{"paper_id":"1ffc06de-74ea-44de-b464-eb196a6428e9","body_text":"Falls After Stroke in a University Hospital Falls Clinic: A Retrospective Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Falls After Stroke in a University Hospital Falls Clinic: A Retrospective Cross-Sectional Study NOR IZZATI SAEDON, Farah Dela Abdul Rahman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9046228/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Falls are a leading cause of morbidity among older adults and are particularly common after stroke. Although falls during the acute and subacute phases of stroke have been extensively studied, data on fall characteristics among community-dwelling older adults with chronic stroke , especially in Asian settings, remain limited. This study aimed to describe fall characteristics and outcomes among older adults with chronic stroke attending a dedicated Falls Clinic and to identify factors associated with falls in this population. Methods: We conducted a retrospective cross-sectional analysis of the University Malaya Medical Centre (UMMC) Falls Clinic registry from June 2013 to October 2018. Adults aged ≥ 60 years attending their first Falls Clinic visit were included. Participants with stroke onset > 6 months prior to presentation were classified as having chronic stroke. Sociodemographic characteristics, clinical factors, fall circumstances, and outcomes were compared between fallers with and without chronic stroke. Multivariable logistic regression was performed to identify factors independently associated with falls among chronic stroke survivors. Results: Among 778 eligible patients, 90 (11.6%) had chronic stroke (mean age 78.2 ± 7.2 years; 52.2% male). Compared with non-stroke fallers, chronic stroke fallers more frequently reported dizziness (37.8% vs 23.8%), falls aggravated by postural change (35.6% vs 20.3%), and indoor falls (55.6% vs 33.0%). Living with family was more common among chronic stroke fallers (33.3% vs 19.3%). Independent factors associated with falls among chronic stroke survivors included dizziness (OR 1.66, 95% CI 1.03–2.68), postural change (OR 1.96, 95% CI 1.20–3.18), indoor falls (OR 2.05, 95% CI 1.29–3.26), and living with family (OR 2.14, 95% CI 1.31–3.52). Emergency department attendance following a fall was more frequent in the chronic stroke group (10.0% vs 2.0%). Conclusion: Older adults with chronic stroke attending a Falls Clinic demonstrate distinct and largely modifiable fall profiles characterised by dizziness, postural change, indoor environmental factors, and family living arrangements. These findings support the integration of stroke-specific, multidimensional fall risk assessment into post-stroke and geriatric care pathways. Introduction Falls are a common and serious geriatric syndrome, reflecting the cumulative effects of age-related physiological changes, multimorbidity, polypharmacy, sensory impairment, frailty, and environmental hazards. Rather than isolated accidents, falls frequently represent sentinel events that signal functional vulnerability and precede adverse outcomes such as disability, institutionalisation, and mortality.¹˒² Approximately one-third of community-dwelling adults aged 65 years and older experience at least one fall annually, with prevalence increasing substantially with advancing age.³ The consequences extend beyond individual morbidity, contributing to increased healthcare utilisation and societal costs.⁴ Stroke is a well-recognised and persistent risk factor for falls. Survivors often live with residual motor weakness, impaired balance, gait abnormalities, visuospatial deficits, cognitive impairment, dizziness, and autonomic dysfunction, all of which increase fall risk.⁵–⁷ While falls in the acute and subacute phases of stroke and during inpatient rehabilitation have been extensively described,⁸–¹⁰ less is known about falls among community-dwelling older adults with chronic stroke , in whom long-term neurological sequelae interact with environmental exposures and social circumstances.¹¹–¹³ This knowledge gap is particularly relevant in low- and middle-income countries (LMICs) such as Malaysia, where stroke prevalence is increasing and rehabilitation resources are often constrained.¹⁴ In many Asian societies, older adults commonly reside in multigenerational households. Although family co-residence may provide social support, crowded living environments and assumptions regarding functional capacity may inadvertently increase fall risk.¹⁵ Despite these contextual differences, data describing falls among chronic stroke survivors in Asian settings remain sparse. Falls prevention is a key component of global healthy ageing strategies. The World Health Organization’s Decade of Healthy Ageing (2021–2030) emphasises preserving functional ability and reducing disability in later life.