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Published in: BMC Geriatrics 1/2009

Open Access 01-12-2009 | Research article

Falls among community-residing stroke survivors following inpatient rehabilitation: a descriptive analysis of longitudinal data

Authors: Laura M Wagner, Victoria L Phillips, Amanda E Hunsaker, Pamela G Forducey

Published in: BMC Geriatrics | Issue 1/2009

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Abstract

Background

Stroke victims are at relatively high risk for injurious falls. The purpose of this study was to document longitudinal fall patterns following inpatient rehabilitation for first-time stroke survivors.

Methods

Participants (n = 231) were recruited at the end of their rehab stay and interviewed monthly via telephone for 1 to 32 months regarding fall incidents. Analyses were conducted on: total reports of falls by month over time for first-time and repeat fallers, the incidence of falling in any given month; and factors differing between fallers and non fallers.

Results

The largest percentage of participants (14%) reported falling in the first month post-discharge. After month five, less than 10% of the sample reported falling, bar months 15 (10.4%) and 23 (13.2%). From months one to nine, the percentage of those reporting one fall with and without a prior fall were similar. After month nine, the number of individuals who reported a single fall with a fall history was twice as high compared to those without a prior fall who reported falling. In both cases the percentages were small. A very small subset of the population emerged who fell multiple times each month, most of whom had a prior fall history. At least a third of the sample reported a loss of balance each month. Few factors differed significantly between fallers and non-fallers in months one to six.

