50+ health

Older people receiving sub-standard treatment for stroke

zone image Study investigates stroke treatment provision in the UK

Older people are less likely to receive drug treatment after a stroke compared to younger people, despite the fact that treatment is equally effective, according to a study published in the British Medical Journal today.

There is also some indication that women may be less likely to receive treatment than men. However, the study also found that treatment was not dependant on the patient's social or economaic background.

Stroke is the second most common cause of death after coronary heart disease in developed countries and 80% of cases occur in people over 64 years of age. After a stroke, patients should receive a combination of drugs to help prevent another stroke, known as secondary drug prevention. The drugs used are blood pressure and cholesterol lowering drugs, and anti-clotting drugs.

Previous studies have suggested that elderly people, socially disadvantaged people and women are less likely to receive medical interventions compared to younger, affluent people and to men. So researchers based in London decided to investigate the delivery of treatment for stroke.

They analysed data for 12,830 patients aged 50 years and above from 113 general practices in England. All participants had experienced a stroke between 1995 and 2005 and had survived the first 30 days after their stroke.

Rates of secondary drug prevention were generally low – only 25.6% of men and 20.8% of women received treatment. This did not vary by socio-economic status. However, older patients were substantially less likely to receive cholesterol lowering treatment (26.4% of patients aged 50-59 received treatment compared with 15.6% of patients aged 80-89 and just 4.2% of those aged 90 or more).

This variation in treatment is important, say the authors, because secondary drug prevention halved the risk of dying during the first year after a stroke (on average, patients on treatment had a 5.7% risk of death within the first year compared to 11.1% for patients not on treatment).

Survival differed between social groups and gender - the most socially disadvantaged patients had lower one year survival than the most affluent, and women had a higher likelihood of one year survival than men – but this was not due to treatment differences.

There was also little evidence that the effect of treatment differed between social groups.

Under-treatment of older people cannot be justified because older people are at least as likely to benefit from treatment as younger people, say the authors. This issue must be addressed if the Government is to fulfil its commitment to reducing health care inequalities, they conclude.

More information

Know the signs and sympoms of strokes:

The Stroke Association www.stroke.org.uk

This article was published on Wed 22 April 2009

Image © James Steidl - Fotolia.com

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