Recovering Stroke Patients at High Risk for a Fall

By Todd Neale
AUCKLAND, 16 may 2008-- More than a third of older patients who had a stroke suffered a fall within six months of the event, a population-based study revealed.
Of 1,104 recovering stroke patients about age 70, 37% had a fall, Ngaire Kerse, Ph.D., of the University of Auckland, and colleagues reported online in Stroke: Journal of the American Heart Association. About 30% of older patients in the general population suffer falls.
Of those who fell, 37% were injured and 8% broke a bone, the investigators said.
"Our study confirms that falls and fall-related injury are major morbidity issues among patients with stroke," they added. "Falls prevention interventions should be emphasized as part of routine stroke rehabilitation services."
As part of the Auckland Regional Community Stroke (ARCOS) study, Dr. Kerse and colleagues interviewed 1,104 stroke survivors after onset of the event and at one and six months post-stroke about falls.
Those who fell within six months of suffering their stroke were significantly older (72.9 versus 69.4, P<0.001) and were more likely to have fallen in the past year (38% versus 25%, P<0.001), to have had a previous stroke (27% versus 20%, P=0.01), and to be more dependent (28% versus 17%, P<0.001).
About half (47%) of the patients had fallen once and 12% had fallen more than five times. Three-quarters (77%) fell at home.
In a multivariable regression model controlling for age at stroke, sex, a fall in the year before the stroke, previous stroke at baseline, and cognitive function, the following factors were identified as independent risk factors for falling:
A fall in the year before stroke: OR 1.60, 95% CI 1.19 to 2.16, P=0.002
Older age at stroke: OR 1.06, 95% CI 1.00 to 1.12, P=0.03
Physical dependence: OR 2.09, 95% CI 1.40 to 3.12, P<0.001
Intermediate physical dependence: OR 1.72, 95% CI 1.25 to 2.36, P=0.001
Sadness or depression: OR 1.48, 95% CI 1.09 to 2.01, P=0.011
Independent risk factors for an injury from falling in the six months after suffering a stroke were female sex (P=0.01), reduced cognitive function (P=0.01), and New Zealand or European ethnicity (P=0.02).
Factors that predicted a lower risk of sustaining an injury from falling were premorbid dependency (P=0.01) and higher levels of physical functioning (P<0.001).
Stroke type was not related to the risk of falling.
The study design did not allow the researchers to establish causality in any of the relationships, and, particularly in regard to mood, "it is possible that falls themselves triggered the onset of depression," they said.
However, they continued, "falls and depression will complicate recovery from stroke, and irrespective of the direction of causality, both require appropriate prevention, early recognition, and nonpharmacological intervention."
The authors acknowledged that the study was limited because falls were self-reported and some eligible patients were not available for follow-up assessments and, thus, did not participate, which might have affected the results.
Also, the researchers were unable to obtain specific physical performance measures for the patients.
Nevertheless, they concluded, "these findings emphasize the need to incorporate falls prevention strategies in stroke services."
The study was funded by the Health Research Council of New Zealand. Dr. Kerse was supported by a visiting scholarship to the Robert Graham Center of the American Academy of Family Physicians and one of her co-authors received an Australian National Health and Medical Research Council Postdoctoral Research Fellowship.
The authors made no disclosures.
Primary source: Stroke: Journal of the American Heart AssociationSource reference:Kerse N, et al "Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) study, 2002 to 2003" Stroke 2008; DOI: 10.1161/STROKEAHA.107.509885.