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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.
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References
Agostini, J. V., Han, L., & Tinetti, M. E. (2004). The relationship between number of medications and weight loss or impaired balance in older adults. Journal of the American Geriatrics Society, 52, 1719-1723. doi:10.1111/j.1532-5415.2004.52467.x
Alibhai, S. M., Breunis, H., Timilshina, N., Johnston, C., Tomlinson, G., Tannock, I., … Naglie, G. (2010). Impact of androgen-deprivation therapy on physical function and quality of life in men with nonmetastatic prostate cancer. Journal of Clinical Oncology, 28, 5038-5045. doi:10.1200/JCO.2010.29.8091
American Cancer Society. (2008). Cancer facts and figures, 2008. Atlanta, GA: Author.
Anderson, D., Kish L., & Cornell, R. G. (1978). On stratification, grouping, and matching. Scandinavian Journal of Statistics, 7, 61-66.
Balducci, L., & Extermann, M. (2000). Management of cancer in the older person: A practical approach. Oncologist, 5, 224-237. doi:10.1634/theoncologist.5-3-224
Ballinger, G. A. (2004). Using generalized estimating equations for longitudinal data analysis. Organizational Research Methods, 7, 127-150. doi:10.1177/1094428104263672
Barsevick, A. M., Dudley, W. N., & Beck, S. L. (2006). Cancer-related fatigue, depressive symptoms, and functional status: A mediation model. Nursing Research, 55, 366-372.
Blaauwbroek, R., Stant, A. D., Groenier, K. H., Kamps, W. A., Meyboom, B., & Postma, A. (2007). Health-related quality of life and adverse late effects in adult (very) long-term childhood cancer survivors. European Journal of Cancer, 43, 122-130. doi:10.1016/j.ejca.2006.08.003
Bylow, K., Mohile, S. G., Stadler, W. M., & Dale, W. (2007). Does androgen-deprivation therapy accelerate the development of frailty in older men with prostate cancer? A conceptual review. Cancer, 110, 2604-2613. doi:10.1016/j.urology.2008.03.032
Chen, C. C., Kenefick, A. L., Tang, S. T., & McCorkle, R. (2004). Utilization of comprehensive geriatric assessment in cancer patients. Critical Review of Oncology and Hematology, 49, 53-67. doi:10.1016/S1040-8428(03)00098-2
Chen, Z., Maricic, M., Aragaki, A. K., Mouton, C., Arendell, L., Lopez, A. M., … Chlebowski, R. T. (2009). Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: Results from the Women's Health Initiative. Osteoporosis International, 20, 527-536. doi:10.1007/s00198-008-0721-0
Cheville, A. L., Troxel, A. B., Basford, J. R., & Kornblith, A. B. (2008). Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. Journal of Clinical Oncology, 26, 2621-2629. doi:10.1200/jco.2007.12.3075
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
Deimling, G. T., Bowman, K. F., & Wagner, L. J. (2007). The effects of cancer-related pain and fatigue on functioning of older adult, long-term cancer survivors. Cancer Nursing, 30, 421-433. doi:10.1097/01.NCC.0000300168.88089.2b
Deimling, G. T., Sterns, S., Bowman, K. F., & Kahana, B. (2007). Functioning and activity participation restrictions among older adult, long-term cancer survivors. Cancer Investigation, 25, 106-116. doi:10.1080/07357900701224813
Delbaere, K., Close, J. C., Brodaty, H., Sachdev, P., & Lord, S. R. (2010). Determinants of disparities between perceived and physiological risk of falling among elderly people: Cohort study. BMJ, 341, c4165. doi:10.1136/bmj.c4165
DeSanto-Madeya, S., Bauer-Wu, S., & Gross, A. (2007). Activities of daily living in women with advanced breast cancer. Oncology Nursing Forum, 34, 841-846. doi:10.1188/07.ONF.841-846
Ferrans, C. E., Zerwic, J. J., Wilbur, J. E., & Larson, J. L. (2005). Conceptual model of health-related quality of life. Journal of Nursing Scholarship, 37, 336-342. doi:10.1111/j.1547-5069.2005.00058.x
Fox, S. W., & Lyon, D. (2007). Symptom clusters and quality of life in survivors of ovarian cancer. Cancer Nursing, 30, 354-361. doi:10.1097/01.NCC.0000290809.61206.ef
Freedman, V. A., Martin, L. G., Schoeni, R. F., & Cornman, J. C. (2008). Declines in late-life disability: The role of early- and mid-life factors. Social Science and Medicine, 66, 1588-1602.
Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004). Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting of care. Journal of Gerontology, 59, 255-263. doi:10.1093/gerona/59.3.M255
Gillespie, L., Robertson, M., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2012, CD007146.
