Unit of Neurology, University Hospital of Verona, Verona, Italy.
Division of Neurologic, Cardiologic, and Pneumological Rehabilitation, European Institute of Rehabilitation, Isernia, Italy.
Eur J Phys Rehabil Med. 2019 Apr;55(2):148-155. doi: 10.23736/S1973-9087.18.05297-8. Epub 2018 Aug 29.
Considering the demographic trend, characterized by a marked aging due to the increase in life expectancy and the improvement in medical care, in the next future elderly patients will represent the majority of stroke victims with a strong impact on rehabilitative services.
To investigate and characterize differences in functional outcome in elderly patients after stroke.
Observational study.
Post-acute inpatient rehabilitation.
Subjects aged ≥65 years with acute (i.e. within 30 days from onset) ischemic or hemorrhagic stroke.
At admission, all patients underwent neurological and clinical examination, functional evaluation and laboratory assessment. Comorbidities and clinical complications during hospital stay were recorded. Functional status was evaluated by means of the Functional Independence Measure (FIM) administered at admission and discharge. All patients underwent neuromotor rehabilitation, and speech therapy in case of aphasia, once a day, six days per week.
The study enrolled 402 patients, who were stratified in three groups according to age: 145 patients in Group 1, the young-old (65-74.9 years, G1), 206 in Group 2, the middle-old (75-84.9 years, G2) and 51 in Group 3, the oldest-old (≥85 years, G3). At discharge, FIM total scores increased significantly for all the groups (P<0.001); however FIM gains, as well as the efficiency parameters derived from FIM were significantly lower in G3 when compared with G1 and G2. G3 showed a significantly higher rate of comorbidities and a higher presence of pressure sores; infections occurred mainly in G2 and G3. Hospitalization was significantly longer for G1 and G2 with respect to G3, while mortality rates were significantly higher in G2 and G3 with respect to G1. The variables that predicted functional outcome were age, previous stroke, stroke severity and functional status at admission.
Despite advancing age seems to be associated with a reduced effectiveness of the rehabilitation process and a greater number of complications, intensive rehabilitation can produce significant functional gains for all stroke survivors, regardless of age.
Understanding the specificity of this population will offer older subjects targeted interventions and, for health systems, better allocation of resources and the development of more effective approaches.
考虑到人口趋势，由于预期寿命的延长和医疗保健的改善，人口老龄化明显，在未来，老年患者将成为中风患者的大多数，这对康复服务产生重大影响。
调查和描述老年中风患者的功能结局差异。
观察性研究。
急性住院康复后。
年龄≥65 岁的急性（即发病后 30 天内）缺血性或出血性中风患者。
入院时，所有患者均接受神经和临床检查、功能评估和实验室评估。记录住院期间的合并症和临床并发症。功能状态通过入院和出院时进行的功能独立性测量（FIM）进行评估。所有患者均接受神经运动康复治疗，如果有失语症，则接受言语治疗，每天一次，每周六天。
该研究共纳入 402 名患者，根据年龄分为三组：145 名患者在第 1 组（65-74.9 岁，G1），206 名患者在第 2 组（75-84.9 岁，G2），51 名患者在第 3 组（≥85 岁，G3）。出院时，所有组的 FIM 总分均显著增加（P<0.001）；然而，与 G1 和 G2 相比，G3 的 FIM 获益以及从 FIM 得出的效率参数显著较低。G3 的合并症发生率和压疮发生率明显较高；感染主要发生在 G2 和 G3。与 G3 相比，G1 和 G2 的住院时间明显更长，而 G2 和 G3 的死亡率明显高于 G1。预测功能结局的变量是年龄、既往中风、中风严重程度和入院时的功能状态。
尽管年龄增长似乎与康复过程效果降低和并发症增多相关，但强化康复可以为所有中风幸存者带来显著的功能获益，无论年龄大小。
了解这一人群的特殊性将为老年患者提供针对性干预措施，为卫生系统提供更好的资源分配，并开发更有效的方法。
