Falls in the community-dwelling elderly with a history of cancer

Global prevalence of falls among older adults with cancer: A systematic review and meta-analysis

INTRODUCTION

Falls are a significant health concern among older adults, particularly those with cancer, due to aging-related frailty, treatment-related adverse effects, and comorbidities. Existing reviews have highlighted the burden of falls in this population; however, the absence of a comprehensive meta-analysis to synthesize pooled results from relevant studies has limited the generalizability of their findings. This systematic review and meta-analysis aimed to estimate the global prevalence of falls among older adults with cancer and provide evidence to guide prevention efforts.

MATERIALS AND METHODS

A systematic search of PubMed, Embase, and Web of Science databases was conducted through October 2024, following PRISMA 2020 guidelines. Studies reporting fall prevalence in patients with cancer aged 65 years or older were included. Pooled prevalence estimates were calculated using a random-effects meta-analysis.

RESULTS

Seventy-six studies, including 177,212 participants, met the inclusion criteria. The pooled prevalence of falls was 24 % (95 % confidence interval [CI], 20; 28), with significant heterogeneity (I2 = 100 %). Fall prevalence increased with follow-up duration: short-term 12 % (95 % CI, 5.2; 28.4), medium-term 23 % (95 % CI, 18.9; 29.5), and long-term 54 % (95 % CI, 14.9; 89.1) studies (p = 0.13). Older adults with breast cancer had the highest prevalence of falls at 31 % (95 % CI, 17; 48), while patients with colorectal cancer had the lowest at 15 % (95 % CI, 1; 78) (P ≤0.001). Fall prevalence ranged from 19 % in Australia to 24 % in North America (p = 0.89).

DISCUSSION

Falls are frequent among older adults with cancer, with prevalence varying by cancer type, geographic region, and follow-up duration.

Falls experienced by adult cancer survivors: a scoping review

PURPOSE

Accidental falls among adult cancer survivors are a health concern. Falls impose economic burdens and detrimental consequences to cancer survivors. This review aimed to synthesize findings from published research to explore the relationship between falls and cancer diagnosis and treatment among cancer survivors.

MATERIALS AND METHODS

A scoping review was conducted using four databases (Medline, EMBASE, CINAHL, and Scopus) for the years 2001-2021. A total of 425 abstracts were identified after removing duplicates. A second search for the years 2022-2023 was completed where 80 abstracts were identified. Abstract screening, full-text review, and data extraction were conducted. Study characteristics and key findings were extracted from full texts. Descriptive numerical summaries were presented, and narrative analyses were performed.

RESULTS AND CONCLUSIONS

A total of 42 articles were included in the scoping review which demonstrated (1) an increased prevalence of falls among cancer survivors, (2) the presence of cancer-specific fall risk factors, (3) a lack of cancer-specific fall prediction tools, and (4) few fall prevention interventions as part of usual care among cancer survivors. Younger cancer survivors were underrepresented. Cancer survivors should be aware of their risk of falls, and health professionals should ensure that fall prevention is part of usual care.

Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study

BACKGROUND

Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy.

OBJECTIVE

We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms.

METHODS

Patients scheduled to receive autoHSCT (78/156, 50%) and controls (78/156, 50%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale-short form), and depression (Center for Epidemiological Studies-Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms.

RESULTS

Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability (ß=.001; P=.005) and heel strike angle (ß=-.088; P=.02). Pain was associated with worse gait speed (ß=-.003; P=.003), stride time variability (ß=.012; P=.02), stride length (ß=-.002; P=.004), and distance traveled (ß=-.786; P=.005). Nausea and pain explained 17% to 33% and 14% to 36% of gait variance measured in patients, respectively.

CONCLUSIONS

Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term.

Communication About Fall Risk in Community Oncology Practice: The Role of Geriatric Assessment

PURPOSE

Falls are a modifiable source of morbidity for older adults with cancer, yet are underassessed in oncology practice. In this secondary analysis of a nationwide cluster-randomized controlled trial, we examined characteristics associated with patient-oncologist conversations about falls, and whether oncologist knowledge of geriatric assessment (GA) resulted in more conversations.

