Graduation Semester and Year

Spring 2024



Document Type


Degree Name

Doctor of Nursing Practice



First Advisor

Dr. Deborah Behan


Background: Multiple Myeloma (MM) is a hematological malignancy with demographic disparities. MM is a debilitating cancer mainly affecting older adults, with 66% over the age of 70. Additionally, 33% of older patients with MM are frail with weakness, fatigue, slow gait, weight loss, and malnutrition.

PICOTS: The purpose of this Doctor of Nursing (DNP) scholarly project is to implement an evidence-based practice (EBP) change consisting of a Step Squad Bundle that will identify frailty in older patients with MM hospitalized for an Autologous Stem Cell Transplant (ASCT) to reduce morbidity and mortality and increase the chances of a quality of life.

Methods: Guided by the IOWA model, this project consisted of seven steps intended to identify frailty in hospitalized older adults with MM undergoing ASCT and improve their physical status by their hospital discharge. The Frail Scale was utilized as a screening tool for frailty on admission (pre-test) and discharge (post-test). The intervention was implementing a Step Squad Bundle, which includes appropriate referrals to physical and occupational therapy, referral to a nutritionist, verbal and written education on walking, and a walking diary as a resource tool to document walking time.

Results: 21 patients participated in the project. Results indicated no statistical difference in the pre-test and post-test Frail Scale scores, consistent with maintenance of baseline physical status even after hospitalization. These results were clinically significant because their baseline physical function even after undergoing aggressive chemotherapy and a stem cell transplant did not decrease.

Conclusion: The Step Squad Bundle project has the potential to facilitate the identification of frailty in older adults with MM undergoing ASCT and teach them to use tools to stay physically active in the hospital.


Frailty, Older adults, Seniors, Elderly, Multiple Myeloma, Autologous Stem Cell Transplant, Walking, Physical Activity, Nutritionist


Hemic and Lymphatic Diseases | Movement and Mind-Body Therapies | Physical Therapy


Acknowledgments: Dr. Deborah Behan, Faculty Project Advisor Dr. Yungfei Kao, Statistician Deerbrook Gerontology Scholarship Edward and Dorothy Perez Scholarship.



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