Bhalla A, Grieve R, Tilling K, Rudd A G, Wolfe C D A
Department of Public Health Sciences, GKT School of Medicine, London, UK.
Age Ageing. 2004 Nov;33(6):618-24. doi: 10.1093/ageing/afh219.
in order to implement cost-effective stroke services for older patients, it is necessary to identify how stroke care is currently provided for these patients and how provision relates to outcome.
to estimate the structure and process of care, and identify independent factors associated with 3 month mortality and functional outcome in patients aged over 75 years compared with younger stroke patients across Europe.
13 hospitals in 10 European countries.
1,847 subjects with first in a lifetime stroke admitted to hospital. Sociodemographic details, acute case severity, resource use and 3-month survival and dependency were collected.
from a total of 1,847 patients, 1,112 patients (60%) were under 75 years. Older stroke patients were more likely to be incontinent, dysphasic, dysphagic and comatose (P < 0.001). Computed tomography scan rates were higher in younger (87%) than in older patients (79%) (P < 0.001). Access to organised stroke care was higher in older (58%) than in younger patients (51%) (P = 0.002). Median acute length of stay was longer in younger (14 days, range 7-21 days) than in older patients (11 days, range 8-22 days) (P = 0.04). Nursing time in hospital was higher in older patients (P = 0.01), whilst therapy time was higher in younger patients (P = 0.03). By 3 months, younger patients were more likely to receive outpatient care (P < 0.001), physiotherapy (P < 0.001) and occupational therapy (P < 0.001). For older stroke patients, not having a computed tomography scan (OR = 0.2, 95% confidence intervals (CI) = 0.01-0.6, P = 0.003) was significantly related to mortality at 3 months after adjusting for case mix. Access to organised stroke care was significantly associated with reduced 3-month mortality in younger patients only (OR = 0.29, 95% CI = 0.14-0.6, P < 0.001).
stroke care varies considerably across European centres, with older people more likely to gain access to organised stroke care in many centres but less likely to receive diagnostic investigations, therapy input and outpatient review. Where there is evidence of age discrimination for access to stroke services, guidelines need to be adopted to ensure patients of all ages receive optimal evidence-based stroke care at all stages of their illness.
为了给老年患者提供具有成本效益的中风服务，有必要确定目前如何为这些患者提供中风护理，以及护理提供情况与治疗结果之间的关系。
评估护理的结构和过程，并确定与欧洲75岁以上中风患者相比，年轻中风患者3个月死亡率和功能结局相关的独立因素。
欧洲10个国家的13家医院。
1847例首次发生中风并入院的患者。收集了社会人口统计学细节、急性病例严重程度、资源使用情况以及3个月生存率和依赖性。
在总共1847例患者中，1112例患者（60%）年龄在75岁以下。老年中风患者更易出现大小便失禁、言语障碍、吞咽困难和昏迷（P<0.001）。年轻患者的计算机断层扫描率（87%）高于老年患者（79%）（P<0.001）。老年患者（58%）获得有组织中风护理的比例高于年轻患者（51%）（P=0.002）。年轻患者的急性住院中位时长（14天，范围7-21天）长于老年患者（11天，范围8-22天）（P=0.04）。老年患者的住院护理时间更长（P=0.01），而年轻患者的治疗时间更长（P=0.03）。到3个月时，年轻患者更有可能接受门诊护理（P<0.001）、物理治疗（P<0.001）和职业治疗（P<0.001）。对于老年中风患者，在对病例组合进行调整后，未进行计算机断层扫描（比值比=0.2，95%置信区间=0.01-0.6，P=0.003）与3个月死亡率显著相关。仅在年轻患者中，获得有组织中风护理与3个月死亡率降低显著相关（比值比=0.29，95%置信区间=0.14-0.6，P<0.001）。
欧洲各中心的中风护理差异很大，在许多中心，老年人更有可能获得有组织的中风护理，但接受诊断检查、治疗投入和门诊复查的可能性较小。在存在中风服务获取方面年龄歧视证据的地方，需要采用指南以确保所有年龄段的患者在疾病的各个阶段都能获得最佳的循证中风护理。
