BACKGROUND AND OBJECTIVES: Nationwide social inequalities of oral anticoagulation (OAC) usage after the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) have not been well identified in patients with atrial fibrillation (AF). This study assessed overall rate and social inequalities of OAC usage after the introduction of NOAC in Korea.METHODS: Between January 2002 and December 2016, we identified 888,540 patients with AF in the Korea National Health Insurance system database. The change of OAC rate in different medical systems after the introduction of NOAC were evaluated.RESULTS: In all population, overall OAC use increased from 13.2% to 23.4% (p for trend <0.001), and NOAC use increased from 0% to 14.6% (p for trend <0.001). Compared with pre-reimbursement (0.48%), the annual increase of OAC use was significantly higher after partial (1.16%, p<0.001), and full reimbursement of OAC (3.72%, p<0.001). Full reimbursement of NOAC (adjusted odds ratio, 2.10; 95% confidence interval, 2.04–2.15) was independently associated with higher OAC use. However, the difference of overall OAC usage between tertiary referral hospitals and nursing or public health centers increased from 17.9% in 2010 to 36.8% in 2016. Moreover, usage rate of NOAC was significantly different among different medical systems from 37.2% at the tertiary referral hospital and 5.5% at nursing or public health centers.CONCLUSIONS: Introduction of NOACs in routine practice for stroke prevention in AF was associated with improved rates of overall OAC use. However, significant practice-level variations in OAC and NOAC use remain producing social inequalities of OAC despite full reimbursement.
Anticoagulants ; Atrial Fibrillation ; Humans ; Insurance ; Korea ; National Health Programs ; Nursing ; Odds Ratio ; Public Health ; Socioeconomic Factors ; Stroke ; Tertiary Care Centers

BACKGROUND: The purpose of this study was to confirm the effects of a stroke education program for disease acceptance and knowledge among acute ischemic senior stroke patients.METHODS: This study used a nonequivalent control group non-synchronized design. The study was performed from September 8 to November 2, 2014. The subjects were selected as an experiment group of 28 people and a control group of 28 people from acute ischemic senior stroke patients at D hospital in B metropolitan city. The data were analyzed using χ² test and Mann-Whitney U test using SPSS WIN 19.0 program.RESULTS: 1. Disease acceptance score in the experimental group revealed to be significantly higher(Z=−4.568, p<.001) than that of the control group. Hypothesis 1 was accepted. 2. Knowledge score in the experimental group revealed to be significantly higher(Z=−4.740, p<.001) than that of the control group. Hypothesis 2 was accepted.CONCLUSION: The stroke education program can be used for nursing intervention and evidence-based research hereafter because it has been confirmed that the program develops higher disease acceptance and improves knowledge among acute ischemic senior stroke patients.
Education ; Humans ; Nursing ; Stroke

PURPOSE: The purpose of this study was to explore the influencing factors on the family caregivers burden who have has inpatients with acute stroke. METHODS: Subjects were 126 family caregivers who have has inpatients with acute stroke. Data were collected by questionnaires. The collected data were analyzed by t-test, ANOVA, Scheffe's test, Pearson's coefficients and multiple regression. RESULTS: The Anxiety of family caregivers was identified as a determinant of family caregivers burden who have has inpatients with acute stroke by the multiple regression analysis (β=.58, p<.001). Gender and low cognitive function of inpatients were significantly related to family caregivers burden. And knowledge about care (r=−.27, p=.002) was correlated with anxiety significantly. CONCLUSION: The family caregivers burden is not only an important issue for nursing but also major nursing problem to be addressed nurses. Family caregivers with acute stroke inpatients feel more anxiety than family caregivers with other illnesses. The anxiety of family caregivers is important especially to the family caregivers who have to care acute stroke inpatients to reduce their burden.
Anxiety ; Caregivers ; Cognition ; Humans ; Inpatients* ; Nursing ; Stroke*

Korea is one of the fastest aging country in the world. As the old population increases, incidence of stroke would rapidly increase. We estimated future of the neurologist supply in Korea, and assessed whether the present neurologist supply is appropriate to cope with future increase of stroke. We reviewed the resource database of neurologists affiliated to Korean Neurological Association. Age, sex, location of workplace, and work positions were identified. The stroke incidence was calculated from age group specific incidence data and projected age group number. Age group specific incidence data was adapted from the 2006 report of the Construction of National Surveillance System for Cardiovascular and Cerebrovascular Disease. Total 1,828 neurologists in practice were identified. Six hundred and fifty-five (30%) worked in training hospitals. 457 (21%) in other general hospitals, 305 (14%) in private clinics, and 148 (7%) worked in nursing hospitals. Assuming that the neurologists are trained 82 people per year as in the present, 2,073 neurologists would be present in 2020, 2,659 in 2030. However, stroke incidence would show more rapid increment, and is expected about 170,000 per year in 2020 and 300,000 per year in 2030. Therefore, there will be a shortage of neurologists needed for stroke care in the future. Because of rapid increase in the elderly population, current supply of neurologists may not meet the expected need for stroke care. Therefore, national health system needs more neurologists to cope with that situation.
Aged ; Aging ; Cerebrovascular Disorders ; Delivery of Health Care ; Hospitals, General ; Humans ; Incidence ; Korea ; Nursing ; Stroke

