Characteristics and outcomes amongst of older subjects from Long-term Care admitted with Stroke to hospital.

IntroductionInternationally about 3% of people [&ge;]65 years live in Long Term Care (LTC). We examined the characteristics and outcomes of people admitted from LTC with stroke nationally and how this changed over the COVID19 pandemic. MethodsData from Irish National Audit of Stroke 2019-2023 were analysed by source of admission. An age, sex and subtype matched control group was derived from patients admitted from home. Pre-stroke and discharge modified Rankin Disability Scores (mRS) were analysed. ResultsOf 25451 admissions, 891 (3.5%) came from LTC and 22393 (88.0%) from home, 864 (4.6%) of 18805 [&ge;]65 years came from LTC. Patients median ages were higher from LTC (84 vs. 74 years) and there were more women (58.4% vs 42.6% (p<0.001, Chi Sq)). Ischaemic strokes (IS) constituted 750 (84.2%) of LTC and 19106 (85.3%) of home admissions (p=0.34). LTC admissions declined significantly during the pandemic 2019 3.74%, 2020: 3.07%, 2021: 3.19, 2022: (3.58%) and 2023: (3.98%) (p=0.045 Chi Sq). A lower proportion of LTC admissions than controls were independent pre-stroke (mRS<3) (17.1% vs. 73.5%) (Figure 1). Mortality was significantly higher for LTC residents (21.2% vs 17.3%, p=0.03). LTC patients were admitted less frequently to stroke units (60.4% vs 70.7%, p<0.001) but were equally likely to be thrombolysed (LTC: 8.9%, Home: 9.6% p=0.74). Admission from nursing home was not independently associated with discharge mRS on linear regression. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=120 SRC="FIGDIR/small/25326324v1_fig1.gif" ALT="Figure 1"> View larger version (11K): org.highwire.dtl.DTLVardef@19a61adorg.highwire.dtl.DTLVardef@82b92borg.highwire.dtl.DTLVardef@4aba6aorg.highwire.dtl.DTLVardef@14a519_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 1.C_FLOATNO Changes in proportion of admissions (p=0.045 Chi Sq) and inpatient mortality (p=0.09 Chi Sq) of patients admitted from LTC with stroke over the period of the COVID19 pandemic C_FIG Conclusion.Strokes from LTC had worse outcomes than controls and were less likely to receive organized care. The proportion of strokes from LTC declined during the pandemic.