Balance Score and a History of Falls in Hospital Predict Recurrent Falls in the 6 Months Following Stroke Rehabilitation

Abstract Background Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians. Methods Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up. Results Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04–2.36), being single (OR: 5.31; 95 % CI: 3.36–37.48), having history of fall (OR: 1.86; 95 % CI: 1.19–2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02–1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45–5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12–34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01–1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77–0.97) appeared as recurrent falls predictors. Conclusions Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.

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Emotional Freedom Techniques for Stroke Rehabilitation: A Single Case Study

OBM Integrative and Complementary Medicine ◽

10.21926/obm.icm.2104038 ◽

2021 ◽

Vol 06 (04) ◽

pp. 1-1

Author(s):

Sue Anne Fuller ◽

◽

Peta Stapleton ◽

Keyword(s):

Stroke Rehabilitation ◽

Guided Imagery ◽

Single Case ◽

Ct Scans ◽

Anxiety And Depression ◽

Single Case Study ◽

History Of ◽

Emotional Freedom Techniques ◽

The Right

A 37-year-old female with a history of complex trauma, anxiety and depression was treated with Emotional Freedom Techniques (EFT) supplemented with guided imagery within the first 24 hours of having a stroke that affected the right side. CT scans indicated a haemorrhage and brain clot. Surgery was delayed as another seizure was expected. Interventions occurred during COVID-19 restrictions. The patient then engaged in 90 minutes of EFT every day over the course of a week while in hospital. After seven days she was discharged, and there were significant reductions in depression, anxiety and pain, and mobility returned. Upon discharge the patient had evident improvement in balance and coordination and successfully completed a driving test within the weeks that followed. Subsequent CT scans reveal very little scaring or evidence of the stroke, blood pressure remained stable, and no medication was warranted. This case study presents the practitioner’s perspective of the sessions provided.

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Asystole in an older patient with recurrent falls. Case report

Case reports ◽

10.15446/cr.v6n1.82558 ◽

2020 ◽

Vol 6 (1) ◽

pp. 77-83

Author(s):

William Fernando Bautista-Vargas

Keyword(s):

Case Report ◽

Older Patients ◽

Implantable Devices ◽

Loop Recorder ◽

General Terms ◽

Recurrent Falls ◽

History Of ◽

Rule Out

Introduction: Recurrent falls are a usual problema in older patients. It is therefore important to learn how to differentiate a pathological or syncopal episode from a simple stumbling fall, especially in patients who have limitations for communicating clearly and are poorly understood, in general terms, during the medical consultation. Implantable loop recorders (ILR) have been used as an investigation tool in selected cases of recurrent falls in older patients. Consequently, this case report aims to describe its usefulness in this type of patients.Case presentation: An 87-year-old female patient, hypertensive, with a history of recent stroke and frequent falls —referred to as stumbling—, received an implantable loop recorder due to atrial fibrillation. During one follow-up appointment, a 36-second pause related to a fall was documented, so a bicameral pacemaker was implanted.Conclusions: Evaluating repeated falls in older patients is complex; it must be done in detail to rule out syncopal episodes. Implantable devices to diagnose arrhythmic causes are useful and allow achieving accurate diagnoses and establish specific behaviors aimed at improving the quality of life of patients.

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Qualität des Antikoagulationsmanagements bei ambulanten Patienten mit Vorhofflimmern

Praxis ◽

10.1024/0369-8394.92.21.991 ◽

2003 ◽

Vol 92 (21) ◽

pp. 991-995 ◽

Cited By ~ 1

Author(s):

Gubler ◽

Martina ◽

Arpagaus ◽

Dieterle

Keyword(s):

Atrial Fibrillation ◽

Emergency Department ◽

Oral Anticoagulation ◽

Medical Emergency ◽

Psychiatric Disease ◽

Recurrent Falls ◽

History Of ◽

Acute Condition

Many patients with atrial fibrillation do not receive anticoagulation due to accepted contraindications but also due to considerable underuse. We screened 2215 consecutive patients when they entered the Medical Emergency Department for any acute condition. The decision on correct use or underuse of oral anticoagulation was made from the charts by consensus of two experienced physicians. The prevalence of atrial fibrillation was 3.7%. 43 of 83 patients with atrial fibrillation had oral anticoagulation (52%, mean age 76 years). 32 patients were treated with Aspirin only (38%, mean age 79 years). 29 patients (35%) did not receive anticoagulation because of accepted contraindications, i.e., dementia and risk for recurrent falls (n = 16), history of bleeding (n = 6), drug malcompliance due to forgetfulness (n = 4) and psychiatric disease (n = 1). Underuse of anticoagulation occurred only in three patients (4%, unclear reasons in two patients, patient's unwillingness in one patient). Conclusion: We did not observe substantial underuse of anticoagulation in patients with atrial fibrillation.