Conclusion

Longitudinal data suggest that falls most likely linked to first time strokes occur in the first six months post discharge, particularly month one. Data routinely available at discharge does not distinguish fallers from non-fallers. Once a fall incident has occurred however, preventive intervention is warranted.
Literature
1.
go back to reference Davenport RJ, Dennis MS, Wellwood I, Warlow CP: Complications after acute stroke. Stroke. 1996, 27: 415-420.CrossRefPubMed Davenport RJ, Dennis MS, Wellwood I, Warlow CP: Complications after acute stroke. Stroke. 1996, 27: 415-420.CrossRefPubMed
2.
go back to reference Saliba D, Cadogan MP, Roth C: Nursing home medical record quality review abstraction form: Measuring resident characteristics and care processes for depression, incontinence, mobility, nutrition, pain, pressure ulcers, restraints, and sensory impairment. 2002, Publication #04, COE 102. Supulveda, CA: Center for the Study of Healthcare Provider Behavior, RAND affiliate Saliba D, Cadogan MP, Roth C: Nursing home medical record quality review abstraction form: Measuring resident characteristics and care processes for depression, incontinence, mobility, nutrition, pain, pressure ulcers, restraints, and sensory impairment. 2002, Publication #04, COE 102. Supulveda, CA: Center for the Study of Healthcare Provider Behavior, RAND affiliate
3.
go back to reference Langhorne P, Stott DJ, Robertson L, et al: Medical complications after stroke: A multicenter study. Stroke. 2000, 31: 1223-1229.CrossRefPubMed Langhorne P, Stott DJ, Robertson L, et al: Medical complications after stroke: A multicenter study. Stroke. 2000, 31: 1223-1229.CrossRefPubMed
4.
go back to reference Roth EJ, Lovell L, Harvey RL, Heinemann AW, Semik P, Diaz S: Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke. 2001, 32: 523-529.CrossRefPubMed Roth EJ, Lovell L, Harvey RL, Heinemann AW, Semik P, Diaz S: Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke. 2001, 32: 523-529.CrossRefPubMed
5.
go back to reference Walt Van der JH, Sweeney DB, Runciman WB, Webb RK: Paediatric incidents in anaesthesia: An analysis of 2000 incident reports. Anaesthesia and Intensive Care. 1993, 21 (5): 655-658.PubMed Walt Van der JH, Sweeney DB, Runciman WB, Webb RK: Paediatric incidents in anaesthesia: An analysis of 2000 incident reports. Anaesthesia and Intensive Care. 1993, 21 (5): 655-658.PubMed
6.
go back to reference Muro MJ, de Pedro-Cuesta J, Almazan J, Holmqvist W: Stroke patients in South Madrid: Function and motor recovery, resource utilization, and family support. Stroke. 2000, 31: 1352-1359.CrossRefPubMed Muro MJ, de Pedro-Cuesta J, Almazan J, Holmqvist W: Stroke patients in South Madrid: Function and motor recovery, resource utilization, and family support. Stroke. 2000, 31: 1352-1359.CrossRefPubMed
7.
go back to reference Sattin RW: Falls among older persons: A public health perspective. Annual Reviews of Public Health. 1992, 13: 489-508. 10.1146/annurev.pu.13.050192.002421.CrossRef Sattin RW: Falls among older persons: A public health perspective. Annual Reviews of Public Health. 1992, 13: 489-508. 10.1146/annurev.pu.13.050192.002421.CrossRef
8.
go back to reference Jorgensen L, Engstad T, Jacobsen BJ: Higher incidence of falls in long-term stroke survivors than in population controls: Depressive symptoms predict falls after stroke. Stroke. 2002, 33: 542-547. 10.1161/hs0202.102375.CrossRefPubMed Jorgensen L, Engstad T, Jacobsen BJ: Higher incidence of falls in long-term stroke survivors than in population controls: Depressive symptoms predict falls after stroke. Stroke. 2002, 33: 542-547. 10.1161/hs0202.102375.CrossRefPubMed
9.
go back to reference Herndon JG, Helmick CG, Sattin RW, Stevens JA, DeVito CA, Wingo PA: Chronic medical conditions and risk of fall injury events at home in older adults. JAGS. 1997, 45 (6): 739-743.CrossRef Herndon JG, Helmick CG, Sattin RW, Stevens JA, DeVito CA, Wingo PA: Chronic medical conditions and risk of fall injury events at home in older adults. JAGS. 1997, 45 (6): 739-743.CrossRef
