Gender and Family Composition Related to Discharge Destination and Length of Hospital Stay after Acute Stroke

Abstract

Informal care by family members still plays an important role in home care after acute stroke. This study determined the clinical and demographic factors, such as family structure, that predict discharge to home and length of hospital stay (LOS) after acute stroke hospitalization. We reviewed the sex, age, family structure before stroke, type of stroke, size of the lesion, activities of daily living (ADL) function at discharge, discharge destination, and LOS of stroke patients (114 cerebral infarctions and 44 intracerebral hemorrhages) admitted to a neurosurgical hospital. Patients with cerebral infarction were older than those with intracerebral hemorrhage (median 75 vs 66 years). Ninety-eight were discharged to home (62%). In the logistic regression analysis, low ADL function, medium or large infarction, and intracerebral hemorrhage (vs lacunar infarction) were significantly associated with discharge to a destination other than home. Of the patients discharged home, low ADL function was strongly associated with LOS in the multiple regression analysis. In addition, living with a spouse only had the opposite effect on LOS in men and women ( p = 0.050 and 0.071, respectively). LOS tended to be shorter for men with a wife, but longer for women with a husband. The structure and gender roles in a stroke patient's household may need further attention for the efficient use of hospital resources.gender; family; stroke outcome; hospitalization © 2005 Tohoku University Medical PressStroke remains the third highest cause of mortality in Japan, resulting in 130,000 deaths per year (Ministry of Health, Labour and Welfare 2004). Although the fatality rate has decreased in the last few decades, a large number of acute survivors still suffer functional disabilities that lead to institutionalization and a consequent economic burden on the patient's household and society as a whole. With the rapid increase in the population of elderly, it is even more important to identify stroke patients who are at risk of a prolonged hospital stay in order to enhance their return home.

Factors associated with prolonged length of stay in older patients

“…(8) Interestingly, a study by Ohwaki et al found that women living with only their husband were associated with pLOS. (9) A recent study by Bo et al revealed associations between prolonged hospital stay and cognitive impairment, functional dependence and higher comorbidity burden. (10) Other studies have also evidenced that poorer functional status, (11) the presence of cognitive impairment and walking difficulties (12) are associated with pLOS.…”

Derivation and Validation of a Discharge Disposition Predicting Model after Acute Stroke

“…Risk prediction models involving a number of selected variables have been established using multivariable regression models. [1][2][3][4][5][6] However, quantifying the risk for clinical practice directly from the multiple logistic regression models is difficult because of complicated calculation. For simplifying the computation, the Framingham Heart Study used Cox proportional hazards regression methods to estimate cardiovascular diseases risk using risk scores.…”

Factors affecting the Functional Independence Measure Gain of Patients with Stroke

“…Glader et al (19) explained that the reason of functional inadequacy of females at 3 months post-stroke was the more advanced age compared to males and more risk factors. However, Ohwaki et al (20) stated that there was no effect of gender on functional impairment in patients at 2 months post-stroke.…”

“…In our study, although the functional status at admission in female patients was better, there was no difference between genders in terms of FIM gain and FIM efficiency. Nevertheless, there are conflicting results in the literature on gender and its effect on functional improvement (16)(17)(18)(19)(20)25,28). In a study by Hachisuka et al (16), it has been found that although there was no significant difference in terms of motor function in stroke between female and male patients, FIM scores of male patients with stroke tended to be lower than those of female patients with stroke.…”