|
Modification of therapy
|
Polypharmacy
|
• Re-evaluate treatment indications (with general practitioner), optimize treatment according to elderly patient protocols.
|
|
• Use the STOPP-START* tool as a reference [37, 38].
|
|
Balancing chronic diseases
|
CIRS-G* Grade ≥ 3,
|
• Adaptation of therapy.
|
|
arterial hypertension, diabetes, arthritis, or sensory problems
|
• Other non-drug interventions such as dietary advice, devices.
|
|
• Referral to specialist doctor.
|
|
Pain treatment
|
Pain >1 on numeric scale
|
• Drug: WHO levels 1–3 antalgic treatment
|
|
• Non-drug: physiotherapy, devices
|
|
Nutritional intervention
|
Malnutrition (MNA* ≤ 17)
|
• Referral to dietician (nutritional supplements, artificial nutrition, etc.)
|
|
Weight loss ≥5 % over 3 m, or ≥10 % over 6 m
|
|
At risk of malnutrition - 17 < MNA ≤ 23.5
|
• Advice on increasing dietary uptake (use of food pyramid adapted for elderly patients)
|
|
Physical activity
|
Sedentary or at risk of falls
|
• Recommend daily walk, walking upstairs, carrying groceries
|
|
Physiotherapy
|
Difficulty with walking and balance (TUG*, and SPPB*). Fall in the last 12 m, weight loss, muscle loss
|
• Prescribe physiotherapy for muscular reinforcement Work on balance, and getting up from lying down position
|
|
• Prescribe walking aids
|
|
Psychological support
|
GDS* ≥ 6
|
• Consultation with psychologist or psychiatrist
|
|
Apparent anxiety (clinical assessment)
|
|
Antecedent of depression
|
|
Prevention of further cognitive impairment
|
MMSE* < 24
|
• Behavioral monitoring during chemotherapy
|
|
• Prevention of confusion [39]
|
|
Treatment for sleeping disorders
|
Positive screening score on adapted Epworth scale [40]
|
• Introduction, modification or discontinuation of treatment by hypnosis according to STOPP and START recommendations [37, 38]
|
|
Assistance
|
Social fragility identified (absence of social support)
|
• Ask patient directly if help is needed
|
|
• Refer to a social worker
|
|
Home help
|
Difficulties performing daily tasks such as grooming, housework
|
• Prescribe support within the home (nursing, physiotherapy, housecleaner, etc.)
|
