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Risk of Exclusion From Stroke Rehabilitation in the Oldest Old

Published:September 07, 2017DOI:https://doi.org/10.1016/j.apmr.2017.08.469

      Abstract

      Objective

      To investigate whether oldest-old age (≥85y) is an independent predictor of exclusion from stroke rehabilitation.

      Design

      Retrospective cohort study.

      Setting

      Stroke unit (SU) of a tertiary hospital.

      Participants

      Elderly patients (N=1055; aged 65–74y, n=230; aged 75–84y, n=432; aged ≥85y, n=393) who, between 2009 and 2012, were admitted to the SU with acute stroke and evaluated by a multiprofessional team for access to rehabilitation. The study excluded patients for whom rehabilitation was unnecessary or inappropriate.

      Interventions

      Not applicable.

      Main Outcome Measures

      Access to an early mobilization (EM) protocol during SU stay and subsequent access to postacute rehabilitation after SU discharge. Analyses were adjusted for prestroke and stroke-related characteristics.

      Results

      32.2% of patients were excluded from EM. Multivariable-adjusted odds ratios (ORs) of EM exclusion were 1.30 (95% confidence interval [CI], .76–2.21) for ages 75 to 84 years and 2.07 (95% CI, 1.19–3.59) for ages ≥85 years compared with ages 65 to 74 years. Of 656 patients admitted to EM and who, at SU discharge, had not yet fully recovered their prestroke functional status, 18.4% were excluded from postacute rehabilitation. For patients able to walk unassisted at SU discharge, the probability of exclusion did not change across age groups. For patients unable to walk unassisted at SU discharge, ORs of exclusion from postacute rehabilitation were 3.74 (95% CI, 1.26–11.13) for ages 75 to 84 years and 9.15 (95% CI, 3.05–27.46) for ages ≥85 years compared with ages 65 to 74 years.

      Conclusions

      Oldest-old age is an independent predictor of exclusion from stroke rehabilitation.

      Keywords

      List of abbreviations:

      CI (confidence interval), EM (early mobilization), mRS (modified Rankin Scale), NHS (National Health System), OR (odds ratio), SU (stroke unit)
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