Journal of the American Medical Directors Association
Original StudyInstitutionalized Stroke Patients: Status of Functioning of an Under Researched Population
Section snippets
Study Design
From May 2008 to July 2009 a cross-sectional, observational study design was used to collect data about functioning of stroke patients who received long term care in Dutch NHs. We approached 22 NHs in the Northern, Middle, and Western parts of The Netherlands of which 17 agreed to participate. The study protocol was approved by the medical ethics committee of the VU University Medical Center.
Patient Selection
Institutional long term care in The Netherlands is differentiated into somatic and psychogeriatric care,
Results
We collected data of 284 residents, of which 10 cases were excluded because of incomplete questionnaires. The number of residents per NH ranged from 3 to 31. Table 1 shows the resident and stroke characteristics of the total sample. Age was rather normally distributed (mean 76.6 ± 10.6, median 78 years). In 7.5% of the residents the stroke was not specifically located in the left or right hemisphere, due to for example bilateral or multi-infarcts. The distribution of time post-stroke was skewed
Discussion
As part of our aim to develop an integrated care and treatment program for institutionalized stroke patients tailored to their needs, we explored the functioning of this population in multiple domains. The main findings are that (1) almost 60% of the residents are in pain, (2) nearly half of the residents have moderate or severe cognitive impairment, (3) irritability, depressive symptoms and apathy occur as the most frequent neuropsychiatric symptoms, (4) more than a quarter of the residents
Conclusion
This study among institutionalized stroke patients in Dutch NHs revealed very high prevalence of impairments on all domains of functioning. Above the well-known severe disabilities in basic ADL, many residents suffered from pain and many had neuropsychiatric problems. A substantial proportion had poor expressive abilities, and there were many residents with severe cognitive impairment in the context of the somatic wards where they resided. The monitoring and management of both pain and
Acknowledgments
The authors thank all the residents and personnel of the Dutch nursing homes who made this study possible: Zorgcombinatie Nieuwe Maas, location het Zonnehuis (Vlaardingen), Argos Zorggroep, locations DrieMaasStede (Schiedam) and DrieMaasHave (Maassluis), Zonnehuisgroep Amstelland, location het Zonnehuis (Amstelveen), Zorgcombinatie Zwolle, location het Zonnehuis, Zorggroep Solis, location PW Janssen (Deventer), Zorggroep Apeldoorn e.o, location Randerode, Quarijn, location het Zonnehuis Doorn,
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The authors declare that they have no competing interests.