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Predicting Discharge to Institutional Long-Term Care After Stroke: A Systematic Review and Metaanalysis

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY (2018)

Journal

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY

Volume 66, Issue 1, Pages 161-169

Publisher

WILEY

DOI: 10.1111/jgs.15101

Keywords

stroke; long-term care; hospitalization; predictors

Funding

Alzheimer Scotland
cross-council Lifelong Health and Wellbeing Initiative [MR/L501530/1]
Biotechnology and Biological Sciences Research Council
Medical Research Council
joint Stroke Association and Chief Scientist Office Senior Lecturer Fellowship
Medical Research Council [MR/K026992/1] Funding Source: researchfish
National Institute for Health Research [ACF-2012-11-503] Funding Source: researchfish
Stroke Association [TSA15LECT05, PPA2015/01_CSO] Funding Source: researchfish

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Abstract

Background/ObjectivesStroke is a leading cause of disability worldwide, and a significant proportion of stroke survivors require long-term institutional care. Understanding who cannot be discharged home is important for health and social care planning. Our aim was to establish predictive factors for discharge to institutional care after hospitalization for stroke. DesignWe registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42015023497) of observational studies. We searched MEDLINE, EMBASE, and CINAHL Plus to February 2017. Quantitative synthesis was performed where data allowed. SettingAcute and rehabilitation hospitals. ParticipantsAdults hospitalized for stroke who were newly admitted directly to long-term institutional care at the time of hospital discharge. MeasurementsFactors associated with new institutionalization. ResultsFrom 10,420 records, we included 18 studies (n=32,139 participants). The studies were heterogeneous and conducted in Europe, North America, and East Asia. Eight studies were at high risk of selection bias. The proportion of those surviving to discharge who were newly discharged to long-term care varied from 7% to 39% (median 17%, interquartile range 12%), and the model of care received in the long-term care setting was not defined. Older age and greater stroke severity had a consistently positive association with the need for long-term care admission. Individuals who had a severe stroke were 26 times as likely to be admitted to long-term care than those who had a minor stroke. Individuals aged 65 and older had a risk of stroke that was three times as great as that of younger individuals. Potentially modifiable factors were rarely examined. ConclusionAge and stroke severity are important predictors of institutional long-term care admission directly from the hospital after an acute stroke. Potentially modifiable factors should be the target of future research. Stroke outcome studies should report discharge destination, defining the model of care provided in the long-term care setting.

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Predictors of short-term hospitalization and emergency department presentations in aged care

Maria C. Inacio, Robert N. Jorissen, Jyoti Khadka, Craig Whitehead, John Maddison, Alice Bourke, Clarabelle T. Pham, Jonathon Karnon, Steve L. Wesselingh, Elizabeth Lynch, Gillian Harvey, Gillian E. Caughey, Maria Crotty

Summary: The study found that one in five older individuals in aged care sector experienced unplanned hospitalizations and/or ED presentations within 90 days of entering the sector, with several predictors identified at the time of aged care eligibility assessment. This highlights the importance of targeting at-risk individuals during this actionable period to reduce hospitalizations.

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY (2021)