Guilley, E., Ghisletta, P., Armi, F., Berchtold, A., d'Epinay, C. L., Michel, J., & Ribaupierre, A. D. (2008). Dynamics of frailty and ADL dependence in a five-year longitudinal study of octogenarians. Research on Aging, 30, 299-317. doi:10.1177/0164027507312115
Hawkins, M. M., Lancashire, E. R., Winter, D. L., Frobisher, C., Reulen, R. C., Taylor, A. J., … Jenney, M. (2008). The British Childhood Cancer Survivor Study: Objectives, methods, population structure, response rates and initial descriptive information. Pediatric Blood and Cancer, 50, 1018-1025. doi:10.1002/pbc.21335
Hewitt, M., Rowland, J. H., & Yancik, R. (2003). Cancer survivors in the United States: Age, health, and disability. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58, 82-91.
Holley, S. (2002). A look at the problem of falls among people with cancer. Clinical Journal of Oncology Nursing, 6, 193-197. doi:10.1188/02.CJON.193-197
Hurria, A., Lichtman, S. M., Gardes, J., Li, D., Limaye, S., Patil, S., … Kelly, E. (2007). Identifying vulnerable older adults with cancer: Integrating geriatric assessment into oncology practice. Journal of the American Geriatrics Society, 55, 1604-1608.
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
Kagan, S. H. (2004). Shifting perspectives: Gero-oncology nursing research. Oncology Nursing Forum, 31, 293-299.
Keating, N. L., Nørredam, M., Landrum, M. B., Huskamp, H. A., & Meara, E. (2005). Physical and mental health status of older long-term cancer survivors. Journal of the American Geriatrics Society, 53, 2145-2152. doi:10.1111/j.1532-5415.2005.00507.x
Klabunde, C. N., Harlan, L. C., & Warren, J. L. (2006). Data sources for measuring comorbidity: A comparison of hospital records and Medicare claims for cancer patients. Medical Care, 44, 921-928.
Koroukian, S. M., Murray, P., & Madigan, E. (2006). Comorbidity, disability, and geriatric syndromes in elderly cancer patients receiving home health care. Journal of Clinical Oncology, 24, 2304-2310.
Kupper, L. L., Karon, J. M., Kleinbaum, D. G., Morgenstern, H., & Lewis, D. K. (1981). Matching in epidemiologic studies: Validity and efficiency considerations. Biometrics, 37, 271-291.
Landi, T., Tua, E., Onder, G., Carrara, B., Sgadari, A., Rinaldi, C., … Bernabei, R. (2000). Minimum data set for home care: A valid instrument to assess frail older people living in the community. Medical Care, 38, 1184-1190. doi:10.1097/00005650-200012000-00005
LeBlanc, A. J., Tonner, M. C., & Harrington, C. (2000). Medicaid 1915(c) home and community-based services waivers across the states. Health Care Financing Review, 22, 159-174.
Limburg, C. E. (2007). Screening, prevention, detection, and treatment of cancer therapy-induced bone loss in patients with breast cancer. Oncology Nursing Forum, 34, 55-63. doi:10.1188/07.ONF.55-63
Luctkar-Flude, M. F., Groll, D. L., Tranmer, J. E., & Woodend, K. (2007). Fatigue and physical activity in older adults with cancer: A systematic review of the literature. Cancer Nursing, 30, E35-E45.
Malin, J. L., Kahn, K. L., Adams, J., Kwan, L., Laouri, M., & Ganz, P. A. (2002). Validity of cancer registry data for measuring the quality of breast cancer care. Journal of the National Cancer Institute, 94, 835-844. doi:10.1093/jnci/94.11.835
Mandelblatt, J. S., Lawrence, W. F., Cullen, J., Stanton, A. L., Krupnick, J. L., Kwan, L., & Ganz, P. A. (2006). Patterns of care in early-stage breast cancer survivors in the first year after cessation of active treatment. Journal of Clinical Oncology, 24, 77-84. doi:10.1200/jco.2005.02.2681
Mohile, S. G., Fan, L., Reeve, E., Jean-Pierre, P., Mustian, K., Peppone, L., … Dale, W. (2011). Association of cancer with geriatric syndromes in older Medicare beneficiaries. Journal of Clinical Oncology, 29, 1458-1464. doi:10.1200/JCO.2010.31.6695
Morris, J. N., Fries, B. E., Mehr, D. R., Hawes, C., Phillips, C., Mor, V., & Lipsitz, L. A. (1994). MDS Cognitive Performance Scale. Journal of Gerontology, 49, M174-M182. doi:10.1093/geronj/49.4.M174
Morris, J. N., Fries, B. E., Steel, K., Ikegami, N., Bernabei, R., Carpenter, G. I., … Topinkova, E. (1997). Comprehensive clinical assessment in community setting: Applicability of the MDS-HC. Journal of the American Geriatrics Society, 45, 1017-1024.
