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The Home Environment May Be A Risk Fact For Falling Among Stroke Patients

May 16, 2011

Following a stroke, people are at high risk of falls, with the highest rates occurring upon discharge from the hospital. Because falls may lead to a series of cascading negative events, such as fractures, a fear of falling, activity restriction and depression, creating improved fall prevention strategies early after stroke is essential for people going through recovery and rehabilitation. To get an accurate understanding of fall risks and predictors, researchers from University of British Columbia in Vancouver, Canada, Lisa A. Simpson of the Graduate Program in Rehabilitation Sciences, William C. Miller of the Department of Occupational Science and Occupational Therapy and Janice J. Eng of the Department of Physical Therapy followed 80 people recently discharged from stroke rehabilitation and 90 control subjects matched by age and gender for just over a year. Their goal was to compare the rates of falls, the location of falls and the contribution of balance, mobility and balance confidence to falls between the two groups.

The researchers found that patients who were recently discharged home are at greater risk of falling than individuals who had not suffered a stroke. Balance function can predict falls for both people with stroke and without, and increased mobility may increase exposure to fall opportunities, they wrote. The stroke patients had a total of 109 falls while the control group experienced a total of 70 falls. The individuals in the stroke group had significantly lower balance, mobility and balance confidence than the control group. Those who experienced a stroke also fell more at home than the control group— with 59 percent of the falls experienced by the stroke group occurring at home compared to 31 percent of the falls by the control group. “Our results suggest that people recently discharged from stroke rehabilitation to home are at greater risk for falls in their home,” explained the researchers. “Following a stroke, people might be more likely to spend more time at home or be more cautious when outside of their home. Clinically, this finding underlies the importance of home assessment, home safety education and environmental modifications as part of discharge planning.” While balance confidence was not an independent predictor of falls among the individuals with recent stroke, it could still play a role through the interaction with other variables. “For instance, given a particular level of mobility, balance confidence could help to explain the types of activities a person with recent stroke engages in which could in turn influence one's risk of falling.”

The findings point to the need for a qualified home assessment from a trained professional to safeguard the patient’s home and eliminate as many fall risks as possible. Stroke rehabilitation can be a challenging time—taking steps to avoid preventable complications from a fall should be seriously considered as part of the rehab plan.