Risk Factors Related to Falling in Patients after Stroke
-
Olivera Djurovic
,
Olgica Mihaljevic
,
Snezana Radovanovic
,
Smiljana Kostic
,
Marjana Vukicevic
,
Biljana Georgievski Brkic
,
Snezana Stankovic
,
Danijela Radulovic
,
Ivana Simic Vukomanovic
,
Svetlana R Radevic
Abstract
Background: The aim of this study was to identify the risk factors associated with falling in post stroke patients.
Methods: This retrospective case-control study included 561 neurology patients hospitalized for a stroke and divided into two groups: falling patients and non-falling patients. They referred to the Special Hospital for Cerebrovascular Diseases "Sveti Sava" in Belgrade, Serbia, from 2018- 2019. Logistic regression analysis was applied to examine socio-economic factors associated with predictors of unmet healthcare needs.
Results: A significant difference was seen in the length of hospitalization of falling patients compared to the non-falling (P<0.001). We established statistically significant differences in mental status (P<0.001), sensibility (P=0.016), depressed mood (P<0.001), early (P=0.001) and medium insomnia (P=0.042), psychomotor slowness (P=0.030), somatic anxiety (P=0.044) and memory (P<0.001).
Conclusion: Cerebrovascular disease distribution and the degree of neurological deficit primarily altered mental status, which could be recognized as one of the more important predictors for falling after stroke. The identification of risk factors may be a first step toward the design of intervention programs for preventing a future fall among hospitalized stroke patients.
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2. Cho K, Yu J, Rhee H (2015). Risk fac-tors related to falling in stroke pa-tients: a cross-sectional study. J Phys Ther Sci, 27(6):1751-3.
3. Sullivan R, Harding K (2019). Do pa-tients with severe poststroke commu-nication difficulties have a higher in-cidence of falls during inpatient reha-bilitation? A retrospective cohort study. Top Stroke Rehabil, 26(4):288-293.
4. Indredavik B, Rohweder G, Naalsund E, Lydersen S (2008). Medical complica-tions in a comprehensive stroke unit and an early supported discharge ser-vice. Stroke, 39:414-420.
5. Kerse N, Parag V, Feigin VL, et al (2008). Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003. Stroke, 39:1890-1893.
6. Morello R, Barker A, Watts J, et al (2015). The extra resource burden of in-hospital falls: a cost of falls study. Med J Aust, 203(9):367. doi:10.5694/mja15.00296
7. Oliver D, Daly F, Martin FC, McMurdo ME (2004). Risk factors and risk as-sessment tools for falls in hospital in-patients: a systematic review. Age Age-ing, 33(2):122-30.
8. Ashburn A, Hyndman D, Pickering R, Yardley L, Harris S (2008). Predicting people with stroke at risk of falls. Age Ageing, 37:270–6.
9. Schwendimann R, Bühler H, De Geest S, Milisen K (2006). Falls and conse-quent injuries in hospitalized patients: effects of an interdisciplinary falls prevention program. BMC Health Serv Res, 6:69.
10. Walsh ME, Horgan NF, Walsh CD, Gal-vin R (2016). Systematic review of risk prediction models for falls after stroke. J Epidemiol Community Health, 70:513-9.
11. Xu T, Clemson L, O'Loughlin K, Lannin NA, Dean C, Koh G (2018). Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil, 99(3):563-573.e5.
12. Schmid AA, Rittman M (2009). Conse-quences of poststroke falls: activity limitation, increased dependence, and the development of fear of falling. Am J Occup Ther, 63(3):310–6.
13. Lukaszyk C, Harvey L, Sheerington C, Keay L, Tiedemanu A, Commles J (2016). Risk factors, incidence, con-sequences and prevention strategies for falls and full-ingury within older indigenous populations. A systematic review. Aust N Z J Public Health, 40(6):564-568.
14. Watanabe Y (2005). Fear of falling among stroke survivors after discharge from inpatient rehabilitation. Int J Re-habil Res, 28(2):149-52.
