Predictive Risk Factors Associated with Stroke Patient Falls in Acute Care Settings

Byers, Vicki L.; Arrington, Mary E.; Finstuen, Kenn

doi:10.1097/01376517-199006000-00003

Cited by 60 publications

(52 citation statements)

References 0 publications

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“…Over 15 scales attempt to identify patients at risk of falling. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The majority of these tools have not been validated, include only 1 population, or lack adequate sensitivity or specificity for clinical use. Three of these fall risk tools have been validated in multiple studies across the populations.…”

Section: Risk Stratificationmentioning

confidence: 99%

“…23 Common themes that indicate increased risk of patient falls between these 3 tools, and others, include assessment for previous falls or admission secondary to falling, presence of mental confusion or agitation, necessity for frequent toileting, and altered gait or mobility. 9,13,14,19,21,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] One of the most common populations studied and cited as high risk of falls is the older adult (!65). 8,16,17,[27][28][29][30][42][43][44][45][46][47][48] Medications including benzodiazepines, anticonvulsants, antihypertensives, antidepressants, and sleep aids have also been targeted as high-risk medications.…”

Section: Risk Stratificationmentioning

confidence: 99%

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Inpatient Falls

Cumbler

Simpson

Rosenthal

et al. 2013

The Neurohospitalist

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In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement.

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Section: Risk Stratificationmentioning

confidence: 99%

Section: Risk Stratificationmentioning

confidence: 99%

Inpatient Falls

Cumbler

Simpson

Rosenthal

et al. 2013

The Neurohospitalist

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“…[1][2][3][4][5] Long-term stroke survivors may also be at increased risk of falling, since several studies have shown that they are at increased risk of fracture, especially hip fracture. 6 -9 Information about the incidence of falls in this group is sparse, however.…”

mentioning

confidence: 99%

Higher Incidence of Falls in Long-Term Stroke Survivors Than in Population Controls

Jørgensen¹,

Engstad²,

Jacobsen³

2002

Stroke

368

298

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Background and Purpose-The incidence of falls among noninstitutionalized individuals with long-standing stroke has not been examined previously, although fractures are more common and the consequences more severe for stroke patients than for elderly people in general. Methods-For 4 months (September to December 1998), we followed 111 home-living patients who had suffered a stroke a mean of 10 years previously and 143 control subjects randomly selected from the same municipality, matched with respect to age and sex. Falls were registered daily by use of "fall calendars." Before the fall registration period, information about morbidity, use of medication, and activities of daily living had been registered. Height, weight, vision, blood pressure, motor function, and body sway had been measured, and depressive symptoms as well as cognitive function had been assessed. Results-During follow-up, 23% of the patients and 11% of the control subjects fell once or more, and the risk of falling at least once was more than twice as high for the patients with stroke, when controlled for potential confounders (relative riskϭ2.2; 95% CI, 1.1 to 4.3). Among the stroke patients, depressive symptomatology predicted falls, and the relative risk for falling increased by 1.5 per standard deviation increase in the depression score. Conclusions-We conclude that falls are more frequent among noninstitutionalized long-term stroke survivors than among community control subjects and that the risk of falling and depressive symptoms are related in stroke patients. (Stroke. 2002;33:542-547.)

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“…57 Earlier Japanese studies indicated that 25(OH)D was lower in patients with a long illness duration and where dietary intake of vitamin D was low 58 -important since stroke patients get little sunlight exposure. 52 Later studies from the same group 40 Bilateral motor signs 31 Bilateral cortical lesions 31 Impaired sit-to-stand 37 Delay in starting to walk 36 Impaired turning whilst walking 36 Delayed motor response times 38 Clinical inco-ordination 36 Hemineglect syndrome 26,41,31 Bias towards right space 41 Impaired general cognition 26 Impaired decision making 24 Decreased orientation 36 Low ADL (Barthel) scores 25,31 Postural instability 39,31 Asymmetrical weight bearing 37 Increased medio-lateral sway 37 Decreased proprioception 26 Dysphasia 25 Clinically severe stroke 34,33 Right cerebral hemisphere stroke 33 Widespread white matter lesions 35 Previous stroke 26,35 Depressed, anxiety, emotionalism 26,33,29,30 Restlessness, fatigue, weakness 24 Increased incidence of pain 33,30 Increased urine infection rate 34 Increased respiratory infection rate 33,30 Seizures 33,30 Urinary incontinence …”

Section: Bone Markers and Vitamin D Metabolitesmentioning

confidence: 99%

“…24 Falls during rehabilitation in hospital are frequent, but are particularly common among stroke patients. Reports of the proportion of patients falling during their inpatient stay whilst recovering from stroke vary from 11.5% 25 to 46%, 26 most occurring early after admission.…”

Section: Falling After Stroke and Fracturementioning

confidence: 99%