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

Introduction

Phobic anxiety is common after mild stroke and TIA patients (Chun et al. 2017). Agoraphobia accounted for the majority of phobic disorders in our recent prospective cohort. 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 FoF and agoraphobia.

Method

Secondary analysis of a prospective cohort of community-based mild stroke and TIA (n=175, mean age 70, 40% women). Multivariable logistic regression for outcome: clinical diagnosis of agoraphobia at 3 months. Explanatory variables: i) age, ii) past history of anxiety/depression, iii) ability to walk on discharge, iv) history of actual falls, v) living alone pre-stroke, and vi) Falls Efficacy Scale (FES), a measure of FoF—10 items; each item is scored between 1-10; higher scores indicate greater FoF (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 (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

FoF 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 anxiety post-stroke/TIA. Psychological support for stroke/TIA should address FoF even in the absence of mobility issues or history of falls.

FEAR OF FALLING IS INDEPENDENTLY ASSOCIATED WITH AGORAPHOBIA AFTER MILD STROKE AND TRANSIENT ISCHAEMIC ATTACK