15. Sacco RL, Kasner SE, Broderick JP, et al (2013). An updated definition of stroke for the 21st century: a state-ment for healthcare professionals from the American Heart Associa-tion/American Stroke Association. Stroke, 44(7):2064-89.
16. Morse JM, Black C, Oberle K, Donahue P (1989). A prospective study to identify the fall-prone patient. Soc Sci Med, 28(1): 81-86.
17. Mahoney FI, Barthel D (1965). “Functional evaluation: the Barthel Index.” Maryland State Med Journal, 14:56-61.
18. Brott T, Adams Jr HP, Olinger CP, et al. (1989). Measurements of acute cerebral infarction: a clinical examination scale. Stroke, 20(7):864-870.
19. Williams JB (1988). A structured interview guide for the Hamilton Depression Rat-ing Scale. Arch Gen Psychiatry, 45(8):742–7.
20. Molloy DW, Standish TI (1977). A guide to the standardized Mini-Mental State Ex-amination. Int Psychogeriatr, 9 Suppl 1:87-94; discussion 143-50.
21. Stolze H, Klebe S, Zechlin C, et al (2004). Falls in frequent neurological diseases – prevalence, risk factors and aetiology. J Neurol, 251: 79 – 84.
22. Liu-Ambrose T, Pang MY, Eng JJ (2007). Executive function is independently asso-ciated with performances of balance and mobility in community-dwelling older adults after mild stroke: implications for falls prevention. Cerebrovasc Dis, 23: 203 – 210.
23. Teasell R, McRae M, Foley N, et al (2002). The incidence and consequences of falls in stroke patients during inpatient rehabil-itation: factors associated with high risk. Arch Phys Med Rehabil, 83: 329 – 333.
24. Kishi Y, Robinson RG, Kosier JT (1996). The validity of observed depression as criteria for mood disorders in patients with acute stroke. J AVect Disord, 9:53–60.
25. Jørgensen L, Engstad T, Jacobsen BK (2002). Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke. Stroke, 33:542-7
26. Schmid AA, Wells CK, Concato J, et al (2010). Prevalence, predictors, and out-comes of poststroke falls in acute hospi-tal setting. J Rehabil Res Dev, 47(6):553-62.
27. Fujikawa T, Yokota N, Muraoka M (1996). Response of patients with major depres-sion and silent cerebral infarction to anti-depressant drug therapy, with emphasis on central nervous system adverse reac-tions. Stroke, 27:2040–2.
28. Vellas BJ, Wayne SJ, Romero LJ, Baumgart-ner RN, Garry PJ (1997). Fear of falling and restriction of mobility in elderly fall-ers. Age and Ageing, 26: 189–193.
29. Dionyssiotis Y (2012). Analyzing the prob-lem of falls among older people. Int J Gen Med, 5 805–813.
30. Nyberg L, Gustafson Y (1995). Patient falls in stroke rehabilitation. Stroke, 26:838–42.
31. Cahit Ugur, Demet Gücüyener, Nevzat Uz-uner, Serhat Özkan, Gazi Özdemir (2000). Characteristics of falling in pa-tients with stroke. J Neurol Neurosurg Psy-chiatry, 69:649–651.
32. Lewis A Lipsitz, Manor B, Habtemariam D, et al (2018). The pace and prognosis of peripheral sensory loss in advanced age: association with gait speed and falls. BMC Geriatrics, 18:274.
33. Marigold DS, Eng JJ, Tokuno CD, Donnel-ly CA (2004). Contribution of muscle strength and integration of afferent input to postural instability in persons with stroke. Neurorehabil Neural Repair, 18(4):222–29.
34. Gu Y, Dennis SM (2017). Are falls preven-tion programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropa-thy: a systematic review with narrative synthesis? J Diabetes Complicat, 31:504–16.
35. Strotmeyer ES, De Rekeneire N, Schwartz AV, et al (2009). Sensory and motor pe-ripheral nerve function and lower-extremity quadriceps strength: the health, aging and body composition study. J Am Geriatr Soc, 57:2004–10.
