Factors Associated With Transition From Community to Permanent Residential Aged Care Following Stroke: A Linked Registry Data Study

Abstract

BACKGROUND: Understanding factors that influence the transition to permanent residential aged care following a stroke or transient ischemic attack may inform strategies to support people to live at home longer. We aimed to identify the demographic, clinical, and system factors that may influence the transition from living in the community to permanent residential care in the 6 to 18 months following stroke/transient ischemic attack. METHODS: Linked data cohort analysis of adults from Queensland and Victoria aged ≥65 years and registered in the Australian Stroke Clinical Registry (2012–2016) with a clinical diagnosis of stroke/transient ischemic attack and living in the community in the first 6 months post-hospital discharge. Participant data were linked with primary care, pharmaceutical, aged care, death, and hospital data. Multivariable survival analysis was performed to determine demographic, clinical, and system factors associated with the transition to permanent residential care in the 6 to 18 months following stroke, with death modeled as a competing risk. RESULTS: Of 11 176 included registrants (median age, 77.2 years; 44% female), 520 (5%) transitioned to permanent residential care between 6 and 18 months. Factors most associated with transition included the history of urinary tract infections (subhazard ratio [SHR], 1.41 [95% CI, 1.16–1.71]), dementia (SHR, 1.66 [95% CI, 1.14–2.42]), increasing age (65–74 versus 85+ years; SHR, 1.75 [95% CI, 1.31–2.34]), living in regional Australia (SHR, 31 [95% CI, 1.08–1.60]), and aged care service approvals: respite (SHR, 4.54 [95% CI, 3.51–5.85]) and high-level home support (SHR, 1.80 [95% CI, 1.30–2.48]). Protective factors included being dispensed antihypertensive medications (SHR, 0.68 [95% CI, 0.53–0.87]), seeing a cardiologist (SHR, 0.72 [95% CI, 0.57–0.91]) following stroke, and less severe stroke (SHR, 0.71 [95% CI, 0.58–0.88]). CONCLUSIONS: Our findings provide an improved understanding of factors that influence the transition from community to permanent residential care following stroke and can inform future strategies designed to delay this transition.