Stroke in the Very Elderly: Characteristics and Outcome in Patients Aged ≥85 Years with a First-Ever Ischemic Stroke

Abstract

Background: Epidemiological and clinical features of very elderly patients with stroke are still uncertain. Our aim was to study the patient characteristics and outcomes in the very elderly (aged ≥85 years) with a first-ever ischemic stroke in the National Acute Stroke Israeli Survey (NASIS) registry. Methods: The NASIS registry is a nationwide prospective hospital-based study performed triennially (2004, 2007, 2010). Patients with ischemic stroke aged ≥85 years were compared with those 65–84 years old regarding their baseline characteristics, stroke severity, etiology of stroke and stroke outcomes. Logistic regression analyses were used to adjust for potential confounders. Stroke severity was determined according to the National Institute of Health Stroke Scale (NIHSS) score. Results: The proportion of very elderly (≥85 years) patients among the NASIS population increased from 18.3% in 2004 to 19.9% in 2007 and 24.5% in 2010 (p for trend = 0.005). The percentage of women was higher in patients aged ≥85 years (p < 0.0001). Atrial fibrillation, congestive heart disease and prior disability were significantly more common, while diabetes, current smoking and dyslipidemia were less frequent in the very elderly. The very elderly presented with more severe strokes: 36.3% of the ≥85-year-old patients had an NIHSS score ≥11 compared with 22.0% in the younger age group (p < 0.05). Conclusions: There is an increasing proportion of very elderly subjects, mostly women, among first-ever ischemic stroke patients. Current information on age-specific aspects of stroke in the very elderly is crucial to set up successful prevention pathways and implementing well-organized stroke care for this population.

Age-related differences in interferon regulatory factor-4 and -5 signaling in ischemic brains of mice

“…Aging is associated with low-grade neuroinflammation (termed "inflammaging" [5] ) demonstrated by basal increases in levels of circulating proinflammatory cytokines, increased expression of pro-inflammatory mediators and decreased anti-inflammatory markers in microglia [6] . Clinically aged stroke patients have worse outcomes and higher morbidity/mortality than do young patients [7] . This phenomenon has been recapitulated in experimental studies.…”

A study of age as a risk factor in ischemic stroke of elderly

“…Gur AY et al, studied characteristics and outcome in patients aged<85 years and those with≥85year-old. 27 The very elderly presented with more severe strokes; 36.3% of the≥85-year-old patients had an NIHSS score ≥11 compared with 22.0% in the younger age group (p<0.05).…”

Ischemic Stroke in the Elderly: Septuagenarians Versus Octogenarians

“…In a recent study investigating ischemic stroke in patients aged 65-84 or ≥85 years, DM was greater in the 65-84-year age group; however, HT demonstrated no difference between the two age groups (7). Similarly, in a study assessing patients on a decade-by-decade scale for the age ranges <50 and >90 years, the results for DM were higher in septuagenarians than in octogenarians, but no variance was found for HT (1).…”

“…Aging is a multivariate process as elderly patients of different age groups are likely to present varied stroke characteristics. Prior studies have investigated ischemic stroke patients using decade-by-decade classification scales over broad age groups (e.g., 50-90 years) (1) or via wide-ranging dual age segregation (e.g., >80 years versus <80 years and 65-84 years versus >85 years) (6,7). The current study seeks to affirm the relationship between stroke and age with a specific focus on two age groups: 70-79 years (septuagenarians) and 80-89 years (octogenarians).…”