Falls are one of the most serious problems of the elderly in the community, acute care hospitals, nursing homes and VA healthcare. These falls are more commonly related to age and functional ability and are influenced by disease status, physical strength, coordination, and level of alertness. Our previous work with cancer patients in a cancer-related fatigue group rehabilitation project uncovered anecdotally that greater than 50% of the participants had fallen during the previous month. In pilot work at the James A. Haley VAMC, we found that falls occurred most frequently on the oncology unit and the hospice unit. A search of all major literature databases for cancer patient falls revealed only one, a 22-year old quality assurance audit report of falls in persons with cancer.
The specific aims of this 2.5 year descriptive study are to: 1) describe intrinsic risk factors for falls in hospitalized cancer patients; 2) describe extrinsic factors related to falls; and 3) describe the extent and type of clinical management strategies used for the prevention of subsequent falls in the acute care setting.
This is a 2.5-year, multi-site, descriptive study design. Patients with cancer who fall will be identified starting October 2002. This study will take place in three different inpatient settings (James A. Haley VAMC, University Community Hospital, and Moffitt Cancer Center). Approximately 280 cases (fallers) will be obtained during the 2 .5-year period. Once a fall occurs on a nursing unit in one of the three facilities, the patient will be considered for enrollment into this study. Within 7 days, the patient who fell will be approached, the study will be explained to the patient and/or family, and will be invited to be a participant in the study. If they agree, we will obtain written informed consent. Chart reviews will be performed and the subject will be asked to complete the Short Portable Mental Status Questionnaire, the Cancer Related Fatigue Distress Scale, and the Functional Living Index-Cancer questionnaires. Demographics, veteran status, concomitant illnesses, medications, fatigue distress scale scores and fatigue intensity scores, quality of life scores, mental status scores, and clinical management strategies tried will be summarized for the cases. Descriptive statistics will be calculated to examine the demographic characteristics of the cases.
Collection began October 2002. In March 2003 we decided to add more sites. In May 2003 we added Brandon Regional Hospital. In June 2003 we added Tampa General Hospital. Accrual continues to be slow. Current numbers of non-enrolled subjects includes 496 with no cancer diagnosis and 160 with a cancer diagnosis. Of the 160 subjects, 13 were inappropriate due to age, 4 expired, 32 refused, 78 were cognitively impaired, 18 were discharged, and 14 were received too late based in inclusion criteria. We have requested a no cost extension to continue data collection beyong December 2004.
The findings from this study will reshape our thinking about falls, by changing the focus from reactive to proactive. We will identify the intrinsic and extrinsic factors that predispose cancer patients to falls. The study will identify factors not now accounted for, and factors now unknown, that cause falls in persons with cancer. It will also determine whether the risk factors are the same for VA and non-VA cancer patients. From our findings, we will develop a risk assessment tool for identifying at-risk cancer patients who may benefit from interventions to reduce the incidence and severity of falls, and reduce the costs of falls.
- Holley S. A look at the problem of falls among people with cancer. Clinical Journal of Oncology Nursing. 2002 Jul 1; 6(4):193-7.
- Holley S. Cancer-Related Fatigue and Aging. In: Overcash J, Balducci L, editors. The Older Cancer Patient: A Guide for Nurses and Related Professionals. New York, NY: Springer Publishing; 2003. Chapter 10. 168-180 p.
- Holley S. Energy for living with cancer. Paper presented at: Society of Otorhinolaryngology and Head-Neck Nurses Annual Congress; 2003 Sep 21; Orlando, FL.
- Holley S. Sex and the male cancer experience. Paper presented at: Oncology Nursing Society Annual Congress; 2002 Apr 19; Washington, DC.