PURPOSE: We made a clinical comparison of elderly patients from home and residential aged care facilities (RACFs) who visited the emergency department and were hospitalized with acute ischemic stroke. In addition, we investigated the factors associated with prehospital delay in acute ischemic stroke. METHODS: A retrospective study was conducted in a public hospital between January 2013 and December 2016. Information regarding the patients was registered including gender, age, comorbidities, symptoms at onset, use of emergency medical services, National Institute of Health Stroke Scale (NIHSS) at the emergency department, symptom-to-door time, etc. Characteristics of the patients were analyzed and logistic regression analysis was conducted to identify factors associated with symptom-to-door time. RESULTS: A total of 402 patients were enrolled during the study period. Overall, 339 elderly patients visited from home and 63 patients from RACFs, and patients from home were divided into two groups, living with family (n=274) and living alone (n=65). Patients from RACFs were older (≤0.001) and had higher NIHSS (p=0.007) than patients from home, but there were no significant relationships between symptom-to-door time and age (p=0.525), NIHSS (p=0.428). There was no difference in symptom-to-door time between patients living with family and patients from RACFs, but patients living alone had delayed symptom-to-door time (p < 0.001). CONCLUSION: Elderly patients living alone were among the three groups that had the most delayed symptom-to-door time. Therefore, it is necessary to expand and supplement support for elderly patients living alone, as well as to improve education regarding acute ischemic stroke.
Aged ; Cerebral Infarction ; Comorbidity ; Education ; Emergency Medical Services ; Emergency Service, Hospital ; Hospitals, Public ; Housing for the Elderly ; Humans ; Logistic Models ; Nursing Homes ; Retrospective Studies ; Stroke ; Transportation of Patients

OBJECTIVE: The aim of this study is to analyze relationships between dysphagia, and the timing and frequency of videofluoroscopic swallowing studies (VFSS) in patients with acute stroke. METHOD: We retrospectively reviewed the medical records of 111 patients with acute stroke whose dysphagia were evaluated by VFSS. The data were analyzed with descriptive statistics, t-test, and one-way ANOVA; Pearson correlation coefficient was also reported for all analyses. RESULT: Dysphagia was significantly different by transit time from stroke onset to arrival at the hospital (F=4.74, P=.011), paralysis site (F=3.05, P=.032), nasogastric tube (t=−3.81, P=.001), and diet just before the first VFSS (F=23.27, P<.001). VFSS timing was significantly different by smoking (t=2.88, P=.005), underlying disease (t=−3.58, P=.001), transit time from stroke onset to arrival at the hospital (F=5.90, P=.004), type of stroke (t=−5.24, P<.001), paralysis site (F=5.89, P=.001), nasogastric tube (t=−4.86, P=.001), surgery or angiography (t=−2.22, P=.032), level of consciousness (F=6.07, P=.000), length of stay (F=53.73, P=.001), department (F=16.37, P<.001), and diet just before the first VFSS (F=5.38, P=.006). VFSS frequency was significantly different by type of stroke (t=2.69, P=.008), nasogastric tube (t=−5.11, P=.001), length of stay (F=19.41, P=.001), department (F=7.18, P<.001), and the diet just before the first VFSS (F=16.67, P<.001). There was a significant correlation between dysphagia degree and the timing and frequency of VFSS. CONCLUSION: The more severe the degree of dysphagia, the longer the VFSS timing, and the greater VFSS frequency. The findings could be used for establishing systematic nursing care plans and active nursing intervention for dysphagia-related characteristics.
Angiography ; Consciousness ; Deglutition Disorders* ; Deglutition* ; Diet ; Humans ; Length of Stay ; Medical Records ; Methods ; Nursing ; Paralysis ; Patient Care Planning ; Retrospective Studies ; Smoke ; Smoking ; Stroke*

