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Affiliation
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Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Ageing and Age Associated Disorders Research Group, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. |
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Abstract
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BACKGROUND: Falls are common after stroke with potentially serious consequences. Few investigations have included age-matched controls to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population.
OBJECTIVE: To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors DESIGN: Case-control observational study SETTING: Primary teaching hospital PARTICIPANTS: Seventy-five patients with stroke (mean age ± standard deviation, 66 ± 7) and 50 age-matched controls with no previous stroke were tested.
METHODS: Fall history, fear of falling, and physical, cognitive and psychological function were assessed. Chi-squared test was performed to compare characteristics between groups and logistic regression was done to determine the risk factors for falls and fear of falling. MAIN OUTCOME MEASURES: Fall events in the past 12 months, Fall Efficacy Scale-International (FES-I), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), Fatigue Severity Scale (FSS), Montreal Cognitive Assessment (MoCA), and Patient Healthy Questionnaire-9 (PHQ-9) were measured for all participants. Fugl-Meyer Motor Assessment (FM) was used to quantify severity of stroke motor impairments.
RESULTS: Twenty-three patients and 13 controls reported at least one fall in the past 12 months (p =.58). Nine stroke participants had recurrent falls (≥ 2 falls) compared to none of the controls (p <.01). Participants with stroke reported greater concern for falling than non-stroke controls (p <.01). Female gender was associated with falls in the non-stroke group while falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group.
CONCLUSIONS: Compared to non-stroke individuals, patients with stroke were significantly more likely to experience recurrent falls and fear of falling. Falls in stroke were not explained by any of the outcome measures used, while fear of falling was predicted by functional ambulation level. This study has identified potentially modifiable risk factor with which to devise future prevention strategies for falls in stroke patients.
Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Language: en |