Stroke in the very old : clinical presentation and determinants of 3-month functional outcome: A European perspective. European BIOMED Study of Stroke Care Group.
OBJECTIVE
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.
Di Carlo
A
A
National Research Council of Italy (CNR-CSFET), Italian Longitudinal Study on Aging, Florence, Italy.
Lamassa
M
M
Pracucci
G
G
Basile
A M
AM
Trefoloni
G
G
Vanni
P
P
Wolfe
C D
CD
Tilling
K
K
Ebrahim
S
S
Inzitari
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003128:Coma / Q000150:complications; D016001:Confidence Intervals; D003680:Deglutition Disorders / Q000150:complications; D003710:Demography; D003952:Diagnostic Imaging; D006233:Persons with Disabilities / Q000145:classification; D005060:Europe; D005260:Female; D005544:Forecasting; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007326:Institutionalization; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010243:Paralysis / Q000150:complications; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy; D000071939:Stroke Rehabilitation; D014549:Urinary Incontinence / Q000150:complications