Home Health & Hospice Week

With OASIS C around the corner, now's the time for staff to brush up on their patient medical history skills.

While questioning the patient is often useful in gathering her medical history for OASIS and medical records, it may not be the best way to track older adults who have suffered strokes. The responses of older adults who are asked whether they had a stroke frequently do not agree with diagnoses obtained by magnetic resonance imaging (MRI) of the brain, according to a report in the July print issue of Archives of Neurology, one of the Journal of the American Medical Association/Archives journals.

"In general, self-reports on medical conditions that are well defined and relatively easy to diagnose often have a high positive predictive value, in contrast to conditions characterized by complex symptoms," the authors write. "Stroke is associated with motor impairment but can also be accompanied by impairments in memory, sensation and speech or language, diminishing the ability of an individual to accurately report a history of stroke."

Columbia University Medical Center physician Christiane Reitz and colleagues acquired MRIs for 717 Medicare recipients 65 years and older (average age 80.1) living in northern Manhattan. Participants underwent an in-person interview about general health and functioning, medical history, a physical and neurological examination, and psychological testing, according to a JAMA release. They or their caregivers also completed an eight-question survey about stroke history, including whether they had ever had symptoms of or been told by a physician they had a stroke. A total of 85 individuals (11.9 percent) reported a history of stroke.

However, MRIs found evidence of a stroke in 225 participants (31.4 percent).

In addition, younger individuals were more likely to accurately report their stroke history than older adults, and accurate memory of a stroke was more common among African American than white or Hispanic individuals. Older adults may have more difficulty recalling prior events, contributing to lower accuracy, the authors noted. Rates of cerebrovascular disease are higher among African Americans, so individuals in this population may have an increased awareness of stroke signs and symptoms due to previous discussions with clinicians or contact with individuals who have had strokes. The study authors conclude that neuroimaging techniques rather than patient reporting should be used to determine stroke history.