Stroke in the Very Old: A Systematic Review of Studies on Incidence, Outcome, and Resource Use

Russo, Tommasina; Felzani, Giorgio; Marini, Carmine

doi:10.4061/2011/108785

Cited by 98 publications

(75 citation statements)

References 36 publications

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“…This is in congruence with previous findings that age remains a non-modifiable and most important singular risk factor for stroke. This risk increases with each successive decade above age 55 years 30,31 . Our findings suggest that the incidence of stroke is slightly higher in males than females based on the proportion of male patients admitted on account of stroke compared to females which is consistent with findings from previous studies 32,33,34 .…”

Section: Discussionmentioning

confidence: 99%

Utilization of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria

Olaleye¹,

Lawal²

2017

Afr H. Sci.

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Objectives: To investigate the pattern of referral for and utilisation of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria. Methods: Referral notes and medical records of patients admitted in the University College Hospital, Ibadan with a clinical diagnosis of stroke between January, 2009 and December, 2013 were retrospectively reviewed. Information on age, sex, type of stroke, length of hospital stay, referral for physiotherapy and utilisation of physiotherapy were retrieved. Data were summarised using descriptive statistics and analysed using Chi-square test. Results: A total of 783 patients with stroke were admitted in the hospital during the period under study. The in-patient mortality rate was 37.2%. The mean Length of Hospital Stay (LoHS) was 16.17±12.34 days. Referral rate for physiotherapy was high (75.8%) and the mean time from admission to referral for physiotherapy was three days. Majority of patients referred utilised physiotherapy (63.4%) and mean number of physiotherapy sessions received during in-patient care was 8.69±6.45. There was a significant association between LoHS and utilisation of in-patientphysiotherapy (p=0.02). Conclusion:The referral rate of stroke patients for physiotherapy was relatively high. Utilisation of in-patient physiotherapy reduced length of hospital stay among patients with stroke. Utilisation of out-patient physiotherapy was low. Strategies to enhance out-patient utilisation should be explored.

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Section: Discussionmentioning

confidence: 99%

Utilization of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria

Olaleye¹,

Lawal²

2017

Afr H. Sci.

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“…Elderly patients are far less MT, mechanical thrombectomy; tPA, tissue plasminogen activator; mRS, modified Rankin Scale; sICH, symptomatic intracranial hemorrhage; ND, no data available. 1 Includes an mRS score of 0-2 or return to baseline functioning. 2 With 10 patients from MR CLEAN with a score >2.…”

Section: Discussionmentioning

confidence: 99%

“…About 30% of all strokes occur in patients over the age of 80 years, with 17% occurring in patients over 85 years [1]. It is anticipated that the incidence of stroke will more than double by 2050, with the largest proportion of these incident cases occurring among patients 75 years and older and minorities [2].…”

Section: Introductionmentioning

confidence: 99%

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

et al. 2018

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Background: The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. Methods: Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review. The data included baseline characteristics, time to treatment, the rate of revascularization, procedural complications, mortality, and 90-day good outcome defined as a modified Rankin Scale (mRS) score of 0–2 or return to baseline. Results: Of the 96 patients, 50 had mild baseline disability (mRS score 0–1) and 46 had moderate disability (mRS score 2–4). Recanalization was achieved in 84% of the patients, and the rate of symptomatic hemorrhage was 6%. At 90 days, 34% of the patients had a good outcome. There were no significant differences in good outcome between those with mild and those with moderate baseline disability (43 vs. 24%, p = 0.08), between those aged ≤85 and those aged > 85 years (40.8 vs. 26.1%, p = 0.19), and between those treated within and those treated beyond 8 h (39 vs. 20%, p = 0.1). The mortality rate was 38.5% at 90 days. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale (NIHSS) predicted good outcome regardless of baseline disability (p < 0.001 and p = 0.009, respectively). Conclusion: Advanced age, baseline disability, and delayed treatment are associated with suboptimal outcomes after MT. However, redefining good outcome to include return to baseline functioning demonstrates that one-third of this patient population benefits from MT, suggesting the real-life utility of this treatment.

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“…According to Russo the elderly have a higher 30-days case fatality rate as compared to those younger (OR 3.07) (15).…”

Section: Survival and Functional Outcomementioning

confidence: 99%

Epidemiology of stroke in the elderly in the Nordic countries. Incidence, survival, prevalence and risk factors

Engstad¹,

Engstad²,

Viitanen³

et al. 2012

Nor J Epidemiol

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Objective:To review what is known at present with respect to incidence, survival, risk factors and prevalence among the elderly stroke patients in the Nordic countries. Method: This article is based mainly on literature identified through search engines (Mc Master Plus, Cochrane Library, Medline and PubMed), restricted to first-ever stroke in Nordic population-based studies and having applied to the standard WHO definition, a prospective study design and no upper age limit. Results: Data from the Nordic countries show an incidence rate of 1250 to 1796/100 000 in the age group 75-84, and 1628 to 2234 in those above 85 years. The incidence rates are higher among men, but women are expected to contribute more to incident cases due to their higher life expectancy. If the age-specific incidence of stroke remains stable, the proportion of stroke patients aged 80 years and older may reach 50% in a few decades. The elderly stroke patients have a higher 30-days case fatality, and a higher risk of dependency. Better treatment of stroke patients has improved the survival over the last two decades. The prevalence is expected to increase due to the decrease in lethality, a slower fall in incidence and a higher proportion of elderly. Cardiovascular risk factors increase with age. Hypertension is a major risk factor for stroke mortality in the elderly. Cardioembolic stroke due to atrial fibrillation is the most common stroke subtype in the elderly. Lifestyle risk factors are less prevalent in the older stroke patients. Conclusion:The growing proportion of elderly stroke patients is a major challenge for future stroke care. The elderly stroke patients have a different risk factor profile compared to younger stroke patients. Treatment should focus on regaining independency. The age-specific epidemiology of stroke needs to be studied further in large studies in order to plan for future health care.

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Stroke in the Very Old: A Systematic Review of Studies on Incidence, Outcome, and Resource Use

Cited by 98 publications

References 36 publications

Utilization of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria

Utilization of physiotherapy in the continuum of stroke care at a tertiary hospital in Ibadan, Nigeria

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

Epidemiology of stroke in the elderly in the Nordic countries. Incidence, survival, prevalence and risk factors

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