Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke

Abstract

Background and purpose: The incidence of falls among noninstitutionalized individuals with long-standing stroke has not been examined previously, although fractures are more common and the consequences more severe for stroke patients than for elderly people in general.

Methods: For 4 months (September to December 1998), we followed 111 home-living patients who had suffered a stroke a mean of 10 years previously and 143 control subjects randomly selected from the same municipality, matched with respect to age and sex. Falls were registered daily by use of "fall calendars." Before the fall registration period, information about morbidity, use of medication, and activities of daily living had been registered. Height, weight, vision, blood pressure, motor function, and body sway had been measured, and depressive symptoms as well as cognitive function had been assessed.

Results: During follow-up, 23% of the patients and 11% of the control subjects fell once or more, and the risk of falling at least once was more than twice as high for the patients with stroke, when controlled for potential confounders (relative risk=2.2; 95% CI, 1.1 to 4.3). Among the stroke patients, depressive symptomatology predicted falls, and the relative risk for falling increased by 1.5 per standard deviation increase in the depression score.

Conclusions: We conclude that falls are more frequent among noninstitutionalized long-term stroke survivors than among community control subjects and that the risk of falling and depressive symptoms are related in stroke patients.