Journal
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume 70, Issue 12, Pages 3402-3412Publisher
WILEY
DOI: 10.1111/jgs.18039
Keywords
advanced cancer; geriatric assessment; geriatric oncology; geriatric syndromes; older adults; palliative care; screening
Categories
Funding
- National Institute on Aging (NIA) [T32 AG000212, K76 AG06443, K24AG068312, P30 AG044281, P01 AG066605]
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Older patients with poor prognosis cancers have complex needs that can benefit from geriatrics and palliative care principles. The prevalence of preexisting geriatric and palliative conditions in this population is unknown.
Background Older patients with poor prognosis cancers have complex needs that can benefit from geriatrics and palliative care principles. Because they are not routinely assessed, the prevalence of preexisting geriatric and palliative conditions in this population is unknown. Methods We used the nationally representative Health and Retirement Study (HRS) linked with Medicare claims (1998-2016) to identify adults aged >= 65 years diagnosed with poor prognosis cancers (cancers with a median survival <= 1 year). Using the HRS interview before the first Medicare cancer claim, we used survey-weighted descriptive statistics and modified Poisson regression analysis to examine the prevalence of the following clinically significant conditions: functional impairment, difficulty with mobility, falls and injurious falls, social support, cognition, advance care planning, use of pain or sleep medications, and presence of pain or breathlessness. Results Of 2105 participants (mean age 76, 53% women, 34% lung cancer, 21% gastrointestinal cancer), the median survival was 9.6 months. Approximately 65% had difficulty climbing stairs (95% CI 63%-67%), 49% had no advance directive (95% CI 45%-54%), 35% lived alone (95% CI 33%-37%), 36% fell in the last 2 years (95% CI 34%-38%), and 32% rated their memory as poor (95% CI 29%-34%). After adjusting for gender, cancer type, and HRS survey time before the first Medicare claim for a poor prognosis cancer, functional impairment and falls were highest among adults aged 85+. Adults aged 65-74 years were less likely to have an advance directive. After adjusting for age, cancer type, and HRS survey time, women had a higher rate of pain and physical impairment. In exploratory analyses, race and socioeconomic status predicted difficulty with mobility and instrumental activities of daily living, living alone, and advance directive completion. Conclusions Due to a high prevalence across multiple domains, all older adults with poor prognosis cancers should be assessed for geriatric and palliative care conditions.
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