Stroke and Falls-Clash of the Two Titans in Geriatrics

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.

Keywords: accidental falls; aged; stroke.

Figure 1

Evaluation of Falls Risk Post-Stroke. Flowchart demonstrated a suggested universal approach to fall risk assessment among all individuals with stroke. *, treatment benefit usually exceeds risk; **, new focal neurological deficits should exist; FAC, functional ambulation category.

Figure 2

Management of Post-stroke Falls. Flowchart outlining suggested management strategy for primary and secondary prevention of post-stroke falls. Fenestrated line suggests adaptation according to locally available resources. * Only if proven deficiency or limited sunlight exposure; FAC, functional ambulation category; TUG, timed-up and go; FR, functional reach.