The role of the environment in falls among stroke survivors. (September 2017)

• Record Type: Journal Article
• Authors: Wing, Jeffrey J.; Burke, James F.; Clarke, Philippa J.; Feng, Chunyang; Skolarus, Lesli E.
• Is Part Of: Archives of gerontology and geriatrics. Volume 72(2017)
• Page Start: 1
• Page End: 5
• Publication Date: 2017-09
• Subjects: EFA exploratory factor analysis -- NHATS National Health and Aging Trends Study -- PCA principal component analysis -- PHQ-2 Patient Health Questionnaire; Stroke -- Epidemiology -- Outcome after stroke -- Stroke in elderly -- Falls; Aging -- Periodicals; Geriatrics -- Periodicals; Gerontology -- Periodicals; Electronic journals; 305.26
• DOI: 10.1016/j.archger.2017.04.007
• Languages: English
• ISSNs: 0167-4943

Abstract

Highlights: Stroke survivors were more likely to fall in the past month than matched controls. Differences in fall prevalence were largely explained by known risk factors and physical capacity. Indoor tripping hazards were associated with a greater prevalence of falling across both groups. Explanations of the protective effect of social disorder warrant additional consideration. Abstract: Background: Stroke survivors' risk of falls may be particularly sensitive to the environment due to deficits such as visuospatial neglect or homonymous hemianopia. We sought to identify the prevalence of falls among stroke survivors and investigate the possible role of the environment in falling. Materials and methods: Data from the National Health and Aging Trends Study (NHATS), a nationally representative population of community-dwelling adults over 65, were used. We compared the prevalence of falling in the past month between stroke survivors and demographic and comorbidity matched controls using sequential Poisson regression models. Results: The proportion of stroke survivors reporting a fall in the previous month was 18.8% compared to 10.8% among matched controls (PR: 1.74; 95% CI: 1.36–2.25). These differences were attenuated after adjusting for known confounders, mediators and aspects of the environment (PR: 1.17; 95% CI: 0.86–1.60). Indoor tripping hazards were associated with falls (PR: 1.24; 95% CI: 1.01–1.53). The association between stroke and falls was modified by neighborhood social disorder, such that in areas of low social disorder, falls in the previous month were more common in stroke survivors compared to non-stroke controls. Conclusions: The difference in falls among stroke survivors and matched controls is largely explained by known risk factors and physical capacity. Indoor tripping hazards were associated with falls among stroke survivors and matched controls. Explanations of why the association between stroke and falls was protective in areas of high social disorder are unclear, but may warrant additional research.