National Cancer Institute. (2013). Cancer Trends Progress Report—2011/2012 update. Retrieved from http://wwwprogressreport.cancer.gov
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.
Overcash, J. (2007). Prediction of falls in older adults with cancer: A preliminary study. Oncology Nursing Forum, 34, 341-346.
Overcash, J. A. (2008). Vitamin D in older patients with cancer. Clinical Journal of Oncology Nursing, 12, 655-662. doi:10.1188/08.CJON.655-662
Overcash, J. A., & Beckstead, J. (2008). Predicting falls in older patients using components of a comprehensive geriatric assessment. Clinical Journal of Oncology Nursing, 12, 941-949. doi:10.1188/08.CJON.941-949
Pautex, S., Herrmann, F. R., & Zulian, G. B. (2008). Factors associated with falls in patients with cancer hospitalized for palliative care. Journal of Palliative Medicine, 11, 878-884. doi:10.1089/jpm.2007.0241
Rowland, J. H., & Yancik, R. (2006). Cancer survivorship: The face of aging, comorbidity, and quality care. Journal of the National Cancer Institute, 98, 504-505.
Rubenstein, L. (2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(Suppl. 2), ii37-ii41. doi:10.1093/ageing/afl084
Rubin, D. B. (1973). Matching to remove bias in observational studies. Biometrics, 29, 159-183.
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(2), 52-60. doi:10.3928/00989134-20100108-01
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
Staat, K., & Segatore, M. (2005). The phenomenon of chemo brain. Clinical Journal of Oncology Nursing, 9, 713-721. doi:10.1188/05.cjon.713-721
Stevens, J. A., & Sogolow, E. D. (2005). Gender differences for non-fatal unintentional fall-related injuries among older adults. Injury Prevention, 11, 115-119. doi:10.1136/ip.2004.005835
Stone, C. A., Lawlor, P. G., & Kenny, R. A. (2011). How to identify patients with cancer at risk of falling: A review of the evidence. Journal of Palliative Medicine, 14, 221-230. doi:10.1089/jpm.2010.0326
Tinetti, M. E. (2003). Clinical practice. Preventing falls in elderly persons. New England Journal of Medicine, 348, 42-49. doi:10.1056/NEJMcp020719
Tinetti, M. E., Allore, H., Araujo, K. L., & Seeman, T. (2005). Modifiable impairments predict progressive disability among older persons. Journal of Aging and Health, 17, 239-256.
Travis, L. B., & Yahalom, J. (2008). Cancer survivorship: Facing forward. Hematology/Oncology Clinics of North America, 22, 365-371.
van Helden, S., van Geel, A., Geusens, P. P., Kessels, A., Nieuwenhuijzen Kruseman, A., & Brink, P. (2008). Bone and fall-related fracture risks in women and men with a recent clinical fracture. Journal of Bone and Joint Surgery, 90, 241-248. doi:10.2106/JBJS. G.00150
Visovsky, C. (2006). The effects of neuromuscular alterations in elders with cancer. Seminars in Oncology Nursing, 22, 36-42. doi:10.1016/j.soncn.2005.10.010
Waltman, N., Gross, G., Lindsey, A., Ott, C., Twiss, J., & Berg, K. (2006). Prevention of falls and osteoporotic fractures in postmenopausal breast cancer survivors [Abstract 27]. Oncology Nursing Forum, 33, 402.
Webster, A. C., Supramaniam, R., O'Connell, D. L., Chapman, J. R., & Craig, J. C. (2010). Validity of registry data: Agreement between cancer records in an end-stage kidney disease registry (voluntary reporting) and a cancer register (statutory reporting). Nephrology, 15, 491-501. doi:10.1111/j.1440-1797.2010.01297.x
Yabroff, K. R., McNeel, T. S., Waldron, W. R., Davis, W. W., Brown, M. L., Clauser, S., & Lawrence, W. F. (2007). Health limitations and quality of life associated with cancer and other chronic diseases by phase of care. Medical Care, 45, 629-637.
Yancik, R., & Ries, L. A. (2000). Aging and cancer in America. Demographic and epidemiologic perspectives. Hematology/Oncology Clinics of North America, 14, 17-23. doi:10.1016/S0889-8588(05)70275-6
Zeger, S. L., Liang, K. Y., & Albert, P. S. (1988). Models for longitudinal data: A generalized estimating equation approach. Biometrics, 44, 1049-1060. doi:10.2307/2531734