Fall predictors in older cancer patients: a multicenter prospective study

BMC Geriatrics

Koen Milisen²  Hans Wildiers³  Jean-Pierre Lobelle⁵  Johan Flamaing⁷  Godelieve Conings⁶  Ingo Beyer¹  Lore Decoster⁶  Katrien Van Puyvelde¹  Pieter Heeren²  Cindy Kenis⁴  Nathalie Vande Walle⁸ 

[1]Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Brussels, Belgium

[2]Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Kapucijnenvoer 35/4, 3000 Leuven, Belgium

[3]Department of Oncology, KU Leuven, Leuven, Belgium

[4]Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium

[5]Beernem, Belgium

[6]Department of Medical Oncology, Oncologisch Centrum, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium

[7]Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium

[8]Department of Geriatric Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium

关键词: Geriatric assessment;    Falls;    Cancer;    Older persons;   

Others  :  1089800
DOI  :  10.1186/1471-2318-14-135

 received in 2014-09-03, accepted in 2014-12-11,  发布年份 2014

【 摘 要 】

Background

In the older population falls are a common problem and a major cause of morbidity, mortality and functional decline. The etiology is often multifactorial making the identification of fall predictors essential for preventive measures. Despite this knowledge, data on falls within the older cancer population are limited. The objective of this study was to evaluate the occurrence of falls within 2 to 3 months after cancer treatment decision and to identify predictors of falls (≥1 fall) during follow-up.

Methods

Older patients (70 years or more) with a cancer treatment decision were included. At baseline, all patients underwent geriatric screening (G8 and Flemish Triage Risk Screening Tool), followed by a geriatric assessment including living situation, activities of daily living (ADL), instrumental activities of daily living (IADL), fall history in the past 12 months, fatigue, cognition, depression, nutrition, comorbidities and polypharmacy. Questionnaires were used to collect follow-up (2–3 months) data. Univariate and multivariate analyses were performed to identify predictors for falls (≥1 fall) during follow-up.

Results

At baseline, 295 (31.5%) of 937 included patients reported at least one fall in the past 12 months with 88 patients (29.5%) sustaining a major injury. During follow-up (2–3 months), 142 (17.6%) patients fell, of whom 51.4% fell recurrently and 17.6% reported a major injury. Baseline fall history in the past 12 months (OR = 3.926), fatigue (OR = 0.380), ADL dependency (OR = 0.492), geriatric risk profile by G8 (OR = 0.471) and living alone (OR = 1.631) were independent predictors of falls (≥1 fall) within 2–3 months after cancer treatment decision.

Conclusion

Falls are a serious problem among older cancer patients. Geriatric screening and assessment data can identify patients at risk for a fall. A patient with risk factors associated with falls should undergo further evaluation and intervention to prevent potentially injurious fall incidents.

