title: Association of a cancer diagnosis with vulnerability and frailty in older Medicare beneficiaries.
abstract: BACKGROUND
  Few studies have evaluated the independent effect of a cancer diagnosis on vulnerability and frailty, which have been associated with adverse health outcomes in older adults.
  
  
  METHODS
  We used data in the 2003 Medicare Current Beneficiary Survey from a nationally representative sample of 12,480 community-dwelling elders. Multivariable logistic regression models were used to evaluate whether cancer was independently associated with vulnerability and frailty. Measures of vulnerability and frailty included disability, geriatric syndromes, self-rated health, and scores on two assessment tools for elderly cancer patients-the Vulnerable Elders Survey-13 (VES-13) and the Balducci frailty criteria. All statistical tests were two-sided.
  
  
  RESULTS
  Diagnosis of a non-skin cancer was reported by 18.8% of the respondents. Compared with respondents without a cancer history, respondents with a personal history of cancer had a statistically significantly higher prevalence of limitations in activities of daily living (31.9% vs 26.9%), limitations in instrumental activities of daily living (49.5% vs 42.3%), geriatric syndromes (60.8% vs 53.9%), low self-rated health (27.4% vs 20.9%), score of 3 or higher on the VES-13 (45.8% vs 39.5%), and satisfying criteria for frailty as defined by Balducci (79.6% vs 73.4%) (P < .001 for all characteristics). After adjustment for confounders, a cancer diagnosis was found to be associated with low self-rated health (adjusted odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.30 to 1.64; relative risk [RR] = 1.33), limitations in activities of daily living (adjusted OR = 1.19, 95% CI = 1.06 to 1.33; RR = 1.13), limitations in instrumental activities of daily living (adjusted OR = 1.25, 95% CI = 1.13 to 1.38; RR = 1.13), a geriatric syndrome (adjusted OR = 1.27, 95% CI = 1.15 to 1.41; RR = 1.11), VES-13 score of 3 or higher (adjusted OR = 1.26, 95% CI = 1.13 to 1.41; RR = 1.14), and frailty (adjusted OR = 1.46, 95% CI = 1.29 to 1.65; RR = 1.09) as defined by Balducci criteria.
  
  
  CONCLUSIONS
  Diagnosis of a non-skin cancer was associated with increased levels of having disability, having geriatric syndromes, and meeting criteria for vulnerability and frailty.
authors.affiliation: James P. Wilmot Cancer Center, University of Rochester, 601 Elmwood Ave, Box 704, Rochester, NY 14642, USA. supriya_mohile@urmc.rochester.edu
authors.forename: Supriya Gupta
authors.initials: SG
authors.lastname: Mohile
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.forename: William
authors.initials: W
authors.lastname: Dale
authors.forename: Susan G
authors.initials: SG
authors.lastname: Fisher
authors.forename: Miriam
authors.initials: M
authors.lastname: Rodin
authors.forename: Gary R
authors.initials: GR
authors.lastname: Morrow
authors.forename: Alfred
authors.initials: A
authors.lastname: Neugut
authors.forename: William
authors.initials: W
authors.lastname: Hall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D012107:Research Design; D012111:Residence Characteristics; D013577:Syndrome; D014481:United States / Q000453:epidemiology