Geriatric, Palliative Care Assessments Critical Among OAs With Poor Prognosis Cancers

Based on the high prevalence of preexisting conditions among older adults (OAs) with poor prognosis cancers, geriatric and palliative care condition assessment should be implemented for this patient population, according to findings published in the Journal of the American Geriatrics Society.

To identify adults aged 65 years and older diagnosed with poor prognosis cancers (cancers with a median survival of 1 year or less), researchers pulled data from the nationally representative Health and Retirement Study (HRS) linked with Medicare claims between 1998 and 2016.

The prevalence of advance care planning, social support, use of pain or sleep medications, functional impairment, presence of pain or breathlessness, difficulty with mobility, and falls and injurious falls were examined using survey-weighted descriptive statistics and modified Poisson regression analysis.

Of 2105 participants the mean age was 76 years, 53% were women, 34% had lung cancer, 21% had gastrointestinal cancer, and median survival was 9.6 months.

Per results, approximately 65% of patients 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%).

Researchers determined functional impairment and falls were highest among adults aged over 85 after adjusting for cancer type, gender, and HRS survey time before the first Medicare claim for a poor prognosis cancer.

An advance directive was less likely among adults aged 65 to 74 years. Women experienced a higher rate of pain and physical impairment after adjusting for cancer type, age, and HRS survey time.

According to researchers, socioeconomic status and race predicted difficulty with mobility and instrumental activities of daily living, living alone, and advance directive completion in exploratory analyses.

“Understanding geriatrics and palliative care needs and gaps is the first step toward identifying ways to address them in this vulnerable patient population,” concluded study authors. “Given the high prevalence of preexisting conditions, findings from this study suggest that all older adults with poor prognosis cancers should be assessed for preexisting geriatric and palliative conditions around the time of diagnosis.”

Reference:
Tsang M, Gan S, Boscardin WJ, Wong ML, Walter LC, Smith AK. The epidemiology of preexisting geriatric and palliative conditions in older adults with poor prognosis cancers. J Am Geriatr Soc. Published online October 19, 2022. doi:10.1111/jgs.18039