Trajectories of long-term care after stroke in Sweden: nationwide study exploring patterns and determinants
Journal of the American Medical Directors Association (2024), forthcoming
Objectives: Stroke is a leading cause of mortality and disability worldwide. Although studies have primarily focused on health and functioning among stroke survivors, there is limited research on longitudinal patterns of long-term care use among older adults with stroke. This study explores long-term care trajectories among older men and women with stroke in the Swedish population.
Design: Nationwide prospective cohort study.
Setting and Participants: All individuals aged ≥70 years hospitalized with a first stroke in 2015-2017 followed in the Swedish population registers for 3 years.
Methods: Care trajectories among stroke patients were visualized and compared to trajectories in 2 control groups: (1) same-aged peers randomly drawn from the general population and (2) older adults with health and sociodemographic characteristics similar to stroke patients but without stroke identified through propensity score matching. Multivariable Cox regression and multistate models were used to identify determinants of mortality and care trajectories among stroke patients.
Results: We identified 31,560 individuals with stroke (mean age 82.9 years). Already before the stroke, these individuals had a higher comorbidity burden and received more long-term care than their same-aged peers. Compared with both control groups, stroke patients were also more likely to enter long-term care. However, 38% of stroke patients survived for 3 years without taking up long-term care. Sex, income, cohabitation, and comorbidities were associated with care trajectories. Care status was a more robust predictor of mortality after stroke than the established Charlson comorbidity index.
Conclusions and Implications: Experiencing a stroke increases both mortality and long-term care utilization, and once formal long-term care is provided, exceedingly few stroke patients return to living without care. However, a considerable part of care utilization and mortality after stroke is concentrated among those with preexisting care needs. Prestroke care utilization should thus be considered in future studies exploring stroke prognosis.
Keywords: Sweden, adult mortality, ageing, cardiovascular diseases, old age