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Not only are more women admitted to nursing homes after experiencing a stroke than men, they also require more care, according to a new study that shows female stroke survivors have disproportionately high rates of pain and depression.

The study, published in the Canadian Journal of Neurological Sciences on Tuesday, sheds light on how stroke survivors fare once they’ve entered nursing homes.

“We’ve known from other studies that women and men recover a bit differently after a stroke, and that women are more likely to go to a nursing home after a stroke compared to men,” said lead author Amy Yu, a stroke neurologist at Toronto’s Sunnybrook Health Sciences Centre and adjunct scientist at ICES (formerly known as the Institute for Clinical Evaluative Sciences). “But I was really interested in understanding what happens to patients after they get to a nursing home, because for them it’s not the end.”

Dr. Yu and her team analyzed data for 4,831 Ontario patients who were admitted to a nursing home after a stroke between 2011 and 2016. They found 61 per cent of these patients were women. Female patients tended to be older, with a median age of 84 (versus age 80 for men), they were less likely to be married and more likely to have been living alone prior to their nursing-home admission.

Over time, female patients, ages 75 and older, had lower mortality than men, but the researchers said they had more health-care needs.

Women had a higher likelihood of being frail, having unstable health, and experiencing symptoms of depression and pain. Nearly 23 per cent of women had symptoms of depression, compared with 18.3 per cent of men, and 48.4 per cent of women had pain, versus 39.9 per cent of men.

Dr. Yu said these findings indicate a need to better understand the reasons behind these rates of depression and pain, to look at whether patients are being appropriately screened for these symptoms and to find ways to address them. The study also highlights the need for more research on this population, she added.

“We don’t talk enough about what happens to patients again after they go into a nursing home,” she said. “We want them to [have a better quality of life] and reduce any suffering.”

Thalia Field, a stroke neurologist at the Vancouver Stroke Program who was not involved in the study, said the findings point to some of the underlying reasons for the differences in outcomes between male and female stroke patients.

Dr. Field, an associate professor at the University of British Columbia, said researchers have long suspected that women generally fare worse after a stroke because of a combination of biological and psycho-social factors. The fact that women were found to be older, more medically complex and more frail are biological differences that likely account, in part, for their worse outcomes, she said. Meanwhile, the finding that women are more likely to be living alone prior to stroke offers a potential psycho-social reason.

“This points to the fact that there are fewer social supports for them that would help them otherwise return to the community or go through rehabilitation successfully,” she said.

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