Frailty and dementia worsen care after cystectomy in older adults

Researchers analyzed 3,600 Medicare beneficiaries aged 66 and older who underwent radical cystectomy for bladder cancer in 2017. Using claims-based measures, the team tracked care trajectories across 12 months before and after surgery. Overall, 11.6% of patients were frail and 3.4% had dementia. Patients with dementia were more often frail, had more comorbidities, and less frequently received standard neoadjuvant chemotherapy. Frailty independently predicted at least two post-discharge care transitions, skilled nursing facility admissions within a year, intensive interventions like dialysis or feeding tubes, and worse survival. Dementia remained associated with skilled nursing facility admissions regardless of frailty level.