[A study on first-time stroke patients in a community use of home visiting assessment by public health nurses (PHNS)].
OBJECTIVE
The purpose of this study was to clarify the source of stroke registration, the type-specificity of incidence, and the degree of independence and caregiving status of stroke patients, as well as to explore the roles of PHNs, by analyzing information about stroke survivors in a community.


METHODS
The subjects were of 323 patients, identified to have suffered a first-time stroke by PHNs' home visits etc., out of a total of 669 who were suspected of having had a stroke from 1983 to 1996 in Shinji-town, Shimane Prefecture. Data on the degree of independence and caregiving status obtained at the time of hospital discharge or after the acute period was over were classified.


RESULTS
1) Twenty-eight (8.7%) out of the 323 were registered through notifications from doctors/medical institutions, 47 (14.6%) through PHN activities, 84 (26.0%) through notice of death, 158 (48.8%) through National Health Insurance Remuneration Specification (NHIRS), and 6 (1.9%) through unknown sources. 2) The stroke incidence rate/1,000 person-year among Shinji-town residents aged 40 and over was 5.3 for males and 3.5 for females, and the type-specific incidence rate/1,000 person-years was 0.9 for cerebral hemorrhage, 3.1 for cerebral infarction, and 0.3 for subarachnoid hemorrhage. The average age at stroke occurrence was 72.1 years old. The 50% survival period was 71 months. 3) The degree of independence was confirmed for 166 disabled elderly: 64.5% of them were able to walk outdoors, 9.0% were capable of moving around inside the house but not of going outside, and 26.5% were bed-ridden. 4) Caregiving status was as follows: caregiving was not necessary for 56.9%. Sixty-nine point six percent of the remainder needed caregiving were living in their homes, and 30.4% were institutionalized or hospitalized. Of cases, where family members were caregivers, spouses were responsible in 58.3%, children or grandchildren in 10.4%, and daughters-in-law in 31.3%.


CONCLUSIONS
The study shows that omission from stroke registration in a community could be minimized by PHNs' continued involvement on a long-term basis, confirming information from other sources through their home visits. PHNs may be required to provide mild case patients living independently with health management support for long period to prevent recurrence.
Ozasa
Yoshiko
Y
Department of Community Health Nursing, School of Health Sciences, Faculty of Medicine, University of the Ryukyus.
D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology; D003152:Community Health Nursing; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000706:statistics & numerical data*; D011637:Public Health Nursing; D012042:Registries; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*