Outcomes after stroke poorer in older patients

NEW YORK (Reuters Health) - Among stroke patients, the fatality rates are higher and the likelihood of being discharged from the hospital to go home is lower for those over age 80 than for their younger counterparts, according to a study in the medical journal Stroke.

“Stroke incidence rates increase steeply with age,” Dr. Gustavo Saposnik, of the University of Toronto, Ontario, Canada, and colleagues write. “Therefore, we would also expect a rise in the number of elderly patients with stroke in the future,” they note. “Unfortunately, limited information is available on stroke care in patients over age 80.”

In a multicenter study, the researchers examined differences in outcomes in Canadians over 80 years of age versus younger patients who were hospitalized for an ischemic stroke over a 1-year period.

An ischemic stroke, the most common type, results from a clot that blocks the brain, which prevents the blood from reaching the brain. The oxygen-starved tissue then begins to die.

A total of 26,676 ischemic stroke patients admitted to 606 hospitals across Canada were included in the study. The subjects were an average of 74 years old, and 10,171 of them (38 percent) were 80 years or older.

The investigators report that stroke fatality at discharge was 5.7 percent among subjects younger than 59 years of age, 8.6 percent among those between the ages of 60 and 69 years, 13.4 percent among those 70 to 79 years old, and 24.2 percent among those 80 years of age and older.

Patients older than 80 years spend more time in the hospital than younger patients did (10 days versus 7 days, respectively), and were less likely to be admitted to the intensive care unit (7.7 percent versus 15.3 percent, respectively.

Overall, 47.2 percent of subjects over 80 years of age and 61.6 percent of those younger than 80 years were discharged to their residence

Further analysis, which focused on patients older than 80 years, factors associated with a higher 7-day stroke fatality rate included intensive care unit admission, low socioeconomic status, and admission to a non-academic institution. Similar results were observed for stroke fatality at discharge.

“Our study should encourage further research to identify potentially remediable factors related to delivery of care to reduce morbidity and mortality in more elderly patients with stroke,” Saposnik and colleagues conclude.

“The recognition of this growing problem may help to implement strategies aimed at involving more elderly subjects in clinical trials and other research, ” they conclude, as well as improving access to specialized stroke care, survival rates and quality of life.”

SOURCE: Stroke, August 2008.