Stroke in Nottingham: provision of nursing care and possible implications for the future

Abstract

Although the care of stroke patients accounts for a considerable proportion of Health Service resources, there have been few attempts to measure this burden directly. A survey was therefore performed in Nottingham (approximate population 700 000) during a two-week period to find out the total number and dependency levels of stroke patients receiving professional nursing care, whether in hospital, nursing homes or at home from the Community Nursing Service. Altogether 822 patients were surveyed, of whom 232 were in hospital (46 in general medical, 171 in geriatric wards and 15 on the stroke unit), 221 were in nursing homes and 369 at home with district nurse support. Of this total, 61 % were aged over 75 and 18% over 85; nearly half of the latter group being in nursing homes. Overall levels of dependency were greatest in nursing homes and the prevalence of severe disability was highest amongst the oldest patients. Two-thirds of all patients had had their strokes over six months before and 39% over two years before and 31 % had suffered more than one stroke. Thus, the main demand for nursing services is amongst the old and those with longstanding stroke disease. The rapid increase in the number of old people and changes in medical practice which reduce fatality in the early stages of stroke are both likely to increase the numbers of disabled elderly stroke survivors, and a large proportion of these may be cared for in private nursing homes. Simple cross-sectional studies of this kind should be repeated every few years so that these trends can be accurately plotted.