METHODS

Eligible patients (ClinicalTrials.gov identifier: NCT02107443) were age ≥ 70 years, had stage III/IV solid tumor or lymphoma, were being treated with noncurative treatment intent, and ≥ 1 GA domain impairment. Patients in both arms underwent GA. At practices randomly assigned to the intervention arm, oncologists were provided a GA summary with management recommendations. In both arms, patients had one clinical encounter audio-recorded, transcribed, and coded to categorize whether a conversation about falls occurred. Generalized linear mixed models adjusted for arm, practice site, and other important covariates were used to generate proportions and odds ratios (ORs) from the full sample.

RESULTS

Of 541 patients (intervention N = 293 and usual care N = 248, mean age: 77 years, standard deviation: 5.3), 528 had evaluable audio recordings. More patients had conversations about falls in the intervention versus usual care arm (61.3% v 10.3%, P < .001). Controlling for the intervention and practice site, history of falls (OR, 2.1; 95% CI, 1.3 to 3.6; P = .005) and impaired physical performance (OR, 4.7; 95% CI, 1.7 to 12.8; P = .002) were significantly associated with patient-oncologist conversations about falls.

CONCLUSION

GA intervention increased conversations about falls. History of falls and impaired physical performance were associated with patient-oncologist conversations about falls in community oncology practice.

Falls in older ambulatory care patients with cancer in Iran: Implications for clinical practice

RATIONALE/AIM

Falls can have severe consequences particularly for older patients with cancer undergoing ambulatory care. The aim of the study is to identify the predictors of falls in older patients receiving cancer ambulatory care and evaluate the accuracy of the final multivariable model in detecting older patients with falls.

METHOD

A retrospective study was conducted on 300 older patients aged 60 years and above that were referred for ambulatory care in three oncology clinics based at hospitals in Tehran, Iran. Participants completed a questionnaire comprising demographic, history of falls, and cancer-related factors. Logistic regression was used to determine risk factors associated with falls.

RESULTS

A total of 35.3% of the older patients with cancer had experienced a fall in the 6 months following the start of their ambulatory care. The most important predictors of falls include the fourth stage of cancer (odds ratio [OR]: 6.47, 95% confidence interval [CI]: 3.20-13.08, p < 0.001), fear of falling (OR: 5.64, 95% CI: 2.58-12.33, p < 0.001), use of hearing (OR: 2.38, 95% CI: 1.07-5.29, p = 0.033) and visual aids (OR: 2.36, 95% CI: 1.12-5.01, p = 0.025), and the number of visits to the doctor (OR: 1.10, 95% CI: 1.01-1.21, p = 0.035).

CONCLUSIONS

The results indicate that a reduction in falls is possible by introducing strategies to improve care for older patients in the advanced stage of cancer, eliminating the causes of fear of falling, examining and improving vision and hearing, and identifying and addressing the underlying causes of visits to the doctor.

Oncology clinic nurses' attitudes and perceptions regarding implementation of routine fall assessment and fall risk screening: A survey study

Falls in older adults with cancer are often under-recognized and under-reported. The objective of this study was to explore oncology clinic nurses' willingness and perceived barriers to implement routine falls assessment and falls screening in their practice. Nurses working in outpatient oncology clinics were invited to complete an online survey. Data were analyzed using descriptive statistics and sorted into thematic categories. The majority of respondents indicated willingness to routinely ask older patients about falls (85.7%) and screen for fall risks (73.5%). The main reasons for unwillingness included: belief that patients report falls on their own, lack of time, and lack of support staff. Findings from this study show many oncology nurses believe in the importance of routine fall assessment and screening and are willing to implement them routinely, although falls are not routinely asked about or assessed. Future work should explore strategies to address barriers nurses face given the implications of falls amongst this vulnerable population.

