1
|
Kabboord AD, Van Eijk M, Buijck BI, Koopmans RTCM, van Balen R, Achterberg WP. Comorbidity and intercurrent diseases in geriatric stroke rehabilitation: a multicentre observational study in skilled nursing facilities. Eur Geriatr Med 2018; 9:347-353. [PMID: 29887923 PMCID: PMC5972181 DOI: 10.1007/s41999-018-0043-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/02/2018] [Indexed: 10/29/2022]
Abstract
Background Older patients often have multiple comorbidities and are susceptible to develop intercurrent diseases during rehabilitation. This study investigates intercurrent diseases and associated factors in patients undergoing geriatric stroke rehabilitation, focussing on pre-existing comorbid conditions, overall comorbidity and baseline functional status. Materials and methods This multicentre prospective cohort study included 15 skilled nursing facilities. Data were collected at baseline and at discharge. The primary outcome measures were presence and number of intercurrent diseases. Furthermore, their impact on change in rehabilitation goals or length of stay was examined. Comorbidity was assessed with the Charlson index, and functional status with the Barthel index (BI). Results Of the 175 included patients, 51% developed an intercurrent disease. A lower baseline BI, a higher Charlson index, presence of diabetes mellitus (DM) and kidney disease were related to the occurrence of an intercurrent disease (p < 0.05). Moreover, a lower BI, a higher Charlson index, and particularly the presence of DM were independently associated. If both comorbidity and a lower baseline functional status were present, the odds ratio (95% CI) of developing intercurrent diseases was 6.70 [2.33-19.2], compared to 1.73 [0.52-5.72] (comorbidity only) and 1.62 [0.53-4.94] (only BI ≤ 14). Conclusions On admission, functional impairments and comorbidity, particularly diabetes, independently contribute to developing intercurrent diseases during geriatric stroke rehabilitation. Therefore, routine evaluation of comorbidity integrated with functional status at the start of rehabilitation is essential to identify patients at risk. Finally, particular attention should be paid to patients with DM to prevent intercurrent diseases and support optimal functional recovery .
Collapse
Affiliation(s)
- Anouk D Kabboord
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Monica Van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Bianca I Buijck
- Department of Neurology, Erasmus MC University Medical Center, 's-Gravendijkwal 230, Rotterdam, The Netherlands.,Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,"Joachim en Anna", Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbus 9600, 2300 RC, Leiden, The Netherlands
| |
Collapse
|
2
|
Kabboord AD, van Eijk M, Fiocco M, van Balen R, Achterberg WP. Assessment of Comorbidity Burden and its Association With Functional Rehabilitation Outcome After Stroke or Hip Fracture: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2016; 17:1066.e13-1066.e21. [DOI: 10.1016/j.jamda.2016.07.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 01/08/2023]
|
3
|
Buijck BI, Zuidema SU, Spruit-van Eijk M, Bor H, Gerritsen DL, Koopmans RTCM. Determinants of geriatric patients' quality of life after stroke rehabilitation. Aging Ment Health 2015; 18:980-5. [PMID: 24679003 DOI: 10.1080/13607863.2014.899969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Geriatric patients' physical disabilities, dependency on care, and possible psychological ill-being may negatively affect both the patient's quality of life and the informal caregiver burden. Focusing on this interrelationship which can be particularly prominent in geriatric patients with stroke, the objective of this study was to identify determinants of patients' quality of life and informal caregiver burden. METHOD This is a prospective, multicentre, cohort study. Data were collected in 84 geriatric home-dwelling patients with stroke three months after their rehabilitation period in skilled nursing facilities (SNFs). We assessed patients' quality of life, depressive complaints, neuropsychiatric symptoms, balance, (instrumental) activities of daily living, and informal caregiver burden. Linear regression models were constructed to study the association between the variables. RESULTS For several domains, high quality of life of these geriatric patients was associated with high functional independence, less neuropsychiatric symptoms, and less depressive complaints. Informal caregiver burden was not associated with patients' quality of life, but patients' neuropsychiatric symptoms were a significant determinant of high informal caregiver burden. CONCLUSION The presence of neuropsychiatric symptoms (more specifically depressive complaints) negatively affects the quality of life of geriatric patients. Their neuropsychiatric symptoms also affect caregiver burden. Health care professionals in SNFs can play an important role in providing the necessary psychosocial support and aftercare.
