Stroke in the Very Old

Abstract

Background and Purpose-The oldest old represent the fastest-growing segment of the elderly population in developed countries. Knowledge of age-specific aspects of stroke is essential to establish diagnostic and therapeutic pathways and to set up prevention and rehabilitation programs. We sought to evaluate stroke features and functional outcome in patients aged Ն80 years compared with the younger age groups. Methods-In a European Union Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month disability (Barthel Index) and handicap (Rankin Scale). Results-Overall, 3141 patients (69.8%) were aged Ͻ80 years, and 1358 (30.2%) were aged Ն80 years. At baseline, female sex, prestroke institutionalization, and a worse prestroke Rankin score were significantly more frequent in the older patients, as were coma, paralysis, swallowing problems, and urinary incontinence in the acute phase (all P values Ͻ0.001). Brain imaging and other diagnostic tools were significantly less used in the older patients. Paralysis, swallowing problems, and incontinence during hospitalization independently predicted 3-month disability or handicap in both groups. For the older patients, prestroke institutionalization proved a further strong and independent determinant of 3-month disability (odds ratio, 2.33; 95% CI, 1.22 to 4.45) and handicap (odds ratio, 7.04; 95% CI, 1.62 to 30.69). Conclusions-In the very old, both medical and sociodemographic factors may significantly influence stroke outcome, showing peculiar characteristics. Knowledge of these determinants may reduce the burden on health systems, improving quality of care.

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

“…Many have found age to be associated with poorer outcomes, independent of stroke type. In general, older patients were more likely to be discharged to an institution other than home, and were more disabled and more severely handicapped at 3 months after stroke [47,48]. Those ≥80 years old with stroke had a longer length of stay compared to younger patients (24.7±27.6 vs 22.3± 24.2 days; p=0.013) [48].…”

“…Those ≥80 years old with stroke had a longer length of stay compared to younger patients (24.7±27.6 vs 22.3± 24.2 days; p=0.013) [48]. In-hospital mortality and case fatality also increase with age [47,48]. Case fatality rate for those ≥80 years old can be as high as 21% [48].…”

“…In general, older patients were more likely to be discharged to an institution other than home, and were more disabled and more severely handicapped at 3 months after stroke [47,48]. Those ≥80 years old with stroke had a longer length of stay compared to younger patients (24.7±27.6 vs 22.3± 24.2 days; p=0.013) [48]. In-hospital mortality and case fatality also increase with age [47,48].…”

“…In-hospital mortality and case fatality also increase with age [47,48]. Case fatality rate for those ≥80 years old can be as high as 21% [48]. Although age seems to influence activities of daily living recovery, it has not been found to have an effect on neurological recovery [47].…”

Outcome after stroke thrombolysis in patients >80 years treated within 3 hours vs >3–4.5 hours

“…9,10 A large proportion of these elderly patients are possible candidates for thrombolysis. Divergent recommendations from professional bodies and regulatory agencies may have a negative impact on IVT treatment in elderly populations.…”