Subarachnoid Hemorrhage in Advanced Age: Comparison of Patients Aged 70-79 Years and 80 Years and Older

Abstract

Background: Clinical routine shows an increasing admission rate of elderly patients suffering from subarachnoid hemorrhage (SAH).

Objective: Aim of the study was to identify differences in outcome and prognostic factors to better anticipate clinical course and therefore treat this special subgroup better.

Methods: We retrospectively compared patients aged 70-79 and older than 80 years (80+). Patients were entered into a prospectively collected database. Between 1999 and June 2014, 191 patients aged ≥70 years suffered from SAH. We stratified between patients aged from 70 to 79 years (n = 138) and 80+ years (n = 53). Outcome was assessed by modified Rankin Scale 6 months after SAH.

Results: During the observation period, the rate of elderly patients increased from 9% to 24%. Patients aged 80+ years less often showed significant early hydrocephalus, cerebral vasospasm, and shunt dependence. A total of 51% of all patients were treated by coiling, whereupon also treatment modality had no influence on outcome. By comparing clinical outcomes, no significant differences could be detected. However, mortality rate was not significantly greater in patients 80+ years. Clinical status at time of admission statistically was a prognostic factor in elderly patients as well as the extent of blood clots and an early hydrocephalus. Patients aged 80+ years suffered less from severe cerebral vasospasm, which statistically was no prognostic factor for a favorable outcome in this group.

Conclusions: Patients aged 80+ years with SAH also can achieve a favorable outcome. There was no difference in clinical outcome comparing both groups, but several pathophysiological mechanisms in elderly patients (especially 80+ years) seem to have a positive influence on typical complications after SAH, such as cerebral vasospasm, early hydrocephalus, and shunt dependence.

Keywords: Elderly patients; Outcome; Prognostic factors; Subarachnoid hemorrhage.