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Survival, hazard function for a new event, and healthcare utilization among stroke patents ≥65 Years
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
2009 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 40, no 11, 3585-3590 p.Article in journal (Refereed) Published
Abstract [en]

Background and Purpose — The natural history of stroke is still incompletely understood. The aim of this study was to present detailed data on survival, recurrence, and all types of healthcare utilization before and after a stroke event in patients with stroke.

Methods — Three hundred ninety stroke survivors constituted the study population. Information on survival data during 5 years of follow-up, all hospital admissions since 1971, all outpatient and primary care consultations, and all municipal social service support during the year before and after the index stroke admission and patient interviews 1 week after discharge were obtained.

Results — The risk of death or a new stroke was high in the early phase after admission but then decreased rapidly during the next few months. Mortality during the first 5 years was influenced by age and functional ability, whereas the risk of stroke recurrence was influenced by number of previous strokes, hypertension diagnosis, and sex. On a day-by-day basis, 35% were dependent on municipal support before and 65% after the stroke. The corresponding proportions in outpatient care were 6% and 10%, and for hospital inpatient care 1% to 2% and 2% to 3%. Of the health care provided, nursing care dominated.

Conclusions — The risk of dying or having a new stroke event decreased sharply during the early postmorbid phase. Healthcare utilization increased after discharge but was still moderate on a day-by-day basis, except for municipal social service support, which was substantial.

Place, publisher, year, edition, pages
2009. Vol. 40, no 11, 3585-3590 p.
Keyword [en]
epidemiology, hazard function, health care utilization, municipal support, recurrence
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-112848DOI: 10.1161/STROKEAHA.109.556720ISI: 000271160300030OAI: oai:DiVA.org:uu-112848DiVA: diva2:288471
Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Life After a Stroke Event: With Special Reference to Aspects on Prognosis, Health and Municipality Care Utilization, and Life Satisfaction Among Patients and Their Informal Caregivers
Open this publication in new window or tab >>Life After a Stroke Event: With Special Reference to Aspects on Prognosis, Health and Municipality Care Utilization, and Life Satisfaction Among Patients and Their Informal Caregivers
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives. The aim of this thesis was to study the prognosis, health care utilization and health situation in stroke patients, and informal caregiver burden during the first post-stroke year.

Material and methods. 390 patients, 65 years or older, discharged from hospital after a stroke, were followed with repeated patient interviews, patient record and register data, and hospital staff and informal caregiver questionnaires.

Results. Prognosis assessments performed by hospital staff at discharge regarding the course of events during the following year were highly accurate and were mainly influenced by the patient’s pre- and post-morbid state. The risk of dying or having a new stroke decreased rapidly during the early post-morbid phase. Health care utilization, in hospitals as well as in primary health care, and municipal social service support was considerably higher after the stroke than before, but the utilization of services was lower than previously reported. Health problem prevalence according to interview and record scrutiny was modest, peaked early after discharge and then declined. Support from informal caregivers increased significantly after discharge and remained high during the first post-stroke year. The support given was mainly determined by patient functional ability, distance to patient, relation to patient, municipal social service support provided, and patient sex. The informal caregivers reported considerable strain and burden, with significantly higher levels of anxiety and depression than the stroke patients. Moreover, there was a parallel between the patient’s and the caregiver’s situation regarding anxiety, emotional and social situation, and home, social and outdoor activities.

Conclusion. Hospital staff prognosis assessments of patient outcomes during the next year were highly accurate. Risk of recurrence and mortality, and health problem prevalence was high in the early post-stroke period, and than declined. Health care utilization and municipality social support increased over time. Informal caregivers reported considerable strain and burden.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 78 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 517
Keyword
stroke, older age, prognosis, care utilization, life situation, informal caregiver, health problems, survival, hazard, nursing
National Category
General Practice
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-112875 (URN)978-91-554-7711-0 (ISBN)
Public defence
2010-03-06, Föreläsningssalen, Falu lasarett, Falun, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-02-12 Created: 2010-01-21 Last updated: 2018-01-12Bibliographically approved

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Olai, LenaSvärdsudd, Kurt

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