¹⁶ Identifying modifiable fall risk factors after stroke is therefore critical for informing integrated clinical care and health system planning. This study aimed to (1) describe the sociodemographic and clinical characteristics of older adults with chronic stroke attending a university hospital Falls Clinic, (2) compare fall circumstances and outcomes with those of fallers without stroke, and (3) identify factors independently associated with falls among chronic stroke survivors. Methods Study Design and Setting This retrospective cross-sectional study utilised data from the Falls Clinic registry at University Malaya Medical Centre (UMMC), a tertiary academic hospital in Kuala Lumpur, Malaysia. The Falls Clinic, established in 2013, provides a geriatric-led multidisciplinary service for older adults presenting with falls or recurrent falls. Multidisciplinary Falls Assessment All patients attending the Falls Clinic undergo a structured comprehensive geriatric assessment focused on fall risk. Assessments are conducted by a multidisciplinary team comprising geriatricians, physiotherapists, occupational therapists, and trained nursing staff. The evaluation includes review of medical comorbidities and medications, neurological and cardiovascular contributors to falls, gait and balance assessment, cognitive and psychological screening, sensory assessment, and evaluation of social circumstances and home environment. Where indicated, patients are referred for targeted interventions including physiotherapy, occupational therapy-led home modification, medication optimisation, and caregiver education. Participants All patients aged ≥ 60 years attending the Falls Clinic for a first visit between June 2013 and October 2018 were eligible. Participants with a documented history of stroke occurring more than six months prior to clinic presentation were classified as having chronic stroke . This threshold was chosen to reflect individuals beyond the acute and subacute recovery phases, in whom fall risk is more likely to reflect long-term neurological sequelae and environmental factors. Patients younger than 60 years and those with incomplete records were excluded. Registry Data Capture and Quality Clinical data were recorded at the point of care using a standardised Falls Clinic proforma by members of the multidisciplinary team. Data entry was performed as part of routine clinical care, and completeness was reviewed during clinic sessions and at the time of registry compilation. The registry was designed to capture fall-related characteristics and outcomes relevant to clinical management; however, not all geriatric domains (e.g., frailty indices, nutritional scores, stroke severity scales) were systematically recorded. Data Collection Variables analysed included age, sex, living arrangements, comorbidities, fall-related symptoms (e.g., dizziness, syncope), aggravating factors (e.g., postural change), fall location (indoor or outdoor), and outcomes including emergency department attendance, hospitalisation, and fractures. Sensory impairments were recorded based on clinical assessment and patient report. Ethics and Informed Consent This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Medical Research Ethics Committee (MREC), University Malaya Medical Centre (Reference No: [insert reference number] ). Written informed consent was obtained from all patients at enrolment into the Falls Clinic database, permitting the use of anonymised clinical data for research and publication. No additional consent was required for this retrospective analysis. Statistical Analysis Continuous variables were summarised as mean ± standard deviation and compared using independent-sample t tests. Categorical variables were summarised as frequencies and percentages and compared using χ² tests. Multivariable logistic regression was performed to identify factors independently associated with falls among chronic stroke survivors. Clinically relevant variables were entered into the model. Multicollinearity was assessed prior to analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Missing data were minimal and handled using complete-case analysis. As analyses were exploratory, no formal adjustment for multiple comparisons was applied. Statistical significance was defined as p < 0.05. Analyses were conducted using IBM SPSS Statistics version 26. Results Among 778 eligible patients, 90 (11.6%) had chronic stroke. The mean age of chronic stroke fallers was 78.2 ± 7.2 years, and 52.2% were male. Compared with non-stroke fallers, chronic stroke fallers were significantly more likely to experience dizziness, falls aggravated by postural change, indoor falls, and to live with family members. Emergency department attendance following a fall was more frequent among chronic stroke fallers. Multivariable logistic regression identified dizziness, postural change, indoor falls, and living with family as independent factors associated with falls among chronic stroke survivors. Given the modest size of the chronic stroke subgroup, effect estimates should be interpreted cautiously. (Tables placed at end of manuscript.) Discussion In this retrospective study of older adults attending a dedicated Falls Clinic, individuals with chronic stroke demonstrated distinct fall profiles compared with non-stroke fallers. Dizziness, postural change, indoor falls, and living with family were independently associated with falls among chronic stroke survivors, highlighting the multifactorial nature of fall risk in this population. Falls are widely regarded in geriatric medicine as sentinel events that may herald accelerating frailty and functional decline. Among chronic stroke survivors, falls may further exacerbate disability through injury, fear of falling, and activity restriction, creating a cycle of deconditioning and dependency. The prominence of dizziness and postural triggers suggests that potentially modifiable contributors—such as orthostatic hypotension, vestibular dysfunction, and medication effects—warrant systematic assessment in post-stroke care.⁷˒¹⁷ The association between living with family and falls contrasts with findings from many Western studies, where social isolation and living alone are often implicated.