36. Azhary H, Farooq MU, Bhanushali M, Majid A, Kassab MY (2010). Periph-eral Neuropathy: Differential Diagno-sis and Management. Am Fam Physi-cian, 81(7):887-892.
37. Suzuki T, Sonoda S, Misawa K, Saitoh E, Shimizu Y, Kotake T (2005). Incidence and consequence of falls in inpatient re-habilitation of stroke patients. Exp Aging Res, 31(4):457–69.
2. Cho K, Yu J, Rhee H (2015). Risk fac-tors related to falling in stroke pa-tients: a cross-sectional study. J Phys Ther Sci, 27(6):1751-3.
3. Sullivan R, Harding K (2019). Do pa-tients with severe poststroke commu-nication difficulties have a higher in-cidence of falls during inpatient reha-bilitation? A retrospective cohort study. Top Stroke Rehabil, 26(4):288-293.
4. Indredavik B, Rohweder G, Naalsund E, Lydersen S (2008). Medical complica-tions in a comprehensive stroke unit and an early supported discharge ser-vice. Stroke, 39:414-420.
5. Kerse N, Parag V, Feigin VL, et al (2008). Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003. Stroke, 39:1890-1893.
6. Morello R, Barker A, Watts J, et al (2015). The extra resource burden of in-hospital falls: a cost of falls study. Med J Aust, 203(9):367. doi:10.5694/mja15.00296
7. Oliver D, Daly F, Martin FC, McMurdo ME (2004). Risk factors and risk as-sessment tools for falls in hospital in-patients: a systematic review. Age Age-ing, 33(2):122-30.
8. Ashburn A, Hyndman D, Pickering R, Yardley L, Harris S (2008). Predicting people with stroke at risk of falls. Age Ageing, 37:270–6.
9. Schwendimann R, Bühler H, De Geest S, Milisen K (2006). Falls and conse-quent injuries in hospitalized patients: effects of an interdisciplinary falls prevention program. BMC Health Serv Res, 6:69.
10. Walsh ME, Horgan NF, Walsh CD, Gal-vin R (2016). Systematic review of risk prediction models for falls after stroke. J Epidemiol Community Health, 70:513-9.
11. Xu T, Clemson L, O'Loughlin K, Lannin NA, Dean C, Koh G (2018). Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil, 99(3):563-573.e5.
12. Schmid AA, Rittman M (2009). Conse-quences of poststroke falls: activity limitation, increased dependence, and the development of fear of falling. Am J Occup Ther, 63(3):310–6.
13. Lukaszyk C, Harvey L, Sheerington C, Keay L, Tiedemanu A, Commles J (2016). Risk factors, incidence, con-sequences and prevention strategies for falls and full-ingury within older indigenous populations. A systematic review. Aust N Z J Public Health, 40(6):564-568.
14. Watanabe Y (2005). Fear of falling among stroke survivors after discharge from inpatient rehabilitation. Int J Re-habil Res, 28(2):149-52.
15. Sacco RL, Kasner SE, Broderick JP, et al (2013). An updated definition of stroke for the 21st century: a state-ment for healthcare professionals from the American Heart Associa-tion/American Stroke Association. Stroke, 44(7):2064-89.
16. Morse JM, Black C, Oberle K, Donahue P (1989). A prospective study to identify the fall-prone patient. Soc Sci Med, 28(1): 81-86.
17. Mahoney FI, Barthel D (1965). “Functional evaluation: the Barthel Index.” Maryland State Med Journal, 14:56-61.
18. Brott T, Adams Jr HP, Olinger CP, et al. (1989). Measurements of acute cerebral infarction: a clinical examination scale. Stroke, 20(7):864-870.
19. Williams JB (1988). A structured interview guide for the Hamilton Depression Rat-ing Scale. Arch Gen Psychiatry, 45(8):742–7.
20. Molloy DW, Standish TI (1977). A guide to the standardized Mini-Mental State Ex-amination. Int Psychogeriatr, 9 Suppl 1:87-94; discussion 143-50.
