Predictors of dependency in post-discharge activities of daily living among stroke in-patients managed in a comprehensive stroke unit

Sixty-one individuals hospitalized for hip fractures received activities of daily living (ADL) assessments during the 3 days prior to discharge. Information was also collected regarding anticipated role loss, depression, mental status, health status, and social support. Independence in ADL at home was measured 3 weeks following discharge by telephone interviews. The concordance between predischarge and post discharge ADL scores was low but statistically significant (Kw = .223; p < .05). Approximately 50.8% of the subjects demonstrated greater dependence post discharge. More dependent ADL performance at home was not related to role loss, depression, mental status, health status, or social support. Predischarge ADL assessments are often taken into consideration when formulating discharge plans. However, these evaluations do not always accurately predict post discharge ADL independence. It is recommended, therefore, that community follow-up be carried out with patients who have fractured hips.

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FROM HOSPITAL TO HOME: LIMITED NUTRITIONAL AND FUNCTIONAL RECOVERY FOR OLDER ADULTS

Journal of Frailty & Aging ◽

10.14283/jfa.2015.51 ◽

2015 ◽

pp. 1-5

Author(s):

A.M. YOUNG ◽

A.M. MUDGE ◽

M.D. BANKS ◽

L. ROGERS ◽

J. ALLEN ◽

...

Keyword(s):

Activities Of Daily Living ◽

Functional Status ◽

Grip Strength ◽

Lean Body Mass ◽

Body Mass ◽

Daily Living ◽

Medical Patients ◽

Post Discharge ◽

Walk Speed ◽

Nutrition Risk

Background: The post-hospital period may be a vulnerable time for elders recovering from acute illness. Few studies have examined nutrition outcomes of older people at nutrition risk after acute hospitalisation. Objectives: This study aims to describe a) standard nutrition care received by recently discharged older medical patients, b) change in nutritional and functional status at six weeks post-discharge and c) clinical outcomes at twelve weeks post discharge. Design: Prospective cohort study. Setting: Two metropolitan teaching hospitals in Brisbane, Australia. Participants: Medical patients aged ≥65 years at risk of malnutrition (Malnutrition Screening Score ≥2) and discharged to independent living in the community. Measurement: Nutritional status (Mini Nutritional Assessment (MNA), weight, lean body mass), functional status (grip strength, walk speed, activities of daily living) and health-related quality of life assessed on discharge and six weeks post-discharge. Inpatient and post-discharge nutrition intervention was recorded. Death and unplanned admissions were measured at 12 weeks. Results: Of the 42 consented participants, only 14% (n=6) received post-discharge dietitian review and 19% (n=8) received practical nutrition supports at home (meal delivery, shopping assistance) as part of standard care. While there was a small improvement in MNA (18.4±4.0 to 20.1±4.2, p=0.004) and walk speed (0.7±0.3 m/s to 0.9±0.3, p=0.004) at six weeks, there was no difference in mean weight, lean body mass, grip strength or activities of daily living. Five (15%) participants lost ≥5% body weight. By twelve weeks, 17 participants (46%) had at least one unplanned hospital admission and four (10%) had died. Conclusions: Few patients at nutrition risk received nutrition-focussed care in the post-hospital period, and most did not improve nutritional or functional status at 6 weeks.

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The effect of HIV status on post-stroke outcomes in personal activities of daily living

British Journal of Occupational Therapy ◽

10.1177/0308022620902683 ◽

2020 ◽

Vol 83 (11) ◽

pp. 710-718 ◽

Cited By ~ 2

Author(s):

Hymeri Augustyn ◽

Patricia de Witt ◽

Denise Franzsen

Keyword(s):

Activities Of Daily Living ◽

Functional Recovery ◽

Daily Living ◽

Hiv Positive ◽

Stroke Survivors ◽

Post Discharge ◽

Discharge Data ◽

Positive Group ◽

The Impact ◽

Hiv Negative

Introduction This study explored the impact of HIV on the functional recovery of personal activities of daily living of stroke survivors. This assisted in identifying possible implications for the rehabilitation of stroke survivors who are also HIV-positive. Method A quantitative, descriptive, longitudinal comparative research design was used to determine the change in personal activities of daily living scores of HIV-negative and HIV-positive stroke survivors from admission to 1 month after discharge. Data were collected at a rehabilitation unit using the South African Database Functional Measure. Results There was no difference in the rate and nature of functional recovery of personal activities of daily living between the two groups between admission and discharge. A difference was noticed during the period from admission to 1 month after discharge, during which the HIV-negative group continued to show improvement, while the HIV-positive group showed little improvement or a decline in personal activities of daily living scores. Conclusions While the rate and nature of functional recovery related to personal activities of daily living for HIV-positive and HIV-negative stroke survivors is similar during inpatient care, discharge planning for the HIV-positive group needs to consider the decline in personal activities of daily living functioning post discharge. Regular follow-ups and the inclusion of the stroke survivors in an outpatient treatment programme is recommended.

