title: Frequency and factors associated with falls in patients with advanced cancer presenting to an outpatient supportive care clinic.
abstract: OBJECTIVE
  The aim of this study was to determine the frequency and factors associated with fall episodes in advanced cancer patients.
  
  
  METHODS
  We analyzed data that included demographic characteristics, utilization of assistive devices, cancer diagnosis, metastatic site, performance status, medications including hypnotics and opioids, Edmonton Symptom Assessment Scale (ESAS) score, and Memorial Delirium Assessment Scale (MDAS) score in 384 consecutive patients who were newly referred to the Supportive Care Clinic at the MD Anderson Cancer Center from January 1 to December 31, 2009. All patients completed standardized forms to report falls within the last month. Multivariate backward regression analyses were employed to identify factors predictive of falls in advanced cancer.
  
  
  RESULTS
  The mean age of patients was 58 years, and 192 (50%) were male. Mean (SD)/median score for pain was 5 (2.8), 5; fatigue 5.6 (2.6), 6; sleep disturbance 5(2.7), 5; drowsiness 3.7(3), 3; and anorexia 5(3), 5. Some 31 patients (8%) reported fall episodes within the past month, 17 (55%) of whom reported the use of assistive devices. Using assist devices (OR = 5.5, 95% CI: 2.6-11.9, p < 0.0001) and taking zolpidem (OR = 3.39, 95% CI: 1.39-7.7, p = 0.008) were associated with an enhanced chance of falling. Higher MDAS score (4.00 vs. 1.42, p = 0.001) and MDAS positive screening for delirium (21 vs. 3.6%, p < 0.001) were also associated with falls. However, severity on the ESAS at the initial consult was not associated with falls.
  
  
  CONCLUSIONS
  We conclude that 31 of 384 patients (8%) with advanced cancer receiving outpatient supportive care reported falls in the previous month. Patients with assistive devices, taking zolpidem, and with a higher MDAS score, and a positive delirium screening reported more frequent falls. Further studies are warranted.
authors: Department of Palliative and Supportive Care,Seirei Mikatahara General Hospital,Hamamatsu, Shizuoka,Japan.
authors: Meiko
authors: M
authors: Kuriya
authors: Department of Palliative Care and Rehabilitative Medicine,The University of Texas MD Anderson Cancer Center,Houston, Texas.
authors: Sriram
authors: S
authors: Yennurajalingam
authors: Department of Palliative Care and Rehabilitative Medicine,The University of Texas MD Anderson Cancer Center,Houston, Texas.
authors: Maxine Grace
authors: MG
authors: de la Cruz
authors: Department of Biostatistics,The University of Texas MD Anderson Cancer Center,Houston, Texas.
authors: Wei
authors: W
authors: Wei
authors: Department of Biostatistics,The University of Texas MD Anderson Cancer Center,Houston, Texas.
authors: Shana
authors: S
authors: Palla
authors: Department of Palliative Care and Rehabilitative Medicine,The University of Texas MD Anderson Cancer Center,Houston, Texas.
authors: Eduardo
authors: E
authors: Bruera
mesh_terms: D000058:Accidental Falls; D000554:Ambulatory Care Facilities; D000855:Anorexia / Q000209:etiology; D003693:Delirium / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010147:Pain Measurement; D011725:Pyridines / Q000008:administration & dosage; D012307:Risk Factors; D012656:Self-Help Devices; D012893:Sleep Wake Disorders / Q000209:etiology; D011795:Surveys and Questionnaires; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem
keywords: Falls