22. European Stroke Conference 2035 Stroke care problems Involving people with severe communication disability and cognitive impairment in stroke re-search R. Allison1, C. Kilbride2, I. Frampton3, J. Marsden4 TORBAY & SOUTHERN DEVON HEALTH & CARE TRUST, NEWTON ABBOT, UNIT-ED KINGDOM1, Brunel University, LONDON, UNITED KINGDOM2, UNIVERSITY OF EX-ETER, EXETER, UNITED KINGDOM3, UNIVERSITY OF PLYMOUTH, PLYMOUTH, UNITED KINGDOM4 Background: Stroke is the principal cause of severe adult disability, but research studies frequent-ly exclude people with more severe communication disability and cognitive impairments, leading to difficulty with generalisability of results. Care of the Arm after STroke (CAST) is a longitudinal study of people with a severely affected arm. A key tenet is to be maximally inclusive, with no peo-ple with stroke excluded on the basis of age, communication or cognition. Methods: To promote an individual’s ability to participate in decision making about the study, re-searchers used enhanced communication techniques and repeated visits to give information in small amounts. Capacity to make a decision was assessed using the Mental Capacity Act, and personal consultees were approached if necessary. Participants cognition was assessed with the Mini Mental State Exam (MMSE) and communication was assessed by a speech therapist with Addenbrookes Cognitive Exam Revised language section (ACER-L) recorded. Data have been collected for the first eighty-five participants. Results: Average age of participants is 74 years (range 38-94). Twenty-eight (33%) participants had aphasia, thirty-six (42%) were dysarthric, and forty-six (54%) had cognitive impairment. Nineteen participants (22%) were assessed as not having capacity to make a decision and personal consultees gave assent on their behalf. Of those who were assessed as having capacity MMSE scores ranged from 9 to 30; with ACER-L scores from 3 to 25. Of those who did not have capacity MMSE scores ranged from 0 to 14; with ACER-L scores from 0 to 9. Conclusion: Our data on cognitive impairment and capacity show similar results to findings in stud-ies of research recruitment of people with dementia. Using a range of resources to facilitate involve-ment, and by engaging with personal consultees, it has been possible to include significant numbers of people with severe cognitive impairment and communication disability in stroke research. 214 © 2013 S. Karger AG, Basel 7. Nurses & AHP‘s Meeting 2036 Stroke care problems ADHERENCE TO ORAL ANTICOAGULANT TREATMENT IN STROKE PATIENTS Z. Tulek1, R.R. Cekmegeli2, C. Polat3 Istanbul University Florence Nightingale School of Nursing, Istanbul, TURKEY1, Istanbul Training and Research Hospital, Istanbul, TURKEY2, GATA Haydarpasa Military Hospital, Istan-bul, TURKEY3 Aim: Warfarin is the most frequently used medication for reducing risk of thromboembolic compli-cations in stroke patients with atrial fibrillation. Nonadherence, frequently goes unreported by pa-tients, may lead to considerable health risks. This study aims to determine adherence to warfarin in stroke patients. Methods: This descriptive cross sectional study has been carried out in a stroke outpatient clinic in a state hospital. 99 consecutive stroke patients, able to communicate and using warfarin for min 6 months, were assessed by face to face interview. Patients have been assessed by MedTake to deter-mine adherence, modified Morisky to measure knowledge and motivation about medication use, HADS, MMSE, Barthel index, modified Rankin Scale and EQ-5D QoL scale. For data analysis SPSS program (version 16.0) was used. Descriptives, student t, ANOVA, Pearson correlation tests were used. All parameters which showed significance (p<0.05) was entered into logistic regression analysis. Findings: Age of patients were 68.6 (range 46-93). 55% of the patients were male with a low edu-cational background, married and retired/housewife. They were mostly living at home, with their family. Patients had stroke for 5.9 years. Most of them were independent in ADLs and ambulatory. Patients had been using warfarin for 51.2 months (6-156) and only 62.6% were taking medicines on their own, the rest of the patients were given medications by a spouse or daughter. 72.7% vis-ited hospital regularly for INR checks. Their MedTake score was 78.6 (35-100). Their knowledge and motivation were moderate (2.6, 2.4, range 0-3). But 30.3% reported that they sometimes forgot to take medications. Many associations were found in univariate analysis but in regression most of them lost significance; older age, longer duration of stroke and taking medications predicted nonad-herence while motivation and mental functioning facilitated adherence. And also medication adher-ence was found to be correlated with quality of life. Conclusions: Given a suboptimal adherence to medication and its correlation with quality of life, stroke patients should be assessed and supported for adherence.
Karger_ESC London_2013
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