Clarification of Factors Determining Discharge Destination Among Elderly Patients After Stroke With Low Levels of Independence in Activities of Daily Living: A Retrospective Study.
Yasushi Onishi, Shinji Kimura, Koichi Benjamin Ishikawa and 1 others
PMID 36545528WHAT IT FOUND
Among stroke survivors with severe disability, those who could eat by mouth, had better cognitive scores, and lived with family were more likely to go home.
Patients living alone all went to long-term care, regardless of their physical ability.
Key findings
01Patients discharged home with severe motor disability had significantly higher cognitive function scores and were more likely to have oral intake compared to those discharged to long-term care facilities.
02Every patient in the study who lived alone before the stroke was discharged to a long-term care facility rather than home.
03Tube feeding was a major barrier to home discharge, with most patients requiring it sent to long-term care facilities.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was conducted at a single hospital in a rural area of Japan, so the results may not apply to urban settings or other countries with different healthcare systems. The sample size for the subgroup analysis of patients with severe disability was small (67 patients total), which limits the statistical power to detect differences in some variables. The study did not measure the exact amount of rehabilitation each patient received, so variations in therapy intensity could have influenced the outcomes. The analysis was retrospective and relied on medical records, which may not capture the full complexity of patient-family decision-making.
The easy way to misread this
Do not interpret the high rate of institutionalization for patients living alone as a failure of rehabilitation. The study shows that social structure, not just physical ability, determined where these patients went, and formal home-care services in this rural setting were limited.