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Prevalence of falls in the last weeks of life and relationship between falls, independence and quality of dying in Japan: a large prospective cohort study. | LitMetric

AI Article Synopsis

  • The study investigates the frequency and complications of falls in palliative care units (PCUs) for advanced cancer patients and how these relate to independence and quality of dying.
  • Among 1,633 patients observed, 150 (9.2%) experienced falls in the last month of life, primarily due to needing to use the toilet, with serious injuries being very rare.
  • The findings suggest that while falls can be common, they are not necessarily harmful and may reflect a patient's independence, indicating that healthcare providers should balance fall prevention with supporting patient autonomy.

Article Abstract

Objective: This study aims to determine the frequency of falls and their serious complications in palliative care units (PCUs), as well as explore the complex interplay between falls, independence and quality of dying.

Design: A prospective cohort study.

Setting And Participants: The dying process of patients with advanced cancer in 23 PCUs in Japan.

Outcome Measures: Palliative care specialist physicians recorded whether patients experienced falls, serious complications from falls, activities that led to falls, independence (workability in the last days and use of indwelling urinary catheter) and Good Death Scale as an indicator of quality of dying.

Results: Of the 1633 patients evaluated, 150 patients (9.2%; 95% CI 7.8% to 11%) experienced falls within 30 days prior to death. The patients who fell were mostly men, had Eastern Cooperative Oncology Group performance status 3 on admission, a longer estimated prognosis on admission and delirium during hospitalisation. Serious falls causing fractures or intracranial haemorrhages were rare in five patients (0.3%; 95% CI 0.038% to 0.57%). The most common reason for falls was the need to use the toilet (64.7%). The Good Death Scale and indwelling urinary catheter use were not significantly associated with falls (p=0.34; p=0.34).

Conclusion: Falls occur in approximately 10% of patients in PCUs, but serious complications are rare. The relationship between falls, independence and quality of dying is complex, that is, a fall may not be necessarily bad, if it is the result of respect for the patient's independence. Healthcare providers need to consider fall prevention while supporting patients' desire to move on their own to maintain independence.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529517PMC
http://dx.doi.org/10.1136/bmjopen-2024-085315DOI Listing

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