Risk factors of falls among inpatients with cancer

Development and internal validation of a prediction model for patients with hematologic diseases of fall risk: a cohort study

BACKGROUND

To develop and internally validate a prediction model for identifying patients with hematologic diseases of fall risk.

RESEARCH DESIGN AND METHODS

This is a prospective cohort study from a prospective collection of data for 6 months. We recruited 412 patients with hematologic diseases in medical institutions and home environment of China. The outcome of the prediction model was fall or not. These variables were filtered via univariable logistic analysis, LASSO, and multivariable logistic analysis. We adopt an internal validation method of K-fold cross validation. The area under the ROC curve and the H-L test were used to evaluate the discrimination and calibration of the model.

RESULTS

Five influencing factors were identified multivariable logistic regression analysis. The established model equation is as follows: the H-L goodness-of-fit test of the model p > 0.05. The area under the ROC curve of train is 0.957 (95% CI: 0.936 ~ 0.978), and the area under the ROC curve of test is 0.962 (95% CI: 0.884 ~ 1), so the model calibration and discriminant validity are good.

CONCLUSION

Our equation has good sensitivity and specificity in predicting the fall risk of patients with hematologic diseases, and has certain positive significance for clinical assessment of their fall risk.

TRIAL REGISTRATION NUMBER

ChiCTR2200063940.

Effect of a fall prevention strategy for the older patients: A quasi-experimental study

AIM

To explore the effect of a fall prevention strategy on older patients based on the Patient Engagement Framework.

DESIGN

A longitudinal quasi-experimental quantitative design.

METHODS

Older patients who met the inclusion criteria were recruited from geriatric, oncology, neurology and cardiology departments of a teaching general hospital in China. Development of a fall prevention intervention strategy for older patients was based on the Patient Engagement Framework. Patients in the intervention group were given this fall prevention strategy (N = 58), and those in the control group were given conventional measures (N = 58). The following indicators were compared between the two groups after intervention: (a) number of falls; (b) Knowledge-Attitude-Practice (KAP) score; (c) Modified Fall Efficacy Scale score.

RESULTS

After the implementation of an intervention strategy in older patients, the number of falls decreased from 3 to 0; the score of KAP and Modified Fall Efficacy Scale was promoted (p < .05).

Risk factors for falls in hospitalized patients with cancer: A systematic review and meta-analysis

A primary cancer diagnosis has been confirmed as an important risk factor for falls, and the incidence of falls has been shown to be higher in patients who have undergone cancer treatment than in those who have not undergone cancer treatment. Falls during hospitalization increase the medical costs of additional treatment and falls-related mortality. Many falls are preventable and a good understanding of the predictors of falls in this population is needed. However, the risk factors for falls have not yet been identified. The purpose of this review was to identify the risk factors for falls in hospitalized patients with cancer. Eleven English and Chinese electronic databases were searched from their inception to April 2022 and the methodological quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Five studies involving 1237 patients with cancer were included. The meta-analysis identifies eleven risk factors for falls in hospitalized patients with cancer, including age, history of falls, opiates, benzodiazepines, steroids, antipsychotics, sedatives, radiation therapy, chemotherapy, the use of an assistive device and length of hospitalization. Based on the evidence presented in this article, healthcare workers have the capacity to help reduce fall risk through the development of preventive support strategies in this population. Multicenter, prospective studies of patients with cancer should be conducted to further identify and validate their risk factors for falls.

Fall predictors in hospitalized patients living with cancer: a case-control study

PURPOSE

To identify fall predictors and develop an assessment tool to be used for screening hospitalized cancer patients at risk for fall.

METHODS

A retrospective case-control study was conducted in 2018 at a cancer center in Northern Italy. The study participants were 448 adult cancer patients admitted to the oncology ward from 2009 to 2013. The case group consisted of 112 patients presenting at least one fall, while controls were randomly chosen by matching each case for age, sex, and admission period with three patients who did not fall. Data for the fall predictors were extracted from the electronic medical records. Conditional logistic regression was used to evaluate the association between patient's characteristics and fall risk.

RESULTS

The overall prevalence of patients having at least one candidate fall predictor was high (98%). Seven of the studied variables showed an independent association with fall risk at multivariate analysis. These were tumor site, the presence of neurologic diseases, gait imbalance disorders, fatigue, and the assumption of certain medications such as diuretics, hypnotics, and opioids (odds ratios and 95% confidence intervals in brackets were 3.78 (1.78-8.13), 2.26 (1.08-4.77), 4.22 (1.87-9.52), 2.76 (1.45-5.26), 2.66 (1.52-4.66), 2.41 (1.20-4.85), and 3.03 (1.68-5.45), respectively).

CONCLUSIONS

In this study, we identified falling risk factors in an Italian population of hospitalized cancer patients and developed a new risk assessment tool. An external validation is necessary before implementing our screening tool in clinical practice.

