82FEAR OF FALLING IS INDEPENDENTLY ASSOCIATED WITH AGORAPHOBIA AFTER MILD STROKE AND TIA

Abstract

Introduction: In our recent prospective cohort, phobic disorder affected around 18% of mild stroke and TIA patients at 3 months and agoraphobia accounted for the majority of phobic disorders. Fear of falling (FoF) may contribute to agoraphobia post-stroke/TIA, with or without the presence of mobility problems. FoF can lead to actual falls, muscle deconditioning and impaired functioning. We aim to assess the association between fear of falling and agoraphobia. Method: Secondary analysis of a prospective cohort of community-based mild stroke and TIA patients (n = 175, mean age 70, 40% women). We carried out multivariable logistic regression analyses for the outcome variable: diagnosis of agoraphobia on psychiatric diagnostic interview (SCID) at 3 months. Explanatory variables were: i) age (per decade increase), ii) past history of anxiety or depression, iii) ability to walk at discharge, iv) history of actual falls, v) living alone pre-stroke, and vi) (Falls Efficacy Scale (FES), a measure of fear of falling (10 items, each item is scored between 1-10, score range 10- 100, higher scores indicate greater fear of falling (Tinetti 1990). Results: In the fully adjusted model, every 10-point increase on the FES was associated with a 2-fold increase in the likelihood of agoraphobia (per 10-point rise in FES: adjusted OR 2.47, 95%CI 1.52-3.00). For every decade increase in age, the likelihood of agoraphobia reduced by a third (adjusted OR 0.62, 95%CI 0.39-0.97). Conclusion: Fear of falling is independently associated with agoraphobia at 3 months after mild stroke and TIA. Older age was associated with decreased likelihood of agoraphobia, consistent with findings that younger people are more at risk of developing anxiety disorder post-stroke/TIA. Psychological support for stroke/TIA should address the fear of falling even in the absence of mobility issues or previous history of falls.