Falls in Cancer Patients

[David Baxter PhD]

Falls
By Marisa Healy, BSN, RN, OncoLink.org
August 1, 2019

One of the most common safety issues for cancer patients, both in the hospital and at home, is falls. While receiving treatment, side effects from medications can cause lightheadedness, dizziness, and weakness. Some of these effects, such as peripheral neuropathy (numbness/tingling in your hands/feet), fatigue, and deconditioning, can be a concern long after treatment has ended. Cancer itself, depending where it is in the body, can also make you more prone to falls by making you weaker or interfering with the nerves and muscles that help you to keep your balance. We will review some ways to stay safe from falls, both in the hospital and at home.

Avoiding Falls in the Hospital
Even if you have never fallen and you feel steady, there are a lot of variables in the hospital. It is an unfamiliar room with equipment around you and you may be on medications you do not usually take. Follow these precautions to avoid falls:

• Ask your nurse or aide if you are considered a “fall risk.” If you are, or you think you should be, certain precautions will be followed. At some facilities a “fall risk” band will be placed on your wrist, you will be given non-slip socks, and you may have an alarm activated on your bed or chairs to alert staff if you try to get out of bed without assistance. This is not done to startle or embarrass you, but to keep you safe.
• Keep the call bell nearby, within reach at all times. If you need help the call bell will be used to alarm the staff that you are in need of assistance.
• If you are given the “okay” to move about and get out of bed on your own, take things slowly. When going from a lying to a sitting or standing position, do so slowly. Sitting or standing too quickly is a common cause of lightheadedness and dizziness, which can lead to falls.
• If at any time you feel unsteady, sit back down and use your call bell to ask for help.
• When using the commode or toilet, especially at night, put the lights on. There is a call bell in the bathroom if you need assistance or if you feel dizzy or lightheaded.
• If you are hooked up to an IV and have to roll the IV pole with you, or if you have equipment you haven’t used before (walker, crutches, cane, etc.), practice walking with these with a nurse, aide, or physical therapist. If you don’t feel comfortable walking alone with the IV pole or any other equipment, use your call bell to ask for help. Do not try yourself.
• Over time, especially while in the hospital, your body may become weaker. If you feel as though you are becoming weak, ask to be seen by a physical therapist. A physical therapist can give you exercises to regain and maintain your strength which will also help prevent falls.

Avoiding Falls at Home
There are some things you can do to lessen the risk of falling at home. If you are unable to do some of these things yourself, be sure to ask a friend or family member for help, or let your care team know. If at any point during or after treatment you feel unsafe at home, let your provider know immediately. The most important thing is for you to feel and remain safe.

• Keep your living area free of clutter, especially hallways and stairways. Make sure extension cords and plugs are not in your path.
• If you have area or throw rugs, make sure they have a nonslip bottom. If the edges curl, either tape down or remove the rug.
• Consider an emergency call device that you can wear at all times.
• If at any time you feel unsteady or unable to stand up or walk on your own, call for help. It can help to keep your cell phone or home phone close by in these situations.
• Be sure to talk with your provider and pharmacist about any new medications you may be taking, discussing side effects and possible interactions.
• Wear shoes or socks with nonslip bottoms.
• Consider installing handrails in your house. For your bathroom, you may need handrails in the shower and next to the toilet. You can also use a shower chair or stool to prevent fatigue while washing.
• Avoid really hot showers, as this can drop your blood pressure.
• If you don’t feel safe walking to and from the bathroom, a commode or urinal next to your bed will be helpful.
• Keep your house well-lit.
• Keep hydrated. Dehydration can cause dizziness and low blood pressure which can lead to falls.
• Ask about home health aides or physical therapy if you feel unsafe or unable to do things on your own.

There are many things that can be considered tripping or fall hazards, both in and out of the hospital. Keeping these tips in mind will help keep you from falling. If you do fall at home, however, and you need assistance immediately, call 911. Always tell your care team about any falls or near-falls, even while in the hospital. Even if you don’t think the fall caused any damage, your care team should know about it.

About Marisa Healy
Marisa worked at the Hospital of the University of Pennsylvania on a medical-oncology unit for 4.5 years. She most recently worked as an outpatient infusion nurse in Cherry Hill, NJ, prior to joining the OncoLink team full time! She also has her Bachelor’s degree in English Literature from the University of Scranton, where she played basketball and made many lifelong friends. Originally from Philadelphia, she now resides in Mt. Ephraim, NJ. She spends her free time either in Cape May, skiing in the Poconos, or spending time with her family and friends - including her dog Peanut.

