Abstract
Both stroke and falls are common conditions affecting the older adult. Despite stroke being considered a well-established major risk factor for falls, there remains no evidence for effective prevention strategies for falls specifically for stroke survivors. Previous observational studies evaluating falls risk factors in stroke have mainly been uncontrolled and found similar risk factors for stroke populations compared to general older populations. Specific risk factors, however, are likely to play a greater role in stroke survivors including unilateral weakness, hemisensory or visual neglect, impaired coordination, visual field defects, perceptual difficulties and cognitive issues. In addition, individuals with stroke are also more likely to have other associated risk factors for falls including diabetes, falls risk increasing drugs, atrial fibrillation, and other cardiovascular risk factors. While anticoagulation is associated with increased risk of intracranial bleeding after a fall, the risk of suffering a further stroke due to atrial fibrillation outweigh the risk of bleeding from a recurrent fall. Similarly, while blood pressure lowering medications may be linked to orthostatic hypotension which in turn increases the risk of falls, the benefit of good blood pressure control in terms of secondary stroke prevention outweighs the risk of falls. Until better evidence is available, the suggested management approach should then be based on local resources, and published evidence for fall prevention. Multicomponent exercise and individually tailored multifactorial interventions should still be considered as published evidence evaluating the above have included stroke patients in their study population.
Highlights
The risk of stroke and falls both increase with age
This study revealed that stroke participants were more likely to suffer both recurrent falls and fear of falling [2]
As stroke survivors are at greater risk of recurrent falls, the initiation of other investigations should perhaps occur after the first fall, rather than waiting for a further fall to occur, even when there is no gait and balance abnormality
Summary
The risk of stroke and falls both increase with age. In addition, stroke is an established risk factor for falls with up to 37% of all stroke survivors reporting at least one fall in the preceding six months [1]. This study revealed that stroke participants were more likely to suffer both recurrent falls and fear of falling [2]. Despite both these condition being highly prevalent among older adults, the relationship between falls and stroke remains understudied. Few studies to date have addressed specific risk factors for falls in stroke and effective management strategies for falls prevention in stroke. We will propose a rational approach to the evaluation for falls risk and complications, as well as suggested topics for future research. Contentious issues such as anticoagulation and antihypertensive treatment will be addressed.
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