Does patient age influence the quality of care received by patients with acute stroke?.

Objectives: To assess whether the quality of care received by patients with stroke admitted to acute care hospitals varied by age group. Method(s): Quality of care was assessed for patients admitted to 40 hospitals registered in the Australian Stroke Clinical Registry (AuSCR; 2010-2013). Primary outcomes were the processes of care (POCs) recorded in AuSCR: admitted to a Stroke Unit (SU); received tPA if an ischemic stroke; prescribed antihypertensive medication at discharge; or received a discharge care plan if discharged to the community. Age was categorised into 5 groups and each group compared to the rest of the sample. Multivariable analysis was used to assess the association with outcome. Models were adjusted for gender, previous stroke, in-hospital stroke, socioeconomic status, stroke type, stroke severity and patient clustering. Result(s): Data were available for 14571 episodes of care (47% female, 64% ischaemic stroke). Age was associated with receiving each of the POCs with variations in the direction of the association age by subgroup. Those aged 65-74 years were most likely to receive recommended POCs, especially SU care (aOR: 1.27, 95% CI: 1.13, 1.43) and tPA (aOR: 1.29, 95% CI: 1.10, 1.51). Age >84 years was associated with a reduced odds of receiving SU care (aOR: 0.74, 95% CI: 0.66, 0.82), tPA (aOR: 0.59, 95% CI: 0.50, 0.70) and a discharge care plan (aOR: 0.75, 95% CI: 0.65, 0.87). Aged <55 (aOR: 0.36, 0.32, 0.41) or age 55-64 years (aOR: 0.81, 85%CI: 0.72, 0.92) were associated with not being prescribed antihypertensive medication. Conclusion(s): Our results confirm that age bias may exist with regards to stroke care delivery in Australia. This bias is not always specific to older patients.