Stroke discharges from a rehabilitation unit: 1-year and 5-year domicile outcomes. Function is important.
BACKGROUND
Stroke units save lives, reduce disability and increase the chances of the person returning to their own home. Following the introduction of a stroke rehabilitation unit, we assessed the durability of stroke discharges over a 1-year period and predictors of early 'failed' home discharges. Stability of discharge domicile and survival over 5 years was also reviewed.


METHODS
A 6-month cohort of all discharges was followed for 5 years. Changes in domicile, including entry into institutional care, were recorded out to 5 years or until death. Predictors of early (3 months) and later (1 year) discharge stability were assessed.


RESULTS
There were 142 discharges. Fifty-eight (76%) of those who returned home were still at home 12 months later. In contrast, there was a high mortality of dependent patients who were discharged to high dependency care (9 (29%) and 13 (42%) at 3 and 12 months, respectively). The chance of an early failed discharge was associated with lower functional ability on discharge (P= 0.012). Lower function on discharge was also independently associated with death in the next 12 months (P < 0.0001). At 5 years the mortality for the whole sample was 55% (78 of 141) and 38 (61%) of the survivors still lived in the community whereas 24 (39%) resided in institutional care.


CONCLUSIONS
Functional ability on discharge is a key predictor of ability to remain at home as well as survival and therefore every effort should be made to maximize function.
Hanger
H C
HC
Older Persons Health, The Princess Margaret Hospital, Christchurch, New Zealand. carl.hanger@cdhb.govt.nz
Wilkinson
T J
TJ
Mears
A
A
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D020127:Recovery of Function / Q000502:physiology*; D012047:Rehabilitation Centers / Q000639:trends*; D012111:Residence Characteristics; D020521:Stroke / Q000503:physiopathology* / Q000628:therapy; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome