[en] [en] BACKGROUND: Falls and fall-related injuries are a major public health problem. Data on falls in older persons with cancer is limited and robust data on falls within those with a frailty profile are missing. The aim of this study is to investigate the incidence and predictive factors for falls and fall-related injuries in frail older persons with cancer.
METHODS: This study is a secondary data analysis from data previously collected in a large prospective multicenter observational cohort study in older persons with cancer in 22 Belgian hospitals (November 2012-February 2015). Patients ≥70 years with a malignant tumor and a frailty profile based on an abnormal G8 score were included upon treatment decision and evaluated with a Geriatric Assessment (GA). At follow-up, data on falls and fall-related injuries were documented.
RESULTS: At baseline 2141 (37.2%) of 5759 included patients reported at least one fall in the past 12 months, 1427 patients (66.7%) sustained an injury. Fall-related data of 3681 patients were available at follow-up and at least one fall was reported by 769 patients (20.9%) at follow-up, of whom 289 (37.6%) fell more than once and a fall-related injury was reported by 484 patients (62.9%). Fear of falling was reported in 47.4% of the patients at baseline and in 55.6% of the patients at follow-up. In multivariable analysis, sex and falls history in the past 12 months were predictive factors for both falls and fall-related injuries at follow-up. Other predictive factors for falls, were risk for depression, cognitive impairment, dependency in activities of daily living, fear of falling, and use of professional home care.
CONCLUSION: Given the high number of falls and fall-related injuries and high prevalence of fear of falling, multifactorial falls risk assessment and management programs should be integrated in the care of frail older persons with cancer. Further studies with long-term follow-up, subsequent impact on cancer treatment and interventions for fall prevention, and integration of other important topics like medication and circumstances of a fall, are warranted.
TRIAL REGISTRATION: B322201215495.
Disciplines :
Oncology
Author, co-author :
Kenis, Cindy; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium ; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium ; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
Decoster, Lore; Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
Flamaing, Johan; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium ; Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven - University of Leuven, Leuven, Belgium
Debruyne, Philip R; Department of Medical Oncology, Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium & Medical Technology Research Centre (MTRC), School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
De Groof, Inge; Department of Geriatric Medicine, St. Augustinus, Wilrijk, Belgium
Focan, Christian; Department of Oncology, Clinique CHC Montlégia, Liège, Belgium
Cornélis, Frank; Department of Medical Oncology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
Verschaeve, Vincent; Department of Medical Oncology, GHDC Grand Hôpital de Charleroi, Charleroi, Belgium
Bachmann, Christian; Department of Geriatric Medicine, AZ Sint-Lucas, Ghent, Belgium
Bron, Dominique; Department of Hematology, ULB Institut Jules Bordet, Brussels, Belgium
Van den Bulck, Heidi; Department of Medical Oncology, Imelda hospital, Bonheiden, Belgium
Schrijvers, Dirk; Department of Medical Oncology, ZNA Middelheim, Antwerp, Belgium
Langenaeken, Christine; Department Medical Oncology, AZ Klina, Brasschaat, Belgium
Specenier, Pol; Department of Medical Oncology, University Hospital Antwerp, Antwerp, Belgium
Jerusalem, Guy ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'oncologie médicale
Praet, Jean-Philippe; Department of Geriatric Medicine, CHU St-Pierre, Free Universities Brussels, Brussels, Belgium
De Cock, Jessie; Department of Geriatric Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
Lobelle, Jean-Pierre; Department of Oncology, Laboratory of Experimental Oncology, KU Leuven - University of Leuven, Leuven, Belgium
Wildiers, Hans; Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium ; Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
Milisen, Koen ; Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium. koen.milisen@kuleuven.be ; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium. koen.milisen@kuleuven.be
FOD Volksgezondheid - Federale Overheidsdienst Volksgezondheid - Veiligheid van de Voetselketen en Leefmilieu
Funding text :
This study was funded by the Cancer Plan 2012–2015, a grant provided by the Federal Public Service of Health, Food Chain Safety and Environment, Belgium (KPC_24_A_025).HW is a recipient of a grant of the ‘Fonds Voor Wetenschappelijk Onderzoek Vlaanderen’ (1802211 N).
