title: Poststroke discharge destination: functional independence and sociodemographic factors in urban Japan.
abstract: To assess how functional independence and sociodemographic factors influence discharge destination of patients recovering from stroke in urban Japan. Patients recovering from first-ever stroke (supratentorial lesions) discharged from a long-term rehabilitation hospital. Scores for individual patients were collected at both admission and discharge for the motor components of the Functional Independence Measure (FIM-m), and FIM-m increase was ascertained; patients were also surveyed to gather data for explanatory variables: age, sex, type of stroke, length of hospital stay, number of people in the household, co-residence with a spouse, and number of sons/daughters. Outcomes were defined as dichotomous categories, discharge to home versus to a nursing home. Logistic analyses were performed on these data. Of the 163 patients enrolled in the study, 123 were discharged to home and 40 were discharged to a nursing home. Analyses showed that older age and lower FIM-m scores at both admission and discharge were associated with greater probability of discharge to a nursing home. The number of children, including sons/daughters living in separate households, had no statistically significant relationship to discharge destination. Patients without a spouse at home who lived in less populous households were more likely to be discharged to a nursing home. Meanwhile, improvement in FIM-m score was not statistically significantly related to discharge destination. Our findings indicate that level of functional independence and number of co-resident household members are powerful predictors of discharge destination. For patients with a lower level of functional independence, the presence of a social network to provide support and care is a decisive factor in discharge to home.
authors.affiliation: Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan. ytkoyama@bd6.so-net.ne.jp
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Koyama
authors.forename: Yukari
authors.initials: Y
authors.lastname: Sako
authors.forename: Misa
authors.initials: M
authors.lastname: Konta
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Domen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005191:Family Characteristics; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D057187:Independent Living; D007564:Japan; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012944:Social Support; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D019037:Urban Health Services / Q000706:statistics & numerical data*