Risk Factors for Falls and Fear of Falling Among Older Patients with Cancer

Introduction: Cancer is a disease of the elderly with more than 60% of all cancers diagnosed in adults aged 60 or older. Falls pose a substantial risk for older cancer patients leading to hip fractures, traumatic brain injury, and are the leading cause of injury-related hospitalizations in persons aged 60 and older. This risk is due to aging changes compounded by the effect of cancer and cancer therapy. This report aims at understanding risk factors for falls and the perception of fear of falling (FOF) among older patients with cancer. Methods: As a single-site, retrospective cohort study, data was derived from 250 geriatric oncology patients from Senior Adult Oncology Center at Jefferson Health. The primary endpoints are the number of falls in the preceding 12 months and FOF as part of a self-reported fall screening. Multivariate logistic regression model was used to identify the independent risks factors by including patients' age, sex, race/ethnicity, BMI, polypharmacy, cancer types, ECOG scores, timed up and go (TUG) test, ADL, IADL, Mini-Cog, and Geriatric Depression Scale (GDS) for each endpoint separately. Results: The majority were white (63.65%), females (60%) with a mean age of age 77.6. The most common cancer diagnosis was hematologic malignancies (41.0%). TUG was abnormal in 89 patients (43.2%), impaired Mini-Cog in 52 (22.7%) patients, Impaired ADL in 73 (30.2%) patients, Impaired IADL in 134 (55.4%) patients. Polypharmacy was positive in 245 patients. 64 (32.0%) had moderate to severe depression by GDS. We have found that the risk of FOF is higher in patients with abnormal TUG scores (OR= 5.88, 95% CI =2.87 ~ 12.62, p=0.00). The risk of falling was increased in abnormal ADL group (OR= 2.75, 95% CI = 1.51-5.02, p = 0.001). Conclusion: We have found that among patients aged 65 and older FOF was related to abnormal TUG scores and the risk of falling was increased in abnormal ADL group. Further implementation of systematic screening is crucial in fall prevention and our results suggest the TUG and ADL should be used in an initial screening modality for elderly cancer patient as well as subsequent treatment visits due to the rapidly devolving functional status from cancer treatments.