Stroke in the very old: incidence, risk factors, clinical features, outcomes and access to resources--a 22-year population-based study.
BACKGROUND
For several years, the burden of stroke in very old patients has been increasing in western countries. Nevertheless, we have little information about this new challenge in individuals >or=80.


METHODS
We ascertained all first-ever strokes in the population of Dijon, France (150,000 inhabitants), from 1985 to 2006. The incidence of stroke, risk factors, clinical presentation, resource mobilization and 1-month outcome were evaluated in individuals >or=80 and compared to the data obtained in younger patients.


RESULTS
We collected 1,410 first-ever strokes in people >or=80 years (39%) versus 2,130 in those <80 years. The incidence was 997/100,000, and 68/100,000, respectively. Over the 22 years, the incidence of stroke in individuals >or=80 years rose significantly. A lower prevalence of diabetes, hypercholesterolemia and alcohol intake, as well as a higher prevalence of hypertension, atrial fibrillation, previous myocardial infarction and use of prestroke antiplatelet agents were noted in patients >or=80 years. The clinical presentation was severer and the 1-month outcome in terms of case fatality and handicap was worse, despite improvements observed over time. Finally, in patients >or=80 years, the use of CT scan, MRI, cervical Doppler, angiography and carotid surgery were significantly lower than for younger patients. Length of stay >30 days was more frequent, and discharge to prestroke residence was less common. However, all these improved between the first and the last study periods.


CONCLUSIONS
Our findings have important implications not only for clinical management but also for initiating preventive strategies and health policy.
Béjot
Yannick
Y
Stroke Registry of Dijon (INSERM et Institut de Veille Sanitaire), EA4184, University Hospital and Faculty of Medicine and Department of Neurology, Dijon, France. ybejot @ yahoo.fr
Rouaud
Olivier
O
Jacquin
Agnès
A
Osseby
Guy-Victor
GV
Durier
Jérôme
J
Manckoundia
Patrick
P
Pfitzenmeyer
Pierre
P
Moreau
Thibault
T
Giroud
Maurice
M
D000367:Age Factors; D000369:Aged, 80 and over; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D006295:Health Resources / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011159:Population Surveillance; D020127:Recovery of Function; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome