NURS 601 Collaboration Week 1: Holistic Geriatric Assessment and Care Planning for Marianne Driscoll

Assignment Brief: Person-Centered Care for the Aging Adult with Advanced Cancer

This week’s collaboration focuses on applying foundational geriatric care principles to a complex clinical case. You will analyze a client’s situation through the lens of holistic assessment, the Geriatric 5Ms framework, and evidence-based care planning strategies.

Step 1: Review the Client’s Case

Review the client’s case, considering the foundational concepts and principles of caring for aging and maturing individuals from this week’s Explore pages. Marianne Driscoll, a 72-year-old client with Stage IV colorectal cancer, has undergone multiple rounds of aggressive chemotherapy, which have been unsuccessful. Despite her diagnosis, Mary has been in denial about the severity of her condition and has previously avoided discussions about advance care planning. Recently, she has expressed a desire to stop aggressive treatments due to overwhelming fatigue and the negative impact on her quality of life. Her spouse, who is her primary caregiver, is exhausted and experiencing anticipatory grief, struggling to cope with the impending loss. The couple’s other family members live out of state and cannot assist with care. Mary is currently on Medicare and does have supplemental private insurance.

Step 2: Answer the Discussion Prompts

Answer the discussion prompts below with explanation and detail. As you formulate your responses, consider how the 5Ms framework—addressing what matters most, mind, mobility, medications, and multicomplexity—provides a structured yet flexible approach to geriatric care that prioritizes the older adult’s unique values and circumstances.

Step 3: Reply to Two Peers

Reply to two peers with different assigned clients.

1. Application of Course Knowledge

Answer all questions/criteria with explanations and detail.

Describe your assigned client’s situation. What holistic assessment data concerns you?

Marianne Driscoll’s situation represents a critical juncture in advanced cancer care where treatment efficacy has plateaued and quality-of-life considerations have become paramount. The holistic assessment data that raises significant concern includes her recent shift from denial to acknowledgment of her condition’s severity, the profound physical exhaustion from unsuccessful chemotherapy, and the evident deterioration in her functional status. Her spouse’s documented exhaustion and anticipatory grief signal a caregiver system under tremendous strain, which directly impacts Mary’s ability to receive consistent, quality care at home. The geographic distance of other family members compounds this vulnerability, creating an isolated caregiving dyad with limited external support. Additionally, Mary’s previous avoidance of advance care planning discussions suggests potential gaps in goals-of-care communication that now require urgent attention as her preferences evolve toward comfort-focused care. Research indicates that older adults with cancer often have different priorities compared with younger patients, yet many never communicate their goals of care to clinicians, raising the risk that care received will not match their values.

Review the 5M framework elements from this week’s lesson. How does the 5M framework apply to your particular client?

The Geriatric 5Ms framework offers a comprehensive, person-centered approach to addressing the complex needs of older adults, and each element applies directly to Mary’s case. Regarding What Matters Most, Mary’s recent expression of wanting to stop aggressive treatments indicates a values shift toward prioritizing comfort and quality of life over disease-directed therapy—a preference that must guide all subsequent care decisions. The Mind component encompasses her history of denial about her condition’s severity, the psychological impact of treatment failure, and the emotional toll of confronting mortality, all of which suggest a need for psychosocial support and possibly mental health intervention. Mobility concerns are evident in the overwhelming fatigue she describes, which likely limits her functional independence and contributes to her diminished quality of life. The Medications element requires careful review of her chemotherapy regimen, supportive care medications, and any potential polypharmacy issues that may exacerbate her symptoms or interact adversely. Finally, Multicomplexity captures the intersection of her advanced cancer, treatment-related side effects, psychological distress, caregiver burden, and healthcare system navigation challenges—all of which demand coordinated, interdisciplinary management. The 5Ms approach offers a way for providers to address the whole person, including their medical conditions, functional abilities, psychosocial needs, and what is most important to them.

Consider the client’s current presentation. What plan of care would you recommend and why?

