A LONG-TERM FOLLOW-UP OF STROKE PATIENTS

Background and Purpose Two hundred ninety-one residents of southeast L ondon, younger than 75 years, suffered their first stroke in 1989/1990 . The objectives of this study were to determine the long-term outcome of this cohort of stroke patients in terms of impairment, disability, handicap, and quality of life and their use of services and preventio n measures subsequent to their stroke. Methods The survivors and their identified caregivers were traced and completed a structured intervie w questionnaire that included the Barthel Index, modified Rankin Scale , Hospital Anxiety and Depression Scale (HAD), Mini-Mental State Exami nation, Frenchay Activities Index, and Caregiver Strain Index. Results One hundred twenty-three people (42%) were alive, of whom 106 were in terviewed. The mean interval between the stroke and the long-term foll ow-up was 4.9 years. Thirty-one of the survivors (29%) were severely o r moderately disabled, 39 (37%) were mildly disabled, and 36 (34%) wer e functionally independent. Of the 96 people who completed the HAD, 35 (36%) had scores suggesting that they were depressed or had borderlin e depression. The most likely nontherapy services to have been provide d were chiropody and district nursing. Five people had received respit e care. Of the 104 subjects for whom information about their home was available, 53 (51%) had had an adaptation. Seventy-five people (71%) h ad an aid or appliance. Sixty-five people (61%) were on aspirin, and a n additional 14 (13%) were on warfarin. Fifty subjects (47%) identifie d a main caregiver. No one with a moderate or more severe disability w as living at home without an identified caregiver. Conclusions The lev els of both health and social service provision are likely to be inade quate for this population. The use of prevention measures is encouragi ng. There is a clear need for a coordinated policy to guide assessment and management across sectors.