 

[H011yHawkJ311yBean]

Rats. I thought at first that “Falls In Cancer Patients” meant there were less people getting cancer. [emoji3525]

But good info, thank you! [emoji106]


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[David Baxter PhD]

No. The thing that struck me about this is that the weakness and unsteadiness and other symptoms can last long after you finish chemotherapy, which corresponds with my experience going on 5 years later. That also applies to memory loss - I have a devil of a time with names now and with walking into a room and forgetting what I was going to do.

 

[H011yHawkJ311yBean]

Hm. My David still has to have naps everyday, but his memory seems okay. I think he’s in a deep depression though (seems like he’s finally doing something about that, by the way). But he doesn’t seem to have issues with falling. At least not yet...

Me, on the other hand... Never was a cancer patient, but I seem to be falling more than usual lately. Or getting bruises that I don’t remember getting bumped. But that’s probably just more my ADHD: not being mindful... Being in a hurry.... Or like, when I have a migraine: hard to be mindful when you’ve got fog in your brain.

I have to read that article again, I may have missed something (more than likely)...

I’m sorry to hear you’ve been having falls! That’s a big concern! Is it always around the same time of day? Like before you’ve eaten? Or when you’ve been doing something standing/physical for a certain amount of time? Or when you get up from sitting/prone position? Or just randomly in different places at randomly different times?

Sorry. I obviously shouldn’t be peppering you with questions. I’ll have to read that again, like I said. My brain is a bit fuzzy today from all this intense heat... Going to bed but will check out the above info again tomorrow. [emoji106]


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[David Baxter PhD]

I’m sorry to hear you’ve been having falls! That’s a big concern! Is it always around the same time of day? Like before you’ve eaten? Or when you’ve been doing something standing/physical for a certain amount of time? Or when you get up from sitting/prone position? Or just randomly in different places at randomly different times?

No I haven't actually fallen, ever. But I do get periods of lightheadedness or vertigo if I turn suddenly or get up quickly, or try to walk fast around a corner at home. And muscle weakness, lack of energy and stamina, and ongoing fatigue are daily issues.

I just try to be very careful now when I'm walking and outside my home I use a cane, more for balance that anything else but it's also there if I need to lean on it.

The memory is a bit more than just the normal aging. It's like chemo brain except it never really stopped.

Another thing I've noticed is my immune system really sucks. It seems like I get some sort of virus almost every time I go to a hospital for follow up tests. And when I catch something, it takes a long time for me to get over it.

 

[H011yHawkJ311yBean]

No I haven't actually fallen, ever. But I do get periods of lightheadedness or vertigo if I turn suddenly or get up quickly, or try to walk fast around a corner at home. And muscle weakness, lack of energy and stamina, and ongoing fatigue are daily issues.

Oh, I see! I read that people can get that nerve/tingling, and yes, my David has that mostly in his fingertips. Lack of energy/stamina though, for sure. Poor dude finds some tasks (that would be otherwise quick and barely a thought) to be mentally overwhelming and frustrating. He gets exhausted mentally, more than physically, I think. Is that how you would describe it, too?

He spirals a bit sometimes, too, in depression. I understand depression can also be associated with chemo brain. I mean it could be that he was depressed and the chemo made it worse, too... Do you feel angry or sad or have you been a good doctor and seen another doctor (heal thyself and all that) to get evaluated? Or do all your doctors just dismiss everything that’s happening to you as chemo-related? Because that wouldn’t be fair to you. [emoji3525]


[QUOTE ]I just try to be very careful now when I'm walking and outside my home I use a cane, more for balance that anything else but it's also there if I need to lean on it. [/QUOTE]

I’m glad you’ve got that cane handy for support, Doc. And you can also pretend it’s a lightsaber, if the spirit moves you. Or whack weirdos like me on the head. I know my David really had to walk slow and carefully and was easily fatigued just by walking from the parking lot to his appointments. But only while he was actually taking chemo and probably for some time after.

The memory is a bit more than just the normal aging. It's like chemo brain except it never really stopped.

My David STILL has a better memory than mine. But that might not be saying much. If you cut my head open you could use the top as a spaghetti strainer... But for whatever reason his memory seems just as good as it’s ever been. It’s his mood that seems most affected. I know how frustrating it can be to have a bad memory! I suppose you have to write down/use reminders more nowadays? For someone that used to have really awesome short term memory and then find out that it’s been compromised by chemo, that has GOT to be so frustrating! *hugs*

Another thing I've noticed is my immune system really sucks. It seems like I get some sort of virus almost every time I go to a hospital for follow up tests. And when I catch something, it takes a long time for me to get over it.