Collapse
Affiliation(s)
- Bianca I Buijck
- a Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands
| | | | | | | | | | | |
Collapse
|
4
|
Wissink KS, Spruit-van Eijk M, Buijck BI, Koopmans RTCM, Zuidema SU. [Stroke rehabilitation in nursing homes: intensity of and motivation for physiotherapy]. Tijdschr Gerontol Geriatr 2014; 45:144-153. [PMID: 24801121 DOI: 10.1007/s12439-014-0072-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Stroke is a frequent and potential invalidating disease, of which recovery can be improved by rehabilitation. In The Netherlands old and frail stroke patients are rehabilitated in nursing homes. Probably, the intensity of and motivation for physiotherapy are important for successful discharge. The aim was to determine (1) therapy intensity of and motivation for physical therapy of geriatric stroke patients (2) its correlates and (3) the effect on discharge destination. METHODS Data were obtained from the 'GRAMPS'-study, a longitudinal observational study of stroke rehabilitation in 15 Dutch nursing homes. Direct time spent on physiotherapy was registered during admission. Motivation was measured by the Pittsburgh Rehabilitation Participation Scale (PRPS). Data of 84 patients were analysed using uni- and multivariate regression analysis. RESULTS Patients received an average 109 min of physiotherapy per week. 69 patients (82%) were good motivated for physiotherapy (had all PRPS scores 4 or higher). Therapy intensity was positively associated with the presence of a partner and good motivation. No significant independent variables of motivation were found. Therapy-intensity was positively related to discharge to prior living situation. CONCLUSION Intensity of physiotherapy of stroke rehabilitation is an independent variable of successful discharge and is higher when the patient has a partner or is better motivated. These findings stress the importance of high motivation and therapy intensity in geriatric stroke rehabilitation.
Collapse
Affiliation(s)
- K S Wissink
- TriviumMeulenbeltZorg, Hengelo, The Netherlands,
| | | | | | | | | |
Collapse
|
5
|
Vermeulen CJ, Buijck BI, van der Stegen JC, Spruit-van Eijk M, Koopmans RT, Hafsteinsdóttir TB. Time Use of Stroke Patients with Stroke Admitted for Rehabilitation in Skilled Nursing Facilities. Rehabil Nurs 2013; 38:297-305. [DOI: 10.1002/rnj.79] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2012] [Indexed: 01/06/2023]
|
6
|
Buijck BI, Zuidema SU, Spruit-van Eijk M, Bor H, Gerritsen DL, Koopmans RTCM. Is patient-grouping on basis of condition on admission indicative for discharge destination in geriatric stroke patients after rehabilitation in skilled nursing facilities? The results of a cluster analysis. BMC Health Serv Res 2012; 12:443. [PMID: 23211058 PMCID: PMC3537742 DOI: 10.1186/1472-6963-12-443] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 11/29/2012] [Indexed: 11/28/2022] Open
Abstract
Background Geriatric stroke patients are generally frail, have an advanced age and co-morbidity. It is yet unclear whether specific groups of patients might benefit differently from structured multidisciplinary rehabilitation programs. Therefore, the aims of our study are 1) to determine relevant patient characteristics to distinguish groups of patients based on their admission scores in skilled nursing facilities (SNFs), and (2) to study the course of these particular patient-groups in relation to their discharge destination. Methods This is a longitudinal, multicenter, observational study. We collected data on patient characteristics, balance, walking ability, arm function, co-morbidity, activities of daily living (ADL), neuropsychiatric symptoms, and depressive complaints of 127 geriatric stroke patients admitted to skilled nursing facilities with specific units for geriatric rehabilitation after stroke. Results Cluster analyses revealed two groups: cluster 1 included patients in poor condition upon admission (n = 52), and cluster 2 included patients in fair/good condition upon admission (n = 75). Patients in both groups improved in balance, walking abilities, and arm function. Patients in cluster 1 also improved in ADL. Depressive complaints decreased significantly in patients in cluster 1 who were discharged to an independent- or assisted-living situation. Compared to 80% of the patients in cluster 2, a lower proportion (46%) of the patients in cluster 1 were discharged to an independent- or assisted-living situation. Conclusion Stroke patients referred for rehabilitation to SNFs could be clustered on the basis of their condition upon admission. Although patients in poor condition on admission were more likely to be referred to a facility for long-term care, this was certainly not the case in all patients. Almost half of them could be discharged to an independent or assisted living situation, which implied that also in patients in poor condition on admission, discharge to an independent or assisted living situation was an attainable goal. It is important to put substantial effort into the rehabilitation of patients in poor condition at admission.
