ABSTRACT
The purpose of this study was to analyze the socioeconomic factors influencing patient discharge destination and the length of their hospital stay. We investigated 83 consecutive stroke patients admitted to our rehabilitation ward between January 1 and December 31, 2008. The mean age was 68.1 years old, the mean length of stay was 86.1 days, and 57% were men. The outcome for this study was the patient discharge destination, defined as home or a nursing home type of facility. To examine the predictors of the discharge destination, we collected data including patient age, sex, total Functional Independence Measure (FIM) scores at discharge, ‘living alone’, ‘over 65 years old’, ‘requiring public assistance’, and ‘having a family member at home who requires nursing care’. In all, 69 patients were able to return home, and 14 patients were discharged to a nursing home type of facility. The home group showed a higher total FIM score (p<0.001). Logistic regression analysis showed that two factors, ‘living alone’ and ‘having a family member at home who requires nursing care’, adversely affected patient discharge to home. Also, the length of stay was longer among those patients who required public assistance (p<0.01). This study suggests that it is harder for patients to be discharged back to their homes who have these factors : ‘having a family member at home who requires nursing care’ and ‘living alone’. Additionally, having the patient characteristic of ‘requiring public assistance’ could prolong the length of hospital stay.
ABSTRACT
The following report illustrates a rare case of dysphagia caused by secondary adrenal insufficiency in a patient with isolated ACTH deficiency. A 76-year-old man with progressive appetite loss, weight loss and general fatigue was hospitalized due to dehydration, aspiration pneumonia and hypoglycemia. He was unable to stand and walk by himself. His serum cortisol and ACTH levels were both low. An endocrinological examination resulted in a diagnosis of isolated ACTH deficiency. Following the administration of 15mg of glucocorticoids daily, his symptoms diminished without dysphagia. Furthermore, we investigated his swallowing function using a videofluoroscopic examination of swallowing (VF). The VF showed an impaired laryngeal movement as well as an upper esophageal opening and severe aspiration without a delay in his swallowing reflex. Oral intake was judged to be impossible, but his swallowing function gradually improved and he was able to resume eating all of his meals 2 months after treatment. Dysphagia is not a common symptom in ACTH deficient patients but a few similar cases have been reported. The swallowing function of the patients in these cases was not evaluated in detail, so we evaluated this case according to the results of the VF and the patient's process of recovery. Careful monitoring of swallowing function and appropriate treatment for both dysphagia and adrenocortical failure are required for the recovery of such patients. In conclusion, practitioners should be wary of isolated ACTH deficiency in elderly patients with progressive weight loss and dysphagia.