Predicting Stroke Re-hospitalization

Depression and your post stroke social support may lead to rehospitalization

(RxWiki News) Certain easy-to-watch factors may predict which stroke patients are at risk of being rehospitalized. Pinpointing those factors can help doctors treat or more closely watch those at the highest risk.

Stroke patients that receive in-patient rehabilitation are more likely to wind up back in the hospital within three months if they have poor functioning, are depressed or have little social support.

"Talk to a psychiatrist if you have symptoms of depression."

Dr. Kenneth Ottenbacher, director of the Center for Rehabilitation Sciences at the University of Texas Medical Branch (UTMB) at Galveston, and associate director of the UTMB Sealy Center on Aging, said that identifying clear demographic, clinical and environmental factors that may lead to rehospitalization helps doctors develop quality indicators to improve care after a stroke and reduce the likelihood of readmission.

He said that currently more than 30 percent of stroke patients receive in-patient rehabilitation after release from acute care. While doctors intuitively knew depressed and isolated patients were at a higher risk, data did not previously exist to support this, Dr. Ottenbacher said.

Older adults rehospitalized within 30 days of discharge cost Medicare about $18 billion each year. Most previous research examined only Medicare data, which has more detailed payment information than patient data.

During the study researchers enrolled 700 patients suffering a first-time stroke at nine U.S. medical facilities between 2005 and 2006. Patients were interviewed upon hospital discharge, 72 hours after discharge and three months later regarding demographic information, functional status, symptoms of depression and social support.

They also were asked about stroke type, length of rehabilitation, previous medical history and rehospitalization.

Investigators found that 18 percent of patients were rehospitalized during the initial three months. Patients who had reported stronger social support, fewer symptoms of depression and better motor and cognitive abilities were less likely to be rehospitalized.

Social support was pinpointed as one of the most important predictors because it can help identify patients who may benefit from supportive services such as home health care.

Caucasian patients suffering from depression were 21 percent more likely to be rehospitalized, while minorities with symptoms of depression were found to be 5 percent less likely to be rehospitalized.

The difference between the groups was considerably smaller after researchers considered racial variables, the presence of other medical conditions, and the fact that the study had a small number of minority participants. Investigators plan additional research on the topic since the initial findings suggested there could be differences, which would allow for more personalized care.

"Though this disparity did not hold up in our study after adjusting for sample size, we were surprised by the preliminary finding and believe it is an important topic for future research in a larger minority population," Dr. Ottenbacher noted.

The study was published in The Journals of Gerontology Series A: Biological Sciences and Medical Sciences.

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Review Date: 
April 6, 2012