Intracerebral Hemorrhage in the Very Old

Abstract

Background and Purpose-In most European societies and in the United States, the percentage of patients Ն80 years has been rising over the past century. The present study was conducted to observe this demographic change and its impact on patients with intracerebral hemorrhage (ICH). Methods-We reviewed patients' data with the diagnosis of ICH from January 2007 to December 2009. All data were collected out of a prospective stroke registry covering the entire state of Hesse, Germany. Incidence rates and absolute numbers of patients with ICH for 2009 to 2050 were calculated. Results-Of 3448 patients, 34% had an age Ն80 years. Hospital mortality was 35.9% for patients Ն80 years and 20.0%for patients Ͻ80 years. Unfavorable outcome (modified Rankin Scale score Ͼ2) was more often found in patients Ն80 years compared with patients Ͻ80 years (84.9% versus 74.8%). By the year 2050, the proportion of all patients with ICH Ն80 years will be 2.5-fold higher than in 2009. The total number of ICH cases will increase approximately 35.2% assuming that ICH probability stays the same. The number of patients who die in the hospital will increase approximately 60.2%. The total number of patients with severe disability due to ICH will increase approximately 36.8%. Conclusions-If current treatment strategies according to age remain unchanged, an increase of in-hospital mortality and a higher proportion of patients who need lifelong care after ICH can be expected in the coming decades. (Stroke.

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

“…The results of the present study indicate a higher incidence of ICH in an emerging and vulnerable population subgroup, such as CCPs, than in both general and elderly populations. Data on time trends for ICH in the general population indicate no significant changes in the incidence of ICH over the last two decades [6,15], but the incidence density of ICH was 5to-60-fold higher than that observed in the general population, both within the study area and worldwide (Table 6) [6,[16][17][18][19][20][21][22][23][24]. Comparisons between studies are difficult due to several interacting and overlapping emerging risk factors and aetiologies, new imaging techniques, demographic changes, comorbidities and associated treatments, different target populations, and the lack of a standardized methodology for data recording and exploitation, which makes it impossible to make adjustments to the incidences for different series of patients.…”

Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update

“…For all ages, the annual incidence rate per 100,000 persons was higher in men than in women; 5.9 vs. 5.1 in people aged 35-54 years, 37.2 vs. 26.4 in those aged 55-74 years, and 176.3 vs. 140.1 in those aged 75-94 years [ 16 ]. In a German study analyzing database of a regional prospective stroke registry between 2007 and 2009, 34% of 3,448 patients with ICH were aged 80 years or more [ 17 ].…”

The cerebral circulation and cerebrovascular disease III: Stroke

“…to project that, by 2050, in-hospital mortality for intracerebral haemorrhage (ICH) will rise to 60.2%, and the number of ICHs patients in the United States will double. [ 54 ] Assuming no breakthroughs in treatment occur over the next 30 years, then, it appears that hemorrhagic stroke is here to stay.…”