Stroke severity, stroke knowledge, social support, and perceived health status were all significantly and negatively associated with prehospital delay among older adults surviving ischemic stroke in a low-to-middle-income setting.
Key Findings
Results
The mean prehospital delay among older adult ischemic stroke survivors was 253.36 minutes, approaching the upper boundary of the 4.5-hour therapeutic window.
Mean prehospital delay was 253.36 min (SD = 278.70)
The 4.5-hour therapeutic window corresponds to 270 minutes
The authors note that when mandatory in-hospital processing times are considered, 'intravenous thrombolysis would be effectively precluded for most patients arriving at this stage'
Study sample consisted of 106 older adults aged 60 years and above who survived an ischemic stroke
Data were collected through structured interviews and medical record reviews between February and May 2025 at Ban Phaeo Hospital, Thailand
Results
Stroke severity was significantly and negatively correlated with prehospital delay, indicating that greater stroke severity was associated with shorter delays.
Pearson's correlation coefficient r = -0.521, p < 0.001
This was the strongest bivariate correlation with prehospital delay among the four variables assessed
Association remained significant after adjusting for other variables in multiple linear regression
Stroke severity was one of four variables selected based on theoretical and empirical rationale
Results
Stroke knowledge was significantly and negatively correlated with prehospital delay, indicating that greater stroke knowledge was associated with shorter delays.
Pearson's correlation coefficient r = -0.452, p < 0.001
Stroke knowledge was assessed as one of four key variables
The association was evaluated both bivariately and independently via multiple linear regression
Findings underscore the need for nurse-led educational programs to enhance symptom recognition
Results
Social support was significantly and negatively correlated with prehospital delay, indicating that greater social support was associated with shorter delays.
Pearson's correlation coefficient r = -0.468, p < 0.001
Social support was assessed as one of four key variables based on theoretical and empirical rationale
The association remained significant in multiple linear regression adjusting for other factors
Authors recommend interventions to 'mobilize social support systems among older adults'
Results
Perceived health status was significantly and negatively correlated with prehospital delay, indicating that better perceived health status was associated with shorter delays.
Pearson's correlation coefficient r = -0.489, p < 0.001
Perceived health status was one of four variables assessed based on theoretical and empirical rationale
The association was independently evaluated using multiple linear regression
Authors note the finding offers insights for designing interventions to 'promote early treatment-seeking behaviors'
Methods
The study was conducted in a low-to-middle-income setting in Thailand, addressing a gap in stroke care literature for such contexts.
Study conducted at Ban Phaeo Hospital, Thailand
Cross-sectional design with 106 participants aged 60 years and above
Authors state the study 'addressed a gap in stroke care literature by focusing on these factors in a low-to-middle-income setting'
Data collected through structured interviews and medical record reviews from February to May 2025
Pearson's correlation and multiple linear regression were used as the primary analytical methods
What This Means
This research examined why older adults in Thailand who survived an ischemic stroke often waited too long before reaching the hospital. The study surveyed 106 stroke survivors aged 60 and older and found that the average time between stroke onset and hospital arrival was about 253 minutes — just under the 4.5-hour window during which a clot-dissolving treatment called thrombolysis can be safely administered. However, the authors note that because additional time is needed for hospital processing once a patient arrives, most patients arriving at this average delay would likely miss the opportunity for this treatment.
The study found four factors that were each linked to shorter prehospital delays: more severe stroke symptoms, better knowledge about strokes, stronger social support networks, and better self-perceived health status. In other words, patients who had more dramatic symptoms, knew more about stroke warning signs, had people around to help them act quickly, or who generally felt healthier tended to seek care faster. These associations held up even when the researchers accounted for all four factors simultaneously in a statistical model.
This research suggests that community-based efforts — particularly nurse-led education programs — could help reduce dangerous delays in stroke care among older adults in lower-income countries. Teaching people to recognize stroke symptoms, encouraging stronger social support systems, and promoting proactive health behaviors may all play a role in getting stroke patients to the hospital in time to benefit from available treatments.