title: The poor outcome of ischemic stroke in very old people: a cohort study of its determinants.
abstract: OBJECTIVE
  To assess how much of the excess risk of poor outcome from stroke in people aged 80 and older aging per se explains, independent of other prognostic determinants.
  
  
  METHODS
  Cohort, observational.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  One thousand five hundred fifty-five patients with first-ever ischemic stroke consecutively referred to an in-hospital Clinical Pathway program were studied.
  
  
  METHODS
  The relationship between age and 1-month outcome (death, disability (modified Rankin Scale 3-5), and poor outcome (modified Rankin Scale 3-6)) was assessed, with adjustment for several prognostic factors.
  
  
  RESULTS
  Six hundred twelve patients aged 80 and older showed worse outcome after 1 month than those who were younger, in terms of mortality (19% vs 5%, hazard ratio (HR)=3.85, 95% confidence interval (CI)=2.8-5.4) and disability (51% vs 33%, odds ratio (OR)=3.16, 95% CI=2.5-4.0), although in multivariate models, the adjusted HR for mortality decreased to 1.47 (95% CI=1.0-2.16) and the ORs for disability and poor outcome decreased to 1.76 (95% CI=1.32-2.3.) and 1.83 (95% CI=137-2.43), respectively. Stroke severity, the occurrence of at least one medical complication, and premorbid disability explained most of the risk excess in the oldest-old.
  
  
  CONCLUSIONS
  Stroke outcome is definitely worse in very old people, and most of the excess risk of death and disability is attributable to the higher occurrences of the most-severe clinical stroke syndromes and of medical complications in the acute phase. These represent potential targets for preventive and therapeutical strategies specifically for elderly people.
authors.affiliation: Geriatric and Rehabilitation Department, University Hospital of Parma, Parma, Italy. ldenti@ao.pr.it
authors.forename: Licia
authors.initials: L
authors.lastname: Denti
authors.forename: Umberto
authors.initials: U
authors.lastname: Scoditti
authors.forename: Claudio
authors.initials: C
authors.lastname: Tonelli
authors.forename: Marsilio
authors.initials: M
authors.lastname: Saccavini
authors.forename: Caterina
authors.initials: C
authors.lastname: Caminiti
authors.forename: Rita
authors.initials: R
authors.lastname: Valcavi
authors.forename: Mario
authors.initials: M
authors.lastname: Benatti
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ceda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D020521:Stroke / Q000401:mortality*