Survival-determining factors in patients with neurologic impairments who received home health care in Japan

Abstract

Background The Japanese have become the longest-lived nation population in the world, and numbers of elderly who require medical and nursing care are increasing. The capacity of nursing homes and nursing institutions is sharply limited in Japan; further, as a group, elderly Japanese patients prefer home care to institutional care. For these reasons, the home health care system in Japan has been increasingly important. Objective We sought to identify factors determining long-term survival in Japanese patients receiving home health care for neurologic disorders. Patients and methods We retrospectively evaluated 180 patients with neurologic disease, who received home health care conducted by our hospital between 1992 and 2001. Factors considered were age; gender; illnesses; prognosis; follow-up period; activities of daily living (ADL); behavioral, cognitive, and communicative functions; swallowing function; feeding method; serum nutritional values (total protein, albumin, and total cholesterol); hemoglobin concentration; and social care services provided at home. Results Variables affecting long-term survival in 180 patients with neurologic disease were age ( P<0.0002) and severity of dysphagia ( P<0.04) by Cox's proportional hazard test. Conclusion Maintenance of swallowing function and adequate nutrition through a variety of feeding methods that can be provided by a home health care program are important for long-term survival of patients with stroke and also that of patients with other neurologic diseases.