Évaluation systématique des chutes et du risque de chutes : Sondage sur l’attitude et les perceptions des infirmières cliniques en oncologie

Chez les personnes âgées atteintes de cancer, les chutes sont un problème souvent sous-estimé et peu rapporté. La présente étude visait à explorer la volonté des infirmières cliniques en oncologie à évaluer et à dépister systématiquement les chutes dans leur pratique; l’étude examinait également les obstacles perçus à l’évaluation et au dépistage systématique. Les infirmières ont donc été invitées à remplir un sondage en ligne. Les données ont été analysées à l’aide de statistiques descriptives. La majorité des infirmières ayant répondu ont dit qu’elles accepteraient de poser systématiquement des questions sur les chutes (85,7 %) et de dépister les risques de chutes (73,5 %) chez les personnes âgées. Voici les principales raisons des réticences : conviction que les patients signalent les chutes d’euxmêmes, manque de temps, pénurie de personnel de soutien. Selon les résultats de l’étude, beaucoup d’infirmières en oncologie trouvent important d’évaluer et de dépister systématiquement les chutes, et sont d’accord pour l’intégrer à leur pratique bien que, d’habitude, les chutes ne fassent pas automatiquement l’objet de questions ou d’une évaluation. Étant donné les conséquences des chutes sur ces patients vulnérables, la recherche à venir devra explorer les stratégies permettant de surmonter les obstacles auxquels se butent les infirmières.

Application of Ferrans et al.'s conceptual model of health-related quality of life: A systematic review

Ferrans, Zerwic, Wilbur, and Larson proposed the conceptual model of health-related quality of life (HRQOL) in 2005 to explicate the constructs associated with HRQOL and to describe the associations among those constructs. In this systematic review, the authors aimed to describe empirical studies that used Ferrans et al.'s model and to examine the evidence related to the hypothesized model concepts. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Relevant articles were identified using Crossref, CINAHL, and PubMed. To be included, studies had to employ the model as a theoretical framework and be published in English between 2005 and 2020. Type of theory use was coded using four designations: informed by theory, applied theory, testing theory, and building theory. Thirty-one studies were included. Most studies involved adult patients with chronic illnesses (n = 20) and were conducted in Western countries (n = 22). The most common type of theory use was testing theory (74.19%). Among the seven concepts in Ferrans et al.'s model, all 20 hypothesized associations were tested and 19 were supported by study results. The three associations most frequently supported were between symptoms and functional status (n = 13), environmental characteristics and quality of life (n = 10), and individual characteristics and functional status (n = 8). No studies found an association between environmental characteristics and biological function. Our review found that Ferrans et al.'s model has been used extensively to guide HRQOL research. An emerging body of research provides preliminary support for the associations hypothesized in the model. Additional research is needed to confirm the hypothesized associations among model concepts.

Fear of falling in community-dwelling older adults diagnosed with cancer: A report from the International Mobility in Aging Study (IMIAS)

BACKGROUND

The incidence of fear of falling (FOF) is high among people with cancer. However, factors that are associated with FOF in people with cancer has not yet been investigated. Therefore, the objective of this study was to identify the associated factors with FOF in people with cancer.

METHOD

This is a secondary analysis of the International Mobility in Aging Study (IMIAS) study. A total of 175 people self-identified as patients with cancer (mean age: 69.3 years, women: 50.2%) and 177 healthy age-matched group. FOF measured using the Falls Efficacy Scale-International (FES-I) was the primary outcome. Potential variables/factors for consistency known to be associated with FOF (cognitive status, depression, physical performance, the number of falls in the last year, visual acuity and grip strength) were assessed. Simple linear regression was used to identify factors associated with FOF. Variables with p-value <0.05 were then included in a multiple linear regression adjusted for the study confounders (study site, sex, and age).

RESULTS

For people with cancer, FES-I was significantly associated with the Leganes Cognitive Test, The Short Physical Performance Battery (SPPB) total scores and the number of falls reported in the past 12 months (P-value <0.05). For the healthy group, FOF was only associated with depression and SPPEB.

