Disability, rehabilitation and after-care of stroke patients after discharge from hospital, Singapore 1983-84.
ABSTRACT 135 new onset stroke patients admitted over a nine-month period to a medical unit in Singapore were studied with emphasis on their rehabilitation and community care after discharge. Follow-up visits were made to 79 survivors at third month after onset. 16.7% of the patients made apparently complete recoveries, 20.3% remained slightly disabled, 21.5% moderately disabled, and the remaining 41.8% severely disabled. Sixty-five patients were staying in private households at third month follow-up. The main care-givers were usually female relatives. These informal carers assisted a large proportion of patients in various activities of living: 62.0% in dressing, 54.4% in walking and toileting, 30.4% in feeding, and 22.8% in turning in bed. The study establishes the need to develop and strengthen supportive services to enable disabled stroke patients to be cared for in their own homes. These include the home nursing service, elderly day care service, home help service, and meals-on-wheel service.
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ABSTRACT: Stroke is the fourth leading cause of death and the major cause of disability in Singapore. The number of stroke survivors is expected to rise with the increase in the ageing population. This paper describes how occupational therapists are involved in stroke and work rehabilitation in Singapore. A retrospective study of stroke clients referred to a vocational assessment unit in 2004 showed that 55% of the clients were able to return to work. The majority of the clients changed their job positions from blue-collar workers to clerical workers. On the other hand, the main reasons for poor outcome were: unfit to work in general, needed further rehabilitation, further medical care was indicated, failed to meet appointments and withdrawal from the job trial. Three case vignettes are discussed to illustrate the multifactorial aspects influencing positive work outcomes. Further research is needed in exploring the factors that affect stroke rehabilitation and return-to-work outcomes.Occupational Therapy International 06/2008; 15(2):87-99. DOI:10.1002/oti.248 · 0.67 Impact Factor
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ABSTRACT: To determine the pattern and frequency of elder abuse presenting to an urban Emergency unit in Singapore. The survey was conducted from May 1994 to December 1997. The patients consisted of adults who were 65 years or older who presented to the Emergency Department with non-accidental trauma or complained of other acts of cruelty. 17 cases of elder abuse were found, out of a total of 62,826 elderly patients. The frequency of elder abuse presenting to the Emergency Department was 0.03%. Elder abuse makes up 2.9% of all cases of family violence involving adults in this period. The average age was 74.6 years old. There was a predominance of Chinese females. In 58.8% the assailants were the daughter-in-law or son. 70.5% were ambulatory. Most (76.4%) had a chronic medical illness, commonly hypertension, diabetes mellitus, or both. Blunt musculoskeletal trauma, head or maxillofacial injuries were the commonest injuries encountered. Elder abuse is a significant subset of Family Violence. It may be more widespread than thought. Awareness of its occurrence is a first step in halting its progression.Singapore medical journal 01/2001; 41(12):571-4. · 0.63 Impact Factor
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ABSTRACT: This study determines the extent of, and factors associated with, delayed discharges for stroke patients from inpatient rehabilitation. A retrospective cohort study utilising medical notes review was conducted at an inpatient rehabilitation centre in Singapore. Acute stroke patients (n = 487) admitted between March 2005 and December 2006 were studied. The primary measure was delayed discharge defined as an extension in inpatient stay beyond the planned duration. Factors associated with delays in discharge were categorised as individual, caregiver, medical and organisational. There were a total of 172 delayed discharges (35.6%). The mean [standard deviation (SD)] length of stay was 40.5 days (SD, 19.5 days) and 25.8 days (SD, 11.4 days) for patients with delayed and prompt discharges, respectively. Mean extension of stay was 9.7 days (SD, 13.8 days). Caregiver-related reasons were cited for 79.7% of the delays whereas organisational factors (awaiting nursing home placement, investigations or specialist appointments) accounted for 17.4%. Four factors were found to be independently associated with delayed discharge: discharge to the care of foreign domestic helper, nursing home placement, lower admission Functional Independence Measure (FIM) motor score and discharge planning process. Our study suggests that caregiver and organisational factors were main contributors of delayed discharge. Targeted caregiver training and the provision of post-discharge support may improve the confidence of caregivers of patients with greater motor disability. The use of structured discharge planning programmes may improve the efficiency of the rehabilitation service. To reduce delays, problems with the supply of formal and informal post-discharge care must also be addressed.Annals of the Academy of Medicine, Singapore 06/2010; 39(6):435-41. · 1.22 Impact Factor