PURPOSE The association between geriatric assessment (GA)–identified impairments and long-term health care use in older cancer survivors remains unknown. Our objective was to evaluate whether a GA performed at cancer diagnosis was predictive of hospitalizations and long-term care (LTC) use in older adult cancer survivors. METHODS Older adults with GA performed between 3 months before through 6 months after diagnosis were included (N = 125). Patients with Medicare Parts A and B coverage and no managed care were identified. Hospitalizations and LTC use (skilled nursing or assisted living) were assessed up to 5 years postdiagnosis. GA risk measures were evaluated in separate Poisson models estimating the relative risk (RR) for hospital and LTC visits, adjusting for age and Charlson comorbidity score. RESULTS The mean age of patients was 74 years, and the majority were female (80%) and white (90%). Breast cancer (64%) and early-stage disease (stages 0 to III, 77%) were common. Prefrail/frail status (RR, 2.5; P, .001), instrumental activities of daily living impairment (RR, 5.47; P, .001), and limitations in climbing stairs (RR, 2.94; P, .001) were associated with increased hospitalizations. Prefrail/frail status (RR, 1.86; P, .007), instrumental activities of daily living impairment (RR, 4.58; P, .001), presence of falls (RR, 6.73; P, .001), prolonged Timed Up and Go (RR, 5.45; P, .001), and limitations in climbing stairs (RR, 1.89; P, .005) were associated with LTC use. CONCLUSION GA-identified impairments were associated with increased hospitalizations and LTC use among older adults with cancer. GA-focused interventions should be targeted toward high-risk patients to reduce long-term adverse health care use in this vulnerable population.