Based on Mary’s current presentation, I recommend a comprehensive plan of care centered on transitioning from aggressive treatment to palliative and hospice-focused supportive care. The plan should begin with an immediate goals-of-care conversation involving Mary, her spouse, and the healthcare team to formally document her treatment preferences and establish advance directives. Concurrently, a palliative care consultation should be initiated to address symptom management, particularly her debilitating fatigue, pain, and any other physical symptoms contributing to her diminished quality of life. A structured medication review should be conducted to deprescribe medications that no longer align with her goals and to optimize symptom management agents. The caregiver support component must include referrals to respite care services, caregiver support groups, and possibly home health aides to alleviate the burden on her spouse. Given that older spousal caregivers often experience physical and emotional exhaustion and loneliness, proactive support for Mary’s husband is essential to prevent caregiver burnout and ensure sustainable home-based care. Additionally, given the evidence that palliative care interventions can improve psychological and quality-of-life outcomes for elderly patients with colorectal cancer, integrating palliative services early in this transition phase is both clinically appropriate and evidence-based.

Consider the provider’s role in delivering culturally sensitive care, eliminating health disparities, fostering health promotion and disease prevention, and preventing polypharmacy. What strategies will you use to address at least one of these concerns in your client’s situation?

In addressing polypharmacy prevention for Mary, I would implement a structured medication review and deprescribing process involving the multidisciplinary team. The strategy would begin with a comprehensive medication reconciliation to identify all prescribed and over-the-counter medications, supplements, and alternative therapies she may be using. Next, I would prioritize medications for review based on their potential for adverse effects in older adults, their contribution to her symptom burden, and their alignment with her current goals of care. Chemotherapy agents would be evaluated for discontinuation given her stated preference to stop aggressive treatments, while supportive medications would be assessed for ongoing necessity and dosage optimization. The deprescribing process would follow evidence-based guidelines, involving careful tapering where appropriate, close monitoring for withdrawal or symptom rebound, and clear communication with Mary and her spouse about the rationale for each medication change. This approach aligns with research showing that structured medication review and deprescribing processes involving the multidisciplinary team can effectively reduce polypharmacy in older adults. Furthermore, I would collaborate with Mary’s primary care provider and any specialists to ensure coordinated medication management, potentially utilizing a pharmacist-led review to identify high-risk medications for deprescribing.

2. Professionalism in Communication

Communicate with minimal errors in English grammar, spelling, syntax, and punctuation. Please provide AI and similarity report.

Sample Answer Excerpt: Holistic Assessment and Care Planning for Marianne Driscoll

When approaching Marianne Driscoll’s case, the most pressing concern is the misalignment between her evolving care preferences and the current treatment trajectory. Mary’s recent acknowledgment of her condition’s severity and her expressed desire to discontinue aggressive treatments represent a pivotal moment that demands immediate, compassionate response from the healthcare team. The Geriatric 5Ms framework provides an excellent structure for organizing her care needs: what matters most to Mary now appears to be comfort and quality time with her spouse rather than extended survival at the cost of debilitating side effects. Her cognitive and emotional state requires careful assessment, given her history of denial and the psychological weight of confronting treatment failure. The impact of overwhelming fatigue on her mobility and functional independence cannot be overstated, as this symptom alone significantly compromises her quality of life. The medication regimen requires thorough review to eliminate agents that no longer serve her goals and to optimize those that provide symptom relief. The complexity of her situation—advanced cancer, caregiver strain, financial considerations, and healthcare navigation—necessitates coordinated interdisciplinary management that addresses each layer of her experience. Research demonstrates that quality-of-life data from randomized trials in older patients with metastatic colorectal cancer receiving palliative chemotherapy are essential for guiding treatment decisions.

Addressing caregiver burden represents another critical component of Mary’s care plan. Her spouse’s documented exhaustion and anticipatory grief reflect findings from recent research showing that providing care to a spouse with cancer has a negative association on health-related quality of life, perceived burden, and psychological distress outcomes. Interventions to support the caregiver might include referral to counseling services, connection with caregiver support groups, education about the dying process and what to expect, and practical assistance with care tasks through home health aides or respite care services. The healthcare team should normalize the caregiver’s emotional responses and validate the difficulty of their role while providing concrete resources to alleviate some of the practical and emotional burdens. Additionally, given that many older adults from minority ethnic groups experience inequalities towards the end of life, the care team should remain vigilant about potential disparities in access to palliative and hospice services and work proactively to ensure equitable care delivery. Mary’s supplemental private insurance may facilitate access to services that Medicare alone does not cover, and the care team should leverage this resource to optimize her support network.

