Balance Problems and Falls

A person who is weak, unsteady on their feet, or confused is at high risk for falling. Someone who has these problems could fall when trying to get out of bed, using the toilet, taking a bath or shower, or walking.

Managing balance problems and falls

Your health care team can look for certain factors that could increase your risk of falling:

  • A history of falling
  • Changes in vision
  • Changes in mood, memory/confusion , or coordination
  • Muscle weakness, fatigue or changes in how you walk (gait)
  • Neuropathy
  • Bowel and bladder problems
  • Low blood counts
  • Environmental risks around the home (ie clutter, dim lights,pets that may be a tripping hazard, uneven floors, or stairs)
  • Changes in medication
  • Changes in nutritional status

Your health care team may have you work with a physical or occupational therapist and home health care to find different ways to lower your risk of falling. These specialists may also teach you certain exercises or how to use equipment (wheelchair, walker, cane) that can help with daily routines (transportation, preparing meals, shopping, or grooming). Strength training and coordination exercises, along with equipment to assist you, can all help improve your safety, balance, coordination, and strength.

Managing cancer symptoms and other medical conditions may also be part of managing your balance problems and falls. Fatigue, confusion, and low blood counts are some common symptoms that occur with cancer and its treatment. These conditions may add to problems with balance and falling.

Different medications can also affect these symptoms and your risk of falling. It's important that you review both your medication list and any new symptoms with your health care team regularly so they can adjust your medicines and treat symptoms as early as possible.

What the patient can do

  • Go over your list of medicines with your health care team. Use only one pharmacy to fill your prescriptions, this may help keep track of ongoing medication changes.
  • If you notice you're having problems with weakness, poor balance, changes in mood or memory, ask for help getting up or walking.
  • If you fall, let your cancer care team and your caregivers know. They’ll want to help prevent future falls, and might need to check you for injuries.
  • If you have trouble walking, ask about a home health nursing visit. A home health team may be able to make your surroundings safer for you. They also have ways to help you walk more safely.
  • If a walker or wheelchair is recommended, keep it by the bed or next to where you sit. Use it every time you get up, even for short trips.

What caregivers can do

  • Report any signs of memory or mood changes, or confusion to the cancer care team.
  • Report any changes to the medication or vitamin list to the cancer care team. Also report if the patient is not taking medications, vitamins, or supplements as directed (non-compliant).
  • When the patient needs to get out of bed, first sit them on the side of the bed for a minute or so. This will help if changing positions makes them feel dizzy or unsteady.
  • If the patient is unsteady, help them walk.
  • If the patient feels light-headed, stay with them when they go to the bathroom.
  • Remind the patient to call for help before trying to get up.
  • In the tub or shower, use bath mats or non-slip stickers, and grab bars. You can also put a stool or chair in the shower so the patient can sit while bathing.
  • Keep electric cords off the floor. Walking paths need to be clear of clothing, throw rugs, and other items that can cause tripping or slipping.
  • Tape the edges of rugs to the floor. There also is special tape for the underside of rugs to keep them from moving.
  • Have a bedpan or urinal within easy reach, place a commode near the bed, or put the bed near a bathroom.
  • The patient should wear shoes, non-skid socks or slippers when walking or standing. Avoid using slippery shoes or open-heel bedroom slippers.
  • Ask about a home health nursing visit to check your home for ways to prevent falls. Handrails, bedside commodes, grab bars, shower chairs, and other tools can help keep some patients from falling.

If the patient falls

  • Call 911 right away if they aren’t breathing, unless the patient is in hospice or has a Durable Power of Attorney for Health Care that states they do not wish to be revived.
  • Call 911 right away if the patient is unconscious
  • Call 911 right away if the patient is bleeding, or has fluid draining from the mouth, ears, or nose.
  • Let the patient stay where they’ve fallen until you can find out if there are serious injuries.
  • If you can’t move the patient, make them as comfortable as possible until help comes.
  • If the patient can answer you, ask if they have any pain.
  • Check the patient’s head, arms, legs, and buttocks for cuts and bruises, and look to see if anything looks strange or out of shape (possibly due to a broken bone).
  • If the patient is not in pain and isn’t bleeding, help them back to a bed or chair. (If possible, get help moving the patient.)
  • Apply ice packs and pressure to any bleeding area. (Put ice in a plastic bag and wrap bag in a towel.)

Call the cancer care team if the patient

  • Notices new weakness, numbness, or change in mental status (such as if the patient is confused, doesn’t know where they are, becomes forgetful, or isn’t making sense)
  • Gets weak or unsteady enough that a fall seems likely
  • Is concerned about possible injury from a fall

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Bower JE, Bak K, Berger A, et al. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical Oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32(17):1840-1850.

Campbell G, Wolfe RA, Klem ML.  Risk factors for falls in adult cancer survivors: An integrative review.  Rehab Nurs. 2018;43(4):201-213.

Guerard EJ, Allison MD, et al.  Falls in older adults with cancer: evaluation by oncology providers. J Oncol Pract. 2015; 11(6);470-474.

National Comprehensive Cancer Network. (NCCN).  Cancer-related fatigue. Version 1.2019. Accessed at
www.nccn.org/professionals/physician_gls/f_guidelines.asp on September 18, 2019.

National Comprehensive Cancer Network (NCCN). Survivorship. Version 2.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf on September 11, 2019 .

 

References

Bower JE, Bak K, Berger A, et al. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical Oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32(17):1840-1850.

Campbell G, Wolfe RA, Klem ML.  Risk factors for falls in adult cancer survivors: An integrative review.  Rehab Nurs. 2018;43(4):201-213.

Guerard EJ, Allison MD, et al.  Falls in older adults with cancer: evaluation by oncology providers. J Oncol Pract. 2015; 11(6);470-474.

National Comprehensive Cancer Network. (NCCN).  Cancer-related fatigue. Version 1.2019. Accessed at
www.nccn.org/professionals/physician_gls/f_guidelines.asp on September 18, 2019.

National Comprehensive Cancer Network (NCCN). Survivorship. Version 2.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf on September 11, 2019 .

 

Last Medical Review: February 1, 2020 Last Revised: February 1, 2020

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