¹¹ In Asian multigenerational households, environmental clutter, limited living space, and caregiver overestimation of functional ability may increase fall risk.¹⁵ These findings underscore the need for culturally tailored fall-prevention strategies that include caregiver education and home hazard assessment. Limitations This study has several limitations. Its retrospective design is subject to information and selection bias, and the Falls Clinic population may not be representative of all community-dwelling stroke survivors. Stroke severity, functional status, medication burden, and time since stroke were not systematically captured, limiting adjustment for key confounders. Some variables, including sensory impairments, were partly based on patient report and may be subject to misclassification. The modest size of the chronic stroke subgroup limits statistical power, and the cross-sectional design precludes causal inference. As analyses were exploratory, findings should be confirmed in prospective studies. Despite these limitations, the study provides real-world data from a multidisciplinary falls service in an LMIC setting and highlights clinically relevant, potentially modifiable factors associated with falls after stroke. Conclusion Community-dwelling older adults with chronic stroke attending a Falls Clinic exhibit distinct fall patterns characterised by dizziness, postural change, indoor environmental factors, and family living arrangements. These findings support the integration of stroke-specific, multidimensional fall risk assessment into routine post-stroke and geriatric care. Prospective, multicentre studies are needed to further delineate causal pathways and to evaluate targeted interventions aimed at reducing falls and healthcare utilisation among chronic stroke survivors. Declarations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflicts of interest / Competing interests The authors declare that they have no competing interests. Ethics approval This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Medical Research Ethics Committee, University Malaya Medical Centre, Kuala Lumpur, Malaysia. (Approval No: MREC 2020627-11343). Consent to participate As this was a retrospective study using registry data and existing medical records, informed consent to participate was waived by the Medical Research Ethics Committee, University Malaya Medical Centre. Authors’ Contributions: Nor Izzati Saedon conceptualised and designed the study, supervised data collection, performed data interpretation, and drafted and critically revised the manuscript for important intellectual content. Farah Dela Abdul Rahman contributed to data collection, data management, and statistical analysis, and assisted in drafting the manuscript. Both authors contributed to the interpretation of results, reviewed and approved the final version of the manuscript, and agree to be accountable for all aspects of the work. Written consent for publication Not applicable. Availability of data and material The datasets generated and/or analysed during the current study are not publicly available due to institutional and patient confidentiality requirements but are available from the corresponding author on reasonable request and subject to approval by the relevant ethics and institutional authorities. Code availability No custom code or software was used in this study. Statistical analyses were performed using SPSS version 26. References Tinetti ME, Kumar C. The patient who falls: “It’s always a trade-off”. JAMA . 2010;303(3):258-266. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing . 2006;35(Suppl 2):ii37-ii41. World Health Organization. WHO Global Report on Falls Prevention in Older Age . WHO; 2007. Hartholt KA, van Beeck EF, Polinder S, et al. Societal consequences of falls in the older population. J Trauma . 2011;71(3):748-753. Weerdesteyn V, de Niet M, van Duijnhoven HJ, Geurts AC. Falls in individuals with stroke. J Rehabil Res Dev . 2008;45(8):1195-1213. Hyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community. Arch Phys Med Rehabil . 2002;83(2):165-170. Shaw BH, Claydon VE. The relationship between orthostatic hypotension and falling in older adults. Clin Auton Res . 2014;24(1):3-13. Forster A, Young J. Incidence and consequences of falls due to stroke. BMJ . 1995;311(6997):83-86. Teasell R, McRae M, Foley N, Bhardwaj A. The incidence and consequences of falls in stroke patients during inpatient rehabilitation. Arch Phys Med Rehabil . 2002;83(3):329-333. Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls predict recurrent falls after stroke rehabilitation. Arch Phys Med Rehabil . 2006;87(12):1583-1589. Kerse N, Parag V, Feigin VL, et al. Falls after stroke: results from the Auckland Regional Community Stroke Study. Stroke . 2008;39(6):1890-1893. Schmid AA, Yaggi HK, Burrus N, et al. Circumstances and consequences of falls among people with chronic stroke. J Rehabil Res Dev . 2013;50(9):1277-1286. Ashburn A, Hyndman D, Pickering R, Yardley L, Harris S. Predicting people with stroke at risk of falls. Age Ageing . 2008;37(3):270-276. Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke epidemiology in South, East, and South-East Asia. J Stroke . 2017;19(3):286-294. Yeong UY, Tan SY, Yap JF, Choo WY. Prevalence of falls among community-dwelling elderly in Malaysia. Malays Fam Physician . 2016;11(1):7-14. World Health Organization. Decade of Healthy Ageing: Baseline Report . WHO; 2021. Panel on Prevention of Falls in Older Persons, AGS/BGS. Summary of the updated clinical practice guideline. J Am Geriatr Soc . 