Long-Term Factors Associated With Falls and Fractures Poststroke

Emma J. Foster, Raphae S. Barlas, Joao H. Bettencourt-Silva, Allan B. Clark, Anthony K. Metcalf, Kristian M. Bowles, John F. Potter, Phyo K. Myint

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Abstract

Background: Risk factors for poststroke falls and fractures remain poorly understood. This study aimed to evaluate which factors increased risk of these events after stroke.

Methods: Data from 7,267 hospitalized stroke patients were acquired from the Norfolk and Norwich University Hospital Stroke Register from 2003–2015. The impacts of multiple patient level and stroke characteristics and comorbidities on post-discharge falls and fractures were assessed. Univariate and multivariable models were constructed, adjusting for multiple confounders, using binary logistic regression for short-term analysis (up to 1-year post-discharge) and Cox-proportional hazard models for longer term analysis (1–3, 3–5, and 0–10 years follow-up).

Results: The mean age (SD) was 76.3 ± 12.1 years at baseline. 1,138 (15.7%) participants had an incident fall; and 666 (9.2%) an incident fracture during the 10-year follow-up (total person years = 64,447.99 for falls and 67,726.70 for fractures). Half of the sample population were females (50.6%) and the majority had an ischemic stroke (89.8%). After adjusting for confounders: age, sex, previous history of falls, and atrial fibrillation were associated with an increased risk of both falls and fractures during follow-up. Furthermore, chronic kidney disease and hyperlipidemia were associated with an increased risk of falls, while previous stroke/transient ischemic attack increased fracture risk. Total anterior circulation stroke and a prestroke modified Rankin Scale score of 3–5 were associated with decreased risk of both events, with hypertension and cancer decreasing risk of falls only.

Conclusion: We identified demographic, stroke-related, and comorbid factors associated with poststroke falls and fracture incidence. Further studies are required to examine and establish the relationship between reversible factors and further explore the role of preventative measures to prevent poststroke falls and fractures.
Original languageEnglish
Article number210
Pages (from-to)1-9
Number of pages9
JournalFrontiers in Neurology
Volume9
Early online date16 Mar 2018
DOIs
Publication statusPublished - 3 Apr 2018

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Stroke
Transient Ischemic Attack
Hyperlipidemias
Chronic Renal Insufficiency
Proportional Hazards Models
Atrial Fibrillation
Comorbidity
Logistic Models
Demography
Hypertension
Incidence
Population
Neoplasms

Keywords

  • falls
  • fracture
  • stroke
  • risk
  • factor

Cite this

Foster, E. J., Barlas, R. S., Bettencourt-Silva, J. H., Clark, A. B., Metcalf, A. K., Bowles, K. M., ... Myint, P. K. (2018). Long-Term Factors Associated With Falls and Fractures Poststroke. Frontiers in Neurology, 9, 1-9. [210]. https://doi.org/10.3389/fneur.2018.00210

Long-Term Factors Associated With Falls and Fractures Poststroke. / Foster, Emma J.; Barlas, Raphae S.; Bettencourt-Silva, Joao H.; Clark, Allan B.; Metcalf, Anthony K.; Bowles, Kristian M.; Potter, John F.; Myint, Phyo K.

In: Frontiers in Neurology, Vol. 9, 210, 03.04.2018, p. 1-9.

Research output: Contribution to journalArticle

Foster, EJ, Barlas, RS, Bettencourt-Silva, JH, Clark, AB, Metcalf, AK, Bowles, KM, Potter, JF & Myint, PK 2018, 'Long-Term Factors Associated With Falls and Fractures Poststroke', Frontiers in Neurology, vol. 9, 210, pp. 1-9. https://doi.org/10.3389/fneur.2018.00210
Foster EJ, Barlas RS, Bettencourt-Silva JH, Clark AB, Metcalf AK, Bowles KM et al. Long-Term Factors Associated With Falls and Fractures Poststroke. Frontiers in Neurology. 2018 Apr 3;9:1-9. 210. https://doi.org/10.3389/fneur.2018.00210
Foster, Emma J. ; Barlas, Raphae S. ; Bettencourt-Silva, Joao H. ; Clark, Allan B. ; Metcalf, Anthony K. ; Bowles, Kristian M. ; Potter, John F. ; Myint, Phyo K. / Long-Term Factors Associated With Falls and Fractures Poststroke. In: Frontiers in Neurology. 2018 ; Vol. 9. pp. 1-9.
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note = "Acknowledgments We thank the stroke services data team at the Norfolk and Norwich University Stroke Research Group for collecting and maintaining the data of the Norfolk and Norwich University Hospital Stroke and Transient Ischemic Attack Register (NNSTR), which was used in this study. Funding EF was supported by an 8-week Vacation Scholarship grant awarded by Medical Research Scotland to carry out the research. The funder has no role in study design or interpretation of the results.",
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AU - Foster, Emma J.

