Post-stroke disposition from a geriatric-rehabilitative stroke care area: an Italian experience

  • Marco Masina | marco.masina@ausl.bo.it UOC Geriatria Bentivoglio, Azienda USL di Bologna, Italy.
  • Simona Malservisi UOC Geriatria Bentivoglio, Azienda USL di Bologna, Italy.
  • Pio Francesco Censoni UOC Medicina Riabilitativa Nord, Azienda USL di Bologna, Italy.
  • Annalena Cicognani UOC Geriatria Bentivoglio, Azienda USL di Bologna, Italy.
  • Paolo Marzaroli UOC Epidemiologia, Promozione della Salute e Comunicazione del Rischio, Azienda USL di Bologna, Italy.
  • Paolo Pandolfi UOC Epidemiologia, Promozione della Salute e Comunicazione del Rischio, Azienda USL di Bologna, Italy.
  • Francesca Ugenti UOS Lungodegenza Nord, Azienda USL di Bologna, Italy.

Abstract

A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6), after stroke functional status (mRankin≥3), poor pre-stroke functional level (mRankin≥3) and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled longterm ward of older patients with pre-stroke disability seemed positive on an economic ground but further studies are mandatory to understand the consequences in terms of functional recovery and social costs.

Downloads

Download data is not yet available.

Author Biographies

Paolo Marzaroli, UOC Epidemiologia, Promozione della Salute e Comunicazione del Rischio, Azienda USL di Bologna

Paolo Pandolfi, UOC Epidemiologia, Promozione della Salute e Comunicazione del Rischio, Azienda USL di Bologna


Published
2014-02-04
Section
Original Articles
Keywords:
post-stroke disposition, disability, age, multi-professional assessment.
Statistics
Abstract views: 939

PDF: 579
HTML: 349
Share it

PlumX Metrics

PlumX Metrics provide insights into the ways people interact with individual pieces of research output (articles, conference proceedings, book chapters, and many more) in the online environment. Examples include, when research is mentioned in the news or is tweeted about. Collectively known as PlumX Metrics, these metrics are divided into five categories to help make sense of the huge amounts of data involved and to enable analysis by comparing like with like.

How to Cite
Masina, M., Malservisi, S., Censoni, P., Cicognani, A., Marzaroli, P., Pandolfi, P., & Ugenti, F. (2014). Post-stroke disposition from a geriatric-rehabilitative stroke care area: an Italian experience. Italian Journal of Medicine, 9(1), 49-56. https://doi.org/10.4081/itjm.2014.445