Causes of prehospital delay in stroke patients in an urban aging society

Abstract

PurposePrehospital delay is the major cause of treatment delay in cerebrovascular disease (CVD). An increasing number of elderly people reside alone or with their spouse with limited support from younger generations. The aim of this study was to identify the factors that may affect prehospital delay in our aging society, and examine the role of lifestyle on prehospital delay. MethodsWe retrospectively analyzed data for 469 consecutive patients who were hospitalized within 2 weeks of the onset of CVD between May 2007 and March 2009. Prehospital delay was defined as the time from the onset to arrival at our hospital. ResultsThere was no significant difference in prehospital delay between 91 patients who lived alone and 378 patients who lived with other people. We also analyzed whether lifestyle factors were causes of prehospital delay in the 378 patients who lived with other people. Living with a spouse was associated with a significant prehospital delay compared with patients living in a nursing home or those living with two or more generations. There were significant differences in prehospital delay between those living alone or with other people, and between those living with a spouse or with other people. Living with a spouse and living alone were associated with the prehospital delay. Knowledge of recombinant tissue plasminogen activator and the use of emergency medical systems were associated with a shorter prehospital delay, whereas visiting local doctors and the patient's recognition of symptoms increased the prehospital delay. The onset of CVD after office hours, National Institute of Health Stroke Scale score ≤ 4 at the initial visit, and prior stroke did not affect the prehospital delay. ConclusionHealth care promotion should target patients living alone as well as patients living with a spouse, especially in aging societies.