CONCLUSION

FOF is multifactorial in people with cancer and it is associated with cognitive status, physical performance and number of falls in the last year. Healthcare providers for patients with cancer should evaluate all potential factors associated with FOF and manage it.

Factors associated with self-reported falls, balance or walking difficulty in older survivors of breast, colorectal, lung, or prostate cancer: Results from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage

Background

Cancer and its treatment affect body systems that are important in preventing falls and controlling balance/walking. This study examined factors associated with self-reported falls and balance/walking difficulty in the past 12 months in older survivors of four major cancers.

Methods

This was a cross-sectional study analyzing population-based data from Surveillance, Epidemiology, and End Results–Medicare Health Outcomes Survey (SEER-MHOS). Data from cohorts 9 to 14 (January 2006 to December 2013) were extracted. Inclusion criteria were: age ≥65 years at cancer diagnosis, first MHOS completed during years 1–5 post-cancer diagnosis, first primary breast (n = 2725), colorectal (n = 1646), lung (n = 752), and prostate (n = 4245) cancer, and availability of cancer staging information. Primary outcomes were self-reported falls and balance/walking difficulty in the past 12 months. Multivariable logistic regression was constructed for each cancer type to examine independent factors associated with falls and balance/walking difficulty.

Results

In all cancer types, advancing age at cancer diagnosis and dependence in activities of daily living were significant independent factors associated with increased odds of reporting falls and balance/walking difficulty in the past 12 months. Additionally, depression was independently associated with falls and sensory impairment in feet was independently linked to balance/walking difficulty in all cancer types. Other independent factors of falls and balance/walking difficulty varied across cancer types. In breast cancer only, localized or regional cancer stage was significantly associated with increased odds of reporting falls and balance/walking difficulty, whereas treatment with radiation decreased the odds of falling. No association between falls and balance/walking difficulty with time since cancer diagnosis, cancer stage, or cancer treatment was found in colorectal, lung, and prostate cancer.

Conclusion

There exists some heterogeneity in factors associated with self-reported falls and balance/walking difficulty between different cancer types. Future research is necessary to ascertain factors predictive of falls and balance/walking difficulty in older cancer survivors, particularly factors related to cancer diagnosis and treatment.

Exercise for reducing falls in people living with and beyond cancer

BACKGROUND

Current treatment modalities for cancer have been successful in achieving improved survivorship; however, they come with a number of long-term adverse effects. Accidental falls are a common and clinically significant adverse event in people living with and beyond cancer and rates are higher than in the rest of the population.

OBJECTIVES

To assess the effects of prescribed or provided exercise for reducing accidental falls, and falls risk factors of strength, flexibility and balance, in people living with and beyond cancer.

SEARCH METHODS

We searched the following electronic databases from inception to 10 July 2018, with no restrictions: CENTRAL, MEDLINE, Embase, and seven other databases. We searched clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP) for ongoing trials, and reference lists of reviews and retrieved articles for additional studies.

SELECTION CRITERIA

We included all randomised controlled trials investigating exercise interventions versus no treatment, usual care or non-exercise interventions on falls incidence or falls risk factors in adults living with and beyond cancer (18 years of age or older at diagnosis). We excluded cross-over studies and studies in acute or inpatient hospice care.

DATA COLLECTION AND ANALYSIS

At least two review authors independently completed data extraction for included papers. We used Covidence software to manage screening, data collection and extraction. We assessed evidence using GRADE and presented results in a 'Summary of findings' table.

