Moving to care homes in Wales with recent history of stroke: prevalence, trends, recurrent stroke and mortality

The objectives were to determine the proportion of older people moving to a care home with recent history of stroke, trends over time, and associations with recurrent stroke and mortality. The Secure Anonymised Information Linkage (SAIL) Databank links population-scale health and social care data in Wales. Older people (≥65 years) newly resident in a care home and captured within the SAIL databank between 2003-2018 were included. Age and sex standardized proportions were calculated for recent history of stroke (ischaemic, haemorrhagic or unspecified stroke within 12-month period before moving to a care home). Cox proportional hazard models were used to determine associations between recent history of stroke and recurrent stroke and mortality, adjusted for age, sex, co-morbidities and frailty. During the study period, 91,004 older people became new residents in care homes in Wales and were captured in the SAIL Databank; 8.3% (n=7,517) had recent history of stroke. The age and sex-standardized proportions for recent history of stroke decreased from 9.2% (95% confidence interval (CI): 8.4%, 10.1%) in 2003 to 6.1% (95%CI: 5.5%, 6.8%) in 2018; absolute change -3.1% (95%CI: -4.2%, -2.1%). Recent history of stroke was associated with a higher risk of one-year stroke after moving to a care home (adjusted Hazard Ratio 4.38 (95%CI: 4.16, 4.61) and all-cause mortality (adjusted Hazard Ratio 1.13 (95%CI: 1.09, 1.18). Our findings suggest that a more rigorous approach to assessment, treatment and monitoring of modifiable risk factors for stroke may be warranted in older people moving to care homes with recent history of stroke.