Palliative care for stroke affected by age, gender, stroke type

Whether patients with stroke are referred to palliative care services (PCS) depends on their age, their gender, and what type of stroke they have had, Australian study results indicate.

Specifically, older, female patients and those with primary intracerebral hemorrhage were most likely to be referred to PCS, the researchers report.

The findings also revealed that a need for assistance with end-of-life care was the most common reason for referral to PCS, which the researchers say suggests "a more traditional view of palliative care as synonymous with terminal management."

This "may reflect a lack of awareness among non-palliative care health professionals regarding other services palliative care can offer," write Peter Eastman (Royal Melbourne Hospital, Parkville, Victoria) and colleagues in BMJ Supportive and Palliative Care.

Study participants included 544 stroke patients admitted to a Stroke Care Unit (SCU) between January and December 2008, of whom 54% were men, and 11% were referred to the PCS after an average of 5.5 days.

Patients referred to the PCS were significantly older than their counterparts who remained in the SCU, at 79 years versus 69 years, and significantly more women than men were referred to the PCS, at 63% versus 37%.

Pre-stroke modified Rankin score (indicating functional ability, where higher scores out of 6 indicate increasing debility) was also significantly associated with the likelihood of referral to PCS, with significantly fewer PCS-referred patients having scores of 0 compared with those who remained in the SCU, at 37% versus 69%.

These figures indicate that a "considerable proportion of overall SCU presentations" are fully independent before their stroke, highlighting the dramatic change in condition associated with stroke.

"While the trajectory of many oncological and non-malignant diseases afford the opportunity for end-of-life planning to take place, the suddenness of a devastating stroke often precludes this," note the researchers.

Having a primary intracerebral hemorrhage - known to be associated with high 30-day mortality - increased the chances of PCS referral by a significant 28% compared with having an infarction, report Eastman et al.

They conclude that their findings are "pertinent" in light of the anticipated increase in stroke rates with an aging population.

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