Age, rehabilitation timing factor in functional outcomes in stroke survivors

Older age and early initiation of rehabilitation predict functional improvement in patients undergoing stroke rehabilitation within Singapore’s community hospital setting, according to local research.

In univariate analysis, the odds of achieving functional improvement at day 26 post-rehabilitation was 54-percent lower for patients aged <65 vs ≥65 years (odds ratio [OR], 0.46, 95 percent confidence interval [CI], 0.21–1; p=0.02) and 63-percent lower for those who initiated rehabilitation ≥3 vs ≤2 days after stroke onset (OR, 0.37, 95 percent CI, 0.15–0.93; p=0.04). [Front Stroke 2025;doi:10.3389/fstro.2025.1704636]

The associations were confirmed in multivariate analysis adjusting for depression, history of previous stroke, initial stroke severity, and functional status upon admission (<65 vs ≥65 years: adjusted OR, 0.42, 95 percent CI, 0.19–1; p=0.03; rehab initiation ≥3 vs ≤2 days after stroke onset: adjusted OR, 0.36, 95 percent CI, 0.14–1.00; p=0.04).

The age paradox

“Contrary to the common belief that older age is associated with poorer rehabilitation outcomes, our findings showed that older adults had better short-term functional improvement,” and this may be explained by local referral patterns, the investigators said.

Younger stroke survivors referred to community hospitals often have more complex stroke aetiologies, such as arterial dissections, congenital heart conditions, autoimmune disorders, or clotting abnormalities, “which may limit their rehabilitation potential,” they pointed out. “In addition, lifestyle-related risk factors (eg, smoking, obesity, hyperlipidaemia) may exacerbate stroke severity in younger individuals, further complicating recovery.”

Meanwhile, early functional recovery in older stroke survivors tends to be transient, with many experiencing a decline between 18 and 60 months post-stroke. [JAMA Netw Open 2022;5:e2233094]

The investigators emphasized the need for age-tailored strategies, such as early intensive rehabilitation for younger patients, and ongoing monitoring and support for older patients to sustain functional gains. “In Singapore, [this means] streamlined workflows to facilitate early transfer (within 48 h) from acute hospitals to community care, along with standardized rehabilitation pathways to minimize care variation and optimize recovery.”

Study details

The study involved 216 stroke survivors (mean age 71.2 years, 59.3 percent male, 82 percent Chinese, 59.7 percent married) admitted to Outram and Sengkang Community Hospitals for inpatient rehabilitation. Most of them were living with family (86.5 percent), retired or unemployed (58.8 percent), had comorbidities (90.7 percent), had no prior stroke (79.1 percent), and were nonsmokers (76.4 percent) and nondrinkers (80.1 percent).

A total of 150 patients demonstrated significant functional improvement at day 26 post-rehabilitation. These patients were more likely to be premorbidly independent (94.7 percent), have mild depressive symptoms (PHQ-2 ≤2; 90.7 percent), have no previous stroke (80.7 percent), have <5 comorbidities (67.3 percent), and have a mild stroke severity according to the NIHSS category (62 percent).

“Future studies should aim to validate these findings across multiple community and regional rehabilitation settings to enhance generalizability,” the investigators said. “Comparative research between Singapore and other health systems could clarify how differences in healthcare financing, rehabilitation intensity, and care coordination influence recovery trajectories.”