Aging Clinical and Experimental Research

, Volume 17, Issue 2, pp 74–81 | Cite as

Falls incidence and factors associated with falling in older, community-dwelling, chronic stroke survivors (>1 year after stroke) and matched controls

  • Shylie F. H. MackintoshEmail author
  • Patricia Goldie
  • Keith Hill
Original Articles


Background and aims: Using data from the Australian Longitudinal Study of Ageing, this study aimed at: 1) investigating differences in the incidence of falls between chronic Stroke subjects (n=181) and matched Non-stroke subjects (n=181) who were 65 years or older and community dwellers, and 2) establishing factors associated with falling within chronic Stroke subjects. Methods: Subjects reporting a history of stroke 12 or more months ago, and age- and gender-matched Non-stroke subjects were extracted from the first wave of the Australian Longitudinal Study of Ageing database. Falls incidence and factors associated with falling were examined. Falls data were collected based on recall of the number of falls in the past year, including falls that did not result in injury. Results: Significantly more Stroke subjects reported falling in the previous twelve months than Non-stroke subjects (36 vs 24%, p<0.05). When comparing Stroke Fallers to Stroke Non-fallers within the Stroke group, Stroke Fallers were significantly more likely to report (i) difficulty in stooping or kneeling, (ii) getting up in the night to urinate more than once, and (iii) having a greater number of Instrumental Activities of Daily Living problems (p<0.05). Self-reported difficulty in stooping or kneeling was the most significant factor associated with falling in the Stroke group (OR 2.44, 95% CI 1.30–4.58). Conclusions: Falls are a problem for community dwelling older people with chronic stroke and are associated with physical function difficulties. Factors identified in this and other similar studies should form the basis for targeted falls prevention programs in this high falls risk clinical group.


