Older Subjects Admitted to Hospital With Stroke From Long-Term Care: A National Cohort and Case Control Study

Internationally about 3% of people ≥65 years live in long-term care (LTC) settings. Older people living in nursing homes are more likely to be admitted to hospital. We examined the characteristics and outcomes of patients with strokes admitted from LTC nationally and how this changed over the COVID-19 pandemic.

Data from the Irish National Audit of Stroke 2019-2023 were analyzed 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 analyzed.

Data collected by hospitals and stroke services on patients admitted with acute stroke from LTC, home, and other settings.

Of 25,451 admissions, 891 (3.5%) came from LTC and 22,393 (88.0%) from home, 864 (4.6%) of 18,805 ≥65 years came from LTC. Patients' median ages were higher from LTC (84 vs 74 years) and there were more women (58.4% vs 42.6%, P < .001, χ²). Ischemic strokes constituted 750 (84.2%) of LTC and 19,106 (85.3%) of home admissions (P = .34). LTC admissions dropped during the pandemic: 2019: 3.74%, 2020: 3.07%, 2021: 3.19%, 2022: 3.58%, and 2023: 3.98% (P = .045, χ²). Compared with controls, a lower proportion of LTC admissions were independent (mRS < 3) pre-stroke (17.1% vs 73.5%). Mortality was significantly higher for LTC residents (21.2% vs 17.3%, P = .03). LTC patients were admitted less frequently to stroke units (60.4% vs 70.7%, P < .001) but were equally likely to be swallow screened and to be thrombolyzed (ischemic strokes, LTC: 8.9%, home: 9.6%, P = .74). Linear regression analysis showed that admission from nursing home was not independently associated with discharge outcome defined by mRS.

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