Stroke in Older Survivors of Ischemic Stroke: Standard Care or Something Different?

Hubbard, Isobel J.; Wass, S. H.; Pepper, Elizabeth

doi:10.3390/geriatrics2020018

Cited by 7 publications

(5 citation statements)

References 82 publications

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“…Our sample's profile was similar to that of recent research ( 60 , 61 ). When assessing the relationship between functionality and QoL with the sociodemographic data, comorbidities, and risk factors presented by the stroke patients, we found that older and less educated patients showed less favorable participation in daily-life activities up to 2 years post-stroke ( 62 ).…”

Section: Discussionsupporting

confidence: 84%

Functionality and quality of life in Brazilian patients 6 months post-stroke

et al. 2023

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BackgroundSurviving a stroke poses a social and economic impact that requires the care system to be reformulated and the patient to be addressed in a comprehensive approach.PurposeThis study aims to investigate if there is a relationship between functional activities performed before the stroke, patients' clinical and hospitalization data, and functionality and quality of life measures in the first 6 months after the stroke.MethodsThis study used a prospective cohort of 92 patients. We investigated sociodemographic and clinical data, the modified Rankin Scale (mRS), and the Frenchay Activities Index (FAI) during hospitalization. The Barthel Index (BI) and EuroQol-5D (EQ-5D) were applied at the following time points: 30 days (T1), 90 days (T2), and 180 days (T3) following postictal state. Statistical analysis was conducted using Spearman's coefficient, Friedman's non-parametric test, and multiple linear regression models.ResultsNo correlation was found between FAI, BI, and EQ-5D average scores. Severe patients, patients with comorbidities, and patients with extended hospital stays showed lower BI and EQ-5D scores □in the follow-up. BI and EQ-5D scores increased.ConclusionThis research found no relationship between activities performed before the stroke and functionalities and quality of life after the stroke, but comorbidities and extended hospital stay were associated with worse outcomes.

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Section: Discussionsupporting

confidence: 84%

Functionality and quality of life in Brazilian patients 6 months post-stroke

et al. 2023

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“…Strategies need to be inducted in order to encounter this challenge [17]. Poor and unspecialized management of elderly patients suffering from stroke might even lead to higher financial and healthcare burden in the form of increased morbidity, long term disability, and placement in residential care [18]. Goldberg et al found in a collective of poor grade patients that unfavourable outcomes 6 to 12 months after aneurysmal SAH were strongly related to older age.…”

Section: Late Improvement Is Independent From Age and Wfns Gradementioning

confidence: 99%

Dynamics of outcome after aneurysmal subarachnoid hemorrhage

Hammer

Ranaie

Yakubov

et al. 2020

Aging

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In this observational study, we analyzed and described the dynamics of the outcome after aneurysmal subarachnoid hemorrhage (SAH) in a collective of 203 cases. We detected a significant improvement of the mean aggregate modified Rankin Score (mRS) in every time interval from discharge to 6 months and up to 1 year. Every forth to fifth patient with potential of recovery (mRS 1-5) at discharge improved by 1 mRS point in the time interval from 6 month to 1 year (22.6%). Patients with mRS 3 at discharge had a remarkable late recovery rate (73.3%, p = 0.000085). Multivariate analysis revealed age ≤ 65 years (odds ratio 4.93; p = 0.0045) and "World Federation of Neurological Surgeons" (WFNS) grades I and II (odds ratio 4.77; p = 0.0077) as significant predictors of early improvement (discharge to 6 months). Absence of a shunting procedure (odds ratio 8.32; p = 0.0049) was a significant predictor of late improvement (6 months to 1 year), but not age ≤ 65 years (p = 0.54) and WFNS grades I and II (p = 0.92). Thus, late recovery (6 month to 1 year) is significant and independent from age and WFNS grade.

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“…[21][22][23] Advanced age is one of the most common reasons of withholding IVT. 24 Several previous relevant studies have shown that older patients (>80 years) generally have poorer outcome and higher rates of mortality regardless of receiving IVT, yet IVT can improve the final outcome in both groups of patients under and over 80 years. 4,21,25 TA B L E 1 Demographic and clinical characteristics and laboratory findings of patients ≥80 years old with poorer outcome or significant increased rates of sICH and mortality.…”

Section: Discussionmentioning

confidence: 97%

“…Advanced age is one of the most common reasons of withholding IVT 24 . Several previous relevant studies have shown that older patients (>80 years) generally have poorer outcome and higher rates of mortality regardless of receiving IVT, yet IVT can improve the final outcome in both groups of patients under and over 80 years 4,21,25 .…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis for stroke in elderly in the late window period

Mowla

Shakibajahromi

Arora

et al. 2021

Acta Neuro Scandinavica

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Objectives Safety of intravenous thrombolysis (IVT) within 3–4.5 hours of stroke onset in patients ≥80 years is still disputable. We evaluated the association of symptom onset‐to‐treatment time (SOTT) with the symptomatic intracranial hemorrhage (sICH), poor outcome, and mortality in patients≥80 years. Materials and Methods In a retrospective study, patients treated with IVT following stroke were registered. Outcomes were poor outcome (mRS>2), sICH/ECASS‐2, and in‐hospital mortality. We compared the patients≥80 years who received IVT within 3 hours with those receiving IVT within 3–4.5 hours. We further compared the patients who were <80 years with those ≥80 years and SOTT of 3–4.5 hours. Results Of 834 patients, 265 aged over 80. In those above 80 and in multivariable analysis, the associations of SOTT with poor outcome (aOR: 1.401, CI: 0.503–3.903, p=0.519), sICH (aOR=2.50, CI=0.76–8.26, p= 0.132) and mortality (aOR=1.12, CI=0.39–3.25, p= 0.833) were not significant. 106 patients received IVT within 3–4.5 hours. In multivariable analysis, the associations of age (≥80 versus <80) with poor outcome (aOR=1.87, CI=0.65–5.37, p=0.246), sICH (aOR=0.65, CI=0.14–3.11, p=0.590), and mortality (aOR=0.87, 95% CI=0.16–4.57, p=0.867) were not significant in patients with SOTT of 3–4.5 hours. Conclusion IVT within 3–4.5 hours in patients ≥80 years is not associated with increased sICH, poor outcome, and mortality compared to the early time window, and also compared to the younger patients in 3–4.5 hours window period. The decision of IVT administration in this age group should not be made solely on the basis of stroke onset timing.

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Stroke in Older Survivors of Ischemic Stroke: Standard Care or Something Different?

Cited by 7 publications

References 82 publications

Functionality and quality of life in Brazilian patients 6 months post-stroke

Functionality and quality of life in Brazilian patients 6 months post-stroke

Dynamics of outcome after aneurysmal subarachnoid hemorrhage

Thrombolysis for stroke in elderly in the late window period

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