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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.
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References
Alcee, D. (2000). The experience of a community hospital in quantifying and reducing patient falls. Journal of Nursing Care Quality, 14, 43-53.
Anstey, K. J., Burns, R., von Sanden, C., & Luszcz, M. A. (2008). Psychological well-being is an independent predictor of falling in an 8-year follow-up of older adults. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 63, 249-257.
Byers, V., Arrington, M. E., & Finstuen, K. (1990). Predictive risk factors associated with stroke patient falls in acute care settings. Journal of Neuroscience Nursing, 22, 147-154.
Capone, L. J., Albert, N. M., Bena, J. F., & Morrison, S. M. (2010). Characteristics of hospitalized cancer patients who fall. Journal of Nursing Care Quality, 25, 216-223. doi:10.1097/NCQ.0b013e3181d4a1ce
Centers for Medicare and Medicaid Services. (2012). Hospital-acquired conditions (present on admission indicator). Retrieved from http://www.cms.hhs.gov/HospitalAcqCond/01_Overview.asp
Chelly, J. E., Conroy, L., Miller, G., Elliott, M. N., Horne, J. L., & Hudson, M. E. (2008). Risk factors and injury associated with falls in elderly hospitalized patients in a community hospital. Journal of Patient Safety, 4, 178-183. doi:10.1097/PTS.0b013e3181841802
Chen, J. S., Simpson, J. M., March, L. M., Cameron, I. D., Cumming, R. G., Lord, S. R., … Sambrook, P. N. (2008). Risk factors for fracture following a fall among older people in residential care facilities in Australia. Journal of the American Geriatrics Society, 56, 2020-2026. doi:10.1111/j.1532-5415.2008.01954.x
Dean, G., Spears, L., Ferrell, B. R., Quan, W. D., Groshon, S., & Mitchell, M. S. (1995). Fatigue in patients with cancer receiving interferon alpha. Cancer Practice, 3, 164-172.
Dharmarajan, T. S., Avula, S., & Norkus, E. P. (2006). Anemia increases risk for falls in hospitalized older adults: An evaluation of falls in 362 hospitalized, ambulatory, long term care, and community patients. Journal of the American Medical Directors Association, 7, 287-293. doi:10.1016/j.jamda.2005.10.010
Dykes, P. C., Carroll, D. L., Hurley, A. C., Benoit, A., & Middleton, B. (2009). Why do patients in acute care hospitals fall? Can falls be prevented? Journal of Nursing Administration, 39, 299-304. doi:10.1097/NNA.0b013e3181a7788a
Enloe, M., Wells, T. J., Mahoney, J., Pak, M., Gangnon, R. E., Pellino, T. A., … Leahy-Gross, K. (2005). Falls in acute care: An academic medical center six-year review. Journal of Patient Safety, 1, 208-214. doi:10.1097/01.jps.0000195776.91068.93
Fisher, I., Krauss, M., Dunagan, W., Birge, S., Hitcho, E., Johnson, S., … Fraser, V. J. (2005). Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital. Infection Control and Hospital Epidemiology, 26, 822-827. doi:10.1086/502500
Halfon, P., Eggli, Y., Van Melle, G., & Vagnair, A. (2001). Risk of falls for hospitalized patients: A predictive model based on routinely available data. Journal of Clinical Epidemiology, 54, 1258-1266.
Hendrich, A., Bender, P., & Nyhuis, A. (2003). Validation of the Hendrich II Fall Risk Model: A large concurrent case/control study of hospitalized patients. Applied Nursing Research, 16, 9-21. doi:10.1053/apnr.2003.YAPNR2
Hitcho, E. B., Krauss, M. J., Birge, S., Claiborne Dunagan, W., Fischer, I., Johnson, S., … Fraser, V. J. (2004). Characteristics and circumstances of falls in hospital setting: A prospective analysis. Journal of General Internal Medicine, 19, 732-739.
Holley, S. (2000). Cancer-related fatigue: Suffering a different fatigue. Cancer Practice, 8, 87-95. doi:10.1046/j.1523-5394.2000.82007.x
Holley, S., & Borger, D. (2001). Energy for living with cancer: Preliminary findings of a cancer rehabilitation group intervention study. Oncology Nursing Forum, 28, 1393-1396.
Inouye, S. K., Studenski, S., Tinetti, M. E., & Kuchel, G. A. (2007). Geriatric syndromes: Clinical, research, and policy implications of a core geriatric concept. Journal of the American Geriatrics Society, 55, 780-791. doi:10.1111/j.1532-5415.2007.01156.x
Janken, J. K., Reynolds, B. A., & Swiech, K. (1986). Patient falls in the acute care setting: Identifying risk factors. Nursing Research, 35, 215-219.
Krauss, M. J., Nguyen, S. L., Dunagan, W. C., Birge, S., Constantinou, E., Johnson, S., … Fraser, V. J. (2007). Circumstances of patient falls and injuries in 9 hospitals in a midwestern healthcare system. Infection Control and Hospital Epidemiology, 28, 544-550. doi:10.1086/513725
Leveille, S. G., Jones, R. N., Kiely, D. K., Hausdorff, J. M., Shmerling, R. H., Guralnik, J. M., … Bean, J. F. (2009). Chronic musculoskeletal pain and the occurrence of falls in an older population. JAMA, 302, 2214-2221. doi:10.1001/jama.2009.1738
Morse, J. M., Morse, R. M., & Tylko, S. J. (1989). Development of a scale to identify the fall-prone patient. Canadian Journal on Aging, 8, 366-377. doi:10.1017/S0714980800008576
Morse, J. M., Tylko, S. J., & Dixon, H. A. (1987). Characteristics of the fall-prone patient. Gerontologist, 27, 516-522.
O'Connell, B. O., Baker, L., Gaskin, C. J., & Hawkins, M. T. (2007). Risk items associated with patient falls in oncology and medical settings. Journal of Nursing Care Quality, 22, 130-137.
Oliver, D., Britton, M., Seed, P., Martin, F. C., & Hopper, A. H. (1997). Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: Case-control and cohort studies. BMJ, 315, 1049-1053.
Salameh, F., Cassuto, N., & Oliven, A. (2008). A simplified fall-risk assessment tool for patients hospitalized in medical wards. Israel Medical Association Journal, 10, 125-129.
Sherrington, C., Lord, S. R., Close, J. C., Barroclough, E., Taylor, M., O'Rouke, S., … Herbert, R. D. (2010). Development of a tool for predicting falls in rehabilitation settings (Predict_FIRST): A prospective cohort study. Journal of Rehabilitation Medicine, 42, 482-488. doi:10.2340/16501977-0550
Spoelstra, S., Given, B., von Eye, A., & Given, C. (2010a). Fall risk in community-dwelling elderly cancer survivors: A predictive model for gerontological nurses. Journal of Gerontological Nursing, 36, 52-60.
Spoelstra, S., Given, B., von Eye, A., & Given, C. (2010b). Falls in the community-dwelling elderly with a history of cancer. Cancer Nursing, 33, 149-155. doi:10.1097/NCC.0b013e3181bbbe8a
Whittemore, A. (1995). Logistic regression of family data from case-control studies. Biometrika, 82, 57-67.
Wong, C. A., Recktenwald, A. J., Jones, M. L., Waterman, B. M., Bollini, M. L., & Dunagan, W. C. (2011). The cost of serious fall-related injuries at three Midwestern hospitals. Joint Commission Journal on Quality and Patient Safety/Joint Commission Resources, 37(2), 81-87.