MAIN RESULTS

Eleven studies (835 participants) compared exercise to usual care. No studies compared exercise with no treatment or non-exercise interventions. The quality of the evidence was very low for the primary outcome rates of falls, and very low to low for the secondary outcomes. We downgraded the evidence due to study limitations (risk of bias), and issues of imprecision due to small sample sizes, inconsistency and indirectness. All studies were at high risk of bias for blinding of participants and personnel due to inability to blind participants to an exercise intervention. Risk of bias was generally low or unclear for other categories.There was generally little information on the important outcomes comparing exercise to usual care.Rates of falls and number of fallers: one study (223 participants) measured accidental falls, but reported neither the rate of falls or the number of fallers; there was no difference in the number of falls between exercise and usual care (very low-quality evidence).Strength: 10 studies (813 participants) reported on strength outcomes. Two analyses favoured exercise over usual care: quadriceps strength (2 studies, 72 participants; mean difference (MD) 8.99 kg, 95% confidence interval (CI) 1.29 to 16.70; low-quality evidence), and leg press (4 studies, 388 participants; MD 21.1 kg, 95% CI 8.47 to 33.74; low-quality evidence). In one analysis of the Sit-to-Stand Test, there was no difference between exercise and usual care (4 studies, 214 participants; standardised mean difference (SMD) -0.45, 95% CI -1.05 to 0.14; very low-quality evidence).Flexibility: one study (21 participants) reported on flexibility for Sit-and-Reach Distance (MD 2.05 cm, 95% CI 0.59 to 3.51; very low-quality evidence).Balance: five studies (350 participants) measured three different balance outcomes. Two analyses favoured exercise over usual care: postural balance (4 studies, 127 participants; standardised mean difference (SMD) 0.44, 95% CI 0.08 to 0.79; very low-quality evidence), and Backward Walk Test (2 studies, 280 participants; SMD -0.24, 95% CI -0.48 to -0.01; low-quality evidence). There was no difference between exercise and usual care for the Timed Up-and-Go Test (1 study, 15 participants; MD -0.35 seconds, 95% CI -1.47 to 0.77; low-quality evidence).Number of people sustaining a fall-related fracture: the quality of the evidence for exercise reducing fall-related fractures was very low.Adverse events: a single study (223 participants) noted some temporary muscle soreness on initiation of exercise or when there was an increase in the weight lifted. As no occurrence data were reported, we could not assess this variable further. No studies reported musculoskeletal injury. Analysis indicated that there was very low-quality evidence that exercise did not increase fatigue.

AUTHORS' CONCLUSIONS

There is a paucity of evidence for exercise training to reduce fall rates in people living with and beyond cancer. Exercise training may improve strength, flexibility and balance for people in this population, but the evidence is very low quality.

Predictors of falls in older survivors of breast and prostate cancer: A retrospective cohort study of surveillance, epidemiology and end results-Medicare health outcomes survey linkage

OBJECTIVES

To identify predictors of falls in older breast and prostate cancer survivors.

METHODS

This retrospective cohort study analyzed population-based Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linkage. Inclusion criteria were age >65 years at cancer diagnosis, first primary female breast or prostate cancer, cancer staging information available, completion of baseline MHOS during years 2-3 and follow-up MHOS during years 4-5 post-diagnosis, and falls information available. Data from 437 breast and 660 prostate cancer survivors were analyzed. Multivariable logistic regression was constructed to evaluate variables from baseline MHOS with relation to falls from follow-up MHOS. Model accuracy was assessed using area under receiver-operating-characteristic curve (AUC).

RESULTS

At follow-up MHOS, 26% of breast and 22% of prostate cancer survivors reported falls in the past 12 months. In breast cancer, a history of falls (odds ratio (OR) = 4.95, 95% confidence interval (CI) = 2.44-10.04) and sensory impairment in feet (OR = 3.33, 95%CI = 1.51-7.32) were significant predictors of falls. In prostate cancer, a history of falls (OR = 3.04, 95%CI = 1.79-5.15), unmarried (OR = 1.82, 95%CI = 1.12-2.95), lower physical summary score of quality-of-life(OR = 0.96, 95%CI = 0.94-0.98), urinary incontinence (OR = 1.69, 95%CI = 1.08-2.65), older age at diagnosis (OR = 1.05, 95%CI = 1.01-1.09), and shorter time post-diagnosis (OR = 0.96, 95%CI = 0.93-0.99) were significant predictors of falls. AUC was 0.67 and 0.77 for breast and prostate cancer, respectively, indicating moderate accuracy of models in detecting fallers.

