title: Analysis of Factors That Influence Long-Term Independent Living for Elderly Subarachnoid Hemorrhage Patients.
abstract: BACKGROUND
  The number of elderly subarachnoid hemorrhage (SAH) patients has been increasing. The aim of this study was to analyze long-term outcome for elderly (≥75 years) SAH patients and to establish a treatment strategy.
  
  
  METHODS
  From January 2005 to December 2013, 86 consecutive cases were treated. We used a modified Rankin Scale (mRS) at the outpatient clinic or a telephone interview of patients and/or families. Kaplan-Meier plots were done for mortality and independent (mRS 0 ∼ 2) state. Multivariate analysis was done to distinguish factors that influence on outcome.
  
  
  RESULTS
  Median age was 79, Hunt-Kosnik grade 1 ∼ 3 was 79%, and the radical intervention (clipping or coiling) rate was 78%. Mean follow-up period was 28.7 ± 3.4 standard error months. Half of deaths occurred during the first two months. The number of cases of independent living gradually decreased to 50% at 28 months after SAH. Half of patients lived independently for 36 months at HK grades 1 to 3, and 3 months at HK grades 4 to 5 (p < 0.05). Half of patients lived independently for 40 months in the radical intervention group, and 14 months in the conservative treatment group (p < 0.05). Multivariate analysis for independent living revealed that gender, pre-morbid condition, HK grade, and postoperative complication were significant (p < 0.05).
  
  
  CONCLUSIONS
  Good-grade elderly SAH cases that were independent pre-stroke should have radical intervention performed for aneurysm. Avoiding perioperative complications have a positive influence on long-term independent living.
authors.affiliation: Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan. Electronic address: shimab@hirosaki-u.ac.jp.
authors.forename: Norihito
authors.initials: N
authors.lastname: Shimamura
authors.affiliation: Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Naraoka
authors.affiliation: Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Katagai
authors.affiliation: Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Katayama
authors.affiliation: Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Kakuta
authors.affiliation: Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Matsuda
authors.affiliation: Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ohkuma
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D019635:Neurosurgical Procedures / Q000401:mortality* / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000523:psychology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Cerebral aneurysm; Elderly patient; Independent living; Radical intervention; Subarachnoid hemorrhage