Characteristics of Inpatients With Blood Cancers Who Experience a Fall: A Retrospective Study

BACKGROUND

Inpatients with cancer are at the greatest risk for falling. Although studies have identified the characteristics of patients with cancer who fall, few studies have focused on the characteristics of patients with blood cancers who fall.

OBJECTIVES

The objectives of this study are to identify characteristics of inpatients with blood cancers who fall and implement fall-mitigation efforts through an enhanced assessment of chemotherapy-induced peripheral neuropathy.

METHODS

Descriptive design and retrospective review of 51 patient falls were used to identify characteristics of inpatients with cancer who fell.

FINDINGS

The majority of patients who fell were male (n = 33), and most falls occurred during the day shift (n = 24). Few patients were listed on the Morse Fall Risk Scale for mental status and forgetting limitations (n = 7), and most were not identified as a high fall risk (n = 30). The majority of falls were associated with toileting needs (n = 32). Patients spent a mean of 12.73 days in the hospital before falling. Thirty-two patients received chemotherapy prior to their fall, 25 of whom received neurotoxic chemotherapy.

Factors associated with falls in older women with breast cancer: the use of a brief geriatric screening tool in clinic

PURPOSE

Unintentional falls and breast cancer are common among older women, but the associations between them are understudied. We aimed to identify factors associated with falls in older women with breast cancer.

METHODS

We retrospectively reviewed clinical records of older women with breast cancer at Duke Medical Center who had completed the Senior Adult Oncology Program geriatric assessment. Characteristics were compared between women had had at least one fall in the past year and those who did not. Pearson's Chi-square tests and t tests were used for comparison of groups' characteristics. Logistic regression determined factors associated with falling.

RESULTS

We identified 425 women, age 76.2 years (range 65-89 years), at the time of the assessment. 118 (27.8%) women reported a fall in the prior year. Age, race, ethnicity, and time since diagnosis (all p > 0.05) were similar between groups. In univariate analyses, metastatic disease (p = 0.023) and history of endocrine therapy (p = 0.042) were more common among women who fell. Women who fell had lower systolic (p = 0.001), diastolic (p < 0.001) blood pressures, and SpO₂ (p = 0.018). Women who had fallen had a higher Charlson Comorbidity Index (CCI: p = 0.033), and were more likely to report using a walking aide (p < 0.001), nutritional issues (p = 0.006), and depression symptoms (p = 0.038). In multivariate analysis, falling was associated with low DBP (OR 0.93; p = 0.0017), low SpO₂ (OR 0.79; p = 0.0169), a higher CCI (OR 1.23; p = 0.0076), and depression symptoms (OR 1.61; p = 0.039).

CONCLUSIONS

Among older women with breast cancer, depressive symptoms, higher comorbidity level, and vital sign measurements were associated with having fallen.

Incidence and risk of falls in patients treated for hematologic malignancies in the Intensive Hematology Unit

Objective:

to determine the incidence and rate of risk of falls in adult patients treated for hematologic malignancies in the Intensive Hematology Unit of a reference hospital.

Method:

this is a retrospective observational study. A total of 101 patients were evaluated. The occurrence of falls was obtained from records of the unit and the predictive variables of the Hendrich II model were collected, namely: sex, presence of dizziness or vertigo, mental confusion, elimination problems, depression, use of benzodiazepines, use of anticonvulsants, and the Get up and Go test.

Results:

two fall events were reported in 101 patients (incidence of 1.98% over a 1.5-year period). Based on the cut-off point 5 of the Hendrich II Model, 30 patients (29.7%) were at risk of fall at the moment of hospital admission, 41 (40.6%) in the middle of the hospitalization period, and 38 (37.6%) at the moment of hospital discharge.

Conclusions:

patients treated for hematological malignancies presented low incidence and high risk of falls during hospitalization.

Risk Factors for Falls in Adult Cancer Survivors: An Integrative Review

PURPOSE

The aim of the study was to identify risk factors for falls among cancer survivors.

DESIGN

Integrative literature review.

METHODS

We searched PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and PEDro for studies investigating fall risk in cancer. Reports of randomized controlled trials, descriptive studies (quantitative and qualitative), and theoretical papers meeting predetermined criteria were included. Quality ratings of included studies were done, and data were extracted and compiled by two independent reviewers.

FINDINGS

Twenty-nine articles met inclusion criteria. Literature quality was moderate (median quality score: 1.67 out of 3 possible points). Heterogeneity of statistics and reporting methods precluded calculation of summary effect sizes, but physical function, cognitive function, balance/gait, and certain medication types appear to increase fall risk.

CONCLUSIONS AND CLINICAL RELEVANCE

Modifiable risk factors, such as those identified in this review, represent tangible intervention targets for rehabilitation professionals for decreasing the risk of falls among cancer survivors.