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• W2940749938 abstract "To the Editor: The evidence supports interventions to ensure the continuity of care after stroke in individuals aged 65 years and older, but research in stroke patients aged 80 and older is limited.1-3 In a 2016 study, we found that the prognosis of a relevant group of stroke survivors who attended inpatient postacute geriatric rehabilitation units in the Catalan public health system in southern Europe, with target patients and care standards equivalent to skilled nursing facilities, was potentially good enough to allow alternative management strategies, namely home-based comprehensive geriatric care and rehabilitation.4 We aimed to explore functional results of a new community-based protocol tailored to stroke survivors at risk of negative outcomes due to their advanced age and geriatric profile. We present case series of a clinical practice service, with data from consecutive patients with stroke attended during a 1-year period by a hospital-at-home program that demonstrated its effectiveness and efficiency for other disabling health processes.5-7 Older patients with stroke were selected from the acute ward of Hospital Municipal de Badalona, a 109-bed hospital in an urban area north of Barcelona, after being treated in the hyperacute phase. Inclusion criteria were age 65 years or older; geriatric profile (due to multimorbidity, frailty, or baseline disability); stroke resulting in a sudden onset of disability; good functional prognosis after acute treatments; a caregiver with sufficient physical and cognitive capacity to ensure healthcare at home 24 hours per day, 7 days a week; and providing informed written consent. The home-based protocols were aimed to provide individualized person-centered care plans by a multidisciplinary team, based on comprehensive geriatric assessment (CGA).5-7 Home visits were provided by nurses and geriatricians (1-5 visits/wk lasting between 30 and 60 min), and by physiotherapists and occupational therapists (1-3 visits/wk lasting up to 45 min). At admission to the home unit, we collected prestroke and poststroke disability8 (modified Rankin Scale8 [mRS] and Barthel Index), stroke type and severity, and clinical characteristics including geriatric syndromes. At discharge, we recorded destination, functional outcomes (based on mRS, Barthel Index score, absolute and relative functional gain9), length of acute stay, and length of the intervention. Analyses were performed using Stata software v.11.1. We included 32 patients (87.5% ischemic; 12.5% hemorrhagic strokes). The population was very old (median age = 88.5 y [range = 81-91.7 y]) and disabled (median mRS = 2 [range = 1-3]; 56.2% had an mRS ≥2; prestroke median Barthel Index score 88 [range = 62-100]). After acute treatment, most patients had mild-to-moderate symptoms (National Institutes of Health Stroke Scale = 5.5 [range = 4-12.7]). At admission to home care, median Barthel Index was 48.5 (range = 33.5-65.7), representing a median functional loss of 31.5 points. Patients had a median of 4 (range = 3-5) geriatric syndromes; 37.5% had cognitive impairment, and 25% had delirium. Median length of stay was 9 days (range = 6-12 d) in the acute unit and 46.5 days (range = 38.2-60.2 d) in the home-based unit; 28 patients (87.5%) were discharged to the community. Table 1 shows patients’ characteristics and outcomes according to baseline mRS subgroups. Outcomes were positive in all the groups, without differences in the discharge destination. Relative functional gain was especially good in the mRS 3 to 4 subgroup (moderate-to-severe disability). This pilot experience showed effective poststroke home-based care for very old patients. Most patients obtained very good functional outcomes and remained at home. Patients with moderate-to-severe prestroke disability achieved the best clinical results, with 13 of 14 patients recovering their baseline Rankin status. Little is known about home-based care for stroke survivors aged 80 years and older. In a randomized controlled trial published in this journal,10 including 120 first-time stroke patients, the home-based strategy was at least as effective as the hospital-based strategy; moreover, patients treated at home had less depression and fewer medical complications, and they were more likely to remain at home at 6 months. Similar to our work, many patients had various clinical conditions that increased the risk of negative outcomes, and the multidisciplinary approach was centered on a CGA-based protocol. The home-based care was provided tailored to individual patient conditions. Outcomes in this home-based pilot were similar to those achieved by the low complexity with caregiver profile in our previous study in nine inpatient units in Catalonia.4 If replicated in further studies, this community-based strategy might be expanded to provide care to this profile of stroke survivors throughout our health system, avoiding postacute inpatient admission. As a future research step, controlled multicenter designs should be implemented. In conclusion, despite older stroke survivors’ vulnerability, related to their geriatric profile, those who meet minimum health and social criteria could achieve functional gains and positive outcomes through home-based patient-centered care, possibly due to the potential adaptability to person needs and views. Conflict of Interest: The authors have declared no conflict of interest for this article. Author Contributions: All the authors contributed to the design and development of the study, and the writing and revision of the manuscript. Sponsor's Role: None declared." @default.
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• W2940749938 date "2019-04-24" @default.
• W2940749938 modified "2023-10-05" @default.
• W2940749938 title "Home as a Place for Care of the Oldest Stroke Patients: A Pilot from the Catalan Stroke Program" @default.
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• W2940749938 doi "https://doi.org/10.1111/jgs.15944" @default.
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