J. C. Brocklehurst

Incidence and Correlates of Incontinence in Stroke Patients

The incidence of incontinence in a series of 135 consecutive stroke patients was 51% (urine) and 23% (feces) within one year. In 75% the urinary incontinence started within the first two weeks, and in 41% it had cleared during that time. Incontinence at onset is associated with measures of severity of stroke (and of immobility for fecal incontinence). Among 92 survivors at one year, 15% were incontinent of urine, a proportion that rose in two‐ and three‐year survivors to 23 to 24%, but by four years was again 14%, a level similar to that of the general elderly population. It is concluded that incontinence is more commonly a by‐product of immobility and dependency than of involvement of the neurologic pathways, and most of it is transient. J Am Qeriatr Soc 33:540, 1985

The rate of recovery from stroke - and its measurement

A battery of tests to measure improvement over time in physical recovery of stroke patients - and to compare this with varying levels of disability at onset, is described. Recovery in a series of 135 patients with fresh stroke treated by traditional methods of rehabilitation is principally in the first 3 months - but also continues in the second 3 months, except for muscle power. Recovery after 6 months is least in muscle power and is limited mainly to walking and mobility (e.g. getting out of the house) which in some cases may be due to altered environmental factors. At onset only 62 per cent showed moderate or severe impairment of muscle power compared to 88 per cent with similar impairment in mobility and dependency. By 1 year 30 per cent of survivors remained dependent.

The influence of age on the clinical presentation and outcome of stroke

Of 135 patients who survived the first 2 weeks following a stroke 25% were under the age of 65 years, 40% between 65 and 74 years and 35% were 75 years of age or older. Those under 65 years had a lower incidence of a previous history of lower limb arthritis, balance problems, and limited mobility but a greater incidence of ischaemic heart disease than those 65 years and over. This younger age group had a lower mortality and were more likely to progress beyond severe degrees of disability. However, if only those who survived the first year are included, then there was no difference in outcome between the age groups. In none of the parameters studied was there any difference between those 65 to 74 years of age and those 75 years and over. It was, however, those over the age of 74 years who were more likely to require long-term institutional care. These findings suggest that, although elderly 1-year survivors had a similar level of functional recovery to younger patients, other factors, probably social, affected the eventual placement of stroke patients.