Falls and fractures 2 years after acute stroke: the North Dublin Population Stroke Study.
BACKGROUND
Stroke patients are at increased risk of falls and fractures. The aim of this study was to determine the rate, predictors and consequences of falls within 2 years after stroke in a prospective population-based study in North Dublin, Ireland.


METHODS
Prospective population-based cohort study.


METHODS
567 adults aged >18 years from the North Dublin Population Stroke Study.


METHODS
Participants were enrolled from an Irish urban population of 294,592 individuals, according to recommended criteria. Patients were followed for 2 years. Outcome measures included death, modified Rankin Scale (mRS), fall and fracture rate.


RESULTS
At 2 years, 23.5% (124/522) had fallen at least once since their stroke, 14.2% (74/522) had 2 or more falls and 5.4% (28/522) had a fracture. Of 332 survivors at 2 years, 107 (32.2%) had fallen, of whom 60.7% (65/107) had 2 or more falls and 23.4% (25/107) had fractured. In a multivariable model controlling for age and gender, independent risk factors for falling within the first 2 years of stroke included use of alpha-blocker medications for treatment of hypertension (P = 0.02). When mobility measured at Day 90 was included in the model, patients who were mobility impaired (mRS 2-3) were at the highest risk of falling within 2 years of stroke [odds ratio (OR) 2.30, P = 0.003] and those functionally dependent (mRS 4-5) displayed intermediate risk (OR 2.02, P = 0.03) when compared with independently mobile patients.


CONCLUSIONS
Greater attention to falls risk, fall prevention strategies and bone health in the stroke population are required.
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Callaly
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Ni Chroinin
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Hannon
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Sheehan
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Marnane
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Merwick
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Kelly
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Horgan
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Williams
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Harris
Beaumont Hospital, Dublin, Ireland Royal College of Surgeons, Dublin, Ireland.
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Williams
Beaumont Hospital, Dublin, Ireland.
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Moore
Connolly Hospital, Dublin, Ireland.
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Dolan
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland Royal College of Surgeons, Dublin, Ireland.
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Murphy
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Kelly
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Duggan
Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland.
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Kyne
D000058:Accidental Falls / Q000401:mortality / Q000706:statistics & numerical data*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007494:Ireland / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D014504:Urban Health
D000317:Adrenergic alpha-Antagonists; D000959:Antihypertensive Agents
falls; older people; outcome; stroke