Tableaux de données probantes et liste de reference (en anglais)
Following a stroke event, when community-based supports are not available to support non-institutional living, people may enter a long-term care (LTC) institution. Independent predictors of discharge to a nursing home have been identified and include increasing age, increasing dependency for ADLs and absence of availability of a caregiver (Burton et al. 2018, Pereira et al. 2014, Brodaty et al. 2010, Portelli et al. 2005). The numbers of patients admitted to a long-term care facility, both immediately upon discharge from hospitals, and up to 10 years post stroke have been examined. Pooling the results from 18 studies, Burton et al (2018) reported a median of 17% of patients were transferred directly to a LTC facility following discharge from an acute care hospital with a diagnosis of stroke. Between 10% and 11% of patients admitted to an acute care hospital were residing at an LTC facility at one, three and 6 months following stroke (Chuang et al. 2005). Brodaty et al. (2010) followed 202 participants, mean age of 72 years, without dementia who had suffered an ischemic stroke. Among those who survived, nursing home admission rates were 24% at 5 years and 32% at 10 years. Walsh et al. (2008) reported that among a group of 136 patients admitted to a stroke unit of a single hospital (median age was 77 years), 40.3% of patients were institutionalized at 4 years.
Patients discharged to long term care require discharge planning much like individuals returning to their own homes. Several studies have examined factors for effective discharge communication between inpatient hospital care and institutional care facilities. Clear communication between facilities regarding nutritional needs, functional status, communication abilities, risk assessment, and medical management is necessary for an optimal transition (Sackley & Pound 2002; Sackley & Pound 2002).
Individuals residing in skilled nursing facilities with staff trained in stroke management, and who have access to post stroke therapy resources, may experience better quality of life. In a study (Brajkovic 2009) examining individuals living in a nursing home who received 24-hour care including access to psychiatric care, physician visits, daily physiotherapy, and weekly massage services, nursing home residents experienced greater quality of physical, psychological, social, and environmental quality of life scores compared with individuals living in their own homes receiving many of the same services. Individuals residing in nursing homes also experienced better perceived quality of life and health status than their residentially residing counterparts. However, the authors of a Cochrane review (Fletcher-Smith et al. 2013) stated there was insufficient evidence to support or refute the efficacy of occupational therapy interventions for improving, restoring or maintaining independence in ADL for persons with stroke residing in care homes.