The poor outcome of ischemic stroke in very old people: a cohort study of its determinants.
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.
Denti
Licia
L
Geriatric and Rehabilitation Department, University Hospital of Parma, Parma, Italy. ldenti@ao.pr.it
Scoditti
Umberto
U
Tonelli
Claudio
C
Saccavini
Marsilio
M
Caminiti
Caterina
C
Valcavi
Rita
R
Benatti
Mario
M
Ceda
Gian Paolo
GP
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*