FALLS, FALL SEQUELAE, AND HEALTHCARE USE IN THE COMMUNITY DWELLING ELDERLY WITH A HISTORY OF CANCER

FALLS, FALL SEQUELAE, AND HEALTHCARE USE IN THE COMMUNITY DWELLING ELDERLY WITH A HISTORY OF CANCER By Sandra Lee Spoelstra Cancer survivors are living longer, but continue to encounter physical, psychosocial, and economic impacts of their cancer until the end of life. Of all types of injuries, falls pose the most serious threat to quality of life in the elderly. The hypothesis in this study was that communitydwelling elderly cancer survivors experience the influence of the disease or treatment of cancer and have increased falls and fall sequelae with increased use of health care subsequent to a fall. If it can be shown that elderly cancer survivors experience a higher rate of falls, a convincing case can be made for modification of nursing practice, taking cancer history into account when assessing and treating patients. There is a gap in the literature with few studies focusing on falls, fractures, or health care use in elderly survivors subsequent to cancer. This study was an analysis of data from the Michigan Home and Community Based Services program combined with information from the Cancer Registry; exploring, comparing, and contrasting in those with and without a cancer diagnosis, the clinical presentation of falls, fall sequelae, and use of healthcare, in a vulnerable, disparate community-dwelling elderly patient population. Specific aims were: 1) after adjusting for sociodemographic characteristics, medications, comorbidities, and frailty to determine the extent to which patients with a cancer diagnosis experience a greater number of falls, fractures, Emergency Room use, hospitalization, or nursing home placement, in the year following the cancer diagnosis compared with those patients with no diagnosis of cancer; and if there are differences in the number of falls among cancer patients according to site, stage, or cancer treatment; and 2) to examine if the effects of frailty variables on falls are different with respect to site, stage, or cancer treatment. An aging and nursing model of care were synthesized for use as a conceptual model to guide this study. This was a longitudinal, retrospective, cohort study comparing 865 with cancer to 8617 without cancer. Generalized Estimating Equations modeling was used. Findings include mean age was 77.1 years, 67.8% female, 74.0% Caucasian. Cancer diagnosis was stage 2 or later for 92.7%. Cancer survivors‘ fall rate was 32.7% compared to 29.4% in those without cancer. Adjusted odds ratios (ORs) of falls were: 1.16 (95% Confidence Interval [CI]=1.02, 1.33) for those with cancer versus those without cancer; 1.12 (95% CI=1.03, 1.22) for male versus female, 1.29 (95% CI=1.19, 1.40) for antidepressants versus none, 1.53 (95% CI=1.41, 1.65) short-term memory recall problems versus none, 1.45 (95% CI=1.32, 1.59) for evidence of pain daily versus none, 1.56 (95% CI=1.37, 1.77) for weight loss versus none, and 1.07 (95% CI=1.04, 1.12) for comorbidities versus none. ORs for increased fractures were 1.28 (95% CI= 1.17, 1.40) for daily pain versus none, and 1.61 (95% CI=1.11, 1.22) for comorbidities versus none. The odds were smaller with age OR= 0.95 (95% CI=0.87, 0.99), for males versus females 0.76 (95% CI=0.67, 0.69), African Americans versus Whites 0.36 (95% CI=0.26, 0.51), and short-term memory recall problems versus none 0.91 (95% CI=0.83, 1.00). Cancer survivors fell at a higher rate, and the risk of fall was higher closer to the date of cancer diagnosis; however, fractures did not occur more. As elderly cancer survivor‘s transition through life, clinicians need to be aware that these patients are prone to increased falls, assess risk, and implement fall prevention measures. Nurses can integrate fall risk assessment and behavioral and psychological interventions to prevent the onset of falls. Fall incidents should be used to prompt reassessment of the underlying cause, with subsequent interventions to prevent further falls. Copyright by SANDRA LEE SPOELSTRA 2010