Eating and dietary intake in communication-impaired stroke survivors: a cohort study from acute-stage hospital admission to 6 months post-stroke

Background & Aims: Stroke is a major cause of chronic morbidity but despite the importance of nutrition for recovery and rehabilitation, nutritional features have received limited attention, particularly amongst those with communication impairments. This study reports a group of patients followed through acute hospital admission and at 6 months post-stroke. Methods: Subjects were survivors of a consecutive cohort admitted to a South London hospital with clinical diagnosis of acute stroke March–August 2001, with motor and communication deficits at initial assessment. Sequential assessments were undertaken from one week after admission to hospital discharge; then in normal residence at 6 months. Assessments focused on stroke-related impairments; functional abilities in activities of daily living and eating; nutritional indices; dietary intake derived from food diaries maintained by carers. Local Research Ethics Committee approval was obtained. Results & Conclusion: Thirty-six participants were studied in hospital; 18 at 6 months. Severely impaired and disabled at initial assessment (median Barthel Index score 1), significant improvements occurred by hospital discharge (to median score 7) despite substantial nutritional inadequacies and significant body tissue loss; mean energy intake met 60% Estimated Average Requirements. At 6 months the median Barthel Index score of survivors was 12.5 but multiple eating-related difficulties persisted, linked with dietary deficits; mean energy intake was 81% of Estimated Average Requirements. Body tissue losses continued across domiciliary settings. Closer attention to assessment and monitoring of nutrition-related aspects of stroke management is warranted across the continuum of care.