Mary E Walsh1,2, Rose Galvin3, David Jp Williams4,5, Joseph A Harbison6,7, Sean Murphy4,8,9, Ronan Collins7,10, Dominick Jh McCabe11,12,13, Morgan Crowe14, N Frances Horgan1. 1. School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland. 2. HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland. 3. Department of Clinical Therapies, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Ireland. 4. School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland. 5. Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland. 6. Department of Medicine for the Elderly, St James's Hospital, Dublin, Ireland. 7. Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland. 8. Department of Medicine for the Older Person and Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland. 9. School of Medicine, University College Dublin, Dublin 4, Ireland. 10. Department of Age-related Healthcare, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Dublin, Ireland. 11. Department of Neurology, Vascular Neurology Research Foundation and Stroke Service, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Dublin, Ireland. 12. Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK. 13. Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland. 14. Department of Medicine for the Elderly, St Vincent's University Hospital, Dublin 4, Ireland.
Abstract
INTRODUCTION: Falls are common post-stroke adverse events. This study aimed to describe the first-year falls incidence, circumstances and consequences among persons discharged home after stroke in Ireland, and to examine the association between potential risk factors and recurrent falls. PATIENTS AND METHODS: Patients with acute stroke and planned home-discharge were recruited consecutively from five hospitals. Variables recorded pre-discharge included: age, stroke severity, co-morbidities, fall history, prescribed medications, hemi-neglect, cognition and functional independence (Barthel index). Falls were recorded with monthly diaries, and 6 and 12-month interviews. The association of pre-discharge factors with recurrent falls (>1 fall) was examined using univariable logistic regression. RESULTS: A total of 128 participants (mean age = 68.6, SD = 13.3) were recruited; 110 completed the 12-month follow-up. The first-year falls incidence was 44.5% (95% CI = 35.1-53.6) with 25.6% falling repeatedly (95% CI = 18.5-34.4). Fallers experienced 1-18 falls (median = 2) and five reported fractures; 47% of fallers experienced at least one fall outdoors. Only 10% of recurrent fallers had bone health medication prescribed at discharge. Lower Barthel index scores (<75/100, RR = 4.38, 1.64-11.72) and psychotropic medication prescription (RR = 2.10, 1.13-3.91) were associated with recurrent falls. DISCUSSION: This study presents prospectively collected information about falls circumstances. It was not powered for multivariable analysis of risk factors. CONCLUSION: One-quarter of stroke survivors discharged to the community fall repeatedly and mostly indoors in the first year. Specific attention may be required for individuals with poor functional independence or those on psychotropic medication. Future falls-management research in this population should explore falls in younger individuals, outdoor as well as indoor falls and post-stroke bone health status.
INTRODUCTION: Falls are common post-stroke adverse events. This study aimed to describe the first-year falls incidence, circumstances and consequences among persons discharged home after stroke in Ireland, and to examine the association between potential risk factors and recurrent falls. PATIENTS AND METHODS: Patients with acute stroke and planned home-discharge were recruited consecutively from five hospitals. Variables recorded pre-discharge included: age, stroke severity, co-morbidities, fall history, prescribed medications, hemi-neglect, cognition and functional independence (Barthel index). Falls were recorded with monthly diaries, and 6 and 12-month interviews. The association of pre-discharge factors with recurrent falls (>1 fall) was examined using univariable logistic regression. RESULTS: A total of 128 participants (mean age = 68.6, SD = 13.3) were recruited; 110 completed the 12-month follow-up. The first-year falls incidence was 44.5% (95% CI = 35.1-53.6) with 25.6% falling repeatedly (95% CI = 18.5-34.4). Fallers experienced 1-18 falls (median = 2) and five reported fractures; 47% of fallers experienced at least one fall outdoors. Only 10% of recurrent fallers had bone health medication prescribed at discharge. Lower Barthel index scores (<75/100, RR = 4.38, 1.64-11.72) and psychotropic medication prescription (RR = 2.10, 1.13-3.91) were associated with recurrent falls. DISCUSSION: This study presents prospectively collected information about falls circumstances. It was not powered for multivariable analysis of risk factors. CONCLUSION: One-quarter of stroke survivors discharged to the community fall repeatedly and mostly indoors in the first year. Specific attention may be required for individuals with poor functional independence or those on psychotropic medication. Future falls-management research in this population should explore falls in younger individuals, outdoor as well as indoor falls and post-stroke bone health status.
Authors: P Langhorne; D J Stott; L Robertson; J MacDonald; L Jones; C McAlpine; F Dick; G S Taylor; G Murray Journal: Stroke Date: 2000-06 Impact factor: 7.914
Authors: Ziad S Nasreddine; Natalie A Phillips; Valérie Bédirian; Simon Charbonneau; Victor Whitehead; Isabelle Collin; Jeffrey L Cummings; Howard Chertkow Journal: J Am Geriatr Soc Date: 2005-04 Impact factor: 5.562
Authors: H P Adams; P H Davis; E C Leira; K C Chang; B H Bendixen; W R Clarke; R F Woolson; M D Hansen Journal: Neurology Date: 1999-07-13 Impact factor: 9.910