Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
J Gerontol A Biol Sci Med Sci. 2021 Apr 30;76(5):851-858. doi: 10.1093/gerona/glaa139.
To determine whether preexisting dementia is associated with poorer quality of care and outcomes after stroke in the acute hospital phase.
This was a retrospective analysis of pooled data from the Australian Stroke Foundation national audit conducted in 2015 and 2017. Dementia status was obtained from the medical records. Processes of care to assess quality included: stroke unit care, time-dependent therapy, nursing/allied health assessments, and preparation for discharge. Outcomes included in-hospital complications, independence on discharge, and destination. Logistic regression was used to examine associations between dementia status and processes of care. Multilevel random effects logistic regression, with level defined as hospital, was used to examine associations between dementia status and outcomes.
There were 683/7,070 (9.7%) audited patients with dementia included. Patients with dementia were less likely to be treated in stroke units (58.3% vs 70.6%), receive thrombolysis if an ischemic stroke (5.8% vs 11.1%), have access within 48 hours to physiotherapy (56.4% vs 69.7%) or occupational therapy (46.8% vs 55.6%), see a dietitian if problems with nutrition (64.4% vs 75.9%), or have mood assessed (2.6% vs 12.3%). Patients with dementia were more likely to receive no rehabilitation (adjusted odds ratio 1.88, 95% confidence interval 1.25, 2.83) and be discharged to residential care (adjusted odds ratio 2.36, 95% confidence interval 1.50, 3.72).
People with dementia received poorer quality of care and had worse outcomes after stroke. Our findings raise questions regarding equity and the need for better understanding of why the quality of care differs after stroke for people with dementia.
为了确定在急性医院阶段，是否预先存在的痴呆症与中风后的护理质量和结果较差有关。
这是对 2015 年和 2017 年澳大利亚中风基金会全国审计中汇集的数据进行的回顾性分析。痴呆症的状况是从病历中获得的。评估护理质量的过程包括：卒中单元护理、时间依赖性治疗、护理/联合健康评估以及出院准备。结果包括院内并发症、出院时的独立性和出院去向。使用逻辑回归检查痴呆症状态与护理过程之间的关联。使用具有医院水平定义的多级随机效应逻辑回归检查痴呆症状态与结果之间的关联。
在 7070 名被审核患者中，有 683 名（9.7%）患有痴呆症。患有痴呆症的患者更不可能在卒中单元接受治疗（58.3%比 70.6%），患有缺血性中风的患者接受溶栓治疗的可能性更低（5.8%比 11.1%），在 48 小时内接受物理治疗的机会更少（56.4%比 69.7%）或职业治疗（46.8%比 55.6%），有营养问题时看营养师的机会更少（64.4%比 75.9%），或接受情绪评估的机会更少（2.6%比 12.3%）。患有痴呆症的患者更不可能接受康复治疗（调整后的优势比 1.88，95%置信区间 1.25，2.83），更有可能出院到养老院（调整后的优势比 2.36，95%置信区间 1.50，3.72）。
患有痴呆症的人在中风后接受的护理质量较差，结果更差。我们的发现提出了有关公平性的问题，并需要更好地了解为什么患有痴呆症的人中风后的护理质量存在差异。
