Factors associated with successful home discharge after inpatient rehabilitation in frail older stroke patients

Abstract

Background: 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. 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. Methods: This 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. Results: Mean 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. Conclusions: Our 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.

Precision implementation of early ambulation in elderly patients undergoing off-pump coronary artery bypass graft surgery: a randomized-controlled clinical trial

“…Factors affecting early discharge destination in elderly patients is potentially confounded by multiple factors. Some studies showed that a higher level of independence in activities of daily living or less degree of frailty was significantly related to early discharge among younger patients, better functional and cognitive status [33,34]. In our study, we found that EA was an independent factor that was as important as age and Euro score in achieving an early discharge.…”

Nutrition in the First Week after Stroke Is Associated with Discharge to Home

“…Aggressive nutritional support in the early phase after onset, when there is a high risk of malnutrition, may lead to significant improvements in ADL. Moreover, it has been reported that a high level of ADL was associated with high home discharge rate [ 10 , 11 , 21 , 25 ]. This evidence supports our findings.…”

Socio-environmental predictive factors for discharge destination after inpatient rehabilitation in patients with stroke: a systematic review and meta-analysis

“…Fourteen studies [13,14,16,28,[34][35][36][37][38][39][40][41][42][43] comparing discharge destination in patients living with a spouse, family or friends (cohabitation) and those living alone before stroke onset were analysed (Figure 3). The pooled OR was 2.60 (95%CI 1.84-3.68) showing a significant effect.…”

“…Meanwhile, several observational studies examined socio-environmental factors for discharge destination. Among them, presence of a caregiver at home [12,13], number of family members [13], number of cohabiting people [13,14], marital status [12,15,16] and type of insurance [16] were shown to influence the discharge destination. There is, therefore, a need to review the predictive socioenvironmental factors for discharge home after inpatient rehabilitation in patients with stroke.…”