CONCLUSIONS

Asking older breast and prostate cancer survivors about falls in the past 12 months is imperative in fall prevention. Further examination of deficits specific to each cancer is necessary to assess fall risks.

Research of falls risk of taking central nervous system drugs in oncology inpatients

This study aimed to analyze the medication use and related falls risk of central nervous system(CNS) drugs in oncology inpatients, explore the association between CNS drugs and falls. In this study, we enrolled inpatients, hospitalized in the oncology department of the Teaching Hospital of Chengdu University of Traditional Chinese Medicine, from March 2013 to October 2015. All inpatients were divided into two groups: taking-CNS drugs group (treatment group) and non CNS drugs group (control group). The falls risk between two groups were being compared and analyzed. Results showed that a total of 768 inpatients were enrolled in this study; 401 of them were males and 367 were females; the average age was 47.9±5.8 year-old. Of them, 129 were taking CNS drugs, while 639 were not. In the treatment group, the number of fall patients was 39, at an incidence rate of 30.23%; of the 39 fall patients, 3 suffered fractures, and 1 suffered an intracranialhemorrhage; while in the control group, the incidence of falls totaled at 45, at an incidence rate of 7.04%; 4 of the patients suffered fractures. The difference of incidence rate between two groups had statistical significance (P＜ 0.01). The incidence rate of falls in the treatment group was 4.29 times that in the control group. By the further analysis of CNS drugs, results implied that hypnotics, sedatives, selective serotonin reuptake inhibitors (no patient taking tricyclic antidepressants in this study), opioids, antiepileptics and antipsychotics had relationship with falls (OR>1). Our finding indicates that oncology inpatients have a higher risk of falls resulting from taking CNS drugs. Therefore, it is necessary to build up a systemic mechanism of nursing safety management on preventing falls of oncology inpatients, to improve nursing quality, and reduce the risk of falls.

Falls and Physical Inactivity in Patients with Gastrointestinal Cancer and Hand-Foot Syndrome

Objective

This study aims to ascertain the incidence and association of falls and physical inactivity in patients with gastrointestinal cancer and hand-foot syndrome (HFS) after receiving chemotherapy or targeted therapy.

Methods

The present cross-sectional study was conducted on 50 outpatients with HFS of Grade 1 or above, according to the National Cancer Institute Common Terminology Criteria for Adverse Events, following the receipt of chemotherapy or targeted therapy for gastrointestinal cancer in Japan between November 2016 and February 2017. For measurement, Dermatology Life Quality Index (DLQI) and the International Physical Activity Questionnaire were used. Data were analyzed by logistic regression analysis.

Results

Of the participants, 18% experienced falls and 60% reported physical inactivity. Multivariate logistic regression revealed that the DLQI treatment domain score was the only factor associated with falls (odds ratio [OR] =8.01, 95% confidence interval [CI] =1.27-50.63, P = 0.027). Physical inactivity was associated with DLQI symptom and feeling domain scores (OR = 5.54, 95% CI = 1.26-24.33, P = 0.023) and the with-oxaliplatin or paclitaxel regimen (OR = 3.71, 95% CI = 1.06-13.03, P = 0.041).

Conclusions

The results of the present study suggest patients should be informed that HFS is a risk factor for physical inactivity and falls.

Falls in older adults with cancer: a systematic review of prevalence, injurious falls, and impact on cancer treatment

PURPOSE

The purpose of this systematic review was to update and expand the existing systematic review with the aim to answer the following questions: (1) How often do older adults (OA)s with cancer fall? (2) What are the predictors of falls in OA with cancer? (3) What is the rate of injurious falls and predictors of injurious falls in OA with cancer? (4) What are the circumstances and outcomes of falls in this population? (5) How do falls in cancer patients affect subsequent cancer treatment?

METHODS

Medline, Pubmed, Embase, and CINAHL were searched. Eligible studies included clinical trials, cross-sectional, cohort, case-control, and qualitative studies in which the entire sample or a sub-group of the sample were OA aged 60 and above, had cancer, in which falls were examined as a primary or secondary outcome and published in English.