【 授权许可】

   
2014 Vande Walle et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Dionyssiotis Y: Analyzing the problem of falls among older people. Int J Gen Med 2012, 5:805-813.
• [2]O’Halloran AM, Penard 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. BioMed Central Full Text
• [3]Rubenstein LZ: Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006, 35(Suppl 2):ii37-ii41.
• [4]Stone CA, Lawlor PG, Kenny RA: How to identify patients with cancer at risk of falling: a review of the evidence. J Palliat Med 2011, 14(2):221-230.
• [5]Ungar A, Rafanelli M, Iacomelli I, Brunetti MA, Ceccofiglio A, Tesi F, Marchionni N: Fall prevention in the elderly. Clin Cases Mineral Bone Metab: Off J Italian Soc Osteoporos Miner Metab Skeletal Dis 2013, 10(2):91-95.
• [6]Hanley A, Silke C, Murphy J: Community-based health efforts for the prevention of falls in the elderly. Clinical Int Aging 2011, 6:19-25.
• [7]Karlsson MK, Magnusson H, von Schewelov T, Rosengren BE: Prevention of falls in the elderly–a review. Osteoporos Int 2013, 24(3):747-762.
• [8]Lee J, Geller AI, Strasser DC: Analytical review: focus on fall screening assessments. PM R: J Inj Funct Rehabil 2013, 5(7):609-621.
• [9]Kenis C, Bron D, Libert Y, Decoster L, Van PK, Scalliet P, Cornette P, Pepersack T, Luce S, Langenaeken C, Rasschaert M, Allepaerts S, Van Rijswijk R, Milisen K, Flamaing J, Lobelle JP, Wildiers H: Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. Annals of oncology: official journal of the European Society for Medical Oncology/ESMO 2013, 24(5):1306-12.
• [10]Puts MT, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H: The fall rate of older community-dwelling cancer patients. Support Care Cancer 2013, 21(3):775-783.
• [11]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):2128-2133.
• [12]Hitcho EB, Krauss MJ, Birge S, Claiborne Dunagan W, Fischer I, Johnson S, Nast PA, Costantinou E, Fraser VJ: Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med 2004, 19(7):732-739.
• [13]Kenis C, Decoster L, Van Puyvelde K, De Greve J, Conings G, Milisen K, Flamaing J, Lobelle JP, Wildiers H: Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 2014, 32(1):19-26.
• [14]Bellera CA, Rainfray M, Mathoulin-Pelissier S, Mertens C, Delva F, Fonck M, Soubeyran PL: Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 2012, 23(8):2166-2172.
• [15]Deschodt M, Wellens NI, Braes T, De VA, Boonen S, Flamaing J, Moons P, Milisen K: Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools. Aging Clin Exp Res 2011, 23(5–6):421-426.
• [16]Soubeyran P, Bellera CA, Gregoire F, Blanc J, Ceccaldi J, Blanc-Bisson C, Mertens C, Mathoulin-Pelissier S, Fonck M, Rainfray M: Validation of a screening test for elderly patients in oncology. J Clin Oncol 2008., 26(Abstr 20568)
• [17]Abellan Van Kan G, Sinclair A, Andrieu S, Olde Rikkert M, Gambassi G, Vellas B: The Geriatric Minimum Data Set for clinical trials (GMDS). J Nutr Health Aging 2008, 12(3):197-200.
• [18]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, 185:914-919.
• [19]Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969, 9(3):179-186.
• [20]Lamb SE, Jorstad-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):1618-1622.
• [21]Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 1988, 319(26):1701-1707.
• [22]Milisen K, Coussement J, Flamaing J, Vlaeyen E, Schwendimann R, Dejaeger E, Surmont K, Boonen S: Fall prediction according to nurses’ clinical judgment: differences between medical, surgical, and geriatric wards. J Am Geriatr Soc 2012, 60(6):1115-1121.
• [23]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):189-198.
• [24]Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982, 17(1):37-49.
• [25]Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B: Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A: Biol Med Sci 2001, 56(6):M366-M372.
• [26]Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL: The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999, 15(2):116-122.
• [27]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):373-383.
• [28]Avlund K, Holstein BE: Functional ability among elderly people in three service settings: the discriminatory power of a new functional ability scale. Eur J Epidemiol 1998, 14(8):783-790.
• [29]Collins SL, Moore RA, McQuay HJ: The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 1997, 72(1–2):95-97.
• [30]Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, Mcfadden ET, Carbone PP: Toxicity and response criteria of the eastern-cooperative-oncology-group. Am J Clin Oncol-Cancer Clin Trials 1982, 5(6):649-655.
• [31]Yoo IY: Recurrent falls among community-dwelling older Koreans: prevalence and multivariate risk factors. J Gerontol Nurs 2011, 37(9):28-40.
• [32]Nowak A, Hubbard RE: Falls and frailty: lessons from complex systems. J R Soc Med 2009, 102(3):98-102.
• [33]Luciani A, Jacobsen PB, Extermann M, Foa P, Marussi D, Overcash JA, Balducci L: Fatigue and functional dependence in older cancer patients. Am J Clin Oncol 2008, 31(5):424-430.
• [34]Smee DJ, Anson JM, Waddington GS, Berry HL: Association between physical functionality and falls risk in community-living older adults. Curr Gerontol Geriatr Res 2012, 2012:864516.
• [35]Aoyama M, Suzuki Y, Onishi J, Kuzuya M: Physical and functional factors in activities of daily living that predict falls in community-dwelling older women. Geriatr Gerontol Int 2011, 11(3):348-357.
• [36]Helbostad JL, Leirfall S, Moe-Nilssen R, Sletvold O: Physical fatigue affects gait characteristics in older persons. J Gerontol A: Biol Med Sci 2007, 62(9):1010-1015.
• [37]Luctkar-Flude M, Groll D, Woodend K, Tranmer J: Fatigue and physical activity in older patients with cancer: a six-month follow-up study. Oncol Nurs Forum 2009, 36(2):194-202.
• [38]Cramp F, Byron-Daniel J: Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2012, 11:Cd006145.
• [39]AGS/BGS clinical practice guideline for prevention of falls in older persons. [http://www.medcats.com/FALLS/frameset.htm webcite.]
• [40]NICE guideline for assessment and prevention of falls in older people. [http://www.nice.org.uk/guidance/CG161 webcite]