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 w ards remain equivocal. A prospective controlled study was undertaken i n 144 stroke survivors over 75 years. These patients were stratified i nto 3 groups according to prognosis 2 weeks after stroke. Patients wer e randomly allocated to a stroke rehabilitation unit (n = 71) or to mi xed (acute and rehabilitation) geriatric wards (n = 73) and managed ac cording to existing practices in either setting. Both groups were comp arable in baseline characteristics. Patients on geriatric wards receiv ed more physiotherapy on average(18.4 +/- 9.6 vs 15.2 +/- 6.7 h, p<0.0 5) but similar occupational therapy (10.4 +/- 3.1 vs. 10.7 +/- 2.4 h) compared with stroke rehabilitation unit patients. Then was no differe nce in the proportion of time spent on different rehabilitation activi ties. 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 o n geriatric wards, especially in patients with intermediate or poor pr ognosis. Median discharge Barthel scores (14 vs. 13) and the percentag e of patients going home (65 vs. 59%) were comparable in both settings . Functional outcome of stroke rehabilitation was comparable between t he stroke unit and mixed geriatric wards. Stroke rehabilitation units have the advantage of reducing late mortality due to systemic complica tions and the length of hospital stay in elderly stroke survivors.