Age disparities in stroke quality of care and delivery of health services.
OBJECTIVE
Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.


METHODS
This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.


RESULTS
Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.


CONCLUSIONS
In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
Saposnik
Gustavo
G
Stroke Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Black
Sandra E
SE
Hakim
Antoine
A
Fang
Jiming
J
Tu
Jack V
JV
Kapral
Moira K
MK
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology / Q000523:psychology*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000517:prevention & control; D015331:Cohort Studies; D017281:Cost of Illness; D003680:Deglutition Disorders / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006291:Health Policy; D006296:Health Services / Q000191:economics; D006757:Hospital Units / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008136:Longevity; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009864:Ontario; D017063:Outcome Assessment, Health Care / Q000191:economics; D010351:Patient Discharge / Q000191:economics; D011014:Pneumonia / Q000453:epidemiology; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D011788:Quality of Life; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data / Q000639:trends; D014859:Warfarin / Q000627:therapeutic use
D014859:Warfarin