2011;59(1):148-157. Tables Table 1. Baseline sociodemographic characteristics Characteristic Chronic stroke (n=90) Non-stroke (n=688) p Age, mean (SD), y 78.2 (7.2) 77.3 (7.5) 0.499 Male sex, n (%) 47 (52.2) 304 (44.2) 0.150 Falls indoors, n (%) 50 (55.6) 227 (33.0) 0.001 Falls outdoors, n (%) 17 (18.9) 90 (13.1) 0.132 Table 2. Clinical and social factors associated with falls Factor Chronic stroke (%) Non-stroke (%) p Dizziness 37.8 23.8 0.004 Syncope 47.8 34.2 0.011 Aggravated by postural change 35.6 20.3 0.001 Living with family 33.3 19.3 <0.001 Hearing impairment 13.3 6.5 0.020 Visual impairment 17.8 10.6 0.045 Table 3. Outcomes after falls Outcome Chronic stroke (%) Non-stroke (%) p ED visit 10.0 2.0 <0.001 Hospitalisation 7.8 3.3 0.040 Fracture 7.8 4.9 0.257 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Apr, 2026 Editor assigned by journal 27 Mar, 2026 Submission checks completed at journal 27 Mar, 2026 First submitted to journal 06 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9046228\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":613162032,\"identity\":\"922e1ff9-6626-4010-a5a2-829f7cb04a15\",\"order_by\":0,\"name\":\"NOR IZZATI SAEDON\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYBACNjBpYIPCJULLAYM0ErSAwQGGwyRo4eM//vDzh4LziWunHX7A8KHsMIPujARCDjuQLHHA4HbitttpBowzzh1mMLtBSAtjwwGolhwGZt42YrQwMzb/OGBwDqLlL1Fa2JjZgLYcgGhhJEoLDxubxRmDZGOQXw72nEvnMTvzAL8W+f7jj29U/LGT3XY7+eGDH2XWcmbHCdiCAg4AMQ+DAClaIID/AMlaRsEoGAWjYHgDABUORwtrZTg4AAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"University of Malaya\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"NOR\",\"middleName\":\"IZZATI\",\"lastName\":\"SAEDON\",\"suffix\":\"\"},{\"id\":613162033,\"identity\":\"df3aa152-619e-487a-9765-9afdcad35134\",\"order_by\":1,\"name\":\"Farah Dela Abdul Rahman\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Malaya\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Farah\",\"middleName\":\"Dela Abdul\",\"lastName\":\"Rahman\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-03-06 05:23:14\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-9046228/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9046228/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":106093024,\"identity\":\"dd0f6909-31dc-4635-a937-ae2554ca1baa\",\"added_by\":\"auto\",\"created_at\":\"2026-04-03 11:32:48\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":776713,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9046228/v1/1a8d67e8-35d9-473a-9e2d-af76af467e99.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Falls After Stroke in a University Hospital Falls Clinic: A Retrospective Cross-Sectional Study\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eFalls are a common and serious geriatric syndrome, reflecting the cumulative effects of age-related physiological changes, multimorbidity, polypharmacy, sensory impairment, frailty, and environmental hazards. Rather than isolated accidents, falls frequently represent \\u003cb\\u003esentinel events\\u003c/b\\u003e that signal functional vulnerability and precede adverse outcomes such as disability, institutionalisation, and mortality.\\u0026sup1;˒\\u0026sup2; Approximately one-third of community-dwelling adults aged 65 years and older experience at least one fall annually, with prevalence increasing substantially with advancing age.\\u0026sup3; The consequences extend beyond individual morbidity, contributing to increased healthcare utilisation and societal costs.⁴\\u003c/p\\u003e \\u003cp\\u003eStroke is a well-recognised and persistent risk factor for falls. Survivors often live with residual motor weakness, impaired balance, gait abnormalities, visuospatial deficits, cognitive impairment, dizziness, and autonomic dysfunction, all of which increase fall risk.⁵\\u0026ndash;⁷ While falls in the acute and subacute phases of stroke and during inpatient rehabilitation have been extensively described,⁸\\u0026ndash;\\u0026sup1;⁰ less is known about falls among \\u003cb\\u003ecommunity-dwelling older adults with chronic stroke\\u003c/b\\u003e, in whom long-term neurological sequelae interact with environmental exposures and social circumstances.\\u0026sup1;\\u0026sup1;\\u0026ndash;\\u0026sup1;\\u0026sup3;\\u003c/p\\u003e \\u003cp\\u003eThis knowledge gap is particularly relevant in low- and middle-income countries (LMICs) such as Malaysia, where stroke prevalence is increasing and rehabilitation resources are often constrained.\\u0026sup1;⁴ In many Asian societies, older adults commonly reside in multigenerational households. Although family co-residence may provide social support, crowded living environments and assumptions regarding functional capacity may inadvertently increase fall risk.\\u0026sup1;⁵ Despite these contextual differences, data describing falls among chronic stroke survivors in Asian settings remain sparse.\\u003c/p\\u003e \\u003cp\\u003eFalls prevention is a key component of global healthy ageing strategies. The World Health Organization\\u0026rsquo;s Decade of Healthy Ageing (2021\\u0026ndash;2030) emphasises preserving functional ability and reducing disability in later life.\\u0026sup1;⁶ Identifying modifiable fall risk factors after stroke is therefore critical for informing integrated clinical care and health system planning.\\u003c/p\\u003e \\u003cp\\u003eThis study aimed to (1) describe the sociodemographic and clinical characteristics of older adults with chronic stroke attending a university hospital Falls Clinic, (2) compare fall circumstances and outcomes with those of fallers without stroke, and (3) identify factors independently associated with falls among chronic stroke survivors.