Accidental falls older adults stroke 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Dolinis J, Harrison JE. Factors associated with falling in older Adelaide residents. Aust NZ J Public Health 1997; 21: 462–8.CrossRefGoogle Scholar
  2. 2.
    Yasumura S, Haga H, Nagai H, Suzuki T, Amano H, Shibata M. Rate of falls and the correlates among elderly people living in a urban community in Japan. Age Ageing 1994; 23: 323–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Berg WP, Alessio HM, Mills EM, Tong C. Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing 1997; 26: 261–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Hill K, Schwarz J, Flicker L, Carroll S. Falls among healthy, community-dwelling, older women: a prospective study of frequency, circumstances, consequences and prediction accuracy. Aust NZ J Public Health 1999; 23: 41–8.CrossRefGoogle Scholar
  5. 5.
    Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 1989; 44: M112–7.PubMedGoogle Scholar
  6. 6.
    Graafmans WC, Ooms ME, Hofstee HMA, Bezemer PD, Bouter LM, Lips P. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 1996; 143: 1129–36.PubMedCrossRefGoogle Scholar
  7. 7.
    Jørgensen L, Engstad T, Jacobsen BK. Higher incidence of falls in long-term stroke survivors than in population controls — depressive symptoms predict falls after stroke. Stroke 2002; 33: 542–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Ramnemark A, Nyberg L, Borssen B, Olsson T, Gustafson Y. Fractures after stroke. Osteoporos Int 1998; 8: 92–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Ugur C, Gücüyener D, Uzuner N, Ozkan S, Özdemir G. Characteristics of falling in patients with stroke. J Neurol Neurosurg Psychiatry 2000; 69: 649–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Forster A, Young J. Incidence and consequences of falls due to stroke: a systematic inquiry. BMJ 1995; 311: 83–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Sackley CM. Falls, sway, and symmetry of weight-bearing after stroke. Int Disabil Stud 1991; 13: 1–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Cheng PT, Liaw MY, Wong MK, Tang FT, Lee MY, Lin PS. The sit-to-stand movement in stroke patients and its correlation with falling. Arch Phys Med Rehabil 1998; 79: 1043–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Nyberg L. Gustafson Y. Fall prediction index for patients in stroke rehabilitation. Stroke 1997; 28: 716–21.Google Scholar
  14. 14.
    Rapport LJ, Webster JS, Hemming KL, et al. Predictors of falls among right-hemisphere stroke patients in the rehabilitation setting. Arch Phys Med Rehabil 1993; 74: 621–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Webster JS, Roades LA, Morrill B, et al. Rightward orienting bias, wheelchair manoeuvring, and fall risk. Arch Phys Med Rehabil 1995; 76: 924–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Nyberg L. Gustafson Y. Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. Stroke 1995; 26: 838–42.Google Scholar
  17. 17.
    Tutuarima JA, van der Meulen JHP, de Haan RJ, van Straten A. Limburg M. Risk factors for falls of hospitalized stroke patients. Stroke 1997; 28: 297–301.Google Scholar
  18. 18.
    Gücüyener D, Ugur C, Uzuner N, Özdemir G. The importance of falls in stroke patients. Annals of Saudi Medicine 2000; 20: 322–3.PubMedGoogle Scholar
  19. 19.
    Ivers RQ, Cumming RG, Mitchell P, Attebo K. Visual impairment and falls in older adults: the Blue Mountains Eye Study. J Am Geriatr Soc 1998; 46: 58–64.PubMedGoogle Scholar
  20. 20.
    Lord SR, Ward JA, Williams P, Anstey KJ. Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 1994; 42: 1110–7.PubMedGoogle Scholar
  21. 21.
    Lord SR, Ward JA, Williams P, Anstey KJ. An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Aust J Public Health 1993; 17: 240–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Andrews G. Choek F. Carr S. The Australian Longitudinal Study of Ageing. Aust J Ageing 1989; 8: 31–5.CrossRefGoogle Scholar
  23. 23.
    Finucane P, Giles LC, Withers RT, et al. Exercise profile and subsequent mortality in an elderly Australian population. Aust NZ J Public Health 1997; 21: 155–8.CrossRefGoogle Scholar
  24. 24.
    Bond MJ. Clark MS. Clinical applications of the Adelaide Activities Profile. Clin Rehabil 1998; 12: 228–37.Google Scholar
  25. 25.
    Hanlon JT, Cutson T, Ruby CM. Drug-related falls in the older adult. Topics in Geriatric Rehabilitation 1996; 11: 38–54.Google Scholar
  26. 26.
    Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47: 30–9.Google Scholar
  27. 27.
    Biderman A, Cwikel J, Fried AV, Galinsky D. Depression and falls among community dwelling elderly people: a search for common risk factors. J Epidemiol Community Health 2002; 56: 631–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Close JCT, Ellis M, Hooper R, Glucksman E, Jackson SHD, Swift CG. Predictors of falls — results from prevention of falls in the elderly trial (PROFET). Age Ageing 1999; 28: S14.Google Scholar
  29. 29.
    Lord SR, Sherrington C, Menz HB. Falls in older people. Risk factors and strategies for prevention. Cambridge, UK: Cambridge University Press; 2001.Google Scholar
  30. 30.
    Cummings SR, Nevitt MC, Kidd S. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 1988; 36: 613–6.Google Scholar
  31. 31.
    Hyndman D, Ashbum A, Stack E. Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallere. Arch Phys Med Rehabil 2002; 83: 165–170.PubMedCrossRefGoogle Scholar
  32. 32.
    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Tromp AM, Smit JH, Deeg DJH, Bouter LM, Lips P. Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res 1998; 13: 1932–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y. Falls among frail older people in residential care. Scand J Public Health 2002; 30: 54–61.PubMedGoogle Scholar
  35. 35.
    Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 1995; 273: 1348–53.Google Scholar

Copyright information

© Springer Internal Publishing Switzerland 2005

Authors and Affiliations

  • Shylie F. H. Mackintosh
    • 1
    Email author
  • Patricia Goldie
    • 1
  • Keith Hill
    • 2
  1. 1.La Trobe UniversityUniversity of South Australia AdelaideAustralia
  2. 2.National Ageing Research Institute and Melbourne Extended Care and Rehabilitation ServiceParkvilleAustralia

Personalised recommendations