21. Stolze H, Klebe S, Zechlin C, et al (2004). Falls in frequent neurological diseases – prevalence, risk factors and aetiology. J Neurol, 251: 79 – 84.
22. Liu-Ambrose T, Pang MY, Eng JJ (2007). Executive function is independently asso-ciated with performances of balance and mobility in community-dwelling older adults after mild stroke: implications for falls prevention. Cerebrovasc Dis, 23: 203 – 210.
23. Teasell R, McRae M, Foley N, et al (2002). The incidence and consequences of falls in stroke patients during inpatient rehabil-itation: factors associated with high risk. Arch Phys Med Rehabil, 83: 329 – 333.
24. Kishi Y, Robinson RG, Kosier JT (1996). The validity of observed depression as criteria for mood disorders in patients with acute stroke. J AVect Disord, 9:53–60.
25. Jørgensen L, Engstad T, Jacobsen BK (2002). Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke. Stroke, 33:542-7
26. Schmid AA, Wells CK, Concato J, et al (2010). Prevalence, predictors, and out-comes of poststroke falls in acute hospi-tal setting. J Rehabil Res Dev, 47(6):553-62.
27. Fujikawa T, Yokota N, Muraoka M (1996). Response of patients with major depres-sion and silent cerebral infarction to anti-depressant drug therapy, with emphasis on central nervous system adverse reac-tions. Stroke, 27:2040–2.
28. Vellas BJ, Wayne SJ, Romero LJ, Baumgart-ner RN, Garry PJ (1997). Fear of falling and restriction of mobility in elderly fall-ers. Age and Ageing, 26: 189–193.
29. Dionyssiotis Y (2012). Analyzing the prob-lem of falls among older people. Int J Gen Med, 5 805–813.
30. Nyberg L, Gustafson Y (1995). Patient falls in stroke rehabilitation. Stroke, 26:838–42.
31. Cahit Ugur, Demet Gücüyener, Nevzat Uz-uner, Serhat Özkan, Gazi Özdemir (2000). Characteristics of falling in pa-tients with stroke. J Neurol Neurosurg Psy-chiatry, 69:649–651.
32. Lewis A Lipsitz, Manor B, Habtemariam D, et al (2018). The pace and prognosis of peripheral sensory loss in advanced age: association with gait speed and falls. BMC Geriatrics, 18:274.
33. Marigold DS, Eng JJ, Tokuno CD, Donnel-ly CA (2004). Contribution of muscle strength and integration of afferent input to postural instability in persons with stroke. Neurorehabil Neural Repair, 18(4):222–29.
34. Gu Y, Dennis SM (2017). Are falls preven-tion programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropa-thy: a systematic review with narrative synthesis? J Diabetes Complicat, 31:504–16.
35. Strotmeyer ES, De Rekeneire N, Schwartz AV, et al (2009). Sensory and motor pe-ripheral nerve function and lower-extremity quadriceps strength: the health, aging and body composition study. J Am Geriatr Soc, 57:2004–10.
36. Azhary H, Farooq MU, Bhanushali M, Majid A, Kassab MY (2010). Periph-eral Neuropathy: Differential Diagno-sis and Management. Am Fam Physi-cian, 81(7):887-892.
37. Suzuki T, Sonoda S, Misawa K, Saitoh E, Shimizu Y, Kotake T (2005). Incidence and consequence of falls in inpatient re-habilitation of stroke patients. Exp Aging Res, 31(4):457–69.
| Files | ||
| Issue | Vol 50 No 9 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v50i9.7056 | |
| Keywords | ||
| Falls Stroke patients Risk factors Hospitalization | ||
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How to Cite
1.
Djurovic O, Mihaljevic O, Radovanovic S, Kostic S, Vukicevic M, Georgievski Brkic B, Stankovic S, Radulovic D, Simic Vukomanovic I, Radevic S. Risk Factors Related to Falling in Patients after Stroke. Iran J Public Health. 2021;50(9):1832-1841.
