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L'AVC est la première cause de handicap, donc de dépendance, dans les pays développés. La Mesure d'Indépendance Fonctionnelle (MIF) est une échelle de référence pour l'évaluation de la dépendance. La prévention de la dépendance repose sur le contrôle des principaux facteurs de risques cardiovasculaires, la prise en charge des comorbidités, la rééducation, en unités spécialisées.

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AimsTo evaluate the clinical performance of a geriatric stroke unit welcoming elderly patients after a stroke for functional rehabilitation.ProgramThis unit proposes a multidisciplinary approach performed by a team composed of a geriatrician, a neurologist, a rehabilitative physician, a physiotherapist, a psychomotrician, an occupational therapist, a speech therapist, a psychologist/neuropsychologist, a dietetician and a social worker. Multiple indicators like vascular risk factors, etiologies, comorbidities, rehabilitation program type, functional outcome, decease rate and home returning rate are yearly analysed. Before leaving the geriatric stroke department, home visiting by the occupational therapist and the social worker is proposed.ResultsOn admission, an individual program has been proposed to each patient after medical evaluation and discussed with the physical rehabilitation team to specify the modalities of patient installation, sympathetic reflex algodystrophy prevention and rehabilitation program. A functional deglutition evaluation has been performed to each patient by the speech therapist in the first 48 h after admission. If alimentation is allowed, mixed food is given during the first 48 h and then adapted to speech therapist evaluation to prevent inhalation pneumopathies. High blood pressure has been disclosed in 68.2% of admitted patients, tobacco use in 13,6%, hypercholesterolaemia in 59.1%, diabetes in 16.7% and obesity in 18.2%. Atrial fibrillation has been found in 48.9% of patients and ischaemic myocardiopathy in 33.3%. A systematic cognitive evaluation has revealed that 32% of patients fullfilled the criteria of mild cognitive impairment or dementia. The mean MMSE score was 21.4/30. The main complications were inhalation pneumopathies (13.6%) and sympathetic reflex algodystrophy (16%).Global clinical impactThe home returning rate is 58%.and the mortality rate is 5.9% since the unit birth in 2003. In 2008, the home returning rate for hemiplegic patient was stable at 39%, whereas the hemiparetic patient one was increasing from 65.5 in 2003 to 78,8%. Between admission and outgoing, the mean benefit on the functional independence measure since 2003 is 20 points.Discussion/conclusionIt has been established in literature that stroke units improve the functional outcome and the home returning rate of patients regardless their age. The experience of the geriatric stroke unit of Lyon is clearly positive. The population ageing makes crucial the development of stroke units devoted to elderly patients who associate geriatric syndromes like frailty and cognitive impairment, multiple comorbidities and treatments, and strokes that necessitate specific care.ObjectifsEvaluation d'une Unité Neuro-Vasculaire Gériatrique crée en 2003 accueillant les patients âgés en soins de suite et réadaptation après un accident vasculaire cérébral.ProgrammeUne approche systématique est proposée grâce à une équipe pluridisciplinaire composée d'un gériatre, un neurogériatre, un médecin rééducateur, des kinésithérapeutes, un e...