Factors Inhibiting Home Return of Stroke Patients Living Alone

Abstract

To clarify the factors inhibiting home return of stroke patients living alone. [Participants and Methods] The subjects were 97 stroke patients who were living alone. We conducted hierarchical cluster analysis with variables of outcome, admission Functional Independence Measure (FIM), age, and inpatient days in order to identify groups having difficulty adjusting to discharge, and made comparisons among the groups. We conducted a text mining analysis after investigating the causes of difficulty in adjusting to discharge using a free-form questionnaire addressed to the relevant staff. [Results] The results of the cluster analysis were classified into 4 groups, and the results of text mining analysis were divided into 7 groups. [Conclusion] The results suggest that the factors inhibiting home return of stroke patients living alone were: higher brain dysfunction, motor paralysis, ADL ability, human resources such as family and supporters, financial problems, care insurance adjustment, and disparity between patient hope and reality.

A retrospective study on return to living alone of stroke patients who were living alone before stroke

“…In fact, studies by Morita et al 38) and Asakawa et al 3) have also highlighted the importance of understanding the patient's living environment before discharge and planning appropriate support. Thus, in addition to the report by Sawamura et al 17) , many other studies have revealed social problems of stroke patients that are similar to the social score established in this study. Therefore, the social score in this study was considered to have some validity.…”

“…Recently, it has been reported that not only ADL ability but also social factors such as family structure 1 , 2 , 3 , 4 , 5 , 29 ) , economic issues 30 , 31 , 32 ) , and coordination of social resources such as long-term care insurance services and the community 33 , 34 , 35 ) are involved in the return home of stroke patients. Sawamura et al 17 ) found that the following factors inhibited the return to living alone of stroke patients who had lived alone before the illness: patient’s abilities such as higher brain dysfunction, motor paralysis, and ADL ability; human resources such as family and supporters; financial problems; adjustment of long-term care insurance; difference between the patient’s wishes and reality. Based on this report, we defined social score using five items: (1) absence of a key person, (2) absence of a neighborhood supporter, (3) financial problems, (4) receipt of public assistance, and (5) difficulty in coordinating long-term care insurance services upon discharge.…”

“…The social score was also calculated from the conference records and medical social worker records. The content of the social score was based on the study by Sawamura et al 17 ) who reported the disincentives to returning home in stroke patients who were living alone before stroke onset. Specifically, the social score was calculated based on the number of items that fell into the following five categories: (1) absence of a key person, (2) absence of a neighborhood support person, (3) financial problems, (4) receipt of public assistance, and (5) difficulty in coordinating long-term care insurance services at the time of discharge.…”

“…In addition, single-person households are often estranged from their relatives, have no support person nearby, and may have financial problems such as receiving public assistance 14 , 15 ) . In such cases, it is often difficult to establish a support system 16 , 17 ) , which may lead to a lower return home rate, increased medical costs due to prolonged hospitalization, and a lower quality of life of the patient 18 , 19 , 20 ) .…”