Systematic review and meta-analysis of the effect of cognitive impairment on the risk of admission to long-term care after stroke

Abstract

<ns4:p><ns4:bold>Introduction: </ns4:bold>Admission to long-term care (LTC) post-stroke can be a significant source of costs. Studies evaluating the effect of cognitive impairment (CI) and dementia on risk of LTC admission post-stroke have not been systematically reviewed. The aim of this paper was to conduct a systematic review and meta-analysis of studies of the association between post-stroke CI/dementia and admission to LTC.</ns4:p><ns4:p> <ns4:bold>Patients and methods: </ns4:bold>PubMed, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for peer-review articles in English published January 2000-June 2018. Included studies were population-based or hospital-based studies assessing the relationship between CI or dementia, and admission to LTC post-stroke. Abstracts were screened, followed by full-text review of potentially relevant articles. Relevant data was extracted using a standard form and the Crowe Critical Appraisal Tool was used for quality appraisal. Results were pooled using random-effects meta-analysis and heterogeneity was assessed using the I² statistic.</ns4:p><ns4:p> <ns4:bold>Results:</ns4:bold> 18 articles were included in the review and 12 in a meta-analysis. 14/18 studies adjusted for covariates including functional impairment. Increased odds of admission to LTC was associated with post-stroke CI [Odds Ratio (CI 95%): 2.36 (1.18, 4.71), I²=77%] and post-stroke dementia [Odds Ratio (CI 95%): 2.58 (1.38 to 4.82), I²=60%].</ns4:p><ns4:p> <ns4:bold>Discussion and conclusion: </ns4:bold>Post-stroke CI and dementia increase odds of admission to LTC post-stroke, independent of functional impairment. This indicates the potential for interventions that reduce post-stroke CI and dementia to also reduce risk of admission to LTC post-stroke, and ultimately costs.</ns4:p>

The impact of stroke, cognitive function and post-stroke cognitive impairment (PSCI) on healthcare utilisation in Ireland: a cross-sectional nationally representative study

“…While stroke and poor cognitive function were associated with increased emergency services utilisation in the unadjusted models, disability and depression appeared to mediate emergency visits in the adjusted analysis. Stroke survivors and individuals with cognitive impairment are commonly affected by disability and depression [ 15 , 19 , 49 ], which may explain why no significant association was found once these confounders were included in the model. The number of nights spent in hospital also failed to reach significance in the adjusted regression analysis.…”

“…PSCI is associated with impaired activities of daily living (ADL), which in turn may result in greater utilisation of healthcare services and reduced capacity for independent living [ 17 ]. Individuals with PSCI are more likely to be re-admitted to hospital [ 18 ] and a recent systematic review found a significant two-fold increase in long-term care admissions of patients with PSCI and dementia [ 19 ]. The exact trajectory of PSCI is unpredictable—some stroke survivors show improvement or stable cognitive function over time, while others experience cognitive decline [ 9 , 20 ].…”

“…While stroke and cognitive impairment are associated with poorer health outcomes and increased need for long-term care [ 11 , 19 ], it is unclear whether these conditions increase healthcare utilisation, independent of other comorbidities and demographic factors. This study aims to address this gap by adjusting for potential confounders and exploring the impact of stroke, cognitive function, and post-stroke cognitive impairment (PSCI) on health service utilisation.…”

Impaired Cognition and Stroke Rehabilitation Outcomes: Are They Related?

“…Minimal research has focused on the specific effects of post-stroke cognitive status on functional outcomes (such as functional gains, rehabilitation stays, and discharge living settings) following inpatient rehabilitation. A few previous studies have suggested that impaired cognition correlates with older age [8], longer rehabilitation stays [2] [6], and discharge to extended care facilities [2] [9] [10] [11] [12]. A single study reported a decrease in functional gains among cognitively impaired patients [13], but other studies demonstrated improvements in motor function among stroke patients with impaired cognition [6] [14].…”

The Prevalence of Cognitive Impairment on Admission to Nursing Home among Residents with and without Stroke: A Cross–Sectional Survey of Nursing Homes in Ireland

“…While the risk of nursing home entry for those with PSCI has been examined, results have varied by study setting, sample size and follow–up periods. Consequently, the strength of the effect of PSCI on nursing home placement has varied between studies [ 16 ]. The characteristics of stroke survivors admitted to nursing homes have been examined in a number of studies [ 17 , 18 , 19 , 20 , 21 ].…”