RESULTS

Twenty-seven studies met our inclusion criteria with most involving the outpatient setting. Fall rates and injurious fall rates varied widely. Consistent predictors of falls were prior falls among outpatients and cognitive impairment among inpatients. There were no data on impact of falls on cancer treatment. Data on circumstances of falls were limited.

CONCLUSION

Falls and fall-related injuries are common in older cancer patients. However, little is known about circumstances of falls and impact of falls on cancer treatment. Many known fall predictors in community-dwelling OA have not been explored in oncology. More research is needed to address gaps in these areas.

An instructional DVD fall-prevention program for patients with cancer and family caregivers

PURPOSE/OBJECTIVES

Determine the efficacy of a fall-prevention skills training program for patients with cancer and family caregivers.

DESIGN

Randomized, controlled trial with repeated measures and postintervention measure of fall occurrence.

SETTING

A comprehensive cancer center in the midwestern United States.

SAMPLE

132 patient and family caregiver dyads.

METHODS

Dyads were randomly assigned to one of two groups: a control group that received standard fall-prevention education or a treatment group that received standard education and a fall-prevention DVD program to view at home. Participants completed surveys at baseline, one week, one month, and three months. Follow-up phone calls were made at three months.

MAIN RESEARCH VARIABLES

Fall occurrence, perceptions of fall risks, and fall-prevention knowledge.

FINDINGS

Patients in the treatment group were significantly more likely to report not falling at three months than patients in the control group. The number of falls was lower for the treatment group. The difference was not statistically significant. Dyads in the treatment group showed significantly greater improvement over time in fall risk awareness and fall-prevention knowledge.

CONCLUSIONS

Mobility skills training is a promising educational intervention for reducing fall occurrences in the home for patients with cancer.

IMPLICATIONS FOR NURSING

Efforts are needed for improving the knowledge and skills of cancer survivors and their family members in recognizing patient fall risks, making home adjustments, and performing mobility skills competently.

Systematic review of falls in older adults with cancer

OBJECTIVES

Older adults frequently experience falls, at great cost to themselves and society. Older adults with cancer may be at greater risk for falls and have unique risk factors.

MATERIALS AND METHODS

We undertook a systematic review of the available medical literature to examine the current evidence regarding factors associated with falls in older adults with cancer. PubMed, Embase, CINAHL, CENTRAL, DARE, Cochrane Database of Systematic Reviews and clinical trials.gov were searched using standardized terms for concepts of oncology/cancer, people 60 and older, screening, falls and diagnosis. Eligible studies included cohort or case-control studies or clinical trials in which all patients, or a subgroup of patients, had a diagnosis of cancer and in which falls were either the primary or secondary outcome.

RESULTS

We identified 31 studies that met our inclusion criteria. Several studies suggest that falls are more common in older adults with a diagnosis of cancer than those without. Among the 11 studies that explored factors associated with outpatient falls, some risk factors for falls established in the general population were also associated with falls in older adults with cancer, including dependence in activities of daily living and prior falls. Other factors associated with falls in a general population, such as age, polypharmacy and opioid use, were not predictive of falls among oncology populations. Falls among older adults with cancer in the inpatient setting were associated with established risk factors for falls in people without cancer, but also with factors unique to an oncology population, such as brain metastases.

CONCLUSIONS

Falls in older adults with cancer are more common than in the general population, and are associated with risk factors unique to people with cancer. Further study is needed to establish methods of screening older adults with cancer for fall risk and ultimately implement interventions to reduce their risk of falls. Identifying which older adults with cancer are at greater risk for falls is a requisite step to ultimately intervene and prevent falls in this vulnerable population.

Do older adults with cancer fall more often? A comparative analysis of falls in those with and without cancer

PURPOSE/OBJECTIVES

To examine whether a history of cancer increased the likelihood of a fall in community-dwelling older adults, and if cancer type, stage, or time since diagnosis increased falls.