12.
go back to reference Sze K, Wong E, Leung HY, Woo J: Falls among chinese stroke patients during rehabilitation. Archives of Physical Medicine and Rehabilitation. 2001, 82: 1219-1225. 10.1053/apmr.2001.25094.CrossRefPubMed Sze K, Wong E, Leung HY, Woo J: Falls among chinese stroke patients during rehabilitation. Archives of Physical Medicine and Rehabilitation. 2001, 82: 1219-1225. 10.1053/apmr.2001.25094.CrossRefPubMed
13.
go back to reference Nyberg L, Gustafson Y: Patient falls in stroke rehabilitation: A challenge to rehabilitation strategies. Stroke. 1995, 26: 838-842.CrossRefPubMed Nyberg L, Gustafson Y: Patient falls in stroke rehabilitation: A challenge to rehabilitation strategies. Stroke. 1995, 26: 838-842.CrossRefPubMed
14.
go back to reference Byers V, Arrington ME, Finstuen K: Predictive risk factors associated with stroke patient falls in acute care settings. Journal of Neuroscience Nursing. 1990, 22: 147-154.CrossRefPubMed Byers V, Arrington ME, Finstuen K: Predictive risk factors associated with stroke patient falls in acute care settings. Journal of Neuroscience Nursing. 1990, 22: 147-154.CrossRefPubMed
15.
go back to reference Nyberg L, Gustafson Y: Fall prediction index for patients in stroke rehabilitation. Stroke. 1997, 28: 716-721.CrossRefPubMed Nyberg L, Gustafson Y: Fall prediction index for patients in stroke rehabilitation. Stroke. 1997, 28: 716-721.CrossRefPubMed
16.
go back to reference Tutuarima JA, Meulen van der JHP, de Hann RJ, van Straten A, Limburg M: Risk factors for falls of hospitalized stroke patients. Stroke. 1997, 28: 297-301.CrossRefPubMed Tutuarima JA, Meulen van der JHP, de Hann RJ, van Straten A, Limburg M: Risk factors for falls of hospitalized stroke patients. Stroke. 1997, 28: 297-301.CrossRefPubMed
17.
go back to reference Teasell R, McRae M, Foley N, Bhardwaj A: The incidence and consequences of falls in stroke patients during inpatient rehabilitation: Factors associated with high risk. Archives of Physical Medicine and Rehabilitation. 2002, 83: 329-333. 10.1053/apmr.2002.29623.CrossRefPubMed Teasell R, McRae M, Foley N, Bhardwaj A: The incidence and consequences of falls in stroke patients during inpatient rehabilitation: Factors associated with high risk. Archives of Physical Medicine and Rehabilitation. 2002, 83: 329-333. 10.1053/apmr.2002.29623.CrossRefPubMed
18.
go back to reference Ugur C, Gucuyener D, Uzuner N, Ozkan S, Ozdemir G: Characteristics of falling in patients with stroke. Journal of Neurology, Neurosurgery, & Psychiatry. 2000, 69: 649-651. 10.1136/jnnp.69.5.649.CrossRef Ugur C, Gucuyener D, Uzuner N, Ozkan S, Ozdemir G: Characteristics of falling in patients with stroke. Journal of Neurology, Neurosurgery, & Psychiatry. 2000, 69: 649-651. 10.1136/jnnp.69.5.649.CrossRef
19.
go back to reference Lamb RM, Studdert DM, Bohmer RMJ, Berwick DM, Brennan TA: Hospital disclosure practices: Results of a national survey. Health Affairs. 2003, 22 (2): 73-83. 10.1377/hlthaff.22.2.73.CrossRefPubMed Lamb RM, Studdert DM, Bohmer RMJ, Berwick DM, Brennan TA: Hospital disclosure practices: Results of a national survey. Health Affairs. 2003, 22 (2): 73-83. 10.1377/hlthaff.22.2.73.CrossRefPubMed
20.
go back to reference Hyndman D, Ashburn A, Stack E: Fall events among people with stroke living in the community: Circumstances of falls and characteristics of fallers. Archives of Physical Medicine and Rehabilitation. 2002, 83: 165-170. 10.1053/apmr.2002.28030.CrossRefPubMed Hyndman D, Ashburn A, Stack E: Fall events among people with stroke living in the community: Circumstances of falls and characteristics of fallers. Archives of Physical Medicine and Rehabilitation. 2002, 83: 165-170. 10.1053/apmr.2002.28030.CrossRefPubMed
21.