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Design and Setting\\u003c/h2\\u003e \\u003cp\\u003eThis retrospective cross-sectional study utilised data from the Falls Clinic registry at University Malaya Medical Centre (UMMC), a tertiary academic hospital in Kuala Lumpur, Malaysia. The Falls Clinic, established in 2013, provides a geriatric-led multidisciplinary service for older adults presenting with falls or recurrent falls.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eMultidisciplinary Falls Assessment\\u003c/h3\\u003e\\n\\u003cp\\u003eAll patients attending the Falls Clinic undergo a structured \\u003cb\\u003ecomprehensive geriatric assessment\\u003c/b\\u003e focused on fall risk. Assessments are conducted by a multidisciplinary team comprising geriatricians, physiotherapists, occupational therapists, and trained nursing staff. The evaluation includes review of medical comorbidities and medications, neurological and cardiovascular contributors to falls, gait and balance assessment, cognitive and psychological screening, sensory assessment, and evaluation of social circumstances and home environment. Where indicated, patients are referred for targeted interventions including physiotherapy, occupational therapy-led home modification, medication optimisation, and caregiver education.\\u003c/p\\u003e\\n\\u003ch3\\u003eParticipants\\u003c/h3\\u003e\\n\\u003cp\\u003eAll patients aged\\u0026thinsp;\\u0026ge;\\u0026thinsp;60 years attending the Falls Clinic for a first visit between June 2013 and October 2018 were eligible. Participants with a documented history of stroke occurring more than six months prior to clinic presentation were classified as having \\u003cb\\u003echronic stroke\\u003c/b\\u003e. This threshold was chosen to reflect individuals beyond the acute and subacute recovery phases, in whom fall risk is more likely to reflect long-term neurological sequelae and environmental factors. Patients younger than 60 years and those with incomplete records were excluded.\\u003c/p\\u003e\\n\\u003ch3\\u003eRegistry Data Capture and Quality\\u003c/h3\\u003e\\n\\u003cp\\u003eClinical data were recorded at the point of care using a standardised Falls Clinic proforma by members of the multidisciplinary team. Data entry was performed as part of routine clinical care, and completeness was reviewed during clinic sessions and at the time of registry compilation. The registry was designed to capture fall-related characteristics and outcomes relevant to clinical management; however, not all geriatric domains (e.g., frailty indices, nutritional scores, stroke severity scales) were systematically recorded.\\u003c/p\\u003e\\n\\u003ch3\\u003eData Collection\\u003c/h3\\u003e\\n\\u003cp\\u003eVariables analysed included age, sex, living arrangements, comorbidities, fall-related symptoms (e.g., dizziness, syncope), aggravating factors (e.g., postural change), fall location (indoor or outdoor), and outcomes including emergency department attendance, hospitalisation, and fractures. Sensory impairments were recorded based on clinical assessment and patient report.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eEthics and Informed Consent\\u003c/h2\\u003e \\u003cp\\u003e This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Medical Research Ethics Committee (MREC), University Malaya Medical Centre (Reference No: \\u003cb\\u003e[insert reference number]\\u003c/b\\u003e). Written informed consent was obtained from all patients at enrolment into the Falls Clinic database, permitting the use of anonymised clinical data for research and publication. No additional consent was required for this retrospective analysis.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e \\u003cp\\u003eContinuous variables were summarised as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation and compared using independent-sample \\u003cem\\u003et\\u003c/em\\u003e tests. Categorical variables were summarised as frequencies and percentages and compared using χ\\u0026sup2; tests. Multivariable logistic regression was performed to identify factors independently associated with falls among chronic stroke survivors. Clinically relevant variables were entered into the model. Multicollinearity was assessed prior to analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Missing data were minimal and handled using complete-case analysis. As analyses were exploratory, no formal adjustment for multiple comparisons was applied. Statistical significance was defined as \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05. Analyses were conducted using IBM SPSS Statistics version 26.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eAmong 778 eligible patients, 90 (11.6%) had chronic stroke. The mean age of chronic stroke fallers was 78.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.2 years, and 52.2% were male. Compared with non-stroke fallers, chronic stroke fallers were significantly more likely to experience dizziness, falls aggravated by postural change, indoor falls, and to live with family members. Emergency department attendance following a fall was more frequent among chronic stroke fallers.\\u003c/p\\u003e \\u003cp\\u003eMultivariable logistic regression identified dizziness, postural change, indoor falls, and living with family as independent factors associated with falls among chronic stroke survivors. Given the modest size of the chronic stroke subgroup, effect estimates should be interpreted cautiously.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e(Tables placed at end of manuscript.)