PURPOSE: The study was conducted to investigate the change of care dependency in stroke patients from inpatient wards and outpatient units in Indonesia. METHODS: This study is longitudinal and multicentered. One hundred and nine patients were included from four hospitals on the island of Java. Care dependency was assessed using the Indonesian version of the 15-item Care Dependency Scale (CDS) at five points in time: at inpatient wards for admission and discharge and at outpatient units after discharge in the 1st week, the 5th week, and the 13th week. RESULTS: Most of the patients were male (65.1%), and diagnosed with ischemic stroke (71.5%). The results showed that care dependency in stroke patients decreased significantly from admission to discharge, as well as from the 5th to the 13th week as measured by the CDS. At admission, 23.0% of the patients were completely dependent on care, and at the 13th week about 1.0% were. Patients' care dependency decreased significantly in all care dependency items of the CDS in the inpatient ward, but five care dependency items of the CDS did not significantly decrease in the outpatient unit. CONCLUSIONS: Based on the findings of this study,we recommend that hospital-based andcommunity-based services should include continual care dependence monitoring using this comprehensive instrument. Care dependency is subject to change over time, therefore nurses have to plan and tailor adequate nursing care measures to patient needs in the different stages, especially with respect to the aspect of mobility.
Humans ; Indonesia ; Inpatients ; Male ; Nursing Assessment ; Nursing Care ; Outpatients ; Stroke*

Urinary incontinence (UI) is one of the most common urologic conditions that afflict the elderly in a rapidly aging world. The prevalence of UI increases in both sexes as aging progresses. Additionally, the prevalence of UI is higher in patients of nursing facilities, including geriatric hospitals and sanatoriums, than in the general population because most of them have chronic diseases such as dementia and stroke that can cause neurogenic bladder dysfunction. UI in nursing facilities is often overlooked or neglected, as it may be regarded as a natural part of the aging process. However, UI can have significant negative impacts on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. In many cases, treating UI can improve patients' quality of life and reduce the costs associated with UI itself and its complications. For this purpose, the initial assessment of patients entering a nursing home should include an item on UI, and when a patient exhibits UI, it should be treated as an important disease. The purpose of this review is to provide an overview of the causes, classification, evaluation, and management of geriatric UI in nursing facilities.
Activities of Daily Living ; Aged ; Aging ; Chronic Disease ; Classification ; Dementia ; Depression ; Geriatrics ; Humans ; Nursing ; Nursing Homes ; Prevalence ; Quality of Life ; Stroke ; Urinary Bladder, Neurogenic ; Urinary Incontinence*

BACKGROUND AND PURPOSE: The objective of this study was to determine the prevalence of and risk factors for dementia in residents aged 65 years and older in a Chinese nursing home. METHODS: A cross-sectional study was carried out in a nursing home located in Hangzhou, Zhejiang Province, China. Cognitive status, including the presence of dementia and mild cognitive impairment (MCI), was measured using a combination of medical history and objective cognitive assessments. Logistic regression analysis was conducted to predict the associated risk factors. RESULTS: In total, 943 residents (334 males and 609 females) aged 84.00±6.67 years (mean±SD) were included. Dementia was diagnosed in 420 (44.5%) residents, and MCI was diagnosed in 195 (20.7%). Mild, moderate, and severe dementia were present in 20.3%, 14.0%, and 65.7% of those in the dementia group, respectively. Logistic regression analysis revealed that dementia was associated with a low education level (p=0.000), an advanced age (p=0.010), and a history of stroke (p=0.023). CONCLUSIONS: Our study found a high prevalence of dementia in a Chinese nursing home, and a high prevalence of patients with severe dementia. Risk factors for dementia included a low educational level, an advanced age, and a history of stroke. Appropriate interventions need to be applied to this population.
Asian Continental Ancestry Group* ; China ; Cross-Sectional Studies ; Dementia* ; Education ; Humans ; Logistic Models ; Male ; Mild Cognitive Impairment ; Nursing Homes* ; Nursing* ; Prevalence* ; Risk Factors* ; Stroke

PURPOSE: The aim of this study was to develop and measure the effect of a movie-based-nursing intervention program designed to enhance motivation for rehabilitation and reduce depression levels in stroke patients. METHODS: The study used a quasi-experimental, nonequivalent control group and a pretest-posttest design. The 60 research subjects were assigned to the experimental (n=30) or control group (n=30). The movie-based nursing intervention program was provided for the experimental group during 60-minute sessions held once per week for 10 weeks. The program consisted of patient education to strengthen motivation for rehabilitation and reduce depression, watching movies to identify role models, and group discussion to facilitate therapeutic interaction. RESULTS: After 10 weeks of participation in the movie-based nursing intervention program, the experimental group's rehabilitation motivation score was significantly higher, F=1161.54 (within groups df=49, between groups df=1), p<.001, relative to that observed in the control group. In addition, the experimental group's depression score was significantly lower relative to that observed in the control group, F=258.97 (within groups df=49, between groups df=1), p<.001. CONCLUSION: The movie-based nursing intervention program could be used for stroke patients experiencing psychological difficulties including reduced motivation for rehabilitation and increased depression during the rehabilitation process.
Depression* ; Humans ; Motion Pictures as Topic ; Motivation* ; Nursing* ; Patient Education as Topic ; Program Development ; Rehabilitation* ; Research Subjects ; Stroke*