Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

Abstract

Abstract-Falls are a serious medical complication following stroke. The objectives of this study were to (1) confirm the prevalence of falls among patients with stroke during acute hospitalization, (2) identify factors associated with falls during the acute stay, and (3) examine whether in-hospital falls were associated with loss of function after stroke (new dependence at discharge). We completed a secondary analysis of data from a retrospective cohort study of patients with ischemic stroke who were hospitalized at one of four hospitals. We used logistic regression to identify factors associated with inpatient falls and examine the association between falls and loss of function. Among 1,269 patients with stroke, 65 (5%) fell during the acute hospitalization period. We found two characteristics independently associated with falls: greater stroke severity (National Institutes of Health Stroke Scale [NIHSS] 8, adjusted odds ratio [OR] = 3.63, 95% confidence interval [CI]: 1.46-9.00) and history of anxiety (adjusted OR = 4.90, 95% CI: 1.70-13.90). Falls were independently associated with a loss of function (adjusted OR = 9.85, 95% CI: 1.22-79.75) even after adjusting for age, stroke severity, gait abnormalities, and past stroke. Stroke severity (NIHSS 8) may be clinically useful during the acute inpatient setting in identifying those at greatest risk of falling. Given the association between falls and poor patient outcomes, rehabilitation interventions should be implemented to prevent falls poststroke.Abbreviations: ADL = activity of daily living, CI = confidence interval, IADL = instrumental activity of daily living, NIHSS = National Institutes of Health Stroke Scale, OR = odds ratio, SD = standard deviation, TIA = transient ischemic attack, UTI = urinary tract infection, VA = Department of Veterans Affairs.

Association between dual-task performance and balance during gait in community-dwelling elderly people after stroke

“…Previous studies, including patients both in the acute and chronic phase after stroke, have already related the severity of the event with the compromise of functional status and the occurrence of falls [6,27]. Although a lower NIHSS median score was found in those studies, the findings of this study suggest that the severity of injury is an important factor to be considered, regardless of the injury time.…”

“…These are common events in the elderly population, and are also frequent in individuals with neurological diseases [5]. In addition, to compromise the performance of basic and instrumental daily living activities, falls may restrict social participation [6], and generate direct and indirect costs for the family and Brazil's Unified Health System (SUS) [7].…”

Inpatient Falls

“…18 Sensitivity of the original scale was 78% and specificity was 83%. This scale placed patients into categories of high risk (!45), medium risk (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), and low risk ( 20). The meta-analysis by Harrington et al stated that the MFS had significantly higher sensitivity, but lower specificity than that of STRATIFY.…”

“…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.…”

Fear of Falling in People With Chronic Stroke

“…Falls are a common complication after a stroke (Batchelor, Mackintosh, Said, & Hill, 2012) and have been associated with loss of function for people with acute stroke (Schmid et al, 2010). Approximately 73% of people returning to the community after stroke experience a fall during the first 6 mo (Forster & Young, 1995).…”