Fall risk in stroke survivors: Effects of stroke plus dementia and reduced motor functional capacity

  • Daniel G. Whitney
    Affiliations
    Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
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  • Aviroop Dutt-Mazumder
    Affiliations
    Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
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  • Mark D. Peterson
    Affiliations
    Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
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  • Chandramouli Krishnan
    Correspondence
    Corresponding author at: Neuromuscular & Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E Eisenhower Parkway (Suite 3013), Ann Arbor, MI 48108, USA.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA

    Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA

    Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA

    School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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Published:April 26, 2019DOI:https://doi.org/10.1016/j.jns.2019.04.035

      Highlights

      • Effect of dementia and motor function on falls among stroke survivors is unknown.
      • Odds of a recent fall is elevated in stroke survivors in the presence of dementia.
      • Lower motor capacity accounts for increased fall risk only in stroke survivors.
      • Secondary prevention of dementia may reduce fall risk in individuals with stroke.

      Abstract

      Background

      Despite extensive research on falls among individuals with stroke, little is known regarding the impact of neurological conditions with comorbid diagnoses and motor functional capacity on the risk of falls in these individuals. Hence, the purpose of this study was to determine the fall risk and the contribution of reduced motor functional capacity to fall risk in individuals with stroke, dementia, and stroke plus dementia.

      Methods

      Data from the National Health and Aging Trends Study (NHATS), a nationally-representative sample of Medicare beneficiaries, were analyzed for this cross-sectional study. The odds of self-reported falls within the past month in three subgroups of neurological conditions [stroke (n = 751), dementia (n = 369), and stroke plus dementia (n = 141)] were evaluated with a reference group of individuals with no stroke/dementia [i.e., controls (n = 6337)] using logistic regression models.

      Results

      The prevalence of a recent fall was significantly higher (P < .05) in the three neurological disorder groups compared with controls. After adjusting for sociodemographics, mobility device use, and other comorbidities (i.e., chronic disease, vision impairment, and major surgery), the odds of a recent fall were significantly elevated in individuals with stroke (odds ratio [OR] = 1.45), dementia (OR = 2.45), and stroke plus dementia (OR = 2.64) compared with controls. After further adjustment for the lower motor functional capacity, the elevated odds in individuals with stroke were attenuated (OR = 1.16); however, the odds remained significantly elevated in individuals with dementia (OR = 1.67) and stroke plus dementia (OR = 1.82).

      Conclusion

      Findings indicate that the odds for falls in stroke survivors are elevated in the presence of comorbid dementia. Further, lower motor functional capacity accounted for increased likelihood of a fall in individuals with stroke, but it was not sufficient to account for the increased likelihood of a fall in individuals with dementia or stroke plus dementia. Thus, interventions focusing on secondary prevention of dementia and improving motor functional capacity may reduce fall risk in individuals with stroke.

      Keywords

      Abbreviations:

      OR (Odds Ratio), CI (Confidence Interval), NHATS (National Health and Aging Trends Study)
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