I Editorial

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
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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