Survivorship Care Plan: Mobility and Safety

Hello, my name is Sandy Kurtin. Welcome to the Multiple Myeloma Center for Nurses video: Survivorship Care Plan: Mobility and Safety.

In this video, we’ll discuss interventions that focus on helping patients with multiple myeloma address mobility issues and reduce fall risk.^1,2

When we talk about survivorship plans for mobility and safety in patients with multiple myeloma, we are particularly concerned with falls.

Specifically, we need to assess fall risk and employ interventions to prevent them.

This is important because patients with multiple myeloma are at particular risk for falls due to bone disease, fatigue or asthenia, and neuropathy that may be associated with the disease or treatment.¹

Remember, too, that the median age at diagnosis of multiple myeloma is 69 years old, so they are in the demographic of people highly susceptible to falls: More than one-third of all adults aged 65 or older fall each year.^2,3

Those who fall once are 2 to 3 times more likely to fall again.² This can reduce a patient’s independence and may lead to significant disabilities.²

Fortunately, studies of interventions designed to prevent falls have shown that falls can be reduced.²

Some practice recommendations for assessing fall risk include history and physical exam, blood tests, bone surveys or other imaging, and functional tests for strength, balance, and home safety.¹

For example, functional status assessments recommended by the National Comprehensive Cancer Network include activities of daily living, instrumental activities of daily living, performance status, history or fear of falls, and gait speed.⁴

The guidelines recommend these assessments can be performed at baseline and with every patient encounter.¹

Patients can be at risk for falls in the hospital or home setting.

The St. Thomas’s Risk Assessment Tool in Falling Elderly Inpatients, or STRATIFY, is a common tool used to assess fall risk among hospitalized, acutely ill adult patients.⁵

The STRATIFY Risk Assessment Tool is a brief questionnaire based on your observations of the patient.⁶

A score of 2 or more as a definition of high risk predicted 93% of falls that occurred in the following week.⁶

At home, the “Timed Up and Go” or “TUG” test can be used to assess risk for fall and is recommended by NCCN for older patients who have fallen or have a fear of falling.⁴

This is a timed test in which a patient is seated in an armchair and is instructed to stand up, walk 10 feet, then return to the chair and sit down.⁴

An older adult who takes 12 seconds or more to complete the test is considered to be at high risk for falling.⁷

We can work with the patient and their caregivers to help reduce fall risk in the home.

For example, tripping hazards such as loose rugs, slippery surfaces, unsecured cords, or poor lighting can increase fall risk.²

Advise patients to clear away clutter in walkways, secure rugs with a pad or grippers, and mop up spills immediately.²

You can also suggest that patients wear nonslip shoes that fit well. Low, rounded heels are recommended over high heels.²

Maintaining eye health through annual eye exams and protecting the eyes from the sun can help reduce fall risk.²

Additionally, patients may report balance problems because of their medication, cold or sinus issues, or hearing loss. All of these can negatively impact a patient’s balance and should be discussed.²

Finally, maintaining a moderate activity level has been shown to help reduce fall risk in patients.

One study in inactive adults aged 70 years or older showed a 55% reduction in fall risk for those who took part in a 6-week Tai Chi program compared with people doing low-level stretching control activity.⁸

Additionally, those Tai Chi participants reported fewer medical care visits resulting from an injurious fall.⁸

Otago exercises, developed specifically to help improve balance and reduce falls, have also shown fall risk reduction in high-risk or fall-prone persons.^2,9

Work with each of your patients to develop an exercise program that’s right for them.

This concludes the Survivorship Care Plan: Mobility and Safety. To find out more on this and other topics related to multiple myeloma, please see additional videos and resources on this site.

Here you will also find a number of educational tools to help you discuss these topics with your patients, answers to common questions, and other downloadable materials.

Thank you.

References
1. Rome SI, Jenkins BS, Lilleby KE; International Myeloma Foundation Nurse Leadership Board. Mobility and safety in the multiple myeloma survivor: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurs. 2011;15(suppl):41-52.
2. Stevens JA, Burns E. A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. 3rd ed. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2015.
3. National Cancer Institute. SEER cancer stat facts: myeloma. Available at: https://seer.cancer.gov/statfacts/html/mulmy.html. Accessed July 24, 2019.
4. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines^™). Older Adult Oncology. V1.2019. Accessed July 8, 2019.
5. Aranda-Gallardo M, Morales-Asencio JM, Canca-Sanchez JC, et al. Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis. BMC Health Serv Res. 2013;13:122-136.
6. Oliver D, Britton M, Seed P, Martin FC, Hopper AH. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. BMJ. 1997;315(7115):1049-1053.
7. Centers for Disease Control Web site. Timed Up and Go (TUG) Test. Available at: https://www.cdc.gov/steadi/pdf/TUG_Test-print.pdf. Accessed July 19, 2019.
8. Li F, Harmer P, Fisher KJ, et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2005;60(2):187-194.
9. Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls Management Exercise – FaME) reduces falls in community-dwelling older frequent fallers (an RTC). Age Ageing. 2005;34(6):636-639.
10. Rome S, Noonan K, Bertolotti P, et al. Bone health, pain and mobility: evidence-based recommendations for patient with multiple myeloma. Clin J Onc Nurs. 2017;21(suppl)(5):47-59.