AU - Barlas, Raphae S.

AU - Bettencourt-Silva, Joao H.

AU - Clark, Allan B.

AU - Metcalf, Anthony K.

AU - Bowles, Kristian M.

AU - Potter, John F.

AU - Myint, Phyo K.

N1 - Acknowledgments We thank the stroke services data team at the Norfolk and Norwich University Stroke Research Group for collecting and maintaining the data of the Norfolk and Norwich University Hospital Stroke and Transient Ischemic Attack Register (NNSTR), which was used in this study. Funding EF was supported by an 8-week Vacation Scholarship grant awarded by Medical Research Scotland to carry out the research. The funder has no role in study design or interpretation of the results.

PY - 2018/4/3

Y1 - 2018/4/3

N2 - Background: Risk factors for poststroke falls and fractures remain poorly understood. This study aimed to evaluate which factors increased risk of these events after stroke.Methods: Data from 7,267 hospitalized stroke patients were acquired from the Norfolk and Norwich University Hospital Stroke Register from 2003–2015. The impacts of multiple patient level and stroke characteristics and comorbidities on post-discharge falls and fractures were assessed. Univariate and multivariable models were constructed, adjusting for multiple confounders, using binary logistic regression for short-term analysis (up to 1-year post-discharge) and Cox-proportional hazard models for longer term analysis (1–3, 3–5, and 0–10 years follow-up).Results: The mean age (SD) was 76.3 ± 12.1 years at baseline. 1,138 (15.7%) participants had an incident fall; and 666 (9.2%) an incident fracture during the 10-year follow-up (total person years = 64,447.99 for falls and 67,726.70 for fractures). Half of the sample population were females (50.6%) and the majority had an ischemic stroke (89.8%). After adjusting for confounders: age, sex, previous history of falls, and atrial fibrillation were associated with an increased risk of both falls and fractures during follow-up. Furthermore, chronic kidney disease and hyperlipidemia were associated with an increased risk of falls, while previous stroke/transient ischemic attack increased fracture risk. Total anterior circulation stroke and a prestroke modified Rankin Scale score of 3–5 were associated with decreased risk of both events, with hypertension and cancer decreasing risk of falls only.Conclusion: We identified demographic, stroke-related, and comorbid factors associated with poststroke falls and fracture incidence. Further studies are required to examine and establish the relationship between reversible factors and further explore the role of preventative measures to prevent poststroke falls and fractures.

AB - Background: Risk factors for poststroke falls and fractures remain poorly understood. This study aimed to evaluate which factors increased risk of these events after stroke.Methods: Data from 7,267 hospitalized stroke patients were acquired from the Norfolk and Norwich University Hospital Stroke Register from 2003–2015. The impacts of multiple patient level and stroke characteristics and comorbidities on post-discharge falls and fractures were assessed. Univariate and multivariable models were constructed, adjusting for multiple confounders, using binary logistic regression for short-term analysis (up to 1-year post-discharge) and Cox-proportional hazard models for longer term analysis (1–3, 3–5, and 0–10 years follow-up).Results: The mean age (SD) was 76.3 ± 12.1 years at baseline. 1,138 (15.7%) participants had an incident fall; and 666 (9.2%) an incident fracture during the 10-year follow-up (total person years = 64,447.99 for falls and 67,726.70 for fractures). Half of the sample population were females (50.6%) and the majority had an ischemic stroke (89.8%). After adjusting for confounders: age, sex, previous history of falls, and atrial fibrillation were associated with an increased risk of both falls and fractures during follow-up. Furthermore, chronic kidney disease and hyperlipidemia were associated with an increased risk of falls, while previous stroke/transient ischemic attack increased fracture risk. Total anterior circulation stroke and a prestroke modified Rankin Scale score of 3–5 were associated with decreased risk of both events, with hypertension and cancer decreasing risk of falls only.Conclusion: We identified demographic, stroke-related, and comorbid factors associated with poststroke falls and fracture incidence. Further studies are required to examine and establish the relationship between reversible factors and further explore the role of preventative measures to prevent poststroke falls and fractures.

KW - falls

KW - fracture

KW - stroke

KW - risk

KW - factor

U2 - 10.3389/fneur.2018.00210

DO - 10.3389/fneur.2018.00210

M3 - Article

VL - 9

SP - 1

EP - 9

JO - Frontiers in Neurology

JF - Frontiers in Neurology

SN - 1664-2295

M1 - 210

ER -