Preoperative frailty is a severely unhealthy status that reflects the reduction of overall physiological reserve, which is highly prevalent in elderly patients with gastric cancer. Understanding the perceived influencing factors of preoperative frailty can provide an important basis for developing individualized intervention plans.

To perform a qualitative descriptive study to identity the perceived influencing factors of preoperative frailty among elderly gastric cancer patients using the theory of health ecology.

A qualitative descriptive study was conducted based on health ecology theory. Purposive sampling method was used to select 29 frail elderly patients who would undergo gastric cancer surgery in the First Affiliated Hospital with Nanjing Medical University from February to June 2021 for semi-structured interview. Directed content analysis was used for data analysis.

Five themes and thirteen sub-themes were extracted: physiological traits, including accumulated aging-related losses, obvious gastrointestinal symptoms, and successive attacks of multiple diseases; behavioral characteristics, including lack of exercise behavior and overexertion; interpersonal networks, including insufficient peer social interaction, lack of parent-child interaction, and lack of communication and self-disclosure between couples; living and working conditions, including heavy individual financial burden, heavy unplanned family care tasks, insufficient information resources for health and disease management; macro factors, including limited medical services and medical insurance support.

This study described the effects of different perceived factors on preoperative frailty among elderly gastric cancer patients from the perspective of health ecology. Medical workers should formulate and implement systematic prehabilitation programs based on the above factors to improve the patients' preoperative anti-stress capacity and postoperative outcomes.