Multiple physical changes can impair the mental health of the aging individual. These changes include: acid-based imbalances, dehydration, electrolyte changes, hypothermia or hyperthermia, and hypothyroidism. This chapter reviews the most common mental health disorders affecting the elderly population and trends affecting care delivery. Moreover, chronic, unresolved pain has been associated with an increased risk of a mental health disorder such as depression, suicide, or anxiety. The aging individual may exhibit signs and symptoms of insomnia such as sleeping for short periods during the night, sleeping during times of normal social activities, arising early in the morning while others sleep, and experiencing daytime sleepiness. The chapter concludes by applying the nursing process from an interpersonal perspective to the care of an elderly patient with a mental health disorder.

Minor changes in cognitive function are a normal part of healthy aging; however, any cognitive impairments that significantly interfere with usual daily functioning or quality of life are caused by underlying pathological conditions. Nurses who provide care for older adults in any setting need to be knowledgeable about cognitive changes to accurately assess and address functioning and quality of life. Cognitive changes that are an inherent part of aging do not significantly affect functioning, personality, or behavior. Moreover, not all cognitive changes are negative. Mild cognitive impairment (MCI) has been used since the mid-1990s to describe a state of cognitive function that lies between normal aging changes and dementia. This chapter presents information about normal cognitive aging and dementia and provides the foundation for incorporating a person-centered approach when caring for older adults who are cognitively compromised. It also describes the roles of nurses in identifying dementia.

Delirium is increasingly being addressed in healthcare settings as a commonly occurring condition that is serious, preventable, treatable, and often unrecognized. In addition, it can have serious consequences—including death—when it is not recognized and addressed. Older adults with dementia have the double disadvantage of having a higher incidence of delirium and having it overlooked as a separate and treatable condition. This chapter provides the definition and types of delirium. It discusses the predisposing and precipitating conditions associated with delirium. The chapter explains the consequences associated with delirium and delirium superimposed on dementia. It describes the roles of nurses in identifying conditions associated with delirium and the roles of nurses in addressing the needs of patients with delirium.

Older adults experience age-related changes or mild cognitive impairment (MCI), but these changes do not significantly affect usual daily functioning. In recent years, there has been increasing attention paid to age-related hearing loss as a potentially reversible cause of dementia. Attention is also being paid to ototoxic medications as a risk for developing hearing loss and cognitive impairment. This chapter reviews conditions that can cause significant changes in cognitive function and affect usual functioning, with particular attention to those that can be addressed to prevent or reverse cognitive impairment. The manifestations of these conditions are sometimes mistakenly attributed to either “normal aging” or dementia, with the consequence of having treatable conditions left unrecognized and untreated. Nurses have important responsibilities to assess for conditions that affect cognitive function and facilitate referrals for further evaluation.

Clinical trials are often considered the gold standard of care for cancer treatment. The National Cancer Institute reports less than 3% of adult cancer patients participate in clinical trials and participation rates among certain vulnerable populations (elderly, racial and ethnic minority, rural, and low social economic status patients) are even lower. This chapter focuses on understanding the cancer burden in these identified populations and describing barriers to accrual, followed by effective solutions to addressing barriers in these populations. It uses two frameworks to describe clinical trial accrual in vulnerable populations. First, the Accrual to Clinical Trials framework, which posits that the majority of accrual barriers can be categorized as patient, system, and provider factors that influence or impact accrual to clinical trials. The second framework is Multilevel Model of Health Disparities, which states that disparities interact synergistically to promote reduced access and increased risk of developing and dying from disease.

The current gold standard for assessment of older adults with cancer is a comprehensive geriatric assessment (CGA). The primary purpose of a screening tool in geriatric oncology is to provide a busy clinician with a means to quickly identify patients in need of a CGA. This chapter outlines the G8, Vulnerable Elders Survey (VES-13), and other screening tools used for older adults with cancer. It discusses the evidence for the benefits and limitations of these screening tools. The chapter provides recommendations for how to implement geriatric screening tools into routine oncology practice. In addition to being used as a screening tool, the G8 has also been studied to predict treatment toxicity, functional decline and falls, and overall survival. Investigators have also assessed the predictive ability of the VES-13 in older patients with cancer for treatment-related toxicity and overall survival.

The four pillars of survivorship care: surveillance for recurrence and secondary cancers, encouragement of beneficial lifestyle choice, management of long-term systemic therapy sequelae, and addressing of psychosocial burdens associated with a cancer diagnosis, must be integrated with care for preexisting comorbid medical conditions typically present among older patients. This chapter summarizes how to best leverage the survivorship care plan (SCP) to ameliorate problems in and enhance geriatric survivorship care, both by addressing specific elements of the SCP itself and by considering how SCPs optimize transitioning patients to nononcologist-driven survivorship care. It underscores the importance of adapting SCPs to not only meet the unique issues of an older population, but also to act as a potentially critical communication tool to be disseminated among all medical specialists, including primary care providers, who are providing care to an older adult with a history of cancer.

Treatment of older colorectal cancer patients presents different challenges than treatment of younger patients. This chapter discusses the concept of frailty as it impacts chemotherapy decision making, and reviews some of the most common challenges that may be faced by medical oncologists taking care of older colorectal cancer patients. Patients with more deficits based on geriatric assessment (GA) are considered to be frail. Cancer treatment decision making is based on GA and organ function of older colorectal cancer patients. The chapter describes treatment decision making for older cancer patients with localized colorectal cancer and metastatic colorectal cancer. Be cautious about the use of oxaliplatin in adjuvant setting and metastatic disease, especially if the patient suffers from neuropathy. It recommends chemotherapy toxicity calculators when deciding on number and dose of agents. Administering more than two lines of chemotherapy to metastatic colorectal cancer patients older than age 75 has extremely limited benefit.