocial issues particular to older adults affect decision-making, treatment and survivorship. Fourthly, there are practice approaches within gerontology that could be of value to oncology. In particular, the application and use of a comprehensive geriatric assessment (CGA) is one practice approach that shows promise. This approach evaluates a number of dimensions including functionality, mobility/risk of falls, cognition, depression, comorbidity, polypharmacy, social situation, and geriatric syndromes and allocates individuals into one of three categories: fit, vulnerable, frail. Such groupings can then guide decisions about what further assessments are necessary and what interventions may be required. In busy clinical settings, it is suggested that a screening for frailty triage be completed, as a first step to determine the need for further assessment through the full CGA approach. Oncology nurses are in an ideal position to engage with older adults and tailor the care approaches to the needs of the individual. Factors such are functional limitations, co-morbidities, cognitive decline and social support are key ones in determining how well the older adult will cope with the diagnosis and treatment. Attitudes, values and preferences for decision-making and engagement held by older individuals are other important areas for nurses to assess and incorporate into their care interventions. Person-centred care begins with gaining a clear understanding of what is important to the individual. The heterogeneity of the older adult population demands we engage with the individual and not approach care with stereotypical notions of what it means to be an aging adult. Margaret Fitch, RN, PhD Editor in Chief, CONJ REFERENCE Canadian Cancer Society’s Advisory Committee on Cancer Statistics (2015). Canadian Cancer Statistics 2015. Toronto, ON: Canadian Cancer Society. Volume 26, Issue 3, Summer 2016 • Canadian Oncology Nursing Journal Revue canadienne de soins infirmiers en oncologie