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Factors associated with falls in older adults with cancer: a validated model from the Cancer and Aging Research Group

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Abstract

Background

Falls in older adults with cancer are common, yet factors associated with fall-risk are not well-defined and may differ from the general geriatric population. This study aims to develop and validate a model of factors associated with prior falls among older adults with cancer.

Methods

In this cross-sectional secondary analysis, two cohorts of patients aged ≥ 65 with cancer were examined to develop and validate a model of factors associated with falls in the prior 6 months. Potential independent variables, including demographic and laboratory data and a geriatric assessment (encompassing comorbidities, functional status, physical performance, medications, and psychosocial status), were identified. A multivariate model was developed in the derivation cohort using an exhaustive modeling approach. The model selected for validation offered a low Akaike Information Criteria value and included dichotomized variables for ease of clinical use. This model was then applied in the validation cohort.

Results

The development cohort (N = 498) had a mean age of 73 (range 65–91). Nearly one-fifth (18.2%) reported a fall in the prior 6 months. The selected model comprised nine variables involving functional status, objective physical performance, depression, medications, and renal function. The AUC of the model was 0.72 (95% confidence intervals 0.65–0.78). In the validation cohort (N = 250), the prevalence of prior falls was 23.6%. The AUC of the model in the validation cohort was 0.62 (95% confidence intervals 0.51–0.71).

Conclusion

In this study, we developed and validated a model of factors associated with prior falls in older adults with cancer. Future study is needed to examine the utility of such a model in prospectively predicting incident falls.

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Funding

This publication was made possible by Grant Number 1K12CA167540 through the National Cancer Institute (NCI) at the National Institutes of Health (NIH) and Grant Number UL1 TR000448 through the Clinical and Translational Science Award (CTSA) program of the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCI, NCATS or NIH. (T.W.) This work was also supported by the National Institutes of Health, National Institute on Aging Grant No. K23-AG026749–01 (A.H.), Paul Beeson Career Development Award in Aging Research, and American Society of Clinical Oncology, Association of Specialty Professors, Junior Development Award in Geriatric Oncology (A.H.).

Research reported in this publication included work performed in the Survey Research Core supported by the National Cancer Institute of the National Institutes of Health under award number P30CA33572. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funded in part through the Memorial Sloan Kettering Cancer Center Support Grant P30 CA008748 (S.L.)

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Authors and Affiliations

  1. Division of Medical Oncology, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8056, St Louis, MO, 63110, USA

    Tanya M. Wildes

  2. University of Rochester Medical Center, Rochester, NY, USA

    Ronald J. Maggiore & Supriya G. Mohile

  3. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    William P. Tew & Stuart M. Lichtman

  4. City of Hope, Duarte, CA, USA

    David Smith, Can-Lan Sun, Vani Katheria & Arti Hurria

  5. Duke University, Raleigh, Durham, NC, USA

    Harvey Cohen

  6. Upstate University Hospital, Syracuse, NY, USA

    Ajeet Gajra

  7. Wake Forest University, Wake Forest, NC, USA

    Heidi D. Klepin

  8. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Cynthia Owusu

  9. Yale University, New Haven, CT, USA

    Cary P. Gross

  10. Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Hyman Muss

  11. Thomas Jefferson University, Philadelphia, PA, USA

    Andrew Chapman

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  1. Tanya M. Wildes
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  2. Ronald J. Maggiore
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Correspondence to Tanya M. Wildes.

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Wildes, T.M., Maggiore, R.J., Tew, W.P. et al. Factors associated with falls in older adults with cancer: a validated model from the Cancer and Aging Research Group. Support Care Cancer 26, 3563–3570 (2018). https://doi.org/10.1007/s00520-018-4212-3

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