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Geriatric assessment guided interventions:The role of occupational therapy and allied
health
Mackenzi Pergolotti, PhD, OTR/L
ReVital Cancer Rehabilitation, Select Medical, USA
Colorado State University
University of North Carolina at Chapel Hill
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Meet Cliff …“Life isn’t as carefree as it used to
be”
“I feel like I’m
walking with moon
boots.”
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Neo, J., Fettes, L., Gao, W., Higginson, I. J., & Maddocks, M. (2017). Disability in activities of daily living among adults with cancer: A systematic review and meta-analysis. Cancer Treatment Reviews, 61, 94-106. doi:https://doi.org/10.1016/j.ctrv.2017.10.006
1/3 describe difficulty with activities of daily living
1/2 describe challenges with instrumental activities of daily living
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• 30% report health as fair/poor
• 50 % have pain
• 20 % have an impairment in IADL
• 83 % already receiving some assistance
• 11 % dementia
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Mohile, S. G., Dale, W., Somerfield, M. R., Schonberg, M. A., Boyd, C. M., Burhenn, P. S., ... & Janelsins, M. C. (2018). Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: American Society of Clinical Oncology Guideline for Geriatric Oncology. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 36(22), 2326.
“The evidence supports, at a minimum, assessment of function, comorbidity, falls,
depression, cognition, and nutrition”
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Increased Risk:
*Chemotherapy Toxicity
*Unplanned Hospitalization
*Mortality
Mobility Issue
Decreased Performance
Status
Severe Co-morbid
Conditions
+ 1 Fall
van Abbema DL, van den Akker M, Janssen-Heijnen ML, et al. (2018). Patient-and tumor-related predictors of chemotherapy intolerance in older patients with cancer: A systematic review. Journal of Geriatric Oncology.
Why Cancer Rehabilitation?Predictors of chemotherapy intolerance
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Falls• “only” 1
Function• Mobility• ADL• IADL
Cognition• Attention• Memory
Cancer
Comorbidities:• Diabetes• Arthritis• Macular degeneration
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Activity
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Photo by Ban Yido on Unsplash
Participation
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Note. PROMIS physical health, PROMIS mental health and FACT-G plotted against Patient-Generated Subjective Global Assessment- Activities/ Function (PG-SGA-AF); Response options for activities/ function range from 0 “normal activity with no limitations” to 4 “pretty much bedridden, rarely out of bed”.
Significant decline in QOL associated with lower levels of activity and function
Pergolotti, M., Deal, A. M., Williams, G. R., Bryant, A. L., Bensen, J. T., Muss, H. B., & Reeve, B. B. (2017). Activities, function, and health-related quality of life (HRQOL) of older adults with cancer. Journal of geriatric oncology, 8(4), 249-254.
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What can rehabilitation do?
Screen Assess Intervene
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The Role of Cancer Rehabilitation:Living Well Beyond Cancer
Cancer & Anticipated Side Effects
Improved function,
activity and participation
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Oncology Medicine &
NursingPhysical TherapyPhysical Therapy
Occupational Therapy
Occupational Therapy
Speech & Language Pathology
Speech & Language Pathology
Physiatry & Rehab Nursing
Psychology & Psychiatry
Social work & Case
Management
Exercise Physiology
Audiology
Nutrition and Dietetics
Cardiology, Endocrinology,
Neurology
Dentistry
Restore Function
Reduce risk of late effects
Improve Quality of
Life
Restore Participation (work, life)
Components of Comprehensive Cancer Rehabilitation Care
Reproduced from: Alfano CM, Pergolotti M. Next-generation cancer rehabilitation: a giant step forward for patient care. Rehabilitation Nursing Journal. 2018 Jul 1;43(4):186-94.
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Prospective Surveillance Model
Personal Factors
Environmental Factors
Diagnosis/ Pre-op
Treatment Survivorship End of Life
Cancer Care Continuum
Reproduced from: Alfano CM, Pergolotti M. Next-generation cancer rehabilitation: a giant step forward for patient care. Rehabilitation Nursing
Journal. 2018 Jul 1;43(4):186-94.
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Function• Mobility• ADL• IADL
Falls• “only” 1
Cognition• Attention• Memory
Comorbidities:• Diabetes• Arthritis• Macular degeneration
Cancer
Activity:Wearing button-downs
Zippers
Participation:Social events
Yard-workWoodworking
Speech and Swallowing
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Function• Mobility• ADL• IADL
Falls• “only” 1
Cognition• Attention• Memory• Speech
CancerCo-
morbidities
Physical Therapy
Occupational Therapy
Speech and Language
Speech and Swallowing
Activity:Wearing button-downs
Zippers
Participation:Social events
Yard-workWoodworking
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What can rehabilitation do?
Supervised
Targeted
Problem solving-adapting
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Engagement in activity and participation improves QOL
Occupational therapy• Improved QOL, function and
mental health
• Improved problem-solving
• Self-efficacy and activity expectations
(Cheville, 2005; Cheville & Tchou, 2007; Lyons, 2006; Lyons, Erickson, & Hegel, 2012; Lyons, Orozovic, Davis, & Newman, 2002; Pergolotti, Cutchin, & Muss, 2014; Pergolotti, Cutchin, Weinberger, & Meyer, 2014; Pergolotti, Deal, Lavery, Reeve, & Muss, 2015; Unruh & Elvin, 2004; Vrkljan & Miller-Polgar, 2001)
Speech and language• Improved swallowing• Decreased trismus
Physical therapy• Increased physical
activity• Increased strength• Decreased fatigue
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Cancer RehabilitationSpecialists in Function, Activity & Participation