Paper
Sunday, November 4, 2007
163
Additive Effects of Cognitive and Physical Disability on Mortality in Older Adults with Cancer
Nancy A. Hodgson, RN, PhD, CS, Madlyn and Leonard Abramson Center for Jewish Life, Polisher Research Institute, North Wales, PA, USA
| Learning Objective #1: describe the dimensions of disability that effect survival in older adults with cancer |
| Learning Objective #2: describe the population at greatest risk for mortality among older adults with cancer |
Background: Cognitive and physical disability frequently coexist in the older population with cancer. However the joint effect of these factors on cancer mortality risk is not well understood. This study examined whether the combination of varying levels of cognitive and physical disability affect the risk of mortality in older adults with cancer.
Methods: Data were from the Medicare claims files linked to the AHEAD cohort of the Health and Retirement Study (HRS), a nationally representative panel of persons aged 70 and over. Analysis were limited to 340 respondents with incident cancer of the four leading types (lung, breast, prostate, colorectal). Participants were divided into mutually exclusive groups ranging from the best functioning on both measures to worst functioning on both measures. Mortality rates were compared across groups. Cox proportion hazards models were used to control for potential confounders such as demographics, comorbidity and site and stage of cancer.
Results: Together, cognitive and physical disability differentiated between older adults at markedly different risk for mortality, ranging from 16% in the best group to 54 % on the worst group. After adjusting for confounders, participants in the worst function in both measures remained at considerably higher risk from death than participants in the best function on both measures (adjusted hazard ratio 3.3: 95 % confidence interval, 1.8-7.1).
Conclusions: Given the significance of cognitive and physical disability on cancer survival, discussion focuses on the possible mechanisms of this relationship and the importance of nursing interventions targeting physical and cognitive function