About 40 percent of stroke survivors suffer serious falls within a year of stroke and now research may point to a possible explanation: balance problems while getting dressed, researchers report in today’s rapid access issue of Stroke: Journal of the American Heart Association. Previous research indicates that stroke survivors are four times more likely than others to suffer a hip fracture during a fall, which can slow rehabilitation and open the door to new complications. From the American Heart Association:Balance problems make dressing hazardous for stroke survivors
DALLAS, Jan. 17 ? About 40 percent of stroke survivors suffer serious falls within a year of stroke and now research may point to a possible explanation: balance problems while getting dressed, researchers report in today’s rapid access issue of Stroke: Journal of the American Heart Association.
Previous research indicates that stroke survivors are four times more likely than others to suffer a hip fracture during a fall, which can slow rehabilitation and open the door to new complications.
In this study, women stroke survivors who reported that they often had difficulty maintaining their balance while dressing were seven times more likely to fall than women who didn’t have residual balance problems, says lead author Sarah E. Lamb, D.Phil, professor, Interdisciplinary Research Centre in Health, School of Health and Social Services, Coventry University, Coventry, United Kingdom.
In addition, overall balance problems, dizziness, or a “spinning” sensation as the result of stroke were associated with more than a five-fold increase in risk for falls, she says.
Interestingly, common risk factors for fall among the general population such as the use of hypnotic or sedative medications, incontinence, walking problems and a history of falls were less useful in predicting risk of falls in these stroke patients, Lamb says.
“What is important here is that it is not the initial stroke symptoms but what you are left with ? the residual stroke symptoms ? that have a significant impact on fall risk,” Lamb says.
Researchers used data collected by the Women’s Health and Aging Study, a large, on-going study of elderly women in Baltimore, Md. Women were eligible for the study if they lived at home rather than in a nursing homes, but reported difficulty in at least two areas: mobility, upper body strength, basic self-care (bathing, showering, dressing, eating or toileting) and higher function domain (telephoning, light housework, preparing meals, medication management.)
Researchers used medical records, in-home interviews, physical examinations and neurologist reviews of the 124 women with a prior stroke. Forty-eight percent of them fell during the one-year follow-up, with 26 percent of them suffering repeated falls.
Despite the high incidence of falls recorded, this study “underestimates the impact of this serious health problem,” writes Yngve Gustafson, M.D., Ph.D. in an accompanying editorial.
The study excluded women in nursing home facilities ? women who are more likely to have serious cognitive impairment and thus a higher risk of falling, says Gustafson, professor of geriatric medicine at Umea University Hospital, Department of Geriatric Medicine, Umea, Sweden.
Not only are falls among the most common and often very serious complications of stroke, they also increase the fear of falling, which may result in inactivity and social isolation, he says.
“In most stroke patients balance is disturbed, and the patient needs to compensate for this change by paying greater attention when performing a variety of activities,” he says.
Studies in Sweden with nursing home patients suggest that a structured fall prevention program that included “environmental adjustment, exercise, drug review, aids, hip protectors and post-fall problem-solving conferences” significantly reduced the incidence of falls and hip fractures, Gustafson notes.
Lamb and colleagues also urge that therapies to address balance during complex activities and residual balance symptoms after stroke be tested in randomized studies.