Age and Ageing Advance Access originally published online on October 25, 2007
Age and Ageing 2008 37(1):90-95; doi:10.1093/ageing/afm134
Older patients with acute stroke in Denmark: quality of care and short-term mortality. A nationwide follow-up study
1 Department of Clinical Epidemiology, Aarhus University Hospital, Ole Worms Allé 1150, 8000 Aarhus C, Denmark
2 Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
3 The Coordinating Secretariat (NIP), County of Aarhus, Lyseng Allé 1, 8270 Hojbjerg, Denmark
Address correspondence to: Kaare Dyre Palnum. Tel: +45 8942 4808; Fax: +45 8942 4801. Email: kdp{at}dce.au.dk
Background and purpose: age may predict level of care and subsequent outcome among patients with stroke. We examined fulfilment of quality-of-care criteria according to age and the possible impact of any age-related differences on short-term mortality in a population-based nationwide follow-up study in Denmark.
Methods: we identified 29,549 patients admitted with stroke between January 2003 and October 2005 in the Danish National Indicator Project (DNIP). Data on 30- and 90-day mortality were obtained from the Civil Registration System. We compared proportions of patients receiving adequate care across age groups, as measured by admission to a specialised stroke unit, administration of antiplatelet or anticoagulant therapy, examination with CT/MR scan, assessment by a physiotherapist and an occupational therapist, or assessment of nutritional risk. Further, we estimated 30- and 90-day mortality rate ratios (MRRs) across age groups, adjusted for fulfilment of quality-of-care criteria and patient characteristics.
Results: the proportion of eligible patients who received adequate care declined with age for all the examined processes. The relative risk (RR) of receiving specific components of care ranged from 0.66 (95% confidence interval (CI): 0.60–0.73) to 0.97 (95% CI: 0.95–0.99) when comparing patients >80 years of age with patients 
65 years of age. Although mortality increased with age, adjusting for the age-related differences in care did not alter the magnitude of the increase.
Conclusions: elderly stroke patients in Denmark receive a lower quality of care than do younger stroke patients, however, the age-related differences are modest for most examined quality-of-care criteria and do not appear to explain the higher mortality among older patients.
Keywords: quality of care, prognosis, elderly, stroke
Received 30 November 2006; accepted in revised form 26 July 2007.
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