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Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales

Stephanie L. Harrison Orcid Logo, Gregory Y.H. Lip, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Leona A. Ritchie, Asangaedem Akpan, Julian Halcox Orcid Logo, Sarah Rodgers, Joseph Hollinghurst, Daniel Harris, Deirdre A. Lane

Journal of the American Medical Directors Association, Volume: 23, Issue: 9, Pages: 1548 - 1554.e11

Swansea University Authors: Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Julian Halcox Orcid Logo, Joseph Hollinghurst, Daniel Harris

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DOI (Published version): 10.1016/j.jamda.2022.05.003

Abstract

ObjectivesTo determine the proportion of older people moving to care homes with a recent stroke, incidence of stroke after moving to a care home, mortality following stroke, and secondary stroke prevention management in older care home residents.DesignRetrospective cohort study using population-scal...

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Published in: Journal of the American Medical Directors Association
ISSN: 1525-8610
Published: Elsevier BV 2022
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2022-09-09T15:31:58.9955907</datestamp><bib-version>v2</bib-version><id>60151</id><entry>2022-06-07</entry><title>Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales</title><swanseaauthors><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>f569591e1bfb0e405b8091f99fec45d3</sid><ORCID>0000-0002-5853-4625</ORCID><firstname>Fatemeh</firstname><surname>Torabi</surname><name>Fatemeh Torabi</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3676f695eeda169d0f8c618adf27c04b</sid><ORCID>0000-0001-6926-2947</ORCID><firstname>Julian</firstname><surname>Halcox</surname><name>Julian Halcox</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>d7c51b69270b644a11b904629fe56ab0</sid><firstname>Joseph</firstname><surname>Hollinghurst</surname><name>Joseph Hollinghurst</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>e60c9c73b645f0e8033ae26fa8e634b8</sid><firstname>Daniel</firstname><surname>Harris</surname><name>Daniel Harris</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2022-06-07</date><deptcode>MEDS</deptcode><abstract>ObjectivesTo determine the proportion of older people moving to care homes with a recent stroke, incidence of stroke after moving to a care home, mortality following stroke, and secondary stroke prevention management in older care home residents.DesignRetrospective cohort study using population-scale individual-level linked data sources between 2003 and 2018 in the Secure Anonymized Information Linkage (SAIL) Databank.Setting and ParticipantsPeople aged &#x2265;65 years residing in long-term care homes in Wales.MethodsCompeting risk models and logistic regression models were used to examine the association between prior stroke, incident stroke, and mortality following stroke.ResultsOf 86,602 individuals, 7.0% (n = 6055) experienced a stroke in the 12 months prior to care home entry. The incidence of stroke within 12 months after entry to a care home was 26.2 per 1000 person-years [95% confidence interval (CI) 25.0, 27.5]. Previous stroke was associated with higher risk of incident stroke after moving to a care home (subdistribution hazard ratio 1.83, 95% CI 1.57, 2.13) and 30-day mortality following stroke (odds ratio 2.18, 95% CI 1.59, 2.98). Severe frailty was not significantly associated with risk of stroke or 30-day mortality following stroke. Secondary stroke prevention included statins (51.0%), antiplatelets (61.2%), anticoagulants (52.4% of those with atrial fibrillation), and antihypertensives (92.1% of those with hypertension).Conclusions and ImplicationsAt the time of care home entry, individuals with history of stroke in the previous 12 months are at a higher risk of incident stroke and mortality following an incident stroke. These individuals are frequently not prescribed medications for secondary stroke prevention. Further evidence is needed to determine the optimal care pathways for older people living in long-term care homes with history of stroke.