Ack! My David has already got a not-great immune system. No spleen because TPP or whatever that blood disorder he has. So he doesn’t visit or teach people who are sick. He did have to be hospitalized during chemo for an intestinal infection and when his white blood cell count dropped to nil. But yeah, he sure as heck can get sick relatively easy. I’m so sorry you’ve been going through this, Doc.

One might wonder if chemo makes the dopamine levels drop in the brains, or maybe neuro-pathways are a bit frazzled from the chemo. Or the brain maybe shrinks a mm or 2 from all the chemicals and stress. That totally sucks. How long have your symptoms been bugging you? Do you feel your health has improved a little bit since chemo? Or it’s just this way all the damn time?

With you being a doctor, I’m curious what would you do to get support for any of your symptoms? Or maybe you already have...

Is your broken sleep also caused by the chemo, do you think?




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[David Baxter PhD]

Oh, I see! I read that people can get that nerve/tingling, and yes, my David has that mostly in his fingertips. Lack of energy/stamina though, for sure. Poor dude finds some tasks (that would be otherwise quick and barely a thought) to be mentally overwhelming and frustrating. He gets exhausted mentally, more than physically, I think. Is that how you would describe it, too?

Exactly, except really it's both - psychological and physical exhaustion that comes on very suddenly, so I can go from engaged to not at all engaged in a matter of a minute, especially in social interactions. And for me, the tingling - sometimes even soreness - is in both my feet and my hands.

He spirals a bit sometimes, too, in depression. I understand depression can also be associated with chemo brain. I mean it could be that he was depressed and the chemo made it worse, too... Do you feel angry or sad or have you been a good doctor and seen another doctor (heal thyself and all that) to get evaluated? Or do all your doctors just dismiss everything that’s happening to you as chemo-related? Because that wouldn’t be fair to you.

I have an excellent family doctor and an excellent team of specialists, and they all keep the others informed. I am very fortunate in that respect. I did experience a full blown depression after finishing chemotherapy and I went back on Prozac for about a year or so to manage that.

[QUOTE ]I just try to be very careful now when I'm walking and outside my home I use a cane, more for balance that anything else but it's also there if I need to lean on it.

I’m glad you’ve got that cane handy for support, Doc. And you can also pretend it’s a lightsaber, if the spirit moves you. Or whack weirdos like me on the head. I know my David really had to walk slow and carefully and was easily fatigued just by walking from the parking lot to his appointments. But only while he was actually taking chemo and probably for some time after. [/QUOTE]

I like to pretend I can sit on a porch and wave my cane at all the young neighborhood punks with their pants around their knees - although it seems that silly fad is finally dying out. How ridiculous that was/is.

[QUOTE ]My David STILL has a better memory than mine. But that might not be saying much. If you cut my head open you could use the top as a spaghetti strainer... But for whatever reason his memory seems just as good as it’s ever been. It’s his mood that seems most affected. I know how frustrating it can be to have a bad memory! I suppose you have to write down/use reminders more nowadays? For someone that used to have really awesome short term memory and then find out that it’s been compromised by chemo, that has GOT to be so frustrating! *hugs*

Ack! My David has already got a not-great immune system. No spleen because TPP or whatever that blood disorder he has. So he doesn’t visit or teach people who are sick. He did have to be hospitalized during chemo for an intestinal infection and when his white blood cell count dropped to nil. But yeah, he sure as heck can get sick relatively easy. I’m so sorry you’ve been going through this, Doc.

One might wonder if chemo makes the dopamine levels drop in the brains, or maybe neuro-pathways are a bit frazzled from the chemo. Or the brain maybe shrinks a mm or 2 from all the chemicals and stress. That totally sucks. How long have your symptoms been bugging you? Do you feel your health has improved a little bit since chemo? Or it’s just this way all the damn time? [/QUOTE]

No it has improved, for sure. But there are lingering after-effects that I've described which I'm pretty sure are here to stay. I do have family support. I don't feel sorry for myself - whatever I must accept now it beats the alternative. I'm still on the right side of the ground.

Is your broken sleep also caused by the chemo, do you think?

I don't know. I have had bouts of insomnia since I was a boy so it's nothing new. With reduced energy and stamina, it's definitely worse than before, but part of that is also just age. And now I can nap ion the afternoon which helps but probably also perpetuates the cycle of broken sleep at night. It seems now that most days/nights, whenever I sleep it only lasts for about 4 hours, but since I can get two of those in a 24 hour period it does the job.

