Abstract
BackgroundThe objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. Two research questions are addressed: (1) How strong is the association between age and care dependency risk 1 year after stroke and (2) can this association be explained by burden of disease?MethodsThe study is based on claims data from a German statutory health insurance fund. The study population was drawn from all continuously insured members with principal diagnoses of ischaemic stroke, hemorrhagic stroke, or transient ischaemic attack in 2007 who survived for 1 year after stroke and who were not dependent on care before their first stroke (n = 2864). Data were collected over a 1-year period. People are considered to be dependent on care if they, due to a physical, mental or psychological illness or disability, require substantial assistance in carrying out activities of daily living for a period of at least 6 months. Burden of disease was assessed by stroke subtype, history of stroke, comorbidities as well as geriatric multimorbidity. Regression models were used for data analysis.Results21.6 % of patients became care dependent during the observation period. Post-stroke care dependency risk was significantly associated with age. Relative to the reference group (0–65 years), the odds ratio of care dependency was 11.30 (95 % CI: 7.82–16.34) in patients aged 86+ years and 5.10 (95 % CI: 3.88–6.71) in patients aged 76–85 years. These associations were not explained by burden of disease. On the contrary, age effects became stronger when burden of disease was included in the regression model (by between 1.1 and 28 %).ConclusionsOur results show that age has an effect on care dependency risk that cannot be explained by burden of disease. Thus, there must be other underlying age-dependent factors that account for the remaining age effects (e.g., social conditions). Further studies are needed to explore the causes of the strong age effects observed.
Highlights
The objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke
As pointed out by Hankey et al [7], advancing age is known to be strongly associated with increasing levels of disability and an increasing number of comorbidities, few studies have examined the independent effect of age on post-stroke outcomes
There were more haemorrhage patients in this youngest age group (12.4 %) than in the other age groups (5.7–7.2 %; most fatalities occurred in the older age groups). 24.3 % of patients were classified as affected by geriatric multimorbidity
Summary
The objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. As the number of older people in western populations rises, stroke prevalence is expected to increase [1] In both men and women, stroke rates increase exponentially with age [2]. Stroke is a main cause of disability and care dependency in adults [3, 4], and age is known to play an important role in post-stroke outcomes. As pointed out by Hankey et al [7], advancing age is known to be strongly associated with increasing levels of disability and an increasing number of comorbidities, few studies have examined the independent effect of age on post-stroke outcomes. It could be assumed that older stroke patients are at a higher risk of becoming care dependent because they have more comorbidities
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