Factors Associated With Prehospital Delay Among Older Adults Surviving Ischemic Stroke: A Cross-Sectional Study

Ischemic stroke is a major public health concern and a leading cause of disability among older adults. Because treatment effectiveness is highly time-dependent, timely medical intervention is crucial for improving outcomes, while delays in hospital arrival often result in poorer recovery and higher mortality.

To examine prehospital delay and associated factors among older adults with ischemic stroke.

A Cross-sectional study.

This research was conducted with 106 older adults aged 60 years and above who survived an ischemic stroke and received care at Ban Phaeo Hospital, Thailand. Data were collected through structured interviews and medical record reviews between February and May 2025. Four variables were assessed based on theoretical and empirical rationale: stroke severity, stroke knowledge, social support, and perceived health status. Pearson's correlation analysis was used to assess bivariate relationships between these factors and prehospital delay. Multiple linear regression was subsequently performed to evaluate the independent association of each factor while adjusting for the others.

The mean prehospital delay was 253.36 min (SD = 278.70). Although this value falls near the upper boundary of the 4.5-h (270-min) therapeutic window, when mandatory in-hospital processing times are considered, intravenous thrombolysis would be effectively precluded for most patients arriving at this stage. Prehospital delay was significantly and negatively correlated with stroke severity (r = -0.521, p < 0.001), stroke knowledge (r = -0.452, p < 0.001), social support (r = -0.468, p < 0.001), and perceived health status (r = -0.489, p < 0.001).

This study found that stroke severity, stroke knowledge, social support, and perceived health status were significantly associated with prehospital delay among older adults. This study addressed a gap in stroke care literature by focusing on these factors in a low-to-middle-income setting. It offers insights for healthcare professionals to design targeted interventions that may promote early treatment-seeking behaviors and improve stroke outcomes.

These findings underscore the need for nurse-led educational and community outreach programs to enhance symptom recognition, foster proactive health behaviors, and mobilize social support systems among older adults.

This research, patients only participated in the data collection process by completing the survey.