Poststroke discharge destination: functional independence and sociodemographic factors in urban Japan

To assess how functional independence and sociodemographic factors influence discharge destination of patients recovering from stroke in urban Japan. Patients recovering from first-ever stroke (supratentorial lesions) discharged from a long-term rehabilitation hospital. Scores for individual patients were collected at both admission and discharge for the motor components of the Functional Independence Measure (FIM-m), and FIM-m increase was ascertained; patients were also surveyed to gather data for explanatory variables: age, sex, type of stroke, length of hospital stay, number of people in the household, co-residence with a spouse, and number of sons/daughters. Outcomes were defined as dichotomous categories, discharge to home versus to a nursing home. Logistic analyses were performed on these data. Of the 163 patients enrolled in the study, 123 were discharged to home and 40 were discharged to a nursing home. Analyses showed that older age and lower FIM-m scores at both admission and discharge were associated with greater probability of discharge to a nursing home. The number of children, including sons/daughters living in separate households, had no statistically significant relationship to discharge destination. Patients without a spouse at home who lived in less populous households were more likely to be discharged to a nursing home. Meanwhile, improvement in FIM-m score was not statistically significantly related to discharge destination. Our findings indicate that level of functional independence and number of co-resident household members are powerful predictors of discharge destination. For patients with a lower level of functional independence, the presence of a social network to provide support and care is a decisive factor in discharge to home.