[Neuroemergency and rehabilitation--consideration of a comprehensive stroke care system in the community]

According to the data-bank on the patients with acute illness transferred to the emergency hospitals in Nagasaki city and surrounding towns (population: approximately 550,000, 18-22% of the patients were aged 65 years and more), the number of stroke patients per year has been the highest among those patients each year from 1998 to 2007. And over 50% of these stroke patients were 70 years or more. These results suggest that care of elderly patients who have had stroke is a main community-wide concern in emergency medicine. Further, it is well known that older patients who suffer an acute illness and are consequently hospitalized often become physically dependent; this greatly influences to prognosis and the quality of life. In addition, older patients are probably undernourished, and their immune system tends toward functional decline. Therefore, to maximize the effectiveness of stroke care and to improve its outcome in terms of functional effectiveness, it is critical that hospital management of acute stroke patients focuses not only on stroke-specific medical care, but also on the nutritional interventions and rehabilitation offered by a multidisciplinary team. And after acute medical treatment, stabilization, nutrition interventions, and early rehabilitation, patients with disability could be transferred to kaifukuki- rehabilitation wards, in where measures to overcome their disabilities (impairments, activity limitations and also participation restrictions) can be taken by a interdisciplinary team, which can provide effective enriched rehabilitation. Eventually, these patients could be discharged and sent either home, or to care houses, community-based long-term rehabilitation center or to hospital-based long-term rehabilitation center.