go back to reference Mackintosh SFH, Goldie P, Hill K: Falls incidence and factors association with falling in older, community-dwelling, chronic stroke survivors (>1 year after stroke) and matched controls. Aging Clinical and Experimental Research. 2005, 17: 74-81.CrossRefPubMed Mackintosh SFH, Goldie P, Hill K: Falls incidence and factors association with falling in older, community-dwelling, chronic stroke survivors (>1 year after stroke) and matched controls. Aging Clinical and Experimental Research. 2005, 17: 74-81.CrossRefPubMed
23.
go back to reference Yates JS, Lai SM, Duncan PW, Studenski S: Falls in community-dwelling stroke survivors: An accumulated impairments model. Journal of Rehabilitation Research and Development. 2002, 39: 385-394.PubMed Yates JS, Lai SM, Duncan PW, Studenski S: Falls in community-dwelling stroke survivors: An accumulated impairments model. Journal of Rehabilitation Research and Development. 2002, 39: 385-394.PubMed
24.
go back to reference Mackintosh SFH: Falls and injury prevention should be part of every stroke rehabilitation plan. Clinical Rehabilitation. 2005, 19: 441-451. 10.1191/0269215505cr796oa.CrossRefPubMed Mackintosh SFH: Falls and injury prevention should be part of every stroke rehabilitation plan. Clinical Rehabilitation. 2005, 19: 441-451. 10.1191/0269215505cr796oa.CrossRefPubMed
25.
go back to reference Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG: Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Archives of Physical Medicine and Rehabilitation. 2006, 87: 1583-1589. 10.1016/j.apmr.2006.09.004.CrossRefPubMed Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG: Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Archives of Physical Medicine and Rehabilitation. 2006, 87: 1583-1589. 10.1016/j.apmr.2006.09.004.CrossRefPubMed
26.
go back to reference Kanis J, Oden A, Johnell O: Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke. 2001, 32: 702-706.CrossRefPubMed Kanis J, Oden A, Johnell O: Acute and long-term increase in fracture risk after hospitalization for stroke. Stroke. 2001, 32: 702-706.CrossRefPubMed
27.
go back to reference Poole KES, Reeve J, Warburton EA: Falls, fractures, and osteoporosis after stroke: Time to think about protection. Stroke. 2002, 33: 1432-1436. 10.1161/01.STR.0000014510.48897.7D.CrossRefPubMed Poole KES, Reeve J, Warburton EA: Falls, fractures, and osteoporosis after stroke: Time to think about protection. Stroke. 2002, 33: 1432-1436. 10.1161/01.STR.0000014510.48897.7D.CrossRefPubMed
28.
go back to reference Black TM, Soltis T, Bartlett C: Using the functional independence measure instrument to predict stroke rehabilitation outcomes. Rehabilitation Nursing. 1999, 24: 109-121.CrossRefPubMed Black TM, Soltis T, Bartlett C: Using the functional independence measure instrument to predict stroke rehabilitation outcomes. Rehabilitation Nursing. 1999, 24: 109-121.CrossRefPubMed
29.
go back to reference Ottenbacher KJ, Smith PM, Illig SB, Fiedler RC, Gonzalez V, Granger CV: Characteristics of persons rehospitalized after stroke rehabilitation. Archives of Physical Medicine and Rehabilitation. 2002, 82: 1367-1374. 10.1053/apmr.2001.26088.CrossRef Ottenbacher KJ, Smith PM, Illig SB, Fiedler RC, Gonzalez V, Granger CV: Characteristics of persons rehospitalized after stroke rehabilitation. Archives of Physical Medicine and Rehabilitation. 2002, 82: 1367-1374. 10.1053/apmr.2001.26088.CrossRef
30.
go back to reference Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB: The structure and stability of the functional independence measure. Archives of Physical Medicine and Rehabilitation. 1994, 75: 127-132.PubMed Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB: The structure and stability of the functional independence measure. Archives of Physical Medicine and Rehabilitation. 1994, 75: 127-132.PubMed
31.
go back to reference Granger CV, Hamilton BB, Linacre JM, Heinemann AW, Wright BD: Performance profiles of the functional independence measure. American Journal of Physical Medicine & Rehabilitation. 1993, 72: 84-89. 10.1097/00002060-199304000-00005.CrossRef Granger CV, Hamilton BB, Linacre JM, Heinemann AW, Wright BD: Performance profiles of the functional independence measure. American Journal of Physical Medicine & Rehabilitation. 1993, 72: 84-89. 10.1097/00002060-199304000-00005.CrossRef
