Clinical characteristics and risk factors for falls within two years after stroke in elderly patients / 中华老年医学杂志

ABSTRACT

Objective To examine the incidence ,clinical characteristics ,and risk factors for falls within two years after stroke in elderly patients. Methods A total of 365 elderly stroke patients from the Department of Neurology at the 8th Nanning People's Hospital were recruited from June 1 , 2013 to December 31 ,2014. They were divided into a fall group and a non-fall group and were followed up for two years. The incidence and clinic characteristics of falls were analyzed. The risk factors for falls were analyzed by multiple Logistic regression analysis. Results Of the 365 stroke patients included in this study ,falls were observed in 146(40.2％ )patients. The interval between the stroke and the first fall72(49.3％ )patients had the first fall within 3 months;22(15.1％ )occurred between 4 and 6 months;20 (13.7％ )between 7 and 12 months ;17 (11.6％ )between 13 and 18 months ;and 15 (10.3％ )between 19 and 24 months.A hundred and five(71.9％ )patients fell during daytime and 41 (28.1％ )patients during night.Eighteen(12.3％ )patients had one fall ;65(44.5％ )patients fell 2 to 4 times ;60(41.1％ )patients fell 5 to 10 times ;and 3(2.1％ )patients fell over 10 times.A total of 709 falls were observed.Places of falls102(69.9％ )falls happened indoors and 44(30.1％ )falls occurred outdoors.Circumstances of falls27 (18.5％ )patients fell when turning over ;23 (15.8％ )fell when rising from a seating position ;4(2.7％ )patients fell when showering ;15(10.3％ )patients fell while standing ;9(6.8％ )fell when turning around ;56(38.3％ )fell while walking ;and 12(8.2％ )fell while climbing the stairs or running.The severity of falls52(35.6％ )patients had no injury ;78(53.2％ ) suffered soft tissue injury ;16 (11.0％ )had fractures ;and 78 (53.2％ )had fear of falling.Multiple Logistic regression analysis showed that age(OR=2.41 ;95％ CI1.69-3.05) ,history of falls(OR =2.85 ;95％ CI1.46-3.81) ,history of stroke(OR=1.87 ;95％ CI1.12-2.79) ,right hemiplegia(OR=2.37 ;95％ CI1.62-4.59) ,left hemiplegia(OR= 2.47 ;95％ CI1.46-4.78) ,paraplegia(OR= 2.55 ;95％ CI1.57-4.98) ,visual impairment(OR=2.35 ;95％ CI1.35-6.62) ,apraxia(OR=2.53 ;95％ CI1.42-5.63) ,unilateral spatial neglect (OR=3.34 ;95％ CI2.82-6.34) ,use of psychotropic medications (OR= 1.76 ;95％ CI1.11-1.98) ,impaired physical mobility (OR = 1.58 ;95％ CI1.82-2.91) ,low MMSE scale(OR = 3.42 ;95％ CI1.38-7.41) ,low Barthel Index score(OR = 2.83 ;95％ CI0.97-4.68) ,BBS scale<45(OR=2.48 ;95％ CI1.27-4.18) ,TUG>15seconds(OR=3.56 ;95％ CI1.91-5.23) ,and lack of rehabilitation therapy (OR=3.42 ;95％ CI1.38-7.41)were independent predictors for falls(all P<0.05). Conclusions Falls are common among elderly patients within two years after stroke.Most falls happen indoors ,during daytime and while moving.Age ,history of falls ,history of stroke ,hemiplegia ,visual impairment ,apraxia ,unilateral spatial neglect ,use of psychotropic medications ,walk with a walker ,low MMSE scale ,low Barthel Index score ,BBS scale<45 ,TUG>15 seconds ,and lack of rehabilitation therapy are independent risk factors for falls after stroke.