</abstract><type>Journal Article</type><journal>Journal of the American Medical Directors Association</journal><volume>23</volume><journalNumber>9</journalNumber><paginationStart>1548</paginationStart><paginationEnd>1554.e11</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1525-8610</issnPrint><issnElectronic/><keywords>Nursing homes; cerebrovascular disease; antiplatelets; anticoagulants</keywords><publishedDay>1</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-09-01</publishedDate><doi>10.1016/j.jamda.2022.05.003</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>No specific funding was received for this work. This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales program of work. The ADR Wales program of work is aligned to the priority themes as identified in the Welsh Government's national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and Analyse anonymized data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). Sarah Rodgers is part-funded by the National Institute for Health Research (NIHR) Applied Research Collaboration North West Coast (ARC NWC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.</funders><projectreference/><lastEdited>2022-09-09T15:31:58.9955907</lastEdited><Created>2022-06-07T17:01:33.8906677</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Stephanie L.</firstname><surname>Harrison</surname><orcid>0000-0002-8846-0946</orcid><order>1</order></author><author><firstname>Gregory Y.H.</firstname><surname>Lip</surname><order>2</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>3</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>4</order></author><author><firstname>Leona A.</firstname><surname>Ritchie</surname><order>5</order></author><author><firstname>Asangaedem</firstname><surname>Akpan</surname><order>6</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>7</order></author><author><firstname>Sarah</firstname><surname>Rodgers</surname><order>8</order></author><author><firstname>Joseph</firstname><surname>Hollinghurst</surname><order>9</order></author><author><firstname>Daniel</firstname><surname>Harris</surname><order>10</order></author><author><firstname>Deirdre A.</firstname><surname>Lane</surname><order>11</order></author></authors><documents><document><filename>60151__25104__e0e71818d5bd49acba048a3d98682425.pdf</filename><originalFilename>60151_VoR.pdf</originalFilename><uploaded>2022-09-09T15:30:07.6766203</uploaded><type>Output</type><contentLength>673349</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright 2022 The Authors. 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spelling 2022-09-09T15:31:58.9955907 v2 60151 2022-06-07 Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false d7c51b69270b644a11b904629fe56ab0 Joseph Hollinghurst Joseph Hollinghurst true false e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false 2022-06-07 MEDS ObjectivesTo determine the proportion of older people moving to care homes with a recent stroke, incidence of stroke after moving to a care home, mortality following stroke, and secondary stroke prevention management in older care home residents.DesignRetrospective cohort study using population-scale individual-level linked data sources between 2003 and 2018 in the Secure Anonymized Information Linkage (SAIL) Databank.Setting and ParticipantsPeople aged ≥65 years residing in long-term care homes in Wales.MethodsCompeting risk models and logistic regression models were used to examine the association between prior stroke, incident stroke, and mortality following stroke.ResultsOf 86,602 individuals, 7.0% (n = 6055) experienced a stroke in the 12 months prior to care home entry. The incidence of stroke within 12 months after entry to a care home was 26.2 per 1000 person-years [95% confidence interval (CI) 25.0, 27.5]. Previous stroke was associated with higher risk of incident stroke after moving to a care home (subdistribution hazard ratio 1.83, 95% CI 1.57, 2.13) and 30-day mortality following stroke (odds ratio 2.18, 95% CI 1.59, 2.98). Severe frailty was not significantly associated with risk of stroke or 30-day mortality following stroke. Secondary stroke prevention included statins (51.0%), antiplatelets (61.2%), anticoagulants (52.4% of those with atrial fibrillation), and antihypertensives (92.1% of those with hypertension).Conclusions and ImplicationsAt the time of care home entry, individuals with history of stroke in the previous 12 months are at a higher risk of incident stroke and mortality following an incident stroke. These individuals are frequently not prescribed medications for secondary stroke prevention. Further evidence is needed to determine the optimal care pathways for older people living in long-term care homes with history of stroke. Journal Article Journal of the American Medical Directors Association 23 9 1548 1554.e11 Elsevier BV 1525-8610 Nursing homes; cerebrovascular disease; antiplatelets; anticoagulants 1 9 2022 2022-09-01 10.1016/j.jamda.2022.05.003 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University No specific funding was received for this work. This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales program of work. The ADR Wales program of work is aligned to the priority themes as identified in the Welsh Government's national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and Analyse anonymized data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). Sarah Rodgers is part-funded by the National Institute for Health Research (NIHR) Applied Research Collaboration North West Coast (ARC NWC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. 