Survival, disability, and residence 20 months after acute stroke in a Chinese population: implications for community care

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Abstract
A total of 304 Chinese patients with acute stroke were assessed at 3 and 20 months to determine survival, disability, and place of residence, and so to provide an estimate of the impact on community care resources. Approximately 30% of patients had died by 3 months; thereafter the mortality rate decreased, with a further 13% dying by 20 months. Age, rather than stroke subtype, determined the likelihood of death. Fifty-seven per cent of 3-month survivors were independent at 20 months, with only 18% moderately to severely disabled (Barthel Index < 15). Thirteen per cent of patients improved and 14% deteriorated between 3 and 20 months. Older subjects had a lower Barthel Index at 20 months, and were more likely to show deterioration. Seventeen per cent of patients were living in institutions by 20 months, predisposing factors being age and mental test score. Although a low Barthel Index was a factor in univariate analysis, it did not contribute to the discriminant function model for predicting institutionalization, and nor did previous stroke, coexisting cardiovascular diseases, or diabetes mellitus influence eventual placement. Approximately 30% of patients were readmitted during the follow-up period, particularly elderly patients and those with a Barthel Index < 15. Although only 9% of the original cohort required institutional care by 20 months, approximately half of all the government nursing home places in Hong Kong are likely to be taken up by these patients because of the large number of strokes occurring each year.