RESEARCH TO PRACTICE
Rehabilitation of Elders over 85 after a Stroke
Lieberman, D. & Lieberman, D. (2005). Rehabilitation following stroke in patients aged 85 and above. Journal of Rehabilitation Research & Development 42, 1, 47-54.
Devora Lieberman, M.D. and David Lieberman, M.D. found very little research has been reported on elders 85 and older. Generally research has been limited to those under 80 years. This prospective study compares elders who have had a stroke and are 85 years old and up to younger elderly patients who have suffered a stroke.
Stroke is common in the elder population with many of them requiring rehabilitation. Rehabilitation’s goal is to return an individual, as closely as possible, to the functional capacity they enjoyed prior to having the stroke. The study took place in the geriatric ward of the Soroka Medical Center in Beer-Sheva, Israel over 86 months. Two groups of residents were considered. One group aged 75 to 84 years and the second aged 85 years and older were assessed. Only patients found to require rehabilitation and who were reasonable candidates for relatively short-term rehabilitation (8 weeks or less) were enrolled in the study.
The rehab program was identical for the two age groups of patients. All underwent an identical conventional rehabilitation program. The program included one-hour daily of physical therapy and one-hour daily of occupational therapy for five days each week. Staff decided on an individual basis whether the hour would be continuous or divided into two 30-minute sessions, one in the morning and one in the evening.
The Functional Independence Measure (FIM) scale was used. Successful rehabilitation was defined as FIM > 80 at discharge. Forty-percent of the 85+ elders compared with 52% of the younger elders benefited significantly from the rehabilitation. It appears that if the investment of resources to rehabilitate patients under 85 years of age is justified an investment in patients above this age limit is not much less justified.
No significant differences were found between the groups in any other parameters. No differences in the length of rehabilitation and complications rates were found between groups.
The researchers “conclude that patients in the 85+ group who are carefully selected fro rehabilitation following stroke are similar in most basic clinical, mental, and functional characteristics to younger elderly populations undergoing the same process. The length of rehabilitation and the rate of complications are similar in the two groups. Although the success rate for rehabilitation is lower in the oldest old, the results still appear to justify the effort invested in rehabilitation in the 85+ group, at least no less than that in the younger elderly group.”
Implications: It appears that age should not be a criteria for determining whether rehabilitation is selected after a person has had a stroke.