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Background: Accurate prognostic assessments of need of help, health and dwelling situation in stroke patients are important for patient management, rehabilitation, discharge planning, and for providing reliable information to patients and their relatives. Objective: To analyse factors affecting the accuracy of discharge prognosis assessments. Design: Prospective study of stroke patients discharged from hospital. Setting: two cities in central Sweden. Subjects: Three hundred and ninety stroke patients, 65 years or older, living in their own homes and having no dementia diagnosis prior to hospital admission. Methods: At discharge, physicians, nurses, occupational therapists and physiotherapists in the Departments of Internal Medicine and Geriatrics were asked to make an individual prognosis assessment regarding patients' need for help, health and dwelling situation at 3 and 12 months after admission to hospital. Results: The prognosis assessments were on average accurate in 68.4% (3 months) and 61.5% (12 months), far better than chance (33.3%). There were no significant differences between staff categories. The accuracy was influenced by a number of patient linked factors, such as activity degree, household situation before admission, and Mini Mental State Examination level and need of help measured 1 week after discharge, and ranged from 22 to 89%, depending on factor combinations. Conclusions: Prognosis assessments based on clinical judgement were on average quite accurate but the accuracy varied markedly with patient linked factors. Feedback of outcome might be one way to further improve the accuracy of prognosis assessment.

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.

Background. A wide range of health problems has been reported in elderly post-stroke patients. Aim. The aim of this study was to analyse the prevalence and timing of health problems identified by patient interviews and scrutiny of primary health care and municipality elderly health care records during the first post-stroke year.

Methods. A total of 390 consecutive patients, >= 65 years, discharged alive from hospital after a stroke event, were followed for 1 year post-admission. Information on the health care situation during the first post-stroke year was obtained from primary health care and municipal elderly health care records and through interviews with the stroke survivors, at 1 week after discharge, and 3 and 12 months after hospital admission.

Results. More than 90% had some health problem at some time during the year, while based on patient record data only 4-8% had problems during a given week. The prevalence of interview-based health problems was generally higher than record-based prevalence, and the ranking order was moderately different. The most frequently interview-reported problems were associated with perception, activity, and tiredness, while the most common record-based findings indicated pain, bladder and bowel function, and breathing and circulation problems. There was co-occurrence between some problems, such as those relating to cognition, activity, and tiredness.

Conclusions. Almost all patients had a health problem during the year, but few occurred in a given week. Cognitive and communication problems were more common in interview data than record data. Co-occurrence may be used to identify subtle health problems.

Background and Purpose Stroke related problems may affect the life situation of not only stroke patients but also their informal caregivers. The objective of this study was to assess life situation aspects in stroke patients and their informal caregivers during the first post-stroke year.

Methods 377 patients surviving a stroke event were followed during the first post stroke year with interviews 1 week after discharge from hospital and three and twelve months after the index stroke admission. Their informal caregivers answered questionnaires in connection to the interviews. In both groups information based on the Hospital Anxiety and Depression Scale (HAD), the Nottingham Health Profile (NHP), and GQL-Activity Scale was obtained. Additional information was sought among patients on their health situation and Mini Mental State Examination (MMSE) score, and among informal caregivers on the nature and amount of assistance provided, measured as support score and number of hours per week and perceived caregiver burden (CB) score.

Results Before index admission 85% of informal caregivers provided on average five hours’ care per week and 8-10 support score. The corresponding numbers after discharge were 91%, 10 hours per week and 13-15 support score. Support determinants were patient’s functional ability, distance to patient’s home, relation to patient, municipality social service support given. CB score determinants were municipality support given, relation to patient, functional ability, and patient age. The caregivers had higher anxiety and depression scores than the patients. Significant associations between caregiver and patient responses were found for HAD anxiety, NHP emotional and social, and GQL activity score.

Conclusions The informal caregivers reported a significant caregiver burden. There was a parallel situation between patients’ and caregivers’ situation.