35DETERMINANTS OF POST-DISCHARGE FALLS AND FRACTURES AFTER STROKE OVER LONG TERM FOLLOW UP

Abstract

Background: Neurological deficits post-stroke and associated reduced bone mass lead to increased fall and fracture risk, known to be associated with increased mortality. Despite recent advances identifying risk factors for falls post-stroke in survivors, they remain poorly understood. This study aimed to investigate which factors increased the risk of falls and fractures after stroke. Methods: We analysed data from a regional stroke register, between 2003-2015. The data entry team documented paper-based records at baseline. Incident falls and fractures were followed up by record linkage. Univariate and multivariate Cox Proportional Hazard models were constructed - adjusting for patient/stroke characteristics and co-morbidities - analysing over 10-years follow up. Results: 7248 patients discharged after acute stroke (89.6% ischaemic) were included. The mean age (SD) was 76.3 ± 12.1 years; 50.6% women. 1136 (15.7%) had an incident fall; and 666 (9.2%) an incident fracture during the 10-year follow up (median 6.94 years). Increasing age [HR 1.04(95%CI:1.03-1.04)], falls history [1.42(1.14-1.75)], atrial fibrillation [1.18(1.03-1.35)], previous stroke/TIA [1.16(1.01-1.32)] and hyperlipidaemia [1.36 (1.01-1.81)] were identified as risk factors for falls post-discharge; while, increasing age [1.03(1.02-1.03)], falls history [1.82(1.39-2.37)] and atrial fibrillation [1.21(1.02-1.43)] were associated with increased risk of fracture post-discharge. Male sex [falls 0.77(0.68-0.87), fractures 0.63(0.53-0.75)], Total Anterior Circulation Stroke [falls 0.58(0.46-0.72), fractures 0.59(0.44-0.79)] and a pre-stroke modified Rankin Score (measure of pre-stroke disability) of 3-5 [falls 0.78(0.65-0.95), fractures 0.69(0.54-0.89)] were associated with reduced risk of falls and fractures. Previous malignancy was also associated with reduced fall risk [0.76(0.62-0.93)]. Conclusion: We identified new personal and stroke-related fall and fracture risk factors post-stroke. This knowledge may allow earlier targeted preventative measures to be instituted, preventing future fall and fracture risk among stroke survivors.