More than half of stroke patients who reside in nursing homes do not have access to appropriate levels of physiotherapy and occupational therapy services — despite very high levels of dependency and disability — a new study has revealed.

The national study, which forms part of the Irish National Audit of Stroke Care, and was carried out by the Department of General Practice at the RCSI. It surveyed 570 residents with a history of stroke (and staff) in 60 nursing homes around the country — 20 in Dublin and 40 from outside the capital.

Despite 80 per cent of stroke patients reporting mobility difficulties, more than 60 per cent reporting cognitive problems and over 50 per cent having difficulties with swallowing and communication, the survey found that access to physiotherapy and occupational therapy was ‘low’.

While access to GPs was considered to be ‘very good’, access to other members of the multidisciplinary team was poor — for example 60 per cent and 83 per cent respectively reported that access to physiotherapy and occupational therapy was low. The audit also found that despite the fact that 28 per cent of the residents surveyed were found to be depressed, access to a counsellor or psychologist was ‘almost non-existent’.

The research, which was presented at the recent Scientific Meeting of the Association of University Departments of General Practice in Ireland (AUDGPI), concluded that the care needs of this vulnerable group were not addressed in a systematic manner — with an absence of integration between primary and secondary care.

“There was a lack of Primary Care Teams to co-ordinate communication between community health professionals and nursing homes. Many opportunities for secondary prevention were missed. These nursing home patients were generally considered ‘discharged from active rehabilitation’ from the acute services. Thus nursing homes face many challenges as chronically sick people require complex healthcare.”

A further study from the Division of Population Health Sciences which carried out the Irish National Audit of Stroke Care also presented at the meeting, found there was ‘little or no organised system of care for the prevention and management of stroke within primary care in Ireland’.