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

Introduction Internationally about 3% of people ≥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.

Data 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.

Of 25451 admissions, 891 (3.5%) came from LTC and 22393 (88.0%) from home, 864 (4.6%) of 18805 ≥65 years came from LTC. Patient’s 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. 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. Competing Interest Statement The authors have declared no competing interest. Funding Statement NOCA and INAS are both Government agencies. Not external sources of funding were used. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Joint Tallaght University Hospital / St James's Hospital Ethics Committee. Irish National Audit of Stroke Governance committee. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data is available on application to the National Office for Clinical Audit.https://www.noca.ie/about-noca/access-to-audit-data/