Risk Factors for Falls Among Hospitalized Acute Post–Ischemic Stroke Patients

Cox, Robynn S; Buckholtz, Beth; Bradas, Cheryl; Bowden, Victoria; Kerber, Kathleen; McNett, Molly

doi:10.1097/jnn.0000000000000322

Cited by 16 publications

(15 citation statements)

References 17 publications

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“…The fallers were found to stay longer in rehabilitation than the non-fallers, the repeat fallers longest. Longer length of hospitalisation has also previously been associated with falls in subacute rehabilitation [5,59,81,86], and in acute care [91]. In line with previous studies, most incidents and especially the first events occurred within the first two weeks of stay [3,9].…”

Section: Discussionsupporting

confidence: 69%

“…The onetime fallers had higher Charlson index and more often comorbidities, cardiovascular disease and a history of myocardial infarction than the other two subgroups; of them myocardial infarction was found to be an independent predictor for the number of incidents. A history of myocardial infarction has also previously been found to predict falls in a population of acute stroke patients [91], but medication-related falls have been surprisingly uncommon in subacute stroke rehabilitation [58].…”

Section: Discussionmentioning

confidence: 98%

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Fall assessment in subacute inpatient stroke rehabilitation using clinical characteristics and the most preferred stroke severity and outcome measures

Tarvonen-Schröder

Niemi

Hurme

et al. 2021

European Journal of Physiotherapy

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Introduction: No single tool is able to distinguish fallers from non-fallers. The aim of this study was to detect subacute stroke inpatients at higher risk for falls, predictors for the number of falls and near falls and the impact of these incidents on functional outcome. Methods: An observational prospective cohort study comparing clinical differences between non-fallers, onetime and repeat fallers. Bivariate and multivariate Poisson regression analyses with length of stay as an offset variable were conducted. Results: Fallers had mostly intermediate level of impairment and disability (NIHSS, FIM, mRS, the ICF minimal generic data set). The onetime fallers who were oldest, most disabled and most often institutionalised achieved the same functional improvement as the non-fallers, however, after significantly longer inpatient rehabilitation. The repeat fallers who were youngest and had the longest rehabilitation in-stay, achieved equal functioning as the non-fallers having faster motor gain and the greatest overall functional improvement compared to the other two subgroups. Conclusions: Right hemispheric stroke, previous myocardial infarction and shorter time from stroke onset were independent predictors for the number of incidents. In the future, larger studies are recommended to investigate fall rate and different severities of incidents, falls and near falls separately.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 98%

Fall assessment in subacute inpatient stroke rehabilitation using clinical characteristics and the most preferred stroke severity and outcome measures

Tarvonen-Schröder

Niemi

Hurme

et al. 2021

European Journal of Physiotherapy

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“…OH is clinically important after stroke because of the increased fall risk. Although the incidence varies among studies, up to 37% of post-stroke inpatients report at least 1 fall (214–216), accounting for up to 40% of all adverse hospital events post-stroke (217). Surprisingly few studies, if any, have prospectively examined the association between falls and OH early post-stroke.…”

Section: Protecting the Brain During Mobilizationmentioning

confidence: 99%

Aerobic Training and Mobilization Early Post-stroke: Cautions and Considerations

Marzolini

Robertson

et al. 2019

Front. Neurol.

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Knowledge gaps exist in how we implement aerobic exercise programs during the early phases post-stroke. Therefore, the objective of this review was to provide evidence-based guidelines for pre-participation screening, mobilization, and aerobic exercise training in the hyper-acute and acute phases post-stroke. In reviewing the literature to determine safe timelines of when to initiate exercise and mobilization we considered the following factors: arterial blood pressure dysregulation, cardiac complications, blood-brain barrier disruption, hemorrhagic stroke transformation, and ischemic penumbra viability. These stroke-related impairments could intensify with inappropriate mobilization/aerobic exercise, hence we deemed the integrity of cerebral autoregulation to be an essential physiological consideration to protect the brain when progressing exercise intensity. Pre-participation screening criteria are proposed and countermeasures to protect the brain from potentially adverse circulatory effects before, during, and following mobilization/exercise sessions are introduced. For example, prolonged periods of standing and static postures before and after mobilization/aerobic exercise may elicit blood pooling and/or trigger coagulation cascades and/or cerebral hypoperfusion. Countermeasures such as avoiding prolonged standing or incorporating periodic lower limb movement to activate the venous muscle pump could counteract blood pooling after an exercise session, minimize activation of the coagulation cascade, and mitigate potential cerebral hypoperfusion. We discuss patient safety in light of the complex nature of stroke presentations (i.e., type, severity, and etiology), medical history, comorbidities such as diabetes, cardiac manifestations, medications, and complications such as anemia and dehydration. The guidelines are easily incorporated into the care model, are low-risk, and use minimal resources. These and other strategies represent opportunities for improving the safety of the activity regimen offered to those in the early phases post-stroke. The timeline for initiating and progressing exercise/mobilization parameters are contingent on recovery stages both from neurobiological and cardiovascular perspectives, which to this point have not been specifically considered in practice. This review includes tailored exercise and mobilization prescription strategies and precautions that are not resource intensive and prioritize safety in stroke recovery.

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“…Patient-specific factors are those factors that are often internal to the patient. These include the following: increased age (Brown, et al, 2013;Cox, et al, 2015;Dykes et al, 2011;Florence, et al, 2018;Hester et al, 2016), multiple diagnoses and comorbidities (Brown, et al, 2013;Cox, et al, 2015;Dykes et al, 2011;Florence, et al, 2018;Hester et al, 2016;McNett et al, 2017;Tzeng & Yin, 2008), gender and ethnicity (Cho, Ketefian, Barkauskas, & Smith, 2003;Cox, et al, 2015), history of previous falls and cognitive impairment (Brandis, 1999;Cox, et al, 2015;Dykes et al, 2011;Hester et al, 2016;Tzeng & Yin, 2008), polypharmacy (Brandis, 1999;Florence, et al, 2018;Hester et al, 2016;Pierce, Shirley, Johnson, & Kang, 2013) and sensory deficits (Brown, et al, 2013;Dykes et al, 2011).…”

Section: Backg Rou N Dmentioning

confidence: 99%

Impact of level of nurse experience on falls in medical surgical units

2019

Self Cite

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Aim To describe nurse‐specific and patient risk factors present at the time of a patient fall on medical surgical units within an academic public health care system. Background The incidence of falls can be devastating for hospitalized patients and their families. Few studies have investigated how patient and nurse‐specific factors can decrease the occurrence of falls in hospitals. Method In this retrospective cohort study, data were gathered on all patients who experienced a fall during January 2012 to December 2013. Results Falls were reduced dramatically when the number of nurses on the unit increased to five or six. Patient falls occurred most often when either the least experienced or most experienced nursing staff were providing care. Conclusion Patient falls in hospitals can be influenced not only by patient‐specific factors, but also by nurse staffing and experience level. Implications for nursing management Findings from this study highlight factors which may contribute to hospital‐based falls prevention initiatives and are amenable to nursing management decisions.

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Risk Factors for Falls Among Hospitalized Acute Post–Ischemic Stroke Patients

Cited by 16 publications

References 17 publications

Fall assessment in subacute inpatient stroke rehabilitation using clinical characteristics and the most preferred stroke severity and outcome measures

Fall assessment in subacute inpatient stroke rehabilitation using clinical characteristics and the most preferred stroke severity and outcome measures

Aerobic Training and Mobilization Early Post-stroke: Cautions and Considerations

Impact of level of nurse experience on falls in medical surgical units

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