Falls and Physical Performance Deficits in Older Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy

• Published in: Urology (Ridgewood, N.J.) Vol. 72; no. 2; pp. 422 - 427
• Main Authors: Bylow, Kathryn, Dale, William, Mustian, Karen, Stadler, Walter M, Rodin, Miriam, Hall, William, Lachs, Mark, Mohile, Supriya G
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2008; Elsevier Science
• Subjects: Accidental Falls; Activities of Daily Living; Aged; Aged, 80 and over; Androgen Antagonists - adverse effects; Biological and medical sciences; Gonadotropin-Releasing Hormone - adverse effects; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Nephrology. Urinary tract diseases; Physical Fitness; Prostate-Specific Antigen - blood; Prostatic Neoplasms - drug therapy; Risk Factors; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; Human; Nephrology; Urinary system disease; Androgen deprivation therapy; Prostate disease; Physical performance; Malignant tumor; Urology; Fall; Male genital diseases; Prostate cancer; Elderly; Age; Cancer
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2008.03.032

Objectives Men experience a decrease in lean muscle mass and strength during the first year of androgen deprivation therapy (ADT). The prevalence of falls and physical and functional impairment in this population have not been well described. Methods A total of 50 men aged 70 years and older (median 78) receiving ADT for systemic prostate cancer (80% biochemical recurrence) underwent functional and physical assessments. The functional assessments included Katz's Activities of Daily Living (ADLs) and Lawton's Instrumental Activities of Daily Living (IADLs). Patients completed the Vulnerable Elder's Survey-13, a short screening tool of self-perceived functional and physical performance ability. Physical performance was assessed using the Short Physical Performance Battery. The history of falls was recorded. Of the 50 patients, 40 underwent follow-up assessment with the same instruments 3 months after the initial assessment. Results Of the 50 men, 24% had impairment in the ADLs, 42% had impairment in the IADLs, 56% had abnormal Short Physical Performance Battery findings, and 22% reported falls within the previous 3 months. Within the Short Physical Performance Battery, deficits occurred within all subcomponents (balance, walking, and chair stands). On univariate analysis, age, deficits in ADLs and IADLs, and abnormal cognitive and functional screen findings were associated with an increased risk of abnormal physical performance. ADL deficits, the use of an assistive device, and abnormal functional screen findings were associated with an increased risk of falling. Conclusions The results of our study have shown that older men with prostate cancer receiving long-term ADT exhibit significant functional and physical impairment and are at risk of falls that is greater than that for similar-aged cohorts. Careful assessment of the functional and physical deficits in older patients receiving ADT is warranted.