[Stroke in the very old: myths and realities]

Abstract

Background and 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.

Material and 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.