Clarification of Factors Determining Discharge Destination Among Elderly Patients After Stroke With Low Levels of Independence in Activities of Daily Living: A Retrospective Study

Abstract

Objective: To determine factors influencing discharge destination of elderly patients after stroke with low levels of independence in activities of daily living (ADL). Design: Cross-sectional study. Setting: A community-based public hospital in a rural area in Japan. Participants: A total of 67 patients with low daily function among 205 elderly patients with stroke screened for eligibility (N=67). Interventions: Not applicable. Main Outcome Measures: Motor component of functional independence measure (M-FIM) at discharge and discharge destination—home or long-term care facility (LCF). Results: Among the 205 eligible patients, 147 were discharged home and 58 were discharged to LCFs. Patients with an M-FIM score of ≤30 at discharge were defined as patients deemed difficult to discharge home because of low independence levels in ADL. Of the 147 patients discharged home, 24 (16.3%) had M-FIM scores of ≤30. Of the 58 patients discharged to LCFs, 43 (74.1%) had M-FIM scores of ≤30. Patients with an M-FIM score of ≤30 at discharge significantly tended to be discharged home if they obtained oral intake vs tube feeding as a nutritional method (P=.047) and higher cognitive component of FIM scores at discharge (P=.002). All six patients who lived alone among patients with an M-FIM score of ≤30 were discharged to LCFs. Two patients on tube feeding were discharged home. Conclusions: Nutritional method, cognitive function at discharge, and the prestroke living situation with or without household caregivers are important factors of discharge among elderly patients after stroke with low independence levels in ADL. However, only a small number of severely disabled patients were successfully discharged home.

Keywords

• Activities of daily living
• Aged
• Long-term care
• Patient discharge
• Rehabilitation
• Stroke