\\u003c/h2\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this retrospective study of older adults attending a dedicated Falls Clinic, individuals with chronic stroke demonstrated distinct fall profiles compared with non-stroke fallers. Dizziness, postural change, indoor falls, and living with family were independently associated with falls among chronic stroke survivors, highlighting the multifactorial nature of fall risk in this population.\\u003c/p\\u003e \\u003cp\\u003eFalls are widely regarded in geriatric medicine as sentinel events that may herald accelerating frailty and functional decline. Among chronic stroke survivors, falls may further exacerbate disability through injury, fear of falling, and activity restriction, creating a cycle of deconditioning and dependency. The prominence of dizziness and postural triggers suggests that potentially modifiable contributors\\u0026mdash;such as orthostatic hypotension, vestibular dysfunction, and medication effects\\u0026mdash;warrant systematic assessment in post-stroke care.⁷˒\\u0026sup1;⁷\\u003c/p\\u003e \\u003cp\\u003eThe association between living with family and falls contrasts with findings from many Western studies, where social isolation and living alone are often implicated.\\u0026sup1;\\u0026sup1; In Asian multigenerational households, environmental clutter, limited living space, and caregiver overestimation of functional ability may increase fall risk.\\u0026sup1;⁵ These findings underscore the need for culturally tailored fall-prevention strategies that include caregiver education and home hazard assessment.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations\\u003c/h2\\u003e \\u003cp\\u003eThis study has several limitations. Its retrospective design is subject to information and selection bias, and the Falls Clinic population may not be representative of all community-dwelling stroke survivors. Stroke severity, functional status, medication burden, and time since stroke were not systematically captured, limiting adjustment for key confounders. Some variables, including sensory impairments, were partly based on patient report and may be subject to misclassification. The modest size of the chronic stroke subgroup limits statistical power, and the cross-sectional design precludes causal inference. As analyses were exploratory, findings should be confirmed in prospective studies.\\u003c/p\\u003e \\u003cp\\u003eDespite these limitations, the study provides real-world data from a multidisciplinary falls service in an LMIC setting and highlights clinically relevant, potentially modifiable factors associated with falls after stroke.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eCommunity-dwelling older adults with chronic stroke attending a Falls Clinic exhibit distinct fall patterns characterised by dizziness, postural change, indoor environmental factors, and family living arrangements. These findings support the integration of stroke-specific, multidimensional fall risk assessment into routine post-stroke and geriatric care. Prospective, multicentre studies are needed to further delineate causal pathways and to evaluate targeted interventions aimed at reducing falls and healthcare utilisation among chronic stroke survivors.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflicts of interest / Competing interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Medical Research Ethics Committee, University Malaya Medical Centre, Kuala Lumpur, Malaysia. (Approval No: MREC 2020627-11343).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAs this was a retrospective study using registry data and existing medical records, informed consent to participate was waived by the Medical Research Ethics Committee, University Malaya Medical Centre.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors’ Contributions:\\u0026nbsp;\\u003c/strong\\u003eNor Izzati Saedon conceptualised and designed the study, supervised data collection, performed data interpretation, and drafted and critically revised the manuscript for important intellectual content. Farah Dela Abdul Rahman contributed to data collection, data management, and statistical analysis, and assisted in drafting the manuscript. Both authors contributed to the interpretation of results, reviewed and approved the final version of the manuscript, and agree to be accountable for all aspects of the work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eWritten consent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and material\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated and/or analysed during the current study are not publicly available due to institutional and patient confidentiality requirements but are available from the corresponding author on reasonable request and subject to approval by the relevant ethics and institutional authorities.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCode availability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNo custom code or software was used in this study. Statistical analyses were performed using SPSS version 26.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eTinetti ME, Kumar C. The patient who falls: \\u0026ldquo;It\\u0026rsquo;s always a trade-off\\u0026rdquo;. \\u003cem\\u003eJAMA\\u003c/em\\u003e. 2010;303(3):258-266.\\u003c/li\\u003e\\n\\u003cli\\u003eRubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. \\u003cem\\u003eAge Ageing\\u003c/em\\u003e. 2006;35(Suppl 2):ii37-ii41.\\u003c/li\\u003e\\n\\u003cli\\u003eWorld Health Organization. \\u003cem\\u003eWHO Global Report on Falls Prevention in Older Age\\u003c/em\\u003e. WHO; 2007.