ABSTRACT
Objective：This study aimed to analyze the relationship between improvement in activities of daily living (ADL) and discharge to home among older stroke patients in a convalescent rehabilitation ward.Methods：The medical records of 291 stroke patients discharged from a convalescent rehabilitation ward were used to determine the association between the magnitude of ADL improvement and discharge disposition across two age groups (65-74 years and ≥ 75 years). The motor functional independence measure (FIM) motor score (FIM-M) was used to quantify ADL improvement.Results：Among the 291 patients, 213 (73.2％) were discharged home and 78 (26.8％) were institutionalized. In multivariate logistic regression analysis adjusted by functional evaluation at the time of admission, the magnitude of ADL improvement during hospitalization was significantly associated with discharge to home in each group (p＜0.01). The magnitude of ADL improvement was not associated with discharge disposition in analysis adjusted by functional evaluation at the time of discharge. But, FIM-M at discharge was significantly associated with discharge to home for individuals aged 65-74 years, and FIM cognitive score (FIM-C) at discharge was significantly associated with discharge home for individuals aged ≥ 75 years.Conclusion：Intensive rehabilitation during hospitalization in patients aged both 65-74 years and ≥ 75 years has been suggested to facilitate discharge to home. Patients aged 65-74 with low FIM-M at discharge and those aged ≥ 75 years with low FIM-C at discharge may require more effective intervention in addition to improving the ADL in order to be discharged home.
ABSTRACT
Objective：This study aimed to analyze the relationship between improvement in activities of daily living (ADL) and discharge to home among older stroke patients in a convalescent rehabilitation ward.Methods：The medical records of 291 stroke patients discharged from a convalescent rehabilitation ward were used to determine the association between the magnitude of ADL improvement and discharge disposition across two age groups (65-74 years and 75 years). The motor functional independence measure (FIM) motor score (FIM-M) was used to quantify ADL improvement.Results：Among the 291 patients, 213 (73.2％) were discharged home and 78 (26.8％) were institutionalized. In multivariate logistic regression analysis adjusted by functional evaluation at the time of admission, the magnitude of ADL improvement during hospitalization was significantly associated with discharge to home in each group (p＜0.01). The magnitude of ADL improvement was not associated with discharge disposition in analysis adjusted by functional evaluation at the time of discharge. But, FIM-M at discharge was significantly associated with discharge to home for individuals aged 65-74 years, and FIM cognitive score (FIM-C) at discharge was significantly associated with discharge home for individuals aged ≥ 75 years.Conclusion：Intensive rehabilitation during hospitalization in patients aged both 65-74 years and ≥ 75 years has been suggested to facilitate discharge to home. Patients aged 65-74 with low FIM-M at discharge and those aged ≥ 75 years with low FIM-C at discharge may require more effective intervention in addition to improving the ADL in order to be discharged home.
ABSTRACT
Purpose : The purpose of this study was to investigate the risk factors for falls among wheelchair users who were institutionalized in a long-term care health facility. Subjects : The participants were 62 new residents (mean age, 85.4±7.9) of a long-term care health facility. Methods : A longitudinal study of 6 months follow-up for falls was carried out. Baseline data were obtained regarding age, history of falls, functional status, psychological variables, physiological function, medical treatments and economic status. Risk factors for falls were analyzed by logistic regression. Results : During the follow-up, falls by 29 patients (46.8% of participants) were reported. Our analysis showed that four risk factors were significantly associated with falls : the patient had a bent back, a high FIM score, polypharmacy and benzodiazepine use. Logistic regression analysis revealed that a bent back was the best predictor of falls (OR 4.11 ; CI 95% 1.25-13.5).