Dementia is associated with poorer quality of care and outcomes after stroke: an observational study

Background: To determine if pre-existing dementia is associated with poorer quality of care and outcomes after stroke in the acute hospital phase.

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.