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

  • Amy Y. X. Yu (a1) (a2) (a3) (a4), Laura C. Maclagan (a3), Christina Diong (a3), Peter C. Austin (a3) (a4), Moira K. Kapral (a3) (a4) (a5), Richard H. Swartz (a1) (a2) (a3) and Susan E. Bronskill (a2) (a3) (a4)...

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.

RÉSUMÉ :

Différences entre les sexes en matière de besoins en soins et de taux de survie dans le cas de patients admis dans des foyers de soins en longue durée à la suite d’un AVC.Contexte: Les femmes sont plus susceptibles que les hommes d’être admises dans des foyers de soins en longue durée (nursing homes) à la suite d’un AVC. Ceci dit, une fois ces patients institutionnalisés, on comprend encore mal les différences entre les sexes en ce qui concerne leurs caractéristiques et l’évolution de leur état de santé. Nous avons ainsi analysé ces différences, tant en ce qui concerne les caractéristiques des patients que leurs besoins en soins, après qu’ils ont été admis dans des foyers de soins en longue durée à la suite d’un AVC auquel ils ont survécu. Méthodes: C’est en utilisant des données administratives associées que nous avons identifié des patients ontariens victimes d’AVC et nouvellement admis entre avril 2001 et mars 2016, patients ayant fait l’objet d’un suivi jusqu’en mars 2018. Dans le but de comparer les femmes aux hommes, nous avons calculé les taux de prévalence (IC 95 %) en mettant l’accent sur les aspects suivants : dépendance à l’égard d’autrui en ce qui a trait aux activités du quotidien, atteinte cognitive, fragilité et instabilité de l’état de santé, symptômes de dépression et manifestations de douleur. De façon secondaire, nous nous sommes également penchés sur les taux de mortalité toutes causes confondues. Résultats: Parmi les 4 831 patients, 60,9 % étaient des femmes. Comparées aux hommes, ces dernières étaient plus âgées (âge médian [EI] : 84 [78,89] contre 80 [71,86]) et plus susceptibles d’être considérées « fragiles » (taux de prévalence 1,14 ; IC 95 % [1,08 – 1,19]), d’avoir une santé instable (1,45 [1,28 – 1,66]), de présenter des symptômes de dépression (1,25 [1,11 – 1,40]) et des manifestations de douleur (1,21 [1,13 – 1,30]). Ajoutons aussi que les femmes étaient moins susceptibles d’avoir des comportements agressifs (0,87 [0,80 – 0,94]). De façon générale, le taux médian de survie de ces patients a été de 2,9 années. À l’aide de la méthode d’appariement de cohortes en fonction de scores de propension (propensity score matched cohort), il s’est avéré que les femmes avaient un taux de mortalité inférieur à celui des hommes (rapport de risque 0,85 ; IC 95 % [0,77 - 0,94]). Toutefois, lors d’une analyse des taux de survie stratifiés selon l’âge, l’avantage des femmes en termes de survie a été limité à celles âgées de plus de 75 ans. Conclusions: En dépit de taux de mortalité inférieurs à la suite d’un AVC, il a été démontré que les femmes admises en foyers de soins en longue durée vont avoir besoin de plus de soins si on les compare aux hommes. À cet égard, la douleur et la dépression sont deux symptômes traitables qui les affectent de façon disproportionnée.

Copyright

Corresponding author

Correspondence to: Amy Y. X. Yu, Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Office A-442, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. Email: amyyx.yu@utoronto.ca

References

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

  • Amy Y. X. Yu (a1) (a2) (a3) (a4), Laura C. Maclagan (a3), Christina Diong (a3), Peter C. Austin (a3) (a4), Moira K. Kapral (a3) (a4) (a5), Richard H. Swartz (a1) (a2) (a3) and Susan E. Bronskill (a2) (a3) (a4)...

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