An analysis of falls experienced by older adult patients diagnosed with cancer

PURPOSE/OBJECTIVES: To examine themes associated with falls specific to older adult patients diagnosed with cancer. DESIGN: Prospective, exploratory, qualitative study. SETTING: A senior adult oncology program at a cancer and research center in the southeastern United States. SAMPLE: Men and women aged 70 years and older with any cancer diagnosis who had experienced a fall within three months. METHODS: Patients were telephoned after research consent to participate in an interview about their falls. Frequencies were conducted on the biographic data. Themes were identified and grouped according to topic. MAIN RESEARCH VARIABLES: Eastern Cooperative Oncology Group performance status, cancer site, cancer treatment modality, location of fall, and fear of falls. FINDINGS: Mean age was 76.2 years. Most falls occurred at home (75%). The themes of physical problems, general weakness, and walking were found to be the most common motivations for falls. Themes associated with self-imposed activities as a result of falls included "being more careful" and "using an assistive device." CONCLUSIONS: Perceptions of physical problems, general weakness, and difficulty walking should be included in an oncology nursing fall-risk assessment. Exploration of perceptions concerning activities that have potentially caused a past fall and self-imposed activities also should be included. IMPLICATIONS FOR NURSING: Beyond the boundaries of a fall-risk assessment, conducting a subjective interview to identify the individualities of falls and fall risk is vital to constructing a realistic plan of care.

Predicting falls in older patients using components of a comprehensive geriatric assessment

This prospective study evaluated components of a comprehensive geriatric assessment (CGA) to identify rates and predictors of falls in older patients. Fall rates and scores on components of the CGA were compared among adults aged 70 or older in three groups: patients with cancer receiving chemotherapy, patients with cancer not receiving chemotherapy, and community-dwelling adults without cancer. Older adults in the chemotherapy group were hypothesized to fall significantly more often than those in the nonchemotherapy group. Among the patients with cancer, scores on the Activities of Daily Living Scale were a significant predictor of falls. The scores were the only domain of the CGA found to be a significant predictor; therefore, more research is needed to better understand fall risk assessment among older patients with cancer. Nurses should conduct fall risk assessments with measures of functional status as included in a CGA.

Fatigue and functional dependence in older cancer patients.

OBJECTIVES: Functional dependence is a costly manifestation of aging that compromises the quality of life of elderly individuals and their caregivers. In this study, we hypothesized that fatigue may be a cause of functional dependence in older cancer patients. To establish whether fatigue was associated with dependence in 1 or more activities of daily living (ADLs) or instrumental activities of daily living (IADLs), and declining performance status (PS). In addition, we studied the prevalence of fatigue and its correlation with anemia, depression, and nutritional status. MATERIALS AND METHODS: Retrospective cross-sectional study of 214 patients aged 70 and older were seen over a 3-month period by the Senior Adult Oncology Program of the H. Lee Moffitt Cancer Center in Tampa, FL. Each patient was screened with a questionnaire assessing ADLs, IADLs, PS, cognitive impairment, depression, and malnutrition. In addition, each patient underwent assessment of fatigue with the fatigue symptom inventory and a determination of complete blood counts and complete chemical panel. RESULTS: Fatigue was reported by 81% of the patients. The interference score of fatigue seemed to be a mediator for dependencies in ADLs and IADLs (P < 0.001 and 0.001), and poorer PS (P < 0.001). CONCLUSIONS: Fatigue is a common chronic problem for older cancer patients and may represent a major cause of functional dependence.

Physical performance evaluation of older cancer patients: a preliminary study.

UNLABELLED: Performance status measures can provide clinical incite into understanding patients who are at risk for falls. PURPOSE: This preliminary, prospective study is to determine the sensitivity and specificity of the Timed Up & Go instrument and the Simmonds Performance Test Battery in older cancer patients with falls as the outcome measure. METHODS: The Timed Up & Go instrument, fall assessment and the Simmonds Performance Test Battery were administered. RESULTS: Age range was 68-83 years. Participants (n=20) who reported Falls Within a Year were 65% (n=13), 79% (n=15) reported Falls Within Three Months, and 60% (n=12) reported Falls Since Cancer Diagnosis. The questions of Falls Within One Year and Falls Within Three Months had equal area under the curve at .85. CONCLUSION: The sensitivity and specificity of the fall assessment questions of Falls Within One Year and Falls Within Three Months were found to be equal when using the Timed Up & Go as an outcome measure. The Timed Up & Go instrument was found to have more robust sensitivity and specificity levels as compared to the Simmonds performance status battery.