32.
go back to reference Dodds TA, Martin DP, Stolov WC, Deyo RA: A validation of the functional independence measurement and its performance among rehabilitation patients. Archives of Physical Medicine and Rehabilitation. 1993, 74: 531-536. 10.1016/0003-9993(93)90119-U.CrossRefPubMed Dodds TA, Martin DP, Stolov WC, Deyo RA: A validation of the functional independence measurement and its performance among rehabilitation patients. Archives of Physical Medicine and Rehabilitation. 1993, 74: 531-536. 10.1016/0003-9993(93)90119-U.CrossRefPubMed
33.
go back to reference Wagner LM, Capezuti E, Taylor JA, Sattin RW, Ouslander JG: Impact of a falls menu-driven incident reporting system on documentation and quality improvement in nursing homes. The Gerontologist. 2005, 45: 835-842.CrossRefPubMed Wagner LM, Capezuti E, Taylor JA, Sattin RW, Ouslander JG: Impact of a falls menu-driven incident reporting system on documentation and quality improvement in nursing homes. The Gerontologist. 2005, 45: 835-842.CrossRefPubMed
34.
go back to reference Hobeika CP: Equilibrium and balance in the elderly. Ear, Nose and Throat Journal. 1999, 78: 558-567. Hobeika CP: Equilibrium and balance in the elderly. Ear, Nose and Throat Journal. 1999, 78: 558-567.
35.
go back to reference Cox DR: Regression models and life tables. Journal of the Royal Statistical Society. 1972, 34: 187-220. Cox DR: Regression models and life tables. Journal of the Royal Statistical Society. 1972, 34: 187-220.
36.
go back to reference Hinkle JL: A descriptive study of function in acute motor stroke. Western Journal of Nursing Research. 2001, 23: 296-312. 10.1177/01939450122045168.CrossRefPubMed Hinkle JL: A descriptive study of function in acute motor stroke. Western Journal of Nursing Research. 2001, 23: 296-312. 10.1177/01939450122045168.CrossRefPubMed
37.
go back to reference Hennekens CH, Buring JE: Epidemiology in Medicine. 1987, Philadelphia: Lippincott Williams & Wilkins Hennekens CH, Buring JE: Epidemiology in Medicine. 1987, Philadelphia: Lippincott Williams & Wilkins
38.
go back to reference Jensen J, Nyberg L, Gustafson Y, Lundin-Olsson L: Fall and injury prevention in residential care--Effects in residents with higher and lower levels of cognition. Journal of the American Geriatrics Society. 2003, 51: 627-635. 10.1034/j.1600-0579.2003.00206.x.CrossRefPubMed Jensen J, Nyberg L, Gustafson Y, Lundin-Olsson L: Fall and injury prevention in residential care--Effects in residents with higher and lower levels of cognition. Journal of the American Geriatrics Society. 2003, 51: 627-635. 10.1034/j.1600-0579.2003.00206.x.CrossRefPubMed
39.
go back to reference Ray WA, Taylor JA, Meador KG, et al: A randomized trial of a consultation service to reduce falls in nursing homes. Journal of the American Medical Association. 1997, 278: 557-596. 10.1001/jama.278.7.557.CrossRefPubMed Ray WA, Taylor JA, Meador KG, et al: A randomized trial of a consultation service to reduce falls in nursing homes. Journal of the American Medical Association. 1997, 278: 557-596. 10.1001/jama.278.7.557.CrossRefPubMed
40.
go back to reference Lethbridge-Cejku M, Vickerie J: Summary health statistics for US. adults: National health interview survey, 2003. 2005, Hyattsville, MD: National Center for Health Statistics Lethbridge-Cejku M, Vickerie J: Summary health statistics for US. adults: National health interview survey, 2003. 2005, Hyattsville, MD: National Center for Health Statistics
41.
go back to reference McGruder HF: Differences in disability among black and white stroke survivors- United States, 2000-2001. Morbidity and Mortality Weekly Report. 2005, 54: 3-6. McGruder HF: Differences in disability among black and white stroke survivors- United States, 2000-2001. Morbidity and Mortality Weekly Report. 2005, 54: 3-6.
42.
