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Prognosis assessment in stroke patients at discharge from hospital
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. (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, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. (Family Medicine and Clinical Epidemiology)
2007 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 36, no 2, 184-189 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2007. Vol. 36, no 2, 184-189 p.
Keyword [en]
prognosis assessment, outcome, functional capacity, health situation, dwelling, stroke, elderly
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-10401DOI: 10.1093/ageing/afl146ISI: 000244959500014PubMedID: 17178766OAI: oai:DiVA.org:uu-10401DiVA: diva2:38169
Available from: 2007-03-22 Created: 2007-03-22 Last updated: 2017-12-11Bibliographically 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
Family Medicine
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: 2010-02-12Bibliographically approved

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Olai, LenaOmne-Pontén, MarianneSvärdsudd, Kurt

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