title: [Stroke in the very old: myths and realities].
abstract: OBJECTIVE
  The incidence of stroke in the very old is increasing. However, there are very few data regarding the differences in the management and outcomes in Spain.
  
  
  METHODS
  We analyzed the clinical characteristics, diagnostic and therapeutic procedures, medical complications and intrahospitalary mortality in 463 subjects admitted because of ischemic stroke between 2009 and 2010. Very-old patients (≥ 85 year-old) were compared with younger patients.
  
  
  RESULTS
  Very old patients showed on admission higher frequency of atrial fibrillation (34 vs 19%, P>.001) and lower use of antiplatelet agents and oral anticoagulants (P<.001). Disability and stroke severity were higher among the very old (P<.001) and the use of diagnostic and therapeutic procedures was significantly lower (P<.001). The length of stay was longer in the very old (12 [6-24] days vs 8 [5-15], P<.001), as wells as the intrahospitalary mortality (27 vs 6%, P<.001). After a multivariate analysis, independent predictive factors of mortality were previous disability, measured by the modified Rankin scale (95% confidence interval [95%CI] 1.6-10.7), impaired level of consciousness (IC95% 2.1-13.9) and stroke severity measured by the National Institutes of Health Stroke Scale (95%CI 1.8-38.1).
  
  
  CONCLUSIONS
  Very old patients admitted with ischemic stroke undergo less diagnostic and therapeutic procedures. However, in our study, very old age was not an independent predictor of mortality, which was essentially determined by previous functional status and stroke severity.
authors.affiliation: Servicio de Medicina Interna III, Hospital Clínico San Carlos, Madrid, España. serranovillar@gmail.com
authors.forename: Sergio
authors.initials: S
authors.lastname: Serrano-Villar
authors.forename: Gema
authors.initials: G
authors.lastname: Fresco
authors.forename: Pedro
authors.initials: P
authors.lastname: Ruiz-Artacho
authors.forename: Ana
authors.initials: A
authors.lastname: Bravo
authors.forename: Cristina
authors.initials: C
authors.lastname: Valencia
authors.forename: Manuel
authors.initials: M
authors.lastname: Fuentes-Ferrer
authors.forename: Vicente
authors.initials: V
authors.lastname: Estrada
authors.forename: Jesús
authors.initials: J
authors.lastname: Porta-Etessam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data; D004198:Disease Susceptibility; D004363:Drug Utilization; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D020766:Intracranial Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors