Home as a Place for Care of the Oldest Stroke Patients: A Pilot from the Catalan Stroke Program

Abstract

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][2][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][6][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][6][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 disability 8 (modified Rankin Scale 8 [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 gain 9 ), length of acute stay, and length of the intervention. Analyses were performed using Stata software v.11.1.