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Journal Club

Prediction of Falls in Older Adults With Cancer: A Preliminary Study

Janine Overcash
ONF 2007, 34(2), 341-346 DOI: 10.1188/07.ONF.341-346

Purpose/Objectives: To determine the extent to which falls occur in older adult patients with cancer; to identify how falls relate to depression, age, functional status, and cognition; and to develop a model for predicting falls.

Design: Descriptive, prospective, quantitative.

Setting: Patients in the Senior Adult Oncology Program at the H. Lee Moffitt Cancer Center and Research Institute.

Sample: 165 patients aged 70 years or older with any diagnosis of cancer, treatment type, and stage.

Methods: Data were collected during a one-time interview using a comprehensive geriatric assessment consisting of the Instrumental Activities of Daily Living (IADL) Scale, Activities of Daily Living (ADL) Scale, Geriatric Depression Scale, Mini-Mental State Examination, and a fall assessment.

Main Research Variables: Falls, functional status, depression, cognition, age, and gender.

Findings: IADL scores were found to be a predictor of falls while controlling for age and ADL status. An IADL score of 22 predicts a 21% risk of a fall. Fall risk increases to 81% at an IADL score of 9.

Conclusions: IADL score is a predictor of falls in this older adult population with cancer. ADL scores are not a predictor of falls when IADL is included in the model.

Implications for Nursing: Nurses must play a vital role in conducting fall screening and risk assessments for older adults with cancer.

References 

Babiy, M., Stubblefield, M.D., Herklotz, M., & Hand, M. (2005). Asterixis related to gabapentin as a cause of falls. <i>American Journal of Physical Medicine and Rehabilitation</i>, <b>84</b>, 136-140.

Balducci, L., & Extermann, M. (2000). Management of cancer in the older person: A practical approach. <i>Oncologist</i>, <b>5</b>, 224-237.

Balducci, L., & Yates, J. (2000). General guidelines for the management of older patients with cancer. <i>Oncology</i>, <b>14</b>(11A), 221-227.

Cesari, M., Landi, F., Torre, S., Onder, G., Lattanzio, F., & Bernabei, R. (2002). Prevalence and risk factors for falls in an older community-dwelling population. <i>Journals of Gerontology. Series A, Biological Sciences and Medical Sciences</i>, <b>57</b>, M722-M726.

Chen, H., Cantor, A., Meyer, J., Beth Corcoran, M., Grendys, E., Cavanaugh, D., et al. (2003). Can older cancer patients tolerate chemotherapy? A prospective pilot study. <i>Cancer</i>, <b>97</b>, 1107-1114.

Chu, L.W., Chiu, A.Y., & Chi, I. (2006). Impact of falls on the balance, gait, and activities of daily living functioning in community-dwelling Chinese older adults. <i>Journals of Gerontology. Series A, Biological Sciences and Medical Sciences</i>, <b>61</b>, 399-404.

Extermann, M., Aapro, M., Bernabei, R., Cohen, H.J., Droz, J.P., Lichtman, S., et al. (2005). Use of comprehensive geriatric assessment in older cancer patients: Recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). <i>Critical Reviews of Oncology/Hematology</i>, <b>55</b>, 241-252.

Feder, G., Cryer, C., Donovan, S., & Carter, Y. (2000). Guidelines for the prevention of falls in people over 65. <i>BMJ</i>, <b>321</b>, 1007-1011.

Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinic. <i>Journal of Psychiatric Research</i>, <b>12</b>, 189-1998.

Ganz, D.A., Higashi, T., & Rubenstein, L.Z. (2005). Monitoring falls in cohort studies of community-dwelling older people: Effect of the recall interval. <i>Journal of the American Geriatrics Society</i>, <b>53</b>, 2190-2194.

Guideline for the prevention of falls in older persons. (2001). <i>Journal of the American Geriatrics Society</i>, <b>49</b>, 664-672.

Hausdorff, J.M., Rios, D.A., & Edelberg, H.K. (2001). Gait variability and fall risk in community-living older adults: A one-year prospective study. <i>Archives of Physical Medicine and Rehabilitation</i>, <b>82</b>, 1050-1056.

Holley, S. (2002). A look at the problem of falls among people with cancer. <i>Clinical Journal of Oncology Nursing</i>, <b>6</b>, 193-197.