Lamb SE, Jørstad-Stein EC, Hauer K, Becker C. Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. J Am Geriatr Soc. 2005;53(9):1618–22.
Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing. 2006;35(1):5–10.
WHO Global Report on Falls Prevention in Older Age. https://www.who.int/ageing/publications/Falls_prevention7March.pdf?ua=1. Accessed 23 Apr 2021.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.
Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35 Suppl 2:ii37–41.
Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693–8.
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27(17):2758–65.
World Cancer Report: Cancer Research for Cancer Prevention. https://publications.iarc.fr/Non-Series-Publications/World-Cancer-Reports/World-Cancer-Report-Cancer-Research-For-Cancer-Prevention-2020. Accessed 23 Apr 2021.
Vande Walle N, Kenis C, Heeren P, et al. Fall predictors in older cancer patients: a multicenter prospective study. BMC Geriatr. 2014;14:135.
Wildes TM, Maggiore RJ, Tew WP, et al. Factors associated with falls in older adults with cancer: a validated model from the Cancer and aging research group. Support Care Cancer. 2018;26(10):3563–70.
Zhang X, Sun M, Liu S, et al. Risk factors for falls in older patients with cancer. BMJ Support Palliat Care. 2018;8(1):34–7.
Mohile SG, Fan L, Reeve E, et al. Association of cancer with geriatric syndromes in older Medicare beneficiaries. J Clin Oncol. 2011;29(11):1458–64.
Spoelstra SL, Given BA, Schutte DL, Sikorskii A, You M, Given CW. Do older adults with cancer fall more often? A comparative analysis of falls in those with and without cancer. Oncol Nurs Forum. 2013;40(2):E69–78.
Wildes TM, Dua P, Fowler SA, et al. Systematic review of falls in older adults with cancer. J Geriatr Oncol. 2015;6(1):70–83.
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.
Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr, Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004;52(4):625–34.
Mohile SG, Xian Y, Dale W, et al. Association of a cancer diagnosis with vulnerability and frailty in older Medicare beneficiaries. J Natl Cancer Inst. 2009;101(17):1206–15.
Lang PO, Michel JP, Zekry D. Frailty syndrome: a transitional state in a dynamic process. Gerontology. 2009;55(5):539–49.
Reiser E, Pötsch N, Seebacher V, et al. Impact of frailty on the management of patients with gynecological cancer aged 80 years and older. Arch Gynecol Obstet. 2021;303(2):557–63.
Sattar S, Alibhai SM, Spoelstra SL, Fazelzad R, Puts MT. Falls in older adults with cancer: a systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer. 2016;24(10):4459–69.
Sattar S, Haase K, Kuster S, et al. Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer. 2021;29(1):21–33.
Kenis C, Decoster L, Flamaing J, et al. Adherence to geriatric assessment-based recommendations in older patients with cancer: a multicenter prospective cohort study in Belgium. Ann Oncol. 2018;29(9):1987–94.
Liuu E, Canouï-Poitrine F, Tournigand C, et al. Accuracy of the G-8 geriatric-oncology screening tool for identifying vulnerable elderly patients with cancer according to tumour site: the ELCAPA-02 study. J Geriatr Oncol. 2014;5(1):11–9.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.
Sharma M, Loh KP, Nightingale G, Mohile SG, Holmes HM. Polypharmacy and potentially inappropriate medication use in geriatric oncology. J Geriatr Oncol. 2016;7(5):346–53.
Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol. 1982;5(6):649–55.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.
Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997;72(1–2):95–7.
Lee KA, Hicks G, Nino-Murcia G. Validity and reliability of a scale to assess fatigue. Psychiatry Res. 1991;36(3):291–8.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1):37–49.
