Old stroke
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Stroke in the Very Old: Incidence, Outcomes, and Risk Factors
Incidence of Stroke in the Very Old
Stroke incidence significantly increases with age, particularly in individuals over 80 years old. Studies have shown that the incidence rates for first strokes in those over 80 are approximately 20.78 per 1000 person-years, with similar rates observed in those over 85. This age group contributes nearly 30% of all strokes, highlighting the substantial burden of stroke in the very old population.
Clinical Characteristics and Short-Term Outcomes
Very old stroke patients, defined as those aged 85 years or older, exhibit distinct clinical characteristics compared to younger stroke patients. They are more likely to be women, live alone, and have pre-existing conditions such as atrial fibrillation and disabilities. These patients also tend to experience more severe strokes, as indicated by lower scores on the Scandinavian Stroke Scale.
Short-term outcomes for very old stroke patients are generally poor. They have higher short-term mortality rates and are more likely to be discharged to nursing homes or die in the hospital. Factors such as the severity of the stroke at onset, pre-existing disabilities, and atrial fibrillation are significant predictors of these outcomes.
Long-Term Outcomes and Functional Disability
Long-term outcomes for very old stroke patients are similarly concerning. Five years post-stroke, very old age remains a strong predictor of mortality and nursing home placement. Additionally, functional outcomes at three months post-stroke are often worse in very old patients, with higher rates of disability and handicap. Prestroke institutionalization and acute-phase complications like paralysis, swallowing problems, and urinary incontinence are significant determinants of these poor outcomes.
Risk Factors and Stroke Subtypes
The risk factor profile for stroke in the very old differs from that of younger populations. Hypertension and atrial fibrillation are more prevalent in those over 80, while diabetes, hyperlipidemia, smoking, and obesity are less common. Lacunar stroke is the most frequent subtype in this age group, accounting for 41.7% of cases.
Resource Use and Diagnostic Challenges
Despite the high incidence and severe outcomes, very old stroke patients often receive less diagnostic and therapeutic intervention. Brain imaging and other diagnostic tools are used less frequently in this age group, which may contribute to poorer outcomes . This underutilization of resources underscores the need for tailored stroke care strategies for the very old.
Prevention and Management Strategies
Effective stroke prevention and management in the very old require a multifaceted approach. Managing modifiable risk factors such as hypertension and atrial fibrillation is crucial. Lifestyle changes, including smoking cessation, regular physical activity, and a heart-healthy diet, are also important preventive measures. Given the high risk and poor outcomes associated with stroke in the very old, healthcare providers must adopt comprehensive strategies to monitor and manage these risk factors effectively.
Conclusion
Stroke in the very old presents unique challenges due to higher incidence rates, severe outcomes, and distinct risk factor profiles. Effective management requires a comprehensive approach that includes both medical and lifestyle interventions. By understanding and addressing the specific needs of this vulnerable population, healthcare systems can improve outcomes and reduce the burden of stroke in the very old.
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