Prestroke physical function predicts stroke outcomes in the elderly

OBJECTIVE: To determine whether physical function before stroke is an independent predictor of physical function and institutionalization 6 months after discharge from hospital in elderly stroke patients. DESIGN: Population-based prospective cohort design where incidence of stroke was monitored from 1982 through 1988. Baseline demographic and health information including prestroke function was collected prospectively. Eligible subjects who had a stroke were interviewed 6 months after discharge from hospital to assess outcomes. SETTING: New Haven, Connecticut. PATIENTS: Subjects were recruited from an initial sample of 2,812 older adults. Of 79 subjects who survived a first stroke at 6 months postdischarge, complete follow-up data were obtained on 63 subjects. MAIN OUTCOME MEASURE: Physical function as measured by the Katz scale and institutionalization. RESULTS: Fewer limitations in activities of daily living before stroke were associated with fewer limitation in physical function after stroke controlling for stroke severity and other relevant health and sociodemographic conditions (p < .01). Fewer limitations in gross mobility function before stroke were also independently associated with a lower risk of institutionalization (p < .05). CONCLUSION: This study provides useful information in assessing the prognosis of elderly stroke patients upon admission to hospital. It also supports the concept of general frailty being a risk factor for poorer health and institutionalization overall in aged persons. Studies have shown that factors related to physical frailty, such as decline in muscle function, can be reversed. The effect of interventions aimed at improving the physical function of the elderly on stroke incidence, stroke outcomes, and all-cause mortality, however, needs to be determined.