Research, Writing, Citation and Referencing Notes

When developing your discussion post response, prioritize evidence-based reasoning that directly addresses each component of the prompt. Begin with a clear thesis statement that establishes your analytical framework, then systematically apply the 5Ms framework to Mary’s specific situation. Support your care plan recommendations with references to current geriatric and palliative care literature, and explicitly connect your strategies to the principles of culturally sensitive care, health equity, and medication safety. Use academic hedging where appropriate (e.g., “may,” “could,” “appears”) to acknowledge the complexity of clinical decision-making in advanced cancer care. Ensure that your writing maintains formal academic tone while demonstrating empathy for the patient and caregiver experience.

Why This Matters in Practice

The principles demonstrated in this case study translate directly to clinical practice across healthcare settings. Providers caring for older adults with advanced illness must recognize when treatment goals shift and respond with flexible, person-centered care planning. The 5Ms framework offers a practical, memorable structure for comprehensive geriatric assessment that can be applied in primary care, oncology, palliative care, and hospital settings. Understanding the intersection of polypharmacy, caregiver burden, and goals of care enables providers to deliver more effective, compassionate care that aligns with what matters most to older adults and their families.

Frequently Asked Questions

What is the Geriatric 5Ms framework and why is it important in caring for older adults?

The Geriatric 5Ms framework consists of five domains: Matters Most, Mind, Mobility, Medications, and Multicomplexity. This framework is important because it provides a structured yet flexible approach to addressing the complex, interrelated needs of older adults, ensuring that care is person-centered and holistic rather than disease-focused.

How does early palliative care benefit older adults with advanced cancer?

Early palliative care improves quality of life, reduces symptom burden, and supports psychological well-being for older adults with advanced cancer. Palliative care also facilitates goals-of-care discussions and helps align treatment with patient values, potentially reducing aggressive interventions that do not improve outcomes.

What strategies can prevent polypharmacy in older adults with advanced illness?

Strategies to prevent polypharmacy include structured medication reviews, deprescribing protocols involving multidisciplinary teams, patient and caregiver education about medication purposes and risks, and regular medication reconciliation during care transitions. Prioritizing medications that align with current care goals and discontinuing those that do not is essential.

How can providers support family caregivers of older adults with cancer?

Providers can support family caregivers through routine assessment of caregiver burden, referral to counseling and support groups, education about the disease trajectory and care tasks, provision of respite care resources, and validation of the caregiver’s emotional experience. Recognizing caregiver strain as a clinical concern that affects patient outcomes is essential.

References

Kochar, B., et al. (2022). The 5Ms of geriatrics in gastroenterology: The path to creating age-friendly care for older adults with inflammatory bowel diseases and cirrhosis. Clinical and Translational Gastroenterology, 13(1), e00445.

Liposits, G., et al. (2021). Quality of life in vulnerable older patients with metastatic colorectal cancer receiving palliative chemotherapy—The randomized NORDIC9-study. Cancers, 13(11), 2604.

Radcliffe, E., et al. (2025). Development of a complex multidisciplinary medication review and deprescribing intervention in primary care for older people living with frailty and polypharmacy. PLOS ONE, 20(4), e0319615.

Zhang, A., et al. (2022). The impact of palliative care and nursing intervention on the psychology and quality of life of elderly patients with colorectal cancer. Journal of Oncology, 2022, 7777446.

Donison, V., et al. (2022). Care provided by older adult caregivers to a spouse in active cancer treatment: A scoping review. Supportive Care in Cancer, 30(11), 8679-8688.

Compose a 500-750 word discussion post analyzing a 72-year-old client with Stage IV colorectal cancer through the Geriatric 5Ms framework, addressing holistic assessment, care planning, and polypharmacy prevention strategies in this NURS 601 Collaboration Week 1 assignment.

Next Assignment (Week 2 / Module 2)

Course Code/Title: NURS 601 – Gerontological Nursing: Advanced Practice Role

Assignment Description: For Week 2, students will complete a comprehensive geriatric assessment and care plan for an older adult client experiencing a transition in care setting (e.g., hospital to home, hospital to skilled nursing facility, or home to assisted living). The assignment requires students to conduct a virtual or simulated comprehensive geriatric assessment incorporating the 5Ms framework, identify three priority nursing diagnoses, develop an evidence-based interdisciplinary care plan, and address medication reconciliation and polypharmacy prevention strategies. Students will also analyze the role of the advanced practice nurse in coordinating care transitions and communicating with community-based providers to ensure continuity of care. The written assignment should be 4-5 pages (excluding title and reference pages) and include a minimum of five peer-reviewed references published within the last five years.

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