Home hospitalization service for acute uncomplicated first ischemic stroke in elderly patients: a randomized trial.
OBJECTIVE
To evaluate whether home treatment of elderly patients with acute uncomplicated first ischemic stroke is associated with different mortality rates and clinical outcomes from those of patients treated on a general medical ward (GMW).


METHODS
Randomized, controlled, single-blind trial.


METHODS
S. Giovanni Battista Hospital of Turin.


METHODS
One hundred twenty elderly patients admitted to the emergency department of the hospital with first acute ischemic stroke were randomized to home treatment from a geriatric home hospitalization service (GHHS) or to GMW treatment.


METHODS
Main outcome was cumulative survival at 6 months in the two groups. Residual functional impairment, neurological deficit, depression, morbidity, and admission to rehabilitation and long-term care facilities were considered as secondary outcomes in survivors.


RESULTS
One hundred twenty patients (mean age 82; 54 men and 66 women) were enrolled (60 in each study arm). The cumulative proportion of cases surviving at 6 months was 0.65 in the GHHS group and 0.60 in GMW group (log-rank test P=.53). Functional and neurological parameters were significantly improved in both GHHS and GMW patients, without significant differences between the two groups. Depression score was significantly better in home-treated patients (P<.001), who were more likely to remain at home at 6 months than hospital-treated patients and had a lower rate of select medical complications.


CONCLUSIONS
Home-treated elderly patients with ischemic stroke have better depressive scores and lower rates of admission to nursing homes. These results should prompt further studies to evaluate home hospitalization for elderly stroke patients.
Ricauda
Nicoletta Aimonino
NA
Department of Medical and Surgical Science, Section of Gerontology, University of Turin, Italy.
Bo
Mario
M
Molaschi
Mario
M
Massaia
Massimiliano
M
Salerno
Dominga
D
Amati
Dario
D
Tibaldi
Vittoria
V
Fabris
Fabrizio
F
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D020521:Stroke / Q000401:mortality; D000071939:Stroke Rehabilitation; D015996:Survival Rate; D016896:Treatment Outcome