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Stroke Unit Versus General Medical Wards, II: Neurological Deficits and Activities of Daily Living

Stroke ◽

10.1161/01.str.29.3.586 ◽

1998 ◽

Vol 29 (3) ◽

pp. 586-590 ◽

Cited By ~ 72

Author(s):

Ole Morten Rønning ◽

Bjørn Guldvog

Keyword(s):

Activities Of Daily Living ◽

Daily Living ◽

Stroke Unit ◽

Neurological Deficits ◽

Medical Wards

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Prognostic Impact of the Preservation of Activities of Daily Living on Post-Discharge Outcomes in Patients With Acute Heart Failure

Circulation Journal ◽

10.1253/circj.cj-18-0279 ◽

2018 ◽

Vol 82 (11) ◽

pp. 2793-2799 ◽

Cited By ~ 7

Author(s):

Yusuke Uemura ◽

Rei Shibata ◽

Kenji Takemoto ◽

Masayoshi Koyasu ◽

Shinji Ishikawa ◽

...

Keyword(s):

Heart Failure ◽

Activities Of Daily Living ◽

Acute Heart Failure ◽

Daily Living ◽

Prognostic Impact ◽

Post Discharge ◽

Discharge Outcomes

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Dependency in Activities of Daily Living During the First Year After Stroke

Frontiers in Neurology ◽

10.3389/fneur.2021.736684 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hannah E. Wurzinger ◽

Tamar Abzhandadze ◽

Lena Rafsten ◽

Katharina S. Sunnerhagen

Keyword(s):

Logistic Regression ◽

Activities Of Daily Living ◽

Daily Living ◽

Stroke Unit ◽

Binary Logistic Regression ◽

Early Discharge ◽

University Hospital ◽

Regression Analyses ◽

Patient Centered ◽

Post Stroke

Background: Dependency in personal activities of daily living (ADL) is a common short-term and long-term consequence of stroke and requires targeted rehabilitation. As the duration of hospital stay has become shorter in recent decades, early identification of patients who require rehabilitation has become vital. To our knowledge, no study has investigated whether ADL dependency in the very early stages after admission to the stroke unit can explain ADL dependency 3 and 12 months later. This knowledge would facilitate planning for very early discharge and patient-centered rehabilitation.Objective: This study evaluated whether ADL dependency within 2 days after stroke could explain ADL dependency at 3 and 12 months after stroke.Methods: This longitudinal cohort study included patients with stroke who were treated at a stroke unit in the Sahlgrenska University Hospital (Gothenburg, Sweden) between May 2011 and March 2016. The primary independent variable was ADL dependency at 36–48 h after admission to the stroke unit, which was assessed using a Barthel Index (BI) score of ≤90. The dependent variables were self-reported personal ADL dependency at 3 and 12 months after stroke. Binary logistic regression analyses were performed.Results: Of 366 eligible patients (58% male; median age 71 years), a majority (76%) had mild stroke and 60% were ADL dependent 36–48 h after stroke. Univariable and multivariable logistic regression analyses showed that patients who were dependent within the first 2 days after stroke had higher odds for being dependent 3 months as well as 12 months after stroke.Conclusion: The results indicated that dependency in personal ADL during the first 2 days can explain dependency at 3- and 12-month post-stroke. Therefore, early ADL assessments post-stroke can be used for understanding rehabilitation needs after stroke.

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A trial based economic evaluation of occupational therapy discharge planning for older adults: the HOME randomized trial

Clinical Rehabilitation ◽

10.1177/0269215518764249 ◽

2018 ◽

Vol 32 (7) ◽

pp. 919-929 ◽

Cited By ~ 5

Author(s):

Kylie Wales ◽

Glenn Salkeld ◽

Lindy Clemson ◽

Natasha A Lannin ◽

Laura Gitlin ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Activities Of Daily Living ◽

Incremental Cost ◽

Acute Care ◽

Daily Living ◽

Discharge Planning ◽

Post Discharge ◽

The Cost ◽

Quality Adjusted Life

Objective: To compare the cost effectiveness of two occupational therapy–led discharge planning interventions from the HOME trial. Design: An economic evaluation was conducted within the superiority randomized HOME trial to assess the difference in costs and health-related outcomes associated with the enhanced program and the in-hospital consultation. Total costs of health and community service utilization were used to calculate incremental cost-effectiveness ratios, activities of daily living and quality-adjusted life years. Setting: Medical and acute care wards of Australian hospitals ( n=5). Subjects: A total of 400 people ≥ 70 years of age. Interventions: Participants were randomized to either (1) an enhanced program (HOME), involving pre/post discharge visits and two follow-up phone calls, or (2) an in-hospital consultation using the home and community environment assessment and the Lawton Instrumental Activities of Daily Living assessment. Main measures: Nottingham Extended Activities of Daily Living (global measure of activities of daily living) and SF-12V2, transformed into SF-6D (quality-adjusted life year) measured at baseline and three months post discharge. Results: The cost of the enhanced program was higher than that of the in-hospital consultation. However, a higher proportion of patients showed improvement in activities of daily living in the enhanced program with an incremental cost-effectiveness ratio of $61,906.00 per person with clinically meaningful improvement. Conclusion: Health services would not save money by implementing the enhanced program as a routine intervention in medical and acute care wards. Future research should incorporate longer time horizons and consider which patient groups would benefit from home visits.

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