Abstract
BackgroundStroke is a highly prevalent disease among older people and can have a major impact on daily functioning and quality of life. When community-dwelling older people are hospitalized due to stroke, discharge to an intermediate care facility for geriatric rehabilitation is indicated when return to the previous living situation is expected but not yet possible. However, a substantial proportion is still unable to return home after discharge and has to be admitted to a residential care setting. This study aims to identify which factors are associated with home discharge after inpatient rehabilitation among frail and multimorbid older stroke patients.MethodsThis study is a longitudinal cohort study among 92 community-dwelling stroke patients aged 65 years or over. All patients were admitted to one of eight participating intermediate care facilities for geriatric rehabilitation, under the expectation to return home after rehabilitation. We examined whether 16 potentially relevant factors (age; sex; household situation before admission; stroke history; cardiovascular disorders; diabetes mellitus; multimorbidity; cognitive disability; neglect; apraxia; dysphagia; urinary and bowel incontinence; emotional problems; sitting balance; daily activity level; and independence in activities of daily living) measured at admission were associated with discharge to the former living situation. Logistic regression analysis was used for statistical analysis.ResultsMean age of the patients was 79.0 years (SD 6.4) and 51.1% was female. A total of 71 patients (77.1%) were discharged to the former living situation within 6 months after the start of geriatric rehabilitation. Of the 16 factors analysed, only a higher level of independence in activities of daily living at admission was significantly associated with home discharge.ConclusionsOur study shows that the vast majority of previously identified factors predicting home discharge among stroke patients, could not predict home discharge among a group of frail and multimorbid older persons admitted to geriatric rehabilitation. Only a higher level of independence in activities of daily living at admission was significantly related to home discharge. Additional insight in other factors that might predict home discharge after geriatric rehabilitation among this specific group of frail older stroke patients, is needed. Trial registration: ISRCTN ISRCTN62286281. Registered 19-3-2010.
Highlights
Stroke is a highly prevalent disease among older people and can have a major impact on daily functioning and quality of life
In the Netherlands, after admission to a hospital, about one third of older stroke patients is referred to an intermediate care facility for rehabilitation, which is aimed at the rehabilitation of frail and multimorbid communitydwelling older people [2]
In the Netherlands, admission to an intermediate care facility for geriatric rehabilitation is indicated for community-dwelling frail older people, who are expected to have the capacity to improve to a functional level that enables discharge to their former living situation within a maximum of 6 months of rehabilitation [2]
Summary
Stroke is a highly prevalent disease among older people and can have a major impact on daily functioning and quality of life. When community-dwelling older people are hospitalized due to stroke, discharge to an intermediate care facility for geriatric rehabilitation is indicated when return to the previous living situation is expected but not yet possible. In the Netherlands, admission to an intermediate care facility for geriatric rehabilitation is indicated for community-dwelling frail older people, who are expected to have the capacity to improve to a functional level that enables discharge to their former living situation within a maximum of 6 months of rehabilitation [2]. Up to 25% of these older stroke patients appears not to be able to return to their previous living situation after geriatric rehabilitation [3] Often, these patients are admitted to a nursing home or other residential care setting [4, 5]. More insight into factors associated with home discharge of frail and multimorbid older stroke patients after geriatric rehabilitation is needed to support care professionals to make an adequate prognosis of discharge destination and to support them to focus their treatment on increasing the chances of home discharge
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