Johnson, M., Cusick, A., & Chang, S. (2001). Home-screen: A short scale to measure fall risk in the home. <i>Public Health Nursing</i>, <b>18</b>, 169-177.

Katz, S., Downs, T.D., Cash, H.R., & Grotz, R.C. (1970). Progress in development of the index of ADL. <i>Gerontologist</i>, <b>10</b>, 20-30.

Kose, N., Cuvalci, S., Ekici, G., Otman, A.S., & Karakaya, M.G. (2005). The risk factors of fall and their correlation with balance, depression, cognitive impairment, and mobility skills in elderly nursing home residents. <i>Saudi Medical Journal</i>, <b>26</b>, 978-981.

Kurtz, M.E., Kurtz, J.C., Given, C.W., & Given, B. (1993). Loss of physical functioning among patients with cancer: A longitudinal view. <i>Cancer Practice</i>, <b>1</b>, 275-281.

Kurtz, M.E., Kurtz, J.C., Stommel, M., Given, C.W., & Given, B. (1999). The influence of symptoms, age, comorbidity, and cancer site on physical functioning and mental health of geriatric women patients. <i>Women and Health</i>, <b>29</b>(3), 1-12.

Lamb, S.E., Jorstad-Stein, E.C., Hauer, K., & Becker, C. (2005). Development of a common outcome data set for fall injury prevention trials: The Prevention of Falls Network Europe consensus. <i>Journal of the American Geriatrics Society</i>, <b>53</b>, 1618-1622.

Lawton, M.P., & Brody, E.M. (1969). Assessment of older people: Selfmaintaining and instrumental activities of daily living. <i>Gerontologist</i>, <b>9</b>, 179-186.

Lord, S.R., Menz, H.B., & Tiedemann, A. (2003). A physiological profile approach to falls risk assessment and prevention. <i>Physical Therapy</i>, <b>83</b>, 237-252.

Lyons, S.S. (2005). Evidence-based protocol: Fall prevention for older adults. <i>Journal of Gerontological Nursing</i>, <b>31</b>(11), 9-14.

Mathias, S., Nayak, U.S., & Isaacs, B. (1986). Balance in elderly patients: The "Get-up and Go" test. <i>Archives of Physical Medicine and Rehabilitation</i>, <b>67</b>, 387-389.

Montero-Odasso, M., Schapira, M., Soriano, E.R., Varela, M., Kaplan, R., Camera, L.A., et al. (2005). Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. <i>Journals of Gerontology. Series A, Biological Sciences and Medical Sciences</i>, <b>60</b>, 1304-1309.

Montero-Odasso, M., Schapira, M., Varela, C., Pitteri, C., Soriano, E.R., Kaplan, R., et al. (2004). Gait velocity in senior people. An easy test for detecting mobility impairment in community elderly. <i>Journal of Nutrition, Health and Aging</i>, <b>8</b>, 340-343.

Morse, J.M., Black, C., Oberle, K., & Donahue, P. (1989). A prospective study to identify the fall-prone patient. <i>Social Science and Medicine</i>, <b>28</b>, 81-86.

Myers, H., & Nikoletti, S. (2003). Fall risk assessment: A prospective investigation of nurses' clinical judgment and risk assessment tools in predicting patient falls. <i>International Journal of Nursing Practice</i>, <b>9</b>, 158-165.

O'Connell, B., Cockayne, M., Wellman, D., & Baker, L. (2005). Fall risk factors and the nature of falls in inpatient oncology and palliative care settings. <i>Contemporary Nurse</i>, <b>18</b>, 247-257.

Overcash, J. (1998). Symptom management in the geriatric patient. <i>Cancer Control</i>, <b>5</b>(3, Suppl. 1), 46-47.

Overcash, J.A. (2004). Using narrative research to understand the quality of life of older women with breast cancer. <i>Oncology Nursing Forum</i>, <b>31</b>, 1153-1159.

Overcash, J.A., Beckstead, J., Extermann, M., & Cobb, S. (2005). The abbreviated comprehensive geriatric assessment (aCGA): A retrospective analysis. <i>Critical Reviews in Oncology/Hematology</i>, <b>54</b>, 129-136.

