Risk of falling doubled after mild stroke or tia Rehabilitation and fall prevention reduce risk of fall

People who have experienced a mild stroke or transient ischemic attack (TIA) are at significantly greater risk of a fall than their healthy peers. They also have more balance and walking problems, and they move at lower intensity. This is shown by research by Radboud university medical center. Balance and fall prevention training can reduce risks.

In the Netherlands, 2% of the population lives with the consequences of a stroke. Every year, 40,000 people are affected by a stroke for the first time, about half of whom experience a mild stroke. In addition, about 53,000 people sustain a TIA every year. In people with mild symptoms, hospitalization generally lasts less than three days and no permanent balance problems appear to occur. After a one-time consultation for secondary stroke prevention, they often receive no further treatment by a healthcare provider. 

Researchers from Radboud university medical center and Delft University of Technology wondered whether this group really does not suffer any mobility-related consequences from a mild stroke or TIA, especially in the longer term. Therefore, they examined 70 people who had had a stroke at least six months earlier. They compared these with 47 people without stroke, the control group. They all came to the hospital for a balance and gait assessment. After that, an activity meter recorded the movements during activities of daily life for a week. Participants also kept track of any falls for a year. 

The results show that the risk of falling was twice as high in the people with mild stroke/TIA than the control group. These people also walked slower and suffered from balance problems more often. Lead researcher Vivian Weerdesteyn, professor at the Department of Rehabilitation at Radboud university medical center: ‘These problems can often not be seen with the naked eye, but the tests in the hospital showed minor abnormalities. This was then reflected in the activity meter and fall calendar data. A mild stroke or TIA also can have an impact on balance, walking and the risk of falling.’ 

Predictor of a new fall

The increased risk of a fall was particularly striking. ‘Until now, we didn't know that this group, which is quite large anyway, falls so often’, says Weerdesteyn. These patients generally get out of the picture of healthcare providers, because they have no clear complaints. Weerdesteyn: ‘The participants in our study were still relatively young, in their early 60s. They resume their daily lives after the event. Some of them are still working, living life to the fullest. Yet these people may have problems, we see now.’ 

That is why Weerdesteyn advocates more awareness, both among the population and among healthcare providers. Because previous research has already shown that a fall history is the strongest predictor of a new fall. ‘This also applies if the first fall did not result in serious damage, such as bone fractures or a concussion. A possible later fall can lead to serious damage. And that is important, because we also know: the older someone is, the higher the risk that a fall will turn out to be serious. So, if someone falls again ten years later, the damage is often greater.’ 

People can reduce their risk of falling through fall prevention training. Weerdesteyn recommends this training to people who have experienced a mild stroke or TIA, even if they no longer have any obvious complaints. ‘With training focused on balance and gait ability, people can improve these skills. This significantly reduces the risk of a fall. And therefore, also on a serious fall that requires a visit to the Emergency Department, for example.’ 

About this publication

This article appeared in Neurorehabilitation and Neural Repair: Mild stroke, serious problems: limitations in balance and gait capacity and the impact on fall rate, and physical activity – Jolanda M.B. Roelofs, Sarah B. Zandvliet, Ingrid M. Schut, Anouk C.M. Huisinga, Alfred C. Schouten, Henk T. Hendricks, Digna de Kam, Leo A.M. Aerden, Johannes B.J. Bussmann, Alexander C.H. Geurts, Vivian Weerdesteyn. The research was made possible in part by ZonMw.

The Dutch government made extra money available for fall prevention training in 2023. In 2022, 117,000 over-65s reported to the Emergency Department after a fall, 11% more than in 2021. In other words: every four minutes an elderly person over 65 reported to the hospital because of a fall.

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