go back to reference Thom T, Haase N, Rosamond W, et al: Heart disease and stroke statistics: 2006 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006, 113: e85-151. 10.1161/CIRCULATIONAHA.105.171600.CrossRefPubMed Thom T, Haase N, Rosamond W, et al: Heart disease and stroke statistics: 2006 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006, 113: e85-151. 10.1161/CIRCULATIONAHA.105.171600.CrossRefPubMed
43.
go back to reference Lipson DM, Sangha H, Foley NC, Bhogal S, Pohani G, Teasell RW: Recovery from stroke: Differences between subtypes. International Journal of Rehabilitation Research. 2005, 28: 303-308. 10.1097/00004356-200512000-00002.CrossRefPubMed Lipson DM, Sangha H, Foley NC, Bhogal S, Pohani G, Teasell RW: Recovery from stroke: Differences between subtypes. International Journal of Rehabilitation Research. 2005, 28: 303-308. 10.1097/00004356-200512000-00002.CrossRefPubMed
44.
go back to reference Deutsch A, Fiedler RC, Granger CV, Russell CF: The uniform data system for medical rehabilitation report of patients discharged from comprehensive medical rehabilitation programs in 1999. American Journal of Physical Medicine and Rehabilitation. 2002, 81: 133-142. 10.1097/00002060-200202000-00010.CrossRefPubMed Deutsch A, Fiedler RC, Granger CV, Russell CF: The uniform data system for medical rehabilitation report of patients discharged from comprehensive medical rehabilitation programs in 1999. American Journal of Physical Medicine and Rehabilitation. 2002, 81: 133-142. 10.1097/00002060-200202000-00010.CrossRefPubMed
45.
go back to reference Murkami M, Inouye M: Stroke rehabilitation outcome study: A comparison of Japan with the United States. American Journal of Physical Medicine and Rehabilitation. 2002, 81: 279-282. 10.1097/00002060-200204000-00006.CrossRef Murkami M, Inouye M: Stroke rehabilitation outcome study: A comparison of Japan with the United States. American Journal of Physical Medicine and Rehabilitation. 2002, 81: 279-282. 10.1097/00002060-200204000-00006.CrossRef
46.
go back to reference Kelly-Hayes M, Beiser A, Kase CS, Scaramucci A, D'Agnostino RB, Wolf PA: The influence of gender and age on disability following ischemic stroke: the Framingham study. Journal of Stroke & Cerebrovascular Diseases. 2003, 12: 119-126. 10.1016/S1052-3057(03)00042-9.CrossRef Kelly-Hayes M, Beiser A, Kase CS, Scaramucci A, D'Agnostino RB, Wolf PA: The influence of gender and age on disability following ischemic stroke: the Framingham study. Journal of Stroke & Cerebrovascular Diseases. 2003, 12: 119-126. 10.1016/S1052-3057(03)00042-9.CrossRef
47.
go back to reference Cicchitto D: Effects of cognitive-linguistic load on measurements of gait in healthy elderly. 2007, Tallahassee, FL: College of Communication, The Florida State University Cicchitto D: Effects of cognitive-linguistic load on measurements of gait in healthy elderly. 2007, Tallahassee, FL: College of Communication, The Florida State University
48.
go back to reference Alexander MP: Stroke rehabilitation outcome: A potential use of predictive variables to establish levels of care. Stroke. 1994, 25: 128-134.CrossRefPubMed Alexander MP: Stroke rehabilitation outcome: A potential use of predictive variables to establish levels of care. Stroke. 1994, 25: 128-134.CrossRefPubMed
49.
go back to reference Watanabe Y: Fear of falling among stroke survivors after discharge from inpatient rehabilitation. International Journal of Rehabilitation Research. 2005, 28: 149-152. 10.1097/00004356-200506000-00008.CrossRefPubMed Watanabe Y: Fear of falling among stroke survivors after discharge from inpatient rehabilitation. International Journal of Rehabilitation Research. 2005, 28: 149-152. 10.1097/00004356-200506000-00008.CrossRefPubMed
Metadata
Title
Falls among community-residing stroke survivors following inpatient rehabilitation: a descriptive analysis of longitudinal data
Authors
Laura M Wagner
Victoria L Phillips
Amanda E Hunsaker
Pamela G Forducey
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2009
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-9-46

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