\\u003c/li\\u003e\\n\\u003cli\\u003eHartholt KA, van Beeck EF, Polinder S, et al. Societal consequences of falls in the older population. \\u003cem\\u003eJ Trauma\\u003c/em\\u003e. 2011;71(3):748-753.\\u003c/li\\u003e\\n\\u003cli\\u003eWeerdesteyn V, de Niet M, van Duijnhoven HJ, Geurts AC. Falls in individuals with stroke. \\u003cem\\u003eJ Rehabil Res Dev\\u003c/em\\u003e. 2008;45(8):1195-1213.\\u003c/li\\u003e\\n\\u003cli\\u003eHyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community. \\u003cem\\u003eArch Phys Med Rehabil\\u003c/em\\u003e. 2002;83(2):165-170.\\u003c/li\\u003e\\n\\u003cli\\u003eShaw BH, Claydon VE. The relationship between orthostatic hypotension and falling in older adults. \\u003cem\\u003eClin Auton Res\\u003c/em\\u003e. 2014;24(1):3-13.\\u003c/li\\u003e\\n\\u003cli\\u003eForster A, Young J. Incidence and consequences of falls due to stroke. \\u003cem\\u003eBMJ\\u003c/em\\u003e. 1995;311(6997):83-86.\\u003c/li\\u003e\\n\\u003cli\\u003eTeasell R, McRae M, Foley N, Bhardwaj A. The incidence and consequences of falls in stroke patients during inpatient rehabilitation. \\u003cem\\u003eArch Phys Med Rehabil\\u003c/em\\u003e. 2002;83(3):329-333.\\u003c/li\\u003e\\n\\u003cli\\u003eMackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls predict recurrent falls after stroke rehabilitation. \\u003cem\\u003eArch Phys Med Rehabil\\u003c/em\\u003e. 2006;87(12):1583-1589.\\u003c/li\\u003e\\n\\u003cli\\u003eKerse N, Parag V, Feigin VL, et al. Falls after stroke: results from the Auckland Regional Community Stroke Study. \\u003cem\\u003eStroke\\u003c/em\\u003e. 2008;39(6):1890-1893.\\u003c/li\\u003e\\n\\u003cli\\u003eSchmid AA, Yaggi HK, Burrus N, et al. Circumstances and consequences of falls among people with chronic stroke. \\u003cem\\u003eJ Rehabil Res Dev\\u003c/em\\u003e. 2013;50(9):1277-1286.\\u003c/li\\u003e\\n\\u003cli\\u003eAshburn A, Hyndman D, Pickering R, Yardley L, Harris S. Predicting people with stroke at risk of falls. \\u003cem\\u003eAge Ageing\\u003c/em\\u003e. 2008;37(3):270-276.\\u003c/li\\u003e\\n\\u003cli\\u003eVenketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke epidemiology in South, East, and South-East Asia. \\u003cem\\u003eJ Stroke\\u003c/em\\u003e. 2017;19(3):286-294.\\u003c/li\\u003e\\n\\u003cli\\u003eYeong UY, Tan SY, Yap JF, Choo WY. Prevalence of falls among community-dwelling elderly in Malaysia. \\u003cem\\u003eMalays Fam Physician\\u003c/em\\u003e. 2016;11(1):7-14.\\u003c/li\\u003e\\n\\u003cli\\u003eWorld Health Organization. \\u003cem\\u003eDecade of Healthy Ageing: Baseline Report\\u003c/em\\u003e. WHO; 2021.\\u003c/li\\u003e\\n\\u003cli\\u003ePanel on Prevention of Falls in Older Persons, AGS/BGS. Summary of the updated clinical practice guideline. \\u003cem\\u003eJ Am Geriatr Soc\\u003c/em\\u003e. 2011;59(1):148-157.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1. Baseline sociodemographic characteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCharacteristic\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChronic stroke (n=90)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-stroke (n=688)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge, mean (SD), y\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e78.2 (7.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e77.3 (7.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.499\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMale sex, n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e47 (52.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e304 (44.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.150\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFalls indoors, n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e50 (55.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e227 (33.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFalls outdoors, n (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e17 (18.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e90 (13.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.132\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2. Clinical and social factors associated with falls\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFactor\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChronic stroke (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-stroke (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDizziness\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e37.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e23.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.004\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSyncope\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e47.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e34.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.011\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAggravated by postural change\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e35.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e20.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLiving with family\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e33.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e19.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHearing impairment\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e13.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e6.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVisual impairment\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e17.