Guigoz Y, Vellas B. The Mini nutritional assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history and validation. Nestle Nutr Workshop Ser Clin Perform Programme. 1999;1:3–11 discussion 11-12.
Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56(6):M366–72.
O'Halloran AM, Pénard N, Galli A, Fan CW, Robertson IH, Kenny RA. Falls and falls efficacy: the role of sustained attention in older adults. BMC Geriatr. 2011;11:85.
Milisen K, Coussement J, Flamaing J, et al. Fall prediction according to nurses' clinical judgment: differences between medical, surgical, and geriatric wards. J Am Geriatr Soc. 2012;60(6):1115–21.
Milisen K, Staelens N, Schwendimann R, et al. Fall prediction in inpatients by bedside nurses using the St. Thomas's risk assessment tool in falling elderly inpatients (STRATIFY) instrument: a multicenter study. J Am Geriatr Soc. 2007;55(5):725–33.
Sattar S, Spoelstra SL, Alibhai SMH, Puts MTE. Circumstances of falls and fear of falling in community-dwelling older adults with cancer: results from a mixed-methods study. J Geriatr Oncol. 2019;10(1):105–11.
Sammels M, Vandesande J, Vlaeyen E, Peerlinck K, Milisen K. Falling and fall risk factors in adults with haemophilia: an exploratory study. Haemophilia. 2014;20(6):836–45.
Puts MT, Monette J, Girre V, et al. The fall rate of older community-dwelling cancer patients. Support Care Cancer. 2013;21(3):775–83.
Stone CA, Lawlor PG, Savva GM, Bennett K, Kenny RA. Prospective study of falls and risk factors for falls in adults with advanced cancer. J Clin Oncol. 2012;30(17):2128–33.
Edwards BJ, Sun M, Zhang X, et al. Fractures frequently occur in older cancer patients: the MD Anderson Cancer Center experience. Support Care Cancer. 2018;26(5):1561–8.
Sattar S, Alibhai SMH, Spoelstra SL, Puts MTE. The assessment, management, and reporting of falls, and the impact of falls on cancer treatment in community-dwelling older patients receiving cancer treatment: results from a mixed-methods study. J Geriatr Oncol. 2019;10(1):98–104.
Aburub AS, Phillips SP, Curcio CL, Guerra RO, Auais M. Fear of falling in community-dwelling older adults diagnosed with cancer: a report from the international mobility in aging study (IMIAS). J Geriatr Oncol. 2020;11(4):603–9.
Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008;37(1):19–24.
Campbell AJ, Spears GF, Borrie MJ. Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men. J Clin Epidemiol. 1990;43(12):1415–20.
Ward PR, Wong MD, Moore R, Naeim A. Fall-related injuries in elderly cancer patients treated with neurotoxic chemotherapy: a retrospective cohort study. J Geriatr Oncol. 2014;5(1):57–64.
Jehu DA, Davis JC, Barha CK, et al. Sex differences in subsequent falls and falls risk: a prospective cohort study in older adults. Gerontology. 2022;68(3):272–9.
Kenis C, Decoster L, Van Puyvelde K, et al. Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol. 2014;32(1):19–26.
Muir SW, Gopaul K, Montero Odasso MM. The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing. 2012;41(3):299–308.
Murphy SL, Dubin JA, Gill TM. The development of fear of falling among community-living older women: predisposing factors and subsequent fall events. J Gerontol A Biol Sci Med Sci. 2003;58(10):M943–7.
Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the falls efficacy scale-international (FES-I). Age Ageing. 2005;34(6):614–9.
Turner JP, Shakib S, Singhal N, et al. Prevalence and factors associated with polypharmacy in older people with cancer. Support Care Cancer. 2014;22(7):1727–34.
de Jong MR, Van der Elst M, Hartholt KA. Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf. 2013;4(4):147–54.
