Sir, - The report of the National Rehabilitation Board on the care of stroke victims, as reported (The Irish Times, October 28th), presents an unduly narrow approach to care options. Stroke is a devastating illness, causing enormous personal suffering and is the second highest source of healthcare spending in the developed world.
Although many specialities provide care for stroke, five out of six strokes occur in people aged over 60. In many European countries the acute care and rehabilitation for stroke is carried out by geriatricians. There are now over 30 consultant geriatricians with training in acute care and rehabilitation of stroke in Ireland, and their departments of geriatric medicine provide the majority of focussed stroke care. In at least one case, the service also caters for those under 65. Irish geriatricians have participated in two major international studies looking at early treatment of stroke, have written the only guidebook for patients (published by the Irish Heart Foundation) and are also active in teaching the principles of rehabilitation of older adults in Irish teaching hospitals.
We would agree with the National Rehabilitation Board that the level of resources for rehabilitation of stroke is low by international standards. We would also agree that there is undue pressure to try and site rehabilitation away from the general hospital. Rehabilitation is a complex process involving many disciplines and requiring specialised medical input: 65 per cent of patients with stroke develop a medical complication during the course of their rehabilitation. The most recent report from the National Council on Ageing and Older People has emphasised that rehabilitation should take place on the general hospital site. We fully support this position which would enable all patients with stroke to benefit from interdisciplinary care and specialist medical input. - Yours, etc., Desmond O`Neill
MD FRCPI
Secretary,
Irish Society of Physicians
in Geriatric Medicine,
c/o Age-Related Health Care,
Meath Hospital,
Dublin 8