Falls in the Community Dwelling Elderly with a History of Cancer

描述（由申请人提供）：癌症幸存者的寿命更长，但在生命结束之前，他们会继续遇到癌症对身体、心理和经济的影响。在所有类型的伤害中，跌倒对老年人的生活质量构成最严重的威胁，因此对老年癌症幸存者也是如此。文献中有一个空白，很少有研究关注癌症后的跌倒。本提案的假设是，社区居住的老年癌症幸存者经历了疾病或癌症治疗的影响，并增加了跌倒，跌倒后遗症和使用医疗保健。该提案的计划是：对密歇根家庭和社区服务项目的数据进行分析，并结合癌症登记处的信息，以及医疗保险和医疗补助索赔。本研究将探讨、比较和对比社区居住老年患者中有和没有癌症诊断的跌倒、跌倒后遗症和医疗保健使用情况。具体目的包括：1)在调整年龄、性别、种族/民族、药物、合并症、ADLs、认知、抑郁、失禁、体重减轻和癌症诊断前一年跌倒次数后，确定癌症诊断后一年与未诊断癌症的患者相比，癌症诊断后一年跌倒、骨折、急诊室使用、住院或养老院安置次数更多的程度；根据癌症部位（乳腺癌、结肠癌、前列腺癌、肺癌或血液学）、癌症分期（I-IV）或癌症治疗（化疗和/或放疗），癌症患者在诊断后一年内跌倒的次数是否存在差异；2)检查虚弱（ADL、认知、抑郁、大小便失禁、体重减轻）对诊断后一年内跌倒的影响是否与癌症部位（乳腺癌、结肠癌、前列腺癌、肺癌或血液病）、癌症分期或癌症治疗（化疗和/或放疗）有关。此外，社会因素将被描述。本研究采用纵向广义线性模型和广义估计方程作为统计方法。如果癌症幸存者的跌倒、跌倒后遗症或医疗保健使用情况不同，那么老年临床医生可以将重点放在标准化跌倒风险评估上，并实施行为和心理干预措施来预防跌倒。因此，可能需要在癌症幸存者护理计划机制中纳入预防跌倒的措施，以试图减少癌症幸存者跌倒的发生。随着老年癌症幸存者人数的增加和医疗费用的持续上升，跌倒将变得更加重要。

DESCRIPTION (provided by applicant): Cancer survivors are living longer, but continue to encounter physical, psychosocial, and economic impacts of their cancer until the end of life. Of all types of injuries, falls pose the most serious threat to quality of life in the elderly, and consequently in elderly cancer survivors. There is a gap in the literature with few studies focusing on falls subsequent to cancer. The hypothesis in this proposal is that community dwelling elderly cancer survivors experience the influence of the disease or treatment of cancer, and have increased falls, fall sequelae, and use of healthcare. The plan in this proposal is: to conduct an analysis of data from the Michigan Home and Community Based Services program combined with information from the Cancer Registry, and Medicare and Medicaid claims. This study will explore, compare and contrast falls, fall sequelae, and healthcare use in those with and without a cancer diagnosis in community dwelling elderly patient population. Specific aims include: 1) After adjusting for age, sex, race/ethnicity, medications, comorbidities, ADLs, cognition, depression, incontinence, weight loss, and number of falls in the year prior to cancer diagnosis, to determine the extent to which: patients with a cancer diagnosis experience a greater number of falls, fractures, ER use, hospitalization, or nursing home placement, in the year following the cancer diagnosis compared to those patients with no diagnosis of cancer; and if there are differences in the number of falls among cancer patients in the year following diagnosis according to site of cancer (breast, colon, prostate, lung, or hematological), stage of cancer (I-IV.), or cancer treatment (chemotherapy and/or radiation); and 2) to examine if the effects of frailty (ADL, cognition, depression, incontinence, weight loss) on falls in the year after diagnosis are different with respect to site of cancer (breast, colon, prostate, lung, or hematological), stage of cancer, or cancer treatment (chemotherapy and/or radiation). Moreover, social factors will be described. The statistical approaches that accommodate the variables in this study are longitudinal Generalized Linear models and Generalized Estimating Equations. If falls, fall sequelae, or healthcare use in cancer survivors are different, then gerontological clinicians could focus on standardize fall risk assessment, and implement behavioral and psychological interventions to prevent falls. Accordingly, inclusion of fall prevention measures may be needed in Cancer Survivorship Care Planning mechanisms, to attempt to reduce the occurrence of falls in cancer survivors. Falls will become more important as the elderly cancer survivors population increases in size and health care costs continue to rise. PUBLIC HEALTH RELEVANCE: This research proposal is important to the health of elderly cancer survivors. If it is found that those who have a cancer diagnosis fall more often than those who do not have cancer, healthcare provides could target interventions to those who are most in need.