@article {7646, title = {Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008.}, journal = {Stroke}, volume = {42}, year = {2011}, note = {Divani, Afshin A Majidi, Shahram Barrett, Anna M Noorbaloochi, Siamak Luft, Andreas R K24 HD062647-01/HD/NICHD NIH HHS/United States K24 HD062647-02/HD/NICHD NIH HHS/United States K24HD062647/HD/NICHD NIH HHS/United States R01 NS055808/NS/NINDS NIH HHS/United States R01 NS055808-01A2/NS/NINDS NIH HHS/United States R01 NS055808-02/NS/NINDS NIH HHS/United States R01 NS055808-03/NS/NINDS NIH HHS/United States R01 NS055808-04/NS/NINDS NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Stroke; a journal of cerebral circulation Nihms297056 Stroke. 2011 Jul;42(7):1821-5. Epub 2011 May 19.}, month = {2011 Jul}, pages = {1821-5}, publisher = {42}, abstract = {

BACKGROUND AND PURPOSE: Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke.

METHODS: We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups.

RESULTS: Stroke survivors frequently developed new or worsened motor impairment (33\%), sleep problems (up to 33\%), falls (30\%), urinary incontinence (19\%), and memory deficits (9\%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95\% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95\% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95\% CI, 1.16 to 2.24), falls (OR, 1.5; 95\% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95\% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95\% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects.

CONCLUSIONS: The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.

}, keywords = {Activities of Daily Living, Aged, Case-Control Studies, Cohort Studies, Comorbidity, Female, Geriatrics, Humans, Male, Quality of Life, Retirement, Risk, Social Environment, Stroke}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.110.607630}, author = {Afshin A Divani and Shahram Majidi and Anna M Barrett and Noorbaloochi, Siamak and Andreas R Luft} } @article {7363, title = {Risk factors associated with injury attributable to falling among elderly population with history of stroke.}, journal = {Stroke}, volume = {40}, year = {2009}, month = {2009 Oct}, pages = {3286-92}, publisher = {40}, abstract = {

BACKGROUND AND PURPOSE: Stroke survivors are at high risk for falling. Identifying physical, clinical, and social factors that predispose stroke patients to falls may reduce further disability and life-threatening complications, and improve overall quality of life.

METHODS: We used 5 biennial waves (1998-2006) from the Health and Retirement Study to assess risk factors associated with falling accidents and fall-related injuries among stroke survivors. We abstracted demographic data, living status, self-evaluated general health, and comorbid conditions. We analyzed the rate ratio (RR) of falling and the OR of injury within 2 follow-up years using a multivariate random effects model.

RESULTS: We identified 1174 stroke survivors (mean age+/-SD, 74.4+/-7.2 years; 53\% female). The 2-year risks of falling, subsequent injury, and broken hip attributable to fall were 46\%, 15\%, and 2.1\% among the subjects, respectively. Factors associated with an increased frequency of falling were living with spouse as compared to living alone (RR, 1.4), poor general health (RR, 1.1), time from first stroke (RR, 1.2), psychiatric problems (RR, 1.7), urinary incontinence (RR, 1.4), pain (RR, 1.4), motor impairment (RR, 1.2), and past frequency of > or = 3 falls (RR, 1.3). Risk factors associated with fall-related injury were female gender (OR, 1.5), poor general health (OR, 1.2), past injury from fall (OR, 3.2), past frequency of > or = 3 falls (OR, 3.1), psychiatric problems (OR, 1.4), urinary incontinence (OR, 1.4), impaired hearing (OR, 1.6), pain (OR, 1.8), motor impairment (OR, 1.3), and presence of multiple strokes (OR, 3.2).

CONCLUSIONS: This study demonstrates the high prevalence of falls and fall-related injuries in stroke survivors, and identifies factors that increase the risk. Modifying these factors may prevent falls, which could lead to improved quality of life and less caregiver burden and cost in this population.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Aging, Causality, Cohort Studies, Comorbidity, disease progression, Female, Health Status, Humans, Male, Marital Status, Mental Disorders, Movement Disorders, Prevalence, Risk Factors, Risk Reduction Behavior, Sex Distribution, Stroke, Urinary incontinence, Wounds and Injuries}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.109.559195}, author = {Afshin A Divani and Vazquez, Gabriela and Anna M Barrett and Asadollahi, Marjan and Andreas R Luft} }