Early discharge support

8.6   Services that provide early supported discharge should ensure that the person with aphasia and their family are linked in with ongoing (social) supports and appropriately prepared for the transition.

Reference: Hilari, 2011: Non-randomised observational study; Hilari et al., 2021: RCT; Langhorne et al., 2017: Cochrane review; Robinson et al., 1999: Nonrandomised observational study; Salter et al., 2010: Systematic review of 10 RCTs; Thomas & Lincoln, 2008: Nonrandomised observational study

NHMRC Level of evidence: I

Rationale: Home-based early supported discharge services can reduce the length of hospital stay and long-term care needs for some people with mild to moderate disability following stroke (Langhorne et al., 2017). In the initial weeks following stroke, the presence of social supports and contacts is essential to individuals who are facing considerable life changes following a stroke event (Robinson et al., 1999). Improvement of available social support and prevention of social isolation can be an important strategy in reducing or preventing distress and post-stroke depression (Hilari, 2011; Salter et al., 2010; Thomas & Lincoln, 2008).

In the case of early discharge, speech pathologists should still ensure that people with aphasia are still appropriately prepared for the transition. This includes raising awareness and/or referring people to appropriate (social) supports, such as: 

• peer befriending services (Hilari et al., 2021),community-based groups for people with aphasia and their families (e.g., conversation groups, peer support      groups, arts and leisure groups),
• Aboriginal Community Controlled Health Organisations (see National Aboriginal Community Controlled Health Organisation, n.d.),
• local and national aphasia advocacy organisations (e.g., the AAA),
• aphasia research organisations, and
• University-based aphasia clinics.

References:

1. Hilari, K. (2011). The impact of stroke: Are people with aphasia different to those without? Disability and Rehabilitation, 33(3), 211-218. DOI: 10.3109/09638288.2010.508829
2. Hilari, K., Behn, N., James, K., Northcott, S., Marshall, J., Thomas, S., Simpson, A., Moss, B., Flood, C., McVicker, S., & Goldsmith, K. (2021). Supporting wellbeing through peer-befriending (SUPERB) for people with aphasia: A feasibility randomised controlled trial. Clinical Rehabilitation, 35(8), 1151-1163. DOI: 10.1177/0269215521995671
3. Langhorne, P., Baylan, S., & Early Supported Discharge Trialists (2017). Early supported discharge services for people with acute stroke. The Cochrane database of systematic reviews, 7(7), CD000443. https://doi.org/10.1002/14651858.CD000443.pub4
4. Robinson, R. G., Murata, Y., & Shimoda, K. (1999). Dimensions of social impairment and their effect on depression and recovery following stroke. International Psychogeriatrics, 11(4). doi: 10.1017/s1041610299005992
5. Salter, K., Foley, N., & Teasell, R. (2010). Social support interventions and mood status post stroke: A review. International Journal of Nursing Studies, 47, 616-625. doi: 10.1016/j.ijnurstu.2009.12.002
6. Thomas, S. A. & Lincoln, N. B. (2008). Predictors of Emotional Distress After Stroke. Stroke (1970), 39(4), 1240–1245. https://doi.org/10.1161/STROKEAHA.107.498279