長期介護による脳卒中で入院した高齢者:全国的なコホートとケースコントロール研究
Joseph Harbison1, Joan McCormack2, Olga Brych2
1Department of Medical Gerontology, Trinity College, Dublin, Ireland; Irish National Audit of Stroke Care, National Office of Clinical Audit, Dublin, Ireland.
Journal of the American Medical Directors Association
|September 6, 2025
まとめ
長期介護 (LTC) 施設の脳卒中患者は,自宅での介護と比べて,より悪い結果を示し,脳卒中ユニットでの介護を少なく受けました. COVID-19 パンデミックの間,LTCによる脳卒中患者の割合は減少しました.
科学分野:
- 高齢者医療
- 神経科学
- 公衆衛生
背景:
- 65歳以上の人の約3%が長期介護施設にいます.
- 介護施設の高齢者の入院率は高い.
- LTCによる脳卒中患者の特徴と結果を理解することは,特にパンデミックの影響を考えると極めて重要です.
研究 の 目的:
- 国内でLTCから入院した急性脳卒中患者の特徴とアウトカムを調べる.
- COVID-19 パンデミック期間中のLTC脳卒中患者数の変化を分析する.
- LTC脳卒中患者のアウトカムと自宅から入院した患者のアウトカムを比較する
主な方法:
- アイルランド国立脳卒中監査 (2019-2023) のデータ分析
- LTCから入院した患者と,自宅から入院した対照群の比較.
- 脳卒中前と退院後のランキン障害スコア (mRS) の評価
主要な成果:
- すべての脳卒中患者の3. 5% (891人) がLTCから発生した.
- LTC患者は高齢で,女性の割合が高く,脳卒中前の機能状態が悪かった (mRS < 3: 17. 1% vs 73. 5%).
- LTC患者の死亡率はかなり高かった (21. 2% vs 17. 3%) で,脳卒中ユニットに入院する確率は低かった (60. 4% vs 70. 7%).
結論:
- LTCでの脳卒中患者は,自宅で治療を受けた患者と比較して,専門の脳卒中治療室へのアクセスが低くなっています.
- LTCから発症した脳卒中患者の割合は,COVID-19のパンデミック期間中に減少した.
- 退行分析では,介護施設からの入院は退院結果 (mRS) と独立して関連付けられませんでした.
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