Does age affect benefits of stroke unit rehabilitation?

Abstract

The influence of age on benefits of stroke unit rehabilitation is largely unknown. A prospective controlled study was undertaken in 245 stroke survivors randomized to a stroke unit or to general wards 2 weeks after stroke. Patients were divided into older (75 years and over) and younger (under 75 years) age groups, and their characteristics, prognosis, duration, and type of therapy input and outcome were compared in different settings. Younger (n = 101) and older (n = 144) stroke patients were comparable for neurological and functional deficits and were distributed equally between the stroke unit and general wards. The duration of therapy input was similar in younger patients in either setting. Older patients received more occupational therapy in both settings (10.7 +/- 2.4 versus 7.9 +/- 04.1) and more physiotherapy (18.4 +/- 9.6 versus 15.2 +/- 7.8) on general wards. Younger patients on the stroke unit showed better outcome compared with those on general wards (discharge home, 83% versus 60%; median Barthel score, 17 versus 13; median length of hospital stay, 27 versus 56 days) and with older patients on the stroke unit (discharge home, 83% versus 65%; median Barthel score, 17 versus 14). Outcome in older stroke patients was similar in both settings except for a shorter median length of hospital stay on the stroke unit (36 versus 84 days). Outcome in younger patients managed on general wards was worse than that in older patients with similar prognostic expectations (discharge home, 41% versus 61%; median Barthel score, 11 versus 13). Younger stroke patients benefited more by stroke unit rehabilitation compared with older patients, not only because of their age but also because of differences in the multidisciplinary input available for elderly patients outside the stroke unit.