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Disability is an Independent Predictor of Falls and Recurrent Falls in People with Parkinson’s Disease Without a History of Falls: A One-Year Prospective Study

Journal of Parkinson s Disease ◽

10.3233/jpd-150651 ◽

2015 ◽

Vol 5 (4) ◽

pp. 855-864 ◽

Cited By ~ 17

Author(s):

Lorena R.S. Almeida ◽

Catherine Sherrington ◽

Natalie E. Allen ◽

Serene S. Paul ◽

Guilherme T. Valenca ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Prospective Study ◽

Independent Predictor ◽

Recurrent Falls ◽

History Of ◽

One Year

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Mood Disorder Following Cerebrovascular Accident

The British Journal of Psychiatry ◽

10.1192/bjp.154.2.195 ◽

1989 ◽

Vol 154 (2) ◽

pp. 195-200 ◽

Cited By ~ 165

Author(s):

M. R. Eastwood ◽

S. L. Rifat ◽

H. Nobbs ◽

J. Ruderman

Keyword(s):

Risk Factors ◽

Psychiatric Disorder ◽

Depressed Mood ◽

Cerebrovascular Accident ◽

Patient Population ◽

Stroke Rehabilitation ◽

Brain Lesion ◽

Hemispheric Differences ◽

Rehabilitation Unit ◽

History Of

Depression appears to be common after stroke, and therefore may have a bearing upon rehabilitation. To examine whether the depression is due to a specific brain lesion, or is reactive to the consequent disability, this study looked at the frequency and associations of depressed mood in a stroke rehabilitation unit in-patient population, unselected for site of lesion. Depression affected 50% of the patients; history of previous psychiatric disorder and cerebrovascular accident appeared to be important risk factors. There were hemispheric differences in the relationships between measures, with both the site-of-lesion and reactive viewpoints being upheld.

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Early rehabilitation after haemorrhagic stroke in a patient with a history of heart transplantation. A case study

Aktualności Neurologiczne ◽

10.15557/an.2016.0027 ◽

2016 ◽

Vol 16 (4) ◽

pp. 208-211

Author(s):

Anna Grygielska ◽

◽

Elżbieta Miller ◽

◽

Keyword(s):

Heart Rate ◽

Heart Transplantation ◽

Functional Status ◽

Barthel Index ◽

Stroke Rehabilitation ◽

Haemorrhagic Stroke ◽

National Institutes Of Health ◽

Exercise Heart Rate ◽

Post Stroke ◽

History Of

Introduction: Stroke is the most common form of central nervous system condition. An average of about 80 heart transplantations are performed in Poland yearly. A transplanted heart is prone to tachycardia. Early, complex post-stroke rehabilitation requires physical effort from the patient. Case report: We present a clinical case of a patient with left-sided hemiparesis after a haemorrhagic stroke and on immunosuppressive treatment after heart transplantation (2005). Methods: The outcomes of rehabilitation therapy were assessed based on the following scales: the Barthel Index, a modified Rankin Scale, the Rivermead Motor Index, the National Institutes of Health Stroke Scale, the Mini–Mental State Examination, and the Geriatric Depression Scale. Moreover, pre- and post-exercise heart rate monitoring was performed. Results: As a result of comprehensive rehabilitation treatment, functional status improvement was observed in all estimated scales. The highest change was reported for Barthel Index (50%) and National Institutes of Health Stroke Scale (30%). Heart rate was between 75 and 180 bpm. Conclusions: A patient with a history of heart transplantation shows good tolerance of physical exercise despite tachycardia. Early post-stroke rehabilitation significantly improves functional status.

