Older patients with acute stroke in Denmark: quality of care and short-term mortality. A nationwide follow-up study

Abstract

Background and purpose: age may predict level of care and subsequent outcome among patients with stroke. We examined fulfilment of quality-of-care criteria according to age and the possible impact of any age-related differences on short-term mortality in a population-based nationwide follow-up study in Denmark. Methods: we identified 29,549 patients admitted with stroke between January 2003 and October 2005 in the Danish National Indicator Project (DNIP). Data on 30- and 90-day mortality were obtained from the Civil Registration System. We compared proportions of patients receiving adequate care across age groups, as measured by admission to a specialised stroke unit, administration of antiplatelet or anticoagulant therapy, examination with CT/MR scan, assessment by a physiotherapist and an occupational therapist, or assessment of nutritional risk. Further, we estimated 30- and 90-day mortality rate ratios (MRRs) across age groups, adjusted for fulfilment of quality-of-care criteria and patient characteristics. Results: the proportion of eligible patients who received adequate care declined with age for all the examined processes. The relative risk (RR) of receiving specific components of care ranged from 0.66 (95% confidence interval (CI): 0.60–0.73) to 0.97 (95% CI: 0.95–0.99) when comparing patients >80 years of age with patients ≤65 years of age. Although mortality increased with age, adjusting for the age-related differences in care did not alter the magnitude of the increase. Conclusions: elderly stroke patients in Denmark receive a lower quality of care than do younger stroke patients, however, the age-related differences are modest for most examined quality-of-care criteria and do not appear to explain the higher mortality among older patients.