Risk of exclusion from stroke rehabilitation in the oldest-old

Publication date: Available online 7 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Paola Forti, Fabiola Maioli, Elisabetta Magni, Letizia Regazzoni, Roberto Piperno, Marco Zoli, Maura Coveri, Gaetano Procaccianti
ObjectiveTo investigate whether oldest-old age (≥85 yr) is an independent predictor of exclusion from stroke rehabilitation.DesignRetrospective cohort study.SettingStroke Unit (SU) of an Italian tertiary hospital.Participants1055 elderly patients (age 65-74 yr, n=230; age, 75-84 yr, n=432; age ≥ 85 yr, n=393), who, between 2009 and 2012, were admitted to SU with acute stroke and evaluated by a multiprofessional team for access to rehabilitation. The study excluded patients for whom rehabilitation was unnecessary or inappropriate.InterventionsNot applicable.Main Outcome MeasuresAccess to an early mobilization (EM) protocol during SU stay and subsequent access to post-acute rehabilitation after SU discharge. Analyses were adjusted for prestroke and stroke-related characteristics.Results32.2% of patients were excluded from EM. Multivariable-adjusted Odds Ratio (OR) of EM exclusion was 1.30 (95% CI: 0.76, 2.21) for age 75-84 yr and 2.07 (95% CI: 1.19, 3.59) for age ≥85 yr compared to age 65-74 yr. Of 656 patients admitted to EM and who, at SU discharge, had not yet fully recovered their prestroke functionally status, 18.4% were excluded from post-acute rehabilitation. For patients able to walk unassisted at SU discharge, probability of exclusion did not change across age groups. For patients unable to walk unassisted at SU discharge, OR of exclusion from post-acute rehabilitation was 3.74 (95% CI: 1.26, 11.13) for age 75-84 yr and 9.15 (95% CI: 3.05, 27.46) for age ≥85 yr compared to age 65-74 yr.ConclusionOldest-old age is an independent predictor of exclusion from stroke rehabilitation.



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