Prehabilitation in geriatric oncology

With advancing age, older adults with cancer often face reductions in functional capacity and comorbid conditions become more prevalent. An overall state of deconditioning can be further exacerbated by a combination of sedentary behaviour and malnutrition that independently contribute to cachexia, morbidity and mortality. Collectively, these changes can induce a state of frailty that undermines the tolerability and safety of cancer treatments. For example, among older adults with cancer undergoing surgery, those who are classified as frail by common multidimensional instruments (e.g., Comprehensive Geriatric Assessment) have a higher risk of surgical complications, longer hospital stays, higher readmission rates, and higher mortality. Given that frailty indices typically capture functional, psychosocial, and/or nutritional assessments, interventions that target deficits in these health domains including exercise, stress reduction, and dietary optimization, respectively, may be particularly valuable for reducing the risk of potential treatment-related adverse effects. In fact, the evidence supporting the role of pre-treatment conditioning via one or more targeted health behaviours, referred to as prehabilitation, has rapidly grown in recent years, giving rise to questions about its potential role in models of care. In this commentary, we provide a synopsis of prehabilitation for the older adult with cancer, including a brief review of its origins in geriatric and clinical care, current applications, and a pragmatic implementation model for consideration

An approach to the management of unintentional weight loss in elderly people

UNINTENTIONAL WEIGHT LOSS, or the involuntary decline in total body weight over time, is common among elderly people who live at home. Weight loss in elderly people can have a deleterious effect on the ability to function and on quality of life and is associated with an increase in mortality over a 12-month period. A variety of physical, psychological and social conditions, along with age-related changes, can lead to weight loss, but there may be no identifiable cause in up to one-quarter of patients. We review the incidence and prevalence of weight loss in elderly patients, its impact on morbidity and mortality, the common causes of unintentional weight loss and a clinical approach to diagnosis. Screening tools to detect malnutrition are highlighted, and nonpharmacologic and pharmacologic strategies to minimize or reverse weight loss in older adults are discussed