Falls among older adults with cancer: A nationwide analysis.

Abstract

e13759 Background: Falls represent a failure of physiologic reserve rather than a normal consequence of aging. In oncology, fall events are particularly consequential due to frailty, treatment toxicities, and polypharmacy. Falls may lead to serious injury, delay cancer therapy, and alter treatment goals. We examined the prevalence, temporal trends, and predictors of fall-related admissions among older adults with cancer. Methods: Using the National Readmissions Database from 2019–2022, we identified hospital admissions among patients aged ≥60 years with a cancer diagnosis using ICD-10-CM codes. Malignancies were categorized by primary site and metastatic status. Fall-related admissions were identified using validated ICD-10 codes. Baseline characteristics, comorbidities, complications, length of stay (LOS), hospital costs, and discharge disposition were analyzed. Multivariable logistic regression was used to identify independent predictors of fall-related admission. Adjusted odds ratios (aOR) are reported with 95% confidence intervals, and P value < 0.05 was considered statistically significant. Results: Among an estimated 5.17 million weighted cancer admissions, 5.55% were fall-related. The proportion increased significantly from 5.09% in 2019 to 6.10% in 2022 (P trend < 0.001). Patients with falls were older (mean age 77 vs 73 years), and 53% were male. Among cancer types, multiple myeloma conferred the highest odds of fall-related admission (aOR 1.28, P < 0.001). While metastatic disease overall was associated with lower odds (aOR 0.94), site specific analyses showed increased risk with brain metastases (aOR 1.27) and bone metastases (aOR 1.22) (all P < 0.001). Geriatric syndromes were the strongest predictors, including prior falls (aOR 4.67), orthostatic hypotension (aOR 3.04), dementia (aOR 1.69), and urinary incontinence (aOR 1.30). Sensory impairments including neuropathy (aOR 1.32), vision loss (aOR 1.17), and hearing loss (aOR 1.15) were independently associated with higher odds of falls. Laboratory abnormalities including anemia (aOR 1.16), hypercalcemia (aOR 1.14), and hyponatremia (aOR 1.08) were significant predictors (all P < 0.001). Falls resulted in substantial morbidity: 16.3% sustained hip fractures, 7.0% spine fractures, 21.2% other major fractures, and 9.4% intracranial hemorrhage. Mean LOS was 7.97 days, mean costs were $95,175, and discharge to skilled nursing facilities was markedly higher among patients who had falls (43.5% vs 17.4%). Conclusions: Fall-related admissions among older adults with cancer increased steadily over time and were associated with severe complications, prolonged hospitalization, and frequent discharge to post-acute care. Many identified risk factors are directly related to cancer or its treatment and may be modifiable. These findings highlight the need for systematic fall-risk screening and preventive interventions as a core component of geriatric oncology care.