Falls in Community-dwelling Older Adults with Cancer: Impact on Cancer Treatment, Circumstances, Assessment, Management, and Reporting

Falls are major health issues among older adults and even more so in older cancer patients due to cancer and its treatment. Knowledge on circumstances surrounding falls and fear of falling is vital for understanding how various factors may precipitate falls and for informing development of effective interventions to prevent falls in this population. Delays in cancer treatment caused by fall injuries may have significant implications on disease trajectory and patient outcomes. However, a systematic review found gaps in knowledge in terms of how falls impact cancer treatment in this population. The aim of this research was to explore the circumstances of falls and fear of falling in community-dwelling older adults with cancer, as well as to examine how falls are assessed, reported, and managed in outpatient oncology clinics, and how falls might impact cancer treatment in this population. A cross-sectional study using a convergent-parallel mixed-methods design was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. Data were collected by self-reported survey, chart review, and open-ended interviews. One hundred older adults (aged >=65) and 14 oncologists participated in this study. Falls were not commonly reported by patients to their oncologists (43%), and were rarely assessed by oncologists (7%). One in twenty who fall appears to lead to change in cancer management. However, falls were not commonly reported by patients nor prioritized by oncologists. Older patients perceived falls as minor incidents not worth mentioning (57%). When a fall was reported, oncologists’ actions included determining cause of falls (64%), asking circumstances of falls (36%), and referrals (29%). Oncologists indicated that the majority of older patients were not forthcoming in reporting falls. Circumstances of falls seem to be similar to those in the general geriatric population. This research shows that incorporating routine fall assessment in oncology clinic appointments may help identify those at risk for falls so that timely interventions can be triggered. Additionally, strategies for fall prevention and management used in the general geriatric population can potentially benefit this population as well. Attention may be warranted regarding medication review, health-teaching on fall safety, home evaluation, and referral for balance training.Ph.D