Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
Clin Oncol (R Coll Radiol). 2020 Sep;32(9):569-578. doi: 10.1016/j.clon.2020.03.011. Epub 2020 Apr 11.
Falls among older people are common and are associated with substantial morbidity, mortality and healthcare costs. Increasingly cancer is becoming a disease of older people and fall rates are higher in elders living with cancer. Cancer and its treatments potentiate important risk factors for falls, including muscle weakness, poor balance, proprioception, cognitive impairment and functional disability. Sarcopenia refers to the progressive deterioration in muscle strength, mass and quality with ageing. Chronic conditions and cancer amplify this decline and are associated with a greater negative effect on function. Age-related impairments of lower limb neurological function are commonly exacerbated by neurotoxic chemotherapy, resulting in gait and balance deficits. Postural instability and falls erode confidence and result in a negative cycle of diminishing activity levels, further deconditioning and a higher risk of further falls. Cancer-related fatigue, sleep and mood disturbances compound this progressive frailty, further worsening treatment tolerance and outcomes. Cognitive impairment is a potent risk factor for falling and is frequently associated with gait abnormalities. The well-recognised effects of cancer treatment on working memory, attention, processing speed and executive function are often apparent (when their presence is sought) before treatment and may be as much the result of the cancer itself as they are 'chemo brain'. Structured exercise programmes focusing on progressively challenging strength and balance training are of proven benefit in falls prevention. Regular aerobic exercise accrues additional benefits in improved cardiorespiratory resilience and concomitant positive effects on treatment tolerance. Increased activity levels positively influence cognition, mood and foster an improved sense of well-being. Simple, practicable clinic-based tests of physical functioning, cognition and neurological function can help to identify those at high risk of falls and functional decline. The use of such instruments can aid judicious treatment planning and identify those most likely to benefit from more detailed specialist comprehensive geriatric assessment.
老年人跌倒很常见，会导致严重的发病率、死亡率和医疗保健费用。随着癌症患者逐渐老龄化，癌症患者的跌倒率更高。癌症及其治疗会增加跌倒的重要风险因素，包括肌肉无力、平衡不良、本体感觉、认知障碍和功能障碍。肌肉减少症是指随着年龄的增长，肌肉力量、质量和功能逐渐恶化。慢性疾病和癌症会加剧这种下降，并对功能产生更大的负面影响。与神经毒性化疗相关的下肢神经功能的年龄相关性损伤通常会加剧步态和平衡缺陷。姿势不稳和跌倒会削弱信心，导致活动水平下降、进一步去适应和更高的再次跌倒风险的恶性循环。与癌症相关的疲劳、睡眠和情绪障碍使这种逐渐衰弱更加复杂，进一步恶化治疗耐受性和结果。认知障碍是跌倒的一个强有力的风险因素，常与步态异常有关。众所周知，癌症治疗对工作记忆、注意力、处理速度和执行功能的影响在治疗前就很明显（当寻求其存在时），而且可能是癌症本身的结果，而不仅仅是“化疗脑”。专注于逐步挑战力量和平衡训练的结构化运动计划已被证明对预防跌倒有效。定期进行有氧运动除了对治疗耐受性有积极影响外，还能增加心肺复苏的弹性。增加活动水平可以积极影响认知、情绪，并培养更好的幸福感。简单可行的临床身体功能、认知和神经功能测试有助于确定那些有高跌倒风险和功能下降风险的人。使用这些工具可以帮助合理的治疗计划，并确定最有可能从更详细的综合老年评估中受益的人。
