METHODS
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.
RESULTS
There
were 683/7070 (9.7%) audited patients with dementia included. Patients
with dementia were less likely to be treated in stroke units (58.3%
versus 70.6%), receive thrombolysis if an ischemic stroke (5.8% versus
11.1%), have access within 48 hours to physiotherapy (56.4% versus
69.7%) or occupational therapy (46.8% versus 55.6%), see a dietitian if
problems with nutrition (64.4% versus 75.9%), or have mood assessed
(2.6% versus 12.3%). Patients with dementia were more likely to receive
no rehabilitation (aOR 1.88 95%CI 1.25, 2.83) and be discharged to
residential care (aOR 2.36 95%CI 1.50, 3.72).
CONCLUSION
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.(Simple, look at the rehab they are getting, nothing that leads to 100% recovery. Why should I have to explain this? It is obvious to anyone with half a brain.)
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