Collapse
Affiliation(s)
- Bianca I Buijck
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, P,O,Box 9101, Nijmegen, 6500 HB, the Netherlands.
| | | | | | | | | | | |
Collapse
|
7
|
Buijck BI, Zuidema SU, Spruit-van Eijk M, Geurts ACH, Koopmans RTCM. Neuropsychiatric symptoms in geriatric patients admitted to skilled nursing facilities in nursing homes for rehabilitation after stroke: a longitudinal multicenter study. Int J Geriatr Psychiatry 2012; 27:734-41. [PMID: 21932248 DOI: 10.1002/gps.2781] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/11/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the prevalence and course of neuropsychiatric symptoms (NPS) in geriatric patients admitted to skilled nursing facilities (SNFs) for rehabilitation after stroke. METHODS This was a longitudinal multicenter study within 15 SNFs in the Netherlands. NPS were assessed in 145 patients with stroke through the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) with measurements on admission and at discharge. The prevalence and course of NPS were described in terms of cumulative prevalence (symptoms either on admission or at discharge), conversion (only symptoms at discharge), remission (only symptoms on admission), and persistence (symptoms both on admission and at discharge) for patients who were discharged to an independent living situation within one year after admission and patients who had to stay in the SNF for long term care. RESULTS Eighty percent had a first-ever stroke and 74% could be successfully discharged. Overall, the most common NPS were depression (33%), eating changes (18%), night-time disturbances (19%), anxiety (15%), irritability (12%), and disinhibition (12%). One year after admission, the patients who were still in the SNF showed significantly more hallucinations (p = 0.016), delusions (p = 0.016), agitation (p = 0.004), depression (p = 0.000), disinhibition (p = 0.004), irritability (p = 0.018), and night-time disturbances (p = 0.001) than those who had been discharged. DISCUSSION The overall prevalence of NPS in this study was lower than reported by other studies in different settings. There was a high prevalence of NPS in patients that could not be successfully discharged. CONCLUSIONS The findings suggest that NPS should be optimally treated to improve outcome of rehabilitation.
Collapse
Affiliation(s)
- Bianca I Buijck
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. .
| | | | | | | | | |
Collapse
|
8
|
Buijck BI, Zuidema SU, van Eijk MS, Gerritsen DL, Koopmans RTCM, Linde H. Determinants of Quality of Life in Older Adults After Lower Limb Amputation and Rehabilitation in Skilled Nursing Facilities. J Am Geriatr Soc 2012; 60:796-8. [DOI: 10.1111/j.1532-5415.2011.03880.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Debby L. Gerritsen
- Primary and Community Care; Centre for Family Medicine; Geriatric Care and Public Health; Radboud University Nijmegen Medical Centre; Nijmegen
| | - Raymond TCM Koopmans
- Primary and Community Care; Centre for Family Medicine; Geriatric Care and Public Health; Radboud University Nijmegen Medical Centre; Nijmegen
| | - Harmen Linde
- Rehabilitation; Nijmegen Centre for Evidence Based Practice; Radboud University Nijmegen Medical Centre; Nijmegen
| |
Collapse
|
9
|
Spruit-van Eijk M, Zuidema SU, Buijck BI, Koopmans RT, Geurts AC. To what extent can multimorbidity be viewed as a determinant of postural control in stroke patients? Arch Phys Med Rehabil 2012; 93:1021-6. [PMID: 22464737 DOI: 10.1016/j.apmr.2012.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the determinants of postural imbalance after stroke in geriatric patients admitted for low-intensity rehabilitation in skilled nursing facilities (SNFs), particularly the role of multimorbidity. DESIGN Cross-sectional study design. SETTING Fifteen SNFs. PARTICIPANTS All patients who were admitted for rehabilitation after stroke in one of the participating SNFs (N=378) were eligible. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Berg Balance Scale (BBS) was selected as a measure of standing balance and the Functional Ambulation Categories (FAC) as a measure of walking balance. RESULTS Multimorbidity was present in 34% of the patients. The patients with multimorbidity differed from the patients without multimorbidity with respect to age, proprioception, and vibration sense, but not for any of the cognitive tests, muscle strength, or sitting balance. Patients with multimorbidity had, on average, lower scores on both outcome measures. In linear regression analyses, both the BBS and FAC were best explained by multimorbidity, muscle strength, and the interaction between muscle strength and static sitting balance (overall explained variance 66% and 67%, respectively), while proprioception added only to the variance of the FAC. CONCLUSIONS Multimorbidity was independently related to postural imbalance after stroke in patients admitted for rehabilitation in SNFs. Muscle strength and the interaction of muscle strength with static sitting balance were important determinants of both standing and walking balance, indicating these factors as essential targets for rehabilitation.
Collapse
Affiliation(s)
- Monica Spruit-van Eijk
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|