Falls in Older Adults with Multiple Myeloma

Introduction: Multiple myeloma (MM) is a disease of aging.  The prognosis of older adults with MM is influenced by the presence of geriatric syndromes, including dependence in daily activities and comorbidities. Falls, another common geriatric syndrome, are associated with greater risk for severe toxicity of chemotherapy and survival in older adults with solid tumors. Among older adults with MM, the prevalence of falls and factors predictive of falls are yet unknown. Thus, we sought to determine the prevalence of falls in a cohort of older adults with newly diagnosed MM and examine associations between falls and functional status, comorbidities and self-reported health.

Methods: Using data from the linkage of the Surveillance, Epidemiology, and End Results (SEER) national cancer registry with the Medicare Health Outcomes Survey (MHOS), we identified unique patients with a diagnosis of MM in the SEER registry who participated in the MHOS survey, which includes individuals who are enrolled in Medicare Advantage organizations. An item inquiring about falls was present in the MHOS survey starting in 2006.  For this analysis, participants (pts) were included if they completed the MHOS baseline survey within 1 year of their diagnosis of MM.  Baseline characteristics were examined with descriptive statistics.  Associations between falls and patient-reported data on function, comorbidities and self-rated health were examined using Student’s t-test, Pearson Chi-square or Fisher’s exact test, as appropriate. We identified 1327 unique patients, of whom 376 completed their baseline MHOS survey within 1 year of diagnosis.  Of these, 190 provided responses to the item regarding falls and are included in this analysis. 

Results: The median age of the cohort was 77 years (range 47-97). The cohort was diverse, with 58.9% white race, 19.5% Asian/Pacific Islander, 11.6% Hispanic/Latino and 10.0% black race. Half (50.0%) were male, 48.4% female, and 1.6% unknown gender. Over one-quarter (25.2%) of pts reported a fall within the prior 12 months. Fallers were more likely to report a history of congestive heart failure than nonfallers (22.7% vs 7.9%, p=0.012); the remaining comorbidities examined (coronary artery disease, stroke, chronic obstructive pulmonary disease and diabetes) were not associated with falls.  Of those who reported 2 or more weeks of depression in the past year, 41.4% reported a fall, compared with only 20.1% of those who did not report depression (p=0.004).  Fallers were more likely to report limitations in moderate activities (81.2% vs 62.1%, p=0.015) and in climbing several flights of stairs (89.1% vs 64.9%, p=0.001). Pts who reported numbness in their feet some, most or all of the time were numerically but not statistically more likely to report a fall (35% vs 21.9%, p=0.070).  Compared with nonfallers, fallers reported more days in the past 30 days when their physical health was not good (15.8 vs 10.0 days, p=0.024), more days in the past 30 days when their mental health was not good (10.7 days vs 4.1 days, p=0.002) and more days in the past 30 days when their health interfered with their daily activities (14.3 vs 7.0 days, p=0.001). Pts who had fallen were more likely to report that their health was fair or poor than those who had not fallen (67.4% vs 33.8%, p<0.001).

Of pts who reported a fall, one-third (33.3%) had not talked with their doctor about falling or walking problems.  Nonetheless, pts who had fallen were much more likely to have received a recommendation to use an assistive device, attend physical therapy, or have other fall-prevention screenings performed (72.9% vs 29.4%, p<0.001).  The median overall survival among fallers was 25.0 months (95% confidence intervals 15.3-34.7), versus 52.0 months (95% CI 36.7-67.3), p=0.072.

Conclusions: Falls are a common occurrence in older adults with newly diagnosed MM, occurring in 25% of pts in the past year.  Falls are associated with more limited activity, depression and congestive heart failure. Pts who fell also reported poorer physical and mental health than nonfallers. Prospective studies are needed to determine factors predictive of falls in order to target interventions to those at high fall-risk and to prevent falls.