Young and Forster highlight the benefits of a devoted stroke unit.1 However, the advantages of specialised rehabilitation for unselected elderly patients are less widely accepted.
With distinct stroke and general geratology rehabilitation units, we were able to conduct a retrospective study investigating the impact of rehabilitation on functional status of general geratology patients. Case notes of 95 patients were reviewed (31% male, average age 85, average length of stay 52 days). Patients were referred from a variety of specialties (acute general medicine (72%), trauma (11%), non-orthopaedic surgery (5%)) and the reason for initial admission to hospital was categorised as fall or musculoskeletal injury (30%), infection or acute confusional state (29%), other medical problem (31%), or surgical problem (5%).
All patients were assessed and managed by a dedicated team of doctors, nurses, physiotherapists, occupational therapists, pharmacists, speech and language therapists, and dietitians. The average Barthel index on admission to the rehabilitation unit was 9, compared with 12 on discharge; 45% reached a functional capacity allowing discharge straight to their pre-admission home. The positive effect on functional status was significant (P<0.0001) and, importantly, independent of the acute diagnosis precipitating admission.
Running a dedicated unit may be expensive, but by avoiding nursing home admission, it has been shown to actually reduce the overall cost of care.2
Competing interests: None declared.
References
- 1.Young J, Forster A. Review of stroke rehabilitation. BMJ 2007;334:86-90.(13 January) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Phibbs CS, Holty JEC, Goldstein MK, Garber AM, Wang Y, Feussner JR, et al. The effect of geriatrics evaluation and management on nursing home use and health care costs. Results from a randomised trial. Med Care 2006;44:91-5. [DOI] [PubMed] [Google Scholar]