Liu Siqi, Su Mingzhu, Liu Li, Wang Quan, Qin Tingting, Wang Fang
Center of Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
Asia Pac J Oncol Nurs. 2025 May 29;12:100736. doi: 10.1016/j.apjon.2025.100736. eCollection 2025 Dec.
Limited information exists on the association among frailty, cancer history, and health care utilization in older adults, particularly cancer survivors. This study aimed to examine the relationship between frailty level, cancer history, and health care utilization among older adults.
A total of 14,562 older adults were identified from the 2019 and 2020 National Health Interview Survey, including cancer survivors ( = 3944) and those without a cancer history ( = 10,618). Frailty was assessed using a modified FRAIL Scale (Fatigue, Resistance, Ambulation, Illness, and Low body mass index). Health care utilization outcomes included urgent care, emergency care, hospitalization, delayed care, and needed but did not get care due to cost. Multivariate logistic regressions examined the association between cancer-frailty characteristics and health care utilization.
Participants with cancer were more likely to be older, with a higher proportion aged 75-84 (37.1% vs. 27.4%) and 85+ (12.6% vs. 9.4%) years, compared to those without a cancer history. Cancer survivors also showed higher rates of frailty (23.8% vs. 14.5%) and pre-frailty (36.0% vs. 33.7%). In adjusted analyses, both higher frailty severity and cancer history were independently associated with increased odds of emergency care and hospitalization. Frail older cancer survivors had the highest likelihood of these outcomes, with odds ratios of 4.738 for emergency care and 5.643 for hospitalization. Sensitivity analyses confirmed the robustness of these findings.
Using nationally representative data, this study demonstrates that frailty and cancer history are independently associated with increased emergency care and hospitalization among older adults.
关于老年人，尤其是癌症幸存者中衰弱、癌症病史和医疗服务利用之间的关联，现有信息有限。本研究旨在探讨老年人衰弱程度、癌症病史与医疗服务利用之间的关系。
从2019年和2020年全国健康访谈调查中识别出总共14562名老年人，包括癌症幸存者（n = 3944）和无癌症病史者（n = 10618）。使用改良的衰弱量表（疲劳、抵抗力、活动能力、疾病和低体重指数）评估衰弱情况。医疗服务利用结果包括紧急护理、急诊护理、住院治疗、延迟护理以及因费用问题需要但未获得护理。多因素逻辑回归分析了癌症-衰弱特征与医疗服务利用之间的关联。
与无癌症病史者相比，癌症患者年龄更大的可能性更高，75 - 84岁（37.1%对27.4%）和85岁及以上（12.6%对9.4%）的比例更高。癌症幸存者的衰弱率（23.8%对14.5%）和衰弱前期率（36.0%对33.7%）也更高。在调整分析中，更高的衰弱严重程度和癌症病史均与急诊护理和住院治疗几率增加独立相关。衰弱的老年癌症幸存者出现这些结果的可能性最高，急诊护理的优势比为4.738，住院治疗的优势比为5.643。敏感性分析证实了这些发现的稳健性。
本研究使用具有全国代表性的数据表明，衰弱和癌症病史与老年人急诊护理和住院治疗增加独立相关。
