1. Falls and Fractures in Community Dwelling Elderly Cancer Survivors
Sandra Spoelstra, PhD, MSN, RN 1; Barbara Given, PhD, RN, FAAN 1; Charles Given, PhD 3; Alla Sikorskii, PhD 2; Debra Schutte, PhD, RN 1.
Affiliations: Michigan State University of Nursing, 1 College of Nursing, 2 Department of Statistics, 3 College of Human Medicine.
Design & Methodology
Longitudinal retrospective secondary cohort study
A comparison of 9,481community dwelling elderly age >65
8,617 without Cancer & 864 with Cancer
Minimum Data Set-Home Care & CA Registry
Home & Community Based Waiver Program in State of Michigan
Descriptive & GEE models compared those with & without cancer
Problem Statement
Cancer survivors are diagnosed at an older age, with treatment often complicated by comorbidity, which may exacerbate functional decline leading to falls & fractures.
Purposes. To examine the effect of cancer diagnosis on falls and fractures.
Hypotheses. Elderly cancer survivors experience the influence of the disease or treatment of cancer & have increased falls and fractures.
Results
Cancer: 64% solid tumors; 49% Stage III-IV.
Falls: cancer 33% (n=273); non-cancer 30% (n=2790)
ADL: cancer 13.23; non-cancer (range 0-52) summed
Memory : cancer 46% (n=395); non-cancer 52% (n=4471)
Daily pain: cancer 56% (n=466); non-cancer 58% (n=4598)
Weight loss: cancer 16% (n=141); non-cancer 7% (n=576)
Comorbidities: 90% with 1; & 36% with >2
Results
Mean age 77 years old, 62% Female, 74% White, 24% African American.
GEE Modeling: Falls occurred at a higher rate (p = .03) in cancer survivors; & risk of fall was higher closer to the date of cancer diagnosis. No associations were found (p > .05) between fractures & cancer.
Conclusion
A higher frequency of falls was found in elderly cancer survivors. No difference was found in fracture rates in this sample.
Conceptual Framework
Environment: housing, caregivers, time alone during day
Nursing & Research Implications
Nurses caring for cancer survivors need to be aware that fall risk is prevalent & conduct fall risk assessments followed by fall prevention interventions.
Nurses need to incorporate fall prevention interventions in the ‘Cancer Survivors Care Plan’ .
Replication of this study in a data set with more refined measures & a broader range in variation of frailty factors would allow better understanding of factors leading to falls in cancer survivors. Examining fall patterns in those with cancer compared to other chronic conditions may also be of interest.
CA survivors falls compared to those without CA
Odds Ratio
95% Confidence Interval
Cancer vs. no-cancer
1.16
1.02
1.33
Weight loss vs. none
1.56
1.37
1.77
Short-term memory recall problems vs. none/some
1.53
1.41
1.65
Pain daily versus none/some
1.45
1.32
1.59
Antidepressants vs. none
1.29
1.19
1.40
Male versus Female
1.12
1.03
1.22
Comorbidities vs. none
1.07
1.04
White vs. African American
0.83
1.28
Cancer:
-Type
-Stage
-Date of Diagnosis
Age, Sex, Race, Marital Status
Falls
Fractures
ADLs
Medications
Cognition
Comorbidity
-A synthesis of: The Life Course Aging Model (Elders, 1985) &
Health Related Quality of Life Model (Ferrans, 2005).
Source: Spoelstra, S. (2010). Falls, fall sequelae, and healthcare use in community dwelling elderly with a history of cancer. A doctoral dissertation. Michigan State University College of Nursing, East Lansing, MI.
Funding sources: NRSA Grant number 1 F31 NR , State of Michigan Nurse Corp, Blue Cross & Blue Shield & MSU Graduate School Dissertation Awards.