[Patient characteristics and factors associated with unfavourable in-hospital rehabilitation therapy outcome in very old geriatric patients with first-ever ischemic stroke--a retrospective case-control study].

AIM: A retrospective case-control study was performed to evaluate patient characteristics or other factors possibly predicting unfavourable outcome of rehabilitation therapy in geriatric stroke patients. A total of 47 patients with first-ever ischaemic stroke were included in each group, mean age 81 years, 79% females, basic functional competence level </=65 points as assessed by the Barthel Index total score on admission. Per definition, the cases did not improve in functional competence level or even deteriorated during the hospital stay, whereas the patients of the control group increased in Barthel Index total score level by at least 10 points.
METHODS: Beginning on January 1, 2003, patients were recruited from all consecutively admitted patients using the data from the hospital information system and information from the Gemidas project (quality assurance system). From the complete case notes, information was extracted on grade of neurological deficit, particular clinical signs and stroke symptoms, relevant comorbidity, medication at the time of patients' death or hospital discharge, complications including its therapeutic consequences, and patients' discharge destination. We performed uni-variate comparisons and a logistic regression analysis.
RESULTS: Elderly in-hospital patients with first-ever ischaemic stroke and poor therapeutic outcome showed a high prevalence of severe neurological deficits and poor functional competence level on admission. During the hospital stay, these patients even suffered more often and more severe nonneurological and neurological complications. These were associated with high mortality and the need of further reference to other hospital clinical departments such as the intensive care unit. Hospital acquired infections accounted for more than half of the complications. Pneumonia, dementive diseases, and incontinence were the factors revealed to be associated with unfavourable therapeutic outcome.
CONCLUSIONS: The results of this retrospective evaluation shows that geriatric patients with first-ever ischaemic stroke with severe neurological deficits and poor functional competence level on admission suffered frequently from non-neurological and neurological complications. Particularly in elderly stroke patients with dysphagia, dementive diseases and/or cognitive impairment, there is a need of intensified preventive measures to avoid complications.