Vitamin D in older patients with cancer

Vitamin D insufficiency has been found to be as high as 75% among community-dwelling adults aged 65 and older. The purpose of this article is to provide a review of published literature focused on the benefits of vitamin D and calcium supplementation in older patients with cancer. Insufficient vitamin D levels may have considerable effects on cancer-related diagnosis and treatment. Patient education should include information concerning vitamin D and calcium administration to reduce falls and injury from falls and enhance functional status. This article will consider the issue of vitamin D levels related to cancer prevention, diagnosis, treatment, functional status, and falls in older patients with cancer. Dosing and serum measurement information will be discussed.

The abbreviated comprehensive geriatric assessment (aCGA) for use in the older cancer patient as a prescreen: scoring and interpretation.

UNLABELLED: The abbreviated CGA (aCGA) can be used as a prescreening assessment to identify patients who would most benefit from the complete CGA. OBJECTIVE: To develop cutpoints for scoring the aCGA that are consistent with existing limitations as revealed by the full CGA. DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on cancer patients 70 and over. MEASUREMENTS: Each of the four domains: functional status (activities of daily living (ADL), instrumental activities of daily living (IADL), depression, using the geriatric depression scale (GDS), and cognition using the mini-mental state examination (MMSE)) are scored separately. RESULTS: For the depression domain, a score of 2 or more toward depression indicates that the entire GDS be administered. For the MMSE, a score of 6 or lower indicates necessity of the entire MMSE. For the ADL/IADL, any deficit on either scale (needs assistance or complete assistance) requires further clinical evaluation using the entire instruments. CONCLUSIONS: These guidelines provide the clinician with parameters to target patients most likely to benefit from more intensive geriatric evaluation.

The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis.

BACKGROUND: A comprehensive geriatric assessment (CGA) is a multidimensional assessment that is designed to detect health problems. A barrier to conducting the CGA is the length of time required to complete the entire assessment. OBJECTIVE: To understand what items contained in the instruments that make up the CGA could be compiled to construct an abbreviated CGA (aCGA). DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on patients 70 and over. MEASUREMENTS: Item-to-total correlations and Cronbach's alpha coefficient were calculated. Construct validity was assessed using a Pearson's product moment correlation coefficient. RESULTS: Fifteen items were compiled to form the aCGA. Cronbach's alpha was 0.65-0.92 on each instrument of the entire CGA compared to 0.70-0.94 on the aCGA. Correlations ranged from 0.84 to 0.96 for the entire CGA and the aCGA. CONCLUSION: An aCGA can be helpful in screening for those seniors who would benefit from the entire CGA.

Using narrative research to understand the quality of life of older women with breast cancer

PURPOSE/OBJECTIVES: To elucidate some of the issues that affect the quality of life of older women (70 years of age and older) diagnosed with breast cancer. DESIGN: Descriptive design SETTING: A National Cancer Institute-designated site in the southeastern United States. SAMPLE: 12 women who were at least 70 years of age undergoing treatment (radiation, hormonal, or chemotherapy) for breast cancer. METHODS: Two to three interview encounters per participant, each lasting approximately one hour. FINDINGS: Eight major themes emerged: Importance of God, Positive Attitude, No Alteration in Lifestyle, Physician Trust, Caregiver to Others, Importance of Health, Importance of Family, and Alteration in Lifestyle. CONCLUSIONS: The eight major themes are similar in terminology but varied in individual meanings. IMPLICATIONS FOR NURSING: Nurses must determine whether older women with a diagnosis of breast cancer are also primary caregivers to other individuals. As the story-gatherers for the healthcare team, nurses can use the data derived from interviews to document patients' health histories and provide a therapeutic process of coping with illness.

Narrative research: a viable methodology for clinical nursing.

TOPIC: Narrative research provides a reasonable methodology for gathering rich, multidimensional data in the clinical setting. PURPOSE: To familiarize nurses with the concept of narrative research, review pertinent narrative research literature, and identify some ways this methodology can be integrated into clinical nursing. SOURCES: A review of published literature from psychology, sociology, anthropology, and nursing, with citations from women with breast cancer. CONCLUSIONS: Narrative research can make a valid contribution to nursing science in language familiar to nurses and other healthcare professionals.

Narrative research: a review of methodology and relevance to clinical practice.

Using qualitative narrative research to explore how people proceed through cancer diagnosis and treatment may help clinicians render better care and consequently enhance the probability of optimal health outcomes. Narrative research can be defined as collecting and analyzing the accounts people tell to describe experiences and offer interpretation. Often, oncology clinicians use narrative methods to investigate issues such as clinical outcomes, coping, and quality of life. Narrative research provides an option to explore personal experiences beyond the boundaries of a questionnaire, providing insight into decisions involving treatment, screening or various health practices, which can help guide how health care services are developed and provided. The purpose of this article is to illustrate the use of narrative research methods to a clinical audience who may not be as familiar with narrative technique. Definitions of narrative research, examples of published research using narrative methods in healthcare, validity and data analysis will be addressed. A review of current literature from sociology, anthropology, nursing and psychology demonstrates that narrative methods are an effective research option that can lead to enhanced patient care.