Overcash, J.A., Beckstead, J., Moody, L., Extermann, M., & Cobb, S. (2006). The abbreviated Comprehensive Geriatric Assessment (aCGA) for use in the older cancer patient as a prescreen: Scoring and interpretation. <i>Critical Reviews in Oncology/Hematology</i>, <b>59</b>, 205-210.

Pearse, H., Nicholson, L., & Bennett, M. (2004). Falls in hospices: A cancer network observational study of fall rates and risk factors. <i>Palliative Medicine</i>, <b>18</b>, 478-481.

Pluijm, S.M., Smit, J.H., Tromp, E.A., Stel, V.S., Deeg, D.J., Bouter, L.M., et al. (2006). A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: Results of a 3-year prospective study. <i>Osteoporosis International</i>, <b>56</b>, 417-425.

Podsiadlo, D., & Richardson, S. (1991). The timed "Up and Go": A test of basic functional mobility for frail elderly persons. <i>Journal of the American Geriatrics Society</i>, <b>39</b>, 142-148.

The prevention of falls in later life. (1987). <i>Danish Medical Bulletin</i>, <b>34</b>(Suppl. 4), 1-24.

Salter, A.E., Khan, K.M., Donaldson, M.G., Davis, J.C., Buchanan, J., Abu-Laban, R.B., et al. (2006). Community-dwelling seniors who present to the emergency department with a fall do not receive guideline care and their fall risk profile worsens significantly: A 6-month prospective study. <i>Osteoporosis International</i>, <b>17</b>, 672-683.

Sheeran, T., Brown, E.L., Nassisi, P., & Bruce, M.L. (2004). Does depression predict falls among home health patients? Using a clinical research partnership to improve the quality of geriatric care. <i>Home Healthcare Nurse</i>, <b>22</b>, 384-389.

Stevens, J.A. (2005). Falls among older adults—Risk factors and prevention strategies. <i>Journal of Safety Research</i>, <b>36</b>, 409-411.

Stevens, J.A., Powell, K.E., Smith, S.M., Wingo, P.A., & Sattin, R.W. (1997). Physical activity, functional limitations, and the risk of fall-related fractures in community-dwelling elderly. <i>Annals of Epidemiology</i>, <b>7</b>, 54-61.

Stevens, J.A., & Sogolow, E.D. (2005). Gender differences for non-fatal unintentional fall related injuries among older adults. <i>Injury Prevention</i>, <b>11</b>, 115-119.

Suzuki, T., Kim, H., Yoshida, H., & Ishizaki, T. (2004). Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women. <i>Journal of Bone and Mineral Metabolism</i>, <b>22</b>, 602-611.

Tinetti, M.E., Baker, D.I., McAvay, G., Claus, E.B., Garrett, P., Gottschalk, M., et al. (1994). A multifactorial intervention to reduce the risk of falling among elderly people living in the community. <i>New England Journal of Medicine</i>, <b>331</b>, 821-827.

Tinetti, M.E., Mendes de Leon, C.F., Doucette, J.T., & Baker, D.I. (1994). Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. <i>Journal of Gerontology</i>, <b>49</b>, M140-M147.

Turcu, A., Toubin, S., Mourey, F., D'Athis, P., Manckoundia, P., & Pfitzenmeyer, P. (2004). Falls and depression in older people. <i>Gerontology</i>, <b>50</b>, 303-308.

Vellas, B.J., Wayne, S.J., Romero, L., Baumgartner, R.N., Rubenstein, L.Z., & Garry, P.J. (1997). One-leg balance is an important predictor of injurious falls in older persons. <i>Journal of the American Geriatrics Society</i>, <b>45</b>, 735-738.

Visovsky, C. (2006). The effects of neuromuscular alterations in elders with cancer. <i>Seminars in Oncology Nursing</i>, <b>22</b>, 36-42.

Wolf, S.L., Barnhart, H.X., Kutner, N.G., McNeely, E., Coogler, C., & Xu, T. (2003). Selected as the best paper in the 1990s: Reducing frailty and falls in older persons: An investigation of tai chi and computerized balance training. <i>Journal of the American Geriatrics Society</i>, <b>51</b>, 1794-1803.

Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., et al. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. <i>Journal of Psychiatric Research</i>, <b>17</b>, 37-49.