Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom.
Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.
J Am Geriatr Soc. 2018 Jan;66(1):161-169. doi: 10.1111/jgs.15101. Epub 2017 Oct 9.
BACKGROUND/OBJECTIVES: Stroke is a leading cause of disability worldwide, and a significant proportion of stroke survivors require long-term institutional care. Understanding who cannot be discharged home is important for health and social care planning. Our aim was to establish predictive factors for discharge to institutional care after hospitalization for stroke.
We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42015023497) of observational studies. We searched MEDLINE, EMBASE, and CINAHL Plus to February 2017. Quantitative synthesis was performed where data allowed.
Acute and rehabilitation hospitals.
Adults hospitalized for stroke who were newly admitted directly to long-term institutional care at the time of hospital discharge.
Factors associated with new institutionalization.
From 10,420 records, we included 18 studies (n = 32,139 participants). The studies were heterogeneous and conducted in Europe, North America, and East Asia. Eight studies were at high risk of selection bias. The proportion of those surviving to discharge who were newly discharged to long-term care varied from 7% to 39% (median 17%, interquartile range 12%), and the model of care received in the long-term care setting was not defined. Older age and greater stroke severity had a consistently positive association with the need for long-term care admission. Individuals who had a severe stroke were 26 times as likely to be admitted to long-term care than those who had a minor stroke. Individuals aged 65 and older had a risk of stroke that was three times as great as that of younger individuals. Potentially modifiable factors were rarely examined.
Age and stroke severity are important predictors of institutional long-term care admission directly from the hospital after an acute stroke. Potentially modifiable factors should be the target of future research. Stroke outcome studies should report discharge destination, defining the model of care provided in the long-term care setting.
背景/目的：卒中是全世界范围内导致残疾的主要原因，相当一部分卒中幸存者需要长期机构护理。了解哪些患者不能出院回家，对于医疗保健和社会护理规划非常重要。我们的目的是确定卒中住院患者出院后入住机构护理的预测因素。
我们对观察性研究进行了注册和系统综述及荟萃分析（PROSPERO：CRD42015023497）。我们检索了 MEDLINE、EMBASE 和 CINAHL Plus，检索时间截至 2017 年 2 月。如果数据允许，我们进行了定量综合分析。
急性和康复医院。
新入院直接接受长期机构护理的卒中住院患者。
与新机构化相关的因素。
从 10420 条记录中，我们纳入了 18 项研究（n=32139 名参与者）。这些研究存在异质性，分别在欧洲、北美和东亚进行。8 项研究存在选择偏倚的高风险。从出院到新转入长期护理的患者中，存活并出院至长期护理机构的比例为 7%~39%（中位数为 17%，四分位间距为 12%），且长期护理机构所提供的护理模式并未明确界定。年龄较大和卒中严重程度与长期护理入院的需求呈一致的正相关。严重卒中患者入住长期护理机构的可能性是轻度卒中患者的 26 倍。65 岁及以上的患者发生卒中的风险是年轻患者的 3 倍。很少有研究检查潜在的可改变因素。
年龄和卒中严重程度是急性卒中医院直接转入机构长期护理的重要预测因素。潜在的可改变因素应该是未来研究的目标。卒中结局研究应报告出院去向，明确长期护理机构所提供的护理模式。
