(Stroke. 1999;30:2313-2319.)
© 1999 American Heart Association, Inc.
Original Contributions |
Stroke in the Very Old
Clinical Presentation and Determinants of 3-Month Functional Outcome: A European Perspective
From the National Research Council of Italy (CNR-CSFET), Italian Longitudinal Study on Aging, Florence, Italy (A. Di C); Department of Neurological and Psychiatric Sciences, University of Florence (Italy) (M.L., G.P., A.M.B., G.T., P.V., D.I.); Department of Public Health Sciences, The Guy's, Kings College, and St Thomas' Hospital Medical and Dental School, Guy's Campus, London, England (C.D.A.W., K.T.); and Department of Social Medicine, Bristol University (England) (S.E.).
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 
80 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 <80
years, and 1358 (30.2%) were aged 80 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 <0.001). 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.
Key Words: disability evaluation • elderly • stroke outcome
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