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.
"Rehabilitation is reported to improve functional outcomes across a wide range of diagnoses with multiple demographic, clinical and social-cultural variables associated with primary functional outcome (Ng, Jung et al., 2007). Rehabilitation has been reported benefi cial in stroke (Tan, 1983), elderly (Fong et al., 1987; Ee et al., 1991) and young stroke patients (Kong et al., 1995) and those with brainstem stroke (Chua and Kong, 1996). Post-stroke depression was reported to be 55% (Ng et al., 1995) but decreased to 29% on discharge (Loong et al., 1995). "
[Show abstract][Hide abstract] 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 · 0.78 Impact Factor
[Show abstract][Hide abstract] 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. · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the predictors of hospital length of stay (LOS) of stroke patients at the point of admission.
A retrospective cohort study.
An acute hospital rehabilitation center in Singapore.
Stroke patients (N=491) admitted between March 2005 and December 2006.
Rehabilitation LOS was calculated as the total number of rehabilitation days before discharge. We measured the functional status of patients by using the Functional Independence Measure (FIM).
The median LOS was 29 days (mean = 30.8d). Independent clinical and sociodemographic characteristics found to significantly predict rehabilitation LOS were FIM motor score at admission, the presence of more than 3 comorbid conditions at admission, living with nonimmediate relatives before admission, and the hospital subsidy status of the patient. In particular, the admission FIM motor score explained 43% of the variation in LOS and decreased the LOS by approximately 1.1 days for each 1-point increase in score.
Patients' socioeconomic status and family structure was found to influence LOS and should be considered in allocating resources and determining treatment need. The extent of motor function of patients at admission is an important factor influencing rehabilitation LOS and is a useful tool for facilitating rehabilitation resource planning for stroke patients.
Archives of physical medicine and rehabilitation 08/2009; 90(7):1202-7. DOI:10.1016/j.apmr.2009.01.027 · 2.57 Impact Factor
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