Characteristics and outcomes amongst of older subjects from Long-term Care admitted with Stroke to Hospital

Internationally about 3% of people ≥65 years live in Long Term Care (LTC). We examined the characteristics and outcomes of people admitted from LTC with stroke nationally and how this changed over the COVID19 pandemic.

Methods:

Data from Irish National Audit of Stroke 2019-2023 were analysed by source of admission. An age, sex and subtype matched control group was derived from patients admitted from home. Pre-stroke and discharge modified Rankin Disability Scores (mRS) were analysed.

Results

Of 25451 admissions, 891 (3.5%) came from LTC and 22393 (88.0%) from home, 864 (4.6%) of 18805 ≥65 years came from LTC. Patient’s median ages were higher from LTC (84 vs. 74 years) and there were more women (58.4% vs 42.6% (p<0.001, Chi Sq)). Ischaemic strokes (IS) constituted 750 (84.2%) of LTC and 19106 (85.3%) of home admissions (p=0.34).

LTC admissions declined significantly during the pandemic 2019 3.74%, 2020: 3.07%, 2021: 3.19, 2022: (3.58%) and 2023: (3.98%) (p=0.045 Chi Sq).

A lower proportion of LTC admissions than controls were independent pre-stroke (mRS<3) (17.1% vs. 73.5%) (Figure 1). Mortality was significantly higher for LTC residents (21.2% vs 17.3%, p=0.03). LTC patients were admitted less frequently to stroke units (60.4% vs 70.7%, p<0.001) but were equally likely to be thrombolysed (LTC: 8.9%, Home: 9.6% p=0.74). Admission from nursing home was not independently associated with discharge mRS on linear regression.

Conclusion.

Strokes from LTC had worse outcomes than controls and were less likely to receive organized care. The proportion of strokes from LTC declined during the pandemic.