2022-09-09T15:31:58.9955907 2022-06-07T17:01:33.8906677 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Stephanie L. Harrison 0000-0002-8846-0946 1 Gregory Y.H. Lip 2 Ashley Akbari 0000-0003-0814-0801 3 Fatemeh Torabi 0000-0002-5853-4625 4 Leona A. Ritchie 5 Asangaedem Akpan 6 Julian Halcox 0000-0001-6926-2947 7 Sarah Rodgers 8 Joseph Hollinghurst 9 Daniel Harris 10 Deirdre A. Lane 11 60151__25104__e0e71818d5bd49acba048a3d98682425.pdf 60151_VoR.pdf 2022-09-09T15:30:07.6766203 Output 673349 application/pdf Version of Record true Copyright 2022 The Authors. This is an open access article under the CC BY license true eng http://creativecommons.org/licenses/by/4.0/
title Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales
spellingShingle Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales
Ashley Akbari
Fatemeh Torabi
Julian Halcox
Joseph Hollinghurst
Daniel Harris
title_short Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales
title_full Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales
title_fullStr Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales
title_full_unstemmed Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales
title_sort Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales
author_id_str_mv aa1b025ec0243f708bb5eb0a93d6fb52
f569591e1bfb0e405b8091f99fec45d3
3676f695eeda169d0f8c618adf27c04b
d7c51b69270b644a11b904629fe56ab0
e60c9c73b645f0e8033ae26fa8e634b8
author_id_fullname_str_mv aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
d7c51b69270b644a11b904629fe56ab0_***_Joseph Hollinghurst
e60c9c73b645f0e8033ae26fa8e634b8_***_Daniel Harris
author Ashley Akbari
Fatemeh Torabi
Julian Halcox
Joseph Hollinghurst
Daniel Harris
author2 Stephanie L. Harrison
Gregory Y.H. Lip
Ashley Akbari
Fatemeh Torabi
Leona A. Ritchie
Asangaedem Akpan
Julian Halcox
Sarah Rodgers
Joseph Hollinghurst
Daniel Harris
Deirdre A. Lane
format Journal article
container_title Journal of the American Medical Directors Association
container_volume 23
container_issue 9
container_start_page 1548
publishDate 2022
institution Swansea University
issn 1525-8610
doi_str_mv 10.1016/j.jamda.2022.05.003
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description ObjectivesTo determine the proportion of older people moving to care homes with a recent stroke, incidence of stroke after moving to a care home, mortality following stroke, and secondary stroke prevention management in older care home residents.DesignRetrospective cohort study using population-scale individual-level linked data sources between 2003 and 2018 in the Secure Anonymized Information Linkage (SAIL) Databank.Setting and ParticipantsPeople aged ≥65 years residing in long-term care homes in Wales.MethodsCompeting risk models and logistic regression models were used to examine the association between prior stroke, incident stroke, and mortality following stroke.ResultsOf 86,602 individuals, 7.0% (n = 6055) experienced a stroke in the 12 months prior to care home entry. The incidence of stroke within 12 months after entry to a care home was 26.2 per 1000 person-years [95% confidence interval (CI) 25.0, 27.5]. Previous stroke was associated with higher risk of incident stroke after moving to a care home (subdistribution hazard ratio 1.83, 95% CI 1.57, 2.13) and 30-day mortality following stroke (odds ratio 2.18, 95% CI 1.59, 2.98). Severe frailty was not significantly associated with risk of stroke or 30-day mortality following stroke. Secondary stroke prevention included statins (51.0%), antiplatelets (61.2%), anticoagulants (52.4% of those with atrial fibrillation), and antihypertensives (92.1% of those with hypertension).Conclusions and ImplicationsAt the time of care home entry, individuals with history of stroke in the previous 12 months are at a higher risk of incident stroke and mortality following an incident stroke. These individuals are frequently not prescribed medications for secondary stroke prevention. Further evidence is needed to determine the optimal care pathways for older people living in long-term care homes with history of stroke.
published_date 2022-09-01T02:28:41Z
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