Abstract
BackgroundGeriatric stroke patients are generally frail, have an advanced age and co-morbidity. It is yet unclear whether specific groups of patients might benefit differently from structured multidisciplinary rehabilitation programs. Therefore, the aims of our study are 1) to determine relevant patient characteristics to distinguish groups of patients based on their admission scores in skilled nursing facilities (SNFs), and (2) to study the course of these particular patient-groups in relation to their discharge destination.MethodsThis is a longitudinal, multicenter, observational study. We collected data on patient characteristics, balance, walking ability, arm function, co-morbidity, activities of daily living (ADL), neuropsychiatric symptoms, and depressive complaints of 127 geriatric stroke patients admitted to skilled nursing facilities with specific units for geriatric rehabilitation after stroke.ResultsCluster analyses revealed two groups: cluster 1 included patients in poor condition upon admission (n = 52), and cluster 2 included patients in fair/good condition upon admission (n = 75). Patients in both groups improved in balance, walking abilities, and arm function. Patients in cluster 1 also improved in ADL. Depressive complaints decreased significantly in patients in cluster 1 who were discharged to an independent- or assisted-living situation. Compared to 80% of the patients in cluster 2, a lower proportion (46%) of the patients in cluster 1 were discharged to an independent- or assisted-living situation.ConclusionStroke patients referred for rehabilitation to SNFs could be clustered on the basis of their condition upon admission. Although patients in poor condition on admission were more likely to be referred to a facility for long-term care, this was certainly not the case in all patients. Almost half of them could be discharged to an independent or assisted living situation, which implied that also in patients in poor condition on admission, discharge to an independent or assisted living situation was an attainable goal. It is important to put substantial effort into the rehabilitation of patients in poor condition at admission.
Highlights
Geriatric stroke patients are generally frail, have an advanced age and co-morbidity
The expectation is that the number of patients with stroke will rise in the future, because of the ageing of the population; there will be a growing demand for rehabilitation services
In the Netherlands if the patient survives after the acute phase in the hospital, a stroke patient is referred to either rehabilitation centers or specific geriatric rehabilitation units in skilled nursing facilities (SNFs)
Summary
Geriatric stroke patients are generally frail, have an advanced age and co-morbidity. It is yet unclear whether specific groups of patients might benefit differently from structured multidisciplinary rehabilitation programs. The expectation is that the number of patients with stroke will rise in the future, because of the ageing of the population; there will be a growing demand for rehabilitation services. In the Netherlands if the patient survives after the acute phase in the hospital, a stroke patient is referred to either rehabilitation centers or specific geriatric rehabilitation units in skilled nursing facilities (SNFs). Dutch SNFs provide elderly patients after a stroke with low-intensity multidisciplinary rehabilitation programs, with the objective to discharge them to an independent-living situation. Patients receiving rehabilitation in these SNFs are generally frail, have an advanced age and are suffering from co-morbidity. The more demanding rehabilitation in rehabilitation centers is not appropriate for these elderly patients [4]
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