Intracranial Hemorrhage in Older Adults: Implications for Fall Risk Assessment and Prevention

Shih, Richard D.; Ouslander, Joseph G.

doi:10.1111/jgs.16399

Cited by 8 publications

(5 citation statements)

References 38 publications

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“…Comparative studies between the elderly versus younger age have indicated that women were predominant above the age of 65 years, 70 years, or with increasing age. 12,13 In the present study, ICH was the most common vascular diagnosis followed by SAH. ICH is a growing cause of mortality and morbidity worldwide, because of the increasing number of elderly people.…”

Section: Discussionmentioning

confidence: 52%

Geriatric Cerebrovascular Neurosurgery: Institutional Experience from Khoula Hospital

Al-Mirza

Al-Taei

Al‐Saadi

2021

Int Clin Neurosci J

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Background: The aging of the healthy population without severe morbidity exposes them to cerebrovascular diseases and demand effective management. This study aimed to study the prevalence of geriatric cerebrovascular neurosurgical conditions in the Neurosurgical Department at Khoula Hospital, Muscat, Sultanate of Oman. Methods: A retrospective chart review of was done on geriatric cases admitted to the Neurosurgery Department in Khoula Hospital as an example of a neurosurgical center in a high-income developing country from January 2016 to 31st December 2019. Patients’ demographics, risk factors, diagnosis, Glasgow Coma Scale (GCS) on arrival, medications used, and length of stay were recorded. Results: 109 patients aged over 65 years were recruited in our retrospective review with a mean age of 74.12 years. Male-to-female ratio was (1.2:1). Intracerebral hemorrhage (ICH) was the most common vascular diagnosis (39.0%) followed by subarachnoid hemorrhage (SAH) (22.9%). Most patients (41.9%) had a GCS score of less than 8. About one-fifth of the patients received antiplatelet and anticoagulant medications. Most of the patients underwent surgical intervention (61.9%). 59% of the patients stayed in the hospital for less than 15 days. There were significant associations between the length of stay, treatment types (surgical vs. conservative), and age (P<0.05). Conclusion: Cerebrovascular pathologies are a growing cause of mortality and morbidity worldwide including developing countries because of the increasing number of elderly people. Antiplatelet medication and anticoagulants should be used with caution in the elderly.

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Section: Discussionmentioning

confidence: 52%

Geriatric Cerebrovascular Neurosurgery: Institutional Experience from Khoula Hospital

Al-Mirza

Al-Taei

Al‐Saadi

2021

Int Clin Neurosci J

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“…There has been recent debate about the suitability of CT scanning low-risk patients (35). The AHEAD study concluded that the decision to recommend CT scanning in guidance should take into account the potential benefits, harms and costs of CT scanning (18).…”

Section: Anticoagulants and Intracranial Hemorrhagementioning

confidence: 99%

Head injury among older adults and their clinical management: one year of emergency department attendances at a UK trauma center

et al. 2022

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Objectives: Primary: describe characteristics of adults aged ≥65 attending the Emergency Department (ED) at one major trauma center. Secondary: examine co-morbidities and complications; identify use of anticoagulant/antiplatelet medication among older adults presenting with Head Injury (HI); assess clinical management against UK guidelines. Methods: All ED admissions were screened prospectively to identify HI using case notes, hospital records and Trauma Audit Research Network data. Data were collected on demographics, cause and severity of injury, co-morbidities, anticoagulation/antiplatelet use, diagnostic imaging and discharge outcomes. Results: Over 12 months, 697 patients aged ≥65 years attended the ED for HI, representing over a quarter of adult ED attendances for HI. Mean age was 78.5 years (range 65-106), 395 (56.7%) were female. Most HIs were mild (93.5%) and 86% caused by falls. Three-quarters were discharged without hospital admission. Most had a preexisting medical condition andtaking medications prior to HI. Of these 116 were taking anticoagulants/antiplatelets but only 37 (31.9%) received a head CT scan. Half the patients were given a written HI information sheet at ED discharge. Conclusions: Care of HI in older adults is challenging due to comorbidities. Practising evidence-based clinical management and following guidelines is important, but strict adherence is not common practice.

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“…Some risk factors for ICH in the general adult population include smoking, cerebral amyloid angiopathy, drug/alcohol use, and pre-existing comorbidities such as hypertension, diabetes mellitus (DM), heart disease and chronic kidney disease 11,12 . In addition, anticoagulation usage is strongly associated with higher mortality and disability rates 10,13 . Most, if not all of these risk factors are likely to be more prevalent in older patients and age itself is one of the greatest independent risk factors for spontaneous ICH 12,14 .…”

Section: Introductionmentioning

confidence: 99%

Trends and Predictors of Outcomes of Primary Intracerebral Hemorrhage in Very Elderly Patients

Gilotra,

Janssen,

Zhang

et al. 2024

Preprint

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IntroductionPrimary intracerebral hemorrhage (ICH) is known to have poor management outcomes. Very elderly patients (age>80) might have a significantly higher incidence of worse management morbidity and mortality after primary ICH. The aim of this study was to explore presenting status and pre-existing comorbidities in very elderly patients and compare the inpatient management outcomes with younger counterparts.MethodsThe Stony Brook ICH database is a retrospective cohort of 814 patients that presented with primary ICH from January 2011 to January 2021. Demographic data, presenting symptoms, pre-existing medical conditions, and imaging findings were recorded. Inpatient outcomes and functional state presented as modified Rankin Scale (MRS) at discharge were evaluated.ResultsOur results indicate very elderly patients had significantly higher baseline MRS and comorbidities such as hypertension, hyperlipidemia, and atrial fibrillation at presentation. Similarly, usage of statins, antiplatelets, and anticoagulants were significantly higher in this age group. Very elderly patients were also found to have higher average volume of hematoma at presentation. Our results indicate significantly higher discharge MRS, and inpatient mortality in the very elderly group.ConclusionPresent study demonstrates a wide variety of pre-existing factors that correlate with worse outcomes amongst very elderly patients presenting with primary ICH. Given the importance of aging population as a major healthcare issue in many parts of world, it is crucial to continue exploring these associations in future research. Findings of this study can be utilized to plan further prospective studies on this topic.

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Intracranial Hemorrhage in Older Adults: Implications for Fall Risk Assessment and Prevention

Abstract: This editorial comments on the article by https://doi.org/10.1111/jgs.16400. and https://doi.org/10.1111/jgs.16338.

Cited by 8 publications

References 38 publications

Geriatric Cerebrovascular Neurosurgery: Institutional Experience from Khoula Hospital

Geriatric Cerebrovascular Neurosurgery: Institutional Experience from Khoula Hospital

Head injury among older adults and their clinical management: one year of emergency department attendances at a UK trauma center

Trends and Predictors of Outcomes of Primary Intracerebral Hemorrhage in Very Elderly Patients

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