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.045\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3. Outcomes after falls\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOutcome\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChronic stroke (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-stroke (%)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eED visit\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e10.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e2.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHospitalisation\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e3.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.040\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFracture\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e7.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e4.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e0.257\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"sn-comprehensive-clinical-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"sncm\",\"sideBox\":\"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)\",\"snPcode\":\"42399\",\"submissionUrl\":\"https://submission.nature.com/new-submission/42399/3\",\"title\":\"SN Comprehensive Clinical Medicine\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9046228/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9046228/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground:\\u003c/h2\\u003e \\u003cp\\u003eFalls are a leading cause of morbidity among older adults and are particularly common after stroke. Although falls during the acute and subacute phases of stroke have been extensively studied, data on fall characteristics among community-dwelling older adults with \\u003cb\\u003echronic stroke\\u003c/b\\u003e, especially in Asian settings, remain limited. This study aimed to describe fall characteristics and outcomes among older adults with chronic stroke attending a dedicated Falls Clinic and to identify factors associated with falls in this population.\\u003c/p\\u003e\\u003ch2\\u003eMethods:\\u003c/h2\\u003e \\u003cp\\u003eWe conducted a retrospective cross-sectional analysis of the University Malaya Medical Centre (UMMC) Falls Clinic registry from June 2013 to October 2018. Adults aged\\u0026thinsp;\\u0026ge;\\u0026thinsp;60 years attending their first Falls Clinic visit were included. Participants with stroke onset\\u0026thinsp;\\u0026gt;\\u0026thinsp;6 months prior to presentation were classified as having chronic stroke. Sociodemographic characteristics, clinical factors, fall circumstances, and outcomes were compared between fallers with and without chronic stroke. Multivariable logistic regression was performed to identify factors independently associated with falls among chronic stroke survivors.\\u003c/p\\u003e\\u003ch2\\u003eResults:\\u003c/h2\\u003e \\u003cp\\u003eAmong 778 eligible patients, 90 (11.6%) had chronic stroke (mean age 78.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.2 years; 52.2% male). Compared with non-stroke fallers, chronic stroke fallers more frequently reported dizziness (37.8% vs 23.8%), falls aggravated by postural change (35.6% vs 20.3%), and indoor falls (55.6% vs 33.0%). Living with family was more common among chronic stroke fallers (33.3% vs 19.3%). Independent factors associated with falls among chronic stroke survivors included dizziness (OR 1.66, 95% CI 1.03\\u0026ndash;2.68), postural change (OR 1.96, 95% CI 1.20\\u0026ndash;3.18), indoor falls (OR 2.05, 95% CI 1.29\\u0026ndash;3.26), and living with family (OR 2.14, 95% CI 1.31\\u0026ndash;3.52). Emergency department attendance following a fall was more frequent in the chronic stroke group (10.0% vs 2.0%).\\u003c/p\\u003e\\u003ch2\\u003eConclusion:\\u003c/h2\\u003e \\u003cp\\u003eOlder adults with chronic stroke attending a Falls Clinic demonstrate distinct and largely modifiable fall profiles characterised by dizziness, postural change, indoor environmental factors, and family living arrangements. These findings support the integration of stroke-specific, multidimensional fall risk assessment into post-stroke and geriatric care pathways.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Falls After Stroke in a University Hospital Falls Clinic: A Retrospective Cross-Sectional Study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-03-31 09:19:02\",\"doi\":\"10.21203/rs.3.rs-9046228/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-04-16T08:06:02+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-03-27T08:57:40+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-03-27T07:47:35+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"SN Comprehensive Clinical Medicine\",\"date\":\"2026-03-06T05:08:46+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"sn-comprehensive-clinical-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"sncm\",\"sideBox\":\"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)\",\"snPcode\":\"42399\",\"submissionUrl\":\"https://submission.nature.com/new-submission/42399/3\",\"title\":\"SN Comprehensive Clinical Medicine\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"c1b1db36-a177-4275-a432-97eeee39c8d6\",\"owner\":[],\"postedDate\":\"March 31st, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-17T08:08:47+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-03-31 09:19:02\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9046228\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9046228\",\"identity\":\"rs-9046228\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}