Fall-related experiences of stroke survivors: a meta-ethnography

Walsh, Mary E.; Galvin, Rose; Horgan, Frances

doi:10.3109/09638288.2016.1160445

Cited by 29 publications

(20 citation statements)

References 43 publications

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“…Our findings confirm many of our hypotheses and are aligned with the existing literature describing accidental falls, assistive devices, and home care [31][32][33][34]. The increased rate of falls among health conditions (e.g., dizziness or lightheadedness, parkinsonism, etc.)…”

Section: Principal Findingssupporting

confidence: 89%

Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

2020

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Background: Accidental falls among older adults are a leading cause of injury-related hospitalizations. Reducing falls is an ongoing quality improvement priority for home care, given that many home care clients experience falls. In this study, we identify factors associated with the rate of falls among home care clients. Methods: We conducted a population-based, cross-sectional study using secondary data from the Hamilton, Niagara, Haldimand, and Brant health region of Ontario, Canada from January 1-March 31, 2018. We captured person-level characteristics with falls from the Resident Assessment Instrument-Home Care (RAI-HC). Negative binomial regression was used to model the rate of falls. Results: Functional characteristics of home care clients had strong, statistically significant associations with the rate of falls. Declines in activities of daily living, assistive device use for locomotion indoors, polypharmacy, and health conditions, such as dizziness or lightheadedness, and parkinsonism, were associated with a higher rate of falls. Males who used assistive devices had a higher rate of falls compared to females; however, males with neurological and cardiovascular health conditions had a decrease in the rate of falls compared to females. Home care clients with parkinsonism who used a cane and took eight or more drugs had stronger associations with an increased rate of falls compared to those who do not have parkinsonism. Conclusions: Functional characteristics, polypharmacy, and health conditions are associated with increased rates of falls among home care clients. Home care clients who are at a greater risk of falls may require environmental adjustments in their home to reduce or eliminate the possibility of falling.

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Section: Principal Findingssupporting

confidence: 89%

Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

2020

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“…These form barriers to social and community participation, and negatively impact quality of life [3]. Overcoming these are challenging, as patients require significant cognitive and emotional adjustment to successfully adopt coping strategies [4]. It is thus important to develop effective interventions to reduce risks of a post-stroke fall.…”

Section: Introductionmentioning

confidence: 99%

Post-stroke patients with moderate function have the greatest risk of falls: a National Cohort Study

et al. 2019

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BackgroundStroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients.MethodsThis retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls. Data for patients who suffered ischemic strokes and survived the index hospital admission was obtained from the Singapore National Stroke Registry and matched to the National Trauma Registry, from 2011 to 2015. The primary outcome measure was a low fall (fall height ≤ 0.5 m). Competing risk analysis was performed to examine the association between functional level (by modified Rankin score [mRS] at discharge) and the risk of subsequent low falls.ResultsIn all, 2255 patients who suffered ischemic strokes had recorded mRS. The mean age was 66.6 years and 58.5% were men. By the end of 2015, 54 (2.39%) had a low fall while 93 (4.12%) died.After adjusting for potential confounders, mRS was associated with fall risk with an inverted U-shaped relationship. Compared to patients with a score of zero, the sub-distribution hazard ratio (SHR) increased to a maximum of 3.42 (95%CI:1.21–9.65, p = 0.020) for patients with a score of 2. The SHR then declined to 2.45 (95%CI:0.85–7.12, p = 0.098), 2.86 (95%CI:0.95–8.61, p = 0.062) and 1.93 (95%CI:0.44–8.52, p = 0.38) for patients with scores of 3, 4 and 5 respectively.ConclusionsAn inverted U-shaped relationship between functional status and fall risk was observed. This is consistent with the complex interplay between decreasing mobility (hence decreased opportunity to fall) and increasing susceptibility to falls. Fall prevention intervention could be targeted accordingly.(263 words)

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“…In agreement with other studies [40,41], despite demonstrating an awareness of intrinsic risk factors, our participants primarily focussed on extrinsic triggers as the main causes and potentially modifiable contributors to falls. It has been proposed that this may be because extrinsic factors are perceived as more controllable than intrinsic changes [42], however, it may also add evidence to the suggestion that peoples' response to falling is influenced by their struggle to acknowledge internal limitations associated with their stroke [19]. Given that addressing modifiable intrinsic factors is likely to be a central tenet of falls interventions, supporting people to recognise and prioritise these is essential.…”

Section: Discussionmentioning

confidence: 99%

“…Understanding the challenges faced by people with stroke, and the methods they use to cope with falls in the community, is essential to ensure an intervention provides optimum long-term support and assistance. Despite the prevalence and significance of falls, review findings offer some evidence that people with stroke may not perceive adopting falls prevention strategies as either desirable, or achievable [19]. Similarly, research with older people suggests that they are reluctant to engage with 'falls prevention' exercise classes [20] as they do not perceive the relevance [21].…”

Section: Introductionmentioning

confidence: 99%

What are the perceptions and experiences of falls amongst people with stroke who live in the community?

Munford

Gunn

2018

Disability and Rehabilitation

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Purpose: To explore the perceptions and experiences of people with stroke living in the community with regard to the perceived causes, impact and solutions to minimise falls. Method: A qualitative research approach underpinned by a constructivist paradigm utilising a phenomenological methodology. 12 people with stroke participated in focus groups; the data was analysed using thematic analysis. Results: Three themes and one foundation theme were identified. 1. Trips and Triggers: falls were perceived to be linked to external triggers, one of which was walking aids. 2. Blame and Burden: self-blame and worry about being a burden may be associated with underreporting of falls. 3. Restrict and Reduce: people with stroke restrict activity and reduce participation to manage falls. The underpinning theme of self-efficacy highlights the apparent diminished falls self-efficacy, and the perception amongst the participants that falls are inevitable. Conclusions: This study highlights the perceived negative consequences of falls amongst people with stroke, and the potential contribution of falls to the reduced levels of physical activity often seen following a stroke. Our findings emphasise the need to address falls and balance related self-efficacy alongside strategies to promote safe mobility. A paradigm shift may be needed to highlight potentially modifiable intrinsic risk factors and emphasise the relevance and value of proactive fall prevention to people with stroke.

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Fall-related experiences of stroke survivors: a meta-ethnography

Cited by 29 publications

References 43 publications

Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

Post-stroke patients with moderate function have the greatest risk of falls: a National Cohort Study

What are the perceptions and experiences of falls amongst people with stroke who live in the community?

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