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Home Safety Evaluation Model for Older Adults With Recurrent Falls

Innovation in Aging ◽

10.1093/geroni/igaa057.850 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 265-265

Author(s):

Willy Marcos Valencia ◽

Kimberly Cabrera ◽

Vincent Hsu

Keyword(s):

Older Adults ◽

Fear Of Falling ◽

Evaluation Model ◽

Safety Evaluation ◽

Falls Prevention ◽

Home Safety ◽

Recurrent Falls ◽

History Of ◽

The Impact

Abstract Recurrent falls are a major threat in older adults. Home environment can be a hazard, but it is potentially modifiable/reversible. In Miami VA, occupational therapists conduct home safety evaluations (HSE) to ascertain the need for modifications to reduce falls risk. We reviewed the cohort of high-risk, recurrent falls patients evaluated at our Falls Prevention Clinic (FPC) between August 2017 to November 2019, to evaluate the impact of HSE. We identified 48 Veterans, age 76.5±6.9 years, of whom 15 (31.3%) reported 1-2 falls/year, 18 (37.5%) reported 3-4 falls/year, and 15 (31.3%) reported ≥5 falls/year. Twenty-eight (58.3%) were offered a HSE. Within these subjects, 74.2% reported falling at least once within their home, 43.8% had fear of falling, 5 (17.9%) had a history of substance or alcohol abuse. We observed that 29 (60.4%) would benefit from the addition of grab bars and 26 (54.2%) could benefit from toilet adjustments. Twelve (25.0%) were recommended to install bed rails. Only 15 (31.3%) Veterans agreed to all recommendations, 25 (52.1%) declined due to preference, and 8 (16.7%) declined for other reasons. Only 8 (16.7%) of these Veterans lived alone. Another factor is that 11 (22.9%) Veterans were renting and 32 (66.7%) owned their homes. Addressing and improving environmental hazards may ameliorate the risk for recurrent falls. Our next steps are to evaluate the extent of home modifications, and the long-term changes in falls/year. Further research needs to determine the long-term efficacy and cost-effectiveness of HSE, and how it can be more accessible to the community.

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84 Identifying Potential Recurrent Fallers in the Community using Frailty Indicators

Age and Ageing ◽

10.1093/ageing/afz164.84 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv18-iv27

Author(s):

Freddy M H Lam ◽

Jason C S Leung ◽

Timothy C Y Kwok

Keyword(s):

Older Women ◽

Characteristic Curve ◽

Community Dwelling ◽

Classification And Regression Tree ◽

Health Study ◽

Cardiovascular Health Study ◽

Clinical Value ◽

Cart Analysis ◽

Recurrent Falls ◽

History Of

Abstract Introduction Frailty indicators were proposed to be significant predictors of falls. However, their comparative and additional value to other simple fall predictors has not been evaluated. This study aims to compare the clinical value of three frailty indicators to fall history in predicting recurrent falls in older adults. Methods Four thousand community-dwelling elderly (2000 female) aged 65 years or above were recruited in Hong Kong. The three candidate frailty indicators were the FRAIL scale, the Cardiovascular Health Study Criteria (CHS), and the Study for Osteoporosis and Fracture Criteria (SOF). The comparative predictor was fall history. The area under the receiver operating characteristic curve (AUC) was used to assess their ability to predict recurrent falls in the second year after baseline. Classification and Regression Tree (CART) analysis was used to evaluate the clinical potential of significant predictors on identifying older recurrent fallers in a simulated clinical pathway. Results Fall history is better than all frailty indicators in predicting recurrent falls in men and women (Fall History: AUC: men=0.681; women=0.645; Frailty indicators: AUC≤0.641). Upon adjusting for fall history, FRAIL and SOF remained as significant predictors for women but no frailty indicator remained significant for men. FRAIL could separate older women into two groups with different proportion of recurrent fallers in those with history of recurrent falls (16.0% vs 30.8%), single fall history (9.5% vs 37.5%), and no fall history (3.8% vs 7.5%). SOF provides limited value in people with a single fall history (history of recurrent falls: 16.5% vs 20.6%; single fall history: 10.2% vs 10.9%; no fall history: 3.9% vs 8.6%). Conclusion Adding FRAIL or SOF on top of fall history improves the prediction of recurrent falls in older women but not men. FRAIL could be a useful tool for identifying community-dwelling older women at high risk of recurrent falls.

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