DESIGN

A longitudinal, retrospective, cohort study.

SETTING

A home- and community-based waiver program in Michigan.

SAMPLE

862 older adults aged 65 years or older with cancer compared to 8,617 older adults without cancer using data from the Minimum Data Set-Home Care and Michigan cancer registry.

METHODS

Reports of falls were examined for 90-180 days. Generalized estimating equations were used to compare differences between the groups.

MAIN RESEARCH VARIABLES

Cancer, falls, patient characteristics, comorbidities, medications, pain, weight loss, vision, memory recall, and activities, as well as cancer type, stage, and time since diagnosis.

FINDINGS

A fall occurred at a rate of 33% in older adults with cancer compared to 29% without cancer (p < 0.00). Those with a history of cancer were more likely to fall than those without cancer (adjusted odds ratio 1.16; 95% confidence interval [1.02, 1.33]; p = 0.03). No differences in fall rates were determined by cancer type or stage, and the odds of a fall did not increase when adding time since cancer diagnosis.

CONCLUSIONS

The fall rate was higher in older adults with cancer than in older adults without cancer.

IMPLICATIONS FOR NURSING

Nurses need to assess fall risk and initiate fall prevention measures for older adults at the time of cancer diagnosis.

KNOWLEDGE TRANSLATION

When caring for older adults with cancer, nurses should be aware of an increased risk for falls. Healthcare staff also should be aware of an increased risk for falls in that population during cancer treatment. Evidence-based fall prevention measures should be included in care plans for older adult cancer survivors.

Predictors of a fall event in hospitalized patients with cancer

PURPOSE/OBJECTIVES

To determine predictors of fall events in hospitalized patients with cancer and develop a scoring system to predict fall events.

DESIGN

Retrospective medical record review.

SETTING

A 1,200-bed tertiary care hospital in northeastern Ohio.

SAMPLE

145 patients with cancer who did not have a fall event were randomly selected from all oncology admissions from February 2006-January 2007 and compared to 143 hospitalized patients with cancer who had a fall event during the same period.

METHODS

Multivariable logistic regression models predicting falls were fit. Risk score analysis was completed using bootstrap samples to evaluate discrimination between patients who did or did not fall and agreement between predicted and actual fall status. A nomogram of risk scores was created.

MAIN RESEARCH VARIABLES

Fall episodes during hospitalization and patient characteristics that predict falls.

FINDINGS

While patients were hospitalized for cancer care, their predictors of a fall episode were low pain level, abnormal gait, cancer type, presence of metastasis, antidepressant and antipsychotic medication use, and blood product use (all p < 0.02); risk model c-statistic was 0.89.

CONCLUSIONS

For hospitalized patients with cancer, predictors reflecting greater fall episode risk can be assessed easily by nursing staff and acted on when the risk is sufficiently high.

IMPLICATIONS FOR NURSING

Understanding specific risk factors of falls in an adult oncology population may lead to interventions that reduce fall risk.

The contribution falls have to increasing risk of nursing home placement in community-dwelling older adults

PURPOSE

To determine whether a fall, as an adverse event in combination with other risk factors, influences nursing home placement (NHP).

METHOD

A retrospective longitudinal study of 6,515 high-risk, community-dwelling, dually eligible (Medicare/Medicaid) participants in a waiver program during 2002-2007 are examined. Data are obtained from the Minimum Data Set-Home Care linked with Medicaid claim files. The authors fit multiple factors to a logistic curve, using generalized linear modeling to predict increased risk of NHP when a fall occurred.

RESULTS

Prior NHP and an increased rate of falls (Odds Ratio [OR] = 1.52, 95% Confidence Interval [CI] = 1.25-1.84) and prior NHP and the same rate of falls (OR = 1.55, 95% CI = 1.26-1.91) both increased NHP.

CONCLUSION

An adverse event such as a fall and prior NHP is a strong predictor of future NHP and should be taken into consideration while developing care plans for community-dwelling older adults.