 

[H011yHawkJ311yBean]

Yeah, I don’t know what all this “get off my lawn” was so popular for, other than the movie “Gran Torino” with Clint Eastwood. Have you seen that 2008 movie? I just remembered, his character had cancer! And also he had a shotgun, not a cane. But his lawn was very green!! [emoji23]

I’m SO happy to hear you have family/friends/medical/doctor support! That is so important! And thank you, because although I can’t remember if my David has been depressed only around the time of his chemo and/or after, but I reminded him that we were told about cancer/chemo fatigue and depression and he does remember that. If it wasn’t for this conversation I would have forgotten to mention it.
And I like that there’s another reason he could stand to see a psychiatrist about it. Not just me saying “should.” You know what I mean?

I’m so annoyed about aging because in my head I feel younger than my age, most of the time... I’m 48 but I still usually “feel” about 30. And then I see my reflection in a mirror and I’m like, “Ugh. That image does not line up with how I feel.” [emoji13][emoji12][emoji14]
Do you feel this way at all? Because I get the impression from your text/writing that you’re still pretty sharp, if you ask me.

And I’ve had a crappy memory seemingly forever, so I guess I’m used to it. I don’t know if that makes you feel any better, but you can be in my secret club for me. We’ll probably both forget there’s a club because it’s secret. Maybe we should make it a public club...




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[David Baxter PhD]

I’m so annoyed about aging because in my head I feel younger than my age, most of the time... I’m 48 but I still usually “feel” about 30. And then I see my reflection in a mirror and I’m like, “Ugh. That image does not line up with how I feel.”

I think everybody feels that way.I can remember my mom saying things like that (in her 40s) when I was a teenager and in my 20s. She said she would look in the mirror and think how can I look like that when I don't feel any different really than in my 20s?

Do you feel this way at all? Because I get the impression from your text/writing that you’re still pretty sharp, if you ask me.

Thank you. No signs of dementia so far!

 

[Daniel E.]

I’m so annoyed about aging

My husband turns 60 in a few months, and I can't wait to get more senior discounts

 

[H011yHawkJ311yBean]

I think I’m already senile, but I don’t know how one can tell if it’s ADHD or dementia. Sometimes it feels like I have a leak in my brain. Or an air pocket. Maybe some rocks.

Hm, yes. I don’t mind senior discounts. They should have coupons for those of us who live our lives having “senior moments.” C’mon, I could use some help here... [emoji58]


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[Daniel E.]

Study shows risk of falling remains after cataract surgery

A new study has found that though cataract surgery doesn’t always help reduce the risk of falls, optometrists’ role in helping post-surgical patients reduce their risk of falls is critical.

www.aoa.org

"Unrelated to their cataract surgery status, people who wear multifocal lenses have been shown to have increased fall rates," Dr. Lewerenz says. "If we sense that a patient is somewhat unsteady, and might be at relatively high risk for a fall anyway, we might talk to that patient about the option of having two pair of glasses—one for distance vision and one for reading—rather than going with multifocal glasses."

 

[David Baxter PhD]

I know I could not wear continuous focal reasons for that reason but I don't find bifocals to be a problem at all. I also used to wer bifocal contact lenses without incident.

 

[Daniel E.]

How to Get Up From a Fall: Step-by-Step Guide for Seniors – DailyCaring

After a fall, seniors lying on the floor too long or getting up incorrectly can cause added injury. See a useful demo of how to get up from a fall safely.

dailycaring.com

 

[Daniel E.]

For preventing fragility:

The Importance of Protein for Cancer Patients

Learn why cancer patients often need to add plenty of protein to their diets and how to do so, even with dietary restrictions or taste changes.

cancer.osu.edu

“Protein helps build and maintain muscle, which is important for cancer patients who might be having problems eating and are losing weight. When they lose weight, it’s often muscle and not fat, so protein is vital during treatment.”

 

[Daniel E.]

Older Adults and Obesity ? Is Dieting the Answer?

Older Adults and Obesity ? Is Dieting the Answer? By Lindsey Getz Today's Dietitian August 2013 Issue Vol. 15 No. 8 P. 44 Weight loss in obese elder patients can be detrimental to their health, but dietitians can take certain steps to help them lose weight appropriately and healthfully to...

forum.psychlinks.ca

"You already have muscle loss from aging, and when you couple that with muscle loss from weight loss, it can significantly affect functional status and bone density."