Ricauda Nicoletta Aimonino, Bo Mario, Molaschi Mario, Massaia Massimiliano, Salerno Dominga, Amati Dario, Tibaldi Vittoria, Fabris Fabrizio
Department of Medical and Surgical Science, Section of Gerontology, University of Turin, Italy.
J Am Geriatr Soc. 2004 Feb;52(2):278-83. doi: 10.1111/j.1532-5415.2004.52069.x.
To evaluate whether home treatment of elderly patients with acute uncomplicated first ischemic stroke is associated with different mortality rates and clinical outcomes from those of patients treated on a general medical ward (GMW).
Randomized, controlled, single-blind trial.
S. Giovanni Battista Hospital of Turin.
One hundred twenty elderly patients admitted to the emergency department of the hospital with first acute ischemic stroke were randomized to home treatment from a geriatric home hospitalization service (GHHS) or to GMW treatment.
Main outcome was cumulative survival at 6 months in the two groups. Residual functional impairment, neurological deficit, depression, morbidity, and admission to rehabilitation and long-term care facilities were considered as secondary outcomes in survivors.
One hundred twenty patients (mean age 82; 54 men and 66 women) were enrolled (60 in each study arm). The cumulative proportion of cases surviving at 6 months was 0.65 in the GHHS group and 0.60 in GMW group (log-rank test P=.53). Functional and neurological parameters were significantly improved in both GHHS and GMW patients, without significant differences between the two groups. Depression score was significantly better in home-treated patients (P<.001), who were more likely to remain at home at 6 months than hospital-treated patients and had a lower rate of select medical complications.
Home-treated elderly patients with ischemic stroke have better depressive scores and lower rates of admission to nursing homes. These results should prompt further studies to evaluate home hospitalization for elderly stroke patients.
评估老年急性单纯性首次缺血性卒中患者的居家治疗与普通内科病房（GMW）治疗患者的死亡率及临床结局是否存在差异。
随机对照单盲试验。
都灵的圣乔瓦尼·巴蒂斯塔医院。
120名因首次急性缺血性卒中入住该院急诊科的老年患者被随机分为接受老年居家住院服务（GHHS）的居家治疗组或GMW治疗组。
主要结局是两组患者6个月时的累积生存率。幸存者的残余功能障碍、神经功能缺损、抑郁、发病率以及入住康复和长期护理机构的情况被视为次要结局。
共纳入120例患者（平均年龄82岁；54名男性和66名女性）（每个研究组60例）。GHHS组6个月时存活病例的累积比例为0.65，GMW组为0.60（对数秩检验P = 0.53）。GHHS组和GMW组患者的功能和神经学参数均显著改善，两组间无显著差异。居家治疗患者的抑郁评分显著更好（P<0.001），与住院治疗患者相比，他们在6个月时更有可能居家，且特定医疗并发症的发生率更低。
居家治疗的老年缺血性卒中患者抑郁评分更好，入住养老院的比例更低。这些结果应促使进一步研究以评估老年卒中患者的居家住院治疗。
