STROKE REHABILITATION UNITS - DO ELDERLY STROKE PATIENTS BENEFIT

Despite increasing costs of stroke management in patients aged over 75 years, the advantages of stroke rehabilitation units over geriatric wards remain equivocal. A prospective controlled study was undertaken in 144 stroke survivors over 75 years. These patients were stratified into 3 groups according to prognosis 2 weeks after stroke. Patients were randomly allocated to a stroke rehabilitation unit (n = 71) or to mixed (acute and rehabilitation) geriatric wards (n = 73) and managed according to existing practices in either setting. Both groups were comparable in baseline characteristics. Patients on geriatric wards received more physiotherapy on average(18.4 +/- 9.6 vs 15.2 +/- 6.7 h, p<0.05) but similar occupational therapy (10.4 +/- 3.1 vs. 10.7 +/- 2.4 h) compared with stroke rehabilitation unit patients. Then was no difference in the proportion of time spent on different rehabilitation activities. Patients managed on geriatric wards showed higher mortality (p < 0.05), especially in those with poor prognosis. The median length of stay (84 vs. 36 days, p < 0.001) was also longer in patients managed on geriatric wards, especially in patients with intermediate or poor prognosis. Median discharge Barthel scores (14 vs. 13) and the percentage of patients going home (65 vs. 59%) were comparable in both settings. Functional outcome of stroke rehabilitation was comparable between the stroke unit and mixed geriatric wards. Stroke rehabilitation units have the advantage of reducing late mortality due to systemic complications and the length of hospital stay in elderly stroke survivors.