Risk Factors for Falls in Adult Stroke Patients: A Comprehensive Model

Stroke is a prevalent disease among the adult population in the world (Cho, Yu, & Rhee, 2015; Thrift et al., 2014). For stroke patients, falling is a major concern that accounts for 30% of complications, resulting in fractures, head trauma, even death (Benjamin et al., 2017; Chin, Wang, Ong, Lee, & Kong, 2013; Jalayondeja, Sullivan, & Pichaiyongwongdee, 2014; Ng, Hill, Batchelor, & Burton, 2017). Nonetheless, the current literature lacks a comprehensive model that synthesizes findings from individual studies. As a result, it is difficult to understand the overall risk factors for falls in stroke patients. The purpose of this review was to build a comprehensive model that can explain risk factors for falls in adult stroke patients.

I searched CINAHL, Pubmed, Scopus, and PsycINFO using the keywords, stroke, fall, factor, influence, and characteristics. Inclusion criteria included: published in English between 1980 and 2017 with full-text available. Exclusion criteria included: duplicate articles or citations with abstracts only. Seventeen studies met both inclusion/exclusion criteria.

Using theory synthesis, I constructed an integrated model that involved risk factors of falls in stroke patients. First, I specified the focal concept to be falls among stroke patients. Second, I reviewed 17 studies that investigated risk factors of falls among stroke patients and examined the relationships between each factor and falls. Lastly, I combined the relationships to construct an integrated model that can explain the overall risk factors of falls.

Twenty-one fall risk factors in stroke patients emerged from the 17 studies. For a parsimonious integrative model, I sorted the 21 risk factors into five categories based on attribute similarities. To ensure whether each risk factor was sorted into the appropriate category, I continuously compared with other researchers’ work. When more than two researchers classified a risk factor differently than me, I moved that risk factor to their category. After verifying the accuracy of the categories, I labeled each category by its attributes.

Through theory synthesis, I built a comprehensive model that consisted of five categories of fall risk factors in stroke patients. Risk factor categories were patients’ general characteristics (included old age and living with household members), physical function (including impaired gait/mobility, lower extremity muscle weakness, hemiplegia, and decreased gross/fine motor skill), neurological function (impaired balance and impaired cognitive function), stroke-specific characteristics (affected left side of the body, longer duration since a stroke, and acute stage of a stroke), and patients’ medical history (previous fall experiences, having comorbidity, and use of polymedication).

Using the developed comprehensive model, nurses may develop care plans to prevent falls by focusing on the specific risk factors. For example, if a stroke patient has physical impairment on his/her left side of the body, a nurse can recognize the patient may have high risks of falls based on the comprehensive model. This is because patients who affected left side of the body usually have left neglect and vision problems. Therefore, nurses can encourage patients to practice daily activities in front of the huge mirror to increase awareness of the left side.