Physiological, Pharmacological and Environmental Factors Related to Falling in Geriatric Oncology Inpatients: A Case Control Study in a Major Cancer Center

Background: Although older adults are at an increased risk for falls, those with a cancer diagnosis are even more likely to experience falls and related injuries. Forty-four percent of this major cancer center’s admissions are 65 years and older and over 90% are cancer related diagnosis.

Purpose: The purpose of this study is to examine fall-related variables in oncology patients age 65 and over who have fallen during an inpatient admission and those less than 65 years of age who have fallen during an inpatient admission.

Methods: Retrospective case-control study of oncology inpatients that have fallen over the course of 18 months were matched with non-fallers admitted during same time frame for age, diagnosis, and gender. These cases were representative of the target population (to strengthen the external validity).

Results: Result of 181 fallers, 45% (n=81) were 65 years or older. These fallers (mean age 71.9 years) were matched to non-fallers (mean age 73.78). Seven variables were statistically significant predictors of falling in univariate logistic regression analysis. These were the presence of Orthostatic Hypotension (OH) (odds ratio 4.61; 95% CI 1.24-17.16) administration of chemotherapy (2.30; 1.05-5.05), benzodiazepines (6.66; 2.16-20.56) and diphenhydramine (3.59; 1.23-10.48). History of a previous fall (3.5; 1.03-11.90) and the use of assistive devices (6.96; 1.92-25.28) were also significant. Although the presence of Chemo Induced Peripheral Neuropathy (CIPN) was not independently significant in older fallers, inpatient oncology patients with CIPN were 3 times more likely to fall (3.05; 1.87-4.97).

Discussion: Fall history and assistive devices are included in risk assessments however potentially inappropriate medications and presence of CIPN are often not included in fall screening tools. Evaluation of OH may also provide valuable safety strategies for reducing falls in the oncology inpatient.