Sex Differences in Care Need and Survival in Patients Admitted to Nursing Home Poststroke

Abstract

ABSTRACT:Background:Women are more likely to be admitted to nursing home after stroke than men. Differences in patient characteristics and outcomes by sex after institutionalization are less understood. We examined sex differences in the characteristics and care needs of patients admitted to nursing home following stroke and their subsequent survival.Methods:We identified patients with stroke newly admitted to nursing home between April 2011 and March 2016 in Ontario, Canada, with follow-up until March 2018 using linked administrative data. We calculated prevalence ratios and 95% confidence intervals (CIs) for the primary outcomes of dependence for activities of daily living, cognitive impairment, frailty, health instability, and symptoms of depression or pain, comparing women to men. The secondary outcome was all-cause mortality.Results:Among 4831 patients, 60.9% were women. Compared to men, women were older (median age [interquartile range, IQR]: 84 [78, 89] vs. 80 [71, 86]), more likely to be frail (prevalence ratio 1.14, 95% CI [1.08, 1.19]), have unstable health (1.45 [1.28, 1.66]), and experience symptoms of depression (1.25 [1.11, 1.40]) or pain (1.21 [1.13, 1.30]), and less likely to have aggressive behaviors (0.87 [0.80, 0.94]). Overall median survival was 2.9 years. In a propensity-score-matched cohort, women had lower mortality than men (hazard ratio 0.85, 95% CI [0.77, 0.94]), but in the age-stratified survival analysis, the survival advantage in women was limited to those aged 75 years and older.Conclusions:Despite lower subsequent mortality, women admitted to nursing home after stroke required more care than men. Pain and depression are two treatable symptoms that disproportionately affect women.

Nursing Methods and Experience of Local Anesthesia Patients under Arthroscope

“…And it was advocated that postoperative pain should be treated as “the fifth vital sign,” which was equal to vital signs such as blood pressure, heart rate, respiration, and temperature, and timely treatment should be given [ 8 ]. Yu, A. et al believed that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2001) also added the pain assessment and the pain treatment to the hospital assessment items [ 9 ]. Zhu, L. et al believed that learning surgical knowledge and understanding the pain mechanism of the disease could better grasp the characteristics of pain and alleviate the unpleasant pain of patients by taking effective analgesic measures in time [ 10 ].…”

Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis

“…A summary of pain-related data extracted from each of these peer-reviewed journal articles is provided in Table 1 . Pain prevalence rates within Canadian LTC facilities ranged from 27.1 to 75.6%, but it is important to note that methodological differences in definitions of pain, instruments used to measure pain, and populations examined existed [ 40 , 51 , 60 , 64 , 69 ]. Pain has also been shown to increase from admission to the end of residents’ stay in LTC [ 47 ].…”

The Allure of Big Data to Improve Stroke Outcomes: Review of Current Literature

“…Data on mortality after stroke were reported in 28 studies (n = 1,367 to 86,189 individuals) from 14 countries (Australia, Belgium, Canada, Denmark, France, Germany, Hong Kong, Italy, Korea, Netherlands, Norway, Sweden, UK, and USA) [8 •, 9, 10, 11 In these studies, mortality was ascertained using hospital administrative data [26, 27, 30••, 33], death registers [8•, 9, 10, 11 , or a combination of linkage with death registers and prospective follow-up assessments [12]. Cumulative crude rates of mortality post-stroke/TIA ranged from 7 to 18% within 30 days [9, 11••, 16, 20, 26] and 14 to 28% within 1 year [8••, 10••, 11••, 13,20,36]. In studies with longer-term data, 82% of patients with ischemic stroke died within 15 years [17].…”

“…Patient sociodemographic and clinical factors are important considerations when examining poststroke mortality. Although evidence on whether mortality rates after stroke/TIA differ by sex is equivocal [15,36], other sociodemographic factors have been shown to be associated with greater risk of mortality post-stroke. These include low income [16,26], poor educational attainment [16], and being unmarried and without children [28].…”