Stroke in the very old - Clinical presentation and determinants of 3-monthfunctional outcome: A European perspective

Background and Purpose-The oldest old represent the fastest-growing segment of the elderly population in developed countries. Knowledge of age-specifi c aspects of stroke is essential to establish diagnostic and therapeutic pa thways and to set up prevention and rehabilitation programs. We sought to e valuate stroke features and functional outcome in patients aged greater tha n or equal to 80 years compared with the younger age groups. Methods-In a European Union Concerted Action involving 7 countries, 4499 pa tients hospitalized for first-in-a-lifetime stroke were evaluated for demog raphics, risk factors, clinical presentation, resource use, and 3-month dis ability (Barthel Index) and handicap (Rankin Scale). Results-Overall, 3141 patients (69.8%) were aged <80 years, and 1358 (30.2% ) were aged greater than or equal to 80 years. At baseline, female sex, pre stroke institutionalization, and a worse prestroke Rankin score were signif icantly more frequent in the older patients, as were coma, paralysis, swall owing problems, and urinary incontinence in the acute phase (all P values < 0.001). Brain imaging and other diagnostic tools were significantly less us ed in the older patients. Paralysis, swallowing problems, and incontinence during hospitalization independently predicted 3-month disability or handic ap in both groups. For the older patients, prestroke institutionalization p roved a further strong and independent determinant of 3-month disability (o dds ratio, 2.33; 95% CI, 1.22 to 4.45) and handicap (odds ratio, 7.04; 95% CI, 1.62 to 30.69), Conclusions-In the very old, both medical and sociodemographic factors may significantly influence stroke outcome, showing peculiar characteristics. K nowledge of these determinants may reduce the burden on health systems, imp roving quality of care.